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Sulfate conjugation may be the key to hepatotoxicity in paracetamol overdose
Author(s) -
Li Jingyun,
Chiew Angela L.,
Isbister Geoffrey K.,
Duffull Stephen B.
Publication year - 2021
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/bcp.14642
Subject(s) - sulfation , glucuronidation , toxicity , pharmacology , sulfate , liver toxicity , chemistry , medicine , biochemistry , enzyme , microsome , organic chemistry
Paracetamol‐induced hepatotoxicity is the leading cause of acute liver failure in many countries, including North America and the United Kingdom. Among the three dominant paracetamol metabolism pathways (i.e. glucuronidation, sulfation and oxidation), the importance of sulfation is often underestimated because of the general thinking that the sulfation pathway is saturated at therapeutic doses and ultimately accounts for a limited proportion of the fate of a paracetamol dose. We illustrate that insufficient sulfation leads to a shift in biotransformation of paracetamol to toxic oxidation pathways and patients with low sulfate reserves are at higher risk of paracetamol toxicity. Here, we propose that sulfation is of critical importance in understanding the risk of liver toxicity secondary to paracetamol overdose. Serum inorganic sulfate, a measurable substrate on the causal path of paracetamol‐induced liver toxicity, should be considered a biomarker for potential toxicity as well as a target for treatment.