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PubMed1992

Hepatic function after porto-systemic shunt.

Advanced hepatic injury can be identified by the appearance of jaundice, coagulopathy, or encephalopathy but these conditions are late, irreversible findings and represent the end stage of a long insidious process. Currently available methods for assessing "liver function" (SGOT, SGPT, GGT, LDH, etc.) do not actually measure liver function. In this study we prospectively evaluated "true" liver function in patients undergoing porto-systemic shunt. Effective hepatic blood flow [low dose galactose clearance (EHBF)], hepatocyte transport (theophylline levels at 24 hr), and hepatic conjugation ability [acetaminophen metabolism to its glucuronide and sulfate conjugates ( (S + G)/A) and acetaminophen remaining at 24 hr (A24)] were measured in normal males (NL) and in patients pre- and post-8-mm H-graft portacaval shunt (PCS). All data are means +/- SEM, analyzed by Student's t test, and significance was accepted if P less than 0.05. There were no significant differences in EHBF even after PCS. Hepatocyte transport was decreased in pre-op (1.43 +/- 0.16 vs 0.74 +/- 0.08) and post-op (1.79 +/- 0.34) PCS patients. Hepatic conjugating ability was also decreased in pre-op PCS patients [A24 was increased (0.24 +/- 0.11 vs 0.01 +/- 0.01) while the ratio of conjugation products to acetaminophen remained the same]. The ability of the liver to conjugate substrate was severely compromised postoperatively [A24 - 1.27 +/- 0.67, (S + G)/A - 1.19 +/- 0.34]. We believe that changes in liver function can be accurately measured using these noninvasive methods, and in using these methods we have identified altered hepatocyte transport and conjugating ability in patients undergoing porto-systemic shunt surgery.

Acetaminophen↗
PubMed1983

Altered hepatic functions and microsomal activity in perfused rat liver by hyperthermia combined with alkylating agents.

Livers of fasted rats were perfused for one hour in the presence of cyclophosphamide (CP), mechlorethamine (HN2), or melphalan (L-PAM) at 37 degrees and 42 degrees C. Hepatic biosynthetic function was assessed by determining gluconeogenesis from lactate, ureogenesis from NH4Cl, and O2 consumption. Antipyrine (AP) metabolism was employed to assess microsomal mixed function oxygenase enzyme activity at elevated temperatures. The t 1/2 of AP increased 2.8-fold in a temperature-dependent manner between 37 degrees and 43 degrees C. In the presence of biosynthetic substrates, the t 1/2 of AP increased 1.8-fold between 37 degrees and 43 degrees C. CP activation was suppressed (27% at 125 micrograms/ml, 49% at 500 micrograms/ml) at 42 degrees C. The presence of biosynthetic substrates significantly attenuated the suppression of CP activation by hyperthermia. A dose-dependent decrease in biosynthetic function occurred in the presence of CP at 37 degrees and 42 degrees C suggesting hepatotoxicity and/or competition for biochemical intermediates. The t 1/2 of HN2 at 50 micrograms/ml was slightly decreased by 11% at 42 degrees C (19.6 min vs. 17.4 min). The half-lives of 10 micrograms/ml HN2 and 5 micrograms/ml L-PAM were not altered at 42 degrees C (17.1 min vs. 16.4 min and 44.6 min vs. 44.1 min, respectively). The adverse effects of HN2 and L-PAM on hepatic biosynthetic functions were minimal suggesting that alkylating agents not requiring metabolism by the liver would be most useful for hepatic thermochemotherapy. The data indicate that hyperthermia depresses hepatic microsomal drug metabolizing enzyme function and alters the perfusate pharmacokinetics of alkylating agents. Moreover, manipulation of the hepatic biochemical environment may modify the adverse effects of hyperthermia on microsomal activity.

Alkylating Agents↗
PubMed1985

Macrophage-mediated modulation of hepatic function in multiple-system failure.

