Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UNIPROT:P01275 (glucagon)
 26,492 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Severe alcoholic hepatitis is still a therapeutic challenge. It has been recently advocated that a 3-wk infusion with insulin and glucagon reduces its short-term mortality rate. A multicenter, randomized, single-blind, sequential trial was designed to compare this treatment with placebo. The triangular boundary was defined with alpha = 0.05, beta = 0.10 and estimated survival at 4 wk of 50% with placebo, 75% with treatment. Patients with biopsy-proven severe alcoholic hepatitis (presence of one or more of three criteria: encephalopathy, prothrombin activity less than or equal to 50%, bilirubinemia greater than or equal to 100 mumol/L) were randomized into two groups; one treatment group received an infusion (12 hr/day) of an association of insulin (30 IU) and glucagon (3 mg), and a control group received an infusion of glucose. Treatments were administered during a 3-wk period, and the mortality rate was noted at 4 wk. The decision to discontinue the trial was reached on the basis of results from the first 44 patients. Overall results were assessed in the 72 patients included at the time of this decision (treatment group: n = 37; control group: n = 35). Fifty-three patients had cirrhosis. No significant differences were noted between the two groups at inclusion on the basis of clinical, laboratory and histological criteria. The mortality rate was not significantly different in the two groups; 10 patients (27%) in the treatment group and 5 patients (14%) in the control group died. Causes of death were similar in the two groups and consisted primarily of gastrointestinal hemorrhage, hepatic failure and infectious events.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Treatment of severe alcoholic hepatitis by infusion of insulin and glucagon: a multicenter sequential trial. 172 3

A randomised controlled trial of insulin and glucagon infusion was carried out in 18 patients in grade III or IV coma from fulminant hepatic failure due to viral or drug-induced hepatic necrosis to see whether mortality could be reduced by stimulating hepatic regeneration. Nine patients received a continuous infusion of insulin 3 U/h and glucagon 200 micrograms/h made up in 5% dextrose containing 1% human albumin solution (HAS) while controls received 5% dextrose and HAS alone. Baseline plasma insulin and glucagon levels were comparably raised in both groups and, on infusion, rose significantly higher in the insulin- and glucagon-treated patients compared to controls. Two control and one treated patient recovered. Median survival time from enrolment to death was similar for insulin- and glucagon-treated patients and controls--2 and 3 days, respectively. Insulin and glucagon therapy did not enhance hepatic synthetic function, as measured by a fall in prothrombin time or a rise in alpha-fetoprotein; nor did it stimulate hepatic regeneration, only one patient in each group showed histological evidence of hepatic regeneration at post-mortem.
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PMID:Failure of insulin and glucagon infusion to stimulate liver regeneration in fulminant hepatic failure. 219 8

Alcoholic hepatitis is a necrotizing, often inflammatory, process that is an important precursor to the development of cirrhosis. Acetaldehyde, which is derived from alcohol by the action of alcohol dehydrogenase, is apparently the most important factor leading to alcohol-induced liver injury. Other factors of importance in determining the appearance and rate of progression of liver diseases in patients who are chronic alcoholics include sex, nutritional status, and various immunologic reactions. In addition, there is an incompletely understood genetic predisposition to the development of alcoholic hepatitis. Several histologic features found in patients with alcoholic hepatitis have been evaluated in efforts to determine which are of prognostic value. The predominance of the alcohol-induced injury in zone III of the hepatic lobule; deposition of collagen, IgA, and fibronectin in the space of Disse; defenestration of endothelial cells; and transformation of lipocytes and myofibroblasts to fibroblasts have been investigated. Prolongation of the prothrombin time and marked elevation of serum bilirubin levels are indicators of a subgroup of patients with alcoholic hepatitis who have a poor prognosis, especially if there is also evidence of hepatic encephalopathy. Supportive care and abstinence from alcohol are the foundations of therapy. Corticosteroid therapy appears to decrease the number of early deaths in patients with severe alcoholic hepatitis. Other experimental approaches to therapy include the use of propylthiouracil, anabolic-androgenic steroids, and insulin and glucagon.
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PMID:Alcoholic hepatitis: pathogenesis and approaches to treatment. 223 74

The records of 57 patients with acute viral hepatitis (28 given hormones and 29 placebo) in a double blind controlled trial of one week of glucagon and insulin therapy were analyzed. In the placebo group, SGPT values dropped after treatment with improved prothrombin time and serum levels of total bilirubin and albumin. In the hormone group, they changed similarly, except serum albumin levels which were reversed during treatment (P less than 0.05). There was a bottom line of serum albumin levels which preceded a peak of serum alpha-fetoprotein levels within one week in the placebo group, but was around the peak in the hormone group. There were 12 patients in the hormone group in whom serum alpha-fetoprotein levels rose with treatment and decreased after its discontinuation, and 5 in the placebo group (P less than 0.05). Such a change in serum alpha-fetoprotein levels was accompanied by decreased serum albumin levels in 6 of 10 patients given hormones and none of the 5 given placebo (P less than 0.05). These results indicate reciprocal changes in serum albumin and alpha-fetoprotein levels appearing during the recovery course of acute viral hepatitis, and suggest that this therapy may stimulate its development. Stimulation of liver regeneration by this therapy merits consideration.
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PMID:Reciprocal changes in serum albumin and alpha-fetoprotein levels in the recovery course of acute viral hepatitis stimulated by glucagon and insulin therapy: analysis of a double blind controlled trial. 247 94

