ABSTRACT:Grapefruit juice has been found to cause an increase in the oral bioavailability of many therapeutic agents. Such interactions are believed to result from the mechanism-based inhibition of CYP3A4 activity in the intestine. Furanocoumarin dimers present in the juice have been found to be extremely potent inhibitors of CYP3A4 activity. The aim of this work was to synthesize and test a series of dimers with a view to defining the relationship between structure and inhibitory activity and establish whether they might make suitable probes of CYP3A4 activity. Eleven furanocoumarin dimers were synthesized and evaluated as inhibitors of CYP3A4 using human liver microsomes, with testosterone as the marker substrate. Four of the most potent dimers were also investigated for their effects on CYP3A4 activity in the human intestine and on five additional hepatic cytochrome P450 isoforms. The dimers showed In conclusion, all the dimers tested were extremely potent inhibitors of CYP3A4 activity. In particular, dimer 55EE was highly selective toward the enzyme, suggesting that this compound is a suitable probe for determining the contribution of CYP3A4 to drug metabolism.There has been substantial interest in the inhibition of CYP3A4 activity by the constituents of grapefruit juice. This effect was first recognized by Bailey et al. (1989) from a chance finding in a felodipine-ethanol interaction study in which grapefruit juice was used to mask the taste of the alcohol. Elevated plasma felodipine concentrations were observed both in the alcohol and control phases of the study, and in a later study, grapefruit juice was found to triple the mean area under the plasma concentration-time curve through inhibition of CYP3A4 . Subsequently, a large number of studies have been performed on the effects of grapefruit juice on a range of drugs of therapeutic importance, such as terfenadine (Benton et al., 1996;Rau et al., 1997) , 1995). The constituents of grapefruit juice that cause inhibition of CYP3A4 have not been conclusively identified. Strong candidates are the furanocoumarins, particularly the bergamottin series (Ohnishi et al., 2000;Kakar et al., 2004). However, there is no clear evidence that any one compound is primarily responsible, and it is possible that the interaction arises from the accumulative effect of a number of constituents present in the juice. Of the compounds isolated, three dimers, namely, GF-I-1, GF-I-4, and GF-I-6 (Fig. 1), possibly derived from the geranyloxy monomer (6Ј,7Ј-dihydroxybergamottin), were the most potent inhibitors of CYP3A4 activity (Fukuda et al., 1997;Guo et al., 2000a;Tassaneeyakul et al., 2000). Potencies were found to exceed that of ketoconazole and were shown to be 1 to 2 orders of magnitude higher than those observed for the monomers bergamottin, 6Ј,7Ј-epoxybergamottin, and 6Ј,7Ј-dihydroxybergamottin, when using testosterone as the marker substrate (Guo et al., 2000b).Inhibition of CYP3A4 activity by grapefruit juice is believed to be the result of mechanism-based inactivation (S...