Some observations on the oxidation phenotype status of Nigerian patients presenting with cancer

Applications of Biochemical Epidemiology in the Study of Human Carcinogenesis

The measurement of biochemical parameters in epidemiologic studies can contribute to a better understanding of mechanisms of chemical carcinogenesis. Through identification and quantitation of chemicals in tissues or body fluids or through markers of « effective dose » such as DNA adducts, mechanisms of cancer etiology and pathogenesis can be elucidated. Different approaches and the associated methodologic problems are discussed along with examples. As a comprehensive case study, the relationship between aromatic amine exposure and bladder cancer is considered in light of different biochemical aspects which could be the target of epidemiologic studies.

The role of cytochrome P450 enzymes in endogenous signalling pathways and environmental carcinogenesis

Some cytochrome P450 (CYP) heme-thiolate enzymes participate in the detoxication and, paradoxically, the formation of reactive intermediates of thousands of chemicals that can damage DNA, as well as lipids and proteins. CYP expression can also affect the production of molecules derived from arachidonic acid, and alters various downstream signal-transduction pathways. Such changes can be precursors to malignancy. Recent studies in mice have changed our perceptions about the function of CYP1 enzymes. We suggest a two-tiered system to predict an overall inter-individual risk of tumorigenesis based on DNA variants in certain 'early defence' CYP genes, combined with polymorphisms in various downstream target genes.

Urinary 6 beta-hydroxycortisol excretion in Hong Kong Chinese patients with hepatocellular carcinoma and other chronic liver diseases

BACKGROUND

The biotransformation of xenobiotics into toxic metabolites by cytochrome P-450 has been implicated in carcinogenesis. This study investigated CYP3A4 activity, which metabolically activates procarcinogens such as aflatoxin B1, by measuring the urinary 6 beta-hydroxycortisol (6 beta OHF) to free cortisol (F) ratio in patients with hepatocellular carcinoma (HCC) and other chronic liver diseases.

METHODS

One hundred forty-three controls and 150 patients with different liver diseases, including chronic liver disease (due to alcoholism and/or chronic hepatitis B virus infection), cirrhosis (any cause), and resectable and nonresectable HCC, were recruited. Twenty-four hour urine samples were collected for measurement of 6 beta OHF and free cortisol by an enzyme-linked immunosorbent assay (ELISA) and a radioimmunoassay, respectively.

RESULTS

Patients with nonresectable HCC showed a significant increase in 6 beta OHF excretion as well as their 6 beta OHF/F ratio (P < 0.05) when compared with the controls and other liver disease groups including patients with resectable HCC. The nonresectable HCC group showed a bimodal distribution in the 6 beta OHF/F ratio. Using a ratio of 9 or more in all HCC patients, the sensitivity and specificity of using the 6 beta OHF/F ratio to predict nonresectability of HCC was 48.8% and 92.6%, respectively.

CONCLUSIONS

Our results show an increase in mean CYP3A4 enzyme activity, reflected as an increase in the 6 beta OHF/F ratio, in Hong Kong Chinese with nonresectable HCC compared with those with resectable HCC and other liver diseases. Although the role of increased CYP3A4 activity in the aetiology of HCC is not known, our specificity and sensitivity estimates suggest that a high 6 beta OHF/F ratio indicates probable inoperability. However, a normal level is a poor predictor of resectability.

Expression of xenobiotic-metabolizing enzymes by primary and secondary hepatic tumors in man

PURPOSE

To determine the immunohistochemical expression of xenobiotic-metabolising enzymes (XME) in normal livers, primary hepatocellular carcinomas (hepatomas) and secondary hepatic tumors from colonic primary tumors.

METHODS AND MATERIALS

The expression of XME in primary (n = 16) and secondary (n = 21) hepatic tumors and patients with no malignancies (n = 20) were investigated using polyclonal antibodies raised against the following rat enzymes CYP1A1, CYP2B1, CYP2C6, CYP3A1, CYP4A1, cytochrome P-450 reductase, epoxide hydrolase and testosterone UDP-glucuronyl transferase. The rat cytochrome P-450 antibodies recognize various human isoenzymes within the same gene family. Immunohistochemistry was undertaken using the immunoperoxidase and alkaline phosphatase anti-alkaline phosphatase techniques.

RESULTS

There was a reduction in the overall expression of all XME by tumor tissue compared to adjacent nonneoplastic liver cells (p = 0.008), more in livers with secondary tumors (p < 0.0001) and reduced expression of XME by hepatomas and secondary liver tumors compared to livers with no malignancy. A tendency for higher expression of all XME by nonneoplastic liver cells from patients with hepatomas relative to nonmalignant livers was observed, with significantly higher expression of CYP3A4/5 and testosterone UDP-GT enzymes (odds ratio 3.12; CI 1.59-6.10).

CONCLUSION

The expression of XME by tumor tissue is reduced in primary and secondary hepatic malignancies. The expression of XME by nonneoplastic liver cells is higher in patients with hepatomas than patients with no hepatic malignancies. These alterations in XME activities may have important therapeutic implications in the response and toxicity to systemic anti-cancer therapy, due to altered pharmacokinetics. In addition, differential expression of these enzymes by normal and malignant cells may be important for the rational design of selective anti-tumor drugs.

