Regulation of uridine diphosphate glucuronosyltransferase during the acute-phase response

Natural deletion of mouse carboxylesterases Ces1c/d/e impacts drug metabolism and metabolic syndrome development

Mammalian carboxylesterase 1 enzymes can hydrolyze many xenobiotic chemicals and endogenous lipids. We here identified and characterized a mouse strain (FVB/NKI) in which three of the eight Ces1 genes were spontaneously deleted, removing Ces1c and Ces1e partly, and Ces1d entirely. We studied the impact of this Ces1c/d/e deficiency on drug and lipid metabolism and homeostasis. Ces1c/d/e-/- mice showed strongly impaired conversion of the anticancer prodrug irinotecan to its active metabolite SN-38 in plasma, spleen and lung. Plasma hydrolysis of the oral anticancer prodrug capecitabine to 5-DFCR was also profoundly reduced in Ces1c/d/e-/- mice. Our findings resolved previously unexplained FVB/NKI pharmacokinetic anomalies. On a medium-fat diet, Ces1c/d/e-/- female mice exhibited moderately higher body weight, mild inflammation in gonadal white adipose tissue (gWAT), and increased lipid load in brown adipose tissue (BAT). Ces1c/d/e-/- males showed more pronounced inflammation in gWAT and an increased lipid load in BAT. On a 5-week high-fat diet exposure, Ces1c/d/e deficiency predisposed to developing obesity, enlarged and fatty liver, glucose intolerance and insulin resistance, with severe inflammation in gWAT and increased lipid load in BAT. Hepatic proteomics analysis revealed that the acute phase response, involved in the dynamic cycle of immunometabolism, was activated in these Ces1c/d/e-/- mice. This may contribute to the obesity-related chronic inflammation and adverse metabolic disease in this strain. While Ces1c/d/e deficiency clearly exacerbated metabolic syndrome development, long-term (18-week) high-fat diet exposure overwhelmed many, albeit not all, observed phenotypic differences.

UGT1A1 genetic variants are associated with increases in bilirubin levels in rheumatoid arthritis patients treated with sarilumab

Sarilumab is a human monoclonal antibody against interleukin (IL)-6Rα that has been approved for the treatment of adult patients with moderately to severely active rheumatoid arthritis (RA) and an inadequate response or intolerance to one or more disease-modifying antirheumatic drugs (DMARDs). Mild liver function test abnormalities have been observed in patients treated with sarilumab. We describe a genome-wide association study of bilirubin elevations in RA patients treated with sarilumab. Array genotyping and exome sequencing were performed on DNA samples from 1075 patients. Variants in the UGT1A1 gene were strongly associated with maximum bilirubin elevations in sarilumab-treated patients (rs4148325; p = 2.88 × 10⁻⁴¹) but were not associated with aminotransferase elevations. No other independent loci showed evidence of association with bilirubin elevations after sarilumab treatment. These findings suggest that most bilirubin increases during sarilumab treatment are related to genetic variation in UGT1A1 rather than underlying liver injury.

Non-amyloid liver involvement in familial Mediterranean fever: A systematic literature review

INTRODUCTION

Familial Mediterranean fever (FMF), the most frequent autoinflammatory disease, is caused by mutations in the MEFV gene. It is characterized by recurrent febrile attacks of polyserositis. Liver abnormalities may develop during its course, but they remain poorly defined.

OBJECTIVE

To describe liver involvement in FMF patients.

METHODS

A systematic search was conducted through PubMed/Medline and Embase from 1946 to January 2020. All articles describing children and adults with FMF and liver involvement were included. Patients with amyloidosis were excluded. The selected full-text articles were independently reviewed by three investigators.

RESULTS

Forty-three articles were identified, of which 20 articles with a total of 99 patients were included: 74 adults, 23 children and two patients of unknown age. Ten patients had cryptogenic cirrhosis, 48 had nonalcoholic fatty liver disease (NAFLD), four had Budd-Chiari syndrome (BCS), 12 had isolated hyperbilirubinaemia and 25 had elevated liver enzymes.

CONCLUSION

Despite a low prevalence of metabolic risk factors, FMF may be associated with NAFLD and cryptogenic cirrhosis as a consequence of chronic or recurrent inflammation. FMF patients should be regularly screened for liver injury. The latter may be prevented and treated by daily colchicine intake. The evidence was insufficient to establish an association with BCS, hyperbilirubinaemia or autoimmune hepatitis.

