4,4′-Diaminodiphenylsulfone (DDS) can produce methemoglobinemia in vivo, apparently by the action of an unidentified metabolic product. To discern the chemical nature of such a compound, 13 p-substituted diphenylsulfones have been examined for their ability to oxidize hemoglobin (Hb) to methemoglobin (MHb) in human erythrocytes in vitro. 4-Amino-4′-hydroxyaminodiphenylsulfone (DDS-NOH) is most effective, 1·9 × 10 −5 M of drug oxidizing as much as 60 per cent of the Hb, or 100 heme equivalents/mole of DDS-NOH in 2 hr. Oxygen is required for this process, and glucose, while not required, enhances MHb formation. With dialyzed hemolysates and solutions of purified Hb, the heme equivalents oxidized/mole of drug becomes less than 10, but a ratio of 80 : 100 can be restored by adding reduced glutathione (GSH) or NADPH. Apparently DDS-NOH produces MHb by coupled oxidation with Hb and O 2 and DDS-NOH can be regenerated by reducing compounds to yield the high heme oxidation ratio. In intact cells, DDS-NOH causes a 7-fold increase in the activity of the hexose monophosphate shunt as measured by 14CO 2 production from glucose 1- 14C. Incubation with galactose, which is minimally oxidized by the shunt pathway, results in decreased formation of MHb, and the GSH concentration drops by 75 per cent. Depletion of intracellular GSH by a sulfhydryl oxidizing compound also reduces MHb formation by DDS-NOH. These observations implicate GSH or NADPH or both in the recycling of DDS-NOH in erythrocytes. Consistent with these interpretations, DDS-NOH produced only one-half as much MHb in erythrocytes from three individuals with glucose 6-phosphate dehydrogenase deficiency as it did in normal erythrocytes.
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