1
|
Richards SE, Bradshaw PR, Johnson CH, Stachulski AV, Athersuch TJ, Nicholson JK, Lindon JC, Wilson ID. Transacylation and hydrolysis of the acyl glucuronides of ibuprofen and its α-methyl-substituted analogues investigated by 1H NMR spectroscopy and computational chemistry: Implications for drug design. J Pharm Biomed Anal 2024; 246:116238. [PMID: 38805849 DOI: 10.1016/j.jpba.2024.116238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 05/30/2024]
Abstract
Drugs and drug metabolites containing a carboxylic-acid moiety can undergo in vivo conjugation to form 1-β-O-acyl-glucuronides (1-β-O-AGs). In addition to hydrolysis, these conjugates can undergo spontaneous acyl migration, and anomerisation reactions, resulting in a range of positional isomers. Facile transacylation has been suggested as a mechanism contributing to the toxicity of acyl glucuronides, with the kinetics of these processes thought to be a factor. Previous 1H NMR spectroscopic and HPLC-MS studies have been conducted to measure the degradation rates of the 1-β-O-AGs of three nonsteroidal anti-inflammatory drugs (ibufenac, R-ibuprofen, S-ibuprofen) and a dimethyl-analogue (termed here as "bibuprofen"). These studies have also determined the relative contributions of hydrolysis and acyl migration in both buffered aqueous solution, and human plasma. Here, a detailed kinetic analysis is reported, providing the individual rate constants for the acyl migration and hydrolysis reactions observed in buffer for each of the 4 AGs, together with the overall degradation rate constants of the parent 1-β-O-AGs. Computational modelling of the reactants and transition states of the transacylation reaction using density functional theory indicated differences in the activation energies that reflected the influence of both substitution and stereochemistry on the rate of transacylation/hydrolysis.
Collapse
Affiliation(s)
- Selena E Richards
- Department of Chemistry, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Peter R Bradshaw
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, Burlington Danes Building, London W12 0NN, UK
| | - Caroline H Johnson
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA
| | - Andrew V Stachulski
- Department of Chemistry, The Robert Robinson Laboratories, University of Liverpool, Liverpool L69 7ZD, UK
| | - Toby J Athersuch
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, Burlington Danes Building, London W12 0NN, UK
| | - Jeremy K Nicholson
- The Australian National Phenome Centre and Computational and Systems Medicine, Health Futures Institute, Murdoch University, Harry Perkins Building, Perth WA6150, Australia; Institute of Global Health Innovation, Faculty of Medicine, Imperial College London, Level 1, Faculty Building, South Kensington Campus, London SW7 2NA, UK
| | - John C Lindon
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, Burlington Danes Building, London W12 0NN, UK
| | - Ian D Wilson
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, Burlington Danes Building, London W12 0NN, UK.
| |
Collapse
|
2
|
Aleksic M, Meng X. Protein Haptenation and Its Role in Allergy. Chem Res Toxicol 2024; 37:850-872. [PMID: 38834188 PMCID: PMC11187640 DOI: 10.1021/acs.chemrestox.4c00062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/14/2024] [Accepted: 05/21/2024] [Indexed: 06/06/2024]
Abstract
Humans are exposed to numerous electrophilic chemicals either as medicines, in the workplace, in nature, or through use of many common cosmetic and household products. Covalent modification of human proteins by such chemicals, or protein haptenation, is a common occurrence in cells and may result in generation of antigenic species, leading to development of hypersensitivity reactions. Ranging in severity of symptoms from local cutaneous reactions and rhinitis to potentially life-threatening anaphylaxis and severe hypersensitivity reactions such as Stephen-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), all these reactions have the same Molecular Initiating Event (MIE), i.e. haptenation. However, not all individuals who are exposed to electrophilic chemicals develop symptoms of hypersensitivity. In the present review, we examine common chemistry behind the haptenation reactions leading to formation of neoantigens. We explore simple reactions involving single molecule additions to a nucleophilic side chain of proteins and complex reactions involving multiple electrophilic centers on a single molecule or involving more than one electrophilic molecule as well as the generation of reactive molecules from the interaction with cellular detoxification mechanisms. Besides generation of antigenic species and enabling activation of the immune system, we explore additional events which result directly from the presence of electrophilic chemicals in cells, including activation of key defense mechanisms and immediate consequences of those reactions, and explore their potential effects. We discuss the factors that work in concert with haptenation leading to the development of hypersensitivity reactions and those that may act to prevent it from developing. We also review the potential harnessing of the specificity of haptenation in the design of potent covalent therapeutic inhibitors.
Collapse
Affiliation(s)
- Maja Aleksic
- Safety
and Environmental Assurance Centre, Unilever,
Colworth Science Park, Sharnbrook, Bedford MK44
1LQ, U.K.
| | - Xiaoli Meng
- MRC
Centre for Drug Safety Science, Department of Molecular and Clinical
Pharmacology, The University of Liverpool, Liverpool L69 3GE, U.K.
| |
Collapse
|
3
|
Thomson P, Fragkas N, Kafu LM, Aithal GP, Lucena MI, Terracciano L, Meng X, Pirmohamed M, Brees D, Kullak‐Ublick GA, Odermatt A, Hammond T, Kammüller M, Naisbitt DJ. Patients with naproxen-induced liver injury display T-cell memory responses toward an oxidative (S)-O-desmethyl naproxen metabolite but not the acyl glucuronide. Allergy 2024; 79:200-214. [PMID: 37515456 PMCID: PMC10952231 DOI: 10.1111/all.15830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/30/2023] [Accepted: 06/13/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Exposure to nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (IBU) and naproxen (NAP) is associated with idiosyncratic drug-induced liver injury (DILI). Carboxylate bioactivation into reactive metabolites (e.g., acyl glucuronides, AG) and resulting T-cell activation is hypothesized as causal for this adverse event. However, conclusive evidence supporting this is lacking. METHODS In this work, we identify CD4+ and CD8+ T-cell hepatic infiltration in a biopsy from an IBU DILI patient. Lymphocyte transformation test and IFN-γ ELIspot, conducted on peripheral blood mononuclear cells (PBMCs) of patients with NAP-DILI, were used to explore drug-specific T-cell activation. T-cell clones (TCC) were generated and tested for drug specificity, phenotype/function, and pathways of T-cell activation. Cells were exposed to NAP, its oxidative metabolite 6-O-desmethyl NAP (DM-NAP), its AG or synthesized NAP-AG human-serum albumin adducts (NAP-AG adduct). RESULTS CD4+ and CD8+ T-cells from patients expressing a range of different Vβ receptors were stimulated to proliferate and secrete IFN-γ and IL-22 when exposed to DM-NAP, but not NAP, NAP-AG or the NAP-AG adduct. Activation of the CD4+ TCC was HLA-DQ-restricted and dependent on antigen presenting cells (APC); most TCC were activated with DM-NAP-pulsed APC, while fixation of APC blocked the T-cell response. Cross-reactivity was not observed with structurally-related drugs. CONCLUSION Our results confirm hepatic T-cell infiltrations in NSAID-induced DILI, and show a T-cell memory response toward DM-NAP indicating an immune-mediated basis for the adverse event. Whilst bioactivation at the carboxylate group is widely hypothesized to be pathogenic for NSAID associated DILI, we found no evidence of this with NAP.
Collapse
Affiliation(s)
- Paul Thomson
- Molecular& Clinical PharmacologyUniversity of LiverpoolLiverpoolUK
| | - Nik Fragkas
- Novartis Institutes for BioMedical ResearchBaselSwitzerland
| | - Laila M. Kafu
- Molecular& Clinical PharmacologyUniversity of LiverpoolLiverpoolUK
| | - Guruprasad P. Aithal
- NIHR Nottingham Biomedical Research Centre and Nottingham Digestive Diseases Centre, Translational Medical Sciences, West Block, Queen's Medical CentreUniversity of NottinghamNottinghamUK
| | - M. Isabel Lucena
- Unidad de Gestión Clínica de Aparato Digestivo y Servicio de Farmacología Clínica, Instituto de Investigación Biomédica de Málaga‐IBIMA, Hospital Universitario Virgen de la VictoriaUniversidad de Málaga, CIBERehdMalagaSpain
| | | | - Xiaoli Meng
- Molecular& Clinical PharmacologyUniversity of LiverpoolLiverpoolUK
| | - Munir Pirmohamed
- Molecular& Clinical PharmacologyUniversity of LiverpoolLiverpoolUK
| | | | - Gerd A. Kullak‐Ublick
- University Hospital ZurichUniversity of ZurichZurichSwitzerland
- Novartis Global Drug DevelopmentBaselSwitzerland
| | - Alex Odermatt
- Division of Molecular & Systems Toxicology, Department of Pharmaceutical SciencesUniversity of BaselBaselSwitzerland
| | - Thomas Hammond
- Division of Molecular & Systems Toxicology, Department of Pharmaceutical SciencesUniversity of BaselBaselSwitzerland
- Oncology Safety, Clinical Pharmacology and Safety Sciences R&DCambridgeUK
| | | | - Dean J. Naisbitt
- Molecular& Clinical PharmacologyUniversity of LiverpoolLiverpoolUK
| |
Collapse
|
4
|
Gladchuk AS, Gorbunov AY, Keltsieva OA, Ilyushonok SK, Babakov VN, Shilovskikh VV, Kolonitskii PD, Stepashkin NA, Soboleva A, Muradymov MZ, Krasnov NV, Sukhodolov NG, Selyutin AA, Frolov A, Podolskaya EP. Coating of a MALDI target with metal oxide nanoparticles by droplet-free electrospraying – a versatile tool for in situ enrichment of human globin adducts of halogen-containing drug metabolites. Microchem J 2023. [DOI: 10.1016/j.microc.2023.108708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
|
5
|
Ishii H, Shibuya M, Kusano K, Sone Y, Kamiya T, Wakuno A, Ito H, Miyata K, Sato F, Kuroda T, Yamada M, Leung GNW. Pharmacokinetic Study of Vadadustat and High-Resolution Mass Spectrometric Characterization of its Novel Metabolites in Equines for the Purpose of Doping Control. Curr Drug Metab 2022; 23:850-865. [PMID: 36017833 DOI: 10.2174/1389200223666220825093945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/08/2022] [Accepted: 06/17/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Vadadustat, a hypoxia-inducible factor prolyl hydroxylase (HIF-PHD) inhibitor, is a substance which carries a lifetime ban in both horse racing and equestrian competition. A comprehensive metabolic study of vadadustat in horses has not been previously reported. OBJECTIVE Metabolism and elimination profiles of vadadustat in equine plasma and urine were studied for the purpose of doping control. METHODS A nasoesophageal administration of vadadustat (3 g/day for 3 days) was conducted on three thoroughbred mares. Potential metabolites were comprehensively detected by differential analysis of full-scan mass spectral data obtained from both in vitro studies with liver homogenates and post-administration samples using liquid chromatography high-resolution mass spectrometry. The identities of metabolites were further substantiated by product ion scans. Quantification methods were developed and validated for the establishment of the excretion profiles of the total vadadustat (free and conjugates) in plasma and urine. RESULTS A total of 23 in vivo and 14 in vitro metabolites (12 in common) were identified after comprehensive analysis. We found that vadadustat was mainly excreted into urine as the parent drug together with some minor conjugated metabolites. The elimination profiles of total vadadustat in post-administration plasma and urine were successfully established by using quantification methods equipped with alkaline hydrolysis for cleavage of conjugates such as methylated vadadustat, vadadustat glucuronide, and vadadustat glucoside. CONCLUSION Based on our study, for effective control of the misuse or abuse of vadadustat in horses, total vadadustat could successfully be detected for up to two weeks after administration in plasma and urine.
