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Related Concept Videos

Hepatic Drug Clearance: Restrictive and Nonrestrictive Clearance01:09

Hepatic Drug Clearance: Restrictive and Nonrestrictive Clearance

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Hepatic clearance refers to the volume of blood cleared of a drug by the liver per unit of time. It plays a crucial role in drug metabolism and elimination. While hepatic clearance is commonly estimated by subtracting renal clearance from total body clearance, other pathways, such as pulmonary or biliary clearance, may also contribute. However, these pathways are generally less significant than hepatic and renal clearance.
Most drugs undergo restrictive clearance, which is proportional to the...
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Hepatic Drug Clearance: Effect of Protein Binding01:09

Hepatic Drug Clearance: Effect of Protein Binding

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Hepatic clearance is influenced by protein binding based on the drug's extraction ratio. Drugs with high extraction ratios are considered flow-limited and remain unaffected by protein binding during hepatic clearance. On the other hand, drugs with low extraction ratios may be impacted by plasma protein binding, although the extent of this influence depends on the fraction of the drug bound.
For low-extraction-ratio drugs that are less than 80% protein-bound, minor changes in protein binding...
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Hepatic Drug Excretion: Enterohepatic Cycling01:17

Hepatic Drug Excretion: Enterohepatic Cycling

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Enterohepatic cycling involves the active secretion of drugs and their metabolites into the bile via transporters in the canalicular membrane of hepatocytes. This secretion is an integral part of the digestive process, releasing these substances into the gastrointestinal (GI) tract.
Post-release drugs and metabolites can be reabsorbed into the body from the intestine. For conjugated metabolites like glucuronides, reabsorption requires enzymatic hydrolysis by intestinal microflora. This...
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Hepatic Drug Excretion: Influencing Factors01:16

Hepatic Drug Excretion: Influencing Factors

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The biliary system of the liver, crucial for bile secretion and drug excretion, comprises intrahepatic bile ducts that merge to form the common hepatic duct. This duct, carrying hepatic bile, combines with the cystic duct, draining the gallbladder and forming the common bile duct, which empties into the duodenum. Bile, produced by hepatic cells lining the bile canaliculi, is composed primarily of water, bile salts, pigments, electrolytes, and lesser amounts of cholesterol and fatty acids. Bile...
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Hepatic Drug Clearance: Role of Transporters01:14

Hepatic Drug Clearance: Role of Transporters

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In the liver and bile canaliculi, influx and efflux transporters modification can influence intrinsic clearance. Transporters play a significant role in moving drugs within liver cells. Elaborate models, such as the Biopharmaceutical Classification System (BCS), are essential to relate transporters to drug disposition. This system categorizes drugs into four classes based on solubility and permeability, providing insights into elimination routes and the effects of transporters following oral...
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Drug Elimination: The Concept of Clearance01:06

Drug Elimination: The Concept of Clearance

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Drug elimination refers to removing drugs from the body, either through urine by the kidneys or through bile by the liver. Drug clearance is a pharmacokinetic parameter that measures the efficiency of drug removal from the bloodstream within a specific time frame. It is calculated as the rate at which a drug is eliminated from plasma divided by the plasma concentration of the drug.
Drug clearance is not limited to renal excretion but encompasses all organs involved in drug elimination,...
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Related Experiment Video

Updated: Sep 17, 2025

Analysis of HBV-Specific CD4 T-cell Responses and Identification of HLA-DR-Restricted CD4 T-Cell Epitopes Based on a Peptide Matrix
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HBeAg clearance in chronic Hepatitis B: is it predictable?

Tuba İlgar1, Aybegüm Özşahin2, Sudem Mahmutoğlu Çolak2

  • 1Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Türkiye.

Journal of Infection in Developing Countries
|July 3, 2025
PubMed
Summary

Predicting Hepatitis B e-antigen (HBeAg) loss is key for chronic hepatitis B (CHB) treatment. AST-Platelet Ratio Index (APRI) and FIB-4 scores, along with platelet count, are significant predictors of HBeAg clearance.

Keywords:
APRIAntiviralFIB-4HBeAg clearance

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Area of Science:

  • Hepatology
  • Virology
  • Clinical Medicine

Background:

  • Hepatitis B e-antigen (HBeAg) loss is a critical marker for prognosis in chronic hepatitis B (CHB).
  • Accurate prediction of HBeAg clearance aids in optimizing antiviral treatment duration and patient management.
  • Identifying reliable predictive factors is essential for personalized CHB therapy.

Purpose of the Study:

  • To identify clinical and biochemical factors that predict HBeAg clearance in patients with HBeAg-positive CHB undergoing antiviral therapy.
  • To evaluate the predictive performance of various scoring systems, including APRI and FIB-4, for HBeAg loss.

Main Methods:

  • Retrospective analysis of 94 patients with HBeAg-positive CHB receiving antiviral treatment from 2008-2022.
  • Evaluation of parameters: age, platelet count, treatment duration, liver enzymes (ALT, AST), ALBI, PALBI, APRI, and FIB-4.
  • Receiver Operating Characteristic (ROC) analysis to determine the predictive ability of identified factors for HBeAg loss.

Main Results:

  • HBeAg clearance was observed in 34% of patients, with longer treatment duration.
  • Patients achieving HBeAg clearance were older and had higher median APRI and FIB-4 scores at treatment initiation.
  • ROC analysis confirmed age, FIB-4, platelet count, and APRI as significant predictors, with APRI demonstrating the highest predictive value (AUC=0.771).

Conclusions:

  • AST-Platelet Ratio Index (APRI) and FIB-4 are valuable non-invasive markers for predicting HBeAg clearance in CHB patients.
  • Platelet count and patient age also contribute to predicting HBeAg loss.
  • These findings support the use of APRI and FIB-4 in clinical decision-making for CHB treatment optimization.