Overdose of acetaminophen, a widely used antipyretic
and analgesic
drug, is one of the leading causes of drug-induced acute liver injury
in the United States and worldwide. Phase-I metabolism of acetaminophen
generates the toxic N-acetyl-p-benzoquinone
imine (NAPQI) intermediate. Reactions of NAPQI with a wide range of
biomolecules cause increased oxidative stress, endoplasmic reticulum
(ER) stress, inflammation, and mitochondrial dysfunction, some of
the cellular events contributing toward liver toxicity. Previously,
we evaluated the potential of an FDA-approved, ER stress-modulating
antihypertensive drug, Wytensin (trans-guanabenz, E-GA), as an antidote for acetaminophen hepatotoxicity. E-GA prevented elevation of the liver enzyme alanine aminotransferase
(ALT), even when administered up to 6 h after acetaminophen overdose,
and exhibited synergistic analgesic interactions. However, the commercially
available guanabenz exists solely as a trans-isomer and suffers from
sedative side effects resulting from the inhibition of central α2A-adrenergic receptors in locus coeruleus. Here, we studied
the utility of the relatively unexplored cis-isomer of guanabenz as
a treatment option for acetaminophen-induced liver toxicity. cis(Z)-Guanabenz acetate (Z-GA) lacks interaction with α2A-adrenoreceptors and
is thus devoid of sedative, blood-pressure-lowering side effects of E-GA. Treatment of mice with Z-GA (10 mg/kg)
before acetaminophen overdose and up to 6 h post APAP administration
prevented liver injury and suppressed the elevation of serum ALT levels.
Mechanistically, hepatoprotective effects of both isomers are similar
and partly attributed to attenuation of the ER stress and oxidative
stress in the liver. The results of this study suggest that Z-GA may be a safer, effective antidote for the clinical
management of acute liver injury resulting from acetaminophen overdose.
It also raises a tantalizing possibility of a prophylactic combination
of the geometric isomer of the approved drug guanabenz with acetaminophen
in a clinical setting.