Mnemonic

Free Radical Injury

A memory aid for the sources and consequences of free radical damage.

Expansion

Unpaired electrons attacking lipids, proteins and DNA

Expansion

Sources

  • Normal metabolism: leakage from the electron transport chain
  • Inflammation: the neutrophil respiratory burst, using NADPH oxidase and myeloperoxidase
  • Ionising radiation, ultraviolet light
  • Drug metabolism: paracetamol (NAPQI), carbon tetrachloride
  • Transition metals: iron and copper, through the Fenton reaction
  • Reperfusion after ischaemia

Three targets

  1. Lipids: lipid peroxidation of membranes, a self-propagating chain reaction
  2. Proteins: cross linking, misfolding, loss of enzyme function
  3. DNA: strand breaks and base modification, causing mutation and malignancy

Defences

  • Enzymes: superoxide dismutase, catalase, glutathione peroxidase (which needs selenium)
  • Antioxidants: vitamins C and E, glutathione, beta carotene
  • Metal binding proteins: transferrin, ferritin, caeruloplasmin, which keep iron and copper unavailable

“Free radicals explain the toxicity of paracetamol, the damage of reperfusion, and the mutagenicity of radiation.”

Chronic granulomatous disease demonstrates the other side: failure of NADPH oxidase means neutrophils cannot generate the burst, so catalase positive organisms survive and cause recurrent abscesses.