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Biomedical subjects

M V Relling

Publications and source records attributed to M V Relling.

At least 91 records · Page 5Linked to original sources
PubMed1996

Allopurinol inhibits de novo purine synthesis in lymphoblasts of children with acute lymphoblastic leukemia.

Allopurinol is used to prevent hyperuricemia in newly diagnosed patients with acute lymphoblastic leukemia (ALL). Although allopurinol has been shown to inhibit de novo purine synthesis (DNPS) in fibroblasts in vitro, this effect has not been assessed in ALL lymphoblasts. We assessed DNPS in ALL lymphoblasts in 46 consecutive patients with ALL. DNPS was determined by 14C-formate incorporation in purine bases both at diagnosis (n = 46) and 44h after MTX therapy +/- allopurinol (n = 31). The 27 patients who had received no allopurinol prior to the diagnostic bone marrow aspirate had significantly higher rates of DNPS (median, 102 fmol new purines/nmol total purines/h) compared to the 12 patients who had received more than one dose of allopurinol (100 mg/m2 orally) (median, 2.3 fmol/nmol/h; P < 0.001); the seven patients who received one dose of allopurinol had intermediate rates of DNPS (median, 58.5 fmol/nmol/h). Among patients who were evaluable for MTX effects at 44h (n = 31), the percent inhibition of DNPS was greater in the eight patients who received concomitant allopurinol (median, 100% inhibition) compared to the 23 patients who received only methotrexate therapy (median, 89% inhibition, P = 0.03). These data indicate that allopurinol suppresses may contribute to the decrease in circulating blasts in patients with newly diagnosed acute leukemias.

Adolescent↗
PubMed1995

Polymorphic thiopurine methyltransferase in erythrocytes is indicative of activity in leukemic blasts from children with acute lymphoblastic leukemia.

The activity of thiopurine methyltransferase (TPMT) exhibits genetic polymorphism, with approximately 1 in 300 individuals inheriting TPMT deficiency as an autosomal recessive trait, and about 11% having intermediate activity (ie, heterozygotes). Patients with TPMT deficiency accumulate excessive concentrations of 6-thioguanine nucleotides (TGNs) and develop severe toxicity when treated with standard dosages of mercaptopurine. High TPMT activity has been associated with lower concentrations of TGNs, yielding a higher risk of treatment failure in children with acute lymphoblastic leukemia (ALL). As the biochemical basis of these pharmacodynamic relationships has not been fully elucidated, we investigated the variability and relationship of TPMT activity in erythrocytes and lymphoblasts from children with ALL. A 58-fold range of erythrocyte TPMT activity was found among 119 patients receiving ALL chemotherapy (0.6 to 34.9 U/mL packed erythrocytes), but relatively low intrapatient variability (coefficient of variation, 13.5%) was observed over 1 year. A 27-fold range in TPMT activity was observed in leukemic blasts obtained from 42 patients at initial diagnosis (3.3 to 88.9 U/1 x 10(9) cells). TPMT activity in leukemic blasts at diagnosis was significantly correlated with TPMT in erythrocytes before therapy (rs = .75, P < .0001, N = 13). These data document extensive interpatient variability of TPMT activity in ALL blasts and establish its linkage to polymorphic TPMT activity in erythrocytes, providing a new mechanism by which erythrocytes serve as prognostic markers of mercaptopurine metabolism and TPMT activity in children with ALL.

Adolescent↗
PubMed1995

A single point mutation leading to loss of catalytic activity in human thiopurine S-methyltransferase.

Thiopurine S-methyltransferase (TPMT; S-adenosyl-L-methionine:thiopurine S-methyltransferase, EC 2.1.1.67) activity exhibits genetic polymorphism, with approximately 0.33% of Caucasians and African-Americans inheriting TPMT deficiency as an autosomal recessive trait. To determine the molecular genetic basis for this polymorphism, we cloned the TPMT cDNA from a TPMT-deficient patient who had developed severe hematopoietic toxicity during mercaptopurine therapy. Northern blot analysis of RNA isolated from leukocytes of the deficient patient demonstrated the presence of TPMT mRNAs of comparable size to that in subjects with high TPMT activity. Sequencing of the mutant TPMT cDNA revealed a single point mutation (G238-->C), leading to an amino acid substitution at codon 80 (Ala80-->Pro). When assessed in a yeast heterologous expression system, this mutation led to a 100-fold reduction in TPMT catalytic activity relative to the wild-type cDNA, despite a comparable level of mRNA expression. A mutation-specific PCR amplification method was developed and used to detect the G238-->C mutation in genomic DNA of the propositus and her mother. This inactivating mutation in the human TPMT gene provides insights into the genetic basis for this inherited polymorphism in drug metabolism.

