Application of metabolomics in intrahepatic cholestasis of pregnancy: a systematic review

A new incompatible combination: Reynoutria multiflora combined with Cullen corylifolium enhances idiosyncratic hepatotoxicity under immunological stress

ETHNOPHARMACOLOGICAL RELEVANCE

Compound preparations of traditional Chinese medicines (TCMs) have gained considerable interest. However, ensuring their safety is difficult because of ingredient complexity. Reynoutria multiflora (Thunb.) Moldenke (PM), commonly used in tonic preparations for clinical use, has been frequently reported to cause drug-induced liver injury (DILI). Liver injury caused by PM is idiosyncratic and its underlying mechanisms have been elucidated. However, a systematic evaluation of the safety of PM compound formulations is lacking. Our preliminary research predicted a potential compatibility risk between PM and Cullen corylifolium (Linnaeus) Medikus (PF); however, the specific effects and mechanisms of their combined action on the liver have not been fully studied.

AIM OF THE STUDY

To determine the effects of the PM and PF combination on the liver and its mechanisms.

MATERIALS AND METHODS

This study used a lipopolysaccharide-induced idiosyncratic (IDILI) model. Kits were employed to measure the liver function indices and ELISA was used to detect inflammatory factor content. The histopathological changes of the liver were observed using H&E and TUNEL staining. Serum metabolomics and liver transcriptomics were performed simultaneously to detect overall differences in metabolite and gene expression. Network pharmacology and molecular docking were used to screen hepatotoxic components and their potential pathways.

RESULTS

Liver function indicators and pathological results demonstrated that the combined treatment with PM and PF may exacerbate immune-mediated liver injury compared to treatment with either herb alone. Inflammatory factor levels indicated that the combination had an immuno-amplifying effect, further increasing inflammatory cytokine levels. Integrated metabolomic and transcriptomic analysis revealed that the combination primarily affected the primary bile acid synthesis and glycerophospholipid metabolism. This exacerbated hepatocyte apoptosis and liver injury by down-regulating the expression of key genes (BAAT and ALB) for bile acid metabolism. Network pharmacology and molecular docking identified 2,3,5,4'-Tetrahydroxy stilbene-2-Ο-β-D-glucoside and psoralidin as potential toxic components of PM and PF, respectively. These two ingredients specifically targeted the cytosolic DNA-sensing pathway and NOD-like receptor signalling pathway. When combined, PM and PF triggered immune hyperactivation via dual-pathway cross-regulation, leading to immuno-metabolic disorders, increased hepatocyte apoptosis and enhanced inflammatory cascade responses.

CONCLUSIONS

The PM and PF combination represents a newly identified incompatible pair that can aggravate IDILI under specific conditions. Our findings provide a critical reference for the safe use of compound medication, enriching the TCM combination theory.

The severity of intrahepatic cholestasis of pregnancy and its association with pregnancy complications and neonatal asphyxia: A single-center case analysis and systematic review

Intrahepatic cholestasis of pregnancy (ICP) poses significant risks to maternal and neonatal health. Our study at Jiangxi Provincial Maternal and Child Health Hospital analyzed clinical and biochemical markers in singleton pregnancies diagnosed with ICP from October 2016 to December 2022. This research, supported by a systematic review and meta-analysis of existing studies, highlights the increasing incidence of ICP and its association with elevated levels of total bile acids, transaminases, and bilirubin. Our findings indicate a marked increase in the risk of preterm birth, cesarean delivery, and neonatal asphyxia as the severity of ICP escalates. This underscores the need for vigilant monitoring and management of affected pregnancies. By confirming the relationship between biochemical marker abnormalities and adverse pregnancy outcomes, our study advocates for enhanced clinical strategies and paves the way for future research aimed at improving prevention, diagnosis, and treatment methods for ICP.

The impact of maternal intrahepatic cholestasis during pregnancy on the growth trajectory of offspring: a population-based nested case‒control cohort study

BACKGROUND

Intrahepatic cholestasis of pregnancy (ICP) is associated with an increased risk of adverse fetal outcomes, yet its influence on offspring growth remains unclear. Our study dynamically tracks growth rates in children from ICP and healthy mothers and investigates the link between maternal liver function and developmental abnormalities in offspring.

METHOD

Our case‒control study involved 97 women with ICP and 152 with uncomplicated pregnancies nested in a cohort of their offspring, including 50 from the ICP group and 87 from the uncomplicated pregnancy group. We collected pediatric growth and development data, with a maximum follow-up duration of 36 months. Stratified analyses of children's height, weight, and head circumference were conducted, and Spearman's rank correlation was applied to examine the relationships between maternal serological markers and pediatric growth metrics.

RESULT

Maternal liver and renal functions, along with serum lipid profiles, significantly differed between the ICP and normal groups. In the ICP group, the offspring showed elevated alanine aminotransferase (ALT), direct bilirubin (DBIT), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and apolipoprotein B (APOB) levels. Notably, the length-for-age z score (LAZ), weight-for-age z score (WAZ), and head circumference-for-age z score (HCZ) were lower in ICP offspring compared with those from normal pregnancies within the 1- to 12-month age range (P < 0.05). However, no significant differences in LAZ, weight-for-length z score (WLZ), BMI-for-age z score (BAZ), or HCZ were observed between groups in the 13- to 36-month age range. Maternal maximum lactate dehydrogenase (LDH) and total bile acids (TBA) levels during pregnancy were inversely correlated with LAZ and WAZ in the first year. Furthermore, offspring of mothers with ICP exhibited a greater incidence of stunting (24% vs. 6.9%, P = 0.004) and abnormal HCZ (14% vs. 3.7%, P = 0.034).

CONCLUSIONS

Growth disparities in offspring of ICP-affected pregnancies were most significant within the 1- to 12-month age range. During this period, maximum maternal LDH and TBA levels were negatively correlated with LAZ and WAZ values of offspring. The observation of similar growth rates between ICP and control group offspring from 13 to 36 months suggested catch-up growth in the ICP group.

Metabolomic profiling of serum and tongue coating of pregnant women with intrahepatic cholestasis in pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is associated with an increased risk of cesarean section and adverse fetal outcomes. Currently, ICP diagnosis depends largely on serum levels of bile acids and lacks sensitivity and specificity for accurate diagnosis. Tongue diagnosis is an important diagnostic tool in traditional Chinese medicine (TCM) and is used in our clinic as complementary treatment and personalized medicine for ICP. However, the molecular basis of the manifestation of greasy white tongue coatings in ICP remains unknown. In this study, we performed untargeted metabolomic profiling of the serum, tongue coating, and saliva of 66 pregnant women, including 22 with ICP. The metabolomic profiles of the serum and tongue coatings showed marked differences between the two clinical groups. Forty-six differentially abundant metabolites were identified, and their relative concentrations correlated with total bile acid levels. These differential metabolites included bile acids, lipids, microbiota- and diet-related metabolites, and exposomes. Conventional biochemical markers, including serum aminotransferases and bilirubin, were not significantly increased in the ICP group, whereas the total cholesterol and triglyceride levels were significantly increased as early as the first trimester. Our data provide insights into the pathophysiology of ICP and implicate the gut-liver axis and environmental exposure. Tongue coating has the potential to be a non-invasive diagnostic approach. Further studies are required to validate the clinical utility of these findings.