review flavonoides

543

Metabolism of Drugs and Other Xenobiotics, First Edition. Edited by Pavel Anzenbacher, Ulrich M. Zanger.© 2012 Wiley-VCH Verlag GmbH & Co. KGaA. Published 2012 by Wiley-VCH Verlag GmbH & Co. KGaA.

20 Flavonoids Petr Hodek

20.1 Flavonoids – Plant Phytochemicals

The fl avonoids are a large group of plant secondary metabolites categorized as phenolic compounds. Their wide distribution in plants makes them the most abundant phenolics in the human diet. Owing to a wide range of biological activi-ties, fl avonoids have been extensively studied for several decades. Although fl avo-noids provide numerous benefi cial properties to human health, they are foreign compounds (xenobiotics), the administration of which into the human body should be considered with caution. The aim of this chapter is to summarize our knowledge about fl avonoid metabolism and the interactions of fl avonoids with important metabolic pathways in mammalian systems. Special attention will be paid to the human health aspects related to fl avonoid consumption.

20.1.1 Classifi cation of Flavonoids and Their Physicochemical Properties

Flavonoids share the common C6 – C3 – C6 carbon framework of their basic structure. These compounds (Figure 20.1 ) are derivatives of bicyclic chromene (benzopyran) having its heterocyclic ring C substituted with an aromatic ring (B). Depending on the position of the aromatic ring B linkage to chromene these fl avans may be classifi ed into three groups: position 2 – fl avonoids (2 - phenylbenzopyrans); position 3 – isofl avonoids (3 - phenylbenzopyrans); and position 4 – neofl avonoids (4 - phenylbenzopyrans). Further, the fl avonoids are sub-divided according to their oxidation status of ring C: the introduction of an oxo group in position 4 provides fl avanones; a double bond between C2 and C3 is characteristic for fl avones (compounds with quinone - like properties); the presence an additional double bond in ring C (instead of a C4 - oxo group) results in a group of anthocyanidins. Formerly, chalcones (derivatives of diphenylpropane skeleton),

544 20 Flavonoids

which are precursors of some fl avonoids, were also counted among fl avonoids. More than 8000 compounds with a fl avonoid structure have been identifi ed [1] . The large number of compounds arises from various combinations of multiple hydroxyl and methoxyl groups, substituting the basic fl avonoid skeleton. Moreo-ver, natural fl avonoids usually occur as glycosides (e.g., glucosides, rhamnogluco-sides, rutinosides) and even as more complex structures (e.g., oligomeric forms of procyanidins, fl avonolignans, catechin esters, or prenylated chalcones) [2] .

Physicochemical properties of fl avonoids as well as their physiological activities are closely related to the oxidation level of the C ring (number of double bonds, presence of oxo groups), hydroxylation pattern of the whole fl avonoid skeleton, and the extent of glycosylation or methylation of hydroxyl groups. According to their water solubility, fl avonoids can be basically classifi ed into two types: hydrophilic fl avonoids (highly hydroxylated fl avonoids, glycosides, and anthocy-anins) and nonpolar fl avonoids (aglycones, methylated, or alkylated fl avonoids). All fl avonoids are UV - light - absorbing chemicals and some of them are colorful compounds, such as the well - known anthocyanins, showing pH - sensitive color transitions. Flavonoids are frequently referred to as powerful antioxidants. The effi ciency of their antioxidant activity depends on their fl avonoid hydroxylation pattern, in particular on the 3 ′ ,4 ′ - dihydroxy catechol structure in the B ring and the presence of 2,3 - unsaturation in conjunction with the 4 - oxo group in the C ring [3] .

Figure 20.1 Structures of basic fl avonoid skeletons and chalcone.

1'

A C A C

B8

5

7

6

2

3

O1

4

chromene

8

5

7

6

2

3

O1

4

2'

6'

3'

5'

4'

flavan

O+

OH

anthocyanidin

O

Oflavanone

O

Oflavone

chalconeO

20.2 Absorption and Metabolism of Flavonoids 545

20.1.2 Biosynthesis of Flavonoids and Their Biological Function in Plants

Flavonoids in plants were disregarded by some as byproducts or unwanted compounds with no obvious purpose. Recently, we have been gradually discover-ing that their production is of great importance for plants, since these compounds play numerous roles in plant physiology, development, and ecology. One of the most obvious functions for fl avonoids is to serve as UV - light shields (i.e., protect-ing against solar UV - B – the irradiation that is damaging to DNA) [4] . Flavonoids mentioned above as antioxidants can exert antioxidant properties for the benefi t of the plant against potential oxidative stress. Flavonoids are also able to mediate specifi c interactions between plants and insect pollinators (e.g., sweet taste, color, smell), and/or symbiotic plants and microorganisms (e.g., attraction of nitrogen - fi xing bacteria). Moreover, some fl avonoids are required for germination of pollen grains and for successful pollen growth [4] . In addition to these positive functions for plants, fl avonoids may serve as attractants for pathogenic fungi and bacteria [5] .

The biosynthesis of fl avonoids starts with the condensation of a cinnamic acid with three malonyl - CoA moieties. All fl avonoids arise from this initial reaction, via the chalcone intermediate (for structure see Figure 20.1 ), which is usually converted into phenylbenzopyran (fl avan), and further elaboration leads to the fl avones, isofl avones, fl avonols, or anthocyanins [6] . Next, the glycosylation (even multiple) of the fl avonoid skeleton potentiates the huge variety of fl avonoid phy-tochemicals present in plants [7] .

20.2 Absorption and Metabolism of Flavonoids

Flavonoids of the vegetable diet are known to provide multiple pharmacological effects on mammalian systems. To achieve this, these phytochemicals need to be fi rst absorbed from the gastrointestinal tract. The fl avonoids from ingested food are usually not absorbed into blood circulation in their native form. They are frequently converted via endogenous and/or microbial enzymes into derivatives or forms allowing their absorption. Thus, bioavailability of fl avonoids is closely related to their metabolism. It should be noted that fl avonoid species exerting a detectable effect on the target organ, tissue, or protein most likely differ from those present in the original plant material. Hence, the assignment of some health - promoting effect to a particular fl avonoid is defi nitely not simple and straightfor-ward, and requires an extensive study of the metabolic fate of that fl avonoid.

20.2.1 Flavonoid Bioavailability

Obtaining reliable data on average fl avonoid amounts consumed daily throughout the world is quite diffi cult because of signifi cant differences in the sources of

546 20 Flavonoids

fl avonoids available, and dietary habits and preferences. The total fl avonoid intake probably reaches up to 1 g/day in people who eat several servings of fruit and vegetables per day [8] . For the United States, it was calculated by Kuhnau [9] that dietary fl avonoid intake consisted of the following: 16% fl avonols, fl avones, and fl avanones; 17% anthocyanins; 20% catechins; and 45% “ bifl avones ” (dimeric fl avonoids). Current knowledge allowed revising the original data and gives us a better estimate of a typical mean intake that is in the range 450 – 600 mg as agly-cones [10] . More precise data is available for the intake of individual classes of fl avonoids. For instance, anthocyanin consumption (based on data from Finland) was found to be 82 mg/day on average, although some intakes exceeded 200 mg/day [11] . The consumption of fl avonols has been estimated at 20 – 25 mg/day in the United States [12] . For isofl avones, an average dietary intake of 30 – 40 mg/day was determined in Asian countries, where soy products are frequently consumed [13] . Although fl avonoids belong to xenobiotics, which daily intake in diet is rather high (10 – 100 mg of a single compound), their plasma concentrations hardly reach the micromolar range and thus the concentrations are typically in the range of tens to hundreds of nanomoles per liter.

The great majority of natural fl avonoids occur as glycosylated forms that nega-tively infl uence their absorption. Although much remains unknown about the mechanisms of gastrointestinal fl avonoid absorption, it is assumed that fl avonoids (i.e., their glycosides) are too hydrophilic to penetrate the gut wall [8] . Thus, only fl avan - 3 - ols – fl avonoids naturally occurring as aglycones – may be absorbed intact. Moreover, it is speculated that the uptake of glucosides of cyanidin and quercetin proceeds specifi cally via the sodium - dependent glucose transporter [14] . At fi rst glance the connection between bioavailability and metabolism of most fl avonoids reminds us of the “ chicken and egg ” causality dilemma – to be absorbed into the circulation system and metabolized in the liver, fl avonoids need to be bioavailable; however, their bioavailability depends on their metabolic conversion. It is gener-ally believed that the removal of the glycosidic moiety is necessary prior to fl avo-noid absorption. The released aglycone is thought then to undergo passive diffusion across the intestine brush border. Cleavage of fl avonoid glycosides is catalyzed by hydrolytic enzymes – glycosidases – either cytosolic or secreted into gastrointestinal tract as well as extensively provided by colonic microfl ora. The important role of glycosidases for fl avonoid absorption is evident from the com-parison of the time course of quercetin conjugate concentrations in plasma after quercetin aglycone and rutin. The time to reach the peak of quercetin concentra-tion was markedly delayed after rutin administration, which is consistent with the necessity of rutin hydrolysis into quercetin in the more distal part of the small intestine [15] .

The extent of absorption of dietary fl avonoids in the small intestine is rela-tively low depending on the particular fl avonoid. Baicalin (baicalein 7 - O - β - glucopyranuronoside) is an example of a well - absorbed fl avonoid, with bioavaila-bility determined to be about 2.2 and 27.8%, based on baicalin and its conjugated metabolites, respectively [16] . However, for chrysin, after an oral dose of 400 mg,


there were only trace amounts of this lipid - soluble fl avonoid in plasma, corre-sponding to an estimated bioavailability of 0.003 – 0.02% [17] . Similarly, orally administered quercetin (8 – 50 mg) allows us to detect quercetin conjugates in plasma, although almost no aglycone [15] . Thus, a major part of the fl avonoids ingested (75 – 99%) is not found in urine [18] . This fi nding implies low bioavai-lability of released aglycones and/or their rapid further metabolism, including, for example, conjugation reactions and even the breakdown of the fl avonoid skel-eton catalyzed by colonic microfl ora (see Section 20.2.2). In addition, the bioavail-ability of some fl avonoids might be reduced by multidrug resistance - associated protein s ( MRP s) serving as effective effl ux transporters. For instance, epicatechin - 3 - gallate – a neutral tea fl avonoid – was shown to be a substrate of MRPs [19] .

To conclude, some polyphenols may be less effi ciently absorbed than others, but nevertheless reach equivalent plasma concentrations because of lower secre-tion toward the intestinal lumen, and lower metabolism and elimination [8] . Apparently, the absorption of fl avonoids from the gastrointestinal tract is a rather complex process, whose full understanding requires much more information on the fate of ingested fl avonoids.

20.2.2 Metabolism of Flavonoids

In general, metabolism of fl avonoids proceeds via phase I and phase II biotrans-formation similarly to other xenobiotics. The major task of this process is their fast detoxifi cation and excretion from the body. However, metabolism of fl avo-noids is unusual in two aspects. (i) The majority of ingested fl avonoids are already conjugated with polar compounds, saccharides (glycosides), which should be fi nal products of phase II of biotransformation. (ii) Flavonoids, even though considered health - promoting compounds (see Section 20.4), are paradoxically eliminated from the body.

The fi rst principal site of fl avonoid metabolism is the small intestine. Flavonoid glycosides are at fi rst subjected to enzymatic hydrolysis, resulting in the formation of free aglycone ready for fl avonoid absorption as well as for the C - hydroxylation of the skeleton and/or O - demethylation [20] . In the next step, fl avonoids undergo O - methylation and conjugation with glucuronate, sulfate, or glycine (and their combinations) via endogenous phase II enzymes. Moreover, fl avonoids and their derivatives are exposed to a huge enzyme machinery of colonic microfl ora, which is even able to degrade fl avonoids completely into carbon dioxide [21] .

In addition to the intestinal tract, the second key site of fl avonoid metabolism is the liver, where the absorbed fl avonoids are metabolized further. Resulting derivatives, mostly fl avonoid glucuronates and sulfates, are transported by the biliary route into the small intestine and/or to plasma, from where a substantial part of metabolites is excreted in urine. Interestingly, the fl avonoid dose deter-mines the primary site of metabolism. Large doses are metabolized mostly in the liver, while small doses may be metabolized in the small intestine with the

548 20 Flavonoids

liver playing a secondary role to further modify fl avonoid conjugates from the small intestines. A much smaller portion of fl avonoid metabolism, mainly deglycosylation, can be assigned to other tissues. Surprisingly, enzymes present in human saliva are also involved (e.g., in hydrolysis of rutin into quercetin).

20.2.2.1 Intestinal Metabolism As mentioned in Section 20.2.1, only a few of the naturally occurring fl avonoids are aglycones – the forms suitable for their absorption; others are present as the conjugated form, mainly with saccharide moieties. Thus, intestinal fl avonoid metabolism begins with the hydrolytic cleavage of the O - glycosidic bond of glyco-sides, resulting in the liberation of free fl avonoid aglycone. This reaction is cata-lyzed by glycosidases present in food (endogenous plant enzymes), produced by cells of the gastrointestinal mucosa, or secreted by colon microfl ora. Whereas human cells express various β - glucosidases, which are specifi c for the cleavage of the attached glucose (possibly arabinose and xylose) from fl avonoids [18] , plants and namely bacteria provide glycosidases with a much wider range of hydrolytic activities. These enzyme data can explain the delayed (more than 5 h) maximum of quercetin in plasma after per os administration of quercetin - 3 - O - rhamnoglucoside compared to that of quercetin - 4 ′ - O - glucoside [22] . O - glucoside is both rapidly deglycosylated and actively absorbed from the small intestine, whereas quercetin - 3 - O - rhamnoglucoside is absorbed only after a deglycosylation later in the colon by microfl ora. Apart from cytosolic β - glucosidases, another deglycosylation pathway involves the lactase phloridzine hydrolase – a glucosidase of the brush border membrane – that catalyzes extracellular hydrolysis of some glucosides [23] . Both enzymes are probably involved, but their relative contribution for the various glucosides remains to be clarifi ed.

After deconjugation, fl avonoids are conjugated again, but with other compounds than in plants. Most frequently, fl avonoid glucoronates are formed in phase II of their biotransformation. The reaction is catalyzed by UDP - glucuronosyltransferase ( UGT ). In human intestinal mucosa, there are two isoforms – UGT1A8 and UGT1A10 – that are absent in the liver [24] . The extent of glucuronidation seems to be dependent on the fl avonoid structure; it is obviously sensitive to the position(s) of hydroxyl group(s) on the B ring. When the fl avonoids are hydroxylated in posi-tions 3 ′ ,4, the glucuronidation of them (e.g., quercetin) occurred predominantly at the 5 - and 7 - positions on the A ring [14] . Flavan - 3 - ols are much more often subjected to O - methylation of hydroxyls via catechol - O - methyltransferase ( COMT ) than other fl avonoids. O - methylated fl avonoids may be glucuronidated, as is common with catechins. In addition to O - methylation and conjugation with glu-curonate, fl avonoid sulfates are formed in the small intestine, but probably to a much less extent than in the liver. It has been shown that some fl avonoids can inhibit human cytosolic sulfotransferase s ( SULT s), while the others are readily transformed into sulfate conjugates.

Although the total mass of cytochromes P450 ( cytochrome P450 CYP s) in the entire small intestine has been estimated to be less than 1% of that in the liver, human studies have demonstrated that enteric CYPs (i.e., the major forms of the


CYP3A subfamily) can contribute signifi cantly to the overall fi rst - pass metabolism of foreign compounds [25] . Only limited information is available on the role of CYP - mediated O - demethylation and/or C - hydroxylation in fl avonoid metabolism in the human small intestine. Similarly, the function of glutathione S - transferase ( GST ), N - acetyltransferase ( NAT ), and epoxide hydrolase remains unclear.

20.2.2.2 Decisive Role of Colonic Microfl ora Flavonoids, their derivatives, oligomers, or other forms not suitable for absorption into the portal circulation, are faced with the enormous catalytic and hydrolytic potential of colonic microfl ora. Bacterial degradation of fl avonoids includes, for example, hydrolysis, dehydroxylation, demethylation, decarboxylation, repeated deconjugation of glucuronates, and ring cleavage, resulting in breakdown products such as phenolic and carboxylic acids [8] . Thus, the processing of fl avonoids by the colonic microfl ora generates a large variety of new metabolites and their con-jugates. For example, as a breakdown product of quercetin - 3 - O - rhamnoglucoside, 3,4 - dihydroxyphenylacetic acid and 4 - hydroxybenzoic acid were found. A typical glycine conjugate of benzoic acid – hippuric acid – is attributed to the action of intestinal bacteria, too. Interestingly, colon microfl ora mediates reductive meta-bolic conversion of soy isofl avone diadzein into equol (isofl avan), exhibiting even stronger estrogenic activity than daidzein [26] .

