Anti-cytochrome P450 autoantibodies in drug-induced disease

Drugs may induce hepatitis through immune mechanisms. In this review we have used the examples of 2 drugs to elucidate the first steps leading to the triggering of such disease, namely tienilic acid (TA) and dihydralazine (DH). These drugs are transformed into reactive metabolite(s) by cytochrome P450 (2C9 for TA and 1A2 for DH) (step 1). The reactive metabolites produced are very short-lived and bind directly to the enzymes which generated them (step 2). A neoantigen is thus formed which triggers an immune response (step 3), characterized by the presence of autoantibodies in the patient's serum (step 4). The autoantibodies are directed against the cytochrome P450 which generated the metabolite(s). Although the process by which TA and DH induce-hepatitis has been elucidated, further studies are necessary to generalize this mechanism. In addition, an animal model will also be useful to fully understand the immune mechanism of this type of disease.

Oxidation of tienilic acid by human yeast-expressed cytochromes P-450 2C8, 2C9, 2C18 and 2C19. Evidence that this drug is a mechanism-based inhibitor specific for cytochrome P-450 2C9

Oxidation of tienilic acid by human cytochromes P-450 (CYP) 2C9, 2C18, 2C8 and 2C19 was studied using recombinant enzymes expressed in yeast. CYP 2C9 was the best catalyst for 5-hydroxylation of tienilic acid (K(m) = 5 +/- 1 microM, kcat = 1.7 +/- 0.2 min-1), 30-fold more potent in terms of kcat/K(m) than CYP 2C18 (K(m) = 150 +/- 15 microM, kcat = 1.8 +/- 0.2 min-1) and 300-fold more potent than CYP 2C8 (K(m) = 145 +/- 15 microM, kcat = 0.2 +/- 0.1 min-1). CYP 2C19 was unable to catalyze this hydroxylation under our experimental conditions. During this study, a marked effect of the ionic strength on the activities (hydroxylations of tienilic acid and tolbutamide) of these cytochromes P-450 expressed in the yeast strain 334 was observed. The effect was particularly great in the case of CYP 2C18, with a tenfold decrease of activity upon increasing ionic strength from 0.02 to 0.1. Specific-covalent binding of tienilic acid metabolites to cytochrome P-450 (incubations in the presence of 5 mM glutathione) was markedly higher upon tienilic acid oxidation by CYP 2C9 than by CYP 2C18 and CYP 2C8. Mechanism-based inactivation of cytochrome P-450 during tienilic acid oxidation was observed in the case of CYP 2C9 but was not detectable with CYP 2C18 and CYP 2C8. Tienilic acid thus appears to be a mechanism-based inhibitor specific for CYP 2C9 in human liver. Experiments performed with human liver microsomes confirmed that tienilic acid 5-hydroxylase underwent a time-dependent inactivation (apparent t1/2 = 10 +/- 5 min) during 5-hydroxylation of tienilic acid.

Antigenic targets in tienilic acid hepatitis. Both cytochrome P450 2C11 and 2C11-tienilic acid adducts are transported to the plasma membrane of rat hepatocytes and recognized by human sera

Patients with tienilic acid hepatitis exhibit autoantibodies that recognize unalkylated cytochrome P450 2C9 in humans but recognize 2C11 in rats. Our aim was to determine whether the immune reaction is also directed against neoantigens. Rats were treated with tienilic acid and hepatocytes were isolated. Immunoprecipitation, immunoblotting, and flow cytometry experiments were performed with an anti-tienilic acid or an anti-cytochrome P450 2C11 antibody. Cytochrome P450 2C11 was the main microsomal or plasma membrane protein that was alkylated by tienilic acid. Inhibitors of vesicular transport decreased flow cytometric recognition of both unalkylated and tienilic acid-alkylated cytochrome P450 2C11 on the plasma membrane of cultured hepatocytes. Tienilic acid hepatitis sera that were preadsorbed on microsomes from untreated rats (to remove autoantibodies), poorly recognized untreated hepatocytes in flow cytometry experiments, but better recognized tienilic acid-treated hepatocytes. This recognition was decreased by adsorption with tienilic acid or by preexposure to the anti-tienilic acid or the anti-cytochrome P450 2C11 antibody. We conclude that cytochrome P450 2C11 is alkylated by tienilic acid and follows a vesicular route to the plasma membrane. Tienilic acid hepatitis sera contain antibodies against this tienilic acid adduct, in addition to the previously described anticytochrome P450 autoantibodies.

