Mechanism-based inhibition irreversible

Following concurrent administration of two drugs, especially when they are metabolized by the same enzyme in the liver or small intestine, the metabolism of one or both drugs can be inhibited, which may lead to elevated plasma concentrations of the dtug(s), and increased pharmacological effects. The types of enzyme inhibition include reversible inhibition, such as competitive or non-competitive inhibition, and irreversible inhibition, such as mechanism-based inhibition. The clinically important examples of drug interactions involving the inhibition of metabolic enzymes are listed in Table 1 [1,4]. 

Irreversible CYP inhibition can arise from different chemical mechanisms. However, a common initial step is the metabolic activation of a substrate into a reactive metabolite that is trapped within the active site of the CYP to form a tightly bound complex causing a long-lasting inactivation of enzyme activity. Enzymatic activity can be restored only through the new synthesis of the enzyme. For this reason, irreversible CYP inhibition is often referred to as mechanism-based inhibition , metabolite-based inhibition or suicide inhibition . 

Allenic amino acids belong to the classical suicide substrates for the irreversible mechanism-based inhibition of enzymes [5], Among the different types of allenic substrates used for enzyme inhibition [128, 129], the deactivation of vitamin B6 (pyr-idoxal phosphate)-dependent decarboxylases by a-allenic a-amino acids plays an important role (Scheme 18.45). In analogy with the corresponding activity of other /3,y-unsaturated amino acids [102,130], it is assumed that the allenic amino acid 139 reacts with the decarboxylase 138 to furnish the imine 140, which is transformed into a Michael acceptor of type 141 by decarboxylation or deprotonation. Subsequent attack of a suitable nucleophilic group of the active site then leads to inhibition of the decarboxylase by irreversible formation of the adduct 142 [131,132]. 

In addition to the assessment of reversible inhibition, the role played by mechanism-based inhibitors (irreversible inhibitors) provides a focus during lead development, as it can result in a more profound and prolonged effect than that suggested by the therapeutic dose or exposure. Mechanism-based inhibition (MBI) occurs as a result of the CYP generating reactive intermediates that bind to the enzyme causing irreversible loss of activity. Oxidative metabolism via that CYP is only restored upon re-synthesis of that enzyme. Three mechanisms have been reported showing how intermediate species act as mechanism-based inhibitors ... 

Mechanism-based inhibition should be irreversible. Dialysis, ultrafiltration, or washing the protein (e.g., by isolating microsomes by centrifugation and resuspending them in drug-free buffer) will not restore enzyme activity, and the inhibition is highly resistant to sample dilution. Mechanism-based inhibition should be saturable. The rate of inactivation is proportional to the concentration of the inactivator until all enzyme molecules are saturated, in accordance with Michaelis-Menten kinetics. Additionally, the decrease in enzymatic activity over time should follow pseudo-first-order kinetics. 

Studies in recent years have revealed a number of remarkable drug interactions with irreversible or mechanism-based inhibitors of CYP3A, many of which can be attributed to inhibition of sequential intestinal and hepatic first-pass metabolism. Mechanism-based inhibition involves the metabolism of an inhibitor to a reactive metabolite, which either forms a slowly reversible metabolic-intermediate (MI) complex with the heme moiety or inactivates the enzyme irreversibly via covalent binding to the enzyme catalyzing the last step in the bioactivation sequence. As a result, mechanism-based inhibition is both... 

The CYP inhibition assay utilizes the 96-well plate format with a robotic system, where both incubation and analysis are performed in the same plates. The setup of the sample plates is shown in Figure 4.1. For each compound, both direct inhibition and metabolism/mechanism-based inhibition, which is caused by a metabolite of the NCE that is either a more potent direct reversible inhibitor (metabolism-based) or a time-dependent irreversible inhibitor (mechanism-based), are evaluated. Both direct and mechanism-based inhibitors could result in inhibitory DDIs [51,52],... 

Finasteride and dutasteride are both mechanism-based inhibitors of type 1 and type 2 5a-reductase isoenzymes that inactivate 5a-reductase by an apparent irreversible modification of 5o-reductase (105,106). The inhibition constants (median inhibitory concentrations [ICsos]) in Table 45.5 suggest that finasteride is 30 times more selective for type 2 5a-reductase, whereas dutasteride appears to be approximately 10 times more potent as an inhibitor of type 2 5a-reductase than as a inhibitor of type 1 5a-reductase. The reduction of finasteride to dihydrofinasteride proceeds through an enzyme-bound, NADP-dihydrofinasteride adduct (see Chapter 5) (105). The mechanism- based inhibition explains the exceptional potency and specificity of finasteride and dutasteride in the treatment of BPH. This concept of mechanism-based inhibition may have application to the development of other inhibitors of pyridine nucleotide-linked enzymes. 