It is assumed that for fl avonoids that are not easily absorbed from the small intestine the microbial metabolism can be higher than that in all human tissues involved. Many bacterial metabolites and conjugates are then absorbed, as is clear from their detection in the human urine. Hence, the precise determination of microbial metabolites is turning out to be an important direction of fl avonoid research since microbial metabolites may have physiologic effects originally assigned to fl avonoid aglycones.

As the fl avonoids themselves can exert infl uence on the microfl ora, it is possible that fl avonoid - induced changes in the composition of the colonic bacterial popula-tion may affect the metabolic capacity of the microfl ora and, consequently, the overall metabolism of xenobiotics as well as the health of the individual [14] .

20.2.2.3 Metabolism in Liver In the liver, fl avonoids can be further metabolized via metabolic pathways gener-ally similar to those in the small intestine. These reactions include hydrolytic deconjugation of fl avonoid glucuronides by β - glucuronidases as well as a reverse aglycone conjugation with glucoronate by UGTs and/or with “ active sulfate ” by SULTs. In vivo studies demonstrate the liberation of aglycone, such as quercetin from glucuronides, which is catalyzed by liver β - glucuronidase [27] . Flavonoid hydroxyl groups may also undergo their methylation by COMT and hydroxyme-thyl group demethylation by CYPs. Flavonoids with monohydroxymethylated B rings, which can hardly form glucuronides in the small intestine, may be effi -ciently glucuronidated by liver enzymes. In addition to CYP O - demethylation of methoxylated fl avonoids, the CYP monooxygenase system also catalyzes C - hydroxylation of the fl avonoid skeleton. Data from in vitro experiments with liver

550 20 Flavonoids

microsomal samples suggest CYP - mediated C - hydroxylation of various fl avonoids with no or one hydroxyl group on the B ring, such as chrysin or apigenin. The presence of two or more hydroxyl groups on this ring prevents the further hydrox-ylation by CYPs [28] . Similarly, the O - demethylation of hydroxymethyl groups is signifi cantly affected by the hydroxylation pattern of the B - ring. While CYPs cata-lyze O - demethylation at the 4 ′ - position (e.g., tamarixetin, tangeretin and hesperi-tin), no reaction is performed at the 3 ′ - position (e.g., isorhamnetin) [28] . It has been shown that CYP1A2 plays a major role in hydroxylation and demethylation of fl avonoids. The involvement of isoforms 3A4, 2C9, and probably 2E1 and 2B6 is suggested, too, but their relevance for the metabolism of fl avonoids in vivo seems to be limited [29] . The most prevailing fl avonoid metabolites formed in the liver are products of fl avonoid conjugation reactions (i.e., glucuronidation and sulfation) and methylation in various mixed and multiple combinations. The CYP - mediated oxidation of fl avonoids seems to be of a minor importance com-pared to the conjugation reactions. However, in O - demethylation of fl avonoids containing multiple hydroxymethyl groups (e.g., fi ve in tangeretin), CYPs are apparently involved since demethylated derivatives were found in the urine of tangeretin - treated rats [30] . The participation of other xenobiotic - metabolizing enzymes (e.g., NATs, GSTs, and epoxy hydrolases) is not considered to be impor-tant for fl avonoid metabolism.

Large amounts of methylated, glucuronidated, and sulfated metabolites are transported via the bile to the small intestine and subjected to the next absorption cycle. This enterohepatic fl avonoid cycling may cause signifi cant retention of these compounds within the body. At this point it is worth emphasizing that the use of in vivo experimental models based on living animals missing the gall bladder (e.g., rats) and biliary route to predict the metabolic fate of fl avonoids in the human body may easily be erroneous.

20.2.2.4 Flavonoid Excretion Ingested fl avonoids are excreted from the body via two main routes – in urine and in feces. When the fl avonoid carbon backbone is degraded by colonic microfl ora, the fi nal product is carbon dioxide, released by lungs, and carboxylic acids, occur-ring possibly in sweat secreted by skin. Recovery of total excreted radioactivity in human subjects was determined after an oral dose of [ 14 C]quercetin (100 mg). The average values for urine, feces, and expired air (carbon dioxide trapped) are 4.6, 1.9, and 52.1%, respectively [21] . As an inner excretory mechanism the transport of fl avonoid metabolites from the liver into the bile should be considered. Further-more, on a cellular level the excretion of fl avonoid metabolites is performed through active effl ux mediated by MRPs.

Flavonoids are predominantly excreted in the form of glucuronidated and sul-fated (mixed or multiple) conjugates. The urinary route is preferred by small conjugates such as monosulfates, whereas extensively conjugated metabolites are more likely transported in the bile [8] . Biliary excretion of fl avonoids in humans may differ greatly from that in rats because of the existence of the gall bladder in humans; however, this has never been examined [8] . From animal studies, biliary


excretion seems to be a major pathway for the elimination of, for example, genis-tein [31] and epigallocatechin gallate [32] . As aglycones are present, if at all, in rather low concentrations in blood and are effectively conjugated in the liver, they should be generally absent in the urine. Nevertheless, free aglycons of isofl avones, daidzein, and genistein were detected in urine in quantities ranging from nonde-tectable concentrations (below 0.3%) up to 18% of the total daidzein content and below 0.3 – 22% for free genistein after acute dosing (up to 500 mg/day). The expla-nation for this may lie in the instability of the isofl avone glycosides against gly-cosidases present in plasma and/or extrahepatic tissues. The pattern of daidzein conjugates consists of 7 - glucuronide (54%), 4 ′ - glucuronide (25%), monosulfates (13%), sulfoglucuronides (0.9%), diglucuronide (0.4%), and disulfate (0.1%) [33] . The composition of hydrophilic fl avonoid metabolites in urine is usually propor-tional to that determined in the plasma. The total amount of metabolites excreted in urine is roughly correlated with maximum plasma concentrations. Epigallocate-chin gallate, however, constitutes an exception to this rule, because this compound is present at high concentrations in plasma, but no detectable amounts were found in urine [34] . The urinary excretion is quite high; for instance, for citrus fl a-vanones, up to 30% of the intake for naringenin, and for soy isofl avones, up to 66% for daidzein. However, low urinary excretion was determined for anthocy-anins, ranging from 0.005 to 0.1% of their intake [8] . Low recovery of anthocyanins in urine may be indicative of their high biliary excretion, extensive metabolism (bacterial or endogenous), and possibly complexing with plasma proteins. Thus, based on numerous human and animal studies, it is possible to estimate that, on average, the major part of the fl avonoids ingested (75 – 99%) is not found in urine [18] . A similar conclusion has been drawn more recently based on reviewing a study of 97 fl avonoids. The excretion in urine ranged from 0.3 to 43% of the dose recalculated to 50 mg aglycone [35] . This general statement cannot, however, entirely refl ect all possible variables; specifi c properties of any particular fl avonoid, microfl ora status (strain diversity), diet matrix components (content of fi ber or fat), and other factors, such as a the diuretic effect of ethanol, consumed simultaneously.

While hydrophilic fl avonoid metabolites of various kinds are excreted in bile and urine, only hardly bioavailable, large fl avonoid molecules and derivatives are retained in feces. These residual compounds either escaped from absorption or bacterial degradation because of their insolubility or binding to undigested fi ber and other food constituents. The limited absorption through the gut barrier is typical for proanthocyanidins (i.e., their oligomeric forms). Experiments with their dimers resulted in the detection of large amounts of unmetabolized/unconjugated epicatechin monomers that were retained [14] .

20.2.3 Overall Flavonoid Fate in Organisms

This section summarizes the overall absorption, distribution, and metabolic fate of ingested fl avonoids discussed in detail in the previous Sections 20.2.1 and

552 20 Flavonoids

20.2.2. The general scheme showing the prevailing routes and pathways is pre-sented in Figure 20.2 . The key site of fl avonoid metabolism/absorption is the small intestine. Ingested oligomeric fl avonoids (proanthocyanidins) can be hydrolyzed in the acidic stomach juice prior to entering the small intestine. Flavonoid glyco-sides are then hydrolyzed by β - glucosidases to liberate free aglycones suitable for absorption. Most fl avonoids that are taken up by enterocytes are metabolized before they reach the portal blood. They are partially resecreted into the intestinal lumen (e.g., MRP effl ux). Flavonoids absorbed in the duodenum enter the circula-tion again as conjugates produced by a combination of methylation, sulfate con-jugation, glucuronide conjugation plus glycine conjugation in the case of phenolic acids. Only a very small amount of fl avonoids consumed (5 to 10%) enters the plasma as unchanged plant fl avonoids (e.g., glucosides via transporter) [36] . Not yet absorbed fl avonoids proceed to lower colonic parts and are metabolized by the gut microfl ora.

Further fl avonoid metabolism takes place in the liver, where conjugates are possible cleaved (glycosidases), fl avonoid hydroxyl groups may be methylated (COMT), and hydroxymethyl groups demethylated (CYPs) or the fl avonoid skele-ton C - hydroxylated. In the liver, an additional (mixed/multiple) conjugation with sulfate and glucuronate frequently occurs. However, deconjugation to free agly-

Figure 20.2 Overall fl avonoid fate in an organism.

PlantDiet

STOMACH

SMALL INTESTINECOLON

cleavageof

oligomers

urine

BLOOD

portalvein

bile

faeces

gut microflora

glucuronates

hydroxylationdemethylation

glucuronidation sulfatation

conjugation

aglycones phenolic acids

bacterial cleavage of glycosides & flavonoid skeleton

CYP

CYP-mediated C-hydroxylation & O-demethylation

KIDNEY

LIVER

glucuronates & sulfates

aglycones

glycosides

BLOOD

methylated forms

glucuronates

GSH

glucuronatessulfates

conjugation with glucuronate and sulfate & O-methylation

sulfates

glucuronates

sulfates

glycosidesaglycones

sulfates

fragment conjugates

glucuronates/sulfates

oligomers

LUNG

CO2

CO2BLOOD


cone takes place rapidly, too. Thus, for example, the actual glucuronidation yield of fl avonoids in the liver refl ects the balance between the activity of UGT and β - glucuronidase, which is regularly shifted toward the conjugated forms. From the liver, the fl avonoid metabolites are secreted into the bile (returning back to the small intestine) and transferred to plasma for the kidney - mediated excretion of fl avonoid metabolites. In addition to enterohepatic cycling, liver uptake of cir-culating fl avonoid metabolites is also possible. In the scheme, the cleavage of conjugates into aglycones by plasma glycosidases (e.g., β - glucuronidases) is also considered.

20.2.3.1 Plasma Levels and Pharmacokinetics of Flavonoids It is rather diffi cult to carry out precise pharmacokinetic analyzes with fl avonoids because neither ingested conjugates of these compounds nor their aglycones are detectable in plasma. Pharmacokinetic data are usually based on the con-centrations of aglycones obtained after specifi c hydrolysis of conjugates in plasma or urine. However, not all the conjugates are equally sensitive to enzymic or chemical hydrolysis, which makes the results of analyses misleading to some extent. That is why this kind of methodology is referred to as “ pseudo - pharmacokinetics. ”

Isofl avones are clearly the best - absorbed fl avonoids – plasma concentrations of 1.4 – 4 μ mol/l are reached in adults after intake of about 50 mg isofl avones [8] . Plasma concentrations up to 5 μ mol/l are reported for citrus fl avanones and soy isofl avones [8] . Proanthocyanidins may serve as an example of fl avonoids that are hardly absorbed from the small intestine into circulation. However, hydroxylated fl avan - 3 - ols with a galloyl moiety (e.g., epigallocatechin gallate and epigallocate-chin) reach the blood mainly as the aglycon form (up to 80 – 90%) [29] . For an extensive overview of fl avonoid plasma concentrations, please refer to review arti-cles by Clifford [10] and Manach [35] .

Although fl avonoids may vary among their subclasses in their pharmacokinet-ics, it is possible to estimate T max values for plasma concentrations of their metabo-lites. For fl avonoids absorbed in the duodenum, T max values range from 1 to 2.5 h, whereas for those that require metabolism by colonic microfl ora prior to absorp-tion, T max values increase up to 5 – 12 h. Consequently, elimination half - lives are highly variable (1 – 20 h) [10] and even up to 42 h has determined after an oral dose of [ 14 C]quercetin [21] . High values may be related to a biphasic elimination, includ-ing enterohepatic circulation of a signifi cant portion of metabolites (e.g., glucuro-nides), followed by their deconjugation and further degradation by colonic microfl ora before they enter the circulation. The methylation appears to provide higher metabolic stability as well as higher membrane transport properties and thus may extend their half - lives. As methylated fl avones are missing free hydroxyl groups, they cannot serve as acceptors for conjugating glucuronic and sulfate groups. They can be O - demethylated by CYPs and then conjugated [37] . It is gener-ally accepted that most fl avan - 3 - ols should be cleared from the body within 10 – 20 h. A few studies, however, reported appreciable plasma levels 24 h after fl avonoid consumption [38] .

554 20 Flavonoids

20.3 Interactions of Flavonoids with Mammalian Proteins with Possible Implications for Drug Metabolism

Flavonoids belong to remarkable biologically active phytochemicals exerting various effects on living systems, including humans [39] . Although these com-pounds are well - known antioxidants per se , a much wider range of their activities is manifested through their interactions with proteins (i.e., receptors and enzymes) involved in cell regulation and metabolic pathways of endogenous and foreign compounds. For health concerns arising from these interactions, see Sections 20.4 and 20.5. Thus, fl avonoids have to be viewed as foreign compounds (xenobiotics) with potential health benefi cial as well as negative activities [40] .

20.3.1 Plasma Proteins

Very little is known about the interactions of fl avonoids with plasma proteins in general. Weak fl avonoid binding has been reported, for example, for α 1 - glycoprotein (quercetin); for fi bronectin, fi brinogen, and histidine - rich glycoprotein (fl avan - 3 - ols having a 3 - O - galloyl moiety); and for apolipoprotein A1 of high - density lipo-proteins (catechins) [41] . However, most of the data are available for the interaction of fl avonoids with serum albumin – the principal carrier protein of many endog-enous and exogenous compounds in blood plasma. This highly abundant protein (blood concentration of about 7.0 × 10 − 4 M) affects the pharmacokinetics of many drugs and, thus, for instance, fl avonoid binding in a competitive manner increas-ing the concentration of free drug can be of a great signifi cance. Fortunately, that is not the case when the common fl avonoid quercetin is present in the binding cavity of human serum albumin ( HSA ). The binding site of HSA is large enough to accommodate additional ligands such as salicylate and warfarin [41] . In addition, the binding of endogenous compounds to HSA may affect the binding affi nity of some fl avonoids. This effect has been shown for oleate, which effectively binds HSA. In the presence of oleate, the affi nity of daidzein, genistein, naringenin, and quercetin for the albumin decreased up to 2 - fold (as judged from dissociation equilibrium constants) [42] .

Since the binding of ligand with the serum albumin cavity is mainly driven by dispersion interactions (such as a hydrophobic effect), it is to be expected that lipophilic fl avonoids (e.g., aglycones with low number of hydroxyl groups) circulate in blood as albumin complexes rather than in their free form. The infl uence of aglycone glycosylation, methylation, and sulfation on albumin binding has been assessed. Glucoside of quercetin (quercetin - 3 - O - β - d - glucoside) shows the binding affi nity lowered by 3 - fold compared to the parent compound. On the contrary, the glucuronyl moiety that is typical of most fl avonoid conjugates does not change the binding to HSA, at least in the case of baicalin (5,6,7 - trihydroxyfl avone - 7 - O - β - d - glucuronide) when compared to baicalein (5,6,7 - trihydroxyfl avone). Similarly, methylation of 4 ′ - OH of quercetin, resulting in tamarixetin, gave a high binding

20.3 Interactions of Flavonoids with Mammalian Proteins with Possible Implications 555

constant for HSA. In addition, a single sulfation of quercetin (quercetin - 7 - O - sulfate) does not affect HSA binding affi nity, whereas an additional sulfation of 4 ′ - OH markedly weakens the binding [41] . From these examples, it is clear that fl avonoid – albumin complexation does not follow the simple logic of the lipophilic-ity rule, but a more complex mode of interactions is involved. Usually, site - specifi c conjugations of the fl avonoid skeleton (e.g., with glucuronate) as well as the pres-ence of free hydroxyl groups in certain positions are prerequisites for an effective HSA binding.

20.3.2 ATP - Binding Proteins

Flavonoids were shown to interfere with the function of several ATP - binding proteins, such as various ATPases, protein kinases, topoisomerase II, and MRPs. It is assumed that their inhibition is possibly caused by fl avonoid binding to the ATP - binding site. Two major groups of ATP - binding proteins – MRPs and kinases – that are of the major interest from the viewpoint of pharmacology and drug metabolism are discussed in following sections.