Large-bowel mucosal biotransformation activity in persons at high risk for colorectal cancer. A preliminary report

The transformation of xenobiotics and endogenous compounds to active carcinogens and their subsequent deactivation as an aid to eradication may be important in the etiology of some gastrointestinal cancers. In mammals the gastrointestinal tract has been shown to be an important site of inducible enzyme systems active in mucosal biotransformation, but few data are available in man. The mucosal activity of CYPIA1 (formerly aryl hydrocarbon hydroxylase), a potential carcinogen-activating enzyme, and catechol-O-methyl transferase, a potential carcinogen-inactivating enzyme were determined in colonic tissue obtained by biopsy. There were no significant differences in activity rates in normal mucosa between colorectal cancer and healthy persons, but significant differences are seen in patients with a history of neoplasia with no evidence of recurrence. The levels of activity of these carcinogen-inductive and -protective enzymes may be prognostic markers, in that the balance or imbalance could play a role in the recurrence of neoplasia. This will require confirmation and prospective studies.

Genetically Determined Polymorphisms in Drug Metabolism

Many factors can influence the metabolism and disposition of drugs. Genetically determined differences in an individual's capacity to metabolize drugs are known causes of interindividual and interethnic variabilities in drug disposition and response. In general, a poor metabolizer for a specific metabolic pathway would likely develop adverse effects, and an extensive metabolizer for the same metabolic pathway might have less than optimal response. Although there are different types of polymorphism in drug metabolism, polymorphisms in debrisoquine-type oxidation, S-mephenytoin oxidation, and N-acetylation have been the most extensively studied. This article will present the basic concepts of pharmacogenetics, review the major types of metabolic polymorphisms, outline ways to determine phenotyping and genotyping differences in metabolizing enzyme activities, and discuss how these differences relate to drug metabolism, response, and toxicity. When evaluating drug response and adverse reactions in individual patients, an awareness of genetic differences in metabolic capacities would help contribute to optimization in drug therapy.

Idiosyncratic reactions to antidepressants: a review of the possible mechanisms and predisposing factors

Antidepressants, a widely used group of drugs, are associated with a range of idiosyncratic reactions affecting in particular the liver, skin and both the hematological and central nervous systems. These reactions seem to be mediated by chemically reactive metabolites formed by the cytochrome P450 enzyme system, the toxicity occurring either directly or indirectly via an immune mechanism. Individual susceptibility is determined by factors, both genetic and environmental, which result in inadequate detoxication of the chemically reactive metabolite. Prevention of such reactions will depend on either the development of new compounds which are not converted to toxic metabolites or by prediction of individual susceptibility prior to drug administration.

Polymorphisms in oxidative drug metabolism: relationship to food preference

To determine whether a correlation exists between polymorphisms of oxidative drug metabolism and dietary preference, 29 poor metabolizers of dextromethorphan, 18 poor metabolizers of mephenytoin and 134 extensive metabolizers of both drugs were screened for their preferences for various food items. Poor metabolizers of dextromethorphan showed a diminished stated preference for cauliflower and coconut, and poor metabolizers of mephenytoin showed a diminished stated preference for spinach and cabbage.

Metabolism of paracetamol and phenacetin in relation to debrisoquine oxidation phenotype

The metabolism of paracetamol and phenacetin has been studied in subjects previously phenotyped as either extensive or poor metabolisers of debrisoquine (EM and PM, respectively), in order to examine the relationship between phenacetin and paracetamol activation and debrisoquine oxidation status. In separate experiments, paracetamol and phenacetin were administered orally to groups of 5 EM and 5 PM subjects, and the excretion of metabolites measured for 24 h. There were no differences between EM and PM subjects in the excretion of metabolites. After phenacetin, 0.82 of the dose was recovered in urine, mostly as paracetamol glucuronide (51%) and sulphate (30%), with smaller amounts of free paracetamol (4%) and the mercapturate (5%) and cysteine conjugates (5%), 2-hydroxyphenetidine (5%) and N-hydroxyphenacetin (0.5%). Following paracetamol, 0.87 of the dose was recovered, with similar proportions of paracetamol-derived metabolites. It is concluded that the debrisoquine oxidation phenotype is unrelated to either the metabolic activation of phenacetin and paracetamol, or to their overall metabolic clearance.

Oxidative polymorphism of debrisoquine is not related to human colo-rectal cancer

The oxidative polymorphism of debrisoquine (DBQ) has been determined in 89 patients with colo-rectal cancer and in 556 normal control subjects. Four patients and 34 controls, with a metabolic ratio greater than 12.6, were classified as poor metabolisers of DBQ (n.s.). No difference was found in the distribution of the frequencies of the MR of DBQ between patients and controls. It is concluded that polymorphic oxidation of DBQ is not related to the risk of developing colo-rectal cancer in human beings.

