A mechanism for primaquine mediated oxidation of NADPH in red blood cells

The incubation of NADPH with primaquine results in the formation of free radicals which were demonstrated by the electron spin resonance (ESR) technique of spin trapping using 5,5-dimethyl-l-pyrroline-N-oxide (DMPO) as the spin trap. The free radicals formed were identified as the superoxide (DMPO-OOH) and hydroxyl (DMPO-OH) spin adducts of DMPO. Copper/zinc superoxide dismutase inhibited the formation of DMPO-OOH while it only partly inhibited the formation of DMPO-OH which could be totally inhibited by catalase. This indicates that the formation of hydroxyl radicals is not totally arising from the Haber-Weiss reaction. However since the formation of hydroxyl radicals is dependent on hydrogen peroxide, a non-metal catalysed reduction of hydrogen peroxide is postulated for their formation. Oxygen consumption during the reaction between primaquine and NADPH was found to be consistent with the spin trapping experiments and the rate of production of DMPO-OH indicates the formation of 1:1 catalytic complex between the two reactants. Quenching of the fluorescence of NADPH at 460 nm in the presence of primaquine indicates the formation of a charge transfer complex. When red blood cells are incubated with primaquine a hydroxyl spin adduct (DMPO-OH) is observed. The formation of this radical is probably the main cause of primaquine mediated toxicity.     

Generation of hydroxyl radical by anticancer quinone drugs,carbazilquinone, mitomycin C,aclacinomycin A and adriamycin,in the presence of NADPH-cytochrome P-450 reductase

The generation of hydroxyl free radicals in the system consisting of purified NADPH-cytochrome P-450 reductase and anticancer quinone drugs, such as carbazilquinone, mitomycin C, aclacinomycin A and adriamycin, has been confirmed by two methods. In the spin trapping study, using N-tert-butyl-α-phenylnitrone as the spin trapping agent, four drugs generated hydroxyl radical-trapped signals, and the formation of the spin adduct was dependent on time and the enzyme concentration. Among the four drugs, the generation time of signal was in the order of carbazilquinone, aclacinomycin A, adriamycin and mitomycin C, but the magnitude of signal intensity was different. In both aclacinomycin A and adriamycin, the signal disappeared in a few minutes. Catalase completely inhibited the formation of the spin adduct, while superoxide dismutase did not significantly inhibit, but effected in some manner. The generation of hydroxyl radical was also confirmed by the ethylene production from methional. Among the four drugs, the order of the magnitude of ethylene production was different from that of signal intensity by ESR study. Catalase potently inhibited the ethylene production, while superoxide dismutase effected in some manner. From these results, the interactions of anticancer quinone drugs with NADPH-cytochrome P-450 reductase and oxygen, and the possible relations of the enzymes to the radical related actions of these drugs are discussed.     

Studies on the activation of molecular oxygen and the biological defence mechanism against active oxygen species

One of the active oxygen species, superoxide (O2-), was generated by the electrolytic reduction of molecular oxygen in acetonitrile. O2- was determined by the ultraviolet (UV) (lambda max/nm = 255, epsilon = 1.48 x 10(3) M-1 cm-3) and the electron spin resonance (ESR) (g parallel = 2.083, g perpendicular = 2.008) spectrum. O2- could easily react with tocopherols (vitamin E and its derivatives) to give the corresponding chromanoxyl radicals of which structures were determined by ESR. ESR studies of the reactions of O2- with tocopherols or their model compounds indicate that the radical concentrations from tocopherol models correlate with the physiological activities of the tocopherols. O2- could also react with some biologically active quinones such as vitamin K3 and vitamin E quinone to give the corresponding semiquinone radicals. The fact that vitamin E quinone, an irreversible metabolite of vitamin E, was reduced by O2- to the semiquinone radical suggests that, like vitamin E, vitamin E quinone may also scavenge O2- and protect living cells from the effects of O2- in a hydrophobic environment. Further, O2- could react with some metalloporphyrins. In this case, non-redox metalloporphyrins such as Zn(II)TPP (TPP: tetraphenylporphine), Cd(II)TPP, Mg(II)TPP generated the superoxide adduct by the reaction with O2-. On the other hand, redox-active metalloporphyrins such as Cr(III)TPP.Cl, Mn(III)TPP.Cl, Co(II)TTP TTP: tetra-p-tolylporphine) and Co(III)TTP.Cl underwent the addition and/or redox reactions with O2-. Another active oxygen species, hydroxyl radical (OH.), was first detected from some copper (II) coplexes such as Cu(en)2 (en: ethylenediamine) with hydrogen peroxide (H2O2) by ESR spin trapping and thiobarbituric acid (TBA) methods. Further, by using Cu(en)2-H2O2 system the most active OH. scavenger was determined. This Cu(en)2-H2O2 system will be useful for determing the antioxidant ability against OH..     

