Genetic, Immunologic and Biotransformation Studies of Patients on Procainamide

Louis E. Adams, Kamala Balakrishnan, Rick Belcher, Anne Barbara Mongey, Evelyn V. Hess, Stephen M. Roberts, T. J. Thomas

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


This report represents follow-up observations of a unique long-term study of patients on procainamide (PA) for various cardiac arrhythmias. Serologic and clinical evaluations associated with drug-related autoimmunity were assessed and patients were characterized for factors postulated to influence susceptibility to autoimmunity, including acetylator phenotype, oxidative metabolism of PA, HLA class profile, and production of interleukin-1 (IL-1) and tumor necrosis factor (TNF). Fifty-two percent had IgM and 70% IgG antibodies to total histones; 67% had IgG antibodies to histone H2A/H2B. Patients were equally divided between fast and slow acetylators. N-oxidative metabolism of PA was indicated by the presence of urinary nitroprocainamide, which correlated with elevated titers of antihistone antibodies. There was a significant incidence of the DQw7 split of DQw3 in PA patients when compared to controls, and the frequency of antibodies to total histones and H2A/H2B was significantly increased in the DQw7 patients. C4A*QO and C4B*QO alleles were more frequent in the PA patients than in controls. IL-1 and TNF production was not different in patients compared to controls. These data suggest that certain genetic factors may serve as markers for PA-related autoimmunity.

Original languageAmerican English
Pages (from-to)89-98
Number of pages10
Issue number2
StatePublished - Apr 1993

ASJC Scopus subject areas

  • Rheumatology


  • Autoimmunity
  • Drug-related lupus
  • Nitroprocainamide
  • Procainamide


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