Role of genetics and drug metabolism in human cancer risk

The research field concerning responses to drugs having a hereditary basis is called 'pharmacogenetics'. At least 5 dozen pharmacogenetic polymorphisms have been described in clinical medicine; many are responsible for marked differences in genetic predisposition toward toxicity or cancer. Three are detailed here: the acetylation, the debrisoquine, and the AH locus polymorphism. All 3 are very common among the United States' population: 1 in 2 is a 'slow acetylator', 1 in 12 is a 'poor metabolizer' for more than 2 dozen commonly prescribed drugs in the debrisoquine panel, and the CYP1A1 and CYP1A2 (cytochromes P(1)450 and P(3)450) genes are highly inducible by cigarette smoke in 1 of 10 patients. Differences in xenobiotic metabolism between individuals in the same family can be greater than 200-fold, suggesting that occupationally hazardous chemicals, as well as prescribed drugs having a narrow therapeutic window, might cause strikingly dissimilar effects between patients of differing genotypes. Our ultimate goal is 'preventive toxicology', i.e. the development of simple, inexpensive, unequivocal and sensitive assays to predict individual risk of toxicity or cancer. These tests could help the individual in choosing a safer life style or place of work and might aid the physician in deciding which drug to prescribe.

Future research directions in cancer ecogenetics

There are many productive directions for future research in cancer ecogenetics. Genetic variation in susceptibility to chemicals and other carcinogenic agents has been neglected in most epidemiologic and rodent investigations of cancer etiology. Genetic variation is important to characterization of risks for population subgroups. Genetic investigations also may enhance inquiries into the underlying mechanisms of carcinogenesis and of cancer prevention. Polymorphisms of cytochrome P450 mono-oxygenases, epoxide hydrolase, glutathione-S-transferases, and N-acetyltransferase offer important windows on biotransformation of pro-carcinogens. Assays in peripheral blood cells need to be related closely to variation in activity in target organs. Tumor suppressor genes, signal transduction pathways, and cell surface receptors are additional sites where genetic variation would be highly important to cancer risks.

Is environmental carcinogenesis modulated by host polymorphism?

It is now clear that tobacco smoking, alcohol consumption, dietary factors and occupation can all interact with genetic host factors to place one individual at a greater or lesser risk of a particular cancer than another. Phenotypes which confer significantly elevated risks arise from the human CYP1A1. CYP2D6, GST1 and NAT (N-acetyltransferase) genes. The last is the only one remaining to be cloned. It is envisaged that several of these genes may interact in a given circumstance cooperatively to increase susceptibility. For example CYP1A1, CYP2D6 and GST1 genotypes may have additive or multiplicative risks of bronchogenic carcinoma in cigarette smokers. CYP2D6 and NAT genotypes may interact in bladder cancer. The advent of molecular genetics brings us closer to the day when, for example, factory workers in potentially hazardous environments might be screened using PCR methodology on skin scrapings or buccal swabs for their innate susceptibility to combined workplace and lifestyle cancer risks.

Cytochrome P-450 isozyme pattern is related to individual susceptibility to diethylnitrosamine-induced liver cancer in rats

Differences in susceptibility to chemical carcinogenesis between rodent strains and species have been linked to variations in genetically-determined mixed function oxidase activities. In order to verify whether such variations also determine the susceptibility of individual animals of the same strain to a chemical carcinogen, outbred male Wistar rats were administered diethylnitrosamine (DEN) (1, 2, or 3 mg/kg) five times a week for 20 weeks. The relationship was examined between the outcome (i.e., presence or absence of liver tumors, and latency period) and the hepatic activities of mixed function oxidases and conjugating enzymes, as well as of O6-methylguanine-DNA-methyltransferase, measured before the carcinogen treatment. In addition, the metabolic profiles of two model drugs, antipyrine and disopyramide, in the urine were analyzed and correlated with the carcinogen susceptibility. The length of the latency period of hepatocellular tumors in individual rats was negatively related to the activities of hepatic dimethylnitrosamine N-demethylase, aryl hydrocarbon hydroxylase and epoxide hydrolase and positively related to the amount of microsomal protein. Consistent relationships between the other 10 measured parameters and the susceptibility to DEN-induced carcinogenesis were not detected. Long-term treatment with DEN slightly decreased the proportion of metabolism of antipyrine into norantipyrine, and increased the share of 4-hydroxyantipyrine; a decrease in the metabolism of disopyramide to N-deisopropyldisopyramide was also detected. It is concluded that the pattern of cytochrome P-450 isoenzymes is related to differences in individual susceptibility to nitrosamine-induced carcinogenesis. The relationship was most marked at low dose levels, which are the levels at which nitrosamine exposures of humans are known to occur.

Metabolic phenotypes and colorectal neoplasia

It now appears likely that the development of colonic adenomas and carcinomas involves a series of steps in which environmental or endogenous carcinogens induce or promote neoplasia through the accumulation of multiple, specific genetic mutations. Genetic predisposition to this process may take the form of inherited defects in control of cellular proliferation as in familial polyposis coli, or genetically determined polymorphism which affects enzyme activities relevant to the production or detoxication of carcinogens. Genetic effects may also influence levels of hormones and/or their target cell receptors which regulate the metabolic and proliferative activity of colonocytes. This review highlights data suggesting a role for polymorphism associated with xenobiotic acetylation, hydroxylation, and conjugation with glutathione in the metabolism of potential carcinogens, as well as for dehydroepiandrosterone in the metabolic control of cell proliferation. The study of genetically determined polymorphism in colorectal cancer may provide new insights into the epidemiology of cancer and result in new methods for the detection of higher risk groups.

