title: Extracorporal albumin dialysis (MARS) improves cholestasis and normalizes low apo A-I levels in a patient with benign recurrent intrahepatic cholestasis (BRIC).
abstract: The familial cholestatic diseases Benign Recurrent Intrahepatic Cholestasis (BRIC) and Progessive Familial Intrahepatic Cholestasis type 1 (PFIC1) are characterized by intermittent or permanently elevated plasma bile salt levels, therapy-resistant extreme pruritus and peculiar biochemical abnormalities including low apolipoprotein apo A-I. Previously, symptomatic improvement has been demonstrated in BRIC patients after extracorporal albumin dialysis (MARS). We hypothesized that MARS improves cholestasis, induces changes in the bile salt profile and normalizes apo A-I serum levels in BRIC. A 17-year-old-female patient with BRIC experienced an episode of cholestasis lasting for more than 6 months with extreme pruritus and diarrhoea not responding to standard therapy. During a period of five days the patient was treated 3 x 8 h with MARS. The procedures were well tolerated and resulted in reduction of plasma bile salts by 58%. The plasma bile salt profile changed into a more hydrophilic composition after MARS. Diarrhoea discontinued and the pruritus improved significantly from 9 to 4 on a subjective scale. These effects lasted 4 months until a relapse occurred. Low plasma apo A-I levels (0.52 g/l) normalized after MARS (0.98 g/l). The procedures were well tolerated. Fatigue was noted as the only transient side-effect. In conclusion, MARS may induce a long-term symptomatic improvement and decrease of cholestatic markers in BRIC. Further studies evaluating efficacy and mechanism of MARS in patients with BRIC are needed.
authors.affiliation: Center for Liver, Digestive and Metabolic Diseases, Department of Pediatrics, University Hospital Groningen, The Netherlands. e.surm@bkk.azg.nl
authors.forename: E
authors.initials: E
authors.lastname: Sturm
authors.forename: C F M
authors.initials: CF
authors.lastname: Franssen
authors.forename: A
authors.initials: A
authors.lastname: Gouw
authors.forename: B
authors.initials: B
authors.lastname: Staels
authors.forename: R
authors.initials: R
authors.lastname: Boverhof
authors.forename: R J
authors.initials: RJ
authors.lastname: De Knegt
authors.forename: F
authors.initials: F
authors.lastname: Stellaard
authors.forename: C M A
authors.initials: CM
authors.lastname: Bijleveld
authors.forename: F
authors.initials: F
authors.lastname: Kuipers
mesh_terms: D000293:Adolescent; D016632:Apolipoprotein A-I / Q000097:blood*; D001647:Bile Acids and Salts / Q000097:blood; D002780:Cholestasis, Intrahepatic / Q000097:blood / Q000628:therapy*; D005260:Female; D006801:Humans; D011537:Pruritus / Q000097:blood / Q000628:therapy; D012008:Recurrence; D006435:Renal Dialysis; D012709:Serum Albumin / Q000378:metabolism; D016060:Sorption Detoxification
chemical_list: D016632:Apolipoprotein A-I; D001647:Bile Acids and Salts; D012709:Serum Albumin