Cells of Monocytic Origin as Surrogate Markers for Individual Drug Effects and Hepatotoxicity

Study Overview
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Brief Summary
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Drug metabolism in the liver is subject to large fluctuations (differences between women and men, people of different ethnic backgrounds, children and adults). These large differences are responsible for very different drug effects and side-effects (and especially liver damage caused by drugs) between individuals. Recent scientific findings suggest that blood derived cells can be used to model individual effects of drugs on the liver reflect inter-individual differences. Since liver damage caused by drugs is a diagnosis of exclusion, the aforementioned cells can be used to identify patients that show higher sensitivity to hepatotoxic side-effects and - in case several drugs are involved - identify the causal agent or possible interactions.

Detailed Description
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Drug-induced liver injury (DILI), especially its idiosyncratic for is often an unpredictable complication of drug therapy. Until now it is very challenging to predict occurrence, severity and outcome of DILI. Previous data provide evidence that cells from peripheral blood may reflect hepatocellular damage (Fannin RD, Hepatology. 2010). Own research could show that peripheral monocytes are capable to obtain several hepatocyte-like functions while maintaining individual characteristics of the donor, especially cytochrome P450 metabolism (Benesic, Gerbes, et al, Lab Invest 2012). This study investigates the effects of potentially hepatotoxic drugs on cells generated from patient blood in comparison to the clinical presentation. Its aim is the evaluation of in vitro tests using monocyte derived cells for diagnosis and exclusion of DILI and the potential to use the patient derived-cells for mechanistic investigations of DILI. 4 groups are investigated: 1) donors without liver disease 2) patients who will start a therapy with DILI-potential; 3) DILI patients; 4) patients with liver injuries other than DILI. Patient history and clinical data are obtained and a single blood sample will be collected after informed consent.

Official Title
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Cells of Monocytic Origin as Surrogate Markers for Individual Drug Effects and Hepatotoxicity

Conditions
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Drug-induced Disorder of Liver, Adverse Reaction to Drug

Intervention / Treatment
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* Procedure: Blood sampling


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age ≥ 2 years Informed consent given by the patient or in case of inability to give informed consent informed consent of the legally nominated consultee Exclusion Criteria: Anemia requiring blood transfusion acute or chronic hepatitis B, C or human immunodeficiency virus infection lack of informed consent

Ages Eligible for Study
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Minimum Age: 2 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| healthy<br>donors/patients without liver disease, with and without ongoing drug therapy including buffy coat samples of healthy blood / thrombocyte donors. After pseudonymisation a detailed history and clinical data are obtained and blood sampling will be performed . Buffy coats are obtained anonymously. | Procedure: Blood sampling<br>* In each group a blood sample of approximately 50 mL will be obtained upon study inclusion.<br>|
| prior to therapy<br>History will be obtained and blood sampling will be performed in patients in whom a drug therapy with a drug with DILI potential is planned. | Procedure: Blood sampling<br>* In each group a blood sample of approximately 50 mL will be obtained upon study inclusion.<br>|
| iDILI<br>Patients with clinical suspicion of idiosyncratic drug-induced liver injury. After pseudonymisation a detailed history and clinical data are obtained and blood sampling will be performed. | Procedure: Blood sampling<br>* In each group a blood sample of approximately 50 mL will be obtained upon study inclusion.<br>|
| non DILI<br>Patients with other forms of liver injury. After pseudonymisation a detailed history and clinical data are obtained and blood sampling will be performed. | Procedure: Blood sampling<br>* In each group a blood sample of approximately 50 mL will be obtained upon study inclusion.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Reflection of individual drug hepatotoxicity in monocyte derived cells | After blood sampling, monocyte derived cells will be generated and tested in vitro for the respective compounds in short term and up to 4 weeks. If possible, the patient will have a clinical follow up during routine care to assess liver injury , course and outcome of the disease when applicable. | 12 months |