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Xie Y, Shao Y, Gong X, Wang M, Chen Y. Evaluation of P-glycoprotein-targeting circulating microRNAs as peripheral biomarkers for medically intractable epilepsy. ACTA EPILEPTOLOGICA 2023. [DOI: 10.1186/s42494-022-00116-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Abstract
Background
Early diagnosis of medically intractable epilepsy is challenging in clinical work. P-glycoprotein (P-gp) is one of the most important multidrug efflux transporters, which has been demonstrated to contribute to the drug resistance of intractable epilepsy. The present study was aimed to explore the diagnostic value of microRNAs (miRNAs) targeting P-gp for medically intractable epilepsy.
Methods
Thirty-six patients with intractable epilepsy and 36 epilepsy patients responsive to anti-epilepsy drugs, who visited Jinshan Hospital of Fudan University from September 2014 to September 2016, were enrolled in this study. Clinical information of the patients was obtained by retrospectively reviewing medical records. MiRNAs with differential serum expression between the two groups of patients were detected by microarray assay. Meanwhile, miRNAs that were confirmed to regulate P-gp in vitro by western blot were selected for further validation. In the validation phase, reverse transcription quantitative PCR (RT-qPCR) was conducted to confirm the differential expression of the candidate miRNAs in the epilepsy cohorts. Receiver operating characteristic (ROC) curve analysis was carried out to evaluate the diagnostic value of the miRNAs for intractable epilepsy.
Results
Three miRNAs including miR-6514-3p, miR-6076-5p, and miR-6855-3p were identified to be candidate miRNAs by microarray assay. The results of western blotting validated that miR-146a-5p and miR-138-5p could regulate P-gp expression in vitro, so they were included in the candidate miRNAs for further validation. In the validation phase, the results of RT-qPCR indicated that compared with drug-responsive patients, the patients with intractable epilepsy showed decreased level of miR-138-5p and increased level of miR-146a-5p. The results of ROC curve analysis indicated that miR-138-5p (AUC = 0.877) and miR-146a-5p (AUC = 0.866) had high diagnostic value for intractable epilepsy. In addition, the miR-panel composed of miR-138-5p and miR-146a-5p showed higher diagnostic value (AUC = 0.926) than the miRNAs selected by microarray assay.
Conclusions
Our results indicated that the dysregulated miR-138-5p and miR-146a-5p which target P-gp expression have high potential as peripheral biomarkers for medically intractable epilepsy.
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Taggi V, Riera Romo M, Piquette-Miller M, Meyer zu Schwabedissen HE, Neuhoff S. Transporter Regulation in Critical Protective Barriers: Focus on Brain and Placenta. Pharmaceutics 2022; 14:pharmaceutics14071376. [PMID: 35890272 PMCID: PMC9319476 DOI: 10.3390/pharmaceutics14071376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/14/2022] [Accepted: 06/24/2022] [Indexed: 01/06/2023] Open
Abstract
Drug transporters play an important role in the maintenance of chemical balance and homeostasis in different tissues. In addition to their physiological functions, they are crucial for the absorption, distribution, and elimination of many clinically important drugs, thereby impacting therapeutic efficacy and toxicity. Increasing evidence has demonstrated that infectious, metabolic, inflammatory, and neurodegenerative diseases alter the expression and function of drug transporters. However, the current knowledge on transporter regulation in critical protective barriers, such as the brain and placenta, is still limited and requires more research. For instance, while many studies have examined P-glycoprotein, it is evident that research on the regulation of highly expressed transporters in the blood–brain barrier and blood–placental barrier are lacking. The aim of this review is to summarize the currently available literature in order to better understand transporter regulation in these critical barriers.
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Affiliation(s)
- Valerio Taggi
- Biopharmacy, Department of Pharmaceutical Sciences, University of Basel, 4056 Basel, Switzerland; (V.T.); (H.E.M.z.S.)
| | - Mario Riera Romo
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada; (M.R.R.); (M.P.-M.)
| | - Micheline Piquette-Miller
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada; (M.R.R.); (M.P.-M.)
| | | | - Sibylle Neuhoff
- Certara UK Ltd., Simcyp Division, Sheffield S1 2BJ, UK
- Correspondence:
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Vázquez M, Fagiolino P. The role of efflux transporters and metabolizing enzymes in brain and peripheral organs to explain drug-resistant epilepsy. Epilepsia Open 2021; 7 Suppl 1:S47-S58. [PMID: 34560816 PMCID: PMC9340310 DOI: 10.1002/epi4.12542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 09/07/2021] [Accepted: 09/15/2021] [Indexed: 11/08/2022] Open
Abstract
Drug‐resistant epilepsy has been explained by different mechanisms. The most accepted one involves overexpression of multidrug transporters proteins at the blood brain barrier and brain metabolizing enzymes. This hypothesis is one of the main pharmacokinetic reasons that lead to the lack of response of some antiseizure drug substrates of these transporters and enzymes due to their limited entrance into the brain and limited stay at the sites of actions. Although uncontrolled seizures can be the cause of the overexpression, some antiseizure medications themselves can cause such overexpression leading to treatment failure and thus refractoriness. However, it has to be taken into account that the inductive effect of some drugs such as carbamazepine or phenytoin not only impacts on the brain but also on the rest of the body with different intensity, influencing the amount of drug available for the central nervous system. Such induction is not only local drug concentration but also time dependent. In the case of valproic acid, the deficient disposition of ammonia due to a malfunction of the urea cycle, which would have its origin in an intrinsic deficiency of L‐carnitine levels in the patient or by its depletion caused by the action of this antiseizure drug, could lead to drug‐resistant epilepsy. Many efforts have been made to change this situation. In order to name some, the administration of once‐daily dosing of phenytoin or the coadministration of carnitine with valproic acid would be preferable to avoid iatrogenic refractoriness. Another could be the use of an adjuvant drug that down‐regulates the expression of transporters. In this case, the use of cannabidiol with antiseizure properties itself and able to diminish the overexpression of these transporters in the brain could be a novel therapy in order to allow penetration of other antiseizure medications into the brain.
