Drug control of steroid metabolism by the hepatic endoplasmic reticulum

Use of antidepressants and the risk of breast cancer: a meta-analysis

The goal of this study was to perform a meta-analysis to examine the association between the use of antidepressants (AD) and the risk of breast cancer. We searched the EMBASE and MEDLINE databases from inception through February 25, 2012, using search terms related to ADs and breast cancer. Two evaluators independently reviewed and selected articles and extracted data based on predetermined selection criteria. Pooled effect estimates were obtained by using random- and fixed effects meta-analyses. Of the 3,209 titles identified, 18 articles met the inclusion criteria. The overall risk of breast cancer did not increase among AD users [adjusted odds ratio (aOR) 1.02; 95 % CI 0.96-1.08]. Those who took tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs) were not at increased risks of breast cancer. In subgroup meta-analyses, null associations were consistent across the type of AD, funding sources, the number of adjusted variables, medication dose, the ascertainment of exposure, and methodological quality. In subgroup analyses based on exposure duration, a marginal association was observed for the use of SSRIs < 1-2 years (aOR 1.10; 95 % CI 1.02-1.19). However, this effect was attenuated over time and those using SSRIs for more than 1-2 years had no elevated breast cancer risk. These results support the lack of a clinically meaningful association between AD use and the development of breast cancer and provide considerable reassurance. Given that the data collected to date do not support changing the current prescribing patterns for ADs, the important benefits of AD therapy must be considered.

A Toxicologist's Guide to the Preclinical Assessment of Hepatic Microsomal Enzyme Induction

The assessment of hepatic microsomal enzyme induction at the completion of preclinical toxicology studies in rodents and large mammals provides a wealth of information to the toxicologist and pharmacokineticist regarding how the drug-metabolizing system of the hepatocyte endoplasmic reticulum responded to high-dose levels of a xenobiotic designed for a specific pharmacological target in any of several target organs. The interpretation of these data can be greatly enhanced by a clear understanding of how this system functions and what the immediate and long-term ramifications are to organs and organ systems. This review focuses on how drugs modify the hepatic cytochrome P450 system, how those modifications are detected, the various consequences of these modifications, and some differences in the induction response among species.

Steroid hormone biotransformation and xenobiotic induction of hepatic steroid metabolizing enzymes

Normal reproductive development depends on the interplay of steroid hormones with their receptors at specific tissue sites. The concentrations of hormone ligands in the circulation and at target sites are maintained through coordinated regulation on steroid biosynthesis and degradation. Changed bioavailability of steroids, through alteration of steroidogenesis or biotransformation rates, leads to changes in endocrine function. Steroid hormones lose their receptor reactivity in most cases when they are bound to binding proteins, while metabolic conversion can result in either active or inactive metabolites. Hydroxylation by cytochrome P450 (CYP) enzymes and conjugation with glucuronide and sulfate are among the major hepatic pathways of steroid inactivation. The expression of these biotransformation enzymes can be induced by many xenobiotics. The barbiturate phenobarbital and the environmental toxicant 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (DDE) are among the well characterized inducers for the CYP 2B and 3A enzymes and selected conjugation enzymes. The induction of the steroid biotransformation enzymes is partly mediated through the activation of a group of nuclear receptors including the glucocorticoid receptor, the constitutive androstane receptor (CAR), the pregnane X receptor (PXR), and the peroxisome proliferator activated receptors (PPAR). Drug or chemical-induced increases in hepatic enzyme activities are often a basis for drug-drug interactions that lead to enhanced elimination and reduced therapeutic efficacy of steroidal drugs. The effects of enzyme induction on endogenous steroid clearance, along with its possible consequence, are less well understood. While enzyme induction by xenobiotics may increase clearance of the endogenous steroid, regulatory mechanisms for steroid homeostasis may adapt and compensate for altered clearance.

Determination of progesterone in commercial formulations and in non conventional micellar systems

Progesterone was determined in commercial pharmaceutical formulations and experimental micellar systems by means of two analytical methods based on liquid chromatography and derivative spectrophotometry. The chromatographic analysis, with ultraviolet detection at 245 nm, was carried out on a C8 column using a mobile phase composed of 2-propanol and a pH 2.5, 30 mM phosphate buffer. Derivative spectrophotometry (DS) used the difference between the values of the first derivative at 227.2 and 253.6 nm. Both methods require only a simple extraction procedure of progesterone from the formulations before analysis. The high-performance liquid chromatography (HPLC) procedure allows for the quantitative determination of progesterone in all pharmaceutical formulations tested (oily and alcoholic injectable solutions, gel preparations and soft capsules) and also of the newly-developed polymeric micellar system. On the contrary, the derivative spectrophotometric method is not suitable for the pharmaceutical formulation containing estradiol and for the new micellar systems. The results obtained with the two methods are in good agreement and always satisfactory in terms of precision and accuracy.

