Reação Adversa ao Medicamento (RAM) é definida como a reação a um medicamento que é nociva e não-intencional. O dano hepático induzido por medicamento (DILI) é um exemplo de RAM que pode ser muito severa e provocar casos de transplante hepático e morte. A falta de marcadores específicos ou testes para o diagnóstico de DILI conduziu ao desenvolvimento de escalas para avaliar a imputabilidade do medicamento na ocorrência do dano hepático. O presente estudo teve como objetivo caracterizar os tipos de danos hepáticos induzidos por medicamentos e investigar a concordância de três escalas utilizadas na sua identificação: RUCAM, Maria & Victorino (M&V) e Naranjo. Trata-se de um estudo seccional realizado em um hospital universitário no Rio de Janeiro em que a população fonte foi composta por 230 pacientes internados no período de junho de 2006 a novembro de 2007, que apresentaram dano hepático segundo os critérios do CIOMS (Council for Internacional Organizations of Medical Science), que consideram os resultados dos exames hepáticos e os níveis enzimáticos. Com a aplicação dos critérios CIOMS e após a exclusão das causas alternativas de dano hepático, foram identificados 41 indivíduos com suspeita de serem portadores de dano hepático induzido por medicamento. A imputabilidade do medicamento foi investigada mediante aplicação de escalas específicas para estudo da hepatotoxicidade, RUCAM e Maria & Victorino, e pela aplicação da escala Naranjo utilizada para qualquer tipo de RAM. O estimador kappa foi utilizado para interpretação da concordância entre as escalas. Foram avaliados 23 homens e 18 mulheres e a grande maioria dos pacientes (87,8%) apresentava dano hepático do tipo colestático. Todos os homens apresentavam este tipo de dano, enquanto que entre as mulheres, a distribuição foi: 72,2% para danos colestáticos, 22,2% para danos hepatocelulares e 5,6% para danos mistos. Para cada medicamento suspeito utilizado pelos pacientes foram aplicadas as escalas RUCAM, M&V e Naranjo, o que resultou em 166 avaliações. O cálculo para avaliar a concordância entre as escalas RUCAM e M&V resultou em Кw = 0, 2492, IC 95% (0,1293- 0,3617), valor superior ao encontrado na comparação entre RUCAM e Naranjo, Кw = 0,0006. A avaliação entre as escalas M&V e Naranjo com valor de Кw= 0,013 também apontou baixa concordância. Os resultados mostraram que a concordância no diagnóstico de DILI entre as escalas utilizadas é baixa, sendo, como esperado, um pouco maior quando da avaliação das escalas específicas para hepatotoxicidade (RUCAM e M&V), quando comparada às concordâncias entre estas e a escala global de Naranjo, que foi desenhada para a avaliação de todos os tipos de RAM. A aplicação de escalas para avaliação da hepatotoxicidade representa uma alternativa ao diagnóstico baseado apenas no julgamento clínico. Entretanto, a baixa concordância entre as escalas demonstra que existem limitações das definições e dos escores adotados pelos métodos que devem ser reavaliados. Espera-se que um consenso sobre definições em comum, critérios diagnósticos e terminologias oriente a construção de um novo instrumento para avaliar causalidade. / ADR (Adverse Drug Reaction) is defined as a response to a drug that is noxious and unintended. Drug induced liver injury (DILI) is a type of ADR that can be very severe and result in liver failure and death. The lack of specific biomarkers or diagnostic tests for DILI led to the development of numeric scales to assess the imputability of drug in DILI cases. The aim of this present work was to describe the types of DILI and assess the agreement of three scales used for its identification: RUCAM, Maria & Victorino and Naranjo. It is a sectional study was conducted at a university hospital in Rio de Janeiro. The target population was composed of 230 inpatients between June 2006 and November 2007, who had liver injury classified according to the criteria of CIOMS (Council for Internacional Organizations of Medical Science) that consider the results of liver tests and the enzyme levels. With the use of CIOMS criteria and after the exclusion of alternative causes of liver injury, 41 inpatients were identified as suspected DILI cases. Drug causality was assessed through the use of specific scales to study cases of hepatotoxicity, RUCAM and Maria & Victorino, and with Naranjo scale, used in the evaluation of any type of ADR. Kappa statistical test was used to assess the agreement between the scales. Twenty-three men and 18 were women were evaluated. The great majority of patients (87.8%) had cholestatic liver injury. All men had cholestatic liver injury, while for women, 72.2% of the cases were cholestatic, 22.2% were hepatocelular and 5.6% were mixed cases. For each suspected drug taken by the patients, the three scales were used, with a total of 166 ratings generated for each scale. The agreement between RUCAM and M & V was Кw = 0. 2492, CI 95% (0.1293 0.3617), as compared to RUCAM and Naranjo (Кw = 0.0006). The comparison between M&V and Naranjo (Кw= 0.013) showed low agreement. Results showed low agreement between the scales used for the diagnostic of DILI. As expected, the results were a little bit higher when assessment was made with specific scales for hepatotoxicity (RUCAM and M&V), as compared to the agreement made with these scales and the global scale Naranjo, which was designed to assess all types of RAM. The use of scales to assess hepatotoxicity are an alternative to diagnosis based only on clinical judgment. However, the low agreement between the scales shows that there are limitations in definitions and methods adopted by the scores that should be reconsidered. It is hoped that a consensus on common definitions, diagnostic criteria and terminology guide the construction of a new instrument to assess causality.

