Chlorpromazine therapy frequently is complicated by asymptomatic alkaline phosphatase elevation and occasionally by cholestatic jaundice. To investigate the mechanism of this toxicity, we studied the effect of Chlorpromazine and several of its metabolites in vitro on rat liver plasma membrane ATPase activity and membrane fluidity, two factors of potential importance for normal bile formation. Liver plasma membranes were isolated by discontinuous sucrose ultracentrifugation and were enriched, compared with homogenate, 53-fold in NaK-ATPase, 23-fold in Mg-ATPase, and 28-fold in alkaline phosphatase, suggesting the presence of sinusoidal and lateral as well as canalicular hepatocyte membrane surfaces. Chlorpromazine and its metabolites caused an immediate, dose-dependent and reversible inhibition of NaK-ATPase activity over a 2–200 μM concentration range. Compared with the parent compound, relative inhibition of NaK-ATPase activity by Chlorpromazine metabolites varied—chlorpromazine sulfoxide was half as potent, 7-hydroxychlorpromazine equally potent, and 7,8-dihydroxychlorpromazine and 7,8-dioxochlorpromazine five times more active. Mg-ATPase activity was inhibited by Chlorpromazine and the 7-hydroxy and sulfoxide metabolites, but not by the 7,8-dihydroxy or 7,8-dioxo metabolites. The selective nature of this inhibition was further evidenced by the failure of chlorpromazine or its metabolites to inhibit the activity of 5′-nucleotidase, another liver plasma membrane enzyme. ATPase inhibition by 100 μM Chlorpromazine appeared to be noncompetitive. Chlorpromazine and each of its metabolites also altered liver plasma membrane lipid fluidity, as determined by fluorescence polarization, and the potency with which CPZ and its metabolites altered ATPase activity was closely related to their ability to alter lipid fluidity. These studies indicate that chlorpromazine-induced cholestasis may result from alteration of both physical and enzymatic properties of liver plasma membranes and further suggest that formation of more toxic metabolites in some individuals might account for their susceptibility to Chlorpromazine hepatotoxicity.
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