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Molecular regulation of hepatobiliary transport systems: clinical implications for understanding and treating cholestasis.
[benign recurrent intrahepatic cholestasis]
Hepatobiliary
transport
systems
are
responsible
for
hepatic
uptake
and
excretion
of
bile
salts
and
other
biliary
constituents
(
eg
,
bilirubin
)
into
bile
.
Hereditary
transport
defects
can
result
in
progressive
familial
and
benign
recurrent
intrahepatic
cholestasis
.
Exposure
to
acquired
cholestatic
injury
(
eg
,
drugs
,
hormones
,
proinflammatory
cytokines
,
biliary
obstruction
or
destruction
)
also
results
in
altered
expression
and
function
of
hepatic
uptake
and
excretory
systems
,
changes
that
may
maintain
and
contribute
to
cholestasis
and
jaundice
.
Recruitment
of
alternative
efflux
pumps
and
induction
of
phase
I
and
II
detoxifying
enzymes
may
limit
hepatic
accumulation
of
potentially
toxic
biliary
constituents
in
cholestasis
by
providing
alternative
metabolic
and
escape
routes
.
These
molecular
changes
are
mediated
by
bile
salts
,
proinflammatory
cytokines
,
drugs
,
and
hormones
at
a
transcriptional
and
posttranscriptional
level
.
Alterations
of
hepatobiliary
transporters
and
enzymes
are
not
only
relevant
for
a
better
understanding
of
the
pathophysiology
of
cholestatic
liver
diseases
,
but
may
also
represent
important
targets
for
pharmacotherapy
.
Drugs
(
eg
,
ursodeoxycholic
acid
,
rifampicin
)
used
to
treat
cholestatic
liver
diseases
and
pruritus
may
counteract
cholestasis
via
stimulation
of
defective
transporter
expression
and
function
.
In
addition
,
therapeutic
strategies
may
be
aimed
at
supporting
and
stimulating
alternative
detoxification
pathways
and
elimination
routes
for
bile
salts
in
cholestasis
.
Diseases
Validation
Diseases presenting
"progressive familial"
symptom
benign recurrent intrahepatic cholestasis
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