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23 April 2019

The Mercapturomic Profile of Health and Non-Communicable Diseases

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1
CEDOC, Chronic Diseases Research Centre, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-006 Lisboa, Portugal
2
Centro de Química Estrutural, Instituto Superior Técnico, ULisboa, 1049-001 Lisboa, Portugal
*
Author to whom correspondence should be addressed.
These authors contributed to this manuscript equally.
This article belongs to the Special Issue Adductomics: Elucidating the Environmental Causes of Disease

Abstract

The mercapturate pathway is a unique metabolic circuitry that detoxifies electrophiles upon adducts formation with glutathione. Since its discovery over a century ago, most of the knowledge on the mercapturate pathway has been provided from biomonitoring studies on environmental exposure to toxicants. However, the mercapturate pathway-related metabolites that is formed in humans—the mercapturomic profile—in health and disease is yet to be established. In this paper, we put forward the hypothesis that these metabolites are key pathophysiologic factors behind the onset and development of non-communicable chronic inflammatory diseases. This review goes from the evidence in the formation of endogenous metabolites undergoing the mercapturate pathway to the methodologies for their assessment and their association with cancer and respiratory, neurologic and cardiometabolic diseases.

1. Brief Overview of the Mercapturate Pathway

The mercapturate pathway is one of the key traits of renal proximal tubular cells, although it is also present in hepatocytes [1]. The main function of this pathway is to detoxify electrophilic species [2]. These electrophiles might arise either from the metabolism of endogenous substances or from exogenous compounds (or their biotransformation products) present in air, food or water [3,4,5,6,7]. Once generated in any cell and upon conjugation with glutathione (GSH) (Figure 1), an electrophile-GSH-S-conjugate is formed [8]. As cells are not able to metabolize these conjugates intracellularly, those conjugates are effluxed into the bloodstream to undergo the mercapturate pathway. Thus GSH-S-conjugates are the precursors that will generate mercapturates, through the three sequential steps that constitute this pathway. The first two steps are extracellular and generate cysteinyl-glycine-S-conjugates (CysGly-S-conjugates) and cysteine-S-conjugates (Cys-S-conjugates) by the membrane-bound-enzymes, gamma-glutamyl-transferase (GGT) and dipeptidase or aminopeptidase-M, respectively [9,10,11]. Despite their presence in tissues such as liver, small intestine, lung, brain, spleen and pancreas, the main local of expression of these enzymes is the kidney tubule [12]. The Cys-S-conjugates enter the renal tubular cells and hepatocytes via various transporters including organic anion transport polypeptides and cystine/cysteine transporters for the last reaction of the mercapturate pathway [12,13,14]. The last step of this pathway relies on the microsomal N-acetyl-transferase 8 (NAT-8) that is expressed almost exclusively in the kidney proximal tubular cells, with much lower presence at the liver [1]. An N-acetyl-cysteine-S-conjugate, also known as a mercapturate, is lately formed upon NAT8 activity and is majorly eliminated in urine.
Figure 1. The mercapturomic profile of health and non-communicable chronic diseases. Any cell can generate GSH-S-conjugates that are excreted into the circulation and metabolized at the external apical membrane of kidney proximal tubular cells (major route) and hepatocytes (minor route). The Cys-S-conjugates that are formed might be subsequently detoxified by the N-acetyl-transferase NAT8, allowing the formation of mercapturates that are eliminated in urine. The Cys-S-conjugates can also be reabsorbed into the bloodstream and distributed into several organs. Blood and urine can be used for biomonitoring of mercapturate pathway-related metabolites. CysS-X: cysteine-S-conjugates; GSH-X: glutathione-S-conjugates; N-AcCysS-X: mercapturates; NAT8: N-acetyl-transferase 8.

