Hepatic microsomal enzymes in man and rat: induction and inhibition by ethanol

A novel epigenetic mechanism unravels hsa-miR-148a-3p-mediated CYP2B6 downregulation in alcoholic hepatitis disease

Cytochrome P450 (CYP) enzymes play critical roles in drug transformation, and the total CYPs are markedly decreased in alcoholic hepatitis (AH), a fatal alcoholic liver disease. miRNAs are endogenous small noncoding RNAs that regulate many essential biological processes. Knowledge concerning miRNA regulation of CYPs in AH disease is limited. Here we presented the changes of key CYPs in liver samples of AH patients retrieved from GEO database, performed in silico prediction of miRNAs potentially targeting the dysregulated CYP transcripts, and deciphered a novel mechanism underlying miRNA mediated CYPs expression in liver cells. Nine miRNAs were predicted to regulate CYP1A2, CYP2A6, CYP2B6, CYP2C8, CYP2C19, CYP2J2, and CYP3A4, among which hsa-miR-148a-3p was selected as a case study. Biochemical and molecular evidences demonstrated that miR-148a promoted CYP2B6 expression by increasing mRNA stability via directly binding to the 3'UTR sequence, and that this positive posttranscriptional regulation was AGO1/2-dependent. Further, luciferase reporter gene assay and RNA secondary structure analysis illustrated that the seedless target site, not the seed target site, controlled miR-148a-mediated CYP2B6 upregulation. Moreover, we identified HNF4A as a liver-specific transcription factor of MIR-148A through EMSA and chromatin immunoprecipitation experiments. In conclusion, ethanol downregulated miR-148a in hepatocytes through HNF4A regulation, which eventually decreased CYP2B6 expression. Our finding will benefit the understanding of dysregulated drug metabolism in AH patients and highlight an unconventional mechanism for epigenetic regulation of CYP gene expression.

Asymptomatic Theophylline Overdose

A case of severe theophylline overdose is described in which clinical signs of toxicity initially were minimal despite extremely high serum drug levels. Hemodialysis was performed because of the risk of seizures and cardiac arrhythmias. The predialysis, dialysis, and postdialysis half-lives were 13.1, 4.3, and 6.7 hours, respectively. Corresponding total body clearance values were 23.8, 72.5, and 46.3 ml/kg/h. The patient showed apparent saturation kinetics of theophylline clearance at high serum levels. Hemodialysis is effective for enhancing the removal of theophylline.

Impact of repeated nicotine and alcohol coexposure on in vitro and in vivo chlorpyrifos dosimetry and cholinesterase inhibition

Chlorpyrifos (CPF) is an organophosphorus insecticide, and neurotoxicity results from inhibition of acetylcholinesterase (AChE) by its metabolite, chlorpyrifos-oxon. Routine consumption of alcohol and tobacco modifies metabolic and physiological processes impacting the metabolism and pharmacokinetics of other xenobiotics, including pesticides. This study evaluated the influence of repeated ethanol and nicotine coexposure on in vivo CPF dosimetry and cholinesterase (ChE) response (ChE- includes AChE and/or butyrylcholinesterase (BuChE)). Hepatic microsomes were prepared from groups of naive, ethanol-only (1 g/kg/d, 7 d, po), and ethanol + nicotine (1 mg/kg/d 7 d, sc)-treated rats, and the in vitro metabolism of CPF was evaluated. For in vivo studies, rats were treated with saline or ethanol (1 g/kg/d, po) + nicotine (1 mg/kg/d, sc) in addition to CPF (1 or 5 mg/kg/d, po) for 7 d. The major CPF metabolite, 3,5,6-trichloro-2-pyridinol (TCPy), in blood and urine and the plasma ChE and brain acetylcholinesterase (AChE) activities were measured in rats. There were differences in pharmacokinetics, with higher TCPy peak concentrations and increased blood TCPy AUC in ethanol + nicotine groups compared to CPF only (approximately 1.8- and 3.8-fold at 1 and 5 mg CPF doses, respectively). Brain AChE activities after ethanol + nicotine treatments showed significantly less inhibition following repeated 5 mg CPF/kg dosing compared to CPF only (96 ± 13 and 66 ± 7% of naive at 4 h post last CPF dosing, respectively). Although brain AChE activity was minimal inhibited for the 1-mg CPF/kg/d groups, the ethanol + nicotine pretreatment resulted in a similar trend (i.e., slightly less inhibition). No marked differences were observed in plasma ChE activities due to the alcohol + nicotine treatments. In vitro, CPF metabolism was not markedly affected by repeated ethanol or both ethanol + nicotine exposures. Compared with a previous study of nicotine and CPF exposure, there were no apparent additional exacerbating effects due to ethanol coexposure.

The effect of ethanol on drug oxidations in vitro and the significance of ethanol-cytochrome P-450 interaction

The effect of ethanol on N-demethylation of aminopyrine in rat liver slices and in the microsomal fraction and on microsomal hydroxylation of pentobarbital and aniline was studied. With liver slices N-demethylation of aminopyrine was stimulated by 35-40% at low ethanol concentrations (2mm), whereas no stimulation occurred at high concentrations (100mm). With the liver microsomal fraction, an inhibitory effect was observed only at high ethanol concentrations (100mm). This was also observed with the other drugs studied. In agreement with these results, only at a high concentration did ethanol interfere with the binding of drug substrates to cytochrome P-450. Further, as previously reported, ethanol produced a reverse type I spectral change when added to the liver microsomal fraction. Evidence that this spectral change is due to removal of substrate, endogenously bound to cytochrome P-450, is reported. A dual effect of ethanol is assumed to explain the present findings; in liver slices, at a low ethanol concentration, the enhanced rate of drug oxidation is the result of an increased NADH concentration, whereas the inhibitory effect observed with the microsomal fraction at high ethanol concentration is due to the interference by ethanol with the binding of drug substrates to cytochrome P-450.

