Protease Domain Exosites Regulate Plasma Recovery and Extravascular Distribution of Factor IX(a) Variants in Hemophilic Mice

Abstract Introduction: Among the coagulation protease, factor IX (FIX) is unique in that a substantial pool of extravascular factor exists that contributes to in vivo hemostasis. Extravascular distribution of FIX contributes to poor plasma recovery of infused FIX in hemophilia B (HB). The effect of mutations in the heparin (K126A/K132A) and antithrombin (R150A) binding exosites of FIX and FIXa on the distribution of these variants between the plasma and extravascular binding sites was examined in HB and hemophilia A (HA) mice, respectively. Methods: Recombinant human FIX wild type (18 U/kg) or equimolar FIX K126A/K132A was administered to HB mice (n=8) via tail vein injection with sacrifice 5 min post-injection following retro-orbital blood collection. Equimolar doses of human FIXa wild type (WT), K126A/K132A and R150A were similarly injected into HA mice (n=4-8), with blood collection and sacrifice 5 min post-injection. Plasma was isolated by centrifugation, organs (liver, spleen, kidneys, heart, lung, and brain) harvested, rinsed with PBS, weighed, with a portion made into tissue lysates and remainder frozen. FIX(a) content of tissue lysates was determined by a species-specific human FIX(a) ELISA with variant-specific standard curves. Tissue concentration was determined by total FIX(a) present in lysate (ng) divided by respective tissue weight (mg). Organ distribution was determined by extrapolating FIX(a) tissue concentration to total organ weight. The FIX(a) present in a specific organ was divided by the administered FIX(a) dose to determine the % organ distribution. Results: PK studies in HB mice demonstrated that FIX WT and R150A demonstrated a similar pattern and time course of elimination. In contrast, FIX K126A/K132A demonstrated ~2.4 fold higher plasma recovery relative to FIX WT. Based on plasma concentrations at 5 min post-injection (plasma volume 40 ml/kg), ~12.9% of FIX WT and 30.5% of FIX K126A/K132A was localized to the plasma compartment. Tissue lysates from the liver, spleen, kidney and brain demonstrated that liver had the highest FIX content by far, with ~41% of the FIX WT dose at 5 min post-injection. Other tissues demonstrated markedly less FIX WT content, including kidney (1%), spleen (0.1%) and brain (undetectable). FIX tissue concentration was significantly higher in the liver (0.69 ng/mg tissue) compared to other tissues, followed by kidney (0.07 ng/mg), spleen (0.02 ng/mg) and brain (undetectable). Comparison of FIX K126A/K132A tissue content to WT demonstrated reduced liver localization (25% dose) with concomitant reduction in tissue concentration (0.45 ng/mg). In contrast, FIX K126A/K132A increased localization to the kidney (1.7%) and spleen (0.37%) relative to WT. In protease PK studies, FIXa K126A/K132A and R150A both enhanced plasma recovery (2.2-2.5 fold) in HA mice compared to FIXa WT. Based on plasma concentrations at 5 min post-injection, ~16.1% of FIXa WT and 41.1% of FIXa K126A/K132A dose localized in the plasma compartment. Similar to zymogen, tissue lysates demonstrated that liver had the highest FIXa WT content (28%). Other tissues contained markedly less FIXa, including kidney (2.4%), spleen (0.2%), heart (0.5%) and brain (undetectable). Similarly, FIXa tissue concentration was 4-fold higher in the liver (0.47 ng/mg) compared to other tissues, followed by kidney (0.12 ng/mg), spleen and heart (0.06 ng/mg) and brain (undetectable). Localization of FIXa K126A/K132A to the liver was reduced by nearly half compared to FIXa WT (16%) with reduction in liver tissue concentration (0.29 ng/mg). FIXa K126A/K132A had increased localization to the kidney (3.3%) relative to WT. In contrast, FIXa R150A (not shown) had similar liver distribution (31.9% dose) and tissue concentration (0.53 ng/mg) to FIXa WT, despite increased localization to the plasma (36.2%). Conclusions: Liver is the predominant organ for extravascular FIX binding and the heparin binding exosite contributes to this localization, similar to the collagen IV binding site in the Gla domain. Heparan sulfate and collagen IV co-localize in the basement membrane suggesting synergistic roles. FIXa also localizes to extravascular sites via the heparin-binding exosite, although that binding may be modestly limited by endogenous FIX in the HA mouse. Disruption of the antithrombin binding exosite re-distributes FIXa to the plasma compartment by an independent mechanism, as liver content is unchanged. Disclosures Sheehan: Bayer: Consultancy, Research Funding; Roche: Consultancy, Research Funding; BioMarin: Consultancy, Research Funding.

