¹Departments of Hepatology A, Transplantation V, and Clinical Pharmacology Q, Rigshospitalet, Copenhagen, and Department of Drug Metabolism, Novo Nordisk, Måløv, Denmark

Correspondence: Lars E. Schmidt, MD, Department of Hepatology A.2.12.1, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark. E-mail: lars.schmidt@dadlnet.dk

^*Supported by grants from The Medical Research Foundation for Copenhagen, Faroe Islands and Greenland, Savvæksejer Jeppe Juhl and Hustru Ovita Juhls Mindelegat, Svend Hansens Fond, and Roches Transplantationslegat.

Received 3 July 2001; Accepted 27 August 2001.

Abstract

Background: Interindividual variation in the pharmacokinetics of the immunosuppressive agents cyclosporine (INN, ciclosporin) and tacrolimus may result from differences in the activity of cytochrome P4503A (CYP3A). The erythromycin breath test is an in vivo assay of hepatic CYP3A activity, but the method has never been directly validated. The aim of the study was to investigate whether an early post-operative erythromycin breath test correlated with the hepatic CYP3A protein level and catalytic activity in liver transplant recipients.

Methods: In 18 liver transplant recipients, the erythromycin breath test was performed within 2 hours after transplantation. A graft biopsy was obtained during surgery and analyzed for the CYP3A protein level by Western blotting and for CYP3A activity with erythromycin demethylation and testosterone 6-hydroxylation assays.

Results: The erythromycin breath test values ranged from 0.14% to 1.65% of carbon 14 per hour, and the CYP3A protein level ranged from 732 to 7822 as measured by optical density. The in vitro catalytic activity determined by the erythromycin demethylation assay ranged from 94 to 902 disintegrations per minute per 5 minutes per milligram of protein, and the activity determined by testosterone 6-hydroxylation ranged from 0.030 to 0.627 nmol per minute per milligram of protein. Significant correlation was demonstrated between the erythromycin breath test and both the erythromycin demethylation (Spearman correlation coefficient: R = 0.76, R² = 0.57; P = .0004) and the testosterone 6-hydroxylation (Spearman correlation coefficient: R = 0.79, R² = 0.63; P = .0001) assays. The erythromycin breath test also correlated with the CYP3A protein level (Spearman correlation coefficient: R = 0.60, R² = 0.36; P = .01).

Conclusion: Our data support the erythromycin breath test as a specific in vivo assay of CYP3A activity in humans. The test is applicable in liver transplant recipients in the early postoperative phase. Future studies should evaluate the clinical usefulness of an early postoperative erythromycin breath test as a predictor of cyclosporine-tacrolimus pharmacokinetics in liver transplantation.