overview phase i and phase ii enzymes reaction mechanisms, substrates enzyme inhibitors and...

BIOTRANSFORMATION OF XENOBIOTICS

Overview Phase I and Phase II enzymes Reaction mechanisms, substrates Enzyme inhibitors and inducers Genetic polymorphism Detoxification Metabolic activation

Introduction

Purpose Converts lipophilic to hydrophilic

compounds Facilitates excretion

Consequences Changes in PK characteristics Detoxification Metabolic activation

Comparing Phase I & Phase II

Enzyme Phase I Phase II

Types of reactions Hydrolysis Oxidation Reduction

Conjugations

Increase in hydrophilicity

Small Large

General mechanism

Exposes functional group

Polar compound added to functional group

Consquences May result in metabolic activation

Facilitates excretion

First Pass Effect

Biotransformation by liver or gut enzymes before compound reaches systemic circulation

Results in lower systemic bioavailbility of parent compound

Examples: Propafenone, Isoniazid, Propanolol

Phase I reactions

Hydrolysis in plasma by esterases (suxamethonium by cholinesterase)

Alcohol and aldehyde dehydrogenase in liver cytosol (ethanol)

Monoamine oxidase in mitochondria (tyramine, noradrenaline, dopamine, amines)

Xanthine oxidase (6-mercaptopurine, uric acid production)

Enzymes for particular substrates (tyrosine hydroxylase, dopa-decarboxylase etc.)

Phase I: Hydrolysis

Carboxyesterases & peptidasesHydrolysis of esters

eg: valacyclovir, midodrine Hydrolysis of peptide bonds

e.g.: insulin (peptide)

Epoxide hydrolaseH2O added to epoxides

eg: carbamazepine

Phase I: Reductions

Azo ReductionN=N to 2 -NH2 groups

eg: prontosil to sulfanilamide

Nitro ReductionN=O to one -NH2 group

eg: 2,6-dinitrotoluene activationN-glucuronide conjugate hydrolyzed by gut

microfloraHepatotoxic compound reabsorbed

Reductions

Carbonyl reductionChloral hydrate is reduced to trichlorothanol

Disulfide reductionFirst step in disulfiram metabolism

Reductions

Quinone reductionCytosolic flavoprotein NAD(P)H quinone

oxidoreductasetwo-electron reduction, no oxidative stresshigh in tumor cells; activates diaziquone to

more potent form

Flavoprotein P450-reductaseone-electron reduction, produces

superoxide ionsmetabolic activation of paraquat,

doxorubicin

Reductions

DehalogenationReductive (H replaces X)

Enhances CCl4 toxicity by forming free radicals

Oxidative (X and H replaced with =O)Causes halothane hepatitis via reactive

acylhalide intermediatesDehydrodechlorination (2 X’s removed, form

C=C)DDT to DDE

Phase I: Oxidation-ReductionAlcohol dehydrogenase

Alcohols to aldehydesGenetic polymorphism; Asians metabolize

alcohol rapidlyInhibited by ranitidine, cimetidine, aspirin

Aldehyde dehydrogenaseAldehydes to carboxylic acidsInhibited by disulfiram

Phase I: Monooxygenases

Monoamine OxidasePrimaquine, haloperidol, tryptophan are

substratesActivates 1-methyl-4-phenyl-1,2,5,6-

tetrahydropyridine (MPTP) to neurotoxic toxic metabolite in nerve tissue, resulting in Parkinsonian-like symptoms

MonoOxygenases

Peroxidases couple oxidation to reduction of H2O2 & lipid hydroperoxidaseProstaglandin H synthetase (prostaglandin

metabolism)Causes nephrotoxicity by activating aflatoxin

B1, acetaminophen to DNA-binding compounds

Lactoperoxidase (mammary gland)Myleoperoxidase (bone marrow)

Causes bone marrow suppression by activating benzene to DNA-reactive compound

Monooxygenases

Flavin-containing Mono-oxygenasesGenerally results in detoxificationMicrosomal enzymesSubstrates: Nicotine, Cimetidine,