Collapse
Affiliation(s)
- Hideaki Ishii
- Drug Analysis Department, Laboratory of Racing Chemistry, 1731-2 Tsuruta-machi, Utsunomiya, Tochigi, Zip 320-0851, Japan.,Department of Pharmaceutical Sciences, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Zip 980-8574, Japan
| | - Mariko Shibuya
- Drug Analysis Department, Laboratory of Racing Chemistry, 1731-2 Tsuruta-machi, Utsunomiya, Tochigi, Zip 320-0851, Japan
| | - Kanichi Kusano
- Veterinarian Section, Equine Department, Japan Racing Association, 6-11-1 Roppongi, Minato-ku, Tokyo, Zip 105-0003, Japan
| | - Yu Sone
- Veterinarian Section, Equine Department, Japan Racing Association, 6-11-1 Roppongi, Minato-ku, Tokyo, Zip 105-0003, Japan
| | - Takahiro Kamiya
- Equine Veterinary Clinic, Horse Racing School, Japan Racing Association, 835-1 Ne, Shiroi, Chiba, Zip 270-1431, Japan
| | - Ai Wakuno
- Equine Veterinary Clinic, Horse Racing School, Japan Racing Association, 835-1 Ne, Shiroi, Chiba, Zip 270-1431, Japan
| | - Hideki Ito
- Equine Veterinary Clinic, Horse Racing School, Japan Racing Association, 835-1 Ne, Shiroi, Chiba, Zip 270-1431, Japan
| | - Kenji Miyata
- JRA Equestrian Park Utsunomiya Office, 321-4 Tokamicho, Utsunomiya, Tochigi, Zip 320-0856, Japan
| | - Fumio Sato
- Clinical Veterinary Medicine Division, Equine Research Institute, Japan Racing Association, 1400-4, Shiba, Shimotsuke, Tochigi, Zip 329-0412, Japan
| | - Taisuke Kuroda
- Clinical Veterinary Medicine Division, Equine Research Institute, Japan Racing Association, 1400-4, Shiba, Shimotsuke, Tochigi, Zip 329-0412, Japan
| | - Masayuki Yamada
- Drug Analysis Department, Laboratory of Racing Chemistry, 1731-2 Tsuruta-machi, Utsunomiya, Tochigi, Zip 320-0851, Japan
| | - Gary Ngai-Wa Leung
- Drug Analysis Department, Laboratory of Racing Chemistry, 1731-2 Tsuruta-machi, Utsunomiya, Tochigi, Zip 320-0851, Japan
| |
Collapse
|
6
|
Shibazaki C, Mashita O, Takahashi K, Nakamura S, Mashino T, Ohe T. Development of a Fluorescent-Labeled Trapping Reagent to Detect Reactive Acyl Glucuronides. Chem Res Toxicol 2021; 34:2343-2352. [PMID: 34705453 DOI: 10.1021/acs.chemrestox.1c00236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Acyl glucuronides are common metabolites of carboxylic acid-containing compounds. Since acyl glucuronides sometimes show high reactivity, they are considered to be involved in drug toxicity. Therefore, it is important to evaluate the risk posed by acyl glucuronides in the development of safe drugs; however, there are no suitable evaluation methods for the early stages of drug discovery. We aimed to develop a trapping reagent that detects reactive acyl glucuronides to assess their risk. We designed a diamine-structured trapping reagent, Dap-Dan, and compared its trapping ability with the reported one that has an amino group, and results showed that Dap-Dan showed higher accuracy. In the trapping assay with 17 medicines containing a carboxylic acid, Dap-Dan trapped acyl glucuronides that had a higher risk of toxicity. In conclusion, Dap-Dan can be useful for evaluating the risk of reactive acyl glucuronides.
Collapse
Affiliation(s)
- Chikako Shibazaki
- Faculty of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512, Japan
| | - Okishi Mashita
- Laboratory for Safety Assessment and ADME, Pharmaceuticals Research Center, Asahi Kasei Pharma Corporation, 632-1 Mifuku, Izunokuni, Shizuoka 410-2321, Japan
| | - Kyoko Takahashi
- Department of Chemistry, Nippon Medical School, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-0023, Japan
| | - Shigeo Nakamura
- Department of Chemistry, Nippon Medical School, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-0023, Japan
| | - Tadahiko Mashino
- Faculty of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512, Japan
| | - Tomoyuki Ohe
- Faculty of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512, Japan
| |
Collapse
|
7
|
Tateishi Y, Ohe T, Ogawa M, Takahashi K, Nakamura S, Mashino T. Development of Novel Diclofenac Analogs Designed to Avoid Metabolic Activation and Hepatocyte Toxicity. ACS OMEGA 2020; 5:32608-32616. [PMID: 33376898 PMCID: PMC7758955 DOI: 10.1021/acsomega.0c04942] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/25/2020] [Indexed: 06/12/2023]
Abstract
Diclofenac (DCF) is widely used as a nonsteroidal anti-inflammatory drug; however, it is associated with severe liver injury. This adverse reaction is thought to be related to the reactive quinone imine (QI) and acyl glucuronide (AG) metabolites of DCF, but it remains controversial which reactive metabolites mainly contribute to DCF-induced toxicity. In this study, we synthesized five types of DCF analogs that were designed to mitigate the formation of reactive QI and/or AG metabolites and evaluated their metabolic stability, cyclooxygenase (COX) inhibitory activity, and toxicity to cryopreserved human hepatocytes. Compounds with fluorine at the 5- and 4'-positions of aromatic rings exhibited modest and high metabolic stability to oxidation by cytochrome P450, respectively, but induced cytotoxicity comparable to DCF. Replacing the carboxylic group of DCF with its bioisosteres was effective in terms of stability to oxidative metabolism and glucuronidation; however, sulfonic acid and sulfonamide groups were not preferable for COX inhibition, and tetrazole-containing analogs induced strong cytotoxicity. On the other hand, compounds that have fluorine at the benzylic position were resistant to glucuronidation and showed little toxicity to hepatocytes. In addition, among these compounds, those with hydrogen at the 4'-position (2a and 2c) selectively inhibited the COX-2 enzyme. Throughout these data, it was suggested that compounds 2a and 2c might be novel safer and more efficacious drug candidates instead of DCF.
Collapse
Affiliation(s)
- Yasuhiro Tateishi
- Faculty
of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512, Japan
| | - Tomoyuki Ohe
- Faculty
of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512, Japan
| | - Mai Ogawa
- Faculty
of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512, Japan
| | - Kyoko Takahashi
- Faculty
of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512, Japan
| | - Shigeo Nakamura
- Department
of Chemistry, Nippon Medical School, 1-7-1 Kyonan-cho, Musashino, Tokyo 180-0023, Japan
| | - Tadahiko Mashino
- Faculty
of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512, Japan
| |
Collapse
|
8
|
Meng X, Waddington JC, Tailor A, Lister A, Hamlett J, Berry N, Park BK, Sporn MB. CDDO-imidazolide Targets Multiple Amino Acid Residues on the Nrf2 Adaptor, Keap1. J Med Chem 2020; 63:9965-9976. [PMID: 32787104 DOI: 10.1021/acs.jmedchem.0c01088] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Synthetic triterpenoids including CDDO, its methyl ester (CDDO-Me, bardoxolone methyl), and its imidazolide (CDDO-Im) enhance Nrf2-mediated antioxidant and anti-inflammatory activity in many diseases by reacting with thiols on the adaptor protein, Keap1. Unlike monofunctional CDDO-Me, the bifunctional analog, CDDO-Im, has a second reactive site (imidazolide) and can covalently bind to amino acids other than cysteine on target proteins such as glutathione S-transferase pi (GSTP), serum albumin, or Keap1. Here we show for the first time that bifunctional CDDO-Im (in contrast to CDDO-Me), as low as 50 nM, can covalently transacylate arginine and serine residues in GSTP and cross-link them to adjacent cysteine residues. Moreover, we show that CDDO-Im binds covalently to Keap1 by forming permanent Michael adducts with eight different cysteines, and acyl adducts with lysine and several tyrosine residues. Modeling studies suggest that the Tyr 85 adduct stabilizes the Keap1-Cul3 complex, thereby enhancing the potency of CDDO-Im.
Collapse
Affiliation(s)
- Xiaoli Meng
- MRC Centre for Drug Safety Science, Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool L69 3GE, U.K
| | - James C Waddington
- MRC Centre for Drug Safety Science, Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool L69 3GE, U.K
| | - Arun Tailor
- MRC Centre for Drug Safety Science, Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool L69 3GE, U.K
| | - Adam Lister
- MRC Centre for Drug Safety Science, Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool L69 3GE, U.K
| | - Jane Hamlett
- MRC Centre for Drug Safety Science, Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool L69 3GE, U.K
| | - Neil Berry
- Department of Chemistry, University of Liverpool, Liverpool L69 7ZD, U.K
| | - B Kevin Park
- MRC Centre for Drug Safety Science, Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool L69 3GE, U.K
| | - Michael B Sporn
- Molecular and Systems Biology, Dartmouth Medical School, Lebanon, New Hampshire 03756, United States
| |
Collapse
|
9
|
Acyl glucuronide reactivity in perspective. Drug Discov Today 2020; 25:1639-1650. [PMID: 32681884 DOI: 10.1016/j.drudis.2020.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/22/2020] [Accepted: 07/08/2020] [Indexed: 12/12/2022]
Abstract
Acyl glucuronidation is a common metabolic fate for acidic drugs and their metabolites and, because these metabolites are reactive, they have been linked to adverse drug reactions (ADRs) and drug withdrawals. However, alternative routes of metabolism leading to reactive metabolites (e.g., oxidations and acyl-CoA thioesters) mean that unambiguous proof that acyl glucuronides are toxic is lacking. Here, we review the synthesis and reactivity of these metabolites, and describe the use of molecular modelling and in vitro and in vivo reactivity assessment of acyl glucuronide reactivity. Based on the emerging structure-dependent differences in reactivity and protein adduction methods for risk assessment for acyl glucuronide-forming acid drugs or drug candidates in drug discovery/development are suggested.
