Comparison of three CYP2D6 probe substrates and genotype in Ghanaians, Chinese and Caucasians.

The ability to metabolize CYP2D6 substrates sparteine, debrisoquine, and dextromethorphan was studied in healthy Caucasian (n = 20), Ghanaian (n = 21), and Chinese (n = 22) CYP2D6 extensive metabolizers. Genotype analysis for the CYP2D6*1, *3, *4, *5, *9, *10, and *17 alleles was performed. Interethnic differences in the disposition of the probe drugs were found among the extensive metabolizers; extensive metabolizer status was confirmed by phenotype and genotype analysis. The mean metabolic rate was lower for Caucasians than for Ghanaians for sparteine (P < 0.02) and for both Ghanaians and Chinese for debrisoquine (P < 0.02). Correlation comparisons resulted in lower pairwise correlation coefficients in Ghanaians compared with Chinese and Caucasians for every combination of probe substrates. In addition, in Chinese and Caucasians, metabolic rates for each pair of probe drugs were significantly correlated (P < 0.002), but in Ghanaians the dextromethorphan metabolic rates were not correlated to either sparteine or debrisoquine (P < 0.05). Even when only those with a CYP2D6*1/*1 genotype were included in the correlation calculations, the Ghanaians had very low correlation coefficients (r(s) - 0.02-0.2, n = 9); much lower than those found in Caucasian (r(s) 0.78-0.92, n = 14) or Chinese (r(s) 0.54-0.96, n = 7) individuals. Quinidine had significantly less affect on sparteine metabolic rates in Ghanaians than both Caucasians and Chinese (P < 0.02). In addition, five of the 21 Ghanaian individuals had dextromethorphan metabolic ratios which were unaffected by quinidine. These individuals also had differences in urinary recovery of dextromethorphan and its metabolites when compared to the other Ghanaian individuals. These results confirm the large ethnic differences in probe drug metabolism and quinidine sensitivity among these ethnic groups. They also suggest that the Ghanaians have an additional unidentified allele(s) with altered substrate specificity and quinidine sensitivity which is currently genotyped as CYP2D6*1.

Imipramine demethylation and hydroxylation: impact of the sparteine oxidation phenotype.

Eighteen healthy volunteers, selected according to their ability to oxidize sparteine, took single oral doses of 100 mg imipramine and desipramine. For imipramine the following clearances (L X min-1) were found in six rapid extensive metabolizers (EM), six slow EM, and six poor metabolizers (PM), respectively (mean and range): apparent oral clearance: 2.55 (1.39 to 3.47), 2.28 (1.18 to 4.26), and 1.35 (0.96 to 1.64). Clearance via demethylation was: 1.42 (0.61 to 2.01), 1.60 (0.78 to 3.81), and 1.09 (0.76 to 1.64); clearance via other pathways was: 1.13 (0.74 to 1.75), 0.69 (0.40 to 1.59), and 0.26 (0 to 0.46). For desipramine the apparent oral clearance (L X min-1) was 0.19 (0.12 to 0.24) in PM compared with 1.64 (1.46 to 1.80) and 1.03 (0.77 to 1.13) in rapid EM and slow EM. Extremely long elimination t1/2s of desipramine were seen in PM: 81 to 131 hours compared with 13 to 23 hours in EM. 2-OH-imipramine and 2-OH-desipramine were detectable in plasma of only the 12 EM, where the ratio-to-parent compound was higher in rapid EM than in slow EM. This study confirms that 2-hydroxylation of imipramine and desipramine depends almost exclusively on the sparteine oxygenase, whereas the demethylation of imipramine depends mainly on a different isozyme.

Deficient metabolism of debrisoquine and sparteine.

Genetic deficiencies of alicyclic hydroxylation of debrisoquine and of sparteine oxidation are independently discovered entities, each of clinical significance in its sphere. This paper reports evidence to indicate that these 2 deficiencies have the same cause. Previous investigation of one of the affected subjects had revealed normal oxidative metabolism of amobarbital and antipyrine in terms of both metabolic rates and urinary metabolite patterns. Thus the genetic defect in the metabolism of sparteine and debrisoquine is not a generalized deficiency of drug oxidation or of the cytochrome P450 system.

