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Previous studies have suggested that the esteratic metabolism of cocaine to benzoylecgonine may be inhibited by the presence of ethanol. In this study, the effects of ethanol on the esteratic metabolism of cocaine to benzoylecgonine and to ecgonine methyl ester were examined in vitro using 60,000g supernatant from mouse and human liver. The addition of ethanol (40 mM) to an incubation mixture containing cocaine (24 microM) resulted in substantial decreases in benzoylecgonine and ecgonine methyl ester formation in liver from both species. Sodium fluoride (40 mM), included in the experiment as a positive control, also produced marked inhibition of cocaine metabolism to benzoylecgonine and ecgonine methyl ester. Additional studies were conducted in vivo in which mice were administered cocaine (50 mg/kg, ip) with or without ethanol pretreatment (3 g/kg by gavage). Ethanol pretreatment resulted in 2- to 3-fold increases in peak hepatic concentrations of cocaine, ecgonine methyl ester, and the N-oxidative metabolite norcocaine, and the areas under the hepatic concentration vs. time curve (AUCs) for these compounds were doubled. In contrast, the hepatic concentrations and AUC for benzoylecgonine were halved. These observations are consistent with an inhibition in vivo of esteratic metabolism of cocaine to benzoylecgonine, resulting in higher cocaine levels and metabolism through alternative pathways. Such an interaction may be of importance in the reported effects of ethanol to enhance the activity and toxicity of cocaine.

Cocaethylene is a novel metabolite of cocaine formed in the presence of ethanol. When administered to ICR male mice in dosages ranging from 10 to 50 mg/kg, i.p., cocaethylene was found to produce dose-dependent hepatic necrosis in the midlobular zone (zone 2). Severity of the lesion was maximal 12-24 hr after administration. A transient but significant decrease in hepatic glutathione content was observed 1 hr after cocaethylene administration. Pretreatment with the cytochrome P450 inhibitors cimetidine (200 mg/kg, i.p., in divided doses) or SKF 525A (50 mg/kg, i.p.) diminished toxicity. Pretreatment of mice with the esterase inhibitor diazinon (10 mg/kg, i.p.) increased cocaethylene hepatotoxicity, as did pretreatment with the cytochrome P450 inducing agents phenobarbital (80 mg/kg/day, i.p., for 3 days) or beta-naphthoflavone (40 mg/kg/day, i.p., for 3 days). Phenobarbital pretreatment also caused a shift in the morphologic site of necrosis from midzonal to peripheral lobular (zone 1) regions. The type of hepatic lesion produced by cocaethylene, its morphologic distribution (including the shift with phenobarbital treatment), the potency of cocaethylene in producing this effect, and the apparent requirement of oxidative metabolism for hepatoxicity were all remarkably similar to observations with its parent compound, cocaine, in this and earlier studies. This suggests that these compounds produce liver toxicity through the same or similar mechanisms.

Cocaethylene (benzoylecgonine ethyl ester or ethyl cocaine) is a transesterification product of cocaine and ethanol that has been observed in the urine of individuals using these drugs in combination. There is evidence that cocaethylene is pharmacologically active, and its formation in vivo may contribute to the toxicity of cocaine. A new method is presented here which enables the quantification of cocaethylene and cocaine, as well as the cocaine metabolites benzoylecgonine and norcocaine in liver tissue. This method utilizes high-performance liquid chromatography with uv detection (235 nm), and the propyl ester of cocaine is used as an internal standard. Liver homogenates are first buffered with 0.1 N dibasic potassium phosphate (pH 9.1) and then extracted with methylene chloride:isopropanol (9:1). Extraction efficiencies were approximately 75-85% for the compounds of interest. The coefficient of variation for replicate determinations (N = 10) of cocaethylene concentration was 5.75%, with comparable values obtained for cocaine, norcocaine, and benzoylecgonine. The detection limit for cocaethylene, based on a peak height threefold greater than background noise, was approximately 1.7 ng of injected compound. Using this method, it was demonstrated that cocaethylene is present in mouse liver following cocaine and ethanol administration, with an apparent rapid rate of formation and elimination.

Cocaine-induced hepatotoxicity has been reported in human beings and is well documented in mice. One interesting feature of this toxicity that appears to be common to both species is an apparent shift in the intraacinar site of necrosis under circumstances known to alter cocaine metabolism. However, the evidence in human subjects is limited, and studies elucidating the mechanism of this phenomenon cannot be performed in human beings. Although future studies in mice may define the basis of this mechanism, the current evidence is a somewhat fragmented composite of studies using different mouse strains and enzyme-inducing agents. Therefore a comprehensive pathologic investigation was initiated for the purpose of identifying and establishing an animal model suitable for studying this phenomenon. In naive ICR mice a single 60 mg/kg dose of cocaine was found to produce midzonal (zone 2) coagulative necrosis. In mice whose oxidative metabolism had been increased with beta-ionone or in which esterase metabolism had been inhibited by diazinon, the severity of the toxicity was increased but the intraacinar origin of the lesion did not change. However, when the oxidative microsomal metabolism of ICR mice was induced by phenobarbital or beta-naphthoflavone, the acinar zone affected was dramatically different. Phenobarbital induction produced zone 1 necrosis, whereas beta-napthoflavone induction caused necrosis in zone 3. The site of necrosis corresponded with the distribution of cocaine, and its metabolites were identified with colloidal gold-conjugated antibody probes. The results of this study suggest that the agents shifting the location of cocaine-induced hepatic necrosis alter the intraacinar site of protein binding of cocaine and its metabolites.

