The significance of bile pigment deconjugation by beta-glucuronidase in canine hyperbilirubinemia

In dogs, the differentiation between haemolytic and cholestatic hepatobiliary diseases cannot be achieved by measuring of the unconjugated:conjugated bilirubin ratio, which is in contrast with generally held clinical concepts. The overlap of the bilirubin ratios between the two groups of icterus-generating diseases might in part be explained by deconjugation of conjugated bilirubin. Enzymatic cleavage by hepatic beta-glucuronidase might result in higher unconjugated bilirubin (UCB) fractions in cholestatic disease. The influence of deconjugation of bilirubins by beta-glucuronidase was investigated in 25 healthy dogs and 35 dogs with spontaneous hyperbilirubinemia due to either hepatobiliary or haemolytic disease. UCB and its mono- and diconjugates were measured by alkaline methanolysis and HPLC in plasma and liver tissue. The activity of beta-glucuronidase was also measured in both liver and plasma. In addition, semiquantitative histochemical quantitation of bilirubins in liver tissue was performed. The concentration and the fraction of UCB in plasma of dogs with hepatobiliary disease were not significantly different from those of dogs with autoimmune haemolytic anaemia. There was a correlation between the fraction of UCB in liver and plasma of jaundiced dogs (r = 0.42, P less than 0.01) and between the histochemically estimated and the biochemically measured total bilirubin concentration in liver tissue. There was no correlation between the beta-glucuronidase activity and either unconjugated or monoconjugated bilirubin in plasma or liver of diseased animals. The fraction and the concentration of UCB in the liver of dogs with hepatic and with haemolytic disease were identical. It is concluded that beta-glucuronidase activity is not the significant factor in explaining the similar levels and fractions of UCB in dogs with hyperbilirubinemia due to either hepatobiliary or haemolytic disease.     

Pathology of the mononuclear cell leukemia of Fischer rats. III. Clinical chemistry

Serum biochemical analyses were done on F344 rats in the early and late stages of mononuclear cell leukemia. There were marked increases in serum bilirubin, alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase and alkaline phosphatase. Increases in these parameters generally were more severe in the late stages of leukemia. Both direct and indirect-reacting bilirubin were increased with the unconjugated form predominating early and the conjugated form predominating late in the course of the disease. Lactate dehydrogenase isoenzyme determination correlated with histological examination indicated that liver damage was responsible for the observed changes. Urinalysis revealed marked hemoglobinuria, bilirubinuria and increased urine urobilinogen. Serum protein electrophoresis revealed marked reductions in the alpha globulin fractions.     

Contribution of delta bilirubin to the interpretation of hyperbilirubinemia in the horse - a pilot study

A study was conducted to examine the relationship of delta bilirubin to traditional bilirubin fractions to determine if delta bilirubin might assist in differentiating causes of hyperbilirubinemia in the horse. A recently introduced thin-film method was used for delta bilirubin determination. Thin-film and the traditional diazo methods were used for determining total, unconjugated, and conjugated bilirubin fractions. Sera from 38 healthy and 85 sick horses were examined.

Thin-film serum delta bilirubin determination does not appear to assist in differentiating causes of unconjugated hyperbilirubinemia in horses. There was good correlation between thin-film and diazo-determined total bilirubin and bilirubin fractions. Only small changes in reference limits would appear to be necessary for clinical application of the thin-film bilirubin methods used in this study.

     

Hepatic Lipidosis in Anorectic, Lactating Holstein Cattle: A Retrospective Study of Serum Biochemical Abnormalities

