In vitro assessment of pharmacogenetic susceptibility to toxic drug metabolites in humans.

An experimental approach to the pharmacogenetics of human idiosyncratic drug reactions requires an assay for determining individual differences in susceptibility that does not expose patients to further drug-related risk. We have developed an in vitro drug toxicity assay designed to test the hypothesis that differences in susceptibility may be based on genetic abnormalities in the detoxification of electrophilic drug metabolites. Lymphocytes are challenged with metabolites generated by a murine hepatic microsomal system. By using cells from patients deficient in glutathione synthetase, we found that cells with decreased glutathione defenses are more sensitive to toxicity from metabolites of drugs such as acetaminophen, nitrofurantoin, and metronidazole. The assay was then applied to studying the pharmacogenetics of phenytoin hepatotoxicity. We found an inherited defect in the detoxification of phenytoin arene oxide metabolites in cells from patients and their relatives. The studies have led to an elucidation of a genetically heterogeneous group of detoxification defects for arene oxide metabolites of various aromatic drugs. Such experimental approaches may be useful in diagnosing idiosyncratic drug reactions, in establishing their pharmacogenetic basis, and perhaps in predicting toxicity potential of drugs for selected patients and families.