Collapse
|
10
|
Walles M, Brown AP, Zimmerlin A, End P. New Perspectives on Drug-Induced Liver Injury Risk Assessment of Acyl Glucuronides. Chem Res Toxicol 2020; 33:1551-1560. [PMID: 32525307 DOI: 10.1021/acs.chemrestox.0c00131] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Drug-induced liver injury (DILI) remains one of the key challenges in drug development due to the mechanisms of action being multifactorial in nature. This is particularly the case for idiosyncratic DILI which occurs in a very low frequency in humans (e.g., 1:10,000). Despite perceptions that acyl glucuronide metabolites are defacto risks for DILI, scientific evidence suggests that acyl glucuronide formation alone does not pose an increased risk compared to other drug metabolites. This applies in particular to those acyl glucuronides which are not reactive and do not form covalent adducts with proteins. The goal of this paper is to provide guidance on preclinical and clinical strategies to evaluate the potential for acyl glucuronide formation to contribute to DILI. A key element of our proposed safety assessment is to investigate whether a particular acyl glucuronide is reactive or not and whether systemic exposure in humans can be demonstrated in animal toxicology studies following administration of the parent drug. While standard animal toxicology studies can identify overtly hepatotoxic compounds, these studies are not predictive for drugs that produce idiosyncratic forms of DILI. In addition, we do not recommend conducting toxicology studies of administered individual acyl glucuronides due to differences in pharmacokinetic and dispositional properties from the endogenously produced metabolites. Once a drug candidate has entered clinical trials, the focus should be on clinical safety data and emerging risk-benefit analysis.
Collapse
Affiliation(s)
- Markus Walles
- PK Sciences, Novartis Institutes for Biomedical Research, Novartis Campus, 4052 Basel, Switzerland
| | - Alan P Brown
- Preclinical Safety, Novartis Institutes for Biomedical Research, 220 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Alfred Zimmerlin
- PK Sciences, Novartis Institutes for Biomedical Research, Novartis Campus, 4052 Basel, Switzerland
| | - Peter End
- PK Sciences, Novartis Institutes for Biomedical Research, Novartis Campus, 4052 Basel, Switzerland
| |
Collapse
|
11
|
Inoue K, Mizuo H, Ishida T, Komori T, Kusano K. Bioactivation of diclofenac in human hepatocytes and the proposed human hepatic proteins modified by reactive metabolites. Xenobiotica 2020; 50:919-928. [PMID: 32039641 DOI: 10.1080/00498254.2020.1728592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
To reveal putative bioactivation pathways of diclofenac, in vitro human liver materials such as microsomal fractions and hepatocytes were used to confirm metabolic activation of diclofenac by 35S-cysteine trapping assay and covalent binding assay. Candidate human liver proteins possibly targeted by 14C-diclofenac via bioactivation were investigated using two-dimensional gel electrophoresis followed by detection of remaining radioactivity on the modified proteins with bio-imaging analyzer.In the 35S-cysteine trapping assay, three and two adducts with 35S-cysteine were observed in NADPH-fortified and UDPGA-fortified human liver microsomes, respectively. In the covalent binding assay using 14C-diclofenac in human hepatocytes, the extent of covalent binding of diclofenac to human hepatic proteins increased time-dependently. Addition of glutathione attenuated the extent of covalent binding of 14C-diclofenac to human liver microsomal proteins.Fifty-nine proteins from human hepatocytes were proposed as the candidate proteins targeted by reactive metabolites of diclofenac. Proteins modified by cytochrome P450-mediated reactive metabolites were identified by using a cytochrome P450 inhibitor, 1-aminobenzyltriazole and seven of the nine radioactive protein spots were removed by 1-aminobenzyltriazole treatment.In contrast, the remaining two radioactive protein spots, mainly containing human serum albumin and heat shock proteins, were not affected by the addition of 1-aminobenzyltriazole, which suggested the involvement of the acyl glucuronide of diclofenac, formed via uridine diphosphate-glucuronosyl transferases, in the covalent modifications induced by diclofenac.
Collapse
Affiliation(s)
- Kazuko Inoue
- Drug Metabolism and Pharmacokinetics, Eisai Co., Ltd, Tsukuba, Japan
| | - Hitoshi Mizuo
- Drug Metabolism and Pharmacokinetics, Eisai Co., Ltd, Tsukuba, Japan
| | - Tomomi Ishida
- Drug Metabolism and Pharmacokinetics, Eisai Co., Ltd, Tsukuba, Japan
| | - Takafumi Komori
- Drug Metabolism and Pharmacokinetics, Eisai Co., Ltd, Tsukuba, Japan
| | - Kazutomi Kusano
- Drug Metabolism and Pharmacokinetics, Eisai Co., Ltd, Tsukuba, Japan
| |
Collapse
|
12
|
Bradshaw PR, Richards SE, Wilson ID, Stachulski AV, Lindon JC, Athersuch TJ. Kinetic modelling of acyl glucuronide and glucoside reactivity and development of structure–property relationships. Org Biomol Chem 2020; 18:1389-1401. [DOI: 10.1039/c9ob02008j] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Detailed kinetic and transition structure modelling to rationalise the differences in reactivity observed between the acyl glucuronide and glucoside metabolites of a series of phenylacetic acid analogues.
Collapse
Affiliation(s)
- Peter R. Bradshaw
- Department of Metabolism
- Digestion and Reproduction
- Faculty of Medicine
- Imperial College London
- London
| | - Selena E. Richards
- Department of Chemistry
- Khalifa University of Science and Technology
- Abu Dhabi
- United Arab Emirates
| | - Ian D. Wilson
- Department of Metabolism
- Digestion and Reproduction
- Faculty of Medicine
- Imperial College London
- London
| | - Andrew V. Stachulski
- Department of Chemistry
- The Robert Robinson Laboratories
- University of Liverpool
- Liverpool L69 7ZD
- UK
| | - John C. Lindon
- Department of Metabolism
- Digestion and Reproduction
- Faculty of Medicine
- Imperial College London
- London
| | - Toby J. Athersuch
- Department of Metabolism
- Digestion and Reproduction
- Faculty of Medicine
- Imperial College London
- London
| |
Collapse
|
13
|
Ariza A, Torres MJ, Moreno-Aguilar C, Fernández-Santamaría R, Fernández TD. Early Biomarkers for Severe Drug Hypersensitivity Reactions. Curr Pharm Des 2019; 25:3829-3839. [DOI: 10.2174/1381612825666191107105440] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 11/06/2019] [Indexed: 02/08/2023]
Abstract
Drug hypersensitivity reactions (DHRs) are typically classified into immediate and delayed reactions
based on the time interval between drug exposure and onset of symptoms. Clinical manifestations range from
mild to severe and life-threatening reactions. The most severe clinical entities are anaphylaxis and anaphylactic
shock for immediate reactions, and severe cutaneous adverse reactions such as Steven Johnson Syndrome and
Toxic Epidermal Necrolysis for delayed reactions. The diagnosis is complex and challenging, as drug provocation
tests and even skin tests can be very risky procedures, which makes them not recommended. Therefore, it is necessary
to search for useful early biomarkers to manage the diagnosis of these reactions. These biomarkers could
be useful to determine the clinical entity, but not to identify the culprit drug. Some of the currently available
biomarkers are few genetic associations of drug allergy with polymorphisms of human leukocyte antigen (HLA),
the detection of inflammatory and lipid mediators in serum, or the detection of cytokines, chemokines, and cytotoxic
markers in skin biopsies. In this literature review, it has been summarize the immunological mechanisms
involved in severe reactions, both immediate and delayed, and different early biomarkers: those currently used for
the diagnosis of these reactions as well as possible early biomarkers that could be useful with further studies to
standardize their clinical use.
Collapse
Affiliation(s)
- Adriana Ariza
- Allergy Research Group, Instituto de Investigacion Biomedica de Malaga-IBIMA, Malaga, Spain
| | - Maria J. Torres
- Allergy Research Group, Instituto de Investigacion Biomedica de Malaga-IBIMA, Malaga, Spain
| | - Carmen Moreno-Aguilar
- Immunology and Allergy Unit, IMIBICHospital Universitario Reina Sofía, Córdoba, Spain
| | | | - Tahia D. Fernández
- Allergy Research Group, Instituto de Investigacion Biomedica de Malaga-IBIMA, Malaga, Spain
| |
Collapse
|
14
|
Ali SE, Waddington JC, Park BK, Meng X. Definition of the Chemical and Immunological Signals Involved in Drug-Induced Liver Injury. Chem Res Toxicol 2019; 33:61-76. [PMID: 31682113 DOI: 10.1021/acs.chemrestox.9b00275] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Idiosyncratic drug-induced liver injury (iDILI), which is rare and often recognized only late in drug development, poses a major public health concern and impediment to drug development due to its high rate of morbidity and mortality. The mechanisms of DILI are not completely understood; both non-immune- and immune-mediated mechanisms have been proposed. Non-immune-mediated mechanisms including direct damage to hepatocytes, mitochondrial toxicity, interference with transporters, and alteration of bile ducts are well-known to be associated with drugs such as acetaminophen and diclofenac; whereas immune-mediated mechanisms involving activation of both adaptive and innate immune cells and the interactions of these cells with parenchymal cells have been proposed. The chemical signals involved in activation of both innate and adaptive immune responses are discussed with respect to recent scientific advances. In addition, the immunological signals including cytokine and chemokines that are involved in promoting liver injury are also reviewed. Finally, we discuss how liver tolerance and regeneration can have profound impact on the pathogenesis of iDILI. Continuous research in developing in vitro systems incorporating immune cells with liver cells and animal models with impaired liver tolerance will provide an opportunity for improved prediction and prevention of immune-mediated iDILI.
Collapse
Affiliation(s)
- Serat-E Ali
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology , University of Liverpool , Liverpool L69 3GE , United Kingdom
| | - James C Waddington
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology , University of Liverpool , Liverpool L69 3GE , United Kingdom
| | - B Kevin Park
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology , University of Liverpool , Liverpool L69 3GE , United Kingdom
| | - Xiaoli Meng
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology , University of Liverpool , Liverpool L69 3GE , United Kingdom
| |
Collapse
|
15
|
Mayorga C, Montañez MI, Jurado-Escobar R, Gil-Ocaña V, Cornejo-García JA. An Update on the Immunological, Metabolic and Genetic Mechanisms in Drug Hypersensitivity Reactions. Curr Pharm Des 2019; 25:3813-3828. [PMID: 31692430 DOI: 10.2174/1381612825666191105122414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/31/2019] [Indexed: 11/22/2022]
Abstract
Drug hypersensitivity reactions (DHRs) represent a major burden on the healthcare system since their diagnostic and management are complex. As they can be influenced by individual genetic background, it is conceivable that the identification of variants in genes potentially involved could be used in genetic testing for the prevention of adverse effects during drug administration. Most genetic studies on severe DHRs have documented HLA alleles as risk factors and some mechanistic models support these associations, which try to shed light on the interaction between drugs and the immune system during lymphocyte presentation. In this sense, drugs are small molecules that behave as haptens, and currently three hypotheses try to explain how they interact with the immune system to induce DHRs: the hapten hypothesis, the direct pharmacological interaction of drugs with immune receptors hypothesis (p-i concept), and the altered self-peptide repertoire hypothesis. The interaction will depend on the nature of the drug and its reactivity, the metabolites generated and the specific HLA alleles. However, there is still a need of a better understanding of the different aspects related to the immunological mechanism, the drug determinants that are finally presented as well as the genetic factors for increasing the risk of suffering DHRs. Most available information on the predictive capacity of genetic testing refers to abacavir hypersensitivity and anticonvulsants-induced severe cutaneous reactions. Better understanding of the underlying mechanisms of DHRs will help us to identify the drugs likely to induce DHRs and to manage patients at risk.
