title: Thiazide-like diuretic drug metolazone activates human pregnane X receptor to induce cytochrome 3A4 and multidrug-resistance protein 1.
abstract: Human pregnane X receptor (hPXR) regulates the expression of drug-metabolizing enzyme cytochrome P450 3A4 (CYP3A4) and drug transporters such as multidrug-resistance protein 1 (MDR1). PXR can be modulated by small molecules, including Federal Drug Administration (FDA)-approved drugs, thus altering drug metabolism and causing drug-drug interactions. To determine the role of FDA-approved drugs in PXR-mediated regulation of drug metabolism and clearance, we screened 1481 FDA-approved small-molecule drugs by using a luciferase reporter assay in HEK293T cells and identified the diuretic drug metolazone as an activator of hPXR. Our data showed that metolazone activated hPXR-mediated expression of CYP3A4 and MDR1 in human hepatocytes and intestine cells and increased CYP3A4 promoter activity in various cell lines. Mammalian two-hybrid assays showed that hPXR recruits its co-activator SRC-1 upon metolazone binding in HepG2 cells, explaining the mechanism of hPXR activation. To understand the role of other commonly-used diuretics in hPXR activation and the structure-activity relationship of metolazone, thiazide and non-thiazide diuretics drugs were also tested but only metolazone activates hPXR. To understand the molecular mechanism, docking studies and mutational analysis were carried out and showed that metolazone binds in the ligand-binding pocket and interacts with mostly hydrophobic amino acid residues. This is the first report showing that metolazone activates hPXR. Because activation of hPXR might cause drug-drug interactions, metolazone should be used with caution for drug treatment in patients undergoing combination therapy.
authors.affiliation: Department of Chemical Biology and Therapeutics, St. Jude Children's Research Hospital, Mail Stop 1000, 262 Danny Thomas Place, Memphis, TN 38105-3678, USA.
authors.forename: Monimoy
authors.initials: M
authors.lastname: Banerjee
authors.affiliation: Department of Chemical Biology and Therapeutics, St. Jude Children's Research Hospital, Mail Stop 1000, 262 Danny Thomas Place, Memphis, TN 38105-3678, USA. Electronic address: taosheng.chen@stjude.org.
authors.forename: Taosheng
authors.initials: T
authors.lastname: Chen
mesh_terms: D002470:Cell Survival / Q000187:drug effects / Q000502:physiology; D051544:Cytochrome P-450 CYP3A / Q000096:biosynthesis*; D065701:Cytochrome P-450 CYP3A Inducers / Q000494:pharmacology*; D004232:Diuretics / Q000494:pharmacology*; D004305:Dose-Response Relationship, Drug; D057809:HEK293 Cells; D056945:Hep G2 Cells; D006801:Humans; D008788:Metolazone / Q000494:pharmacology*; D027425:ATP-Binding Cassette, Sub-Family C Proteins / Q000096:biosynthesis*; D000077297:Pregnane X Receptor; D011485:Protein Binding / Q000502:physiology; D011987:Receptors, Steroid / Q000378:metabolism*; D049971:Thiazides / Q000494:pharmacology
chemical_list: D051544:Cytochrome P-450 CYP3A; D065701:Cytochrome P-450 CYP3A Inducers; D004232:Diuretics; D008788:Metolazone; D027425:ATP-Binding Cassette, Sub-Family C Proteins; D000077297:Pregnane X Receptor; D011987:Receptors, Steroid; D049971:Thiazides; C421109:multidrug resistance-associated protein 1
keywords: CYP3A4; Drug metabolism; MDR1; Metolazone; PXR