Free radical production and DNA cleavage by copper chelating peptide-anthraquinones

Two pseudopeptides incorporating a peptide metal-chelating moiety (Gly-His-Lys) and a polyhydroxy anthraquinone ring related to the nuclei of anti-tumor drugs such as mitoxantrone and ametantrone, have been synthesized. The goal was to conjugate the redox effects of a quinone ring with the iron-chelating properties of the peptide in order to generate free radical species capable of damaging DNA. Indeed quinone-containing drugs undergo, in vivo, one-electron reduction to the corresponding semiquinone radicals which, in the presence of molecular oxygen, produce a superoxide anion radical, hydrogen peroxide and ultimately, in the presence of metal, hydroxyl radical (Fenton reaction). Hydroxyl radicals (OH.) are short-lived and extremely reactive with their bioenvironment. The interaction of both drugs with DNA has been studied by fluorescence quenching and DNA melting experiments. Spectroscopic and e.s.r. studies demonstrated that several types of Cu-complex are formed depending on the copper-drug ratio. The production of free radicals, as evidenced by spin-trapping, is optimum with a Cu/drug ratio of 0.1; in this case the metal ion is chelated by the peptide moiety. This latter complex is able to induce DNA breakage at a high level. Thus, it appears that the proposed concept works but that care must be taken in the choice of the relative concentration of copper.     

The effects of the quinone type drugs on hydroxyl radical (OH.) production by rat liver microsomes

The quinone drugs are known to be metabolized to semiquinone free-radical intermediates and to enhance NADPH oxidation in microsomal system. The effect of adriamycin and mitomycin C on the decarboxylation of [14C] carboxyl benzoate via hydroxyl radical (OH.) production in the microsomal system was examined. The activity of these drugs was compared to 5-fluorouracil, cyclophosphamide, and methotrexate, which are inactive in oxygen consumption experiments and are non-quinone-type drugs. Adriamycin and mitomycin C stimulated decarboxylation of benzoate 100 and 50% above the controls, respectively, while 5-fluorouracil, cyclophosphamide, and methotrexate were not different from controls. Addition of superoxide dismutase increased benzoate decarboxylation with or without the drugs present, while catalase was inhibitory in both circumstances. These results suggest that the quinone drugs enhanced hydroxyl radical (OH.) production by liver microsomes, and offer a possible mechanism of cellular toxicity by these agents.     

Oxygen-derived free radical and active oxygen complex formation from cobalt(II) chelates in vitro.

The electron paramagnetic resonance (EPR) spin trapping technique was used to study the generation of oxygen free radicals from the reaction of hydrogen peroxide with various Co(II) complexes in pH 7.4 phosphate buffer. The 5,5-dimethyl-1-pyrroline N-oxide (DMPO) spin trap was used in these experiments to detect superoxide and hydroxyl free radicals. Superoxide radical was generated from the reaction of H2O2 with Co(II), but was inhibited when Co(II) was chelated with adenosine 5'-diphosphate or citrate. Visible absorbance spectra revealed no change in the final oxidation state of the cobalt ion in these samples. The EDTA complex also prevented detectable free-radical formation when H2O2 was added, but visible absorbance data indicated oxidation of the Co(II) to Co(III) in this case. The amount of DMPO/.OOH adduct detected by EPR was greatly enhanced when H2O2 reacted with the nitrilotriacetate complex relative to Co(II) alone, and in addition, concurrent formation of the DMPO/.OH adduct due to slow oxidation of Co(II) was observed. The hydroxyl radical adduct formation was suppressed by ethanol, but not DMSO, indicating that free hydroxyl radical was not formed. The deferoxamine nitroxide radical was exclusively formed when H2O2 was added to the Co(II) complex of this ligand, most probably in a site-specific manner. In the presence of ethylenediamine, Co(II) bound molecular O2 and directly oxidized DMPO to its DMPO/.OH adduct without first forming free superoxide, hydroxyl radical, or hydrogen peroxide. An experiment using 17O-enriched water revealed that the Co(II)-ethylenediamine complex caused the DMPO to react with solvent water to form the DMPO/.OH adduct. The relevance of these results to toxicological studies of cobalt is discussed.     

