Hepatoprotective effect of rebamipide against methotrexate-induced hepatic intoxication: role of Nrf2/GSK-3β, NF-κβ-p65/JAK1/STAT3, and PUMA/Bax/Bcl-2 signaling pathways

Immunopharmacol Immunotoxicol. 2020 Oct;42(5):493-503. doi: 10.1080/08923973.2020.1811307. Epub 2020 Aug 29.

Abstract

Objectives: The fact that methotrexate (MTX) is hepatotoxic is an important reason to limit its clinical use. Rebamipide (REB) has antioxidant and anti-inflammatory properties and is useful for the treatment of gastro-duodenal ulcers. This study investigated the impact and protective mechanisms of REB against MTX-induced hepatotoxicity in rats.

Materials and methods: Animals were divided into four groups of six rats each: a control group, REB group (REB 100 mg/kg/day, orally), MTX control group (20 mg/kg, single i.p.), and MTX + REB group.

Results: The administration of MTX induced marked hepatic injury in the form of hepatocyte inflammatory swelling, degeneration, apoptosis, and focal necrosis. In parallel, our biochemical investigations revealed a marked hepatic dysfunction associated with the disturbance of the oxidant/antioxidant balance in the group treated with only MTX. Moreover, MTX led to the down-regulation of the hepatic Nrf2 and Bcl-2 expressions along with a marked elevation in the hepatic NF-κβ-p65, GSK-3β, JAK1, STAT3, PUMA, and Bax expressions. On the other hand, co-treatment with REB significantly ameliorated the aforementioned histopathological, biochemical, and molecular defects caused by MTX treatment.

Conclusion: the outcomes of the present study showed REB's ability to protect from hepatic injury induced by MTX, possibly through its antioxidant, anti-inflammatory, and anti-apoptotic properties. These effects could be attributed to REB's ability to modulate, at least in part, the Nrf2/GSK-3β,NF-κβ-p65/JAK1/STAT3, and PUMA/Bax/Bcl-2signaling pathways.

Keywords: NF-κβ-p65/JAK1/STAT3; Nrf2/GSK-3β; PUMA/Bax/Bcl-2; Rebamipide.

MeSH terms

  • Alanine / analogs & derivatives*
  • Alanine / pharmacology
  • Animals
  • Anti-Inflammatory Agents / pharmacology*
  • Antioxidants / pharmacology*
  • Apoptosis / drug effects
  • Apoptosis Regulatory Proteins / metabolism*
  • Chemical and Drug Induced Liver Injury / enzymology
  • Chemical and Drug Induced Liver Injury / etiology
  • Chemical and Drug Induced Liver Injury / pathology
  • Chemical and Drug Induced Liver Injury / prevention & control*
  • Disease Models, Animal
  • Glycogen Synthase Kinase 3 beta / metabolism*
  • Janus Kinase 1 / metabolism*
  • Liver / drug effects*
  • Liver / enzymology
  • Liver / pathology
  • Male
  • Methotrexate
  • NF-E2-Related Factor 2 / metabolism*
  • Necrosis
  • Oxidative Stress / drug effects
  • Proto-Oncogene Proteins c-bcl-2 / metabolism*
  • Quinolones / pharmacology*
  • Rats, Wistar
  • STAT3 Transcription Factor / metabolism*
  • Signal Transduction
  • Transcription Factor RelA / metabolism*
  • bcl-2-Associated X Protein / metabolism*

Substances

  • Anti-Inflammatory Agents
  • Antioxidants
  • Apoptosis Regulatory Proteins
  • Bax protein, rat
  • Bbc3 protein, rat
  • Bcl2 protein, rat
  • NF-E2-Related Factor 2
  • Nfe2l2 protein, rat
  • Proto-Oncogene Proteins c-bcl-2
  • Quinolones
  • Rela protein, rat
  • STAT3 Transcription Factor
  • Stat3 protein, rat
  • Transcription Factor RelA
  • bcl-2-Associated X Protein
  • Jak1 protein, rat
  • Janus Kinase 1
  • Glycogen Synthase Kinase 3 beta
  • Gsk3b protein, rat
  • rebamipide
  • Alanine
  • Methotrexate