Collapse
Affiliation(s)
- Cristobalina Mayorga
- Allergy Research Group, Instituto de Investigacion Biomedica de Malaga-IBIMA-ARADyAL. Malaga, Spain.,Allergy Unit, Hospital Regional Universitario de Málaga-ARADyAL. Málaga, Spain.,Andalusian Center for Nanomedicine and Biotechnology-BIONAND. Malaga, Spain
| | - Maria I Montañez
- Allergy Research Group, Instituto de Investigacion Biomedica de Malaga-IBIMA-ARADyAL. Malaga, Spain.,Andalusian Center for Nanomedicine and Biotechnology-BIONAND. Malaga, Spain
| | - Raquel Jurado-Escobar
- Allergy Research Group, Instituto de Investigacion Biomedica de Malaga-IBIMA-ARADyAL. Malaga, Spain.,Universidad de Málaga, Málaga, Spain
| | - Violeta Gil-Ocaña
- Andalusian Center for Nanomedicine and Biotechnology-BIONAND. Malaga, Spain.,Department of Organic Chemistry, Universidad de Málaga, ARADyAL, Málaga, Spain
| | - Jose A Cornejo-García
- Allergy Research Group, Instituto de Investigacion Biomedica de Malaga-IBIMA-ARADyAL. Malaga, Spain
| |
Collapse
|
16
|
Abstract
Cumulative research over several decades has implicated the involvement of reactive metabolites in many idiosyncratic adverse drug reactions (IADRs). Consequently, "avoidance" strategies have been inserted into drug discovery paradigms, which include the exclusion of structural alerts and possible termination of reactive metabolite-positive compounds. Several noteworthy examples where reactive metabolite-related liabilities have been resolved through structure-metabolism studies are presented herein. Considerable progress has also been made in addressing the limitations of the avoidance strategy and further refining the process of managing reactive metabolite issues in drug development. These efforts primarily stemmed from the observation that numerous drugs, which contain structural alerts and/or form reactive metabolites, are devoid of ADRs. The Perspective also dwells into an analysis of the structural alert/reactive metabolite concept with a discussion of risk mitigation tactics to support the progression of reactive metabolite-positive drug candidates.
Collapse
Affiliation(s)
- Amit S Kalgutkar
- Medicine Design, Pfizer Worldwide Research, Development and Medical, 1 Portland Street, Cambridge, Massachusetts 02139, United States
| |
Collapse
|
17
|
Nunes J, Charneira C, Morello J, Rodrigues J, Pereira SA, Antunes AMM. Mass Spectrometry-Based Methodologies for Targeted and Untargeted Identification of Protein Covalent Adducts (Adductomics): Current Status and Challenges. High Throughput 2019; 8:ht8020009. [PMID: 31018479 PMCID: PMC6631461 DOI: 10.3390/ht8020009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 04/18/2019] [Accepted: 04/20/2019] [Indexed: 12/12/2022] Open
Abstract
Protein covalent adducts formed upon exposure to reactive (mainly electrophilic) chemicals may lead to the development of a wide range of deleterious health outcomes. Therefore, the identification of protein covalent adducts constitutes a huge opportunity for a better understanding of events underlying diseases and for the development of biomarkers which may constitute effective tools for disease diagnosis/prognosis, for the application of personalized medicine approaches and for accurately assessing human exposure to chemical toxicants. The currently available mass spectrometry (MS)-based methodologies, are clearly the most suitable for the analysis of protein covalent modifications, providing accuracy, sensitivity, unbiased identification of the modified residue and conjugates along with quantitative information. However, despite the huge technological advances in MS instrumentation and bioinformatics tools, the identification of low abundant protein covalent adducts is still challenging. This review is aimed at summarizing the MS-based methodologies currently used for the identification of protein covalent adducts and the strategies developed to overcome the analytical challenges, involving not only sample pre-treatment procedures but also distinct MS and data analysis approaches.
Collapse
Affiliation(s)
- João Nunes
- Centro de Química Estrutural, Instituto Superior Técnico, ULisboa, 1049-001 Lisboa, Portugal.
| | - Catarina Charneira
- Centro de Química Estrutural, Instituto Superior Técnico, ULisboa, 1049-001 Lisboa, Portugal.
| | - Judit Morello
- Centro de Química Estrutural, Instituto Superior Técnico, ULisboa, 1049-001 Lisboa, Portugal.
| | - João Rodrigues
- Clarify Analytical, Rua dos Mercadores 128A, 7000-872 Évora, Portugal.
| | - Sofia A Pereira
- CEDOC, Chronic Diseases Research Centre, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-006 Lisboa, Portugal.
| | - Alexandra M M Antunes
- Centro de Química Estrutural, Instituto Superior Técnico, ULisboa, 1049-001 Lisboa, Portugal.
| |
Collapse
|
18
|
Tugcu G, Sipahi H. QSPR modelling of in vitro degradation half-life of acyl glucuronides. Xenobiotica 2018; 49:1007-1014. [DOI: 10.1080/00498254.2018.1527049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Gulcin Tugcu
- Department of Toxicology, Yeditepe University, Istanbul, Turkey
| | - Hande Sipahi
- Department of Toxicology, Yeditepe University, Istanbul, Turkey
| |
Collapse
|
19
|
Kaliyaperumal K, Grove JI, Delahay RM, Griffiths WJH, Duckworth A, Aithal GP. Pharmacogenomics of drug-induced liver injury (DILI): Molecular biology to clinical applications. J Hepatol 2018; 69:948-957. [PMID: 29792895 DOI: 10.1016/j.jhep.2018.05.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 05/02/2018] [Accepted: 05/11/2018] [Indexed: 12/14/2022]
Abstract
A 21-year old woman was admitted to hospital with a two-week history of painless jaundice, fatigue and anorexia having previously been fit and well. One month prior to presentation, the patient had taken a five-day course of amoxicillin-clavulanic acid for an infected skin cyst. Otherwise, she was only on the oral contraceptive pill and reported minimal alcohol intake. On examination, she was deeply jaundiced, but alert and oriented with no asterixis. She had no stigmata of chronic liver disease, but hepatomegaly extending 3 cm from below the right subcostal margin was evident. Investigations showed: white cell count 13.4 × 109/L (normal 3.6-9.3), haemoglobin 11.8 g/dl (normal 11-15), platelet count 356 × 109/L (normal 170-420), sodium 138 mmol/L (normal 134-144), potassium 3.5 mmol/L (normal 3.5-5.0), creatinine 32 µmol/L (normal 40-75), albumin 30 g/L (normal 35-48), alanine aminotransferase 707 IU/L (normal 15-54), alkaline phosphatase 151 IU/L (normal 30-130), bilirubin 384 µmol/L (normal 7-31) and prothrombin time 27.2 s (normal 11.7-14). Screening for hepatitis A, B, C, E, Epstein-Barr virus, cytomegalovirus and autoimmune hepatitis was negative. Tests for anti-smooth muscle, antinuclear, and anti-liver-kidney microsomal-1 antibodies were negative; immunoglobulin levels and ceruloplasmin levels were normal. Liver ultrasonography demonstrated a liver of normal contour with no biliary dilatation, a normal spleen size and patent vessels. Liver biopsy revealed severe portal interface hepatitis with lobular inflammation and scant plasma cells. Her clinical condition deteriorated in the following days with prothrombin time and bilirubin rising to 56.6 s and 470 µmol/L, respectively. At follow-up after 11 days, her alanine aminotransferase level was 1,931 IU/L. She developed grade 2 hepatic encephalopathy 14 days after presentation, and was listed for a super-urgent liver transplant. Human leucocyte antigen (HLA) typing was performed as a part of preparatory investigations and showed the patient carried the HLA haplotype HLA-DRB1∗15:02-DQB1∗06:01. Following orthotopic transplantation of a deceased donor graft her explant histology revealed severe ongoing hepatitis with multi-acinar necrosis (Fig. 1A and B). This case raised a number of important questions about the diagnosis of drug-induced liver injury and tools available for clinicians to make the best decisions for patient care: In this Grand Rounds article, we will explore these questions, describing the pathophysiology, diagnostic and prognostic biomarkers, and clinical management of drug-induced liver injury. We will also discuss ongoing areas of uncertainty.
Collapse
Affiliation(s)
- Kalaiyarasi Kaliyaperumal
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
| | - Jane I Grove
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK; Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, UK
| | - Robin M Delahay
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK; Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, UK
| | | | - Adam Duckworth
- Department of Pathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Guruprasad P Aithal
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK; Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, UK.
| |
Collapse
|
20
|
Aycan İÖ, Elpek Ö, Akkaya B, Kıraç E, Tuzcu H, Kaya S, Coşkunfırat N, Aslan M. Diclofenac induced gastrointestinal and renal toxicity is alleviated by thymoquinone treatment. Food Chem Toxicol 2018; 118:795-804. [PMID: 29935248 DOI: 10.1016/j.fct.2018.06.038] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 06/11/2018] [Accepted: 06/18/2018] [Indexed: 02/06/2023]
Abstract
The aim of this study was to investigate whether thymoquinone (TQ) could alleviate diclofenac (DCLF)-induced gastrointestinal and renal toxicity in rats. Diclofenac was administered via intramuscular injection twice daily for 5 days and TQ was given by gavage for the same period. Hematological and biochemical profiles were measured with autoanalyzers while reactive oxygen/nitrogen species (ROS/RNS) generation and total antioxidant capacity (TAC) were assayed by standard kits. Tissue injuries were evaluated by microscopy and histopathological scoring. Diclofenac treatment caused kidney and liver function test abnormalities, reduced hematocrit and hemoglobin levels but increased WBC and platelet counts. Histopathological findings showed renal tubular damage, gastrointestinal lesions and increased fibrosis in DCLF treated rats. Thymoquinone administration, along with DCLF treatment, attenuated hematological test abnormalities and DCLF induced renal functional impairment as evident by significantly restored serum creatinine and blood urea nitrogen levels. Similarly, TQ treatment significantly alleviated liver function test abnormalities and decreased tissue injury in the stomach and duodenum. Diclofenac treatment caused increased ROS/RNS formation and decreased TAC in the kidney, stomach and duodenal tissue. Thymoquinone administration increased gastrointestinal and renal TAC in DCLF treated rats. These results indicate that TQ could ameliorate gastrointestinal and renal toxicity induced by high dose DCLF treatment.