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Affiliation(s)
- Marta Vázquez
- Pharmaceutical Sciences Department, Faculty of Chemistry, Universidad de la República, Montevideo, Uruguay
| | - Pietro Fagiolino
- Pharmaceutical Sciences Department, Faculty of Chemistry, Universidad de la República, Montevideo, Uruguay
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Czornyj L, Auzmendi J, Lazarowski A. Transporter hypothesis in pharmacoresistant epilepsies Is it at the central or peripheral level? Epilepsia Open 2021; 7 Suppl 1:S34-S46. [PMID: 34542938 PMCID: PMC9340303 DOI: 10.1002/epi4.12537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 12/22/2022] Open
Abstract
The multidrug‐resistance (MDR) phenotype is typically observed in patients with refractory epilepsy (RE) whose seizures are not controlled despite receiving several combinations of more than two antiseizure medications (ASMs) directed against different ion channels or neurotransmitter receptors. Since the use of bromide in 1860, more than 20 ASMs have been developed; however, historically ~30% of cases of RE with MDR phenotype remains unchanged. Irrespective of metabolic biotransformation, the biodistribution of ASMs and their metabolites depends on the functional expression of some ATP‐binding cassette transporters (ABC‐t) in different organs, such as the blood‐brain barrier (BBB), bowel, liver, and kidney, among others. ABC‐t, such as P‐glycoprotein (P‐gp), multidrug resistance–associated protein (MRP‐1), and breast cancer–resistance protein (BCRP), are mainly expressed in excretory organs and play a critical role in the pharmacokinetics (PK) of all drugs. The transporter hypothesis can explain pharmacoresistance to a broad spectrum of ASMs, even when administered simultaneously. Since ABC‐t expression can be induced by hypoxia, inflammation, or seizures, a high frequency of uncontrolled seizures increases the risk of RE. These stimuli can induce ABC‐t expression in excretory organs and in previously non‐expressing (electrically responsive) cells, such as neurons or cardiomyocytes. In this regard, an alternative mechanism to the classical pumping function of P‐gp indicates that P‐gp activity can also produce a significant reduction in resting membrane potential (ΔΨ0 = −60 to −10 mV). P‐gp expression in neurons and cardiomyocytes can produce membrane depolarization and participate in epileptogenesis, heart failure, and sudden unexpected death in epilepsy. On this basis, ABC‐t play a peripheral role in controlling the PK of ASMs and their access to the brain and act at a central level, favoring neuronal depolarization by mechanisms independent of ion channels or neurotransmitters that current ASMs cannot control.
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Affiliation(s)
- Liliana Czornyj
- Neurology Service, "Juan P. Garrahan" National Children's Hospital, Buenos Aires, Argentina
| | - Jerónimo Auzmendi
- Institute for Research in Physiopathology and Clinical Biochemistry (INFIBIOC), Clinical Biochemistry Department, School of Pharmacy and Biochemistry, University of Buenos Aires, Buenos Aires, Argentina.,National Council for Scientific and Technical Research (CONICET), Buenos Aires, Argentina
| | - Alberto Lazarowski
- Institute for Research in Physiopathology and Clinical Biochemistry (INFIBIOC), Clinical Biochemistry Department, School of Pharmacy and Biochemistry, University of Buenos Aires, Buenos Aires, Argentina
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New Evidence for P-gp-Mediated Export of Amyloid-β PEPTIDES in Molecular, Blood-Brain Barrier and Neuronal Models. Int J Mol Sci 2020; 22:ijms22010246. [PMID: 33383667 PMCID: PMC7795149 DOI: 10.3390/ijms22010246] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/23/2020] [Accepted: 12/25/2020] [Indexed: 12/17/2022] Open
Abstract
Defective clearance mechanisms lead to the accumulation of amyloid-beta (Aβ) peptides in the Alzheimer’s brain. Though predominantly generated in neurons, little is known about how these hydrophobic, aggregation-prone, and tightly membrane-associated peptides exit into the extracellular space where they deposit and propagate neurotoxicity. The ability for P-glycoprotein (P-gp), an ATP-binding cassette (ABC) transporter, to export Aβ across the blood-brain barrier (BBB) has previously been reported. However, controversies surrounding the P-gp–Aβ interaction persist. Here, molecular data affirm that both Aβ40 and Aβ42 peptide isoforms directly interact with and are substrates of P-gp. This was reinforced ex vivo by the inhibition of Aβ42 transport in brain capillaries from P-gp-knockout mice. Moreover, we explored whether P-gp could exert the same role in neurons. Comparison between non-neuronal CHO-APP and human neuroblastoma SK-N-SH cells revealed that P-gp is expressed and active in both cell types. Inhibiting P-gp activity using verapamil and nicardipine impaired Aβ40 and Aβ42 secretion from both cell types, as determined by ELISA. Collectively, these findings implicate P-gp in Aβ export from neurons, as well as across the BBB endothelium, and suggest that restoring or enhancing P-gp function could be a viable therapeutic approach for removing excess Aβ out of the brain in Alzheimer’s disease.
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Juvale IIA, Che Has AT. Possible interplay between the theories of pharmacoresistant epilepsy. Eur J Neurosci 2020; 53:1998-2026. [PMID: 33306252 DOI: 10.1111/ejn.15079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 11/22/2020] [Accepted: 12/04/2020] [Indexed: 02/06/2023]
Abstract
Epilepsy is one of the oldest known neurological disorders and is characterized by recurrent seizure activity. It has a high incidence rate, affecting a broad demographic in both developed and developing countries. Comorbid conditions are frequent in patients with epilepsy and have detrimental effects on their quality of life. Current management options for epilepsy include the use of anti-epileptic drugs, surgery, or a ketogenic diet. However, more than 30% of patients diagnosed with epilepsy exhibit drug resistance to anti-epileptic drugs. Further, surgery and ketogenic diets do little to alleviate the symptoms of patients with pharmacoresistant epilepsy. Thus, there is an urgent need to understand the underlying mechanisms of pharmacoresistant epilepsy to design newer and more effective anti-epileptic drugs. Several theories of pharmacoresistant epilepsy have been suggested over the years, the most common being the gene variant hypothesis, network hypothesis, multidrug transporter hypothesis, and target hypothesis. In our review, we discuss the main theories of pharmacoresistant epilepsy and highlight a possible interconnection between their mechanisms that could lead to the development of novel therapies for pharmacoresistant epilepsy.