Metabolism of Estrogens: Turnover Differs Between Platinum-Sensitive and -Resistant High-Grade Serous Ovarian Cancer Cells

High-grade serous ovarian cancer (HGSOC) is currently treated with cytoreductive surgery and platinum-based chemotherapy. The majority of patients show a primary response; however, many rapidly develop drug resistance. Antiestrogens have been studied as low toxic treatment options for HGSOC, with higher response rates in platinum-sensitive cases. Mechanisms for this difference in response remain unknown. Therefore, the present study investigated the impact of platinum resistance on steroid metabolism in six established HGSOC cell lines sensitive and resistant against carboplatin using a high-resolution mass spectrometry assay to simultaneously quantify the ten main steroids of the estrogenic metabolic pathway. An up to 60-fold higher formation of steroid hormones and their sulfated or glucuronidated metabolites was observed in carboplatin-sensitive cells, which was reversible by treatment with interleukin-6 (IL-6). Conversely, treatment of carboplatin-resistant cells expressing high levels of endogenous IL-6 with the monoclonal anti-IL-6R antibody tocilizumab changed their status to “platinum-sensitive”, exhibiting a decreased IC₅₀ value for carboplatin, decreased growth, and significantly higher estrogen metabolism. Analysis of these metabolic differences could help to detect platinum resistance in HGSOC patients earlier, thereby allowing more efficient interventions.

UDP-glucuronosyltransferases (UGTs) and their related metabolic cross-talk with internal homeostasis: A systematic review of UGT isoforms for precision medicine

UDP-glucuronosyltransferases (UGTs) are the primary phase II enzymes catalyzing the conjugation of glucuronic acid to the xenobiotics with polar groups for facilitating their clearance. The UGTs belong to a superfamily that consists of diverse isoforms possessing distinct but overlapping metabolic activity. The abnormality or deficiency of UGTs in vivo is highly associated with some diseases, efficacy and toxicity of drugs, and precisely therapeutic personality. Despite the great effects and fruitful results achieved, to date, the expression and functions of individual UGTs have not been well clarified, the inconsistency of UGTs is often observed in human and experimental animals, and the complex regulation factors affecting UGTs have not been systematically summarized. This article gives an overview of updated reports on UGTs involving the various regulatory factors in terms of the genetic, environmental, pathological, and physiological effects on the functioning of individual UGTs, in turn, the dysfunction of UGTs induced disease risk and endo- or xenobiotic metabolism-related toxicity. The complex cross-talk effect of UGTs with internal homeostasis is systematically summarized and discussed in detail, which would be of great importance for personalized precision medicine.

Inflammation and pharmacokinetics: potential implications for HIV-infection

INTRODUCTION

The physiological changes accompanying inflammation may alter the pharmacokinetics (PK) of certain medications. Individuals infected with HIV have chronically elevated inflammatory markers despite viral suppression following effective antiretroviral therapy (ART), as well as age-related inflammation. Understanding the potential clinical implications of inflammation on the PK of medications is important for understanding dose-response relationships and necessitates future research. Areas covered: An extensive literature search was carried out using PubMed and associated bibliographies to summarize the current state of knowledge regarding altered PK in response to inflammation and its application to the field of HIV. Expert opinion: Preclinical and clinical studies show that inflammation leads to a downregulation of certain drug metabolizing enzymes and both up and down regulation of transporters depending on the transporter and cell type. Decreased gastric acidity, fluid shifts, and plasma protein alterations also occur with inflammation, leading to potential absorption, distribution, and clearance changes. More research is needed including controlled PK studies to address the clinical relevance of these observations, especially in the aging HIV-infected population. Results from future studies will enable us to better predict drug concentrations in individuals with inflammation, in line with efforts to provide personalized pharmacotherapy in our healthcare system.

Understanding Disease-Drug Interactions in Cancer Patients: Implications for Dosing Within the Therapeutic Window

The human inflammatory response can result in the alteration of drug clearance through effects on metabolizing enzymes or transporters. In this article we briefly review the theory of how cancer can lead to indirect changes in drug metabolism, review acute phase proteins and cytokines as markers of changes in cytochrome P450 (CYP) activity in cancer patients, and provide clinical case examples of how the inflammation in advanced cancer patients can lead to altered CYP-mediated drug clearance.