Chlopromazine, Imipramine

Phase I: Cytochrome P450

Microsomal enzyme ranking first among Phase I enzymes

Heme-containing proteinsComplex formed between Fe2+ and CO

absorbs light maximally at 450 (447-452) nm

Cytochrome P450 reactions

Hydroxylation

Testosterone to 6-hydroxytestosterone (CYP3A4)

Cytochrome P450 reactions

EPOXIDATION OF DOUBLE BONDSCarbamazepine to 10,11-epoxide

HETEROATOM OXYGENATIONOmeprazole to sulfone (CYP3A4)

Cytochrome P450 reactions

HETEROATOM DEALKYLATIONO-dealkylation (e.g., dextromethorphan to

dextrophan by CYP2D6)N-demethylation of caffeine to:

theobromine (CYP2E1)paraxanthine (CYP1A2)theophylline (CYP2E1)

Cytochrome P450 reactions

Oxidative Group TransferN, S, X replaced with OParathion to paroxon (S by O)Activation of halothane to

trifluoroacetylchloride (immune hepatitis)

Cytochrome P450 reactions

Cleavage of EstersCleavage of functional group, with O

incorporated into leaving groupLoratadine to Desacetylated loratadine

(CYP3A4, 2D6)

Cytochrome P450 reactions

DehydrogenationAbstraction of 2 H’s with formation of C=CActivation of Acetaminophen to

hepatotoxic metabolite N-acetylbenzoquinoneimine

Cytochrome P450 expression

Gene family, subfamily names based on amino acid sequences

At least 15 P450 enzymes identified in human Liver Microsomes

Cytochrome P450 expressionVARIATION IN LEVELS activity due to

Genetic PolymorphismEnvironmental Factors: inducers,

inhibitors, diseaseMultiple P450’s can catalyze same

reaction

A single P450 can catalyze multiple pathways

Major P450 Enzymes in Humans

CYP1A1/ 2

Expressed in:

Substrates Inducers Inhibitors

Liver Lung Skin GI Placenta

Caffeine Theophylline

Cigarrette smoke; Cruciferous veggies; Charcoal-broiled meat

Furafylline (mechanism-based); -naphtho-flavone (reversible)

Major P450 Enzymes in Humans

CYP2B6

Expressedin:

Substrates Inducers Inhibitors

Liver DiazepamPhenanthrene

??? Orphenadrine(mechanism-based)

Major P450 Enzymes in Humans

CYP2C19

Genetic polymorphism Substrates Inducers Inhibitors

Poor metabolizers have defective CYP2C9

Phenytoin Piroxicam Tolbutamide Warfarin

Rifampin

Sulfafenazole

Major P450 Enzymes in Humans

CYP2C19

Genetic polymorphism Substrates Inducers Inhibitors

Rapid and slowmetabolizers of S-mephenytoin

N-demethylationpathway of S-mephenytoinmetabolismpredominates in slowmetabolizers

S-mephenytoin(4’-hydroxylationis catalyzed byCYP2C19)

Rifampin Tranylcypromine

Major P450 Enzymes in HumansCYP2D6

Genetic polymorphism Substrates Inducers Inhibitors

Poor metabolizers lackCYP2D6

Debrisoquine causes marked,prolonged hypotension inslow metabolizers

No effect on response topropanolol in poormetabolizers; alternatepathway (CYP2C19) willpredominate

5-10% of Caucasians arepoor metabolizers

< 2% of Asians, AfricanAmericans are poormetabolizers

PropafenoneDesipraminePropanololCodeineDextromethorphanFluoxetineClozapineCaptopril

Poor metabolizersidentified byurinary exrection ofDextrorphan

None known FluoxetineQuinidine

Major P450 Enzymes in Humans

CYP2E1

Expressed in: Substrates Inducers Inhibitors

LiverLungKidneyLympocytes

EthanolAcetaminophenDapsoneCaffeineTheophyllineBenzene

EthanolIsoniazid

Disulfiram

Major P450 Enzymes in HumansCYP3A4

Expressedin:

Substrates Inducers Inhibitors

Liver;Kidney;Intestine;MostabundantP450enzyme inliver

AcetaminophenCarbamazepineCyclosporineDapsoneDigitoxinDiltiazemDiazepamErythromycinEtoposideLidocaineLoratadineMidazolamLovasatinNifedipineRapamycinTaxolVerapamil

RifampinCarbamazepinePhenobarbitalPhenytoin

Ketoconazole;Ritonavir;Grapefruit juice;Troleandomycin

Major P450 Enzymes in Humans

CYP4A9/ 11

Expressed in:

Substrates Inducers Inhibitors

Liver

Fatty acids and

??? ???

Metabolic activation by P450

Formation of toxic species De-chlorination of chloroform to phosgene De-hydrogenation and subsequent

epoxidation of urethane (CYP2E1) Formation of pharmacologically active

species Cyclophosphamide to electrophilic

aziridinum species (CYP3A4, CYP2B6)

Inhibition of P450

Drug-drug interactions due to reduced rate of biotransformation

Competitive S and I compete for active site e.g., Rifabutin & Ritonavir;

Dextromethorphan & Quinidine

Mechanism-based Irreversible; covalent binding to active

site

Induction and P450

Increased rate of biotransformation due to new protein synthesisMust give inducers for several days for effect

Drug-drug interactionsPossible sub-therapeutic plasma

concentrationseg, co-administration of Rifampin and oral

contraceptives is contraindicated

Some drugs induce, inhibit same enzyme (Isoniazid, Ethanol (2E1), Ritonavir (3A4)

PHASE 2 Reactions

CONJUGATIONS -OH, -SH, -COOH, -CONH with glucuronic acid to give

glucuronides -OH with sulphate to give sulphates -NH2, -CONH2, amino acids, sulpha drugs with acetyl-

to give acetylated derivatives -halo, -nitrate, epoxide, sulphate with glutathione to

give glutathione conjugates

all tend to be less lipid soluble and therefore better excreted (less well reabsorbed)

Phase II: Glucuronidation

Major Phase II pathway in mammalsUDP-glucuronyltransferase forms O-, N-,

S-, C- glucuronides; six forms in human liverCofactor is UDP-glucuronic acidInducers: phenobarbital, indoles, 3-

methylcholanthrene, cigarette smokingSubstrates include dextrophan, methadone,

morphine, p-nitrophenol, valproic acid, NSAIDS, bilirubin, steroid hormones

Glucuronidation & genetic polymorphism

Crigler-Nijar syndrome (severe): inactive enzyme; severe hyperbilirubinemia; inducers have no effect

Gilbert’s syndrome (mild): reduced enzyme activity; mild hyperbilirubinemia; phenobarbital increases rate of bilirubin glucuronidation to normal

Patients can glucuronidate morphine, chloroamphenicol

Glucuronidation &

-glucuronidase

Conjugates excreted in bile or urine (MW)

-glucuronidase from gut microflora cleaves glucuronic acid

Aglycone can be reabsorbed & undergo enterohepatic recycling

Glucuronidation and -glucuronidase

Metabolic activation of 2.6-dinitrotoluene) by -glucuronidase

-glucuronidase removes glucuronic acid from N-

glucuronide nitro group reduced by microbial N-reductase

resulting hepatocarcinogen is reabsorbed

Phase II: Sulfation

Sulfo-transferases are widely-distributed enzymes

Cofactor is 3’-phosphoadenosine-5’-phosphosulfate (PAPS)

Produce highly water-soluble sulfate esters, eliminated in urine, bile

Xenobiotics & endogenous compounds are sulfated (phenols, catechols, amines, hydroxylamines)

Sulfation

Sulfation is a high affinity, low capacity pathwayGlucuronidation is low affinity, high capacity