Reação Adversa ao Medicamento (RAM) é definida como a reação a um medicamento que é nociva e não-intencional. O dano hepático induzido por medicamento (DILI) é um exemplo de RAM que pode ser muito severa e provocar casos de transplante hepático e morte. A falta de marcadores específicos ou testes para o diagnóstico de DILI conduziu ao desenvolvimento de escalas para avaliar a imputabilidade do medicamento na ocorrência do dano hepático. O presente estudo teve como objetivo caracterizar os tipos de danos hepáticos induzidos por medicamentos e investigar a concordância de três escalas utilizadas na sua identificação: RUCAM, Maria & Victorino (M&V) e Naranjo. Trata-se de um estudo seccional realizado em um hospital universitário no Rio de Janeiro em que a população fonte foi composta por 230 pacientes internados no período de junho de 2006 a novembro de 2007, que apresentaram dano hepático segundo os critérios do CIOMS (Council for Internacional Organizations of Medical Science), que consideram os resultados dos exames hepáticos e os níveis enzimáticos. Com a aplicação dos critérios CIOMS e após a exclusão das causas alternativas de dano hepático, foram identificados 41 indivíduos com suspeita de serem portadores de dano hepático induzido por medicamento. A imputabilidade do medicamento foi investigada mediante aplicação de escalas específicas para estudo da hepatotoxicidade, RUCAM e Maria & Victorino, e pela aplicação da escala Naranjo utilizada para qualquer tipo de RAM. O estimador kappa foi utilizado para interpretação da concordância entre as escalas. Foram avaliados 23 homens e 18 mulheres e a grande maioria dos pacientes (87,8%) apresentava dano hepático do tipo colestático. Todos os homens apresentavam este tipo de dano, enquanto que entre as mulheres, a distribuição foi: 72,2% para danos colestáticos, 22,2% para danos hepatocelulares e 5,6% para danos mistos. Para cada medicamento suspeito utilizado pelos pacientes foram aplicadas as escalas RUCAM, M&V e Naranjo, o que resultou em 166 avaliações. O cálculo para avaliar a concordância entre as escalas RUCAM e M&V resultou em Кw = 0, 2492, IC 95% (0,1293- 0,3617), valor superior ao encontrado na comparação entre RUCAM e Naranjo, Кw = 0,0006. A avaliação entre as escalas M&V e Naranjo com valor de Кw= 0,013 também apontou baixa concordância. Os resultados mostraram que a concordância no diagnóstico de DILI entre as escalas utilizadas é baixa, sendo, como esperado, um pouco maior quando da avaliação das escalas específicas para hepatotoxicidade (RUCAM e M&V), quando comparada às concordâncias entre estas e a escala global de Naranjo, que foi desenhada para a avaliação de todos os tipos de RAM. A aplicação de escalas para avaliação da hepatotoxicidade representa uma alternativa ao diagnóstico baseado apenas no julgamento clínico. Entretanto, a baixa concordância entre as escalas demonstra que existem limitações das definições e dos escores adotados pelos métodos que devem ser reavaliados. Espera-se que um consenso sobre definições em comum, critérios diagnósticos e terminologias oriente a construção de um novo instrumento para avaliar causalidade. / ADR (Adverse Drug Reaction) is defined as a response to a drug that is noxious and unintended. Drug induced liver injury (DILI) is a type of ADR that can be very severe and result in liver failure and death. The lack of specific biomarkers or diagnostic tests for DILI led to the development of numeric scales to assess the imputability of drug in DILI cases. The aim of this present work was to describe the types of DILI and assess the agreement of three scales used for its identification: RUCAM, Maria & Victorino and Naranjo. It is a sectional study was conducted at a university hospital in Rio de Janeiro. The target population was composed of 230 inpatients between June 2006 and November 2007, who had liver injury classified according to the criteria of CIOMS (Council for Internacional Organizations of Medical Science) that consider the results of liver tests and the enzyme levels. With the use of CIOMS criteria and after the exclusion of