The Activity of Members of the UDP-Glucuronosyltransferase Subfamilies UGT1A and UGT2B is Impaired in Patients with Liver Cirrhosis

• Published in: Clinical pharmacokinetics Vol. 62; no. 8; pp. 1141 - 1155
• Main Authors: Duthaler, Urs, Bachmann, Fabio, Ozbey, Agustos C., Umehara, Kenichi, Parrott, Neil, Fowler, Stephen, Krähenbühl, Stephan
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.08.2023; Springer Nature B.V
• Subjects: Analgesics; Antiretroviral drugs; Caffeine; Caffeine - metabolism; Child; Chromatography; Drug dosages; Enzymes; Flurbiprofen - metabolism; Glucuronides - metabolism; Glucuronosyltransferase - metabolism; Humans; Hypotheses; Internal Medicine; Investigations; Liver Cirrhosis; Mass spectrometry; Medicine; Medicine & Public Health; Metabolism; Metabolites; Metoprolol - metabolism; Microsomes, Liver - metabolism; Midazolam - metabolism; Morphine; NCT; NCT03337945; Original; Original Research Article; Pharmacokinetics; Pharmacology/Toxicology; Pharmacotherapy; Plasma; Scientific imaging; Uridine Diphosphate - metabolism; Switzerland
• ISSN: 0312-5963; 1179-1926; 1179-1926
• DOI: 10.1007/s40262-023-01261-3

Background and Objective The impact of liver cirrhosis on the activity of UDP-glucuronosyltransferases (UGTs) is currently not well characterized. We investigated the glucuronidation capacity and glucuronide accumulation in patients with liver cirrhosis. Methods We administered the Basel phenotyping cocktail (caffeine, efavirenz, flurbiprofen, omeprazole, metoprolol, midazolam) to patients with liver cirrhosis ( n = 16 Child A, n = 15 Child B, n = 5 Child C) and n = 12 control subjects and obtained pharmacokinetic profiles of substrates and primary metabolites and their glucuronides. Results Caffeine and its metabolite paraxanthine were only slightly glucuronidated. The metabolic ratio (AUC glucuronide /AUC parent , MR) was not affected for caffeine but decreased by 60% for paraxanthine glucuronide formation in Child C patients. Efavirenz was not glucuronidated whereas 8-hydroxyefavirenz was efficiently glucuronidated. The MR of 8-hydroxyefavirenz-glucuronide formation increased three-fold in Child C patients and was negatively correlated with the glomerular filtration rate. Flurbiprofen and omeprazole were not glucuronidated. 4-Hydroxyflurbiprofen and 5-hydroxyomeprazole were both glucuronidated but the corresponding MRs for glucuronide formation were not affected by liver cirrhosis. Metoprolol, but not α-hydroxymetoprolol, was glucuronidated, and the MR for metoprolol-glucuronide formation dropped by 60% in Child C patients. Both midazolam and its metabolite 1′-hydroxymidazolam underwent glucuronidation, and the corresponding MRs for glucuronide formation dropped by approximately 80% in Child C patients. No relevant glucuronide accumulation occurred in patients with liver cirrhosis. Conclusions Detailed analysis revealed that liver cirrhosis may affect the activity of UGTs of the UGT1A and UGT2B subfamilies according to liver function. Clinically significant glucuronide accumulation did not occur in the population investigated. Clinical Trial Registration NCT03337945.