A cooperative study was conducted to determine the efficacy of one week of treatment with infusion of 1 mg glucagon and 10 units insulin twice daily in severe acute hepatitis. Ninty-eight patients with either prothrombin time less than 60% or thrombotest or hepaplastin test less than 50% of normal were randomly assigned to hormone or placebo treatment. SGOT and SGPT values dropped after treatment with a gradual decrease or increase in total serum bilirubin or cholesterol levels similarly in both groups receiving hormone or placebo. Deranged prothrombin time improved more rapidly in the hormone group than in the placebo group. Glucagon and insulin infusion may stimulate recovery of the liver from injury.
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PMID:A multi-centre double-blind controlled trial of glucagon and insulin therapy for severe acute hepatitis. 266 9

Rats given a dose of carbon tetrachloride (CCl4) immediately received injections of glucagon and insulin every 4 h. They frequently died after 4 h and showed a significantly higher mortality between 8 h and 28 h as compared to the control rats where such deaths occurred 16 h later. At 8 h, the derangements of SGPT values and prothrombin time were significantly greater in the hormone-treated rats than in the control rats. In these CCl4-intoxicated rats, hepatic reduced glutathione content at 4 h was significantly reduced after hormone treatment. The treatment significantly enhanced CCl4 metabolism, conversion of 14CCl4 into 14CO2 in vitro, by microsomes isolated from the liver, whereas it did not affect the microsomal cytochrome P450 content. These results suggest that glucagon and insulin treatment increased CCl4 hepatotoxicity in rats through activating the cytochrome P450-dependent mono-oxygenase system. This would merit consideration for the clinical application of this treatment.
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PMID:Enhancement of carbon tetrachloride-induced liver injury by glucagon and insulin treatment. 328 Nov 98

A randomized, single-blind controlled multicenter study of insulin and glucagon infusion was carried out in 66 patients with acute alcoholic hepatitis. Thirty-three patients were treated with insulin 10 U and glucagon 1 mg in 500 ml 5% glucose in water via a peripheral vein for 2-6 h three times every day for 3 weeks. Patients in the control group received 5% glucose in an identical fashion. Fourteen control patients and five treated patients died from liver failure during the study (P less than 0.02). Clinical features of liver disease on entry into the study were similar in the two groups, but the total serum bilirubin, aspartate aminotransferase, gamma-glutamyltranspeptidase activities and prothrombin time significantly improved in the treated patients (P less than 0.05). Insulin and glucagon infusion appears to be a promising treatment of acute alcoholic hepatitis.
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PMID:A prospective multicenter study of insulin and glucagon infusion therapy in acute alcoholic hepatitis. 332 Jan 81

The response of plasma cyclic AMP to glucagon was investigated in 18 patients with acute liver injury to determine its value as a marker for the severity of the hepatic damage. We also investigated the interrelationship between plasma cyclic AMP response and the hyperglucagonemia often seen in this disease. Plasma cyclic AMP response to glucagon was reduced significantly in patients with acute hepatitis, particularly in severe cases with bridging hepatic necrosis. There was a significant negative correlation between log (peak % cAMP) and prothrombin time (r = -0.715, p less than 0.01), and also total bilirubin (r = -0.819, p less than 0.01). In fatal cases, the early phase of plasma cyclic AMP response after glucagon stimulation was blunted. In patients with acute liver injury, basal IRG levels were significantly high and a significant negative correlation was found between log (peak % cAMP) and basal IRG levels (r = -0.816, p less than 0.01). Our results suggest that the response of plasma cyclic AMP to exogenous glucagon could be useful in evaluating the severity of acute liver injury. The lower cyclic AMP response may be attributed to reduced hepatic reserve and endogenous hyperglucagonemia.
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PMID:Impaired plasma cyclic AMP response to exogenous glucagon in acute liver injury. 609 May 30

Plasma glucagon, insulin and glucose concentrations, and liver function tests were determined after an overnight fast in 24 normal subjects and 50 male cirrhotic patients. In cirrhotic patients with normal liver profiles, plasma glucagon remained within normal limits, irrespective of the presence of portasystemic anastomoses either pathological or surgical. Hyperglucagonemia was documented in presence of advanced liver dysfunction alone. Significant correlations were established between plasma glucagon and several liver function tests, i.e., serum bilirubin, albumin/globulin ratio, and prothrombin time. Moreover, hyperglucagonemia normalized on recovery from clinical manifestations and improvement in liver profile. Plasma insulin was raised primarily in the presence of a significant portasystemic shunting and maximum levels were observed in patients manifesting advanced liver dysfunction as well. However, no correlation was evident between plasma insulin and any of the liver function tests. Fasting plasma glucose was not altered in cirrhotic patients. Therefore, it is concluded that in hepatic cirrhosis, glucagon secretion by pancreatic alpha-cell may be dependent on the severity of the hepatocellular damage whereas portasystemic shunting may be responsible for hyperinsulinemia which may be further exaggerated in presence of advanced liver dysfunction.
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PMID:Hyperglucagonemia in hepatic cirrhosis: its relation to hepatocellular dysfunction and normalization on recovery. 636 96

Since glucagon and insulin (G/I) have been suggested to be hepatotrophic substances, the effect of G/I infusion on the ability to excrete water and sodium was tested in seven patients with cirrhosis and ascites (decompensated group), and compared with that in seven cirrhotics without ascites (compensated group). A constant infusion of 1 U glucagon and 10 U regular insulin over 2 hours daily for 14 days resulted in a significant improvement of prothrombin time in the decompensated group. Concomitantly, an increase in urine volume (62%, p less than 0.02) and a tendency toward an increase in urinary sodium excretion (68%, 0.05 less than p less than 0.1) were observed only in the decompensated group after the G/I infusion. In addition, these were associated with increases in creatinine clearance and osmotic clearance. These results suggest that glucagon and insulin merit further study in hepatorenal syndrome cases.
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PMID:Effect of simultaneous administration of glucagon and insulin on renal function in patients with liver cirrhosis and ascites. 637 77


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