Ethanol-induced oxidative stress: basic knowledge

After a general introduction, the main pathways of ethanol metabolism (alcohol dehydrogenase, catalase, coupling of catalase with NADPH oxidase and microsomal ethanol-oxidizing system) are shortly reviewed. The cytochrome P(450) isoform (CYP2E1) specifically involved in ethanol oxidation is discussed. The acetaldehyde metabolism and the shift of the NAD/NADH ratio in the cellular environment (reductive stress) are stressed. The toxic effects of acetaldehyde are mentioned. The ethanol-induced oxidative stress: the increased MDA formation by incubated liver preparations, the absorption of conjugated dienes in mitochondrial and microsomal lipids and the decrease in the most unsaturated fatty acids in liver cell membranes are discussed. The formation of carbon-centered (1-hydroxyethyl) and oxygen-centered (hydroxyl) radicals during the metabolism of ethanol is considered: the generation of hydroxyethyl radicals, which occurs likely during the process of univalent reduction of dioxygen, is highlighted and is carried out by ferric cytochrome P(450) oxy-complex (P(450)-Fe(3+)O(2) (.-)) formed during the reduction of heme-oxygen. The ethanol-induced lipid peroxidation has been evaluated, and it has been shown that plasma F(2)-isoprostanes are increased in ethanol toxicity.

Regulation of human drug metabolism by dietary factors

Several dietary factors influence the oxidative metabolism of chemicals in humans. Increasing the ratio of protein to carbohydrate or fat in the diet, feeding cabbage and brussels sprouts or feeding charcoal-broiled beef for several days stimulates human drug metabolism. The chronic ingestion of ethanol stimulates drug metabolism whereas the chronic ingestion of methylxanthine-containing foods inhibits drug metabolism. In contrast, an increase in the ratio of fat to carbohydrate in the diet of normal subjects or the fasting of obese individuals for several days has little or no effect on drug metabolism. Flavonoids in edible plants influence the metabolism of foreign chemicals by human liver in vitro. The addition of flavone, tangeretin or nobiletin to human liver microsomes activates both the hydroxylation of benzo[alpha]pyrene and the metabolism of aflatoxin B1 to mutagens. On the other hand, quercetin, kaempferol, morin and chrysin, which are also normally occurring flavonoids, inhibit the hydroxylation of benzo[alpha]pyrene by human liver microsomes.

The detection of minimal alcoholic liver disease by three methods

The serum aspartate transaminase, 2-h post-prandial bile acids and the aminopyrine breath test were measured in 14 alcoholics with histologically proved minimal liver damage. A raised aspartate transaminase value was found in 64% (9/14) of the patients and was the commonest abnormality found. In three patients all three tests were normal. Six patients stopped abusing alcohol and, when reassessed a mean of 33 days later, showed significant changes in the mean aspartate transaminase value and the mean value for the aminopyrine breath test. There was no significant change in the mean post-prandial bile acids value. The remaining eight patients continued to drink alcohol and, when reassessed at a mean of 118 days, showed no significant change in any of these indices. Of the methods assessed, the serum aspartate transaminase appeared to be the most useful for detecting and monitoring patients with minimal alcoholic liver disease. However, all three tests failed to detect an unacceptably high percentage of the patients, and liver biopsy therefore remains a more certain diagnostic method.

A human PBPK model for ethanol describing inhibition of gastric motility

A physiologically based pharmacokinetic model for investigating inter-individual and inter-racial variability in ethanol pharmacokinetics is presented. The model is a substantial modification of an existing model which described some genetic polymorphisms in the hepatic alcohol dehydrogenase enzymes. The model was modified to incorporate a description of ethanol absorption from the stomach and gastro-intestinal tract and the retardation of gastric emptying due to a concentration-dependent inhibition of gastric peristalsis. In addition, intra-venous and intra-arterial routes of administration were added to investigate whether the biological structure of the model provided a core which may be easily adapted for any route of exposure. The model is proposed as suitable for the investigation of the effects of both acute and chronic ethanol exposure.

Plasma phosphatidylcholine hydroperoxide as a new marker of oxidative stress in alcoholic patients

Quantitative analysis of plasma phosphatidylcholine hydroperoxide (PCOOH) is an important step in evaluating the biochemical processes leading to oxidative injury. However, secondary products of lipid peroxidation are now used as indices. One hundred nine alcoholic patients, aged 22-81 years (mean +/- SEM, 52.0 +/- 1.3 years), and 21 healthy volunteers, aged 41-79 years (51.2 +/- 2.2 years), participated in this study. Plasma PCOOH was measured by HPLC with chemiluminescence detection. Plasma PCOOH concentration was significantly higher in alcoholic patients (46.1 +/- 4.1 pmol/ml) than in controls (15.6 +/- 1.8 pmol/ml). It was significantly higher in patients with blood alcohol (88.0 +/- 10.5 pmol/ml) than in those without alcohol (32.6 +/- 3.1 pmol/ml). The patients with high levels of aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transpeptidase (gamma-GTP), and triglyceride (TG) showed significantly higher PCOOH concentrations than did patients with normal levels. The PCOOH level was positively correlated with levels of gamma-GTP, HDL, blood alcohol concentration, and TG. Plasma PCOOH levels in 29 alcoholic patients after a 6 week abstinence were decreased significantly (22.8 +/- 11.1 pmol/ml), which was associated with improvement on liver function tests. This is the first measurement of plasma PCOOH in alcoholic patients. These results suggest the involvement of lipid peroxidation in alcohol-induced liver damage and confirm that the PCOOH plasma concentration is a new marker of alcohol consumption as well as oxidative stress in alcoholic patients.

