WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT⢠Carboxylic acid NSAIDs are extensively glucuronidated as either the parent drug or hydroxylated metabolites and UGT2B7 is ranked highest in terms of NSAIDglucuronidation activity.⢠NSAIDs cause adverse renal effects including sodium and water retention and hyperkalaemia.⢠In human kidney the mineralocorticoid aldosterone is glucuronidated directly to form aldosterone 18b-glucuronide.
WHAT THIS STUDY ADDS⢠Human liver and kidney microsomes and UGT1A10 and UGT2B7 catalyze aldosterone18b-glucuronidation.⢠Non-selective NSAIDs inhibit renal and hepatic aldosterone18b-glucuronidation and in vivo this may lead to elevated intra-renal concentrations of this hormone.⢠Common involvement of UGT2B7 in NSAID and aldosterone glucuronidation predicates an intra-renal NSAID-aldosterone interaction that may explain in part the clinical observations of variable effects of NSAIDs on electrolytes, fluid retention and blood pressure.
AIMSTo characterize: i) the kinetics of aldosterone (ALDO) 18b-glucuronidation using human liver and human kidney microsomes and identify the human UGT enzyme(s) responsible for ALDO 18b-glucuronidation and ii) the inhibition of ALDO 18b-glucuronidation by non-selective NSAIDs.
METHODSUsing HPLC and LC-MS methods, ALDO 18b-glucuronidation was characterized using human liver (n = 6), human kidney microsomes (n = 5) and recombinant human UGT 1A1, 1A3, 1A4, 1A5, 1A6, 1A7, 1A8, 1A9, 1A10, 2B4, 2B7, 2B10, 2B15, 2B17 and 2B28 as the enzyme sources. Inhibition of ALDO 18b-glucuronidation was investigated using alclofenac, cicloprofen, diclofenac, diflunisal, fenoprofen, R-and S-ibuprofen, indomethacin, ketoprofen, ketorolac, meclofenamic acid, mefenamic acid, S-naproxen, pirprofen and tiaprofenic acid. A rank order of inhibition (IC50) was established and the mechanism of inhibition investigated using diclofenac, S-ibuprofen, indomethacin, mefenamic acid and S-naproxen.
RESULTSALDO 18b-glucuronidation by hepatic and renal microsomes exhibited Michaelis-Menten kinetics. Mean (ϮSD) Km, Vmax and CLint values for HLM and HKCM were 509 Ϯ 137 and 367 Ϯ 170 mM, 1075 Ϯ 429 and 1110 Ϯ 522 pmol min -1 mg -1 , and 2.36 Ϯ 1.12 and 3.91 Ϯ 2.35 ml min -1 mg -1 , respectively. Of the UGT proteins, only UGT1A10 and UGT2B7 converted ALDO to its 18b-glucuronide. All NSAIDs investigated inhibited ALDO 18b-G formation by HLM, HKCM and UGT2B7. The rank order of inhibition (IC50) of renal and hepatic ALDO 18b-glucuronidation followed the general trend: fenamates > diclofenac > arylpropionates.
CONCLUSIONA NSAID-ALDO interaction in vivo may result in elevated intra-renal concentrations of ALDO that may contribute to the adverse renal effects of NSAIDs and their effects on antihypertensive drug response.