Polymorphic oxidation of debrisoquine in lung cancer patients

Oxidative polymorphism of debrisoquine (DBQ) was assessed in 84 patients (81 male) with histologically proven bronchogenic carcinoma and in 143 healthy male smokers. 80 (95%) patients and 133 (93%) controls, with a metabolic ratio (MR) below 12.6, were classified as extensive metabolisers of DBQ (no significant difference between patients and controls). Only 1 of the 73 patients with epidermoid or microcytic carcinomas was classified as a poor metaboliser (PM) (P = 0.031 compared with controls). 63 patients (75%) and 110 controls (77%) showed a very fast oxidative rate, with MR values under 1 (not significant). The EM phenotype of DBQ might be a secondary genetic risk factor for developing bronchogenic carcinoma in male smokers.

Polymorphic oxidation of debrisoquine in bladder cancer

The oxidative polymorphism of debrisoquine has been determined in 125 patients with bladder cancer and in 556 healthy control subjects; 96.6% of patients and 93.9% of controls with a metabolic ratio of debrisoquine less than 12.6 were classified as extensive metabolizers of debrisoquine (P = NS). The distribution of frequencies of metabolic ratio values tended to have lower values in the patients (P less than 0.05), reflecting a higher oxidative rate of debrisoquine in urothelioma patients that cannot be explained solely in terms of enzymatic induction by drugs, tobacco or alcohol. Patients with a high occupational risk for urothelioma had lower metabolic ratio values (P = 0.03). Our results suggest that oxidative polymorphism of debrisoquine might be related to the pathogenesis of bladder cancer.

Acetylator status of kwashiorkor children in Ibadan (south-west Nigeria)

Acetylator status was determined in 25 kwashiorkor children, aged between 8 months and 3 years and in 25 age-matched control group of healthy children after a single oral dose of sulphamethazine (40 mg/kg body weight) and by measuring the acetylated sulphamethazine in blood samples, collected 6 h after the administration of sulphamethazine. The percentage of slow acetylators among kwashiorkor children was 40% while among the control group of children it was 48%. The difference between the two groups was not significant. Therefore, it is probable that the slow acetylator status of the Nigerian African children may not be a contributing factor for the development of kwashiorkor, a syndrome of protein-energy malnutrition. Furthermore, the polymorphic activity of N-acetyl transferase enzyme may not be impaired in kwashiorkor.

Genetically determined N-acetylation and oxidation capacities in Japanese patients with non-occupational urinary bladder cancer

Genetically determined polymorphisms of N-acetylation and oxidative capacity have been studied using dapsone and metoprolol in 51 Japanese patients with spontaneous bladder cancer and 203 healthy control subjects. The results for N-acetylation pharmacogenetics were against the initial expectation that there would be a preponderance of slow acetylators in the cancer group, as 3 such patients (5.9%) were found as compared to 13 (6.4%) in the healthy group. There was no poor metabolizer (PM) of metoprolol in the cancer group, whereas in the healthy group one (0.5%) was a PM. There were no significant differences between the groups in the frequency of slow acetylator and poor oxidiser phenotypes, or in the frequency distribution profiles of acetylation (monoacetyldapsone/dapsone) and oxidative metabolic ratio (log metoprolol/alpha-hydroxymetoprolol). The results indicate that neither N-acetylation nor the debrisoquine/sparteine-type oxidative phenotype and/or capacity represent a genetic predisposition to spontaneous bladder carcinogenesis in Japanese patients. In the normal Japanese population there is a great predominance of rapid acetylators and extensive oxidisers.

Polymorphic ochratoxin A hydroxylation in rat strains phenotyped as poor and extensive metabolizers of debrisoquine

1. Dark agouti (DA) and Lewis rat strains, which show a genetic polymorphism for debrisoquine-4-hydroxylation, were treated either with a single dose of ochratoxin A (OA) or for 8 weeks with 5 doses per week. Levels of OA and its 4-hydroxy metabolite (4-hydroxy-OA) excreted in urine were determined. 2. At all doses, the metabolic ratio of OA:4-hydroxy-OA was two to five times greater in DA than in Lewis rats, as was the metabolic ratio of debrisoquine:4-hydroxy-debrisoquine. These results are consistent with our previous findings in vitro that hepatic and renal OA 4-hydroxylase activity is three to four times lower in DA than in Lewis rats. These data give further support to the possible co-segregation of genes regulating OA and debrisoquine 4-hydroxylation.

