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Z Gastroenterol 2019; 57(01): 37-45
DOI: 10.1055/a-0784-8815
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Die Bedeutung von Cytochrom P4502E1 bei der alkoholischen Lebererkrankung und bei der alkoholmediierten Karzinogenese

The role of Cytochrom P4502E1 in Alcoholic Liver Disease and alcohol mediated carcinogenesis
Helmut Karl Seitz
1   Department of Medicine, Salem Medical Center, Heidelberg, Germany
,
Sebastian Mueller
2   Department of Medicine and Liver Diseases, Salem Medical Center, University of Heidelberg, Germany
› Author Affiliations
Further Information

Publication History

30 August 2018

05 November 2018

Publication Date:
14 January 2019 (online)

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Zusammenfassung

Verschiedene Faktoren sind in der Pathogenese der alkoholischen Lebererkrankung (ALE) und der alkoholvermittelten Karzinogenese beteiligt. Neben genetischen, epigenetischen und immunologischen Mechanismen spielen die toxische Wirkung von Acetaldehyd, oxidativer Stress und zytokinvermittelte Entzündungen eine wesentliche Rolle. Oxidativer Stress mit der Generierung von reaktiven Sauerstoffspezies (ROS) entsteht entweder in der Entzündung (alkoholische Hepatitis) oder bei der Alkoholoxidation via Cytochrom P4502E1 (CYP2E1). CYP2E1 wird durch Alkohol induziert, oxidiert Äthanol zu Acetaldehyd und generiert dabei ROS. ROS führt unter anderem zu Proteinschädigung, Fibrogenese und DNA-Mutationen. Weiterhin resultiert die CYP2E1-Induktion in einer gesteigerten Prokarzinogenaktivierung und einem verstärkten Abbau von Retinol und Retinsäure, einem Faktor, der für eine geordnete Zelldifferenzierung und Zellproliferation verantwortlich ist. Eine Hemmung von CYP2E1 führt zu einer Verbesserung der ALE und zu einer Hemmung der chemisch induzierten Karzinogenese im Tierexperiment. Beim Menschen wird CYP2E1 bereits bei 40 Gramm Alkohol pro Tag innerhalb einer Woche induziert, jedoch gibt es signifikante interindividuelle Unterschiede. Der Mechanismus dafür ist unklar. Bei Patienten mit ALE korreliert CYP2E1 mit dem Ausmaß von hochkarzinogenen Etheno-DNA-Addukten in Leber und Ösophagus und mit der Schwere der Leberfibrose. Erste Ergebnisse zu einer Hemmung von CYP2E1 durch Chlormethiazol, einem spezifischen CYP2E1-Hemmer, bei Patienten mit ALE sind in Kürze zu erwarten.

Abstract

Various factors are involved in the pathogenesis of alcoholic liver disease (ALD) and ethanol-mediated carcinogenesis. In addition to genetic, epigenetic and immunologic mechanisms, acetaldehyde-associated toxicity, oxidative stress as well as cytokine-mediated inflammation are of major importance. Oxidative stress, with the generation of reactive oxygen species (ROS), develops either in inflammation (alcoholic hepatitis) or during oxidation of ethanol via cytochrome P4502E1 (CYP2E1). CYP2E1 is induced by ethanol, oxidizes ethanol to acetaldehyde, and generates ROS during this process. ROS results in protein damage, enhanced fibrogenesis and DNA lesions. Furthermore, CYP2E1 induction results in an enhanced activation of various procarcinogens and an increased degradation of retinol and retinoic acid (RA), a compound responsible for cell differentiation and proliferation. An inhibition of CYP2E1 results in an improvement of ALD and chemically induced carcinogenesis in animal experiments. In humans, CYP2E1 is induced following the consumption of 40 grams of ethanol per day after one week. However, the induction varies inter-individually. The mechanism for this is still unclear. Patients with ALD show a significant correlation between CYP2E1, the occurrence of highly carcinogenic etheno DNA adducts and the severity of fibrosis. First results on the effect of CYP2E1 inhibition by chlormethiazole, a specific CYP2E1 inhibitor on ALD, can be expected soon.

Schlüsselwörter

Alkoholische Lebererkrankung - Zytochrom P4502E1 - Reaktive Sauerstoffspezies - Karzinogenaktivierung - Retinoide - Etheno-DNA-Addukte

Key words

alcohol - Cytochrome P 4502E1 - reactive oxygen species - retinoids - cancer
 

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