Alleles↗
PubMed1995

Pharmacokinetics and pharmacodynamics of 21-day continuous oral etoposide in pediatric patients with solid tumors.

PURPOSE: The objectives of this study were to determine etoposide pharmacokinetics during continuous low-dose oral administration to children with solid tumors and to evaluate the relationships between parameters of etoposide systemic exposure and toxicity. PATIENTS AND METHODS: In this phase I study, children were administered oral etoposide (25 to 75 mg/m2/day) for 21 days as a diluted solution of the intravenous preparation, divided into three equal daily doses. Plasma pharmacokinetics were studied on day 1 of therapy in 18 children and again on day 21 in 14 of these children. Etoposide plasma concentration-time data were fitted to a first-order absorption, two-compartment model with use of bayesian estimation. Pharmacokinetic parameter estimates from day 1 were used to estimate steady-state etoposide systemic exposure in all children. Stepwise multivariate regression was used in an exploratory manner to determine patient, laboratory, or pharmacokinetic predictors of toxicity. RESULTS: Although there was substantial intrapatient variability, there was no difference in the area under the concentration-time curve [AUC(0-8hr)] measured at day 21 compared with the steady-state AUC(0-8hr) estimated from day 1 pharmacokinetic parameters (p = 0.64). Degree of neutropenia was best predicted by the estimated duration that steady-state plasma etoposide concentrations were maintained above 1 microgram/ml (t > 1 microgram/ml) rather than peak plasma concentrations, AUC(0-8hr), dosage, or other patient characteristics. Assuming a bioavailability of the oral solution of approximately 50%, the median etoposide systemic clearance was 21.4 ml/min/m2, a value similar to clearance estimates after intravenous etoposide in pediatric populations. CONCLUSION: We conclude that a parameter reflective of etoposide systemic exposure (t > 1 microgram/ml) correlates more strongly with neutropenia than does dosage or other patient characteristics.

Administration, Oral↗
PubMed1995

Nomenclature for N-acetyltransferases.

A consolidated classification system is described for prokaryotic and eukaryotic N-acetyltransferases in accordance with the international rules for gene nomenclature. The root symbol (NAT) specifically identifies the genes that code for the N-acetyltransferases, and NAT* loci encoding proteins with similar function are distinguished by Arabic numerals. Allele characters, denoted by Arabic numbers or by a combination of Arabic numbers and uppercase Latin letters, are separated from gene loci by an asterisk, and the entire gene-allele symbols are italicized. Alleles at the different NAT* loci have been numbered chronologically irrespective of the species of origin. For designation of genotypes at a single NAT* locus, a slash serves to separate the alleles; in phenotype designations, which are not italicized, alleles are separated by a comma.

Alleles↗
PubMed1995

Variability in human cytochrome P450 paclitaxel metabolism.

