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Shalaby AS, Eid HH, El-Shiekh RA, Mohamed OG, Tripathi A, Al-Karmalawy AA, Sleem AA, Morsy FA, Ibrahim KM, Tadros SH, Youssef FS. Taming Food-Drug Interaction Risk: Potential Inhibitory Effects of Citrus Juices on Cytochrome Liver Enzymes Can Safeguard the Liver from Overdose Paracetamol-Induced Hepatotoxicity. ACS OMEGA 2023; 8:26444-26457. [PMID: 37521669 PMCID: PMC10373174 DOI: 10.1021/acsomega.3c03100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/30/2023] [Indexed: 08/01/2023]
Abstract
Paracetamol overdose is the leading cause of drug-induced hepatotoxicity worldwide. Because of N-acetyl cysteine's limited therapeutic efficacy and safety, searching for alternative therapeutic substitutes is necessary. This study investigated four citrus juices: Citrus sinensis L. Osbeck var. Pineapple (pineapple sweet orange), Citrus reticulata Blanco × Citrus sinensis L. Osbeck (Murcott mandarin), Citrus paradisi Macfadyen var. Ruby Red (red grapefruit), and Fortunella margarita Swingle (oval kumquat) to improve the herbal therapy against paracetamol-induced liver toxicity. UHPLC-QTOF-MS/MS profiling of the investigated samples resulted in the identification of about 40 metabolites belonging to different phytochemical classes. Phenolic compounds were the most abundant, with the total content ranked from 609.18 to 1093.26 μg gallic acid equivalent (GAE)/mL juice. The multivariate data analysis revealed that phloretin 3',5'-di-C-glucoside, narirutin, naringin, hesperidin, 2-O-rhamnosyl-swertisin, fortunellin (acacetin-7-O-neohesperidoside), sinensetin, nobiletin, and tangeretin represented the crucial discriminatory metabolites that segregated the analyzed samples. Nevertheless, the antioxidant activity of the samples was 1135.91-2913.92 μM Trolox eq/mL juice, 718.95-3749.47 μM Trolox eq/mL juice, and 2304.74-4390.32 μM Trolox eq/mL juice, as revealed from 2,2'-azino-bis-3-ethylbenzthiazoline-6-sulfonic acid, ferric-reducing antioxidant power, and oxygen radical absorbance capacity, respectively. The in vivo paracetamol-induced hepatotoxicity model in rats was established and assessed by measuring the levels of hepatic enzymes and antioxidant biomarkers. Interestingly, the concomitant administration of citrus juices with a toxic dose of paracetamol effectively recovered the liver injury, as confirmed by normal sections of hepatocytes. This action could be due to the interactions between the major identified metabolites (hesperidin, hesperetin, phloretin 3',5'-di-C-glucoside, fortunellin, poncirin, nobiletin, apigenin-6,8-digalactoside, 6',7'-dihydroxybergamottin, naringenin, and naringin) and cytochrome P450 isoforms (CYP3A4, CYP2E1, and CYP1A2), as revealed from the molecular docking study. The most promising compounds in the three docking processes were hesperidin, fortunellin, poncirin, and naringin. Finally, a desirable food-drug interaction was achieved in our research to overcome paracetamol overdose-induced hepatotoxicity.