Hepatic insufficiency associated with the multiple-system organ-failure (MSOF) syndrome is a frequent sequellae of sepsis and severe trauma. Although its etiology is poorly understood, there is a growing literature suggesting that it may be mediated in part by secretory products of cells of monocyte/macrophage lineage including Kupffer cells. Several investigators have reported in vitro macrophage/Kupffer cell-mediated cytotoxicity toward target cells following appropriate stimulation. In addition, in vivo hepatocyte toxicity has been documented following activation of the reticuloendothelial system. The role of several secretory products including active oxygen intermediates, neutral proteases, and interleukin 1 in this cell-mediated model of hepatocellular modulation is reviewed.

Cell Communication↗
PubMed1985

Changes in quantitative measures of hepatic function after 90% hepatectomy in rats.

Quantitative measures of liver functions were investigated in rats up to 360 h after 90% hepatectomy and related to total hepatic DNA. Galactose elimination capacity (cytosolic phosphorylation of carbohydrate), p-nitro-anisole demethylase activity (endoplasmic drug hydroxylation) and prothrombin index (protein synthesis at rough endoplasmic membranes) were initially reduced as much as the liver weight, but recovered differently. During hepatic regeneration prothrombin index and galactose elimination were back to control values after an interval of 360 h, while p-nitro-anisole demethylase activity was about 0.4 times control value after that interval. The correlation between total hepatic DNA and liver weight, and between total hepatic protein and liver weight was 0.92 in both cases, indicating their close relationship during hepatic regeneration. Compared to earlier studies on 70% hepatectomy the recovery of metabolic functions after 90% hepatectomy is delayed, as compared to regeneration of total hepatic DNA. The compensatory hyperfunction observed after 70% hepatectomy was not found after 90% hepatectomy, indicating a lost ability to hyperfunction when hepatic function is reduced close to the minimal residual function. This is suggested to be important for the sudden onset of hepatic insufficiency.

Animals↗
PubMed1990

Assessment of hepatic function. Comparison of caffeine clearance in serum and saliva during the day and at night.

Hepatic microsomal function was assessed by a caffeine clearance test at night and during the day using saliva and serum samples obtained simultaneously. In 26 patients with cirrhosis, 21 patients with noncirrhotic liver disease and 15 control subjects caffeine elimination correlated well during the day and at night (r = 0.915 for serum and 0.917 for saliva). The correlation coefficients for caffeine clearance in saliva and serum were 0.940 during the day and 0.963 overnight. In the cirrhotic patients, clearance differed significantly from noncirrhotic liver disease and controls in saliva samples overnight: 0.51 +/- 0.45 ml/min per kg versus 0.91 +/- 0.44 and 1.41 +/- 0.56, respectively. Comparable results were obtained for serum clearance overnight and clearances during the day. Serum and saliva clearances at night correlated well with the aminopyrine breath test (rs = 0.884 and 0.907, respectively). Overnight caffeine clearance in saliva might be a simple useful method for assessing progression and prognosis of liver disease.

Aminopyrine↗
PubMed1991

[In vivo measurement of hepatic binding protein in chronic liver disease--validation as a measure of hepatic functional reserve].

