Cytochrome P-450 in the brain. Potential evolutionary and therapeutic relevance of localization of drug-metabolizing enzymes.

The cytochrome P-4502D6 enzyme is reportedly expressed in the brain. It was hypothesized that brain P-450 may serve to diminish exposure and toxicity from exogenous substances by enhancing their elimination from the central nervous system (CNS). To test this, a physiologic-based kinetic model was developed to simulate drug concentrations in brain and blood in the presence and absence of CNS metabolism. The amount of cytochrome P-450 in the brain was set at 0.25% of hepatic levels to reflect the small amounts of enzyme reportedly present in the CNS. Simulations were performed for low, intermediate, and high clearance drugs, assuming the presence or absence of brain P-450 enzymes. Enzyme localization was simulated by systematically reducing the volume into which the enzyme was expressed. No difference could be detected in drug concentrations in the blood, regardless of whether enzyme was present and/or localized in brain tissue. Marked differences, however, were observed in steady-state tissue drug levels that were highly dependent on the presence or absence of the brain enzyme, its degree of localization, and its efficiency for its substrate. These results suggest that large intersubject variability in CNS response to some drugs could reflect interpatient differences in CNS drug metabolism.