Hepatoprotective Therapy Research Articles

IMMUNE IMBALANCE IN THE PATHOGENESIS OF ABDOMINAL SEPSIS IN THE PATIENTS WITH THE PRIMARY AND SECONDARY LIVER ABSCESSES.FEATURES OF THE DIAGNOSTICS AND OPTIMIZATION OF COMPLEX TREATMENT

The purpose ofourworkwas to identify markers of immune imbalance in the patients with abdominal sepsis due toprimary and secondary liver abscesses, to study methods of the correction of the infraction in the organism and a volume of the infusion. There were analyzed the results of treatment of 64 patients with primary and secondary liver abscesses.The results of analysis indicate a pronounced immune imbalance and the formation of secondary immune deficiency at the T-suppressor type. The main stage of the treatment of abdominal sepsis due to primary and secondary abscesses is draining the source of infection with antibacterial, hepatoprotective and detoxification therapy.

Differentiated Antiplatelet and Hepatoprotective Therapy in Patients with Stable Coronary Heart Disease on the Background of Nonalcoholic Fatty Liver Disease in Stage of Steatosis

The objective of the research was to evaluate the effectiveness of long-term antiplatelet and hepatoprotective differentiation therapy in patients with postinfarction cardiosclerosis and co-existent non-alcoholic fatty liver disease in stage of steatosis.Materials and methods. There were examined 72 patients with stable coronary heart disease functional classes II-III and co-existent non-alcoholic fatty liver disease in stage of steatosis. All the patients underwent a complete clinical examination; the functional state of their liver and platelet haemostasis were assessed. All patients received standard therapy the effectiveness of which was assessed 3 and 6 months after treatment.Results. The effectiveness of antiplatelet therapy was found to depend on treatment duration, the functional state of the liver and the scheme of antiplatelet and hepatoprotective differentiation therapy. In particular, 6 months after treatment, a positive dynamics of platelet haemostasis was observed in all the patients of Group I. However, the target value of its indicators was achieved in 60.5% of patients. In Group II, the target level of platelet aggregation activity was achieved in 38.3% of patients. The level of liver enzymes was within the control limits in 52.8% of patients. In 47.2% of patients, however, an increase in their level was observed, which necessitated the administration of appropriate hepatoprotective therapy.Conclusions. The developed concept of differentiation treatment of patients with coronary heart disease and co-existent non-alcoholic fatty liver disease in stage of steatosis envisages the need for monitoring the indicators of platelet haemostasis and liver function every three months after the administration of antiplatelet therapy with the possibility of its intensification and the inclusion of hepatoprotective drugs.

Proinflammatory cytokines and endotoxemia level change in patients with type 2 diabetes and nonalcoholic fatty liver disease after hepatoprotective and probiotic therapy usage

Proinflammatory cytokines and endotoxemia level change in patients with type 2 diabetes and nonalcoholic fatty liver disease after hepatoprotective and probiotic therapy usage

Эффективность гепатопротекторной терапии бетаин-аргининовым комплексом «Бетаргин» при применении у детей с неалкогольной жировой болезнью печени

Эффективность гепатопротекторной терапии бетаин-аргининовым комплексом «Бетаргин» при применении у детей с неалкогольной жировой болезнью печени

Protective Effects of Moringa oleifera extract on Isoniazid and Rifampicin Induced Hepatotoxicity in Rats: Involvment of Adiponectin and Tumor Necrosis Factor-α

H EPATOTOXICITY is the major health problem that is a global concern worldwide especially in Egypt because the liver injury is one of the most ten disease leading to death. There are many factors leading to hepatotoxicity as antibiotics like Isoniazid (INH) and rifampicin (RIF) which are the first line remedies in treatment of tuberculosis. The present study evaluates the possible hepatoprotective effects of Moringa oleifera against the experimentally induced hepatotoxicity with INH/RFP in rats. Forty eight rats (200-250g) were allocated into six groups (8 rats in each group), and treated as follow: group I: received normal saline orally, group II: received INH/ RIF (50 mg/Kg/day of each)for 28 days orally, group III: received Silymarin (50 mg/kg/day) + INH/ RIF for 28 days orally, group IV, V, VI: received Moringa oleifera ethanolic extract (MOEE) (250, 500 and 1000 mg/Kg/day) + INH/ RIF for 28 days respectively. Co-administration of Moringa oleifera with INH/ RIF reduced elevated serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and (bilirubin total &direct) levels but also decreased the elevated malondialdehyde (MDA) & tumor necrosis factor-α (TNF-α) contents in liver homogenate. Moreover, administration of Moringa oleifera increased glutathione peroxidase (GPX) & adiponectin activity. Microscopic examination of Moringa olifera extract administration revealed reduction in the severity of liver damage. It is concluded that Moringa olifera might be considered as adjuvant drug in treatment of liver disorder and or as hepatoprotective therapy with anti-tubercular drugs.

