Depression of drug metabolizing activity in the human liver by interferon-α

Summary The depressant effect of interferon- on drug metabolizing activity in the liver has been investigated in 12 patients with chronic active hepatitis B. 7-methoxy-coumarin (7-MC) O-demethylase and 7-ethoxycoumarin (7-EC) O-deethylase, in specimens obtained by liver biopsy, were measured before and after interferon treatment. 7-MC and 7-EC O-dealkylase activity were significantly reduced after interferon treatment, from 13.4 to 9.24 nmol·g^–1 liver·min^–1, and from 3.22 to 2.16 nmol·g^–1 liver·min^–1, respectively. The magnitude of the fall varied widely between individual patients. The study provides the first direct evidence that interferon- can impair the activity of drug metabolizing enzymes in the human liver.     

Pharmacogenetic testing for drug metabolizing enzymes: is it happening in practice?

It is widely claimed that pharmacogenetics may form the basis of 'personalized medicine'. We sought to determine the current utilization of pharmacogenetic testing for drug metabolizing enzymes (DMEs). The hypothesis was that these tests were rarely performed clinically. Questionnaires were sent to 629 individuals representing laboratories, hospitals and universities throughout Australia and New Zealand. The questionnaires asked which facilities performed pharmacogenetic tests for selected DMEs, and details about the tests, if performed. The overall response rate was 81.1% (510/629); three respondents declined to participate. Clinical genotyping and phenotyping tests for DMEs could be performed by 10 (2.0% of 507) and 18 (3.6%) facilities, respectively. The most frequently performed genetic tests were for thiopurine methyltransferase (approximately 400 times in 2003) and pseudocholinesterase (approximately 250 times). The frequency of phenotyping exceeded genotyping by five- and eight-fold, respectively. One centre performed CYP2D6 phenotyping frequently (approximately 4200 times in 2003) for perhexiline. Genotyping and phenotyping tests for other cytochrome P450 enzymes, N-acetyltransferase-2 and dihydropyrimidine dehydrogenase were effectively never undertaken for clinical purposes. Pharmacogenetic tests for DMEs are currently performed rarely in clinical practice, despite repeated claims that they may benefit patient care. The only tests performed with any regularity in Australasia are for thiopurine methyltransferase and pseudocholinesterase, and CYP2D6 phenotyping in one centre for patients on perhexiline. The low clinical utilization reflects a poor evidence base, unestablished clinical relevance and, in the few cases with the strongest rationale, a slow translation to the clinical setting.     

Does rapid dose titration affect the hepatic safety profile of Bosentan?

RATIONALE: Bosentan, a dual endothelin receptor antagonist, has proven efficacy in pulmonary hypertension. Due to an association with hepatic dysfunction, it is typically initiated at a sub-therapeutic dose for 4 weeks before titration to a therapeutic dose. At our institution some patients have undergone rapid titration, to potentially benefit from therapy earlier. This study assesses the impact of this practice on hepatic safety. METHOD: All patients initiated on bosentan therapy before April 2005 were included. Rapidly titrated patients achieved a therapeutic dose by 3 days, whereas standard titration patients were titrated at 4 weeks. All patients were monitored with monthly liver function tests. RESULTS: 149 patients commenced bosentan, of which 55 were rapidly titrated. At baseline, the two groups were similar in age, BMI, diagnosis, 6-min walking distance, alanine aminotransferase (ALT), cardiac index and pulmonary artery pressures. The rapid group had elevated right atrial pressures (9.7 mm Hg versus 7.4 mm Hg, p = 0.016) and worse WHO functional class (p = 0.008) and included less females (31% versus 69%, p = 0.024). The incidence of hepatic dysfunction in all patients was 12.8% at 12 months. There was no statistical difference in incidence between the rapid and standard groups (4% versus 11% at 3 months, p = 0.211 and 6% versus 15% at 12 months, p = 0.219). Of all patients on bosentan, hepatic dysfunction was most significantly associated with a higher baseline ALT (p = 0.021), female sex (p = 0.003) and underlying connective tissue disease (p = 0.025). Subgroup analysis suggested these factors were not confounders when comparing rapid and standard titration. CONCLUSIONS: Rapid and standard titration of bosentan resulted in similar hepatic safety profiles. Baseline ALT, female sex and the presence of connective tissue disease increased the risk of hepatic dysfunction independent of the titration method used.     

Nuclear receptors: the controlling force in drug metabolism of the liver?

