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Comparison of S-Adenosyl-L-methionine and N-acetylcysteine protective effects on acetaminophen hepatic toxicity.

Nutraceuticals are widely used by the general public, but very little information is available regarding the effects of nutritional agents on drug toxicity. Excessive doses of acetaminophen (APAP, 4-hydroxyacetanilide) induce hepatic centrilobular necrosis. The naturally occurring substance S-adenosyl-l-methionine (SAMe) has been reported to reduce the hepatic toxicity of APAP. The present study was designed to investigate the hepatoprotective effects of SAMe in comparison to the clinically used antidote N-acetylcysteine (NAC). Male C57BL/6 mice were injected intraperitoneally (i.p.) with an equimolar dose (1.25 mmol/kg) of either SAMe or NAC just before APAP, and the groups were denoted SAMe+APAP and NAC+APAP, respectively. Mice were immediately injected i.p. with 300 mg/kg APAP, and hepatotoxicity was evaluated after 4 h. SAMe was more hepatoprotective than NAC at a dose of 1.25 mmol/kg as liver weight was unchanged by APAP injection in the SAMe+APAP group, whereas liver weight was increased in the NAC+APAP group. SAMe was more hepatoprotective for APAP toxicity than NAC, because alanine aminotransferase levels were lower in the SAMe+APAP. Pretreatment with SAMe maintained total hepatic glutathione (GSH) levels higher than NAC pretreatment before APAP, although total hepatic GSH levels were lower in the SAMe+APAP and NAC+APAP groups than the vehicle control values. Oxidative stress was less extensive in the SAMe+APAP group compared with the APAP-treated mice as indicated by Western blots for protein carbonyls and 4-hydroxynonenal-adducted proteins. In summary, SAMe reduced APAP toxicity and was more potent than NAC in reducing APAP hepatotoxicity.

Acetaminophen↗

Androgenic/Anabolic steroid-induced toxic hepatitis.

Athletes and bodybuilders often misuse androgenic/anabolic steroids. When used in therapeutic doses, these drugs produce clinical jaundice in just a small number of recipients. We present a 26-year-old male bodybuilder who self-administered high doses of androgenic/anabolic steroids that induced liver damage. One month before admission to the hospital, he used testosterone enanthate (500 mg intramuscularly, twice weekly), stanozolol (40 mg/d), and methylandrostenediol (30 mg/d by mouth, for 5 weeks). On admission, his bilirubin level was 470 micromol/L (direct, 360 micromol/L), his aspartate aminotransferase (AST) level was 5,870 IU/L, his alanine aminotransferase (ALT) level was 10,580 IU/L, his alkaline phosphatase (ALP) level was 152 IU/L, his gamma-glutamyl-transpeptidase level was 140 IU/L, his albumin level was 27.6 g/L, and his prothrombin time was 29%. During the patient's prolonged hospitalization, multiple tests and liver biopsy were performed, showing only toxic hepatic lesions. The patient was provided with supportive medical treatment. Clinical signs and laboratory findings improved substantially 12 weeks after the patient discontinued androgenic/anabolic steroids. The reasons for presenting this case were the much higher values of AST and ALT levels than reported in other studies, although the values of bilirubin and ALP were similar to those found in the literature. To our knowledge, it is the first case of toxic hepatitis induced by androgenic/anabolic steroids with predominantly hepatocellular necrosis instead of intrahepatic cholestasis.

Adult↗

[Alcohol-induced toxic hepatitis--a "free radical" associated disease. Lowering fatality by adjuvant antioxidant therapy].

Toxic liver diseases coincide with oxidative stress correlating positively with the seriousness of the course of disease. For the purpose of elucidating the pathogenic significance of an increased radical generation. 56 patients suffering from acute alcohol-toxic hepatitis of the clinical grade of seriousness B and C according to Child/Pugh were classified randomly into antioxidant subgroups (n = 31) and control groups (= 25). The basis therapy being identical, the patients of the antioxidant group received additionally 600 mg of D-alpha tocopherol per day, 200 micrograms of selenium and 12 mg of zinc. Due to the supplementation of antioxidants there were quicker significant changes in the concentration of bilirubin, malondialdehyde and of ammonia in the serum. In comparison with the control group the length of stay in hospital could be reduced by 6 days. In the control group the mortality rates amounted to 40% (10 of 25), in the antioxidant group to 6.5% (2 of 31). The results confirm the pathogenic significance of oxidative stress in alcohol-toxic liver disease because a distinct improvement of prognosis could be achieved by using a low-cost adjuvant antioxidant supplementation.

Adult↗

[Effect of splenic humoral factors on the cholinesterase activity of liver tissue and blood serum in experimental toxic hepatitis in rats].