Oxidative damage to the hepatocellular proteins after chronic ethanol intake in the rat

BACKGROUND

Protein carbonyl content, a measure of oxidative damage to hepatocellular proteins, and the activities of some thiol-containing proteins were assayed in the liver and plasma, as thiol-containing protein, appear to be targets for free radicals. These may be important in the mechanism of ethanol-induced liver injury.

METHODS

Tap water containing ethanol at the concentration of 25% (v/v) and phenobarbital (500 mg/l) was the only source of drinking water for the experimental rats for 24 months. Another group of rats were administered 25% (v/v) ethanol alone in drinking water for 24 months. Control rats were administered either phenobarbital alone in drinking water or tap water for 24 months. At the end of 24 months, the rats were sacrificed. The protein carbonyl content, activities of glutamine synthase and biotinidase-sulfhydryl group containing enzymes were assayed in the liver along with alkaline protease, an enzyme that degrades oxidized proteins. The total thiol, albumin and the activity of biotinidase were measured in the plasma.

RESULTS

The protein carbonyl content of the liver was increased in the ethanol/phenobarbital-treated rats as well as in the ethanol-treated rats as compared with the controls. The activities of glutamine synthase and biotinidase were decreased significantly in the livers of ethanol/phenobarbital-treated rats as well as the ethanol-treated rats as compared with the controls. The activity of alkaline protease was increased significantly in both the ethanol-treated groups. In the plasma of ethanol/phenobarbital-treated rats as well as the ethanol-treated rats total thiol, albumin and the activity of biotinidase were decreased significantly as compared with the controls. The ethanol/phenobarbital-treated rats as well as the ethanol-treated rats developed fatty liver.

CONCLUSIONS

Damage to proteins occurs upon chronic ethanol intake in the rat, and it may play a role in the pathogenesis of alcohol-induced fatty liver.

High-dose vitamin E lowers urine porphyrin levels in patients affected by porphyria cutanea tarda

Porphyria cutanea tarda (PCT) is a metabolic disorder of heme biosynthesis, characterized by reduced uroporphyrinogen decarboxylase (UROD) activity and increased urinary excretion of eight and seven carboxyl group porphyrins. Specific factors such as iron, alcohol and halogenated compounds further inhibit enzyme activity by generating reactive oxygen species. Antioxidant vitamin E has frequently been used to counteract oxidative stress in porphyria patients, but a number of studies have failed to detect any significant effect on porphyrin metabolism. Since the use of vitamin E in the treatment of porphyria is a debated question, it seemed of interest to administer high doses to five patients with PCT in order to evaluate the effects on urine porphyrin excretion. The patients had high urinary porphyrin excretion levels, but vitamin E significantly reduced the urinary excretion of eight carboxyl group porphyrins. This result is attributable to the increase in UROD activity caused by the vitamin, which is a known scavenger of the oxygen reactive species that interfere with the activity of the enzyme. In conclusion, this paper shows that vitamin E high doses significantly lowers the urine porphyrin excretion in studied patients affected by PCT.

Influence of acute and chronic alcohol intake on the clinical course and outcome in acetaminophen overdose

BACKGROUND

Animal studies on acetaminophen toxicity suggest that chronic alcohol intake affects the outcome adversely, whereas acute alcohol intake seems protective. Few clinical data are available.

METHODS

We studied 209 consecutive patients with single-dose acetaminophen overdose. The combined influence of independent variables (gender, age, dose, delay to antidote treatment, chronic and acute alcohol intake and nomogram risk group) on dependent variables (death, development of hepatic encephalopathy and biochemical liver markers) was studied using multiple or logistic regression analysis.

RESULTS

Fifty-seven (27.3%) patients had chronic alcohol intake and 45 (21.5%) patients had acute alcohol intake. Forty-four (21.1%) patients developed hepatic coma and 20 (43.5%) of these patients died. Chronic alcohol intake was significantly and independently associated with the development of hepatic coma, with a lower prothrombin index, lower platelet count, higher creatinine and higher bilirubin. The relative risks for hepatic coma and death were 5.3 (95% confidence interval, 2.2-12.4) and 1.4 (95% confidence interval, 0.5-3.9), respectively, in the chronic alcohol intake group compared with the no chronic alcohol intake group. Acute alcohol intake was not significantly associated with any of the dependent variables studied.

CONCLUSIONS

Chronic alcohol intake enhances acetaminophen hepatotoxicity, whereas acute alcohol intake does not affect the clinical course.

Cholesterol-derived hydroperoxides in alcoholic liver disease

Human liver samples from 33 patients were collected at autopsy (controls, n = 9; fatty liver, n = 12; liver cirrhosis, n = 12), and samples homogenized. Lipids extracted with chloroform and methanol were injected into the octyl column of a high-performance liquid chromatograph with post-column chemiluminescence. Liquid chromatography-mass spectrometry was developed to identify 7-hydroperoxycholest-5-en-3 beta-ol (7-OOH). We found that two cholesterol-derived hydroperoxides, 7 alpha-hydroperoxycholest-5-en-3 beta-ol (7 alpha-OOH) and 7 beta-hydroperoxycholest-5-en-3 beta-ol (7 beta-OOH), are present in significantly elevated amounts (12.4 and 25.0 nmol/g tissue, respectively) in lipid extracts from alcoholic fatty liver, but not in extracts from alcoholic cirrhotic liver. 7 alpha-OOH and 7 beta-OOH are early intermediates produced during free radical-mediated cholesterol oxidation and can serve as molecular indicators of chain peroxidative damage in cell membranes. This is the first demonstration of 7 alpha-OOH and 7 beta-OOH accumulations in human liver, and it is presumed to reflect greater oxidative stress pathology in alcoholic fatty liver.

