- Open Access
The protective effect of N-acetyl cysteine against carbon tetrachloride toxicity in rats
The Journal of Basic and Applied Zoology volume 79, Article number: 14 (2018)
Carbon tetrachloride (CCL4) is used as a solvent for oils and fats, as a refrigerant, and as a dry-cleaning agent. Inhalation of its vapors can depress central nervous system activity and cause degeneration of the liver and kidneys.
The aim of this study was to investigate whether N-acetyl cysteine (NAC) has a protective effect on the toxicity caused by carbon tetrachloride.
Male rats were used in this experiment. Animals were divided into five groups, 5 animals each: G1 received olive oil, G2 was treated with CCL4 (1 ml/kg body wt) dissolved in olive oil (1:1), G3 received NAC (300 mg/kg body wt), G4 received CCL4 plus NAC, and G5 received NAC for 1 week then administrated to the same treatment of G4. All administrations were performed by gavage and maintained for 4 weeks.
The present study revealed that administration of CCL4 caused a significant increase in liver marker enzymes Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), and alkaline phosphatase (ALP); also, malondialdehyde (MDA) content in the liver tissue was increased. However, serum total protein showed no change in all groups. Also, histopathological investigation of CCL4 on the liver, testis, and kidney showed different deleterious effects. Additionally, CCl4 induced a highly significant increase in the percentage of sperm shape abnormality and sperm DNA tail moment values. Alternatively, result revealed that the two routes of NAC administrations caused a significant decrease in liver marker enzymes as well as MDA contents; improvement in liver, kidney, and testes architecture; a significant decrease in the percentage of sperm head abnormalities; and decline in the DNA tail moment values.
The present study pointed out the protective effect of NAC against the toxicity of CCL4.
Carbon tetrachloride (CCl4) is an agent that is commonly used in the dry-cleaning industry, is well known as a typical toxic agent, used to induce oxidative stress in experimental models (Nabeshima et al., 2006; Noori, Rehman, Qureshi, & Mahboob, 2009). A single dose of CCl4 can cause both oxidative stress and acute hepatic injuries (Khan & Alzohairy, 2011). This attributed to the conversion of CCl4 through hepatic microsomal cytochrome P450 into trichloromethyl-free radical (·CCl3 or ·CCl3OO) (Stal & Olson, 2000) which sequentially initiate lipid peroxidation process causing injury to the cell plasma membrane and cell organelles, leading to the release of reactive aldehydes with initiation of both pro-inflammatory and pro-fibrotic process (Novo & Parola, 2012). The liver is not the only target organ of CCl4 toxicity, but there are other organs such as the kidney (Ozturk, Ucar, Ozturk, Vardi, & Batcioglu, 2003). CCl4 can lead to acute tubular necrosis in the kidney, lung (Ӧgetürk, Çolakoğlu, Kuş, Kuş, & Sarsılmaz, 2009), brain (Soliman & Fahmy, 2011), and testis (Abdel Moneim, 2016). Previous data demonstrated that CCl4 induced decline in rat testicular size and weight and severe irregularities in the testicular architecture, including reduced tubular diameters, loss of the germinal line and reduction in cellular proliferation, degeneration of germ and Leydig cells along with distortions in spermatogenesis (Castilla-Cortazar, Garcia, Quiroga, Diez, & Diez-Caballero, 2000; Khan & Ahmed, 2009 and Abdel Moneim, 2016). Moreover, the free radicals of CCl4 bind with the unsaturated fatty acid of sperm plasma membrane forming alkoxy and peroxy radicals; as a result, lipid peroxides are produced, which are extremely reactive leading to alteration in sperm concentration, modification of the hormonal levels, and induction of necrosis (Ogeturk et al., 2005). Free radicals also induce decrease in GSH content, oxidative DNA damages, DNA adducts, DNA fragmentation, chromosomal aberrations and genetic mutations (Jia, Han, & Chen, 2002; Khan, Rizvi, Khan, Khan, & Shaheen, 2009 and Ahmed et al., 2014), germ cells necrosis, and degeneration in the testicular tubules (Guo, Lu, & Hsu, 2005 and Horn et al., 2006). On the other hand, N-acetyl cysteine (NAC), a potent antioxidant, has been utilized clinically for the treatment of many diseases (Rodrigues, Eiora, & Schaff, 2004; Akgun et al., 2005; Atkuri, Mantovani, Herzenberg, & Herzenberg, 2007; Sadowska, Manuel, & de Backer, 2007; Baker et al., 2009 and Samuni, Goldstein, Dean, & Berk, 2013). It is a small membrane permeable molecule that can rapidly permeate the intracellular sections. This antioxidant has a diversity of applications, mostly because of the reduced thiol moiety existing in its structure, which can scavenge reactive oxygen species (ROS) directly, and indirectly, NAC protects the liver by being hydrolyzed into cysteine; this, in turn, plays a significant role in the production of glutathione (Pereira-Filho et al., 2008) and enhancement of glutathione-S-transferase activity leading to the intracellular defense against oxidative stress and promotes detoxification (Aremu, Madejczyk, & Ballatori, 2008). Previous studies revealed the protective effects of NAC against CCl4-induced hepatotoxicity (Ritter, Reinke, Andrades, et al., 2004; Maksimchik, Lapshina, Sudnikovich, Zabrodskaya, & Zavodnik, 2008, Sahin and Alatas 2010), nephrotoxicity (Hanly et al., 2013 and Ustyol et al., 2017), and genotoxicity (Gurbuz, Ozkul, & Burgaz, 2009). Therefore, the present study was designated to investigate whether NAC has a protective effect on the toxicity of CCl4 by its antioxidant actions through biochemical, histopathological, and genetic investigations.