20.3.2.1 MRP s The phenomenon of so - called “ multidrug resistance ” is defi ned as the resistance of tumor cells against drugs used in cancer chemotherapy. One mechanism of multi-drug resistance is via the active effl ux of drugs through the cellular membrane, which is mediated by MRPs. This group of proteins contains the ATP - dependent xenobiotic transporters (ABC family), namely P - glycoprotein ( P - gp /MDR1), MRPs (e.g., MRP1, MRP2), and breast cancer resistant protein ( BCRP ) [43] .

The inhibitory mechanisms of fl avonoids on P - gp function may involve ATPase activity inhibition and/or binding to the P - gp substrate site. For example, fl avo-noids such as morin inhibited P - gp substrate binding, while ATPase activity was inhibited by epigallocatechin - 3 - gallate [44] . Furthermore, some fl avones and fl avon - 3 - ols may act as dual inhibitors whose binding site overlaps both ATP - and xenobiotic - binding sites. Using multidrug - resistant human epidermal carcinoma cell line KB - C2 cells, which overexpress P - gp, and daunorubicin as P - gp substrate, the structure requirements for the inhibitory effects of fl avonoids were suggested. For fl avonoids missing large substituents, the planarity of the skeleton and the hydrophobicity are important for the interaction with P - gp. Nonplanar fl avonoids, having large substituents like the galloyl group (e.g., tea catechins), require the presence of both a hydrophobic region and neighboring hydrophilic hydroxyl groups for the interaction with P - gp [45] . Contrary to the effl ux inhibition, several fl avonols, such as galangin, kaempferol, fi setin, and quercetin, were shown to be effective in increasing P - gp - mediated effl ux of the drug doxorubicin from HCT - 15 colon cells, while fl avanols catechin and epicatechin did not exert any effect on the P - gp effl ux [46] . Interestingly, catechins with a gallate moiety (epigallocatechin - 3 - gallate and epicatechin - 3 - gallate) are, in accordance with previous data, inhibitors of P - gp - mediated xenobiotic transport.

556 20 Flavonoids

The MRP members (i.e., MRP1, MRP2, and MRP3) exhibit similar substrate specifi city to P - gp and are also able to transport xenobiotic metabolites, including their glutathione, glucuronide, and sulfate conjugates. Thus, various fl avonoids are substrates of MRPs. In the intestinal cell line Caco - 2, quercetin, chrysin, epi-catechin, epicatechin gallate, genistein as well as some of their glycosides and other conjugated metabolites are secreted via MRP2 [29] . Hence, effl ux transport-ers limit the intestinal absorption of fl avonoid glycosides and metabolites. However, fl avon - 3 - ols substituted with a pyrogallol group in the B ring (e.g., myricetin, robi-netin) were shown to inhibit MRP2 in MDCKII cells expressing this protein. In addition, the effect of quercetin conjugation after phase II metabolism on its capacity to inhibit MRP1 and MRP2 was investigated. While 4 ′ - O - methylation of quercetin appeared to reduce the potential to inhibit both MRP1 and MRP2, glu-curonidation, resulting in 7 - O - glucuronosyl quercetin, signifi cantly increased the potential of quercetin to affect MRPs – the inhibition of MRP1 - mediated transport of the model drug, calcein, being more effective than that of MRP2 [47] . This particular fi nding for quercetin suggests that even fl avonoid metabolites could enhance the inhibitory potential of the parent compound in order to overcome MRP - mediated multidrug resistance.

In addition to P - gp and MRPs, BCRP is responsible for multidrug resistance in some cancer cells. This transporter is also expressed in various normal human tissues and cells, where it transports physiologic substrates such as sulfated estro-gens. Several fl avonoids (e.g., genistein, naringenin) were demonstrated to dimin-ish the function of BCRP as an effl ux pump and thus reverse BCRP - mediated resistance to anticancer agents [48 ] . More recently, fl avonoid compounds from various classes were screened for their BCRP - inhibitory activity [49] . Among 20 active compounds, 3 ′ ,4 ′ ,7 - trimethoxyfl avone showed the strongest anti - BCRP activity so far. In other studies with the tamoxifen - resistant MCF - 7 cell line, cell treatment with epigallocatechin - 3 - gallate resulted in strong inhibition of BCRP effl ux of the drug mitoxantrone and a signifi cant downregulation of BCRP activity [50] . Thus, the green tea catechin – epigallocatechin - 3 - gallate – seemed to provide a double action on BCRP in this cell line. Although the accumulating evidence sug-gests fl avonoids as promising multidrug resistance modulators, it is quite diffi cult to draw a more general picture of their role in this process as the majority of data was obtained with cancer cell lines overexpressing MRPs, which were exposed to unrealistically high fl avonoid concentrations.

20.3.2.2 Kinases Phosphotransferases (kinases) represent a large group of enzymes involved in phosphorylation of proteins (at Ser, Thr, and Tyr residues) or low - molecular - weight compounds such as lipids, carbohydrates, amino acids, and nucleotides. The phosphorylation of the target molecule usually triggers intracellular signal transduction important for various cellular functions as well as for metabolism regulation. Flavonoids are able to interact with various protein kinases, and thus interfere with cellular signaling pathways controlling, for example, the cell cycle, differentiation, apoptosis, angiogenesis, and metastasis. The majority of fl avo-

noids share the same mechanism of action based on the competitive inhibition at the catalytic ATP - binding site of the kinase; however, some fl avonoids have been found to bind to an allosteric site on protein kinases rather than the ATP pocket. For instance, the fl avonoids luteolin, apigenin, and quercetin exhibited high affi n-ity for the catalytic ATP domain of protein kinase C, or myricetin inhibited mitogen - activated protein kinase 4 directly by competing with ATP [51, 52] . Quer-cetin and, likely, delphinidin are examples of inhibitory fl avonoids not binding the ATP site of the mitogen - activated protein kinase/extracellular signal - regulated kinase 1 ( MEK1 ) and Fyn kinase, respectively [53, 54] . Actually, the most reviewed kinase inhibitor is epigallocatechin gallate. This versatile catechin was described as a specifi c inhibitor of numerous protein kinases, including MEK1/2, extracel-lular signal - regulated protein kinase 1/2, c - Jun N - terminal kinase, Akt kinase, dual - specifi city tyrosine phosphorylation - regulated kinase 1A, and cyclin - dependent kinase 1 and 2 [55] . Via affecting kinase cascades, fl avonoids can act as inhibitor of carcinogenesis, namely on the cell cycle and apoptosis levels (for review, see [55] ). Contrary to inhibitory effects, several fl avonoids, such as epigal-locatechin gallate, quercetin, and resveratrol, have been shown to activate AMP - activated protein kinases – key regulators of the metabolic pathways [56] . By modulation of these kinases, fl avonoids could help to prevent the development of numerous metabolic diseases (e.g., diabetes, obesity, cardiac hypertrophy, and even cancer).

20.3.3 Flavonoid - Binding Receptors

20.3.3.1 Estrogen Receptor The estrogen receptor ( ER ) is a ligand - inducible nuclear transcription factor, which depending on ligand binding mediates activation or repression of the target genes. Two forms – ER - α and ER - β – were discovered to be expressed differently in various tissues. It was found that some fl avonoids (i.e., present in soybeans and to a lesser extent in other legumes) bind this receptor like the endogenous steroidal ligand 17 β - estradiol. These so - called phytoestrogens, belonging to the group of iso-fl anones, are structurally similar to 17 β - estradiol and thus have estrogenic effects. The typical isofl avone phytoestrogens are daidzein and genistein, their naturally occurring glucosides, daidzin and genistin, and their methyl ether precursors, formononetin and biochanin A. These precursors are converted to daidzein and genistein by intestinal glucosidases. Intestinal bacteria further metabolize daid-zein to isofl avan equol and nonfl avonoid O - desmethylangolensin [57] . It is inter-esting to note that isofl avonoids, genistein, and daidzein preferentially bind ER - β , while endogenous estrogen ligand binds both ERs with similar affi nities. The affi nity of, for example, genistein for ER - α and ER - β is 0.7 and 13% of that for the endogenous ligand 17 β - estradiol, respectively [58] . Equol has been found to be a much more potent ER - α agonist compared to either genistein or daidzein, while it acts similarly to daidzein on ER - β [59] . Although isofl avonoids exert only limited estrogenic potency (compared to steroids), their rather high levels in humans


558 20 Flavonoids

under certain dietary conditions could result in signifi cant biological effects. Epi-demiological studies suggest that the intake of isofl avone - rich soy foods is inversely correlated with the risk of prostate and breast cancers, and helps to overcome health problems associated with the menopause [57] .

20.3.3.2 GABA - A Receptor GABA - A receptors are transmembrane proteins regulating a chloride fl ux through their ion channel in response to binding γ - aminobutyric acid ( GABA ) – the major inhibitory neurotransmitter. In addition to the GABA - binding site, the receptor contains a number of different allosteric binding sites such as the benzodiazepine ( BDZ ) - binding site, where variety of neuroactive ligands, including fl avones, bind and thus indirectly modulate the receptor activity [60] . Chrysin – 5,7 - dihydroxyfl avone from the folk medicine Passifl ora coerulea – was the fi rst fl avonoid reported to be a competitive ligand for the BDZ site, with anxiolytic activities [61] . Similar activity was described also for apigenin – a component of Matricicaria recutita fl owers [62] . A fl avonoid purifi ed from Scutellaria baicalensis Georgi – 5,7,2 ′ - trihydroxy - 6,8 - dimethoxyfl avone – manifested a high affi nity for the BDZ site comparable to that of diazepam [63] . Studies using sets of neuroactive fl avonoids revealed a number of structural moieties important for their binding to the BDZ site. For instance, 2 ′ - hydroxyl substitution of the skeleton plays a critical role for BDZ site affi nities for some fl avonoids. Hydroxyl moieties at positions 5 and 7 had negligible effects on the affi nity of fl avone, whereas hydroxylation at positions 3, 3 ′ , and 4 ′ resulted in reduced affi nity [60] . In addition, the substitution at position 6 affects the BDZ site binding. Hispidulin (4 ′ ,5,7 - trihydroxy - 6 - methoxyfl avone) – the 6 - methoxy derivative of apigenin – was 30 times more potent that apigenin in displacing fl umazenil binding [64] . Accordingly, semisynthetic nitrofl avones were prepared and their binding affi nity compared. Two nitroderivatives – 6 - methyl - 3 ′ - nitrofl avone and 6 - methyl - 3 ′ ,5 - dinitrofl avone – were effective agonistics, binding the BDZ site with a potency comparable of fl umazenil [65] . At anxiolytic doses, these com-pounds exert minimal sedative action.

20.3.3.3 Aryl Hydrocarbon Receptor Flavonoids are well - known compounds that can upregulate gene expression and consequently levels of xenobiotic - metabolizing enzymes in the body. This is an adaptive mechanism enabling herbivores to metabolize xenobiotics administered in the diet in order to detoxicate and excrete them. Flavonoids induce xenobiotic - metabolizing enzymes via activation of a soluble ligand - dependent transcription factor – the aryl hydrocarbon receptor ( AhR ). After ligand (fl avonoid) binding, the activated AhR in collaboration with associated proteins binds to a AhR - specifi c DNA recognition site – the xenobiotic - responsive element ( XRE ) – and fi nally acti-vates the gene promoter. The most responsive genes are, for example, CYP1A1 , CYP1A2 , and CYP1B1 , GST , UGT , and NADPH quinone reductase [66] . In numer-ous investigations, many fl avonoids have been screened as agonists or antagonists of AhR. In fact, they may exhibit weak AhR agonist and/or partial antagonist activities.

Tests of AhR activation by fl avonoids are mostly based on the use of aryl hydrocarbon - responsive cancer cells or cell lines containing a stably transfected AhR - responsive luciferase reporter gene. Results of these in vitro assays are signifi -cantly affected by the cell context and fl avonoid concentrations used. In aryl hydrocarbon - responsive MCF - 7 human breast cells, HepG2 human liver cancer cells, and mouse Hepa - 1 cells, chrysin and baicalein (both at 10 μ M) induced luciferase activity, while galangin, genistein, daidzein, apigenin, and diosmin were active only in stably transfected Hepa - 1. However, kaempferol, quercetin, myrice-tin, and luteolin behaved as AhR antagonists depending on the cell lines used [67] . A more recent study confi rmed these data; for example, apigenin (weak agonist) showed notable inhibitory effects on the in vitro activation of AhR induced by 2,3,7,8 - tetrachlorodibenzo - p - dioxin ( TCDD ). Moreover, it has been suggested that glycosides, in general, show lower or no AhR responses than the corresponding aglycones [68] .

Flavonoid – AhR interactions could be also examined indirectly in in vivo experi-ments by determination of the AhR - responsive gene products, such as transcribed mRNAs or expressed proteins. This approach, which provides more consistent results than in vitro assays with cells, is being used for the responsive gene prod-ucts (e.g., the CYP1 family ). In this respect, synthetic 5,6 - benzofl avone, known as β - naphthofl avone ( BNF ), may serve as a prototype CYP1A1/2 inducer and, thus, AhR agonist [69] . In addition, several natural fl avonoids have been proven to induce CYP1A1/2 [70] . In experiments where rats were treated with tested fl avo-noids by gavage, quercetin glycosides, rutin, isoquercitrin, and aglycone morin caused CYP1A1 induction in the small intestine, while fl avone, rutin, and isoquer-citrin, and partially quercetin, increased levels of CYP1A2 in the liver, but always to a less extent than BNF did [71, 72] . The possible drawback of this approach, which allows potential metabolic conversion of administered fl avonoids, is the uncertainty as to what is the ultimate fl avonoid form (derivative) that binds to AhR as its agonist.

Since AhR - responsive gene products are involved in the metabolism of drugs and in the processes of chemical carcinogenesis, interactions of fl avonoids with AhR give rise to several important issues. By induction of xenobiotic - metabolizing enzymes, fl avonoids might dramatically affect the plasma concentrations of phar-maceutical drugs, resulting in either overdose or loss of their therapeutic effect [70] . These potential drug – fl avonoid interactions are discussed in Sections 20.4 and 20.5.

20.3.4 Redox Enzyme Activity Modulation

Flavonoid anticancer, antioxidant, and anti - infl ammatory activities are at least in part associated with the direct inhibition of enzymes dealing with reactive oxygen species ( ROS ) in their catalytic cycle. The inhibition of CYPs, lipoxygenase s ( LOX s), cyclooxygenase s ( COX s), and xanthine oxidase ( XO ) are well documented examples of fl avonoid interaction with redox enzymes. Inhibitory fl avonoids may


560 20 Flavonoids

interfere with the formation of ROS and/or products of enzyme reactions, such as leukotrienes and prostaglandins (LOXs and COXs), and activated carcinogens (CYPs). However, redox enzymes can convert fl avonoids into reactive pro - oxidant forms (e.g., the fl avonoid semiquinone radical resulting from one - electron oxida-tion via peroxidase) [73] .

20.3.4.1 Xenobiotic - Metabolizing Enzymes Among enzymes involved in phase I metabolism of xenobiotics, CYPs play a key role, since they comprise 70 – 80% of all phase I enzymes. Although CYPs generally convert xenobiotics (e.g., drugs, carcinogens, food components, pollutants) to less - toxic products, the reactions frequently involve the formation of reactive intermedi-ates or allow the leakage of free radicals capable of causing toxicity. Flavonoids interact with CYPs at least in three ways. (i) As mentioned in the Section 20.3.3, fl avonoids are able to increase the xenobiotic - metabolizing capacity by inducing the expression of, for example, members of the CYP1 family via AhR activation. The induction of CYP2B1 in the liver and small intestine after administration of fl avone ( per os to rats) is an example of another induction mechanism than via AhR activation [71] . (ii) Flavonoids may undergo O - demethylation and/or C - hydroxylation catalyzed by CYPs to be conjugated by phase II enzymes (see Section 20.2.2). (iii) Flavonoids can modulate CYP activities as inhibitors by direct binding to CYP enzymes; for a comprehensive study on 33 fl avonoids, see Shimada et al. [74] .

