Pulmonary implications of acetaminophen exposures independent of hepatic toxicity

Am J Physiol Lung Cell Mol Physiol. 2021 Nov 1;321(5):L941-L953. doi: 10.1152/ajplung.00234.2021. Epub 2021 Sep 29.


Both preclinical and clinical studies have demonstrated that exposures to acetaminophen (APAP) at levels that cause hepatic injury cause pulmonary injury as well. However, whether exposures that do not result in hepatic injury have acute pulmonary implications is unknown. Thus, we sought to determine how APAP exposures at levels that do not result in significant hepatic injury impact the mature lung. Adult male ICR mice (8-12 wk) were exposed to a dose of APAP known to cause hepatotoxicity in adult mice [280 mg/kg, intraperitoneal (ip)], as well as a lower dose previously reported to not cause hepatic injury (140 mg/kg, ip). We confirm that the lower dose exposures did not result in significant hepatic injury. However, like high dose, lower exposure resulted in increased cellular content of the bronchoalveolar lavage fluid and induced a proinflammatory pulmonary transcriptome. Both the lower and higher dose exposures resulted in measurable changes in lung morphometrics, with the lower dose exposure causing alveolar wall thinning. Using RNAScope, we were able to detect dose-dependent, APAP-induced pulmonary Cyp2e1 expression. Finally, using FLIM we determined that both APAP exposures resulted in acute pulmonary metabolic changes consistent with mitochondrial overload in lower doses and a shift to glycolysis at a high dose. Our findings demonstrate that APAP exposures that do not cause significant hepatic injury result in acute inflammatory, morphometric, and metabolic changes in the mature lung. These previously unreported findings may help explain the potential relationship between APAP exposures and pulmonary-related morbidity.

Keywords: CYP2E1; FLIM; acetaminophen; lung injury; paracetamol.

Publication types

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

MeSH terms

  • Acetaminophen / metabolism
  • Acetaminophen / toxicity*
  • Animals
  • Cytochrome P-450 CYP2E1 / metabolism
  • Disease Models, Animal
  • Glycolysis / drug effects
  • Liver / drug effects*
  • Liver / metabolism
  • Lung / drug effects*
  • Lung / metabolism
  • Lung Injury / drug therapy*
  • Lung Injury / metabolism
  • Mice
  • Mice, Inbred ICR


  • Acetaminophen
  • Cytochrome P-450 CYP2E1