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      A history of the roles of cytochrome P450 enzymes in the toxicity of drugs

      review-article
      Toxicological Research
      Springer Singapore
      Cytochrome P450, Drugs, Toxicity, Reactive intermediates, Drug-drug interactions, Toxicophores

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          Abstract

          The history of drug metabolism began in the 19th Century and developed slowly. In the mid-20th Century the relationship between drug metabolism and toxicity became appreciated, and the roles of cytochrome P450 (P450) enzymes began to be defined in the 1960s. Today we understand much about the metabolism of drugs and many aspects of safety assessment in the context of a relatively small number of human P450s. P450s affect drug toxicity mainly by either reducing exposure to the parent molecule or, in some cases, by converting the drug into a toxic entity. Some of the factors involved are enzyme induction, enzyme inhibition (both reversible and irreversible), and pharmacogenetics. Issues related to drug toxicity include drug–drug interactions, drug-food interactions, and the roles of chemical moieties of drug candidates in drug discovery and development. The maturation of the field of P450 and drug toxicity has been facilitated by advances in analytical chemistry, computational capability, biochemistry and enzymology, and molecular and cell biology. Problems still arise with P450s and drug toxicity in drug discovery and development, and in the pharmaceutical industry the interaction of scientists in medicinal chemistry, drug metabolism, and safety assessment is critical for success.

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          The online version of this article (10.1007/s43188-020-00056-z) contains supplementary material, which is available to authorized users.

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          Most cited references189

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          Immune self-reactivity triggered by drug-modified HLA-peptide repertoire.

          Human leukocyte antigens (HLAs) are highly polymorphic proteins that initiate immunity by presenting pathogen-derived peptides to T cells. HLA polymorphisms mostly map to the antigen-binding cleft, thereby diversifying the repertoire of self-derived and pathogen-derived peptide antigens selected by different HLA allotypes. A growing number of immunologically based drug reactions, including abacavir hypersensitivity syndrome (AHS) and carbamazepine-induced Stevens-Johnson syndrome (SJS), are associated with specific HLA alleles. However, little is known about the underlying mechanisms of these associations, including AHS, a prototypical HLA-associated drug reaction occurring exclusively in individuals with the common histocompatibility allele HLA-B*57:01, and with a relative risk of more than 1,000 (refs 6, 7). We show that unmodified abacavir binds non-covalently to HLA-B*57:01, lying across the bottom of the antigen-binding cleft and reaching into the F-pocket, where a carboxy-terminal tryptophan typically anchors peptides bound to HLA-B*57:01. Abacavir binds with exquisite specificity to HLA-B*57:01, changing the shape and chemistry of the antigen-binding cleft, thereby altering the repertoire of endogenous peptides that can bind HLA-B*57:01. In this way, abacavir guides the selection of new endogenous peptides, inducing a marked alteration in 'immunological self'. The resultant peptide-centric 'altered self' activates abacavir-specific T-cells, thereby driving polyclonal CD8 T-cell activation and a systemic reaction manifesting as AHS. We also show that carbamazepine, a widely used anti-epileptic drug associated with hypersensitivity reactions in HLA-B*15:02 individuals, binds to this allotype, producing alterations in the repertoire of presented self peptides. Our findings simultaneously highlight the importance of HLA polymorphism in the evolution of pharmacogenomics and provide a general mechanism for some of the growing number of HLA-linked hypersensitivities that involve small-molecule drugs.
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            St. John's wort induces hepatic drug metabolism through activation of the pregnane X receptor.

            St. John's wort (Hypericum perforatum) is an herbal remedy used widely for the treatment of depression. Recent clinical studies demonstrate that hypericum extracts increase the metabolism of various drugs, including combined oral contraceptives, cyclosporin, and indinavir. In this report, we show that hyperforin, a constituent of St. John's wort with antidepressant activity, is a potent ligand (K(i) = 27 nM) for the pregnane X receptor, an orphan nuclear receptor that regulates expression of the cytochrome P450 (CYP) 3A4 monooxygenase. Treatment of primary human hepatocytes with hypericum extracts or hyperforin results in a marked induction of CYP3A4 expression. Because CYP3A4 is involved in the oxidative metabolism of >50% of all drugs, our findings provide a molecular mechanism for the interaction of St. John's wort with drugs and suggest that hypericum extracts are likely to interact with many more drugs than previously had been realized.
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              Pharmacogenetics of morphine poisoning in a breastfed neonate of a codeine-prescribed mother.

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                Author and article information

                Contributors
                f.guengerich@vanderbilt.edu
                Journal
                Toxicol Res
                Toxicol Res
                Toxicological Research
                Springer Singapore (Singapore )
                1976-8257
                2234-2753
                18 August 2020
                : 1-23
                Affiliations
                GRID grid.152326.1, ISNI 0000 0001 2264 7217, Department of Biochemistry, , Vanderbilt University School of Medicine, ; 638B Robinson Research Building, 2200 Pierce Avenue, Nashville, TN 37232-0146 USA
                Author information
                http://orcid.org/0000-0002-7458-3048
                Article
                56
                10.1007/s43188-020-00056-z
                7431904
                32837681
                ceb369d3-b0bf-41ba-ba67-27782a36daaf
                © Korean Society of Toxicology 2020

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                : 22 May 2020
                : 22 May 2020
                : 11 June 2020
                Funding
                Funded by: National Institutes of Health (US)
                Award ID: R01 GM118122
                Award Recipient :
                Categories
                Invited Review

                cytochrome p450,drugs,toxicity,reactive intermediates,drug-drug interactions,toxicophores

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