Clearance of purified human liver γ-glutamyltransferase after intravenous injection in the rat

Scientific and Regulatory Policy Committee Points to Consider: Integration of Clinical Pathology Data With Anatomic Pathology Data in Nonclinical Toxicology Studies

Integrating clinical pathology data with anatomic pathology data is a common practice when reporting findings in the context of nonclinical toxicity studies and aids in understanding and communicating the nonclinical safety profile of test articles in development. Appropriate pathology data integration requires knowledge of analyte and tissue biology, species differences, methods of specimen acquisition and analysis, study procedures, and an understanding of the potential causes and effects of a variety of pathophysiologic processes. Neglecting these factors can lead to inappropriate data integration or a missed opportunity to enhance understanding and communication of observed changes. In such cases, nonclinical safety information relevant to human safety risk assessment may be misrepresented or misunderstood. This "Points to Consider" manuscript presents general concepts regarding pathology data integration in nonclinical studies, considerations for avoiding potential oversights and errors in data integration, and focused discussion on topics relevant to data integration for several key organ systems, including liver, kidney, and cardiovascular systems.

Scientific and Regulatory Policy Committee Points to Consider: Integration of Clinical Pathology Data With Anatomic Pathology Data in Nonclinical Toxicology Studies

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Effects of Hepatic Drug-metabolizing Enzyme Induction on Clinical Pathology Parameters in Animals and Man

Hepatic drug-metabolizing enzyme (DME) induction is an adaptive response associated with changes in preclinical species; this response can include increases in liver weight, hepatocellular hyperplasia and hypertrophy, and upregulated tissue expression of DMEs. Effects of DME induction on clinical pathology markers of hepatobiliary injury and function in animals as well as humans are not well established. This component of a multipart review of the comparative pathology of xenobiotically mediated induction of hepatic metabolizing enzymes reviews pertinent data from retrospective and prospective preclinical and clinical studies. Particular attention is given to studies with confirmation of DME induction and concurrent evaluation of liver and/or serum hepatobiliary marker enzyme activities and histopathology. These results collectively indicate that in the rat, when histologic findings are limited to hepatocellular hypertrophy, DME induction is not expected to be associated with consistent or substantive changes in serum or plasma activity of hepatobiliary marker enzymes such as alanine aminotransferase, alkaline phosphatase, and gamma glutamyltransferase. In the dog and the monkey, published studies also do not demonstrate a consistent relationship across DME-inducing agents and changes in these clinical pathology parameters. However, increased liver alkaline phosphatase or gamma glutamyltransferase activity in dogs treated with phenobarbital or corticosteroids suggests that direct or indirect induction of select hepatobiliary injury markers can occur both in the absence of liver injury and independently of induction of DME activity. Although correlations between tissue and serum levels of these hepatobiliary markers are limited and inconsistent, increases in serum/plasma activities that are substantial or involve changes in other markers generally reflect hepatobiliary insult rather than DME induction. Extrahepatic effects, including disruption of the hypothalamic-pituitary-thyroid axis, can also occur as a direct outcome of hepatic DME induction in humans and animals. Importantly, hepatic DME induction and associated changes in preclinical species are not necessarily predictive of the occurrence, magnitude, or enzyme induction profile in humans.

Diagnostic performance of traditional hepatobiliary biomarkers of drug-induced liver injury in the rat

Nonclinical studies provide the opportunity to anchor biochemical with morphologic findings; however, liver injury is often complex and heterogeneous, confounding the ability to relate biochemical changes with specific patterns of injury. The aim of the current study was to compare diagnostic performance of hepatobiliary markers for specific manifestations of drug-induced liver injury in rat using data collected in a recent hepatic toxicogenomics initiative in which rats (n = 3205) were given 182 different treatments for 4 or 14 days. Diagnostic accuracy of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (Tbili), serum bile acids (SBA), alkaline phosphatase (ALP), gamma glutamyl transferase (GGT), total cholesterol (Chol), and triglycerides (Trig) was evaluated for specific types of liver histopathology by Receiver Operating Characteristic (ROC) analysis. To assess the relationship between biochemical and morphologic changes in the absence of hepatocellular necrosis, a second ROC analysis was performed on a subset of rats (n = 2504) given treatments (n = 152) that did not cause hepatocellular necrosis. In the initial analysis, ALT, AST, Tbili, and SBA had the greatest diagnostic utility for manifestations of hepatocellular necrosis and biliary injury, with comparable magnitude of area under the ROC curve and serum hepatobiliary marker changes for both. In the absence of hepatocellular necrosis, ALT increases were observed with biochemical or morphologic evidence of cholestasis. In both analyses, diagnostic utility of ALP and GGT for biliary injury was limited; however, ALP had modest diagnostic value for peroxisome proliferation, and ALT, AST, and total Chol had moderate diagnostic utility for phospholipidosis. None of the eight markers evaluated had diagnostic value for manifestations of hypertrophy, cytoplasmic rarefaction, inflammation, or lipidosis.

Clearance of circulating gamma-glutamyltransferase by the asialoglycoprotein receptor. Enzyme forms with different sialic acid content are eliminated at different clearance rates and without apparent desialylation

gamma-Glutamyltransferase is eliminated from the circulation via the asialoglycoprotein receptor in liver. After purifying the enzyme from human liver, a subfractionation into differently sialylated forms was obtained using MonoQ ion exchange chromatography. The uptake of such forms from rat circulation was studied and the slowest rate was measured for the most sialylated form. To test if the uptake of the sialylated enzymes was dependent on prior desialylation in the circulation the enzyme was recovered from liver after uptake and from serum after inhibiting the uptake with asialofetuin. Analysis of these recovered forms showed no apparent alteration in charge. The enzyme is apparently eliminated without prior desialylation through available galactose units which bind with low affinity to the receptor.

Clearance of circulating gamma-glutamyltransferase by the hepatic galactose receptor. Variability in clearance rate due to carbohydrate heterogeneity of the enzyme

The clearance and organ uptake of gamma-glutamyltransferase was studied by injecting the purified human liver enzyme intravenously in the rat. The enzyme was almost exclusively taken up by liver hepatocytes with a rapid initial uptake. The clearance was significantly inhibited by asialofetuin as well as by galactose and fucose. The uptake of neuraminidase-treated enzyme was much more rapid than that of the native enzyme. Subfractions of gamma-glutamyltransferase obtained by lectin affinity chromatography revealed significant differences in clearance rates. The data strongly indicates that the uptake of circulating gamma-glutamyltransferase involves the galactose (asialo-glycoprotein) receptor of the parenchymal cells, and that the heterogeneity of gamma-glutamyltransferase results in varying clearance rates.

The level of gamma-glutamyltransferase in serum, effect of carbohydrate heterogeneity on clearance rate

The measurement of serum gamma-glutamyltransferase (GT) is a frequently used parameter of liver diseases. The serum enzyme originates from liver and is cleared from the circulation by the galactose receptor in liver. The rate of uptake will thus vary with the amount of terminal galactose residues on the enzymes' carbohydrate moiety. Using an experimental rat model we have studied the relative clearance rates of variant forms of GT with different carbohydrate composition. GT purified from pancreas and kidney contains less sialic acid and showed considerably higher clearance rates than the enzyme from liver. The rapid uptake of the kidney and pancreas enzymes indicates that these enzymes may not reach detectable levels if released from these organs to the circulation. On the other hand, GT in serum of alcoholics contains increased amount of sialic acid and this enzyme variant showed a slightly decreased clearance rate compared to the normal liver enzyme. Increased sialylation of GT may thus contribute to the increased level of the enzyme in serum after alcohol abuse.