Chemicals and reagents
Carbon tetrachloride (CCL4) and N-acetyl cysteine (NAC) were obtained from Sigma Company. Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), alkaline phosphate, and total protein assays kits were purchased from bio-diagnostic company, EL-Doki, Giza, Egypt. All chemicals and reagents used were of analytical grade.
The present study was carried out using 25 male albino rats weighing 100–120 g which were purchased from the Egyptian Organization for Biological products and vaccines. Animals were housed in plastic cages and maintained in conditions of good ventilation, normal temperatures, and humidity ranges (55 ± 5%), a 12-h light-dark cycle. Rats were fed with standard pellets, containing all nutritive elements, drinking water ad libitum, and were acclimatized for 1 week prior to the treatment. All animal procedures were performed in accordance with the Declaration of Helsinki and the guidelines for the care and use of experimental animals established by the Committee for the Purpose of Control and Supervision of Experiments on Animals. Animals procedures were also made in accordance with the National Institutes of Health (NIH) protocol approved by Ain Shams University. Effort were made to minimize animal distress and to reduce the number of animals used in this study.
Rats were randomly divided into five groups, 5 animals each. Group (1) control group received olive oil only (1 ml/kg) 3 times/week. In group 2, animals received 1 ml/kg of CCl4 dissolved in olive oil (1:1) 3 times/week for 4 weeks; the selective dose was according to Hanafi (2012). Group (3) animals in this group received NAC 300 mg/kg orally according to (Galicia-Moreno et al., 2009). In group 4, rats received CCl4 accompanied with NAC. In group 5, rats received NAC for 1 week then administrated to the same treatment of group 4. All administrations were performed by gavage and maintained for 4 weeks, and all animals survived until the scheduled necropsy in all study groups.
Animals were sacrificed by deep isoflurane inhalation. After deep anesthesia, blood was collected by cardiac puncture; it was withdrawn slowly to prevent the heart collapsing and was processed to serum by allowing it to clot for at least 30 min at room temperature, followed by centrifugation at 2500g for 15 min at 4 °C. The liver, kidneys, testes, and cauda epididymis were dissected out for the different investigations which described below.
Assessment of hepatotoxicity
Liver marker enzymes ALT, AST, and alkaline phosphatase were estimated in serum by using kits (bio-diagnostic company, EL-Doki, Giza, Egypt) according to the manufacturer protocol.
Estimation of lipid peroxidation product (MDA)
Lipid peroxidation in tissue liver was estimated calorimetrically by measuring MDA using thiobarbituric acid (TBA) assay modified according to the method of Daper and Hadley (1990). Also, serum total protein was measured.
Immediately, organs such as the liver, kidney, and testes were collected and fixed in 10% buffered formaldehyde solution for at least 24 h before the histopathological study. Then, samples were embedded in paraffin wax, and 5-μm sections were prepared with a rotational microtome. These thin sections were stained with hematoxylin and eosin (H&E); also, liver sections only were stained with masson trichrome. Then, slides were mounted on glass slides with Canada balsam (Sigma, co) and observed for pathological changes under a binocular microscope.
Sperm shape abnormality assay
Assessment of sperm-shape anomaly was made by system portrayed by Wyrobek and Bruce (1978). After the rat was sacrificed, cauda epididymis was dismembered out and set in a Petri-plate containing 0.5 ml of saline solution (0.9%Nacl) at room temperature. The epididymis was sliced into little pieces to permit the sperms to swim out. After that, the smears were prepared using 2–3 drops of the solution, air dried overnight, fixed with absolute methanol for 15 min, and stained with hematoxylin and eosin. One thousand sperms for each rat were analyzed to decide the morphological variations from the norm under oil immersion. Sperm shape abnormalities were classified as sperm head morphology which was categorized as normal, triangular, amorphous, collapsed, deformed orientation, acute curvature, double head, banana shape, without hook and tail abnormality. Data were shown in terms of percentage of abnormal sperms.
DNA damage in sperm was measured using an alkaline Comet assay according to the method described by Singh, Mc Coy, Tice, and Schneider (1988) with some modifications published by Simon and Carrell (2013). Sperm cells were adjusted to a concentration of (6 × 106 spermatozoa/ml) using PBS, and then, 10 μl was mixed with 75 μl of 0.5% low-melting-point agarose. Quickly, 15 μl of the mixture was placed on a precoated slide with (1% normal-melting point agarose) for gel adhesion, covered with coverslips and allowed to solidify on a cold plate at 4 °C for 15 min. Next, coverslips were carefully removed, and slides were submerged in fresh lysis solution (2.5 M NaCl, 100 mM Na2EDTA, 10 mM Tris–HCl, and 1% Triton X-100, pH 10 (was added immediately before use)) for 1 h at 4 °C. Afterward, slides were removed from the lysis buffer and 1.25 ml of dithiothreitol (DTT) was added to lysis buffer and inverted to ensure mixing; then, cells were incubated in lysis buffer with dithiothreitol for a further 30 min at 4 °C, after which lithium diiodosalicyclate (LIS) was added (4 mM final concentration) and incubated for 1.5 h at room temperature. Following lysis, cells were drained off any remaining liquid by standing them vertically on tissue paper against a support. All samples were incubated in chilled alkaline electrophoresis buffer (1 mM EDTA, 0.3 M NaOH) for 20 min. Electrophoresis was carried out for 10 min (25 V, 300 mA). After electrophoresis, slides were drained and washed thrice with neutralizing buffer (0.4 M Tris-HCl, pH 7.4) for 5 min each. The whole procedure was performed in dim light or dark to minimize artefactual DNA damage. Just before visualization, each slide was stained with 50 μl of ethidium bromide (20 μl/ml), rinsed with water, and covered with a coverslip. The slides were examined at 200x magnification using Olympus fluorescent microscope. All slides were coded and examined blindly. A total of 100 randomly selected cells from two replicate slides (50 cells per slide) were examined per sample. The analysis of comet cells was done using TriTek Comet Score Freeware v1.5.