Production of hydroxyl radical by decomposition of superoxide spin-trapped adducts

The spin trapping of superoxide by nitrone spin traps, in particular 5,5-dimethyl-1-pyrroline-1-oxide (DMPO), was found to lead to the de novo production of hydroxyl radical and a nonradical species. Hydroxyl radical is then spin-trapped by DMPO, producing DMPO-OH. It was determined that a background level of approximately 3% DMPO-OH relative to DMPO-OOH is produced by this mechanism. Thus, the detection of hydroxyl radical by spin trapping with DMPO must be used with caution if the level of hydroxyl radical is less than 3% of the rate of superoxide generation. Several examples are cited in which investigators suggested that hydroxyl radical is produced when in fact the spin trapping of this free radical may have been an artifact of the system.     

NAD(P)H (quinone acceptor) oxidoreductase (DT-diaphorase)-mediated two-electron reduction of anthraquinone-based antitumour agents and generation of hydroxyl radicals.

The anthraquinone-based antitumour agents mitoxantrone, daunorubicin and ametantrone were found to be substrates for NAD(P)H (quinone acceptor) oxidoreductase (DT-diaphorase) [QAO] isolated from rat liver. This was indicated by the stimulation of QAO-dependent NADPH oxidation by these agents. This effect followed Michaelis-Menten kinetics and was dependent on the concentration of QAO, inhibited by the specific QAO inhibitor dicumarol (15 microM) and enhanced by the QAO activators bovine serum albumin (0.01%) and Triton X-100 (0.03%). As indicated by the Vmax/Km ratio, mitoxantrone (26.53) was considerably more active than ametantrone (11.25) or daunorubicin (7.35). Metabolism of these anthraquinones was associated with the formation of superoxide anions, hydrogen peroxide and hydroxyl radicals as indicated by electron spin resonance spin trapping studies with 5,5-dimethyl-1-pyrroline-N-oxide. This is likely to be due to the slow auto-oxidation of the respective dihydroquinones in the presence of molecular oxygen. QAO needs to be considered as a possible route of bioreductive activation of these agents.     

地奥心血康对羟基自由基的清除作用

利用紫外线辐照过氧化氢水溶液方法产生羟基自由基，并通过电子自旋共振及自旋捕捉方法，对自旋加合物谱线的相对高度进行比较，得到地奥心血康浓度０．７１％，１．４３％和２．１４％时，分别清除掉羟基自由基６６％。８０％和１００％。并与甲酸钠进行比较，得到该药物的作用机制与药效信息。     

Evidence for intracellular superoxide formation following the exposure of guinea pig enterocytes to bleomycin

Spin trapping of free radicals during the exposure of guinea pig enterocytes to bleomycin (BLM) was investigated using an in vitro cell suspension. The spin traps employed in this study were 5,5-dimethyl-1-pyrroline-1-oxide (DMPO) and 3,3-diethyl-5,5-dimethyl-1-pyrroline-1-oxide (DEDMPO). The hydroxyl radical spin-trapped adduct 2-hydroxy-5,5-dimethyl-1-pyrrolidinyloxyl (DMPO-OH) was observed with DMPO. In the presence of dimethyl sulfoxide (DMSO), the only 2,2,5-trimethyl-1-pyrrolidinyloxyl (DMPO-CH3) observed was that expected from hydroxyl radical formation by the decomposition of the superoxide spin-trapped adduct 2-hydroperoxy-5,5-dimethyl-1-pyrrolidinyloxyl (DMPO-OOH). Production of hydroxyl radical was not detected in the presence of DEDMPO, which is a nitrone that will spin trap hydroxyl radical, but not superoxide, at cellular concentrations. Thus, these data indicate that superoxide was produced during the exposure of guinea pig enterocytes to BLM and that DMPO-OH resulted from the cellular bioreduction of DMPO-OOH by glutathione peroxidase. Addition of superoxide dismutase to the in vitro reaction mixture indicated that superoxide production was intracellular.     

