Premium
Combination of tauroursodeoxycholic acid and N‐acetylcysteine exceeds standard treatment for acetaminophen intoxication
Author(s) -
Paridaens Annelies,
Raevens Sarah,
Colle Isabelle,
Bogaerts Eliene,
Vandewynckel YvesPaul,
Verhelst Xavier,
Hoorens Anne,
Grunsven Leo A.,
Van Vlierberghe Hans,
Geerts Anja,
Devisscher Lindsey
Publication year - 2017
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.13261
Subject(s) - tauroursodeoxycholic acid , unfolded protein response , acetylcysteine , acetaminophen , acetaminophen overdose , liver injury , medicine , pharmacology , oxidative stress , transaminase , endoplasmic reticulum , chemistry , biochemistry , enzyme , antioxidant
Background & Aims Acetaminophen overdose in mice is characterized by hepatocyte endoplasmic reticulum stress, which activates the unfolded protein response, and centrilobular hepatocyte death. We aimed at investigating the therapeutic potential of tauroursodeoxycholic acid, a hydrophilic bile acid known to have anti‐apoptotic and endoplasmic reticulum stress‐reducing capacities, in experimental acute liver injury induced by acetaminophen overdose. Methods Mice were injected with 300 mg/kg acetaminophen, 2 hours prior to receiving tauroursodeoxycholic acid, N‐acetylcysteine or a combination therapy, and were euthanized 24 hours later. Liver damage was assessed by serum transaminases, liver histology, terminal deoxynucleotidyl transferase dUTP nick end labelling staining, expression profiling of inflammatory, oxidative stress, unfolded protein response, apoptotic and pyroptotic markers. Results Acetaminophen overdose resulted in a significant increase in serum transaminases, hepatocyte cell death, unfolded protein response activation, oxidative stress, NLRP 3 inflammasome activation, caspase 1 and pro‐inflammatory cytokine expressions. Standard of care, N‐acetylcysteine and, to a lesser extent, tauroursodeoxycholic treatment were associated with significantly lower transaminase levels, hepatocyte death, unfolded protein response activation, oxidative stress markers, caspase 1 expression and NLRP 3 levels. Importantly, the combination of N‐acetylcysteine and tauroursodeoxycholic acid improved serum transaminase levels, reduced histopathological liver damage, UPR ‐activated CHOP , oxidative stress, caspase 1 expression, NLRP 3 levels, IL ‐1β levels and the expression of pro‐inflammatory cytokines and this to a greater extend than N‐acetylcysteine alone. Conclusions These findings indicate that a combination strategy of N‐acetylcysteine and tauroursodeoxycholic acid surpasses the standard of care in acetaminophen‐induced liver injury in mice and might represent an attractive therapeutic opportunity for acetaminophen‐intoxicated patients.