Serum bile acid concentrations as an indicator of liver dysfunction induced during danazol therapy

Recent Progress in Prediction Systems for Drug-induced Liver Injury Using in vitro Cell Culture

BACKGROUND

In order to avoid drug-induced liver injury (DILI), in vitro assays, which enable the assessment of both metabolic activation and immune reaction processes that ultimately result in DILI, are needed.

OBJECTIVE

In this study, the recent progress in the application of in vitro assays using cell culture systems is reviewed for potential DILI-causing drugs/xenobiotics and a mechanistic study on DILI, as well as for the limitations of in vitro cell culture systems for DILI research.

METHODS

Information related to DILI was collected through a literature search of the PubMed database.

RESULTS

The initial biological event for the onset of DILI is the formation of cellular protein adducts after drugs have been metabolically activated by drug metabolizing enzymes. The damaged peptides derived from protein adducts lead to the activation of CD4+ helper T lymphocytes and recognition by CD8+ cytotoxic T lymphocytes, which destroy hepatocytes through immunological reactions. Because DILI is a major cause of drug attrition and drug withdrawal, numerous in vitro systems consisting of hepatocytes and immune/inflammatory cells, or spheroids of human primary hepatocytes containing non-parenchymal cells have been developed. These cellular-based systems have identified DILIinducing drugs with approximately 50% sensitivity and 90% specificity.

CONCLUSION

Different co-culture systems consisting of human hepatocyte-derived cells and other immune/inflammatory cells have enabled the identification of DILI-causing drugs and of the actual mechanisms of action.

Concomitant treatment of severe uterine adenomyosis in a premenopausal woman with an aromatase inhibitor and a gonadotropin-releasing hormone agonist

OBJECTIVE

To assess the effect of aromatase inhibitors with GnRH agonist for a severe symptomatic adenomyosis that is refractory to GnRH agonist and danazol with GnRH agonist.

DESIGN

Case report.

SETTING

Clinical practice in university hospital.

PATIENT(S)

A 34-year-old woman with a complaint of severe dysmenorrheal, symptomatic anemia, and a desire to retain fertility.

INTERVENTION(S)

Aromatase inhibitor anastrozole given orally (1.0 mg or 2.0 mg daily) for 16 weeks and GnRH agonist given monthly (injected SC, 1.8 mg) for 4 months.

MAIN OUTCOME MEASURE(S)

Measurements of uterine volume and levels of serum E(2), estrone, A, dehydroepiandrosterone sulfate, LH, FSH, and CA125.

RESULT(S)

Uterine volume was reduced. The reduction rate of uterine volume estimated by magnetic resonance imaging and ultrasonography was 60% after 8 weeks of treatment.

CONCLUSION(S)

Aromatase inhibitor with GnRH agonist therapy was useful for the management of a severely adenomyotic woman whose desire was for conservative treatment.