Heme oxygenase (HMOX) catalyzes first and rate-limiting step in heme degradation. By its action, carbon monoxide (CO), ferrous iron and biliverdin which is subsequently reduced to bilirubin are produced. Before discovery of HMOX reaction mechanism, CO was considered only a toxic waste product without any significant importance for human organism. Bilirubin, marker of liver dysfunction, has been also exposed to similar perception. But results from past decades show that HMOX and its metabolic products play an important role in number of physiological as well as defense against pathophysiological processes. The aim of this thesis was to clarify the role of HMOX and its metabolic products, presumably CO and bilirubin, in vivo and in vitro. We focused on the role of CO in a rat model of lipopolysaccharide-induced cholestasis. We were first to describe tissue distribution and pharmacokinetics of inhaled CO in this animal model and found out that CO inhalation is associated with anti-inflammatory and hepatoprotective effects. In a rat model of ethinylestradiol-induced cholestasis, we demonstrated the anticholestatic effect of HMOX. The induction of HMOX by its substrate heme increased the expression of liver transporters thereby increasing bile flow and simultaneously facilitated effective clearance of...

For a long time, bilirubin (BR) has been considered a waste molecule with potential toxic effects especially on the central nervous system. Later, it was found that BR exhibited cytoprotective effects and mildly elevated BR levels showed antioxidant, anti-inflammatory and immunomodulatory properties, however, exact mechanisms of the anti-inflammatory actions of BR have not been fully understood yet. The main aim of this study was to assess the protective effects of BR using experimental in vivo and in vitro models in relation to inflammation and oxidative stress. Partial goal was to establish validated analytical method for determination of BR and lumirubin. Gunn and heterozygous rats were treated with lipopolysaccharide (LPS, 6 mg/kg, IP) or vehicle (saline). After 12 hours, blood and organs were collected for analyses of inflammatory and hepatic injury markers. Primary rat hepatocytes were treated with BR and TNF-α, HepG2 and SH-SY5Y cell lines were treated with BR and chenodeoxycholic acid. LPS-treated Gunn rats had a significantly decreased inflammatory response and hepatic injury compared to LPS- treated normobilirubinemic controls. We found different profile of leukocytes subsets and decreased systemic mRNA expressions and concentrations of IL-6, TNF-α, IL-1β and IL-10 in Gunn rats. Hepatic mRNA...

Introduction: High levels of bilirubin in newborns can cause permanent neurodevelopmental disabilities, and it is crucial to keep the incidence low. However, the Swedish Neonatal Register revealed a high incidence of extreme neonatal hyperbilirubinemia (bilirubin ≥425 umol/L) in Region Örebro County during 2014-2019, and the reason behind this is unknown. Aim: This study aimed to review cases of extreme neonatal hyperbilirubinemia regarding the compliance to the local guidelines, and to explore potential benefits of an alternative method considering bilirubin’s rate of rise, the ruler method. Method: In this case series, a retrospective medical record review was performed on 63 newborns who were delivered at ≥35 gestational weeks and developed extreme hyperbilirubinemia before or during an admission to a hospital in Region Örebro County within the first 14 days of life (2014-2020). Results: The incidence was 2.7 cases per 1000 live births during 2014-2020. Forty-three (68.3%) cases were related to failed detection/treatment initiation and 20 (31.7%) to failed treatment. Out of the newborns classified as failed detection/treatment initiation, 27 individual newborns (62.8%) could potentially have been prevented from developing extreme hyperbilirubinemia if there were no cases of non-compliance (30.2%), if a pre-discharge screening had been performed (14.0%) and if the ruler method had been applied (19/31 investigated). Conclusion: The local guidelines used in Region Örebro County might not be sufficient in preventing the development of extreme neonatal hyperbilirubinemia. However, mandatory pre-discharge screening and a consideration of bilirubin’s current rate of rise when scheduling follow-ups could potentially lower the incidence further.

No description available.