Debrisoquine hydroxylation capacity: problems of assessment in two populations.

Following the investigation of debrisoquine (D) metabolism to 4-hydroxydebrisoquine (4OHD) in two populations, problems with the current practice of assessing this capacity by urinary D:4OHD ratios presented themselves. The distributions of both components of this ratio, when examined separately, clearly displayed interethnic differences. The mean 0- to 8-hr recovery of 4OHD in the Caucasian group was 15.5 +/- 1.1% (SE) of a 20-mg dose and 8.0 +/- 1.5% in the Oriental group. The corresponding values for unchanged D excretion were 33.0 +/- 4.1% in Orientals and 18.2 +/- 2.3% in Caucasians, a difference that is overlooked when D:4OHD ratios alone are examined. Although D and 4OHD excretion rates were equally variable, they correlated poorly; that is, they tended to vary independently of each other. This finding, in conjunction with the two separate ethnic differences, indicates that the ratio D:4OHD does not solely reflect an individual's capacity towards D 4-hydroxylation, and that equating these is unwarranted. This limitation does not necessarily invalidate judicious use of the ratio at the edges of the distribution curve, but it does call for additional investigations into the means to assess D metabolizing capacity in most subjects.

Comparative pharmacogenetics of sparteine and debrisoquine.

Capacities to oxidize sparteine and debrisoquine in healthy Canadian Caucasians were compared. The Spearman rank correlation between the conventional urinary metabolic ratios (drug/metabolite) was rs = 0.79 (P less than 0.001), but the sparteine metabolic ratio appears to be the more discriminating probe to distinguish metabolizers and nonmetabolizers. The urinary amount of oxidized sparteine alone may allow reliable detection of nonmetabolizers. From a total of 17 poor metabolizers observed in this study and in studies in Germany and Sweden, all were deficient in metabolizing capacity for both sparteine and debrisoquine.

Sparteine metabolism in Canadian Caucasians.

The capacity for sparteine (SP) metabolism was determined in 48 Caucasian subjects by measuring amounts of drug and dehydrogenated metabolites in urine after an oral dose of SP sulfate. Three phenotypes were recognized and were assumed to represent individuals homozygous for poor SP oxidation (group III) and those heterozygous (group II) and homozygous (group I) for extensive SP oxidation. Separation of groups I and II, although incomplete, was improved by alterations in the published analytic procedure. The pattern of deviations from the normal distribution was similar for both dehydrosparteine metabolites. This supports the hypothesis of a common intermediate, the formation of which is monogenically controlled. Correlation analysis of the two metabolites indicates the possibility of further metabolism of 5-dehydrosparteine.

Inhibition by fluoxetine of cytochrome P450 2D6 activity.

Potent inhibition of cytochrome P450 2D6 (CYP2D6) in human liver microsomes by fluoxetine and its major metabolite norfluoxetine was confirmed (apparent inhibition constant values, 0.2 mumol/L). Several other serotonergic agents were also found to be competitive inhibitors of this genetically polymorphic enzyme. The O-demethylation ratio of dextromethorphan that expressed CYP2D6 activity in 19 patients receiving fluoxetine fell in the region of the antimode separating the O-demethylation ratio values observed in 208 extensive metabolizers from 15 poor metabolizers of a control group of healthy subjects. Inhibition of CYP2D6 activity in patients undergoing treatment with fluoxetine or other serotonin uptake inhibitors could contribute to toxicity or attenuated response from concurrent medications that are substrates of this enzyme. Other in vitro studies indicated that CYP2D6 catalyzes the O-demethylation of oxycodone to form oxymorphone. This reaction was inhibited by fluoxetine and its normetabolite in liver microsomes from both extensive and poor metabolizer individuals, indicating that these compounds are not selective inhibitors of CYP2D6 activity.

CYP2D6 phenotype determines the metabolic conversion of hydrocodone to hydromorphone.