The DNA damage in the treated cells was quantified as the tail moment (the DNA product in tail X the migration distance in the tail) was compared with untreated cells (Olive, Banath, & Durand, 1990).
Data from control and treated animals for all tests were analyzed statistically to assess the significant differences using Student’s t test.
Results and discussion
CCL4 is well known as a typical toxic agent; its toxic effects occur through the production of free radicals. When the generation of the free radicals exceeds the cellular radicals scavenging capacity, the hepatocellular damage might occur. In the present study, the assessment of liver toxicity by CCL4 was done by measuring the marker enzymes AST, ALT, and ALP. Administration of CCl4 caused marked increase in the levels of serum AST, ALT, and ALP as shown in Table 1. This might be due to the release of these enzymes from the cell cytoplasm, into the blood flow quickly after rupture of the plasma membrane and cellular damage (Sallie, Tredger, & Williams, 1991). The present study agrees with Nitin and Khosas (2010); Sahreen, Khan, and Khan (2011); Domitrovic et al. (2015); and Reza, Sagor, and Alam (2015). In addition, CCL4 induced a significant increase in MDA level in liver tissue as compared to control Fig. 1, which in agreement with Lee et al. (2010) and Cai et al. (2015). The high level of MDA is a reflection of the occurrence of lipid peroxidation, leading to liver tissue damage and failure of antioxidant defense mechanisms (Termini, 2000). Alternatively, results showed that administration of NAC before or in combination with CCL4 caused a significant reduction in all liver maker enzymes (Table 1). These results were in accordance with Wong, C-Ooi, and Wong (2003); Kamalakkannan et al. (2005); Priya, Vijayalakshmi, Vivekanandan, and Karthikeyan (2011); and Sahin and Alatas (2013). NAC is an excellent source of sulfhydryl compound, which converted in hepatocytes into metabolites capable of stimulating GSH synthesis; it also provides sufficient cysteine to promote detoxification and eliminates directly reactive oxygen species. Previous studies showed the protective effect of NAC against liver damage induced by various hepatotoxic chemicals such as methanol (Raza, Ahmad, Gado, & Alshabanah, 2003) and ethanol (Ronis, Butura, Sampey, Shankar, & Prior, 2005). Interestingly, animals received NAC before or in combination with CCl4 showed a significant decrease in the MDA levels when compared with those received CCL4 alone; this result is in accordance with Sahin & Alatas, 2010. Also, Wang et al. (2014) reported that NAC was able to ameliorate oxidative stress and cytotoxicity in HepG cells. Additionally, Morsy, Abd Alla, Mahmoud, Abdel Wahab, and Mahmoud (2012) showed that curcumin, α–lipoic acid and NAC caused a significant decrease of hepatic MDA levels as compared to CCL4 fibrotic rats. However, results revealed insignificant change in serum total protein in all groups as compared to control; this was context with Hanafi (2012).
Histological examination of liver sections from control and NAC groups stained with H&E showed normal architecture (Fig. 2), and Masson trichrome staining revealed the minimal amount of thin and fine collagen fibers around the central vein and portal tract area (Fig. 3). Liver sections of rats that received CCL4 showed vacuolated cytoplasm and congestion (Fig. 4), dense amorphous material in eosinophilic between and around hepatocytes vacuolar degeneration (Fig. 5), aggregations of inflammatory cells and marked inflammatory changes associated with fatty changes (Fig.6), focal necrotic areas, congestion and pyknotic nuclei were also observed (Fig.7). These observations agree with Manjrekar, Jisa, Bag, and Adikary (2008); Morsy et al. (2012); Morakinyo, Oludare, Anifowose, and Adegoke (2012); Domitrovic et al. (2015); and Hismiogullari et al. (2015). Masson trichrome stained sections showed congested thickened portal tract with dense fibrous tissues radiating from the portal vein and extending into the parenchyma (Fig. 8). Conversely, liver sections from animals treated with NAC 1 week before CCL4 or in combination with CCL4 stained with H&E (Figs. 9 and 10) and Masson showed improvement in liver architecture sections. NAC prevented the accumulation of collagen fibers as shown in Fig. 11; these results agree with Galicia-moreno et al. (2009) and Pereira-Filho et al. (2008) who found that administration of NAC preserved the normal levels of collagen in CCl4-intoxicated rats. The effects of CCl4 were prevented completely or partially by NAC antioxidant activity as it prevented the increase in lipid peroxidation products (Manibusan, Odin, & Eastmond, 2007; Morsy et al., 2012 and Demiroren et al., 2014). The development of CCl4-induced liver fibrosis is usually associated with oxidative stress and lipid peroxidation (Manibusan et al., 2007). Bedossa, Houglum, Trautwein, Holstege, and Chojkier (1994) reported that hepatocyte lipid peroxidation plays a major role in the regulation of collagen α1(I) gene expression and that it may be a link between hepatocyte injury and hepatic fibrosis. Additionally, Galicia-Moreno et al. (2009) reported that NAC increased liver GSH levels, reduced lipid peroxidation products and transforming growth factor (TGF) levels, and prevented collagen accumulation. Additionally, Pereira-Filho et al. (2008) reported that NAC decreases the fibrosis scores, increases glutathione per-oxidase levels, and reduces inducible nitric oxide synthase levels. The reduction of glutathione (GSH) plays a key role in detoxifying the reactive toxic metabolites of CCl4, and the fibrotic process begins when the GSH stores are markedly depleted (Annadurai, Vigneshwari, Thirukumaran, Thomas, & Geraldine, 2011).