A Síndrome de Gilbert é caracterizada por uma hiperbilirrubinemia indireta benigna que ocorre na ausência de hemólise ou doença estrutural do fígado. Manifesta-se por episódios intermitentes de icterícia, desencadeados por exposição a estressores físicos, baixa ingesta calórica, entre outros. A base genética da redução da atividade da enzima UDP - Glucoroniltransferase foi descoberta em 1995: em uma população caucasiana. Todos os pacientes estudados apresentaram uma adição dos nucleotídeos Timina-Adenina (TA) na região TATA box presente no promotor do gene UGT1A1, em ambos os alelos. Embora considerada uma condição benigna, a síndrome de Gilbert tem sido recentemente associada à hiperbilirrubinemia e a outros efeitos colaterais na utilização de algumas drogas como o Indinavir e Irinotecan. Outro ponto importante diz respeito ao nível de bilirrubina sérica como um indicador da severidade do acometimento de hepatopatas. A presença de mutação no gene UGT1A1 em pacientes hepatopatas pode levar ao aumento da bilirrubina sérica, supervalorizando o acometimento hepático da condição patológica. O objetivo deste estudo foi verificar a frequência do alelo UGT1A1*28 em doadores de sangue da Fundação Pró-sangue Hemocentro de São Paulo HC-FMUSP e em pacientes portadores de hepatite crônica C atendidos no ambulatório de Gastroenterologia Clínica da FMUSP. Relacionar o genótipo TA7/7 com o aumento de bilirrubina sérica nos pacientes com hepatite crônica C e avaliar a técnica de análise de fragmento no rastreamento e genotipagem da Síndrome de Gilbert. A frequência encontrada para o genótipo TA7/7 no grupo doador foi de 9% (30/313) e no grupo de pacientes VHC, de 10% (51/494). O genótipo TA7/7 parece estar relacionado com o aumento de bilirrubina. A técnica de análise de fragmentos mostrou-se rápida, sendo possível para fazer uma análise em grande escala. A herança genética da população brasileira é muito heterogênea. É constituída de caucasianos, africanos, indios, orientais e outros. Os dados sugerem que a variação genética da região promotora do gene UGT1A1 é alta entre pacientes com bilirrubina maior que 1mg/dL, e que a genotipagem para UGT1A1*28 deve ser considerada na avaliação dos pacientes com hepatite C crônica com hiperbilirrubinemia. / Gilberts syndrome is a benign condition characterized by unconjugated hiperbilurubinemia that occurs in the absence of hemolysis or liver chronic disease. It is clinically manifested by intermittently jaundice, triggered by exposition to physical stress, low calory diet, among others. The genetic base is the reduction of the activity of UDP-glucuronosyltransferase enzyme described in 1995: in a Caucasian population, all patients studied presented a Thymine Adenine (TA) addition in the TATA box region in both alleles of the UGT1A1 gene promoter. Although, Gilberts syndrome has been considered a benign condition, recently it has been associated to hiperbilirrubinemia and other adverse events during the utilization of some drugs such as Indinavir and Irinotecan. Another important issue to consider is that bilirubin is used to evaluate the severity of liver dysfunction in chronic liver diseases. The presence of this mutation in those patients could increase bilirubin levels, overestimating liver damage. The aim of this study were: 1) to verify the frequency of the genotype UGT1A1*28 (TA7/7) in blood donors and in chronic hepatitis C patients from the Gastroenterology outpatients clinics of the University of São Paulo School of Medicine; 2) to establish a relationship with TA7/7 genotype and bilirubin elevation in chronic hepatitis C patients and 3) to evaluate the fragment analysis technique to screening and genotyping the Gilbert syndrome. The frequencies of TA7/7 genotype found in blood donors group were 9.6% (30/313) and in the chronic hepatitis C group were 10% (51/494). The TA7/7 genotype seems to be related with increase of bilirubin. The fragment analysis technique is fast and able to a large scale screening approach. The genetic background of Brazilian population is highly heterogeneous. It is comprised of Caucasians, Africans, Indians, Orientals and others. The data suggests that genetic variation of promoter region of UGT1A1 gene is high among patients with bilirubin levels greater than 1 mg/dl, and UGT1A1*28 genotypes should be considered when evaluating chronic hepatitis C patients with hiperbilirubinemia.