2. The Mercapturomic Profile

The metabolites that are formed through this pathway include the precursors GSH-S-conjugates and their catabolic products, the CysGly-S-conjugates and Cys-S-conjugates, and finally their mercapturates. This mercapturate pathway-related metabolites is herein called the mercapturomic profile. As Cys-S-conjugates seem to have significantly higher half-life than their precursors [4,15], they are the plausible ones to be used for biomonitoring purposes in human biological fluids (Table 1, Table 2, Table 3, Table 4 and Table 5). In addition, the urinary mercapturates represent a prominent non-invasive approach to profile this pathway.
Table 1. Mercapturomic profile of respiratory diseases.
Table 2. Mercapturomic profile of cancer.
Table 3. Mercapturomic profile of neurologic diseases.
Table 4. Mercapturomic profile of cardiometabolic diseases.
Table 5. Methodologies for mercapturomic profiling.

3. Biological Actions of Mercapturate Pathway-Related Metabolites

The effects of Cys-S-conjugates might have been underestimated, probably because the mercapturate pathway has been classically considered a detoxification route for xenobiotics. However, it is for instance known that the Cys-S-conjugate of cisplatin is more toxic to kidney tubular cells than cisplatin by itself [16]. Additionally, the Cys-S-conjugate of paracetamol is related to its nephrotoxicity, but not to its hepatotoxicity [17].
Cys-S-conjugates have been associated with hemodynamic properties [18], such as arteriolar vasoconstriction [19,20,21] and enhanced postcapillary venules permeability [22]. Cys-S-conjugates are involved in glucose-stimulated insulin secretion [23] and might have pro-inflammatory [5], cytotoxic [16,17,24,25], genotoxic [25] and immunogenic [26] properties. Most of available studies have investigated the role of specific mercapturate pathway related metabolites in an experimental model or in a particular group of patients. Thus far, no work has given a comprehensive view of the mercapturomic profile, similarly to what it is performed for protein adducts [27]. In fact, Wang and Ballatori (1998) have brilliantly reviewed dozens of compounds that generate GSH-S-conjugates [28] such as leukotrienes [3], prostaglandins [29] and lipid peroxidation products [6,7].
The cysteinyl-leukotrienes (CysLTs) might be the best described example in the literature, concerning its association with non-communicable diseases. CysLTs are products of arachidonic acid metabolism and key mediators of inflammatory conditions [30,31,32] and stem from the catabolism of leukotriene C4 (LTC4), which is a GSH-S-conjugate. Extracellular LTC4 undergoes a two-step catabolic process originating the CysGly-S-conjugate (leukotriene D4, LTD4) and Cys-S-conjugate (leukotriene E4, LTE4) respectively, through the mercapturate pathway [31,32]. These compounds are generally termed CysLTs, although this denomination fully suits only LTE4, which has the longest half-life [15]. LTE4 mercapturate formation is mediated by NAT8 activity as described by the team of Veiga da Cunha (2010) [3]. CysTL are well known for their role in the pathophysiology of asthma and increasing evidence links these metabolites with non-communicable chronic inflammatory conditions [33,34], namely cardiovascular, neurologic and kidney disease [35] and cancer [36,37]. Altogether, non-communicable diseases represent the most common cause of death and multi-morbidity in the modern world [38]. Expanding investigations have shown that many of these diseases share pathophysiological mechanisms, with a similar profile of molecular changes, despite affecting diverse organs and systems differently. To fulfil this concept in a mercapturate pathway-related perspective, we herein review the available knowledge about the association between mercapturate pathway-related metabolites and the major non-communicable diseases. All included reports are clinical studies.

4. The Human Mercapturomic Profile in Health and Disease

4.1. Respiratory Diseases

CysLTs are important inflammatory mediators in the pathophysiology of respiratory disorders (Table 1) [39,40,41,42]. They are potent bronchoconstrictors and can cause acute and chronic structural defects in the airways [43,44,45]. Common treatment of asthma might include CysLTs receptor type 1 antagonists. There are also inhibitors available for 5-lypoxygenase, the enzyme involved in the synthesis of the precursor of CysLT from arachidonic acid. Three studies evaluated CysLTs in saliva, exhaled breath condensate and urine samples of patients with asthma (Table 1). Both chronic and acute asthma were associated with increased levels of LTE4 in all the biological matrixes analyzed [40,46,47]. Moreover, smoking habits did not affect LTE4 levels in exhaled breath condensate and the use of CysLTs receptor antagonists during asthma exacerbation did not affect LTE4 levels in urine [40]. Cys-S-conjugates which are disulfides were increased in children with difficult-to-treat asthma [34] and associated with asthma severity, including poorer control of symptomatology, greater medication use and a worse response to glucocorticoid therapy [48].
CysLTs have also been associated to silica-induced lung fibrogenesis [49]. In fact, increased LTE4 levels were observed in exhaled breath condensate of patients with pneumoconiosis derived from asbestos and silica exposure [39].

