Summary
Liver biopsies were obtained from four patients treated with rifampicin 600 mg for 6–10 days. Hepatic microsomes were incubated with an NADPH-regenerating system and the substrates [2, 4, 6, 7--3H] oestradiol, [6, 7-3H] oestradiol, [2, 4, 6, 7-3H] ethinyloestradiol and [6, 7-3H] ethinyloestradiol. The hydroxylation rates of these steroids at the labelled positions of rings A and B were determined by measuring the transformation of tritium into HTO by the microsomal enzymes. Comparison with previously published data showed that treatment with rifampicin caused a fourfold increase in the rate of hydroxylation of oestradiol and ethinyloestradiol at positions C-2/C-4 of ring A and C-6/C-7 of ring B. The acceleration of oestrogen hydroxylation by rifampicin was paralleled by an increase in microsomal cytochrome P-450, and also by microsomal reduction of rifampicin-quinone, a reactive metabolite of rifampicin. The increased aromatic hydroxylation of oestradiol and ethinyloestradiol leads to enhancement of their irreversible binding to microsomal protein. The data provide an explanation for the diminished efficacy of oestrogens in contraceptive formulations given to patients under treatment with rifampicin.
Similar content being viewed by others
References
Abdel-Aziz, M.T., Williams, K.I.H.: Metabolism of radioactive 17α-ethynylestradiol by women. Steroids15 695–710 (1970)
Ackermann, E., Heinrich, I.: Die Aktivität der N- und O-Demethylase in der Leber des Menschen. Biochem. Pharmacol.19 327–342 (1970a)
Ackermann, E., Heinrich, I.: Die Demethylierung von Aminophenazon und Codein in der Leber des Menschen. Biochem. Pharmacol.19 1955–1973 (1970b)
Alvarez, A.P., Schilling, G., Levin, W., Kuntzman, R., Brand, L., Mark, L.: Cytochrome P-450 and b-5 in human liver microsomes. Clin. Pharmacol. Ther.10 655–659 (1969)
Ball, P., Gelbke, H.P., Haupt, O., Knuppen, R.: Metabolism of 17α-ethynyl-4-14C-oestradiol and 4-14C-mestranol in rat liver slices and interaction between 17α-ethynyl-2-hydroxyoestradiol and adrenalin. Hoppe-Seylers Z. physiol. Chem.354 1567–1575 (1973)
Ball, P., Knuppen, R.: Metabolism of ethynylestradiol and epinephrine. Acta endocr. (Kbh.), Suppl.184, 32 (1974)
Beretta, E., Barone, D., Tenconi, L.T.: Rifampicina e sistemi enzimatici del fegato interessati al metabolismo dei farmaci: Studi in cavie, ratti e topi. Presentato al Associazione Italiana per lo studio del Fegato. Padova 1972
Bolt, H.M., Bolt, W.H.: Pharmacokinetics of mestranol in man in relation to its oestrogenic activity. Europ. J. clin. Pharmacol.7 295–305 (1974)
Bolt, H.M., Kappus, H.: Irreversible binding of ethynyl-estradiol metabolites to protein and nucleic acids as catalyzed by rat liver microsomes and mushroom tyrosinase. J. Steroid Biochem.5 179–184 (1974)
Bolt, H.M., Kappus, H., Käsbohrer, R.: Metabolism of 17α-ethynyl-estradiol by human liver microsomes in vitro: Aromatic hydroxylation and irreversible protein binding of metabolites. J. clin. Endocr.39 1072–1080 (1974)
Bolt, H.M., Kappus, H., Remmer, H.: Studies on the metabolism of ethynylestradiol in vitro and in vivo: The significance of 2-hydroxylation and the formation of polar products. Xenobiotica3 773–785 (1973)
Bolt, H.M., Kappus, H., Bolt, M.: Rifampicin and oral contraception. Lancet1974 aI 1280–1281
Bolt, W.H., Kappus, H., Bolt, H.M.: Ring A oxidation of 17α-ethynyl-estradiol in man. Horm. Metab. Res.6 432 (1974b)
Breuer, J., Breuer, H.: Halbwertszeit von 4-14C-Östradiol-17 β in vivo sowie Stoffwechsel von 4-14C-Östron und 4-14C-Östradiol in vitro bei Lebergesunden und bei Patienten mit Leberzirrhose. Z. klin. Chem.11 263–269 (1973)
Cargill, D.I., Steinetz, B.G., Gosnell, E., Beach, V.L., Meli, A., Fujimoto, G.I., Raynolds, B.M.: Fate of ingested radiolabelled ethynylestradiol and its 3-cyclopentyl ether in patients with bile fistulas. J. clin. Endocr.29 1051–1061 (1969)
Davies, D.S., Thorgeirsson, S.S.: Mechanism of hepatic drug oxidation and its relationship to individual differences in rates of oxidation in man. Ann. N. Y. Acad. Sci.179 411–420 (1971)
Edwards, O.M., Courtenay-Evans, R.J., Galley, J.M., Hunter, J., Tait, A.D.: Changes in cortisol metabolism following rifampicin therapy. Lancet1974 II 549–551