Culture of porcine hepatocytes or bile duct epithelial cells by inductive serum-free media

A serum-free, feeder cell-dependent, selective culture system for the long-term culture of porcine hepatocytes or cholangiocytes was developed. Liver cells were isolated from 1-wk-old pigs or young adult pigs (25 and 63 kg live weight) and were placed in primary culture on feeder cell layers of mitotically blocked mouse fibroblasts. In serum-free medium containing 1% DMSO and 1 μM dexamethasone, confluent monolayers of hepatocytes formed and could be maintained for several wk. Light and electron microscopic analysis showed hepatocytes with in vivo-like morphology, and many hepatocytes were sandwiched between the feeder cells. When isolated liver cells were cultured in medium without dexamethasone but with 0.5% DMSO, monolayers of cholangioctyes formed that subsequently self-organized into networks of multicellular ductal structures, and whose cells had monocilia projecting into the lumen of the duct. Gamma-glutamyl transpeptidase (GGT) was expressed by the cholangiocytes at their apical membranes, i.e., at the inner surface of the ducts. Cellular GGT activity increased concomitantly with the development of ductal structures. Cytochrome P-450 was determined in microsomes following addition of metyrapone to the cultures. In vivo-like levels of P-450s were found in hepatocyte monolayers while levels of P-450 were markedly reduced in cholangiocyte monolayers. Serum protein secretion in conditioned media was analyzed by Western blot and indicated that albumin, transferrin, and haptoglobin levels were maintained in hepatocytes while albumin and haptoglobin declined over time in cholangiocytes. Quantitative RT-PCR analysis showed that serum protein mRNA levels were significantly elevated in the hepatocytes monolayers in comparison to the bile ductule-containing monolayers. Further, mRNAs specific to cholangiocyte differentiation and function were significantly elevated in bile ductule monolayers in comparison to hepatocyte monolayers. The results demonstrate an in vitro model for the study of either porcine hepatocytes or cholangiocytes with in vivo-like morphology and function.

General and specific host responses to bacterial infection in Peyer's patches: a role for stromelysin-1 (matrix metalloproteinase-3) during Salmonella enterica infection

Salmonella enterica serovar Typhimurium (S. typhimurium) and Yersinia enterocolitica are enteric pathogens capable of colonizing and inducing inflammatory responses in Peyer's patches (PPs) and mesenteric lymph nodes (MLNs). Although the tissue colonization pattern is similar between these two pathogens, their pathogenic lifestyles are quite different. For example, while S. typhimurium is primarily an intracellular pathogen, Y. enterocolitica survives primarily extracellularly. We determined and compared the transcriptional changes occurring in response to S. typhimurium and Y. enterocolitica colonization of PP using Affymetrix GeneChip technology. Both pathogens elicited a general inflammatory response indicated by the upregulation of cytokines and chemokines. However, specific differences were also observed, most notably in the transcriptional regulation of gamma interferon (IFN-gamma) and IFN-gamma-regulated genes in response to S. typhimurium but not Y. enterocolitica. Of particular note, a group of genes encoding matrix metalloproteinases (MMPs) had increased transcript numbers in the PPs following infection with both pathogens. The experiments described here compare oral S. typhimurium or Y. enterocolitica infection in stromelysin-1 (MMP-3)-deficient mice (mmp-3(-/-)) with mice possessing functional MMP-3 (mmp-3(+/+)). There was little difference in the survival of MMP-3-deficient mice infected with Y. enterocolitica when compared with littermate controls. Surprisingly though, mmp-3(-/-) mice were markedly more resistant to S. typhimurium infection than the control mice. S. typhimurium was able to colonize mmp-3(-/-) mice, albeit in a delayed fashion, to equivalent levels as mmp-3(+/+) mice. Nevertheless, significantly lower levels of inflammatory cytokines were detected in tissues and serum in the mmp-3(-/-) mice in comparison with mmp-3(+/+) mice. We hypothesize that MMP-3 is involved in initiating an early and lethal cytokine response to S. typhimurium colonization.