Ethanol metabolism, cirrhosis and alcoholism

Alcohol-induced tissue damage results from associated nutritional deficiencies as well as some direct toxic effects, which have now been linked to the metabolism of ethanol. The main pathway involves liver alcohol dehydrogenase which catalyzes the oxidation of ethanol to acetaldehyde, with a shift to a more reduced state, and results in metabolic disturbances, such as hyperlactacidemia, acidosis, hyperglycemia, hyperuricemia and fatty liver. More severe toxic manifestations are produced by an accessory pathway, the microsomal ethanol oxidizing system involving an ethanol-inducible cytochrome P450 (2E1). After chronic ethanol consumption, there is a 4- to 10-fold induction of 2E1, associated not only with increased acetaldehyde generation but also with production of oxygen radicals that promote lipid peroxidation. Most importantly, 2E1 activates many xenobiotics to toxic metabolites. These include solvents commonly used in industry, anaesthetic agents, medications such as isoniazid, over the counter analgesics (acetaminophen), illicit drugs (cocaine), chemical carcinogens, and even vitamin A and its precursor beta-carotene. Furthermore, enhanced microsomal degradation of retinoids (together with increased hepatic mobilization) promotes their depletion and associated pathology. Induction of 2E1 also yields increased acetaldehyde generation, with formation of protein adducts, resulting in antibody production, enzyme inactivation, decreased DNA repair, impaired utilization of oxygen, glutathione depletion, free radical-mediated toxicity, lipid peroxidation, and increased collagen synthesis. New therapies include adenosyl-L-methionine which, in baboons, replenishes glutathione, and attenuates mitochondrial lesions. In addition, polyenylphosphatidylcholine (PPC) fully prevents ethanol-induced septal fibrosis and cirrhosis, opposes ethanol-induced hepatic phospholipid depletion, decreased phosphatidylethanolamine methyltransferase activity and activation of hepatic lipocytes, whereas its dilinoleoyl species increases collagenase activity. Current clinical trials with PPC are targeted on susceptible populations, namely heavy drinkers at precirrhotic stages.

Effects of diet and ethanol on the expression and localization of cytochromes P450 2E1 and P450 2C7 in the colon of male rats

Local activation of procarcinogens in target tissues such as the colon by cytochrome P450-dependent microsomal monooxygenases is considered to be an important factor in the etiology of cancer. Diet and alcohol consumption are considered risk factors in colon cancer, and the cytochrome P450 isozymes CYP2E1 and CYP2C7 have been implicated in the biochemical mechanisms underlying colon cancer. The current study was conducted to determine the effects of diet and ethanol consumption on colonic and hepatic expression of these two enzymes. Adult male rat Sprague-Dawley rats were fed rat chow ad lib. or were infused intragastrically with control or ethanol-containing diets. Our results indicate that CYP2E1 is present in colonic epithelial cells, and expression of colonic and hepatic microsomal CYP2E1 and CYP2C7 was increased by chronic ethanol intake. As compared with rats having ad lib. access to standard rat food, rats receiving total enteral nutrition had significant (P < 0.01) reductions of CYP2C7 and slight, but not statistically significant, reductions in the expression of CYP2E1 in colon. Diet and ethanol differentially regulated CYP2E1 and CYP2C7 in a tissue-specific manner such that the ethanol induced CYP2E1 and CYP2C7 in the colon and liver, and the intragastric diet alone had a tendency to induce these isozymes in the liver and reduce them in the colon. These results may provide a partial explanation for the mechanism underlying effects of diet and ethanol on colon cancer.

Mechanisms of ethanol-drug-nutrition interactions

Mechanisms of the toxicologic manifestations of ethanol abuse are reviewed. Hepatotoxicity of ethanol results from alcohol dehydrogenase-mediated excessive hepatic generation of nicotinamide adenine dinucleotide and acetaldehyde. It is now recognized that acetaldehyde is also produced by an accessory (but inducible) pathway, the microsomal ethanol-oxidizing system, which involves a specific cytochrome P450. It generates oxygen radicals and activates many xenobiotics to toxic metabolites, thereby explaining the increased vulnerability of heavy drinkers to industrial solvents, anesthetics, commonly used drugs, over-the-counter medications and carcinogens. The contribution of gastric alcohol dehydrogenase to the first pass metabolism of ethanol and alcohol-drug interactions is now recognized. Alcohol also alters the degradation of key nutrients, thereby promoting deficiencies as well as toxic interactions with vitamin A and beta-carotene. Conversely, nutritional deficits may affect the toxicity of ethanol and acetaldehyde, as illustrated by the depletion in glutathione, ameliorated by S-adenosyl-L-methionine. Other supernutrients include polyenylphosphatidylcholine, shown to correct the alcohol-induced hepatic phosphatidylcholine depletion and to prevent alcoholic cirrhosis in non-human primates. Thus, a better understanding of the pathology induced by ethanol has now generated improved prospects for therapy.

