title: Plasma elimination of cholyl-lysyl-fluorescein (CLF): a pilot study in patients with liver cirrhosis.
abstract: BACKGROUND
  Cholyl-lysyl-fluorescein (CLF) is a fluorescein-labelled bile acid whose biological behaviour closely resembles that of naturally occurring cholyl glycine.
  
  
  OBJECTIVE
  The aim of this study was to analyze the CLF plasma elimination in patients with liver cirrhosis.
  
  
  METHODS
  A dose of CLF at 0.02 mg/kg b.w. was administered i.v. in 26 patients with liver cirrhosis and 9 healthy volunteers. Blood samples were collected before injection and then at 10 min intervals over 60 min. Plasma fluorescence was measured by a luminescence spectrometer and residual fluorescence over the time of the study was compared in each group. Routine liver function tests (rLFTs) were performed before each injection.
  
  
  RESULTS
  Plasma elimination of CLF was significantly impaired in patients with cirrhosis compared to healthy subjects with p values <0.0001 at each analyzed time point. CLF test showed 100% sensitivity for liver cirrhosis when residual fluorescence was measured 30, 40, 50 and 60 min after injection. Routine LFTs showed 85% sensitivity for bilirubin, 84% for total bile acids, 69% for aspartate aminotransferase 62% for albumin and 50% for alkaline phosphatase. CLF elimination measured 60 min after injection correlated with Child-Pugh score (r=0.3945; p<0.05) and albumin (rs=0.6451; p<0.001). No adverse reaction or side effects of CLF were observed.
  
  
  CONCLUSIONS
  CLF test clearly distinguished between the two analyzed groups and was more sensitive than routine liver function tests. The test appears safe, simple to perform and analyze and after validation in larger cohorts of patients may have the potential to become a useful dynamic test of liver function.
authors.affiliation: Liver and Hepatobiliary Unit, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom.
authors.forename: P
authors.initials: P
authors.lastname: Milkiewicz
authors.forename: S
authors.initials: S
authors.lastname: Saksena
authors.forename: T
authors.initials: T
authors.lastname: Cardenas
authors.forename: C O
authors.initials: CO
authors.lastname: Mills
authors.forename: E
authors.initials: E
authors.lastname: Elias
mesh_terms: D000328:Adult; D002793:Cholic Acids / Q000008:administration & dosage / Q000493:pharmacokinetics*; D005260:Female; D005452:Fluoresceins / Q000008:administration & dosage / Q000493:pharmacokinetics*; D005456:Fluorescent Dyes / Q000008:administration & dosage / Q000493:pharmacokinetics*; D006801:Humans; D007275:Injections, Intravenous; D008099:Liver / Q000378:metabolism / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000378:metabolism*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012016:Reference Values; D012680:Sensitivity and Specificity
chemical_list: D002793:Cholic Acids; D005452:Fluoresceins; D005456:Fluorescent Dyes; C072313:cholyl-lysylfluorescein