The association between hepatic lipidosis (HL) and disease in 59 anorectic, ketotic, lactating Holstein heifers and cows was investigated. Severe HL, as determined by histologic evaluation of liver tissue, was present in 46 animals; only half of these animals required intensive treatment for ketosis, and only half had serum biochemical evidence of liver disease, as determined by the presence of a test value of 2-fold or greater than the upper limit of the reference range for at least 2 of the 4 serum tests: gamma-glutamyl transferase, aspartate aminotransferase, and sorbitol dehydrogenase activities and bile acid concentrations. Most cattle with biochemical evidence of liver disease and severe HL had been lactating for 14 or more days. Cows that required intensive treatment inconsistently had serum biochemical evidence of liver disease.
Although cattle with severe HL had significantly higher serum bilirubin concentrations and aspartate aminotransferase and sorbitol dehydrogenase activities than cattle with less severe lipidosis, the specificity of abnormally high serum sorbitol dehydrogenase activity or bilirubin concentration for severe lipidosis was only 8%. Abnormally high serum aspartate aminotransferase activity was 83% sensitive and 62% specific for severe lipidosis. Serum glucose and total carbon dioxide concentrations were significantly lower in cattle with severe lipidosis than in those with mild or moderate lipidosis, and low serum glucose or total carbon dioxide concentrations were rare in cattle without severe lipidosis. From these data, we conclude that the use of a single biochemical or histopathologic criterion to define severity of disease or degree of liver compromise in anorectic, ketotic cows results in the misidentification of many animals.     

Alkaline phosphatase: beyond the liver

The alkaline phosphatases comprise a heterogeneous group of enzymes that are widely distributed in mammalian cells. They often are associated with cell membranes, but their exact physiologic function is unknown. Despite this, alkaline phosphatase activity is a very useful serum biochemical indicator of liver disease, particularly cholestatic disease. However, increases in the activity of alkaline phosphatase in serum and other body fluids may reflect physiologic or pathologic changes beyond those of hepatic origin. For example, nonhepatic increases in serum alkaline phosphatase activity are found in young animals, in pregnant and lactating females, and in association with high fat diets. Bone disease, endocrine disease, neoplasia, and other disorders can result in increased alkaline phosphatase activity. In addition, alkaline phosphatase activity may be increased due to induction by certain drugs such as glucocorticoids and anticonvulsants. In this article, we will review the physiologic and pathologic factors influencing the activity of alkaline phosphatase in serum and other body fluids, with an emphasis on disorders beyond liver disease.     

Bile acid concentrations in the diagnosis of hepatobiliary disease in the cat

The clinical usefulness of measuring serum bile acid concentrations as a diagnostic test for hepatobiliary disease was examined in 80 cats that were suspected of having hepatic disease. Serum values of total bilirubin, alkaline phosphatase (ALP), alanine transaminase (ALT), and aspartate transaminase (AST) also were measured. Fasting serum bile acid values were determined by use of solid-phase radioimmunoassay for total conjugated bile acids or by a direct enzymatic spectrophotometric method. A definitive diagnosis was established by histologic examination of the liver, and on the basis of these findings, cats were assigned to groups (1 to 8, respectively) including: extrahepatic bile duct obstruction, hepatic lipidosis, cirrhosis, intrahepatic cholestasis (cholangiohepatitis, cholangitis), neoplasia, hepatic necrosis, portosystemic vascular anomalies, and miscellaneous. Cats in group 8 had no morphologic evidence of hepatobiliary disease or had hepatic lesions that were mild. Test efficacy of fasting serum bile acids, total bilirubin, ALP, ALT, and AST were expressed by use of 4 indices: sensitivity, specificity, positive predictive value, and negative predictive value. The diagnostic efficacy of fasting serum bile acids was examined alone and in combinations with the other tests. There was wide overlapping of values of fasting serum bile acids, total bilirubin, ALP, ALT, and AST among cats in groups 1 to 7. The specificity of fasting serum bile acids for the diagnosis of hepatic disease exceeded 90% at values greater than or equal to 5 mumol/L and reached 100% at greater than or equal to 15 mumol/L.(ABSTRACT TRUNCATED AT 250 WORDS)     

Alterations in Coagulation Profiles and Biochemical and Haematological Parameters in Cattle with Traumatic Reticuloperitonitis

This study was designed to investigate alterations in coagulation, and in biochemical and haematological parameters in cattle with traumatic reticuloperitonitis (TRP). In the study, 28 dairy cattle with TRP and 10 clinically healthy cattle (control) of different ages and breeds were used. Cattle with TRP had prolonged prothrombin time (PT), thrombin time (TT) and activated partial thromboplastin time (APTT). Erythrocytopenia, thrombocytopenia and hyperfibrinogenaemia were detected in animals with TRP. Furthermore, the serum concentrations of total protein, globulin and total bilirubin, and the activities of alkaline phosphatase (ALP) and aspartate aminotransferase (AST) were also high in cattle with TRP compared to those of the control group. The serum concentrations of calcium were significantly low in the TRP group. The results of this study, therefore, indicate that TRP causes significant coagulation abnormalities and biochemical and haematological alterations in dairy cattle.     