The body is in a constant battle to achieve homeostasis; indeed, the robustness with which it can respond to moves away from homeostasis is a vital part in the survival of the organism as a whole. There thus exists a need for a network of sensors that are able to capture, interpret, and respond to alterations in chemical levels that move the body away from homeostasis and this applies to both endogenous and exogenous chemicals. With respect to external chemicals (xenobiotics), this xenosensing is often carried out through specific interactions with cellular receptors. The phenomenon of ‘xenosensing’ has attracted much interest of late, whereby xenobiotics interact with receptors resulting in the activation of a battery of genes mediating oxidative drug metabolism, conjugation, and transport, thereby enhancing the elimination of the xenobiotic by the organism. However, this beneficial response is counterbalanced by the increasingly recognized role of nuclear receptors in mediating drug–drug interactions via enzyme induction or the production of toxicity through interaction with endogenous pathways. This review will focus on the role of nuclear receptors in mediating these effects, and how such knowledge will contribute to a mechanism-based risk assessment for xenobiotics.     

Does furan affect the thymus in growing male rats?

Furan has been identified in foods such as heat-treated foods, including coffee, canned meat, hazelnuts, and infant foods and formulas. Children may be exposed to furan via either consumption of these foods or their derivatives. We evaluated the effects of furan on the thymus of weaning male rats in the present study. Five separate groups containing male rats were used: control, oil control, and three furan-treated groups. Furan was given orally to rats in the treatment groups at doses of 2, 4, and 8 mg/kg/day for 90 days. At the end of the experiment, thymus of the rats were examined morphologically, histopathologically, and immunohistochemically. We observed that absolute and relative weights of thymus were decreased significantly in rats treated with 4- and 8-mg/kg/day doses of furan. In histopathological examination, enlargement of interstitial connective tissue between the thymic lobules, lymphocyte depletion, and hemorrhage were observed. We detected an increase in apoptotic cell counts in thymus of the treatment groups. In addition, we found significant differences in the distribution of fibronectin and transforming growth factor-beta in the thymus of the treatment groups. In conclusion, we suggest that furan has affected the thymus in growing male rats.     

Non-alcoholic fatty liver disease (NAFLD) – pathogenesis,classification, and effect on drug metabolizing enzymes and transporters

Non-alcoholic fatty liver disease (NAFLD) is a spectrum of liver disorders. It is defined by the presence of steatosis in more than 5% of hepatocytes with little or no alcohol consumption. Insulin resistance, the metabolic syndrome or type 2 diabetes and genetic variants of PNPLA3 or TM6SF2 seem to play a role in the pathogenesis of NAFLD. The pathological progression of NAFLD follows tentatively a “three-hit” process namely steatosis, lipotoxicity and inflammation. The presence of steatosis, oxidative stress and inflammatory mediators like TNF-α and IL-6 has been implicated in the alterations of nuclear factors such as CAR, PXR, PPAR-α in NAFLD. These factors may result in altered expression and activity of drug metabolizing enzymes (DMEs) or transporters.

Existing evidence suggests that the effect of NAFLD on CYP3A4, CYP2E1 and MRP3 is more consistent across rodent and human studies. CYP3A4 activity is down-regulated in NASH whereas the activity of CYP2E1 and the efflux transporter MRP3 is up-regulated. However, it is not clear how the majority of CYPs, UGTs, SULTs and transporters are influenced by NAFLD either in vivo or in vitro. The alterations associated with NAFLD could be a potential source of drug variability in patients and could have serious implications for the safety and efficacy of xenobiotics. In this review, we summarize the effects of NAFLD on the regulation, expression and activity of major DMEs and transporters. We also discuss the potential mechanisms underlying these alterations.     

Albumin–drug conjugates in the treatment of hepatic disorders

Introduction: This review deals with the use of serum albumin (SA) as a carrier for the selective delivery of drugs to liver cells.

Areas covered: The synthesis and properties of the SA conjugates prepared to enhance the performance of the drugs used in the treatment of viral hepatitis, hepatocellular carcinoma (HCC), liver micrometastases and hepatic fibrosis are reported.

Expert opinion: Studies in humans and laboratory animals demonstrated the capacity of SA conjugates to accomplish a liver targeting of the drugs, but at the same time underscored their limits and drawbacks, which can explain why to date these complexes did not reach a practical application. The major drawback is the need of administration by intravenous route, which prevents long-term daily treatments as required by some liver pathologies, such as chronic virus hepatitis and fibrosis. At present, only a conjugate carrying doxorubicin and addressed to the treatment of HCC showed in laboratory animals a solid potentiality to improve the value of the coupled drug. In the future, conjugation to SA could remain a successful strategy to permit the administration of drugs with rapid resolutive effects inside liver cells without causing severe extrahepatic adverse reactions.     