Aspects of the importance of postoperative hepatoprotector therapy in urgent surgery

The purpose of this study was to determine the effect on the effectiveness of the correction of enteric insufficiency syndrome in patients with urgent surgical pathology included in the scheme of complex therapy Remaxol. The results of complex therapy of 227 patients (98 people with common peritonitis and 129 patients with acute intestinal obstruction) were analyzed. 128 patients of the main group in the postoperative period were included in the therapy scheme Remaxol: intravenously drip in a daily dose of 400 ml at a rate of 40 drops per minute, a course of -5 days. Patients of the control group (99 people) received standard treatment. The study is devoted to the role of postoperative hepatoprotective therapy in the treatment of patients with urgent surgical pathology. The main attention is paid to the hepatoenteric link of the pathogenesis of polyorganism insufficiency. This approach gives hope for a reduction in the risk of abdominal sepsis and a reduction in mortality among patients with acute abdominal pathology. The study found that in patients with acute abdominal pathology, an increase in the severity of enteric insufficiency syndrome due to toxic aggression and bacterial translocation can lead to hepatic dysfunction. Consequently, the implementation of hepatoprotective therapy is a pathogenetic link in the complex treatment of urgent surgical patients. The obtained results allowed to draw a number of conclusions. In particular, it has been established that the use of hepatoprotective therapy in the complex medical treatment of patients with acute abdominal pathology makes it possible to stop hepatorenal syndrome by the 5th day, and the syndrome of enteric insufficiency by the 7th day. Earlier relief of hepatic dysfunction and enteral insufficiency syndrome due to hepatoprotective therapy allowed to reduce the incidence of infectious complications to 9.7%, to reduce the lethality to 9.4% and to shorten hospitalization from 17.29 to 1.734 to 12.14±1.385 bed/day.

The hepatoprotective role of reduced glutathione and its underlying mechanism in oxaliplatin-induced acute liver injury

Currently, the underlying mechanism of oxaliplatin (OXA) induced live injury is unclear. In addition, there is no standard clinical treatment for OXA-induced acute liver injury (ALI). In this study, we established an animal model of OXA-induced ALI, and studied the role of oxidative stress in OXA-induced ALI and the impacts of reduced glutathione (GSH) treatment on OXA-induced ALI. To establish an OXA-induced ALI model, KM mice received intraperitoneal injection of OXA (8 mg/kg) for 4 days. Serum alanine aminotransferase (ALT), aspartate aminotransferase levels (AST), hepatic pathology and oxidative stress indicators in liver tissues were analyzed. To study the impact of GSH treatment on OXA-induced ALI, mice were treated with GSH (400 mg/kg, i.p). In this ALI mouse model, ALT and AST levels were significantly increased (P<0.01). Liver pathological examination revealed varying degrees of liver cell turbidity and degeneration, even balloon-like changes and focal necrosis, and sinusoidal hemorrhage in some cells. Compared with control group, the malondialdehyde (MDA) and GSH levels were significantly increased in OXA-treated group (P<0.01), while the superoxide dismutase SOD and GSH-peroxidase levels were decreased after OXA withdrawal (P<0.01). When GSH was used to treat OXA-induced ALI mice, the pathological injury of liver tissues was alleviated, and serum ALT and AST were significantly decreased. In addition, GSH treatment could reduce the OXA-induced increase of MDA level (P<0.05) in liver tissues, but had no impact on SOD level (P>0.05). We have successfully established an OXA-induced ALI model. Using this model, we discover that oxidative stress plays an important role in OXA-induced ALI. GSH-based hepatoprotective therapy can partially inhibit oxidative stress and alleviate OXA-induced ALI.

Efficacy of detoxification and hepatoprotective therapy in patients with diabetes mellitus type 2 in real clinical practice (clinical experience)

Efficacy of detoxification and hepatoprotective therapy in patients with diabetes mellitus type 2 in real clinical practice (clinical experience)