Activity of cholinesterase in the liver of rats with experimental toxic hepatitis decreases, while in the serum it remains unchanged. Introduction of splenin, a spleen preparation, normalizes indices of the cholinesterase activity, extract of muscles possessing no such property. Boiling-heated spleen preparation looses its activity. Activity of the studied enzyme remains unchanged both after splenectomy and splenin introduction to intact animals.

Animals↗

Toxic hepatitis due to combination therapy with methotrexate and etretinate in psoriasis.

A case of toxic hepatitis caused by combination therapy with methotrexate and etretinate in the treatment of severe psoriasis is presented in a 47-year-old woman. The patient had received methotrexate alone for more than 10 years without any signs of severe liver damage. The liver status had been controlled by consecutive liver biopsies. The treatment was discontinued and after 2 months the liver parameters became normal.

Chemical and Drug Induced Liver Injury↗

Evaluation of the chronic hepatic toxicity of 6-mercaptopurine in the wistar rat.

The ability of choline (C) to prevent hepatic toxicity due to chronic administration of 6-mercaptopurine (6-MP) was evaluated in male Wistar rats. Two dose levels of 6-MP and two dose levels of C were used. Choline did not prevent or diminish the hepatic accumulation of triglyceride when administered in combination with 6-MP. The 6-MP did impair the growth of the experimental animals, and this effect was antagonized by C administration. The data provided experimental support for the clinical observation of growth impairment in children treated with chronic antimetabolite therapy for acute lymphoblastic leukemia.

Animals↗

[Correction of nitrogen metabolism in rats with toxic hepatitis by parenteral administration of an amino acid mixture].

The nitrogen metabolism in rats with toxic affection of the liver caused by administration of CCl4 was studied as affected by the amino acid mixture moriamine S-2. It is established that with toxic hepatitis the nitrogen metabolism is sharply disturbed, especially during protein deficiency. The following evidences for this fact: a rise in the depth of the nitrogen negative balance, an increase in the intensity of amine nitrogen and ammonia excretion with urea as well as an increase in the amount of amine nitrogen in blood and tissues with a simultaneous decrease in the content of protein. The parenteral administration of the amino acid mixture for eight days to the animals with a toxic affection of the liver is more effective when nitrogen preparation is combined with the group B vitamin, vitamin C, insulin, nerobolyl and sirepar.

Amino Acids↗

Hepatoprotective properties of aqueous extract from Pentaphylloides fruticosa during chronic toxic hepatitis.

Hepatoprotective properties of Pentaphylloides fruticosa L. aqueous extract were studied using rat model of chronic toxic hepatitis. The preparation normalized alanine aminotransferase activity and bilirubin concentration in the plasma. Aqueous extract of Pentaphylloides fruticosa produced a protective effect on microsomal metabolism of xenobiotics and lipid peroxidation activity in the plasma and microsomal liver fraction.

Animals↗

[The effect of loading liver lysosomes with triton WR 1339 on the development of chronic toxic hepatitis].

Preliminary administration of triton WR 1339 produced a favourable effect on the course of chronic toxic hepatitis. This was expressed in a reduction of necrotic zones, a delay in development of connective tissue and in improvement of the functional capacity of the liver. Lysosomes of the liver of animals subjected to the action of CCl-4 under conditions of preliminary administration of a detergent were more stable to the injurious actions in vitro.

Acid Phosphatase↗

[Effect of sodium aurothiomalate in acute toxic hepatitis].

The effect of lysosomotropic agent--sodium aurothiomalate on liver damage and lysosomal changes during acute toxic hepatitis was studied. Combined administration of sodium aurothiomalete led to less extensive necrosis and to widening dystrophic areas in the hepatic parenchyma. Solubilization of the acid RNA-ase activity was decreased, and nonsedimentable activities of beta-galactosidase, cathepsin D were the same as in acute CCl4-hepatitis.

Acute Disease↗

A protein toxin from Pasteurella multocida type D causes acute and chronic hepatic toxicity in rats.

Pasteurella toxin given subcutaneously to rats caused severe liver damage and growth suppression in doses as low as 15.6 ng. Toxin was lethal at and above 31.25 ng. Survival times were dose-dependent, and lesions differed with time of survival after toxin. Rats dead of acute toxicity had focal hepatic necrosis. Liver lesions were associated with diffuse endothelial damage, intravascular trapping of leukocytes, and degeneration of hepatocytes (characterized by glycogen depletion, development of vacuoles, and eosinophilic cytoplasmic inclusions). Endothelial cells, Kupffer cells, and macrophages had evidence of activation, e.g., increased cellular size with increases in Golgi vesicles, granules, and lysosomes. Rats with chronic toxicity (survival greater than 150 hr) had cirrhosis, intestinal villous atrophy, and markedly reduced body weight and fat. These data show that the rat is highly sensitive to toxins of Pasteurella multocida, and that even low doses of toxin cause liver injury and growth suppression.