Numerous mainly in vitro studies have been devoted to screening fl avonoids for CYP inhibition ability in order to apply them as protective compounds against CYP - mediated carcinogen activation. Synthetic and naturally occurring fl avonoids are effective inhibitors of fi ve CYPs – xenobiotic - metabolizing CYP1A1, 1A2, 1B1, 2C9, and 3A4 – and one steroidogenic CYP19 (for reviews, see [40, 74 – 76] ). Sum-marizing CYP1A1 and 1A2 inhibitory studies, the structure – function relationship of fl avonoids can be explored. The CYP1A1 active site has a preference for binding 7 - hydroxyl - substituted fl avones. A prerequisite for binding to CYP1A2 is the pres-ence of multiple hydroxyl groups (preferably two in positions 5 and 7) on the fl avone skeleton and an additional hydroxyl substitution of C2 in the case of fl avon - 3 - ols (e.g., morin). Planar molecules with a small volume : surface ratio turn out to possess high inhibitory activity of CYP1A2. That is why fl avanones and fl avanes (missing the C2 – C3 double bond), having a phenyl group (B ring) nearly perpendicular to the rest of the molecule, showed a decreased inhibitory effi ciency. Glycosylation as well as the presence of several hydroxyl groups and/or addition of methoxy groups results in a drastic decrease in their inhibitory activities. Based on the observation that catechins had no effect on CYP enzyme activity, the oxo group (position C4) in the C ring is also an essential factor for enzyme inhibition. The most potent CYP1A2 inhibitors are chrysin (5,7 - dihydroxyfl avone) and 3,5,7 - trihydroxyfl avone, followed by apigenin (5,7,4 ′ - trihydroxyfl avone) and morin (3,5,7,2 ′ ,4 ′ - pentahydroxyfl avone) [74, 77] . For CYP1B1, acacetin (5,7 - dihydroxy - 4 ′ - methoxyfl avone), in addition to galangin (3,5,7 - trihydroxyfl avone), seems to be the most selective and potent inhibitor with an IC 50 that is more than 10 times lower

than that of CYP1A1 and 1A2 [78] . Similarly, hesperetin (5,7,3 ′ - trihydroxy - 4 ′ - methoxyfl avone) is a selective inhibitor of expressed CYP1B1 in lymphoblastoid microsomes. Prenylated fl avonoids from hops are highly effective inhibitors of CYP1 family enzymes. At 0.01 mM concentration, prenylated chalcone – xanthohu-mol – almost completely inhibited CYP1A1 and totally eliminated CYP1B1 activity [79] . The most effective inhibitors of CYP1A2 were 8 - prenylnaringenin and isox-anthohumol. These fi ndings are in agreement with the suggested similarities of the binding sites of CYP1A1 and 1B1 when compared to that of CYP1A2. CYP2C9 was more inhibited by 7 - hydroxy - , 5,7 - dihydroxy - , and 3,5,7 - trihydroxyfl avones than by fl avone, but was weakly inhibited by 3 - and 5 - hydroxyfl avone. Of 33 tested fl avonoids, 3,5,7 - trihydroxyfl avone was the most potent inhibitor of CYP3A4 with an IC 50 of 2.3 μ M [74] . The described studies shed some light on our understand-ing of structural principles of fl avonoid – CYP interactions [70, 74] .

There is accumulating evidence that the metabolic activity of several CYPs (e.g., the CYP1A, CYP2C, and CYP3A families) is stimulated by inhibitors of other CYPs. While specifi c activities of CYP1A1 and CYP1B1 were inhibited by various fl avo-noids, certain metabolic activities of CYP1A2 and CYP3A4 were also stimulated by fl avonoids – α - naphthofl avone and tangeretin, respectively [80, 81] . Several hetero-tropic cooperativity models are used to explain this stimulatory effect of fl avonoids (i.e., in CYP3A4) [82] . Usually, the balance between the positive cooperativity and inhibition of these CYPs is a matter of a compound concentration. The effect of other quercetins on the mutagenicity of 2 - amino - 3,4 - dimethylimidazo[4,5 - f ]quinoline ( MeIQ ) was tested in a system expressing human CYP1A2 and NADPH : CYP reductase. Mutagenicity of MeIQ was enhanced 50 and 42% by quercetin at 0.1 and 1 μ M, respectively, but suppressed 82 and 96% at 50 and 100 μ M, respec-tively [83] . Thus, the MeIQ - induced mutation is a concentration - dependent process showing both stimulation, at low concentrations, and inhibition of CYP1A2 activ-ity, at high concentrations of the fl avonoid used. This example of a dose - dependent manner of stimulation or inhibition of carcinogen activation emphasizes the need for chemopreventive compound testing even at low concentrations, which likely occur in the human body after compound (food) ingestion [40] .

In addition to the phase I enzymes, fl avonoids affect enzymes of phase II of xenobiotic biotransformation. For instance, fl avanone and fl avone, but not tan-geretin and quercetin, induced UGT [84] . Moreover, tangeretin, chrysin, and fl a-vanone were found to be the most potent inhibitors of UGT. Also the activities of other phase II enzymes, such as GSTs and SULTs, are induced and/or inhibited by fl avonoids. For more detailed data, refer to the review by Moon et al. [75] .

20.3.4.2 LOX s, COX s, and XO s LOXs and COXs are involved in the biosynthesis of leukotrienes and prostaglan-dins from arachidonic acid. Mammalian LOX (15 - LOX1) has been proposed as an enzyme oxidizing low - density lipoproteins at an early stage in atherosclerosis. The most potent inhibitors of LOX (IC 50 ∼ 1 mM) are luteolin, baicalein, and fi setin [41] . The mechanism of LOX inhibition is proposed to be a combination of direct inhibition (noncompetitively to fatty acid) and radical scavenging.


562 20 Flavonoids

Flavonoids can interfere with COX - 1 and COX - 2 metabolic activities. For example, fl avonoids such as apigenin, luteolin, kaempferol, and quercetin were shown to be inhibitors of COX - 1, reducing the development of infl ammatory responses [85] . Interestingly, apigenin and luteolin exert COX - 2/5 – LOX dual - inhibitory activity [86] .

XO catalyzes simultaneous biosynthesis of uric acid from xanthine and the formation of superoxide/peroxide. Flavonoids can perform two roles – they act as enzyme inhibitors and/or as scavengers of ROS. The planarity of the C ring (fl a-vones) is important for XO inhibition. Thus, catechins show signifi cantly reduced interaction with XO. The presence of hydroxy groups in positions 5 and 7 on the fl avone C ring (e.g., chrysin, galagin, apigenin, luteolin, kaempferol, quercetin, and myricetin) seems to be an important prerequisite for XO inhibition [87] . Morin (3,5,7,2 ′ ,4 ′ - pentahydroxyfl avone), having reduced inhibitory ability, suggests a role for the hydroxylation position on the fl avone B ring. Moreover, fl avonols with a hydroxylated B ring (e.g., quercetin, myricetin, fi setin) show in addition to XO inhibition also ROS - scavenging activity. Glycosylation of the fl avonoids mostly abolishes XO inhibition (e.g., quercitrin (quercetin - 3 - O - rhamnoside) retained superoxide scavenging, but lost the inhibition of XO) [41] .

20.4 Dietary Flavonoids – Health Issues

Flavonoids are generally accepted as health - promoting compounds present in a plant diet. Since these compounds are able to provide a wide variety of biological activities (i.e., as powerful antioxidants and anticancer agents), they are frequently called chemopreventive compounds. In addition to a regular intake from a plant diet, some fl avonoids are used as food supplements and even drugs. These com-pounds, especially when administered in high doses (food supplements), are not necessarily benefi cial for the organism. In Section 20.3, fl avonoids were shown to target a large number of proteins involved in gene regulation or in metabolic pathways and cell signaling. Although the wide intake of fl avonoids is psychologi-cally acceptable due to their plant origin, potential threats resulting from, for example, drug interactions, effect on metabolism of endogenic compounds should be regarded. Unfortunately, much of the research in this area is focused on simpli-fi ed in vitro systems, which cannot take into account the complexity of fl avonoid interactions with living systems. Moreover, processes such as absorption and biotransformation are often ignored when “ benefi cial ” fl avonoid activities are declared.

20.4.1 Antioxidant and Pro - Oxidant Properties

Many of the benefi cial activities of fl avonoids have been attributed to their anti-oxidant properties. Flavonoids act as antioxidants per se or affect ROS status

20.4 Dietary Flavonoids – Health Issues 563

through more complex mechanisms (e.g., via modulation of redox enzymes and/or signaling pathways) (reviewed by Williams et al. [88] ). Structurally features that defi ne antioxidant activity are mainly the presence of 3 ′ ,4 ′ - dihydroxy groups (cat-echol structure) in the B ring, and 2,3 - unsaturation and a 4 - oxo group in the C ring. In addition, some fl avonoids are effective scavengers of reactive nitrogen species (peroxynitrite), chelators of transition metal ions (Fe - mediated ROS), and quenchers of singlet oxygen [89] .

However, depending on the hydroxylation pattern, fl avonoids can also act as pro - oxidants. Flavonoids promote the generation of hydroxyl radicals in the pres-ence of metal ions (Fenton reaction). Moreover, the scavenging of ROS (antioxi-dant activity) leads to the oxidation of the fl avonoid molecule and its conversion into a potential pro - oxidant. Flavones containing a 3 ′ ,4 ′ - dihydroxy substituent in their B ring (e.g., quercetin) may undergo autoxidation and/or enzymatic oxidation (tyrosinase, peroxidase), resulting in the formation of semiquinone - and quinone - type metabolites. These quinones may covalently bind to cellular macromolecules (proteins, DNA) as well as provide the capability for effi cient redox cycling, result-ing in the production of ROS. The mutagenicity of quercetin is an example of a harmful effect ascribed to the formation of such alkylating quinone - type metabo-lites [73] . 3 - Hydroxyfl avone, apigenin (5,7,4 ′ - trihydroxyfl avone), and luteolin (5,7,3 ′ ,4 ′ - tetrahydroxyfl avone) were shown to be cytotoxic for human lung embry-onic fi broblasts (TIG - 1 cells) due to their intracellular ROS - generating ability [90] . Thus, it is obvious that even a single fl avonoid can act as a pro - oxidant as well as antioxidant, depending on the experimental settings, especially fl avonoid concen-tration, cell type, and/or culture conditions.

20.4.2 Antiviral, Antibacterial, and Antifungal Agents

Flavonoids have been found to be active against a wide range of animal (e.g., poliovirus, adenovirus, herpes simplex virus, HIV, rotavirus) and plant viruses (e.g., tobacco mosaic virus). Although the biological properties of the fl avonoids are well studied, the mechanisms of action underlying their antiviral properties have not been fully elucidated. Current results suggest a combination of effects on both the virus and the host cell. For instance, isofl avones have been reported to affect virus binding, entry, replication, viral protein translation, and formation of certain virus envelope glycoprotein complexes. Isofl avones also affect a variety of host cell signaling processes, including induction of gene transcription factors and secretion of cytokines [91] . Furthermore, the fl avonoid baicalein has been shown to be active against human cytomegalovirus. The fl avonoid seems to inter-fere with virus infection through inhibiting its entry into cells and its replication [92] . Green tea constituents seem to be effective against HIV. Epigallocatechin - 3 - gallate caused the destruction of viral particles and inhibited viral attachment to cells, post - adsorption entry into cells, reverse transcription, and viral production [93] . In the most recent comparative study, the authors evaluated the in vitro antirotavirus activity of 60 fl avonoids, of which 34 compounds showed at least

564 20 Flavonoids

moderate antiviral activity [94] . The analysis of structure – activity relationships indicates that the A ring substitution with a methoxyl group is important for fl a-vonoid antirotavirus activity.

In line with the assumption that fl avonoids are produced by plants as one of their defense mechanisms against microbial infections, fl avonoids have been shown to exert potent antimicrobial activity in general, even to human pathogens. The effi cacy of fl avonoids against a variety of microorganisms can be attributed to their impact on the permeability of the cell wall, membrane integrity, and the porins in the outer membrane. Combinations of fl avonoids were shown to act synergistically and more effectively against Gram - negative microorganisms [95] . Flavonoids having free hydroxyl groups in the A ring at C5 and C7 positions seem to be more active than others [96] . Thus, apigenin exhibited a potent activity ( minimum inhibitory concentration ( MIC ) 3.9 – 15.6 μ g/ml) against 20 strains of methicillin - resistant Staphylococcus aureus . Another common fl avonoid containing a 5,7 - dihydroxylated A ring – kaempferol – effectively inhibited strains of bacteria, such as Salmonella typhi and Shigella dysenteriae (Gram - negative) and Bacillus subtilis (Gram - positive), all with a MIC of 2.4 – 9.7 μ g/ml, and moreover showed activity against Candida glabrata (MIC 2.4 μ g/ml), but hardly any to Candida albi-cans [97] . Even fl avone glycoside, 4 ′ ,5,7 - trihydroxy - 3 ′ - O - β - d - glucuronic acid - 6 ″ - methylester – a compound named vitegnoside – was effective against other yeasts Trichophyton mentagrophytes and Cryptococcus neoformans (MICs both 6.25 μ g/ml) in comparison to the standard antifungal drug fl uconazole (MIC 2.0 μ g/ml) [98] . Thus, fl avonoids could be a promising and effective alternative to conventional antibiotics in the treatment of infections caused especially by antibiotic - resistant microorganisms.

20.4.3 Other Biological Activities of Flavonoids

Due to the frequent targeting of mammalian proteins (including enzymes), fl avo-noids are able to modulate various physiological and pathological processes in the body. As mentioned in Section 20.3.2, fl avonoids through their interactions with ATP - binding proteins (e.g., kinases) can affect important processes proceeding in cells and tissues, such as cell differentiation, apoptosis, angiogenesis, and metas-tasis. In addition, because of binding to specifi c receptor macromolecules (e.g., ER and GABA receptors; see Section 20.3.3), fl avonoids show estrogenic/antiestrogenic and anxiolytic activities, respectively.

In traditional herbal medicine, fl avonoids are also known for their anti - infl ammatory activity. Via inhibition of LOXs and COXs – enzymes that are involved in the biosynthesis of leukotrienes and prostaglandins (see Section 20.3.4) – fl avonoids reduce the formation and release of proinfl ammatory cytokines and mediators. The mechanism of fl avonoid anti - infl ammatory activity is, however, much more complex. It includes, for example, blockage of histamine release, inhibition of phosphodiesterase and protein kinases, and activation of tran-scriptase. For a review dealing with several suggested mechanisms of fl avonoid


anti - infl ammatory action, see [99] . At the cellular level fl avonoids exert their anti - infl ammatory property by inhibition of neutrophil degranulation, which is a direct way to diminish the release of arachidonic acid by neutrophils and other immune cells [99] . Citrus polymethoxy fl avones were reported to suppress production of the cytokine – tumor necrosis factor - α – via inhibition of phosphodiesterase [100] . Moreover, epigallocatechin - 3 - gallate inhibits the expression of inducible nitric oxide synthase, producing another infl ammatory agent – nitric oxide. Another target of fl avonoid action is inhibition of kinases – the key regulatory enzymes in the initiation of infl ammation and the immune response. For instance, myricetin has been shown to inhibit I κ B kinase – the enzyme important for the activation of the nuclear transcription factor NF - κ B, which elicit various biological responses through induction of target genes. Surprisingly, apigenin and kaempferol were almost devoid of any I κ B kinase inhibitory effect [101] .

A number of investigations have revealed that fl avonoids exhibit antithrombotic activities and thus fl avonoids are believed to provide protection against the devel-opment of cardiovascular disease [102] . The antithrombotic activity of fl avonoids is likely elicited by their already - mentioned ability to inhibit the activity of COX and LOX pathways as well as to scavenge free radicals. Flavonoids present in red wine and purple grape juice were shown to exert antioxidant and antiplatelet properties. Both in vitro incubation platelets and human oral supplementation with purple grape juice decreased platelet aggregation and enhanced release of platelet - derived nitric oxide [103] . However, a recent overview evaluating the role of fl avonoids in protection against cardiovascular disease (via antiplatelet effect) does not come up with as many promising conclusions as the results from early in vitro studies. Of 25 intervention studies, one consistent fi nding was that cocoa - related products containing fl avonols have platelet - inhibiting effects when con-sumed in moderate amounts [104] . Owing to the inconsistency in the obtained results, it is not possible to conclude whether fl avonoids from black tea, coffee, and alcoholic beverages have benefi cial effects on platelet function when con-sumed in moderate amounts in the diet.

In addition, fl avonoids make a major contribution to the fl avor of fruits, in particular the bitterness of citrus fruits (grapefruit) [105] . For instance, citrus naringin (4 ′ ,5,7 - trihydroxyfl avanone - 7 - rhamnoglucoside), tangeretin, quercetin, and neohesperidin are very bitter. In red wine, catechins and epicatechins are responsible for its bitter taste. On the other side of the scale, hesperidin dihydro-chalcone is intensely sweet. The most powerful sweetener was found to be 3 ′ - car-boxyhesperetin dihydrochalcone, which was shown to be about 3400 times sweeter than a 6% aqueous solution of sucrose [106] .

