Metabolic activation of clopidogrel: in vitro data provide conflicting evidence for the contributions of CYP2C19 and PON1

Thomas Polasek, Matthew Doogue, John Miners

    Research output: Contribution to journalReview articlepeer-review

    10 Citations (Scopus)

    Abstract

    The recent report that clopidogrel efficacy may be more dependent on paraoxonase-1 (PON1) than on cytochrome P450 2C19 (CYP2C19) activity raises questions about the roles of these and other enzymes in clopidogrel activation. To provide insight into the emerging PON1 versus CYP2C19 debate, this commentary summarizes the clinical evidence on the pharmacokinetic determinants of clopidogrel efficacy. We then review the in vitro studies investigating the enzymes involved in clopidogrel activation, and comment on their strengths and limitations. There is agreement amongst in vitro studies regarding the involvement of CYP1A2 and CYP2B6 in the metabolism of clopidogrel to 2-oxo-clopidogrel. However, the evidence for other CYP enzymes in the first activation step (e.g. CYP2C19 and CYP3A4) is inconsistent and dependent on the in vitro test system and laboratory. All major drug metabolizing CYP enzymes are capable of converting 2-oxo-clopidogrel to sulfenic acid intermediates that subsequently form the active thiol metabolite. However, the extent of CYP involvement in this second step has been challenged, and new evidence suggests that CYP-independent hydrolytic cleavage of the thioester bond may be more important than oxidative metabolism.

    Original languageEnglish
    Pages (from-to)253-261
    Number of pages9
    JournalTherapeutic Advances in Drug Safety
    Volume2
    Issue number6
    DOIs
    Publication statusPublished - Dec 2011

    Keywords

    • antiplatelet
    • clopidogrel
    • cytochrome P4502C19
    • metabolic activation
    • paraoxonase-1
    • pharmacogenomics

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