Nicotine is the primary substance in tobacco causing addiction. In humans the majority (70-80%) of nicotine is inactivated to cotinine in a reaction predominantly catalyzed by CYP2A6 (80-90%), with a minor possible role for CYP2B6. Substantial interindividual variability is observed in the rate of nicotine’s inactivation to cotinine and this variation contributes to differences in smoking behaviors (e.g. cigarette consumption). Twin studies suggest an important genetic contribution to the variability in nicotine metabolism. However in 2004, genetic variation in CYP2A6 and CYP2B6 accounted for only a small portion of the variability suggesting gaps in our knowledge. Our objective was to identify additional genetic and non-genetic sources of variability in CYP2A6 expression/activity, CYP2B6 expression, and nicotine to cotinine metabolism in vivo and/or in vitro. Participants included individuals from different world populations phenotyped for CYP2A6 activity either following oral nicotine administration or using metabolite ratios derived from baseline smoking. Genotyping and sequencing were utilized to identify and characterize multiple new CYP2A6 alleles. In total 17 novel CYP2A6 alleles were identified, many of which were found predominantly among individuals of black African descent and exhibited lower CYP2A6 activity. In addition, human livers were assessed for CYP2A6 and CYP2B6 expression and nicotine to cotinine metabolism. The mechanisms underlying the lower CYP2A6 activity associated with some of the variant CYP2A6 alleles included either a reduction in hepatic CYP2A6 protein expression, an alteration of CYP2A6’s structural property, or a combination of both. DNA methylation was not associated with altered hepatic CYP2A6 expression/activity. Livers from female donors were associated with higher CYP2A6 and CYP2B6 protein expression compared to male livers, while age did not influence the expression of either CYP. Finally, CYP2B6 and its prevalent altered function genetic variant (CYP2B6*6) did not influence nicotine to cotinine metabolism. Identification of factors that contribute to the variability in CYP2A6 and nicotine metabolism is important to improve future association studies between CYP2A6 genotype, nicotine metabolism, and smoking behaviors. In addition, this information could provide the potential to personalize therapy in order to improve the clinical efficacy of nicotine, particularly as a smoking cessation aid.

Nicotine is the primary substance in tobacco causing addiction. In humans the majority (70-80%) of nicotine is inactivated to cotinine in a reaction predominantly catalyzed by CYP2A6 (80-90%), with a minor possible role for CYP2B6. Substantial interindividual variability is observed in the rate of nicotine’s inactivation to cotinine and this variation contributes to differences in smoking behaviors (e.g. cigarette consumption). Twin studies suggest an important genetic contribution to the variability in nicotine metabolism. However in 2004, genetic variation in CYP2A6 and CYP2B6 accounted for only a small portion of the variability suggesting gaps in our knowledge. Our objective was to identify additional genetic and non-genetic sources of variability in CYP2A6 expression/activity, CYP2B6 expression, and nicotine to cotinine metabolism in vivo and/or in vitro. Participants included individuals from different world populations phenotyped for CYP2A6 activity either following oral nicotine administration or using metabolite ratios derived from baseline smoking. Genotyping and sequencing were utilized to identify and characterize multiple new CYP2A6 alleles. In total 17 novel CYP2A6 alleles were identified, many of which were found predominantly among individuals of black African descent and exhibited lower CYP2A6 activity. In addition, human livers were assessed for CYP2A6 and CYP2B6 expression and nicotine to cotinine metabolism. The mechanisms underlying the lower CYP2A6 activity associated with some of the variant CYP2A6 alleles included either a reduction in hepatic CYP2A6 protein expression, an alteration of CYP2A6’s structural property, or a combination of both. DNA methylation was not associated with altered hepatic CYP2A6 expression/activity. Livers from female donors were associated with higher CYP2A6 and CYP2B6 protein expression compared to male livers, while age did not influence the expression of either CYP. Finally, CYP2B6 and its prevalent altered function genetic variant (CYP2B6*6) did not influence nicotine to cotinine metabolism. Identification of factors that contribute to the variability in CYP2A6 and nicotine metabolism is important to improve future association studies between CYP2A6 genotype, nicotine metabolism, and smoking behaviors. In addition, this information could provide the potential to personalize therapy in order to improve the clinical efficacy of nicotine, particularly as a smoking cessation aid.

