A Novel Multidrug Combination Mitigates Rat Liver Steatosis Through Activating AMPK Pathway During Normothermic Machine Perfusion

Background. Hepatic steatosis is now the leading cause of liver discards in deceased donors. Previous studies [Yarmush formula (Y) defatting] have successfully reduced the fat content by treating rat steatotic livers on extracorporeal normothermic machine perfusion (NMP) with a multidrug combination including the GW compounds that were linked to an increased risk of carcinogenesis. Methods. We developed a novel multidrug combination by replacing the GW compounds with 2 polyphenols, epigallocatechin-3-gallate (E) and resveratrol (R). Sixteen rat livers were placed on NMP and assigned to control, Y defatting, Y+E+R defatting, or Y-GW+E+R defatting groups (Y-GW=90% dose-reduced Y defatting, n=4/group). Results. All livers in defatting groups had significant decreases in hepatic triglyceride content at the end of the experiment. However, livers treated with our novel Y'-GW+E+R combination had evidence of increased metabolism and less hepatocyte damage and carcinogenic potential. Our Y'-GW+E+R combination had increased phosphorylation of AMP-activated protein kinase (P=0.019) and acetyl-CoA carboxylase (P=0.023) compared with control; these were not increased in Y+E+R group and actually decreased in the Y group. Furthermore, the Y'-GW+E+R group had less evidence of carcinogenic potential with no increase in AKT phosphorylation compared with control (P=0.089); the Y (P=0.031) and Y+E+R (P=0.035) groups had striking increases in AKT phosphorylation. Finally, our Y'-GW+E+R showed less evidence of hepatocyte damage with significantly lower perfusate alanine aminotransferase (P=0.007) and aspartate aminotransferase (P=0.014) levels. Conclusions. We have developed a novel multidrug combination demonstrating promising defatting efficacy via activation of the AMP-activated protein kinase pathway with an optimized safety profile and reduced hepatotoxicity during ex vivo NMP.