- •CONTENTS
- •Preface
- •Contributors
- •1 Introduction to Toxicology
- •1.1 Definition and Scope, Relationship to Other Sciences, and History
- •1.1.2 Relationship to Other Sciences
- •1.1.3 A Brief History of Toxicology
- •1.3 Sources of Toxic Compounds
- •1.3.1 Exposure Classes
- •1.3.2 Use Classes
- •1.4 Movement of Toxicants in the Environment
- •Suggested Reading
- •2.1 Introduction
- •2.2 Cell Culture Techniques
- •2.2.1 Suspension Cell Culture
- •2.2.2 Monolayer Cell Culture
- •2.2.3 Indicators of Toxicity in Cultured Cells
- •2.3 Molecular Techniques
- •2.3.1 Molecular Cloning
- •2.3.2 cDNA and Genomic Libraries
- •2.3.3 Northern and Southern Blot Analyses
- •2.3.4 Polymerase Chain Reaction (PCR)
- •2.3.5 Evaluation of Gene Expression, Regulation, and Function
- •2.4 Immunochemical Techniques
- •Suggested Reading
- •3.1 Introduction
- •3.2 General Policies Related to Analytical Laboratories
- •3.2.1 Standard Operating Procedures (SOPs)
- •3.2.2 QA/QC Manuals
- •3.2.3 Procedural Manuals
- •3.2.4 Analytical Methods Files
- •3.2.5 Laboratory Information Management System (LIMS)
- •3.3 Analytical Measurement System
- •3.3.1 Analytical Instrument Calibration
- •3.3.2 Quantitation Approaches and Techniques
- •3.4 Quality Assurance (QA) Procedures
- •3.5 Quality Control (QC) Procedures
- •3.6 Summary
- •Suggested Reading
- •4 Exposure Classes, Toxicants in Air, Water, Soil, Domestic and Occupational Settings
- •4.1 Air Pollutants
- •4.1.1 History
- •4.1.2 Types of Air Pollutants
- •4.1.3 Sources of Air Pollutants
- •4.1.4 Examples of Air Pollutants
- •4.1.5 Environmental Effects
- •4.2 Water and Soil Pollutants
- •4.2.1 Sources of Water and Soil Pollutants
- •4.2.2 Examples of Pollutants
- •4.3 Occupational Toxicants
- •4.3.1 Regulation of Exposure Levels
- •4.3.2 Routes of Exposure
- •4.3.3 Examples of Industrial Toxicants
- •Suggested Reading
- •5 Classes of Toxicants: Use Classes
- •5.1 Introduction
- •5.2 Metals
- •5.2.1 History
- •5.2.2 Common Toxic Mechanisms and Sites of Action
- •5.2.3 Lead
- •5.2.4 Mercury
- •5.2.5 Cadmium
- •5.2.6 Chromium
- •5.2.7 Arsenic
- •5.2.8 Treatment of Metal Poisoning
- •5.3 Agricultural Chemicals (Pesticides)
- •5.3.1 Introduction
- •5.3.3 Organochlorine Insecticides
- •5.3.4 Organophosphorus Insecticides
- •5.3.5 Carbamate Insecticides
- •5.3.6 Botanical Insecticides
- •5.3.7 Pyrethroid Insecticides
- •5.3.8 New Insecticide Classes
- •5.3.9 Herbicides
- •5.3.10 Fungicides
- •5.3.11 Rodenticides
- •5.3.12 Fumigants
- •5.3.13 Conclusions
- •5.4 Food Additives and Contaminants
- •5.5 Toxins
- •5.5.1 History
- •5.5.2 Microbial Toxins
- •5.5.3 Mycotoxins
- •5.5.4 Algal Toxins
- •5.5.5 Plant Toxins
- •5.5.6 Animal Toxins
- •5.6 Solvents
- •5.7 Therapeutic Drugs
- •5.8 Drugs of Abuse
- •5.9 Combustion Products
- •5.10 Cosmetics
- •Suggested Reading
- •6 Absorption and Distribution of Toxicants
- •6.1 Introduction
- •6.2 Cell Membranes
- •6.3 Mechanisms of Transport
- •6.3.1 Passive Diffusion
- •6.4 Physicochemical Properties Relevant to Diffusion
- •6.4.1 Ionization
- •6.5 Routes of Absorption
- •6.5.1 Extent of Absorption
- •6.5.2 Gastrointestinal Absorption
- •6.5.3 Dermal Absorption
- •6.5.4 Respiratory Penetration
- •6.6 Toxicant Distribution
- •6.6.1 Physicochemical Properties and Protein Binding