Purpose: The purpose of this study was to determine the relationship of CYP2B6 genotype to the clinical response to meperidine in pediatric dental patients. Methods: Twenty-five patients, ASA I/ II, 45–92 months old, received an oral sedative regimen containing meperidine for dental treatment. The North Carolina Behavior Rating Scale (NCBRS) and Overall Effectiveness of Sedation Scale (OESS) were used to assess their behavior and sedation outcome. Saliva DNA samples were genotyped by PCR-RFLP. Results: We found the following genotype distributions: homozygous wild-type 1*1 (n = 8, 32%), heterozygous 1*6 (n = 13, 52%), and homozygous variant 6*6 (n = 4, 16%). The genotypes were predictive of a significant decrease in the overall effectiveness of sedation. Conclusion: Variation in CYP2B6 appears to be predictive of less successful sedations; wild-type individuals experienced more successful sedations than the homozygous variant 6*6. Future research regarding the enzyme kinetics of meperidine is needed to determine the exact enzymatic function of CYP2B6 and its variants.

Antiretroviral drugs have revolutionized HIV care and enabled better management of the infection thus allowing patients survive for many years. One proposed approach to increase access to such drugs in sub-Saharan Africa is to use of a reduced-dose alternative of the drug efavirenz, with 400 mg rather than regular 600 mg dose. This effectively would provide medication for 50 percent more persons with the same amount of active ingredient. However, antiretroviral drugs require high patient adherence to achieve intended therapeutic effect, and it is unclear if a reduced-dose therapy would have sufficient efficacy, and if it would lead to an increased risk of viral resistance. The time profile of drug plasma concentration and corresponding long-term viral load was estimated using integrated population PK/PD simulations, with model parameters based on selected research studies. The results suggest a reduced dose 400 mg, rather than 600 mg regular dose, efavirenz in HIV therapy would place strict demands on patients to maintain very high adherence levels, at least 80-90 percent, to maintain sufficient drug concentration in blood plasma, and to minimize risk of viral failure. However, it is relatively rare for HIV therapy programs in sub-Saharan Africa to consistently achieve such high adherence levels. In addition, if patients are co-administered rifampin, a drug widely used in TB care, this increases hepatic metabolism and plasma clearance rate, resulting in further reduced average drug plasma concentration. These findings suggest a reduced dose efavirenz treatment alternative may be most (only) relevant for patient categories expected to maintain high adherence; and in particular among persons who have been confirmed to have CYP2B6 genotype consistent with inherently lower drug metabolism. At usual adherence levels it is estimated a reduced dose alternative may increase the share of patients at risk of viral failure by 5 to 15 percent vs. regular dose of 600 mg.