Does the preferred orientation of crystallites in tablets affect the intrinsic dissolution?

The aim of this study was to examine the effect of preferred orientation of crystallites, i.e. texture, on the intrinsic dissolution rate of some active pharmaceutical ingredients. Although it has often been speculated that the intrinsic dissolution of pharmaceutical tablets is affected by texture, no experimental evidence of this effect has been reported. The texture of acetylsalicylic acid, tolbutamide, carbamazepine and entacapone tablets was measured using three different methods both before and after the dissolution measurements. To clarify the effect of texture, texturizing and less-texturizing batches of each material were used. The texturizing batches had big needle or plate-like particles and the less-texturizing batches were prepared by grinding the texturizing powders. The USP rotation disc method was used to measure the intrinsic dissolution rate of the samples. The results indicated that the acetylsalicylic acid, tolbutamide and entacapone tablets texturized strongly in compression and the grinding of the texturizing powders decreased the degree of texture. Also the carbamazepine tablets were slightly texturized. All of the texture measurement methods used were found to give acceptable and consistent results and therefore a special texture goniometer is not required to perform these measurements. The intrinsic dissolution rate of all the tablets compacted from the ground powder was slightly higher than the intrinsic dissolution rate of the more texturized samples. However, these differences were not significant on a large scale. After the dissolution tests the degree of texture of the samples was decreased. The intrinsic dissolution rates of the samples were presumably affected by several different parameters such as texture, solubility, pH, surface energetics and crystal strains. Although only small differences were found between the intrinsic dissolution rates of texturized and less texturized samples the effect of texture on the dissolution behavior of the pharmaceuticals should be considered when performing accurate intrinsic dissolution studies.     

Pharmacokinetics and pharmacodynamics of 3,3′-diindolylmethane (DIM) in regulating gene expression of phase II drug metabolizing enzymes

3,3′-Diindolylmethane (DIM) has been investigated as a potential anti-cancer chemopreventive agent in many preclinical and clinical studies. In this study, we sought to characterize the pharmacokinetics of DIM and to build a pharmacokinetic (PK) and pharmacodynamic (PD) model of the DIM-induced gene expression of phase II drug metabolizing enzymes (DME), which potentially links DIM’s molecular effects to its in vivo chemopreventive efficacy. DIM (10 mg/kg) was administered intravenously (i.v.) to male Sprague–Dawley rats and blood samples were collected at selected time points for 48 h. The plasma concentration of DIM was determined using a validated HPLC method. The mRNA expression of NQO1, GSTP1 and UGT1A1 in blood lymphocytes was measured using quantitative PCR. An indirect response model was employed to relate the concentration of DIM to the expression of the genes NQO1, GSTP1 and UGT1A1, which were chosen as PD markers for DIM. After i.v. administration, the plasma concentration of DIM declined quickly, and the expression of target genes increased significantly, peaking at 1–2 h and then returning to basal levels after 24 h. The parameters in the PK–PD model were estimated. The PK–PD model aptly described the time delay and magnitude of gene expression induced by DIM. Our results indicate that DIM is effective at inducing various phase II DME, which are capable of detoxify carcinogens. This PK–PD modeling approach provides a framework for evaluating the acute effects of DIM or other similar drugs in clinical trials.     

Does the relative silicone content of different syringes affect the stability of foam in sclerotherapy?

BACKGROUND: Sclerotherapy has become the gold standard in the treatment of varicose veins. Foam sclerosing solution with sodium tetradecyl sulfate (STS) is one of the most popular agents used. This study examined the possibility that relative silicone content of different syringes may affect the overall foam stability. MATERIALS AND METHODS: A double-syringe system (DSS) technique to make sclerosing foam (STS 0.5% and air) was applied. Four different brands of syringes were tested. The time required for half of the original volume of sclerosing solution to settle was recorded. RESULTS: The time for the sclerosing solution to settle to half of its initial volume varied with each brand of syringes. CONCLUSION: The type of syringe used in the DSS technique to produce foam for sclerotherapy is a determinant of foam stability. Whether this will affect the result of sclerotherapy requires further investigation.     

Does the exposure to smoking cues in movies affect adolescents' immediate smoking behavior?

