Search

Objectives: It has been suggested that omeprazole is an inducer of the cytochrome P450 1A, both in vitro and in vivo. To evaluate whether omeprazole treatment might affect the activity of P450 1A2, we performed a study of caffeine metabolism, which is mainly via P450 1A., Methods: Thirteen subjects (one healthy volunteer and 12 patients) who were treated with omeprazole, 20 mg each morning for 4 wk, and a control group of 13 healthy volunteers, participated in the study. A test of caffeine metabolism was performed before treatment, 28 days after beginning treatment and, whenever possible, 28 days after treatment. Blood samples were analyzed for theobromine, paraxanthine, and theophylline, by high performance liquid chromatography., Results: P4501A2 activity was determined as the ratio of (paraxanthine + theobromine + theophylline)/(metabolites + caffeine) which represents the total caffeine N-oxidative demethylations; this ratio was expressed as a percentage. For patients, on day 0, the percentage of total metabolism was 34.3% +/- 8.3; on day 28, it was 42.7% +/- 10.8; the difference was statistically significant (p < 0.01). No intra-individual variation of P450 1A2 activity was observed in the control group., Conclusions: These results demonstrate that omeprazole increases the metabolism of caffeine, especially N-1 and N-3 demethylation pathways, after 28 days of treatment with omeprazole, and suggest that omeprazole, when used for this period, is an inducer of hepatic cytochrome P4501A2.

1. Interspecies (including man, monkey, rabbit, rat and mouse) variations in caffeine metabolism by liver microsomes were studied. While N-3 demethylation was the major pathway in man (81% of total dimethylxanthines), N-7 demethylation was predominant in monkey (89%), and the three demethylation pathways were about equal in mouse, rabbit and rat. 2. Three monooxygenase activities (methoxyresorufin O-demethylase, phenacetin O-deethylase and acetanilide 4-hydroxylase) correlated significantly with the rate of metabolism of caffeine. 3. P4501A1 and 1A2 enzymes were immunodetected in different species. P4501A2 was the only isoform detected in liver of man, rat and mouse, while no polypeptide immunorelated to P4501A was detected in monkey and only a minor band of P4501A1 was detected in rat and rabbit. 4. All in vitro data indicate that paraxanthine formation is mediated mainly by P4501A2 in mammals while theophylline formation is mediated mainly by cytochromes P-450 other than those of the 1A family.

Caffeine biotransformation and four monooxygenase activities involving cytochrome P-450IA2, namely ethoxy- and methoxyresorufin O-dealkylases, phenacetin O-deethylase, and acetanilide 4-hydroxylation were studied in 25 human liver microsomes. All these activities were highly significantly intercorrelated (r greater than 0.72, p less than 0.001) and correlated with the level of immunoreactive P-450IA2 content (r greater than 0.65; p less than 0.001). P-450IA content was measured by immunoblotting with anti-rat P-450 beta-naphthoflavone-B, an antibody that detects only a single band corresponding to P-450IA2. The formation rate of two caffeine metabolites, namely paraxathine and theobromine, was correlated with the four monooxygenase activities measured and P-450IA2-specific content (r greater than 0.75). However, inhibition studies of caffeine metabolism by phenacetin, a specific substrate of P-450IA2, clearly indicated that only the N-3 demethylation of caffeine was supported by this enzyme. These in vitro data demonstrate that P-450IA2 is predominantly responsible for the major metabolic pathway of caffeine and that the formation of other demethylated metabolites is mediated, at least partly, by other P-450 enzymes.

