According to the results of our research, the NTiO
2-induced liver damage was prevented by QCT in rats. NTiO
2 markedly enhanced the levels of ALT, AST, and ALP. Increasing the level of ALT and AST is the main indices, reflecting hepatocytes damage because of these enzymes released from hepatocytes into the bloodstream after liver toxicity. The level of ALP reflects the functional efficiency of the liver, and is dramatically enhanced in response to any disease of the liver (
13). The reversal of these enzymes levels by QCT indicates that QCT can stabilize hepatocyte membrane, and hence block the leakage of biomarkers into the circulation. Bona et al. showed that a marked increase in serum levels of AST and ALT was reversed with QCT after inhalation of chloroform in rats (
14). According to the results, NTiO
2 markedly destructed the lobular structure, increased fat deposit in hepatocytes, elevated congestion of RBCs, enhanced leukocytes infiltration, and increased nuclear pyknosis percentage in liver tissue. These findings were in line with other studies showing the histological changes induced by NTiO
2. Ma et al. showed that NTiO
2 induced histological alterations, including vascellum congestion, fatty change, and apoptosis in the liver tissue (
15). In this study, QCT improved the lobular structure, decreased fat deposit in hepatocytes, reduced congestion of RBCs, and suppressed inflammatory cell infiltration. The improved structural changes of the liver with pretreatment of QCT was accompanied by reducing biomarker levels. QCT effectively ameliorated lead-induced structural changes and infiltration of leukocyte in rat liver (
7). In this study, the NTiO
2 significantly elevated the MDA content in the liver tissue, while SOD and CAT levels were markedly reduced. Previous studies demonstrate that NTiO
2 induces oxidative stress and lipid peroxidation in the liver of rodents. Shukla et al. showed that NTiO
2 caused apoptosis and DNA toxicity in hepatocytes (
16). The role of oxidative stress in the liver toxicity induced by NPs was reported by Liang et al. (
17). One of the markers for the intensified peroxidation process is the MDA content (
18). The QCT attenuated the NTiO
2-induced increase in the hepatic MDA content. Boadi et al. demonstrated that QCT reduced lipid peroxidation (
19). Gnoni et al. also showed that QCT prevented the generation of triacylglycerol and fatty acid in hepatocytes of rats (
20). As mentioned above histological analysis of our study also showed that QCT effectively reduced the fat deposit of hepatocytes. The markedly reduced in SOD and CAT levels point out the liver injury in the rats exposed to the NTiO
2. While, pretreatment with QCT caused a marked increase in the level of these enzymes, which revealed the antioxidant property of the QCT. Gonzalez-Esquivel et al. showed that QCT altered the hepatic levels of MDA, antioxidant enzyme activities in male rats exposed to NTiO
2 (
21). In a study by Liu et al. in 2013, the ROS generation was suppressed by the QCT, followed by an increase in the total antioxidant capacity in the liver of rats (
22). El-Faras et al. demonstrated that the antioxidative property of QCT played an important role in its hepatoprotective impacts on paracetamol-induced liver toxicity (
8). Ma et al. demonstrated that the prevention of CCl
4-induced inflammation by QCT was due to its antioxidant property (
23). The marked decrease in structural changes of the liver and the biomarker levels with pretreatment of QCT was accompanied by significant reducing in oxidative stress.
Oxidative stress triggers various intracellular events such as apoptosis (
24). As shown in the results, NTiO
2 significantly increased the apoptotic index in the hepatocytes. Wang et al. reported that NTiO
2 induced DNA damage, and apoptosis in human lung cancer A549 cells (
25). Park et al. also reported NTiO
2 induced apoptosis and oxidative stress in a bronchial epithelial cell line (
26). NTiO
2 induced apoptosis in mouse epidermal (JB6) and human bronchial epithelial (BEAS-2B) cell lines (
27). Alarifi et al. have also demonstrated apoptotic effects of NTiO
2 in the liver of rats (
28). In the present study, QCT intensively decreased the apoptotic index in the liver of rats exposed to NTiO
2. Ansar et al. showed that QCT protected the liver against DNA damage induced by acrylamide (
29). The QCT inhibits apoptosis in alcohol-induced liver toxicity (
30), prevents apoptosis in hepatocytes of diabetic rats (
31), and suppresses the apoptosis in mesangial cells of kidney exposed to H
2O
2 (
32). Anti-apoptotic impacts of QCT against traumatic brain injury were also reported by Yang et al. (
33). According to the results, the decrease in apoptosis by pretreatment of QCT was accompanied by reducing biomarker levels and oxidative stress in the liver.