Introduction

Various studies have demonstrated that environmental smoking cues elicit smoking-related responses in smokers. However, cue reactivity studies among adolescent smokers are scarce. Therefore, the aim of this study was to examine the effect of smoking portrayal in movies on immediate smoking behavior in adolescent smokers.

Method

A total of 65 adolescent daily smokers (between the ages of 16 and 18 years) were exposed to a one-hour movie clip, with or without smoking characters, and were allowed to smoke while watching the movie.

Results

The exposure to smoking cues in movies had no effect on immediate smoking behavior. This association was not affected by several smoking- and movie-related variables.

Conclusions

No influence of smoking cues in movies on immediate smoking behavior in adolescent daily smokers was found. More experimental research on the effects of environmental cues on adolescent smokers in different stages of addiction is needed.     

Does arsenic exposure increase the risk for liver cancer?

Arsenic has been well documented as the major risk factor for development of blackfoot disease (BFD), a unique peripheral vascular disease that was once endemic to the southwestern coast of Taiwan, where residents imbibed artesian well water containing high concentrations of arsenic for more than 50yr. Long-term arsenic exposure has also been reported to be associated with increased incidence of liver cancer in a dose-responsive manner. A tap-water supply system was implemented in the early 1960s in the BFD endemic areas. Artesian well water was no longer used for drinking and cooking after the mid-1970s. The objective of this study was to examine whether liver cancer mortality rates were altered after the consumption of high-arsenic artesian well water ceased and, if so, when the reduction occurred. Standardized mortality ratios (SMRs) for liver cancer were calculated for the BFD endemic area for the years 1971-2000. Cumulative-sum techniques were used to detect the occurrence of changes in the SMRs. The study results show that mortality from liver cancer in females declined starting 9yr after the cessation of consumption of high-arsenic artesian well water. However, data show fluctuations in male liver cancer mortality rates. Based on the reversibility criterion, the association between arsenic exposure and liver cancer mortality is likely to be causal for females but not in males.     

Unbound liver concentration is the true inhibitor concentration that determines cytochrome P450-mediated drug–drug interactions in rat liver

1.?In order to identify the best inhibitor concentration for the accurate prediction of magnitude of a hepatic cytochrome P450 (CYP)-mediated drug–drug interaction (DDI), the DDI between nifedipine, the CYP substrate probe, and fluconazole, ketoconazole, or ritonavir, the CYP inhibitors, in in situ rat liver perfusion system and rats were investigated.

2.?In in situ system, the intrinsic clearance (CLint) of nifedipine was decreased after co-infusion of the CYP inhibitors. The decrease in in situ CLint of nifedipine was most comparable to that in in vitro CLint in rat liver microsomes calculated by using the unbound liver concentrations of inhibitors ([I]liver,u). The ratios of unbound liver concentration to unbound hepatic vein concentration (Kp,uu) of ketoconazole and ritonavir were 4.0–8.0 and 18.4–21.1, suggesting a concentrative uptake of them into liver.

3.?In rats, the DDI effects of orally administered nifedipine with constant infusion of the inhibitors were investigated. The most accurate prediction of magnitude of DDI was achieved when [I]liver,u was applied as the inhibitor concentration.

4.?These results indicated that [I]liver,u is the most reliable inhibitor concentration for CYP-mediated DDI and it is necessary to consider the concentrative uptake of inhibitors into liver for the quantitative prediction of DDI.     

Does collagenase affect the electrophysiological parameters of nerve trunk?

Collegenase is widely used in the process of teasing a nerve in order to perform single fiber action potential (SFAP) recordings. In this study, the effects of collagenase on nerve conduction parameters were investigated. To accomplish this, normal compound action potentials (nCAPs) were recorded from isolated frog sciatic nerve at various distances using the suction technique. Then, the same nerve was treated with collagenased Ringer's solution (3.5 mg/ml, Sigma Type XI) for 90 minutes and action potentials (cCAPs) were recorded again. Numerical analysis of these records was performed and the results were compared. Using the nCAP and cCAP recordings, the conduction velocity distributions (CVD) of the individual nerve trunks were determined by a method that we have previously described. Statistical results indicated significant differences (p < 0.05) between the nCAP and cCAP CVD data. From these findings it is concluded that, when used for teasing the nerve fibers, collagenase may affect the nerve trunk conduction parameters. Specifically, a significant amount of decrease has been observed in conduction velocities of myelinated fibers having diameters smaller than 8 microns.