ABSTRACT:(R,S)-Oxazepam is a 1,4-benzodiazepine anxiolytic drug that is metabolized primarily by hepatic glucuronidation. In previous studies, S-oxazepam (but not R-oxazepam) was shown to be polymorphically glucuronidated in humans. The aim of the present study was to identify UDP-glucuronosyltransferase (UGT) isoforms mediating R-and S-oxazepam glucuronidation in human liver, with the long term objective of elucidating the molecular genetic basis for this drug metabolism polymorphism. All available recombinant UGT isoforms were screened for R-and S-oxazepam glucuronidation activities. Enzyme kinetic parameters were then determined in representative human liver microsomes (HLMs) and in UGTs that showed significant activity. Oxazepam is a 1,4-benzodiazepine derivative that is used in clinical practice for its anxiolytic, sedative, and anticonvulsant effects (Greenblatt et al., 1980(Greenblatt et al., , 1981. In humans, this drug is cleared from the body almost exclusively by hepatic glucuronidation, followed by urinary excretion (Abernethy et al., 1983). Oxazepam is formulated as a racemic preparation of S-and R-stereoisomers although the S-enantiomer is thought to be much more active as a benzodiazepine receptor agonist compared with the R-enantiomer (Mohler et al., 1978). Conjugation occurs via the hydroxyl group attached to the asymmetric 3-carbon position yielding diastereomeric glucuronides that are readily separated by routine high pressure liquid chromatography (HPLC 1 ) (Mascher et al., 1984;Patel et al., 1995a).Interindividual variability in the pharmacokinetics and metabolism of (R,S)-oxazepam have been investigated in human volunteers (Patel et al., 1995a). S-Oxazepam glucuronide was found to be formed preferentially over R-oxazepam glucuronide with S/R glucuronide diastereomeric ratios in the plasma and urine of volunteers averaging 3.5 Ϯ 0.6 and 3.9 Ϯ 0.8, respectively. Interestingly, in 2 of 11 subjects (18%), the S/R ratio in the urine was relatively low (Ͻ1.9). Since the plasma clearance of oxazepam in these individuals was also very low (Ͻ0.6 ml/min/kg) compared with other individuals (0.9 -1.4 ml/min/ kg), it was concluded that these differences probably were the result of slower S-oxazepam clearance by glucuronidation in a significant minority of the study population (i.e., a "slow metabolizer" phenotype). Although pharmacodynamic measurements were not made, the relatively slow elimination of oxazepam would be expected to result in prolonged sedation in these individuals.In vitro studies using human liver microsomes (HLMs) showed a similar picture in that S-oxazepam glucuronide was the predominant metabolite (S/R ratios averaging 4.0), and 4 of 37 livers displayed relatively slow oxazepam glucuronidation activities coinciding with low S/R metabolite ratios (Ͻ2.0) (Patel et al., 1995a). Enzyme kinetic analysis showed that the low glucuronidation activity was associated with higher apparent K m values and lower V max values for S-oxazepam glucuronidation in the four atypical livers compared with ...