4.2. Cancer

Cys-S-conjugates have also been described in different types of cancer, namely in melanoma, non-Hodgkin lymphoma, breast, ovarian and thyroid cancer (Table 2).
Melanoma was linked to the melanin metabolite 5-S-Cys-DOPA (Cys-DOPA). In melanocytes, the amino acid L-DOPA is oxidized into a highly reactive dopaquinone that after binding to a sulfhydryl donor as glutathione is further oxidized to pheomelanin, a yellow to reddish form of melanin. Increases in serum Cys-DOPA have been associated with poor prognosis of malignant melanoma and shorter survival times [50,51,52,53,54]. Additionally, Cys-DOPA also increased in melanoma recurrence after chemotherapy or surgery [50,53,54].
Estrogen metabolism is strongly implicated in the development of hormonal cancers [55,56,57]. Estrogen metabolites, namely 2- and 4-hydroxyestrone and 2- and 4-hydroxyestradiol might generate electrophilic metabolites, and for mercapturate pathway-related metabolites their urinary levels were found to be decreased in patients with breast cancer or non-Hodgkin lymphoma relative to healthy subjects [58,59,60]. Additionally, the ratio of depurinating estrogen deoxyribonucleic acid (DNA) adducts to estrogen metabolites and conjugates (including GSH-S-conjugates, Cys-S-conjugates and mercapturates) was higher in cases of thyroid and ovarian cancer in comparison with healthy individuals [56,57]. Changes in Cys-S-conjugates that are disulfides were also observed in leukemia, lymphoma and colorectal adenoma [61,62].

