CYP-mediated drug metabolism in the brain impacts drug response

The functional role of cytochrome P450 (CYP) enzymes in the brain is an exciting and evolving field of research. CYPs are present and active in the brain, with heterogeneous patterns of expression, activity, and sensitivity to modulation across cell types, regions, and species. Despite total brain CYP expression being a fraction of hepatic CYP expression, the expanding literature of in vitro and in vivo experiments has provided evidence that brain CYPs can impact acute and chronic drug response, susceptibility to damage by neurotoxins, and are associated with altered personality, behaviour, and risk of neurological disease. They may also play a role in endogenous neurotransmitter and neurosteroid homeostasis. This review goes through the characterization of brain CYPs across species, the patterns of susceptibility of brain CYPs to exogenous induction, and recent preclinical evidence of the potential role of brain CYPs in vivo (e.g. CYP2D), along with the development of experiment paradigms that allow modulation of brain CYP activity without affecting CYP activity in the liver. Understanding brain CYP function, and changes therein, may provide unique strategies for the development of CNS-acting therapeutics metabolized locally in the brain, as well as therapeutics to target brain CYPs directly.