Assessment of Hepatic Detoxification Activity: Proposal of an Improved Variant of the 13C-Methacetin Breath Test

Breath tests based on the administration of a ¹³C-labeled drug and subsequent monitoring of ¹³CO₂ in the breath (quantified as DOB – delta over baseline) liberated from the drug during hepatic CPY-dependent detoxification are important tools in liver function diagnostics. The capability of such breath tests to reliably indicate hepatic CYP performance is limited by the fact that ¹³CO₂ is not exclusively exhaled but also exchanged with other compartments of the body. In order to assess this bias caused by variations of individual systemic CO₂ kinetics we administered intravenously the test drug ¹³C-methacetin to 25 clinically liver-healthy individuals and monitored progress curves of DOB and the plasma concentration of ¹³C-methacetin. Applying compartment modelling we estimated for each individual a set of kinetic parameters characterizing the time-dependent exchange of the drug and of CO₂ with the liver and non-hepatic body compartments. This analysis revealed that individual variations in the kinetics of CO₂ may account for up to 30% deviation of DOB curve parameters from their mean at otherwise identical ¹³C-methacetin metabolization rates. In order to correct for this bias we introduced a novel detoxification score which ideally should be assessed from the DOB curve of a 2-step test (“2DOB”) which is initialized with the injection of a standard dose of ¹³C-labeled bicarbonate (in order to provide information on the actual CO₂ status of the individual) followed by injection of the ¹³C-labeled test drug (the common procedure). Computer simulations suggest that the predictive power of the proposed 2DOB breath test to reliably quantity the CYP-specific hepatic detoxification activity should be significantly higher compared to the conventional breath test.