Author
G. Pelaez
Bio: G. Pelaez is an academic researcher from Services Hospital. The author has contributed to research in topics: Liver injury & Liver disease. The author has an hindex of 11, co-authored 15 publications receiving 1614 citations.
Topics: Liver injury, Liver disease, Liver biopsy, Transplantation, Hepatology
Papers
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TL;DR: Patients with drug-induced hepatocellular jaundice have 11.7% chance of progressing to death or transplantation, and amoxicillin-clavulanate stands out as the most common drug related to DILI.
811 citations
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TL;DR: Patients with cholestatic/mixed injury were more prone to chronicity than patients with hepatocellular injury, and cardiovascular and central nervous system drugs are the main groups leading to chronic liver damage.
273 citations
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TL;DR: Age is the most important determinant in the biochemical expression of AC hepatotoxicity; younger age is associated with cytolytic damage and shorter treatment duration, whereas cholestatic/mixed type of damage is related to older age and prolonged AC therapy.
156 citations
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TL;DR: There is no association between any specific HLA allele and the propensity to develop DIILD, however, the genetic influence associated with HLA class II alleles appears to play a role in the biochemical expression of liver injury in cholestatic/mixed hepatotoxicity and may explain why a given drug may cause different patterns of liver damage.
148 citations
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TL;DR: The most common profile of affected patients being a woman with acute hepatocellular hepatitis and low suspicion regarding the putative role of herbs in hepatotoxicity makes diagnosis more difficult, and probably increases the incidence of inadvertent rechallenge in these patients.
Abstract: BACKGROUND: toxic liver damage associated with the use of natural remedies is a growing health problem. OBJECTIVES: to analyze the demographics, and clinical and epidemiological characteristics of patients developing liver injury related to these remedies. PATIENTS AND METHODS: all DILI cases associated with the use of herbal remedies (HR) or dietary supplements (DS) submitted to the Spanish Registry were analyzed. Type of liver damage, severity, and outcome were specifically evaluated. RESULTS: thirteen cases out of 521 DILI cases (2%) submitted to the Spanish Liver Toxicity Registry between 1994 and 2006 were related to HR/DS, which ranked as the 10th therapeutic group with a greater number of cases and above pain killers, anxiolytics, and antipsychotic drugs. Nine patients (69%) were female (mean age 45 years). Nine cases (69%) had jaundice at presentation. The predominating type of liver damage was hepatocellular (12; 92%), and 31% of cases exhibited the common features of hypersensitivity. Camellia sinensis (3, 23%) was the main causative herb, followed by Rhamnus purshianus and isoflavones (Fitosoja(R), Biosoja(R)) (2 cases each, 15%). Three cases (23%) were rechallenged with the offending product. CONCLUSIONS: the incidence of hepatic damage related to HR/DS is not so rare, the most common profile of affected patients being a woman with acute hepatocellular hepatitis. Low suspicion regarding the putative role of herbs in hepatotoxicity makes diagnosis more difficult, and probably increases the incidence of inadvertent rechallenge in these patients. Language: es
89 citations
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TL;DR: The clinical care for patients with cholestatic liver diseases has advanced considerably during recent decades thanks to growing insight into pathophysiological mechanisms and remarkable methodological and technical developments in diagnostic procedures as well as therapeutic and preventive approaches.
1,405 citations
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University of Düsseldorf1, Goethe University Frankfurt2, Vrije Universiteit Brussel3, University of Freiburg4, Leipzig University5, Dow Chemical Company6, University of Tübingen7, Durham University8, University of Turin9, Seoul National University10, University of Jena11, Charité12, University of Valencia13, Heidelberg University14, French Institute for Research in Computer Science and Automation15, University of Paris16, University of Liverpool17, University of Groningen18, Lund University19, University of Manchester20, South Valley University21, University Hospital Regensburg22, Merck KGaA23, Musashino University24, University of Kansas25, Ludwig Maximilian University of Munich26, Fresenius Medical Care27, University of Regensburg28, Merck & Co.29
TL;DR: This review encompasses the most important advances in liver functions and hepatotoxicity and analyzes which mechanisms can be studied in vitro and how closely hepatoma, stem cell and iPS cell–derived hepatocyte-like-cells resemble real hepatocytes.
Abstract: This review encompasses the most important advances in liver functions and hepatotoxicity and analyzes which mechanisms can be studied in vitro. In a complex architecture of nested, zonated lobules, the liver consists of approximately 80 % hepatocytes and 20 % non-parenchymal cells, the latter being involved in a secondary phase that may dramatically aggravate the initial damage. Hepatotoxicity, as well as hepatic metabolism, is controlled by a set of nuclear receptors (including PXR, CAR, HNF-4α, FXR, LXR, SHP, VDR and PPAR) and signaling pathways. When isolating liver cells, some pathways are activated, e.g., the RAS/MEK/ERK pathway, whereas others are silenced (e.g. HNF-4α), resulting in up- and downregulation of hundreds of genes. An understanding of these changes is crucial for a correct interpretation of in vitro data. The possibilities and limitations of the most useful liver in vitro systems are summarized, including three-dimensional culture techniques, co-cultures with non-parenchymal cells, hepatospheres, precision cut liver slices and the isolated perfused liver. Also discussed is how closely hepatoma, stem cell and iPS cell-derived hepatocyte-like-cells resemble real hepatocytes. Finally, a summary is given of the state of the art of liver in vitro and mathematical modeling systems that are currently used in the pharmaceutical industry with an emphasis on drug metabolism, prediction of clearance, drug interaction, transporter studies and hepatotoxicity. One key message is that despite our enthusiasm for in vitro systems, we must never lose sight of the in vivo situation. Although hepatocytes have been isolated for decades, the hunt for relevant alternative systems has only just begun.
1,085 citations
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TL;DR: To survey the burden of liver disease in Europe and its causes 260 epidemiological studies published in the last five years were reviewed and found each of these four major causes is amenable to prevention and treatment.
1,052 citations
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TL;DR: Clinical guidance is provided with regard to the detection, evaluation, and possible prevention of drug-related hepatotoxicity in patients exposed to hepatotoxic effects of new medication.
Abstract: Given its rarity, drug-related hepatotoxicity may not be seen during the initial clinical trials of a new medication. After approval, when many more patients are exposed, toxic effects that are very infrequent may emerge. This review explains the difficulties in identifying the cause of hepatotoxic effects in such situations and provides clinical guidance with regard to the detection, evaluation, and possible prevention of drug-related hepatotoxicity.
944 citations
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Penn State Milton S. Hershey Medical Center1, Kaiser Permanente2, Northwestern University3, University of Cincinnati4, Cornell University5, NewYork–Presbyterian Hospital6, Boston University7, University of Alabama at Birmingham8, Johns Hopkins University9, University of Miami10, University of Pennsylvania11, Harvard University12, Mount Sinai Health System13, Henry Ford Health System14, Mayo Clinic15, Emory University16, Swedish Covenant Hospital17, American Academy of Dermatology18
TL;DR: Issues from grading of acne to the topical and systemic management of the disease are reviewed and suggestions on use are provided based on available evidence.
Abstract: Acne is one of the most common disorders treated by dermatologists and other health care providers. While it most often affects adolescents, it is not uncommon in adults and can also be seen in children. This evidence-based guideline addresses important clinical questions that arise in its management. Issues from grading of acne to the topical and systemic management of the disease are reviewed. Suggestions on use are provided based on available evidence.
928 citations