title: Cytotoxic doses of ketoconazole affect expression of a subset of hepatic genes.
abstract: Ketoconazole is a widely prescribed antifungal drug, which has also been investigated as an anticancer therapy in both clinical and pre-clinical settings. However, severe hepatic injuries were reported to be associated with the use of ketoconazole, even in patients routinely monitored for their liver functions. Several questions concerning ketoconazole-induced hepatic injury remain unanswered, including (1) does ketoconazole alter cytochrome P450 expression at the transcriptional level?, (2) what types of gene products responsible for cytotoxicity are induced by ketoconazole?, and (3) what role do the major metabolites of ketoconazole play in this pathophysiologic process? A mouse model was employed to investigate hepatic gene expression following hepatotoxic doses of ketoconazole. Hepatic gene expression was analyzed using a toxicogenomic microarray platform, which is comprised of cDNA probes generated from livers exposed to various hepatoxicants. These hepatoxicants fall into five well-studied toxicological categories: peroxisome proliferators, aryl hydrocarbon receptor agonists, noncoplanar polychlorinated biphenyls, inflammatory agents, and hypoxia-inducing agents. Nine genes encoding enzymes involved in Phase I metabolism and one Phase II enzyme (glutathione S-transferase) were found to be upregulated. Serum amyloid A (SAA1/2) and hepcidin were the only genes that were downregulated among the 2364 genes assessed. In vitro cytotoxicity and transcription analyses revealed that SAA and hepcidin are associated with the general toxicity of ketoconazole, and might be usefully explored as generalized surrogate markers of xenobiotic-induced hepatic injury. Finally, it was shown that the primary metabolite of ketoconazole (de-N-acetyl ketoconazole) is largely responsible for the hepatoxicity and the downregulation of SAA and hepcidin.
authors.affiliation: Center for Biologics Research, Biologics and Genetic Therapies Directorate, Health Canada, Ottawa, Ontario, Canada.
authors.forename: William L
authors.initials: WL
authors.lastname: Casley
authors.forename: Carolina
authors.initials: C
authors.lastname: Ogrodowczyk
authors.forename: Louise
authors.initials: L
authors.lastname: Larocque
authors.forename: Bozena
authors.initials: B
authors.lastname: Jaentschke
authors.forename: Carole
authors.initials: C
authors.lastname: LeBlanc-Westwood
authors.forename: J Allan
authors.initials: JA
authors.lastname: Menzies
authors.forename: Larry
authors.initials: L
authors.lastname: Whitehouse
authors.forename: Mary Alice
authors.initials: MA
authors.lastname: Hefford
authors.forename: Rémy A
authors.initials: RA
authors.lastname: Aubin
authors.forename: Caroline F
authors.initials: CF
authors.lastname: Thorn
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Whitehead
authors.forename: Xuguang
authors.initials: X
authors.lastname: Li
mesh_terms: D000444:Aldehyde Dehydrogenase / Q000235:genetics; D000080924:Aldehyde Dehydrogenase 1 Family; D000818:Animals; D000935:Antifungal Agents / Q000633:toxicity*; D023181:Antimicrobial Cationic Peptides / Q000235:genetics; D049109:Cell Proliferation / Q000187:drug effects; D003577:Cytochrome P-450 Enzyme System / Q000235:genetics / Q000378:metabolism; D015870:Gene Expression / Q000187:drug effects*; D020869:Gene Expression Profiling; D005982:Glutathione Transferase / Q000235:genetics; D064451:Hepcidins; D007527:Isoenzymes / Q000235:genetics; D007654:Ketoconazole / Q000633:toxicity*; D008099:Liver / Q000187:drug effects* / Q000378:metabolism; D008297:Male; D051379:Mice; D020411:Oligonucleotide Array Sequence Analysis; D012333:RNA, Messenger / Q000378:metabolism; D050697:Retinal Dehydrogenase; D020133:Reverse Transcriptase Polymerase Chain Reaction; D000685:Serum Amyloid A Protein / Q000235:genetics
chemical_list: D000935:Antifungal Agents; D023181:Antimicrobial Cationic Peptides; C579599:Hamp protein, mouse; D064451:Hepcidins; D007527:Isoenzymes; D012333:RNA, Messenger; D000685:Serum Amyloid A Protein; D003577:Cytochrome P-450 Enzyme System; D000080924:Aldehyde Dehydrogenase 1 Family; D000444:Aldehyde Dehydrogenase; C515028:ALDH1A1 protein, mouse; D050697:Retinal Dehydrogenase; D005982:Glutathione Transferase; D007654:Ketoconazole