Procainamide (PA) is a drug that is used to treat tachycardia in post-operative patients or for long term maintenance of cardiac arrythmias. Unfortunately, its use has also been associated with agranulocytosis. Here we have investigated the metabolism of PA by myeloperoxidase (MPO) and the formation of an MPO protein free radical. We hypothesized that PA oxidation by MPO/H 2 O 2 would produce a PA cation radical that, in the absence of a biochemical reductant, would lead to the free-radical oxidation of MPO. We utilized a novel anti-DMPO antibody to detect DMPO (5,5-dimethyl-1-pyrroline N-oxide) covalently bound to protein, which forms only by the reaction of DMPO with a protein free radical. We found that PA metabolism by MPO/H 2 O 2 induced the formation of DMPO-MPO, which was inhibited by MPO inhibitors and ascorbate. N-acetyl-PA did not cause DMPO-MPO formation, indicating that the unsubstituted aromatic amine was more oxidizable. PA had a lower calculated ionization potential than N-acetyl-PA. The DMPO adducts of §To whom correspondence should be addressed: Laboratory of Pharmacology and Chemistry, National Institute of Environmental Health Sciences, 111 TW Alexander Dr., Research Triangle Park, NC USA, 27709. T: (919) 541-5197, F: (919) 541-1043, sirakia@niehs.nih.gov.. Abbreviations: PA, procainamide; NAPA, N-acetyl-procainamide; MPO, myeloperoxidase; ESR, electron spin resonance; DTPA, diethylenetriaminepentaacetic acid; MNP, 2-methyl-2-nitrosopropane; DMPO, 5,5-dimethyl-1-pyrroline N-oxide; ABAH, 4-aminobenzoic acid hydrazide; G/GO,Glucose / glucose oxidase. MPO metabolism, as analyzed by electron spin resonance spectroscopy, included a nitrogen-centered radical and a phenyl radical derived from PA, either of which may be involved in the free radical formation on MPO. Furthermore, we also found protein-DMPO adducts in MPO-containing, intact human promyelocytic leukemia cells . MPO was affinity-purified from HL-60 cells treated with PA/H 2 O 2 and was found to contain DMPO using the anti-DMPO antibody. Mass spectrometry analysis confirmed the identity of the protein as human MPO. These findings were also supported by the detection of protein free radicals with electron spin resonance in the cellular cytosolic lysate. The formation of an MPO protein free radical is believed to be mediated by free radical metabolites of PA, which we characterized by spin trapping. We propose that drug-induced free radical formation on MPO may play a role in the origin of agranulocytosis.
NIH Public AccessProcainamide (PA) is a sodium channel blocker which stabilizes electrical conduction in the heart. It is used for treating atrial tachycardia and is specifically recommended for atrial fibrillation of the Wolff-Parkinson-White syndrome (1). Unfortunately, agranulocytosis, an idiosyncratic adverse drug reaction, is associated with the use of procainamide (PA). This condition is characterized by severe neutropenia, where the absolute neutrophil count decreases below 500/uL (2,3), which greatly increases the risk of b...