The multiple mechanisms and modes of cell death after acetaminophen overdose

Acetaminophen (APAP)-induced liver injury and acute liver failure is a significant clinical problem worldwide; in addition, APAP overdoses in animals or in cell culture are used as popular models to study drug-induced liver injury mechanisms and test therapeutic interventions. Early assumptions that...

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Main Authors: Hartmut Jaeschke, Anup Ramachandran
Format: Article
Language:English
Published: Open Exploration Publishing Inc. 2025-04-01
Series:Exploration of Digestive Diseases
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Online Access:https://www.explorationpub.com/uploads/Article/A100569/100569.pdf
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author Hartmut Jaeschke
Anup Ramachandran
author_facet Hartmut Jaeschke
Anup Ramachandran
author_sort Hartmut Jaeschke
collection DOAJ
description Acetaminophen (APAP)-induced liver injury and acute liver failure is a significant clinical problem worldwide; in addition, APAP overdoses in animals or in cell culture are used as popular models to study drug-induced liver injury mechanisms and test therapeutic interventions. Early assumptions that APAP toxicity is caused by a single mechanism resulting in a defined mode of cell death in hepatocytes had to be questioned when over the years many different mechanisms and modes of cell death were reported. Although many of the contradictory results and conclusions reported over the years can be attributed to lack of understanding of established mechanisms, methodological problems, and misinterpretation of data, it is increasingly recognized that some of the reported differences in signaling mechanisms and even a switch in the mode of cell death can be caused by variations in the experimental conditions. In this review, examples will be discussed how experimental conditions (dose, solvent, etc.), the experimental system (species, strain, and substrain in vivo, cell type, and in vitro conditions), and also adaptive responses and off-target effects of genetic manipulations and chemical interventions, can impact the mechanisms of cell death. Given that the conditions will determine the results, it is therefore of critical importance to keep in mind the translational aspect of the experiments, i.e., the conditions relevant to the human pathophysiology. Only the full appreciation of these issues will lead to reproducible and clinically relevant results that advance our understanding of all facets of the human pathophysiology and identify clinically relevant therapeutic targets.
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spelling doaj-art-1bf867e465c34bd9937d6f47641e5dd72025-08-20T02:08:15ZengOpen Exploration Publishing Inc.Exploration of Digestive Diseases2833-63212025-04-01410056910.37349/edd.2025.100569The multiple mechanisms and modes of cell death after acetaminophen overdoseHartmut Jaeschke0https://orcid.org/0000-0002-8695-6980Anup Ramachandran1https://orcid.org/0000-0002-5438-2409Department of Pharmacology, Toxicology & Therapeutics, University of Kansas Medical Center, Kansas City, KS 66160, USADepartment of Pharmacology, Toxicology & Therapeutics, University of Kansas Medical Center, Kansas City, KS 66160, USAAcetaminophen (APAP)-induced liver injury and acute liver failure is a significant clinical problem worldwide; in addition, APAP overdoses in animals or in cell culture are used as popular models to study drug-induced liver injury mechanisms and test therapeutic interventions. Early assumptions that APAP toxicity is caused by a single mechanism resulting in a defined mode of cell death in hepatocytes had to be questioned when over the years many different mechanisms and modes of cell death were reported. Although many of the contradictory results and conclusions reported over the years can be attributed to lack of understanding of established mechanisms, methodological problems, and misinterpretation of data, it is increasingly recognized that some of the reported differences in signaling mechanisms and even a switch in the mode of cell death can be caused by variations in the experimental conditions. In this review, examples will be discussed how experimental conditions (dose, solvent, etc.), the experimental system (species, strain, and substrain in vivo, cell type, and in vitro conditions), and also adaptive responses and off-target effects of genetic manipulations and chemical interventions, can impact the mechanisms of cell death. Given that the conditions will determine the results, it is therefore of critical importance to keep in mind the translational aspect of the experiments, i.e., the conditions relevant to the human pathophysiology. Only the full appreciation of these issues will lead to reproducible and clinically relevant results that advance our understanding of all facets of the human pathophysiology and identify clinically relevant therapeutic targets.https://www.explorationpub.com/uploads/Article/A100569/100569.pdfdrug hepatotoxicityacetaminophenacute liver failureapoptosisferroptosislipid peroxidationinflammation
spellingShingle Hartmut Jaeschke
Anup Ramachandran
The multiple mechanisms and modes of cell death after acetaminophen overdose
Exploration of Digestive Diseases
drug hepatotoxicity
acetaminophen
acute liver failure
apoptosis
ferroptosis
lipid peroxidation
inflammation
title The multiple mechanisms and modes of cell death after acetaminophen overdose
title_full The multiple mechanisms and modes of cell death after acetaminophen overdose
title_fullStr The multiple mechanisms and modes of cell death after acetaminophen overdose
title_full_unstemmed The multiple mechanisms and modes of cell death after acetaminophen overdose
title_short The multiple mechanisms and modes of cell death after acetaminophen overdose
title_sort multiple mechanisms and modes of cell death after acetaminophen overdose
topic drug hepatotoxicity
acetaminophen
acute liver failure
apoptosis
ferroptosis
lipid peroxidation
inflammation
url https://www.explorationpub.com/uploads/Article/A100569/100569.pdf
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