Radiation Hepatology of the Rat: Microvascular Fibrosis and Enhancement of Liver Dysfunction by Diet and Drugs

Prior to whole-liver irradiation (0, 15, 25 Gy) rats were not treated, placed on a protein-deficient diet for 2 weeks, administered cyclophosphamide, and/or depleted of intracellular glutathione by injection with buthionine sulfoximide and diethyl maleate. At various times (0 to 84 days) after 0- and 25-Gy liver irradiation, liver function, liver mass, and hydroxyproline content were measured in nontreated animals. Liver function was measured in all other preirradiation regimens 2 to 3 months postirradiation. Histology and/or India ink perfusion of the liver were done on ascitic and jaundiced animals from all treatment groups. Approximately 20% of the 25-Gy whole-liver-irradiated animals in each preirradiation treatment group developed clinical signs of acute hepatitis (ascites, jaundice, and elevated liver enzymes in the plasma) 70 to 100 days after irradiation. Twenty-five-gray whole-liver irradiation also resulted in significant liver fibrosis that preceded the onset of liver dysfunction. Fibrotic changes were most dramatic in and around hepatic veins, sometimes resulting in complete or partial occlusion that disrupted intrahepatic blood flow and diminished liver function. In addition, a substantial accumulation of fluid in the liver of 25-Gy-irradiated livers occurred, resulting in a lower dry/wet liver weight ratio. Functional hepatic injury was enhanced by preirradiation treatment with a protein-deficient diet, cyclophosphamide, and/or depletion of intracellular glutathione. This enhancement of functional injury was pronounced after 15-Gy whole-liver irradiation when injury from radiation alone was minimal.