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Affiliation(s)
- Aya S. Shalaby
- Pharmacognosy
Department, Faculty of Pharmacy, Cairo University, Cairo 11562, Egypt
| | - Hanaa H. Eid
- Pharmacognosy
Department, Faculty of Pharmacy, Cairo University, Cairo 11562, Egypt
| | - Riham A. El-Shiekh
- Pharmacognosy
Department, Faculty of Pharmacy, Cairo University, Cairo 11562, Egypt
| | - Osama G. Mohamed
- Pharmacognosy
Department, Faculty of Pharmacy, Cairo University, Cairo 11562, Egypt
- Natural
Products Discovery Core, Life Sciences Institute, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Ashootosh Tripathi
- Natural
Products Discovery Core, Life Sciences Institute, University of Michigan, Ann Arbor, Michigan 48109, United States
- Department
of Medicinal Chemistry, College of Pharmacy, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Ahmed A. Al-Karmalawy
- Pharmaceutical
Chemistry Department, Faculty of Pharmacy, Ahram Canadian University, 6th of October City, Giza 12566, Egypt
| | - Amany A. Sleem
- Pharmacology
Department, National Research Centre, Dokki, Cairo 12622, Egypt
| | - Fatma Adly Morsy
- Pathology
Department, National Research Centre, Dokki, Cairo 12622, Egypt
| | - Khaled M. Ibrahim
- Pharmacognosy
Department, Faculty of Pharmacy, Cairo University, Cairo 11562, Egypt
| | - Soad H. Tadros
- Pharmacognosy
Department, Faculty of Pharmacy, Cairo University, Cairo 11562, Egypt
| | - Fadia S. Youssef
- Department
of Pharmacognosy, Faculty of Pharmacy, Ain-Shams
University, Abbasia, Cairo 11566, Egypt
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2
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Vignali JD, Pak KC, Beverley HR, DeLuca JP, Downs JW, Kress AT, Sadowski BW, Selig DJ. Systematic Review of Safety of Selective Androgen Receptor Modulators in Healthy Adults: Implications for Recreational Users. J Xenobiot 2023; 13:218-236. [PMID: 37218811 DOI: 10.3390/jox13020017] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/24/2023] Open
Abstract
Selective Androgen Receptor Modulators (SARMs) are not FDA approved, and obtaining SARMs for personal use is illegal. Nevertheless, SARM use is increasingly popular amongst recreational athletes. Recent case reports of drug-induced liver injury (DILI) and tendon rupture raise serious concerns for the safety of recreational SARM users. On 10 November 2022 PubMed, Scopus, Web of Science, and ClinicalTrials.gov were searched for studies that reported safety data of SARMs. A multi-tiered screening approach was utilized, and any study or case report of generally healthy individuals exposed to any SARM was included. Thirty-three studies were included in the review with 15 case reports or case series and 18 clinical trials (total patients N = 2136 patients, exposed to SARM N = 1447). There were case reports of drug-induced liver injury (DILI) (N = 15), Achilles tendon rupture (N = 1), rhabdomyolysis (N = 1), and mild reversible liver enzyme elevation (N = 1). Elevated alanine aminotransferase (ALT) was commonly reported in clinical trials in patients exposed to SARM (mean 7.1% across trials). Two individuals exposed to GSK2881078 in a clinical trial were reported to have rhabdomyolysis. Recreational SARM use should be strongly discouraged, and the risks of DILI, rhabdomyolysis, and tendon rupture should be emphasized. However, despite warnings, if a patient refuses to discontinue SARM use, ALT monitoring or dose reduction may improve early detection and prevention of DILI.
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Affiliation(s)
- Jonathan D Vignali
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Kevin C Pak
- Department of Gastroenterology, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Holly R Beverley
- Gorgas Memorial Library, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Jesse P DeLuca
- Clinical Pharmacology Fellowship, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - John W Downs
- Department of Toxicology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Adrian T Kress
- Clinical Pharmacology Fellowship, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Brett W Sadowski
- Department of Gastroenterology, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Daniel J Selig
- Clinical Pharmacology Fellowship, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
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Chidiac AS, Buckley NA, Noghrehchi F, Cairns R. Paracetamol (acetaminophen) overdose and hepatotoxicity: mechanism, treatment, prevention measures, and estimates of burden of disease. Expert Opin Drug Metab Toxicol 2023; 19:297-317. [PMID: 37436926 DOI: 10.1080/17425255.2023.2223959] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/05/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION Paracetamol is one of the most used medicines worldwide and is the most common important poisoning in high-income countries. In overdose, paracetamol causes dose-dependent hepatotoxicity. Acetylcysteine is an effective antidote, however despite its use hepatotoxicity and many deaths still occur. AREAS COVERED This review summarizes paracetamol overdose and toxicity (including mechanisms, risk factors, risk assessment, and treatment). In addition, we summarize the epidemiology of paracetamol overdose worldwide. A literature search on PubMed for poisoning epidemiology and mortality from 1 January 2017 to 26 October 2022 was performed to estimate rates of paracetamol overdose, liver injury, and deaths worldwide. EXPERT OPINION Paracetamol is widely available and yet is substantially more toxic than other analgesics available without prescription. Where data were available, we estimate that paracetamol is involved in 6% of poisonings, 56% of severe acute liver injury and acute liver failure, and 7% of drug-induced liver injury. These estimates are limited by lack of available data from many countries, particularly in Asia, South America, and Africa. Harm reduction from paracetamol is possible through better identification of high-risk overdoses, and better treatment regimens. Large overdoses and those involving modified-release paracetamol are high-risk and can be targeted through legislative change.
