Reinvestigation of in vivo genotoxicity studies in man. I. No induction of DNA strand breaks in peripheral lymphocytes after metronidazole therapy.

Although a rodent carcinogen, metronidazole is widely used in humans for the treatment of infections with anaerobic organisms. Metronidazole is mutagenic for microorganisms, but has a mainly negative data base for mammals and humans. Therefore, metronidazole is generally considered as a non-genotoxic carcinogen. Only the results of two human in vivo studies would allow the classification of metronidazole as genotoxic carcinogen: (1) the induction of DNA strand breaks; and (2) the induction of chromosome aberrations in peripheral lymphocytes after metronidazole therapy. Because the classification of metronidazole as genotoxic carcinogen would imply enormous consequences with respect to its application, both studies were reinvestigated very thoroughly. The present report describes the reinvestigation of the induction of DNA strand breaks after metronidazole therapy. Each two probes of lymphocytes of metronidazole-treated patients (3 x 500 to 3 x 750 mg/day for 5-8 days) were examined separately for the appearance of DNA strand breaks before and after treatment. In total, 400 nuclei were examined per patient. Immediately before the first, and 30 min to 2 h after the last application, 2 x 10 ml blood per patient was sampled, transported to the laboratory at 15-20 degrees C to make DNA repair more difficult, and examined within the next 4-7 h for DNA strand breaks. At the same time, the individual metronidazole blood plasma levels were measured. In contrast to the published reports, no induction of DNA strand breaks after metronidazole therapy could be observed in the present study. As the applied doses (15,750 mg vs. 4800 mg) and the plasma level (up to 25 micrograms/ml vs. not measured) of metronidazole were much higher than in the published study, the relevance of the clearly negative result is obvious. As induction of DNA strand breaks is a frequent prerequisite for genotoxicity, metronidazole should be considered as a non-genotoxic carcinogen, and not as a genotoxic carcinogen.