N-Acetyltransferase (NAT) 1 and NAT2 Enzyme Activities Drive Interindividual Variability in Sulfamethoxazole N-Acetylation
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ABSTRACT: Sulfamethoxazole (SMX) is associated with idiosyncratic drug induced liver injury (DILI), which remains difficult to predict. SMX is primarily metabolized by the N-acetyltransferases NAT1 and NAT2 to form N4-acetyl sulfamethoxazole (NA-SMX) and by cytochrome P450-mediated oxidation to form SMX-hydroxylamine. This study aimed to characterize SMX metabolism in vitro and investigate how NAT1 and NAT2 protein and activity variation influence NA-SMX formation. Using human liver microsomes (HLM), S9 fractions, and primary human hepatocytes (PHH), we quantified NA-SMX and other SMX metabolites. NA-SMX was the predominant metabolite in PHH, showing 4.2-fold variability across n = 26 donors. The NAT2 genotype-inferred acetylator phenotype did not reliably predict NA-SMX formation in six of nine slow acetylators, whose formation rate exceeded the mean rate of intermediate acetylators. However, NA-SMX formation was accurately predicted using the NAT2 probe substrate, sulfamethazine (SMZ), revealing significant differences between phenotype groups (p < 0.05). Activities of NAT1 and NAT2, as measured by p-aminobenzoic acid (PABA) and sulfamethazine (SMZ), respectively, significantly correlated with NA-SMX formation (r = 0.567, p = 0.007; r = 0.459, p = 0.036). The stronger correlation with NAT1 activity supports the relationship of NAT1 to SMX metabolism. Novel proteomic quantification of NAT2 revealed significant correlations between NAT2 protein levels and NAT2 activity (r = 0.823; p < 0.0001 and r = 0.734, p = 0.0002; for two peptides). This work provides quantitative insight into interindividual variability in SMX metabolism and highlights the importance of considering genetic and non-genetic, including proteomic, factors in SMX-induced DILI risk.
INSTRUMENT(S):
ORGANISM(S): Homo Sapiens (human)
TISSUE(S): Hepatocyte, Liver
SUBMITTER:
John Fallon
LAB HEAD: Klarissa Jackson
PROVIDER: PXD066786 | Pride | 2025-12-06
REPOSITORIES: Pride
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