Fishman, J., Hellman, L., Zumoff, B., Gallagher, T.F.: Effect of thyroid on hydroxylation of estrogen in man. J. clin. Endocr.25 365–368 (1965)
Fishman, J., Hellman, L., Zumoff, B., Cassouto, J.: Pathway and stereo-chemistry of the formation of estriols in man. Biochemistry5 1789–1794 (1966)
Fishman, J., Guzik, H., Hellman, L.: Aromatic ring hydroxylation of estradiol in man. Biochemistry9 1593–1598 (1970)
Fleischmann, R., Mattenheimer, H., Remmer, H.: Micromethod for the preparation of a microsomal fraction from rat and human liver by differential sedimentation. Biochem. biophys. Res. Commun.62 289–295 (1975)
Fotherby, K.: Pharmacokinetics of contraceptive steroids in humans. In: Pharmacology and the future of man. Proc. 5th Internat. Congr. Pharmacology, Vol.I pp. 230–239, Basel: Karger 1973
Helton, E.D., Williams, M.C., Goldzieher, J.W.: The metabolism of ethynylestradiol in woman. J. Steroid Biochem.5 320 (1974)
Jellinck, P.H., Smith, G.: Metabolism of 2-hydroxy-4-14C-estradiol by rat liver microsomes. Steroids23 65–74 (1974)
Kappus, H., Bolt, H.M., Remmer, H.: Irreversible protein binding of metabolites of ethynylestradiol in vivo and in vitro. Steroids22 203–225 (1973)
Kappus, H., Bolt, H.M., Remmer, H.: Covalent protein binding of different drugs in vitro. Naunyn-Schmiedebergs Arch. exp. Path. Pharmak., Suppl.285 R 38 (1974)
Lowry, O.H., Rosebrough, N.J., Farr, A.L., Randal, R.J.: Protein measurement with the folin phenol reagent. J. biol. Chem.193 265–275 (1951)
Maggi, N., Pasqualucci, C.R., Ballotta, R., Sensi, P.: Rifampicin: A new orally active rifamycin. Chemotherapia (Basel)11 285–292 (1966)
Marks, F., Hecker, E.: Metabolism and mechanism of action of oestrogens. Biochim. biophys. Acta (Amst.)187 250–265 (1969)
Michot, F., Bürgi, M., Büttner, J.: Rimactan (Rifampicin) und Antikoagulantientherapie. Schweiz. med. Wschr.100 583–584 (1970)
Nelson, E.B., Raj, P.P., Belfi, K.J., Masters, B.S.S.: Oxidative drug metabolism in human liver microsomes. J. Pharmacol. exp. Ther.178 580–588 (1971)
Nocke-Finck, L., Breuer, H., Reimers, D.: Wirkung von Rifampicin auf den Menstruationszyklus und die Östrogenausscheidung bei Einnahme oraler Kontrazeptiva. Dtsch. med. Wschr.98 1521–1523 (1973)
Omura, T., Sato, R.: The carbon monoxide-binding pigment of liver. J. biol. Chem.239 2370–2378 (1964)
Pelkonen, O., Kaltiala, E.H., Larmi, T.K.I., Kärki, N.T.: Comparison of activities of drug-metabolizing enzymes in human fetal and adult livers. Clin. Pharmacol. Ther.14 840–846 (1973)
Peters, U., Hausamen, T.U., Grosse-Brockhoff, F.: Einfluß von Tuberkulostatika auf die Pharmakokinetik des Digitoxins. Dtsch. med. Wschr.99 2381–2386 (1974)
Reimers, D., Ježek, A.: Rifampicin und andere Antituberkulotika bei gleichzeitiger oraler Kontrazeption. Prax. Pneumol.25 255–262 (1971)
Remmer, H., Greim, H., Schenkman, J.B., Estabrook, R.W.: Methods for the elevation of hepatic microsomal mixed function oxidase levels and cytochrome P-450. In: Estabrook, W., Pullman, M.E. (Eds.), Oxidation and phosphorylation. Methods in Enzymology10 703–708 (1967)
Remmer, H., Schoene, B., Fleischmann, R.A.: Induction of the unspecific microsomal hydroxylase in the human liver. Drug Metab. Disposition1 224–230 (1973)
Sunahara, S., Nakagawa, H.: Metabolic study and controlled clinical trials of rifampicin. Chest61 526–532 (1972)
Syvälahti, E.K., Pihlajamäki, K.K., Iisalo, E.J.: Rifampicin and drug metabolism. Lancet1974 II 232–233
Warren, R.J., Fotherby, K.: Plasma levels of ethynyloestradiol after administration of ethynyloestradiol or mestranol to human subjects. J. Endocr.59 369–370 (1973)
Wenzel, M., Stahl, H.J.: Verstärkte Hydroxylierung von Östrogenen beim Menschen nach Arzneimittelgabe: Nachweis durch HTO-Analyse des Körperwassers. Hoppe-Seylers Z. physiol. Chem.351 761–762 (1970)
Author information
Authors and Affiliations
Additional information
Part of the results described in this paper has been presented in preliminary form (Bolt, Kappus and Bolt, 1974a)
Rights and permissions
About this article
Cite this article
Bolt, H.M., Kappus, H. & Bolt, M. Effect of rifampicin.treatment on the metabolism of oestradiol and 17α-ethinyloestradiol by human liver microsomes. Eur J Clin Pharmacol 8, 301–307 (1975). https://doi.org/10.1007/BF00562654
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00562654