Tissue distribution of bufuralol hydroxylase activity in Sprague-Dawley rats

This study has characterised the distribution of bufuralol 1'-hydroxylase activity in various organs of male and female Sprague-Dawley rats. Microsomes were prepared from the liver, kidney, brain, kidney, spleen and adrenals of male and female rats. Measurement of 1'-hydroxybufuralol produced by the incubation of racemic, (+) and (-) bufuralol with the microsomes was by HPLC. The specific activity (nmol/min/mg protein) of bufuralol 1'-hydroxylase in various tissues were: liver (M 12.3; F 10.2), kidney (M 12.3; F 11.7), brain (M 8.9; F 9.0), adrenal (M 0.9; F 0.3), lung (M 4.6; F 3.6) and spleen (M 8.8; F 10.0). Stereoselective preference (+/-) of the isozyme for (+) bufuralol was: Liver (M 2.2; F 2.2), kidney (M 2.2; F 2.1), brain (M 1.0; F 0.9), lung (M 0.74; F 0.95) and spleen (M 1.0; F 1.32).

Evidence for cytochrome P-450NF, the nifedipine oxidase, being the principal enzyme involved in the bioactivation of aflatoxins in human liver

In vitro studies with human liver indicate that the major catalyst involved in the bioactivation of the hepato-carcinogen aflatoxin B1 (AFB1) to its genotoxic 2,3-epoxide derivative is cytochrome P-450NF (P-450NF), a previously characterized protein that also catalyzes the oxidation of nifedipine and other dihydropyridines, quinidine, macrolide antibiotics, various steroids, and other compounds. Evidence was obtained using activation of AFB1 as monitored by umuC gene expression response in Salmonella typhimurium TA1535/pSK1002 and enzyme reconstitution, immunochemical inhibition, correlation of response with levels of P-450NF and nifedipine oxidase activity in different liver samples, stimulation of activity by 7,8-benzoflavone, and inhibition of activity by troleandomycin. Similar results were obtained when levels of 2,3-dihydro-2-(N7-guanyl)-3-hydroxyaflatoxin B1 formed in DNA were measured. P-450NF or a closely related protein also appears to be the major catalyst involved in the activation of aflatoxin G1 and sterigmatocystin, the latter compound being more genotoxic than AFB1 in these systems. Several drugs and conditions are known to influence the levels and activity of P-450NF in human liver, and the activity of the enzyme can be estimated by noninvasive assays. These findings provide a test system for the hypothesis that a specific human disease state (liver cancer) is linked to the level of oxidative metabolism in populations in which aflatoxin ingestion is high.

Characterization of the common genetic defect in humans deficient in debrisoquine metabolism

In population studies of individuals given the antihypertensive drug debrisoquine, two distinct phenotypes have been described: extensive metabolizers excrete 10-200 times more of the urinary metabolite 4-hydroxydebrisoquine than poor metabolizers. In family studies the poor-metabolizer phenotype behaves as an autosomal recessive trait with an incidence between 5% and 10% in the white population of Europe and North America, and extends to the deficient metabolism of more than 20 commonly prescribed drugs. Clinical studies have shown that such individuals are at high risk for the development of adverse side effects from these and probably many other drugs. Here we show that poor metabolizers have negligible amounts of the cytochrome P450 enzyme P450db1. We have cloned the human P450db1 complementary DNA and expressed it in mammalian cell culture. Furthermore, by directly cloning and sequencing cDNAs from several poor-metabolizer livers, we have identified three variant messenger RNAs that are products of mutant genes producing incorrectly spliced db1 pre-mRNA, providing a molecular explanation for one of man's most commonly defective genes (frequency of mutant alleles 35-43%).

Determination of debrisoquine metabolic ratio from hourly urine collections in healthy volunteers

The possibility of simplifying the regimen for the collection of urine samples in the determination of the debrisoquine metabolic ratio (DMR) was explored in 15 normal subjects. In the extensive metaboliser subgroup (EM; n = 11), there was a close correlation between the DMR as determined by an 8 h urine collection and the debrisoquine/4-hydroxydebrisoquine ratio (D/4-OHD) in the hourly samples (excluding the first hour). In the poor metabolisers (PM; n = 4) the phenotype could be identified, but it was not possible to estimate the DMR reliably.

Passively inhaled tobacco smoke: a challenge to toxicology and preventive medicine

The difficulties in defining the exposure of a passive smoker might explain the controversial results regarding an association between passive smoking on one hand and lung cancer, tumors of all sites and ischemic heart diseases on the other. The plausibility of these epidemiological observations will be discussed in the light of analytical, toxicological, biochemical and oncological data. The minute amounts of nicotine and particulate matter, even the much higher concentrations of volatile substances, such as nitrosamines, NOx, acroleine and formaldehyde, present in diluted sidestream compared to mainstream smoke and breathed by involuntarily smoking people, cannot explain their relatively high cancer risk. It is plausible if one considers the high capacity of cigarette smoke to induce drug metabolizing enzymes. Diluted sidestream smoke, however, lacks compounds which induce several iso-enzymes of cyt. P-450 monooxygenase in the tissues. The best evidence is the up to 100-fold increase in placental enzymes if pregnant women smoke, whereas passively inhaled tobacco smoke is ineffective as inducer. The small amounts of paternal smoke inhaled by pregnant women, containing teratogenic and carcinogenic compounds, which are supposedly not detoxified in the placenta, seem to explain the higher risk for malformations of the fetus and the same or even increased risk for perinatal mortality, compared with the outcome of pregnancy if the mother smoked. The induction of placental enzymes very probably protects the fetus against the much higher amounts of toxic agents inhaled by the smoking mother. The increased activity of placental enzymes seems to be a model for the probably greater capacity of certain cyt. P-450 iso-enzymes in the lung and other tissues to convert carcinogens to inactive metabolites when the individual smokes actively. It is well known that concomitant administration of carcinogens with inducing agents inhibits tumor growth in animals because of a shift in the metabolism which favours the formation of ineffective substances. The negligible amounts of nicotine and CO in passively inhaled tobacco smoke cannot be responsible for the surprisingly high risk for ischemic heart diseases of passive smokers. A plausible explanation is offered by experiments with doves and chicken, which develop atherosclerotic lesions due to the action of carcinogens which are metabolized by certain inducible cyt. P-450 iso-enzymes in the aortic wall. Much circumstantial evidence will be presented, indicating that PAHs, contrary to the propagated opinion, play a minor role for the initiation of cancer in active smokers.(ABSTRACT TRUNCATED AT 400 WORDS)