[Tc-99m] Galactosyl-neoglycoalbumin (TcNGA) is a synthetic radiolabeled ligand specific to the hepatocyte receptor, hepatic binding protein (HBP), a specific receptor to serum asialoglycoprotein. A TcNGA study was performed on 34 humans: normal volunteers (7) chronic hepatitis (6), hepatic cirrhosis (8), and hepatocellular carcinoma superimposed on cirrhosis (13). Heart and liver time activity curves were obtained following intravenous injection of TcNGA (5 mCi, 1.82 x 10(-9) mol/kg). HBP concentration ([HBP]) was calculated by curve-fitting techniques using the nonlinear three compartment model, which includes biomolecular reaction between HBP and TcNGA. [HBP] values were compared with conventional liver function tests. [HBP] had a good correlation with prothrombin time (n = 34, r = 0.694, p = 0.0001) thrombotest (n = 34, r = 0.692, p = 0.0001), hepaplastin test (n = 26, r = 0.787, p = 0.0001), albumin (n = 34, r = 0.712, p = 0.0001), cholinesterase (n = 34, r = 0.801, p = 0.0001), ICGR15 (n = 33, r = 0.761, p = 0.0001), KICG (n = 30, r = 0.709, p = 0.0001), ICG Rmax (n = 12, r = 0.735, p = 0.0064) and Child-Turcotte classification score (n = 34, r = 0.819, p = 0.0001). We concluded that excellent correlations of [HBP] to conventional liver function tests suggest that in vivo receptor measurement via TcNGA kinetic analysis is a sensitive and promising method in the estimation of hepatic functional reserve in patients with chronic liver disease.

Adult↗
PubMed2005

Effects of restricted feeding on daily fluctuations of hepatic functions including p450 monooxygenase activities in rats.

Hepatic P450 monooxygenase activities, assessed by measurement of 7-alkoxycoumarin O-dealkylase (ACD) activities, show obvious daily fluctuations in male rats with high values during the dark period and low values during the light period. We have already confirmed that the ACD activities are controlled by the suprachiasmatic nucleus (SCN), which is well known as the oscillator of circadian rhythm. Recently, it is reported that circadian oscillators exist not only in the SCN but also in peripheral organs. To date, it is unclear which circadian oscillators predominantly drive the daily fluctuations of hepatic ACD activities. To address this question, we examined the effects of restricted feeding, which uncouples the circadian oscillators in the liver from the central pacemaker in the SCN, on the daily fluctuations in hepatic ACD activities in male rats. Here we show that restricted feeding inverts the oscillation phase of the daily fluctuations in hepatic ACD activities. Regarding the hepatic P450 content, there were no fluctuations between the light and dark periods under ad libitum and restricted feeding conditions. Therefore, it is considered that the daily fluctuations in hepatic ACD activities are predominantly driven by the circadian factors in peripheral organs rather than by the oscillator in the SCN directly.

7-Alkoxycoumarin O-Dealkylase↗
PubMed1997

Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors.

The respective volumes of hepatic tumors and nontumorous parenchyma of 50 patients requiring hepatectomy of more than one segment of Healey for tumor removal were measured using computed tomography (Vol-CT). The volume estimated by Vol-CT was found to correlate with the real weight resected (P < .0001) with a mean absolute error of 64.9 mL. The ratio of the nontumorous parenchymal volume of the resected liver to that of the whole liver (R2) in 15 patients who underwent right or extended right hepatic lobectomy was 43% +/- 15%. Eight of 15 patients with R2s < 60% underwent the procedures without right portal vein embolization (PE). The other seven with R2s exceeding 60% or an indocyanine green retention rate after 15 minutes (ICG15) of 10% to 20% underwent PE: in six of seven, the nontumorous parenchyma of the right hepatic lobe became atrophic and in all seven, the volume of the remaining left hepatic lobe increased with a decrease in the mean R2 from 62% +/- 14% to 55% +/- 8% (P = .0006). In the remaining 35 who underwent other hepatectomy procedures, R2s also remained <60%. Overall, at surgery, in 27 with normal liver function (ICG15 < 10%), R2s exceeded 60% in one, remained at 50% to 60% in five, and <50% in 21, whereas 23 patients except for one with an ICG15 exceeding 10%, had R2s of <50%. The postoperative serum total bilirubin levels in 84% of the patients remained within the normal range and there was no surgery-related mortality. In conclusion, 1) Vol-CT can accurately assess the extent of liver resection, 2) individuals with normal liver function can undergo resection of up to 60% of the nontumorous parenchyma without the need for PE, and 3) PE can be used to reduce the size of the resected tissue and increase the volume of the remnant liver to approximate the target limits in individuals with large tumors or minimally abnormal liver function.

