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[Ursodeoxycholic acid: history and clinical implications]
Ulrich Beuers1,2, David C Trampert1
1Amsterdam UMC, Amsterdam; Gastroenterology Endocrinology Metabolism (AGEM) Research Institute;Tytgat Institute for Liver and Intestinal Research, Department of Gastroenterology and Hepatology, Amsterdam.
Nederlands Tijdschrift Voor Geneeskunde
|October 27, 2022
Summary
Ursodeoxycholic acid (UDCA) is a key treatment for cholestatic liver diseases like primary biliary cholangitis, improving survival. Its benefits stem from enhanced bile secretion, a protective bicarbonate layer, and reduced liver cell stress and apoptosis.
Area of Science:
- Hepatology and Gastroenterology
- Pharmacology
- Biochemistry
Context:
- Ursodeoxycholic acid (UDCA) is a naturally occurring bile acid with established anticholestatic and litholytic effects.
- It is the first-line therapy for primary biliary cholangitis (PBC), significantly improving patient survival.
- While effective in PBC, its long-term efficacy and mechanisms in other cholestatic conditions require further elucidation.
Purpose:
- To review the mechanisms of action of ursodeoxycholic acid (UDCA) in cholestatic liver diseases.
- To highlight UDCA's role in managing primary biliary cholangitis (PBC) and its potential in other cholestatic conditions.
- To consolidate understanding of UDCA's therapeutic benefits beyond its litholytic properties.
Summary:
- UDCA exhibits potent anticholestatic properties, crucial for managing chronic cholestatic liver diseases.
- Its therapeutic effects involve stimulating hepatobiliary secretion, stabilizing biliary bicarbonate secretion, and inhibiting apoptosis and endoplasmic reticulum stress.
- While its cholesterol-lowering effect explains litholysis, its benefits in cholestasis are attributed to diverse cellular and molecular mechanisms.
Impact:
- UDCA remains a cornerstone therapy for primary biliary cholangitis, offering improved long-term survival.
- Understanding UDCA's multifaceted mechanisms may lead to optimized therapeutic strategies for various cholestatic liver diseases.
- Further research into UDCA's anticholestatic effects can inform the development of novel treatments for liver conditions characterized by bile acid dysfunction.
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