Rutin attenuates ensartinib-induced hepatotoxicity by non-transcriptional regulation of TXNIP

Ensartinib, an approved ALK inhibitor, is used as the first-line therapy for advanced ALK-positive non-small cell lung cancer in China. Ensartinib shows superior efficacy to crizotinib in both systemic and intracranial disease and is prepared to be reviewed overseas. In future, more patients would benefit from it based on its efficacy. However, a high incidence of hepatotoxicity has been observed in clinic, which often demands dose reduction or discontinuation of the drug, hampering its overall efficacy. Hence, it is inevitably valuable to study the mechanism which would be benefit to overcome the ensartinib-induced hepatotoxicity. In addition, based on the toxicity model, it is well established to understand the process of drug-induced liver injury and hepatic function-related molecules. Our findings discovered the level and location of TXNIP in liver homeostasis regulatory, clarified the molecular mechanism for ensartinib-induced hepatotoxicity and identified rutin as a potential strategy for the first time. We find a novel mode of rutin in intervening ROS production and apoptosis by binding TXNIP. Our study is of great significance to the basic theories and clinical practice. And this work is of broad interest to the readers from drug discovery, hepatologists in this filed and biologists in redox homeostasis.