RESULTS OF ADEMETHIONIN ADMINISTRATION AFTER EXTENSIVE LIVER RESECTIONS

Aim. To study adamethionin effect on liver failure course after extensive liver resection. Material and Methods . 538 patients after extensive liver resection were included into study. Adamethionin has been used in the main group (326 patients) postoperatively while in the control group (212 patients) hepatoprotective therapy was absent. Incidence and severity of liver failure as well as postoperative complications were analyzed. Results. Total incidence of post-resection liver failure was 23% (18.7% and 30.2% in the main and control groups respectively, p &lt; 0.05). Mild complications were predominant in the main group while moderate and severe events were observed in the control groups. Post-resection liver failure by “50–50 criteria” was revealed in 27 patients of the control group (12.7%) vs. 13 patients of the main group (4.0%) (p &lt; 0.05). There was significant decrease of ALT and AST activity in the main group compared with the control group postoperatively. Overall incidence of postoperative complications was 18.9% and 17.2% in control and main groups respectively. The incidence of biliary complications was 7.5% and 6.4% in both groups respectively (p &gt; 0.05). Postoperative hospital-stay was 15 (12–28) days in the control group and 11 (9–19) days in the main group (p &lt; 0.05). Conclusion. Liver failure is possible after extensive liver resections (over three segments). Ademetionin contributes to restoration of liver structure and function, reduces the incidence of liver failure and hospital-stay, provides faster recovery of residual liver parenchyma.

Thyrotoxicosis Associated with Cholestatic Jaundice Treated with Therapeutic Plasma Exchange–Case Report

Thyroid disorders, especially thyrotoxicosis, are commonly associated with hepatic dysfunction, but cholestasis is rarely reported. Heart failure, infection, weight loss may play role in the pathogenesis of cholestasis. Cholestasis could be worsened by treatment of hyperthyroidism using Thiamazole, but cholestasis in undiagnosed thyrotoxicosis is uncommon. We present 23 year old female with jaundice, goiter, palpitation and confirmed thyrotoxicosis associated with hepatomegaly, hepatocelluar damage and cholestasis. Liver biopsy excluded the suspicion of autoimmune hepatitis. Therapeutic plasma exchange was performed 5 days after starting the treatment with thyroid supressive therapy, and hepatoprotective therapy due to progressive increase of serum levels of bilirubin (conjugated/direct) and liver enzymes. The patient treatment continued with low doses of thyroid suppressive therapy. Patient achieved euthyroid state after 2 months with normalization of the serum levels of liver enzymes and bilirubin. The final treatment option for our patient was surgical total thyroidectomy.

Evaluation of the Effectiveness and Safety of Combination Therapy Using Drugs Vazonat and Entrop in Patients with Chronic Toxic Liver Damage

The objective: to study the efficacy and safety of using in the complex treatment of cytoprotector Vazonat in combination with the nootropic medicine of entropy in patients with chronic toxic liver damage.&#x0D; Patients and methods. There were examined 60 patients (36 men and 24 women) with signs of liver toxicity in age from 35 to 63 years. The average age of the examined was 43.2±1.3 years. All patients were divided into two statistically homogeneous groups (main and control) for 30 people in each. Patients in both groups received diet therapy, hepatoprotective, according to indications – antispasmodic, choleretic, antisecretory drugs, and enzymes. The main group of patients in the combined therapy was additionally appointed Vazonat 500 mg per day (2 capsules per day) and Entrop 100 mg per day in the first half of day for 1 month.&#x0D; Results. Analysis of the obtained results testifies the effectiveness of additional use of drugs Vazonat and Entrop in combination with a standard hepatoprotective therapy in patients with chronic toxic liver in comparison of using only basic therapy. There was a positive dynamics of the main clinical syndromes. It was proved the positive impact of integrated therapy on the functional activity of the liver and also improving of cognitive abilities.&#x0D; Conclusion. Inclusion in comprehensive standard hepatoprotective therapy of patients with chronic toxic liver damage drugs Vazonat and Entrop accelerates the normalization of the functional state of the liver.

Association of itraconazole and potassium iodide in the treatment of feline sporotrichosis: a prospective study.

Feline sporotrichosis is an endemic disease in Rio de Janeiro, Brazil, where zoonotic transmission of Sporothrix spp. has been reported since 1998. Itraconazole (ITZ) remains the first choice for treating this disease in cats. However, there have been reports of therapeutic failure and a long-term endeavor. Potassium iodide (KI), considered in the past as a drug with variable effectiveness in cats with sporotrichosis, arises as an important option in the treatment of cats from the endemic area of Rio de Janeiro. In order to evaluate the effectiveness of the association of ITZ and KI in naive cats with sporotrichosis, a prospective cohort study was conducted on 30 cats receiving ITZ 100mg/day and KI 2.5 mg-20mg/kg/day. Clinical and laboratory adverse effects were assessed once a month according to the standard care protocol. The cure rate was 96.15% within a median of 14 weeks of treatment. Adverse effects were observed in 50% of cats and were managed with a temporary drug suspension and/or a hepatoprotective therapy. The association of ITZ and KI emerges as an effective option for the treatment of feline sporotrichosis.