Formation of 6 alpha-hydroxypaclitaxel has been described as the primary biotransformation pathway for paclitaxel in vitro and in vivo, with additional formation of two other "minor" metabolites. Using a large group (n = 49) of human liver microsomes, and P450s heterologously expressed in cell lines, our aims were to elucidate the P450s responsible for and investigate variability in paclitaxel metabolite formation. Four metabolites of paclitaxel (6 alpha-hydroxypaclitaxel, metabolites B, C and A) were formed in vitro, via CYP2C8, 3A4, 3A4 and both 2C8 and 3A4, respectively. Although 6 alpha-hydroxypaclitaxel was predominant in the majority of livers, metabolites B and C (formed by CYP3A4) were predominant in 11/49 and 2/49 livers, respectively. Predominance of metabolite B over 6 alpha-hydroxypaclitaxel was more likely in liver microsomes from donors known to be exposed to phenobarbital (P = .009), and tended to be more likely in diseased vs. normal livers (P = .047). Formation rates for 6 alpha-hydroxypaclitaxel, A, B, and C were lower in diseased liver vs. normal liver (P < .001). Rates of formation of metabolites B and C were highly correlated with each other (r2 = .91; P < .001) and with midazolam 4-hydroxylation (r2 = .87 & 0.86, respectively; P < .001). Inhibitor experiments suggest that typical CYP3A substrates/inhibitors (e.g., cyclosporin, epipodophyllotoxins) may significantly interact with paclitaxel in vivo. In a single patient in whom plasma samples were measured on two occasions, metabolite A (the dihydroxylate) was predominant, and systemic clearance of paclitaxel was lower in a course administered 1 day vs. 6 wk after a course of fluconazole therapy. We report that 6 alpha-hydroxypaclitaxel, formed via CYP2C8, is not the predominant paclitaxel metabolite in all individuals, and that CYP3A4 catalytic activity is important to overall paclitaxel metabolism in humans.

Adult↗
PubMed1995

L-asparaginase may potentiate the leukemogenic effect of the epipodophyllotoxins.

The risk for induction of epipodophyllotoxin-related acute myeloid leukemia (AML) depends largely on the schedule of drug administration and, to a lesser degree, the cumulative dose. Concomitant use of other genotoxic drugs, such as alkylating agents and cisplatin, can increase the hazard further. We have treated 154 consecutive higher-risk cases of acute lymphoblastic leukemia in our recent Total Therapy Study XIII with an intensive post-remission regimen of chemotherapy that included etoposide given every other week or less often-a schedule associated with a relatively low cumulative incidence of secondary AML in our Study XI. Unexpectedly, four patients have developed secondary AML at 12 to 23 months from the start of treatment (median, 16 months). The 2-year cumulative risk estimate significantly exceeds that for 185 historical controls in Study XI whose continuation regimen included epipodophyllotoxins every other week: 5.4% (95% confidence interval, 0-11%) compared with 1.1% (0-2.6%), P = 0.046. Compared to patients treated in Study XI, those enrolled in Study XIII receive fewer scheduled doses of epipodophyllotoxin (48 (all etoposide) vs 63 (30 etoposide, 33 teniposide)) but 16 to 19 additional doses of L-asparaginase and eight additional doses of high-dose methotrexate, all within the week preceding etoposide treatment. We attribute the apparently increased rate of secondary AML in Study XIII to the use of L-asparaginase immediately before etoposide administration. On this schedule, the enzyme could increase systemic exposure to etoposide or its catechol metabolites and reduce the ability of cells to repair DNA damage.

Acute Disease↗
PubMed1995

Epipodophyllotoxin-related acute myeloid leukemia: a study of 35 cases.

To define better the risk of epipodophyllotoxin-related acute myeloid leukemia (AML) after extended follow-up and to assess responses to intensive salvage therapy, all patients who developed this complication after treatment for acute lymphoblastic leukemia (ALL) or non-Hodgkin lymphoma (NHL) in consecutive clinical trials at St Jude Children's Research Hospital from 1979 to 1994 were studied. Cases with 'lineage switch' or 'clonal selection' were excluded. Epipodophyllotoxin-related AML developed in 32 of 1140 patients treated for ALL and in three of 332 treated for NHL; it was a first adverse event in 25 and two cases, respectively. The complication was diagnosed at 12-130 months (median 34 months) after the initiation of treatment with epipodophyllotoxins; all but one of the cases occurred within 73 months, indicating that the risk is negligible after 6 years. The predominant karyotypic feature was 11q23 translocations (71% of cases); 21q22 rearrangements were rare. In a stepwise Cox regression analysis, two factors increased the risk of this complication: weekly or twice weekly administration of epipodophyllotoxins (P < 0.001); and the administration of asparaginase immediately before epipodophyllotoxin therapy (P < 0.001). Initial responses to salvage therapy were comparable to those reported for de novo AML: 92% of the evaluable patients entered complete remission after combination treatment. Single-agent therapy with 2-chlorodeoxyadenosine induced complete or partial remissions in one-half of the patients treated. The long-term survival rate was dismal. Of the 17 evaluable patients treated exclusively with chemotherapy, only one is alive at 84 months, compared to three of 16 patients who underwent bone marrow transplantation (alive at 10, 23 and 73 months). Cases of epipodophyllotoxin-related AML constitute a unique clinical syndrome that will require innovative strategies for cure.

