Two specific goals were addressed for this dissertation. First to investigate and identify the mechanistic profile of ketoconazole (KT)-induced hepatotoxicity by utilizing in vivo and in vitro approaches determining the mechanism of action for the hepatotoxicity incurred. To date, there has not been a mechanistic determination of the hepatotoxicity associated with KT in vivo. This dissertation evaluates the possible metabolic bioactivation of KT by cytochrome-P450 (CYP) or flavin-containing monooxygenases (FMO) resulting in covalent binding with hepatic macromolecules. The hypothesis of this study was to reveal whether covalent binding by the parent compound, KT, and/or reactive metabolites produces hepatic damage associated with increased serum alanine aminotransaminase (ALT) release and decreased hepatic glutathione (GSH). The first objective was determination of in vivo covalent binding in a dose-time response comparison in Sprague-Dawley (SD) rat ALT and GSH levels. Increased ALT and reduced hepatic GSH levels occurred. The second objective was an in vitro comparison of covalent binding with GSH levels utilizing SD microsomal protein with incubations of KT. Covalent binding decreased with added GSH to microsomal incubations. Thirdly, correlate in vivo with in vitro findings. Covalent binding of KT in vivo and in vitro occurred with increased doses and time. The final objective was to determine the bioactivation pathway utilizing heat inactivation and no NADPH in vitro. Covalent binding of KT decreased in the absence of NADPH and deactivation of FMO. The second goal was to determine and quantitate in vitro the presence of FMO isozymes in microsomes of the human intestinal duodenum, jejunum, ileum, and colon as well as the Caco-2 (HTB-37), epithelial intestinal (CCL-241) and colon (CRL1790) cell lines. The presence of FMO could result in a first-pass effect decreasing the bioavailability of soft nucleophiles or a toxicity effect due to inhibition or modulation of the enzyme from co-administration. To date, this is the first evaluation of FMO isoforms in human intestine and cell lines. Western blot techniques were utilized for detection of human FMO1, FMO3, and FMO5 using human FMO-expressed recombinant cDNA from a baculovirus system. / Graduation date: 2003