The contribution of cytochrome P450 2D6 (CYP2D6) to the formation of hydrocodone's active metabolite, hydromorphone, was examined in vitro and in vivo. Human liver microsomes prepared from an individual homozygous for the D6-B mutation of the CYP2D6 gene catalyzed this reaction at a negligible rate. Urinary metabolic ratios of hydrocodone/hydromorphone were highly correlated with O-demethylation ratios for dextromethorphan, an established marker drug of CYP2D6 activity (rs = 0.85; n = 18). The kinetics of hydrocodone after a single oral dose and its partial metabolic clearance to hydromorphone were investigated in five extensive metabolizers of dextromethorphan, six poor metabolizers, and four extensive metabolizers after pretreatment with quinidine, a selective inhibitor of CYP2D6 activity. The mean values for partial metabolic clearance by O-demethylation in the three groups were 28.1 +/- 10.3, 3.4 +/- 2.4, and 5.0 +/- 3.6 ml/hr/kg, respectively. No statistically significant phenotypic differences in physiologic measures were observed. However, over the first hour after dosing, the extensive metabolizers reported more "good opiate effects" and fewer "bad opiate effects" than poor metabolizers and extensive metabolizers in whom CYP2D6 was inhibited by quinidine. These data establish the importance of CYP2D6 in the formation of hydromorphone from hydrocodone and suggest that the activity of this enzyme may limit the abuse liability of hydrocodone.

Characterization of metronidazole metabolism by human liver microsomes.

The metabolism of metronidazole was studied in microsomes isolated from livers of human kidney donors. The formation of the major in vivo metabolite, hydroxymetronidazole, proceeded according to biphasic kinetics, suggesting the involvement of at least two enzymatic sites. The affinity constant (Km) of the high affinity site ranged from 140 to 320 microM and metabolism at this site contributed more than 75% of the intrinsic clearance. Thus, at therapeutic doses of metronidazole most of the hydroxylation in vivo should be associated with this site. Antipyrine, cimetidine, alpha-naphthoflavone, caffeine, theophylline, mephenytoin, tolbutamide, quinidine, acetone and nifedipine were poor inhibitors of the formation of hydroxymetronidazole by human liver microsomes. Propranolol (500 microM) inhibited the hydroxylation rate by 70%. Phenacetin inhibited metronidazole hydroxylation with a competitive inhibition constant (Ki) of 4-5 microM. However, metronidazole did not inhibit the O-deethylation of phenacetin. It is concluded that cytochromes P450 IA2, IIC9, IIC10, IID6, IIE1 and IIIA3 do not contribute significantly to the high affinity hydroxylation of metronidazole in man.

Interactions of amphetamine analogs with human liver CYP2D6.

The interaction of fifteen amphetamine analogs with the genetically polymorphic enzyme CYP2D6 was examined. All fourteen phenylisopropylamines tested were competitive inhibitors of CYP2D6 in human liver microsomes. The presence of a methylenedioxy group in the 3,4-positions of both amphetamine (Ki = 26.5 microM) and methamphetamine (Ki = 25 microM) increased the affinity for CYP2D6 to 1.8 and 0.6 microM, respectively. Addition of a methoxy group to amphetamine in the 2-position also increased the affinity for CYP2D6 (Ki = 11.5 microM). The compound with the highest affinity for CYP2D6 was an amphetamine analog (MMDA-2) having both a methoxy group in the 2-position and a methylenedioxy group (Ki = 0.17 microM). Mescaline did not interact with CYP2D6. O-Demethylation of p-methoxyamphetamine (PMA) by CYP2D6 was characterized (Km = 59.2 +/- 22.4 microM, and Vmax = 29.3 +/- 16.6 nmol/mg/hr, N = 6 livers). This reaction was negligible in CYP2D6-deficient liver microsomes, was inhibited stereoselectively by the quinidine/quinine enantiomer pair, and was cosegregated with dextromethorphan O-demethylation (r = 0.975). The inhibitory effect of methylenedioxymethamphetamine (MDMA) was enhanced by preincubation with microsomes, suggesting that MDMA may produce a metabolite complex with CYP2D6. These findings suggest that phenylisopropylamines as a class interact with CYP2D6 as substrates and/or inhibitors. Their use may cause metabolic interactions with other drugs that are CYP2D6 substrates, and the potential for polymorphic oxidation via CYP2D6 may be a source of interindividual variation in their abuse liability and toxicity.