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Affiliation(s)
- Iman Imtiyaz Ahmed Juvale
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Ahmad Tarmizi Che Has
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
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The Interplay of ABC Transporters in Aβ Translocation and Cholesterol Metabolism: Implicating Their Roles in Alzheimer's Disease. Mol Neurobiol 2020; 58:1564-1582. [PMID: 33215389 DOI: 10.1007/s12035-020-02211-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/13/2020] [Indexed: 02/06/2023]
Abstract
The occurrence of Alzheimer's disease (AD) worldwide has been progressively accelerating at an alarming rate, without any successful therapeutic strategy for the disease mitigation. The complexity of AD pathogenesis needs to be targeted with an alternative approach, as provided by the superfamily of ATP-binding cassette (ABC) transporters, which constitutes an extensive range of proteins, capable of transporting molecular entities across biological membranes. These protein moieties have been implicated in AD, based upon their potential in lipid transportation, resulting in maintenance of cholesterol homeostasis. These transporters have been reported to target the primary hallmark of AD pathogenesis, namely, beta-amyloid hypothesis, which is associated with accumulation of beta-amyloid (Aβ) plaques in AD patients. The ABC transporters have been observed to be localized to the capillary endothelial cells of the blood-brain barrier and neural parenchymal cells, where they exhibit different roles, consequently influencing the neuronal expression of Aβ peptides. The review highlights different families of ABC transporters, ABCB1 (P-glycoprotein), ABCA (ABCA1, ABCA2, and ABCA7), ABCG2 (BCRP; breast cancer resistance protein), ABCG1 and ABCG4, as well as ABCC1 (MRP; multidrug resistance protein) in the CNS, and their interplay in regulating cholesterol metabolism and Aβ peptide load in the brain, simultaneously exerting protective effects against neurotoxic substrates and xenobiotics. The authors aim to establish the significance of this alternative approach as a novel therapeutic target in AD, to provide the researchers an opportunity to evaluate the potential aspects of ABC transporters in AD treatment.
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Koetzier SC, van Langelaar J, Blok KM, van den Bosch TPP, Wierenga-Wolf AF, Melief MJ, Pol K, Siepman TA, Verjans GMGM, Smolders J, Lubberts E, de Vries HE, van Luijn MM. Brain-homing CD4 + T cells display glucocorticoid-resistant features in MS. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:7/6/e894. [PMID: 33037101 PMCID: PMC7577536 DOI: 10.1212/nxi.0000000000000894] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/20/2020] [Indexed: 12/20/2022]
Abstract
Objective To study whether glucocorticoid (GC) resistance delineates disease-relevant T helper (Th) subsets that home to the CNS of patients with early MS. Methods The expression of key determinants of GC sensitivity, multidrug resistance protein 1 (MDR1/ABCB1) and glucocorticoid receptor (GR/NR3C1), was investigated in proinflammatory Th subsets and compared between natalizumab-treated patients with MS and healthy individuals. Blood, CSF, and brain compartments from patients with MS were assessed for the recruitment of GC-resistant Th subsets using fluorescence-activated cell sorting (FACS), quantitative polymerase chain reaction (qPCR), immunohistochemistry, and immunofluorescence. Results An MS-associated Th subset termed Th17.1 showed a distinct GC-resistant phenotype as reflected by high MDR1 and low GR expression. This expression ratio was further elevated in Th17.1 cells that accumulated in the blood of patients with MS treated with natalizumab, a drug that prevents their entry into the CNS. Proinflammatory markers C-C chemokine receptor 6, IL-23R, IFN-γ, and GM-CSF were increased in MDR1-expressing Th17.1 cells. This subset predominated the CSF of patients with early MS, which was not seen in the paired blood or in the CSF from patients with other inflammatory and noninflammatory neurologic disorders. The potential of MDR1-expressing Th17.1 cells to infiltrate brain tissue was confirmed by their presence in MS white matter lesions. Conclusion This study reveals that GC resistance coincides with preferential CNS recruitment of pathogenic Th17.1 cells, which may hamper the long-term efficacy of GCs in early MS.
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Affiliation(s)
- Steven C Koetzier
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Jamie van Langelaar
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Katelijn M Blok
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Thierry P P van den Bosch
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Annet F Wierenga-Wolf
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Marie-José Melief
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Kim Pol
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Theodora A Siepman
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Georges M G M Verjans
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Joost Smolders
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Erik Lubberts
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Helga E de Vries
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands
| | - Marvin M van Luijn
- From the Departments of Immunology (S.C.K., J.v.L., A.F.W.-W., M.-J.M., K.P., J.S., M.M.v.L.); Neurology (K.M.B, T.A.S., J.S.); Pathology (T.P.P.v.d.B.); Viroscience (G.M.G.M.V.); Rheumatology (E.L.); and MS Center ErasMS at Erasmus MC (S.C.K, J.v.L., K.M.B., A.F.W.-W, M.-J.M., K.P., T.A.S., J.S., M.M.v.L.), University Medical Center, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonosis (G.M.G.M.V.), University of Veterinary Medicine, Hannover, Germany; Department of Neuroimmunology (J.S.), Netherlands Institute for Neuroscience, Amsterdam; Department of Molecular Cell Biology and Immunology (H.E.d.V.), Amsterdam University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, the Netherlands.
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9
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Ilyas-Feldmann M, Asselin MC, Wang S, McMahon A, Anton-Rodriguez J, Brown G, Hinz R, Duncan JS, Sisodiya SM, Koepp M. P-glycoprotein overactivity in epileptogenic developmental lesions measured in vivo using (R)-[ 11 C]verapamil PET. Epilepsia 2020; 61:1472-1480. [PMID: 32627849 DOI: 10.1111/epi.16581] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Overexpression of the drug transporter P-glycoprotein (P-gp) is thought to be involved in drug-resistance in epilepsy by extrusion of antiepileptic drugs (AEDs). We used positron emission tomography (PET) and the P-gp substrate radiotracer (R)-[11 C]verapamil (VPM) together with the third-generation P-gp inhibitor tariquidar (TQD) to evaluate P-gp function in individuals with drug-resistant epileptogenic developmental lesions. METHODS Twelve healthy controls (7 male, median age 45, range 35-55 years), and two patients with epileptogenic developmental lesions (2 male, aged 24 and 62 years) underwent VPM-PET scans before and 60 minutes after a 30-minute infusion of 2 and 3 mg/kg TQD. The influx rate constant, VPM-K1 , was estimated from the first 10 minutes of dynamic data using a single-tissue compartment model with a VPM plasma input function. Statistical parametric mapping (SPM) analysis was used to compare individual patients with the healthy controls. RESULTS At baseline, SPM voxel-based analysis revealed significantly lower uptake of VPM corresponding to the area of the epileptogenic developmental lesion compared to 12 healthy controls (P < .048). This was accentuated following P-gp inhibition with TQD. After TQD, the uptake of VPM was significantly lower in the area of the epileptogenic developmental lesion compared to controls (P < .002). SIGNIFICANCE This study provides further evidence of P-gp overactivity in patients with drug-resistant epilepsy, irrespective of the type of lesion. Identifying P-gp overactivity as an underlying contributor to drug-resistance in individual patients will enable novel treatment strategies aimed at overcoming or reversing P-gp overactivity.