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Affiliation(s)
- Annabelle S Chidiac
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, Australia
- New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Sydney, Australia
| | - Nicholas A Buckley
- New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Sydney, Australia
- Faculty of Medicine and Health, School of Medical Sciences, Discipline of Biomedical Informatics and Digital Health, The University of Sydney, Sydney, Australia
| | - Firouzeh Noghrehchi
- Faculty of Medicine and Health, School of Medical Sciences, Discipline of Biomedical Informatics and Digital Health, The University of Sydney, Sydney, Australia
| | - Rose Cairns
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, Australia
- New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Sydney, Australia
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Zhang K, Fan X, Wang X, Zhang X, Zeng L, Li N, Han Q, Lv Y, Liu Z. Alterations in circadian rhythms aggravate Acetaminophen-induced liver injury in mice by influencing Acetaminophen metabolization and increasing intestinal permeability. Bioengineered 2022; 13:13118-13130. [PMID: 35635077 PMCID: PMC9275971 DOI: 10.1080/21655979.2022.2079255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Acetaminophen (APAP) is the most common antipyretic and analgesic drug causing drug-induced liver injury (DILI). Alterations in circadian rhythms can adversely affect liver health, especially metabolic and detoxification functions. However, the effect of circadian rhythm alterations induced by environmental factors on APAP-induced liver injury and the underlying mechanisms are not well known. In this study, a mouse model of circadian rhythm alterations was established by light/dark cycle shift and then treated with excessive APAP. The liver injury indexes, APAP-related metabolic enzymes, and intestinal permeability in mice were evaluated by biochemical analysis, quantitative real-time PCR, enzyme-linked immunosorbent assays, and histopathology. Results showed that circadian rhythm alterations resulted in increased reactive oxygen species (ROS) and malondialdehyde (MDA) and decreased liver superoxide dismutase (SOD), glutathione, and CYP1A2 and CYP3A11 mRNA expression, and increased serum diamine oxidase, lipopolysaccharide, and D-lactate in the mice. Compared with control mice, APAP induced higher serum alanine aminotransferase and aspartate aminotransferase, liver interleukin-1β and tumor necrosis factor-α mRNA, ROS and MDA, lower SOD, glutathione, and UDP-glucuronosyltransferases /sulfotransferases mRNA and more severe liver necrosis and intestinal damage in mice with alterations in circadian rhythms. In conclusion, circadian rhythm alterations by light/dark cycle shift resulted in increased oxidative stress and intestinal permeability in the mice and exacerbated APAP-induced liver injury by influencing APAP metabolization and increasing intestinal permeability.