Aged↗
PubMed1995

Hepatic function is preserved following liver-directed, adenovirus-mediated gene transfer.

Inherited and acquired disorders of the liver are attractive targets for gene therapy. Hepatic cells are susceptible targets for shuttle vectors because of a diversity of protein and viral receptors and accessibility of a selective afferent blood supply. Preservation of existing hepatic cell integrity and metabolic function is of paramount importance for successful whole animal gene therapy trials. In this report, we examine hepatic cell function and integrity following adenovirus-mediated reporter gene transfer to the liver in vivo. E1-deleted, replication-defective adenovectors encoding the LacZ gene driven by the human CMV promoter were delivered to the liver by isolated portal perfusion. The gene transfer rate, as determined by specific histochemical staining, approached 30% with recombinant protein detectable by Western blot throughout the course of study. Hepatic cell integrity as assessed by histology and hepatic enzyme profile (serum aspartate aminotransferase, gamma-glutamyl transpeptidase) demonstrated normal cellular architecture and no significant difference between transfected liver and controls. Hepatic synthetic and metabolic function, as determined by albumin levels, prothrombin time, and bilirubin, were similar between the two study groups. This study demonstrates that efficient adenovirus-mediated gene transfer and expression in the rat liver do not compromise hepatic cell metabolism and integrity.

Adenoviridae↗
PubMed1995

Relationship of apolipoproteins AI, B and lipoprotein Lp(a) to hepatic function of liver recipients during the early post-transplant period.

To evaluate serum apo AI, apo B, Lp(a) and the ratio of unesterified cholesterol to total cholesterol as markers of hepatic synthetic capacity after orthotopic liver transplantation, serial measurements of these variables were performed on post-transplant days 1, 3, 5, 7, 10 and 14 in 70 patients. Liver function was assessed by a quantitative dynamic test based on the hepatic conversion of lidocaine to monoethylglycinexylidide (MEGX). Patients were divided into two groups on the basis of clinical and laboratory findings, those with evidence (n = 46) and those without evidence (n = 24) of hepatic dysfunction. Apo AI levels fell in both groups to day 5, but then began to increase in the group with good hepatic function, a highly significant (P < 0.001) positive correlation being found with the results of the MEGX test on post-transplant days 7, 10 and 14. The ratio of unesterified cholesterol to total cholesterol rose in both groups from days 1 to 7 and then began to fall in the group without hepatic dysfunction; a highly significant (P < 0.001) negative correlation was observed with the results of the MEGX test on days 10 and 14, Apo B levels rose in both groups from days 1 to 10, with no significant differences between the two groups; no correlation was observed with the results of the MEGX test on any study day.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Primary biliary cirrhosis: relation between hepatic function and pulmonary function in patients who never smoked.

We studied the relationship between selected variables of hepatic and pulmonary function in 47 patients with primary biliary cirrhosis, who were participating in a prospective study to assess sequential pulmonary function at yearly intervals. An additional 20 patients with primary biliary cirrhosis, who were liver transplant candidates awaiting transplantation, were studied. None of the 67 patients ever smoked cigarettes. Severity of primary biliary cirrhosis was characterized by histological stage and the Mayo risk score derived from a Cox regression model that used the following variables: serum bilirubin and serum albumin levels, age, prothrombin time and clinical severity of edema. Pulmonary function assessment included key variables describing expiratory airflow (forced expiratory volume in 1 sec divided by forced vital capacity) and efficiency of gas exchange (steady-state diffusing capacity for carbon monoxide). We found a significant relationship between histological stage of primary biliary cirrhosis and steady-state diffusing capacity (p = 0.02) and between the Mayo risk score for disease severity and steady-state diffusing capacity (p = 0.03). Progressive deterioration of steady-state diffusing capacity was associated with increasing severity of primary biliary cirrhosis. No relationship existed between pulmonary function and the presence of sicca complex or Sjögren's syndrome or the clinical manifestations of portal hypertension (e.g., esophageal varices, ascites and splenomegaly). No significant relationship existed between expiratory airflow and severity of primary biliary cirrhosis. We conclude that in patients with primary biliary cirrhosis who have never smoked, a statistically significant relationship exists between the severity of the liver disease and the efficiency of gas exchange measured by steady-state diffusing capacity.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed2000

Circulating transforming growth factor beta(1) as an indicator of hepatic function impairment in liver cirrhosis.

