Ferroptosis driven by radical oxidation of n-6 polyunsaturated fatty acids mediates acetaminophen-induced acute liver failure

Cell Death Dis. 2020 Feb 24;11(2):144. doi: 10.1038/s41419-020-2334-2.

Abstract

Acetaminophen (APAP) overdose is a common cause of drug-induced acute liver failure. Although hepatocyte cell death is considered to be the critical event in APAP-induced hepatotoxicity, the underlying mechanism remains unclear. Ferroptosis is a newly discovered type of cell death that is caused by a loss of cellular redox homeostasis. As glutathione (GSH) depletion triggers APAP-induced hepatotoxicity, we investigated the role of ferroptosis in a murine model of APAP-induced acute liver failure. APAP-induced hepatotoxicity (evaluated in terms of ALT, AST, and the histopathological score), lipid peroxidation (4-HNE and MDA), and upregulation of the ferroptosis maker PTGS2 mRNA were markedly prevented by the ferroptosis-specific inhibitor ferrostatin-1 (Fer-1). Fer-1 treatment also completely prevented mortality induced by high-dose APAP. Similarly, APAP-induced hepatotoxicity and lipid peroxidation were prevented by the iron chelator deferoxamine. Using mass spectrometry, we found that lipid peroxides derived from n-6 fatty acids, mainly arachidonic acid, were elevated by APAP, and that auto-oxidation is the predominant mechanism of APAP-derived lipid oxidation. APAP-induced hepatotoxicity was also prevented by genetic inhibition of acyl-CoA synthetase long-chain family member 4 or α-tocopherol supplementation. We found that ferroptosis is responsible for APAP-induced hepatocyte cell death. Our findings provide new insights into the mechanism of APAP-induced hepatotoxicity and suggest that ferroptosis is a potential therapeutic target for APAP-induced acute liver failure.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetaminophen
  • Animals
  • Antioxidants / pharmacology
  • Coenzyme A Ligases / genetics
  • Coenzyme A Ligases / metabolism
  • Cyclohexylamines / pharmacology
  • Cyclooxygenase 2 / genetics
  • Cyclooxygenase 2 / metabolism
  • Deferoxamine / pharmacology
  • Disease Models, Animal
  • Fatty Acids, Omega-6 / metabolism*
  • Ferroptosis* / drug effects
  • Hepatocytes / drug effects
  • Hepatocytes / metabolism*
  • Hepatocytes / pathology
  • Humans
  • Iron Chelating Agents / pharmacology
  • Lipid Peroxidation* / drug effects
  • Liver / drug effects
  • Liver / metabolism*
  • Liver / pathology
  • Liver Failure, Acute / chemically induced
  • Liver Failure, Acute / metabolism*
  • Liver Failure, Acute / pathology
  • Liver Failure, Acute / prevention & control
  • Mice, Inbred C57BL
  • Mice, Knockout
  • Oxidation-Reduction
  • Phenylenediamines / pharmacology
  • alpha-Tocopherol / pharmacology

Substances

  • Antioxidants
  • Cyclohexylamines
  • Fatty Acids, Omega-6
  • Iron Chelating Agents
  • Phenylenediamines
  • ferrostatin-1
  • Acetaminophen
  • Ptgs2 protein, mouse
  • Cyclooxygenase 2
  • Acsl4 protein, mouse
  • Coenzyme A Ligases
  • alpha-Tocopherol
  • Deferoxamine