Transporters and Drug-Metabolizing Enzymes in Drug Toxicity. Albert P. Li

Transporters and Drug-Metabolizing Enzymes in Drug Toxicity - Albert P. Li


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cellular GSH levels, reduced GST activities), enhanced sulfate formation (e.g. enhanced SULT activity), and sensitized cytotoxic immune response.

      Trovafloxacin was approved by FDA in 1997. In 1999, FDA placed limits on its application due to its association with 140 reports of hepatic events [235–237] and, including 14 cases of hepatic failure, leading to 6 deaths [235].

      3.13.1 Metabolism and Toxicity

      While the exact mechanism for the hepatotoxic properties of trovafloxacin is not yet fully elucidated, several lines of evidence suggest that enzymatic oxidation of the cyclopropylamine moiety to reactive metabolites is involved. Via synthesizing a drug model of trovafloxacin which contains the cyclopropylamine substructure, Sun et al. showed that chemical oxidants could oxidize the drug model to a reactive alpha, beta‐unsaturated aldehyde [238]. The same laboratory also showed that CYP1A2 and myeloperoxidase could oxidize the drug model to the same reactive aldehyde which could conjugate reduced GSH and form protein adducts [239]. Shaw et al. showed that hepatotoxicity could be induced with a nonhepatotoxic dose of trovafloxacin upon coadministration of nonhepatotoxic doses of lipopolysaccharide (LPS), with significant elevation of TNFa proceeding the onset of liver injuries. Inhibition of TNFa transcription by pentoxifylline or inhibition of TNFa activity by etanercept were found to reduce trovafloxacin/LPS‐induced hepatotoxicity [240–242]. The results suggest that inflammatory insults may exacerbate trovafloxacin hepatotoxicity, with TNFa as a possible mediator for the initiation of the toxic events.

      3.13.2 Transporters and Toxicity

      While there are no reports on the role of transporters on hepatic uptake and efflux, it has been reported that trovafloxacin could bioaccumulate in cultured human polymorphonuclear leukocytes (PMNs), human peritoneal macrophages, and tissue‐cultured epithelial cells (McCoy cells), albeit in a nonsaturable manner and was enhanced at 4 °C, thereby eliminating the involvement of uptake transporters [243].

      3.13.3 Risk Factors

      The current information suggests that environmental and genetic factors that could enhance the formation of reactive metabolites (e.g. inducers of CYP1A1 and myeloperoxidase), reduction of cellular GSH, and inflammatory insults are likely risk factors for trovafloxacin hepatotoxicity.

Drug Mechanism of drug‐induced toxicity
BSEP inhibition Reactive metabolite formation Metabolic drug interactions
Acetaminophen X
Cerivastatin X
Felbamate X
Flucloxacillin X
Nefazodone X
Obeticholic acid X
Sitaxentan X
Sorivudine X
Tacrine X
Terfenadine X
Troglitazone X X
Trovafloxacin X

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