Inhibition of UDP-glucose dehydrogenase by 6-thiopurine and its oxidative metabolites: Possible mechanism for its interaction within the bilirubin excretion pathway and 6TP associated liver toxicity

J Pharm Biomed Anal. 2018 Mar 20;151:106-115. doi: 10.1016/j.jpba.2017.12.058. Epub 2017 Dec 30.


6-Thiopurine (6TP) is an actively prescribed drug in the treatment of various diseases ranging from Crohn's disease and other inflammatory diseases to acute lymphocytic leukemia and non-Hodgkin's leukemia. While 6TP has beneficial therapeutic uses, severe toxicities are also reported with its use, such as jaundice and liver toxicity. While numerous investigations into the mode in which toxicity originates has been undertaken. None have investigated the effects of inhibition towards UDP-Glucose Dehydrogenase (UDPGDH), an oxidative enzyme responsible for UDP-glucuronic acid (UDPGA) formation or UDP-Glucuronosyl transferase (UGT1A1), which is responsible for the conjugation of bilirubin with UDPGA for excretion. Failure to excrete bilirubin leads to jaundice and liver toxicity. We proposed that either 6TP or its primary oxidative excretion metabolites inhibit one or both of these enzymes, resulting in the observed toxicity from 6TP administration. Inhibition analysis of these purines revealed that 6-thiopurine has weak to no inhibition towards UDPGDH with a Ki of 288 μM with regard to varying UDP-glucose, but 6-thiouric (primary end metabolite, fully oxidized at carbon 2 and 8, and highly retained by the body) has a near six-fold increased inhibition towards UDPGDH with a Ki of 7 μM. Inhibition was also observed by 6-thioxanthine (oxidized at carbon 2) and 8-OH-6TP with Ki values of 54 and 14 μM, respectively. Neither 6-thiopurine or its excretion metabolites were shown to inhibit UGT1A1. Our results show that the C2 and C8 positions of 6TP are pivotal in said inhibition towards UDPGDH and have no effect upon UGT1A1, and that blocking C8 could lead to new analogs with reduced, if not eliminated jaundice and liver toxicities.

Keywords: 6-Thiopurine; Drug metabolism; Glucuronidation; Jaundice; UDP-glucuronic acid.

MeSH terms

  • Antimetabolites / metabolism
  • Antimetabolites / toxicity
  • Bilirubin / metabolism*
  • Chemical and Drug Induced Liver Injury*
  • Liver / drug effects
  • Liver / metabolism
  • Mercaptopurine / metabolism*
  • Mercaptopurine / toxicity*
  • Microsomes, Liver / drug effects
  • Microsomes, Liver / metabolism
  • Uridine Diphosphate Glucose Dehydrogenase / antagonists & inhibitors*
  • Uridine Diphosphate Glucose Dehydrogenase / metabolism*


  • Antimetabolites
  • Mercaptopurine
  • Uridine Diphosphate Glucose Dehydrogenase
  • Bilirubin