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Affiliation(s)
- Kun Zhang
- Department of Infectious Diseases, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Xiude Fan
- Department of Infectious Diseases, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Xiaoyun Wang
- Department of Infectious Diseases, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Xiaoge Zhang
- Department of Infectious Diseases, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Lu Zeng
- Department of Infectious Diseases, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Na Li
- Department of Infectious Diseases, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Qunying Han
- Department of Infectious Diseases, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Yi Lv
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
- Institute of Advanced Surgical Technology and Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Zhengwen Liu
- Department of Infectious Diseases, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
- Institute of Advanced Surgical Technology and Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi, China
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Potential deleterious effects of paracetamol dose regime used in Nigeria versus that of the United States of America. Toxicol Rep 2022; 9:1035-1044. [PMID: 36561959 PMCID: PMC9764198 DOI: 10.1016/j.toxrep.2022.04.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/21/2022] [Accepted: 04/23/2022] [Indexed: 12/25/2022] Open
Abstract
Paracetamol, also known as acetaminophen (N-acetyl-para-aminophenol, APAP) is the world's most used over-the-counter analgesic-antipyretic drug. Despite its good safety profile, acetaminophen can cause severe hepatotoxicity in overdose, and poisoning from paracetamol has become a major public health concern. Paracetamol is now the major cause of acute liver failure in the United States and Europe. This systematic review aims at examining the likelihood of paracetamol use in Nigeria causing more liver toxicity vis-à-vis the reduced maximum recommended daily adult dose of 3 g for the 500 mg tablet. Online searches were conducted in the databases of PubMed, Google Scholar and MEDLINE for publications using terms like "paracetamol toxicity," "acetaminophen and liver toxicity," "paracetamol and liver diseases in Nigeria," and other variants. Further search of related references in PubMed was carried out, and synthesis of all studies included in this review finalized. There were 94 studies that met the inclusion criteria. Evaluation of hepatic disorder was predicated mostly on a constellation of clinical features and limited clinical laboratory investigations. Determination of blood paracetamol concentration was rarely reported, thus excluding paracetamol poisoning as one of the likely causes of liver disorders in Nigeria. In Nigeria and elsewhere, several factors are known to increase paracetamol's predisposition to liver injury. They include: the over-the-counter status of paracetamol, use of fixed-dose combinations of paracetamol with other drugs, malnutrition, dose miscalculations, and chronic alcohol consumption. The tendency to exceed the new paracetamol maximum daily dose of 3 g in Nigeria may increase its risk for hepatotoxicity than observed in the United States of America known for emphasizing lower dose of the drug. In addition to recommending the new maximal daily paracetamol dose allowance, the historical maximum daily adult dose of 4 g should be de-emphasized in Nigeria.
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de Moraes ACN, de Andrade CBV, Ramos IPR, Dias ML, Batista CMP, Pimentel CF, de Carvalho JJ, Goldenberg RCDS. Resveratrol promotes liver regeneration in drug-induced liver disease in mice. Food Res Int 2021; 142:110185. [PMID: 33773662 DOI: 10.1016/j.foodres.2021.110185] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 01/20/2021] [Accepted: 01/24/2021] [Indexed: 12/12/2022]
Abstract
Studies suggest that the bioactive polyphenolic compound resveratrol (RESV, trans-isomer), found naturally in certain foods such as red grapes and peanuts, may be able to ameliorate liver damage. However, the effects and efficacy of long-term treatment with RESV remain unclear. Here, we used an acetaminophen (APAP; 400 mg/kg/d for 15 days) overdose model to induce liver damage in C56BL/6 mice. Three days after the intoxication was stopped, we observed biochemical, histological and ultrastructural alterations in the livers of these mice. The APAP-treated animals were then given RESV (10 mg/kg/d) for 60 days. Blood and tissue were analyzed at days 7, 30 and 60. Our data show that long-term RESV treatment (60 days) ameliorates the liver injury caused by APAP intoxication, restoring histological features, ultrastructural organization and serum biochemical parameters (albumin, alanine aminotransferase). Ck18- and F4/80-positive cells (indicators of hepatocyte recovery) were reestablished and the number of α-SMA positive cells was normalized after long-term RESV treatment. Additionally, downregulation of the drug transporter BCRP was observed. Electron microscopy revealed that treatment with RESV was effective in restoring the shape and size of hepatic microvilli and normalizing both the number and viability of mitochondria. Taken together, these results indicate that long-term treatment with RESV is effective in alleviating liver injury caused by APAP administration.
