Abstract
Methimazole (MMI), the first-line anti-thyroid agent used in clinical practice is known to induce hepatotoxicity in patients with Grave’s disease (GD), although its exact mechanism remains largely unclear. This cohort study aimed to examine the mechanism of MMI-induced hepatotoxicity using metabolomic approach. A total of 40 GD patients with MMI-induced hepatotoxicity (responders) and 80 GD patients without MMI-induced hepatotoxicity (non-responders) were included in this study and their plasma metabolomics was profiled with targeted gas chromatography–tandem mass spectrometry (GC–MS/MS). The plasma levels of 42 metabolites, including glucuronic acid, some amino acids, fatty acids, ethanolamine and octopamine were found to be significantly different between responders and non-responders. In agreement with our previous genotyping data, the genetic polymorphism of uridine 5′-diphospho-glucuronosyltransferase (UGT)1A1*6, which affects the glucuronidation activity and circulating glucuronic acid level was identified as one of the determinants of MMI-induced hepatotoxicity. Plasma level of ethanolamine has a significant correlation with aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activities. The pathway analyses further revealed that monoamine oxidase (MAO) inhibition, reactive oxygen species (ROS) production, mitochondria dysfunction, and DNA disruption might contribute to MMI-induced hepatotoxicity. Interestingly, the metabolomic data further suggested the responders had a higher risk of developing osteoporosis and fatty liver disease in comparison to the non-responders. This mechanistic study sheds light on the pathogenesis of MMI-induced hepatotoxicity and prompts personalized prescription of MMI based on UGT1A1*6 genotype in the management of GD.
Similar content being viewed by others
References
Akmal A, Kung J (2014) Propylthiouracil, and methimazole, and carbimazole-related hepatotoxicity. Expert Opin Drug Saf 13(10):1397–1406. https://doi.org/10.1517/14740338.2014.953796
Akram M (2014) Citric acid cycle and role of its intermediates in metabolism. Cell Biochem Biophys 68(3):475–478. https://doi.org/10.1007/s12013-013-9750-1
Bosma PJ, Chowdhury JR, Bakker C et al (1995) The genetic basis of the reduced expression of bilirubin UDP-glucuronosyltransferase 1 in Gilbert's syndrome. N Engl J Med 333(18):1171–1175. https://doi.org/10.1056/NEJM199511023331802
Dai X, Wu C, He Y et al (2013) A genome-wide association study for serum bilirubin levels and gene-environment interaction in a Chinese population. Genet Epidemiol 37(3):293–300
Dai Y, Yeo SCM, Barnes PJ, Donnelly LE, Loo LC, Lin HS (2018) Pre-clinical pharmacokinetic and metabolomic analyses of isorhapontigenin, a dietary resveratrol derivative. Front Pharmacol 9:753. https://doi.org/10.3389/fphar.2018.00753
Delbarre B, Delbarre G, Casset-Senon D, Sestillange P (1982) Effects of drugs interfering with the metabolism of octopamine on blood pressure of rats. Comp Biochem Physiol C 72(1):153–157
Ehlers M, Schott M, Allelein S (2019) Graves' disease in clinical perspective. Front Biosci (Landmark Ed) 24:35–47
Emiliano AB, Cooper DS, Governale L, Parks M (2010) Shifts in propylthiouracil and methimazole prescribing practices: antithyroid drug use in the United States from 1991 to 2008. J Clin Endocrinol Metab 95(5):2227–2233. https://doi.org/10.1210/jc.2009-2752
Hashimoto K, Ishima T, Sato Y et al (2017) Increased levels of ascorbic acid in the cerebrospinal fluid of cognitively intact elderly patients with major depression: a preliminary study. Sci Rep 7(1):3485. https://doi.org/10.1038/s41598-017-03836-0
Heidari R, Babaei H, Eghbal M (2013) Mechanisms of methimazole cytotoxicity in isolated rat hepatocytes. Drug Chem Toxicol 36(4):403–411. https://doi.org/10.3109/01480545.2012.749272
