Thalidomide increases cytochrome P450 activity and drug metabolism in liver through direct activation of nuclear receptor CAR and PXR

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We demonstrated heterotropic cooperativity of human cytochrome P450 (P450) 3A4/5 by the teratogen thalidomide using a model substrate midazolam in various in vitro and in vivo models. Chimeric mice with humanized liver displayed enhanced midazolam clearance upon pre-treatment with orally administered thalidomide, presumably because of human P450 3A induction. Thalidomide enhanced levels of P450 3A4/2B6 mRNA, protein expression, and/or oxidation activity in human hepatocytes indirectly suggesting activation of gene transcription factors. Thalidomide and its human proportionate metabolite 5-hydroxythalidomide displayed significant modulation of coregulator interaction with CAR and PXR ligand-binding domains similar to established agonists for these receptors. These results collectively suggest that thalidomide could act as a ligand for PXR and CAR and cause enzyme induction. The possibilities of drug interactions during thalidomide therapy in humans should be evaluated further.