Several case reports have documented successful treatment of asparaginase-induced hepatotoxicity using what two drugs?
L-carnitine and Vitamin B complex. The presumed mechanism of asparaginase-induced hepatotoxicity is depletion of the L-asparagine and glutamine pool in the liver, causing decreased protein synthesis. This leads to impaired mitochondrial β-oxidation and accumulation of unoxidized fatty acids in the hepatic parenchyma. L-carnitine and vitamin B complex, both mitochondrial β-oxidation cofactors, have been used to ameliorate hepatotoxicity in several case reports and one case series. L-carnitine is a naturally occurring amino acid derivative that works by facilitating the transport of long-chain fatty acids into the mitochondria. B-complex vitamins serve as cofactors in mitochondrial β-oxidation. A prospective clinical trial is testing levocarnitine’s role: https://clinicaltrials.gov/ct2/show/NCT03564678.
Arora S, Klair, J, Bellizzi AM, et al. L-carnitine and Vitamin B Complex for PEG-L-asparaginase-Induced Hepatotoxicity. ACG Case Rep J. 2019 Aug 28;6(8):e00194. doi: 10.14309/crj.0000000000000194.