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Ibrutinib-Treated Platelets Secure Vascular Integrity in Inflammation

Blood ◽

10.1182/blood.v126.23.2235.2235 ◽

2015 ◽

Vol 126 (23) ◽

pp. 2235-2235

Author(s):

Robert Hugh Lee ◽

Wolfgang Bergmeier

Keyword(s):

Single Dose ◽

Research Funding ◽

Low Dose ◽

Plasma Concentrations ◽

High Dose ◽

Low Grade ◽

Wild Type ◽

Bleeding Events ◽

Vascular Integrity ◽

Induced Aggregation

Abstract Background: Ibrutinib is a potent and irreversible inhibitor of Bruton's tyrosine kinase (Btk), and has been approved for treatment of chronic lymphocytic leukemia (CLL) and mantle cell lymphoma (MCL). In recent clinical trials, Ibrutinib has shown high efficacy with an excellent safety profile. However, bleeding events have been observed in a subset of patients in several of these trials. While these bleeding events are generally low grade and have not led to interruption or dose reduction of treatment, the origin of bleeding remains incompletely understood. In the setting of thrombocytopenia, inflammation can induce robust vascular permeability and hemorrhage, and our lab has previously shown that immunoreceptor tyrosine-based activation motif (ITAM) signaling is necessary for the protective effects of platelets against hemorrhage. In platelets Btk acts downstream of ITAM receptors, therefore we hypothesized that bleeding in Ibrutinib-treated patients may be, at least in part, the result of hemorrhage at sites of inflammation. Methods: To investigate the possibility that bleeding events in Ibrutinib-treated patients are due to inflammatory hemorrhage, we used two inflammatory models - the dermal reverse passive Arthus reaction (rpA) and P. aeruginosa LPS-induced lung inflammation, both of which have been shown to induce hemorrhage in the absence of platelet ITAM signaling. To selectively inhibit Btk in platelets, thrombocytopenic mice were reconstituted with Ibrutinib- or vehicle-treated wild-type platelets and challenged in rpA or LPS model. Bleeding in the dermis or broncho-alveolar lavage (BAL) fluid was assessed by analysis of hemoglobin. In the clinic, patients generally receive once-a-day doses of 420-560 mg of the Btk inhibitor Ibrutinib, and plasma concentrations can transiently reach 0.5-1 µM. Thus, during their lifetime, circulating platelets are exposed to compounding doses of Ibrutinib, which may have greater inhibitory effects than a single dose, a phenomenon which we have observed in mice (see results below). Therefore, we treated mouse platelets in vitro with 0.5 µM Ibrutinib (low dose, equal to a single dose) or 5 µM Ibrutinib (high dose, comparable to multiple dose exposure) before adoptive transfer into mice. Results: While low dose Ibrutinib did not prevent αIIbβ3 integrin activation induced by collagen or convulxin (Cvx), high dose Ibrutinib abolished collagen-induced aggregation. This dose-dependent inhibition of aggregation was also observed in platelets isolated from mice which had received a single vs. multiple doses of Ibrutinib in vivo. αIIbβ3 activation induced by the stronger GPVI agonist, Cvx, however was only partially impaired, suggesting that Ibrutinib may not completely inhibit ITAM-dependent platelet activation. We next tested whether platelets treated ex vivo with Ibrutinib and transfused into thrombocytopenic mice were able to secure vascular integrity at sites of inflammation. In both models, platelet depletion without transfusion of wild-type platelets induced substantial bleeding. However, transfusion of Ibrutinib-treated platelets was able to rescue bleeding to the same extent as vehicle-treated platelets. Summary: Our findings demonstrate that Ibrutinib-treated platelets are capable of securing vascular integrity at sites of inflammation in mice. Our studies suggest that bleeding events in patients treated with Ibrutinib are not due to inflammation-associated hemorrhage. Disclosures Bergmeier: AHA: Research Funding; NIH: Research Funding.