alternative causes of liver injury, 41 inpatients were identified as suspected DILI cases. Drug causality was assessed through the use of specific scales to study cases of hepatotoxicity, RUCAM and Maria & Victorino, and with Naranjo scale, used in the evaluation of any type of ADR. Kappa statistical test was used to assess the agreement between the scales. Twenty-three men and 18 were women were evaluated. The great majority of patients (87.8%) had cholestatic liver injury. All men had cholestatic liver injury, while for women, 72.2% of the cases were cholestatic, 22.2% were hepatocelular and 5.6% were mixed cases. For each suspected drug taken by the patients, the three scales were used, with a total of 166 ratings generated for each scale. The agreement between RUCAM and M & V was Кw = 0. 2492, CI 95% (0.1293 0.3617), as compared to RUCAM and Naranjo (Кw = 0.0006). The comparison between M&V and Naranjo (Кw= 0.013) showed low agreement. Results showed low agreement between the scales used for the diagnostic of DILI. As expected, the results were a little bit higher when assessment was made with specific scales for hepatotoxicity (RUCAM and M&V), as compared to the agreement made with these scales and the global scale Naranjo, which was designed to assess all types of RAM. The use of scales to assess hepatotoxicity are an alternative to diagnosis based only on clinical judgment. However, the low agreement between the scales shows that there are limitations in definitions and methods adopted by the scores that should be reconsidered. It is hoped that a consensus on common definitions, diagnostic criteria and terminology guide the construction of a new instrument to assess causality.

Cadmium (Cd) is present in food at low levels, particularly in crops and is also present in groundwater. Cd can also be obtained from tobacco smoking and occupational exposure. Cd is not effectively excreted from the body. The primary organ that accumulates Cd is liver. Liver is the main organ involved in metabolizing exogenous chemicals. While metabolism of chemicals causes detoxification, it can also result in liver oxidative damage. CYP2A6 (CYP2A5 in mice) is mainly expressed in the liver. CYP2A6 expression is increased in patients with alcoholic or non-alcoholic fatty liver. Alcohol feeding induced CYP2A5 in mice and alcohol-induced fatty liver disease was enhanced in CYP2A5 knockout (CYP2A5-/-) mice, suggesting a protective effect of CYP2A5 on alcoholic fatty liver disease. PPAR-alpha, a transcription factor, is a major regulator of lipid metabolism in the liver.  CYP2A5 and PPAR-alpha are suggested to work together in regulation of lipid metabolism and in protection against alcoholic fatty liver. It is also suggested that CYP2A5 along with PPAR-alpha protects against high fat diet induced metabolic syndrome. Cadmium can also induce CYP2a5 in mice. Recently it was discovered that there is a positive relation between soil heavy metals and fatty liver disease. Exposure to Cadmium leads to lipid accumulation in the liver, which can eventually lead to the development of Non-Alcoholic Fatty Liver Disease (NAFLD). In this study, the effects of CYP2A5 and PPAR-alpha on the acute cadmium-induced liver injury were tested using CYP2A5-/- mice and PPAR-alpha knockout (PPARα -/-) mice and CYP2A5 and PPAR-alpha wild-type mice. Cadmium chloride (CdCl2) was administered intraperitoneally at 5 mg/kg body weight. A control group of mice were injected saline for comparison. The mice were sacrificed after 24 hours of injection. Blood was collected to test for markers indicative of liver disease such as ALT and AST levels, triglyceride levels, and blood glucose levels. The liver was collected to examine the liver damage by biochemical assays and pathological evaluation. Both CYP2A5-/- and PPARα -/- mice exhibited less severe liver injury compared to their wild-type counterparts. These results suggest that despite the beneficial roles of both CYP2A5 and PPAR-alpha towards alcohol-induced liver injury and metabolic syndrome, they are not protective against Cd-induced liver injury.

