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Role of Plant-Based Medicines for Gallstones
Published in Megh R. Goyal, Preeti Birwal, Durgesh Nandini Chauhan, Herbs, Spices, and Medicinal Plants for Human Gastrointestinal Disorders, 2023
Vivek Kumar, Anju Dhiman, Pooja Chawla, Viney Chawla
Ursodeoxycholic acid and chenodeoxycholic acid, extracorporeal shock wave lithotripsy (ESWL), contact dissolution therapy (injection of methyl tertiary-butyl ether (MTBE) into the gallbladder to break down the gallstones), percutaneous cholecystectomy are successful nonsurgical treatments. Clearly, there is a critical need of assistance from alternative treatment to counter these troubles.4,5,10,11,15,20,21,35.
Hepatic disorders in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Ghassan M. Hammoud, Jamal A. Ibdah
Spider naevi and palmar erythema are commonly observed during pregnancy and in oral contraceptive receivers. Spider naevi consist of a central arterial vessel from which small capillaries lead off radially. These are found in 53% by the 9 months of pregnancy (1) and tend to be more common among white women. Palmar erythema is frequently observed in patients with chronic liver disease and in pregnancy. It manifests itself as a diffuse patchy erythema of the palms up to the start of the wrist joint. Occasionally, the soles of the feet are also affected, hence the name plantar erythema. Palmar erythema is observed in 63% of white women and 35% of black women during pregnancy (2). Scratch marks and pruritus are found in cases with cholestasis and biliary cirrhosis. Pregnancy is considered a pruritogenic state. The cause of this unbearable itching is deemed to be due to a decrease in bile salt transport secondary to a reduction in both sinusoidal and canalicular bile salt transporters. The concentration of bile salts in blood is within normal range in most pregnant women, but levels of unconjugated chenodeoxycholic acid are higher in late pregnancy. Anatomically, the liver is displaced toward the chest by an enlarging uterus and palpable liver is considered abnormal in pregnancy. It is important to screen for cirrhosis in the physical examination of pregnant women with viral hepatitis. Detection of cirrhosis may not always be easy because spider angioma and palmar erythema can be seen in both cirrhotic and pregnant states. However, evidence for splenomegaly is suggestive of cirrhosis.
Functions of the Liver
Published in Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal, Principles of Physiology for the Anaesthetist, 2020
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal
The liver produces about 1 L of bile per day, and this passes into the gall bladder where it is concentrated to about one-fifth of its volume. Bile consists of electrolytes, protein, bilirubin, bile salts and lipids. Bile acids (cholic acid and chenodeoxycholic acid) are produced in the liver from cholesterol. In the gut, bacterial action on cholic and chenodeoxycholic acids produces secondary bile acids such as deoxycholic acid and lithocholic acid. The bile acids conjugate with glycine or taurine to form bile salts (Figure 37.5). Bile salts are more water soluble and less lipid soluble, which limits the passive absorption in the small intestine so that the bile salts remain within the gut. The main function of bile salts is the emulsification of dietary fat, which is essential for fat absorption. In addition, bile salts are also important for the absorption of fat-soluble vitamins, especially vitamins A, D, E and K. At the terminal ileum, bile salts are reabsorbed by the apical sodium-dependent bile transporter. The reabsorbed bile salts are carried to the liver in the portal circulation, mostly bound to plasma proteins. The recirculation of bile salts is referred to as enterohepatic circulation.
Early diagnosis for cerebrotendinous xanthomatosis with juvenile cataract and family history
Published in Ophthalmic Genetics, 2023
Nurşen Öncel Acır, Burcu Taskiran Kandeger
The CYP27A1 mutation encoding the enzyme involved in bile acid synthesis results in the shifting of cholesterol to the cholestanol pathway (3). Clinical problems are caused by an increase in cholestanol and bile alcohols in the blood, urine, and feces, which then cross the blood-brain barrier and accumulate in various organs (15). Although cholestanol levels increase significantly in this disease, plasma cholesterol levels remain normal. Despite deposits in multiple organs, early-onset juvenile cataracts, and symptoms such as recurrent diarrhea episodes, the presence of cerebrotendinous xanthomatosis frequently remains misdiagnosed for years. However, with an early diagnosis of the disease, the production and plasma levels of cholestanol and bile alcohols decrease following the initiation of oral chenodeoxycholic acid (6,16). Moreover, the neurological complications of the disease can be prevented or even reversed (16). At this point, the early detection of the condition and the timing of the administration of chenodeoxycholic acid are critical. For this reason, juvenile cataract, which is one of the first symptoms, the morphology of the cataract, and the patient’s family history are of vital importance.
TGR5 agonists for diabetes treatment: a patent review and clinical advancements (2012-present)
Published in Expert Opinion on Therapeutic Patents, 2022
Rachana S. Bhimanwar, Amit Mittal
In another patent, Intercept Pharmaceuticals describes different chenodeoxycholic acid derivatives to treat obesity, insulin sensitivity, and inflammation. The patent retained the general structure 2 and optimized mainly with methyl group substitution at C-23, C-6 of chenodeoxycholic acid. Representative compounds 2e-2 h are illustrated in Figure 2. An in-vitro experiment revealed that CDCA without an alkyl substitution exhibited an EC50 value of 4 µM and the inclusion of the C-6 methyl group increases activity drastically with an EC50 value of 0.37 µM (compound 2 g). The compound 2e (23(R + S)-methyl-6methyl-chenodeoxycholic acid) was found to be most potent with EC50 0.11 µM on the TGR5 receptor and 123% efficacy [27].
Pharmacological effects of nanoencapsulation of human-based dosing of probucol on ratio of secondary to primary bile acids in gut, during induction and progression of type 1 diabetes
Published in Artificial Cells, Nanomedicine, and Biotechnology, 2018
Armin Mooranian, Nassim Zamani, Ryu Takechi, Hesham Al-Sallami, Momir Mikov, Svetlana Goločorbin-Kon, Bozica Kovacevic, Frank Arfuso, Hani Al-Salami
Rau et al. investigated the effects of inflammation on bile acid profile. The authors examined changes in bile acid metabolism and enterohepatic regulation processes associated with inflammatory bowel disorders. They found that there was strong association between bile acid levels in gut and liver, and inflammation, through effects on gene expression and signalling pathways including farnesoid X receptors [29]. This suggests that bile acid based feedback mechanisms take place at the genetic and molecular levels and are not confined only to the gut. Stiehl et al. investigated the effects of chenodeoxycholic acid and ursodeoxycholic acid treatments on the bile acid profile in gallstone patients. The authors explored the effects of chronic daily intake of chenodeoxycholic acid and ursodeoxycholic acids on bile acid metabolism and ratio. The authors found that treatment chenodeoxycholic acid and ursodeoxycholic acid resulted in significant changes in bile acid profile, metabolism and ratios via alteration of liver bile acid synthesis and conjugation [30]. This was not consistent with a previous study in our laboratory which showed that acute treatment of diabetic rats with a conjugated bile acid did not significantly change the concentrations of the bile acid in plasma or tissues [3].