Adverse drug reaction monitoring in Jena. Relevance of polymorphic drug metabolizing enzymes for inducing adverse drug reactions.

Inter-subject variability in therapeutic drug response and drug toxicity is a major problem in clinical practice. In this field genetic polymorphisms of drug metabolizing enzymes play an important role. In a multicenter study supported by the German Federal Institute for Drugs and Medical Devices (BfArM, Z 12.01-68502-201) adverse drug reactions (ADRs) leading to hospital admission to departments of internal medicine have been registered and evaluated. The aim of the presented part of the study was to look for evident differences in genotypes for polymorphic drug metabolizing enzymes between adverse drug reaction cases and controls. All cases found in the local area--Jena and Weimar--were genotyped for N-acetyl-transferase 2 (NAT2), cytochrom P450 (CYP) 2D6 and 2C19 in comparison to a control population of the same region. The investigation on genotype was carried out for about 2 years (2000-2002). 254 blood samples from patients of the ADR study were analyzed. The genotype of drug metabolizing enzymes was determined by means of polymerase chain reaction using allel specific primers or restriction enzyme analysis. Within all ADRs cases genotyped, no exceptional frequencies for slow acetylators or poor metabolizers (PM) of CYP2D6 or CYP2C19 were found. About 65% of the individuals with ADR genotypically displayed a slow acetylator state. 6.3% PM for CYP2D6, including CYP2D6*3, *4 and *6 alleles, and 2.0% PM frequency for CYP2C19 (*2) have been found in ADR cases. A direct connection between PM genotype and the ADR observed may be assumed only in few of them. Further investigations on genotype and ADR-associated drugs require a much larger sample of patients to obtain more data allowing to focus an association on specific drugs, ADR and polymorphisms genotype of drug metabolizing enzymes might be useful.

Cyclosporine A and tacrolimus: in vitro investigations on the differential interactions with the cytochrome P450 system in rat and human liver.

Species differences in the interactions of cyclosporine A (CSA) and tacrolimus (TAC) with the cytochrome P450 (CYP) system in male rat and human liver were investigated in vitro by assessing effects on a series of model reactions for different CYP isoforms. CSA and TAC concentration dependently inhibited ethoxyresorufin O-deethylation, ethoxycoumarin O-deethylation and pentoxyresorufin O-depentylation and 7alpha- and 17-testosterone hydroxylation (TH) activities in both species. In rat liver no effect of CSA was seen on ethylmorphine N-demethylation and 2alpha- and 6beta-TH activities, but an inhibition due to TAC. Both CSA and TAC, however, distinctly decreased ethylmorphine N-demethylation and 2beta- and 6beta-TH activities in human liver. The same results were seen with 14alpha- and 15beta-TH activities. 2alpha-, 16alpha- and 16beta-TH activities were only inhibited in human liver with TAC, whereas only in this case 6alpha-TH activity was left unaffected. p-Nitrophenol hydroxylase activity was not influenced by either substance in both species. Thus, CSA mainly interacts in rat with the CYP isoforms 1A, 2A and 2B and in man with the CYP subtypes 1A, 2A, 2B, 2C and 3A. TAC seems to interfere predominantly in rat with the CYP isoforms 2A, 2B, 2C and 3A and in man with the CYP subtypes 1A, 2B, 2C and 3A. In summary, our results point to distinct species differences in the interactions with the CYP system with both substances, and although from literature CSA and TAC are known to be metabolized mainly by CYP 3A, according to our findings in rat liver CSA seems not to interact with this CYP subtype.