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The heparin-binding exosite of factor IXa is a critical regulator of plasma thrombin generation and venous thrombosis

Blood ◽

10.1182/blood-2008-01-136820 ◽

2008 ◽

Vol 112 (8) ◽

pp. 3234-3241 ◽

Cited By ~ 42

Author(s):

Yang Buyue ◽

Herbert C. Whinna ◽

John P. Sheehan

Keyword(s):

Saphenous Vein ◽

Thrombin Generation ◽

Fold Increase ◽

Factor Ix ◽

Heparin Binding ◽

Wild Type ◽

Factor Ixa ◽

Plasma Factor ◽

The Times

Abstract The role of the factor IXa heparin-binding exosite in coagulation was assessed with mutations that enhance (R170A) or reduce (R233A) stability of the protease-factor VIIIa A2 domain interaction. After tissue factor (TF) addition to reconstituted factor IX-deficient plasma, factor IX R170A supported a 2-fold increase in velocity index (slope) and peak thrombin concentration, whereas factor IX R233A had a 4- to 10-fold reduction relative to factor IX wild-type. In the absence of TF, 5 to 100 pM of factor IXa increased thrombin generation to approach TF-stimulated thrombin generation at 100% factor IX. Factor IXa R170A demonstrated a 2- to 3-fold increase in peak thrombin concentration and 5-fold increase in velocity index, whereas the response for factor IXa R233A was blunted and delayed relative to wild-type protease. In hemophilia B mice, factor IX replacement reduced the average time to hemostasis after saphenous vein incision, and the time to occlusion after FeCl3-induced saphenous vein injury. At 5% factor IX, the times to occlusion for factor IX wild-type, R170A, and R233A were 15.7 minutes, 9.1 minutes (P ≤ .003), and more than 45 minutes. These data support the role of the factor IXa heparin-binding exosite as a critical regulator of coagulation and novel antithrombotic target.

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Very Low Activated Factor VII and Reduced Factor VII Antigen in Familial Abetalipoproteinaemia

Thrombosis and Haemostasis ◽

10.1055/s-0037-1615179 ◽

1998 ◽

Vol 80 (08) ◽

pp. 233-238 ◽

Cited By ~ 8

Author(s):

K. A. Mitropoulos ◽

M. N. Nanjee ◽

D. J. Howarth ◽

J. C. Martin ◽

M. P. Esnouf ◽

...

Keyword(s):

Plasma Concentrations ◽

Positive Association ◽

Factor Ix ◽

Factor Vii ◽

Unesterified Fatty Acid ◽

Factor Xii ◽

Factor X ◽

Factor Xi ◽

Activated Factor Vii ◽

Normal Mean

SummaryAbetalipoproteinaemia is a rare disorder of apolipoprotein B metabolism associated with extremely low plasma concentrations of triglyce-ride. To discover whether the general positive association between factor VII and triglyceride levels extends to this condition, 5 patients were compared with 18 controls. All patients had a triglyceride below 100 μmol/l. Plasma unesterified fatty acid concentration was normal. Although factor IX activity was only slightly reduced (mean 88% standard) and factor IX antigen was normal, mean activated factor VII in patients was strikingly reduced to 34% of that in controls, a level similar to that found in haemophilia B. The patients’ mean factor VII activity and factor VII antigen were also significantly reduced to 54% and 63% of those in controls, respectively. Mean factor XI activity and tissue factor pathway inhibitor activity were reduced in patients to 70% and 75% of control values respectively, while factor XII, factor XI antigen, factor X, prothrombin and protein C were normal.

