Liver hyperthermia and oxidative stress: role of iron and aldehyde production

Hyperthermia has been used to treat cancer in the liver. However, significant hepatotoxicity occurs at a therapeutic temperature of 42-43 degrees C. We have proposed that heat toxicity is the result of oxidative stress from superoxide generation with resultant lipid peroxidation. Further, iron release from liver iron stores (ferritin) appears to play a central role in hyperthermic toxicity. In this study, rat livers were perfused in situ at 37 or 42.5 degrees C with and without deferoxamine for 1 h with an asanguinous perfusate. Oxidative stress was assessed by the efflux of glutathione (GSH) into the perfusage. Prior studies by Skibba et al. (1989a, 1991) showed that perfusage equivalents of GSH were primarily present as oxidized glutathione (GSSG). Lipid peroxidation was assessed by the measurement of aldehydes appearing in the perfusate and formation of hydrocarbon gases (ethane and pentane) in the perfusion chamber head space. Liver injury was assessed by the leakage of cytosolic enzymes, AST and LDH, into the perfusate. Livers perfused at 42.5 degrees C showed significant rises (p < 0.05) in AST and LDH after 60 min of perfusion but perfusion at 42.5 degrees C with deferoxamine added, was not significantly different from perfusion at 37 degrees C. Perfusion at 42.5 degrees C caused an increase in GSH into the perfusate at a level significantly (p < 0.05) greater than at 37 degrees C. GSH levels in the liver after 60 min of perfusion decreased from 4.82 +/- 0.76 microM/gm at 37 degrees C to 1.48 +/- 0.54 microM/gm at 42.5 degrees C (p < 0.05) but only fell to 3.42 +/- 1.23 microM/gm at 42.5 degrees C with deferoxamine added. Efflux of iron into the perfusate increase significantly with time and temperature. Low molecular weight chelated iron within the liver after perfusion increased from 5.88 +/- 1.46 nM/gm at 37 degrees C to 25.8 nM/gm at 42.5 degrees C (p < 0.05). Perfusate total aldehyde levels increased from 0.085 +/- 0.056 to 0.32 +/- 0.09 microM/ml after 60 min at 37 degrees C and 0.87 +/- 0.45 to 2.01 +/- 0.90 microM/ml at 42.5 degrees C (n = 8). There was a significant decrease in total aldehyde levels at 42.5 degrees C with the addition of deferoxamine to the perfusate, 0.36 +/- 0.14 to 0.86 +/- 0.27 microM/ml, when compared to 42.5 degrees C levels (p < 0.05). Levels of ethane and pentane in the perfusion chamber head space showed no significant changes with time or temperature of perfusion. The data suggest that lipid peroxidation may play a causal role in hyperthermia induced liver toxicity and that iron plays a major role in this injury. Failure of hydrocarbon analysis to support this conclusion appears related to the use of membrane oxygenators.