Reactive intermediates acetaminophen

Administration of chloroform to laboratory animals resulted in the depletion of renal GSH, indicating that GSH reacts with reactive intermediates, thus reducing the kidney damage otherwise caused by the reaction of these intermediates with tissue MMBs (Hook and Smith 1985 Smith and Hook 1983, 1984 Smith et al. 1984). Similarly, chloroform treatment resulted in the depletion of hepatic GSH and alkylation of MMBs (Docks and Krishna 1976). Other studies demonstrated that sulfhydryl compounds such as L-cysteine (Bailie et al. 1984) and reduced GSH (Kluwe and Hook 1981) may provide protection against nephrotoxicity induced by chloroform. The sulfhydryl compound N-acetylcysteine is an effective antidote for poisoning by acetaminophen, which, like chloroform, depletes GSH and produces toxicity by reactive intermediates. 

A good example of the importance of tissue availability of the conjugating chemical is found with acetaminophen. At normal therapeutic doses, acetaminophen is safe, but can be hepatotoxic at high doses. The major portion of acetaminophen is conjugated with either sulfate or glucuronic acid to form water-soluble, readily excreted metabolites and only small amounts of the reactive intermediate, believed to be quinoneimine, are formed by the CYP enzymes (Figure 8.6). 

Metabolism of acetaminophen (Ac) to hepatotoxic metabolites. (GSH, glutathione GS, glutathione moiety Ac, reactive intermediate.)... 

FIGURE 37.2. Metabolism and mechanism of acetaminophen toxicity. Bioactivation of acetaminophen by P450 enzymes results in the formation of the reactive intermediate (NAPQI) which forms covalent protein adducts with glutathione which is then converted to mercapturic acid. When the amount of the reactive metabolite formed exceeds the glutathione available for binding, the excess metabolite binds to tissue molecules resulting in centrilobular hepatic necrosis. 

An example of a popular pharmaceutical with a toxic metabolite is acetaminophen (2, 3). A portion of the acetaminophen metabolized in the liver is converted to a reactive intermediate/ N-acetyl-p-benzoquinoneimine (NAPQI)/ which is an excellent substrate for nucleophilic attack by free sulfhydryl groups in proteinS/ as shown in Scheme 11.4. By substituting a high concentration of an alternative... 

SCHEME 11.4 Acetaminophen is metabolized to a reactive intermediate (NAPQI) that can cause hepa to toxicity by reacting with liver proteins. 

The mechanism of acute acetaminophen nephrotoxicity is related to the bioactivation of acetaminophen and/or its metabolites to highly reactive species which are capable of arylating renal macromolecules or generating reactive oxygen species. Acetaminophen hepatotoxicity is the result of conversion of acetaminophen to the reactive intermediate N-acetyl-p-benzoquinoneimine (NAPQI), which can covalently bind to hepatic macromolecules. It is less clear what role formation of NAPQI in the kidney plays in acetaminophen nephrotoxicity. In some species (e.g., the Fischer 344 rat) deacetylation appears to be an important biotransformation step in acetaminophen nephrotoxicity, while in other species (e.g., the CD-I mouse), bioactivation does not appear to require deacetylation of acetaminophen before the ultimate nephrotoxicant species is produced. Therefore, the role of NAPQI in acute acetaminophen nephrotoxicity might be species dependent. 

Figure 1 Examples of compounds that are metabolized to toxic or active metabolites. Acetaminophen and chloroform are metabolized to reactive intermediates that lead to toxicity, whereas levodopa and codeine are metabolized to active metabolites.

The application of an Orbitrap platform was also described for this purpose. In this case, one can use the excellent full scan sensitivity of the high-resolution accurate mass measurement in both the survey and data-dependent scan modes in order to identify the reactive intermediates and then provide data for their structure assignment [23], A labeled form of GSH 2 1 ratio of 5mM glutathione and I3( V5N Gly glutathione was used. The high mass accuracy in the survey scan can be used to detect the GSH adduct. The method was successfully applied for the detection and characterization of GSH conjugates of acetaminophen, tienilic acid, clozapine, ticlo-pidine, and mifepristone. 

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