Cytoprotective effects of trimetazidine in carmustine cholestasis

Carmustine [1 ,3-bis(2-chloroethyl)-1-nitrosurea (BCNU)] is an antitumour agent, however, its usefulness has been limited by a side effect; which involves pericholangitis and intrahepatic cholestasis. The primary effects of cholestasis is well known; bile flow retention, intracellular Ca++ accumulation and acidosis although it may lead to hepatotoxicity by dose-dependent manner. Recent studies provide evidence that lipoperoxidation (LPO) and alterations in the antioxidant system may significantly contribute to BCNU induced hepatotoxicity. Trimetazidine, (1-[2,3,4-Trimethoxy-benzyl] piperazine HCl; TMZ) introduced as an antianginal compound, is found to exhibit various cytoprotective features by preserving cellular ATP levels, limiting intracellular acidosis and inorganic phosphate as well as Na+ and Ca++ accumulation in ischemic cardiac injury. No study was undertaken to investigate the cytoprotective role of TMZ in cholestatic injury till today; therefore we initiated this study to investigate if its cytoprotective features also exhibit in the liver and to characterize further the cholestatic response to BCNU administration. Male rats were randomly seperated to control (CONT) (n = 15), BCNU administered (BCNU) (n = 16) and BCNU+TMZ administered (BCNU+TMZ) (n = 12) groups. The control rats received a single dosage of 2 ml/kg of corn oil (i.p.) while the BCNU group received a single dosage of BCNU (20 mg/kg, i.p.) in corn oil. In the BCNU + TMZ group 2,5 mg/kg/day (i.p.) of TMZ was administered for three days. This group also received BCNU (20 mg/kg, i.p.) in corn oil, 12 hours after the initial dose of TMZ. The cholestatic effect of BCNU was monitored by stasis markers such as ALP, GGT and total bilirubin levels. Hepatic TBARS analysis was determined with the modified method of OKHAWA et al. based on the reaction of lipid peroxides with thiobarbituric acid. Oxidized (GSSG) and reduced (GSH) glutathione levels were measured by the modified enzymatic recycling method of TEARE et al. Statistical tests were performed using Kruskal Wallis one-way Anova test and posthoc analysis by Newman-Keuls test. The BCNU group and the BCNU + TMZ group showed significant increases (p = 0.029) in hepatic TBARS levels compared to the CONT group; however the difference between the BCNU and BCNU + TMZ groups in regard to TBARS was not significant. BCNU and BCNU + TMZ groups manifested a significant decrease (p = 0.0005) in GSH levels as compared to controls. GSH/GSSG ratios in the BCNU and BCNU + TMZ group also manifested a significant decrease (p = 0.0013) as compared to the CONT group. TMZ administration caused a significant increase in total GSH levels (p = 0.0026) in BCNU + TMZ group when compared to the BCNU group. Our results support the hypothesis that BCNU induced cholestasis partly involves LPO revealed by the distinct increase in the content of TBARS in the liver after BCNU administration. BCNU is a potent inhibitor of GSSG reductase altering the preservation of the thiol redox balance in the system. As a result, supranormal concentrations of intracellular GSSG would accumulate in the hepatocyte and the extrusion of this oxidized compound would require active transport leading to ATP hydrolysis. This would deplete the energy stores of the cell which would accelerate further the possible prooxidant status. Although administration of TMZ did not provoke any significant alterations in LPO, it preserved the total GSH levels of the cell probably by improving the energy status of the cell by protection of ATP-producing processes at the mitochondrial level and provision of the necessary substrates for GSH synthesis. This protective role in the antioxidant system normalizes the altered GSH levels by BCNU and hence proposes TMZ to be a promising agent in the cholestatic injury.