ABSTRACT. Like treatment with the parent compound unsaturated intermediates of VPA alkylate, and thereby cause valproic acid (VPA), acute and/or chronic treatment with irreversible inhibition of, key enzymes of /3-oxidation (10, 11). the unsaturated derivative, 2-n-propyl-4-pentenoic acid Gerber et al. (12) were among the first to report VPA-associ-(4-en-VPA), decreased ketogenesis and lowered free CoA, ated irreversible hepatic failure in young infants and children. acetyl CoA, and free carnitine levels in the livers of normal Because of the structural similarity of the unsaturated metabolite developing mice. Concomitantly, there were manifold in-of VPA, 4-en-VPA, to two well-known hepatotoxins-4-pentencreases in the content of medium-chain acyl CoA esters oic acid and toxic hypoglycin A metabolites (13, 14)-the authors (4-en-VPA CoA and 4-en-VPA CoA metabolites). Acute believed that 4-en-VPA played a major role in the pathogenesis cotreatment of 4-en-VPA-treated animals with pantoth-of VPA-induced hepatotoxicity. The present study is a test of enate, carnitine, and acetylcysteine caused significant ame-this hypothesis in normal developing mice. Its results appear to lioration of these metabolic aberrations. In animals chron-be applicable to an explanation of the mechanism of action of ically treated with 4-en-VPA, a single injection of panto-these other hepatotoxins. Because we have found that coadminthenate, carnitine, and acetylcysteine returned the istration of pantothenate and carnitine with VPA ameliorated its 4-en-VPA-depressed levels of P-hydroxybutyrate in adverse effects on ketogenesis and liver CoA metabolism (15), plasma and free CoA and acetyl CoA in liver to normal. effects of a similar regimen in acutely and chronically 4-en-VPAThese findings support the hypothesis that VPA-and treated mice were also examined. 4-en-VPA-induced hepatic dysfunction is produced by CoA sequestration rather than by irreversible inhibition by alkylation of the enzymes of fatty acid &oxidation by reactive MATERIALS AND METHODS intermediates. The findings also support the important but little-known role of carnitine in CoA metabolism-carniPantothenate (D-pantothenic acid, hemicalcium salt), and Ntine relieves the inhibition of pantothenate kinase, the rate-acetyl-L-cysteine were purchased from Sigma Chemical Co., St. controlling first enzyme in the pathway of CoA synthesis Louis, MO. Solutions of N-acetyl-L-cysteine were neutralized to by its product, free CoA, and by CoA esters. (Pediatr Res pH 7.0 with NaOH just before use. 4-en-VPA and sterile 0.9% 33: [72][73][74][75][76]1993) NaCl were gifts of Abbott Laboratories, Chicago, IL; L-carnitine was a gift of Sigma-Tau, Rome, Italy. Abbreviations and many others). Two acutely or chronically, were not significantly different; therefore, major mechanisms for this adverse action have been proposed. results were pooled. Other littermates received 4-en-VPA plus o n e relates to the depletion of free CoA in liver due to its pantothenate (vitamin B5; COA precursor), 2 mmol...