Heidari R, Babaei H, Roshangar L, Eghbal MA (2014) Effects of enzyme induction and/or glutathione depletion on methimazole-induced hepatotoxicity in mice and the protective role of N-acetylcysteine. Adv Pharm Bull 4(1):21–28. https://doi.org/10.5681/apb.2014.004
Hengstmann JH, Hohn H (1985) Pharmacokinetics of methimazole in humans. Klinische Wochenschrift 63(23):1212–1217. https://doi.org/10.1007/BF01733780
Huang CS, Luo GA, Huang ML, Yu SC, Yang SS (2000) Variations of the bilirubin uridine-diphosphoglucuronosyl transferase 1A1 gene in healthy Taiwanese. Pharmacogenetics 10(6):539–544. https://doi.org/10.1097/00008571-200008000-00007
Jin S, Li X, Fan Y et al (2019) Association between genetic polymorphisms of SLCO1B1 and susceptibility to methimazole-induced liver injury. Basic Clin Pharmacol Toxicol. https://doi.org/10.1111/bcpt.13284
Ki CS, Lee KA, Lee SY et al (2003) Haplotype structure of the UDP-glucuronosyltransferase 1A1 (UGT1A1) gene and its relationship to serum total bilirubin concentration in a male Korean population. Clin Chem 49(12):2078–2081. https://doi.org/10.1373/clinchem.2003.024174
Lindon JC, Holmes E, Nicholson JK (2007) Metabonomics in pharmaceutical R&D. FEBS J 274(5):1140–1151. https://doi.org/10.1111/j.1742-4658.2007.05673.x
Lofman O, Magnusson P, Toss G, Larsson L (2005) Common biochemical markers of bone turnover predict future bone loss: a 5-year follow-up study. Clin Chim Acta 356(1–2):67–75. https://doi.org/10.1016/j.cccn.2004.12.014
Manna D, Roy G, Mugesh G (2013) Antithyroid drugs and their analogues: synthesis, structure, and mechanism of action. Acc Chem Res 46(11):2706–2715. https://doi.org/10.1021/ar4001229
Miners JO, Chau N, Rowland A et al (2017) Inhibition of human UDP-glucuronosyltransferase enzymes by lapatinib, pazopanib, regorafenib and sorafenib: Implications for hyperbilirubinemia. Biochem Pharmacol 129:85–95. https://doi.org/10.1016/j.bcp.2017.01.002
Neff NH, Costa E (1966) The influence of monoamine oxidase inhibition on catecholamine synthesis. Life Sci 5(10):951–959. https://doi.org/10.1016/0024-3205(66)90204-9
Nemer MJ, Elwyn D (1960) The conversion of serine to ethanolamine and its derivatives in the rat. J Biol Chem 235(7):2070–2074
Nicholson JK, Lindon JC, Holmes E (1999) 'Metabonomics': understanding the metabolic responses of living systems to pathophysiological stimuli via multivariate statistical analysis of biological NMR spectroscopic data. Xenobiotica 29(11):1181–1189. https://doi.org/10.1080/004982599238047
Niknahad H, Jamshidzadeh A, Heidari R et al (2016) Paradoxical effect of methimazole on liver mitochondria: in vitro and in vivo. Toxicol Lett 259:108–115. https://doi.org/10.1016/j.toxlet.2016.08.003
Nishiumi S, Kobayashi T, Kawana S et al (2017) Investigations in the possibility of early detection of colorectal cancer by gas chromatography/triple-quadrupole mass spectrometry. Oncotarget 8(10):17115–17126. https://doi.org/10.18632/oncotarget.15081
Pannala VR, Vinnakota KC, Rawls KD et al (2019) Mechanistic identification of biofluid metabolite changes as markers of acetaminophen-induced liver toxicity in rats. Toxicol Appl Pharmacol 372:19–32. https://doi.org/10.1016/j.taap.2019.04.001
Rezzi S, Ramadan Z, Fay LB, Kochhar S (2007) Nutritional metabonomics: applications and perspectives. J Proteome Res 6(2):513–525. https://doi.org/10.1021/pr060522z
Selim K, Kaplowitz N (1999) Hepatotoxicity of psychotropic drugs. Hepatology 29(5):1347–1351. https://doi.org/10.1002/hep.510290535
Sikarwar B, Sharma PK, Tripathi BK, Boopathi M, Singh B, Jaiswal YK (2016) Enzyme based electrochemical biosensor for ethanolamine. Electroanalysis 28(4):881–889. https://doi.org/10.1002/elan.201501046