La variabilité de la pharmacocinétique de la névirapine et de l’éfavirenz, deux médicamentsantirétroviraux inhibiteurs non nucléosidiques de la transcriptase inverse du VIH, a été étudiéechez des patients cambodgiens infectés par le VIH par une méthode de pharmacocinétique depopulation. Cent soixante dix patients traités par névirapine faisaient partie de la cohorteESTHER de l’hôpital Calmette de Phnom-Penh et 312 patients co-infectés par le VIH et latuberculose et traités par éfavirenz étaient inclus dans l’essai clinique CAMELIA (ANRS1295–CIPRA KH001) conduit au Cambodge. Les dosages plasmatiques de névirapine et d’éfavirenz ontété réalisés par des méthodes CLHP avec détection UV. Après 18 et 36 mois de traitement, lesconcentrations plasmatiques médianes de la névirapine sont de 5,7 μg/mL. Après 22 et 50semaines de traitement, les concentrations médianes d’éfavirenz sont de 2,7 μg/mL, quel’éfavirenz soit associé (22 semaines) ou non (50 semaines) à la rifampicine. Les clairancesapparentes estimées de la névirapine et de l’éfavirenz sont respectivement de 2,6 L/h et de 7,7L/h. Les variabilités intra et inter individuelles des clairances apparentes sont respectivement de17% et 28% pour la névirapine et 15% et 37% pour l’éfavirenz. Parmi les covariablesdémographiques, biologiques ou génétiques étudiées, seul le polymorphisme génétique duCYP2B6 G516T est significativement associé à la clairance apparente de ces deux médicaments.Ainsi la clairance apparente estimée de la névirapine est de 2,95 L/h, 2,62 L/h et 1,86 L/hrespectivement pour les génotypes CYP2B6 516GG, 516GT, et 516TT. La fréquence de l’allèlemutée T qui code pour une enzyme non fonctionnelle est de 34% dans cette population de 442patients d’Asie du Sud-Est. / HIV-infected patients by population method. 170 patients on nevirapine-based antiretroviraltherapy were from the ESTHER cohort of the Calmette hospital in Phnom-Penh. 312 patients onefavirenz-based therapy were included in the CAMELIA (ANRS1295–CIPRAKH001) clinical trialconducted in Cambodia. Plasma concentrations of nevirapine and efavirenz were measured byHPLC and UV detection. Median plasma concentrations of nevirapine and efavirenz were 5.7μg/mL and 2.7 μg/mL respectively. Apparent plasma clearances of nevirapine and efavirenz were2.6 L/h and 7.7 L/h respectively. Among demographic, clinical, biological or genetic covariates,genetic polymorphism of CYP2B6 G516T was the only one which was shown to affect theclearance of the 2 drugs. Frequency of the T allele was 34% in this population of South-East Asia.

Les cytochromes P450 (CYP) sont des enzymes responsables de la biotransformation de composés exogènes, aussi bien dans les phénomènes de détoxication que d'intoxication par formation d'entités réactives. La forme hépatique humaine la plus abondante (CYP3A4) est responsable du métabolisme de plus de 60 % des médicaments utilisés actuellement, entraînant de nombreuses interactions médicamenteuses indésirables. La connaissance des mécanismes moléculaires de fonctionnement de ces CYPs au moyen de modèles prédictifs est d'un intérêt primordial pour les industriels. L'obtention de ces modèles par modélisation comparative est toutefois pénalisée par la dispersion en séquences dans cette superfamille. Une méthode originale de reconstruction des CYPs basée sur l'identification au sein de cette famille des blocs structuralement conservés (CSB) est proposée ici. Ces CSBs définissent un repliement commun aux CYPs et sont considérés comme la signature structurale de la superfamille. Les CSBs sont codés en termes d'informations statistiques (profile) puis alignés sur les séquences de CYP de structure inconnue, par un outil d'alignement multiple (Caliseq) créé pour produire l'alignement multiple optimal pour les reconstructions par modélisation comparative. Caliseq sert aussi à détecter des séquences originales de CYP dans une banque ou un génome. Le modèle structural obtenu permet de suggérer des mutations pour observer les modifications du comportement de la protéine vis-à-vis de ses substrats spécifiques. Le cas du CYB2B6 est un exemple concret où le modèle a suggéré des mutations permettant d'augmenter l'affinité de l'enzyme pour un substrat spécifique utilisé en chimiothérapie.

The impact of CYP2A6 and CYP2B6 genetic variation on nicotine metabolism, tobacco use behaviours, and nicotine biomarkers was investigated in a group of Alaska Natives (n = 400). CYP2A6 and CYP2B6 allele frequencies were unique and associations of CYP2A6 genotype and CYP2A6 activity (plasma and urine trans 3’-hydroxycotinine/cotinine (3HC/COT) ratios) were robust. Notably, this population possessed a more rapid rate of CYP2A6 activity (higher plasma 3HC/COT) when compared to CYP2A6 wild-type individuals in other ethnic groups (ANOVA P < 0.001). Also demonstrated was a significant difference in urine total nicotine equivalents by CYP2A6 activity median split (t-test P < 0.01), the first evidence of nicotine titration by CYP2A6 activity within a light smoking population. Overall, this population possessed a distinctive pattern of CYP2A6 and CYP2B6 variant frequencies and a faster rate of nicotine metabolism, which may in part explain higher levels of tobacco use prevalence and tobacco-related disease risk.

