Systemic exposure of metronidazole is increased in patients
with
inflammatory bowel diseases (IBDs), while the underlying mechanism
remains unknown. Here, we aim to decipher the mechanisms by which
experimental colitis regulates metronidazole disposition in mice.
We first confirmed that the systemic exposure of metronidazole was
elevated in dextran sulfate sodium (DSS)-induced experimental colitis.
Hepatic microsomal incubation with metronidazole revealed that the
production rate of 2-hydroxymetronidazole was inhibited, suggestive
of a diminished hydroxylation reaction upon colitis. Remarkably, the
hydroxylation reaction of metronidazole was selectively catalyzed
by CYP2A5, which was downregulated in the liver of colitis mice. In
addition, hepatic nuclear factor (NF)-κB (a prototypical and
critical signaling pathway in inflammation) was activated in colitis
mice. Luciferase reporter and chromatin immunoprecipitation assay
indicated that NF-κB downregulated Cyp2a5 transcription
through binding to an NF-κB binding site (−1711 to −1720
bp) in the promoter. We further verified that the regulatory effects
of colitis on CYP2A5 depended on the disease itself rather than the
DSS compound. First, one-day administration of DSS did not alter mRNA
and protein levels of CYP2A5. Moreover, CYP2A5 was suppressed in the Il-10–/–
spontaneously developing
colitis model. Furthermore, Cyp2a5 expression was
downregulated in both groups of mice with modest or severe colitis,
whereas the expression change was much more significant in severe
colitis as compared to modest colitis. Altogether, activated hepatic
NF-κB in experimental colitis regulates CYP2A5 and metronidazole
disposition, revealing the mechanism of pharmacokinetic instability
under IBDs, and providing a theoretical foundation for rational drug
use in the future.