Eupatilin protects against isotretinoin induced hepatotoxicity through immunomodulation of TLR4/MyD88/TRAF6 and NF-κB/NrF2 pathways.

Eupatilin is a pharmacologically active dietary flavone derived from Artemisia princeps Pampanini (family Asteraceae) and found as a major ingredient of several medicinal plants. Isotretinoin has been widely used as an effective treatment for dermatologic diseases, but its use is accompanied by many risks, mostly liver toxicity. This study was designed to investigate the effect of eupatilin against isotretinoin-induced hepatotoxicity with the elucidation of possible underlying mechanisms. Rats were divided into the following groups: control, eupatilin (15 mg/kg/day orally for 14 days), isotretinoin (7.5 mg/kg/day orally for 14 days), isotretinoin + silymarin (100 mg/kg/day), isotretinoin + eupatilin (5 mg/kg/day), isotretinoin + eupatilin (15 mg/kg/day). Liver injury was assessed by histopathological examination and measuring serum ALT, AST, and ALP enzymes. Oxidant/antioxidant balance was determined by assessing hepatic content of MDA, GSH and TAC. Inflammation biomarkers TRAF6 and IL-10 were measured in liver tissue. In addition, hepatic expressions of TLR4, MyD88, NF-κB and Nrf2 were assigned. Isotretinoin significantly increased serum liver enzymes, TRAF6, TLR4, MyD88, and NF-κB, and decreased IL-10 and Nrf2 compared to normal control, indicating liver injury and inflammation. Concurrent eupatilin administration with isotretinoin mitigated these changes. Eupatilin significantly lowered liver enzymes, TRAF6, TLR4, NF-κB and increased IL-10 and Nrf2 versus the isotretinoin group. High dose eupatilin showed maximal effects. Histology also showed that eupatilin attenuated isotretinoin-induced liver damage. Eupatilin can protect against isotretinoin-induced liver injury, possibly by reducing inflammation and oxidative stress. It modulates TLR4/MyD88/TRAF6 and NF-κB/NrF2 pathways. Eupatilin may be a promising adjunctive therapy to isotretinoin that can alleviate risk of hepatotoxicity.