Iron Supplements and Magnesium Peroxide: An Example of a Hazardous Combination in Self‐Medication

The use of self‐medication, which includes dietary supplements and over‐the‐counter drugs, is still on the rise, while safety issues are not well addressed yet. This especially holds for combinations. For example, iron supplements and magnesium peroxide both produce adverse effects via the formation of reactive oxygen species (ROS). This prompted us to investigate the effect of the combination of three different iron supplements with magnesium peroxide on ROS formation. Hydroxyl radical formation by the three iron supplements either combined with magnesium peroxide or alone was determined by performing a deoxyribose assay. Free iron content of iron supplements was determined using ferrozine assay. To determine hydrogen peroxide formation by magnesium peroxide, a ferrous thiocyanate assay was performed. Finally, electron spin resonance spectroscopy (ESR) was performed to confirm the formation of hydroxyl radicals. Our results show that magnesium peroxide induces the formation of hydrogen peroxide. All three iron supplements induced the formation of the extremely reactive hydroxyl radical, although the amount of radicals formed by the different supplements differed. It was shown that combining iron supplements with magnesium peroxide increases radical formation. The formation of hydroxyl radicals after the combination was confirmed with ESR. All three iron supplements contained labile iron and induced the formation of hydroxyl radicals. Additionally, magnesium peroxide in water yields hydrogen peroxide, which is converted into hydroxyl radicals by iron. Hence, iron supplements and magnesium peroxide is a hazardous combination and exemplifies that more attention should be given to combinations of products used in self‐medication.     

Site-specific DNA damage induced by cobalt(II) ion and hydrogen peroxide: role of singlet oxygen

The effect of Co(II) ion on the reaction of hydrogen peroxide with DNA was investigated by a DNA sequencing technique using 32P-5'-end-labeled DNA fragments obtained from human c-Ha-ras-1 protooncogene. Co(II) induced strong DNA cleavage in the presence of hydrogen peroxide even without alkali treatment. Guanine residues were the most alkali-labile site, and the extent of cleavages at the positions of thymine and cytosine was dependent on the sequence. Adenine residues were relatively resistive. Diethylenetriaminepentaacetic acid, present in excess over Co(II), inhibited DNA cleavage. Singlet oxygen scavengers (dimethylfuran, sodium azide, 1,4-diazabicyclo[2.2.2]octane, dGMP), sulfur compounds (methional, methionine), and superoxide dismutase inhibited DNA cleavage completely. Hydroxyl radical scavengers were not so effective as singlet oxygen scavengers. ESR studies using 2,2,6,6-tetramethyl-4-piperidone as a singlet oxygen trap suggest that Co(II) reacts with hydrogen peroxide to produce singlet oxygen or its equivalent. ESR studies using 5,5-dimethylpyrroline N-oxide (DMPO) showed that the hydroxyl radical adduct of DMPO was also formed. The results suggest that Co(II) ion binds to DNA and subsequently reacts with hydrogen peroxide to produce singlet oxygen and hydroxyl radicals and that singlet oxygen plays a more important role in the DNA damage than hydroxyl free radicals.     

Quantitation of the hydroxyl radical adducts of salicylic acid by micellar electrokinetic capillary chromatography: oxidizing species formed by a Fenton reaction

There has been controversy concerning the products formed by a Fenton reaction. We determined the hydroxyl radical (^.OH) generated in a Fenton reaction system with no iron chelator using micellar electrokinetic capillary chromatography (MECC). The hydroxyl radical generated in this Fenton system attacked salicylic acid to produce major products of 2,3- and 2,5-dihydroxybenzoic acid (DHB), 2,3-DHB being prominent. Hydroxyl radical scavengers, such as mannitol, ethanol, thiourea and a ferric chelator, Desferal, significantly diminished the peaks for DHBs, showing production of ^.OH. We compared the MECC method with the electron paramagnetic resonance (EPR) spin trapping technique. The quantity of DHBs obtained by MECC increased dose-dependently up to 1 μM Fe²⁺ at a fixed concentration of H₂O₂, whereas that of the spin adduct by EPR showed a bell-shaped curve. This quantitation of ^.OH adducts by MECC supports the proposal that the oxidizing species formed by a Fenton reaction with no chelator is ^.OH. The EPR spin trapping method appears to be erroneous, particularly when iron is present at a higher concentration than hydrogen peroxide. The application of this method to the paraquat effect in vitro is demonstrated, and the possibility for analysis of ^.OH in vivo is also discussed. Received: 7 February 1994/Accepted: 12 April 1994     

Detection, characterization, and decay kinetics of ROS and thiyl adducts of mito-DEPMPO spin trap