Critical period of carbon tetrachloride-induced pregnancy loss in Fischer-344 rats, with insights into the detection of resorption sites by ammonium sulfide staining

Several low-molecular weight halocarbons have been shown to cause full-litter resorption (FLR), i.e., pregnancy loss, in Fischer-344 rats treated during organogenesis. To determine periods of gestation sensitive to acute exposure, a single dose of 150 mg carbon tetrachloride (CCl4)/kg was administered on gestation day (GD) 6, 7, 8, 10, or 12. Fetuses were delivered by cesarean section on GD 20. Non-gravid uteri were examined for resorption sites, placed in 10% ammonium sulfide, and re-examined for stained resorption sites approximately 1 and 4.5 hr later. FLR was seen in 4% (1/27) of control dams and 36% (4/11), 54% (7/13), 72% (18/25), 54% (7/13), and 0% (0/12) of dams treated on GD 6, 7, 8, 10, and 12, respectively. Ammonium sulfide staining clearly yielded a more accurate account of the incidence of FLR. The technique was most effective when the staining period was extended to 4.5 hr, as two cases of FLR were revealed that had been undetected after 1 hr of staining. For dams with FLR, staining was required to detect resorption sites in all dams treated on GD 6 or 7, most dams treated on GD 8, and one dam treated on GD 10. Fewer implantation sites were detected in the dams treated on GD 6, and the size of the stained resorption sites increased as the day of treatment was delayed. These findings demonstrate a relationship between the time of toxicant exposure and the size and detectability of resorption sites near term, suggesting that the size of the resorption site may reliably reflect the time of embryonic death. Treatment on GD 8 caused the highest incidence of FLR and will be used in subsequent mechanistic research.

Self-reported use of antidepressants or benzodiazepine tranquilizers and risk of epithelial ovarian cancer: evidence from two combined case-control studies (Massachusetts, United States)

Data from two population-based case-control studies in the greater metropolitan Boston, MA (USA) were used to assess the association of self-reported use of antidepressants or benzodiazepine tranquilizers and epithelial ovarian cancer. Cases were women between 18 and 80 years of age diagnosed with epithelial ovarian cancer during two time periods: November 1978 through September 1981, and July 1984 through September 1987. Female controls were identified from Massachusetts town books and were frequency-matched to cases by age, race, and precinct of residence. In-person interviews assessed reproductive and medical histories as well as prescription medication use. Prior use of antidepressants or benzodiazepine tranquilizers exceeding one to six months was associated with an increased risk of ovarian cancer (adjusted odds ratio [OR] = 2.1, 95% confidence interval [CI] = 0.9-4.8, and adjusted OR = 1.8, CI = 1.0-3.1, respectively). The association was confined primarily to women whose first use occurred before age 50 years (adjusted OR = 3.5, CI = 1.3-9.2, and adjusted OR = 2.7, CI = 1.3-5.6, respectively). No association was observed with respect to other non-hormonal medications reported.

Effect of oral contraceptive steroids on the pharmacokinetics of phenprocoumon

1. The effect of chronic administration of oral contraceptive steroids (OCS) on the pharmacokinetics of the oral anticoagulant phenprocoumon was investigated in seven healthy females. 2. Plasma concentrations of phenprocoumon and the urinary recovery of unchanged as well as conjugated drug were measured following a single oral dose of 0.22 mg kg-1. A group of seven non-smoking, drug-free women matched for age and body weight served as controls. 3. Administration of OCS was associated with a significant increase in the clearance of phenprocoumon from 1.6 +/- 0.7 to 2.0 +/- 0.7 ml min-1 kg-1 (P less than 0.05). The urinary recovery of phenprocoumon glucuronide was significantly higher in OCS users (21.0 +/- 16 vs 14.0 +/- 10 (% of dose); P less than 0.05). No difference in plasma protein binding of phenprocoumon was observed, being 99.2 +/- 0.07 in both groups. 4. The accelerated glucuronidation of phenprocoumon in OCS users suggests the need for careful monitoring of the anticoagulatory response in these subjects, especially when the OCS are withdrawn.

Induction of 2-carboxybenzaldehyde reductase by phenobarbital in primary culture of rat hepatocytes

When rats were treated with phenobarbital (PB), the activity of CBA reductase, which catalyzes the conversion of 2-carboxybenzaldehyde (CBA) to 2-hydroxymethylbenzoic acid (HMB), in the liver was markedly enhanced. Likewise, addition of PB to the primary culture of rat hepatocytes increased the activity of CBA reductase. The enzyme recovered from cell lysate of cultured cells showed the same characteristics in molecular and catalytic properties as the enzyme purified from the livers of the rats treated with PB. Experiments with cycloheximide suggest that de novo synthesis of the enzyme protein is enhanced by PB in primary culture.

Effects of oral contraceptive steroids (norethisterone/mestranol) on the activities of hepatic drug-metabolizing enzymes in iron-deficient anemic rats

Either oral contraceptive steroid (norethisterone/mestranol; N/M) treatment or iron-deficiency (Fe(-] anemia alone caused an increase in NADPH cytochrome c reductase and in three hepatic microsomal mixed-function oxidase activities in female rats. When N/M treatment and the Fe(-) diet are combined, no further change in hepatic enzyme activity is seen compared with that with either treatment alone.