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Affiliation(s)
- Maria Ilyas-Feldmann
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Bucks, UK.,Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK.,Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Shaonan Wang
- Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK.,Global Pharmacometrics, Boehringer Ingelheim, Ingelheim am Rhein, Germany
| | - Adam McMahon
- Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
| | | | - Gavin Brown
- Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
| | - Rainer Hinz
- Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Bucks, UK
| | - Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Bucks, UK
| | - Matthias Koepp
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Bucks, UK
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10
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ABC transporters in drug-resistant epilepsy: mechanisms of upregulation and therapeutic approaches. Pharmacol Res 2019; 144:357-376. [PMID: 31051235 DOI: 10.1016/j.phrs.2019.04.031] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 02/07/2023]
Abstract
Drug-resistant epilepsy (DRE) affects approximately one third of epileptic patients. Among various theories that try to explain multidrug resistance, the transporter hypothesis is the most extensively studied. Accordingly, the overexpression of efflux transporters in the blood-brain barrier (BBB), mainly from the ATP binding cassette (ABC) superfamily, may be responsible for hampering the access of antiepileptic drugs into the brain. P-glycoprotein and other efflux transporters are known to be upregulated in endothelial cells, astrocytes and neurons of the neurovascular unit, a functional barrier critically involved in the brain penetration of drugs. Inflammation and oxidative stress involved in the pathophysiology of epilepsy together with uncontrolled recurrent seizures, drug-associated induction and genetic polymorphisms are among the possible causes of ABC transporters overexpression in DRE. The aforementioned pathological mechanisms will be herein discussed together with the multiple strategies to overcome the activity of efflux transporters in the BBB - from direct transporters inhibition to down-regulation of gene expression resorting to RNA interference (RNAi), or by targeting key modulators of inflammation and seizure-mediated signalling.
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11
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Elkhayat HA, Aly RH, Elagouza IA, El-Kabarity RH, Galal YI. Role of P-glycoprotein inhibitors in children with drug-resistant epilepsy. Acta Neurol Scand 2017; 136:639-644. [PMID: 28560774 DOI: 10.1111/ane.12778] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The role of P-glycoprotein (Pgp), one of the known multidrug transporters, has been suggested in drug-resistant epilepsy (DRE). The following study aimed to measure the serum level of Pgp as a possible indicator of tissue Pgp overexpression in patients with DRE and to assess the efficacy of verapamil (as a Pgp inhibitor agent) in these patients. MATERIAL AND METHODS A group of 24 patients with DRE were recruited and subdivided into two groups, one receiving verapamil and the other receiving a placebo in a double-blind randomized study. Pgp serum levels were measured at enrollment and 12 months later. Twenty medically controlled epileptic patients served as a control group. RESULTS A significant statistical increase was found in the Pgp level of patients when compared the control group. Patients on both verapamil and the placebo showed improvement in seizure frequency and severity where statistical analysis showed no significant differences. CONCLUSION Pgp serum levels in patients with DRE were significantly elevated compared to patients with medically controlled epilepsy. The effect of verapamil as Pgp inhibitor on DRE requires further evaluation and research.
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Affiliation(s)
- H. A. Elkhayat
- Department of Pediatrics; Ain Shams University; Cairo Egypt
| | - R. H. Aly
- Department of Pediatrics; Ain Shams University; Cairo Egypt
| | - I. A. Elagouza
- Department of Pediatrics; Ain Shams University; Cairo Egypt
| | | | - Y. I. Galal
- Department of Pediatrics; Ain Shams University; Cairo Egypt
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12
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P-glycoprotein (ABCB1) and Oxidative Stress: Focus on Alzheimer's Disease. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2017; 2017:7905486. [PMID: 29317984 PMCID: PMC5727796 DOI: 10.1155/2017/7905486] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/30/2017] [Indexed: 11/23/2022]
Abstract
ATP-binding cassette (ABC) transporters, in particular P-glycoprotein (encoded by ABCB1), are important and selective elements of the blood-brain barrier (BBB), and they actively contribute to brain homeostasis. Changes in ABCB1 expression and/or function at the BBB may not only alter the expression and function of other molecules at the BBB but also affect brain environment. Over the last decade, a number of reports have shown that ABCB1 actively mediates the transport of beta amyloid (Aβ) peptide. This finding has opened up an entirely new line of research in the field of Alzheimer's disease (AD). Indeed, despite intense research efforts, AD remains an unsolved pathology and effective therapies are still unavailable. Here, we review the crucial role of ABCB1 in the Aβ transport and how oxidative stress may interfere with this process. A detailed understanding of ABCB1 regulation can provide the basis for improved neuroprotection in AD and also enhanced therapeutic drug delivery to the brain.
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13
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Tang F, Hartz AMS, Bauer B. Drug-Resistant Epilepsy: Multiple Hypotheses, Few Answers. Front Neurol 2017; 8:301. [PMID: 28729850 PMCID: PMC5498483 DOI: 10.3389/fneur.2017.00301] [Citation(s) in RCA: 263] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 06/12/2017] [Indexed: 01/16/2023] Open
Abstract
Epilepsy is a common neurological disorder that affects over 70 million people worldwide. Despite the recent introduction of new antiseizure drugs (ASDs), about one-third of patients with epilepsy have seizures refractory to pharmacotherapy. Early identification of patients who will become refractory to ASDs could help direct such patients to appropriate non-pharmacological treatment, but the complexity in the temporal patterns of epilepsy could make such identification difficult. The target hypothesis and transporter hypothesis are the most cited theories trying to explain refractory epilepsy, but neither theory alone fully explains the neurobiological basis of pharmacoresistance. This review summarizes evidence for and against several major theories, including the pharmacokinetic hypothesis, neural network hypothesis, intrinsic severity hypothesis, gene variant hypothesis, target hypothesis, and transporter hypothesis. The discussion is mainly focused on the transporter hypothesis, where clinical and experimental data are discussed on multidrug transporter overexpression, substrate profiles of ASDs, mechanism of transporter upregulation, polymorphisms of transporters, and the use of transporter inhibitors. Finally, future perspectives are presented for the improvement of current hypotheses and the development of treatment strategies as guided by the current understanding of refractory epilepsy.