Collapse
Affiliation(s)
- İlker Öngüç Aycan
- Department of Anesthesiology, Akdeniz University Medical Faculty, 07070, Antalya, Turkey.
| | - Özlem Elpek
- Department of Pathology, Akdeniz University Medical Faculty, 07070, Antalya, Turkey.
| | - Bahar Akkaya
- Department of Pathology, Akdeniz University Medical Faculty, 07070, Antalya, Turkey.
| | - Ebru Kıraç
- Department of Medical Biochemistry, Akdeniz University Medical Faculty, 07070, Antalya, Turkey.
| | - Hazal Tuzcu
- Department of Medical Biochemistry, Akdeniz University Medical Faculty, 07070, Antalya, Turkey.
| | - Sabriye Kaya
- Department of Medical Biochemistry, Akdeniz University Medical Faculty, 07070, Antalya, Turkey.
| | - Nesil Coşkunfırat
- Department of Anesthesiology, Akdeniz University Medical Faculty, 07070, Antalya, Turkey.
| | - Mutay Aslan
- Department of Medical Biochemistry, Akdeniz University Medical Faculty, 07070, Antalya, Turkey.
| |
Collapse
|
21
|
In vivo and in vitro diclofenac 5-hydroxylation mediated primarily by cytochrome P450 3A enzymes in common marmoset livers genotyped for P450 2C19 variants. Biochem Pharmacol 2018; 152:272-278. [DOI: 10.1016/j.bcp.2018.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/02/2018] [Indexed: 11/18/2022]
|
22
|
Claesson A, Minidis A. Systematic Approach to Organizing Structural Alerts for Reactive Metabolite Formation from Potential Drugs. Chem Res Toxicol 2018; 31:389-411. [DOI: 10.1021/acs.chemrestox.8b00046] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Alf Claesson
- Awametox AB, Lilldalsvägen 17 A, SE-14461 Rönninge, Sweden
| | | |
Collapse
|
23
|
Wilson CE, Dickie AP, Schreiter K, Wehr R, Wilson EM, Bial J, Scheer N, Wilson ID, Riley RJ. The pharmacokinetics and metabolism of diclofenac in chimeric humanized and murinized FRG mice. Arch Toxicol 2018; 92:1953-1967. [PMID: 29721588 DOI: 10.1007/s00204-018-2212-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/25/2018] [Indexed: 11/30/2022]
Abstract
The pharmacokinetics of diclofenac were investigated following single oral doses of 10 mg/kg to chimeric liver humanized and murinized FRG and C57BL/6 mice. In addition, the metabolism and excretion were investigated in chimeric liver humanized and murinized FRG mice. Diclofenac reached maximum blood concentrations of 2.43 ± 0.9 µg/mL (n = 3) at 0.25 h post-dose with an AUCinf of 3.67 µg h/mL and an effective half-life of 0.86 h (n = 2). In the murinized animals, maximum blood concentrations were determined as 3.86 ± 2.31 µg/mL at 0.25 h post-dose with an AUCinf of 4.94 ± 2.93 µg h/mL and a half-life of 0.52 ± 0.03 h (n = 3). In C57BL/6J mice, mean peak blood concentrations of 2.31 ± 0.53 µg/mL were seen 0.25 h post-dose with a mean AUCinf of 2.10 ± 0.49 µg h/mL and a half-life of 0.51 ± 0.49 h (n = 3). Analysis of blood indicated only trace quantities of drug-related material in chimeric humanized and murinized FRG mice. Metabolic profiling of urine, bile and faecal extracts revealed a complex pattern of metabolites for both humanized and murinized animals with, in addition to unchanged parent drug, a variety of hydroxylated and conjugated metabolites detected. The profiles in humanized mice were different to those of both murinized and wild-type animals, e.g., a higher proportion of the dose was detected in the form of acyl glucuronide metabolites and much reduced amounts as taurine conjugates. Comparison of the metabolic profiles obtained from the present study with previously published data from C57BL/6J mice and humans revealed a greater, though not complete, match between chimeric humanized mice and humans, such that the liver humanized FRG model may represent a model for assessing the biotransformation of such compounds in humans.
Collapse
Affiliation(s)
- C E Wilson
- Nestlé Skin Health R&D, Les Templiers, Route des Colles, BP 87, 06902, Sophia-Antipolis, France.
| | - A P Dickie
- Evotec (UK) Ltd, 114 Innovation Drive, Abingdon, Oxfordshire, OX14 4RZ, UK
| | - K Schreiter
- Evotec International GmbH, Manfred Eigen Campus, Essener Bogen 7, Hamburg, Germany
| | - R Wehr
- Evotec International GmbH, Manfred Eigen Campus, Essener Bogen 7, Hamburg, Germany
| | - E M Wilson
- Yecuris Corporation, PO Box 4645, Tualatin, OR, 97062, USA
| | - J Bial
- Yecuris Corporation, PO Box 4645, Tualatin, OR, 97062, USA
| | - N Scheer
- CEVEC Pharmaceuticals GmbH, Gottfried-Hagen-Str. 60-62, 51105, Cologne, Germany
| | - I D Wilson
- Department of Surgery and Cancer, Imperial College, Exhibition Rd, South Kensington, London, SW7 2AZ, UK
| | - R J Riley
- Evotec (UK) Ltd, Alderley Park, Nether Alderley, Cheshire, SK10 4TG, UK
| |
Collapse
|
24
|
Smith DA, Hammond T, Baillie TA. Safety Assessment of Acyl Glucuronides-A Simplified Paradigm. Drug Metab Dispos 2018; 46:908-912. [PMID: 29559442 DOI: 10.1124/dmd.118.080515] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 03/16/2018] [Indexed: 11/22/2022] Open
Abstract
While simple O- (ether-linked) and N-glucuronide drug conjugates generally are unreactive and considered benign from a safety perspective, the acyl glucuronides that derive from metabolism of carboxylic acid-containing xenobiotics can exhibit a degree of chemical reactivity that is dependent upon their molecular structure. As a result, concerns have arisen over the safety of acyl glucuronides as a class, several members of which have been implicated in the toxicity of their respective parent drugs. However, direct evidence in support of these claims remains sparse, and due to frequently encountered species differences in the systemic exposure to acyl glucuronides (both of the parent drug and oxidized derivatives thereof), coupled with their instability in aqueous media and potential to undergo chemical rearrangement (acyl migration), qualification of these conjugates by traditional safety assessment methods can be very challenging. In this Commentary, we discuss alternative (non-acyl glucuronide) mechanisms by which carboxylic acids may cause serious adverse reactions, and propose a novel, practical approach to compare systemic exposure to acyl glucuronide metabolites in humans to that in animal species used in preclinical safety assessment based on relative estimates of the total body burden of these circulating conjugates.
Collapse
Affiliation(s)
- Dennis A Smith
- 4 The Maltings, Walmer, Kent, United Kingdom (D.A.S.); Preclinical Safety Consulting Ltd., Loughborough, Leicestershire, United Kingdom (T.H.); and Department of Medicinal Chemistry, School of Pharmacy, University of Washington, Seattle, Washington (T.A.B.)
| | - Timothy Hammond
- 4 The Maltings, Walmer, Kent, United Kingdom (D.A.S.); Preclinical Safety Consulting Ltd., Loughborough, Leicestershire, United Kingdom (T.H.); and Department of Medicinal Chemistry, School of Pharmacy, University of Washington, Seattle, Washington (T.A.B.)
| | - Thomas A Baillie
- 4 The Maltings, Walmer, Kent, United Kingdom (D.A.S.); Preclinical Safety Consulting Ltd., Loughborough, Leicestershire, United Kingdom (T.H.); and Department of Medicinal Chemistry, School of Pharmacy, University of Washington, Seattle, Washington (T.A.B.)
| |
Collapse
|
25
|
Lazarska KE, Dekker SJ, Vermeulen NPE, Commandeur JNM. Effect of UGT2B7*2 and CYP2C8*4 polymorphisms on diclofenac metabolism. Toxicol Lett 2017; 284:70-78. [PMID: 29203276 DOI: 10.1016/j.toxlet.2017.11.038] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/23/2017] [Accepted: 11/28/2017] [Indexed: 02/06/2023]
Abstract
The use of diclofenac is associated with rare but severe drug-induced liver injury (DILI) in a very small number of patients. The factors which predispose susceptible patients to hepatotoxicity of diclofenac are still incompletely understood. Formation of protein-reactive metabolites by UDP-glucuronosyl transferases and cytochromes P450 is commonly considered to play an important role, as indicated by the detection of covalent protein adducts and antibodies in the serum of patients suffering from diclofenac-induced liver injury. Since no associations have been found with HLA-alleles, polymorphisms of genes encoding for proteins involved in the disposition of diclofenac may be important. Previous association studies showed that possession of the UGT2B7*2 and CYP2C8*4 alleles is more common in cases of diclofenac-induced DILI. In the present study, the metabolism of diclofenac by UGT2B7*2 and CYP2C8*4 was compared with their corresponding wild-type enzymes. Enzyme kinetic analysis revealed that recombinant UGT2B7*2 showed an almost 6-fold lower intrinsic clearance of diclofenac glucuronidation compared to UGT2B7*1. The mutant CYP2C8*4 showed approximately 35% reduced activity in the 4'-hydroxylation of diclofenac acyl glucuronide. Therefore, a decreased hepatic exposure to diclofenac acyl glucuronide is expected in patients with the UGT2B7*2 genotype. The increased risk for hepatotoxicity, therefore, might be the result from a shift to oxidative bioactivation to cytotoxic quinoneimines.