Influence of long-term ethanol treatment on rat liver biotransformation enzymes

The influence of rats' long-term ethanol consumption on liver enzymes that could be involved in the biotransformation of benzo(a)pyrene [B(a)P] has been studied. Male and female Wistar rats received an increasing amount of ethanol in their drinking water up to 15% (w/v) in three weeks. The ethanol content was kept at a concentration of 15% for another three weeks. One group of rats also received B(a)P in the last week of the ethanol treatment. Livers were isolated, and microsomal and cytosolic fractions were prepared. In every enzyme measurement sex differences were observed. Long-term ethanol consumption induced P450, especially aniline 4-hydroxylase (P4502E1). However, testosterone 6 beta-hydroxylase (P4503A2 and P4502C13) in males and testosterone 12 beta-hydroxylase in females were decreased. The phase 2 enzymes glutathione S-transferase (subunit 1) and epoxide hydrolase were also decreased in their activity. Our results support the hypothesis that the effect of long-term ethanol consumption on B(a)P biotransformation as found in in vivo and in vitro studies, consisting of lowered formation of phenolic and diolic metabolites, is the result of a decrease of constitutive P450 isoenzymes.

Influence of long-term ethanol treatment on in vitro biotransformation of benzo(a)pyrene in microsomes of the liver, lung and small intestine from male and female rats

The influence of long-term ethanol exposure of rats on the microsomal biotransformation of benzo(a)pyrene [B(a)P] was studied. Male and female Wistar rats received an increasing amount of ethanol in their drinking water: percentages rose to 15% (w/v) in 3 weeks. The ethanol content was kept at a concentration of 15% for another 3 weeks. Livers, lungs and intestinal epithelial cells of the rats were then isolated and microsomal fractions prepared. In all organs, the metabolite most formed was 3-hydroxy-B(a)P. In the liver, males showed significantly higher B(a)P hydroxylase activity than females. On the basis of experiments using monoclonal antibodies, a significant part of the B(a)P biotransformation in male rat liver microsomes can be attributed to the male specific P4502C11. In the lung and intestine, there were no significant differences between the sexes. In the liver, ethanol treatment significantly decreased the microsomal formation of phenolic metabolites. In microsomes of intestinal epithelial cells, ethanol treatment enhanced the formation of phenols and diols. In conclusion, ethanol consumption by rats in moderate amounts leads to an alteration in the microsomal biotransformation of B(a)P. Effects are most prominent in the liver, where the formation of phenols is significantly decreased.

Assessment of occupational health risk from multiple exposure: review of industrial solvent interaction and implication for biological monitoring of exposure

This review is a critical survey and evaluation of recent literature on solvent interactions for the assessment of health risk. It addresses the implications of multiple solvent exposures 1) by examining the influence of solvent-solvent and ethanol-solvent interactions on the biological indices of chemical exposure, and 2) by indicating how the eventual modifying effects can be considered in the biological monitoring of mixed exposure. Reviewed studies reveal the effects of toxicokinetic interactions on the biological parameters, and the gaps in our knowledge. The measurement of potentially toxic molecular species is suggested for the biological monitoring of multiple chemical exposure. This approach appears to be important for drawing better quantitative conclusions on the internal exposure to biologically active chemical species. Finally, research needs arising from the critical analysis of the literature are briefly described.

Alcohol, liver, and nutrition

Until two decades ago, dietary deficiencies were considered to be the major reason why alcoholics developed liver disease. As the overall nutrition of the population improved, more emphasis was placed on secondary malnutrition. Direct hepatotoxic effects of ethanol were also established, some of which were linked to redox changes produced by reduced nicotinamide adenine dinucleotide (NADH) generated via the alcohol dehydrogenase (ADH) pathway. It was also determined that ethanol can be oxidized by a microsomal ethanol oxidizing system (MEOS) involving cytochrome P-450: the newly discovered ethanol-inducible cytochrome P-450 (P-450IIE1) contributes to ethanol metabolism, tolerance, energy wastage (with associated weight loss), and the selective hepatic perivenular toxicity of various xenobiotics. P-450 induction also explains depletion (and enhanced toxicity) of nutritional factors such as vitamin A. Even at the early fatty-liver stage, alcoholics commonly have a very low hepatic concentration of vitamin A. Ethanol administration in animals was found to depress hepatic levels of vitamin A, even when administered with diets containing large amounts of the vitamin, reflecting, in part, accelerated microsomal degradation through newly discovered microsomal pathways of retinol metabolism, inducible by either ethanol or drug administration. The hepatic depletion of vitamin A was strikingly exacerbated when ethanol and other drugs were given together, mimicking a common clinical occurrence. Hepatic retinoid depletion was found to be associated with lysosomal lesions and decreased detoxification of chemical carcinogens. To alleviate these adverse effects, as well as to correct problems of night blindness and sexual inadequacies, the alcoholic patient should be provided with vitamin A supplementation. Such therapy, however, is complicated by the fact that in excessive amounts vitamin A is hepatotoxic, an effect exacerbated by long-term ethanol consumption. This results in striking morphologic and functional alterations of the mitochondria with leakage of mitochondrial enzymes, hepatic necrosis, and fibrosis. Thus, treatment with vitamin A and other nutritional factors (such as proteins) is beneficial but must take into account a narrowed therapeutic window in alcoholics who have increased needs for such nutrients, but also display an enhanced susceptibility to their adverse effects. Massive doses of choline also exerted some toxic effects and failed to prevent the development of alcoholic cirrhosis. Acetaldehyde (the metabolite produced from ethanol by either ADH or MEOS) impairs hepatic oxygen utilization and forms protein adducts, resulting in antibody production, enzyme inactivation, and decreased DNA repair. It also enhances pyridoxine and perhaps folate degradation and stimulates collagen production by the vitamin A storing cells (lipocytes) and myofibroblasts.(ABSTRACT TRUNCATED AT 400 WORDS)

