Effect of alcohol abuse and glutathione administration on the circulating levels of glutathione and on antipyrine metabolism in patients with alcoholic liver cirrhosis

Glutathione: Pharmacological aspects and implications for clinical use in non-alcoholic fatty liver disease

Glutathione is a tripeptide synthesized at cytosolic level, that exists in cells in a reduced form (thiol-reduced-GSH-) and in an oxidized form (disulfide-oxidized). The antioxidant function of GSH has led to speculation about its therapeutic role in numerous chronic diseases characterized by altered redox balance and reduced GSH levels, including, for instance, neurodegenerative disorders, cancer, and chronic liver diseases. Among these latter, non-alcoholic fatty liver disease (NAFLD), characterized by lipid accumulation in hepatocytes, in the absence of alcohol abuse or other steatogenic factors, is one of the most prevalent. The umbrella term NAFLD includes the pure liver fat accumulation, the so-called hepatic steatosis or non-alcoholic fatty liver, and the progressive form with inflammation, also known as non-alcoholic steatohepatitis, which is related to the increase in oxidative stress and reactive oxygen species, eventually leading to liver fibrosis. Although the pathogenetic role of oxidative stress in these diseases is well established, there is still limited evidence on the therapeutic role of GSH in such conditions. Hence, the aim of this review is to depict the current molecular and pharmacological knowledge on glutathione, focusing on the available studies related to its therapeutic activity in NAFLD.

Antioxidant and immunomodulatory effect of AKSS16-LIV01 – a multi herbal formulation against ethanol induced liver dysfunction in mice

Background

Liver complication arises commonly due to high alcohol consumption rate. Majority of the people residing in both developed and under developed countries consuming alcohol face various liver complications such as liver fibrosis, fatty liver, liver cirrhosis and even hepatocellular carcinoma. Invention of safe and symptomatic medication to overcome this situation is a new challenge worldwide. The main objective of the study is to deliver a safe and symptomatic medication to reduce the ethanol induced liver dysfunction.

Methods

In this study we have developed a multi herbal formulation (AKSS-16-LIV01) which minimised liver damage against various toxicants. Swiss albino mice were divided into seven groups where ethanol induced damage was observed for weeks followed by sanative response observation by our herbal formulation. The groups are normal control group, ethanol treated group (50% v/v), AKSS16-LIV01 low dose (75 mg/kg/day) pre-treated group, AKSS16-LIV01 middle dose (150 mg/kg/day) pre-treated group, AKSS16-LIV01 high dose (300 mg/kg/day) pre-treated group, Sylimarin pre-treated group (100 mg/kg/day) and only AKSS16-LIV01 (300 mg/kg/day) treated group.

Results

The results potrayed significant elevation of various biochemical parameters, lipid profile parameters, lipid peroxidation, nitric oxide (NO) concentration, nitric oxide synthase level and pro inflammatory cytokines level i.e. tumor necrosis factor (TNF-α) and transforming growth factor (TGF-β1) in the ethanol induced mice. On the other hand serum total protein, total albumin, albumin globulin ratio and level of tissue antioxidant enzymes activity (SOD, CAT, GSH and GPx) were significantly reduced by ethanol. Dose depended therapeutic application of the formulation (AKSS16-LIV01) significantly suppressed all the relevant above parameters and protected the liver from ethanol induced fibrogenesis. Apart from this gross morphology of the liver, H&E liver histology and massontrichrome&serius red examination of the liver section strongly supported the hepatoprotive effect of the formulation as compared with standard drug Sylimarin. Result of the study implies that developed multi herbal formulation (AKSS16-LIV01) at a dose of 300 mg/kg/day gave the best optimum response to reduce the ethanol intoxication.

Conclusion

Result clearly depict that AKSS16-LIV01 may be a safe and nontoxic medication which protect the liver against ethanol induced oxidative injury and maintained pro inflammatory cytokines level in the future.

