Nontraditional effects of protein binding and hematocrit on uptake of indocyanine green by perfused rat liver

We used a novel parameter-free approach to study the role of protein binding in the hepatic clearance of indocyanine green (ICG) from reconstituted pig blood by perfused rat liver. Either perfusate total plasma protein concentration or hematocrit was changed. By analyzing protein concentration ratios or plasma volume ratios relative to ratios of intrinsic hepatic clearance of ICG (K), it was possible to evaluate current models of hepatic uptake of protein-bound ligands without precise knowledge of some of the model parameters. A four-fold increase in the total plasma protein concentration produced only a 36% decrease in K. This was substantially less than predicted by the traditional model, where K is proportional to the free concentration of ligand. Because an unstirred water layer effect could not by itself account for the observations, the effects of binding disequilibrium in the sinusoids or uptake directly from the bound pool had to be considered. To discriminate, hematocrit was increased from 15% to 29%, causing a 20% decrease in the sinusoidal plasma volume. A significant reduction in K strongly suggested a sinusoidal binding disequilibrium effect. The dissociation rate constant predicted by this model was confirmed by in vitro measurement, further supporting this interpretation. The simple experimental design and its parameter-free evaluation provide a new tool for investigating the hepatic uptake of protein-bound ligands.