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Extravascular Administration of Factor IX: Potential for Replacement Therapy of Canine and Human Hemophilia B

Thrombosis and Haemostasis ◽

10.1055/s-0038-1656082 ◽

1997 ◽

Vol 77 (05) ◽

pp. 0944-0948 ◽

Cited By ~ 20

Author(s):

Darla Liles ◽

Charles N Landen ◽

Dougald M Monroe ◽

Celeste M Lindley ◽

Marjorie s Read ◽

...

Keyword(s):

Gene Therapy ◽

Vitamin K ◽

Absorption Rate ◽

Venous Access ◽

Factor Ix ◽

Hemophilia B ◽

Current Therapy ◽

Home Therapy ◽

Routes Of Administration ◽

Plasma Compartment

SummaryCurrent therapy for hemophilia B requires large intravenous doses of factor IX (F.IX) given in the clinic or at home. Although home therapy is possible for many patients, it is often complicated by factors such as the lack of good venous access. Very little is known about extravascular routes for administering proteins like F.IX (57 kD) or other vitamin K-dependent procoagulant factors into the circulation. Questions about the absorption rate from extravascular administration as well as plasma recovery and bioavailability have arisen recently with the growing availibility of highly purified procoagulant proteins and increased interest in gene therapy of hemophilia B. Therefore, a group of studies were undertaken to determine the absorption rate, plasma recovery, and bioavailability of high purity, human plasma-derived F.IX concentrates administered via extravascular routes in hemophilia B dogs and in one human hemophilia B subject. Five hemophilia B dogs were given human F.IX via either a subcutaneous (SC), intramuscular (IM), intra- peritoneal (IP) or intravenous (IV) route. In a subsequent study, a single SC administration of human F.IX was compared to an identical IV dose of F.IX in the human hemophilia B subject. All extravascular routes of F.IX administration in both the canine and human gave lower levels of circulating plasma F.IX than the IV route, however all routes resulted in measurable F.IX activity. Of the extravascular routes, the IM injection in the canine resulted in a bioavailibility of 82.8%, while the SC injection resulted in a bioavailability of 63.5%. F.IX reached the plasma compartment by all extravascular routes used, confirming that F.IX can be absorbed extravascularly. The duration of measurable F.IX activity following extravascular administration is prolonged beyond that typically seen with IV administration. These data show that significant levels of F.IX may be obtained via SC injection in canine and ‘ human hemophilia B subjects and further highlight the potential of extravascular routes of administration for future experimental and clinical uses of F.IX and other procoagulant proteins.

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Early prolonged neutrophil activation in critically ill patients with sepsis

Innate Immunity ◽

10.1177/1753425920980078 ◽

2021 ◽

Vol 27 (2) ◽

pp. 192-200

Author(s):

Sanna Törnblom ◽

Sara Nisula ◽

Suvi T Vaara ◽

Meri Poukkanen ◽

Sture Andersson ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Unit Admission ◽

Plasma Concentrations ◽

Neutrophil Activation ◽

Early Event ◽

Heparin Binding ◽

Activation Markers ◽

Heparin Binding Protein ◽

Pro Inflammatory Cytokines

We hypothesised that plasma concentrations of biomarkers of neutrophil activation and pro-inflammatory cytokines differ according to the phase of rapidly evolving sepsis. In an observational study, we measured heparin-binding protein (HBP), myeloperoxidase (MPO), IL-6 and IL-8 in 167 sepsis patients on intensive care unit admission. We prospectively used the emergence of the first sepsis-associated organ dysfunction (OD) as a surrogate for the sepsis phase. Fifty-five patients (of 167, 33%) developed the first OD > 1 h before, 74 (44%) within ± 1 h, and 38 (23%) > 1 h after intensive care unit admission. HBP and MPO were elevated at a median of 12 h before the first OD, remained high up to 24 h, and were not associated with sepsis phase. IL-6 and IL-8 rose and declined rapidly close to OD emergence. Elevation of neutrophil activation markers HBP and MPO was an early event in the evolution of sepsis, lasting beyond the subsidence of the pro-inflammatory cytokine reaction. Thus, as sepsis biomarkers, HBP and MPO were not as prone as IL-6 and IL-8 to the effect of sample timing.

