Genetic polymorphisms of drug metabolism. Possible implications during development

Pharmacogenetics and cancer chemotherapy

Cancer chemotherapy is limited by significant inter-individual variations in responses and toxicities. Such variations are often due to genetic alterations in drug metabolising enzymes (pharmacokinetic polymorphisms) or receptor expression (pharmacodynamic polymorphisms). Pharmacogenetic screening prior to anticancer drug administration may lead to identification of specific populations predisposed to drug toxicity or poor drug responses. The role of polymorphisms in specific enzymes, such as thiopurine S-methyltransferases (TPMT), dihydropyrimidine dehydrogenase (DPD), aldehyde dehydrogenases (ALDH), glutathione S-transferases (GST), uridine diphosphate glucuronosyl-transferases (UGTs) and cytochrome P450 (CYP 450) enzymes in cancer therapy are discussed in this review.

Clinical importance of non-genetic and genetic cytochrome P450 function tests in liver disease

Liver disease is associated with reduced metabolic capacity for drugs that are metabolized by oxidative biotransformation. Three cytochrome P450 (P450 or CYP) gene families in liver microsomes (CYP 1, CYP2 and CYP3) appear to be responsible for much of the drug metabolism that takes place. The genetic polymorphism of the CYPs responsible for debrisoquine/ sparteine (CYP2D6) metabolism and S-mephenytoin (CYP2C19) metabolism has been well documented, but information on the impairment of each isoform in liver disease is still limited. There are two types of hepatic P450 function tests. One type consists of non-genetic P450 function tests (CYP1A2, 2A6, 2C9/10, 2E1 and 3A3/4), and probe drugs include caffeine, catalysed by CYP1A2, coumarin by CYP2A6, phenytoin by CYP2C6, chlorzoxazone by CYP2E1, and nifedipine, erythromycin and lidocaine by CYP3A3/4. The second type of genetic P450 function tests (CYP2C19 and CYP2D6) involves probe drugs such as S-mephenytoin, catalysed by CYP2C19, and debrisoquine and sparteine, catalysed by CYP2D6. The metabolism of the probe drugs used in non-genetic P450 function tests in patients with liver disease falls into two categories: reduced (CYP1A2, CYP2C, 2E1 and 3A) and unchanged (CYP2C). In genetic P450 function tests there seems to be a lesser degree of inhibition in poor metabolizers (PMs) than extensive metabolizers (EMs) among patients with liver disease. There have been very few reports on changes in metabolism of the probe drugs used in genetic P450 function tests in liver disease. In this paper the subject is reviewed.

Expression and inducibility of P450 enzymes during liver ontogeny

Several approaches, including immunoquantification of individual enzymes, profiling of substrate activities by immunoinhibition using highly specific polyclonal and monoclonal antibodies, and the estimation of corresponding mRNAs with nucleic acid probes, have been used to investigate the ontogeny of cytochromes P450 in livers of rodents and man. CYP1A1 is expressed very early in development in rodents, whereas most other enzymes either appear at or near birth (CYP2B, CYP2C23, and CYP3A) or between 2 and 4 weeks following birth (CYP2A, CYP2C6, CYP2C7, CYP2C11, CYP2C12, and CYP4A10). The constitutive expression of enzymes is subject to regulation by various transcriptional nuclear and/or hormonal factors (CYP2B and CYP2C) or in a sex-dependent manner (CYP2A, CYP2C11, CYP2C12, CYP3A, and CYP4A10). The enhanced sensitivity and specificity of immunocytochemical and in situ hybridisation studies have revealed differences, with age and xenobiotic treatment, in the intercellular expression of certain P450 enzymes of the liver. For example, in rats, the expression of CYP1A1 and 1A2 is differentially regulated at the level of the individual cell from as early as 24 hours before birth. The human foetal liver relative to rodents has a substantial level of CYP3A and also has the capacity to metabolise a greater repertoire of substrates. Evidence to date suggests that P450 enzymes in man are regulated in a manner similar to that in other animals. The balance between different individual enzymes of cytochrome P450 in foetuses and/or neonates is subject to modulation by xenobiotics, the consequences of which may lead to toxicologically compromised livers with respect to metabolic handling of certain substrates.