Substance abuse and schizophrenia: impediments to optimal care

With lifetime prevalence estimates of substance abuse among schizophrenics as high as 47.01%, there is an increasing awareness of the importance of this dual diagnosis and the global deficiencies in our knowledge about this comorbid condition. Patients with substance abuse disorders and schizophrenia are problematic from a clinical, economic, and health care systems perspective. The lack of systematic research into phenomenology, etiology, and treatment approaches (both psychotherapeutic and psychopharmacologic) has hindered the development of an adequate strategy to care for the needs of these patients. Thus, these patients place a significant burden on the mental health delivery system through chronic disability, social dysfunction, frequent rehospitalizations, and poor overall treatment compliance. The authors critically review the contemporary literature relevant to concurrent substance abuse and schizophrenia, highlight major deficiencies in our knowledge, and call for research to reduce the individual, economic, and social costs of this condition.

Enhancement of carbon tetrachloride-induced liver injury by a single dose of ethanol: proton magnetic resonance imaging (MRI) studies in vivo

Magnetic resonance imaging (MRI) and localized magnetic resonance spectroscopy (MRS) were used to study the effects of a single dose of ethanol, given 18 h prior to experiments, on CC14-induced acute hepatotoxicity in rats in situ. Localized edema in the centrilobular region of the liver, following exposure to ethanol and CCl4, was detected by 1H-MRI techniques. The edema was characterized by a volume selective spectroscopy (VOSY) method, which measured an increase in water concentration from ethanol and CCl4-treated rat livers, in comparison to control livers. Electron microscopy (EM) of the high intensity regions of the ethanol/CCl4 treated liver sections revealed dramatic subcellular changes such as fragmentation of the granular endoplasmic reticulum (ER), formation of large vacuoles and lipid droplets in the cytoplasmic matrix and extensive swelling of the mitochondria as well as disruption of the cristae. Pretreatment with alpha-phenyl tert-butyl nitrone (PBN), a free radical spin trap, prior to halocarbon exposure, was found to reduce the CC14-mediated high intensity region in the liver images. Electron microscopy of the PBN pretreated CCl4 exposed rat liver sections revealed only minor observable differences in subcellular organization, such as some swelling of the mitochondria, when compared to controls. In addition, these data suggest that ethanol may potentiate CCl4 hepatotoxicity by increased formation of free radical intermediates. Inhibition of the CCl4-induced edematous response in rat liver by PBN demonstrates that free radical intermediates, arising from the metabolism of CCl4, are possibly the causal factor in the initiation of the edema.

Effects of ethanol and delta 9-tetrahydrocannabinol on phencyclidine disposition in dogs

A three-way crossover study was performed to determine the influence of delta 9-tetrahydrocannabinol (THC) and ethanol (EtOH) separately upon phencyclidine (PCP) disposition in dogs. Seven dogs were given three single dose treatments: 1.5 mg PCP kg-1 i.v., 1.5 mg PCP kg-1 i.v. with 0.4 mg kg-1 THC i.v., and 1.5 mg PCP kg-1 i.v. with 1.25 g EtOH kg-1 i.v. PCP was measured in plasma samples collected for 24 h after administration of each treatment, with several pharmacokinetic parameters calculated from the plasma concentration vs time data. The PCP serum Cls values were significant change in V beta or t1/2. EtOH did not induce significant changes in any PCP pharmacokinetic parameter, although mean Cls and V beta were increased. These results confirm the observed THC inhibition of PCP metabolism, and suggest that the enhanced pharmacologic action of PCP by THC may result from higher serum PCP concentrations. These results further suggest that enhanced PCP actions by acute EtOH administration may result from increased PCP distribution to the CNS.

Effects of ethanol on microsomal drug metabolism in aging female rats. III. In vivo

The effects of aging on ethanol inhibition of zoxazolamine metabolism in vitro and in vivo were studied in female Fischer 344 rats aged 4, 14 and 26 months. Zoxazolamine hydroxylase activity in freshly-isolated liver microsomes decreased significantly with age (1.88 +/- 0.32, 1.49 +/- 0.30 and 0.74 +/- 0.18 nmol/min per mg protein in young-adult, middle-aged and old rats, respectively). A substantial inhibition of zoxazolamine hydroxylation occurred in the presence of 40 mM ethanol. The extent of inhibition was the same in microsomes from all three age groups. The effect of aging on the duration of zoxazolamine paralysis in vivo reflected the effect of aging on zoxazolamine metabolism in vitro. Mean duration of paralysis following a standard 50 mg/kg dose of zoxazolamine increased significantly as a function of aging (0.5, 2.9 and 4.7 h in young-adult, middle-aged and old rats, respectively). Administration of ethanol (1.2 g/kg) 10 min before zoxazolamine treatment prolonged the duration of zoxazolamine paralysis in young-adult and middle-aged rats by about 2 to 2.5 h, but ethanol pretreatment did not affect paralysis time in old rats. Thus, the inhibitory effect of ethanol on zoxazolamine metabolism in vivo appeared to be attenuated in old age.