Severity of hepatic dysfunction and its correction in the complex treatment of acute intestinal obstruction

The article describes the role that could play a hepatoprotective therapy in the treatment of patients with acute intestinal obstruction. The study involved 128 patients with mechanical acute intestinal obstruction, accompanied by the syndrome of enteral insufficiency. Hepatoprotective drugs have been added in the scheme of treatment. It has been proven beneficial therapeutic effect of this measure on the dynamics of the development of hepatorenal syndrome, syndrome of enteral insufficiency.

The significance of cytolysis syndrome in children

The measurement of aminotransferases levels has become part of the routine biochemical tests done in children regardless of their clinical symptoms. Aminotransferases (ALT, AST) are tissue necrosis markers which change in both hepatic and extra-hepatic conditions. The aim of this study was to establish the etiology and clinical signifi cance of the cytolysis syndrome without cholestasis in children hospitalized for various pediatric conditions. The study group consisted of 394 children (aged between 1.5 months and 16 years)with elevated values of ALT, AST. The investigation protocol applied included history, full physical examination, complete biological investigations, viral markers and liver ultrasounds. Depending on the aminotransferases values as compared to the normal value (NV), the patients were included in 3 study subgroups: 222 patients with slightly elevated transaminases values (&lt; 2xNV) (subgroup I), 164 patients with ALT and AST values between 2-3xNV (subgroup II) and 8 patients with TGP, TGO values &gt; 3 x NV (subgroup III). The ALT and AST values were determined monthly during the first 3 months, and then every 2 to 6 months. In all groups the etiology was dominated by acute bacterial (respiratory, urinary, digestive) and viral (Epstein Barr, Cytomegalovirus infection) conditions. Other causes of cytolysis syndrome were nutritional and metabolic diseases (obesity, mellitus diabetes, phenylketonuria, cystic fibrosis, congenital hypothyroidism). The etiology remained unclear in 20.31% of the cases, yet the transaminase values returned to normal after 6 months with diet and hepatoprotective therapy. Slightly elevated ALT and AST values do not require thorough investigations, as they usually return to normal within the first three months. On the other hand, mildly and severe increases, which persist after three months therapy require further investigation to determine the etiology (viral infections, autoimmune, nutritional and metabolic diseases).

Rechallenge with gefitinib following severe drug-induced hepatotoxicity in a patient with advanced non-small cell lung cancer: A case report and literature review

Gefitinib has come to be the most widely used epidermal growth factor receptor-tyrosine kinase inhibitor in the treatment of advanced non-small cell lung cancer (NSCLC) in Asian patients. Common side effects include mild to moderate skin rash and diarrhea, however, drug-induced liver injury of varying severity is overlooked in long-term gefitinib administration and rarely reported. The current case report presents a female Chinese NSCLC patient who developed severe gefitinib-induced hepatotoxicity and was rechallenged with gefitinib following a 3-month break. The patient achieved partial clinical remission but developed drug-induced grade 4 hepatotoxicity following gefitinib administration for 14 months. As an alternative, 4 cycles of chemotherapy were administered to control tumor progression. Following restoration of the patient’s liver function, gefitinib was rechallenged together with active hepatoprotective therapy. The patient presented good disease control and maintained normal liver function for >6 months. Thus, sequential chemotherapy and gefitinib rechallenge with hepatoprotective therapy may be a potential new treatment strategy for gefitinib-induced hepatotoxicity.

Hepatoprotective therapy for fatty liver diseases

脂肪性肝病(FLD)早期诊断和及时治疗可望减轻FLD患者肝炎的严重程度并延缓肝纤维化的进展,从而减少肝病残疾和死亡.然而,单纯依靠减肥、戒酒以及使用针对代谢综合征和酒精滥用的药物治疗FLD的效果并不理想,保肝抗炎药物在脂肪性肝炎防治中的作用不可忽视[1-7]。

Nanoscale hepatoprotective herbal decoction attenuates hepatic stellate cell activity and chloroform-induced liver damage in mice

BackgroundSan-Huang-Xie-Xin-Tang (SHXXT) decoction, a traditional Chinese medicine containing Rhei rhizome, Coptidis rhizome, and Scutellariae radix, is widely used in hepatoprotective therapy. However, preparation of the decoction requires addition of boiling water that causes loss of numerous effective components.MethodsTo improve the bioavailability of the decoction, nanoscale SHXXT was developed. Chloroform-induced liver injury and hepatic stellate cell activity in mice were used to demonstrate the hepatoprotective characteristics of nanoscale SHXXT decoction.ResultsLiver/body weight ratio and serum aspartate and alanine aminotranferase levels were recovered by the nanoscale SHXXT. TIMP-1 gene expression was inhibited and MMP-2 gene expression was accelerated in activated hepatic stellate cells.ConclusionNanoscale SHXXT decoction prepared in room temperature water could have preserved hepatoprotective ability. The results of this study indicate that nanoscale SHXXT could be extracted easily. The simple preparation of this herbal decoction is more convenient and energy-efficient.