Polymorphism of human cytochrome P-450

The cytochrome P-450 forms involved in debrisoquine 4-hydroxylation (P-450DB), phenacetin O-deethylation (P-450PA), S-mephenytoin 4-hydroxylation (P-450MP), and nifedipine 1,4-oxidation (P-450NF) have been purified to electrophoretic homogeneity from human liver microsomes. All of these reactions show in vivo polymorphism in humans. Evidence for the roles of the purified proteins in these processes comes from in vitro reconstitution and immunoinhibition studies. The rat orthologs of these enzymes are as follows--P-450DB: P-450UT-H; P-450PA: P-450ISF-G; P-450MP: P-450UT-I; P-450NF: P-450PCN-E. Only in the case of P-450UT-H is the primary rat ortholog the same cytochrome P-450 which catalyses the catalytic reaction under consideration. Reconstitution and immunochemical studies establish that the following reactions are catalysed by the individual P-450s--P-450DB: debrisoquine 4-hydroxylation, sparteine delta 5-oxidation, bufuralol 1'-hydroxylation, encainide O-demethylation, and propanolol 4-hydroxylation; P-450PA: phenacetin O-deethylation; P-450MP: S-mephenytoin 4-hydroxylation and tolbutamide methyl hydroxylation; P-450NF: oxidation of nifedipine and 16 other substituted dihydropyridines, estradiol 2- and 4-hydroxylation, aldrin epoxidation, benzphetamine N-demethylation and 6 beta-hydroxylation of testosterone, androstenedione and cortisol. A cDNA clone has been isolated that corresponds to rat P-450UT-H, as shown by a number of criteria. Studies with this probe establish that the sex and strain variation in debrisoquine 4-hydroxylase and related activities is related to differences in the levels of a 2.0 kb length mRNA present.(ABSTRACT TRUNCATED AT 250 WORDS)

Strain differences in the metabolic activation of aflatoxin B1 in the rat

It has been reported that female Fischer rats are much more susceptible to the hepatocarcinogenic effects of aflatoxin B1 than female DA rats. Female Fischer rats are approximately twice as active as female DA rats in producing adducts of aflatoxin B1 with DNA in vivo, in freshly isolated hepatocytes and with hepatic microsomal fractions. There was no difference between the hepatic microsomal fractions from Fischer and DA rats in the production of adducts between aflatoxin B1 and microsomal protein. The difference between the strains in the formation of adducts with DNA was not due to either the activity of glutathione S-transferases or to the selective destruction of cytochrome P-450 in the DA strain. None of the differences reported here was of sufficient magnitude to explain the difference in susceptibility of the rat strains to the hepatocarcinogenic effects of aflatoxin B1.

Acetylation and oxidation phenotypes in malignant lymphoma

101 white British adults with Hodgkin's disease or non-Hodgkin's lymphoma were phenotyped for acetylation status using dapsone and for oxidation status with debrisoquine prior to treatment. The frequencies of acetylation and oxidation phenotypes in these patients were compared with reference populations of normal subjects. No significant difference in phenotype frequency was found in the lymphoma patients. This suggests that neither of these metabolic polymorphisms for exogenous compounds is strongly associated with these malignancies. Owing to the small size of the study, however, an effect of these phenotypes could not be excluded.

Altered distribution of debrisoquine oxidation phenotypes in patients with systemic lupus erythematosus

Oxidative metabolism in patients with systemic lupus erythematosus (SLE) was studied using the antihypertensive drug, debrisoquine. The metabolism of this drug to its principal metabolite, 4-hydroxydebrisoquine, is catalyzed by a discrete isozyme of cytochrome P-450. The extent of this reaction exhibits genetic polymorphism, with 2 phenotypes, "poor metabolizers" and "extensive metabolizers," discernible in the normal population. We observed the poor metabolizer debrisoquine phenotype in 9 of 42 patients with idiopathic SLE (21%), in contrast with 12 of 147 healthy volunteers (8%), which is a significant difference in frequency (P less than 0.04). These data provide further evidence for altered oxidative metabolism in SLE and support the concept that genetic differences in oxidative metabolism of endogenous compounds, such as sex steroid hormones, or of xenobiotics might influence susceptibility to SLE.