Graphical Abstract

Preparation of glutathione loaded nanoemulsions and testing of hepatoprotective activity on THLE-2 cells

To improve bioavailability and stability of hydrophobic and hydrophilic compounds, nanoemulsions are good alternatives as delivery systems because of their nontoxic and nonirritant nature. Glutathione (GSH) suffers from low stability in water, where its encapsulation in nanoemulsions is a powerful strategy to its stability in aqueous systems. The aim of this study was to obtain nanoemulsions from the hydrophobic/hydrophilic contents of N. sativa seed oil so as to improve GSH stability along with bioavailability of N. sativa seed oil. Then, the prepared nanoemulsions were tested for in vitro hepatoprotective activity against ethanol toxicity. To the best of our knowledge, there is no study on the test of nanoemulsions by the combination of Nigella sativa seed oils and GSH in hepatoprotective activity. Here, nanoemulsions with different contents were prepared using Nigella sativa seed oils. Content analyses and characterisation studies of prepared nanoemulsions were carried out. In order to investigate the protective effects against to ethanol exposure, THLE-2 cells were pretreated with nanoemulsions for 2 h with the maximum benign dose (0.5 mg/mL of nanoemulsions). Ethanol (400 mM) was introduced to pretreated cells and nontreated cells for 48- or 72-h periods, followed by cell viability assay was carried out. Fluorescence microscopy tests revealed the introduction of the nanoemulsions into THLE-2 cells. The findings show that nanoformulations have promising in vitro hepatoprotective effects on the THLE-2 cell line against ethanol exposure.

Effect of water-soluble propolis administration on the ethanol-induced hangover in rats

Water soluble propolis was prepared using β-cyclodextrin, and its effect on an ethanol-induced hangover was examined in Sprague-Dawley (SD) rats fed with ethanol. When SD rats were administrated with propolis 30 min after ethanol feeding, ethanol content in the rat serum decreased 2.1 times 1 h after ethanol feeding. Alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) activity in rat liver increased 3.0 and 4.4 times, respectively, 1 h after ethanol feeding and administration of propolis 30 min after ethanol feeding. There were no differences in the expression of ADH and ALDH genes regardless of propolis administration. These results indicated that a decrease in ethanol content in the serum was not due to an increase in the expression of ADH or ALDH genes but rather, an increase in activities of ADH and ALDH.

S-allyl-glutathione, a synthetic analogue of glutathione protected liver against carbon tetrachloride toxicity: Focus towards anti-oxidative efficiency

A simple analogue of well known natural antioxidant glutathione (GSH) called S-allyl-glutathione (SAG) was evaluated against carbon tetrachloride (CCl₄)-induced oxidative stress liver injury in rat. Pretreatment of SAG attenuated the CCl₄-toxicity induced elevation of liver injury markers such as enzymes (AST, ALT, GGT, ALP and LDH) and bilirubin in the blood circulation. Such protective effect of SAG resulted in preservation of liver function observed as normal level of total protein and albumin in plasma as well as inhibition of dyslipidemia in liver. In addition, in silico analysis has proved that SAG has strong affinity with the amino acids present in active site of the human cytochrome P450 2E1 and 3A4. Three important mechanisms provided by SAG such as scavenging of reactive oxidants, replenishing of endogenous antioxidants (SOD, catalase, GPx, GSH and vitamin C) and protection of mitochondrial function (oxidative phosphorylation complex activities) are involved in the optimal function of liver against CCl₄-toxicity.

Metal uptake, oxidative stress and histopathological alterations in gills and hepatopancreas of Callinectes amnicola exposed to industrial effluent

Metal uptake by biota due to elevated environmental concentrations elicits oxidative stress and could lead to pathological outcomes. The relationship between the histopathological profile of hepatopancreas and gills and altered biochemical features (antioxidant enzymes i.e. GSH, GPx, CAT, SOD, lipid peroxidation (MDA) and serum protein) in the blue crab, Callinectes amnicola from contaminated parts of the Lagos Lagoon was investigated. Monthly crab, sediment and surface water samples were taken from effluent receiving areas of the Lagos lagoon i.e. Makoko, Okobaba, Iddo, Ikoyi and Mid-lagoon (control site) over an 18-month period and analyzed for metal levels (Pb, Cd, Zn and Cu). Significantly higher levels of GPx and lower levels of Pb, Zn and Cu was recorded in gills and hepatopancreas of crabs from the mid-lagoon compared to crabs from other sites. Reaction patterns of gills across the different sites of the lagoon included regressive (ranging from epithelial lifting, disruption of pilaster cells, detached cuticle to focal necrosis) and circulatory disruptions (oedema); increased activity of GSH and GPx in gills were positively correlated with lesions of lower importance factor. Reaction patterns in hepatopancreas were more regressive including vacuolation/infiltration of fatty lobules, necrosis, granuloma, disintegrated lumen, atrophied tubules and loss of lobular hepatocyte structure; increased activity of GSH, GPx and CAT were positively correlated with lesions of low importance factor in the hepatopancreas. Findings show that lesions in both gills and hepatopancreas of the blue crab could be associated with uptake of metals, depleted antioxidant activity and incidence of lipid peroxidation in tissue.