Acute Disease↗
PubMed1994

Differences in constitutive and post-methotrexate folylpolyglutamate synthetase activity in B-lineage and T-lineage leukemia.

Folylpolyglutamate synthetase (FPGS) is responsible for the metabolism of natural folates and a broad range of folate antagonists to polyglutamate derivatives. Recent studies indicated increased accumulation of methotrexate (MTX) polyglutamates (MTX-PG) in blast cells as a predictor of favorable treatment outcome in childhood acute lymphoblastic leukemia (ALL). We determined the expression of FPGS activity in blasts from children with ALL at diagnosis and after treatment with MTX as a single agent, before conventional remission induction therapy. The levels of enzyme activity in ALL blasts at diagnosis (median of 689 pmol/h/mg protein) were significantly higher (P = .003) than those found in acute nonlymphoblastic leukemia (ANLL) blasts (median of 181 pmol/h/mg protein). Comparable lineage differences in normal lymphoid versus nonlymphoid cells suggest a lineage-specific control of FPGS expression, FPGS activity increased in ALL blasts after in vivo exposure to MTX. The median increase in FPGS activity was significantly higher (P = .003) in B-lineage ALL (188%) than in T-lineage ALL (37%). Likewise, the percentage of intracellular long chain MTX-PG (Glu3-6) was significantly higher (P = .02) in B-lineage ALL (92%) than in T-lineage ALL (65%), consistent with higher FPGS activity in B-lineage blasts. This finding could explain, at least in part, the superior outcome in children with B-lineage ALL treated with antimetabolite therapy.

Burkitt Lymphoma↗
PubMed1994

Etoposide pharmacokinetics and pharmacodynamics after acute and chronic exposure to cisplatin.

PURPOSE: The objectives of this study were to determine etoposide pharmacokinetics after both acute and chronic exposure to cisplatin and to evaluate the relationship between etoposide systemic exposure and toxicity in children with neuroblastoma. PATIENTS AND METHODS: Seventeen children with newly diagnosed stage C or D neuroblastoma were given continuous infusions of 780 mg/m2 etoposide over 72 hours as part of multiagent chemotherapy. Etoposide pharmacokinetic parameters were estimated on three occasions in each patient: (1) 21 days after the first cisplatin dose (etoposide was given immediately after cyclophosphamide; cumulative cisplatin dose, 90 mg/m2), (2) 2 days after the third cisplatin dose (cumulative cisplatin dose, 270 mg/m2), and (3) 21 days after the final cisplatin dose (etoposide again immediately after cyclophosphamide; cumulative cisplatin dose, 360 mg/m2). Toxicity was scored on the basis of transfusion requirements and need for hospitalization. RESULTS: Etoposide systemic clearance decreased acutely when administered 2 days after cisplatin (median of 15.5 ml/min/m2) compared with both the first study (20.0 ml/min/m2) and the third study (19.7 ml/min/m2; p < 0.001). The decrease in clearance resulted in a median 31% increase in etoposide area under the concentration-time curve (AUC) compared with the first study and a 36% increase compared with the third study. Toxicity scores were higher after the second study than after the first or third study (p = 0.01), and etoposide AUC was significantly correlated with toxicity score (p = 0.006). Neither etoposide renal clearance nor catechol excretion differed significantly among the courses. CONCLUSION: There was an acute decrease in etoposide systemic clearance when etoposide immediately followed cisplatin. No persistent decrease in etoposide clearance was noted after a cumulative dose of 360 mg/m2 cisplatin. Etoposide AUC was positively correlated with toxicity in a multidrug regimen.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1994

Identification of a new variant CYP2D6 allele with a single base deletion in exon 3 and its association with the poor metabolizer phenotype.