- •6.7 Toxicokinetics
- •Suggested Reading
- •7 Metabolism of Toxicants
- •7.1 Introduction
- •7.2 Phase I Reactions
- •7.2.4 Nonmicrosomal Oxidations
- •7.2.5 Cooxidation by Cyclooxygenases
- •7.2.6 Reduction Reactions
- •7.2.7 Hydrolysis
- •7.2.8 Epoxide Hydration
- •7.2.9 DDT Dehydrochlorinase
- •7.3 Phase II Reactions
- •7.3.1 Glucuronide Conjugation
- •7.3.2 Glucoside Conjugation
- •7.3.3 Sulfate Conjugation
- •7.3.4 Methyltransferases
- •7.3.7 Acylation
- •7.3.8 Phosphate Conjugation
- •Suggested Reading
- •8 Reactive Metabolites
- •8.1 Introduction
- •8.2 Activation Enzymes
- •8.3 Nature and Stability of Reactive Metabolites
- •8.4 Fate of Reactive Metabolites
- •8.4.1 Binding to Cellular Macromolecules
- •8.4.2 Lipid Peroxidation
- •8.4.3 Trapping and Removal: Role of Glutathione
- •8.5 Factors Affecting Toxicity of Reactive Metabolites
- •8.5.1 Levels of Activating Enzymes
- •8.5.2 Levels of Conjugating Enzymes
- •8.5.3 Levels of Cofactors or Conjugating Chemicals
- •8.6 Examples of Activating Reactions
- •8.6.1 Parathion
- •8.6.2 Vinyl Chloride
- •8.6.3 Methanol
- •8.6.5 Carbon Tetrachloride
- •8.6.8 Acetaminophen
- •8.6.9 Cycasin
- •8.7 Future Developments
- •Suggested Reading
- •9.1 Introduction
- •9.2 Nutritional Effects
- •9.2.1 Protein
- •9.2.2 Carbohydrates
- •9.2.3 Lipids
- •9.2.4 Micronutrients
- •9.2.5 Starvation and Dehydration
- •9.2.6 Nutritional Requirements in Xenobiotic Metabolism
- •9.3 Physiological Effects
- •9.3.1 Development
- •9.3.2 Gender Differences
- •9.3.3 Hormones
- •9.3.4 Pregnancy
- •9.3.5 Disease
- •9.3.6 Diurnal Rhythms
- •9.4 Comparative and Genetic Effects
- •9.4.1 Variations Among Taxonomic Groups
- •9.4.2 Selectivity
- •9.4.3 Genetic Differences
- •9.5 Chemical Effects
- •9.5.1 Inhibition
- •9.5.2 Induction
- •9.5.3 Biphasic Effects: Inhibition and Induction
- •9.6 Environmental Effects
- •9.7 General Summary and Conclusions
- •Suggested Reading
- •10 Elimination of Toxicants
- •10.1 Introduction
- •10.2 Transport
- •10.3 Renal Elimination
- •10.4 Hepatic Elimination
- •10.4.2 Active Transporters of the Bile Canaliculus
- •10.5 Respiratory Elimination
- •10.6 Conclusion
- •Suggested Reading
- •11 Acute Toxicity
- •11.1 Introduction
- •11.2 Acute Exposure and Effect
- •11.3 Dose-response Relationships
- •11.4 Nonconventional Dose-response Relationships
- •11.5 Mechanisms of Acute Toxicity
- •11.5.1 Narcosis
- •11.5.2 Acetylcholinesterase Inhibition
- •11.5.3 Ion Channel Modulators
- •11.5.4 Inhibitors of Cellular Respiration
- •Suggested Reading
- •12 Chemical Carcinogenesis
- •12.1 General Aspects of Cancer
- •12.2 Human Cancer
- •12.2.1 Causes, Incidence, and Mortality Rates of Human Cancer
- •12.2.2 Known Human Carcinogens
- •12.3 Classes of Agents Associated with Carcinogenesis
- •12.3.2 Epigenetic Agents
- •12.4 General Aspects of Chemical Carcinogenesis
- •12.5 Initiation-Promotion Model for Chemical Carcinogenesis
- •12.6 Metabolic Activation of Chemical Carcinogens and DNA Adduct Formation
- •12.7 Oncogenes
- •12.8 Tumor Suppressor Genes
- •12.8.1 Inactivation of Tumor Suppressor Genes
- •12.8.2 p53 Tumor Suppressor Gene
- •12.9 General Aspects of Mutagenicity
- •12.10 Usefulness and Limitations of Mutagenicity Assays for the Identification of Carcinogens
- •Suggested Reading
