Abstract:Acetaminophen (APAP), a widely used non-steroidal anti-inflammatory drug frequently induces hepatotoxicity in clinical practice with limited therapeutic options. Hydroxytyrosol (HT), a natural phenolic compound, demonstrates significant potential as a therapeutic agent for drug-induced liver injury. In this study, APAP-induced AML-12 cell injury and mouse liver injury models were used to explore the protective effect and mechanism of hydroxytyrosol on APAP-induced liver injury by detecting biomarkers closely related to apoptosis and ferroptosis, pathological sections, changes in targets related to Nrf2/GPX4 and LKB1/AMPK pathways, and molecular mimetic docking of target proteins of HT and Nrf2/GPX4 pathways. The results showed that HT could significantly attenuate APAP-induced liver injury in mice, achieving comparable efficacy to the standard hepatoprotective agent silymarin. HT was able to alleviate the abnormal changes of oxidative stress-related markers, inhibit apoptosis and ferroptosis induced by APAP in AML-12 cells and mouse liver, promote the phosphorylation of LKB1 and AMPK in mouse liver and AML-12 cells, upregulate Nrf2, and promote the expression of GPX4 downstream in mouse liver. These indicated that HT plays a key role in APAP-induced liver injury protection by regulating antioxidant stress response and ferroptosis through the cellular Nrf2/GPX4 signaling pathway.