APAP-induced necrotic death. Results with these in Acetaminophen (N-acetyl-p-aminophenol [APAP]) hepa-vitro models of liver injury are interpreted as supporting totoxicity is a process characterized by Ca 2/ deregulathe hypothesis that increased Ca 2/ availability plays a tion. Cellular functions utilizing Ca 2/ as a second mesmajor role in the progression of APAP-dependent cellusenger molecule affect both cytosolic and nuclear signal lar necrosis, and that the nucleus is a critical target for transduction. Many studies have independently shown APAP hepatotoxicity. (HEPATOLOGY 1997;25:1432-1438.) Ca 2/ -related effects on target molecules in response to toxic doses of APAP; however, the primary Ca 2/ target resulting in liver necrosis has not been determined. WeAcute exposure to toxic doses of acetaminophen (N-acetylhypothesize that Ca 2/ -dependent DNA damage is a critip-aminophenol [APAP]) induces cellular responses driven by cal event in liver necrosis caused by alkylating hepatodisruption of Ca 2/ homeostasis and is strongly correlated to toxins. In this study, Ca 2/ -dependent endonuclease ac-DNA damage in the liver. 1-3 At lethal doses, organ failure tivity was determined from DNA single-strand lesions ensues via mechanisms that produce cell death by necrosis measured by fluorometric analysis of DNA unwinding.and possibly apoptosis. Strategies to treat individuals after The status of cytosolic Ca 2/ was determined by measurtoxic exposure are limited by our understanding of the relaing Ca 2/ -dependent activation of glycogen phosphoryltive contributions of events that produce irreversible damage ase a. Primary cultures of mouse hepatocytes exposed and hepatocyte death. to a toxic concentration of APAP showed twofold and Calcium deregulation has a profound effect on cell survival greater increases in glycogen phosphorylase a stimulavia numerous signal-transducing pathways utilizing Ca 2/ as tion at 6 hours, which was reversible with Ca 2/ -chelating a second messenger. 4,5 Several mechanisms of cell death have agents. Cell death was preceded by a large decline in been proposed for APAP and other alkylating hepatotoxins. intact, double-stranded DNA. Following toxic adminisSites of Ca 2/ activity include cellular macromolecules directly tration of APAP, the percentage of total double-stranded modified by alkylation. APAP-induced cytotoxicity is associ-DNA was significantly reduced by 2 hours. At 6 and 24 ated with mitochondrial damage, adenosine 5 triphosphate hours, genomic integrity was compromised by 26% and (ATP) depletion, and concomitant increases in adenosine di-37%, respectively, compared with untreated controls.phosphate and adenosine monophosphate. 6 Alternatively, the Hepatotoxic effects of APAP-mediated Ca 2/ deregulation DNA Ca 2/ hypothesis of necrotic cell death states that alkylwere confirmed in both primary mouse hepatocytes and ating hepatotoxins damage DNA in various ways, including the human hepatoblastoma HepG2 cell line by lactate damage by adduct formation and Ca 2/ -endonuclease activad...