- •13 Teratogenesis
- •13.1 Introduction
- •13.2 Principles of Teratology
- •13.3 Mammalian Embryology Overview
- •13.4 Critical Periods
- •13.5 Historical Teratogens
- •13.5.1 Thalidomide
- •13.5.2 Accutane (Isotetrinoin)
- •13.5.3 Diethylstilbestrol (DES)
- •13.5.4 Alcohol
- •13.6 Testing Protocols
- •13.6.1 FDA Guidelines for Reproduction Studies for Safety Evaluation of Drugs for Human Use
- •13.6.3 Alternative Test Methods
- •13.7 Conclusions
- •Suggested Reading
- •14 Hepatotoxicity
- •14.1 Introduction
- •14.1.1 Liver Structure
- •14.1.2 Liver Function
- •14.2 Susceptibility of the Liver
- •14.3 Types of Liver Injury
- •14.3.1 Fatty Liver
- •14.3.2 Necrosis
- •14.3.3 Apoptosis
- •14.3.4 Cholestasis
- •14.3.5 Cirrhosis
- •14.3.6 Hepatitis
- •14.3.7 Oxidative Stress
- •14.3.8 Carcinogenesis
- •14.4 Mechanisms of Hepatotoxicity
- •14.5 Examples of Hepatotoxicants
- •14.5.1 Carbon Tetrachloride
- •14.5.2 Ethanol
- •14.5.3 Bromobenzene
- •14.5.4 Acetaminophen
- •14.6 Metabolic Activation of Hepatotoxicants
- •Suggested Reading
- •15 Nephrotoxicity
- •15.1 Introduction
- •15.1.1 Structure of the Renal System
- •15.1.2 Function of the Renal System
- •15.2 Susceptibility of the Renal System
- •15.3 Examples of Nephrotoxicants
- •15.3.1 Metals
- •15.3.2 Aminoglycosides
- •15.3.3 Amphotericin B
- •15.3.4 Chloroform
- •15.3.5 Hexachlorobutadiene
- •Suggested Reading
- •16 Toxicology of the Nervous System
- •16.1 Introduction
- •16.2 The Nervous system
- •16.2.1 The Neuron
- •16.2.2 Neurotransmitters and their Receptors
- •16.2.3 Glial Cells
- •16.3 Toxicant Effects on the Nervous System
- •16.3.1 Structural Effects of Toxicants on Neurons
- •16.3.2 Effects of Toxicants on Other Cells
- •16.4 Neurotoxicity Testing
- •16.4.1 In vivo Tests of Human Exposure
- •16.4.2 In vivo Tests of Animal Exposure
- •16.4.3 In vitro Neurochemical and Histopathological End Points
- •16.5 Summary
- •Suggested Reading
- •17 Endocrine System
- •17.1 Introduction
- •17.2 Endocrine System
- •17.2.1 Nuclear Receptors
- •17.3 Endocrine Disruption
- •17.3.1 Hormone Receptor Agonists
- •17.3.2 Hormone Receptor Antagonists
- •17.3.3 Organizational versus Activational Effects of Endocrine Toxicants
- •17.3.4 Inhibitors of Hormone Synthesis
- •17.3.5 Inducers of Hormone Clearance
- •17.3.6 Hormone Displacement from Binding Proteins
- •17.4 Incidents of Endocrine Toxicity
- •17.4.1 Organizational Toxicity
- •17.4.2 Activational Toxicity
- •17.4.3 Hypothyroidism
- •17.5 Conclusion
- •Suggested Reading
- •18 Respiratory Toxicity
- •18.1 Introduction
- •18.1.1 Anatomy
- •18.1.2 Cell Types
- •18.1.3 Function
- •18.2 Susceptibility of the Respiratory System
- •18.2.1 Nasal
- •18.2.2 Lung
- •18.3 Types of Toxic Response
- •18.3.1 Irritation
- •18.3.2 Cell Necrosis
- •18.3.3 Fibrosis
- •18.3.4 Emphysema
- •18.3.5 Allergic Responses
- •18.3.6 Cancer
- •18.3.7 Mediators of Toxic Responses
- •18.4 Examples of Lung Toxicants Requiring Activation
- •18.4.1 Introduction
- •18.4.2 Monocrotaline
- •18.4.3 Ipomeanol
- •18.4.4 Paraquat
- •18.5 Defense Mechanisms
- •Suggested Reading
- •19 Immunotoxicity
- •19.1 Introduction
- •19.2 The Immune System
- •19.3 Immune Suppression
- •19.4 Classification of Immune-Mediated Injury (Hypersensitivity)
- •19.5 Effects of Chemicals on Allergic Disease