Changes in the liver function tests during the attacks of familial Mediterranean fever

The present study aims to investigate whether or not FMF patients display abnormal liver functions during attack periods. About 41 consecutive FMF patients with attacks were enrolled on this study. Bilirubin levels, liver transaminases, erythrocyte sedimentation rate and C-reactive protein (C-RP) levels were determined within the first 72 h after the onset of attacks. This procedure could be performed on only 28 of these 41 FMF patients, 4 weeks after the attack of the patients' had completely disappeared. As for the disease control group, 44 patients were determined to be eligible for the study. Another 31 healthy individuals were also included. Hyperbilirubinemia was determined in 11 of the 41 patients (26.8%) with FMF. The number of FMF patients with hyperbilirubinemia was significantly higher than in DC and HC (P < 0.001, P = 0.03, respectively). Levels of liver transaminases slightly increased in four patients with FMF during the attack and two of these four patients had also mild hyperbilirubinemia. A significant correlation was found between C-RP levels and total and unconjugated bilirubin levels in FMF patients with attack (r = 0.43, P = 0.01; r = 0.40, P = 0.02, respectively). In conclusion, mild hyperbilirubinemia may occur in one-fourth of the patients with FMF during the attack period.

Regulation of drug-metabolizing enzymes and transporters in inflammation

Inflammation and infection have long been known to downregulate the activity and expression of cytochrome P450 (CYP) enzymes involved in hepatic drug clearance. This can result in elevated plasma drug levels and increased adverse effects. Recent information on regulation of human CYP enzymes is presented, as are new developments in our understanding of the mechanisms of regulation. Experiments to study the effects of modulating CYP activities on the inflammatory response have yielded possible insights into the physiological consequences, if not the purpose, of the downregulation. Regulation of hepatic flavin monooxygenases, UDP-glucuronosyltransferases, sulfotransferases, glutathione S-transferases, as well as of hepatic transporters during the inflammatory response, exhibits similarities and differences with regulation of CYPs.

Expression of UDP-glucuronosyltransferase isoform mRNAs during inflammation and infection in mouse liver and kidney

Inflammation or infection down-regulates the activity and expression of cytochrome P450 (P450) enzymes involved in hepatic drug clearance, possibly altering drug effectiveness and leading to toxicity. The regulation of UDP-glucuronosyltransferases (UGTs) in inflammation and infection is less well characterized. To determine the response of hepatic and renal UGTs during inflammation and infection, mice were administered either saline or 1 mg/kg lipopolysaccharide (LPS) (16 h), or Citrobacter rodentium by oral gavage (6 days). Hepatic mRNA expression of UGT1A1, 1A9, and 2B5 was similarly down-regulated after LPS exposure and C. rodentium infection, whereas UGT1A2 and 1A6 mRNAs were unchanged. Effects of C. rodentium infection did not require a functional Toll-like receptor 4. Conversely, renal UGT isoforms were relatively unaffected, except for UGT2B5 induction after LPS treatment. Regulation of UGTs during the inflammatory response exhibits similarities to and differences from regulation of P450s, and may be cytokine-mediated.

Activity and expression of various isoforms of uridine diphosphate glucuronosyltransferase are differentially regulated during hepatic regeneration in rats

PURPOSE

Glucuronidation pathway is very important in the detoxification of endogenous and exogenous compounds. The objective of this study was to evaluate the activity and expression of various hepatic uridine diphosphate glucuronosyltransferases (UGTs) in rats at various time points after initiation of hepatic regeneration by partial hepatectomy (PHx).

METHODS

The mRNA expression of various UGTs was evaluated using real-time polymerase chain reaction (real-time PCR) with specific primers. The in vitro activity of UGTs was evaluated using different substrates such as estradiol (UGT1A1), acetaminophen (UGT1A6/7), morphine (UGT2B1), testosterone (UGT2B1/3/6), androsterone (UGT2B2), and (-)-borneol (UGT2B12).

RESULTS

Whereas the activity and mRNA expression of UGT1A1, UGT2B1, UGT2B1/3/6, UGT2B2, and UGT2B12 were lower, the activity and mRNA expression of UGT1A6/7 were preserved during hepatic regeneration. The mRNA expression of UGT2B8 was down-regulated, whereas the mRNA expression of UGT1A5 and UGT1A8 was not altered by PHx. The mRNA expression of UGT1A2 and UGT1A3 was increased during hepatic regeneration.

CONCLUSION

UGT-mediated drug-metabolizing ability of the liver was altered differentially in the regenerating rat liver. Individualized dosing regimen for different UGT substrates may be needed when using such substrates of these enzymes in patients with a regenerating liver, especially during the early postoperative period. However, the glucuronide conjugating capacity of the liver in the donor of a living donor liver transplantation is expected to completely return to normal with time after surgery.