Camellia sinensis (L.) Kuntze Extract Ameliorates Chronic Ethanol-Induced Hepatotoxicity in Albino Rats

The goal of this study was to investigate the hepatoprotective effects of aqueous extract of Camellia sinensis or green tea extract (AQGTE) in chronic ethanol-induced albino rats. All animals were divided into 4 groups in the study for a 5-week duration. 50% ethanol was given orally to the rats with two doses (5 mg/kg bw and 10 mg/kg bw) of AQGTE. Ethanol administration caused a significant increase in the levels of plasma and serum enzymatic markers, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP), and nonenzymatic markers (cholesterol and triglycerides), lipid peroxidation contents, malondialdehyde (MDA), and glutathione-S-transferase (GST), and decreased the activities of total proteins, albumin, and cellular antioxidant defense enzymes such as superoxide dismutase (SOD). The elevation and reduction in these biochemical enzymes caused the damage in hepatocytes histologically due to the high production of ROS, which retards the antioxidant defense capacity of cell. AQGTE was capable of recovering the level of these markers and the damaged hepatocytes to their normal structures. These results support the suggestion that AQGTE was able to enhance hepatoprotective and antioxidant effects in vivo against ethanol-induced toxicity.

Metabolomic patterns and alcohol consumption in African Americans in the Atherosclerosis Risk in Communities Study

BACKGROUND

Effects of alcohol consumption on health and disease are complex and involve a number of cellular and metabolic processes.

OBJECTIVE

We examined the association between alcohol consumption habits and metabolomic profiles.

DESIGN

We conducted a cross-sectional study to explore the association of alcohol consumption habits measured by using a questionnaire with serum metabolites measured by using untargeted mass spectrometry in 1977 African Americans from the Jackson field center in the Atherosclerosis Risk in Communities Study. The whole sample was split into a discovery set (n = 1500) and a replication set (n = 477). Alcohol consumption habits were treated as an ordinal variable, with nondrinkers as the reference group and quartiles of current drinkers as ordinal groups with higher values. For each metabolite, a linear regression was conducted to estimate its relation with alcohol consumption habits separately in both sets. A modified Bonferroni procedure was used in the discovery set to adjust the significance threshold (P < 1.9 × 10⁻⁴).

RESULTS

In 356 named metabolites, 39 metabolites were significantly associated with alcohol consumption habits in both discovery and replication sets. In general, alcohol consumption was associated with higher levels of most metabolites such as those in amino acid and lipid pathways and with lower levels of γ-glutamyl dipeptides. Three pathways, 2-hydroxybutyrate-related metabolites, γ-glutamyl dipeptides, and lysophosphatidylcholines, which are considered to be involved in inflammation and oxidation, were associated with incident cardiovascular diseases.

CONCLUSIONS

To our knowledge, this is the largest metabolomic study thus far conducted in nonwhites. Metabolomic biomarkers of alcohol consumption were identified and replicated. The results lend new insight into potential mediating effects between alcohol consumption and future health and disease.

