Bioactivation, protein haptenation, and toxicity of sulfamethoxazole and dapsone in normal human dermal fibroblasts

Toxicol Appl Pharmacol. 2006 Sep 1;215(2):158-67. doi: 10.1016/j.taap.2006.02.006. Epub 2006 Apr 17.


Cutaneous drug reactions (CDRs) associated with sulfonamides are believed to be mediated through the formation of reactive metabolites that result in cellular toxicity and protein haptenation. We evaluated the bioactivation and toxicity of sulfamethoxazole (SMX) and dapsone (DDS) in normal human dermal fibroblasts (NHDF). Incubation of cells with DDS or its metabolite (D-NOH) resulted in protein haptenation readily detected by confocal microscopy and ELISA. While the metabolite of SMX (S-NOH) haptenated intracellular proteins, adducts were not evident in incubations with SMX. Cells expressed abundant N-acetyltransferase-1 (NAT1) mRNA and activity, but little NAT2 mRNA or activity. Neither NAT1 nor NAT2 protein was detected. Incubation of NHDF with S-NOH or D-NOH increased reactive oxygen species formation and reduced glutathione content. NHDF were less susceptible to the cytotoxic effect of S-NOH and D-NOH than are keratinocytes. Our studies provide the novel observation that NHDF are able to acetylate both arylamine compounds and bioactivate the sulfone DDS, giving rise to haptenated proteins. The reactive metabolites of SMX and DDS also provoke oxidative stress in these cells in a time- and concentration-dependent fashion. Further work is needed to determine the role of the observed toxicity in mediating CDRs observed with these agents.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Anti-Infective Agents / metabolism*
  • Anti-Infective Agents / toxicity
  • Arylamine N-Acetyltransferase / genetics
  • Arylamine N-Acetyltransferase / metabolism
  • Cells, Cultured
  • Dapsone / metabolism*
  • Dapsone / toxicity
  • Dose-Response Relationship, Drug
  • Drug Eruptions / etiology
  • Drug Eruptions / metabolism*
  • Epidermal Cells
  • Epidermis / drug effects*
  • Epidermis / metabolism
  • Fibroblasts / drug effects
  • Fibroblasts / metabolism
  • Fibroblasts / pathology
  • Haptens / metabolism
  • Humans
  • Isoenzymes / genetics
  • Isoenzymes / metabolism
  • Oxidative Stress / drug effects
  • RNA, Messenger / metabolism
  • Sulfamethoxazole / metabolism*
  • Sulfamethoxazole / toxicity


  • Anti-Infective Agents
  • Haptens
  • Isoenzymes
  • RNA, Messenger
  • Dapsone
  • Arylamine N-Acetyltransferase
  • N-acetyltransferase 1
  • Sulfamethoxazole