The human CYP2D6 gene codes for the enzyme, debrisoquine 4-hydroxylase, which metabolizes over 25 therapeutically important drugs. The inability to metabolize these drugs, which results in a 'poor metabolizer' (PM) phenotype, can be attributed, in some cases, to the presence of any of three previously described mutations in the CYP2D6 gene. To identify new alleles responsible for the PM phenotype, we have examined the CYP2D6 gene from individuals whose phenotypes were not consistent with their apparent genotypes. DNA sequencing revealed a single base deletion in exon 3, T1795, resulting in a frame shift and generating a stop codon one codon after the deletion. A PCR-based test was designed for this new allele (designated CYP2D6(T)) and 236 unrelated individuals from a lung cancer case control study were tested for the presence of the CYP2D6(T) mutation. Eight unrelated individuals were found to carry the D6(T) allele. Four subjects also carry the non-functional D6(B) allele and the drug metabolism phenotypes of these four D6(B)/D6(T) individuals are consistent with the D6(T) allele being responsible for reduced debrisoquine 4-hydroxylase activity. The frequency of the D6(T) allele among Caucasian controls of the case-control study was 1.8% (4/220 chromosomes).

Alleles↗
PubMed1994

Blast cell methotrexate-polyglutamate accumulation in vivo differs by lineage, ploidy, and methotrexate dose in acute lymphoblastic leukemia.

High-dose methotrexate (HDMTX) is a component of most treatment protocols for childhood acute lymphoblastic leukemia (ALL), yet recent studies of receptor-mediated transport and saturable polyglutamylation have questioned its rationale. To investigate this in vivo, methotrexate and its active polyglutamated metabolites (MTX-PG) were measured in bone marrow blasts obtained from 101 children randomized to single-agent therapy with either HDMTX (1 g/m2 per 24 h i.v., n = 47) or low-dose MTX (LDMTX, 30 mg/m2 by mouth every 6 h x 6, n = 54), before remission induction therapy. Blast concentrations of total MTX-PGs (median 460 vs 1380 pmol/10(9) cells) and of long-chain MTX-glu4-6 were both significantly higher after HDMTX (P < 0.001). With either treatment, MTX-PGs were significantly higher in B-lineage blasts than in T-lineage blasts (LDMTX P = 0.001, HDMTX P = 0.03). In a multiple regression analysis of B-lineage ALL, blast MTX-PG was significantly related to MTX dose (or plasma MTX concentration), lymphoblast ploidy (hyperdiploid > nonhyperdiploid), and percentage S-phase. This is the first evidence that HDMTX achieves higher MTX-PG concentrations in ALL blasts in vivo, establishing a rationale for HDMTX in the treatment of childhood ALL, especially T-lineage or nonhyperdiploid B-lineage ALL, disease characteristics associated with a poor prognosis on conventional therapy.

Adolescent↗
PubMed1994

Saturable pharmacokinetics and paclitaxel pharmacodynamics in children with solid tumors.

PURPOSE: Our aim was to evaluate the pharmacokinetics and pharmacodynamics of paclitaxel (Taxol; Bristol-Myers Squibb Co, Princeton, NJ) in children, and to determine whether paclitaxel exhibited saturable pharmacokinetics. PATIENTS AND METHODS: We evaluated the pharmacokinetics and pharmacodynamics of paclitaxel (200 to 420 mg/m2) administered as a 24-hour intravenous (i.v.) infusion in a phase 1 study of 30 pediatric patients (age, 2.3 to 22.8 years) with refractory solid tumors. Fourteen serial blood samples were obtained during and up to 48 hours after the infusion, and paclitaxel concentrations were measured by a high-performance liquid chromatography-UV (HPLC-UV) method. Four pharmacokinetic models were compared for their ability to describe the patients' data. RESULTS: Paclitaxel disposition was not consistent with a first-order, two-compartment pharmacokinetic model. Rather, the majority of data sets were best described by a two-compartment model that incorporated both saturable tissue distribution and saturable elimination; a smaller number of patient data sets were best described by models that incorporated either saturable distribution or saturable elimination. Clearance was dose-dependent, with a median clearance at the lower dosages (< 400 mg/m2) of 161 mL/min/m2, and at the highest dosages (> 400 mg/m2) of 123 mL/min/m2 (P = .044). The duration that paclitaxel plasma concentrations exceeded 0.1 mumol/L was highly variable (range, 26 to 71 hours). There was a trend toward higher median area under the concentration-versus-time curve (AUC) in those children with musculoskeletal (72 mumol/L.h; P = .054) or neurologic toxicity (54 mumol/L.h; P = .062) versus those without toxicity (30 mumol/L.h). Toxicity was not significantly correlated with dosage. CONCLUSION: We conclude that paclitaxel distribution and elimination are saturable, and that estimates of paclitaxel systemic exposure correlate better with toxicity than does dosage.

