Pralidoxime chloride (2-PAM chloride)

An AChE reactivator

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Background

Pralidoxime reactivates acetylcholinesterase (AChE) that has been deactivated by binding of organophosphates to its esteratic site.¹ Pralidoxime binds to the anionic site of AChE and displaces the phosphate from the esteratic site through formation of phosphate-pralidoxime conjugates. It reactivates paraoxon- and diisopropyl fluorophosphate-inactivated human red blood cell (RBC) AChE with IC₅₀ shifts of 0.3 and 0.8 nM per μM of pralidoxime, respectively.²,³ At a concentration of 10 μM, it reactivates human RBC AChE that has been inactivated by chlorpyrifos , diazinon , and malathion by 17, 61, and 36%, respectively.⁴ Pralidoxime binds to sarin-bound hAChE (K_d = 25.72 μM) and inhibits sarin-induced AChE deactivation (IC₅₀ = 1.21 mM) in hemoglobin-free erythrocyte ghosts.⁵ Formulations containing pralidoxime have been used to treat organophosphate poisoning.¹

1.Jokanovi?, M., and Stojiljkovi?, M.P.Current understanding of the application of pyridinium oximes as cholinesterase reactivators in treatment of organophosphate poisoningEur. J. Pharmacol.553(1-3)10-17(2006) 2.Petroianu, G.A., Arafat, K., Kuca, K., et al.Five oximes (K-27, K-33, K-48, BI-6 and methoxime) in comparison with pralidoxime: In vitro reactivation of red blood cell acetylcholinesterase inhibited by paraoxonJ. Appl. Toxicol.26(1)64-71(2006) 3.Lorke, D.E., Hasan, M.Y., Arafat, K., et al.In vitro oxime protection of human red blood cell acetylcholinesterase inhibited by diisopropyl-fluorophosphateJ. Appl. Toxicol.28(4)422-429(2008) 4.Costa, M.D., Freitas, M.L., Soares, F.A., et al.Potential of two new oximes in reactivate human acetylcholinesterase and butyrylcholinesterase inhibited by organophosphate compounds: An in vitro studyToxicol. In Vitro25(8)2120-2123(2011) 5.Karade, H.N., Raviraju, G., Acharya, B.N., et al.Synthesis and in vitro reactivation study of isonicotinamide derivatives of 2-(hydroxyimino)-N-(pyridin-3-yl)acetamide as reactivators of Sarin and VX inhibited human acetylcholinesterase (hAChE)Bioorg. Med. Chem.24(18)4171-4176(2016)