Molecular mechanisms of hepatotoxic cholestasis by clavulanic acid: Role of NRF2 and FXR pathways.

Treatment of ß-lactamase positive bacterial infections with a combination of amoxicillin (AMOX) and clavulanic acid (CLAV) causes idiosyncratic drug-induced liver injury (iDILI) in a relevant number of patients, often with features of intrahepatic cholestasis. This study aims to determine serum bile acid (BA) levels in amoxicillin/clavulanate (A+C)-iDILI patients and to investigate the mechanism of cholestasis by A+C in human in vitro hepatic models. In six A+C-iDILI patients, significant elevations of serum primary conjugated BA definitely demonstrated A+C-induced cholestasis. In cultured human Upcyte hepatocytes and HepG2 cells, CLAV was more cytotoxic than AMOX, and, at subcytotoxic concentrations, it altered the expression of more than 1,300 genes. CLAV, but not AMOX, downregulated the expression of key genes for BA transport (BSEP, NTCP, OSTα and MDR2) and synthesis (CYP7A1 and CYP8B1). CLAV also caused early oxidative stress, with reduced GSH/GSSG ratio, along with induction of antioxidant nuclear factor erythroid 2-related factor 2 (NRF2) target genes. Activation of NRF2 by sulforaphane also resulted in downregulation of NTCP, OSTα, ABCG5, CYP7A1 and CYP8B1. CLAV also inhibited the BA-sensor farnesoid X receptor (FXR), in agreement with the downregulation of FXR targets BSEP, OSTα and ABCG5. We conclude that CLAV, the culprit molecule in A+C, downregulates several key biliary transporters by modulating NRF2 and FXR signaling, thus likely promoting intrahepatic cholestasis. On top of that, increased ROS production and GSH depletion may aggravate the cholestatic injury by A+C.

Antibiotic Abuse Induced Histopathological and Neurobehavioral Disorders in Mice.

INTRODUCTION: Antibiotic abuse is a common phenomenon in Egypt as medications are prescribed without supervision. It is suggested that the excess use of antibiotics modifies the gut microbiota and plays a role in the development of neurological and psychiatric disorders. OBJECTIVE: The aim of the present study was to use bulb-c mice as models for curam (amoxicillin /clavulanic acid) abuse compared to the locally acting neomycin model, then restoring the probiotic balance to look at the possible effects on the animal brains. METHODS: The results showed early excitable brains demonstrated by S100b immunohistochemistry in both cortexes and hippocampuses of neomycin-treated mice. Staining with PAS stain showed no suggested neurodegenerative changes. Treatment with probiotics improved the S100b immunohistochemistry profile of the curam group partially but failed to overcome the neuroinflammatory reaction detected by hematoxylin and eosin stain. Curam was possibly blamed for the systemic effects. RESULTS: The neurobehavioral tests showed delayed impairment in the open field test for the curam group and impaired new object recognition for the neomycin group. These tests were applied by video recording. The neurobehavioral decline developed 14 days after the end of the 3-week antibiotic course. Unfortunately, curam abuse induced animal fatalities. CONCLUSION: Antibiotic abuse has a neurotoxic effect that works by both local and more prominent systemic mechanisms. It can be said that antibiotic abuse is a cofactor behind the rise of neuropsychiatric diseases in Egypt.

Paciente con fracaso hepático agudo tras toma de Amoxicilina-Acido Clavulánico / Patient with acute hepatic failure after taking Amoxicillin-Clavulanic acid

La amoxiclina-clavulánico es un antibiótico muy utilizado en la práctica clínica para el tratamiento de infecciones de origen bacteriano, debido a su amplio espectro y buena tolerancia. Presentamos el caso de un paciente que sufrió un fracaso hepático agudo como efecto secundario a la toma de dicho fármaco. Consideramos oportuna la comunicación de este caso por la gran frecuencia de utilización de este antibiótico y su potencial toxicidad hepática (AU)

The amoxicillin-clavulanic acid combination is an antibiotic commonly used in clinical practice for the treatment of infections of bacterial origin, due to its wide spectrum and good tolerability. We report a case of acute hepatic failure secondary to the use of amoxicillin-clavulanic acid. Although hepatotoxicity is a rare adverse effect of this antibiotic, due to the drug’s high frequency of use we consider this case should be reported (AU)

Combined chemical and biological oxidation of penicillin formulation effluent.

Antibiotic formulation effluent is well known for its important contribution to environmental pollution due to its fluctuating and recalcitrant nature. In the present study, the chemical treatability of penicillin formulation effluent (average filtered COD(o)=830 mg/l; average soluble COD(o)=615 mg/l; pH(o)=6.9) bearing the active substances penicillin Amoxicillin Trihydrate (C(16)H(19)N(3)O(5)S.3H(2)O) and the beta-lactamase inhibitor Potassium Clavulanate (C(8)H(8)KNO(5)) has been investigated. For this purpose, the penicillin formulation effluent was subjected to ozonation (applied ozone dose=2500 mg/(lxh)) at varying pH (2.5-12.0) and O(3)+H(2)O(2) (perozonation) at different initial H(2)O(2) concentrations (=2-40 mM) and pH 10.5. According to the experimental results, the overall Chemical Oxygen Demand (COD) removal efficiency varied between 10 and 56% for ozonation and 30% (no H(2)O(2)) and 83% (20 mM H(2)O(2)) for the O(3)+H(2)O(2) process. The addition of H(2)O(2) improved the COD removal rates considerably even at the lowest studied H(2)O(2) concentration. An optimum H(2)O(2) concentration of 20 mM existed at which the highest COD removal efficiency and abatement kinetics were obtained. The ozone absorption rate ranged between 53% (ozonation) and 68% (perozonation). An ozone input of 800 mg/l in 20 min was sufficient to achieve the highest BOD(5)/COD (biodegradability) ratio (=0.45) and BOD(5) value (109 mg/l) for the pre-treated penicillin formulation effluent. After the establishment of optimum ozonation and perozonation conditions, mixtures of synthetic domestic wastewater+raw, ozonated and perozonated penicillin formulation effluent were subjected to biological activated sludge treatment at a food-to-microorganisms (F/M) ratio of 0.23 mg COD/(mg MLSSxd), using a consortium of acclimated microorganisms. COD removal efficiencies of the activated sludge process were 71, 81 and 72% for pharmaceutical wastewater containing synthetic domestic wastewater mixed with either raw, ozonated or perozonated formulation effluent, respectively. The ultimate COD value obtained after 24-h biotreatment of the synthetic domestic wastewater+pre-ozonated formulation effluent mixture was around 100 mg/l instead of 180 mg/l which was the final COD obtained for the wastewater mixture containing raw formulation effluent, indicating that pre-ozonation at least partially removed the non-biodegradable COD fraction of the formulation effluent.