- •19.5.1 Allergic Contact Dermatitis
- •19.5.2 Respiratory Allergens
- •19.5.3 Adjuvants
- •19.6 Emerging Issues: Food Allergies, Autoimmunity, and the Developing Immune System
- •Suggested Reading
- •20 Reproductive System
- •20.1 Introduction
- •20.2 Male Reproductive Physiology
- •20.3 Mechanisms and Targets of Male Reproductive Toxicants
- •20.3.1 General Mechanisms
- •20.3.2 Effects on Germ Cells
- •20.3.3 Effects on Spermatogenesis and Sperm Quality
- •20.3.4 Effects on Sexual Behavior
- •20.3.5 Effects on Endocrine Function
- •20.4 Female Reproductive Physiology
- •20.5 Mechanisms and Targets of Female Reproductive Toxicants
- •20.5.1 Tranquilizers, Narcotics, and Social Drugs
- •20.5.2 Endocrine Disruptors (EDs)
- •20.5.3 Effects on Germ Cells
- •20.5.4 Effects on the Ovaries and Uterus
- •20.5.5 Effects on Sexual Behavior
- •Suggested Reading
- •21 Toxicity Testing
- •21.1 Introduction
- •21.2 Experimental Administration of Toxicants
- •21.2.1 Introduction
- •21.2.2 Routes of Administration
- •21.3 Chemical and Physical Properties
- •21.4 Exposure and Environmental Fate
- •21.5 In vivo Tests
- •21.5.1 Acute and Subchronic Toxicity Tests
- •21.5.2 Chronic Tests
- •21.5.3 Reproductive Toxicity and Teratogenicity
- •21.5.4 Special Tests
- •21.6 In vitro and Other Short-Term Tests
- •21.6.1 Introduction
- •21.6.2 Prokaryote Mutagenicity
- •21.6.3 Eukaryote Mutagenicity
- •21.6.4 DNA Damage and Repair
- •21.6.5 Chromosome Aberrations
- •21.6.6 Mammalian Cell Transformation
- •21.6.7 General Considerations and Testing Sequences
- •21.7 Ecological Effects
- •21.7.1 Laboratory Tests
- •21.7.2 Simulated Field Tests
- •21.7.3 Field Tests
- •21.8 Risk Analysis
- •21.9 The Future of Toxicity Testing
- •Suggested Reading
- •22 Forensic and Clinical Toxicology
- •22.1 Introduction
- •22.2 Foundations of Forensic Toxicology
- •22.3 Courtroom Testimony
- •22.4.1 Documentation Practices
- •22.4.2 Considerations for Forensic Toxicological Analysis
- •22.4.3 Drug Concentrations and Distribution
- •22.5 Laboratory Analyses
- •22.5.1 Colorimetric Screening Tests
- •22.5.2 Thermal Desorption
- •22.5.6 Enzymatic Immunoassay
- •22.6 Analytical Schemes for Toxicant Detection
- •22.7 Clinical Toxicology
- •22.7.1 History Taking
- •22.7.2 Basic Operating Rules in the Treatment of Toxicosis
- •22.7.3 Approaches to Selected Toxicoses
- •Suggested Reading
- •23 Prevention of Toxicity
- •23.1 Introduction
- •23.2 Legislation and Regulation
- •23.2.1 Federal Government
- •23.2.2 State Governments
- •23.2.3 Legislation and Regulation in Other Countries
- •23.3 Prevention in Different Environments
- •23.3.1 Home
- •23.3.2 Workplace
- •23.3.3 Pollution of Air, Water, and Land
- •23.4 Education
- •Suggested Reading
- •24 Human Health Risk Assessment
- •24.1 Introduction
- •24.2 Risk Assessment Methods
- •24.2.2 Exposure Assessment
- •24.2.3 Dose Response and Risk Characterization
- •24.3 Noncancer Risk Assessment
- •24.3.1 Default Uncertainty and Modifying Factors
- •24.3.2 Derivation of Developmental Toxicant RfD
- •24.3.3 Determination of RfD and RfC of Naphthalene with the NOAEL Approach
- •24.3.4 Benchmark Dose Approach
- •24.3.5 Determination of BMD and BMDL for ETU
- •24.3.6 Quantifying Risk for Noncarcinogenic Effects: Hazard Quotient