Animals↗

Defensive nature of Sargassum polycystum (Brown alga) against acetaminophen-induced toxic hepatitis in rats: role of drug metabolizing microsomal enzyme system, tumor necrosis factor-alpha and fate of liver cell structural integrity.

AIM: To assess the defensive nature of Sargassum polycystum (S. polycystum) (Brown alga) against acetaminophen (AAP)-induced changes in drug metabolizing microsomal enzyme system, tumor necrosis factor (TNF-alpha) and fine structural features of the liver during toxic hepatitis in rats. METHODS: Male albino Wistar strain rats used for the study were randomly categorized into 4 groups. Group I consisted of normal control rats fed with standard diet. Group II rats were administered with acetaminophen (800 mg/kg body weight, intraperitoneally). Group III rats were pre-treated with S. polycystum extract alone. Group IV rats were orally pre-treated with S. polycystum extract (200 mg/kg body weight for 21 d) prior to acetaminophen induction (800 mg/kg body weight, intraperitoneally). Serum separated and liver was excised and microsomal fraction was isolated for assaying cytochrome P450, NADPH Cyt P450 reductase and b(5). Serum TNF-alpha was detected using ELISA. Fine structural features of liver were examined by transmission electron microscopy. RESULTS: Rats intoxicated with acetaminophen showed considerable impairment in the activities of drug metabolizing microsomal enzymes, such as cytochrome P450, NADPH Cyt P450 reductase and b(5) when compared with the control rats. The rats intoxicated with acetaminophen also significantly triggered serum TNF-alpha when compared with the control rats. These severe alterations in the drug metabolizing enzymes were appreciably prevented in the rats pretreated with S. polycystum. The rats pretreated with S. polycystum showed considerable inhibition in the elevation of TNF-alpha compared to the rats intoxicated with acetaminophen. The electron microscopic observation showed considerable loss of structural integrity of the endoplasmic reticulum, lipid infiltration and ballooning of mitochondria in the acetaminophen-intoxicated rats, whereas the rats treated with S. polycystum showed considerable protection against acetaminophen-induced alterations in structural integrity. CONCLUSION: These observations suggest that the animals treated with S. polycystum extract may have the ability to protect the drug metabolizing enzyme system and mitochondrial functional status from free radical attack, thereby showing its defense mechanism in protecting hepatic cells from acetaminophen toxic metabolite N-acetyl-para-benzoquinone-imine (NAPQI).

Acetaminophen↗

Methylprednisolone-induced toxic hepatitis.

OBJECTIVE: To report the third published case, as of April 8, 2006, of methylprednisolone-induced toxic hepatitis. CASE SUMMARY: A 47-year-old woman was admitted to our clinic with weakness, fatigue, pruritus, and scleral icterus that had developed 10 days prior to presentation. She had been taking topiramate for one year for treatment of chronic isolated central nervous system vasculitis. One week before her symptoms developed, she had completed a self-prescribed 7 day course of oral methylprednisolone for treatment of left arm weakness. She believed that methylprednisolone was appropriate since it had been used previously for acute episodes of vasculitis. Results of liver function tests performed on admission were alanine aminotransferase 2478 U/L, aspartate aminotransferase 1600 U/L, total bilirubin 10 mg/dL, direct bilirubin 8 mg/dL, alkaline phosphatase 138 U/L, and gamma-glutamyl transferase 242 U/L. Topiramate and methylprednisolone were the only drugs she had been taking before admission, and no other causes of liver dysfunction (eg, infection, ischemia, systemic disease) were identified. Topiramate was stopped, and enzyme levels decreased to normal values within 45 days without treatment. There had been no increase in enzyme levels during hospitalization upon the accidental use of topiramate. Based on the history and laboratory findings, the final diagnosis was mixed hepatocellular and cholestatic liver injury caused by methylprednisolone. DISCUSSION: Steroids have rarely been associated with hepatotoxicity; moreover, they are the treatment of choice for severe hepatitis. To date, only 2 cases of methylprednisolone-induced hepatotoxicity have previously been reported. Our case is similar to those with regard to mixed hepatocellular and cholestatic liver injury. Resolution of the hepatotoxicity occurred after discontinuation of the drug, with conservative treatment measures. An objective causality assessment based on the Naranjo scale suggests that hepatotoxicity was probably related to methylprednisolone. CONCLUSIONS: Although rare, hepatotoxicity related to methylprednisolone should be considered in patients who develop elevated enzyme levels while receiving this steroid.