Bovine brucellosis: evaluation of field sera by a competitive and superimposable ELISA utilising a monoclonal antibody against Brucella abortus lipopolysaccharide

With the aid of a horseradish peroxidase (HRP) tagged monoclonal antibody against smooth lipopolysaccharide from Brucella abortus (Bruce 1), a competitive and superimposable ELISA test procedure for bovine brucellosis has been evaluated for its ability to discriminate between Strain 19-vaccinated (S19-Vacc) and Biotype 1-infected (B1-Inf) cattle. In the competitive assay, all sera from S19-Vacc animals competed effectively against HRP-Bruce 1 (low HRP activity), while 10 out of 40 B1-Inf animals competed less effectively with Bruce 1 (high HRP activity). Successful competition by cattle antibodies would result in an increased proportion of cattle Igs binding to the assay antigen. This was confirmed by superimposing an alkaline phosphatase conjugated rabbit anti-cattle Ig after the competitive ELISA had been completed. With the superimposable assay, alkaline phosphatase activity was correspondingly high for S19-Vacc animals, and low for 36 out of 40 B1-Inf animals. The superimposable ELISA had therefore improved the discriminatory capabilities of the assay procedure from 75% to 90%.     

Bilirubin metabolism in canine hepatobiliary and haemolytic disease

The kinetics of unconjugated 3H-bilirubin are described in 25 healthy dogs and 35 dogs with spontaneous hepatobiliary or haemolytic disease, using a two-compartment model. The bilirubin production rates from erythrocyte degradation (PE), ineffective erythropoiesis (PI) and catabolism of hepatic haemoproteins (PL), were derived from the incorporation of 14C-glycine into haemoglobin and stercobilin. These combined measurements permitted an integral survey of bilirubin metabolism in health and disease. The concentration of unconjugated bilirubin in plasma and its fraction of total bilirubin levels were similar in hepatic and haemolytic disorders. This was explained by the highly increased bilirubin production rates in both types of disease. In addition, the hepatic bilirubin clearance was severely impaired in fulminant hepatitis and in cirrhosis, and moderately decreased in the other hepatobiliary diseases and in primary haemolysis. The erythrocyte lifespan was reduced in all animals but one. In addition to haemolysis, the contribution of PI and PL was variable, and in two dogs PL was the principle source of highly increased bilirubin production rates. These data indicate that the concentration of unconjugated bilirubin in plasma or its fraction of total pigments is unreliable in the discrimination of canine hepatobiliary disease from haemolytic disorders.     

Hepatic enzyme changes in bovine hepatogenous photosensitivity caused by water-damaged alfalfa hay

In the winter of 1983, practitioners reported extensive photosensitization in 7 herds of cattle. All herds had a history of having been fed water-damaged alfalfa hay. A cow from one herd was referred to the veterinary teaching hospital at Oklahoma State University. In this herd of approximately 40 adult Polled Herefords, all cattle had had some degree of clinical involvement over the past 4 to 6 weeks. Clinical signs included scaling and erythema of sparsely haired skin, muzzle, and teats, as well as icterus, anorexia, and weight loss. One cow died, and the remaining cattle recovered over an 8- to 10-week period after removal of the hay from the ration. In the referred cow, values for total and conjugated bilirubin, BUN, creatinine, sorbitol dehydrogenase, serum alkaline phosphatase, serum aspartate transaminase, and serum gamma-glutamyl transferase were higher than normal. In the herd of origin, extremely high serum gamma-glutamyl transferase values (180 to 1,400 IU/L) persisted (normal, 2 to 35 IU/L). Feeding the same alfalfa hay to 2 clinically normal cows reproduced the syndrome. The characteristic hepatic lesion was bile duct necrosis, with secondary bile duct hyperplasia.     