Kidney sections from control rat stained with H&E showed normal histological morphology (Fig. 12). While treated group with CCL4 showed that the structure of individual tubular lining cells are enlarged and filled with eosinophilic granules in cytoplasm (Fig. 13), severe congestion, vacuolation, inflammatory changes, and dilatation of Bowman’s space with glomerular atrophy and periglomerular space (Figs. 14, 15, 16, and 17), this agree with Manjrekar et al. (2008); Morakinyo et al. (2012); and Hismiogullari et al. (2015). Kidney sections obtained after the two routes of NAC treatment stained with H&E showed improvement in the architecture (Figs. 18 and 19). The powerful antioxidant effect of NAC appeared in the histological recovery of kidney; this attributed to its potential to eliminate free radicals from CCl4-induced oxidative stress. (Ustyol et al., 2017).
Sections of testes from control rats stained with H&E showed normal histological structure (Fig. 20). CCl4-treated group showed sloughing and destruction of walls of seminiferous tubules necrosis, edema, and increase in fibers deposition (Figs. 21, 22, and 23), in accordance with Manierea et al. (2005); Moustafa et al. (2007)); Manjrekar et al. (2008); Khan and Ahmed (2009); Hanafi (2012), and Khan (2012). These effects are due to the production of oxygen radicals in excess of the antioxidant capacity of the stressed tissue Yousef and Salama (2009). Fig. 24 shows improvement in the testis architecture after treatment with NAC; this agrees with Asadpour, Shahbazfar, Kianifard, Azari, and Nzaboli (2013).
Moreover, a highly significant increase (P < 0.0001) in the percentage of abnormality in sperm head morphology was observed in the CCl4 group (2.78 ± 6.02) when compared to control group (0.72 ± 2.28). This result agrees with Sonmez et al. (2014). Additionally, results revealed that abnormalities such as amorphous and without hook were the most frequently observed types after CCL4 exposure which coincides with Abdou, Salah, Hoda, and Abdel Rahim (2012). On the contrary, deformed orientation, triangular, acute curvature, and double headed sperms were the least common morphological abnormalities (Table 2 and Fig. 25). In addition, CCl4 induced damage in sperm head DNA which represented as a significant (P < 0.05) increase in the tail moment values (Table 2). This result concurs with Khan (2012), who declared that the Free radicals of carbon tetrachloride cause testicular DNA fragmentation qualitatively and quantitatively in testicular tissue.
The oxidative stress is considered as one of the main cause of DNA damage in the germ cells. In normal condition male, reproductive system has a balance between ROS creation and antioxidant activity. But the increase of ROS in semen can affect sperm or seminal plasma antioxidant defense mechanisms and cause oxidative stress (Sabeti, Pourmasumi, Rahiminia, Akyash, & Talebi, 2016). The different CCL4 metabolic pathways result in ROS generation and alteration of antioxidant defense systems in animals (Stal & Olson, 2000). ROS have negative effects on sperm function where sperm plasma membrane contains unsaturated fatty acids that are inclined to free radical attack leading to lipid peroxidation and DNA fragmentation. Compromising the integrity of the sperm membrane may lead to damage in sperm DNA (Agarwal, Saleh, & Bedaiwy, 2003) and decline the sperm’s capacity to repair damage (Ryan, Weil, Newburger, Haugland, & Simons, 1990). Seminal ROS decreases sperm motility (Kao et al., 2008) and distorts sperm morphology. On the other hand, NAC is a free radical scavenger which encourages cell glutathione production and could counteract oxidant-mediated tissue injury (Zembron-Lacny, Slowinska-Lisowska, Szygula, Witkowski, & Szyszka, 2009). In the present study, NAC treatment has been shown to lower the percentages of abnormal sperms and sperm DNA damage. Treatment with NAC accompanied with CCL4 caused a decrease in the percentage of abnormal sperms from 2.78 with CCl4 alone to 1.14% and decreased the tail moment percentage to 0.3036 (Table 2 and Fig. 26), while pre-treatment with NAC for 1 week followed by administration of NAC plus CCL4 caused a decrease in the percentages of abnormal sperms and tail moment into 1.38 and 0.2474 respectively. These values were found to be significant when compared with those which received CCL4 alone. Earlier studies showed that NAC lowers the concentration of damaging ROS within semen, improving semen volume and viscosity, increasing motility (Ciftci, Verit, Savas, Yeni, & Erel, 2009), and increasing the percentage of sperm with normal morphology (Safarinejad & Safarinejad, 2009). Moreover, Yedjou, Tchounwou, Haile et al. (2010) indicate that NAC treatment increases cell viability and affords protection from DNA damage in HepG2 cells exposed to PbNO3. NAC also reduced DNA damage induced by ionizing radiation exposure during cardiac catheterization procedures (Andreassi et al., 2012).
