Mitochondrial superoxide dismutase and glutathione peroxidase in idiosyncratic drug-induced liver injury.

UNLABELLED: Drug-induced liver injury (DILI) susceptibility has a potential genetic basis. We have evaluated possible associations between the risk of developing DILI and common genetic variants of the manganese superoxide dismutase (SOD2 Val16Ala) and glutathione peroxidase (GPX1 Pro200Leu) genes, which are involved in mitochondrial oxidative stress management. Genomic DNA from 185 DILI patients assessed by the Council for International Organizations of Medical Science scale and 270 sex- and age-matched controls were analyzed. The SOD2 and GPX1 genotyping was performed using polymerase chain reaction restriction fragment length polymorphism and TaqMan probed quantitative polymerase chain reaction, respectively. The statistical power to detect the effect of variant alleles with the observed odds ratio (OR) was 98.2% and 99.7% for bilateral association of SOD2 and GPX1, respectively. The SOD2 Ala/Ala genotype was associated with cholestatic/mixed damage (OR = 2.3; 95% confidence interval [CI] = 1.4-3.8; corrected P [Pc] = 0.0058), whereas the GPX1 Leu/Leu genotype was associated with cholestatic injury (OR = 5.1; 95%CI = 1.6-16.0; Pc = 0.0112). The presence of two or more combined risk alleles (SOD2 Ala and GPX1 Leu) was more frequent in DILI patients (OR = 2.1; 95%CI = 1.4-3.0; Pc = 0.0006). Patients with cholestatic/mixed injury induced by mitochondria hazardous drugs were more prone to have the SOD2 Ala/Ala genotype (OR = 3.6; 95%CI = 1.4-9.3; Pc = 0.02). This genotype was also more frequent in cholestatic/mixed DILI induced by pharmaceuticals producing quinone-like or epoxide metabolites (OR = 3.0; 95%CI = 1.7-5.5; Pc = 0.0008) and S-oxides, diazines, nitroanion radicals, or iminium ions (OR = 16.0; 95%CI = 1.8-146.1; Pc = 0.009). CONCLUSION: Patients homozygous for the SOD2 Ala allele and the GPX1 Leu allele are at higher risk of developing cholestatic DILI. SOD2 Ala homozygotes may be more prone to suffer DILI from drugs that are mitochondria hazardous or produce reactive intermediates.

Analysis of IL-10, IL-4 and TNF-alpha polymorphisms in drug-induced liver injury (DILI) and its outcome.

BACKGROUND/AIMS: The aim of this study was to assess whether genetic polymorphism of three important candidate cytokine genes, IL-10 (-1082G/A, -819C/T, and -592C/A), IL-4 (-590C/T) and TNF-alpha (-308G/A), play a role in the susceptibility to developing drug-induced liver injury (DILI), and in determining its phenotypic expression and severity. METHODS: Cytokine genotyping was analysed using TaqMan 5' allelic discrimination assay in 140 DILI patients (mean age 51 y, range 13-82, with equal sex distribution) included in the Spanish Registry and 268 healthy controls. RESULTS: Genotypes, haplotypes and allele frequencies were similar for both cases and controls. The low IL-10 producing haplotype was more prevalent in DILI patients with the absence of peripheral blood eosinophilia (Pc=0.004, OR=5.29, 95% CI: 2.04-13.67), revealing significantly lower median eosinophil counts (0.19 x 10(9)L; P<0.0002) compared to the intermediate (0.24 x 10(9)L) and high (0.40 x 10(9)L) IL-10 haplotypes. All cases with serious DILI outcome carried low or intermediate IL-10 producing haplotype and had normal or low eosinophil counts. CONCLUSIONS: IL-10, IL-4 and TNF-alpha genetic polymorphisms were not related to the risk of developing DILI. Low IL-10 producing haplotype is associated with low eosinophil count, absence of eosinophilia and may be associated with worse clinical outcome from DILI.

