Metabolism and transport of bile salts in the intestine

Physiologically Based Biopharmaceutics Model for Selumetinib Food Effect Investigation and Capsule Dissolution Safe Space - Part I: Adults

OBJECTIVE

A physiologically based biopharmaceutics model (PBBM) was developed to mechanistically investigate the effect of formulation and food on selumetinib pharmacokinetics.

METHODS

Selumetinib is presented as a hydrogen sulfate salt, and in vitro and in vivo data were used to verify the precipitation rate to apply to simulations. Dissolution profiles observed for capsules and granules were used to derive product-particle size distributions for model input. The PBBM incorporated gut efflux and first-pass gut metabolism, based on intravenous and oral pharmacokinetic data, alongside in vitro data for the main enzyme isoform and P-glycoprotein efflux. The PBBM was validated across eight clinical scenarios.

RESULTS

The quality-control dissolution method for selumetinib capsules was found to be clinically relevant through PBBM validation. A safe space for capsule dissolution was established using a virtual batch. The effect of food (low fat vs high fat) on capsules and granules was elucidated by the PBBM. For capsules, a lower amount was dissolved in the fed state due to a pH increase in the stomach followed by higher precipitation in the small intestine. First-pass gut extraction is higher for capsules in the fed state due to drug dilution in the stomach chyme and reduced concentration in the lumen. The enteric-coated granules dissolve more slowly than capsules after stomach emptying, attenuating the difference in first-pass gut extraction between prandial states.

CONCLUSIONS

The PBBM was instrumental in understanding and explaining the different behaviors of the selumetinib formulations. The model can be used to predict the impact of food in humans.

Cholestyramine feeding lowers number of colonic apoptotic cells in rat

Secondary bile acids that are formed in the colon by bacterial action have the potential property of eliciting pathological conditions. Apoptosis of mucosal epithelial cells is recognized as an adaptation that may counteract such pathologies. Cholestyramine, an anion exchange resin that sequesters bile salts in the gut, could decrease levels of secondary bile salt stress and thus conserve the potency of the protective action. Two groups of rats were studied: those fed 4% cholestyramine and those fed regular rat food. Rats were fed cholestyramine for 7, 14, 21, or 28 d. All animals were evaluated for cell death (apoptosis) using in situ TUNEL staining, and confirmed with single-stranded DNA (ssDNA). The effect of cholestyramine on the proliferating cell nuclear antigen (PCNA) in colonic crypt cells was also examined. Our data shows that animals fed cholestyramine for 28 d show evidence of a significant decrease in the levels of apoptotic cells in their large intestines, particularly goblet cells, when compared with the control animals and no change in cell proliferation. Thus, cholestyramine may serve as an alternative in attenuating apoptosis associated with inflammatory disorders that can result in significant enterocyte and goblet-cell death.

Structural biology and function of solute transporters: implications for identifying and designing substrates

Solute carrier (SLC) proteins have critical physiological roles in nutrient transport and may be utilized as a mechanism to increase drug absorption. However, we have little understanding of these proteins at the molecular level due to the absence of high-resolution crystal structures. Numerous efforts have been made in characterizing the peptide transporter (PepT1) and the apical sodium dependent bile acid transporter (ASBT) that are important for both their native transporter function as well as targets to increase absorption and act as therapeutic targets. In vitro and computational approaches have been applied to gain some insight into these transporters with some success. This represents an opportunity for optimizing molecules as substrates for the solute transporters and providing a further screening system for drug discovery. Clearly the future growth in knowledge of SLC function will be led by integrated in vitro and in silico approaches.

Modeling of active transport systems

Transport proteins have critical physiological roles in nutrient transport and may be utilized as a mechanism to increase drug absorption. However, we have little understanding of these proteins at the molecular level due to the absence of high-resolution crystal structures. Numerous efforts have been made to characterize the P-glycoprotein efflux pump, the peptide transporter (PepT1) and the apical sodium-dependent transporter (ASBT) which are important not only for their native transporter function but also as drug targets to increase absorption and bioactivity. In vitro and computational approaches have been applied to gain some insight into these transporters with some success. This represents an opportunity for optimizing molecules as substrates for the solute transporters and providing a further screening system for drug discovery. Clearly the future growth in knowledge of transporter function will be led by integrated in vitro and in silico approaches.

