ABSTRACT
PURPOSE: To predict the CYP2C19 genotype-dependence in anti-Helicobacter pylori (H. pylori) therapy when lansoprazole or rabeprazole was used instead of omeprazole as a proton pump inhibitor (PPI). METHODS: A comparative pharmacokinetic study with each PPI was designed as an open, randomized, and crossover study of 18 Japanese healthy volunteers who were classified into the homozygous, heterozygous extensive metabolizer and the poor metabolizer based on the CYP2C19 genotype determined by PCR-RFLP method. Each subject received a single oral dose of 20 mg omeprazole, 30 mg lansoprazole, or 20 mg sodium rabeprazole, with at least 1 week washout period between treatments. Plasma concentrations of PPIs and their metabolites were monitored until 12 h after medication. RESULTS: Pharmacokinetic profiles of omeprazole and lansoprazole were well correlated with the CYP2C19 genotype. The heterozygous extensive metabolizer was slightly different from the homozygote, but there was no statistically significant difference. The CYP2C19 genotype dependence found for lansoprazole was not obvious compared with omeprazole. As for rabeprazole, the pharmacokinetic profile was independent of the CYP2C19 genotype. CONCLUSIONS: CYP2C19 genotype dependence will be found in the anti-H. pylori therapy even when lansoprazole is used as the PPI.
Subject(s)
Aryl Hydrocarbon Hydroxylases , Cytochrome P-450 Enzyme System/genetics , Enzyme Inhibitors/pharmacokinetics , Mixed Function Oxygenases/genetics , Omeprazole/analogs & derivatives , Proton Pump Inhibitors , 2-Pyridinylmethylsulfinylbenzimidazoles , Adult , Benzimidazoles/blood , Benzimidazoles/pharmacokinetics , Benzimidazoles/therapeutic use , Cross-Over Studies , Cytochrome P-450 CYP2C19 , Cytochrome P-450 Enzyme System/metabolism , Enzyme Inhibitors/blood , Enzyme Inhibitors/therapeutic use , Female , Genotype , Humans , Lansoprazole , Male , Mixed Function Oxygenases/metabolism , Omeprazole/blood , Omeprazole/pharmacokinetics , Omeprazole/therapeutic use , RabeprazoleABSTRACT
PURPOSE: A combination of proton pump inhibitors and antimicrobials has been applied as an anti-Helicobacter pylori (H. pylori) therapy. Omeprazole, one of the proton pump inhibitors, is metabolized by CYP2C19. which exhibits genetic polymorphism. It was reported previously that the overall anti-H. pylori efficacy can be related to the CYP2C19 genotype. The main aim of the present study was to obtain a rational explanation for the relationship between the overall anti-H. pylori efficacy and the CYP2C19 genotype. METHODS: Six healthy volunteers were classified as extensive metabolizers and poor metabolizers, according to their CYP2C19 genotypes. Plasma concentrations and intragastric pH were monitored prior to and until 24 h after the administration of 20 mg omeprazole. The stability of amoxicillin, clarithromycin, and metronidazole was examined using buffer solutions with monitored intragastric pH, and their remaining percentage in the intragastric space was simulated. RESULTS: The poor metabolizers, classified by the CYP2C19 genotypes, showed the higher effectiveness in anti-H. pylori therapy, via the higher plasma concentration of omeprazole and the higher intragastric pH, and possibly the higher stability of antimicrobials in the higher intragastric pH. CONCLUSIONS: CYP2C19 genotyping is a very useful method to determine the effective and safe dosage regimen including the selection of the dual and triple therapy in anti-H. pylori therapy.
Subject(s)
Anti-Ulcer Agents/pharmacology , Aryl Hydrocarbon Hydroxylases , Cytochrome P-450 Enzyme System/genetics , Helicobacter pylori/drug effects , Mixed Function Oxygenases/genetics , Omeprazole/pharmacology , Amoxicillin/chemistry , Anti-Ulcer Agents/chemistry , Area Under Curve , Clarithromycin/chemistry , Cytochrome P-450 CYP2C19 , Drug Combinations , Drug Stability , Gastric Acidity Determination , Genotype , Hydrogen-Ion Concentration , Metronidazole/chemistry , Omeprazole/chemistry , Reverse Transcriptase Polymerase Chain ReactionABSTRACT
Protective effect of the cellular ubiquinone (UQ) reducing system linked to cytosolic NADPH-dependent ubiquinone reductase (NADPH-UQ reductase) against hydrogen peroxide (H2O2)-induced lipid peroxidation was investigated using UQ and control hepatocytes freshly isolated from rats injected with UQ-10 and the vehicles 14 d in advance, respectively. The UQ hepatocytes had higher levels of ubiquinol (UQH2)-10 content and NADPH-UQ reductase activity than the control hepatocytes but did not differ in other antioxidant factors from the latter cells. The UQ hepatocytes exhibited higher cell viability and lower release of lactate dehydrogenase than the control hepatocytes when they were exposed to H2O2 of up to 100 mM for 1 h at 37 degrees C. Furthermore, the formation of thiobarbituric acid reactive substances (TBARS) by H2O2 was almost completely inhibited in the UQ hepatocytes. Decreases in UQH2 and alpha-tocopherol contents and NADPH-UQ reductase activity by H2O2 exposure were observed in both types of the hepatocytes, but those levels in the UQ hepatocytes after the exposure were still higher than in the control hepatocytes. The decreases in ascorbic acid, reduced glutathione and protein thiol contents and DT-diaphorase activity by H2O2 were not different between in the two types of hepatocytes. Antioxidant enzyme activities of catalase, superoxide dismutase, glutathione peroxidase, glutathione S-transferase and glutathione reductase in the hepatocytes were not inhibited by H2O2. From these results, it was concluded that the cellular UQ reducing system linked to cytosolic NADPH-UQ reductase functions mainly as an antioxidant defense for cellular membranes.
