Affiliation:
1. Department of
Diagnostic & Biomedical Sciences, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX,
77030, United States
2. Department of Pharmaceutical & Biomedical Sciences, The University of Georgia, Athens, GA 30602, United States
Abstract
Abstract:
Global estimates indicate that over 600 million individuals worldwide consume the areca (betel) nut in
some form. Nonetheless, its consumption is associated with a myriad of oral and systemic ailments, such as precancerous
oral lesions, oropharyngeal cancers, liver toxicity and hepatic carcinoma, cardiovascular distress, and
addiction. Users commonly chew slivers of areca nut in a complex consumable preparation called betel quid (BQ).
Consequently, the user is exposed to a wide array of chemicals with diverse pharmacokinetic behavior in the body.
However, a comprehensive understanding of the metabolic pathways significant to BQ chemicals is lacking. Henceforth,
we performed a literature search to identify prominent BQ constituents and examine each chemical's interplay
with drug disposition proteins. In total, we uncovered over 20 major chemicals (e.g., arecoline, nicotine, menthol,
quercetin, tannic acid) present in the BQ mixture that were substrates, inhibitors, and/or inducers of various phase I
(e.g., CYP, FMO, hydrolases) and phase II (e.g., GST, UGT, SULT) drug metabolizing enzymes, along with several
transporters (e.g., P-gp, BCRP, MRP). Altogether, over 80 potential interactivities were found. Utilizing this new
information, we generated theoretical predictions of drug interactions precipitated by BQ consumption. Data suggests
that BQ consumers are at risk for drug interactions (and possible adverse effects) when co-ingesting other substances
(multiple therapeutic classes) with overlapping elimination mechanisms. Until now, prediction about interactions is
not widely known among BQ consumers and their clinicians. Further research is necessary based on our speculations
to elucidate the biological ramifications of specific BQ-induced interactions and to take measures that improve the
health of BQ consumers.
Publisher
Bentham Science Publishers Ltd.
Subject
Clinical Biochemistry,Pharmacology