Pentagastrin increases pepsin secretion without increasing its fractional synthetic rate

We studied the effects of increasing doses of pentagastrin on gastric secretion of pepsin and on incorporation of L-[1-13C]leucine into gastric aspirate protein as an index of pepsin synthesis. Pentagastrin (0.25-4.0 micrograms.kg-1.h-1) significantly increased pepsin output from basal 76 mg/h to < or = 181 mg/h but did not significantly alter incorporation of L-[1-13C]leucine from the basal fractional synthetic rate of 3.63 +/- 0.05%/h. In four subjects in whom infusion of tracer leucine was continued for > 1 day, aspiration of pepsin between 24 and 27 h demonstrated that plateau 13C labeling of leucine in pepsin had been attained, but at a value that was only 48% of the 13C labeling of plasma alpha-ketoisocaproic acid (alpha-KIC) [0.730 +/- 0.02 (SE) vs. 1.520 +/- 0.14 atoms %excess]. This suggests that actual rates of pepsin synthesis were approximately double those calculated on the basis of alpha-KIC labeling. The results are consistent with an interpretation that increasing doses of pentagastrin cause increased secretion of pepsinogen by recruitment of gastric chief cells, each synthesizing pepsinogen at an unaltered rate. Plateau 13C enrichment of alpha-KIC may not be a valid surrogate for plateau 13C leucine enrichment when fractional synthetic rates of some secreted proteins are calculated.

Evaluation of the bile acid transporter in enhancing intestinal permeability to renin-inhibitory peptides

To evaluate the bile acid transporter as a means of enhancing the ability of renin-inhibitory peptides (RIPs) to penetrate the intestinal mucosa, two RIP-cholic acid conjugates and an RIP-taurocholic acid conjugate were synthesized. Conjugation was through the N-terminus of an RIP and the 3-position of the bile acid, via a six-carbon spacer. An RIP derivative containing the spacer without the bile acid moiety was also synthesized. The bile acid-RIP conjugates and the RIP derivative were shown to be potent inhibitors of human renin in vivo and to have in vivo hypotensive activity equivalent to that of the parent RIP (ditekiren) in a human renin-infused rat model. The ability of these RIP derivatives to bind to the bile acid transporter and be transported across an epithelial cell monolayer was evaluated in an in vitro model of the intestinal mucosa consisting of Caco-2 cell monolayers grown on microporous membranes. One of the RIP-cholic acid conjugate (KI = 60 +/- 10 microM) and the RIP-taurocholic acid conjugate (KI = 19 +/- 5 microM), but not the RIP derivative, were shown to be potent inhibitors of the apical (AP) to basolateral (BL) transport of [14C]-taurocholic acid ([14C]-TA). At concentrations up to 250 microM these RIP-bile acid conjugates had no effect on the diffusion of [3H]-PEG (800-1000), which is a marker of the paracellular pathway. The permeability coefficients of the RIP-bile acid conjugates, determined using Caco-2 cell monolayers, were shown to be six times less than that of [3H]-PEG (800-1000). In addition, the transport of one of the RIP-cholic acid conjugates was investigated in perfused rat ileum in which the mesenteric vein was cannulated. The conjugate was not detected in blood samples taken from the mesenteric vein, while its concentration in intestinal perfusate remained almost constant during the perfusion experiment. These results suggest that while the peptide-bile acid conjugates retain binding affinity for the intestinal bile acid transporter, the molecules are not themselves transported.

Utilizing bile acid carrier mechanisms to enhance liver and small intestine absorption

On the basis of the enterohepatocycling phenomenon of bile acids involving the intestines, liver, and gallbladder, it was conceptualized that bile acids could serve as a molecular carrier of drugs by taking advantage of the bile acid active transport mechanism. It was further proposed that derivatization or analogation of bile acids at the C3-OH position was the desired route because of the reactive hydroxyl group and, moreover, because of the active transport requirement of retaining the C17 side chain with a single terminal acidic function. Using 3-tosylcholic, 3-benzoylcholic, and 3-iodocholic acids, in situ liver absorption, biliary excretion, and intestinal absorption studies in the rat were successful in establishing the concept that C3-derivatives and analogs of bile acids are, potentially, novel molecular delivery systems for intestinal and liver-site directed absorption.

Effect of intestinal location on growth and function of neomucosa

Growing intestinal neomucosa in patched intestinal defects has been investigated as a means of permanently increasing the absorptive capacity in the short bowel syndrome. Several factors, including luminal contents, appear to affect the growth and function of the neomucosa. The purpose of this study was to compare function and rate of growth of neomucosa in patched defects of the jejunum and ileum. In both the jejunum and ileum of 11 New Zealand white male rabbits 2 X 5-cm patched intestinal defects were created using the serosal surface of adjacent colon. The animals were sacrificed at 4 weeks (n = 6) and 8 weeks (n = 5) after operation. Grossly there was more complete coverage of the defect by neomucosa in the ileum at both 4 and 8 weeks (99.1 +/- 1.1% vs 92.6 +/- 6.3% overall P less than 0.005). Villous height of the ileal neomucosa was similar to normal mucosa at 8 weeks (209 +/- 21 vs 244 +/- 18 m) but was significantly less in the jejunum (209 +/- 16 vs 273 +/- 16 m, P less than 0.005). Glucose uptake by neomucosa was greater in the ileum than the jejunum (3.34 +/- .84 vs 2.39 +/- .46 nmole/min/mg, P less than 0.05) but was similar to normal mucosa at both sites. Disaccharidase activity (lactase, sucrase, and maltase) was similar in both jejunum and ileum but was significantly less in ileal neomucosa than in normal mucosa (P less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Extended dissection of the portahepatis and creation of an intussuscepted ileocolic conduit for biliary atresia