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Myeloid-Derived Growth Factor Protects Against Pressure Overload-Induced Heart Failure by Preserving Sarco/Endoplasmic Reticulum Ca 2+ -ATPase Expression in Cardiomyocytes

Circulation ◽

10.1161/circulationaha.120.053365 ◽

2021 ◽

Author(s):

Mortimer Korf-Klingebiel ◽

Marc R. Reboll ◽

Felix Polten ◽

Natalie Weber ◽

Felix Jäckle ◽

...

Keyword(s):

Heart Failure ◽

Bone Marrow ◽

Endoplasmic Reticulum ◽

Growth Factor ◽

Plasma Concentrations ◽

Pressure Overload ◽

Inflammatory Cells ◽

Left Ventricular ◽

Neonatal Rat ◽

Wild Type

Background: Inflammation contributes to the pathogenesis of heart failure, but there is limited understanding of inflammation's potential benefits. Inflammatory cells secrete myeloid-derived growth factor (MYDGF) to promote tissue repair after acute myocardial infarction. We hypothesized that MYDGF has a role in cardiac adaptation to persistent pressure overload. Methods: We defined the cellular sources and function of MYDGF in wild-type, Mydgf -deficient ( Mydgf -/- ), and Mydgf bone marrow-chimeric or bone marrow-conditional transgenic mice with pressure overload-induced heart failure after transverse aortic constriction surgery. We measured MYDGF plasma concentrations by targeted liquid chromatography-mass spectrometry. We identified MYDGF signaling targets by phosphoproteomics and substrate-based kinase activity inference. We recorded Ca 2+ transients and sarcomere contractions in isolated cardiomyocytes. Additionally, we explored the therapeutic potential of recombinant MYDGF. Results: MYDGF protein abundance increased in the left ventricular (LV) myocardium and in blood plasma of pressure-overloaded mice. Patients with severe aortic stenosis also had elevated MYDGF plasma concentrations, which declined after transcatheter aortic valve implantation. Monocytes and macrophages emerged as the main MYDGF sources in the pressure-overloaded murine heart. While Mydgf -/- mice had no apparent phenotype at baseline, they developed more severe LV hypertrophy and contractile dysfunction during pressure overload than wild-type mice. Conversely, conditional transgenic overexpression of MYDGF in bone marrow-derived inflammatory cells attenuated pressure overload-induced hypertrophy and dysfunction. Mechanistically, MYDGF inhibited G protein coupled receptor agonist-induced hypertrophy and augmented sarco/endoplasmic reticulum Ca 2+ ATPase 2a (SERCA2a) expression in cultured neonatal rat cardiomyocytes by enhancing PIM1 serine/threonine kinase expression and activity. Along this line, cardiomyocytes from pressure-overloaded Mydgf -/- mice displayed reduced PIM1 and SERCA2a expression, greater hypertrophy, and impaired Ca 2+ cycling and sarcomere function compared to cardiomyocytes from pressure-overloaded wild-type mice. Transplanting Mydgf -/- mice with wild-type bone marrow cells augmented cardiac PIM1 and SERCA2a levels and ameliorated pressure overload-induced hypertrophy and dysfunction. Pressure-overloaded Mydgf -/- mice were similarly rescued by adenoviral Serca2a gene transfer. Treating pressure-overloaded wild-type mice subcutaneously with recombinant MYDGF enhanced SERCA2a expression, attenuated LV hypertrophy and dysfunction, and improved survival. Conclusions: These findings establish a MYDGF-based adaptive crosstalk between inflammatory cells and cardiomyocytes that protects against pressure overload-induced heart failure.