Initial experiments to develop a MEMS transducer for a new implantable audioprosthesis to substitute the tympanic-ossicular system.

CONCLUSION: We tested one prototype of a new audioprosthesis including the audioprocessor, the implemented algorithms and fitting platform in a small group of selected patients with mixed hypoacusis due to earlier bilateral radical mastoidectomy. It was effective to compensate the conductive and the neurosensory components of those patients. Results regarding the energy, frequency and other requirements of the output transduction make it possible to develop a suitable actuator with the available Micro-Electromechanic-Machine-System (MEMS) technology to substitute the conventional transducer of the prototype. OBJECTIVES: The objectives were: a) to evaluate the effectiveness of the whole fitting system, and b) to obtain information about the required energy to design the MEMS actuator. MATERIALS AND METHODS: The experiments were conducted with the A prototype of the prosthesis equipped with an output transducer coupled to the oval window. Two algorithms and three cases were tested. RESULTS: The audioprocessor with the implemented FIR filter-67 coefficients paradigm algorithms, and the fitting system were shown to be adequate for clinical use. Effectiveness parameters were: pure tone average gains 20-33.3 dB; gap closure 25.5-31.8 dB; speech reception thresholds improvement 15-20 dB. Required gain: 5-40 dB. Subjectively, patients considered the results very satisfactory.

Growth factor-induced shedding of syndecan-1 confers glypican-1 dependence on mitogenic responses of cancer cells.

The cell surface heparan sulfate proteoglycan (HSPG) glypican-1 is up-regulated by pancreatic and breast cancer cells, and its removal renders such cells insensitive to many growth factors. We sought to explain why the cell surface HSPG syndecan-1, which is also up-regulated by these cells and is a known growth factor coreceptor, does not compensate for glypican-1 loss. We show that the initial responses of these cells to the growth factor FGF2 are not glypican dependent, but they become so over time as FGF2 induces shedding of syndecan-1. Manipulations that retain syndecan-1 on the cell surface make long-term FGF2 responses glypican independent, whereas those that trigger syndecan-1 shedding make initial FGF2 responses glypican dependent. We further show that syndecan-1 shedding is mediated by matrix metalloproteinase-7 (MMP7), which, being anchored to cells by HSPGs, also causes its own release in a complex with syndecan-1 ectodomains. These results support a specific role for shed syndecan-1 or MMP7-syndecan-1 complexes in tumor progression and add to accumulating evidence that syndecans and glypicans have nonequivalent functions in vivo.

Drug-induced liver injury: an analysis of 461 incidences submitted to the Spanish registry over a 10-year period.

BACKGROUND & AIMS: Progress in the understanding of susceptibility factors to drug-induced liver injury (DILI) and outcome predictability are hampered by the lack of systematic programs to detect bona fide cases. METHODS: A cooperative network was created in 1994 in Spain to identify all suspicions of DILI following a prospective structured report form. The liver damage was characterized according to hepatocellular, cholestatic, and mixed laboratory criteria and to histologic criteria when available. Further evaluation of causality assessment was centrally performed. RESULTS: Since April 1994 to August 2004, 461 out of 570 submitted cases, involving 505 drugs, were deemed to be related to DILI. The antiinfective group of drugs was the more frequently incriminated, amoxicillin-clavulanate accounting for the 12.8% of the whole series. The hepatocellular pattern of damage was the most common (58%), was inversely correlated with age (P < .0001), and had the worst outcome (Cox regression, P < .034). Indeed, the incidence of liver transplantation and death in this group was 11.7% if patients had jaundice at presentation, whereas the corresponding figure was 3.8% in nonjaundiced patients (P < .04). Factors associated with the development of fulminant hepatic failure were female sex (OR = 25; 95% CI: 4.1-151; P < .0001), hepatocellular damage (OR = 7.9; 95% CI: 1.6-37; P < .009), and higher baseline plasma bilirubin value (OR = 1.15; 95% CI: 1.09-1.22; P < .0001). CONCLUSIONS: Patients with drug-induced hepatocellular jaundice have 11.7% chance of progressing to death or transplantation. Amoxicillin-clavulanate stands out as the most common drug related to DILI.

