Relationship: 1515



Activation of Cyp2E1 leads to Hepatocytotoxicity

Upstream event


Activation of Cyp2E1

Downstream event



Key Event Relationship Overview


AOPs Referencing Relationship


AOP Name Adjacency Weight of Evidence Quantitative Understanding
Cyp2E1 Activation Leading to Liver Cancer non-adjacent High Not Specified

Taxonomic Applicability


Term Scientific Term Evidence Link
Rodentia sp. Rodentia sp. High NCBI

Sex Applicability


Sex Evidence
Mixed High

Life Stage Applicability


Term Evidence
All life stages High

Key Event Relationship Description


Metabolism of xenobiotics by cytochrome P450 mono-oxygenases produces reactive metabolites. Under normal circumstances, these metabolites immediately become conjugated to molecules like glutathione or glucuronic acid, which facilitates their excretion. However, these metabolites can react with off-target cellular molecules, which in extreme cases (e.g., at toxic doses or following glutathione depletion during periods of oxidative stress) cause damage that results in hepatotoxicity. Typically, the unmetabolised Cyp2E1 substrates are inert, whereas their metabolites are highly cytotoxic; e.g., furan and its metabolite cis-2-butene-1,4-dial (BDA); ethanol (EtOH) and acetaldehyde; carbon tetrachloride and trichloromethyl radical (which forms the trichloromethyl peroxy radical); and, chloroform and phosgene. Lipid peroxidation in the context of Cyp2E1 has been reviewed (Caro and Cederbaum 2004). Moreover, chronic exposure to Cyp2E1 agonists depletes of conjugating enzymes and  diminishes capacity to deal with reactive metabolites in the cell.

Evidence Supporting this KER


Biological Plausibility


Strong. Metabolite-dependent toxicity and adduct formation are well known side-effects of cytochrome P450 mono-oxygenase metabolism of xenobiotics in the liver. Because primary metabolites are more reactive than the parent compound, they often create adducts to cellular proteins or DNA. In both cases, this prevents the normal functioning of the molecules. In extreme cases this will lead to hepatocytotoxicity due to: (1) the large number of adducts, (2) the loss of function of important cellular proteins and the related cellular processes, and (3) the loss of function of important genes due to DNA damage and mutation.

Empirical Evidence


Strong. There is a large amount of published data that demonstrate the cytotoxic effects of Cyp2E1 substrates following metabolic activation.

Cyp2E1 converts furan to BDA. While furan can be tolerated by cells at extremely high doses, BDA is cytotoxic at much lower doses (Kellert, et al. 2008). Furan treatment causes dose-dependent increases in hepatotoxicity in mice (Moser, et al. 2009), which can be prevented by co-treatment with a Cyp2E1 inhibitor (Fransson-Steen, et al. 1997). 

Cyp2E1 converts carbon tetrachloride to the trichloromethyl radical. Trichloromethyl radical reacts with oxygen to form the trichloromethyl peroxy radical. Carbon tetrachloride-dependent cytotoxicity is preventable by pre-treatment with cytochrome P450 inhibitors (Bechtold, et al. 1982, Letteron, et al. 1990, Martinez, et al. 1995), and is exacerbated in cells that over-express Cyp2E1 (Takahashi, et al. 2002). Carbon tetrachloride produces hepatotoxicity in wild-type mice, but not in Cyp2E1-null mice (Wong, et al. 1998).

Cyp2E1 converts chloroform to phosgene. Phosgene protein adducts are co-localized to regions of chloroform-dependent cytotoxicity (Fabrizi, et al. 2001, Ilett, et al. 1973) and protein adducts occur prior to hepatotoxicity (Stevens and Anders 1981). Chloroform-dependent hepatotoxicity increases with dose (Larson, et al. 1994) and levels of cytotoxicity are related to the rate of chloroform biotransformation by Cyp2E1 (Brown, et al. 1974).  

Blocking Cyp2E1 gene transcription (using the drug Bortezomib) blocks acetaminophen-, carbon tetrachloride-, and thioacetamide-dependent hepatotoxicity in a dose and time dependent manner (Park, et al. 2016). 