- •24.3.7 Chemical Mixtures
- •24.4 Cancer Risk Assessment
- •24.5 PBPK Modeling
- •Suggested Reading
- •25 Analytical Methods in Toxicology
- •25.1 Introduction
- •25.2 Chemical and Physical Methods
- •25.2.1 Sampling
- •25.2.2 Experimental Studies
- •25.2.3 Forensic Studies
- •25.2.4 Sample Preparation
- •25.2.6 Spectroscopy
- •25.2.7 Other Analytical Methods
- •Suggested Reading
- •26 Basics of Environmental Toxicology
- •26.1 Introduction
- •26.2 Environmental Persistence
- •26.2.1 Abiotic Degradation
- •26.2.2 Biotic Degradation
- •26.2.3 Nondegradative Elimination Processes
- •26.3 Bioaccumulation
- •26.4 Toxicity
- •26.4.1 Acute Toxicity
- •26.4.2 Mechanisms of Acute Toxicity
- •26.4.3 Chronic Toxicity
- •26.4.5 Abiotic and Biotic Interactions
- •26.5 Conclusion
- •Suggested Reading
- •27.1 Introduction
- •27.2 Sources of Toxicants to the Environment
- •27.3 Transport Processes
- •27.3.1 Advection
- •27.3.2 Diffusion
- •27.4 Equilibrium Partitioning
- •27.5 Transformation Processes
- •27.5.1 Reversible Reactions
- •27.5.2 Irreversible Reactions
- •27.6 Environmental Fate Models
- •Suggested Reading
- •28 Environmental Risk Assessment
- •28.1 Introduction
- •28.2 Formulating the Problem
- •28.2.1 Selecting Assessment End Points
- •28.2.2 Developing Conceptual Models
- •28.2.3 Selecting Measures
- •28.3 Analyzing Exposure and Effects Information
- •28.3.1 Characterizing Exposure
- •28.3.2 Characterizing Ecological Effects
- •28.4 Characterizing Risk
- •28.4.1 Estimating Risk
- •28.4.2 Describing Risk
- •28.5 Managing Risk
- •Suggested Reading
- •29 Future Considerations for Environmental and Human Health
- •29.1 Introduction
- •29.2 Risk Management
- •29.3 Risk Assessment
- •29.4 Hazard and Exposure Assessment
- •29.5 In vivo Toxicity
- •29.6 In vitro Toxicity
- •29.7 Biochemical and Molecular Toxicology
- •29.8 Development of Selective Toxicants
- •Glossary
- •Index
264 HEPATOTOXICITY
14.2SUSCEPTIBILITY OF THE LIVER
The liver, the largest organ in the body, is often the target organ for chemically induced injuries. Several important factors are known to contribute to the liver’s susceptibility. First, most xenobiotics enter the body through the gastrointestinal (GI) tract and, after absorption, are transported by the hepatic portal vein to the liver: thus the liver is the first organ perfused by chemicals that are absorbed in the gut. A second factor is the high concentration in the liver of xenobiotic metabolizing enzymes, primarily the cytochrome P450-dependent monooxygenase system. Although most biotransformations are detoxication reactions, many oxidative reactions produce reactive metabolites (Chapters 7 and 8) that can induce lesions within the liver. Often areas of damage are in the centrilobular region, and this localization has been attributed, in part, to the higher concentration of cytochrome P450 in that area of the liver.
14.3TYPES OF LIVER INJURY
The types of injury to the liver depend on the type of toxic agent, the severity of intoxication, and the type of exposure, whether acute or chronic. The main types of liver damage are discussed briefly in this section. Whereas some types of damage—for example, cholestasis—are liver specific, others such as necrosis and carcinogenesis are more general phenomena.