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Affiliation(s)
- Fei Tang
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, MN, United States.,Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, KY, United States
| | - Anika M S Hartz
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, United States.,Department of Pharmacology and Nutritional Sciences, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Björn Bauer
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, KY, United States.,Epilepsy Center, University of Kentucky, Lexington, KY, United States
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14
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Soares RV, Do TM, Mabondzo A, Pons G, Chhun S. Ontogeny of ABC and SLC transporters in the microvessels of developing rat brain. Fundam Clin Pharmacol 2016; 30:107-16. [PMID: 26662930 DOI: 10.1111/fcp.12175] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 11/19/2015] [Accepted: 12/08/2015] [Indexed: 01/01/2023]
Abstract
The blood-brain barrier (BBB) is responsible for the control of solutes' concentration in the brain. Tight junctions and multiple ATP-binding cassette (ABC) and SoLute Carrier (SLC) efflux transporters protect brain cells from xenobiotics, therefore reducing brain exposure to intentionally administered drugs. In epilepsy, polymorphisms and overexpression of efflux transporters genes could be associated with pharmacoresistance. The ontogeny of these efflux transporters should also be addressed because their expression during development may be related to different brain exposure to antiepileptic drugs in the immature brain. We detected statistically significant higher expression of Abcb1b and Slc16a1 genes, and lower expression of Abcb1a and Abcg2 genes between the post-natal day 14 (P14) and the adult rat microvessels. P-gP efflux activity was also shown to be lower in P14 rats when compared with the adults. The P-gP proteins coded by rodent genes Abcb1a and Abcb1b are known to have different substrate affinities. The role of the Abcg2 gene is less clear in pharmacoresistance in epilepsy, nonetheless the coded protein Bcrp is frequently associated with drug resistance. Finally, we observed a higher expression of the Mct1 transporter gene in the P14 rat brain microvessels. Accordingly to our results, we suppose that age may be another factor influencing brain exposure to antiepileptics as a consequence of different expression patterns of efflux transporters between the adult and immature BBB.
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Affiliation(s)
- Ricardo V Soares
- Inserm U1129, Paris, France.,University Paris Descartes, Faculty of Medicine, Paris, France.,CEA, Direction des Sciences du Vivant, iBiTec-S, Service de Pharmacologie et d'Immunoanalyse, Gif-sur-Yvette, France
| | - Tuan M Do
- CEA, Direction des Sciences du Vivant, iBiTec-S, Service de Pharmacologie et d'Immunoanalyse, Gif-sur-Yvette, France
| | - Aloïse Mabondzo
- CEA, Direction des Sciences du Vivant, iBiTec-S, Service de Pharmacologie et d'Immunoanalyse, Gif-sur-Yvette, France
| | - Gérard Pons
- Inserm U1129, Paris, France.,University Paris Descartes, Faculty of Medicine, Paris, France
| | - Stéphanie Chhun
- University Paris Descartes, Faculty of Medicine, Paris, France.,Inserm U1151, INEM, Paris, France.,APHP, Hôpital Universitaire Necker-Enfants Malades, Laboratoire d'immunologie biologique, Paris, France
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15
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Qosa H, Miller DS, Pasinelli P, Trotti D. Regulation of ABC efflux transporters at blood-brain barrier in health and neurological disorders. Brain Res 2015; 1628:298-316. [PMID: 26187753 PMCID: PMC4681613 DOI: 10.1016/j.brainres.2015.07.005] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 06/28/2015] [Accepted: 07/02/2015] [Indexed: 01/16/2023]
Abstract
The strength of the blood-brain barrier (BBB) in providing protection to the central nervous system from exposure to circulating chemicals is maintained by tight junctions between endothelial cells and by a broad range of transporter proteins that regulate exchange between CNS and blood. The most important transporters that restrict the permeability of large number of toxins as well as therapeutic agents are the ABC transporters. Among them, P-gp, BCRP, MRP1 and MRP2 are the utmost studied. These efflux transporters are neuroprotective, limiting the brain entry of neurotoxins; however, they could also restrict the entry of many therapeutics and contribute to CNS pharmacoresistance. Characterization of several regulatory pathways that govern expression and activity of ABC efflux transporters in the endothelium of brain capillaries have led to an emerging consensus that these processes are complex and contain several cellular and molecular elements. Alterations in ABC efflux transporters expression and/or activity occur in several neurological diseases. Here, we review the signaling pathways that regulate expression and transport activity of P-gp, BCRP, MRP1 and MRP2 as well as how their expression/activity changes in neurological diseases. This article is part of a Special Issue entitled SI: Neuroprotection.
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Affiliation(s)
- Hisham Qosa
- Weinberg Unit for ALS Research, Farber Institute for Neuroscience, Department of Neuroscience, Thomas Jefferson University, 900 Walnut street, Philadelphia, PA 19107, USA.
| | - David S Miller
- Laboratory of Signal Transduction, NIH/NIEHS, Research Triangle Park, NC 27709, USA
| | - Piera Pasinelli
- Weinberg Unit for ALS Research, Farber Institute for Neuroscience, Department of Neuroscience, Thomas Jefferson University, 900 Walnut street, Philadelphia, PA 19107, USA
| | - Davide Trotti
- Weinberg Unit for ALS Research, Farber Institute for Neuroscience, Department of Neuroscience, Thomas Jefferson University, 900 Walnut street, Philadelphia, PA 19107, USA.