Cadmium is present in food and groundwater. Tobacco smoking and occupational exposure are also major sources for cadmium. Cadmium is primarily accumulated in liver, a major organ metabolizing exogenous chemicals. Chemical metabolism may cause detoxification, but it can also cause bio-activation resulting in liver damage. Cytochrome P450s (CYP) are major liver metabolism enzymes, and cadmium chloride (CdCl2) can induce CYP2A5 in mice. We examined the effect of CYP2A5 on CdCl2-induced liver injury using CYP2A5-knockout (cyp2a5-/-) mice. The cyp2a5-/- mice and their control WT mice were injected CdCl2 intraperitoneally at 5 mg/kg body weight, respectively, to induce liver injury. The control group of cyp2a5-/- mice and WT mice were injected saline at the same volume. Twenty-four hours later, all the mice were sacrificed. As indicated by biochemical assays and pathological evaluation, CdCl2-treated WT mice exhibited more severe liver injury than CdCl2-treated cyp2a5-/- mice, suggesting that CYP2A5 contributes to Cd-induced liver injury.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第17974号 / 医博第3838号 / 新制||医||1001(附属図書館) / 80818 / 京都大学大学院医学研究科医学専攻 / (主査)教授 羽賀 博典, 教授 坂井 義治, 教授 千葉 勉 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第19587号 / 医博第4094号 / 新制||医||1014(附属図書館) / 32623 / 京都大学大学院医学研究科医学専攻 / (主査)教授 松原 和夫, 教授 妹尾 浩, 教授 浅野 雅秀 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20985号 / 医博第4331号 / 新制||医||1027(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 妹尾 浩, 教授 湊谷 謙司, 教授 野田 亮 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Liver injury instigates a proinflammatory response in tissue-resident macrophages, called Kupffer cells (KCs), resulting in the recruitment of monocytes and neutrophils. The high energy demand required for a rapid proinflammatory response in macrophages like KCs is achieved through metabolic reprogramming. This is supported by increased glycolysis. On the other hand, injury resolution requires hepatic macrophages to undergo an anti-inflammatory polarization, which relies on oxidative phosphorylation (OXPHOS). In addition to shifts in mechanisms of adenosine triphosphate (ATP) production, lipid metabolic reprogramming supplies metabolic intermediates and lipids for membrane remodeling and the production of inflammatory mediators. AMP-activated protein kinase (AMPK) is a master metabolic regulator that influences the metabolic reprogramming of macrophages. While AMPK activation promotes an anti-inflammatory polarization, disruption of activity exacerbates proinflammatory signaling. For this thesis work, we addressed whether macrophage AMPK is protective against liver injury by altering immunometabolism. Specifically, we investigated this question in the context of chronic (nonalcoholic steatohepatitis (NASH)) and acute (acetaminophen (APAP) overdose) liver injury. While APAP overdose is a robust and directly translational model of acute injury, models of NASH-induced hepatic fibrosis rely on nutrient-deficient diets like the choline-deficient high-fat diet (CDAHFD) or genetic manipulation. Despite the utility of these models, they seldom mirror the pathogenesis of human NASH, with diets like CDAHFD being completely dissociated from metabolic syndrome. Moreover, models are required to address the divergence between male and female mice. Recently, there has been a shift towards addressing other variables that drive inflammation and metabolism. At room temperature (RT) (22 °C), mice experience cold stress that alters various biological functions. Cold stress drives brown adipose tissue (BAT) activation and upregulates corticosterone production and immunosuppression, all processes that blunt NASH progression. Giles et al. (2016) demonstrated that housing mice at thermoneutrality (TN) (30 °C) exacerbated