Inhibitors of cytochrome P450 differentially modify discriminative-stimulus and antinociceptive effects of hydrocodone and hydromorphone in rhesus monkeys.

The present study was conducted to investigate the role of cytochrome P450 in the discriminative-stimulus and antinociceptive effects of hydrocodone (HC) and hydromorphone (HM) in rhesus monkeys. In morphine-deprived monkeys, morphine dose-dependently reversed naltrexone-lever responding, an effect also produced by HC and HM. HC and HM also produced antinociception in a warm-water tail withdrawal procedure. Budipine and naltrexone shifted the dose-effect curves for the discriminative-stimulus effects of HC and HM to the right. In contrast, naltrexone, but not budipine (10.0 mg/kg) or quinidine (10.0 mg/kg), dose-dependently antagonized the antinociceptive effects of HC. Budipine and quinidine decreased the concentration of HM in plasma without significantly affecting the levels of HC, suggesting that these CYP2D6 inhibitors decreased the conversion of HC HM. Thus, some behavioral effects of HC are not modified by a marked inhibition of CYP2D6, suggesting that these effects of HC are not due to its conversion to HM but, rather, that both HC and HM act directly on mu receptors.

Competitive inhibition of sparteine oxidation in human liver by beta-adrenoceptor antagonists and other cardiovascular drugs.

The rate of oxidation of sparteine by the 9000 x g supernatant fraction of a human liver was measured in the presence of various drugs which exert cardiovascular effects. Hexamethonium, ouabain, caffeine and isoproterenol had no effect on this rate, while alprenolol, metoprolol, oxprenolol, propranolol, timolol, pindolol, lidocaine, mexiletine, 17-n-pentyl-sparteine, tolazoline, quinine, quinidine, cinchonine and cinchonidine inhibited the in vitro reaction competitively. Stereoselective inhibition was observed between quinine (Ki = 15 microM) and quinidine (Ki = 0.06 microM). Genetic evidence suggests that the primary metabolism of sparteine depends on a single species of cytochrome P450. In vitro competitive inhibition of sparteine oxidation by a drug indicates that this drug is capable of occupying the same enzymatic site as sparteine. This may mean that the competing drug is also metabolized at that site and thereby subject to the same genetic variation as sparteine's oxidation; absence of inhibition excludes this possibility.

Inhibition of sparteine oxidation in human liver by tricyclic antidepressants and other drugs.

Testing for competitive inhibition of sparteine oxidation in the 9000 x g supernatant fraction from human liver provides an in vitro means to identify drugs which can bind to the same form of cytochrome P450 which oxidizes sparteine. There has so far been only two outcomes of this test: either the drug examined competed with sparteine for a common binding site, or it did not inhibit the reaction. The results of such in vitro testing implicated the involvement of guanoxan, nortriptyline, desipramine, imipramine, amitriptyline and chlorpromazine with this enzyme. Amobarbital, tolbutamide and guanethidine in therapeutic concentrations did not interfere with sparteine oxidation by this preparation.

Drug metabolism and interactions in abuse liability assessment.

The interpretation of acute abuse liability studies and drug interaction studies would be importantly strengthened by the routine inclusion of drug concentration measurements at appropriate sampling times. Reliance on mean kinetic data misrepresents the variation in drug kinetics and fails to take experimental advantage of the natural differences in the population which may represent the extremes of abuse risk. Pharmacokinetic-pharmacodynamic studies to better understand the relationship of plasma drug concentration, drug concentration in the receptor biophase and specific drug reinforced behaviour will ensure proper study design and yield useful theoretic information. Multi- and poly-drug abuse (including heavy smoking and heavy ethanol use) are very common. Such patterns of use can have quite large effects on drug kinetics. Because of the potentially large qualitative and quantitative differences in drug metabolism and kinetics between pre-clinical species and the human, data should be gathered at the earliest possible time with respect to human metabolic rates, patterns, and identification of inhibitors. The availability of human liver microsomes facilitates such studies.

A simple borohydride/GC method for measuring sparteine metabolites in man.

