甘草活性成分对抗抑郁药诱导的肝损伤的防治作用

Preventive and therapeutic effect of bioactive component of licorice on antidepressant-induced liver injury

由于现代精神疾病发病率的激增,抗抑郁药的应用增加。然而,令人担忧的是,抗抑郁药诱导的肝损伤已经逐渐成为严重的健康负担。此外,由于人们对抗抑郁药肝毒性的认知大多来源于药物警戒和临床病例报告,而缺乏观察性的研究,所以对其潜在的分子机制知之甚少并且缺乏有效的治疗策略。在该研究中,抗抑郁药帕罗西汀(paroxetine)直接触发了炎症小体(inflammasome)的活化,表现为caspase-1的成熟和下游效应因子interleukin(IL)-1β的分泌,并且这种活化可以经甘草活性成分刺甘草查尔酮(echinatin)的预处理完全阻断。另外,研究还发现,刺甘草查尔酮有效地抑制了帕罗西汀诱导的炎症小体非依赖性的肿瘤坏死因子α(tumor necrosis factor-α, TNF-α)的产生。从机制上讲,线粒体活性氧(mitochondrial reactive oxygen species, mtROS)的累积是帕罗西汀诱导炎症小体活化的关键上游事件,并且可以被刺甘草查尔酮显著抑制。在脂多糖(lipopolysaccharide, LPS)介导的特异质性药物性肝损伤(idiosyncratic drug-induced liver injury, IDILI)模型中,LPS与抗抑郁药帕罗西汀共同暴露于小鼠触发了炎症小体的异常活化从而诱导了特异质肝毒性,而这种损伤可以通过刺甘草查尔酮预处理得到改善。值得注意的是,此研究还发现甘草的多种活性成分对帕罗西汀触发的炎症小体活化有显著的抑制作用,同时,多种抗抑郁药诱导的炎症小体异常活化可以被刺甘草查尔酮预处理完全阻断。总而言之,该研究为抗抑郁药诱导肝损伤的机制提供了新的见解,同时为抗抑郁药肝毒性的治疗提供了一种新的策略。

Since exploding rates of modern mental diseases, application of antidepressants has increased. Worryingly, the antidepressant-induced liver injury has gradually become a serious health burden. Furthermore, since most of the knowledge about antidepressant hepatotoxicity are from pharmacovigilance and clinical case reports and lack of observational studies, the underlying mechanisms are poorly understood and there is a lack of efficient treatment strategies. In this study, antidepressant paroxetine directly triggered inflammasome activation evidenced by caspase-1 activation and downstream effector cytokines interleukin(IL)-1β secretion. The pretreatment of echinatin, a bioactive component of licorice, completely blocked the activation. This study also found that echinatin effectively inhibited the production of inflammasome-independent tumor necrosis factor α(TNF)-α induced by paroxetine. Mechanistically, the accumulation of mitochondrial reactive oxygen species(mtROS) was a key upstream event of paroxetine-induced inflammasome activation, which was dramatically inhibited by echinatin. In the lipopolysaccharide(LPS)-mediated idiosyncratic drug-induced liver injury(IDILI) model, the combination of LPS and paroxetine triggered aberrant activation of the inflammasome to induce idiosyncratic hepatotoxicity, which was reversed by echinatin pretreatment. Notably, this study also found that various bioactive components of licorice had an inhibitory effect on paroxetine-triggered inflammasome activation. Meanwhile, multiple antidepressant-induced aberrant activation of the inflammasome could be completely blocked by echinatin pretreatment. In conclusion, this study provides a novel insight for mechanism of antidepressant-induced liver injury and a new strategy for the treatment of antidepressant-induced hepatotoxicity.