Inhibition of cytochrome P450 enzymes and biochemical aspects of mechanism-based inactivation (MBI)

Mechanism-based inactivation (MBI) often involves metabolic bioactivation of the xenobiotic by cytochrome P450s (CYPs) to an electrophilic reactive intermediate and results in quasi-irreversible or irreversible inactivation. Such reactive intermediate can cause quasi-irreversible inhibition through coordination to the ferrous state, Fe(II), of the P450 enzyme forming a tight noncovalent bond leading to the formation of metabolic-intermediate complex (MIC). By contrast, irreversible inactivation is one of the most common causes for the observed drug–drug interaction (DDI) and usually implies the formation of a covalent bond between the metabolite and the enzyme via alkylation of either the heme or the P450 apoprotein. Here we illustrate the important points of the current literature understanding of the mechanisms of inhibition of CYP enzymes with emphasis on general mechanistic aspects of MBI for some drugs/moieties associated with the phenomenon. Additionally, the utility of computational and in silico approaches to address bioactivation issues will be briefly discussed.

Oxidative stress and benefits of antioxidant agents in acute and chronic hepatitis

CONTEXT

Oxidative damage due to oxidative stress is the failure of the cell's defense against the deleterious effects of harmful agents by means of its numerous autoprotective mechanisms. oxidative stress is a key impairment induced by various conditions, including atherosclerosis, hypertension, ischemia-reperfusion, hepatitis, pancreatitis, cancer, and neurodegenerative diseases.

EVIDENCE ACQUISITION

Oxidative stress is a common pathogenetic mechanism contributing to the initiation and progression of hepatic damage in cases of inflammatory liver disorders, including acute and chronic hepatitis. Antioxidant administration is a good therapeutic strategy for the treatment of hepatitis.

RESULTS

Our comprehensive review of the literature revealed that contradictory results have been obtained with many antioxidants and antioxidant agents.

CONCLUSION

Since clinical studies to date have generally involved testing of the effects of antioxidant mixtures containing more than 2 antioxidants and also have been limited because of toxic effects of high doses of some antioxidants, antioxidant therapy for acute and chronic hepatitis needs further study.

Co-treatment with Shengmai San-derived herbal product ameliorates chronic ethanol-induced liver damage in rats

Wei Kang Su (WKS) is an antioxidant-enriched herbal product manufactured on the basis of Shengmai San, a well-known traditional Chinese herbal formula. In the present study, we investigated the effects of WKS co-treatment on chronic ethanol toxicity in rats. WKS co-treatment protected against chronic ethanol-induced hepatotoxicity, as evidenced by the suppression of plasma enzyme activities and reactive oxygen metabolite levels, as well as the inhibition of hepatic mitochondrial malondialdehyde production in chronic ethanol-intoxicated rats. The hepatoprotection afforded by WKS co-treatment in chronic ethanol-intoxicated rats was associated with a reversal of altered hepatic mitochondrial antioxidant status and adenosine triphosphate (ATP) generation capacity, as well as heat shock protein 25/70 production. Therefore, WKS may offer the prospect of preventing ethanol-associated liver damage by increasing the resistance of mitochondria to oxidative stress.

Protective effect of reduced glutathione and venous systemic oxygen persufflation on rat steatotic graft following liver transplantation

BACKGROUND

The aim of this study is to explore the protective effect of high-dose reduced glutathione (GSH) preconditioning and venous systemic oxygen persufflation (VSOP) on rat steatotic liver grafts following transplantation.

METHODS

Steatotic liver model was established by feeding rats a high-fat, high-cholesterol diet, and infusing stomach with 50% alcohol (1 mL/100g body weight/d) for 6 wk. In the pretreated group, short-term and high-dose of GSH administration and VSOP were performed. In rat orthotopic liver transplantation model, the recipient survival, liver function, hepatic microcirculation blood flow, hepatic redox, hepatocytes apoptosis and necrosis, and hepatic ultrastructure alteration were observed.

RESULTS

In the pretreated rat steatotic grafts, hepatic GSH (from 29.43 +/- 4.83 to 41.56 +/- 8.51mg/mgprot), superoxide dismutase (SOD) (from 48.32 +/- 6.27 to 67.74 +/- 7.68 NU/mgprot), and adenosine triphosphate (ATP) (from 1.61 +/- 0.20 to 2.28 +/- 0.09 micromoles/g) were significantly increased (P < 0.05), whereas malondialdehyde (MDA) was significantly decreased (from 7.20 +/- 2.18 to 4.63 +/- 0.58 nmol/mgprot, P < 0.05). The hepatocyte necrosis of fatty liver graft was significantly reduced in the pretreated group when compared with non-treated fatty ones (37.71% +/- 9.69% versus 16.63% +/- 5.53%; t = 3.777, P = 0.014), and significantly improved liver function and hepatic ultrastructure were observed in the pretreated fatty liver group after operation. The animal survival after transplanted with fatty liver was significantly improved (chi(2) = 4.07, P = 0.0436).