20.4.4 Flavonoids as Nutraceuticals

In the previous sections, fl avonoids were presented as remarkable biologically active compounds affecting directly or indirectly a large variety of processes in living systems. Many studies suggest positive correlations between the intake of

566 20 Flavonoids

fl avonoid - containing food and the prevention of several human diseases. Epide-miological studies have shown that frequent consumption of, for example, a soy diet high in isofl avonoids (daidzein, genistein) is correlated with a low incidence for breast and prostate cancers as well as reduced menopausal symptoms, such as osteoporosis. Similarly, frequent drinking of green tea is suggested to be associ-ated with a lowered risk of stomach cancer, most likely due to the protective effect of catechins [107] . As a result, plant - based food containing signifi cant amounts of these versatile compounds is nowadays called “ functional food. ” The term “ nutraceuticals, ” which was coined from “ nutrition ” and “ pharmaceuticals, ” is reserved for “ functional food ” used intentionally in order to provide medical or health benefi ts, including the prevention and/or treatment of a disease [108] . In addition, another closely related term – “ dietary supplement ” – is used as a term to describe a product (pill, capsule, tablet, or liquid form) that is intended to supple-ment the diet by increasing the total daily intake of one or a combination of dietary ingredients. Flavonoids defi nitely span all these categories. Moreover, some par-ticular fl avonoids are also used as constituents of drugs. For example, rutin (quercetin - 3 - rutinoside) strengthens the capillaries, decreases their permeability, and inhibits platelet aggregation. The semisynthetic fl avonoid diosmin, frequently in combination with hesperidin, is a major component of a phlebotropic drug used in the treatment of venous disease (i.e., chronic venous insuffi ciency and hemor-rhoidal disease) [109] .

Based on in vitro and ex vivo experiments and epidemiological studies, fl avo-noids seem to be a “ panacea; ” however, data from clinical trials can hardly meet any of the described health - promoting activities of fl avonoids [110] . There are at least two obvious reasons that may explain this discrepancy of in vitro and in vivo results. (i) In vitro studies are mostly carried out with unrealistic fl avonoid con-centrations, which cannot be reached under in vivo conditions because of the rather low bioavailability of fl avonoids and metabolism that signifi cantly reduce their plasma levels. In such experiments, concentrations of tested compounds are orders of magnitude greater than achievable in humans, which rarely exceed the nanomolar range. (ii) Intake of a single compound is rarely as effective as that compound in a complex dietary mixture in which multiple compounds and/or multiple interacting regulatory molecules underlie the biological effect. Appar-ently, additive and synergistic effects of fl avonoids with each other and with other compounds are prerequisites of many of the observed benefi cial effects assigned to “ functional food. ” Hence, it is clear that reliable assessment of the alleged heath benefi ts resulting from human fl avonoid intake has to be based on much more developed authentic models (i.e., considering realistic fl avonoid dosage, long - term exposure, and fl avonoid absorption and metabolism).

20.4.4.1 Cytotoxic and Cytoprotective Effects Flavonoids are frequently referred to as chemopreventive (chemoprophylactic) compounds due to their ability to protect cells from damage caused by ROS and other reactive intermediates. As discussed in Section 20.4.1, fl avonoids provide great antioxidant potential as both radical scavengers and metal cation chelators, or inhibitors of enzymes involved in ROS production. These mechanisms underlie


the protective effect of fl avonoids such as epicatechin and quercetin, which have been shown to reduce the neurotoxicity induced by oxidized low - density lipopro-tein [111] . Moreover, fl avonoids act as anticancer agents via blocking of enzymes (e.g., CYPs) at expression or activity levels, which activate carcinogens into DNA - modifying intermediates [112] (see Section 20.3.4). For instance, baicalein inhibits 7,12 - dimethylbenz[ a ]anthracene – DNA adduct formation by modulating CYP1A1 activity at both expression and activity levels [113] . Flavonoids may also protect cells by other mechanisms; one of them is based on fl avonoid interference with the process of apoptosis. These compounds can affect this process in mitochon-dria, which play pivotal roles in both the life and the death of the cell. Flavonoids specifi cally block mitochondria - dependent apoptotic pathways by reduction of cytochrome c directly or by preventing its oxidation and thus protect the cells [114] .

However, it is necessary to note that fl avonoids are also reported as cytotoxic compounds. In addition to their antioxidant properties, fl avonoids at same time may act as pro - oxidants, especially at high doses. Flavonoids, such as quercetin, have been shown to be cytotoxic in many cell systems by mechanisms involving the production of oxygen radicals through an auto - oxidation process. Moreover, this quercetin paradox is even more pronounced when quercetin is scavenging free radicals that result in the formation of thiol - reactive quercetin quinones depleting, for example, GSH in the cells [115] . Similarly, cytotoxicity toward cul-tured normal human cells through increasing intracellular ROS levels was also reported for apigenin, luteolin, kaemphero, and l - and 3 - hydroxyfl avone [90] . Although cytotoxic, fl avonoids with this activity are invited to eradicate cancer cells. Flavonoids act in a similar way as known anticancer drugs do – binding and cleav-age of DNA, and the generation of ROS in the presence of transition metal ions [116] . Thus, the pro - oxidant action of fl avonoids rather than their antioxidant activ-ity may be important for their anticancer and apoptosis - inducing properties. The ability of fl avonoids to induce mitochondria - mediated apoptosis was: api-genin > quercetin > myricetin > kaempferol [114] . Flavonoids may also induce tumor cell apoptosis by inhibiting DNA topoisomerase II and p53 downregulation or by causing mitochondrial toxicity, which initiates mitochondrial apoptosis [117] .

In conclusion, it is possible to summarize that the issue of chemoprevention versus cytotoxicity is rather complex, and the assessment of fl avonoid activity is strongly dependent on the target cells under consideration. Thus, analogously to drugs, although the fl avonoid cytotoxic effect is desired against cancer cells, it is adverse for normal cells and vice versa. This complexity can be illustrated by the example of genistein, which at high doses (50 – 100 μ M) inhibits the growth of human breast cancer cells in vitro , whereas it induces proliferation at lower doses (0.01 – 10 μ M), [118] .

20.4.5 Flavonoid Interference with the Metabolism of Endo - and Xenobiotics

In addition to the already described fl avonoid activities, these phytochemicals can modulate enzymes involved in the metabolism of endogenous and foreign com-pounds. Thus, administration of fl avonoid - based dietary supplements and/or

568 20 Flavonoids

nutraceuticals has to be considered with caution since fl avonoids have the poten-tial to cause pathological or even life - threatening changes in an organism ’ s physi-ology. Section 20.5 is devoted to the broad issue of fl avonoid – drug interactions.

20.4.5.1 Flavonoid Impact on the Metabolism of Endogenous Compounds Apparently, numerous benefi cial/adverse effects of fl avonoids are associated with their impact on the metabolism of physiological substrates. However, much more data are needed to ascribe the found effects to fl avonoid intake.

In some particular cases, the role of fl avonoids has been suggested. In addition to the already - mentioned inhibition of various enzymes (e.g., kinases, phosphodi-esterases, LOXs, COXs, XOs, and DNA topoisomerase II) of physiological signifi -cance, fl avonoids exert inhibitory activity on the biosynthesis of hormones. Some plant isofl avonoids – genistein and daidzein from soya – inhibit thyroperoxidase that catalyzes iodination and thyroid hormone biosynthesis. Moreover, in millet the hypothyroid effect is attributed to vitexin – a C - glycosyl fl avone that inhibits in vitro thyroid peroxidase [119] . This fl avonoid antithyroid effect seems to explain endemic goiter. It is also suggested that early maternal hypothyroxinemia may produce morphological brain changes leading to autism [120] .

Another well - documented example of fl avonoid interference with hormone syn-thesis is the antiestrogenic action of fl avones and fl avanones. The conversion of androgens (e.g., androstenedione, testosterone) to estrogens (e.g., estrone, estra-diol) is catalyzed by CYP19 (aromatase) via aromatization of the A ring of andro-gens. The presence of a C4 - oxo group in the fl avonoid skeleton seems to be crucial for inhibition. Moreover, one to three hydroxyl groups in certain positions are a prerequisite for a high inhibitory potency. Hydroxylation at C7 or C8 of fl avone increases signifi cantly the aromatase inhibition activity, while the presence of a single hydroxyl group in positions C3, C5, or C6 drastically reduces the inhibitory effect. Thus, 7 - hydroxyfl avone, chrysin (5,7 - dihydroxyfl avone), and apigenin (5,7,4 ′ - trihydroxyfl avone) show IC 50 values in the low micromolar range. Isofl a-vones, such as genistein and daidzein, which are known as ligands of ERs, are far less effective as aromatase inhibitors. The inhibition of aromatase causes complex changes, inducing a shift in the overall hormonal balance of the individual, result-ing in various effects, such as infertility and retardation of cell proliferation [70] . However, these potential problems should be balanced against the chemopreven-tive (benefi cial) roles of fl avonoids.

20.4.5.2 Effect of Flavonoids on Carcinogen Activation Increased consumption of fl avonoids seems to be associated with decreased risk of various kinds of cancers. Benefi cial effects of fl avonoids in prevention and cancer therapy are often linked to their antioxidant activity, anti - infl ammatory properties, activation of immune response against cancer cells, induction of apop-tosis in premalignant or cancerous cells, suppression of growth and proliferation of various types of tumor cells via induction of cell cycle arrest, modulation of drug resistance, and antiangiogenic action [121] . Much less attention is paid to the role of fl avonoids in the direct protection against carcinogen activation. The xenobiotic -


metabolizing enzymes (e.g., CYPs) that are involved in carcinogen activation are discussed in detail in Section 20.3.4 in view of their interactions with fl avonoids. Here, fl avonoids are presented as compounds acting both benefi cially and adversely in the process of carcinogen activation. The complexity and ambiguity of the effects of fl avonoids on the carcinogenicity of chemicals will be shown fi rst at the level of activity modulation of xenobiotic - metabolizing enzymes and then at the level of the induction of these enzyme.

Flavonoids and carcinogens are xenobiotics, whose metabolism proceeds usually via phase I and phase II of their biotransformation. Most carcinogens are initially metabolized by the CYP enzymes (phase I) to inactive metabolites as well as to chemically reactive metabolites that covalently bind to DNA and initiate a carcino-genic process. Considering the CYP monooxygenase system to be responsible for the activation of a particular carcinogen, the inhibition of these enzymes by fl avo-noids should block the initialization phase of carcinogenesis. Accordingly, fl avones (apigenin) and fl avonoles (myricetin, quercetin, and kaempferol) are shown to be potent inhibitors of CYP1A1 - catalyzed epoxidation of 7,8 - diol - benz[ a ]anthracene, forming the major benz[ a ]anthracene metabolite with carcinogenic properties [122] . This straightforward interpretation of the role of fl avonoids in carcinogen-esis inhibition, however, does not necessarily meet all the consequences of fl avo-noid interactions with the CYP monooxygenase system. Multiple CYPs are possibly involved in carcinogen metabolism, some of them responsible for carcinogen activation, others playing detoxifi cation roles. Thus, the inhibition of the detoxifi ca-tion pathway allows the carcinogen to be preferentially metabolized via the activa-tion pathway. Flavonoids, similarly to carcinogens, frequently undergo phase II metabolism mediated by conjugation enzymes (UGTs, SULTs). At this step of carcinogen metabolism, fl avonoids may compete with chemically reactive metabo-lites for the conjugation reactions and cause the accumulation of mutagenic intermediates. Moreover, fl avonoids such as α - naphthofl avone and tangeretin are able to stimulate CYP enzyme activity, and thus enhance carcinogen activation [80, 81] . A stimulatory effect of fl avonoids was described also for the activity of NADPH : CYP reductase. α - Naphthofl avone increases the NADPH : CYP reductase - catalyzed activation of aristolochic acid I into intermediates covalently binding DNA [123] . On the contrary, hydroxylated fl avonoids such as quercetin and morin exerted inhibitory effects, similar to α - lipoic acid that is a known NADPH : CYP reductase inhibitor [124] .

In addition to the ability of fl avonoids to modulate the activity of xenobiotic - metabolizing enzymes by their direct binding, these phytochemicals are inducers of phase I and phase II enzyme expression (see Section 20.3.3). Inducer effects on the carcinogenicity of a certain chemical will depend on the inducer impact on the ratio of carcinogen metabolism to inactive and active metabolites by these enzymes [125] . Paradoxically, the induction of CYP1A1/1A2 involved in the activa-tion of the majority of carcinogens might be protective against the formation of DNA - modifying intermediates from other carcinogens. This protective mecha-nism was shown for activation of afl atoxin B1. Induction of rats with β - naphthofl avone, which stimulates the CYP1A1/1A2 hepatic metabolism of

570 20 Flavonoids

afl atoxin B1 to afl atoxin M1 (an inactivation pathway), inhibits the hepatocarcino-genic activity of afl atoxin B1 [126] . Enzymes of phase II biotransformation (con-jugation enzymes) are generally considered to be protective because of the neutralization of reactive intermediates originating from phase I, but under spe-cifi c conditions their induction is associated with carcinogen activation. That is the case for carcinogens that are present in amino acid pyrrolysates of high - temperature cooked meat. One of these carcinogenic heterocyclic amines – 2 - amino - 1 - methyl - 6 - phenylimidazo[4,5 - b ]pyridine ( PhIP ) – is N - hydroxylated by CYP1A2 and consequently esterifi ed by NAT or N - SULT, that results in the highly muta-genic nitrenium ion [127] . Since, for example, quercetin induces expression of NAT in human volunteers by 88.7%, this popular chemopreventive fl avonoid may potentiate the formation of the ultimate carcinogen from PhIP [128] .

When combining both concepts of fl avonoid induction and inhibition of CYPs, the potential risk of carcinogenesis may evolve from sequential administration of a protective fl avonoid and carcinogen. Ingestion of a protective fl avonoid, such as rutin (quercetin - 3 - rutinoside) and isoquercitrin (quercetin - 3 - β - d - glucoside), causes in vivo induction of CYPs 1A1 and 1A2, and thus increases the carcinogen activa-tion potential [72] . Then, within 48 – 76 h, the carcinogen is administered, but its activation is not inhibited by already excreted protective fl avonoid; however, the activation is considerably enhanced.

Although there is a widely accepted assumption that fl avonoids are solely active in anticancer actions, the above - mentioned examples show possible opposite activ-ity leading to enhanced carcinogen activation.

20.5 Flavonoid – Drug Interactions

From 1989, when the fi rst report of a grapefruit juice – drug interaction was pub-lished, there has been accumulating evidence documenting the signifi cance of food – drug, herb – drug, and also fl avonoid – drug interactions. The majority of studies are devoted to the evaluation of the inhibitory properties of various herbal medicines, but much less attention has been paid to certain chemicals that are behind the herb activities; for reviews, see, for example, papers by Ioannides [129] and Izzo and Ernst [130] .

Drugs and fl avonoids are handled in the organism as foreign compounds, thus similar or identical enzyme systems are involved in the metabolism of these com-pounds. This implies fl avonoids are potential modulators of drug metabolism with all the anticipated impacts on drugs pharmacokinetics and consequent therapeutic effects. In fact, there are two basic possibilities for how the fl avonoid may interfere with the drug therapeutic action. (i) The induction of drug - metabolizing enzymes and/or stimulation of their activity by fl avonoids can result either in speeded up elimination from the body and loss of therapeutic action, or when the drug is administered as a prodrug, in raising the concentrations of therapeutically active drug. (ii) The fl avonoid - mediated inhibition of drug - metabolizing enzymes may

20.5 Flavonoid–Drug Interactions 571

either obstruct drug excretion and cause drug accumulation in the body or prevent conversion of the prodrug into the active compound. In other words, fl avonoid – drug interactions may result in loss of therapeutic action or drug overdosing, which both are possibly life threatening. Moreover, due to the interactions of fl a-vonoids with proteins and enzymes involved in various signaling pathways, fl avo-noids may affect the fate of the drug in an organism in a very specifi c way, which is hardly predictable. In the special case of xenobiotic transporters (MRP, P - gp), by blocking the effl ux of antitumor drug, fl avonoids can increase the effi ciency of chemotherapy. Quite surprisingly, the inhibition of these transporters by fl avo-noids (e.g., chrysin) did not lead to drug - mediated apoptosis of cancer cells. The tested fl avonoid was suggested to increase cancer cell survival by enhanced expres-sion of xenobiotic transporters in cancer cells [131] . Moreover, the fl avonoid effect on the signaling pathway associated with the process of apoptosis is also considered.

Although it is virtually impossible to map and predict all food - based fl avonoid – drug interactions, this phenomenon has received increasing attention and some of the most pronounced interactions have already been described. In Section 20.3.4, some fl avonoids were shown as CYP inducers/inhibitors/stimulators and the basic structure – function relationships were defi ned. Since CYP3A4 is a pre-dominant human CYP enzyme and is responsible for the metabolism of a large number of therapeutic agents, the interaction of fl avonoids with this xenobiotic - metabolizing enzyme is of high importance with the respect to fl avonoid – drug interactions. Selected examples will be presented in this section to illustrate the extent of possible fl avonoid – drug (food – drug) interactions.

