Avaliação do efeito inibitório da n-acetilcisteína no modelo de esteatohepatite induzida por irinotecano em camundongos

Abstract

Background: Colorectal cancer (CRC) is currently one of the most common cancers worldwide. The liver is the main site of metastasis in advanced CRC. Regimens based on irinotecan (IRI) have been used for the treatment of metastatic CRC, usually resulting in the conversion of unresectable liver metastases into resectable metastases. However, these regimens are associated with the occurrence of non-alcoholic steatohepatitis (NASH), which often limits the treatment. The pathogenesis of NASH caused by IRI remains unclear. Recently, our group developed a novel IRI-induced mouse NASH model. N-acetylcysteine (NAC) is an acetylated derivative of L-cysteine that carries a thiol (-SH) group that reacts and neutralizes free radicals, as well as restores cellular antioxidants such as glutathione. NAC is used in clinical practice for the treatment of liver damage induced by paracetamol. Objectives: To assess the protective effect of NAC on IRI-induced ASH. Methods: Male Swiss mice (25 g, n = 8) received saline (5 mL/kg, i.p), NAC (1,000 mg/kg, s.c), IRI (50 mg/kg, i.p), or NAC (10, 100, or 1000 mg/kg) + IRI 3 ×/week for 7 weeks. Weight variation and survival were assessed. At the end of the treatment, blood was collected for the determination of serum levels of ALT and AST (U/L), and the animals were sacrificed for liver collection and weighing (mg/30 g of animal). Histopathological analysis was performed according to Kleiner’s criteria for NASH (lobular inflammation [0–3], steatosis [0–3], and vacuolization [0–3]), as well as measurement of IL-1β production (pg/mL) and immunohistochemical analysis (IHC) of IL-1β, iNOS and nitrotyrosine. For statistical analysis, ANOVA/student’s Newman Keul test or the Kruskal Wallis/Dunn test was used. The level of significance was set at P < 0.05. (CEPA 1/12). Results: IRI induced a significant (P < 0.05) reduction in survival (44%), a marked increase in the serum concentrations of ALT (48.99 ± 13.4), AST (90.55 ± 19.7), cytokine IL1-β (288.5 ± 35.86), liver weight (1,814 ± 159.3), and an increase in Kleiner scores [5.5 (4–7)] vs. the saline group (survival: 100%; ALT: 17.31 ± 5.2; AST: 44.58 ± 5.4; cytokine IL1-β (104 ± 36.9); liver weight: 1,425 ± 39.5; Kleiner: 0 (0–0). These changes were prevented (P < 0.05) by treatment with NAC. NAC increased the survival of animals injected with IRI (10 mg/kg: 90%; 100 mg/kg: 80%). NAC 10 mg/kg prevented the increase of the enzymes ALT: 26.95 ± 7 and AST: 56.42 ± 4.8; NAC (10 mg/kg and 1,000 mg/kg) inhibited the increase in the levels of cytokine IL-1 (152 ± 23.92 and 149 ± 17.21, respectively); NAC (10 mg/kg and 100 9 mg/kg) reversed the increase in liver weight (1,375 ± 68.2 and 1,467 ± 28.6, respectively), and NAC 10 mg/kg reversed the increase in Kleiner scores: 2 [1–4]) vs. the IRI group. The IHC of the IRI group showed a significant increase in immunostaining for IL-1 (3[1–3]), iNOS (3[3–3]) compared to the saline group (IL-1: 0[0–1]; iNOS: 1[1–2]); and NAC at a dose of 10 mg/kg prevented the increase in immunostaining (IL-1: 1[1–1]; iNOS: 2[1–2]) vs. the IRI group. Conclusion: NAC at a dose of 10 mg/kg prevented changes in the clinical, histopathological, biochemical, and inflammatory parameters of the IRI-induced NASH model. Current studies are focused on identifying the mechanisms involved in this protective effect.