Uncertainties and Inconsistencies


While the prevailing opinion in the literature is that the toxicity of these metabolites is the result of non-genotoxic mechanisms, there are studies that argue in favour of direct genotoxic effects. It is widely thought that any observed genotoxicity is actually ‘indirect’ and is the product of oxidative stress.

Quantitative Understanding of the Linkage


Unable to determine.

Response-response Relationship




Known modulating factors


Known Feedforward/Feedback loops influencing this KER


Domain of Applicability




Bechtold, M.M., Gee, D.L., Bruenner, U., Tappel, A.L., 1982. Carbon tetrachloride-mediated expiration of pentane and chloroform by the intact rat: the effects of pretreatment with diethyl maleate, SKF-525A and phenobarbital. Toxicol. Lett. 11, 165-171.

Brown, B.R.,Jr, Sipes, I.G., Sagalyn, A.M., 1974. Mechanisms of acute hepatic toxicity: chloroform, halothane, and glutathione. Anesthesiology 41, 554-561.

Caro, A.A., Cederbaum, A.I., 2004. Oxidative stress, toxicology, and pharmacology of CYP2E1. Annu. Rev. Pharmacol. Toxicol. 44, 27-42.

Fabrizi, L., Taylor, G.W., Edwards, R.J., Boobis, A.R., 2001. Adducts of the chloroform metabolite phosgene. Adv. Exp. Med. Biol. 500, 129-132.

Fransson-Steen, R., Goldsworthy, T.L., Kedderis, G.L., Maronpot, R.R., 1997. Furan-induced liver cell proliferation and apoptosis in female B6C3F1 mice. Toxicology 118, 195-204.

Kellert, M., Brink, A., Richter, I., Schlatter, J., Lutz, W.K., 2008. Tests for genotoxicity and mutagenicity of furan and its metabolite cis-2-butene-1,4-dial in L5178Y tk+/- mouse lymphoma cells. Mutation research 657, 127-32.

Larson, J.L., Wolf, D.C., Butterworth, B.E., 1994. Induced cytolethality and regenerative cell proliferation in the livers and kidneys of male B6C3F1 mice given chloroform by gavage. Fundamental and applied toxicology : official journal of the Society of Toxicology 23, 537-43.

Letteron, P., Labbe, G., Degott, C., Berson, A., Fromenty, B., Delaforge, M., Larrey, D., Pessayre, D., 1990. Mechanism for the protective effects of silymarin against carbon tetrachloride-induced lipid peroxidation and hepatotoxicity in mice. Evidence that silymarin acts both as an inhibitor of metabolic activation and as a chain-breaking antioxidant. Biochem. Pharmacol. 39, 2027-2034.

Martinez, M., Mourelle, M., Muriel, P., 1995. Protective effect of colchicine on acute liver damage induced by CCl4. Role of cytochrome P-450. J. Appl. Toxicol. 15, 49-52.

Moser, G.J., Foley, J., Burnett, M., Goldsworthy, T.L., Maronpot, R., 2009. Furan-induced dose–response relationships for liver cytotoxicity, cell proliferation, and tumorigenicity (furan-induced liver tumorigenicity). Experimental and Toxicologic Pathology 61, 101-111.

Park, W.J., Kim, S.Y., Kim, Y.R., Park, J.W., 2016. Bortezomib alleviates drug-induced liver injury by regulating CYP2E1 gene transcription. Int. J. Mol. Med. 37, 613-622.

Stevens, J.L., Anders, M.W., 1981. Effect of cysteine, diethyl maleate, and phenobarbital treatments on the hepatotoxicity of [1H]chloroform. Chem. Biol. Interact. 37, 207-217.

Takahashi, S., Takahashi, T., Mizobuchi, S., Matsumi, M., Morita, K., Miyazaki, M., Namba, M., Akagi, R., Hirakawa, M., 2002. Increased cytotoxicity of carbon tetrachloride in a human hepatoma cell line overexpressing cytochrome P450 2E1. J. Int. Med. Res. 30, 400-405.