In herb extracts from medicinal herbs, such as milk thistle ( Silybum marianum ) and St John ’ s Wort ( Hypericum perforatum ), in addition to other active compounds, CYP3A4 inhibitors silymarin (mixture of fl avonolignans) and I3,II8 - biapigenin, respectively, were found. The bifl avonoid I3,II8 - biapigenin was shown to be a potent, competitive inhibitor of CYP3A4, 2C9, and 1A2 activities with K i values of 0.038, 0.32, and 0.95 μ M, respectively [132] . Silymarin, in addition to effi cient inhibition of CYP3A4, 2C19, and 2D6, proved to be a strong inhibitor of UGT in cell cultures [133, 134] . The citrus fl avonoid naringenin (5,7,4 ′ - trihydroxyfl a-vanone), which is present in grapefruit juice, also exerts an inhibitory effect on CYP3A4 in some experimental models [135] . Interestingly, an in vivo study with a furanocoumarin - free and a regular grapefruit juice does not establish fl avonoids, but furanocoumarins (e.g., bergamottin, dihydroxybergamottin), as the mediators of the grapefruit juice – drug interactions enhancing the systemic exposure of the drug felodipine [136] . Another citrus fl avonoid – tangeretin – completely blocked the therapeutic inhibitory effect of tamoxifen on mammary cancer in mice [137] . However, simultaneous administration of tamoxifen and genistein showed a synergistic effect on the inhibition of the growth of ER - negative breast cancer cells [138] .

Only a limited number of studies have been undertaken to examine the effect of common fl avonoids, present in the human diet, on the expression of CYPs or conjugation enzymes and on the consequent fl avonoid – drug interactions. For

572 20 Flavonoids

instance, ethinylestradiol ( EE ), which is one of the major components of oral contraceptives, is mainly metabolized by fl avonoid - inducible hepatic CYP3A4 and intestinal CYP1A1 [139] . Therefore, increased EE elimination (even attenuated pharmacological effects of EE) similar to omeprazole users and smokers should be expected after ingestion of high fl avonoid food or food supplements (for CYP induction, refer to Section 20.3.4). The opposite effect (i.e., EE retention) may occur after ingestion of quercetin, which is an effi cient inhibitor of human cytosolic SULT1E1 – the enzyme that is involved in EE sulfation at clinically relevant con-centrations [140] . Moreover, SULT1E1 does not seem to be inducible by fl avonoids such as β - naphthofl avone, contrary to other SULTs (e.g., SULT1A3) [141] . In general, the inhibition of SULT1E1 by quercetin, resulting in elevated estrogen hormone levels in tissues, may be a potentially harmful effect in relation to cancer development. Flavonoid – drug interactions may result also in some cases in health - promoting outcomes. This is documented, for example, by interaction of baicalein and acetaminophen. Baicalein signifi cantly decreased acetaminophen - induced hepatotoxicity associated with the formation of the acetaminophen metabolite, N - acetyl - p - benzoquinoneimine. This hepatoprotective effect of baicalein against acetaminophen overdose may be due to its ability to block the bioactivation of acetaminophen by inhibiting CYP2E1 expression [142] .

Apart from the enzymes of drug biotransformation, transporters of xenobiotics are also potential targets of fl avonoid – drug interactions. The stimulation of activity of xenobiotic transporters (MRP, P - gp), involved in the effl ux of antitumor drugs, by fl avonoids can signifi cantly reduce the effi ciency of the cancer chemotherapy. Conversely, quercetin, genistein, naringenin, and xanthohumol reduced the effl ux of cimetidine – a P - gp substrate – in both Caco - 2 and LLC - PK1 cells [143] . That is an example of a fl avonoid – drug interaction resulting in a desired increase of cel-lular uptake of the drug that is caused by fl avonoid inhibition of P - gp - mediated drug effl ux. Likewise, fl avone may increase the effectiveness of some other antine-oplastic agents such as paclitaxel. Coadministration of paclitaxel with fl avone in rats signifi cantly increased the peak plasma level of paclitaxel and its half - life in comparison to control animals. It is suggested that the bioavailability of paclitaxel coadministered with fl avone was enhanced by both the inhibition of the P - gp effl ux pump and CYPs in the intestinal mucosa [144] . Lethal consequences of fl avonoid – drug interactions have been reported for pigs coadministered with digoxin and quercetin, which both interact with P - gp as a substrate and modulator, respec-tively. The simultaneous administration of this cardiac drug (at nontoxic dose) and quercetin via gavage increased signifi cantly the bioavailability of the drug and elevated (4 - fold) its plasma peak compared to controls, which resulted in sudden death of two of three animals [145] . Similar severe interactions should be consid-ered for other drugs with a very narrow therapeutic range.

The opposite view of fl avonoid – drug interactions is represented by the study examining the effect of antibiotics on the absorption and metabolism of baicalin in the gastrointestinal tract [146] . Coadministration of aminoglycoside antibiotics with baicalin resulted in dramatically decreased levels of baicalin derivatives in plasma, most likely because of the antibiotic bactericidal effect on intestinal

20.6 Conclusion – Double-Edged Sword Properties of Flavonoids 573

bacteria mediating baicalin hydrolysis, which is the rate - limiting step for its absorption.

These selected examples highlight the wide range of possible ways fl avonoids impact on the pharmacokinetics of commonly used drugs, from the direct com-petition of fl avonoid and drug for a certain protein (enzyme or receptor) to indirect fl avonoid – drug interactions represented by, for example, fl avonoid induction of the drug - metabolizing enzyme. Most of the effects shown, however, require fl avo-noid concentrations at micromolar concentrations, which are not regularly achieved with a common intake of a plant - based diet. Thus, extrapolating in vitro fi ndings to conditions in vivo should be done with caution. Although fl avonoids seem to be less active in drug interactions than other well - known phytochemicals interfering with drug bioavailability (e.g., furocoumarins, hyperforin), their simultaneous ingestion with prescribed drugs should be considered as potentially deleterious since knowledge of fl avonoid – drug interactions altering drug pharma-cokinetics is very incomplete at present. This is especially true for food supple-ments containing concentrated fl avonoids.

20.6 Conclusion – Double - Edged Sword Properties of Flavonoids

Flavonoids are plant xenobiotics known mostly for their antioxidant properties. Moreover, they may exert a huge array of biological activities via binding to pro-teins (receptors, enzymes, transporters) of living systems. Epidemiologic studies show plant - based food containing fl avonoids to be health promoting. As a result, a fl avonoid - rich diet is advised as nutraceuticals to prevent and/or cure numerous “ civilization diseases. ” Likewise, concentrated herb extracts and certain fl avonoids are marketed as food supplements. However, the majority of data proving the benefi cial activities of fl avonoids are based on in vitro studies with unrealistically high doses, disregarding fl avonoid absorption, distribution, and metabolism in the body. In in vivo systems exposed to a regular plant diet, the benefi cial effects of fl avonoids are hardly seen, mainly because of their rather low bioavailability. In addition, concentrations of ingested fl avonoids are reduced by their metabolism mediated by xenobiotic - metabolizing enzymes and colon microfl ora, and followed by excretion of metabolites from the body. Similarly, clinical trials with fl avonoids applied at physiological doses during short - term regimen do not meet the expecta-tions extrapolated from in vitro investigations. Owing to the metabolism of fl avo-noids, it is entirely misleading to attribute the potential health - promoting effect(s) to certain compound(s) found in the plant diet. If any benefi cial activities of fl avonoids are implied from epidemiologic studies, one has to keep in mind that the desired effects are not most likely caused by a sole dietary fl avonoid, but by the complex mixture of various phytochemicals acting additively and/or synergistically.

Although consumption of a plant - rich diet and fl avonoid nutraceuticals seems to be, with a few exemptions (e.g., soya milk), safe, the administration of herb

574 20 Flavonoids

extracts and fl avonoid - based food supplements may even cause life - threatening effects. It is worth noting that fl avonoids, in addition to their popular health ben-efi cial activities, are potentially detrimental. For instance, they are both cytoprotec-tive and cytotoxic, antioxidant and pro - oxidant, anticarcinogenic and cocarcinogenic or mutagenic, and antiestrogenic and estrogenic. These equivocal properties strongly depend on the manner in which the fl avonoid compound is applied (i.e., on the dose, route of administration, duration of exposure, subject medication, exposure to other xenobiotics or carcinogens) as well as on the particular com-pound used and cells or tissues effected. Moreover, genetic polymorphisms, espe-cially of xenobiotic - metabolizing enzymes, may also play an important role in the fi nal effect of fl avonoids. The major issues to consider in this respect are fl avonoid – drug interactions, which can cause unpredictable changes in drug pharmacokinet-ics, possibly resulting in a severe impact on human health. This concern is of a special importance regarding the risk – benefi t assessment of fl avonoids intended for prolonged prophylactic human use. Bearing in mind that fl avonoids are clearly not a “ panacea ” given to mankind, but are regular xenobiotics, it is necessary to evaluate carefully the double - edged sword properties of these compounds.

References

1 Pietta , P.G. ( 2000 ) Flavonoids as antioxidants . J. Nat. Prod. , 63 , 1035 – 1042 .

2 Andersen , Ø .M. and Markham , K.R. ( 2006 ) Flavonoids: Chemistry, Biochemistry and Applications , CRC Press, Boca Raton, FL .

3 Rice - Evans , C.A. , Miller , N.J. , and Paganga , G. ( 1996 ) Structure – antioxidant activity relationships of fl avonoids and phenolic acids . Free Radic. Biol. Med. , 20 , 933 – 956 .

4 Bohm , B.A. ( 1998 ) Flavonoid functions in nature , in Introduction to Flavonoids (ed. B.A. Bohm ), Harwood, Amsterdam , pp. 339 – 365 .

5 Treutter , D. ( 2006 ) Signifi cance of fl avonoids in plant resistance: a review . Environ. Chem. Lett. , 4 , 147 – 157 .

6 Packer , L. and Sies , H. , eds ( 2001 ) Flavonoids and other polyphenols , in Methods in Enzymology 335 , Academic Press , New York .

7 Stafford , H.A. ( 1990 ) Flavonoid Metabolism , CRC Press , Boca Raton, FL .

8 Manach , C. , Scalbert , A. , Morand , C. , Remesy , C. , and Jimenez , L. ( 2004 )

Polyphenols: food sources and bioavailability . Am. J. Clin. Nutr. , 79 , 727 – 747 .

9 Kuhnau , J. ( 1976 ) The fl avonoids. A class of semi - essential food components: their role in human nutrition . World Rev. Nutr. Diet. , 24 , 117 – 191 .

10 Clifford , M.N. ( 2004 ) Diet - derived phenols in plasma and tissues and their implications for health . Planta Med. , 70 , 1103 – 1114 .

11 Heinonen , M. ( 2001 ) Anthocyanins as dietary antioxidants , Proceedings of the Third International Conference on Natural Antioxidants and Anticarcinogens in Food, Health, and Disease, Helsinki .

12 Sampson , L. , Rimm , E. , Hollman , P.C. , de Vries , J.H. , and Katan , M.B. ( 2002 ) Flavonol and fl avone intakes in US health professionals . J. Am. Diet. Assoc. , 102 , 1414 – 1420 .

13 Kimira , M. , Arai , Y. , Shimoi , K. , and Watanabe , S. ( 1998 ) Japanese intake of fl avonoids and isofl avonoids from foods . J. Epidemiol. , 8 , 168 – 175 .

14 Spencer , J.P.E. , Rice - Evans , C.A. , and Singh Srai , S.K. ( 2003 ) Metabolism in the small intestine and gastrointestinal

References 575

tract , in Flavonoids in Health and Disease (eds L. Packer and C.A. Rice - Evans ), Dekker, New York , pp. 363 – 391 .

15 Erlund , I. , Kosonen , T. , Alfthan , G. , Maaenpaa , J. , Perttunen , K. , Kenraali , J. , Parantainen , J. , and Aro , A. ( 2000 ) Pharmacokinetics of quercetin from quercetin aglycone and rutin in healthy volunteers . Eur. J. Clin. Pharmacol. , 56 , 545 – 553 .

16 Xing , J. , Chen , X. , and Zhong , D. ( 2005 ) Absorption and enterohepatic circulation of baicalin in rats . Life Sci. , 78 , 140 – 146 .

17 Walle , T. , Otake , Y. , Brubaker , J.A. , Walle , U.K. , and Halushka , P.V. ( 2001 ) Disposition and metabolism of the fl avonoid chrysin in normal volunteers . Br. J. Clin. Pharmacol. , 51 , 143 – 146 .

18 Scalbert , A. and Williamson , G. ( 2000 ) Dietary intake and bioavailability of polyphenols . J. Nutr. , 130 , 2073S – 2085S .

19 Vaidyanathan , J.B. and Walle , T. ( 2003 ) Cellular uptake and effl ux of the tea fl avonoid ( – ) - epicatechin - 3 - gallate in the human intestinal cell line Caco - 2 . J. Pharmacol. Exp. Ther. , 307 , 745 – 752 .

20 Walle , T. ( 2004 ) Absorption and metabolism of fl avonoids . Free Radic. Biol. Med. , 36 , 829 – 837 .

21 Walle , T. , Walle , U.K. , and Halushka , P.V. ( 2001 ) Carbon dioxide is the major metabolite of quercetin in humans . J. Nutr. , 131 , 2648 – 2652 .

22 Hollman , P.C. , Bijsman , M.N. , van Gameren , Y. , Cnossen , E.P. , de Vries , J.H. , and Katan , M.B. ( 1999 ) The sugar moiety is a major determinant of the absorption of dietary fl avonoid glycosides in man . Free Radic. Res. , 31 , 569 – 573 .

23 Day , A.J. , Canada , F.J. , Diaz , J.C. , Kroon , P.A. , Mclauchlan , R. , Faulds , C.B. , Plumb , G.W. , Morgan , M.R. , and Williamson , G. ( 2000 ) Dietary fl avonoid and isofl avone glycosides are hydrolysed by the lactase site of lactase phlorizin hydrolase . FEBS Lett. , 468 , 166 – 170 .

24 Cheng , Z. , Radominska - Pandya , A. , and Tephly , T.R. ( 1999 ) Studies on the substrate specifi city of human intestinal UDP - lucuronosyltransferases 1A8 and 1A10 . Drug Metab. Dispos. , 27 , 1165 – 1170 .

25 Paine , M.F. , Hart , H.L. , Ludington , S.S. , Haining , R.L. , Rettie , A.E. , and Zeldin , D.C. ( 2006 ) The human intestinal cytochrome P450 “ pie ” . Drug Metab. Dispos. , 34 , 880 – 886 .

26 Setchell , K.D. and Clerici , C. ( 2010 ) Equol: history, chemistry, and formation . J. Nutr. , 140 , 1355S – 1362S .

27 Prior , R.L. , Wu , X. , and Gu , L. ( 2006 ) Flavonoid metabolism and challenges to understanding mechanisms of health effects . J. Sci. Food Agric. , 86 , 2487 – 2491 .

28 Nielsen , S.E. , Breinholt , V.M. , Justesen , U. , Cornett , C. , and Dragsted , L.O. ( 1998 ) In vitro biotransformation of fl avonoids by rat liver microsomes . Xenobiotica , 28 , 389 – 401 .

29 Cermak , R. and Wolffram , S. ( 2006 ) The potential of fl avonoids to infl uence drug metabolism and pharmacokinetics by local gastrointestinal mechanisms . Curr. Drug Metab. , 7 , 729 – 744 .

30 Nielsen , S.E. , Breinholt , V.M. , Cornett , C. , and Dragsted , L.O. ( 2000 ) Biotransformation of the citrus fl avone tangeretin in rats. Identifi cation of metabolites with intact fl avane nucleus . Food Chem. Toxicol , 38 , 739 – 746 .

31 Sfakianos , J. , Coward , L. , Kirk , M. , and Barnes , S. ( 1997 ) Intestinal uptake and biliary excretion of the isofl avone genistein in rats . J. Nutr. , 127 , 1260 – 1268 .

32 Kohri , T. , Nanjo , F. , Suzuki , M. , Nanjo , F. , Hara , Y. , and Oku , N. ( 2001 ) Synthesis of ( – ) - [4 - 3 H]epigallocatechin gallate and its metabolic fate in rats after intravenous administration . J. Agric. Food Chem. , 49 , 1042 – 1048 .

33 Clarke , D.B. , Lloyd , A.S. , Botting , N.P. , Oldfi eld , M.F. , Needs , P.W. , and Wiseman , H. ( 2002 ) Measurement of intact sulfate and glucuronide phytoestrogen conjugates in human urine using isotope dilution liquid chromatography – tandem mass spectrometry with [ 13 C3]isofl avone internal standards . Anal. Biochem. , 309 , 158 – 172 .