The N-oxidative metabolism of cocaine has been described previously in some detail in the mouse, and is associated with hepatotoxic effects of cocaine in this species. As part of an effort to determine whether this metabolism-dependent toxicity is relevant to clinical reports of liver injury from cocaine, the in vitro N-oxidative metabolism of cocaine was examined in microsomal suspensions obtained from human liver specimens. Human hepatic microsomal suspensions were capable of metabolizing cocaine to norcocaine, and norcocaine to N-hydroxynorcocaine, which is the sequential oxidative metabolism observed in mice to lead to toxic metabolite formation. Additionally, incubation of 4-[3H]cocaine with human hepatic microsomal suspensions resulted in the formation of a metabolite that bound irreversibly to microsomal protein. Each of these reactions was inhibited or abolished by gassing the incubation mixture with carbon monoxide, omitting NADPH, or adding the cytochrome P-450 inhibitors SKF 525-A (50 microM) or n-octylamine (3 mM). Competing microsomal esterase activity reduced the apparent rate of N-demethylation of cocaine by 50%, but had much less effect on the N-hydroxylation of norcocaine. In general, apparent KM values for both the N-demethylation and N-hydroxylation reactions in human liver microsomal suspensions were greater than those observed in comparable incubations using mouse hepatic microsomal suspensions, whereas Vmax rates were lower. The extent of irreversible (i.e. nonextractable) binding of cocaine following its metabolism in vitro was comparable between human and mouse microsomal suspensions, however. Similarities in the N-oxidative metabolism of cocaine suggest that humans and mice share the same bioactivation mechanism of cocaine-induced liver injury.

The ability of the alpha adrenoreceptor antagonists phentolamine and yohimbine to antagonize cocaine-induced hepatotoxicity was determined in phenobarbital-induced B6C3/F1 mice. Hepatotoxicity was assessed by the histologic extent of necrosis, incidence of latent lethality and increases in serum alanine aminotransferase activity. The depression of hepatic glutathione levels also were measured. The administration of a single 5-mg/kg dose of phentolamine antagonized the decrease in glutathione levels and the elevation of aminotransferase activity caused by a 60-mg/kg dose of cocaine. Similar results were obtained in mice pretreated with the alpha-2 antagonist yohimbine. Whereas the duration of antagonism could be extended by administering a 30-mg/kg dose of yohimbine, the magnitude of the antagonism was not increased. In contrast to the experiments with the larger dose, multiple hourly doses of 2.5 mg/kg of yohimbine increased both the duration of antagonism and the magnitude of protection against the hepatotoxicity produced by cocaine. Yohimbine pretreatment reduced cocaine-induced latent lethality by 50%, but did not alter the time to lethality. The results of these experiments indicate that the alpha adrenoreceptor antagonist reduces the toxicity of cocaine rather than merely delaying its time of onset. This effect does not appear to result from an inhibition of the toxic metabolite(s) of cocaine, as a 10-fold molar excess of yohimbine failed to antagonize lipid peroxidation caused by in vitro incubation of cocaine with hepatic microsomes. Additional experiments in mice whose liver metabolism had not been induced by prior pretreatment with phenobarbital revealed that 60 mg/kg of cocaine lowered glutathione but was not hepatotoxic.(ABSTRACT TRUNCATED AT 250 WORDS)

In vitro experiments with hepatic washed microsomal preparations showed that malondialdehyde (MDA) formation was increased in a time- and concentration-dependent manner using COC or NC as the substrate. Though 1 mM COC or NC inhibited MDA formation, significant elevations were observed for 100, 10 or 1 microM concentrations. NC at 10 microM after a 30 minute incubation produced a 34% decrease in hepatic microsomal cytochrome P450 whereas 1 mM NC had no such effect. MDA formation in vivo, measured as total absorbance at 535 nm per gram liver, was found to be maximal 4 hours after 40 mg/kg NC ip. Elevations of serum transaminase (SGPT) however were not found until 6 hours after NC. We conclude from these studies that COC and NC induce lipid peroxidation in the liver of PB-pretreated Swiss-origin mice and that peroxidative attack may be a mechanism for hepatotoxicity of these compounds.