Is the activation of aflatoxin B1 catalysed by the same form of cytochrome P-450 as that 4-hydroxylating debrisoquine in rat and/or man?

A possible association between the metabolic activation of aflatoxin B1 (AFB1) to a mutagen and the 4-hydroxylation of debrisoquine, which shows genetic variation both in man and in the rat, was investigated. Hepatic microsomal fractions from female DA and Fischer rats catalyse, at the same rate, the conversion of AFB1 to a mutagenic and arylating metabolite, that bound covalently to microsomal proteins. Debrisoquine was without effect on either of these reactions. In contrast, metyrapone did inhibit the mutagenic activation of AFB1. Microsomal fraction from human liver was also capable of activating AFB1 to a mutagenic and arylating metabolite. Again, debrisoquine was without appreciable effect on these reactions. In contrast, cimetidine caused profound inhibition of the mutagenic activation of AFB1. It is concluded that the activation of AFB1 to a mutagenic, and presumably carcinogenic, metabolite is catalysed by a different form of cytochrome P-450 from that catalysing the 4-hydroxylation of debrisoquine, both in rat and in man.

Genetic regulation of the cytochrome P-450 system in Drosophila melanogaster. I. Chromosomal determination of some cytochrome P-450-dependent reactions

The genetic regulation of some cytochrome P-450-dependent enzyme activities has been studied in adult Drosophila. Strains having genetically determined high or low enzyme activities were crossed with a marker strain and the metabolism was analyzed in microsomes from hybrids carrying different combinations of chromosomes from the strain under test. High p-nitroanisole (PNA) N-demethylation, biphenyl 3-hydroxylation and an increased amount of a protein with an apparent mol. wt. of 54 000, after SDS-gel electrophoresis of the microsomes in insecticide-resistant Drosophila strains, are inherited as dominant second chromosome traits. A low capacity for benzo[a]pyrene (BP) hydroxylation and 7-ethoxycoumarin O-deethylation in the Hikone R strain is semidominantly inherited in both cases and determined by gene(s) on the third chromosome. A semidominantly inherited high 4-hydroxylation of biphenyl and a high amount of a protein with an apparent mol. wt. of 56 000 in the Oregon R strain are also localized to the second chromosome. The results indicate that several other cytochrome P-450-dependent activities are not regulated by the genes mentioned above. In conclusion, at least three genes regulating the cytochrome P-450 system in Drosophila have been identified.

Implications for risk assessment of host factors causing large pharmacokinetic variations

Normal human subjects vary widely in their capacity to eliminate many drugs and environmental chemicals. These variations range in magnitude from fourfold to fortyfold depending on the drug and the population studied. Pharmacogenetics deals with only one of many host factors responsible for these large pharmacokinetic differences. Age, sex, diet and exposure to other drugs and chemicals, including oral contraceptives, ethanol and cigarette smoking, can alter the genetically determined rate at which a particular subject eliminates drugs and environmental chemicals. These elimination rates, therefore, are dynamic and change even in the same subject with time and condition. Regulatory legislation has only recently begun to recognize this very broad spectrum of human susceptibility and the existence of multiple special subgroups of particularly sensitive subjects. In setting standards for environmental chemicals, EPA and NIOSH have attempted to protect the most sensitive humans and should be encouraged to continue this policy. For some drugs and environmental chemicals, the commonly used safety factor of 100 may be too low; for these chemicals large, interindividual pharmacokinetic variations produced by pharmacogenetic and other host factors may make a safety factor of 400 or 500 more adequate.

The genetic control of phenformin 4-hydroxylation

Previously published results of phenformin 4-hydroxylation in 195 unrelated white British volunteers and 87 family members of 27 randomly selected probands have been subjected to genetic analysis. The results clearly show that about 9% of this population has a genetically determined defect in carrying out this oxidation reaction. The character for the defect is inherited in a Mendelian autosomal recessive fashion. The polymorphism shows a substantial degree of dominance.

Genetically determined variability in acetylation and oxidation. Therapeutic implications

The clinical significance of two separate genetic polymorphisms which alter drug metabolism, acetylation and oxidation is discussed, and methods of phenotyping for both acetylator and polymorphic oxidation status are reviewed. Particular reference is made to the dapsone method, which provides a simple means of distinguishing fast and slow - and possibly intermediate - acetylators, and to the sparteine method which allows a clear separation of oxidation phenotypes. Although acetylation polymorphism has been known for some time, definite indications for phenotyping are few. It is doubtful whether acetylator phenotype makes a significant difference to the outcome in most isoniazid treatment regimens, and peripheral neuropathy from isoniazid in slow acetylators is easily overcome by pyridoxine administration. However, in comparison with rapid acetylators, slow acetylators receiving isoniazid have an increased susceptibility to phenytoin toxicity, and perhaps also to carbamazepine toxicity. It is also possible that rapid acetylators receiving isoniazid attain higher serum fluoride concentrations from enflurane and similar anaesthetics than do similarly treated slow acetylators. Thus, when drug interactions of these types are suspected, phenotyping for acetylator status may be advisable. If routine monitoring of serum procainamide and N-acetylprocainamide concentrations is practised, phenotyping of subjects prior to therapy with these agents should not be necessary. Although acetylator phenotype influences serum concentrations of hydralazine, when this drug is given in combination with other drugs acetylator phenotype has not been shown to influence the therapeutic response. Slow acetylator phenotype along with female gender and the presence of HLA-DR antigens appear to be risk factors in the development of hydralazine-induced systemic lupus erythematosus (SLE). Determination of acetylator phenotype may therefore help determine susceptibility to this adverse reaction. In the case of sulphasalazine, adult slow acetylators require a lower daily dose of the drug than fast acetylators in order to maintain ulcerative colitis in remission without significant side effects. It is therefore advisable to determine acetylator phenotype prior to sulphasalazine therapy. Work on the association of acetylation polymorphism with various disease states is also reviewed. It is possible that a higher incidence of bladder cancer is associated with slow acetylation phenotype - especially in individuals exposed to high levels of arylamines. The question as to whether idiopathic SLE is more common in slow acetylators remains unresolved. There appears to be no difference between fa

