ABSTRACT:Clopidogrel (SR25990C, PLAVIX) is a potent antiplatelet drug, which has been recently launched and is indicated for the prevention of vascular thrombotic events in patients at risk. Clopidogrel is inactive in vitro, and a hepatic biotransformation is necessary to express the full antiaggregating activity of the drug. Moreover, 2-oxo-clopidogrel has been previously suggested to be the essential key intermediate metabolite from which the active metabolite is formed. In the present paper, we give the evidence of the occurrence of an in vitro active metabolite after incubation of 2-oxoclopidogrel with human liver microsomes. This metabolite was purified by liquid chromatography, and its structure was studied by a combination of mass spectometry (MS) and NMR experiments.MS results suggested that the active metabolite belongs to a family of eight stereoisomers with the following primary chemical structure: 2-{1-[1-(2-chlorophenyl)-2-methoxy-2-oxoethyl]-4-sulfanyl-3-piperidinylidene}acetic acid. Chiral supercritical fluid chromatography resolved these isomers. However, only one of the eight metabolites retained the biological activity, thus underlining the critical importance of associated absolute configuration. Because of its highly labile character, probably due to a very reactive thiol function, structural elucidation of the active metabolite was performed on the stabilized acrylonitrile derivative. Conjunction of all our results suggested that the active metabolite is of S configuration at C 7 and Z configuration at C 3-C 16 double bound.

ABSTRACT:Midazolam (MDZ) is one of the most commonly used in vivo and in vitro CYP3A4 probe substrates for drug-drug interactions (DDI) studies. The major metabolic pathway of MDZ in humans consists of the CYP3A4-mediated 1-hydroxylation followed by urinary excretion as 1-O-glucuronide derivative. In the present study, following incubation of MDZ with human liver microsomes supplemented with UDP-glucuronic acid, two major high-performance liquid chromatography (HPLC) peaks were isolated. HPLC and liquid chromatography/tandem mass spectrometry analyses identified these two metabolites as quaternary direct N-glucuronides of MDZ, thus revealing an additional metabolic pathway for MDZ. Because a large number of currently available drugs and future drugs will be metabolized by the members of the CYP3A subfamily, the potential for drug-drug interaction (DDI) is substantial. DDIs involving the inhibition and induction of CYP3A4 are of great scientific and clinical relevance. Indeed, drugs with potent CYP3A4 inhibitory properties have been implicated in significant CYP3A4-mediated DDIs. Interactions of the benzodiazepines with the azole antifungal agents and especially the inhibition of CYP3A-mediated midazolam (MDZ) metabolism by ketoconazole have been widely studied. Concomitant administration of both drugs results in large, variable, and highly significant increases (5-16-fold) in MDZ exposure, depending on the dose regimen of ketoconazole used. Table 1 summarizes available clinical data on the effects of ketoconazole on MDZ plasma levels following p.o. or i.v. administration of MDZ.MDZ is a short-acting water-soluble imidazobenzodiazepine (Fig. 1) extensively used in clinical practice mainly for induction and maintenance of anesthesia, sedation for diagnostic and therapeutic procedures, and also as an oral hypnotic agent (Reves et al., 1985). MDZ is a well known CYP3A substrate because its metabolism has been the focus of many in vitro investigations (Fabre et al., 1988b;Kronbach et al., 1989;Wrighton and Ring, 1994;Ghosal et al., 1996; Maenpaa et al., 1998;Hosea et al., 2000;Wang et al., 2000). MDZ biotransformation is mediated by at least three different CYP3A isoenzymes: CYP3A4, CYP3A5, and CYP3A7 (Gorski et al., 1994;Kuehl et al., 2001). Because CYP3A7 is principally expressed in fetal tissues, CYP3A4 and CYP3A5 represent the main cytochrome P450 (P450) isoforms in adult liver and intestine (Guengerich, 1995).MDZ biotransformation yields two primary hydroxylated metabolites: 1Ј-hydroxy-MDZ (1Ј-OH-MDZ) and 4-hydroxy-MDZ. 1Ј-OH-MDZ represents the main metabolite because it accounts for 95% of net intrinsic clearance of MDZ in human liver microsomes (von Article, publication date, and citation information can be found at

Intracerebral glucose resonance was directly detected and resolved in vivo by two-dimensional shift-correlated (COSY) 1H NMR spectroscopy in anesthetized rats (n = 4). The relative changes in brain glucose concentration were measured by volume integration of the alpha-D-glucose cross peak in the 2D COSY spectra. This report demonstrates the possibility of monitoring the variations in cerebral glucose following iv injection of glucose.

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