CONCLUSION

A short course pretreatment with high-dose GSH and oxygen persufflation during cold preservation effectively protect steatotic liver grafts from ischemic damage and significantly improve early survival rate in a rat fatty liver transplantation model.

Effect of exercise training on ethanol-induced oxidative damage in aged rats

It is well known that lipid peroxidation increases with age, and alcohol drinking further exacerbates this damage. The present study determined the effect of regular exercise training on alcohol-induced oxidative damage and antioxidant status in the liver of aged animals. The age-matched Wistar albino rats (3 months young, n=24; 18 months old, n=24) were evenly divided into four groups: control (C), exercise trained (Ex), ethanol drinking (Et), and exercise plus ethanol drinking (Ex+Et). With ethanol drinking, hepatic malondialdehyde (MDA) level was significantly elevated above control (P<.001), whereas glutathione (GSH) and ascorbic acid (vitamin C) contents were significantly decreased below control. These changes were found to be greater in the aged rats than those of the young rats. For both age groups, exercise training significantly reversed the increase in MDA and decreases in GSH and ascorbic acid induced by ethanol drinking. The present study showed that ethanol-induced deterioration in lipid peroxidation and reduction in antioxidant status in the liver were exacerbated with age. Here, we found that exercise training significantly reversed the adverse conditions that were caused by ethanol in aged rats.

Antioxidant levels in peripheral blood, disease activity and fibrotic stage in chronic hepatitis C

BACKGROUND

This study addressed the suggested association between levels of the antioxidants glutathione (GSH), vitamin C and vitamin E in peripheral blood and the histological activity and fibrosis stage in chronic hepatitis C (CHC). We then determined whether regular antioxidant supplementation influenced these antioxidant levels or disease severity.

METHODS

Clinical, biochemical, histological and demographic data were collected from 247 CHC patients at the time of liver biopsy. Whole blood total GSH, plasma vitamin C and E were assessed by high-performance liquid chromatography. Statistical analyses were performed to test for associations between the variables and to identify independent predictors for hepatic necroinflammatory and fibrosis scores.

RESULTS

GSH and vitamin C, but not vitamin E correlated with both portal/periportal activity (r = -0.19, P = 0.004; r = -0.19, P = 0.009 respectively) and fibrosis stage (r = -0.18, P = 0.007; r = -0.18, P = 0.009 respectively). GSH was an independent negative predictor of portal/periportal inflammation (P = 0.02) and fibrosis (P = 0.01). Vitamin C was an independent negative predictor of fibrosis stage (P = 0.02). Antioxidant intake was associated with higher vitamin C (P < 0.0001) and vitamin E (P = 0.005) levels, but not GSH.

CONCLUSIONS

Whole blood GSH and plasma vitamin C are negatively associated with hepatic portal/periportal inflammation and fibrosis stage in CHC. Controlled intervention studies with vitamin C and agents that boost endogenous GSH levels are warranted.

Extracellular thiols and thiol/disulfide redox in metabolism

Many proteins present on cell surfaces and located in extracellular fluids contain cysteine and methionine residues that are subject to oxidation. These proteins, which include transporters, receptors, and enzymes, respond to variations in the extracellular thiol/disulfide redox environment. Changes in activity of these proteins can alter the ability of organs to function normally and influence processes such as nutritional absorption, secretory function, neurotransmission, and susceptibility to toxicants. In addition, extracellular redox can regulate tissue homeostasis through effects on cell proliferation, differentiation, apoptosis, and immune function. Consequently, extracellular redox can have important influences on health status and disease states and thus could be a target for nutritional interventions.