Collapse
Affiliation(s)
- Katarzyna E Lazarska
- AIMMS-Division of Molecular Toxicology, Department of Chemistry and Pharmaceutical sciences, Vrije Universiteit, De Boelelaan 1108, 1081 HZ, Amsterdam, The Netherlands
| | - Stefan J Dekker
- AIMMS-Division of Molecular Toxicology, Department of Chemistry and Pharmaceutical sciences, Vrije Universiteit, De Boelelaan 1108, 1081 HZ, Amsterdam, The Netherlands
| | - Nico P E Vermeulen
- AIMMS-Division of Molecular Toxicology, Department of Chemistry and Pharmaceutical sciences, Vrije Universiteit, De Boelelaan 1108, 1081 HZ, Amsterdam, The Netherlands
| | - Jan N M Commandeur
- AIMMS-Division of Molecular Toxicology, Department of Chemistry and Pharmaceutical sciences, Vrije Universiteit, De Boelelaan 1108, 1081 HZ, Amsterdam, The Netherlands.
| |
Collapse
|
26
|
Dickie A, Wilson C, Schreiter K, Wehr R, Wilson E, Bial J, Scheer N, Wilson I, Riley R. The pharmacokinetics and metabolism of lumiracoxib in chimeric humanized and murinized FRG mice. Biochem Pharmacol 2017; 135:139-150. [DOI: 10.1016/j.bcp.2017.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 03/21/2017] [Indexed: 10/19/2022]
|
27
|
Yip VLM, Meng X, Maggs JL, Jenkins RE, Marlot PT, Marson AG, Park BK, Pirmohamed M. Mass Spectrometric Characterization of Circulating Covalent Protein Adducts Derived from Epoxide Metabolites of Carbamazepine in Patients. Chem Res Toxicol 2017; 30:1419-1435. [DOI: 10.1021/acs.chemrestox.7b00063] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Vincent L. M. Yip
- MRC
Centre for Drug Safety Science, Department of Molecular and Clinical
Pharmacology, The University of Liverpool, Liverpool L69 3GE, United Kingdom
- The
Wolfson Centre for Personalized Medicine, Department of Molecular
and Clinical Pharmacology, The University of Liverpool, Liverpool L69 3GL, United Kingdom
| | - Xiaoli Meng
- MRC
Centre for Drug Safety Science, Department of Molecular and Clinical
Pharmacology, The University of Liverpool, Liverpool L69 3GE, United Kingdom
| | - James L. Maggs
- MRC
Centre for Drug Safety Science, Department of Molecular and Clinical
Pharmacology, The University of Liverpool, Liverpool L69 3GE, United Kingdom
| | - Rosalind E. Jenkins
- MRC
Centre for Drug Safety Science, Department of Molecular and Clinical
Pharmacology, The University of Liverpool, Liverpool L69 3GE, United Kingdom
| | - Philippe T. Marlot
- MRC
Centre for Drug Safety Science, Department of Molecular and Clinical
Pharmacology, The University of Liverpool, Liverpool L69 3GE, United Kingdom
- The
Wolfson Centre for Personalized Medicine, Department of Molecular
and Clinical Pharmacology, The University of Liverpool, Liverpool L69 3GL, United Kingdom
| | - Anthony G. Marson
- MRC
Centre for Drug Safety Science, Department of Molecular and Clinical
Pharmacology, The University of Liverpool, Liverpool L69 3GE, United Kingdom
| | - B. Kevin Park
- MRC
Centre for Drug Safety Science, Department of Molecular and Clinical
Pharmacology, The University of Liverpool, Liverpool L69 3GE, United Kingdom
| | - Munir Pirmohamed
- MRC
Centre for Drug Safety Science, Department of Molecular and Clinical
Pharmacology, The University of Liverpool, Liverpool L69 3GE, United Kingdom
- The
Wolfson Centre for Personalized Medicine, Department of Molecular
and Clinical Pharmacology, The University of Liverpool, Liverpool L69 3GL, United Kingdom
| |
Collapse
|
28
|
Vukmanović S, Sadrieh N. Skin sensitizers in cosmetics and beyond: potential multiple mechanisms of action and importance of T-cell assays for in vitro screening. Crit Rev Toxicol 2017; 47:415-432. [DOI: 10.1080/10408444.2017.1288025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Stanislav Vukmanović
- Cosmetics Division, Office of Cosmetics and Colors (OCAC), Center for Food Safety and Applied Nutrition (CFSAN), Food and Drug Administration (FDA), MD, USA
| | - Nakissa Sadrieh
- Cosmetics Division, Office of Cosmetics and Colors (OCAC), Center for Food Safety and Applied Nutrition (CFSAN), Food and Drug Administration (FDA), MD, USA
| |
Collapse
|
29
|
Sabbioni G, Turesky RJ. Biomonitoring Human Albumin Adducts: The Past, the Present, and the Future. Chem Res Toxicol 2017; 30:332-366. [PMID: 27989119 PMCID: PMC5241710 DOI: 10.1021/acs.chemrestox.6b00366] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Indexed: 12/21/2022]
Abstract
Serum albumin (Alb) is the most abundant protein in blood plasma. Alb reacts with many carcinogens and/or their electrophilic metabolites. Studies conducted over 20 years ago showed that Alb forms adducts with the human carcinogens aflatoxin B1 and benzene, which were successfully used as biomarkers in molecular epidemiology studies designed to address the role of these chemicals in cancer risk. Alb forms adducts with many therapeutic drugs or their reactive metabolites such as β-lactam antibiotics, acetylsalicylic acid, acetaminophen, nonsteroidal anti-inflammatory drugs, chemotherapeutic agents, and antiretroviral therapy drugs. The identification and characterization of the adduct structures formed with Alb have served to understand the generation of reactive metabolites and to predict idiosyncratic drug reactions and toxicities. The reaction of candidate drugs with Alb is now exploited as part of the battery of screening tools to assess the potential toxicities of drugs. The use of gas chromatography-mass spectrometry, liquid chromatography, or liquid chromatography-mass spectrometry (LC-MS) enabled the identification and quantification of multiple types of Alb xenobiotic adducts in animals and humans during the past three decades. In this perspective, we highlight the history of Alb as a target protein for adduction to environmental and dietary genotoxicants, pesticides, and herbicides, common classes of medicinal drugs, and endogenous electrophiles, and the emerging analytical mass spectrometry technologies to identify Alb-toxicant adducts in humans.
Collapse
Affiliation(s)
- Gabriele Sabbioni
- Institute of Environmental and Occupational Toxicology, CH-6780 Airolo, Switzerland
- Alpine Institute of Chemistry and Toxicology, CH-6718 Olivone, Switzerland
- Walther-Straub-Institut für Pharmakologie
und Toxikologie, Ludwig-Maximilians-Universität München, D-80336 München, Germany
| | - Robert J. Turesky
- Masonic Cancer Center and Department of
Medicinal Chemistry, College of Pharmacy, University of Minnesota, 2231 Sixth Street SE, Minneapolis, Minnesota 55455, United States
| |
Collapse
|
30
|
Gan J, Zhang H, Humphreys WG. Drug–Protein Adducts: Chemistry, Mechanisms of Toxicity, and Methods of Characterization. Chem Res Toxicol 2016; 29:2040-2057. [DOI: 10.1021/acs.chemrestox.6b00274] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Jinping Gan
- Department of Biotransformation, Bristol-Myers Squibb Pharmaceutical Company, Princeton, New Jersey 08540, United States
| | - Haiying Zhang
- Department of Biotransformation, Bristol-Myers Squibb Pharmaceutical Company, Princeton, New Jersey 08540, United States
| | - W. Griffith Humphreys
- Department of Biotransformation, Bristol-Myers Squibb Pharmaceutical Company, Princeton, New Jersey 08540, United States
| |
Collapse
|
31
|
Ogese MO, Ahmed S, Alferivic A, Betts CJ, Dickinson A, Faulkner L, French N, Gibson A, Hirschfield GM, Kammüller M, Meng X, Martin SF, Musette P, Norris A, Pirmohamed M, Park BK, Purcell AW, Spraggs CF, Whritenour J, Naisbitt DJ. New Approaches to Investigate Drug-Induced Hypersensitivity. Chem Res Toxicol 2016; 30:239-259. [DOI: 10.1021/acs.chemrestox.6b00333] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Monday O. Ogese
- Pathology Sciences, Drug Safety and Metabolism, AstraZeneca R&D, Darwin Building 310, Cambridge Science Park, Milton Road, Cambridge CB4 0WG, U.K
- MRC Centre for Drug Safety Science, Department of Molecular
and Clinical Pharmacology, University of Liverpool, Ashton Street, Liverpool L69 3GE, U.K
| | - Shaheda Ahmed
- Alcyomics
Ltd c/o Haematological Sciences, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne NE2 4HH, U.K
| | - Ana Alferivic
- MRC Centre for Drug Safety Science, Department of Molecular
and Clinical Pharmacology, University of Liverpool, Ashton Street, Liverpool L69 3GE, U.K
| | - Catherine J. Betts
- Pathology Sciences, Drug Safety and Metabolism, AstraZeneca R&D, Darwin Building 310, Cambridge Science Park, Milton Road, Cambridge CB4 0WG, U.K
| | - Anne Dickinson
- Alcyomics
Ltd c/o Haematological Sciences, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne NE2 4HH, U.K
| | - Lee Faulkner
- MRC Centre for Drug Safety Science, Department of Molecular
and Clinical Pharmacology, University of Liverpool, Ashton Street, Liverpool L69 3GE, U.K
| | - Neil French
- MRC Centre for Drug Safety Science, Department of Molecular
and Clinical Pharmacology, University of Liverpool, Ashton Street, Liverpool L69 3GE, U.K
| | - Andrew Gibson
- MRC Centre for Drug Safety Science, Department of Molecular
and Clinical Pharmacology, University of Liverpool, Ashton Street, Liverpool L69 3GE, U.K
| | - Gideon M. Hirschfield
- Centre for Liver Research, NIHR Birmingham Liver Biomedical
Research Unit, Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston, Birmingham B15 2TT, U.K
| | - Michael Kammüller
- Novartis Institutes for Biomedical Research, Klybeckstrasse 141, CH-4057 Basel, Switzerland
| | - Xiaoli Meng
- MRC Centre for Drug Safety Science, Department of Molecular
and Clinical Pharmacology, University of Liverpool, Ashton Street, Liverpool L69 3GE, U.K
| | - Stefan F. Martin
- Department of Dermatology and Venereology,
Allergy Research Group, University of Freiburg, Hauptstraße 7, 79104 Freiburg, Germany
| | - Philippe Musette
- Department of Dermatology and INSERM, University of Rouen, 905 Rouen, France
| | - Alan Norris
- MRC Centre for Drug Safety Science, Department of Molecular
and Clinical Pharmacology, University of Liverpool, Ashton Street, Liverpool L69 3GE, U.K
| | - Munir Pirmohamed
- MRC Centre for Drug Safety Science, Department of Molecular
and Clinical Pharmacology, University of Liverpool, Ashton Street, Liverpool L69 3GE, U.K
- The Wolfson Centre
for Personalised Medicine, Department of Molecular and Clinical Pharmacology, University of Liverpool, Ashton Street, Liverpool L69 3GE, U.K
| | - B. Kevin Park
- MRC Centre for Drug Safety Science, Department of Molecular
and Clinical Pharmacology, University of Liverpool, Ashton Street, Liverpool L69 3GE, U.K
| | - Anthony W. Purcell
- Infection and Immunity
Program and Department of Biochemistry and Molecular Biology, Biomedicine
Discovery Institute, Monash University, Clayton, Victoria 3800, Australia
| | - Colin F. Spraggs
- Medicines