Covalently protein-bound bilirubin conjugates in cholestatic disease of dogs

We investigated the occurrence of covalently protein-bound bilirubins in the plasma of dogs with hyperbilirubinemia attributable to hepatobiliary diseases or Coombs test-positive hemolysis. The bilirubins in plasma were measured with the conventional Van den Bergh reaction, by treatment with diazotized p-iodoaniline, and by high-performance liquid chromatography of bilirubin and its methylesters after alkaline methanolysis. All but one dog had covalently protein-bound bilirubin conjugates. The concentration and the fraction of total bilirubins varied in all diseases investigated, but they tended to be low in primary hemolysis. The "biliprotein" complex accounted for 2 to 94% of total plasma bilirubins. Because biliprotein usually is not cleared by the liver, but has a half-life comparable with that of albumin, it prevents the evaluation of the actual state of the underlying disease. Measurement of the total bilirubin concentration exclusively with the Van den Bergh reaction, therefore, is clinically useless. Other methods should be introduced for routine bilirubin assays, permitting the measurement of noncovalently bound pigment as a meaningful estimate of the course of the disease.     

Toxic hepatic failure in newborn foals

Eight foals, 2 to 5 days of age, with similar clinical signs and laboratory and pathologic findings, died from hepatic failure. The predominant clinical signs were depression and icterus. Abnormally high values were found for plasma ammonia content, aromatic-to-branch-chain amino acid ratio, total serum bilirubin content, gamma glutamyl transferase activity, alkaline phosphatase activity, and PCV; partial thromboplastin time and prothrombin time were prolonged. Some foals had high sorbitol dehydrogenase activity. These laboratory findings were suggestive of subacute hepatic disease and failure. Predominant pathologic findings were limited to the liver and brain. The livers were less than half the expected size for 2- to 5-day-old foals, had prominent bile ductule proliferation, hepatic cell necrosis, and mild periportal fibrosis. These findings suggested both prenatal and postnatal diseases caused by exposure to a hepatoxin. The predominant lesion in the brain was the presence of Alzheimer type II astrocytes, which are characteristic of hepatoencephalopathy. Although the periportal fibrosis was suggestive of in utero exposure to a toxin, epidemiologic information suggested that the hepatic failure more likely resulted from oral inoculation of a microorganism culture product at birth. The same disease was reproduced in 2 newborn foals by feeding this product.     

Clinicopathologic study of horses surviving pyrrolizidine alkaloid (Senecio vulgaris) toxicosis

Twenty horses of various ages had inadvertently ingested alfalfa hay contaminated with Senecio vulgaris. Among them, 4 died of liver disease. Blood was collected from affected horses at monthly intervals for 7 months and at the 9th and 14th months. The following serum enzymes and chemical items were assayed: aspartate aminotransferase, lactate dehydrogenase, alkaline phosphatase, gamma-glutamyl transferase, sorbitol dehydrogenase, total bilirubin, BUN, glucose, cholesterol, inorganic phosphate, calcium, total protein, and albumin. Amino acid profiles, conjugated bile acids, sulfobromophthalein clearance times, and liver histopathologic changes via serial biopsies were also monitored. Liver histopathologic changes revealed lesions progressively increasing in severity. Aspartate aminotransferase and plasma amino acid ratios indicated chronic liver degeneration (0.05 level of significance). gamma-Glutamyl transferase and lactate dehydrogenase as well as BUN values fluctuated, but returned to within reference values. Horses appeared clinically normal 14 months after intoxication, but were unable to tolerate stress of exercise.     

Enzymes Sériques pour le Diagnostic de la Nécrose Hépatique Aigüe Expérimentale

The activity of certain serum enzymes ornithine carbamyl transferase (OCT), serum isocitric dehydrogenase (SIC-D), total serum lactic dehydrogenase (LDH) and its isoenzymes (LD₁ and LD₅) was evaluated as a mean of assessing experimental hepatic necrosis on dogs treated with CCl₄. Measurement of activity levels of these enzymes, seldom carried out in veterinary clinical pathology, was made together with tests commonly used in our laboratories: serum glutamic pyruvic transaminase (SGPT), serum glutamic oxalacetic transaminase (SGOT) and serum alkaline phosphatase (SAP), cholesterol, bilirubin and prothrombin time. Measurement of the level of OCT was useful in the diagnosis of liver necrosis. The SIC-D level was important during the first four days of the experiment, but on subsequent days, the enzymatic activity was practically normal. Because of the wide variations of LDH serum levels in normal animals and since many factors influence its activity, the measurement of this enzyme and its isoenzymes was not a good index in the diagnosis of canine liver necrosis. The evaluation of cholesterol and bilirubin was judged of secondary importance because these metabolites are not specific to hepatic problems.     

