18β-glycyrrhetyl-3-O-sulfate would be a causative agent of licorice-induced pseudoaldosteronism

Sci Rep. 2019 Feb 7;9(1):1587. doi: 10.1038/s41598-018-38182-2.

Abstract

Licorice-induced pseudoaldosteronism is a common adverse effect in traditional Japanese Kampo medicine, and 3-monoglucuronyl glycyrrhetinic acid (3MGA) was considered as a causative agent of it. Previously, we found 22α-hydroxy-18β-glycyrrhetyl-3-O-sulfate-30-glucuronide (1), one of the metabolites of glycyrrhizin (GL) in the urine of Eisai hyperbilirubinuria rats (EHBRs) treated with glycyrrhetinic acid (GA), and suggested that it is also a possible causative agent of pseudoaldosteronism. The discovery of 1 also suggested that there might be other metabolites of GA as causal candidates. In this study, we found 22α-hydroxy-18β-glycyrrhetyl-3-O-sulfate (2) and 18β-glycyrrhetyl-3-O-sulfate (3) in EHBRs' urine. 2 and 3 more strongly inhibited rat type 2 11β-hydroxysteroid dehydrogenase than 1 did in vitro. When EHBRs were orally treated with GA, GA and 1-3 in plasma and 1-3 in urine were detected; the levels of 3MGA were quite low. 2 and 3 were shown to be the substrates of organic anion transporter (OAT) 1 and OAT3. In the plasma of a patient suffering from pseudoaldosteronism with rhabdomyolysis due to licorice, we found 8.6 µM of 3, 1.3 µM of GA, and 87 nM of 2, but 1, GL, and 3MGA were not detected. These findings suggest that 18β-glycyrrhetyl-3-O-sulfate (3) is an alternative causative agent of pseudoaldosteronism, rather than 3MGA and 1.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • 11-beta-Hydroxysteroid Dehydrogenase Type 2 / antagonists & inhibitors
  • Animals
  • Dose-Response Relationship, Drug
  • Female
  • Glycyrrhiza / adverse effects*
  • Glycyrrhiza / chemistry
  • Glycyrrhizic Acid / adverse effects*
  • Glycyrrhizic Acid / chemistry
  • Glycyrrhizic Acid / isolation & purification
  • Glycyrrhizic Acid / urine
  • Kidney Tubules / drug effects
  • Kidney Tubules / metabolism
  • Liddle Syndrome / diagnosis
  • Liddle Syndrome / etiology*
  • Magnetic Resonance Spectroscopy
  • Molecular Structure
  • Rats

Substances

  • Glycyrrhizic Acid
  • 11-beta-Hydroxysteroid Dehydrogenase Type 2