MetMax Human Hepatocyte/HEK Cytotoxic Reactive Metabolite Assay as a Potential In Vitro Experimental System for the Identification of DILI Drugs

Abstract

In drug development, it is important to identify drug candidates where drug metabolism plays key roles in their toxicity. Major reasons for the identification of drug candidates with metabolism-dependent toxicity are as follows: 1. Safety profiles determined in preclinical animal species may not accurately predict human effects due to species difference in drug metabolism; and 2. idiosyncratic drug toxicity may occur in individuals due to enhanced metabolic activation or compromised detoxification. We recently developed a novel in vitro hepatocyte system, the MetMax Human Hepatocyte (MMHH) system with permeabilized human hepatocytes supplemented with metabolic cofactors, for the evaluation of drug metabolism. The permeabilization treatment removes the plasma membrane as a barrier for drug diffusion into the hepatocytes, and the diffusion of the metabolites of the hepatocytes. A further advantage of MMHH is that cytotoxicity of the intended substrate would not affect drug metabolism, a challenge often encountered in the evaluation of metabolism of toxic drugs in intact hepatocytes. We report here the development of the MMHH/HEK assay for the evaluation of metabolic activation and detoxification of toxic drugs. In this assay, drug toxicity is quantified in a drug metabolism incompetent target cell line (HEK293) in the presence of absence of MMHH as an exogenous metabolic activating system, and in the presence of selective cofactors for the evaluation of key metabolic activation and detoxification pathways. As a proof-of-concept study, the MMHH/HEK assay was applied in the the evaluation of the model metabolically-activated drugs that are known to be associated with severe drug induced liver injuries (DILI) - acetaminophen, cyclophosphamide, and troglitazone. Our results showed that the cytotoxicity of these model DILI drugs was enhanced in the presence of MMHH supplemented with NADPH, thereby confirming the role of oxidative metabolism in metabolic activation. Furthermore, supplementation of NADPH with reduced glutathione (GSH), a physiologically relevant detoxifying conjugating cofactor for reactive metabolites, led to significant attenuation of cytotoxicity, demonstrating that these model drugs were metabolized by hepatocytes to to reactive, cytotoxic metabolites. Supplementation with UDPGA and PAPS also attenuated the in vitro cytotoxicity of these model drugs in the MMHH/HEK assay, demonstrating the involvement of glucuronidation and sulfation conjugating pathways in toxification. Troglitazone cytotoxicity in the MMHH/HEK assay was found to be higher than that observed for the known less hepatotoxic analogs, rosiglitazone and pioglitazone. Our results suggest that MMHH/HEK assay can be applied towards the evaluation of metabolic activation and detoxification and the identification of drugs with idiosyncratic DILI potential.