Adolescent↗
PubMed1994

Patient characteristics associated with high-risk methotrexate concentrations and toxicity.

PURPOSE: Following high-dose methotrexate (HD-MTX) treatment, delayed MTX elimination is an important problem because it necessitates increased leucovorin rescue and additional hospitalization for hydration and urinary alkalinization. Our purpose was to identify factors associated with high-risk MTX plasma concentrations (defined by plasma concentration > or = 1.0 mumol/L at 42 hours from the start of MTX) and with toxicity. PATIENTS AND METHODS: Variables associated with MTX concentrations and toxicity were assessed in 134 children treated with one to five courses of HD-MTX (900 to 3,700 mg/m2 intravenously [i.v.] over 24 hours for a total of 481 courses) for acute lymphoblastic leukemia (ALL). RESULTS: High-risk MTX concentrations, toxicity (usually mild mucositis), and delay in resuming continuation chemotherapy occurred in 106 (22%), 123 (26%), and 66 (14%) of 481 courses, respectively. Using a mixed effects model for repeated measures, high-risk MTX concentrations were significantly associated with a higher MTX area-under-the-concentration-time curve (AUC), low urine pH, emesis, low MTX clearance, low urine output relative to intake, use of antiemetics during the MTX infusion, and concurrent intrathecal therapy (all p values < .01). Clinical toxicities and delay in resumption of continuation chemotherapy due to myelosuppression were more common in those with high 42-hour MTX concentrations, despite increased leucovorin rescue for all patients with high-risk MTX concentrations. However, with individualized rescue, no patient developed life-threatening toxicity. A more aggressive hydration and alkalinization regimen for subsequent courses reduced the frequency of high-risk MTX concentrations to 7% of courses (13 of 183) (P = .0001), and the frequency of toxicity decreased to 11% of courses (P = .0074). CONCLUSION: This study identified several clinical variables that influence MTX disposition that, when modified, can reduce the frequency of high-risk MTX concentrations and toxicity.

Child↗
PubMed1994

Clinical pharmacokinetics of paclitaxel.

Paclitaxel is a new anticancer agent showing significant promise as therapy for solid tumours and leukaemia, given alone or in combination with other chemotherapeutic agents. Paclitaxel concentrations in biological specimens can be measured using high performance liquid chromatography, or more recently by immunoassay. Pharmacokinetic studies in which adults have been administered pacliaxel intravenously over 1 to 96 hours have demonstrated the following pharmacokinetic characteristics: extensive tissue distribution; high plasma protein binding (approximately 90 to 95%); variable systemic clearance, with average clearances ranging from 87 to 503 ml/min/m2 (5.2 to 30.2 L/h/m2); and minimal renal excretion of parent drug (< 10%). In vitro and in vivo studies have demonstrated that paclitaxel is extensively metabolised by the liver to 3 primary metabolites. Cytochrome P450 enzymes of the CYP3A and CYP2C subfamilies appear to be involved in hepatic metabolism of paclitaxel. Although early reports suggested that paclitaxel has first-order pharmacokinetics, some recent trials in children and adults suggest that its elimination is saturable. The clinical importance of saturable elimination would be greatest when large dosages are administered and/or the drug is infused over a shorter period of time. In these situations, achievable plasma concentrations are likely to exceed the affinity constant for elimination (Km). Thus, small changes in dosage or infusion duration may result in disproportionately large alterations in paclitaxel systemic exposure, potentially influencing patient response. A pharmacokinetic analysis of the combination of cisplatin and paclitaxel has demonstrated that paclitaxel clearance is apparently sequence dependent. Patients administered cisplatin prior to paclitaxel had lower clearances and greater clinical toxicity than patients receiving paclitaxel before cisplatin. Additional pharmacodynamic analyses have shown nonhaematological and haematological toxicity to correlate better with parameters of paclitaxel exposure (e.g. area under the plasma concentration-time curve, duration of plasma concentrations exceeding 0.1 mumol/L) than with the administered dosage.