Cadmium (Cd), is a non-essential metal with no known physiological function. It is known to alter redox state by disrupting the mitochondrial electron transport chain, as well as inactivating protein and non-protein thiols. It is thus believed that oxidative stress may comprise an important part of the mechanism of Cd toxicity. Accordingly, the initial cellular response to acute Cd exposure is defensive, where various anti-oxidant defence systems are triggered. One of the induced systems is the haem oxygenase-1 (HO-1). Its activation is mediated by the transcription factor Nrf2, which is the general regulator of cellular defence against oxidative stress. The protective effects of HO-1 are mediated, in part, through the generation of potent anti-oxidant bilirubin (BR) and its metabolites, which exploit the intrinsic antioxidant properties of these species at a cellular level. The oxidative metabolism of BR is an important route of detoxification in addition to glucuronidation. However, the major enzyme(s) involved in this oxidative degradation are not known. This thesis presents evidence for a major role of the hepatic cytochrome P450 2a5 (Cyp2a5) in BR degradation during Cd intoxication, where the BR levels are elevated following induction of HO-1. Treatment of DBA/2J male mice with CdCl2 induced both the Cyp2a5 and HO-1, and increased the microsomal BR degradation activity. By way of contrast, the total cytochrome P450 (CYP) content and the expression of Cyp1a2 were down-regulated by the treatment. The induction of the HO-1 and Cyp2a5 was significant at the mRNA, protein and enzyme activity levels. In each case, the up-regulation of the HO-1 preceded that of the Cyp2a5 with a 5-10 hr interval. In addition, BR totally inhibited the microsomal coumarin hydroxylase activity (a Cyp2a5-catalysed reaction) with an IC50 approximately equal to the substrate concentration. The MROD activity, catalysed mainly by the Cyp1a2, was inhibited up to 36% by BR. The microsomal BR degradation was inhibited by coumarin and by a monoclonal antibody against the Cyp2a5 by about 90%. In addition, 7-methoxyresorufin, a substrate for Cyp1a2, inhibited BR degradation activity by approximately 20%. A study using Nrf2 null mutant mice suggests that Cd-mediated induction of Cyp2a5 is dependent on the transcription factor Nrf2. Additionally, acute exposure to Cd activated localisation of Nrf2 from the cytoplasm to the nucleus. Furthermore, electrophoretic mobility shift assay (EMSA) analysis suggests that Cd induced sequence-specific binding of various species of the StRE-binding proteins on the 5’-flanking region of the Cyp2a5 gene. Collectively, these observations strongly suggest that BR may act as a substrate for the hepatic Cyp2a5, a major catalyst for BR degradation under conditions of substantial elevation of BR levels following induction of HO-1 by Cd. Secondly, the concurrent up-regulation of the HO-1 and Cyp2a5 during Cd-mediated injury implicates a coordinated regulation of two enzyme systems in the maintenance of balancing BR production and elimination. Finally, StRE-binding proteins, in particular Nrf2, may be involved in the regulation of the Cyp2a5 gene, which leads to the oxidation of BR. However, the respective roles of these factors in the regulation of the Cyp2a5 gene, as well as the coordinated regulation of ho-1 and Cyp2a5 genes remain an open question, requiring further investigations.

Presented work is focused on heme metabolism with the main interest in bile pigments. Recent data indicate that bilirubin is not only a waste product of the heme catabolic pathway, but also emphasize its important biological impacts, including possible antiproliferative effects. Until today metabolism of bilirubin has not been completely elucidated, which has prevented detailed evaluation of its potential anticancer action. The aim of this study was to clarify some aspects of heme catabolism with respect for antiproliferative properties of its products. Based on the fact that bilirubin potently affects carcinogenesis of the intestine, we initially investigated not properly known bilirubin metabolism by intestinal bacteria. We studied bilirubin neurotoxic effects in hyperbilirubinemic Gunn rats - its distribution in the brain tissue and its degradation during pathological conditions, such as severe newborn jaundice or Crigler-Najjar syndrome. Possible approaches to improve the treatment of severe unconjugated hyperbilirubinemias, combination of the phototherapy and human albumin administration were also investigated. The main reason of these studies was the fact that mechanisms of neurotoxic effects of bilirubin are predominantly identical with those, by which bilirubin inhibits cancer cells growth....