A simple borohydride/GC method was developed for phenotyping sparteine oxidation in man. The major metabolites of sparteine found in human urine, 2- and 5-dehydrosparteine, were converted quantitatively back to sparteine by sodium borohydride reduction. The amount of sparteine metabolites can be estimated from the difference of sparteine concentrations between the borohydride-treated and untreated urine samples. The coefficient of variation of this assay was estimated from repeated analyses to be +/- 3% within a day (intra-assay) and +/- 8% between days (inter-assay).

Sparteine oxidation polymorphism: a family study.

Polymorphic oxidation of the pharmacogenetic probe drug sparteine was investigated in 35 parents and 29 siblings of 20 unrelated poor metabolizer (PM) probands. Phenotyping was carried out on the basis of metabolic ratio (MR) = sparteine/dehydrosparteines in the 12 h urine. The distribution of MR was bimodal: 47 relatives (20 siblings and 27 parents) had MR ranging from 0.22-12 and were defined as extensive metabolizers (EM) whereas MR ranged from 20-340 in nine siblings and eight parents thus defined as PM. The 20 pedigrees confirmed that poor metabolism of sparteine is inherited as an autosomal recessive character. The mean recovery of dehydrosparteines (% of dose) was 27% in 23 positively identified drug free heterozygotes compared with 37% in unrelated EM (both genotypes) (P less than 0.05) previously phenotyped. Degrees of dominance of 73% and 77% were calculated on basis of log excretion of dehydrosparteines (% of dose in 12 h urine) and log MR, respectively.

In vitro evidence against the oxidation of quinidine by the sparteine/debrisoquine monooxygenase of human liver.

Competitive inhibition studies using human liver microsomes have shown that quinidine (QD) has an exceptionally high affinity (60 nM) for the genetically variable cytochrome P-450 that catalyzes the formation of 4-hydroxydebrisoquine and dehydrosparteines from debrisoquine and sparteine. The present study examined the effect of sparteine and debrisoquine on the oxidation of QD by microsomes prepared from two human livers. QD and its major metabolite 3-hydroxy-QD were measured by quantitative TLC. QD 3-hydroxylation followed saturable single-site kinetics over a 1-250 microM range of QD concentrations. The Km and Vmax of the reaction in the two liver specimens were 47.5 +/- 3.5 microM and 58.7 +/- 5.9 microM, and 0.36 +/- 0.08 and 0.29 +/- 0.02 nmol of 3-hydroxy-QD/mg of protein/min. Sparteine and debrisoquine (250 microM) had no effect on this QD 3-hydroxylase activity. Furthermore, near-saturation of the sparteine/debrisoquine isozyme by 250 microM sparteine had no effect on the oxidation of QD by all routes (measured by QD disappearance from an initial level of 70 nM during an 8-hr incubation period). These observations indicate that none of the major oxidative reactions of QD are catalyzed by the sparteine/debrisoquine isozyme; QD may simply bind to this cytochrome P-450, without being oxidized by it.

High affinity of quinidine for a stereoselective microsomal binding site as determined by a radioreceptor assay.

The techniques of the radioreceptor binding assay were applied to detect stereoselective binding of quinidine and quinine to a site on human liver microsomes. Binding of 3H-dihydroquinidine was 50% inhibited by 20-100 nM quinidine, while its enantiomer quinine did not displace the 3H-ligand at concentrations up to 500 nM. This stereoselectivity agreed with the affinity values measured by functional enzyme assays of cytochrome P450 activity using sparteine or debrisoquine as substrates.

Sparteine oxidation polymorphism in Denmark.

Sparteine oxidation was polymorphic among 301 healthy Danish volunteers. Hence 22 subjects or 7.3% were phenotyped as poor metabolizers (PM) whereas 279 subjects were classified as extensive metabolizers (EM). The metabolic ratio (MR) between sparteine and 2- and 5-dehydrosparteine (% of dose) in 12 hrs urine ranged from 0.11-12.6 in EM and from 30-394 in PM. Urinary excretion of 2- and 5-dehydrosparteine also discriminated between PM and EM. Age, sex, and smoking habits did not influence the MR. This study confirms that sparteine is a useful probe drug in pharmacogenetic investigations.