Which Gender is Better Positioned in the Process of Liver Surgery? Male or Female?

Liver surgery is a process which induces various types of stress on the liver including the total occlusion of the blood inflow, hemorrhage, massive volume reduction, and postoperative infection. Animal studies have shown a gender dimorphic response of the liver for various stresses such as ischemia/reperfusion, hemorrhage/resuscitation, hepatectomy, portal branch ligation, and endotoxemia. Most of these studies demonstrated the female liver to be more tolerant under stressful conditions than the male liver. Estrogen, which is a representative female sex hormone, may be one of the responsible factors for this gender dimorphism. The mechanism of estrogen's salutary effect includes circulatory improvement, a reduced inflammatory response, a reduced oxygen radical production, and an improved hepatic regeneration. However, the clinical evidence that supports the results of these experimental studies is still insufficient. A well-controlled prospective clinical study is necessary to clarify the role of gender or sex hormone in the process of liver surgery. This may not only lead to a deeper understanding of the liver pathophysiology, but also to the possibility of hepatoprotective therapy using sex hormone modulators. This review summarizes the current understanding of gender dimorphism in the tolerance of the liver to various hepatic stresses, which occur during the process of major liver surgery.

Attenuation of Inflammation and Apoptosis by Pre- and Posttreatment of Darbepoetin-α in Acute Liver Failure of Mice

In many liver disorders inflammation and apoptosis are important pathogenic components, finally leading to acute liver failure. Erythropoietin and its analogues are known to affect the interaction between apoptosis and inflammation in brain, kidney, and myocardium. The present study aimed to determine whether these pleiotropic actions also exert hepatoprotection in a model of acute liver injury. C57BL/6J mice were challenged with d-galactosamine (Gal) and Escherichia coli lipopolysaccharide (LPS) and studied 6 hours thereafter. Animals were either pretreated (24 hours before Gal-LPS exposure) or posttreated (30 minutes after Gal-LPS exposure) with darbepoetin-alpha (DPO, 10 mug/kg i.v.). Control mice received physiological saline. Administration of Gal-LPS caused systemic cytokine release and provoked marked hepatic damage, characterized by leukocyte recruitment and microvascular perfusion failure, caspase-3 activation, and hepatocellular apoptosis as well as enzyme release and necrotic cell death. DPO-pretreated and -posttreated mice showed diminished systemic cytokine concentrations, intrahepatic leukocyte accumulation, and hepatic perfusion failure. Hepatocellular apoptosis was significantly reduced by 50 to 75% after DPO pretreatment as well as posttreatment. In addition, treatment with DPO also significantly abrogated necrotic cell death and liver enzyme release. In conclusion, these observations may stimulate the evaluation of DPO as hepatoprotective therapy in patients with acute liver injury.

Efficacy and safety of 6-month iron reduction therapy in patients with hepatitis C virus-related cirrhosis: a pilot study

Iron reduction therapy (IRT) has been recognized as beneficial for chronic hepatitis C patients. However, its efficacy for hepatitis C virus-related liver cirrhosis (LC-C) has not been elucidated. We evaluated the efficacy and safety of IRT for LC-C patients. Twenty-two LC-C patients were treated with biweekly phlebotomy and low iron diet for 6 months, in addition to regular hepatoprotective therapy. Nineteen sex- and age-matched patients who refused to receive IRT were used as controls. The efficacy of IRT was evaluated on the basis of biochemical parameters. Of 22 patients receiving IRT, 19 completed the 6-month treatment. IRT significantly reduced serum levels of aspartate aminotransferase (from 89 to 57 U/L; P = 0.003), alanine aminotransferase (from 101 to 54 U/L; P < 0.001), and alpha-fetoprotein (from 28 to 12 ng/mL; P = 0.003). These changes were not observed in the controls. Two patients whose serum albumin concentrations were less than 3.6 g/dL at the beginning of IRT withdrew from IRT because of the new appearance of ascites. IRT improved the serum levels of aminotransferases and alpha-fetoprotein in LC-C patients and was generally safe; however, IRT should be performed in patients who maintain serum albumin concentrations of more than 3.6 g/dL.