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16
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Sun Y, Luo X, Yang K, Sun X, Li X, Zhang C, Ma S, Liu Y, Yin J. Neural overexpression of multidrug resistance-associated protein 1 and refractory epilepsy: a meta-analysis of nine studies. Int J Neurosci 2015; 126:308-17. [DOI: 10.3109/00207454.2015.1015724] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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17
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Sharma AK, Rani E, Waheed A, Rajput SK. Pharmacoresistant Epilepsy: A Current Update on Non-Conventional Pharmacological and Non-Pharmacological Interventions. J Epilepsy Res 2015; 5:1-8. [PMID: 26157666 PMCID: PMC4494988 DOI: 10.14581/jer.15001] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 04/24/2015] [Indexed: 11/12/2022] Open
Abstract
Uncontrolled seizure or epilepsy is intricately related with an increase risk of pharmacoresistant epilepsy. The failure to achieve seizure control with the first or second drug trial of an anticonvulsant medication given at the appropriate daily dosage is termed as pharmacoresistance, despite the fact that these drugs possess different modes of action. It is one of the devastating neurological disorders act as major culprit of mortality in developed as well as developing countries with towering prevalence. Indeed, the presence of several anti-epileptic drug including carbamazepine, phenytoin, valproate, gabapentin etc. But no promising therapeutic remedies available to manage pharmacoresistance in the present clinical scenario. Hence, utility of alternative strategies in management of resistance epilepsy is increased which further possible by continuing developing of promising therapeutic interventions to manage this insidious condition adequately. Strategies include add on therapy with adenosine, verapamil etc or ketogenic diet, vagus nerve stimulation, focal cooling or standard drugs in combinations have shown some promising results. In this review we will shed light on the current pharmacological and non pharmacological mediator with their potential pleiotropic action on pharmacoresistant epilepsy.
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Affiliation(s)
- Arun Kumar Sharma
- Amity Institute of Pharmacy, Amity University, Noida, Uttar Pradesh-201313, India
| | - Ekta Rani
- Chitkara College of Pharmacy, Chitkara University, Rajpura, Punjab-140401, India
| | - Abdul Waheed
- Amity Institute of Pharmacy, Amity University, Noida, Uttar Pradesh-201313, India
| | - Satyendra K Rajput
- Amity Institute of Pharmacy, Amity University, Noida, Uttar Pradesh-201313, India
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18
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Luna-Munguia H, Salvamoser JD, Pascher B, Pieper T, Getzinger T, Kudernatsch M, Kluger G, Potschka H. Glutamate-mediated upregulation of the multidrug resistance protein 2 in porcine and human brain capillaries. J Pharmacol Exp Ther 2015; 352:368-78. [PMID: 25503388 DOI: 10.1124/jpet.114.218180] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
As a member of the multidrug-resistance associated protein (MRP) family, MRP2 affects the brain entry of different endogenous and exogenous compounds. Considering the role of this transporter at the blood-brain barrier, the regulation is of particular interest. However, there is limited knowledge regarding the factors that regulate MRP2 in neurologic disease states. Thus, we addressed the hypothesis that MRP2 might be affected by a glutamate-induced signaling pathway that we previously identified as one key mechanism in the regulation of P-glycoprotein. Studies in isolated porcine brain capillaries confirmed that glutamate and N-methyl-d-aspartic acid (NMDA) exposure upregulates expression and function of MPR2. The involvement of the NMDA receptor was further suggested by the fact that the NMDA receptor antagonist MK-801 [(5S,10R)-(+)-5-methyl-10,11-dihydro-5H-dibenzo[a,d]cyclohepten-5,10-imine], as well as the NMDA receptor glycine binding site antagonist L-701,324 [7-chloro-4-hydroxy-3-(3-phenoxy)phenyl-2(1H)-quinolinone], prevented the impact of glutamate. A role of cyclooxygenase-2 was indicated by coincubation with the cyclooxygenase-2 inhibitor celecoxib and the cyclooxygenase-1/-2 inhibitor indomethacin, which both efficaciously abolished a glutamate-induced upregulation of MRP2. Translational studies in human capillaries from surgical specimen demonstrated a relevant MRP2 efflux function and indicated an effect of glutamate exposure as well as its prevention by cyclooxygenase-2 inhibition. Taken together the findings provide first evidence for a role of a glutamate-induced NMDA receptor/cyclooxygenase-2 signaling pathway in the regulation of MRP2 expression and function. The response to excessive glutamate concentrations might contribute to overexpression of MRP2, which has been reported in neurologic diseases including epilepsy. The overexpression might have implications for brain access of various compounds including therapeutic drugs.
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Affiliation(s)
- Hiram Luna-Munguia
- Institute of Pharmacology, Toxicology, and Pharmacy, Ludwig-Maximilians-University, Munich, Germany (H.L.M., J.D.S., H.P.); Neuropediatric Clinic and Clinic for Neurorehabilitation, Epilepsy Center for Children and Adolescents (B.P., T.P., T.G., G.K.) and Clinic for Neurosurgery and Epilepsy Surgery (M.K.), Schön Klinik Vogtareuth, Vogtareuth, Germany; and Paracelsus Medical University, Salzburg, Austria (G.K.)
| | - Josephine D Salvamoser
- Institute of Pharmacology, Toxicology, and Pharmacy, Ludwig-Maximilians-University, Munich, Germany (H.L.M., J.D.S., H.P.); Neuropediatric Clinic and Clinic for Neurorehabilitation, Epilepsy Center for Children and Adolescents (B.P., T.P., T.G., G.K.) and Clinic for Neurosurgery and Epilepsy Surgery (M.K.), Schön Klinik Vogtareuth, Vogtareuth, Germany; and Paracelsus Medical University, Salzburg, Austria (G.K.)
| | - Bettina Pascher
- Institute of Pharmacology, Toxicology, and Pharmacy, Ludwig-Maximilians-University, Munich, Germany (H.L.M., J.D.S., H.P.); Neuropediatric Clinic and Clinic for Neurorehabilitation, Epilepsy Center for Children and Adolescents (B.P., T.P., T.G., G.K.) and Clinic for Neurosurgery and Epilepsy Surgery (M.K.), Schön Klinik Vogtareuth, Vogtareuth, Germany; and Paracelsus Medical University, Salzburg, Austria (G.K.)
| | - Tom Pieper
- Institute of Pharmacology, Toxicology, and Pharmacy, Ludwig-Maximilians-University, Munich, Germany (H.L.M., J.D.S., H.P.); Neuropediatric Clinic and Clinic for Neurorehabilitation, Epilepsy Center for Children and Adolescents (B.P., T.P., T.G., G.K.) and Clinic for Neurosurgery and Epilepsy Surgery (M.K.), Schön Klinik Vogtareuth, Vogtareuth, Germany; and Paracelsus Medical University, Salzburg, Austria (G.K.)