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Analysing CYP2D6*4 Allele frequency in Patients with Schizophrenia

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.314 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S101-S102

Author(s):

V. Djordjevic ◽

T. Jevtovic Stoimenov

Keyword(s):

Allele Frequency ◽

Plasma Concentrations ◽

Clinical Severity ◽

Genotype Distribution ◽

Healthy Individuals ◽

Wild Type ◽

Specific Pcr ◽

Significant Difference ◽

Schizophrenic Patients ◽

The Right

IntroductionSchizophrenia is treated with antipsychotics and other psychotropic medications, many of which are substrates for the highly polymorphic CYP2D6 enzyme. The most frequent variant allele is CYP2D6*4- leading cause of poor metabolism (PM) phenotype. PM causes the reduction of therapeutic response, increase the risk of adverse drug reactions and increase the plasma concentration of both drug and its metabolites above the levels of toxicity.The AimAnalysing CYP2D6*4 allele frequency among schizophrenic patients for further individualisation and rationalisation of therapy.Patients and methodsResearch was conducted on 38 schizophrenic patients and 110 healthy individuals. CYP2D6*4 allele was detected with allele specific PCR.ResultsBoth wild type allele carriers are 55% of the schizophrenic patients, 45% are wild type/*4heterozygous, and *4/*4 homozygous are not identified. There is a statistically significant difference in the genotype distribution (P < 0.05) between schizophrenic patients and healthy individuals. Significantly higher *4 allele frequency (37%) comparing to healthy individuals (P < 0.0001) indicates the necessary caution in administration of CYP2D6 substrates. A lower frequency of PMs in schizophrenic patients than in healthy individuals could be explained with CYP2D6 neuroactive substrate metabolism. Forty-five percent of the schizophrenic patients are intermediate metabolisers carrying the higher risk of adverse response to CYP2D6 substrates comparing to wild type homozygous. As none of the analyzed patients was PM, exceeded plasma concentrations of medications above toxic levels are not expected when administrating the right dosage.ConclusionAltered CYP2D6 metabolism may contribute to the vulnerability, clinical severity and treatment outcome of schizophrenia.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Complement factor D is linked to platelet activation in human and rodent sepsis

Intensive Care Medicine Experimental ◽

10.1186/s40635-021-00405-8 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

O. Sommerfeld ◽

K. Dahlke ◽

M. Sossdorf ◽

R. A. Claus ◽

A. Scherag ◽

...

Keyword(s):

Platelet Activation ◽

Physiological Function ◽

Plasma Concentrations ◽

Cecal Ligation ◽

Clinical Importance ◽

Surface Expression ◽

Antiplatelet Drugs ◽

Complement Factor ◽

Wild Type ◽

Deficient Mice

Abstract Background The complement factor D (CFD) exerts a regulatory role during infection. However, its physiological function in coagulopathy and its impact on the course of an infection remains unclear. Materials Wild-type and CFD-deficient mice (n = 91) were subjected to cecal ligation and puncture to induce sepsis. At several time points, markers of coagulation and the host-immune response were determined. Furthermore, in patients (n = 79) with sepsis or SIRS, CFD levels were related to clinical characteristics, use of antiplatelet drugs and outcome. Results Septic CFD-deficient mice displayed higher TAT complexes (p = 0.02), impaired maximal clot firmness, but no relevant platelet drop and reduced GPIIb/IIIa surface expression on platelets (p = 0.03) compared to septic wild-type mice. In humans, higher CFD levels (non-survivors, 5.0 µg/ml to survivors, 3.6 µg/ml; p = 0.015) were associated with organ failure (SOFA score: r = 0.33; p = 0.003) and mortality (75% percentile, 61.1% to 25% percentile, 26.3%). CFD level was lower in patients with antiplatelet drugs (4.5–5.3 µg/ml) than in patients without. Conclusion In mice, CFD is linked to pronounced platelet activation, depicted by higher GPIIb/IIIa surface expression in wild-type mice. This might be of clinical importance since high CFD plasma concentrations were also associated with increased mortality in sepsis patients.

