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Vol. 30, Issue 4, 446-451, April 2002
Departments of Pharmacology and Toxicology (K.L.M., L.P.J., L.C.,
S.S.M., H.P.H., J.A.H., P.R.M.) and Pediatrics (L.P.J., S.S.M.), the
University of Arkansas for the Medical Sciences, Little Rock, Arkansas
Acetaminophen-induced hepatotoxicity has been attributed to
covalent binding of the reactive metabolite
N-acetyl-p-benzoquinone imine to cysteine
groups on proteins as an acetaminophen-cysteine conjugate. We report a
high-performance liquid chromatography with electrochemical detection
(HPLC-ECD) assay for the conjugate with increased sensitivity compared
with previous methods. Previous methods to quantitate the protein-bound
conjugate have used a competitive immunoassay or radiolabeled
acetaminophen. With HPLC-ECD, the protein samples are dialyzed and then
digested with protease. The acetaminophen-cysteine conjugate is then
quantified by HPLC-ECD using tyrosine as an internal reference. The
lower limit of detection of the assay is approximately 3 pmol/mg of
protein. Acetaminophen protein adducts were detected in liver and serum
as early as 15 min after hepatotoxic dosing of acetaminophen to mice.
Adducts were also detected in the serum of acetaminophen overdose
patients. Analysis of human serum samples for the
acetaminophen-cysteine conjugate revealed a positive correlation
between acetaminophen-cysteine conjugate concentration and serum
aspartate aminotransferase (AST) activity or time. Adducts were
detected in the serum of patients even with relatively mild liver
injury, as measured by AST and alanine aminotransferase. This
assay may be useful in the diagnostic evaluation of patients with
hepatotoxicity of an indeterminate etiology for which acetaminophen
toxicity is suspect.
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