metabolic-dysfunction associated fatty liver disease (MAFLD) progression toward NASH in both male and female mice. Since then, we and others have implemented TN housing with different dietary interventions and mice strains. We determined that 16-week Western diet (WD) feeding of male and female mice at 29 °C was insufficient to drive hepatic fibrosis, however alterations in glucose tolerance and elevated liver injury enzymes as well as profibrotic gene expression in male mice may indicate that a longer timeline is necessary (24 weeks). Given that our TN NASH model did not produce hepatic fibrosis, we implemented the CDAHFD to investigate macrophage AMPK in chronic liver injury. Male and female AMPK Flox (Prkaa1 fl/fl/Prkaa2 fl/fl) and MacKO (Flox-LysM-Cre+) mice were fed CDAHFD for 8 weeks. In this time frame, CDAHFD produces a lean euglycemic phenotype with hepatic steatosis, inflammation, and fibrosis, to which AMPK MacKO had no influence. Moreover, intervention with a low dose of metformin had no effect, contrary to the reduction in hepatic steatosis observed in HFD-fed mice. Although macrophage AMPK is dispensable in the CDAHFD model of chronic liver injury, acute liver injury needed to be addressed. We found that priming with systemic activation of a direct AMPK activator MK-8722 did not influence hepatic injury and necrosis in our model of APAP-induced liver injury (AILI). Moreover, deletion of hepatocellular AMPK (Flox-Alb-Cre+) or AMPK MacKO did not influence injury at 24 hours post overdose. Despite the lack of effect of systemic AMPK activation, we were interested in a nanoparticle-based targeting of direct AMPK activator MK-8722 (NP-MK8722) delivery. We determined that PLGA-PEG nanoparticles (NPs) accumulated in hepatic macrophages as early as 2 hours post-injection, but NP-MK8722 did not alter hepatic necrosis, injury, or immune infiltration. Overall, my thesis work has advanced our knowledge of the effects of housing temperatures on NASH pathogenesis. Moreover, we are the first to address the effects of macrophage AMPK signaling in NASH and AILI. This is especially true for assessing how AMPK deficiency and targeted activation influences KC immunometabolism during injury.

Yang Lei. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2001. / Includes bibliographical references (leaves 141-148). / Abstracts in English and Chinese. / Acknowledgements --- p.i / Abstract --- p.ii / Abstract (Chinese Version) --- p.iv / Table of Contents --- p.vi / List of Abbreviations --- p.xii / List of Figures --- p.xiii / List of Tables --- p.xviii / Chapter Chapter 1 --- Literature review --- p.1 / Chapter 1.1 --- Carbon tetrachloride (CC14) --- p.1 / Chapter 1.2 --- Major uses of CC14 --- p.1 / Chapter 1.3 --- Potential human exposure pathways to CC14 --- p.2 / Chapter 1.4 --- Toxicity of CC14 --- p.3 / Chapter 1.5 --- Mechanism of CCl4-induced hepatotoxicity --- p.5 / Chapter 1.6 --- Role of CYP2E1 involved in CCl4-induced hepatotoxicity --- p.7 / Chapter 1.7 --- Definite proof of the involvement of CYP2E1 in CCl4-induced hepatotoxicity by CYP2El-null mouse in vivo model --- p.10 / Chapter 1.8 --- Identification of CYP2E1 -dependent genes involved in CCl4-induced hepatotoxicity by fluorescent differential display (FDD) --- p.11 / Chapter 1.9 --- Objectives of the study --- p.14 / Chapter Chapter 2 --- Materials and methods --- p.16 / Chapter 2.1 --- Animals and treatments --- p.16 / Chapter 2.1.1 --- Materials --- p.16 / Chapter 2.1.2 --- Methods --- p.16 / Chapter 2.2 --- Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) analyses --- p.17 / Chapter 2.2.1 --- Materials --- p.17 / Chapter 2.2.2 --- Methods --- p.17 / Chapter 2.2.2.1 --- Serum preparation --- p.17 / Chapter 2.2.2.2 --- Activity determination --- p.18 / Chapter 2.3 --- Tail-genotyping