AimsThe study aimed to identify the specific human cytochrome P450 (CYP450) enzymes involved in the metabolism of artemisinin. Methods Microsomes from human B-lymphoblastoid cell lines transformed with individual CYP450 cDNAs were investigated for their capacity to metabolize artemisinin. The effect on artemisinin metabolism in human liver microsomes by chemical inhibitors selective for individual forms of CYP450 was investigated. The relative contribution of individual CYP450 isoenzymes to artemisinin metabolism in human liver microsomes was evaluated with a tree-based regression model of artemisinin disappearance rate and specific CYP450 activities. Results The involvement of CYP2B6 in artemisinin metabolism was demonstrated by metabolism of artemisinin by recombinant CYP2B6, inhibition of artemisinin disappearance in human liver microsomes by orphenadrine (76%) and primary inclusion of CYP2B6 in the tree-based regression model. Recombinant CYP3A4 was catalytically competent in metabolizing artemisinin, although the rate was 10% of that for recombinant CYP2B6. The tree-based regression model suggested CYP3A4 to be of importance in individuals with low CYP2B6 expression. Even though ketoconazole inhibited artemisinin metabolism in human liver microsomes by 46%, incubation with ketoconazole together with orphenadrine did not increase the inhibition of artemisinin metabolism compared to orphenadrine alone. Troleandomycin failed to inhibit artemisinin metabolism. The rate of artemisinin metabolism in recombinant CYP2A6 was 15% of that for recombinant CYP2B6. The inhibition of artemisinin metabolism in human liver microsomes by 8-methoxypsoralen (a CYP2A6 inhibitor) was 82% but CYP2A6 activity was not included in the regression tree. Conclusions Artemisinin metabolism in human liver microsomes is mediated primarily by CYP2B6 with probable secondary contribution of CYP3A4 in individuals with low CYP2B6 expression. The contribution of CYP2A6 to artemisinin metabolism is likely of minor importance.Keywords: artemisinin, CYP2B6, CYP3A4, cytochrome P450, metabolism species. The fraction excreted unchanged in urine in Introduction humans is less than 1% of an oral administration [2]. In rats, the liver is the major organ of elimination [3]. Four Artemisinin is the parent compound of an emerging class of antimalarial drugs of importance in the treatment of metabolites, deoxy-artemisinin, deoxy-dihydroartemisinin, dihydroxyartemisinin and the so-called 'crystal-7' malaria in areas with multidrug resistant Plasmodium falciparum. Artemisinin is a sesquiterpene lactone with an were identified in urine following oral administration of artemisinin to humans, but plasma metabolites remain internal peroxide bridge (Figure 1) necessary for its antiparasitic effect [1]. Limited data are available on unknown [4]. Artemisinin is commonly used together with other artemisinin metabolism in both humans and animal antimalarial drugs and information on its enzymatic

Artemisinin did not alter CYP3A4 activity, whereas an increase in CYP2C19 activity was observed. The increased elimination of omeprazole in both poor and extensive CYP2C19 metabolizers suggests artemisinin induces both CYP2C19 and another enzyme.