Absorption↗
PubMed1994

O-demethylation of epipodophyllotoxins is catalyzed by human cytochrome P450 3A4.

We previously demonstrated that O-demethylation of the pendant dimethoxyphenol ring of epipodophyllotoxins to produce their respective catechol metabolites is catalyzed by cytochrome(s) P450 in human liver microsomes. Our objective was to identify the specific human cytochrome(s) P450 responsible for catechol formation. Using a panel of prototypical substrates and inhibitors for specific cytochromes P450, we identified substrates for CYP3A4 (midazolam, erythromycin, cyclosporin, and dexamethasone) as inhibitors of catechol formation from both etoposide and teniposide. Dexamethasone inhibition was competitive, with Ki values of 60 and 45 microM for etoposide and teniposide, respectively. In 58 human livers, the correlation coefficients for teniposide catechol formation versus 1'- and 4-hydroxymidazolam formation were 80% and 85%, respectively; for etoposide catechol formation versus 1'- and 4-hydroxymidazolam formation r2 was 83% and 79%, respectively. Teniposide and etoposide catechol formation rates were also significantly correlated with immunodetectable CYP3A (r2 = 49% and 51%, respectively) and not with immunodetectable CYP1A2, 2E1, or 2C8. Finally, cDNAs for human CYP3A4, 3A5, 2A6, 2B6, 2C8, and 2C9 were functionally expressed in HepG2 cells, using a vaccinia viral vector. Teniposide and etoposide catechol formation was catalyzed primarily by 3A4 (15.4 and 40.9 pmol/pmol/hr, respectively) and to a lesser degree by 3A5 (1.94 and 11.3 pmol/pmol/hr, respectively), whereas there was no detectable O-demethylation of epipodophyllotoxins by 2A6, 2B6, 2C8, 2C9, or the control virus alone. Moreover, the relative activities of midazolam hydroxylation, compared with O-demethylation of epipodophyllotoxins, were similar for heterologously expressed 3A4 and for human liver microsomes. We conclude that catechol formation from teniposide and etoposide is primarily mediated by human CYP3A4, making these reactions susceptible to inhibition by prototypical 3A substrates and inhibitors.

Biotransformation↗
PubMed1993

Saturable elimination and saturable protein binding account for flavone acetic acid pharmacokinetics.

Flavone acetic acid (FAA) is an antineoplastic agent that has undergone extensive study in Phase I trials. Concentration-dependent plasma protein binding has been demonstrated in vitro at concentrations of total drug that are achieved in vivo. Moreover, dose-dependent total systemic clearance has been described when FAA has been administered as a short iv infusion. When administered as a prolonged 24-hr infusion, total FAA (bound plus unbound) plasma pharmacokinetics are well described with a first-order two-compartment model. However, measurement of unbound FAA intra- and post-intravenous infusion in eight patients revealed a twofold increase in fraction of FAA unbound in plasma intrainfusion. We attempted to fit pharmacokinetic structural models of varying complexity to the unbound concentrations alone and simultaneously to the unbound and bound FAA plasma concentrations. The data were adequately described only by a model that incorporated simultaneous saturable plasma protein binding and a Michaelis-Menten process for elimination. A comparison among models is presented, as well as pharmacokinetic parameter estimates for FAA in children. These clinical data are consistent with predictions of the clearance model in which both saturable protein binding (resulting in a dynamically increasing unbound fraction) and saturable elimination (resulting in gradually decreasing unbound intrinsic clearance) are operative.

Antineoplastic Agents↗