Hepatotoxicity of germander in mice

BACKGROUND/AIMS

An epidemic of hepatitis due to germander teas or capsules recently occurred in France. The aim of the present study was to show the hepatotoxicity of germander and determine its mechanism in mice.

METHODS

A germander tea lyophilisate and a fraction that isolated and concentrated 10-fold the furano neo-clerodane diterpenoids of the lyophilisate were prepared.

RESULTS

(1) Intragastric administration of the lyophilisate (1.25 g/kg) or the furano neo-clerodane diterpenoid fraction (0.125 mg/kg) produced similar midzonal liver cell necrosis at 24 hours in mice. (2) Toxicity was prevented by pretreatment with a single dose of troleandomycin (a specific inhibitor of cytochromes P4503A) and enhanced by pretreatment with dexamethasone or clotrimazole (two inducers of cytochromes P4503A). (3) Toxicity was attenuated by pretreatment with butylated hydroxyanisole or clofibrate (two inducers of microsomal epoxide hydrolase) and markedly increased by phorone-induced glutathione depletion.

CONCLUSIONS

We conclude that germander constituents (probably its furano neo-clerodane diterpenoids) are transformed by cytochromes P450 (particularly P4503A) into hepatotoxic metabolites. The metabolites (probably epoxides) are partly inactivated by glutathione and probably epoxide hydrolase.

Genetic predisposition to drug hepatotoxicity: role in hepatitis caused by amineptine, a tricyclic antidepressant

Amineptine-induced immunoallergic hepatitis is unpredictable. It may be related to its oxidation into a reactive metabolite acting as hapten. We have looked for a possible genetic predisposition involving drug oxidation capacity and/or cell defense mechanisms in nine patients with previous amineptine hepatitis. Drug oxidation capacity was assessed using dextromethorphan, a test compound recently proposed as a substitute for debrisoquine. The eight patients tested had the extensive metabolizer phenotype. The susceptibility to amineptine metabolites was studied by an in vitro test assessing the destruction of the patients' lymphocytes by reactive metabolites generated from amineptine by a standardized oxidation microsomal system. Lymphocyte death increased with the dose of amineptine (1 to 2.5 mM); it was increased by preincubation with trichloropropene oxide, but was absent when amineptine was omitted or when the oxidation system was not operating. Mean lymphocyte death was twice higher in the nine patients with amineptine hepatitis than in 17 healthy controls. In contrast, when the test was performed with acetaminophen (3 to 10 mM), lymphocyte death was similar in controls and in patients. Basal epoxide hydrolase activity toward benzo[a]pyrene-4,5-oxide and glutathione concentration was similar in lymphocytes from controls and patients. Family studies showed an increased susceptibility to amineptine metabolites in lymphocytes from several first-degree relatives of two patients. These results show that amineptine hepatitis occurs in patients with extensive dextromethorphan oxidation capacity but with an increased susceptibility to amineptine reactive metabolites, probably related to a genetic deficiency in a cell defense mechanism.

Ontogeny of benzo(a)pyrene hydroxylase, epoxide hydrolase and glutathione-S transferase in the brain, lung and liver of C57Bl/6 mice

Typical developmental patterns of three drug-metabolizing enzymes in C57Bl/6 mouse brain, lung and liver could be divided into three stages: stage I, at the end of intrauterine life, where an increase in enzymatic activity was observed; stage II, during the first days after birth, where a decrease was seen; and stage III from the 6th day until weaning, where there was a gradual increase, reaching the same values as in the adult animal. However, pulmonary benzo(a)pyrene hydroxylase activity showed an abrupt burst starting on day 6 of postnatal life, then decreased slowly to become steady, and finally increased again. Our data show that the major metabolic pathways catalyzed by glutathione-S transferase and epoxide hydrolase are operative in mouse fetal brain and lung, just as in liver. In addition, we show that enzymatic systems are inducible during fetal life by exogenous compounds such as 5,6-benzoflavone. The early developmental evolution of the drug-metabolizing enzymes should help understand feto-toxicological and teratological phenomena.

