title: Contribution of CYP2E1 and CYP3A to acetaminophen reactive metabolite formation.
abstract: BACKGROUND
  CYP2E1, 1A2, and 3A4 have all been implicated in the formation of N-acetyl-p-benzoquinone imine (NAPQI), the reactive intermediate of acetaminophen (INN, paracetamol), in studies in human liver microsomes and complementary deoxyribonucleic acid-expressed enzymes. However, recent pharmacokinetic evidence in humans has shown that the involvement of CYP1A2 is negligible in vivo. The purpose of this study was to evaluate the respective roles of CYP2E1 and 3A4 in vivo.
  
  
  METHODS
  The involvement of CYP2E1 was assessed through pretreatment of adult human volunteers with disulfiram to inhibit the enzyme and the role of CYP3A4 through its induction in a second cohort of adults with rifampin (INN, rifampicin). Each of the respective studies was an open-label, balanced-randomized crossover design. Blood samples were obtained serially for 12 hours and urine was collected for 24 hours after acetaminophen administration. Acetaminophen was assayed in plasma, and acetaminophen and metabolites were assayed in urine.
  
  
  RESULTS
  The recovery of the thiol metabolites formed by conjugation of NAPQI with glutathione was decreased by 69%, and the formation clearance of NAPQI was decreased by 74% (both P < .01) by pretreatment with disulfiram. Rifampin pretreatment had no effect on the formation of NAPQI or the recovery of thiol metabolites formed by conjugation of NAPQI with glutathione.
  
  
  CONCLUSIONS
  CYP2E1 accounts for the formation of NAPQI in intact humans; the contribution of other isozymes of cytochrome P450 appears to be negligible. Under some conditions, disulfiram may be useful in diminishing the formation of NAPQI after acetaminophen overdose.
authors.affiliation: Department of Pharmaceutics, University of Washington, 98195-7610, USA.
authors.forename: P T
authors.initials: PT
authors.lastname: Manyike
authors.forename: E D
authors.initials: ED
authors.lastname: Kharasch
authors.forename: T F
authors.initials: TF
authors.lastname: Kalhorn
authors.forename: J T
authors.initials: JT
authors.lastname: Slattery
mesh_terms: D000082:Acetaminophen / Q000097:blood / Q000493:pharmacokinetics* / Q000652:urine; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000097:blood / Q000493:pharmacokinetics* / Q000652:urine; D016227:Benzoquinones / Q000378:metabolism*; D018592:Cross-Over Studies; D019392:Cytochrome P-450 CYP2E1 / Q000378:metabolism*; D051544:Cytochrome P-450 CYP3A; D003577:Cytochrome P-450 Enzyme System / Q000378:metabolism*; D005260:Female; D006801:Humans; D007097:Imines / Q000378:metabolism*; D008297:Male; D006899:Mixed Function Oxygenases / Q000378:metabolism*; D012016:Reference Values
chemical_list: D018712:Analgesics, Non-Narcotic; D016227:Benzoquinones; D007097:Imines; D000082:Acetaminophen; D003577:Cytochrome P-450 Enzyme System; D006899:Mixed Function Oxygenases; D019392:Cytochrome P-450 CYP2E1; C104464:CYP3A protein, human; D051544:Cytochrome P-450 CYP3A; C510163:CYP3A4 protein, human; C028473:N-acetyl-4-benzoquinoneimine