Quasi-irreversible inhibition is observed when CYP metabohsm produces an intermediate that can form a stable metabolite-intermediate MI) complex. This is another example of mechanism-based inhibition. Erythromycin is one such quasi-irreversible CYP3A4 inhibitor. Upon didemethylation of its tertiary amine group and subsequent oxidation, the resulting nitroso species forms a tight complex with the Fe(II) atom of the CYP s heme unit. Unhke truly irreversible adducts, such complexes can be broken up, say by oxidation with potassium ferricyanide, but under normal physiological conditions this obviously doesn t happen. 

Many of the enzymes discussed here are inducible, and another chapter will deal with the issues. Induction can be the result of the drug under consideration for metabolism, another drug, or a separate exposure in the diet or smoking. Most of the enzymes discussed here can also be inhibited. One of the considerations with new drugs is that they may inhibit the metabolism of other drugs and lead to undesirable (and unexpected) drug interactions. A special problem, which is not unusual, is that some inhibitors are mechanism based and irreversible, particularly with the P450s. 

Irreversible inhibition (mechanism-based inhibition, MBI) is among the most specific enzyme inhibitions, which includes CYP suicide inactivation process (the more widely studied process) and metabolite-intermediate complex (MI) formation (Silverman, 1995 Waley, 1980). The former involves metabolism of drugs to products that denature the CYP. In this case, the inactivator for the... 

Kinetic model for mechanism-based inhibition is proposed in Scheme 16.3 (Waley, 1980 Walsh et al., 1978). Inactivation of the enzyme is an irreversible process over the time scale of the experiment. At the given concentrations of inhibitor and enzyme, the reactions indicated in Scheme 16.3 are governed by the first-order rate constants k, k, 2, k, and 4, respectively. The rate of enzyme inactivation can be introduced by Equation 16.3 (Jxmg and Metcalf, 1975 Kitz and Wilson, 1962). 

Time-dependent inhibition defined mainly by mechanism-based inhibition (MBI), which includes CYP suicide inactivation (irreversible inhibition, the more widely studied process) and metabolite-intermediate (MI) complex formation (quasi-irreversible inhibition), is responsible for most clinically significant DDIs (Silverman, 1995 Waley, 1980 Zhou et al., 2005). Suicide inactivation involves the formation of a reactive intermediate that irreversibly inactivates the CYP in the process of catalytic turnover. Quasi-irreversible inhibition occurs when the CYP produces a metabolite (e.g., nitroso intermediate) with the capacity to bind tightly to the CYP heme. TDI (time-dependent inhibition) can be characterized (1) to be dose dependent, (2) to be preincubation time dependent, (3) to have bioactivation of the inhibitor that is required for inactivation of the target enzyme, (4) to have de novo protein synthesis that is required to recover metabolic capacity, and (5) to have potentially slow onset of the effects but be more profound than reversible inhibition. If present, then TDI is the major component of overall enzyme inhibition and frequently leads to clinically relevant DDIs. Table 4.5 contains a list of inhibitors of TDI observed in vitro and in vivo. 

In this chapter, mechanism-based inhibition is discussed in its broadest sense, where an inhibitor is converted by the enzyme catalytic mechanism to form an enzyme-inhibitor complex. Other terms used in the literature for mechanism-based inhibitors include suicide inhibitors, suicide substrate inhibitors, alternate substrates, substrate inhibitors, and enzyme inactivators, as well as irreversible, catalytic, or cat inhibitors. The terms alternate substrate inhibition and suicide inhibition are used here to describe the two major subclasses of mechanism-based inhibition. 

Full kinetic characterization for mechanism-based inhibition can be a challenge. Not only are there multiple rates to determine, but the mechanism of inhibition is often a combination of several different steps. The dividing line between alternate substrate inhibitors and the more eom-plex suicide inhibitors is often blurred, with some alternate substrates being virtually irreversible and some suicide substrates with high partition ratios and a significant alternate substrate element of inhibition. The following examples describe the characterization of an alternate substrate inhibitor and a suicide inhibitor of the serine protease human leukocyte elastase. 

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