Suzanne Pratt, Costas Ioannides

The mechanism of the protective action of methionine and N-acetylcysteine against the toxicity of paracetamol was investigated in vivo. N-acetylcysteine inhibited the O-deethylation of ethoxyresorufin (cytochrome P-448) while methionine enhanced the N-demethylation of benzphetamine (cytochrome P-450) and increased hepatic microsomal levels of cytochrome P-450. These observations indicate that N-acetylcysteine, but not methionine, could afford protection against paracetamol hepatotoxicity, at least partly, by inhibiting cytochrome P-448 activity and thus the generation of the reactive intermediate. However, previous studies demonstrating no decrease in the urinary excretion of glutathione conjugates of paracetamol (derived from the reactive intermediate) in animals treated with N-acetylcysteine suggest that this is unlikely to be the prevailing mechanism of action. Administration of a large dose of paracetamol, as expected, depleted glutathione levels and inhibited cytosolic glutathione transferase activity. Administration of either N-acetylcysteine or methionine 1 h after paracetamol prevented both effects. On the basis of the present work and previously published observations, it is concluded that the major mechanism of action of N-acetylcysteine and methionine in vivo is by acting as precursors of intracellular glutathione.