Endogenous induction of epoxide hydrolase, benzo(a)pyrene hydroxylase and glutathione-S-transferase in "responsive" C57Bl/6 mice and in "nonresponsive" DBA/2 mice during pregnancy

Gestational changes in activity for three enzymes associated with different hepatic and pulmonary drug metabolizing systems were investigated in C57Bl/6 and DBA/2 mice: benzo(a)pyrene hydroxylase, epoxide hydrolase and glutathione-S-transferase. The gestational profiles of hepatic and pulmonary benzo(a)pyrene hydrolase, and epoxide hydrolase were similar in both strains. In addition, we demonstrated higher endogenous stimulation of the three studied enzymic activities in C57Bl/6 mice. During the second moiety of pregnancy, temporal variations were observed: a peak of activity occurred between days 17 and 18 for lung and liver benzo(a)pyrene hydroxylase and at day 20 for epoxide hydrolase in both strains. Hepatic glutathione-S-transferase variations were similar in both strains. However, pulmonary glutathione-S-transferase increased gradually throughout pregnancy in C57Bl/6 mice, while a peak of glutathione-S-transferase activity occurred on day 18 of gestation in DBA/2 mice.

Induction of drug metabolizing enzymes in the liver of diabetic mice

The effects of two classical inducers, phenobarbital and 3-methylcholanthrene, have been tested on some liver microsomal drug-metabolizing enzymes (monooxygenases and phase II enzymes) and on benzo(a)pyrene metabolism in genetically (ob/ob) and chemically (streptozotocin) diabetic mice. 1) In ob/ob mice, the basal activities and the inducibility of phase I and phase II enzymes, as well as the electrophoretic pattern of microsomal proteins, were not notably different from those of similarly treated lean mice. 2) A possibly common form of cytochrome P 450 present both in microsomes from steptozotocin-diabetic non-induced mice and in those from phenobarbital-treated non-diabetic mice could explain the increased "phenobarbital-like" enzyme activities in chemically diabetic animals. 3) The increase of monooxygenase activities produced by streptozotocin treatment is partially depressed by 3-methylcholanthrene, probably as a result of the dilution of "phenobarbital-like" cytochrome P 450 forms by 3-methylcholanthrene-induced cytochrome P 448. 4) The increased formation of the most carcinogenic metabolites of benzo(a)pyrene, and the slight decrease of phase II conjugation enzyme activities, may add their deleterious effects in 3-methylcholanthrene-induced streptozotocin-diabetic animals.

UDP-glucuronosyltransferase, epoxide hydrolase and glutathione S-transferase activities in the liver of diabetic mice

The activities of UDPglucuronosyltransferase, microsomal epoxide hydrolase and cytosolic glutathione S-transferase were measured in the liver of spontaneously (db/db and ob/ob) or streptozotocin-induced diabetic mice. An important (2-3-fold) increase of most phase II activities was observed in streptozotocin-treated animals, whereas slighter changes were detected in spontaneously diabetic animals. The latter also exhibited physico-chemical modifications of the liver microsomal membranes, as shown by the temperature-induced variations of epoxide hydrolase activity.

Mutagenicity and tumor-initiating activity of cyclopenta(c,d)pyrene and structurally related compounds

The biological activities of benzo(a)pyrene, cyclopenta(c,d)pyrene, and 12 other structurally related compounds were assessed by mutagenicity studies with bacterial and mammalian cells and/or skin tumorigenicity studies with mice. The ability of the parent hydrocarbons to be metabolically activated to mutagenic products was examined in strains TA98 and TA100 of Salmonella typhimurium, using 3 experimental protocols. In each case, cyclopenta(c,d)pyrene was metabolically activated to products mutagenic to the bacteria to a greater extent than was benzo(a)pyrene. However, 7,8-dihydrobenzo(a)pyrene and 0,10-dihydrobenzo(e)pyrene were the best substrates for metabolic activation to bacterial mutagens. Highly purified epoxide hydrase added to a purified and reconstituted monooxygenase system readily abolished the mutagenic activity observed in strain TA100 of S. typhimurium when cyclopenta(c,d)pyrene was the substrate, but not when benzo(a)pyrene was the substrate. Inherent mutagenicity of several epoxides of the hydrocarbons generally paralleled the ability of their potential metabolic precursors to be activated to mutagens. 1-Pyrenyloxirane and 10,11-dihydrocycloheptapyrene 8,9-oxide were highly mutagenic in strains TA98 and TA100 of S. typhimurium, and in the former strain these activities were comparable to that observed with 9,10-epoxy-7,8,9,10-tetrahydrobenzo(a)pyrene, 4-Pyrenyloxirane was significantly less mutagenic than was 1-pyrenyloxirane in both strains of bacteria and in mammalian cells. Benzo(a)pyrene was over 20 times more tumorigenic than was cyclopenta-(c,d)pyrene, and it was the most potent of the 11 compounds tested for tumor-initiating activity in 2-stage initiation-promotion experiments on the skin of mice. Cyclopenta(c,d)pyrene had tumor-initiating activity comparable to that of benzo-(a)anthracene, but it was significantly less active than chrysene. Thus, contrary to inferences made from its high mutagenic activity, cyclopenta(c,d)pyrene is a weak tumor initiator on mouse skin.