A Síndrome de Gilbert é caracterizada por uma hiperbilirrubinemia indireta benigna que ocorre na ausência de hemólise ou doença estrutural do fígado. Manifesta-se por episódios intermitentes de icterícia, desencadeados por exposição a estressores físicos, baixa ingesta calórica, entre outros. A base genética da redução da atividade da enzima UDP - Glucoroniltransferase foi descoberta em 1995: em uma população caucasiana. Todos os pacientes estudados apresentaram uma adição dos nucleotídeos Timina-Adenina (TA) na região TATA box presente no promotor do gene UGT1A1, em ambos os alelos. Embora considerada uma condição benigna, a síndrome de Gilbert tem sido recentemente associada à hiperbilirrubinemia e a outros efeitos colaterais na utilização de algumas drogas como o Indinavir e Irinotecan. Outro ponto importante diz respeito ao nível de bilirrubina sérica como um indicador da severidade do acometimento de hepatopatas. A presença de mutação no gene UGT1A1 em pacientes hepatopatas pode levar ao aumento da bilirrubina sérica, supervalorizando o acometimento hepático da condição patológica. O objetivo deste estudo foi verificar a frequência do alelo UGT1A1*28 em doadores de sangue da Fundação Pró-sangue Hemocentro de São Paulo HC-FMUSP e em pacientes portadores de hepatite crônica C atendidos no ambulatório de Gastroenterologia Clínica da FMUSP. Relacionar o genótipo TA7/7 com o aumento de bilirrubina sérica nos pacientes com hepatite crônica C e avaliar a técnica de análise de fragmento no rastreamento e genotipagem da Síndrome de Gilbert. A frequência encontrada para o genótipo TA7/7 no grupo doador foi de 9% (30/313) e no grupo de pacientes VHC, de 10% (51/494). O genótipo TA7/7 parece estar relacionado com o aumento de bilirrubina. A técnica de análise de fragmentos mostrou-se rápida, sendo possível para fazer uma análise em grande escala. A herança genética da população brasileira é muito heterogênea. É constituída de caucasianos, africanos, indios, orientais e outros. Os dados sugerem que a variação genética da região promotora do gene UGT1A1 é alta entre pacientes com bilirrubina maior que 1mg/dL, e que a genotipagem para UGT1A1*28 deve ser considerada na avaliação dos pacientes com hepatite C crônica com hiperbilirrubinemia. / Gilberts syndrome is a benign condition characterized by unconjugated hiperbilurubinemia that occurs in the absence of hemolysis or liver chronic disease. It is clinically manifested by intermittently jaundice, triggered by exposition to physical stress, low calory diet, among others. The genetic base is the reduction of the activity of UDP-glucuronosyltransferase enzyme described in 1995: in a Caucasian population, all patients studied presented a Thymine Adenine (TA) addition in the TATA box region in both alleles of the UGT1A1 gene promoter. Although, Gilberts syndrome has been considered a benign condition, recently it has been associated to hiperbilirrubinemia and other adverse events during the utilization of some drugs such as Indinavir and Irinotecan. Another important issue to consider is that bilirubin is used to evaluate the severity of liver dysfunction in chronic liver diseases. The presence of this mutation in those patients could increase bilirubin levels, overestimating liver damage. The aim of this study were: 1) to verify the frequency of the genotype UGT1A1*28 (TA7/7) in blood donors and in chronic hepatitis C patients from the Gastroenterology outpatients clinics of the University of São Paulo School of Medicine; 2) to establish a relationship with TA7/7 genotype and bilirubin elevation in chronic hepatitis C patients and 3) to evaluate the fragment analysis technique to screening and genotyping the Gilbert syndrome. The frequencies of TA7/7 genotype found in blood donors group were 9.6% (30/313) and in the chronic hepatitis C group were 10% (51/494). The TA7/7 genotype seems to be related with increase of bilirubin. The fragment analysis technique is fast and able to a large scale screening approach. The genetic background of Brazilian population is highly heterogeneous. It is comprised of Caucasians, Africans, Indians, Orientals and others. The data suggests that genetic variation of promoter region of UGT1A1 gene is high among patients with bilirubin levels greater than 1 mg/dl, and UGT1A1*28 genotypes should be considered when evaluating chronic hepatitis C patients with hiperbilirubinemia.

Presented work is focused on heme metabolism with the main interest in bile pigments. Recent data indicate that bilirubin is not only a waste product of the heme catabolic pathway, but also emphasize its important biological impacts, including possible antiproliferative effects. Until today metabolism of bilirubin has not been completely elucidated, which has prevented detailed evaluation of its potential anticancer action. The aim of this study was to clarify some aspects of heme catabolism with respect for antiproliferative properties of its products. Based on the fact that bilirubin potently affects carcinogenesis of the intestine, we initially investigated not properly known bilirubin metabolism by intestinal bacteria. We studied bilirubin neurotoxic effects in hyperbilirubinemic Gunn rats - its distribution in the brain tissue and its degradation during pathological conditions, such as severe newborn jaundice or Crigler-Najjar syndrome. Possible approaches to improve the treatment of severe unconjugated hyperbilirubinemias, combination of the phototherapy and human albumin administration were also investigated. The main reason of these studies was the fact that mechanisms of neurotoxic effects of bilirubin are predominantly identical with those, by which bilirubin inhibits cancer cells growth....

Bilirubin is a major product of the heme catabolism in the vascular bed with substantial antioxidant properties. These importantly contribute to pathogenesis of diseases associated with increased oxidative stress, including cardiovascular or cancer diseases. In the first part of this PhD project serum bilirubin concentrations were examined in the 1 % representative sample of the general Czech population, together with determination of the prevalence of Gilbert's syndrome. Bilirubin concentrations were determined also within individual polymorphisms of the UGT1A1 gene (OMIM*191740) responsible for bilirubin biotransformation in the liver, including their association with the basic risk factors for atherosclerosis. We also assessed the activity of the standard liver enzymes (representing another significant risk factor for the development of cardiovascular diseases) with surprisingly high proportion of subjects with elevated values. Simultaneously, we determined the concentrations of serum bilirubin in a group of patients with an acute coronary syndrome, who manifested with significantly lower concentrations as compared to general population. In the second part of this research project, the relationship between plasma concentrations of bilirubin and individual variants of UGT1A1 gene polymorphisms...