HLA class II genotype influences the type of liver injury in drug-induced idiosyncratic liver disease.

Drug-induced idiosyncratic liver disease (DIILD) depends largely on host susceptibility factors. Small studies support the genetic influence of human leukocyte antigen (HLA) class II molecules on the predisposition to DIILD. We sought associations between HLA-DRB and -DQB alleles and DIILD considered collectively or according to the biochemical expression of liver damage. We studied a total of 140 patients with a definitive or probable diagnosis of DIILD, as assessed with the Council for International Organizations of Medical Sciences scale, with 635 volunteer bone marrow and blood donors serving as controls. HLA-DRB1* and -DQB1* genotyping was performed by hybridization with sequence-specific oligonucleotides after genomic amplification. The group with DIILD did not differ from control subjects with regard to the distribution of HLA-DRB and -DQB antigens. The frequencies of alleles DRB1*15 (35.4% vs. 18.6% of controls; P =.002; odds ratio [OR] 2.31) and DQB1*06 (61.5% vs. 40.8%; P =.001; OR 2.32) were significantly increased in patients with the cholestatic/mixed type of liver damage in comparison to healthy subjects. By contrast, frequencies of alleles DRB1*07 (16.9% vs. 35.4%; P =.003; OR 0.37) and DQB1*02 (32.3% vs. 55.8%; P =.0003; OR 0.39) were significantly decreased. In conclusion, there is no association between any specific HLA allele and the propensity to develop DIILD. However, the genetic influence associated with HLA class II alleles appears to play a role in the biochemical expression of liver injury in cholestatic/mixed hepatotoxicity and may explain why a given drug may cause different patterns of liver damage.

Um caso homossexual feminino e seus filhos: estudo sobre a dinâmica familiar

O objetivo desta pesquisa foi conhecer a dinâmica de uma família formada por um casal de lésbicas, uma filha biológica e um filho adotivo, com vistas a um melhor conhecimento do funcionamento desta estrutura familiar. Buscou-se, ainda, conhecer o padrão de relacionamento do subsistema conjugal e parental nos aspectos de comunicação verbal e não-verbal, vínculos afetivos e papéis familiares - conjugal, materno e paterno, divisão de tarefas domésticas e relação com os filhos. Pretendeu-se, também, investigar a relação do sistema familiar com as famílias de origem e outros sistemas sociais. Para tanto, foi feito um Estudo de Caso que possibilitou o conhecimento, de forma mais aprofundada, da dinâmica familiar e da história de vida dos membros dessa família. Esse estudo teve a participação de uma família constituída pela mãe, 39 anos e sua companheira, 33 anos, a filha biológica de 15 anos e o filho adotivo de 1 ano. A família foi contada a partir da indicação do Setor de Adoção da Vara da Infância e da Juventude do Distrito Federal. Foram realizados sete encontros com a família, em sua residência. Os instrumentos utilizados foram: genograma, ecomapa, entrevista semi-estruturada e colagem. Os resultados da pesquisa foram discutidos com base em dados teóricos e empíricos levantados na revisão bibliográfica e mostraram a existência de uma divisão de papéis familiares a partir de um modelo heterossexual, até mesmo com divisão de papéis familiares a partir de um modelo heterossexual, até mesmo com divisão de tarefas, sendo que a filha biológica adolescente percebe essas características refletidas nos comportamentos tanto de sua mãe como de sua companheira. Existe a expectativa, por parte das 'mães', em garantir ao filho adotivo convivência com uma figura masculina que possa lhe servir de modelo, tirando dúvidas 'que uma mulher não seria capaz de fazê-lo'. Existe, ainda, uma preocupação com o fato de, em sendo um menino, como lidar com os seus futuros amigos, quando perguntarem sobre o pai e sobre a relação homoafetiva do casal parental(AU)