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Wong A, Nejad C, Gantier M, Choy KW, Doery J, Graudins A. MicroRNA from a 12-h versus 20-h acetylcysteine infusion for paracetamol overdose. Hum Exp Toxicol 2019; 38:646-654. [PMID: 30838890 DOI: 10.1177/0960327119833740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Paracetamol overdose is common and microRNA (miR)-122 expression is increased with liver injury. We aimed to measure miR-122 in the setting of an abbreviated paracetamol overdose treatment regimen. We compared miRNA expression in patients treated for paracetamol poisoning with an abbreviated 12-h intravenous acetylcysteine regimen (200 mg/kg over 4 h, 50 mg/kg over 8 h) or a 20-h regimen (200 mg/kg over 4 h, 100 mg/kg over 16 h) (NACSTOP trial). miR-122 expression is increased (decreased cycle threshold (Ct) values) with paracetamol liver injury. We assessed miR-122 expression in patients receiving the two acetylcysteine regimens and in a separate group with acute liver injury (ALI). We examined 121 blood samples in 38 patients. After 20 h of acetylcysteine, median alanine transaminase (ALT) was 12 U/L (18, 14) versus 16 U/L (11, 21) ( p = 0.17) and median miR-122 Ct was 30.1 (interquartile range (IQR): 28.9, 33.3) versus 31.4 (28.9, 33.9) ( p = 0.7) in the NACSTOP abbreviated and control groups, respectively. Median normalized miR-122 Ct after 20 h of acetylcysteine was 2.2 (IQR 1.9, 6.4), 1.1 (0.7, 2.9), 63.9 (2.5, 168), 123.2 (40.9, 207.8) in the NACSTOP-abbreviated, NACSTOP-control, ALI and hepatotoxicity groups, respectively. There was no significant difference in ALT or miRNA between NACSTOP treatment groups and no signal of increased liver injury from an abbreviated 12-h acetylcysteine regimen. These findings suggest that an abbreviated acetylcysteine regimen in low-risk patients who have overdosed on paracetamol is safe. Further study is required to validate this finding utilizing miRNA as a comparative biomarker.
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Affiliation(s)
- A Wong
- 1 Monash Toxicology Unit and Emergency Medicine Service, Monash Health, Victoria, Australia.,2 Austin Toxicology and Emergency Department, Austin Health, Victoria, Australia.,3 Department of Medicine, Clinical Sciences at Monash Health, Monash University, Victoria, Australia
| | - C Nejad
- 4 Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Monash University, Clayton, Victoria, Australia.,5 Department of Molecular and Translational Science, Monash University, Clayton, Victoria, Australia
| | - M Gantier
- 4 Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Monash University, Clayton, Victoria, Australia.,5 Department of Molecular and Translational Science, Monash University, Clayton, Victoria, Australia
| | - K W Choy
- 6 Monash Pathology Department, Monash Health, Victoria, Australia
| | - James Doery
- 3 Department of Medicine, Clinical Sciences at Monash Health, Monash University, Victoria, Australia.,6 Monash Pathology Department, Monash Health, Victoria, Australia
| | - A Graudins
- 1 Monash Toxicology Unit and Emergency Medicine Service, Monash Health, Victoria, Australia.,3 Department of Medicine, Clinical Sciences at Monash Health, Monash University, Victoria, Australia
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