In conclusion, NAC remarkably reduced serum liver marker enzymes and MDA content in liver tissue, also it has ameliorative effects on the liver, kidney, and testis tissues. Additionally, it caused a decrease in the percentage of sperm shape abnormalities and DNA damage induced by CCL4 exposure.
Ethylene diamine tetraacetic Acid
Hematoxylin and eosin
Human liver carcinoma
Sodium salt of Ethylenediaminetetraacetic acid
Reactive oxygen species
Transforming growth factor
Tris (hydroxymethyl) aminomethane Hydrochloride
Abdel Moneim, A. E. (2016). Prevention of carbon tetrachloride (CCl4)-induced toxicity in testes of rats treated with Physalisperuviana L. fruit. Toxicol and Health, 32(6), 1064–1073.
Abdou, H. S., Salah, S. H., Hoda, F. B., & Abdel Rahim, E. A. (2012). Effect of pomegranate pretreatment on genotoxicity and hepatotoxicity induced by carbon tetrachloride (CCl4) in male rats. Journal of Medicinal Plants Research, 6, 3370–3380.
Agarwal, A., Saleh, R. A., & Bedaiwy, M. A. (2003). Role of reactive oxygen species in the pathophysiology of human reproduction. Fertility and Sterility, 79, 829–843.
Ahmed, R. H., Roshdy, N. K., Saleh, H. E., Aref, M. I., Hassan, N. M., & Mohammed, N. R. (2014). Ameliorative potential of mesenchymal stem cells and hematopoietic stem cells against CCl4 induced chromosomal abnormalities in experimental rat liver fibrosis. Stem Cell Discovery, 4, 90–98.
Akgun, E., Caliskan, C., Celik, H. A., Ozutemiz, A. O., Tuniyurek, M., & Aydin, H. H. (2005). Effect of N-acetylcysteine treatment on oxidative stress in acetic acid-induced experimental colitis in rats. The Journal of International Medical Research, 33, 196–206.
Andreassi M.G..,Cioppa A., Manfredi S., Neri M.G., Foffa I. & Picano E. 2012: N-acetyl cysteine reduces chromosomal DNA damage in circulating lymphocytes during cardiac catheterization procedures: A pilot study. International Journal of Cardiology., 15;161(2):93-96.
Annadurai, T., Vigneshwari, S., Thirukumaran, R., Thomas, P. A., & Geraldine, P. (2011). Acetyl-L-carnitine prevents carbon tetrachloride-induced oxidative stress in various tissues of Wistar rats. Journal of Physiology and Biochemistry, 67, 519–530.
Aremu, D. A., Madejczyk, M. S., & Ballatori, N. (2008). N-acetyl cysteine as a potential antidote and biomonitoring agent of methylmercury exposure. Environmental Health Perspectives, 116, 26–31.
Asadpour, R., Shahbazfar, A. A., Kianifard, D., Azari, M., & Nzaboli, N. (2013). Comparison of the protective effects of garlic (Allium sativum L) extract, vitamin E and N acetyl cystein on testis structure and sperm quality in rats treated with lead acetate. Revista de Medicina Veterinaria, 164(1), 27–33.
Atkuri, K. R., Mantovani, J. J., Herzenberg, L. A., & Herzenberg, L. A. (2007). N-acetylcysteine—a safe antidote for cysteine/glutathione deficiency. Current Opinion in Pharmacology, 7, 355–359.
Baker, W. L., Anglade, M. W., Baker, E. L., White, C. M., Kluger, J., & Coleman, C. I. (2009). Use of N-acetylcysteine to reduce post-cardiothoracic surgery complications: A meta-analysis. European Journal of Cardio-Thoracic Surgery, 35, 521–527.
Bedossa, P., Houglum, K., Trautwein, C., Holstege, A., & Chojkier, M. (1994). Stimulation of collagen alpha 1(I) gene expression is associated with lipid peroxidation in hepatocellular injury: A link to tissue fibrosis? Hepatology, 19, 1262–1271.
Cai, Z., Lou, Q., Wang, F., Li, E., Sun, J., Fang, H., et al. (2015). N-acetylcysteine protects against liver injure induced by carbon tetrachloride via activation of the Nrf2/HO-1 pathway. International Journal of Clinical and Experimental Pathology, 8(7), 8655–8662.
Castilla-Cortazar, I., Garcia, M., Quiroga, J., Diez, N., & Diez-Caballero, F. (2000). Insulin-like growth factor-1 reverts testicular atrophy in rats with advanced cirrhosis. Hepatolog., 31, 592–600.
Ciftci, H., Verit, A., Savas, M., Yeni, E., & Erel, O. (2009). Effects of N-acetylcysteine on semen parameters and oxidative/antioxidant status. Urology, 74, 73–76.
Daper, H. H., & Hadley, M. (1990). Malondialdhyde determination as index of lipid peroxidation methods. Enzymology, 186, 421–431.
