'Omics analysis of low dose acetaminophen intake demonstrates novel response pathways in humans

M.J.A. Jetten, S. Gaj, A. Ruiz Aracama, T.M. de Kok, J.H.M. van Delft, A. Lommen, E.P. van Someren, D. Jennen, S.M. Claessen, A.A.C.M. Peijnenburg, R. Stierum, J.C.S. Kleinjans

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    Acetaminophen is the primary cause of acute liver toxicity in Europe/USA, which led the FDA to reconsider recommendations concerning safe acetaminophen dosage/use. Unfortunately, the current tests for liver toxicity are no ideal predictive markers for liver injury, i.e. they only measure acetaminophen exposure after profound liver toxicity has already occurred. Furthermore, these tests do not provide mechanistic information. Here, 'omics techniques (global analysis of metabolomic/gene-expression responses) may provide additional insight. To better understand acetaminophen-induced responses at low doses, we evaluated the effects of (sub-)therapeutic acetaminophen doses on metabolite formation and global gene-expression changes (including, for the first time, full-genome human miRNA expression changes) in blood/urine samples from healthy human volunteers. Many known and several new acetaminophen-metabolites were detected, in particular in relation to hepatotoxicity-linked, oxidative metabolism of acetaminophen. Transcriptomic changes indicated immune-modulating effects (2 g dose) and oxidative stress responses (4 g dose). For the first time, effects of acetaminophen on full-genome human miRNA expression have been considered and confirmed the findings on mRNA level. 'Omics techniques outperformed clinical chemistry tests and revealed novel response pathways to acetaminophen in humans. Although no definitive conclusion about potential immunotoxic effects of acetaminophen can be drawn from this study, there are clear indications that the immune system is triggered even after intake of low doses of acetaminophen. Also, oxidative stress-related gene responses, similar to those seen after high dose acetaminophen exposure, suggest the occurrence of possible pre-toxic effects of therapeutic acetaminophen doses. Possibly, these effects are related to dose-dependent increases in levels of hepatotoxicity-related metabolites.
    Original languageEnglish
    Pages (from-to)320-328
    JournalToxicology and Applied Pharmacology
    Issue number3
    Publication statusPublished - 2012


    • induced liver-injury
    • gene-expression
    • induced hepatotoxicity
    • circulating micrornas
    • liquid-chromatography
    • potential biomarkers
    • toxicity
    • metabolomics
    • metabolites
    • paracetamol

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    Jetten, M. J. A., Gaj, S., Ruiz Aracama, A., de Kok, T. M., van Delft, J. H. M., Lommen, A., van Someren, E. P., Jennen, D., Claessen, S. M., Peijnenburg, A. A. C. M., Stierum, R., & Kleinjans, J. C. S. (2012). 'Omics analysis of low dose acetaminophen intake demonstrates novel response pathways in humans. Toxicology and Applied Pharmacology, 259(3), 320-328. https://doi.org/10.1016/j.taap.2012.01.009