Hepatobiliary transport of indocyanine green and sulfobromophthalein in fed and fasted horses

Fasting is associated with unconjugated hyperbilirubinemia in several species, including the horse. Studies in ponies showed that a 3-day fast decreased plasma clearance of bilirubin, cholic acid, and sulfobromophthalein (BSP). Since these organic anions are conjugated with different substrates, it is possible that observed differences in plasma clearance result from a general decrease in hepatic conjugating capacity during the animals' fasting. To test this hypothesis, the effects of a 3-day fast on plasma clearance of IV injected BSP (4.4 to 5.1 mg/kg), which is conjugated to glutathione, and indocyanine green (ICG; 0.8 to 1.1 mg/kg), which is not conjugated, were studied in 10 healthy horses and 2 ponies with diverted enterohepatic circulations (indwelling T tubes). Blood samples were obtained for 30 minutes after injection, and bile samples from ponies were obtained for 3 hours. Fasting increased plasma bilirubin concentration in all animals studied (from 1.03 +/- 0.337 mg/dl in control animals to 3.49 +/- 1.01 mg/dl in fasted animals). Kinetic values of ICG disappearance were determined from single exponential functions, and those for BSP were determined from both single and curvilinear (2-exponential) functions. Plasma clearance of BSP in fed horses (8.65 +/- 1.02 ml X min-1 X kg-1) was greater than clearance of ICG (3.54 +/- 0.67 ml X min-1 X kg-1), results similar to those reported in dogs, cats, rats, and persons. Fasting significantly decreased fractional plasma disappearance rate of both BSP (-36%) and ICG (-58%) and similarly reduced plasma clearance (BSP,-48%; ICG,-55%).(ABSTRACT TRUNCATED AT 250 WORDS)     

Bilirubin metabolism in canine hepatobiliary and haemolytic disease

Summary

The kinetics of unconjugated ₃H‐bilirubin are described in 25 healthy dogs and 35 dogs with spontaneous hepatobiliary or haemolytic disease, using a two‐compartment model. The bilirubin production rates from erythrocyte degradation (P_E), ineffective erythropoiesis (P_I) and catabolism of hepatic haemoproteins (P_I), were derived from the incorporation of ¹⁴C‐glycine into haemoglobin and stercobilin. These combined measurements permitted an integral survey of bilirubin metabolism in health and disease. The concentration of unconjugated bilirubin in plasma and its of total bilirubin levels were similar in hepatic and haemolytic disorders.

This was explained by the highly increased bilirubin production rates in both types of disease. In addition, the hepatic bilirubin clearance was severely impaired in fulminant hepatitis and in cirrhosis, and moderately decreased in the other hepatobiliary diseases and in primary haemolysis. The erythrocyte lifespan was reduced in all animals but one. In addition to haemolysis, the contribution of P_I and P_L was variable, and in two dogs P_L was the principle source of highly increased bilirubin production rates. These data indicate that the concentration of unconjugated bilirubin in plasma or its fraction of total pigments is unreliable in the discrimination of canine hepatobiliary disease from haemolytic disorders.     

Liver biochemical and histopathological findings in dogs with experimentally induced exocrine pancreatic insufficiency

Routine liver biochemical parameters were evaluated in 8 dogs with exocrine pancreatic insufficiency (EPI) induced by surgical ligation of the pancreatic duct and the pancreatic branch of the pancreaticoduodenal artery and confirmed with the trypsin-like immunoreactivity test. Eight additional dogs were used as healthy controls. Data collection began at the 4th week postoperatively and continued weekly to the 21st week. In the dogs with EPI, the serum activity of alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase were consistently elevated. The serum total and conjugated bilirubin concentrations remained within normal limits throughout the experimental period. Histopathological study revealed hepatic lipidosis in the dogs with EPI. Therefore, since this condition seems to be an additional consequence of EPI in dogs, laboratory evaluation of dogs with EPI must include assessment of liver function, to determine if additional or different therapeutic measures are indicated.     