The impact of CYP2A6 and CYP2B6 genetic variation on nicotine metabolism, tobacco use behaviours, and nicotine biomarkers was investigated in a group of Alaska Natives (n = 400). CYP2A6 and CYP2B6 allele frequencies were unique and associations of CYP2A6 genotype and CYP2A6 activity (plasma and urine trans 3’-hydroxycotinine/cotinine (3HC/COT) ratios) were robust. Notably, this population possessed a more rapid rate of CYP2A6 activity (higher plasma 3HC/COT) when compared to CYP2A6 wild-type individuals in other ethnic groups (ANOVA P < 0.001). Also demonstrated was a significant difference in urine total nicotine equivalents by CYP2A6 activity median split (t-test P < 0.01), the first evidence of nicotine titration by CYP2A6 activity within a light smoking population. Overall, this population possessed a distinctive pattern of CYP2A6 and CYP2B6 variant frequencies and a faster rate of nicotine metabolism, which may in part explain higher levels of tobacco use prevalence and tobacco-related disease risk.

Polychlorinated biphenyls (PCBs) continue to pose a health concern because of their predominance in the diet and air as well as in environmental samples and humans. PCB congeners with 3 or 4 chlorine substituents in ortho position have been associated with neurodevelopmental disorders. Hydroxylated metabolites (OH-PCBs) of these PCBs are also potentially toxic to the developing brain. Metabolism studies have mainly focused on animal models. However, preliminary data from this dissertation work have revealed PCB metabolism differences between laboratory animal models and humans in terms of metabolite profiles, chiral signatures. More concerning, biotransformation of chiral PCBs is poorly investigated in humans. The objective of this dissertation research was to study the biotransformation of chiral and prochiral PCBs to chiral hydroxylated metabolites in humans and rats and to identify individual human P450 enzymes involved in the metabolism of these PCBs. I chose chiral PCB congeners 2,2',3,4',6-pentachlorobiphenyl (PCB 91); 2,2',3,5',6-pentachlorobiphenyl (PCB 95), 2,2',3,3',4,6'-hexachlorobiphenyl (PCB 132) and 2,2',3,3',6,6'-hexachlorobiphenyl (PCB 136) for this investigation because they are environmentally relevant and their metabolism has been studied in rodents and other laboratory animal species (Kania-Korwel et al., 2016a). Prochiral PCB congeners 2,2′,4,6′-tetrachlorobiphenyl (PCB 51) and 2,2′,4,5,6′-pentachlorobiphenyl (PCB 102) were selected because their considerable presence in technical PCB mixtures. To test the hypothesis that P450 enzyme and species differences mediate the congener-specific enantioselective metabolism of chiral PCBs to hydroxylated metabolites, I sought to establish structure-metabolism relationships by studying the enantioselective metabolism of structurally diverse chiral PCBs by human liver microsomes (HLMs). Racemic PCB 91, PCB 95 and PCB 132 were incubated in vitro with pooled or individual donor HLMs at 37 °C, and levels and chiral signatures of the parent PCB and its hydroxylated metabolites were determined by high-resolution gas chromatography equipped with time-of-flight mass spectrometry (GC/TOF-MS) or electron capture detection (GC-ECD). Hydroxylated metabolites formed were identified and metabolic schemes for these PCBs proposed. I found inter-individual differences in the formation of OH-PCBs by individual donor HLMs. Comparison of the metabolite profiles of PCB 91, PCB 95, PCB 132 and PCB 136 (PCB 136 metabolism by HLMs was investigated by other researchers) revealed congener-specific differences in the oxidation of PCBs by human cytochrome P450 enzymes. PCB 91 and PCB 132 were mainly hydroxylated in meta position, with the 1,2-shift metabolites being the major metabolites formed from both PCB congeners by HLMs. In contrast, PCB 95 and PCB 136 were primarily hydroxylated in the para position. Moreover, we determined human P450 isoforms involved in the metabolism of neurotoxic PCBs using in silico and in vitro approaches. In silico predictions suggested that chiral PCBs are metabolized by CYP1A2, CYP2A6, CYP2B6, CYP2E1, and CYP3A4. Experimentally we found that CYP2A6, CYP2B6 and to a minor extent CYP2E1 were the enzymes involved in the metabolism of these chiral PCBS. We also investigated nonchiral sources of chiral OH-PCBs by studying the P450- and species-dependent biotransformation of prochiral PCB 51 and PCB 102 to chiral OH-PCB metabolites. Prochiral PCB 51 and PCB 102 were incubated with liver microsomes prepared from male Sprague-Dawley rats pretreated with various inducers of P450 enzymes including phenobarbital (PB), dexamethasone (DEX), isoniazid (INH), β-naphthoflavone (BNF), clofibric acid (CFA) or corn oil (CO); and untreated male cynomolgus monkeys, Hartley albino guinea pigs, New Zealand rabbits, golden Syrian hamsters; and untreated female Beagle dogs. PCB 51 and PCB 102 were metabolized to 2,2',4,6'-tetrachlorobiphenyl-3'-ol (OH-PCB 51) and 2,2',4,5,6'-pentachlorobiphenyl-3'-ol (OH-PCB 102), respectively. The formation of both metabolites was P450 isoforms- and species-dependent. Moreover, OH-PCB 51 and OH-PCB 102 were chiral and were formed enantioselectively in all microsomes investigated. Taken together, my findings demonstrate (1) considerable inter-individual variability in the congener-specific metabolism of PCBs to OH-PCBs; (2) the enantioselective formation of OH-PCBs by human CYP2A6, CYP2B6, and CYP2E1; and (3) that chiral PCB metabolites are formed enantioselectively from prochiral PCB congeners. Interestingly, the metabolism of PCBs by CYP2A6 appears to involve arene oxide intermediates, as suggested by the formation of 1,2-shift products as major metabolites of PCB 91 and PCB 132. In contrast, 1,2-shift products are minor PCB metabolites formed in rodents. Therefore extrapolation of hepatic metabolism across species may not be consistent and these differences should be considered in future toxicity and risk assessment studies.

