title: Reduced aluminum contamination decreases parenteral nutrition associated liver injury.
abstract: OBJECTIVE
  Parenteral nutrition-associated cholestasis remains a significant problem, especially for the surgical neonates. Aluminum is a toxic element known to contaminate parenteral nutrition. We hypothesize that parenterally administered aluminum causes liver injury similar to that seen in parenteral nutrition-associated cholestasis.
  
  
  METHODS
  Twenty 3- to 6-day-old domestic pigs were divided into 5 equal groups. A control group received daily intravenous 0.9% NaCl. Each subject in experimental groups received intravenous aluminum chloride at 1500 μg kg(-1) d(-1) for 1, 2, 3, or 4 weeks. At the end of the study, blood was sampled for direct bilirubin and total bile acid levels. Liver, bile, and urine were sampled for aluminum content. Liver tissue was imaged by transmission electron microscopy for ultrastructural changes.
  
  
  RESULTS
  Transmission electron microscopy revealed marked blunting of bile canaliculi microvilli in all experimental subjects but not the controls. Serum total bile acids correlated with the duration of aluminum exposure. The hepatic aluminum concentration correlated with the duration of aluminum exposure.
  
  
  CONCLUSIONS
  Parenterally infused aluminum resulted in liver injury as demonstrated by elevated bile acids and by blunting of the bile canaliculi microvilli. These findings are similar to those reported in early parenteral nutrition-associated liver disease.
authors.affiliation: Division of Nutrition and Dietetics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
authors.forename: Abdulla
authors.initials: A
authors.lastname: Alemmari
authors.forename: Grant G
authors.initials: GG
authors.lastname: Miller
authors.forename: Robert F
authors.initials: RF
authors.lastname: Bertolo
authors.forename: Chandani
authors.initials: C
authors.lastname: Dinesh
authors.forename: Janet A
authors.initials: JA
authors.lastname: Brunton
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Arnold
authors.forename: Gord A
authors.initials: GA
authors.lastname: Zello
mesh_terms: D000077410:Aluminum Chloride; D017607:Aluminum Compounds / Q000008:administration & dosage / Q000009:adverse effects* / Q000032:analysis; D000818:Animals; D001647:Bile Acids and Salts / Q000097:blood; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D056486:Chemical and Drug Induced Liver Injury / Q000097:blood / Q000473:pathology / Q000517:prevention & control*; D002712:Chlorides / Q000008:administration & dosage / Q000009:adverse effects* / Q000032:analysis; D002779:Cholestasis / Q000139:chemically induced; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004340:Drug Contamination; D008099:Liver / Q000737:chemistry / Q000473:pathology; D046529:Microscopy, Electron, Transmission; D057947:Parenteral Nutrition Solutions / Q000009:adverse effects* / Q000737:chemistry; D012720:Severity of Illness Index; D034421:Sus scrofa
chemical_list: D017607:Aluminum Compounds; D001647:Bile Acids and Salts; D015415:Biomarkers; D002712:Chlorides; D057947:Parenteral Nutrition Solutions; D000077410:Aluminum Chloride; D001663:Bilirubin