Diagnostic use of serum gamma-glutamyltransferase in canine liver disease.

gamma-Glutamyltransferase (GGT) activity in canine kidney, pancreas, and liver is similar to previously reported values for other species. The low serum GGT activity in dogs (0 to 10 IU/L) may be related to relatively less liver GGT than in some other domestic animals. While determination of serum GGT in dogs may aid in the differentiation of sources of alkaline phosphatase, GGT alone appears to offer little in the diagnosis of canine liver disease. Clinical studies, as well as experimentally induced bile duct obstruction, have shown canine GGT increases to coincide with increases in alkaline phosphatase. The occasional benefit from knowledge of serum GGT in dogs would not seem to merit determination of GGT activity in routine serum chemistry panels for this species.     

The effects of Ehrlichia (Cytoecetes) phagocytophila on the clinical chemistry of sheep and goats

Tick-borne fever (TBF) is a rickettsial disease of domestic and wild ruminants in temperate climates where the hard tick Ixodes ricinus is present. The disease is characterized by a high temperature and severe leukopenia. In the present study, the effects of TBF on the activity of serum alkaline phosphatase (ALP), and on the concentrations of plasma zinc, iron, total bilirubin, urea, creatinine and albumin were investigated by inoculating one group of eight sheep and one group of eight goats with the Old Sourhope (OS) strain of Ehrlichia (Cytoecetes) phagocytophila. All goats and sheep experimentally infected with E. phagocytophila reacted with fever, rickettsiaemia and leukopenia. The leukopenia was due to an acute lymphocytopenia and prolonged neutropenia. In both groups of animals. TBF was characterized by significant reductions in the activities of serum ALP and concentrations of plasma zinc, iron and albumin. However, there were significant increases in the concentrations of plasma total bilirubin, urea and creatinine in both species of animals. The reductions in ALP and iron were significantly more pronounced in sheep than in goats.     

Effects of long-term primidone and phenytoin administration on canine hepatic function and morphology

Primidone, phenytoin, or phenytoin and primidone in combination were given to healthy Beagle dogs for 6 months. Serum biochemical changes in dogs given primidone alone or phenytoin and primidone in combination for the entire 6-month test period included increased activities of alanine aminotransferase, alkaline phosphatase (AP), and gamma-glutamyltransferase, and decreased concentrations of albumin and cholesterol. Changes in dogs given phenytoin alone were limited to increased AP activity and decreased albumin concentration. Sulfobromophthalein excretion and conjugated bile acid concentration were within normal limits. All dogs given primidone alone or phenytoin alone remained clinically healthy throughout the treatment period. Three of 8 dogs given both drugs in combination became clinically ill after 9, 14, and 15 weeks of treatment, and were euthanatized. Two of the dogs developed clinical jaundice. In addition to the serum biochemical abnormalities observed in clinically healthy dogs, these dogs developed hyperbilirubinemia, delayed sulfobromophthalein excretion, and increased conjugated bile acid concentrations. Histologic examination of the liver showed intracanalicular casts of bile pigment typical of intrahepatic cholestasis in all 3 dogs. Histologic findings characteristic of treated dogs included hepatocellular hypertrophy attributable to hyperplasia of the smooth endoplasmic reticulum. Single-cell necrosis and multifocal lipidosis were observed in individuals of all treatment groups. Electron microscopy of the liver showed dilated bile canaliculi and damaged sinusoidal epithelium in dogs given both drugs. The elevated serum AP activity, associated with anticonvulsant drug therapy, was found to be exclusively the liver isoenzyme by cellulose acetate electrophoresis. The hepatic AP was localized to primarily the canalicular membranes by enzyme histochemistry. There was a statistically significant positive correlation between the AP activities of liver and serum. The results of this study indicate that long-term administration of anticonvulsant drugs to dogs is associated with clinical, serum biochemical, and histologic evidence of hepatic dysfunction. High drug dosage contributed most to abnormal serum biochemical test results, and combining phenytoin with primidone was responsible for more severe electron microscopic lesions of the liver of surviving dogs and for the death of 3 dogs.