We report here the detection and characterization of spin adducts formed from the trapping of reactive oxygen species (superoxide and hydroxyl radicals) and glutathiyl and carbon-centered radicals by a newly synthesized nitrone, Mito-DEPMPO. This is a cationic nitrone spin trap with a triphenyl phosphonium cation conjugated to the DEPMPO analogue. The Mito-DEPMPO-OOH adduct, formed from the trapping of superoxide by Mito-DEPMPO, was enzymatically generated using xanthine/xanthine oxidase and neuronal nitric oxide synthase, and chemically generated by KO2 in 18-crown-6. The Mito-DEPMPO-OOH adduct exhibits an eight-line EPR spectrum with partial asymmetry arising from the alternate line-width effect. The half-life of the Mito-DEPMPO-OOH adduct is 2-2.5-times greater than that of the DEPMPO-OOH. The Mito-DEPMPO-SG adduct, formed from the trapping of glutathiyl radicals by Mito-DEPMPO, is 3-times more persistent than the analogue DEPMPO-SG adduct. In this study, we describe the EPR characterization of spin adducts formed from Mito-DEPMPO. The EPR parameters of Mito-DEPMPO adducts are distinctly different and highly characteristic. The detection of superoxide from an intact mitochondrion was feasible with Mito-DEPMPO but not with DEPMPO. We conclude that Mito-DEPMPO nitrone and its analogues are more effective than most nitrone spin traps for trapping superoxide, hydroxyl, and thiyl radicals formed in biological systems, including mitochondria.     

Characterization of hydroxyl radical formation by microsomal enzymes using a water-soluble trap, terephthalate

Using terephthalic acid as a water-soluble trap, we characterized hydroxyl radicals (HO?) formation by liver microsomal enzymes from isoniazid-treated rats. We found that HO? formation was entirely dependent on intact microsomal enzymes, the presence of NADPH, and iron complexed with EDTA. In contrast to the other radical traps, we found no evidence that terephthalate is a substrate for cytochrome P450. Cumene hydroperoxide, an artificial supporter of cytochrome P450-catalyzed oxidation, failed to maintain HO(.-) formation. HO(.-) formation in liver microsomes was inhibited by the HO(.-) radical scavengers: dimethyl sulfoxide (DMSO), mannitol, and citrulline. It was abolished by catalase, but not superoxide dismutase (SOD), indicating that hydrogen peroxide was the sole precursor of the HO(.-). Therefore, the generation of hydroxyl radicals by microsomal enzymes appears to be dependent on two processes: (1) the rate of hydrogen peroxide production; and (2) the availability of iron ions or other transition metals for Fenton type reactions.     

Studies with primaquine in vitro: superoxide radical formation and oxidation of haemoglobin.

1. The production of superoxide radicals from primaquine diphosphate in aqueous solution has been demonstrated, using as indicator the reduction of cytochrome C with inhibition of the reaction by superoxide dismutase. 2. Primaquine-mediated oxidation of haemoglobin to methaemoglobin was reduced by the addition of catalase and increased by superoxide dismutase. Mannitol, a hydroxyl radical scavenger, abolished the increase in methaemoglobin observed in the presence of superoxide dismutase. EDTA reduced the oxidation of haemoglobin with and without superoxide dismutase. 3. Although the oxidation of haemoglobin in the presence of primaquine includes the effects of hydrogen peroxide, superoxide and hydroxyl radicals and metal ions, the results indicate that hydrogen peroxide, rather than the superoxide radical, is the main oxidizing species. The increase in haemoglobin oxidation occurring with superoxide dismutase may result from the augmented rate of hydrogen peroxide formation from superoxide radicals.     

Generation of reactive oxygen species and 8-hydroxy-2'-deoxyguanosine formation from diesel exhaust particle components in L1210 cells.

The generation of the reactive oxygen species during the interaction of diesel exhaust particles (DEP) with NADPH-cytochrome P450 reductase (P450 reductase) was investigated by electron spin resonance using the spin-trap 5,5'-dimethyl-1-pyrroline-N-oxide (DMPO). Addition of DEP extract to an incubation mixture of mouse lung microsomes in the presence of NADPH resulted in a time-dependent NADPH oxidation and acetylated-cytochrome c reduction. Using purified P450 reductase as the enzyme source, superoxide radicals which were detected as the spin adduct (DMPO-OOH) while metabolized by P450 reductase were dependent upon both DEP and enzyme concentrations. The ELISA method using a specific monoclonal antibody revealed that DEP produced 8-hydroxy-2'-deoxyguanosine (8-OHdG), which is formed from deoxyguanosine in DNA by hydroxyl radicals, in the culture medium of L1210 cells. Active oxygen scavengers such as superoxide dismutase and catalase effectively blocked the formation of 8-OHdG in culture medium, and deferoxamine, which inhibits hydroxyl radicals production by chelating iron, was also effective in inhibiting the DEP-produced 8-OHdG formation. These results indicate that DEP components produce 8-OHdG through the hydroxyl radical formation via superoxide by redox cycling of P450 reductase.     

