Non-canonical BIM-regulated energy metabolism determines drug-induced liver necrosis

Cell Death & Differentiation
Lambrecht Rebekka, Rudolf Franziska, Ückert Anna-Katharina, Sladky Valentina C., Phan Truong San, Jansen Jasmin, Naim Samara, Kaufmann Thomas, Keogh Adrian, Kirschnek Susanne, Mangerich Aswin, Stengel Florian, Leist Marcel, Villunger Andreas, Brunner Thomas
DOI: 10.1038/s41418-023-01245-7
PMID: 38001256
Keyword: Acetaminophen* / toxicity · Adenosine Triphosphate / metabolism · Bcl-2-Like Protein 11 / genetics · Bcl-2-Like Protein 11 / metabolism · Chemical and Drug Induced Liver Injury · Energy Metabolism · Hepatocytes / metabolism · Humans · Liver / metabolism · Mitochondria, Liver / metabolism · Necrosis / metabolism · Oxidative Stress


Paracetamol (acetaminophen, APAP) overdose severely damages mitochondria and triggers several apoptotic processes in hepatocytes, but the final outcome is fulminant necrotic cell death, resulting in acute liver failure and mortality. Here, we studied this switch of cell death modes and demonstrate a non-canonical role of the apoptosis-regulating BCL-2 homolog BIM/Bcl2l11 in promoting necrosis by regulating cellular bioenergetics. BIM deficiency enhanced total ATP production and shifted the bioenergetic profile towards glycolysis, resulting in persistent protection from APAP-induced liver injury. Modulation of glucose levels and deletion of Mitofusins confirmed that severe APAP toxicity occurs only in cells dependent on oxidative phosphorylation. Glycolytic hepatocytes maintained elevated ATP levels and reduced ROS, which enabled lysosomal recycling of damaged mitochondria by mitophagy. The present study highlights how metabolism and bioenergetics affect drug-induced liver toxicity, and identifies BIM as important regulator of glycolysis, mitochondrial respiration, and oxidative stress signaling.