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Open Access Research article

HMGB1 neutralization is associated with bacterial translocation during acetaminophen hepatotoxicity

Runkuan Yang127*, Xiaoping Zou3, Jyrki Tenhunen24, Shengtao Zhu5, Henri Kajander6, Marja-Leena Koskinen6 and Tor Inge Tonnessen7

Author Affiliations

1 Department of Critical Care Medicine, University of Pittsburgh Medical School, 3550 Terrace Street, Pittsburgh, PA 15261, USA

2 Department of Intensive Care Medicine, Tampere University Hospital, University of Tampere, 10 Bio Katu, Tampere 33014, Finland

3 Department of Gastroenterology, Drum Tower Hospital, Nanjing University Medical School, 321 Zhongshan Street, 210008 Nanjing, China

4 Department of Surgical Science, Anesthesiology and Intensive Care Medicine, Uppsala University, 751 85 Uppsala, Sweden

5 Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, 95 Yong An Road, 100050 Beijing, China

6 Department of Pathology, University of Tampere Medical School, 10 Bio Katu, 33521 Tampere, Finland

7 Department of Anesthesiology and Intensive Care Medicine, Rikshospital, Oslo University, 4950 Nydalen, 0424 Oslo, Norway

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BMC Gastroenterology 2014, 14:66  doi:10.1186/1471-230X-14-66

Published: 5 April 2014



Acetaminophen (APAP) hepatotoxicity is associated with a high rate of gram-negative enteric bacterial infection; however, the underlying mechanism is still unknown. APAP overdose induces massive hepatocyte necrosis, necrotic tissue releases high mobility group B1 (HMGB1) and exogenous HMGB1 is able to induce gut bacterial translocation (BT) in normal mice; therefore, it is possible that HMGB1 mediates gut BT in APAP hepatotoxicity. This study aims to test this hypothesis by using anti-HMGB1 neutralizing antibody to treat APAP overdose for 24-48 hours.


Male C57BL/6 mice were intraperitoneally (i.p.) injected with a single dose of APAP (350 mg/kg dissolved in 1 mL sterile saline). 2 hrs after APAP injection, the APAP challenged mice were randomized to receive treatment with either anti-HMGB1 antibody (400 μg per dose) or non-immune (sham) IgG every 24 h for a total of 2 doses.


24 and 48 hrs after APAP challenge, anti-HMGB1 treatment instead of sham IgG therapy significantly decreased serum HMGB1 concentrations and reduced BT by 85%; serum HMGB1 levels were positively correlated with the amount of BT; anti-HMGB1 therapy decreased hepatic BT at 48 h, which was associated with better recovered liver structure and better restored hepatic immune system that was shown by enhanced hepatic mRNA expression of TNF-α, IL-6 and extensive proliferation of inflammatory and reticuloendothelial cells; however, anti-HMGB1 treatment did not decrease gut mucosal permeability as compared to the sham IgG therapy at either 24 or 48 hrs.


HMGB1 neutralization is associated with bacterial translocation during APAP hepatotoxicity.

HMGB1; Acetaminophen; Hepatotoxicity; Gut bacterial translocation