Research Centre, GlaxoSmithKline, Gunnels Wood Road, Stevenage SG1 2NY, U.K
| | - Jessica Whritenour
- Drug Safety Research and Development, Pfizer, Eastern Point Road, Groton, Connecticut 06340, United States
| | - Dean J. Naisbitt
- MRC Centre for Drug Safety Science, Department of Molecular
and Clinical Pharmacology, University of Liverpool, Ashton Street, Liverpool L69 3GE, U.K
| |
Collapse
|
32
|
Tailor A, Waddington JC, Meng X, Park BK. Mass Spectrometric and Functional Aspects of Drug–Protein Conjugation. Chem Res Toxicol 2016; 29:1912-1935. [DOI: 10.1021/acs.chemrestox.6b00147] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Arun Tailor
- MRC Center
for Drug Safety
Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Sherrington Building, Ashton Street, Liverpool L69 3GE, United Kingdom
| | - James C. Waddington
- MRC Center
for Drug Safety
Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Sherrington Building, Ashton Street, Liverpool L69 3GE, United Kingdom
| | - Xiaoli Meng
- MRC Center
for Drug Safety
Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Sherrington Building, Ashton Street, Liverpool L69 3GE, United Kingdom
| | - B. Kevin Park
- MRC Center
for Drug Safety
Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Sherrington Building, Ashton Street, Liverpool L69 3GE, United Kingdom
| |
Collapse
|
33
|
Oda S, Shirai Y, Akai S, Nakajima A, Tsuneyama K, Yokoi T. Toxicological role of an acyl glucuronide metabolite in diclofenac-induced acute liver injury in mice. J Appl Toxicol 2016; 37:545-553. [PMID: 27671914 DOI: 10.1002/jat.3388] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/16/2016] [Accepted: 08/19/2016] [Indexed: 12/12/2022]
Abstract
The acyl glucuronide (AG) metabolites of carboxylic acid-containing drugs are potentially chemically reactive and are suggested to be implicated in toxicity, including hepatotoxicity, nephrotoxicity and drug hypersensitivity reactions. However, it remains unknown whether AG formation is related to toxicity in vivo. In this study, we sought to determine whether AG is involved in the pathogenesis of liver injury using a mouse model of diclofenac (DIC)-induced liver injury. Mice that were administered DIC alone exhibited significantly increased plasma alanine aminotransferase levels, whereas mice that were pretreated with the UDP-glucuronosyltransferase inhibitor (-)-borneol (BOR) exhibited suppressed alanine aminotransferase levels at 3 and 6 h after DIC administration although not significant at 12 h. The plasma DIC-AG concentrations were significantly lower in BOR- and DIC-treated mice than in mice treated with DIC alone. The mRNA expression levels of chemokine (C-X-C motif) ligand 1 (CXCL1), CXCL2 and the neutrophil marker CD11b were reduced in the livers of mice that had been pretreated with BOR compared to those that had been administered DIC alone, whereas mRNA expression of the macrophage marker F4/80 was not altered. An immunohistochemical analysis at 12 h samples revealed that the numbers of myeloperoxidase- and lymphocyte antigen 6 complex-positive cells that infiltrated the liver were significantly reduced in BOR- and DIC-treated mice compared to mice that were treated with DIC alone. These results indicate that DIC-AG is partly involved in the pathogenesis of DIC-induced acute liver injury in mice by activating innate immunity and neutrophils. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Shingo Oda
- Department of Drug Safety Sciences, Division of Clinical Pharmacology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Yuji Shirai
- Department of Drug Safety Sciences, Division of Clinical Pharmacology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Sho Akai
- Department of Drug Safety Sciences, Division of Clinical Pharmacology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Akira Nakajima
- Department of Drug Safety Sciences, Division of Clinical Pharmacology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Koichi Tsuneyama
- Department of Molecular and Environmental Pathology, Institute of Health Biosciences, Tokushima University Graduate School, Tokushima, 770-8503, Japan
| | - Tsuyoshi Yokoi
- Department of Drug Safety Sciences, Division of Clinical Pharmacology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| |
Collapse
|
34
|
Ikushiro S, Nishikawa M, Masuyama Y, Shouji T, Fujii M, Hamada M, Nakajima N, Finel M, Yasuda K, Kamakura M, Sakaki T. Biosynthesis of Drug Glucuronide Metabolites in the Budding Yeast Saccharomyces cerevisiae. Mol Pharm 2016; 13:2274-82. [DOI: 10.1021/acs.molpharmaceut.5b00954] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Shinichi Ikushiro
- Department
of Biotechnology, Faculty of Engineering, Toyama Prefectural University, 5180 Kurokawa, Imizu, Toyama 939-0398, Japan
| | - Miyu Nishikawa
- Department
of Biotechnology, Faculty of Engineering, Toyama Prefectural University, 5180 Kurokawa, Imizu, Toyama 939-0398, Japan
- Imizu
Institute, TOPU BIO RESEARCH Co., Ltd, 5180 Kurokawa, Imizu, Toyama 939-0398, Japan
| | - Yuuka Masuyama
- Department
of Biotechnology, Faculty of Engineering, Toyama Prefectural University, 5180 Kurokawa, Imizu, Toyama 939-0398, Japan
| | - Tadashi Shouji
- Department
of Biotechnology, Faculty of Engineering, Toyama Prefectural University, 5180 Kurokawa, Imizu, Toyama 939-0398, Japan
| | - Miharu Fujii
- Imizu
Institute, TOPU BIO RESEARCH Co., Ltd, 5180 Kurokawa, Imizu, Toyama 939-0398, Japan
| | - Masahiro Hamada
- Department
of Biotechnology, Faculty of Engineering, Toyama Prefectural University, 5180 Kurokawa, Imizu, Toyama 939-0398, Japan
| | - Noriyuki Nakajima
- Department
of Biotechnology, Faculty of Engineering, Toyama Prefectural University, 5180 Kurokawa, Imizu, Toyama 939-0398, Japan
| | - Moshe Finel
- Division
of Pharmaceutical Chemistry and Technology, University of Helsinki, P.O. Box 56, 00014 Helsinki, Finland
| | - Kaori Yasuda
- Department
of Biotechnology, Faculty of Engineering, Toyama Prefectural University, 5180 Kurokawa, Imizu, Toyama 939-0398, Japan
| | - Masaki Kamakura
- Department
of Biotechnology, Faculty of Engineering, Toyama Prefectural University, 5180 Kurokawa, Imizu, Toyama 939-0398, Japan
| | - Toshiyuki Sakaki
- Department
of Biotechnology, Faculty of Engineering, Toyama Prefectural University, 5180 Kurokawa, Imizu, Toyama 939-0398, Japan
- Imizu
Institute, TOPU BIO RESEARCH Co., Ltd, 5180 Kurokawa, Imizu, Toyama 939-0398, Japan
| |
Collapse
|
35
|
Characterization of cytochrome P450 isoforms involved in sequential two-step bioactivation of diclofenac to reactive p-benzoquinone imines. Toxicol Lett 2016; 253:46-54. [PMID: 27130197 DOI: 10.1016/j.toxlet.2016.04.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/08/2016] [Accepted: 04/22/2016] [Indexed: 11/23/2022]
Abstract
Idiosyncratic drug-induced lever injury (IDILI) is a rare but severe side effect of diclofenac (DF). Several mechanisms have been proposed as cause of DF-induced toxicity including the formation of protein-reactive diclofenac-1',4'-quinone imine (DF-1',4'-QI) and diclofenac-2,5-quinone imine (DF-2,5-QI). Formation of these p-benzoquinone imines result from two-step oxidative metabolism involving aromatic hydroxylation to 4'-hydroxydiclofenac and 5-hydroxydiclofenac followed by dehydrogenation to DF-1',4'-QI and DF-2,5-QI, respectively. Although the contribution of individual cytochrome P450s (CYPs) in aromatic hydroxylation of DF is well studied, the enzymes involved in the dehydrogenation reactions have been poorly characterized. The results of the present study show that both formation of 4'-hydroxydiclofenac and it subsequent bioactivation to DF-1',4'-QI is selectively catalyzed by CYP2C9. However, the two-step bioactivation to DF-2,5-QI appears to be catalyzed with highest activity by two different CYPs: 5-hydroxylation of DF is predominantly catalyzed by CYP3A4, whereas its subsequent bioactivation to DF-2,5-QI is catalyzed with 14-fold higher intrinsic clearance by CYP2C9. The fact that both CYPs involved in two-step bioactivation of DF show large interindividual variability may play a role in different susceptibility of patients to DF-induced IDILI. Furthermore, expression levels of these enzymes and protective enzymes might be important factors determining sensitivity of in vitro models for hepatotoxicity.
Collapse
|
36
|
Abstract
PURPOSE OF REVIEW The aim of the present review was to discuss recent advances supporting a role of drug metabolism, and particularly of the generation of reactive metabolites, in hypersensitivity reactions to drugs. RECENT FINDINGS The development of novel mass-spectrometry procedures has allowed the identification of reactive metabolites from drugs known to be involved in hypersensitivity reactions, including amoxicillin and nonsteroidal antiinflammatory drugs such as aspirin, diclofenac or metamizole. Recent studies demonstrated that reactive metabolites may efficiently bind plasma proteins, thus suggesting that drug metabolites, rather than - or in addition to - parent drugs, may elicit an immune response. As drug metabolic profiles are often determined by variability in the genes coding for drug-metabolizing enzymes, it is conceivable that an altered drug metabolism may predispose to the generation of reactive drug metabolites and hence to hypersensitivity reactions. These findings support the potential for the use of pharmacogenomics tests in hypersensitivity (type B) adverse reactions, in addition to the well known utility of these tests in type A adverse reactions. SUMMARY Growing evidence supports a link between genetically determined drug metabolism, altered metabolic profiles, generation of highly reactive metabolites and haptenization. Additional research is required to developing robust biomarkers for drug-induced hypersensitivity reactions.
Collapse
|
37
|
Yang X, Bartlett MG. Identification of protein adduction using mass spectrometry: Protein adducts as biomarkers and predictors of toxicity mechanisms. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2016; 30:652-664. [PMID: 26842586 DOI: 10.1002/rcm.7462] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/12/2015] [Accepted: 11/13/2015] [Indexed: 06/05/2023]
Abstract
The determination of protein-xenobiotic adducts using mass spectrometry is an emerging area which allows detailed understanding of the underlying mechanisms involved in toxicity. These approaches can also be used to reveal potential biomarkers of exposure or toxic response. The following review covers studies of protein adducts resulting from exposure to a wide variety of xenobiotics including organophosphates, polycyclic aromatic hydrocarbons, acetaminophen, alkylating agents and other related compounds.