Cytokines Alter the Expression and Activity of the Multidrug Resistance Transporters in Human Hepatoma Cell Lines; Analysis Using RT‐PCR and cDNA Microarrays

Pro-inflammatory cytokines suppress the hepatic expression of the multidrug resistance transporters in rodents, indicating potential usefulness in chemotherapy. Our objective was to investigate their impact in human hepatoma cells. HuH 7 and HepG2 cells were treated with IL-1beta, IL-6, or TNF-alpha for 0-72 h. Expression and activity of MDR1 and the MRP (MRP1, 2, 3, and 6) transporters were examined by RT-PCR, efflux assays, and microarrays. Significant reductions in the MDR1-mediated efflux of Rhodamine 123 and MDR1 mRNA levels were observed in HuH 7 cells treated with IL-6, TNF-alpha, or IL-1beta and in TNF-alpha-treated HepG2 cells. However, cytokine-treated HuH7 cells also demonstrated 1.6- to 2.6-fold greater efflux of the MRP substrate, 5-carboxyfluorescein (5-CF) and higher MRP3 mRNA levels (p < 0.05). IL-1beta and IL-6 treatments increased MRP activity and MRP1 mRNA levels in HepG2 cells (p < 0.05). Microarrays studies performed in IL-6 and TNF-alpha-treated HepG2 cells detected similar changes in the expression of the MDR1 and MRP transporters, but this did not reach significance. However, the microarrays confirmed cytokine-mediated induction of several acute phase proteins. Our data suggests that although cytokine-mediated suppression of PGP may alter drug resistance in malignant cells, these cytokines may also impose an induction in other multidrug resistance genes.

UDP glucuronosyltransferase mRNA levels in human liver disease

The UDP glucuronosyltransferases (UGT) are a family of enzymes in which substrates include drugs, xenobiotics, and products of endogenous catabolism. The main source of most UGT enzymes is the liver, a major organ in the detoxification and inactivation of compounds. Previous studies have indicated that glucuronidation, as measured by pharmacokinetic studies, is relatively spared in liver disease. Because UGT activity toward most substrates is the result of metabolism by different isoforms with overlapping specificities, these studies may not indicate the effect of disease on the levels of individual isoforms. We sought to extend these studies to the measurement of mRNA for individual isoforms in the liver of patients with various forms of liver disease. RNA was extracted from liver tissue samples of patients undergoing clinically necessary percutaneous liver biopsies. UGT mRNA levels for isoforms 1A1, 1A3, 1A4, 1A6, 1A9, 2B4, 2B7, 2B10, 2B11, 2B15, and 2B17 were determined by real-time reverse transcription-polymerase chain reaction. Biopsies were graded using the Metavir system. Results from patients with low fibrosis or inflammatory scores were compared with those with high scores. We found large interindividual variation in the levels of the various isoforms. This was greatest for UGT2B17. A consistent downward trend, reaching statistical significance for UGT1A4, UGT2B4, and UGT2B7, was observed in samples from patients with high inflammation scores. There was no such correlation with the degree of fibrosis. Our results indicate that hepatic UGT mRNA levels are reduced while the tissue is inflamed, but they are not affected in the noninflamed, chronically diseased liver.

Alcohol up-regulates UDP-glucuronosyltransferase mRNA expression in rat liver and in primary rat hepatocyte culture

The interactions between alcohol and cytochrome P-450 enzymes have been well investigated. However, the data regarding the effect of alcohol on the regulation of UDP-glucuronosyltranferase (UGT) activity are less clear. The aim of the present study was to determine the role of alcohol in the regulation of UGT mRNA expression by using whole animal and primary cultured hepatocytes. Chronic ethanol feeding of rats significantly increased the expression of liver UGT1A1 mRNA to 177% of control. The mRNA levels for UGT1A5, UGT2B1 and UGT2B3 were also enhanced, but did not reach statistical significance. In cultured hepatocytes, treatment with either ethanol or isopentanol significantly increased the expression of UGT1A1, UGT1A5, UGT2B1, and UGT2B3 mRNAs, but to different degrees. The induction of UGT1A1 and UGT2B1 mRNAs by ethanol or isopentanol was time-dependent and maximal changes occurred at 48 h. The expression of UGT1A6 mRNA was not significantly modified by either ethanol or isopentanol. In conclusion, ethanol and isopentanol have direct roles in the regulation of UGT.