Liver physiology, Detoxification by the Liver Flashcards
What are Xenobiotics?
- Foreign substances with no nutritional value and need to be excreted
- Can be toxic
Where do Xenobiotics come from?
Most of ingested (e.g. drugs) but also air pollution etc.
What problems can Xenobiotics cause?
- They damage proteins, lipids, and can bind to DNA (carcinogens)
- React with O2 and release free radicals
What are the Phase I biotransformation reactions?
- They are non-synthetic
- They are the addition or exposure of a functional group
What do Phase I biotransformation reactions produce?
- Most commonly produces a hydroxyl group (-OH) but also sulfhydryl, amine, and carboxyl groups
- This only produces a small increase in hydrophilicity
What are the Phase II biotransformation reactions?
- They are conjugation reactions with endogenous molecules; glucuronic acid, sulphate, glutathione which forms covalent bonds
- They are biosynthetic reactions
What do Phase II biotransformation reactions produce?
- These form covalent bonds with molecules entering the liver
- Produce a large increase in hydrophilicity
Where does detoxification occur?
- Most, but not all, occurs in the liver
- Within the Smooth ER of the cells
How many groups of Cytochrome P450 enzymes?
- At least 10 main groups
- Encoded by a superfamily of 60 different genes
What are some features of the Cytochrome P450 enzymes? (6)
- Present in smooth ER (hence microsomal enzymes)
- Oxidise substrates and reduce oxygen
- Have a cytochrome reductase subunit – uses NADPH
- They are inducible – get increased production of enzymes upon exposure to specific molecules
- Generate a reactive free radical
- Have affinity for carbon monoxide and oxygen
Why is CYP3A4 important?
- CYP3A4 is present in the highest concentration and responsible for 2/3rds all known drugs
- It is involved in the metabolism of about 50% of all clinically prescribed drugs
How are the cytochromes induced?
- Via enzymes
- The molecule bind to an intracellular receptor within the cytoplasm
- This molecule-receptor complex migrates to the nucleus
- Increases transcription of mRNA for cytochrome-P450s
- This increases the effect of the CYP
- One substance can induce a number of enzymes
What drugs induce the CYP3A4 to metabolise the drug?
Paracetamol, codeine
What drugs induce the CYP2D6 to metabolise the drug?
Amitriptyline (also codeine)
How do cytochrome P450 breakdown drugs?
- CYPs contain a haem component which is capable of oxidising molecules (-OH addition) by becoming reduced themselves
- The reductases use NADPH to become active
- This reductases reduce CYPs allowing the oxidation of the foreign molecule
What does the reaction of the cytochrome with the drug produced?
- The reaction forms water and has an intermediate of a haem free radical
- Overall, the addition of the –OH group increases the solubility of the molecule
What are some examples of Phase I reactions?
- Oxidation
- Reduction
- Hydrolysis
What are some examples of Phase II reactions?
Glycoside conjugation – glucuronidation (most common)
Sulphate - sulphation
Glutathione (GSH)
What 5 problems can occur when metabolism occurs?
- Complete inactivation and elimination
- Formation of another active compound – can have similar or new activity (e.g. codeine breaking down into morphine)
- Activation of pro-drugs
- Toxification of less toxic xenobiotics
- Active drug to reactive intermediates
What is the Phase III reactions?
Phase III is the removal of drugs/metabolites by transporter-mediated elimination via the liver, gut, kidney and lung
How does smoking have an effect on CYP?
- CYP1A2 can be induced by smoking
- Consequently this increased activity of CYP1A2 has effects on the metabolism of other molecules
E.g. Clozapine – dose has to be tightly controlled depending on how much the patient is smoking
How does grapefruit have an effect on CYP?
Grapefruit juice has effects on medications e.g. statins
Contains products that inhibit CYPs
This means that statins become more potent
This means that grapefruit shouldn’t be eaten
What CYP can cause paracetamol to be harmful?
The harmful intermediate NAPQI is created from CYP2E1 (remaining 10%)
If the normal pathways are overwhelmed CYP2E1 becomes more significant and more NAPQI is created
Normally NAPQI is metabolised by glutathione-S-transferase but this can be overwhelmed by high NAPQI levels
Hepatocytes then become damaged
How can ethanol and alcohol be harmful with CYPs?
Alcohol is polar but also slightly lipid soluble.
Can be excreted but is more commonly used as a fuel
Metabolised into acetaldehyde (toxic),
Further metabolism to acetate by ALDH which can be used in the Krebs Cycle
This second metabolism becomes overwhelmed and acetaldehyde builds up