Green tea protects against ethanol-induced lipid peroxidation in rat organs

Ethanol metabolism is accompanied by generation of free radicals, which stimulates lipid peroxidation. Natural antioxidants are particularly useful in such a situation. The current study was designed to investigate the efficacy of green tea, as a source of water-soluble antioxidants (catechins), on lipid peroxidation in liver, brain, and blood induced by chronic (4 weeks) ethanol intoxication in rats. Feeding of ethanol led to a significant increase in lipid peroxidation, as measured by increased concentrations of lipid hydroperoxides, 4-hydroxynonenal, and malondialdehyde. Feeding of ethanol also changed the glutathione-dependent lipid hydroperoxide decomposition system, resulting in a decrease in both reduced glutathione concentration and activity of glutathione peroxidase. Observed changes were statistically significant in all examined tissues. Enhancement in lipid peroxidation was associated with disruption of hepatocyte cell membranes, as observed through electron microscopic evaluation. Green tea protects phospholipids from enhanced peroxidation and prevents changes in biochemical parameters and morphologic changes observed after ethanol consumption. These results support the suggestion that green tea protects membranes from peroxidation of lipids associated with ethanol consumption.

Oxidative stress in viral and alcoholic hepatitis

Liver damage ranges from acute hepatitis to hepatocellular carcinoma, through apoptosis, necrosis, inflammation, immune response, fibrosis, ischemia, altered gene expression and regeneration, all processes that involve hepatocyte, Kupffer, stellate, and endothelial cells. Reactive oxygen and nitrogen species (ROS, RNS) play a crucial role in the induction and in the progression of liver disease, independently from its etiology. They are involved in the transcription and activation of a large series of cytokines and growth factors that, in turn, can contribute to further production of ROS and RNS. The main sources of free radicals are represented by hepatocyte mitochondria and cytochrome p450 enzymes, by endotoxin-activated macrophages (Kupffer cells), and by neutrophils. The consequent alteration of cellular redox state is potentiated by the correlated decrease of antioxidant and energetic reserves. Indices of free radical-mediated damage, such as the increase of malondialdehyde, 4-hydroxynonenal, protein-adducts, peroxynitrite, nitrotyrosine, etc., and/or decrease of glutathione, vitamin E, vitamin C, selenium, etc., have been documented in patients with viral or alcoholic liver disease. These markers may contribute to the monitoring the degree of liver damage, the response to antiviral therapies and to the design of new therapeutic strategies. In fact, increasing attention is now paid to a possible "redox gene therapy." By enhancing the antioxidant ability of hepatocytes, through transgene vectors, one could counteract oxidative/nitrosative stress and, in this way, contribute to blocking the progression of liver disease.

Practicalities of glutathione supplementation in nutritional support

New nutraceutical products for nutritional support and antioxidant therapy such as glutathione require practical advice and information on the indications, methods and routes of administration, dosing (therapeutic drug monitoring), stability and physicochemical compatibility. This review is based on recent clinical and experimental publications in which glutathione has been used as a drug.

Ethanol consumption, amino acid and glutathione blood levels in patients with and without chronic liver disease

BACKGROUND

Ethanol abuse and liver cirrhosis cause a reduction of glutathione blood levels; liver cirrhosis induces an alteration of the plasma amino acid pattern. We evaluated whether or not ethanol abuse affects amino acid levels, particularly those that are involved in metabolizing glutathione in the plasma and erythrocytes of chronic alcohol abusers with or without liver cirrhosis.

METHODS

We studied 10 chronic alcohol abusers without liver cirrhosis, 10 with alcoholic cirrhosis, 10 affected by hepatitis C virus-related cirrhosis, and 10 healthy subjects. Glutathione, y-glutamyl-cysteine, and cysteine were determined by fluorescent HPLC, glutamic acid, glycine, and other free amino acids by cation exchange chromatography both in the plasma and erythrocytes of all studied subjects.

RESULTS AND CONCLUSIONS

In both alcoholics and cirrhotics, we found a significant increase of plasma-aromatic amino acid and methionine levels, whereas glutathione was significantly reduced. The erythrocytes of these patients showed a significant increase of cysteine, glutamic acid, and glycine; gamma-glutamylcysteine was normal; and glutathione and other free amino acids were significantly decreased. Data suggest that, independent of liver cirrhosis, ethanol abuse affects the metabolism of amino acids and glutathione in both the plasma and the erythrocytes.