Effect of ethanol on the urinary excretion of mandelic and phenylglyoxylic acids after human exposure to styrene

Administration of ethanol in several doses during human exposure to styrene can inhibit the urinary mandelic and phenylglyoxylic acid excretion in a way similar to that reported when ethanol was administered as a single dose. Sensitivity to this inhibitory effect has been found to differ with individual subjects. Differences in long-term consumption of ethanol resulting in different induction of the oxidizing enzymes are suggested to account for this finding. Intra-individual variation in the influence of acute ethanol ingestion on the excretion rate of the mentioned acids can also occur. The habit of drinking ethanol might be important, even for partial redirection of the styrene metabolism from styrene glycol oxidation to styrene glycol conjugation with beta-glucuronic acid and/or sulfate. The consequences of these observations for the occupational hygiene practice are briefly outlined.

Effects of ethanol on microsomal drug metabolism in aging female rats. I. Induction

The purpose of this study was to determine how aging affects the induction by ethanol or acetone of the hepatic microsomal monooxygenase system of female Fischer 344 rats. Young-adult, middle-aged and old rats (4, 14 and 25 months) were fed an ethanol-containing or control liquid diet for 15 days. Cytochrome P-450, cytochrome c reductase, aniline hydroxylase, nitrophenol hydroxylase, nitroanisole O-demethylase and benzphetamine N-demethylase activities were measured in hepatic microsomes. All of the drug metabolism activities except benzphetamine N-demethylase were 20-35% lower in old than in young-adult rats fed the control diet. In addition, the increase in drug metabolism produced by feeding the regular ethanol diet (36% of calories as ethanol) was 50-60% lower in the old rats. However, there was no difference in the magnitude of ethanol induction when ethanol intakes were matched. The effects of chronic acetone consumption (1.2g/day per kg body weight for 15 days) paralleled those of ethanol consumption, except that the extent of induction was greater with acetone. Acetone-induced levels of hepatic microsomal cytochrome P-450, nitrophenol hydroxylase, nitroanisole O-demethylase and aniline hydroxylase were similar in all three age groups. The results of this study indicate that induction of hepatic microsomal drug metabolism by ethanol or acetone is unaffected by the aging process.

Alcohol, cancer, and immunomodulation

There is a great deal of epidemiological evidence indicating that chronic, excessive alcohol consumption is a major risk factor for cancers in humans. However, the experimental basis for the increased cancer risk associated with alcohol intake is not clear. Since it appears that ethanol alone is not carcinogenic, ethanol effects must be explained in terms of its modifying the actions of other causal agents. Current studies indicate that ethanol and its congeners may act as tumor promoters, thereby enhancing the effect of initiating carcinogens from the environment. Available evidence also shows that ethanol is immunosuppressive. Clearly, cirrhosis due to high, prolonged alcohol intake is an indicator of the immunosuppressive effects of ethanol. It is less clear that more moderate intakes of alcohol could have as profound an effect on immune systems. However, changes do occur yielding alterations in lymphocyte sensitivity to alcohol in vitro and in cell development, as shown by increased NK cell function at low concentrations. Since other conditions, such as cytotoxic drugs which suppress cellular immune functions, are clearly associated with increased cancer risk. It is intriguing to think that prolonged exposure to ethanol-induced immunosuppression may be a cofactor in the promotion of cancer. The tumor promotion may take place via a variety of mechanisms as discussed in this paper, including reduced host defenses by direct effects of ethanol, its metabolites, and/or malnutrition. It may be beneficial to test methods for immunostimulation in prolonged alcohol abusers, where cessation of use is unsuccessful or residual immunosuppression remains, to reduce the risk of development or growth of initiated tumors.

The contribution of environmental cues to cross-tolerance between ethanol and pentobarbital

The contribution of Pavlovian conditioning of environmental cues has been studied in relation to tolerance to ethanol-induced hypothermia and cross-tolerance to pentobarbital. Two groups of 12 male Sprague-Dawley rats were exposed every other day to a distinctive set of environmental cues paired with an IP injection of either ethanol 2.5 g/kg or an equivalent volume of isotonic saline. On alternating non-drug days, both groups received saline in the animal room. When they were tested for tolerance to the hypothermic effect of ethanol 2.5 g/kg and cross-tolerance to pentobarbital 25 mg/kg in each environment, tolerance and cross-tolerance in the ethanol-treated group were significantly more pronounced in the ethanol-paired environment than in the saline-paired environment. This indicates the importance of a conditional factor in tolerance and cross-tolerance in this paradigm. Determination of blood levels of ethanol and pentobarbital at various times after injection indicated that conditioned tolerance and cross-tolerance can be explained in part by dispositional factors.

Ethanol-, fasting-, and acetone-inducible cytochromes P-450 in rat liver: regulation and characteristics of enzymes belonging to the IIB and IIE gene subfamilies

Two major forms of hepatic microsomal cytochrome P-450 were purified from starved and acetone-treated rats. On the basis of amino acid sequence analysis, they were identified as P-450j and P-450b. Ethanol or acetone treatment of rats caused a 9-fold increase in the amount of P-450j in liver microsomes accompanied by similar increases in the rate of NADPH-dependent metabolism of carbon tetrachloride, acetone, and benzene. Immunological experiments indicated that P-450j constitutes the major catalyst of the microsomal metabolism of the latter agents and contributes by about 50% to microsomal P-450-dependent ethanol oxidation under the conditions used. The P-450j-dependent catalytic activities had a high rate of turnover. In contrast, this was not the case for the immunodetectable P-450j, indicating the occurrence of inactive forms of this protein in microsomes. Starvation or ethanol or acetone treatment caused 10-30-fold increases in the amount of both mRNA and apoprotein of P-450b,e compared to control. Run-on experiments and the concomitant increases of the P-450b,e gene products at the mRNA and protein levels indicated the appearance of mainly a transcriptional activation by acetone, ethanol, or starvation. Fasting exerted, in addition, a pronounced synergistic effect on acetone-dependent induction of P-450b,e mRNA (3-fold), apo-P-450b,e (4.3-fold), P-450j mRNA (2-fold), and apo-P-450j (2-fold). No increase of mRNA coding for P-450j, compared to control, was seen after acetone or ethanol treatment alone. The results indicate that effects of ethanol, acetone, and/or starvation on drug and xenobiotic metabolism are caused by the induction of P-450 forms belonging to at least two gene subfamilies.