Evidence for superoxide formation during hepatic metabolism of tamoxifen.

Spin trapping of free radicals during the hepatic metabolism of tamoxifen was investigated; the spin trap employed in this study was 5,5-dimethyl-1-pyrroline-1-oxide (DMPO). The spin adduct 2-hydroxy-5,5-dimethyl-1-pyrrolidinyloxyl (DMPO-OH) was detected in an in vitro incubation mixture of phenobarbital-treated rat hepatocytes containing tamoxifen, dimethyl sulfoxide, and DMPO. However, since the spin adduct 2,5,5-trimethyl-1-pyrrolidinyloxyl (DMPO-CH3) was not observed, the DMPO-OH resulted from the cellular bioreduction of 2-hydroperoxy-5,5-dimethyl-1-pyrrolidinyloxyl (DMPO-OOH) by glutathione peroxidase. Addition of superoxide dismutase (SOD) to the in vitro system indicated that superoxide production was intracellular. When noninduced hepatocytes were utilized, free radical production was not evident. Thus, the cytochrome P450 monooxygenase system was responsible, in part, for the intermediacy of superoxide anion during hepatic metabolism.     

EPR studies of in vivo radical production by 3,3',5,5'-tetrabromobisphenol A (TBBPA) in the Sprague-Dawley rat

Brominated flame retardants (BFRs) are present in many consumer products ranging from fabrics to plastics and electronics. Wide use of flame retardants can pose an environmental hazard and it is of interest to determine the mechanism of their toxicity. Of all the BFRs, 3,3',5,5'-tetrabromobisphenol A (TBBPA) is produced in the largest volume. Previous studies by Szymanska et al. (2000) have shown that TBBPA is hepatotoxic in rats. We report here that when TBBPA (100 or 600 mg/kg) dissolved in DMSO and alpha-(4-pyridyl-1-oxide)-N-t-butylnitrone (POBN) was administered ip to male Sprague-Dawley rats the POBN/CH(3) spin adduct was detected by electron paramagnetic resonance (EPR) in the bile. When (13)C-DMSO was employed the POBN/C(13)H(3) adduct was observed. Also present in the bile was the 2,6-dibromobenzosemiquinone radical derived from 2,6-dibromohydroquinone, a known metabolite of TBBPA. Reaction of the 2,6-dibromobenzosemiquinone radical with oxygen would generate superoxide from which hydrogen peroxide can form by dismutation. The hydroxyl radical generated via the Fenton reaction from hydrogen peroxide reacts in vivo with DMSO to give the methyl radical which is trapped by POBN. These observations suggest that the hepatotoxicity of TBBPA in rats may be due to the in vivo generation of the hydroxyl radical as a result of redox reactions involving the TBBPA metabolite 2,6-dibromohydroquinone and its corresponding semiquinone radical.     

Free radicals mediate cardiac toxicity induced by adriamycin

Anthracycline antibiotics, including adriamycin (ADM), are widely used to treat various human cancers, but their clinical use has been limited because of their cardiotoxicity. ADM is especially toxic to heart tissue. The mechanisms responsible for the cardiotoxic effect of ADM have been very/extremely controversial. This review focuses on the participation of free radicals generated by ADM in the cardiotoxic effect. ADM is reduced to a semiquinone radical species by microsomal NADPH-P450 reductase and mitochondrial NADH dehydrogenase. In the presence of oxygen, the reductive semiquinone radical species produces superoxide and hydroxyl radicals. Generally, lipid peroxidation proceeds by mediating the redox of iron. ADM extracts iron from ferritin to form ADM-Fe3+, which causes lipid peroxidation of membranes. These events may lead to disturbance of the membrane structure and dysfunction of mitochondria. However, superoxide dismutase and hydroxyl radical scavengers have little effect on lipid peroxidation induced by ADM-Fe3+. Alternatively, ADM is oxidatively activated by peroxidases to convert to an oxidative semiquinone radical, which participates in inactivation of mitochondrial enzymes or including succinate dehydrogenase and creatine kinase. Here, we discuss the activation of ADM and the role of reductive and oxidative ADM semiquinone radicals in the cardiotoxic effect of this antibiotic.