14.3.1Fatty Liver
Fatty liver refers to the abnormal accumulation of fat in hepatocytes. At the same time there is a decrease in plasma lipids and lipoproteins. Although many toxicants may cause lipid accumulation in the liver (Table 14.1), the mechanisms may be different. Basically lipid accumulation is related to disturbances in either the synthesis or the secretion of lipoproteins. Excess lipid can result from an oversupply of free fatty acids from adipose tissues or, more commonly, from impaired release of triglycerides from the liver into the plasma. Triglycerides are secreted from the liver as lipoproteins (very low density lipoprotein, VLDL). As might be expected, there are a number of points at which this process can be disrupted. Some of the more important ones are as follows (Figure 14.1):
žInterference with synthesis of the protein moiety
žImpaired conjugation of triglyceride with lipoprotein
žInterference with transfer of VLDL across cell membranes
žDecreased synthesis of phospholipids
žImpaired oxidation of lipids by mitochondria
žInadequate energy (adenosine triphosphate [ATP] for lipid and protein synthesis
The role that fatty liver plays in liver injury is not clearly understood, and fatty liver in itself does not necessarily mean liver dysfunction. The onset of lipid accumulation in the liver is accompanied by changes in blood biochemistry, and for this reason blood chemistry analysis can be a useful diagnostic tool.
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TYPES OF LIVER INJURY |
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Table 14.1 Examples of Hepatotoxic Agents and Associated Liver Injury |
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Necrosis and fatty liver |
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Carbon tetrachloride |
Dimethylnitrosamine |
Phosphorous |
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Chloroform |
Cyclohexamide |
Beryllium |
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Trichloroethylene |
Tetracycline |
Allyl alcohol |
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Tetrachloroethylene |
Acetaminophen |
Galactosamine |
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Bromobenzene |
Mitomycin |
Azaserine |
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Thioacetamide |
Puromycin |
Aflatoxin |
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Ethionine |
Tannic acid |
Pyrrolizidine alkaloids |
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Cholestasis (drug-induced) |
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Chlorpromazine |
Imipramine |
Carbarsone |
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Promazine |
Diazepam |
Chlorthiazide |
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Thioridazine |
Methandrolone |
Methimazole |
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Mepazine |
Mestranol |
Sulfanilamide |
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Amitriptline |
Estradiol |
Phenindione |
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Hepatitis (drug-induced) |
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Iproniazid |
Methoxyflurane |
Halothane |
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Isoniazid |
Papaverine |
Zoxazolamine |
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Imipramine |
Phenyl butazone |
Indomethacin |
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6-Mercaptopurine |
Cholchicine |
Methyldopa |
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Carcinogenesis (experimental animals) |
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Aflatoxin B1 |
Dimethylbenzanthracene |
Acetylaminofluorene |
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Pyrrolizidine alkaloids |
Dialkyl nitrosamines |
Urethane |
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Cycasin |
Polychlorinated biphenyls |
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Safrole |
Vinyl chloride |
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LIVER |
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BLOOD |
ADIPOSE TISSUE |
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Albumin Bound |
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Dietary |
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Fatty acid |
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Fat Depot |
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Triglyceride |
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Lipids |
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Free Fatty Acids |
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CO2 |
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Amino acids |
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Carbohydrate |
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Triglyceride |
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Globulin |
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Lipoprotein |
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Apoprotein |
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Recycling |
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Figure 14.1 Triglyceride cycle in the pathogenesis of fatty liver. “=” are metabolic blocks. (From S. A. Meyer, Introduction to Biochemical Toxicology, 3rd ed., Wiley, 2001.)
266 HEPATOTOXICITY
14.3.2Necrosis
Cell necrosis is a degenerative process leading to cell death. Necrosis, usually an acute injury, may be localized and affect only a few hepatocytes (focal necrosis), or it may involve an entire lobe (massive necrosis). Cell death occurs along with rupture of the plasma membrane, and is preceded by a number of morphologic changes such as cytoplasmic edema, dilation of the endoplasmic reticulum, disaggregation of polysomes, accumulation of triglycerides, swelling of mitochondria with disruption of cristae, and dissolution of organelles and nucleus. Biochemical events that may lead to these changes include binding of reactive metabolites to proteins and unsaturated lipids (inducing lipid peroxidation and subsequent membrane destruction) disturbance of cellular Ca+2 homeostasis, inference with metabolic pathways, shifts in Na+ and K+ balance, and inhibition of protein synthesis. Changes in blood chemistry resemble those seen with fatty liver, except they are quantitatively larger. Because of the regenerating capability of the liver, necrotic lesions are not necessarily critical. Massive areas of necrosis, however, can lead to severe liver damage and failure.