This paper introduces a new operation for biliary atresia that establishes successful biliary drainage by extending the portahepatic dissection, and decreases ascending cholangitis by incorporating a nonrefluxing intussuscepted draining conduit. An analysis of the postoperative results is presented. The usual dissection of the portahepatis is extended to include the area between and beneath the branches of the right portal vein to incorporate all potentially usable remnants of the intrahepatic ducts. Ascending cholangitis is decreased by interposing an intussuscepted ileocolic segment between the portahepatis and the abdominal wall. This extended dissection of the portahepatis was performed since 1978 in 15 infants with noncorrectable biliary atresia, and bile drainage was achieved in all. In ten infants an intussuscepted ileocolic conduit was constructed. Ascending cholangitis in these ten infants has been either completely absent or easily controlled by antibiotics. The draining bile was highly concentrated due to the water-absorbing capacity of the interposed colonic segment; therefore, fluid and electrolyte disturbances, which develop frequently in patients having jejunal conduits, have never been encountered.

Bile acid absorption kinetics in Crohn's disease on elemental diet after oral administration of a stable-isotope tracer with chenodeoxycholic-11, 12-d2 acid

A non-radioactive tracer, deuterium, incorporated in chenodeoxycholic acid, was used to study bile acid absorption kinetics employing gas chromatography-mass fragmentography for its analysis. Eight patients with Crohn's disease and four control volunteers were administered chenodeoxycholic-11, 12-d2 acid. In order to obtain constant dietary conditions, they were fed by an elemental diet during the study. There were significant reductions of the biological half-life of chenodeoxycholic-11, 12-d2 acid, the pool size of chenodeoxycholic acid, and the total bile acid pool size in patients with Crohn's disease as compared with those in normal subjects. There was a marked increase in the relative concentration of ursodeoxycholic acid with a concomitant decrease of deoxycholic acid in patients with Crohn's disease, although such differences did not reach statistical significance. The present study confirms that there are some impairments of enterohepatic circulation of bile acids in patients with Crohn's disease.

Diurnal variation of rat liver enzymes catalyzing bile acid conjugation and sulfation

This study investigated the diurnal variation in the activity of the hepatic enzymes catalyzing conjugation and sulfation of bile acids. A circadian rhythm was noted in cholic acid : CoA ligase and glycolithocholate sulfotransferase activity. There was no diurnal variation in lithocholate sulfotransferase activity raising the possibility of multiple bile acid sulfotransferases in liver.

Excretion of bile acids in healthy children and children with cystic fibrosis

Urinary bile acid excretion was investigated in twenty-two patients with cystic fibrosis (CF) and in seven healthy children. CF patients with and without antibiotic treatment were compared. Bile acids were determined in 24-h samples after separation into unconjugated, glycine conjugated, taurine conjugated and sulphate conjugated bile acids. In total twenty bile acids were identified of which cholic, chenodeoxycholic, 3 beta-hydroxy-5-cholenoic acid and 24-nor-5 beta-cholan-23-oic acid were routinely present in samples collected from both CF patients and healthy children. None of the other bile acids were preferentially excreted by CF patients. When compared with the normal group, no statistical significance could be attached to the increased total urinary bile acids excreted by the CF patients (due to the large individual variations). The CF patients excreted increased amounts of cholic acid, 3 alpha, 7 beta, 12 alpha-and 3 beta, 7 beta, 12 alpha-trihydroxy-5 beta-cholanoic acids mainly in the unconjugated state. After administration of 24-[14C]cholic acid to thirteen CF patients the isotope excretion in faeces and urine was studied. Most of the patients had a high faecal excretion indicating great losses of bile acids from enterohepatic circulation. Compared to normal adults CF children excreted isotope in increased amounts in the urine.

Bile salt metabolism. I. The physiology of bile salts

Bile salts are synthesized in the liver from cholesterol, conjugated with glycine or taurine and secreted in bile with cholesterol and lecithin. The molar concentrations of these three lipids determine solubility of cholesterol in bile. Within the gastrointestinal lumen bile salts play an essential role in lipid absorption and faty transport. An efficienct entero-hepatic circulation maintains hepatic bile salt secretion and provides a "feed-back" control of the bile salt and cholesterol metabolism. Potentially hepatotoxic lithocholic acid formed in the intestinal lumen by bacterial action on chenodeoxycholic acid is sulphated in the liver thus decreasing intestinal reabsorption. The total faecal excretion of bile salts balances hepatic synthesis and represents a major catabolic path in cholesterol metabolism.