4.3. Neurologic Diseases

Parkinson’s disease (PD) is characterized by severe depletion of dopamine (DA) [63]. The role of dopamine related cysteinyl-S-conjugates in PD has been investigated in order to evaluate how the failure of anti-oxidative mechanisms, in the prevention of spontaneous dopamine oxidation, might contribute the degeneration of dopaminergic neurons (Table 3).
Dopamine can be oxidized following non-enzymatic and enzymatic pathways. Dopamine can spontaneously oxidize to dopamine-o-quinone, which forms conjugates GSH-S-conjugates. Dopamine can also be oxidized by monoamine oxidase to 3,4-dihydroxyphenylacetaldehyde, which is further metabolized by aldehyde dehydrogenase to 3,4-dihydrophenylacetic acid (DOPAC) and then into homovanillic acid upon catechol-O-methyltransferase activity [64,65].
In 1989, Fornstedt and colleagues [66] identified 5-Cys-S-conjugates of DOPA, DA and DOPAC in three brain regions (substantia nigra, putamen and caudate nucleus) of post-mortem brains from patients with and without depigmentation and neuronal loss within the substantia nigra. The levels of DOPA, DA and DOPAC were decreased in the depigmented group.
Additionally, while no differences were found for the Cys-S-conjugates, the authors observed an increase in the ratio of Cys-DA/DA and Cys-DOPAC/DOPAC in the substantia nigra and Cys-DOPA/DOPA in the putamen of the depigmented group [66]. Similar results were later obtained with patients with PD and parkinsonism (PD and multiple system atrophy parkinsonism). Importantly, patients were not on DOPA therapy. The levels of Cys-DA were not affected in patients with parkinsonism. Nevertheless, as DOPAC or homovanillic acid were decreased, both Cys-DA/DOPAC or Cys-DA/homovanillic acid ratios were increased in these patients [67,68]. The work of Goldstein and co-authors [67] also showed that Cys-DA and DOPAC have the same source: the cytoplasmic dopamine. Thus, the dopamine denervation associated with parkinsonism would be expected to produce equal proportional decreases in Cys-DA and DOPAC levels and consequently unchanged Cys-DA/DOPAC ratios. The authors were not able to explain the observed decrease in DOPAC without the decrease in Cys-DA [67]. Even though, the authors suggested that this might be due to decreased antioxidant capacity [69] and aldehyde dehydrogenase activity [70]. Interestingly, substantia nigra of PD patients has a 50% reduction of their GSH levels [71,72]. This decrease can be presumably due to the reaction of GSH with DA semiquinones or quinones [73]. At the same time, decreased antioxidant capacity might shift the balance from dopamine to dopamine quinone and finally to Cys-DA, which will explain the absence of decreased levels Cys-DA. In opposition, there is one study reporting increased levels of 5-S-Cys-conjugates of DOPA, DA and DOPAC at substantia nigra of patients with PD. However, all patients were under L-DOPA treatment, which could have influenced the results [74].
Catechol estrogens are also present in the brain and, like dopamine, can be bioactivated to catechol quinones able to form adducts with GSH and undergo the mercapturate pathway for elimination. Urinary estrogen-catechol Cys-S-conjugates were lower and estrogen-DNA adducts were higher in PD patients than in healthy controls [75]. The authors suggested that there is an unbalanced estrogen metabolism in PD and that the protective pathways might be unable to avoid the oxidation of catechol estrogens and further DNA adducts formation.
On the other hand, neuro-inflammation might also play a role in autism [76,77]. The levels of CysLTs have been investigated in autistic children, together with a sensitive indicator of bioactive products of lipid peroxidation and oxidative stress, the 8-isoprostane [78,79]. The authors proposed both CysLTs and 8-isoprostane as markers for early recognition of sensory dysfunction in autistic patients that might facilitate earlier interventions [78].
CysLTs increases at the central nervous system [80,81,82], might also be involved in edema formation in brain tumor patients [83].

4.4. Cardiometabolic Diseases

There are several works reporting the association of CysLTs in cardiometabolic diseases (Table 4) and different mechanisms might explain this association. For instance, in cardiometabolic diseases, the 5-lipoxygenase pathway that contributes to CysLTs formation is activated, the CysLTs receptors (mainly CysLT2R) are strongly expressed in cardiac, endothelial and vascular smooth muscle cells. CysLTs exert negative inotropic action on the myocardium and mediate coronary vasoconstriction [84]. Moreover, CysLTs may have pro-atherogenic effects; they may stimulate proliferation and migration of arterial smooth muscle cells and platelet activation [36].
Winking and collaborators (1998) measured urinary LTs in patients suffering from spontaneous intracerebral hemorrhage. Urinary LTC4, LTD4 and LTE4 levels were positively associated with hematoma volume and decreased after hematoma removal by surgery [85].
Regarding coronary artery diseases, urinary LTE4 levels were increased in patients admitted in the hospital with acute chest pain derived from acute myocardial infarction and unstable angina compared with controls [86]. Likewise, urinary LTE4 levels were higher in patients with chronic stable angina than controls before surgery [87]. In another study, urine and plasma levels of CysLTs increased during, and after, cardiac surgery with cardiopulmonary bypass. Interestingly, that increment was greater in patients with moderate-to-severe chronic obstructive pulmonary disease than in patients without this condition [88]. The authors hypothesize that these differences may be related to neutrophil activation and higher lung and airway production of CysLTs in patients with chronic obstructive pulmonary disease.
CysTL were also evaluated in individuals with atherosclerosis lesions in the carotid artery concomitantly with or without periodontal disease. This study was motivated by several reports that have been associating periodontal disease with the development of early atherosclerosis and increased risk of myocardial infarction [89,90,91]. The sum of LTC4, LTD4 and LTE4 was increased in gingival crevicular fluid in subjects with higher dental plaque and also in subjects with atherosclerotic plaques in the carotid artery, regardless of periodontal status [92].
CysLTs might play a role in the development of the cardiovascular complications associated with obstructive sleep apnea (OSA). Urinary LTE4 levels were associated with obesity and hypoxia severity in patients diagnosed with OSA. Continuous positive air treatment decreased LTE4 by 22% only in OSA patients with normal body max index (BMI). Additionally, LTE4 levels were higher in non-obese OSA patients vs. matched controls [93]. In another study, Gautier-Veyret and co-authors (2018) found that urinary LTE4 levels were independently associated with age, history of cardiovascular events and severity of hypoxia in patients with OSA with and without previous cardiovascular events. As such, LTE4 levels were higher in OSA patients with no previous cardiovascular events than in controls with no previous cardiovascular events. Urinary LTE4 levels were also associated with intima-media thickness, suggesting the activation of CysLTs pathway as a driver of vascular remodeling in OSA [94].
CysLTs were also evaluated in patients with diabetes. Urinary LTE4 levels were higher in patients with type 1 diabetes than in controls [95] and decreased 32% after intensive insulin treatment [96]. These results suggest that hyperglycemia activates arachidonic acid metabolism and consequent CysLTs formation. Interestingly, glucose can also generate Cys-S-conjugates that are far more stable than glucose-GSH. In specific, higher urinary levels of glucose-Cys were detected in patients with diabetes [4].
Cys-S-conjugates that are disulfides were related with hypertension, diabetes and Framingham risk score in coronary heart disease patient [97,98] as well as impaired microvascular function and greater epicardial necrotic core [97]. Moreover, these conjugates and GSH-Cys-S-conjugates were independent predictors of endothelium-dependent vasodilation [97].