In the liver, transforming growth factor (TGF) -beta(1)is primarily responsible for activation of fat-storing cells, which are the main source of extracellular matrix proteins. Their deposition play a key role in the development of liver cirrhosis. The aim of this study was to evaluate plasma TGF-beta(1)in patients with different stages of liver cirrhosis and its possible use as an indicator of liver function impairment. TGF-beta(1)was measured in the plasma of 40 patients with liver cirrhosis. To estimate possible effect of liver insufficiency on plasma TGF-beta(1), patients were divided into three groups: A, B and C, univocal with Child-Pugh classes. Normal values were collected from 13 healthy volunteers. Liver cirrhosis resulted in a significant increase of plasma concentration of TGF-beta(1)(39.3+/-3.8 ng/ml), which doubled normal values (18.3+/-1.6 ng/ml). The highest concentrations were observed in alcoholic patients (44.4+/-4.7 ng/ml). TGF-beta(1)level increased depending on the degree of liver insufficiency, demonstrated by a significant positive correlation with Child-Pugh score (r=0.591). Values in group A were similar to normal, but were significantly elevated in groups B and C. These findings suggest possible use of plasma TGF-beta(1)measurement as an indicator of liver function impairment and possible marker of hepatic fibrosis progression in cirrhotic patients.

Alanine Transaminase↗
PubMed2000

Late onset hepatitis and prolonged deterioration in hepatic function associated with nevirapine therapy.

The aetiology of hepatic dysfunction in patients with HIV infection is multifactorial. Re-activation of hepatitis C infection, drug toxicity, and opportunistic infections are all potential causes. Nevirapine (NVP) is a non-nucleoside reverse transcriptase inhibitor used as part of combination antiretroviral therapy for the treatment of HIV infection. It is associated with a significant incidence of hepatotoxicity, usually occurring in the initial month of therapy. We report the case of a 49-year-old man who developed NVP-induced prolonged hepatotoxicity 5 months after commencing antiretroviral therapy.

Anti-HIV Agents↗
PubMed2006

Evaluation of renal and hepatic functions in dogs naturally infected by visceral leishmaniasis submitted to treatment with meglumine antimoniate.

The present study aimed to evaluate the renal and hepatic responses in eight dogs with visceral leishmaniasis submitted to treatment with meglumine antimoniate and to verify the occurrence of possible side effects. Urinalysis, hepatic and renal function tests were carried out in all animals at up to seven moments. After the end of a six-month observation period, all dogs were euthanized. Before the beginning of the experiment urinary and biochemical alterations were observed in four dogs due to the changes caused by the parasite itself. These alterations included the presence of renal cells, cylindruria, proteinuria, azotemia, hyperproteinemia and hypoalbuminemia. One dog died on the third day after treatment because an aggravation of the clinical picture, probably due to the medication. During the course of the study, an increase in hepatic enzymes was verified in two animals. Sixty days after the beginning of the treatment four dogs showed remission of clinical signs. The other three were asymptomatic with persistent biochemical alterations. From these, two presented recurrence of clinical signs about 150 days after the beginning of the treatment while in the other, hyperproteinemia persisted. Meglumine antimoniate was not efficient to treat dogs with severe renal dysfunction and the side effects observed were pain at the site of injection and the probable transient hepatotoxicity, evidenced by biochemical examinations, but without the presence of clinical signs.

Animals↗