Impaired elimination of propranolol due to right heart failure: Drug clearance in the isolated liver and its relationship to intrinsic metabolic capacity
Cy. Ng et al., Impaired elimination of propranolol due to right heart failure: Drug clearance in the isolated liver and its relationship to intrinsic metabolic capacity, DRUG META D, 28(10), 2000, pp. 1217-1221
It is unclear if reduced hepatic drug elimination in congestive heart failu
re is primarily due to impairment of enzyme function as a result of tissue
hypoxia, to the direct effects of hepatic congestion, or to changes intrins
ic to the liver, such as reductions in enzyme content and activity. We ther
efore compared propranolol clearance in perfused rat livers from animals wi
th right ventricular failure (RVF) with that from control animals. Despite
the fact that both groups were perfused at comparable flow rates, perfusion
pressures, and levels of oxygen delivery, hepatic extraction of propranolo
l was significantly reduced in RVF livers (0.688 +/- 0.122 versus 0.991 +/-
0.006 ml/min/g of liver in controls, P < .001). This effect was reflected
in a 97% reduction in propranolol intrinsic clearance in RVF livers (5 +/-
4 versus 172 +/- 82 ml/min/g of liver in controls, P < .01). In RVF livers,
total hepatic CYP expression was reduced by 19% compared with controls, wh
ereas cytochrome P450 isoenzymes 1A1/2 and 2D1 were reduced by 41 and 26%,
respectively. Despite the 97% reduction in propranolol intrinsic clearance
in perfused RVF liver, intrinsic clearance in microsomal preparations from
the same livers was reduced by only 48% compared with controls (P < .05). T
hese findings suggest that impaired propranolol clearance in RVF is not pri
marily accounted for by reduced hepatic oxygen delivery or by changes in he
patic content and activity of drug-metabolizing enzymes.