Demiroren, K., Dogan, Y., Kocamaz, H., Ozercan, I. H., Ilhan, S., Ustundag, B., et al. (2014). Protective effects of L-carnitine, N-acetyl cysteine and genistein in an experimental model of liver fibrosis. Clinics and Research in Hepatology and Gastroenterology, 38, 63–72.
Domitrovic, R., Rashed, K., Cvijanovic, O., Vladimir-Knezevic, S., Škoda, M., & Višnic, A. (2015). Myricitrin exhibits antioxidant, anti-inflammatory and antifibrotic activity in carbon tetrachloride-intoxicated mice. Chemico-Biological Interactions, 230, 21–29.
Galicia-Moreno, M., Rodriguez-rivera, A., Reyes-Gordillo, K., Segovia, J., Shibayama, M., Tsutsumi, V., et al. (2009). N-acetyl cystein prevents carbon tetrachloride-induced liver cirrhosis: Role of liver transforming growth factor –beta and oxidative stress. Eur. J. of gastroenterol. & Hepatol, 21(8), 908–914.
Guo, C., Lu, Y., & Hsu, G. S. W. (2005). The influence of aluminum exposure on male reproduction and offspring in mice. Environmental Toxicology and Pharmacology, 20, 135–141.
Gurbuz, N., Ozkul, A., & Burgaz, S. (2009). Effects of vitamin C and N-acetylcysteine against cyclophosphamide-induced genotoxicity in exfoliated bladder cells of mice in vivo. Journal of BUON, 14(4), 647–652.
Hanafi, N. (2012). Low doses of gamma radiation may impair testicular tissue in a rat treated ccl4 model: Role of BM transplantation. Journal of Biological Sciences, 12(3), 128–137.
Hanly, L., Rieder, M. J., Huang, S. H., Vasylyeva, T. L., Shah, R. K., Regueira, O., & Koren, G. (2013). N-acetylcysteine rescue protocol for nephrotoxicity in children caused by ifosfamide. Journal of Population Therapeutics and Clinical Pharmacology, 20(2), e132–e145.
Hismiogullari, A., Hismiogullari, S., Karaca, O., Sunay, F., Paksoy, S., Can, M. et al. (2015). The protective effect of curcumin administration on carbon tetrachloride (CCl4)-induced nephrotoxicity in rats. Pharmacological Reports, 67(3), 410–416.
Horn, M. M., Ramos, A. R., Winkelmann, L., Matte, U. S., Goldani, H. A., & Silveira, T. R. (2006). Seminiferous epithelium of rats with food restriction and carbon tetrachloride-induced cirrhosis. International Brazilian Journal of Urology, 32(1), 94–99.
Jia, X., Han, C., & Chen, J. (2002). Effect of tea on preneoplastic lesions and cell cycle regulators in rat liver. Cancer Epidemiology Biomarkers and Prevention, 11, 1663–1667.
Kamalakkannan, N., Rukkumani, R., Aruna, K., Varma, R. S., Viswanathan, P., & Menon, V. P. (2005). Protective effect of N-acetyl cystine in carbon tetrachloride-induced hepatotoxicity in rats. Iranian Journal of Pharmacology & Therapeutics., 4, 118–123.
Kao, S. H., Chao, H. T., Chen, H. W., Hwang, T. I., Liao, T. L., Wei, Y. H. (2008). Increase of oxidative stress in human sperm with lower motility. Fertil Steril 89(5), 1183–1190.
Khan, A. A., & Alzohairy, M. A. (2011). Hepatoprotective effects of camel milk against CCL4-induced hepatotoxicity in rats. Asian Journal of Biochemistry, 6, 171–180.
Khan, M. R., & Ahmed, D. (2009). Protective effects of Digeramuricata (L) Mart on testis against oxidative stress of carbon tetrachloride in rat. Food and Chemical Toxicology, 47, 1393–1399.
Khan, M. R., Rizvi, W., Khan, G. N., Khan, R. A., & Shaheen, S. (2009). Carbon tetrachloride induced nephrotoxicity in rat: Protective role of Digeramuricata. Journal of Ethnology Pharmacology, 122, 91–99.
Khan, R. A. (2012). Protective effects of Launaeaprocumbens on rat testis damage by CCl4. Lipids in Health and Disease, 11, 103.
Lee, B. J., Senevirathne, M., Kim, Y. M., Lee, M. S., Jeong, M. H., Kan, Y. M., et al. (2010). Protective effect of fermented sea tangle against ethanol and carbon tetrachloride-induced hepatic damage in sprague Dawley rats. Food and Chemical Toxicology, 48, 1123–1128.
Maksimchik, Y. Z., Lapshina, E. A., Sudnikovich, E. Y., Zabrodskaya, S. V., & Zavodnik, I. B. (2008). Protective effects of N-acetyl-L-Cysteine against acute carbon tetrachloride hepatotoxicity in rats. Cell Biochemistry and Function, 26(1), 11–18.
Manibusan, M. K., Odin, M., & Eastmond, D. A. (2007). Postulated carbon tetrachloride mode of action: A review. Journal of Environmental Science and Health. Part C, Environmental Carcinogenesis & Ecotoxicology Reviews, 25, 185–209.
Manierea, I., Godardb, T., Doergec, D. R., Churchwellc, M. I., Guffroyd, M., Laurentiea, M., et al. (2005). DNA damage and DNA adduct formation in rat tissues following oral administration of acrylamide. Mutation Research., 580, 119–129.