| | - Thekla Getzinger
- Institute of Pharmacology, Toxicology, and Pharmacy, Ludwig-Maximilians-University, Munich, Germany (H.L.M., J.D.S., H.P.); Neuropediatric Clinic and Clinic for Neurorehabilitation, Epilepsy Center for Children and Adolescents (B.P., T.P., T.G., G.K.) and Clinic for Neurosurgery and Epilepsy Surgery (M.K.), Schön Klinik Vogtareuth, Vogtareuth, Germany; and Paracelsus Medical University, Salzburg, Austria (G.K.)
| | - Manfred Kudernatsch
- Institute of Pharmacology, Toxicology, and Pharmacy, Ludwig-Maximilians-University, Munich, Germany (H.L.M., J.D.S., H.P.); Neuropediatric Clinic and Clinic for Neurorehabilitation, Epilepsy Center for Children and Adolescents (B.P., T.P., T.G., G.K.) and Clinic for Neurosurgery and Epilepsy Surgery (M.K.), Schön Klinik Vogtareuth, Vogtareuth, Germany; and Paracelsus Medical University, Salzburg, Austria (G.K.)
| | - Gerhard Kluger
- Institute of Pharmacology, Toxicology, and Pharmacy, Ludwig-Maximilians-University, Munich, Germany (H.L.M., J.D.S., H.P.); Neuropediatric Clinic and Clinic for Neurorehabilitation, Epilepsy Center for Children and Adolescents (B.P., T.P., T.G., G.K.) and Clinic for Neurosurgery and Epilepsy Surgery (M.K.), Schön Klinik Vogtareuth, Vogtareuth, Germany; and Paracelsus Medical University, Salzburg, Austria (G.K.)
| | - Heidrun Potschka
- Institute of Pharmacology, Toxicology, and Pharmacy, Ludwig-Maximilians-University, Munich, Germany (H.L.M., J.D.S., H.P.); Neuropediatric Clinic and Clinic for Neurorehabilitation, Epilepsy Center for Children and Adolescents (B.P., T.P., T.G., G.K.) and Clinic for Neurosurgery and Epilepsy Surgery (M.K.), Schön Klinik Vogtareuth, Vogtareuth, Germany; and Paracelsus Medical University, Salzburg, Austria (G.K.)
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19
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Emich-Widera E, Likus W, Kazek B, Sieroń AL, Urbanek K. Polymorphism of ABCB1/MDR1 C3435T in children and adolescents with partial epilepsy is due to different criteria for drug resistance - preliminary results. Med Sci Monit 2014; 20:1654-61. [PMID: 25223475 PMCID: PMC4173802 DOI: 10.12659/msm.890633] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background The diagnosis of “drug resistance” in epilepsy can be defined and interpreted in various ways. This may be due to discrepant definitions of drug resistance to pharmacotherapy. The aim of our study was to investigate the relationship between C3435T polymorphism of the MDR1 gene and drug resistance in epilepsy with the consideration of 4 different criteria for qualification to groups sensitive and resistant to applied pharmacotherapy. Material/Methods Evaluation of C3435T polymorphism of MDR1/ABCB1 gene was conducted on a group of 82 white children and young adolescents up to 18 years old. While qualifying the patients to the group of sensitive or drug resistant, the following 4 definitions of drug resistance were applied: the ILAE’s, Appleton’s, Siddiqui’s, and Berg’s. Results A detailed analysis of genotypes of the MDR1 gene did not show any significant discrepancies between the groups of patients resistant and sensitive to antiepileptic drugs (AEDs) in 4 consecutive comparisons taking into consideration various criteria of sensitivity and resistance to pharmacotherapy. Conclusions The obtained results clearly confirm the lack of a connection between the occurrence of drug-resistant epilepsy and C435T polymorphism of the MDR1 gene irrespective of the definition of drug resistance applied to the patient.
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Affiliation(s)
- Ewa Emich-Widera
- Department of Neuropediatrics, School of Medicine, Medical University of Silesia, Katowice, Poland
| | - Wirginia Likus
- Department of Human Anatomy, School of Medicine, Medical University of Silesia, Katowice, Poland
| | - Beata Kazek
- Department of Neuropediatrics, School of Medicine, Medical University of Silesia, Katowice, Poland
| | - Aleksander L Sieroń
- Department of General and Molecular Biology and Genetics, School of Medicine, Medical University of Silesia, Katowice, Poland
| | - Ksymena Urbanek
- Department of General and Molecular Biology and Genetics, School of Medicine, Medical University of Silesia, Katowice, Poland
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Marin-Valencia I, Guerrini R, Gleeson JG. Pathogenetic mechanisms of focal cortical dysplasia. Epilepsia 2014; 55:970-8. [PMID: 24861491 PMCID: PMC4107035 DOI: 10.1111/epi.12650] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2014] [Indexed: 02/01/2023]
Abstract
Focal cortical dysplasias (FCDs) constitute a prevalent cause of intractable epilepsy in children, and is one of the leading conditions requiring epilepsy surgery. Despite recent advances in the cellular and molecular biology of these conditions, the pathogenetic mechanisms of FCDs remain largely unknown. The purpose if this work is to review the molecular underpinnings of FCDs and to highlight potential therapeutic targets. A systematic review of the literature regarding the histologic, molecular, and electrophysiologic aspects of FCDs was conducted. Disruption of the mammalian target of rapamycin (mTOR) signaling comprises a common pathway underlying the structural and electrical disturbances of some FCDs. Other mechanisms such as viral infections, prematurity, head trauma, and brain tumors are also posited. mTOR inhibitors (i.e., rapamycin) have shown positive results on seizure management in animal models and in a small cohort of patients with FCD. Encouraging progress has been achieved on the molecular and electrophysiologic basis of constitutive cells in the dysplastic tissue. Despite the promising results of mTOR inhibitors, large-scale randomized trials are in need to evaluate their efficacy and side effects, along with additional mechanistic studies for the development of novel, molecular-based diagnostic and therapeutic approaches.
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Affiliation(s)
- Isaac Marin-Valencia
- Department of Neurology and Neurotherapeutics, and Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
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21
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Otáhal J, Folbergrová J, Kovacs R, Kunz WS, Maggio N. Epileptic focus and alteration of metabolism. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2014; 114:209-43. [PMID: 25078504 DOI: 10.1016/b978-0-12-418693-4.00009-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Epilepsy is one of the most common neurologic disorders affecting a substantial part of the population worldwide. Epileptic seizures represent the situation of increased neuronal activity associated with the enhanced demands for sufficient energy supply. For that purpose, very efficient regulatory mechanisms have to operate to ensure that cerebral blood flow, delivery of oxygen, and nutrients are continuously adapted to the local metabolic needs. The sophisticated regulation has to function in concert at several levels (systemic, tissue, cellular, and subcellular). Particularly, mitochondria play a key role not only in the energy production, but they are also central to many other processes including those leading to neuronal death. Impairment of any of the involved pathways can result in serious functional alterations, neurodegeneration, and potentially in epileptogenesis. The present review will address some of the important issues concerning vascular and metabolic changes in pathophysiology of epilepsy.
