Detoxification By The Liver Flashcards

1
Q

What are xenobiotics?

A

Foreign substances that don’t have nutritional value
∴ excreted - may be toxic if not excreted in time

Can be absorbed across lungs, skin or ingested
-Most are ingested as components of diet, medicines & recreational drug use, but also inhaled chemicals in air pollution

Excreted in bile, urine, sweat and breath

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2
Q

How do xenobiotics act?

A

Act by damaging protein, lipid + DNA; react with O2 in the air to form ‘free radicals’

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3
Q

Phase 1 reactions aim

A

Aim is to make drug more hydrophilic so it can be excreted by the kidneys

Introduce/expose hydroxyl groups/other reactive sites that can be used for conjugation reactions (Phase II)

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4
Q

Non-synthetic catabolic reactions

A

E.g. oxidation
-Hydroxylation ( + -OH)
-Dealkylation (remove -CH side chains)
-Demaniantion (remove -NH)
-Hydrogen removal

E.g. reduction
-Add H2 (saturate unsaturated bonds)

E.g. hydrolysis
-Split amide and ester bonds

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5
Q

Phase 1 reacts are known as

A

Functionalisation

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6
Q

Where do phase 1 reactions take place?

A

Liver mainly

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7
Q

What enzymes catalyse phase 1 reactions?

A

Mainly catalysed by cytochrome P450 enzymes (these are found in the smooth ER)

Cytochrome P450 reductase
Contains flavoproteins:
Flavin adenine dinucleotide (FAD) = accepts electrons from NADPH
Flavin mononucleotide (FMN) = electron donor to CYPs

Required to transfer electrons from NADPH → CYP450

Hydrogen is used by CYP to reduce one of the 2 atoms of O2 → H2O

Other O2 is retained in a highly reactive from - used to force one or the other kinds of reaction on the substrate

Overall reaction: NADPH + H+ + O2 + RH → NADP+ + H2O + R-OH

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8
Q

Phase I reactions can

A

Inactivate drugs
Further activate drugs
Activate drugs from prodrugs
Make a drug into a reactive intermediate (could be carcinogenic/toxic)

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9
Q

Phase II reactions

A

Synthetic anabolic reactions:

Glucuronidation
-Adds a glucuronic acid group to the drug = more hydrophilic
-Enzyme = glucuronosyltransferase (uridine 5’diphospho-glucuronosyltransferase (UGT)) - microsomal enzyme
-Uridine diphospho-glucuronic acid (UDPGA) = a coenzyme/donor compound required to conjugate glucuronic acid
-Substances produced = glucuronides
-Process forms covalent bonds

Sulfatation

Glutathione conjugation

AA conjugative

Acetylation (donor compound - Acetyl CoA)

Methylation (donor compound - S-adenosylmethionine)

Water conjugation

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10
Q

Phase II reactions known as conjugation reaction

A

Attachment of substituent groups

Usually inactive products

Catalysed by transferases

Significantly increased hyrdophilicty for renal
excretion

Occurs mainly in liver but can occur in other tissues, e.g. lungs & kidneys

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11
Q

Cytochrome P450

A

Cytochrome P450 enzymes are responsible for most phase 1 reactions

Products of P450 enzymes are more water soluble

Type of microsomal enzymes

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12
Q

Features in common groups:

A

Present in SER (microsomal enzymes)

Oxidise substrate + reduce oxygen - using heme groups

Contain a cytochrome reductase subunit which uses NADPH

Inducible

Generate a reactive free radical compound

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13
Q

A single CYP450 isoform - CYP3A4 - involved in the metabolism of about 50% of all clinically prescribed drugs

A

Sustained exposure to various chemicals leads to ↑ production of the enzyme - by ↑ transcription for CYP450 (+other enzymes)

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14
Q

When enzyme induction occurs a number of different cytochromes may be induced

A

E.g. phenobarbitone induces CYPs: 1A2, 2C9, 2C19, 3A4 and others, ↑ the metabolism of of a variety of drugs metabolised by these enzymes

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15
Q

With CYP3A4

A

The nuclear hormone receptor (PXR) that mediates induction migrates from cytosol to the nucleus once bound to a suitable compound, e.g. phenobarb

This acts as a TF

↑ production of CYP450, phase II enzymes + ABC transporters

Some patients require larger doses of medication to achieve therapeutic effect

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16
Q

Microsomal enzymes

A

Inducible by diet + drugs

Location - SER

Sites - liver, kidneys, lungs, intestinal tissues

Enzymes - mono-oxygenases (CYPs, FMOs), UGTs

Reactions - majority of drug biotransformation: oxidative, reductive + hydrolytic and glucuronidation

17
Q

Non-microsomal enzymes

A

Not inducible but have polymorphisms

Location - cytoplasm and mitochondria of hepatocytes/other tissues

Enzymes -
Alcohol dehydrogenase
Aldehyde dehydrogenase
Reduction
Hydrolysis

Reactions - non-specific enzymes that catalyse few oxidation, reduction + hydrolytic reactions and all conjugation actions other than glucuronidation

18
Q

Drug metabolism

A

Most drugs are excreted by the kidney but lipophilic drugs are not effectively removed as they are passively absorbed (can diffuse through membranes easily)

19
Q

Aim of drug metabolism

A

make drugs more polar = can’t cross membranes = excreted easily
Most occurs in liver

20
Q

Drug metabolism via phase I and II reactions

A

Drug → elimination (usually polar drug, excreted unchanged)
Drug → phase II → elimination (functionalised without phase I)
Drug → phase I → phase II → elimination

21
Q

Aspirin

A

Analgesic
NSAID
Antiplatelet
Prodrug
Irreversibly inhibits cyclooxygenase (COX)

22
Q

Aspirin phase I metabolism

A

Prodrug activated upon metabolism
Hydrolysis reaction
Aspirin + H2O → salicylic acid + ethanoic acid

23
Q

Phase II metabolism

A

Conjugated with glycine or glucuronic acid
Forms a range of ionised metabolite - not passively absorbed so can be excreted by kidneys in urine

24
Q

Paracetamol

A

Analgesic

Antipyretic agent (lowers body temp.)

Metabolism
Predominantly metabolised via phase II reaction
Conjugated with glucuronic acid + sulfate

25
Q

Paracetamol toxicity

A

If stores of glucuronic acid + sulfate are running low paracetamol will undergo phase I metabolism via oxidation to produce toxic NAPQI
This is removed by conjugation with glutathione
In overdoses stores of glutathione can run low = toxicity
Treated with N-Acetyl Cysteine

26
Q

Alcohol metabolism

A

Ethanol –ADH→ acetaldehyde –ALDH→ acetate → CO2 + H2o
ADH = alcohol dehydrogenase
ALDH = aldehyde dehydrogenase
Operates at different speeds in different people

27
Q

Acetaldehyde is carcinogenic, indications of high levels =

A

Facial flushing
Rapid heartbeat
Nausea