Collapse
Affiliation(s)
- Xiangkun Yang
- Department of Pharmaceutical and Biomedical Sciences, College of Pharmacy, The University of Georgia, Athens, GA, 30602-2352, USA
| | - Michael G Bartlett
- Department of Pharmaceutical and Biomedical Sciences, College of Pharmacy, The University of Georgia, Athens, GA, 30602-2352, USA
| |
Collapse
|
38
|
Lee JJ, Seraj J, Yoshida K, Mizuguchi H, Strychor S, Fiejdasz J, Faulkner T, Parise RA, Fawcett P, Pollice L, Mason S, Hague J, Croft M, Nugteren J, Tedder C, Sun W, Chu E, Beumer JH. Human mass balance study of TAS-102 using (14)C analyzed by accelerator mass spectrometry. Cancer Chemother Pharmacol 2016; 77:515-26. [PMID: 26787503 DOI: 10.1007/s00280-016-2965-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 01/05/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND TAS-102 is an oral fluoropyrimidine prodrug composed of trifluridine (FTD) and tipiracil hydrochloride (TPI) in a 1:0.5 ratio. FTD is a thymidine analog, and it is degraded by thymidine phosphorylase (TP) to the inactive trifluoromethyluracil (FTY) metabolite. TPI inhibits degradation of FTD by TP, increasing systemic exposure to FTD. METHODS Patients with advanced solid tumors (6 M/2 F; median age 58 years; PS 0-1) were enrolled on this study. Patients in group A (N = 4) received 60 mg TAS-102 with 200 nCi [(14)C]-FTD, while patients in group B (N = 4) received 60 mg TAS-102 with 1000 nCi [(14)C]-TPI orally. Plasma, blood, urine, feces, and expired air (group A only) were collected up to 168 h and were analyzed for (14)C by accelerator mass spectrometry and analytes by LC-MS/MS. RESULTS FTD: 59.8% of the (14)C dose was recovered: 54.8% in urine mostly as FTY and FTD glucuronide isomers. The extractable radioactivity in the pooled plasma consisted of 52.7% FTD and 33.2% FTY. TPI: 76.8% of the (14)C dose was recovered: 27.0% in urine mostly as TPI and 49.7% in feces. The extractable radioactivity in the pooled plasma consisted of 53.1% TPI and 30.9% 6-HMU, the major metabolite of TPI. CONCLUSION Absorbed (14)C-FTD was metabolized and mostly excreted in urine. The majority of (14)C-TPI was recovered in feces, and the majority of absorbed TPI was excreted in urine. The current data with the ongoing hepatic and renal dysfunction studies will provide an enhanced understanding of the TAS-102 elimination profile.
Collapse
Affiliation(s)
- James J Lee
- Cancer Therapeutics Program, University of Pittsburgh Cancer Institute, Hillman Research Pavilion, Suite G27E, 5117 Centre Avenue, Pittsburgh, PA, 15213, USA.,Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | | | | | - Sandra Strychor
- Cancer Therapeutics Program, University of Pittsburgh Cancer Institute, Hillman Research Pavilion, Suite G27E, 5117 Centre Avenue, Pittsburgh, PA, 15213, USA
| | - Jillian Fiejdasz
- Clinical Research Services, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Tyeler Faulkner
- Clinical Research Services, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Robert A Parise
- Cancer Therapeutics Program, University of Pittsburgh Cancer Institute, Hillman Research Pavilion, Suite G27E, 5117 Centre Avenue, Pittsburgh, PA, 15213, USA
| | - Patrick Fawcett
- Clinical Research Services, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Laura Pollice
- Clinical Research Services, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Scott Mason
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | | | | | - Weijing Sun
- Cancer Therapeutics Program, University of Pittsburgh Cancer Institute, Hillman Research Pavilion, Suite G27E, 5117 Centre Avenue, Pittsburgh, PA, 15213, USA.,Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Edward Chu
- Cancer Therapeutics Program, University of Pittsburgh Cancer Institute, Hillman Research Pavilion, Suite G27E, 5117 Centre Avenue, Pittsburgh, PA, 15213, USA.,Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jan Hendrik Beumer
- Cancer Therapeutics Program, University of Pittsburgh Cancer Institute, Hillman Research Pavilion, Suite G27E, 5117 Centre Avenue, Pittsburgh, PA, 15213, USA. .,Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. .,Department of Pharmaceutical Sciences, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA.
| |
Collapse
|
39
|
Thompson RA, Isin EM, Ogese MO, Mettetal JT, Williams DP. Reactive Metabolites: Current and Emerging Risk and Hazard Assessments. Chem Res Toxicol 2016; 29:505-33. [DOI: 10.1021/acs.chemrestox.5b00410] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Richard A. Thompson
- DMPK, Respiratory, Inflammation & Autoimmunity iMed, AstraZeneca R&D, 431 83 Mölndal, Sweden
| | - Emre M. Isin
- DMPK, Cardiovascular & Metabolic Diseases iMed, AstraZeneca R&D, 431 83 Mölndal, Sweden
| | - Monday O. Ogese
- Translational Safety, Drug Safety and Metabolism, AstraZeneca R&D, Darwin Building 310, Cambridge Science Park, Milton Rd, Cambridge CB4 0FZ, United Kingdom
| | - Jerome T. Mettetal
- Translational Safety, Drug Safety and Metabolism, AstraZeneca R&D, 35 Gatehouse Dr, Waltham, Massachusetts 02451, United States
| | - Dominic P. Williams
- Translational Safety, Drug Safety and Metabolism, AstraZeneca R&D, Darwin Building 310, Cambridge Science Park, Milton Rd, Cambridge CB4 0FZ, United Kingdom
| |
Collapse
|
40
|
Zhang Y, Han YH, Putluru SP, Matta MK, Kole P, Mandlekar S, Furlong MT, Liu T, Iyer RA, Marathe P, Yang Z, Lai Y, Rodrigues AD. Diclofenac and Its Acyl Glucuronide: Determination of In Vivo Exposure in Human Subjects and Characterization as Human Drug Transporter Substrates In Vitro. ACTA ACUST UNITED AC 2015; 44:320-8. [PMID: 26714763 DOI: 10.1124/dmd.115.066944] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 12/28/2015] [Indexed: 01/05/2023]
Abstract
Although the metabolism and disposition of diclofenac (DF) has been studied extensively, information regarding the plasma levels of its acyl-β-d-glucuronide (DF-AG), a major metabolite, in human subjects is limited. Therefore, DF-AG concentrations were determined in plasma (acidified blood derived) of six healthy volunteers following a single oral DF dose (50 mg). Levels of DF-AG in plasma were high, as reflected by a DF-AG/DF ratio of 0.62 ± 0.21 (Cmax mean ± S.D.) and 0.84 ± 0.21 (area under the concentration-time curve mean ± S.D.). Both DF and DF-AG were also studied as substrates of different human drug transporters in vitro. DF was identified as a substrate of organic anion transporter (OAT) 2 only (Km = 46.8 µM). In contrast, DF-AG was identified as a substrate of numerous OATs (Km = 8.6, 60.2, 103.9, and 112 µM for OAT2, OAT1, OAT4, and OAT3, respectively), two organic anion-transporting polypeptides (OATP1B1, Km = 34 µM; OATP2B1, Km = 105 µM), breast cancer resistance protein (Km = 152 µM), and two multidrug resistance proteins (MRP2, Km = 145 µM; MRP3, Km = 196 µM). It is concluded that the disposition of DF-AG, once formed, can be mediated by various candidate transporters known to be expressed in the kidney (basolateral, OAT1, OAT2, and OAT3; apical, MRP2, BCRP, and OAT4) and liver (canalicular, MRP2 and BCRP; basolateral, OATP1B1, OATP2B1, OAT2, and MRP3). DF-AG is unstable in plasma and undergoes conversion to parent DF. Therefore, caution is warranted when assessing renal and hepatic transporter-mediated drug-drug interactions with DF and DF-AG.
Collapse
Affiliation(s)
- Yueping Zhang
- Pharmaceutical Candidate Optimization, Bristol-Myers Squibb Company, Princeton, New Jersey
| | - Yong-Hae Han
- Pharmaceutical Candidate Optimization, Bristol-Myers Squibb Company, Princeton, New Jersey
| | - Siva Prasad Putluru
- Pharmaceutical Candidate Optimization, Bristol-Myers Squibb Company, Princeton, New Jersey
| | - Murali Krishna Matta
- Pharmaceutical Candidate Optimization, Bristol-Myers Squibb Company, Princeton, New Jersey
| | - Prashant Kole
- Pharmaceutical Candidate Optimization, Bristol-Myers Squibb Company, Princeton, New Jersey
| | - Sandhya Mandlekar
- Pharmaceutical Candidate Optimization, Bristol-Myers Squibb Company, Princeton, New Jersey
| | - Michael T Furlong
- Pharmaceutical Candidate Optimization, Bristol-Myers Squibb Company, Princeton, New Jersey
| | - Tongtong Liu
- Pharmaceutical Candidate Optimization, Bristol-Myers Squibb Company, Princeton, New Jersey
| | - Ramaswamy A Iyer
- Pharmaceutical Candidate Optimization, Bristol-Myers Squibb Company, Princeton, New Jersey
| | - Punit Marathe
- Pharmaceutical Candidate Optimization, Bristol-Myers Squibb Company, Princeton, New Jersey
| | - Zheng Yang
- Pharmaceutical Candidate Optimization, Bristol-Myers Squibb Company, Princeton, New Jersey
| | - Yurong Lai
- Pharmaceutical Candidate Optimization, Bristol-Myers Squibb Company, Princeton, New Jersey
| | - A David Rodrigues
- Pharmaceutical Candidate Optimization, Bristol-Myers Squibb Company, Princeton, New Jersey
| |
Collapse
|
41
|
Kowalski ML, Woessner K, Sanak M. Approaches to the diagnosis and management of patients with a history of nonsteroidal anti-inflammatory drug-related urticaria and angioedema. J Allergy Clin Immunol 2015; 136:245-51. [PMID: 26254051 DOI: 10.1016/j.jaci.2015.06.021] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 06/09/2015] [Accepted: 06/12/2015] [Indexed: 12/13/2022]
Abstract
Nonsteroidal anti-inflammatory drug (NSAID)-induced urticarial and angioedema reactions are among the most commonly encountered drug hypersensitivity reactions in clinical practice. Three major clinical phenotypes of NSAID-induced acute skin reactions manifesting with angioedema, urticaria, or both have been distinguished: NSAID-exacerbated cutaneous disease, nonsteroidal anti-inflammatory drug-induced urticaria/angioedema (NIUA), and single NSAID-induced urticaria and angioedema. In some patients clinical history alone might be sufficient to establish the diagnosis of a specific type of NSAID hypersensitivity, whereas in other cases oral provocation challenges are necessary to confirm the diagnosis. Moreover, classification of the type of cutaneous reaction is critical for proper management. For example, in patients with single NSAID-induced reactions, chemically nonrelated COX-1 inhibitors can be safely used. However, there is cross-reactivity between the NSAIDs in patients with NSAID-exacerbated cutaneous disease and NIUA, and thus only use of selective COX-2 inhibitors can replace the culprit drug if the chronic treatment is necessary, although aspirin desensitization will allow for chronic treatment with NSAIDs in some patients with NIUA. In this review we present a practical clinical approach to the patient with NSAID-induced urticaria and angioedema.
Collapse
Affiliation(s)
- Marek L Kowalski
- Department of Immunology, Rheumatology and Allergy, Medical University of Lodz, Lodz, Poland.
| | | | - Marek Sanak
- Department of Medicine, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|