14.3.3Apoptosis
Apoptosis is a controlled form of cell death that serves as a regulation point for biologic processes and can be thought of as the counterpoint of cell division by mitosis. This selective mechanism is particularly active during development and senescence. Although apoptosis is a normal physiological process, it can also be induced by a number of exogenous factors, such as xenobiotic chemicals, oxidative stress, anoxia, and radiation. (A stimulus that induces a cell to undergo apoptosis is known as an apogen.) If, however, apoptosis is suppressed in some cell types, it can lead to accumulation of these cells. For example, in some instances, clonal expansion of malignant cells and subsequent tumor growth results primarily from inhibition of apoptosis.
Apoptosis can be distinguished from necrosis by morphologic criteria, using either light or electron microscopy. Toxicants, however, do not always act in a clear-cut fashion, and some toxicants can induce both apoptosis and necrosis either concurrently or sequentially.
14.3.4Cholestasis
Cholestasis is the suppression or stoppage of bile flow, and may have either intrahepatic or extrahepatic causes. Inflammation or blockage of the bile ducts results in retention of bile salts as well as bilirubin accumulation, an event that leads to jaundice. Other mechanisms causing cholestasis include changes in membranes permeability of either hepatocytes or biliary canaliculi. Cholestasis is usually drug induced (Table 14.1) and is difficult to produce in experimental animals. Again, changes in blood chemistry can be a useful diagnostic tool.
14.3.5Cirrhosis
Cirrhosis is a progressive disease that is characterized by the deposition of collagen throughout the liver. In most cases cirrhosis results from chronic chemical injury. The
TYPES OF LIVER INJURY |
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accumulation of fibrous material causes severe restriction in blood flow and in the liver’s normal metabolic and detoxication processes. This situation can in turn cause further damage and eventually lead to liver failure. In humans, chronic use of ethanol is the single most important cause of cirrhosis, although there is some dispute as to whether the effect is due to ethanol alone or is also related to the nutritional deficiencies that usually accompany alcoholism.
14.3.6Hepatitis
Hepatitis is an inflammation of the liver and is usually viral in origin; however, certain chemicals, usually drugs, can induce a hepatitis that closely resembles that produced by viral infections (Table 14.1). This type of liver injury is not usually demonstrable in laboratory animals and is often manifest only in susceptible individuals. Fortunately, the incidence of this type of disease is very low.
14.3.7Oxidative Stress
Oxidative stress has been defined as an imbalance between the prooxidant/antioxidant steady state in the cell, with the excess of prooxidants being available to interact with cellular macromolecules to cause damage to the cell, often resulting in cell death. Although the occurrence of reactive oxygen species in normal metabolism and the concept of oxidative stress was derived from these studies, it is apparent that oxidative stress can occur in almost any tissue, producing a variety of deleterious effects. To date, a number of liver diseases, including alcoholic liver disease, metal storage diseases, and cholestatic liver disease, have been shown to have an oxidative stress component.
Reactive oxygen and reactive nitrogen radicals can be formed in a number of ways (Figure 14.2), the former primarily as a by-product of mitochondrial electron transport. Superoxide, hydrogen peroxide, singlet oxygen, and hydroxyl can all arise from this source. Other sources include monooxygenases and peroxisomes. If not detoxified, reactive oxygen species can interact with biological macromolecules such as DNA and protein or with lipids. Once lipid peroxidation of unsaturated fatty acids in phospholipids is initiated, it is propagated in such a way as to have a major damaging effect on cellular membranes. The formation, detoxication by superoxide dismutase and by glutathione-dependent mechanisms, and interaction at sites of toxic action are illustrated in Figure 14.2.
14.3.8Carcinogenesis
The most common type of primary liver tumor is hepatocellular carcinoma; other types include cholangiocarcinoma, angiosarcoma, glandular carcinoma, and undifferentiated liver cell carcinoma. Although a wide variety of chemicals are known to induce liver cancer in laboratory animals (Table 14.1), the incidence of primary liver cancer in humans in the United States is very low.
Some naturally occurring liver carcinogens are aflatoxin, cycasin, and safrole. A number of synthetic chemicals have been shown to cause liver cancer in animals, including the dialkylnitrosamines, dimethylbenzanthracene, aromatic amines such as
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