Dmd052548 1686..1694

Despite metronidazole’s widespread clinical use since the 1960s, the specific enzymes involved in its biotransformation have not been previously identified. Hence, in vitro studies were conducted to identify and characterize the cytochrome P450 enzymes involved in the formation of the major metabolite, 2-hydroxymetronidazole. Formation of 2-hydroxymetronidazole in human liver microsomes was consistent with biphasic, Michaelis-Menten kinetics. Although several cDNA-expressed P450 enzymes catalyzed 2-hydroxymetronidazole formation at a supratherapeutic concentration of metronidazole (2000 mM), at a “therapeutic concentration” of 100 mM only CYPs 2A6, 3A4, 3A5, and 3A7 catalyzed metronidazole 2hydroxylation at rates substantially greater than control vector, and CYP2A6 catalyzed 2-hydroxymetronidazole formation at rates 6fold higher than the next most active enzyme. Kinetic studies with these recombinant enzymes revealed that CYP2A6 has aKm = 289mM which is comparable to the Km for the high-affinity (low-Km) enzyme in human liver microsomes, whereas the Km values for the CYP3A enzymes corresponded with the low-affinity (high-Km) component. The sample-to-sample variation in 2-hydroxymetronidazole formation correlated significantly with CYP2A6 activity (r ‡ 0.970, P < 0.001) at substrate concentrations of 100 and 300 mM. Selective chemical inhibitors of CYP2A6 inhibited metronidazole 2hydroxylation in a concentration-dependent manner and inhibitory antibodies against CYP2A6 virtually eliminated metronidazole 2hydroxylation (>99%). Chemical and antibody inhibitors of other P450 enzymes had little or no effect onmetronidazole 2-hydroxylation. These results suggest that CYP2A6 is the primary catalyst responsible for the 2-hydroxylation of metronidazole, a reaction that may function as a marker of CYP2A6 activity both in vitro and in