Polysubstrate monooxygenases in Drosophila, mammals and man

There is overwhelming evidence that polysubstrate monooxygenases play a central role in the metabolism of endogenous compounds as well as in the biotransformation of xenobiotics. These enzyme systems are of great importance in such diverse fields as insecticide resistance, mutagenicity, carcinogenicity, drug metabolism, etc. The constitutive and, in particular, the induced forms represent various products from a multigene family. This has first been shown for the mouse, but evidence is accumulating that this is also true for other mammals and for man. Also in insects a similar picture is emerging. If the regulation of cytochrome P-450 induction resembles in any way the other methods by which prokaryotes and eukaryotes cope genetically with the many forms of environmental selective pressures, it is very likely that most organisms have the genetic capacity to produce not only hundreds but probably thousands of inducible forms of cytochrome P-450 (Nebert et al., 1981). Doubtless, many fields from pest control to cancer prevention to drug safety will profit from the elucidation of the genetic mechanisms involved.

Human cytochromes P-450

Studies in vivo have provided evidence for a multiplicity of cytochromes P-450 in man, some of which are under independent monogenic control. Although the activity of cytochromes P-450 in man are generally lower than those of rat, this is by no means always the case. There are several important exceptions including the N-hydroxylation of 2-acetamidofluorene. Studies in vitro by a number of different techniques have confirmed the evidence from studies in vivo that there are multiple forms of human cytochrome P-450. In addition to differences in Vmax, the different forms of cytochrome P-450 may also exhibit marked differences in their apparent Km values. The implications that this may have for pharmacokinetics and toxicology are discussed. The polymorphism in the 4-hydroxylation of debrisoquine observed in vivo has been shown to be due to a defect in a specific form of cytochrome P-450 which appears to be under monogenic regulation. Cross-inhibition studies have enabled the specificity of this isozyme to be characterized. Such studies have also enabled the contribution of this isozyme of cytochrome P-450 to the oxidation of other substrates to be determined. Compounds investigated include bufuralol and phenytoin. Evidence from studies both in vivo and in vitro suggest that selective induction of different forms of cytochrome P-450 can occur in man. However, the number of different classes of inducer in man is not yet known. Human cytochromes P-450 have been purified to near homogeneity in several laboratories. Different forms of cytochrome P-450 purified from the same liver sample vary in molecular weight, chromatographic characteristics and substrate specificities.

Interrelationships in mice of antipyrine half-life, hepatic monooxygenase activities and liver S9-mediated mutagenicity of aflatoxin B1, benzo[alpha]pyrene 7,8-dihydrodiol, 2-acetylaminofluorene and N-nitrosomorpholine

To evaluate the predictive value of serum antipyrine half-life AP(T1/2) as an index of hepatic carcinogen metabolism, groups of C57BL/6 and DBA/2 mice were treated with various inducers and inhibitors of cytochrome P-450-dependent monooxygenases (pregnenolone-16 alpha-carbonitrile (PCN), phenobarbital (PB), 5,6-benzoflavone (5,6-BF), 3-methylcholanthrene (MC), disulfiram (DIS), 7,8-BF). Groups of mice were also given ethanol (3% in drinking water) for 12 days. Within each group, mean serum AP-(T1/2) was compared with (i) the in vitro activity of hepatic microsomal benzo[alpha]pyrene (BP) 3-hydroxylase, 2-acetylaminofluorene (AAF)-N-hydroxylase and aldrin monooxygenase, and (ii) the liver S9-mediated mutagenicity of aflatoxin B1 (AFB), trans-7,8-dihydro-7,8-dihydroxybenzo[alpha]pyrene (BP 7,8-diol), 2-acetylaminofluorene and N-nitrosomorpholine (NMOR) in Salmonella typhimurium strains. Serum AP(T1/2) was only correlated negatively with the activity of BP 3-hydroxylase (P less than 0.001) and aldrin monooxygenase (P less than 0.001). No statistically significant correlation was found between serum AP(T1/2) and liver S9-mediated mutagenicity for any of the four carcinogens. On the basis of these results, we conclude that serum AP(T1/2) may not be a reliable index of the capacity of liver to convert carcinogens into reactive intermediates.