Cytochrome P450 (CYP) enzymes, including CYP2C19 and CYP3A4, participate in the bioactivation of clopidogrel. Grapefruit juice constituents potently inactivate intestinal CYP3A4 and have been shown to inhibit CYP2C19 as well. In a randomized crossover study, 14 healthy volunteers ingested 200 ml of grapefruit juice or water three times daily for 3 days. On day 3, they ingested a single 600-mg dose of clopidogrel. Grapefruit juice reduced the peak plasma concentration (Cmax) of the active metabolite of clopidogrel to 13% of the control (range 11-17%, P < 0.001) and the area under the plasma concentration-time curve from 0 to 3 h to 14% (range 12-17%, P < 0.001) of the control, but it had no significant effect on the parent clopidogrel. Moreover, grapefruit juice markedly decreased the platelet-inhibitory effect of clopidogrel, as assessed with the VerifyNow P2Y12 test in two of the participants. In conclusion, concomitant use of grapefruit juice may impair the efficacy of clopidogrel. Therefore, the use of grapefruit juice is best avoided during clopidogrel therapy.

Complement activity in mammalian serum is fundamentally based on three homologous components C3b, C4b and C5. During systemic infection, the gastrointestinal pathogen Salmonella enterica disseminates within host phagocytic cells but also extracellularly. Consequently, systemic Salmonella transiently confronts the complement system. We show here that the surface protease PgtE of S. enterica proteolytically cleaves C3b, C4b and C5 and that the expression of PgtE enhances bacterial resistance to human serum. Degradation of C3b was further enhanced by PgtE-mediated plasminogen activation.

AIMThe aim of the present study was to investigate the effects of the carboxylesterase 1 (CES1) c.428G > A (p.G143E, rs71647871) single nucleotide variation (SNV) on the pharmacokinetics of quinapril and enalapril in a prospective genotype panel study in healthy volunteers. METHODSIn a fixed-order crossover study, 10 healthy volunteers with the CES1 c.428G/A genotype and 12 with the c.428G/G genotype ingested a single 10 mg dose of quinapril and enalapril with a washout period of at least 1 week. Plasma concentrations of quinapril and quinaprilat were measured for up to 24 h and those of enalapril and enalaprilat for up to 48 h. Their excretion into the urine was measured from 0 h to 12 h. RESULTSThe area under the plasma concentration-time curve from 0 h to infinity (AUC 0-∞ ) of active enalaprilat was 20% lower in subjects with the CES1 c.428G/A genotype than in those with the c.428G/G genotype (95% confidence interval of geometric mean ratio 0.64, 1.00; P = 0.049). The amount of enalaprilat excreted into the urine was 35% smaller in subjects with the CES1 c.428G/A genotype than in those with the c.428G/G genotype (P = 0.044). The CES1 genotype had no significant effect on the enalaprilat to enalapril AUC 0-∞ ratio or on any other pharmacokinetic or pharmacodynamic parameters of enalapril or enalaprilat. The CES1 genotype had no significant effect on the pharmacokinetic or pharmacodynamic parameters of quinapril. CONCLUSIONSThe CES1 c.428G > A SNV decreased enalaprilat concentrations, probably by reducing the hydrolysis of enalapril, but had no observable effect on the pharmacokinetics of quinapril. WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Quinapril and enalapril are prodrugs that are hydrolysed in the liver to active metabolites by carboxylesterase 1 (CES1).• The CES1 c.428G > A SNV markedly decreases CES1 activity.• There appear to be no previous studies of the effect of CES1 c.428G > A SNV on the pharmacokinetics of ACE inhibitors in humans. WHAT THIS STUDY ADDS• The CES1 c.428G > A SNV significantly reduced the hydrolytic activation of enalapril, but had no observable effect on quinapril.• These data suggest that CES1 genetic variants can affect the pharmacokinetics of angiotensin-converting enzyme (ACE) inhibitors in humans, and that ACE inhibitors differ in their susceptibility to the effects of CES1 genetic variants.