Manjrekar, A. P., Jisa, V., Bag, P. P., & Adikary, B. (2008). Effect of Phyllanthusnirruri Linn. Treatment on liver, kidney and testes in CCl4 induced hepatotoxic rats. Indian Journal of Experimental Biology, 46, 514–520.
Morakinyo, A. O., Oludare, G. O., Anifowose, A. A., & Adegoke, O. A. (2012). Protective effects of alpha lipoic acid on carbon tetrachloride-induced liver and kidney damage in rats. British Journal of Pharmacology and Toxicology, 3(1), 21–28.
Morsy, M. A., Abd Alla, M., Mahmoud, A. M., Abdel Wahab, S. A., & Mahmoud, M. E. (2012). Protective effects of crucumin, α-lipoic acid and N-acetyl cysteine against carbon tetrachloride-induced liver fibrosis in rats. Journal of Physiology and Biochemistry, 68, 29–35.
Moustafa, G. G., Ibrahim, Z. S., Hashimoto, Y., Alkelch, A. M., Sakamoto, K. Q., Ishizuka, M., & Fujita, S. (2007). Testicular toxicity of profenofos in matured male rats. Archives of Toxicology, 81, 875–881.
Nabeshima, Y., Tazuma, S., Kanno, K., Hyogo, H., Iwai, M., Horiuchi, M., et al. (2006). Antifibrogenic function of angiotensin II type 2 receptor in CCl4 induced liver fibrosis. Biochemical and Biophysical Research Communications, 346, 658–664.
Nitin, N., & Khosas, R. L. (2010) Hepatoprotective of leaves of Zanthoxylumarmatum DC in ccl4 induced hepatotoxicity in rats. Indian Journal of Boichemistry and biophysics, 47, 124-127.
Noori, S., Rehman, N., Qureshi, M., & Mahboob, T. (2009). Reduction of carbon tetrachloride–induced liver injury by coffee and green tea. Pakistan Journal of Nutrition, 8, 452–458.
Novo, E., & Parola, M. (2012). The role of redox mechanisms in hepatic chronic wound healing and fibrogenesis. Fibrogenesis & Tissue Repair, 5, 1.
Ӧgetürk, M., Çolakoğlu, N., Kuş, M. A., Kuş, I., & Sarsılmaz, M. (2009). Protective efficiency of caffeic acid phenethyl ester in carbon tetracloride-induced experimental lung injury (article in Turkish). Fırat University Journal of Health Sciences, 23, 57–61.
Ogeturk, M., Kus, I., Colakoglu, N., Zararsiz, I., Ilhan, N., & Sarsilmaz, M. (2005). Caffeic induced nephrotoxicity and protective effect of betaine in Sprague Dawley rats. Urology, 62, 353–356.
Olive, P. L., Banath, J. P., & Durand, R. E. (1990). Heterogeneity in radiationinduced DNA damage and repair in tumor and normal cells using the “comet” assay. Radiation Research, 122, 86–94.
Ozturk, F., Ucar, M., Ozturk, I. C., Vardi, N., & Batcioglu, K. (2003). Carbon tetrachloride-induced nephrotoxicity and protective effect of betaine in Sprague–Dawley rats. Urology, 62, 353–356.
Pereira-Filho, G., Ferreira, C., Schwengber, A., Marroni, C., Zettler, C., & Marroni, N. (2008). Role of N-acetylcysteine on fibrosis and oxidative stress in cirrhotic rats. Arquivos de Gastroenterologia, 45(2), 156–162.
Priya, S., Vijayalakshmi, P., Vivekanandan, P., & Karthikeyan, S. (2011). N-acetylcysteine attenuates dimethylnitrosamine induced oxidative stress in rats. European Journal of Pharmacology, 654, 181–186.
Raza, M., Ahmad, M., Gado, A., & Alshabanah, O. A. (2003). A comparison of hepato-protective activities of aminoguanidine and N-acetylcysteine in rat against the toxic damage induced by azathioprine. Comp Bio chem Physiol., 134, 451–456.
Reza, H. M., Sagor, A., & Alam, A. (2015). Iron deposition causes oxidative stress, inflammation and fibrosis in carbon tetrachloride-induced liver dysfunction in rats. Bangladesh Journal Pharmacol, 10(1), 152–159.
Ritter, C., Reinke, A., Andrades, M., et al. (2004). Protective effect of N-acetylcysteine and deferoxamine on carbon tetrachlorideinduced acute hepatic failure in rats. Critical Care Medicine, 32, 2079–2083.
Rodrigues, A. J., Eiora, P. R., & Schaff, H. V. (2004). Protective effect of N- acetylcysteine against oxygen radical- mediated coronary artery injury. Braz I Med Biol Res, 37, 1215–1224.
Ronis M. J. J., Butura A., Sampey B. P., Shankar K., Prior R. L., Korouriane. et al. 2005: Effects of N-acetylcysteine on ethanol induced hepatotoxicity in rats fed via total enteral nutri–tion. Free Radical Biology & Medicine, 39: 619-630.
Ryan, T. C., Weil, G. J., Newburger, P. E., Haugland, R., & Simons, E. R. (1990). Measurement of superoxide release in the phagovacuoles of immune complex-stimulated human neutrophils. Journal of Immunological Methods, 130, 223–233.