[Demonstration of "hydroxylase" and "epoxide hydrase" activities in preparations of nucleoli isolated from rat liver]

Aryl hydrocarbon hydroxylase (AHH) activity and epoxyde hydrase (EH) activity have been found in Rat liver nucleoli obtained from untreated (C) and methylcholanthrene (MC) pretreated Rats. Electron microscopic observations of nucleolar preparations did not reveal significant contamination either by intact nuclei or by nuclear membranes. Very low but detectable activity of NADPH cytochrome C reductase was found in the nucleoli. Nucleolar preparations revealed little AHH activity (12-18 pmoles/min/mg). AHH was inducible by MC in nuclei but not in nucleoli. The presence of EH in nucleoli was demonstrated with phenanthrene 9,10-oxide (550-620 pmoles/min/mg) and benzopyrene 4,5-oxide (92-116 pmoles/min/mg). These values were lower than those obtained using intact nuclei. The addition of TCPO (10(-4) M) inhibited EH activity.

Binding of K- and non-K-region arene oxides and phenols of polycyclic hydrocarbons to polyguanylic acid

Arene oxide derivatives of carcinogenic polycyclic hydrocarbons have been postulated as the reactive intermediates responsible for the in vivo binding of the parent hydrocarbon to cellular nucleic acids. In this study the reaction of 12 different K- and non-K-region arene oxides and 7 benzo(a)pyrene phenols with polyguanylic acid in aqueous acetone solutions has been investigated. The extent of binding of the polycyclic hydrocarbon was monitored by changes in the ultraviolet absorption and fluorescence spectra of the reisolated polyguanylic acid. The most reactive compound was the K-region arene oxide of 7,12-dimethylbenz(a)anthracene. A lower but significant level of binding was detected with the K-region arene oxides of benz(a)anthracene, benzo(a)pyrene, and 3-methylcholanthrene. Very low or negligible binding was detected with the K-region arene oxides of pyrene and phenanthrene; the non-K-region arene oxides of benzo(a)pyrene, phenanthrene, and naphthalene; and all of the benzo(a)pyrene phenols. Significant differences in the fluorescence spectra of polyguanylic acid modified with three different benzo(a)-pyrene arene oxides were observed.

Effects of inducers and epoxide hydrase on the metabolism of benzo(a)pyrene by liver microsomes and a reconstituted system: analysis by high pressure liquid chromatography

The mobilities of 24 potential metabolites of benzo[a]pyrene were examined with high pressure liquid chromatography. Twelve phenols, five quinones, four dihydrodiols, and three oxides were studied. The chromatographic procedure employed allowed the separation and quantitation of benzopyrene metabolites into three major groups consisting of phenols, quinones, and dihydrodiols. Two of the benzopyrene oxides were unstable during chromatography, whereas the third oxide was more stable and chromatographed in the quinone fraction. Treatment of rats with phenobarbital or 3-methylcholanthrene enhanced the metabolism of benzopyrene by liver microsomes and altered the relative amounts of the various metabolites formed. In the absence of epoxide hydrase (EC 4.2.1.63), benzopyrene was metabolized primarily to phenols and quinones but was not appreciably metabolized to dihydrodiols by a solubilized, reconstituted cytochrome P-448 monooxygenase system. Addition of partially purified epoxide hydrase resulted in the formation of benzopyrene dihydrodiols with a concomitant decrease in the formation of phenolic metabolites, indicating that benzopyrene undergoes metabolism via arene oxides that are precursors for dihydrodiols and phenols.