Capacity limited by low PAPS levels

ACETAMINOPHEN undergoes both sulfation and glucuronidation

At low doses sulfation predominatesAt high doses glucuronidation predominates

Sulfation

Four sulfotransferases in human liver cytosol

Aryl sulfatases in gut microflora remove sulfate groups; enterohepatic recycling

Usually decreases pharmacologic, toxic activity

Activation to carcinogen if conjugate is chemically unstableSulfates of hydroxylamines are unstable (2-AAF)

Phase II: Methylation

Common, minor pathway which generally decreases water solubility

MethyltransferasesCofactor: S-adenosylmethionine (SAM)-CH3 transfer to O, N, S, C

Substrates include phenols, catechols, amines, heavy metals (Hg, As, Se)

Methylation & genetic polymorphism

Several types of methyltransferases in human tissuesPhenol O-methyltransferase, Catechol O-

methyltransferase, N-methyltransferase, S-methyltransferase

Genetic polymorphism in Thiopurine metabolism

high activity allele, increased toxicitylow activity allele, decreased efficacy

Phase II: Acetylation

Major route of biotransformation for aromatic amines, hydrazines

Generally Decreases Water SolubilityN-acetyltransferase (NAT)

Cofactor is AcetylCoenzyme A

Substrates include Sulfanilamide, Isoniazid, Dapsone

Acetylation & genetic polymorphism

Rapid and slow acetylatorsVarious mutations result in decreased enzyme

activity or stabilityIncidence of slow acetylators

70% in Middle Eastern populations; 50% in Caucasians; 25% in Asians

Drug toxicities in slow acetylatorsnerve damage from dapsone; bladder cancer in

cigarette smokers due to increased levels of hydroxylamines

Phase IIAmino Acid Conjugation

Alternative to GlucuronidationTwo principle pathways-COOH group of substrate conjugated with -

NH2 (amine) of glycine, serine, glutamine, requiring CoA activatione.g: conjugation of Benzoic acid with Glycine

to form hippuric acid

Aromatic -NH2 or NHOH conjugated with -COOH of serine, proline, requiring ATP activation

Amino Acid Conjugation

Substrates: Bile Acids, NSAIDsMetabolic activation

Serine or proline N-esters of hydroxyl-amines are unstable & degrade to reactive electrophiles.

Phase IIGlutathione Conjugation

Glutathione-S-transferase catalyzes conjugation with glutathione

Glutathione is tripeptide of glycine, cysteine, glutamic acidFormed by -glutamyl-cysteine synthetase,

glutathione synthetase

Buthione-S-sulfoxine is inhibitor

Glutathione ConjugationTwo types of reactions with glutathione

1.Displacement of halogen, sulfate, sulfonate, phospho, nitro group

2.Glutathione added to activated double bond

Glutathione substratesHydrophobic, Containing electrophilic atomCan react with glutathione non-enzymatically

Glutathione Conjugation

Conjugation of N-acetylbenzoquinoneimine (activated metabolite of acetaminophen)

O-demethylation of organophosphatesActivation of trinitroglycerin

Products are oxidized glutathione (GSSG), dinitroglycerin, NO (vasodilator)

Reduction of hydroperoxidesProstaglandin metabolism

Glutathione Conjugation

Four classes of soluble glutathione-S-transferase

microsomal and cytosolic glutathione-S-transferases

Genetic polymorphism

Glutathione-S-transferase

Inducers (include phenobarbital, corticosteroids, anti-oxidants)

Over expression of enzyme leads to resistance (e.g., insects to DDT, corn to atrazine, cancer cells to chemotherapy)

Species SpecificityAflatoxin B1 not carcinogenic in mice which can conjugate

with glutathione very rapidly

Glutathione Conjugation

Excretion of Glutathione ConjugatesExcreted in bileConverted to Mercapturic Acids in kidney,

excreted in urineEnzymes involved are -glutamyl-trans-

peptidase, aminopeptidase M