Sabeti, P., Pourmasumi, S., Rahiminia, T., Akyash, F., & Talebi, A. R. (2016). Etiologies of sperm oxidative stress. International Journal Reproductive Biomedine (Yazd)., 14(4), 231–240.
Sadowska, A. M., Manuel, Y. K. B., & de Backer, W. A. (2007). Antioxidant and anti-inflammatory efficacy of NAC in the treatment of COPD: Discordant in vitro and in vivo dose-effects: A review. Pulmonary Pharmacology & Therapeutics, 20, 9–22.
Safarinejad, M., & Safarinejad, S. (2009). Efficacy of selenium and/or N-acetyl-cysteine for improving semen parameters in infertile men: A double-blind, placebo controlled, randomized study. The Journal of Urology, 18(2), 741–751.
Sahin, S., & Alatas, O. (2010). The role of n-acetylcysteine against acute carbon tetrachloride hepatotoxicity in rats. Clinical and Experimental Medical Letters, 51(3–4), 187–192.
Sahin, S., & Alatas, O. (2013). The protective effects of n-acetylcysteine against acute Hepatotoxicity. Indian Journal of Gastroenterology, 32(5), 311–331.
Sahreen, S., Khan, M. R., & Khan, R. A. (2011). Hepatoprotective effect of methanol extract of carissaopaca leaves on ccl4 induced damage in rat. Complementary and Alternative Medicine, 11(48), 1–9.
Sallie, R., Tredger, J. M., & Williams, R. (1991). Drugs and the liver. Biopharmaceutics & drug disposition, 12, 251–259.
Samuni, Y., Goldstein, S., Dean, O. M., & Berk, M. (2013). The chemistry and biological activities of N-acetylcysteine. Biochimica et Biophysica Acta, 1830, 4117–4129.
Simon, L., & Carrell, D. T. (2013). Sperm DNA damage measured by comet assay. Methods in molecular biology (Clifton, N.J.), 927, 137–146.
Singh, N. P., Mc Coy, M. T., Tice, R. R., & Schneider, E. L. A. (1988). Simple technique for quantitation of low levels of DNA damage in individual cells. Experimental Cell Research, 175, 184–191.
Soliman, A. M., & Fahmy S. R. (2011) Protective and curative effects of the 15 KD isolated protein from the Peganumharmala L. seeds against carbon tetrachloride induced oxidative stress in brain, testes and erythrocytes of rats. European Review for Medical and Pharmacological Sciences, 15, 888–899.
Sonmez, M., Turk, G., Ceribas, S., Ciftci, M., Yuce, A., Guvenc, M., et al. (2014). Quercetin attenuates carbon tetrachloride-induced testicular damage in rats. Blackwell Verlag GmbH Andrologia., 46, 848–858.
Stal, P., & Olson, J. (2000). Ubiquinone: Oxidative stress and liver carcinogenesis. In V. E. Kavan, & D. J. Quinn (Eds.), Coenzyme Q: Molecular mechanisms in health and disease, (pp. 317–329). Bocaraton: CRC Press.
Termini, J. (2000) Hydroperoxide-induced DNA damage and mutations. Mutation Research, 450, 107–124.
Ustyol, L., Demirören, K., Kandemir, I., Erten, R., Bulan, K., Kaba, S., et al. (2017). Comparative nephroprotective effects of silymarin, N-acetylcysteine, and thymoquinone against carbon tetrachloride-induced nephrotoxicity in rats. Iranian Red Crescent Medical Journal, 19(1), e37746.
Wang, F. G., Liu, S. R., Shen, Y. Q., Zhuang, R. X., Xi, J. J., Fang, H. Y., et al. (2014). Protective effects of N-acetylcysteine on cisplatin-induced oxidative stress and DNA damage in HepG2 cells. Experimental and Therapeutic Medicine, 8, 1939–1945.
Wong, C. K., C-Ooi, V. E., & Wong, C. K. (2003). Protective effect of N-acetylcysteine against carbon tetrachloride and trichloroethylene induced poisoning in rats. Environ Toxicol Pharmcol., 14, 109–116.
Wyrobek A. J. & Bruce W. R. 1978: The induction of sperm-shape abnormalities in mice and humans, in: A Hollaender and F. J de Serres (Eds.), Chemical Mutagens: Principles and Methods for their Detection, Vol. 5, Plenum, New York, pp. 257–285.
Yedjou, C. G., Tchounwou, C. K., Haile, S., Edwards, F., Tchounwou, P. B. (2010). N-acetyl-cysteine protects against DNA damage associated with lead toxicity in HepG2 cells. Ethnicity & Disease, 20(1 Suppl 1), S1–101-3.
Yousef, M. I., & Salama, A. F. (2009). Propolis protection from reproductive toxicity caused by aluminum chloride in male rats. Food and Chemical Toxicology, 47, 1168–1175.
Zembron-Lacny, A., Slowinska-Lisowska, M., Szygula, Z., Witkowski, K., & Szyszka, K. (2009). The comparison of antioxidant and hematological properties of N-acetylcysteine and alpha-lipoic acid in physically active males. Physiological Research, 58, 855–861.
Availability of data and materials
The datasets supporting the conclusions of this article are included within the article and its additional files.
This study follows the Declaration of Helsinki and the guidelines for the care and use of experimental animals established by the Committee for the Purpose of Control and Supervision of Experiments on Animals. Animals procedures were also made in accordance with the National Institutes of Health (NIH) protocol approved by Ain Shams University.
Consent for publication
The authors declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.