Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, South Carolina
Drug Metab Dispos. 2024 Jul 16;52(8):707-711. doi: 10.1124/dmd.123.001278.
In the early 1970s, Dr. B. B. Brodie, head of the Laboratory of Chemical Pharmacology, National Heart Institute, National Institutes of Health, initiated a program to elucidate the mechanism of hepatic necrosis induced in rats by bromobenzene. These studies showed a crucial role for its 3,4-epoxide intermediate, known in part, to collapse to 4-bromophenol. To examine a possible contribution of this phenol to tissue toxicity, some rats were coadministered a high dose of acetaminophen to suppress phenolic clearance by glucuronidation and sulfation. Subsequent examination of liver slices showed that the acetaminophen-only control rats had extensive centrilobular liver necrosis. This article is a personal reminiscence of the events that led up to this accidental observation, how it happened, and the subsequent resolution of the underlying mechanism, including the covalent binding of NAPQI to liver protein as the initial "hit," the glutathione protective threshold, the antidotal activity of cysteine, and the existence of the "therapeutic window" for antidotal therapy. Collectively, these studies formed the basis for antidotal therapy of acetaminophen overdose patients. SIGNIFICANCE STATEMENT: Studies in the early 1970s extended Dr. B. Brodie's "Reactive Metabolites as a Cause of Tissue Injury" concept to explain the initial events leading to fulminant hepatic necrosis seen after overdoses of acetaminophen. This article, written by one of the key contributors, is a reminiscence of how the studies originated, how they were developed, and their significance for therapy.
20 世纪 70 年代初,美国国立卫生研究院国家心脏研究所化学药理学实验室主任 B.B.布罗迪博士发起了一项阐明溴苯诱发大鼠肝坏死机制的计划。这些研究表明,其 3,4-环氧化物中间体起着至关重要的作用,部分原因是它会塌陷为 4-溴苯酚。为了研究这种苯酚是否可能对组织毒性有贡献,一些大鼠同时给予大剂量对乙酰氨基酚以抑制酚类物质通过葡萄糖醛酸化和硫酸化清除。随后对肝切片的检查表明,仅给予对乙酰氨基酚的对照大鼠有广泛的中央小叶肝坏死。本文是对导致这一意外观察结果的事件、事件发生的经过以及潜在机制的后续解析的个人回忆,包括 NAPQI 与肝蛋白的共价结合作为初始“打击”、谷胱甘肽的保护阈值、半胱氨酸的解毒作用以及解毒治疗的“治疗窗口”的存在。这些研究共同构成了对乙酰氨基酚过量患者解毒治疗的基础。重要性声明:20 世纪 70 年代的研究扩展了布罗迪博士的“反应代谢物是组织损伤的原因”概念,以解释过量服用对乙酰氨基酚后出现的暴发性肝坏死的初始事件。本文由主要贡献者之一撰写,回忆了这些研究的起源、发展以及它们对治疗的意义。