Investigation of the immunogenicity of diclofenac and diclofenac metabolites.

Oral administration of the non-steroidal anti-inflammatory drug diclofenac (DCF) is associated with a high incidence of adverse drug reactions, some of which are thought to be mediated by the immune system. It has been proposed that metabolic activation of DCF and covalent binding to protein generates an antigenic determinant that stimulates immune cells; however, the nature of the metabolite remains ill-defined. The aim of this study was to synthesize and evaluate the antigenic potential of DCF metabolites in the mouse. DCF and DCF metabolites were administered via subcutaneous injection over a 5-day period to BALB/C strain mice to induce immune activation. Proliferation was measured by the addition of [(3)H] thymidine to ex vivo isolated draining auricular lymph node cells. Results were compared with those provoked by exposure to 2,4-dinitrochlorobenzene. Lymph node activation was observed following treatment with 2,4-dinitrochlorobenzene, 5-hydroxy DCF quinoneimine and 4'-hydroxy DCF quinoneimine, but not DCF acyl glucuronide or DCF itself. Interestingly, lymph node cells from 5-hydroxy DCF treated mice were also found to proliferate, when compared with cells from vehicle-treated mice, while 4'-hydroxy DCF did not stimulate lymph node cell activation. The reactivity of 5-hydroxy DCF quinoneimine was confirmed by synthesis and characterization of an N-acetyl cysteine adduct. These data show that formation of 5-hydroxy DCF and subsequent autoxidation provides an antigenic determinant for immune cell activation in the mouse.