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Affiliation(s)
- Alan Cesar Nunes de Moraes
- Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, UFRJ, Rio de Janeiro, Brazil; Biology Department, Federal Fluminense University, UFF, Niterói, RJ, Brazil
| | - Cherley Borba Vieira de Andrade
- Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, UFRJ, Rio de Janeiro, Brazil; Department of Histology and Embryology, State University of Rio de Janeiro, UERJ, Rio de Janeiro, RJ, Brazil
| | - Isalira Peroba Rezende Ramos
- Center for Structural Biology and Bio-imaging, CENABIO, Federal University of Rio de Janeiro, UFRJ, Rio de Janeiro, RJ, Brazil
| | - Marlon Lemos Dias
- Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, UFRJ, Rio de Janeiro, Brazil
| | - Cintia Marina Paz Batista
- Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, UFRJ, Rio de Janeiro, Brazil
| | - Cibele Ferreira Pimentel
- Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, UFRJ, Rio de Janeiro, Brazil
| | - Jorge Jose de Carvalho
- Department of Histology and Embryology, State University of Rio de Janeiro, UERJ, Rio de Janeiro, RJ, Brazil
| | - Regina Coeli Dos Santos Goldenberg
- Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, UFRJ, Rio de Janeiro, Brazil; National Institute of Science and Technology for Regenerative Medicine, INCT-REGENERA, Federal University of Rio de Janeiro, UFRJ, Rio de Janeiro, Brazil.
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Xu Z, Liu F, Zhang T, Gu Y, Lu N, Xu H, Yan X, Song Y, Xing Y, Yu D, Zhang Z, Lu P. Density Functional Theory-Assisted Electrochemical Assay Manipulated by a Donor-Acceptor Structure toward Pharmaceutical Diagnostic. Anal Chem 2020; 92:15297-15305. [PMID: 33185440 DOI: 10.1021/acs.analchem.0c01272] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Oxidative stress is a state of stress injury, which leads to the pathogenesis of most neurodegenerative diseases. Moreover, this is also one of the main reasons for the loss of dopaminergic neurons and the abnormal content of dopamine (DA). In the past decades, a number of studies have found that acetaminophen (AP) is metabolized and distributed in the brain when it is used as a neuroprotective compound. In this context, we proposed an electrochemical sensor based on 9-(4-(10-phenylanthracen-9-yl)phenyl)-9H-carbazole with the goal of diagnosing these two drugs in the body. Carbazole groups can easily be formed into large π-conjugated systems by electropolymerization. The introduction of anthracene exactly combined the carbazole group to establish an efficient electron donor-acceptor pattern, which enhanced π-π interaction with the electrode surface and charge transporting ability. The diagnostic platform showed good sensing activity toward the oxidation of DA and AP. The detection range for DA and AP is from 0.2 to 300 μM and from 0.2 to 400 μM, respectively. The simultaneous detection range is from 0.5 to 250 μM, which is wider than most reports. After a series of electrochemical assessments were determined, the sensor was finally developed to the analysis of pharmaceutical and human serum, displaying a meaningful potential in clinical evaluation.
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Affiliation(s)
- Zhiqian Xu
- College of Chemistry, Jilin University, Changchun 130012, P.R. China
| | - Futong Liu
- State Key Laboratory of Supramolecular Structure and Materials, Jilin University, Changchun 130012, P.R. China
| | - Tingting Zhang
- College of Chemistry, Jilin University, Changchun 130012, P.R. China
| | - Yue Gu
- College of Chemistry, Jilin University, Changchun 130012, P.R. China
| | - Nannan Lu
- College of Chemistry, Jilin University, Changchun 130012, P.R. China
| | - Haixin Xu
- College of Chemistry, Jilin University, Changchun 130012, P.R. China
| | - Xiaoyi Yan
- College of Chemistry, Jilin University, Changchun 130012, P.R. China
| | - Yu Song
- College of Chemistry, Jilin University, Changchun 130012, P.R. China
| | - Yue Xing
- College of Chemistry, Jilin University, Changchun 130012, P.R. China
| | - Dexun Yu
- Jilin Provincial Academy of Traditional Chinese Medicine, Changchun 130021, P.R. China
| | - Zhiquan Zhang
- College of Chemistry, Jilin University, Changchun 130012, P.R. China
| | - Ping Lu
- State Key Laboratory of Supramolecular Structure and Materials, Jilin University, Changchun 130012, P.R. China
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