Chemical and Drug Induced Liver Injury↗

Toxic hepatitis: a rare complication associated with the use of ritodrine during pregnancy.

OBJECTIVES: To evaluate the incidence of toxic hepatitis associated with the use of ritodrine in pregnancy. DESIGN: A prospective study. SETTING: A large teaching hospital in Barcelona, Spain. PATIENTS: One hundred and twenty-three consecutive pregnant women, 101 singleton and 22 multiple pregnancies, receiving intravenous ritodrine with normal transaminase levels prior to the initiation of therapy. MEASUREMENTS: Serum glutamic pyruvic transaminase (SGPT) and glutamic oxaloacetic transaminase (SGOT), gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (PA), direct and total bilirubin. RESULTS: In two (l.9%) of 101 singleton and two (9.1%) of 22 multiple pregnancies, elevation of SGOT and SGPT levels was detected. PA, GGT, and bilirubin were normal in all women studied. Other causes of hepatitis were ruled out, and no other signs of liver impairment were found in these women. Transaminase levels recovered rapidly in all cases after discontinuation of therapy. CONCLUSION: Elevation of liver enzymes is a rare complication of ritodrine. Discontinuation of therapy does not appear to be indicated as long as other signs of liver dysfunction are not present and tocolytic treatment is required.

Adult↗

[Effect of additional administration of essential amino acids on assimilability of casein hydrolysate in rats with toxic hepatitis].

The effect of certain amino acids on assimilability of casein hydrolysate was studied in albino rats with toxic hepatitis. It is established that in case of this pathology casein hydrolysate is uncapable of correcting completely the disturbed protein and nucleic metabolism. An additional administration under these conditions of amino acids, methionine in particular, changes the negative nitrogeneous balance to the positive one, that evidences for an increase in assimilability of the introduced casein hydrolysate, lowers the excretion of amino nitorgen with urea and rises the DNA content in the liver tissue. Triptophan and lysine favour an increase in the protein content in the nuclei and mitochondria of hepatocytes.

Amino Acids, Essential↗

Potential protective role of angiotensin-converting enzyme inhibitors captopril and enalapril against adriamycin-induced acute cardiac and hepatic toxicity in rats.

Captopril and enalapril-angiotensin-converting enzyme (ACE) inhibitors-were evaluated for their antioxidative protective action against adriamycin-induced cardiac and hepatic toxicity. Rats were treated with either captopril (10 mg kg(-1)) or enalapril (2 mg kg(-1)) intragastrically (i.g.) daily for 7 days before single intraperitoneal (i.p.) injection with adriamycin (15 mg kg(-1)). The animals were killed 30 h after adriamycin administration. Adriamycin produced significant elevation in thiobarbituric acid reactive substances (TBARS), which is an indicator of lipid peroxidation, and significantly inhibited the activity of superoxide dismutase (SOD) in heart and liver tissues, with a significant rise in the serum levels of glutamic pyruvic transaminase (GPT), glutamic oxaloacetic transaminase (GOT), creatine kinase isoenzyme (CK-MB) and lactic dehydrogenase (LDH), indicating acute cardiac toxicity. A single injection of adriamycin did not affect the cardiac or hepatic glutathione (GSH) content or cardiac catalase (CAT) activity, but hepatic CAT activity was elevated. Pretreatment with ACE inhibitors significantly reduced the TBARS concentration in both heart and liver and ameliorated the inhibition of cardiac and hepatic SOD activity. In addition, the ACE inhibitors significantly improved the serum levels of GOT, GPT, CK-MB and LDH in adriamycin-treated rats. Thus, these results suggest that captopril and enalapril possess antioxidative potential that may protect the heart against adriamycin-induced acute oxidative toxicity. This protective effect might be mediated, at least in part, by the limitation of culprit free radicals and the amelioration of oxidative stress.

Angiotensin-Converting Enzyme Inhibitors↗

[The effect of splenic humoral factors on corticosteroid metabolism and the cAMP content in the liver of rats with experimental toxic hepatitis].

Corticosteroid metabolism in the liver and the level of c-AMP in the liver and spleen of rats with experimental toxic hepatitis were investigated after splenin administration. Hydrocortisone metabolites were isolated by a method of two-dimensional thin-layer chromatography. It was shown that their production and the level of c-AMP in the liver and spleen after simulation of experimental hepatitis were considerably reduced. The administration of this drug returned the indices under study to normal. The results obtained demonstrated that humoral factors could produce protective action in toxic liver lesion.

Adrenal Cortex Hormones↗