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Vitamin B5 and N-Acetylcysteine in Nonalcoholic Steatohepatitis: A Preclinical Study in a Dietary Mouse Model

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Nonalcoholic fatty liver disease (NAFLD) is the number one cause of chronic liver disease and second indication for liver transplantation in the Western world. Effective therapy is still not available. Previously we showed a critical role for caspase-2 in the pathogenesis of nonalcoholic steatohepatitis (NASH), the potentially progressive form of NAFLD. An imbalance between free coenzyme A (CoA) and acyl-CoA ratio is known to induce caspase-2 activation.


We aimed to evaluate CoA metabolism and the effects of supplementation with CoA precursors, pantothenate and cysteine, in mouse models of NASH.


CoA metabolism was evaluated in methionine–choline deficient (MCD) and Western diet mouse models of NASH. MCD diet-fed mice were treated with pantothenate and N-acetylcysteine or placebo to determine effects on NASH.


Liver free CoA content was reduced, pantothenate kinase (PANK), the rate-limiting enzyme in the CoA biosynthesis pathway, was down-regulated, and CoA degrading enzymes were increased in mice with NASH. Decreased hepatic free CoA content was associated with increased caspase-2 activity and correlated with worse liver cell apoptosis, inflammation, and fibrosis. Treatment with pantothenate and N-acetylcysteine did not inhibit caspase-2 activation, improve NASH, normalize PANK expression, or restore free CoA levels in MCD diet-fed mice.


In mice with NASH, hepatic CoA metabolism is impaired, leading to decreased free CoA content, activation of caspase-2, and increased liver cell apoptosis. Dietary supplementation with CoA precursors did not restore CoA levels or improve NASH, suggesting that alternative approaches are necessary to normalize free CoA during NASH.

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Nonalcoholic fatty liver disease


Nonalcoholic steatohepatitis


Coenzyme A


Methionine–choline deficient


Pantothenate kinase


Wild type


Alanine aminotransferase


Aspartate aminotransferase


Thiobarbituric acid-reactive substances


Alpha-smooth muscle actin


Superoxide dismutase


Glutathione peroxidase




Tumor necrosis factor alpha


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Financial Support

This research is supported by NIH R01 DK077794-08, R37 AA010154-19 and R56 DK106633-01 (Diehl AM), and Duke Endowment: The Florence McAlister Professorship (Diehl AM). MVM is the recipient of a PhD grant from Fundação para a Ciência e Tecnologia, FCT, Portugal.

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Correspondence to Anna Mae Diehl.

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Machado, M.V., Kruger, L., Jewell, M.L. et al. Vitamin B5 and N-Acetylcysteine in Nonalcoholic Steatohepatitis: A Preclinical Study in a Dietary Mouse Model. Dig Dis Sci 61, 137–148 (2016).

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