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Clin Exp Hepatol. 2018 Dec;4(4):260-266. doi: 10.5114/ceh.2018.80128. Epub 2018 Dec 3.

N-acetylcysteine protects hepatocytes from hypoxia-related cell injury.

Author information

Department of General and Visceral Surgery, Goethe-University Hospital Frankfurt, Frankfurt/M., Germany.
Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
European Medical School, University Hospital for General and Visceral Surgery, Klinikum Oldenburg, Carl von Ossietzky University, Oldenburg, Germany.


Aim of the study:

Hepatocyte transplantation has been discussed as an alternative to liver transplantation in selected cases of acute and chronic liver failure and metabolic diseases. Immediately after infusion of hepatocytes, hypoxia-related cell injury is inevitable. N-acetylcysteine (NAC) has been suggested to attenuate hypoxic damage. This study's objective was to evaluate NAC's protective effect in a model of hypoxia-related hepatocyte injury.

Material and methods:

HepG2 cells were used as a model for hepatocytes and were cultured under standardized hypoxia or normoxia for 24 hours with or without NAC. Growth kinetics were monitored using trypan blue staining. The activation of apoptotic pathways was measured using quantitative real-time PCR for Bcl-2/Bax and p53. The proportions of vital, apoptotic and necrotic cells were verified by fluorescence activated cell sorting using annexin V-labelling. The expression of hypoxia inducible factor 1 (HIF-1) was measured indirectly using its downstream target vascular endothelial growth factor A (VEGF-A).


After NAC, cell proliferation increased under both hypoxia and normoxia by 528% and 320% (p < 0.05), while VEGF-A expression decreased under normoxia by 67% and 37% (p < 0.05). Compared to cells treated without NAC under hypoxia, the Bcl-2/Bax ratio increased significantly in cells treated with NAC. This finding was confirmed by an increased number of vital cells in FACS analysis.


NAC protects hepatocytes from hypoxic injury and ultimately activates anti-apoptotic pathways.


HepG2; N-acetylcysteine; hepatocyte transplantation; hypoxia

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