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Liposome-supported peritoneal dialysis in the treatment of severe hyperammonemia: An investigation on potential interactions

Giacalone, Giovanna, Matoori, Simon, Agostoni, Valentina, Forster, Vincent, Kabbaj, Meriam, Eggenschwiler, Sarah, Lussi, Martin, De Gottardi, Andrea, Zamboni, Nicola, Leroux, Jean-Christophe
Journal of controlled release 2018 v.278 pp. 57-65
ammonia, antibiotics, beta-adrenergic antagonists, dialysis, diuretics, drug interactions, encephalopathy, fluoroquinolones, liver failure, metabolites, patients, propranolol, rats
Peritoneal dialysis (PD) performed with transmembrane pH-gradient liposomes was reported to efficiently remove ammonia from the body, representing a promising alternative to current standard-of-care for patients with severe hepatic encephalopathy. In this study, we further characterized the properties of liposome-supported peritoneal dialysis (LSPD) by 1) assessing its in-use stability in the presence of ascitic fluids from liver-disease patients; 2) investigating its interactions with drugs that are commonly administered to acute-on-chronic liver failure patients; and 3) analyzing the in vivo extraction profile of LSPD. We found that LSPD fluid maintained its in vitro ammonia uptake capability when combined with ascitic fluids. The co-incubation of selected drugs (e.g., beta-blockers, antibiotics, diuretics) with LSPD fluids and ammonia resulted in limited interaction effects for most compounds except for two fluoroquinolones and propranolol. However, considering the experimental set-up, these results should be interpreted with caution and confirmatory drug-drug interaction studies in a clinical setting will be required. Finally, metabolite-mapping analysis on dialysates of LSPD-treated rats revealed that the liposomes did not remove important metabolites more than a conventional PD fluid. Overall, these findings confirm that LSPD is a potentially safe and effective approach for treating hyperammonemic crises in the context of acute-on-chronic liver failure.