title: Valproate-induced liver injury: modulation by the omega-3 fatty acid DHA proposes a novel anticonvulsant regimen.
abstract: BACKGROUND
  The polyunsaturated, ω-3 fatty acid, docosahexaenoic acid (DHA), claims diverse cytoprotective potentials, although via largely undefined triggers. Thus, we currently first tested the ability of DHA to ameliorate valproate (VPA)-evoked hepatotoxicity, to modulate its anticonvulsant effects, then sought the cellular and molecular basis of such actions. Lastly, we also verified whether DHA may kinetically alter plasma levels/clearance rate of VPA.
  
  
  RESULTS
  VPA (500 mg/kg orally for 14 days in rats) evoked prominent hepatotoxicity that appeared as a marked rise (2- to 4-fold) in serum hepatic enzymes (γ-glutamyl transferase [γ-GT], alanine aminotransferase [ALT], and alkaline phosphatase [ALP]), increased hepatic lipid peroxide (LPO) and tumor necrosis factor-alpha (TNFα) levels, as well as myeloperoxidase (MPO) activity (3- to 5-fold), lowering of serum albumin (40 %), and depletion of liver reduced-glutathione (GSH, 35 %). Likewise, histopathologic examination revealed hepatocellular degeneration, replacement by inflammatory cells, focal pericentral necrosis, and micro/macrovesicular steatosis. Concurrent treatment with DHA (250 mg/kg) markedly blunted the elevated levels of liver enzymes, lipid peroxides, TNFα, and MPO activity, while raising serum albumin and hepatic GSH levels. DHA also alleviated most of the cytologic insults linked to VPA. Besides, in a pentylenetetrazole (PTZ) mouse convulsion model, DHA (250 mg/kg) markedly increased the latency in convulsion evoked by VPA, beyond their individual responses. Lastly, pharmacokinetic studies revealed that joint DHA administration did not alter serum VPA concentrations.
  
  
  CONCLUSIONS
  DHA substantially ameliorated liver injury induced by VPA, while also markedly boosted its pharmacologic effects. DHA manipulated definite cellular machinery to curb liver oxidative stress and inflammation, without affecting VPA plasma levels. Collectively, these protective and synergy profiles for DHA propose a superior VPA-drug combination regimen.
authors.affiliation: Department of Pharmacology, Faculty of Pharmacy (FOP), Mansoura University, 35512, Mansoura, Egypt.
authors.forename: Marwa A
authors.initials: MA
authors.lastname: Abdel-Dayem
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Elmarakby
authors.forename: Azza A
authors.initials: AA
authors.lastname: Abdel-Aziz
authors.forename: Chelsey
authors.initials: C
authors.lastname: Pye
authors.forename: Shehta A
authors.initials: SA
authors.lastname: Said
authors.forename: Abdalla M
authors.initials: AM
authors.lastname: El-Mowafy
mesh_terms: D000284:Administration, Oral; D000818:Animals; D000927:Anticonvulsants / Q000008:administration & dosage / Q000627:therapeutic use*; D056486:Chemical and Drug Induced Liver Injury / Q000178:diet therapy* / Q000188:drug therapy*; D004281:Docosahexaenoic Acids / Q000008:administration & dosage / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D008297:Male; D051379:Mice; D010433:Pentylenetetrazole / Q000008:administration & dosage / Q000627:therapeutic use*; D051381:Rats; D017207:Rats, Sprague-Dawley; D014635:Valproic Acid / Q000008:administration & dosage / Q000633:toxicity*
chemical_list: D000927:Anticonvulsants; D004281:Docosahexaenoic Acids; D014635:Valproic Acid; D010433:Pentylenetetrazole
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