34 Chow , H. - H.S. , Cai , Y. , Albert , D.S. , Hakim , I. , Dorr , R. , Shahi , F. , Crowell , J. , Yang , C. , and Hara , Y. ( 2001 ) Phase I pharmacokinetic study of tea

576 20 Flavonoids

polyphenols following single - dose administration of epigallocatechin gallate and polyphenon E . Cancer Epidemiol. Biomark. Prev. , 10 , 53 – 58 .

35 Manach , C. , Williamson , G. , Morand , C. , Scalbert , A. , and Remesy , C. ( 2005 ) Bioavailability and bioeffi cacy of polyphenols in humans. I. Review of 97 bioavailability studies . Am. J. Clin. Nutr. , 81 , 230S – 242S .

36 Clifford , M. and Brown , J.E. ( 2006 ) Dietary fl avonoids and health – broadening the perspective , in Flavonoids: Chemistry, Biochemistry and Applications (eds Ø .M. Andersen and K.R. Markham ), CRC Press, Boca Raton, FL , pp. 320 – 344 .

37 Walle , T. ( 2009 ) Methylation of dietary fl avones increases their metabolic stability and chemopreventive effects . Int. J. Mol. Sci. , 10 , 5002 – 5019 .

38 Donovan , J.L. and Waterhouse , A.L. ( 2003 ) Bioavailability of fl avanol monomers , in Flavonoids in Health and Disease (eds L. Packer and C.A. Rice - Evans ), Dekker , New York , pp. 413 – 441 .

39 Han , X. , Shen , T. , and Lou , H. ( 2007 ) Dietary polyphenols and their biological signifi cance . Int. J. Mol. Sci. , 8 , 950 – 988 .

40 Hodek , P. , Krizkova , J. , Burdova , K. , Sulc , M. , Kizek , R. , Hudecek , J. , and Stiborova , M. ( 2009 ) Chemopreventive compounds – view from the other side . Chem. Biol. Interact. , 180 , 1 – 9 .

41 Dangles , O. and Dufour , C. ( 2006 ) Flavonoid – protein interactions , in Flavonoids: Chemistry, Biochemistry and Applications (eds Ø .M. Andersen and K.R. Markham ), CRC Press , Boca Raton, FL , pp. 443 – 464 .

42 Bolli , A. , Marino , M. , Rimbach , G. , Fanali , G. , Fasano , M. , and Ascenzi , P. ( 2010 ) Flavonoid binding to human serum albumin . Biochem. Biophys. Res. Commun. , 398 , 444 – 449 .

43 Perez - Tomas , R. ( 2006 ) Multidrug resistance: retrospect and prospects in anti - cancer drug treatment . Curr. Med. Chem. , 13 , 1859 – 1876 .

44 Zhang , S. and Morris , M.E. ( 2003 ) Effects of the fl avonoids biochanin A, morin, phloretin, and silymarin on P - glycoprotein - mediated transport .

J. Pharmacol. Exp. Ther. , 304 , 1258 – 1267 .

45 Kitagawa , S. ( 2006 ) Inhibitory effects of polyphenols on P - glycoprotein - mediated transport . Biol. Pharm. Bull. , 29 , 1 – 6 .

46 Critchfi eld , J.W. , Welsh , C.J. , Phang , J.M. , and Yeh , G.C. ( 1994 ) Modulation of adriamycin accumulation and effl ux by fl avonoids in HCT - 15 colon cells. Activation of P - glycoprotein as a putative mechanism . Biochem. Pharmacol. , 48 , 1437 – 1445 .

47 van Zanden , J.J. , van der Woude , H. , Vaessen , J. , Usta , M. , Wortelboer , H.M. , Cnubben , N.H. , and Rietjens , I.M. ( 2007 ) The effect of quercetin phase II metabolism on its MRP1 and MRP2 inhibiting potential . Biochem. Pharmacol. , 74 , 345 – 351 .

48 Imai , Y. , Tsukahara , S. , Asada , S. , and Sugimoto , Y. ( 2004 ) Phytoestrogen/fl avonoids reverse breast cancer resistance protein/ABCG2 - mediated multidrug resistance . Cancer Res. , 64 , 4346 – 4352 .

49 Katayama , K. , Masuyama , K. , Yoshioka , S. , Hasegawa , H. , Mitsuhashi , J. , and Sugimoto , Y. ( 2007 ) Flavonoids inhibit breast cancer resistance protein - mediated drug resistance: transporter specifi city and structure – activity relationship . Cancer Chemother. Pharmacol. , 60 , 789 – 797 .

50 Farabegoli , F. , Papi , A. , Bartolini , G. , Ostan , R. , and Orlandi , M. ( 2010 ) ( – ) - Epigallocatechin - 3 - gallate downregulates Pg - P and BCRP in a tamoxifen resistant MCF - 7 cell line . Phytomedicine , 17 , 356 – 362 .

51 Singh , S. , Malik , B.K. , and Sharma , D.K. ( 2007 ) Protein kinase C in prostate cancer and herbal products: a bioinformatics approach . Int. J. Integrat. Biol. , 1 , 72 – 87 .

52 Kim , J.E. , Kwon , J.Y. , Lee , D.E. , Kang , N.J. , Heo , Y.S. , Lee , K.W. , and Lee , H.J. ( 2009 ) MKK4 is a novel target for the inhibition of tumor necrosis factor - α - induced vascular endothelial growth factor expression by myricetin . Biochem. Pharmacol. , 77 , 412 – 421 .

53 Lee , K.W. , Kang , N.J. , Heo , Y.S. , Rogozin , E.A. , Pugiliese , A. , Hwang , M.K. , Bowden , G.T. , Bode , A.M. , Lee ,

References 577

H.J. , and Dong , Z. ( 2008 ) Raf and MEK protein kinases are direct molecular targets for the chemopreventive effect of quercetin, a major fl avonol in red wine . Cancer Res. , 68 , 946 – 955 .

54 Hwang , M.K. , Kang , N.J. , Heo , Y.S. , Lee , K.W. , and Lee , H.J. ( 2009 ) Fyn kinase is a direct molecular target of delphinidin for the inhibition of cyclooxygenase - 2 expression induced by tumor necrosis factoralpha . Biochem. Pharmacol. , 77 , 1213 – 1222 .

55 Lamoral - Theys , D. , Pottier , L. , Dufrasne , F. , Neve , J. , Dubois , J. , Kornienko , A. , Kiss , R. , and Ingrassia , L. ( 2010 ) Natural polyphenols that display anticancer properties through inhibition of kinase activity . Curr. Med. Chem. , 17 , 812 – 825 .

56 Hwang , J.T. , Kwon , D.Y. , and Yoon , S.H. ( 2009 ) AMP - activated protein kinase: a potential target for the diseases prevention by natural occurring polyphenols . N. Biotechnol. , 26 , 17 – 22 .

57 Wiseman , H. ( 2006 ) Isofl avonoids and human , in Flavonoids: Chemistry, Biochemistry and Applications (eds Ø .M. Andersen and K.R. Markham ), CRC Press , Boca Raton, FL , pp. 371 – 388 .

58 Kuiper , G.G. , Lemmen , J.G. , Carlsson , B. , Corton , J.C. , Safe , S.H. , van der Saag , P.T. , van der Burg , B. , and Gustafsson , J.A. ( 1998 ) Interaction of estrogenic chemicals and phytoestrogens with estrogen receptor β . Endocrinology , 139 , 4252 – 4263 .

59 Ricketts , M.L. , Moore , D.D. , Banz , W.J. , Mezei , O. , and Shay , N.F. ( 2005 ) Molecular mechanisms of action of the soy isofl avones includes activation of promiscuous nuclear receptors. A review . J. Nutr. Biochem. , 16 , 321 – 330 .

60 Wang , F. , Shing , M. , Huen , Y. , Tsang , S.Y. , and Xue , H. ( 2005 ) Neuroactive fl avonoids interacting with GABAA receptor complex . Curr. Drug Targets CNS Neurol. Disord. , 4 , 575 – 585 .

61 Wolfman , C. , Viola , H. , Paladini , A.C. , Dajas , D. , and Medina , J.H. ( 1994 ) Possible anxiolytic effects of chrysin, a central benzodiazepine receptor ligand isolated from Passifl ora coerulea . Pharmacol. Biochem. Behav. , 47 , 1 – 4 .

62 Viola , H. , Wasowski , C. , Levi de Stein , M. , Wolfman , C. , Silveira , R. , Dajas , F. ,

Medina , J.H. , and Paladini , A.C. ( 1995 ) Apigenin, a component of Matricaria recutita fl owers, is a central benzodiazepine receptors - ligand with anxiolytic effects . Plant Med. , 61 , 213 – 216 .

63 Huen , M.S. , Hui , K.M. , Leung , J.W. , Sigel , E. , Baur , R. , Wong , J.T. , and Xue , H. ( 2003 ) Naturally occurring 2 ′ - hydroxyl - substituted fl avonoids as high - affi nity benzodiazepine site ligands . Biochem. Pharmacol. , 66 , 2397 – 2407 .

64 Johnston , G.A. ( 2005 ) GABA(A) receptor channel pharmacology . Curr. Pharm. Des. , 11 , 1867 – 1885 .

65 Dekermendjian , K. , Kahnberg , P. , Witt , M.R. , Sterner , O. , Nielsen , M. , and Liljefors , T. ( 1999 ) Structure – activity relationships and molecular modeling analysis of fl avonoids binding to the benzodiazepine site of the rat brain GABA(A) receptor complex . J. Med. Chem. , 42 , 4343 – 4350 .

66 Denison , M.S. , Phelan , D. , and Elferink , C.J. ( 1998 ) The Ah receptor signal transduction pathway , in Toxicant – Receptor Interactions (eds M.S. Denison and W.G. Helferich ), Taylor & Francis , Philadelphia, PA , pp. 3 – 33 .

67 Zhang , S. , Qin , C. , and Safe , S.H. ( 2003 ) Flavonoids as aryl hydrocarbon receptor agonists/antagonists: effects of structure and cell context . Environ. Health Perspect. , 111 , 1877 – 1882 .

68 Amakura , Y. , Tsutsumi , T. , Sasaki , K. , Nakamura , M. , Yoshida , T. , and Maitani , T. ( 2008 ) Infl uence of food polyphenols on aryl hydrocarbon receptor - signaling pathway estimated by in vitro bioassay . Phytochemistry , 69 , 3117 – 3130 .

69 Ioannides , C. and Parke , D.V. ( 1993 ) Induction of cytochrome P4501 as an indicator of potential chemical carcinogenesis . Drug Metab. Rev. , 25 , 485 – 501 .

70 Hodek , P. , Trefi l , P. , and Stiborova , M. ( 2002 ) Flavonoids – potent and versatile biologically active compounds interacting with cytochromes P450 . Chem. Biol. Interact. , 139 , 1 – 21 .

71 Krizkova , J. , Burdova , K. , Hudecek , J. , Stiborova , M. , and Hodek , P. ( 2008 ) Induction of cytochromes P450 in small

578 20 Flavonoids

intestine by chemopreventive compounds . Neuro Endocrinol. Lett. , 29 , 717 – 721 .

72 Krizkova , J. , Burdova , K. , Stiborova , M. , Kren , V. , and Hodek , P. ( 2009 ) Effect of selected fl avonoids on cytochromes P450 in rat liver and small intestine . Interdisc. Toxicol. , 2 , 201 – 204 .

73 Awad , H.M. , Boersma , M.G. , Boeren , S. , van Bladeren , P.J. , Vervoort , J. , and Rietjens , I.M. ( 2001 ) Structure – activity study on the quinone/quinone methide chemistry of fl avonoids . Chem. Res. Toxicol. , 14 , 398 – 408 .

74 Shimada , T. , Tanaka , K. , Takenaka , S. , Murayama , N. , Martin , M.V. , Foroozesh , M.K. , Yamazaki , H. , Guengerich , F.P. , and Komori , M. ( 2010 ) Structure – function relationships of inhibition of human cytochromes P450 1A1, 1A2, 1B1, 2C9, and 3A4 by 33 fl avonoid derivatives . Chem. Res. Toxicol. , 23 , 1921 – 1935 .

75 Moon , Y.J. , Wang , X. , and Morris , M.E. ( 2006 ) Dietary fl avonoids: effects on xenobiotic and carcinogen metabolism . Toxicol. In Vitro , 20 , 187 – 210 .

76 Androutsopoulos , V.P. , Papakyriakou , A. , Vourloumis , D. , Tsatsakis , A.M. , and Spandidos , D.A. ( 2010 ) Dietary fl avonoids in cancer therapy and prevention: substrates and inhibitors of cytochrome P450 CYP1 enzymes . Pharmacol. Ther. , 126 , 9 – 20 .

77 Lee , H. , Yeom , H. , Kim , Y.G. , Yoon , C.N. , Jin , C. , Choi , J.S. , Kim , B.R. , and Kim , D.H. ( 1998 ) Structure - related inhibition of human hepatic caffeine N 3 - demethylation by naturally occurring fl avonoids . Biochem. Pharmacol. , 55 , 1369 – 1375 .

78 Doostdar , H. , Burke , M.D. , and Mayer , R.T. ( 2000 ) Biofl avonoids: selective substrates and inhibitors for cytochrome P450 CYP1A and CYP1B1 . Toxicology , 144 , 31 – 38 .

79 Henderson , M.C. , Miranda , C.L. , Stevens , J.F. , Deinzer , M.L. , and Buhler , D.R. ( 2000 ) In vitro inhibition of human P450 enzymes by prenylated fl avonoids from hops, Humulus lupulus . Xenobiotica , 30 , 235 – 251 .

80 Tsyrlov , I.B. , Goldfarb , I.S. , and Gelboin , H.V. ( 1993 ) Enzyme - kinetic and

immunochemical characteristics of mouse cDNA - expressed, microsomal, and purifi ed CYP1A1 and CYP1A2 . Arch. Biochem. Biophys. , 307 , 259 – 266 .

81 Borek - Dohalsk , L. , Hodek , P. , Sulc , M. , and Stiborova , M. ( 2001 ) Alpha - naphthofl avone acts as activator and reversible or irreversible inhibitor of rabbit microsomal CYP3A6 . Chem. Biol. Interact. , 138 , 85 – 106 .

82 Ueng , Y.F. , Kuwabara , T. , Chun , Y.J. , and Guengerich , F.P. ( 1997 ) Cooperativity in oxidations catalyzed by cytochrome P450 3A4 . Biochemistry , 36 , 370 – 381 .

83 Kang , I.H. , Kim , H.J. , Oh , H. , Park , Y.I. , and Dong , M.S. ( 2004 ) Biphasic effects of the fl avonoids quercetin and naringenin on the metabolic activation of 2 - amino - 3,5 - dimethylimidazo[4,5 - f ]quinoline by Salmonella typhimurium TA1538 co - expressing human cytochrome P450 1A2, NADPH - cytochrome P450 reductase, and cytochrome b 5 . Mutat. Res. , 545 , 37 – 47 .

84 Canivenc - Lavier , M.C. , Vernevaut , M.F. , Totis , M. , Siess , M.H. , Magdalou , J. , and Suschetet , M. ( 1996 ) Comparative effects of fl avonoids and model inducers on drug - metabolizing enzymes in rat liver . Toxicology , 114 , 19 – 27 .

85 Kim , H.P. , Son , K.H. , Chang , H.W. , and Kang , S.S. ( 2004 ) Anti - infl ammatory plant fl avonoids and cellular action mechanisms . J. Pharm. Sci. , 96 , 229 – 245 .

86 Kim , J.S. , Kim , J.C. , Shim , S.H. , Lee , E.J. , Jin , W. , Bae , K. , Son , K.H. , Kim , H.P. , Kang , S.S. , and Chang , H.W. ( 2006 ) Chemical constituents of the root of Dystaenia takeshimana and their anti - infl ammatory activity . Arch. Pharm. Res. , 29 , 617 – 623 .

87 Van Hoorn , D.E. , Nijveldt , R.J. , Van Leeuwen , P.A. , Hofman , Z. , M ’ Rabet , L. , De Bont , D.B. , and Van Norren , K. ( 2002 ) Accurate prediction of xanthine oxidase inhibition based on the structure of fl avonoids . Eur. J. Pharmacol. , 451 , 111 – 118 .

88 Williams , R.J. , Spencer , J.P. , and Rice - Evans , C. ( 2004 ) Flavonoids: antioxidants or signalling molecules? Free Radic. Biol. Med. , 36 , 838 – 849 .

References 579

89 Spencer , J.P.E. , Schroeter , H. , and Rice - Evans , C.A. ( 2003 ) Cytoprotective and cytotoxic effects of fl avonoids , in Flavonoids in Health and Disease (eds L. Packer and C.A. Rice - Evans ), Dekker , New York , pp. 309 – 349 .

