Beyond plasma bilirubin: the effects of herapy and albumin on brain bilirubin levels in Gunn rats

Autor: Charles E. Ahlfors, Christian V. Hulzebos, Renata Koníčková, Henkjan J. Verkade, Jana Vanikova, Andrea B. Schreuder, Libor Vítek, Deirdre E. van Imhoff, Frans J C Cuperus
Přispěvatelé: Center for Liver, Digestive and Metabolic Diseases (CLDM), Lifestyle Medicine (LM), Reproductive Origins of Adult Health and Disease (ROAHD)
Rok vydání: 2013
Předmět:
Zdroj: Journal of Hepatology, 58, pp. 134-140
Journal of Hepatology, 58, 134-140
Journal of Hepatology, 58(1), 134-140. ELSEVIER SCIENCE BV
ISSN: 0168-8278
Popis: Severe unconjugated hyperbilirubinemia, as occurs in Crigler-Najjar disease and neonatal jaundice, carries the risk of neurotoxicity. This neurotoxicity is related to the increased passage of free bilirubin (UCB(free)), the fraction of bilirubin that is not bound to plasma proteins, into the brain. We hypothesized that albumin treatment would lower the UCB(free) fraction, and thus decrease bilirubin accumulation in the brain.We treated chronic (e.g., as a model for Crigler-Najjar disease) and acute hemolytic (e.g., as a model for neonatal jaundice) moderate hyperbilirubinemic Gunn rats with phototherapy, human serum albumin (HSA) or phototherapy+HSA.In the chronic model, adjunct HSA increased the efficacy of phototherapy; it decreased plasma UCB(free) and brain bilirubin by 88% and 67%, respectively (p0.001). In the acute model, adjunct HSA also increased the efficacy of phototherapy; it decreased plasma UCB(free) by 76% (p0.001) and completely prevented the hemolysis-induced deposition of bilirubin in the brain. Phototherapy alone failed to prevent the deposition of bilirubin in the brain during acute hemolytic jaundice.We showed that adjunct HSA treatment decreases brain bilirubin levels in phototherapy-treated Gunn rats. We hypothesize that HSA decreases these levels by lowering UCB(free) in the plasma. Our results support the feasibility of adjunct albumin treatment in patients with Crigler-Najjar disease or neonatal jaundice.
Databáze: OpenAIRE