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Phosphatidylcholine transfer protein/StarD2 promotes microvesicular steatosis and liver injury in murine experimental steatohepatitis

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.00379.2016 ◽

2017 ◽

Vol 313 (1) ◽

pp. G50-G61 ◽

Cited By ~ 6

Author(s):

Hayley T. Nicholls ◽

Jason L. Hornick ◽

David E. Cohen

Keyword(s):

Liver Injury ◽

Lipid Droplets ◽

Plasma Concentrations ◽

Fibroblast Growth Factor 21 ◽

Wild Type ◽

Hepatocellular Injury ◽

Pathogenic Role ◽

Deficient Diet ◽

Transfer Protein ◽

Phosphatidylcholine Transfer Protein

Mice fed a methionine- and choline-deficient (MCD) diet develop steatohepatitis that recapitulates key features of nonalcoholic steatohepatitis (NASH) in humans. Phosphatidylcholine is the most abundant phospholipid in the surfactant monolayer that coats and stabilizes lipid droplets within cells, and choline is required for its major biosynthetic pathway. Phosphatidylcholine-transfer protein (PC-TP), which exchanges phosphatidylcholines among membranes, is enriched in hepatocytes. PC-TP also regulates fatty acid metabolism through interactions with thioesterase superfamily member 2. We investigated the contribution of PC-TP to steatohepatitis induced by the MCD diet. Pctp−/− and wild-type control mice were fed the MCD diet for 5 wk and were then euthanized for histopathologic and biochemical analyses, as well as determinations of mRNA and protein expression. Whereas all mice developed steatohepatitis, plasma alanine aminotransferase and aspartate aminotransferase activities were only elevated in wild-type mice, indicating that Pctp−/− mice were protected from MCD diet-induced hepatocellular injury. Reduced hepatotoxicity due to the MCD diet in the absence of PC-TP expression was further evidenced by decreased activation of c-Jun and reduced plasma concentrations of fibroblast growth factor 21. Despite similar total hepatic concentrations of phosphatidylcholines and other lipids, the relative abundance of microvesicular lipid droplets within hepatocytes was reduced in Pctp−/− mice. Considering that the formation of larger lipid droplets may serve to protect against lipotoxicity in NASH, our findings suggest a pathogenic role for PC-TP that could be targeted in the management of this condition. NEW & NOTEWORTHY Phosphatidylcholine-transfer protein (PC-TP) is a highly specific phosphatidylcholine-binding protein that we previously showed to regulate hepatocellular nutrient metabolism through its interacting partner thioesterase superfamily member 2 (Them2). This study identifies a pathogenic role for PC-TP, independent of Them2, in the methionine- and choline-deficient diet model of experimental steatohepatitis. Our current observations suggest that PC-TP promotes liver injury by mediating the intermembrane transfer of phosphatidylcholines, thus stabilizing more pathogenic microvesicular lipid droplets.

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Monitoring plasma concentrations of psychotropic drugs

Drug and Therapeutics Bulletin ◽

10.1136/dtb.12.2.6 ◽

1974 ◽

Vol 12 (2) ◽

pp. 6-8

Keyword(s):

Steady State ◽

Plasma Concentration ◽

Tissue Concentration ◽

Plasma Concentrations ◽

Water Concentration ◽

Plasma Samples ◽

Active Metabolites ◽

The Relationship ◽

The Brain ◽

Reliable Methods

Techniques are now available for estimating the plasma concentration of several drugs used in psychiatry. These techniques are clearly important for research but they can hardly be expected to improve the clinical management of patients unless the estimation is sensitive, reliable and reasonably quick; the method should be specific for the particular drug but should also specifically estimate any active metabolites. Even when reliable figures have been obtained, much more information is needed before they can be interpreted. The relationship between plasma (or plasma water) concentration and relevant tissue concentration (e. g. in the brain) must be known. Plasma samples should be taken at appropriate times, e. g. after the attainment of ‘steady-state’ conditions: plasma and tissue levels will then be in equilibrium. Diagnoses must be soundly based if inferences are to be drawn. Reliable methods of assessing clinical response must be available. These requirements pose difficult problems in psychiatry.

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