La variabilité de la pharmacocinétique de la névirapine et de l'éfavirenz, deux médicamentsantirétroviraux inhibiteurs non nucléosidiques de la transcriptase inverse du VIH, a été étudiéechez des patients cambodgiens infectés par le VIH par une méthode de pharmacocinétique depopulation. Cent soixante dix patients traités par névirapine faisaient partie de la cohorteESTHER de l'hôpital Calmette de Phnom-Penh et 312 patients co-infectés par le VIH et latuberculose et traités par éfavirenz étaient inclus dans l'essai clinique CAMELIA (ANRS1295-CIPRA KH001) conduit au Cambodge. Les dosages plasmatiques de névirapine et d'éfavirenz ontété réalisés par des méthodes CLHP avec détection UV. Après 18 et 36 mois de traitement, lesconcentrations plasmatiques médianes de la névirapine sont de 5,7 μg/mL. Après 22 et 50semaines de traitement, les concentrations médianes d'éfavirenz sont de 2,7 μg/mL, quel'éfavirenz soit associé (22 semaines) ou non (50 semaines) à la rifampicine. Les clairancesapparentes estimées de la névirapine et de l'éfavirenz sont respectivement de 2,6 L/h et de 7,7L/h. Les variabilités intra et inter individuelles des clairances apparentes sont respectivement de17% et 28% pour la névirapine et 15% et 37% pour l'éfavirenz. Parmi les covariablesdémographiques, biologiques ou génétiques étudiées, seul le polymorphisme génétique duCYP2B6 G516T est significativement associé à la clairance apparente de ces deux médicaments.Ainsi la clairance apparente estimée de la névirapine est de 2,95 L/h, 2,62 L/h et 1,86 L/hrespectivement pour les génotypes CYP2B6 516GG, 516GT, et 516TT. La fréquence de l'allèlemutée T qui code pour une enzyme non fonctionnelle est de 34% dans cette population de 442patients d'Asie du Sud-Est.