Biotransformation of caffeine and theophylline and the effect of two well-known inducers of P-450 isozymes, namely phenobarbital (PB) and methylcholanthrene (3-MC) were studied in cultured hepatocytes from six human adult donors. Hepatocytes co-cultured with rat liver epithelial cells maintained a higher metabolic capacity than pure cultures. PB treatment of cultured hepatocytes for 3 days slightly increased the rate of caffeine metabolism 1.4 +/- 0.5-fold (N = 6) vs controls, and theophylline metabolism 1.2 +/- 0.4-fold (N = 6), whereas 3-MC treatment increased metabolism markedly 5.8 +/- 2.3- and 3.3 +/- 1.1-fold (N = 6) vs controls for caffeine and theophylline, respectively. Paraxanthine and theophylline formations from caffeine were the most induced by 3-MC. Their increase was significantly correlated (rs = 0.89, P less than 0.007) but not with TB formation, suggesting that at least two isozymes of the P-450IA family are involved in the first demethylations of caffeine. In addition, the N-1 demethylation of theophylline (mean increase of 554% vs controls) was not correlated with the N-1 demethylation of caffeine (mean to increase 247% vs controls) for the same donor after 3-MC treatment, suggesting that these two demethylations are mediated by a different P-450.

1. Caffeine was used as a molecular probe for hepatic monooxygenase activity in three in vitro models from human livers: slices, microsomes and hepatocyte cultures. 2. A h.p.l.c. method for determination of all possible metabolites of caffeine (16 compounds) is described. 3. Caffeine biotransformation by these three in vitro systems was low. However, metabolite formation was shown to proceed at a rate close to that calculated from in vivo caffeine elimination half-life. 4. Metabolic profiles were the same whatever the in vitro system used. The ratio of primary demethylated metabolites was similar to that measured by in vivo studies, i.e. the selectivity for caffeine N-3 demethylation to paraxanthine was retained. 5. Significant correlation (p less than 0.001) between 7-ethoxyresorufin O-deethylation and caffeine demethylations was demonstrated for the 12 human livers studied.

Cultured hepatocytes from newborn human (three samples), adult human (eight samples) and adult rat livers were used to study the metabolism of theophylline and caffeine, two drugs of which the metabolic pathways are known to be cytochrome P-450-dependent. Known metabolic pathways of caffeine in vivo were qualitatively maintained. However, only the primary metabolites were formed through oxidative N-demethylation giving theophylline, paraxanthine and theobromine and, through C-8 hydroxylation, giving 1,3,7-trimethyluric acid and a ring-opened compound the 6-amino-5[N-formylmethylamino]1,3-dimethyl uracil. The ratio of the three dimethylxanthine metabolites was dependent upon the species (human, rat), development stage (newborn, adult) and environmental factors. Similarly, theophylline was metabolized as in vivo by the demethylation pathway giving, preferentially, 3-methylxanthine and not 1-methylxanthine, and by a C-8 oxidation giving 1,3-dimethyluric acid. In newborn hepatocytes, all pathways were absent except the well-known methylation to caffeine. Moreover, such a methylation also occurred in adult human hepatocytes. This result was explained by the very low metabolic capacity of cultured cells, allowing the detection of only direct metabolites. Indeed, the overall biotransformation of both the methylxanthines by primary cultures of hepatocytes was remarkably weak, confirming previous studies with liver microsomal incubations. Thus the metabolism rate did not exceed about 30 nmoles/10(6) cells/24 hr in human adults, except for two subjects which were characterized by an extensive metabolism and a different metabolic profile. These two subjects were probably induced in vivo by environmental compounds. Both quantitative and qualitative data obtained from this study were roughly correlated with other in vivo and in vitro studies. Overall the experimental model of cultured human hepatocytes was shown to be capable of assessing the metabolic profile of two methylxanthines which is in agreement with the situation encountered in vivo. This example suggests that a breakthrough may be brought in new drugs development by the predictability from human hepatocyte culture model to the in vivo human situation.

Theophylline has been administered to 76 premature infants with apnea in two therapeutic indications: curative and preventive treatment. Plasmatic theophylline and caffeine concentrations have been performed by gas chromatography for ten days for the determination of the therapeutic range. The maximum effective concentration has been defined from the data observed in 33 subjects presenting with symptoms considered as signs of toxicity. The minimum effective concentration has been determined from the data observed during the failure of treatment (n = 4) and at the reappearance of apnea at the end of treatment (n = 10). The therapeutic concentrations of theophylline has be found on average to be 3 to 8 mg/l and for the theophylline and caffeine together from 5 to 10 mg/l. The sum theophylline and caffeine data is better for therapeutic monitoring than the determination of theophylline alone.