5. Methods in Mercapturates Profiling

Mercapturate pathway-related metabolites and their profile might be useful as biomarkers in characterizing human exposure to electrophilic endogenous substrates and its relation to health and disease. The methodological strategies herein reviewed for the determination of mercapturate pathway-related metabolites are presented in Table 5. These compounds have been measured in different human fluids and tissues requiring pre-treatment of samples. The studies herein reviewed quantify only one type or family of mercapturate pathway-related metabolites (dopamine, estrogens, cysteinyl-leukotrienes and cysteinyl-S-conjugates which are disulfides). Those metabolites were quantified by different methodologies including liquid chromatography with ultraviolet detector or fluorescence detector or mass spectrometry detector, enzyme-linked immunosorbent assay and radioimmunoassay (Table 5).

7. Innovative Potential

Many chronic diseases with an inflammatory component display significantly increased levels of electrophiles. The mercapturomic profile might represent a useful tool to globally characterize both environmental and internal electrophile exposomes and its relation to disease (Figure 2). This holistic omic-approach is expected to provide unique information that includes the identification of new therapeutic targets and commonalities related to mechanisms of different diseases that might facilitate therapeutics development and define preventive strategies. Additionally, this approach might constitute an effective tool to define the mercapturomic phenotypes of drug resistance and adverse reactions; disease progression, encouraging precision medicine standards. Finally, as many environmental compounds undergo this pathway it will also contribute to a better understanding of the contribution of environment to non-communicable diseases.

Author Contributions

S.A.P. projected the paper. C.G.-D., J.M., V.S., M.J.C., N.R.C., S.A.P. wrote the manuscript and prepared figures. A.M.M.A. and E.C.M. assisted with the writing and gave expert advice regarding the topic.

Funding

iNOVA4Health–UID/Multi/04462/2013, a program financially supported by Fundação para a Ciência e Tecnologia/Ministério da Educação e Ciência, through national funds and co-funded by FEDER under the PT2020 Partnership Agreement is acknowledged (Ref: 201601-02-021). Authors supported by Fundação para a Ciência e a Tecnologia (FCT–Portugal): for V.S.; PD/BD/105892/2014 for C.G.-D.; RNEM-LISBOA-01-0145-FEDER-022125022125 for J.M.; SFRH/BD/130911/2017 for M.J.C.; PD/BD/114257/2016 for N.R.C.; Programa Operacional Potencial Humano and the European Social Fund (IF/01091/2013) for A.M.M.A.

Conflicts of Interest

The authors declare no conflict of interests

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