Potential use of cimetidine for treatment of acetaminophen overdose

Acetaminophen, a drug frequently taken in intentional and accidental overdose, causes liver toxicity when concentration of the cytochrome P-450-derived metabolite exceeds the metabolic capacity of available glutathione. Present treatment of acetaminophen overdose involves oral N-acetylcysteine (NAC), which enhances liver glutathione synthesis. An alternative or additive approach to therapy would be to inhibit the formation of the toxic metabolite by inhibiting the cytochrome P-450 system. The H2-receptor antagonist cimetidine inhibits the cytochrome P-450 system, does not interfere with the administration or function of NAC, and therefore affords additive protection. Also, it has little effect on the nontoxic routes of elimination of acetaminophen and is itself quite nontoxic. That cimetidine protects against acetaminophen toxicity in animal models has been demonstrated on the basis of improved survival, as well as decreases in several critical elements used to monitor acetaminophen toxicity: classic histologic changes, aminotransferase activity, metabolite covalent binding, and liver glutathione depletion. Administration of cimetidine well after the overdose is also protective. In contrast, animal models of acetaminophen toxicity demonstrate that ranitidine does not afford protection from acetaminophen hepatotoxicity. Clinical data in well-done trials in humans will be needed to support the experimental animal data.

Effects of habitual alcohol intake and cigarette smoking on the development of hepatocellular carcinoma

To study the effects of habitual alcohol intake and cigarette smoking on the latency period for the development of hepatocellular carcinoma (HCC), 455 patients with HCC were analyzed with respect to age at diagnosis. They were divided into hepatitis B virus (HBV) positive and negative patients based on HbsAg and high titer anti-HBc in serum. HBV-positive and negative HCC patients were further subdivided into four subgroups based on the history of drinking more than one small bottle of Japanese "sake" or its equivalent per day for more than 10 yr and the history of smoking more than one cigarette per day for more than 10 yr. Among HBV-positive HCC patients, the average age of those with a drinking and a smoking habit (50 +/- 10 yr) was younger compared with that of patients with a drinking habit but without a smoking habit (56 +/- 14 yr, not significant, NS), of those who were smokers and nondrinkers (55 +/- 10 yr, NS) and of those who did not drink nor smoke (59 +/- 8 yr, p less than 0.005). Among HBV-negative HCC patients, patients with drinking and smoking habits (57 +/- 9 yr) were younger compared with those with a drinking habit without smoking (59 +/- 9 yr, NS), those who were smokers and nondrinkers (62 +/- 9 yr, p less than 0.005), and those who were nondrinkers and nonsmokers (63 +/- 12 yr, p less than 0.005). These data suggest that habitual alcohol intake may promote the development of HCC if the patients smoke cigarette regardless of the status of HBV seromakers.

Medical management of the depressed alcoholic patient

Since the advent of modern psychopharmacology in the 1950s, use of medications in the treatment of many psychiatric disorders has become commonplace. Alcohol use is also widespread. As alcohol can interact with a wide variety of medications to alter drug effects, understanding the interactions between it and psychiatric medicines is important to the efficacious treatment of the depressed alcoholic with these drugs. This article briefly outlines the effects of alcohol and the mechanisms of its interactions with psychiatric medications. The most commonly used classes of psychiatric medicines, including antidepressants, CNS depressants, benzodiazepines, antipsychotics, psychostimulants, and lithium carbonate, are reviewed as to their potential interactions with alcohol. Clinical implications of these interactions are discussed.

Ethanol oxidation and toxicity: role of alcohol P-450 oxygenase

The isolation and characterization of ethanol-inducible rabbit liver microsomal cytochrome P-450, termed P-450 3a or P-450ALC, has provided definitive evidence for the role of this enzyme in alcohol oxidation. From findings on the distribution, substrate specificity, and mechanism of action of P-450ALC we have suggested "alcohol P-450 oxygenase" as a more biochemically accurate name than "microsomal ethanol-oxidizing system." The present review is concerned with studies in this and other laboratories on activities and inducers associated with this versatile enzyme. Numerous xenobiotics, including alcohols and ketones, nitrosamines, aromatic compounds, and halogenated alkanes, alkenes, and ethers, are known to undergo increased microsomal metabolism after chronic exposure of various species to ethanol. Diverse compounds and treatments may induce P-450ALC, including the administration of ten or more chemically different compounds, fasting, or the diabetic state. Whether a common mechanism of induction is involved is unknown at this time. As direct evidence that P-450ALC catalyzes numerous metabolic reactions, the purified rabbit enzyme has been used in a reconstituted system to demonstrate various metabolic transformations, including the oxidation of various alcohols, acetone, acetol, p-nitrophenol, and aniline, the dealkylation of substituted nitrosamines, the reductive dechlorination of carbon tetrachloride, carbon tetrachloride-induced lipid peroxidation, and acetaminophen activation to form the glutathione conjugate.