Tatara MR, Golynski M, Radzki RP, Bienko M, Krupski W (2017) Effects of long-term oral administration of methimazole on femur and tibia properties in male Wistar rats. Biomed Pharmacother 94:124–128. https://doi.org/10.1016/j.biopha.2017.07.107
Tomonaga S, Okuyama H, Tachibana T, Makino R (2018) Effects of high ambient temperature on plasma metabolomic profiles in chicks. Anim Sci J 89(2):448–455. https://doi.org/10.1111/asj.12951
Vaccari A, Biassoni R, Timiras PS (1983) Selective effects of neonatal hypothyroidism on monoamine oxidase activities in the rat brain. J Neurochem 40(4):1019–1025
Wamelink M, Struys E, Jakobs C (2008) The biochemistry, metabolism and inherited defects of the pentose phosphate pathway: a review. J Inherited Metab Dis 31(6):703–717
Wang Y, Feng F (2019) Evaluation of the hepatotoxicity of the Zhi-Zi-Hou-Po decoction by combining UPLC-Q-exactive-MS-based metabolomics and HPLC-MS/MS-based geniposide tissue distribution. Molecules 24(3) doi:10.3390/molecules24030511
Wendisch VF (2017) Microbial production of amino acid-related compounds. Adv Biochem Eng Biotechnol 159:255–269. https://doi.org/10.1007/10_2016_34
Wing SS, Fantus IG (1987) Adverse immunologic effects of antithyroid drugs. CMAJ 136(2):121–127
Wishart DS (2008) Metabolomics: applications to food science and nutrition research. Trends Food Sci Technol 19(9):482–493. https://doi.org/10.1016/j.tifs.2008.03.003
Woeber KA (2002) Methimazole-induced hepatotoxicity. Endocr Pract 8(3):222–224. https://doi.org/10.4158/ep.8.3.222
Xiang X, Han Y, Neuvonen M et al (2009) Effect of SLCO1B1 polymorphism on the plasma concentrations of bile acids and bile acid synthesis marker in humans. Pharmacogenet Genom 19(6):447–457. https://doi.org/10.1097/FPC.0b013e32832bcf7b
Yang J, Li LF, Xu Q et al (2015) Analysis of 90 cases of antithyroid drug-induced severe hepatotoxicity over 13 years in China. Thyroid 25(3):278–283. https://doi.org/10.1089/thy.2014.0350
Zaitsu K, Hayashi Y, Kusano M, Tsuchihashi H, Ishii A (2016) Application of metabolomics to toxicology of drugs of abuse: a mini review of metabolomics approach to acute and chronic toxicity studies. Drug Metab Pharmacokinet 31(1):21–26. https://doi.org/10.1016/j.dmpk.2015.10.002
Zhang A, Xing Q, Qin S et al (2007) Intra-ethnic differences in genetic variants of the UGT-glucuronosyltransferase 1A1 gene in Chinese populations. Pharmacogenomics J 7(5):333–338. https://doi.org/10.1038/sj.tpj.6500424
Zhang X, Yin J-F, Zhang J, Kong S-J, Zhang H-Y, Chen X-M (2017) UGT1A1*6 polymorphisms are correlated with irinotecan-induced neutropenia: a systematic review and meta-analysis. Cancer Chemother Pharmacol 80(1):135–149. https://doi.org/10.1007/s00280-017-3344-3
Acknowledgements
We thank all of the subjects who participated in this study. This work was supported by the National Natural Science Foundation of China [81473409]; Shanghai Science and Technology Innovation Fund [18140900900]; Foundation of Shanghai Municipal Commission of Health and Family Planning [201840057]; and Science and Technology Commission of Shanghai Municipality [114119b0400].
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
This study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Minhang Hospital, Fudan University. The written informed consent forms were obtained from all the participants. This study was registered in chictr.org.cn (Registration No. 1800018388).
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Li, X., Yang, J., Jin, S. et al. Mechanistic examination of methimazole-induced hepatotoxicity in patients with Grave’s disease: a metabolomic approach. Arch Toxicol 94, 231–244 (2020). https://doi.org/10.1007/s00204-019-02618-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00204-019-02618-z