Berberine protects against gefitinib-induced liver injury by inhibiting the HMGB1/TLR4/NF-κB pathway

BackgroundGefitinib (GEF), a first-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) for non-small cell lung cancer (NSCLC), is frequently associated with drug-induced liver injury (DILI), thereby limiting its clinical application. This study aimed to evaluate the he...

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Main Authors: Qiongyin Zhang, Na Li, Xue Ma, Yue Qiu, Chao Li, Ya Chen
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-08-01
Series:Frontiers in Pharmacology
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Online Access:https://www.frontiersin.org/articles/10.3389/fphar.2025.1645634/full
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author Qiongyin Zhang
Na Li
Xue Ma
Yue Qiu
Chao Li
Ya Chen
author_facet Qiongyin Zhang
Na Li
Xue Ma
Yue Qiu
Chao Li
Ya Chen
author_sort Qiongyin Zhang
collection DOAJ
description BackgroundGefitinib (GEF), a first-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) for non-small cell lung cancer (NSCLC), is frequently associated with drug-induced liver injury (DILI), thereby limiting its clinical application. This study aimed to evaluate the hepatoprotective effects of berberine (BBR) and explore the underlying mechanisms.MethodsIn vitro, human hepatocyte lines (THLE-2 and THLE-3) were exposed to GEF alone or in combination with HMGB1 siRNA, a TLR4 inhibitor, an NF-κB inhibitor, or varying concentrations of BBR to assess hepatotoxicity and the involvement of the HMGB1/TLR4/NF-κB pathway. In vivo, Sprague-Dawley (SD) rats were treated with GEF with or without different doses of BBR for 21 days. Liver injury and inflammatory responses were assessed, and pathway alterations were evaluated at both transcriptional and protein levels.ResultsGEF activated the HMGB1/TLR4/NF-κB pathway in vitro, increasing the levels of p-NF-κB p65, ALT, AST, and pro-inflammatory cytokines (INF-α, IL-1β and IL-6). BBR inhibited these effects in a concentration-dependent manner by suppressing pathway activation, reducing hepatotoxicity, and inhibiting HMGB1 nuclear-to-cytoplasmic translocation. In vivo, GEF induced weight loss, an increased liver-to-body weight ratio, elevated serum transaminases and pro-inflammatory cytokines, and histopathological liver injury, all of which were dose-dependently ameliorated by BBR co-administration. Moreover, BBR significantly downregulated the expression of HMGB1, TLR4, and NF-κB at both mRNA and protein levels in liver tissues.ConclusionGEF-induced liver injury is mediated by HMGB1-driven inflammation via the TLR4/NF-κB pathway. BBR provides dose-dependent hepatoprotection by targeting this pathway, suggesting a potential strategy to protect against GEF-induced liver injury among NSCLC patients.
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spelling doaj-art-d74e13e50cb441e2baa6d006a91de3532025-08-26T08:04:30ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122025-08-011610.3389/fphar.2025.16456341645634Berberine protects against gefitinib-induced liver injury by inhibiting the HMGB1/TLR4/NF-κB pathwayQiongyin Zhang0Na Li1Xue Ma2Yue Qiu3Chao Li4Ya Chen5Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing, ChinaDepartment of Pharmacy, Chongqing University Cancer Hospital, Chongqing, ChinaDepartment of Pharmacy, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, Chengdu, ChinaDepartment of Pharmacy, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, Chengdu, ChinaDepartment of Pharmacy, Chongqing University Cancer Hospital, Chongqing, ChinaDepartment of Pharmacy, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, Chengdu, ChinaBackgroundGefitinib (GEF), a first-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) for non-small cell lung cancer (NSCLC), is frequently associated with drug-induced liver injury (DILI), thereby limiting its clinical application. This study aimed to evaluate the hepatoprotective effects of berberine (BBR) and explore the underlying mechanisms.MethodsIn vitro, human hepatocyte lines (THLE-2 and THLE-3) were exposed to GEF alone or in combination with HMGB1 siRNA, a TLR4 inhibitor, an NF-κB inhibitor, or varying concentrations of BBR to assess hepatotoxicity and the involvement of the HMGB1/TLR4/NF-κB pathway. In vivo, Sprague-Dawley (SD) rats were treated with GEF with or without different doses of BBR for 21 days. Liver injury and inflammatory responses were assessed, and pathway alterations were evaluated at both transcriptional and protein levels.ResultsGEF activated the HMGB1/TLR4/NF-κB pathway in vitro, increasing the levels of p-NF-κB p65, ALT, AST, and pro-inflammatory cytokines (INF-α, IL-1β and IL-6). BBR inhibited these effects in a concentration-dependent manner by suppressing pathway activation, reducing hepatotoxicity, and inhibiting HMGB1 nuclear-to-cytoplasmic translocation. In vivo, GEF induced weight loss, an increased liver-to-body weight ratio, elevated serum transaminases and pro-inflammatory cytokines, and histopathological liver injury, all of which were dose-dependently ameliorated by BBR co-administration. Moreover, BBR significantly downregulated the expression of HMGB1, TLR4, and NF-κB at both mRNA and protein levels in liver tissues.ConclusionGEF-induced liver injury is mediated by HMGB1-driven inflammation via the TLR4/NF-κB pathway. BBR provides dose-dependent hepatoprotection by targeting this pathway, suggesting a potential strategy to protect against GEF-induced liver injury among NSCLC patients.https://www.frontiersin.org/articles/10.3389/fphar.2025.1645634/fullgefitinibberberinedrug-induced liver injury (DILI)HMGB1/TLR4/NF-κBhepatoprotection
spellingShingle Qiongyin Zhang
Na Li
Xue Ma
Yue Qiu
Chao Li
Ya Chen
Berberine protects against gefitinib-induced liver injury by inhibiting the HMGB1/TLR4/NF-κB pathway
Frontiers in Pharmacology
gefitinib
berberine
drug-induced liver injury (DILI)
HMGB1/TLR4/NF-κB
hepatoprotection
title Berberine protects against gefitinib-induced liver injury by inhibiting the HMGB1/TLR4/NF-κB pathway
title_full Berberine protects against gefitinib-induced liver injury by inhibiting the HMGB1/TLR4/NF-κB pathway
title_fullStr Berberine protects against gefitinib-induced liver injury by inhibiting the HMGB1/TLR4/NF-κB pathway
title_full_unstemmed Berberine protects against gefitinib-induced liver injury by inhibiting the HMGB1/TLR4/NF-κB pathway
title_short Berberine protects against gefitinib-induced liver injury by inhibiting the HMGB1/TLR4/NF-κB pathway
title_sort berberine protects against gefitinib induced liver injury by inhibiting the hmgb1 tlr4 nf κb pathway
topic gefitinib
berberine
drug-induced liver injury (DILI)
HMGB1/TLR4/NF-κB
hepatoprotection
url https://www.frontiersin.org/articles/10.3389/fphar.2025.1645634/full
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