by PCR --- p.18 / Chapter 2.3.1 --- Materials --- p.18 / Chapter 2.3.2 --- Methods --- p.20 / Chapter 2.3.2.1 --- Preparation of genomic DNA from mouse tail --- p.20 / Chapter 2.3.2.2 --- PCR reaction --- p.20 / Chapter 2.4 --- Total RNA isolation --- p.21 / Chapter 2.4.1 --- Materials --- p.21 / Chapter 2.4.2 --- Methods --- p.21 / Chapter 2.5 --- DNase I treatment --- p.23 / Chapter 2.5.1 --- Materials --- p.23 / Chapter 2.5.2 --- Methods --- p.23 / Chapter 2.6 --- Reverse transcnption of mRNA and amplification by fluorescent PCR amplification --- p.26 / Chapter 2.6.1 --- Materials --- p.27 / Chapter 2.6.2 --- Methods --- p.27 / Chapter 2.7 --- Fluorescent differential display (FDD) --- p.28 / Chapter 2.7.1 --- Materials --- p.28 / Chapter 2.7.2 --- Methods --- p.28 / Chapter 2.8 --- Excision of differentially expressed cDNA fragments --- p.29 / Chapter 2.8.1 --- Materials --- p.29 / Chapter 2.8.2 --- Methods --- p.29 / Chapter 2.9 --- Reamplification of differentially expressed cDNA fragments --- p.34 / Chapter 2.9.1 --- Materials --- p.34 / Chapter 2.9.2 --- Methods --- p.34 / Chapter 2.10 --- Subcloning of reamplified cDNA fragments --- p.36 / Chapter 2.10.1 --- Materials --- p.36 / Chapter 2.10.2 --- Methods --- p.37 / Chapter 2.11 --- Purification of plasmid DNA from recombinant clones --- p.39 / Chapter 2.11.1 --- Materials --- p.39 / Chapter 2.11.2 --- Methods --- p.39 / Chapter 2.12 --- DNA sequencing of differentially expressed cDNA fragments --- p.40 / Chapter 2.12.1 --- Materials --- p.40 / Chapter 2.12.2 --- Methods --- p.40 / Chapter 2.12.3 --- BLAST search against the GenBank DNA databases --- p.41 / Chapter 2.13 --- Northern blot analysis of differentially expressed cDNA fragments --- p.41 / Chapter 2.13.1 --- Formaldehyde gel electrophoresis of total RNA --- p.41 / Chapter 2.13.1.1 --- Materials --- p.42 / Chapter 2.13.1.2 --- Methods --- p.42 / Chapter 2.13.2 --- Preparation of cDNA probes for hybridization --- p.42 / Chapter 2.13.2.1 --- EcoRI digestion of cDNA inserts from plasmid DNA --- p.42 / Chapter 2.13.2.1.1 --- Materials --- p.42 / Chapter 2.13.2.1.2 --- Methods --- p.43 / Chapter 2.13.2.2 --- Purification of DNA from agarose gel --- p.43 / Chapter 2.13.2.2.1 --- Materials --- p.43 / Chapter 2.13.2.2.2 --- Methods --- p.43 / Chapter 2.13.2.3 --- DIG labeling of cDNA --- p.44 / Chapter 2.13.2.3.1 --- Materials --- p.44 / Chapter 2.13.2.3.2 --- Methods --- p.44 / Chapter 2.13.3 --- Hybridization --- p.45 / Chapter 2.13.3.1 --- Materials --- p.45 / Chapter 2.13.3.2 --- Methods --- p.45 / Chapter Chapter 3 --- Results --- p.47 / Chapter 3.1 --- Liver morphology --- p.47 / Chapter 3.2 --- Serum ALT and AST activities --- p.47 / Chapter 3.3 --- Tail-genotyping by PCR --- p.51 / Chapter 3.4 --- DNase I treatment --- p.51 / Chapter 3.5 --- FDD RT-PCR and excision of differentially expressed cDNA fragments --- p.51 / Chapter 3.6 --- Reamplification of excised cDNA fragments --- p.61 / Chapter 3.7 --- Subcloning of reamplified cDNA fragments --- p.61 / Chapter 3.8 --- DNA sequencing of subcloned cDNA fragments --- p.69 / Chapter 3.9 --- Confirmation of differentially expressed patterns by Northern blot analysis --- p.106 / Chapter 3.10 --- Temporal expression of differentially expressed genes --- p.113 / Chapter 3.11 --- Tissue distribution of differentially expressed genes --- p.117 / Chapter Chapter 4 --- Discussion --- p.125 / Chapter 4.1 --- Liver morphology and serum ALT and AST activities --- p.126 / Chapter 4.2 --- Identification of CYP2E1 -dependent genes involved in CCl4-induced hepatotoxicity --- p.127 / Chapter 4.3 --- Functional roles of the identified differentially expressed genes --- p.129 / Chapter 4.3.1 --- Fragment B4 --- p.129 / Chapter 4.3.2 --- Fragment C12 --- p.130 / Chapter 4.3.3 --- Fragment B13 --- p.131 / Chapter 4.3.4 --- Fragment A5 --- p.132 / Chapter 4.4 --- Temporal expression of differentially expressed genes --- p.133 / Chapter 4.4.1 --- Fragment B4 --- p.133 / Chapter 4.4.2 --- Fragment C12 --- p.134 / Chapter 4.4.3 --- Fragment B13 --- p.134 / Chapter 4.4.4 --- Fragment A5 --- p.135 / Chapter 4.5 --- Tissue distribution of differentially expressed genes --- p.136 / Chapter 4.5.1 --- Fragment B4 --- p.136 / Chapter 4.5.2 --- Fragment C12 --- p.136 / Chapter 4.5.3 --- Fragment B13 --- p.137 / Chapter 4.5.4 --- Fragment A5 --- p.137 / Chapter 4.5.5 --- Roles of the identified genes involved in CCl4-induced hepatotoxicity --- p.138 / Chapter 4.6 --- Normalization of Northern blot analysis --- p.13 8 / Chapter 4.7 --- Limitations of FDD technique to identify differentially expressed genes --- p.138 / Chapter 4.8 --- Future studies --- p.139 / Chapter 4.8.1 --- Investigation of the differential expression patterns of the identified genes in acetaminophen-induced liver injury --- p.139 / Chapter 4.8.2 --- Dot blot analysis --- p.140 / Chapter 4.8.3 --- DNA microarray --- p.140 / References --- p.141

Minimizing anti-cancer drug toxicity is a major challenge for the pharmaceutical industry. Toxicity is most frequently due to either the direct interaction of the drug on previously unidentified targets or its conversion to metabolites by drug metabolizing enzymes (e.g. CYP450 enzymes) that cause cellular, tissue or organ damage. Pharmacoproteomics is beginning to take a central role in studying changes in protein expression corresponding to drug administration, the results of which, inform about the mode of action, toxicity, and resistance in pre-clinical and clinical stages of drug development. The main aim of this research is to apply comparative proteomics studies on livers from male and female mice xenograft models treated with major anti-cancer drugs (5-flourouracil, paclitaxel, cisplatin, and doxorubicin) and CYP inducer, TCPOBOP, to investigate their effect on protein expression profiles (proteome). Within this thesis, an attention is paid to optimise a highly validated proteomics workflow for biomarker identification. Proteins were extracted from liver microsomes of mice treated in two separate sets; Set A – male (5-fluoruracil, doxorubicin, cisplatin and untreated) or Set B – female (5-fluoruracil, paclitaxel, TCPOBOP and untreated) using cryo-pulverization and sonication method. The extracts were digested with trypsin ii and the resulting peptides labelled with 4-plex iTRAQ reagents. The labelled peptides were subjected for separation in two-dimensions by iso-electric focusing (IEF) and RP-HPLC techniques before analysis by mass spectrometry and database searching for protein identification. Set A and Set B resulted in identification and quantification of 1146 and 1743 proteins, respectively. Moreover, Set A and Set B recovered 26 and 34 cytochrome P450 isoforms, respectively. The microsomal changes after drug treatments were quite similar. However, more changes were observed in the male set. Up-regulation of MUPs showed the greatest distinction in the protein expression patterns in the treated samples comparing to the untreated controls. In Set A, 5-fluoruracil and cisplatin increased the expression of three isoforms (MUP1, 2, and 6), whereas doxorubicin has increased the expression of four isoforms (MUP1, 2, 3, and 6). On the other side, only TCPOBOP in Set B has increased the expression of two isoforms (MUP1 and 6). Our findings showed that the expression of MUP, normally involved in binding and excretion of pheromones, have drug- and sex-specific differences. The mechanism and significance of MUP up-regulation are ambiguous. Therefore, the impact of each therapeutic agent on MUP and xenobiotic enzymes will be discussed.