90 Matsuo , M. , Sasaki , N. , Saga , K. , and Kaneko , T. ( 2005 ) Cytotoxicity of fl avonoids toward cultured normal human cells . Biol. Pharm. Bull. , 28 , 253 – 259 .

91 Andres , A. , Donovan , S.M. , and Kuhlenschmidt , M.S. ( 2009 ) Soy isofl avones and virus infections . J. Nutr. Biochem. , 20 , 563 – 569 .

92 Evers , D.L. , Chao , C.F. , Wang , X. , Zhang , Z. , Huong , S.M. , and Huang , E.S. ( 2005 ) Human cytomegalovirus - inhibitory fl avonoids: studies on antiviral activity and mechanism of action . Antiviral Res. , 68 , 124 – 134 .

93 Yamaguchi , K. , Honda , M. , Ikigai , H. , Hara , Y. , and Shimamura , T. ( 2002 ) Inhibitory effects of ( – ) - epigallocatechin gallate on the life cycle of human immunodefi ciency virus type 1 (HIV - 1) . Antiviral Res. , 53 , 19 – 34 .

94 Savi , L.A. , Caon , T. , de Oliveira , A.P. , Sobottka , A.M. , Werner , W. , Reginatto , F.H. , Schenkel , E.P. , Barardi , C.R. , and Sim õ es , C.M. ( 2010 ) Evaluation of antirotavirus activity of fl avonoids . Fitoterapia , 81 , 1142 – 1146 .

95 Alvarez , M.A. , Debattista , N.B. , and Pappano , N.B. ( 2008 ) Antimicrobial activity and synergism of some substituted fl avonoids . Fol. Microbiol. , 53 , 23 – 28 .

96 Saleem , M. , Nazir , M. , Ali , M.S. , Hussain , H. , Lee , Y.S. , Riaz , N. , and Jabbar , A. ( 2010 ) Antimicrobial natural products: an update on future antibiotic drug candidates . Nat. Prod. Rep. , 27 , 238 – 254 .

97 Kuete , V. , Nguemeving , J.R. , Beng , V.P. , Azebaze , A.G. , Etoa , F.X. , Meyer , M. , Bodo , B. , and Nkengfack , A.E. ( 2007 ) Antimicrobial activity of the methanolic extracts and compounds from Vismia laurentii De Wild (Guttiferae) . J. Ethnopharmacol. , 109 , 372 – 379 .

98 Sathiamoorthy , B. , Gupta , P. , Kumar , M. , Chaturvedi , A.K. , Shukla , P.K. , and Maurya , R. ( 2007 ) New antifungal

fl avonoid glycoside from Vitex negundo . Bioorg. Med. Chem. Lett. , 17 , 239 – 242 .

99 Rathee , P. , Chaudhary , H. , Rathee , S. , Rathee , D. , Kumar , V. , and Kohli , K. ( 2009 ) Mechanism of action of fl avonoids as anti - infl ammatory agents: a review . Infl amm. Allergy Drug Targets , 8 , 229 – 235 .

100 Manthey , J.A. , Grohmann , K. , Montanari , A. , Ash , K. , and Manthey , C.L. ( 1999 ) Polymethoxylated fl avones derived from citrus suppress tumor necrosis factor - α expression by human monocytes . J. Nat. Prod. , 62 , 441 – 444 .

101 Tsai , S. - H. , Liang , Y. - C. , Lin - Shiau , S. - Y. , and Lin , J. - K. ( 1999 ) Suppression of TNF α - mediated NF κ B activity by myricetin and other fl avonoids through downregulating the activity of IKK in ECV304 cells . J. Cell. Biochem. , 74 , 606 – 615 .

102 Vita , J.A. ( 2005 ) Polyphenols and cardiovascular disease: effects on endothelial and platelet function . Am. J. Clin. Nutr. , 81 , 292S – 297S .

103 Freedman , J.E. , Parker , C. , 3rd , Li , L. , Perlman , J.A. , Frei , B. , Ivanov , V. , Deak , L.R. , Iafrati , M.D. , and Folts , J.D. ( 2001 ) Select fl avonoids and whole juice from purple grapes inhibit platelet function and enhance nitric oxide release . Circulation , 103 , 2792 – 2798 .

104 Ostertag , L.M. , O ’ Kennedy , N. , Kroon , P.A. , Duthie , G.G. , and de Roos , B. ( 2010 ) Impact of dietary polyphenols on human platelet function – a critical review of controlled dietary intervention studies . Mol. Nutr. Food Res. , 54 , 60 – 81 .

105 Drewnowski , A. and Gomez - Carneros , C. ( 2000 ) Bitter taste, phytonutrients, and the consumer: a review . Am. J. Clin. Nutr. , 72 , 1424 – 1435 .

106 Bohm , B.A. ( 1998 ) Human use of fl avonoids , in Introduction to Flavonoids (ed. B.A. Bohm ), Harwood , Amsterdam , pp. 365 – 395 .

107 Le Marchand , L. ( 2002 ) Cancer preventive effects of fl avonoids – a review . Biomed. Pharmacother. , 56 , 296 – 301 .

108 Kalra , E.K. ( 2003 ) Nutraceutical – defi nition and introduction . AAPS PharmSci. , 5 , 27 – 28 .

580 20 Flavonoids

109 Ramelet , A.A. ( 2001 ) Clinical benefi ts of Dafl on 500 mg in the most severe stages of chronic venous insuffi ciency . Angiology , 52 , S49 – S56 .

110 Meyskens , F.L. , Jr and Szabo , E. ( 2005 ) Diet and cancer: the disconnect between epidemiology and randomized clinical trials . Cancer Epidemiol. Biomarkers Prev. , 14 , 1366 – 1369 .

111 Schroeter , H. , Spencer , J.P. , Rice - Evans , C. , and Williams , R.J. ( 2001 ) Flavonoids protect neurons from oxidized low - density - lipoprotein - induced apoptosis involving c - Jun N - terminal kinase (JNK), c - Jun and caspase - 3 . Biochem. J. , 358 , 547 – 557 .

112 Kale , A. , Gawande , S. , and Kotwal , S. ( 2008 ) Cancer phytotherapeutics: role for fl avonoids at the cellular level . Phytother. Res. , 22 , 567 – 577 .

113 Chan , H.Y. , Chen , Z.Y. , Tsang , D.S. , and Leung , L.K. ( 2002 ) Baicalein inhibits DMBA – DNA adduct formation by modulating CYP1A1 and CYP1B1 activities . Biomed. Pharmacother. , 56 , 269 – 275 .

114 Boyd , C.S. and Cadenas , E. ( 2003 ) Mitochondrial actions of fl avonoids and isofl avonoids , in Flavonoids in Health and Disease (eds L. Packer and C.A. Rice - Evans ), Dekker. , New York , pp. 273 – 301 .

115 Boots , A.W. , Li , H. , Schins , R.P. , Duffi n , R. , Heemskerk , J.W. , Bast , A. , and Haenen , G.R. ( 2007 ) The quercetin paradox . Toxicol. Appl. Pharmacol. , 222 , 89 – 96 .

116 Rahman , A. , Shahabuddin , A. , Hadi , S.M. , and Parish , J.H. ( 1990 ) Complexes involving quercetin, DNA and Cu(II) . Carcinogenesis , 11 , 2001 – 2003 .

117 Galati , G. and O ’ Brien , P.J. ( 2004 ) Potential toxicity of fl avonoids and other dietary phenolics: signifi cance for their chemopreventive and anticancer properties . Free Radic. Biol. Med. , 37 , 287 – 303 .

118 Hsieh , C.Y. , Santell , R.C. , Haslam , S.Z. , and Helferich , W.G. ( 1998 ) Estrogenic effects of genistein on the growth of estrogen receptor - positive human breast cancer (MCF - 7) cells in vitro and in vivo . Cancer Res. , 58 , 3833 – 3838 .

119 Gaitan , E. , Cooksey , R.C. , Legan , J. , and Lindsay , R.H. ( 1995 ) Antithyroid effects in vivo and in vitro of vitexin: a C - glucosylfl avone in millet . J. Clin. Endocrinol. Metab. , 80 , 1144 – 1147 .

120 Rom á n , G.C. ( 2007 ) Autism: transient in utero hypothyroxinemia related to maternal fl avonoid ingestion during pregnancy and to other environmental antithyroid agents . J. Neurol. Sci. , 262 , 15 – 26 .

121 Fresco , P. , Borges , F. , Diniz , C. , and Marques , M.P. ( 2006 ) New insights on the anticancer properties of dietary polyphenols . Med. Res. Rev. , 26 , 747 – 766 .

122 Schwarz , D. and Roots , I. ( 2003 ) In vitro assessment of inhibition by natural polyphenols of metabolic activation of procarcinogens by human CYP1A1 . Biochem. Biophys. Res. Commun. , 303 , 902 – 907 .

123 Stiborova , M. , Frei , E. , Hodek , P. , Wiessler , M. , and Schmeiser , H.H. ( 2005 ) Human hepatic and renal microsomes, cytochromes P450 1A1/2, NADPH : cytochrome P450 reductase and prostaglandin H synthase mediate the formation of aristolochic acid - DNA adducts found in patients with urothelial cancer . Int. J. Cancer , 113 , 189 – 197 .

124 Hodek , P. , Tepla , M. , Krizkova , J. , Sulc , M. , and Stiborova , M. ( 2009 ) Modulation of cytochrome P450 enzyme system by selected fl avonoids . Neuro Endocrinol. Lett. , 30 , S67 – S71 .

125 Conney , A.H. ( 2003 ) Enzyme induction and dietary chemicals as approaches to cancer chemoprevention: the Seventh DeWitt S. Goodman Lecture . Cancer Res. , 63 , 7005 – 7031 .

126 Gurtoo , H.L. , Koser , P.L. , Bansal , S.K. , Fox , H.W. , Sharma , S.D. , Mulhern , A.I. , and Pavelic , Z.P. ( 1985 ) Inhibition of afl atoxin B1 - hepatocarcinogenesis in rats by β - naphthofl avone . Carcinogenesis , 6 , 675 – 678 .

127 Nakagama , H. , Nakanishi , M. , and Ochiai , M. ( 2005 ) Modeling human colon cancer in rodents using a food - borne carcinogen, PhIP . Cancer Sci. , 96 , 627 – 636 .

128 Chen , Y. , Xiao , P. , Ou - Yang , D.S. , Fan , L. , Guo , D. , Wang , Y.N. , Han , Y. , Tu ,

References 581

J.H. , Zhou , G. , Huang , Y.F. , and Zhou , H.H. ( 2009 ) Simultaneous action of the fl avonoid quercetin on cytochrome P450 (CYP) 1A2, CYP2A6, N - acetyltransferase and xanthine oxidase activity in healthy volunteers . Clin. Exp. Pharmacol. Physiol. , 36 , 828 – 833 .

129 Ioannides , C. ( 2002 ) Pharmacokinetic interactions between herbal remedies and medicinal drugs . Xenobiotica , 32 , 451 – 478 .

130 Izzo , A.A. and Ernst , E. ( 2009 ) Interactions between herbal medicines and prescribed drugs: an updated systematic review . Drugs , 69 , 1777 – 1798 .

131 Schumacher , M. , Hautzinger , A. , Rossmann , A. , Holzhauser , S. , Popovic , D. , Hertrampf , A. , Kuntz , S. , Boll , M. , and Wenzel , U. ( 2010 ) Chrysin blocks topotecan - induced apoptosis in Caco - 2 cells in spite of inhibition of ABC - transporters . Biochem. Pharmacol. , 80 , 471 – 479 .

132 Obach , R.S. ( 2000 ) Inhibition of human cytochrome P450 enzymes by constituents of St. John ’ s Wort, an herbal preparation used in the treatment of depression . J. Pharmacol. Exp. Ther. , 294 , 88 – 95 .

133 Venkataramanan , R. , Ramachandran , V. , Komoroski , B.J. , Zhang , S. , Schiff , P.L. , and Strom , S.C. ( 2000 ) Milk thistle, a herbal supplement, decreases the activity of CYP3A4 and uridine diphosphoglucuronosyl transferase in human hepatocyte cultures . Drug Metab. Dispos. , 28 , 1270 – 1273 .

134 Doehmer , J. , Tewes , B. , Klein , K.U. , Gritzko , K. , Muschick , H. , and Mengs , U. ( 2008 ) Assessment of drug – drug interaction for silymarin . Toxicol. In Vitro , 22 , 610 – 617 .

135 Bailey , D.G. , Dresser , G.R. , Kreeft , J.H. , Munoz , C. , Freeman , D.J. , and Bend , J.R. ( 2000 ) Grapefruit – felodipine interaction: effect of unprocessed fruit and probable active ingredients . Clin. Pharmacol. Ther. , 68 , 468 – 477 .

136 Paine , M.F. , Widmer , W.W. , Hart , H.L. , Pusek , S.N. , Beavers , K.L. , Criss , A.B. , Brown , S.S. , Thomas , B.F. , and Watkins , P.B. ( 2006 ) A furanocoumarin - free grapefruit juice establishes

furanocoumarins as the mediators of the grapefruit juice – felodipine interaction . Am. J. Clin. Nutr. , 83 , 1097 – 1105 .

137 Bracke , M.E. , Depypere , H.T. , Boterberg , T. , Van Marck , V.L. , Vennekens , K.M. , Vanluchene , E. , Nuytinck , M. , Serreyn , R. , and Mareel , M.M. ( 1999 ) Infl uence of tangeretin on tamoxifen ’ s therapeutic benefi t in mammary cancer . J. Natl. Cancer Inst. , 91 , 354 – 359 .

138 Shen , F. , Xue , X. , and Weber , G. ( 1999 ) Tamoxifen and genistein synergistically down - regulate signal transduction and proliferation in estrogen receptor - negative human breast carcinoma MDA - MB - 435 cells . Anticancer Res. , 19 , 1657 – 1662 .

139 Wang , B. , Sanchez , R.I. , Franklin , R.B. , Evans , D.C. , and Huskey , S.E. ( 2004 ) The involvement of CYP3A4 and CYP2C9 in the metabolism of 17 alpha - ethinylestradiol . Drug Metab. Dispos. , 32 , 1209 – 1212 .

140 Schrag , M.L. , Cui , D. , Rushmore , T.H. , Shou , M. , Ma , B. , and Rodrigues , A.D. ( 2004 ) Sulfotransferase 1E1 is a low K m isoform mediating the 3 - O - sulfation of ethinyl estradiol . Drug Metab. Dispos. , 32 , 1299 – 1303 .

141 Miyano , J. , Yamamoto , S. , Hanioka , N. , Narimatsu , S. , Ishikawa , T. , Ogura , K. , Watabe , T. , Nishimura , M. , Ueda , N. , and Naito , S. ( 2005 ) Involvement of SULT1A3 in elevated sulfation of 4 - hydroxypropranolol in Hep G2 cells pretreated with beta - naphthofl avone . Biochem. Pharmacol. , 69 , 941 – 950 .

142 Jang , S.I. , Kim , H.J. , Hwang , K.M. , Jekal , S.J. , Pae , H.O. , Choi , B.M. , Yun , Y.G. , Kwon , T.O. , Chung , H.T. , and Kim , Y.C. ( 2003 ) Hepatoprotective effect of baicalin, a major fl avone from Scutellaria radix , on acetaminophen - induced liver injury in mice . Immunopharmacol. Immunotoxicol. , 25 , 585 – 594 .

143 Taur , J.S. and Rodriguez - Proteau , R. ( 2008 ) Effects of dietary fl avonoids on the transport of cimetidine via P - glycoprotein and cationic transporters in Caco - 2 and LLC - PK1 cell models . Xenobiotica , 38 , 1536 – 1550 .

582 20 Flavonoids

144 Choi , J.S. , Choi , H.K. , and Shin , S.C. ( 2004 ) Enhanced bioavailability of paclitaxel after oral coadministration with fl avone in rats . Int. J. Pharm. , 275 , 165 – 170 .

145 Wang , Y.H. , Chao , P.D.L. , Hsiu , S.L. , Wen , K.C. , and Hou , Y.C. ( 2004 ) Lethal

quercetin – digoxin interaction in pigs . Life Sci. , 74 , 1191 – 1197 .

146 Xing , J. , Chen , X. , Sun , Y. , Luan , Y. , and Zhong , D. ( 2005 ) Interaction of baicalin and baicalein with antibiotics in the gastrointestinal tract . J. Pharm. Pharmacol. , 57 , 743 – 750 .

review flavonoides

Technology

interactions of avonoids

biosynthesis of avonoids

hydroxylated avonoids

hydrophilic avonoids

natural avonoids

alkylated avonoids

plants flavonoids

nonpolar avonoids aglycones