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Affiliation(s)
- Jakub Otáhal
- Institute of Physiology, v.v.i., Academy of Sciences of the Czech Republic, Prague, Czech Republic.
| | - Jaroslava Folbergrová
- Institute of Physiology, v.v.i., Academy of Sciences of the Czech Republic, Prague, Czech Republic
| | - Richard Kovacs
- Institute for Neurophysiology, Charité-Medical University Berlin, Berlin, Germany
| | - Wolfram S Kunz
- Department of Epileptology, University of Bonn, Bonn, Germany
| | - Nicola Maggio
- Department of Neurology, The Joseph Sagol Neuroscience Center, The Chaim Sheba Medical Center, Tel HaShomer, Israel; Talpiot Medical Leadership Program, The Chaim Sheba Medical Center, Tel HaShomer, Israel
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22
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Neuropathology of the blood-brain barrier in epilepsy: support to the transport hypothesis of pharmacoresistance. Epilepsy Curr 2013; 13:169-71. [PMID: 24009480 DOI: 10.5698/1535-7597-13.4.169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Abstract
Focal cortical dysplasias are among the most common causes of intractable epilepsy in children. As the neuropathology of these conditions has been better clarified, the nomenclature has undergone numerous revisions. Their recognition has grown with the use of neuroimaging, and recent advances in imaging technology will further improve detection. Clinical, electroencephalographic, and imaging findings are often diagnostic, so it is imperative for the clinician to recognize the characteristic patterns. Treatment for developmental and behavioral disability remains largely symptomatic, and epilepsy medications are often ineffective. Epilepsy surgery, however, can be successful in selected patients. The basic science underlying the development of focal cortical dysplasias may lead to novel therapeutic approaches in the future.
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Affiliation(s)
- John N Gaitanis
- Department of Neurology and Pediatrics (Clinical), The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA.
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24
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CYP3A5*3 and C3435T MDR1 polymorphisms in prognostication of drug-resistant epilepsy in children and adolescents. BIOMED RESEARCH INTERNATIONAL 2013; 2013:526837. [PMID: 23984379 PMCID: PMC3747339 DOI: 10.1155/2013/526837] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 06/25/2013] [Indexed: 01/13/2023]
Abstract
Drug-resistant epilepsies still remain one of the most profound problems of contemporary epileptology. Several mechanisms of drug resistance are possible; among them, genetic factors have a prominent place. Much importance is attached to genes, which encode enzymes that metabolize antiepileptic drugs CYP 3A, which belong to the family of cytochromes P450 and the genome of multidrug resistance, such as multidrug resistance 1 (MDR1) that expresses P-glycoprotein (P-gp), a drug transporter protein. The aim of the study was to assess the relation between polymorphism of gene CYP3A5 and polymorphism C3435T of MDR1 gene with the occurrence of focal, drug-resistant epilepsy in children and youths up to 18 years of age. The study comprised 85 patients, and their age range was from 33 months to 18 years of age, suffering from epilepsy, partly responding well to treatment, partly drug resistant. The polymorphism of both genes has been analysed using the PCR-RFLP method. The study failed to corroborate association between polymorphism CYP3A5∗3 and C3435T polymorphism in MDR1 gene and pharmacoresistant epilepsy. The results of our research do not confirm the prognostic value of the polymorphisms examined in the prognostication of drug resistance in epilepsies.
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25
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Abuznait AH, Kaddoumi A. Role of ABC transporters in the pathogenesis of Alzheimer's disease. ACS Chem Neurosci 2012. [PMID: 23181169 DOI: 10.1021/cn300077c] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disorder and the most common form of age-related dementia that begins with memory loss and progresses to include severe cognitive impairment. A major pathological hallmark of AD is the accumulation of beta amyloid peptide (Aβ) in senile plaques in the brain of AD patients. The exact mechanism by which AD takes place remains unknown. However, an increasing number of studies suggests that ATP-binding cassette (ABC) transporters, which are localized on the surface of brain endothelial cells of the blood-brain barrier (BBB) and brain parenchyma, may contribute to the pathogenesis of AD. Recent studies have unraveled important roles of ABC transporters including ABCB1 (P-glycoprotein, P-gp), ABCG2 (breast cancer resistant protein, BCRP), ABCC1 (multidrug resistance protein 1, MRP1), and the cholesterol transporter ABCA1 in the pathogenesis of AD and Aβ peptides deposition inside the brain. Therefore, understanding the mechanisms by which these transporters contribute to Aβ deposition in the brain is important for the development of new therapeutic strategies against AD. This review summarizes and highlights the accumulating evidence in the literature which describe the role of altered function of various ABC transporters in the pathogenesis and progression of AD and the implications of modulating their functions for the treatment of AD.
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Affiliation(s)
- Alaa H. Abuznait
- Department of Basic Pharmaceutical
Sciences, College
of Pharmacy, University of Louisiana at Monroe, Monroe, Louisiana 71201, United States
| | - Amal Kaddoumi
- Department of Basic Pharmaceutical
Sciences, College
of Pharmacy, University of Louisiana at Monroe, Monroe, Louisiana 71201, United States
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26
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Muñana K, Nettifee-Osborne J, Bergman R, Mealey K. Association between ABCB1 Genotype and Seizure Outcome in Collies with Epilepsy. J Vet Intern Med 2012; 26:1358-64. [DOI: 10.1111/j.1939-1676.2012.01006.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Revised: 06/13/2012] [Accepted: 08/15/2012] [Indexed: 01/02/2023] Open
Affiliation(s)
- K.R. Muñana
- Department of Clinical Sciences; College of Veterinary Medicine, North Carolina State University; Raleigh; NC
| | - J.A. Nettifee-Osborne
- Department of Clinical Sciences; College of Veterinary Medicine, North Carolina State University; Raleigh; NC
| | - R.L. Bergman
- Department of Clinical Sciences; College of Veterinary Medicine, North Carolina State University; Raleigh; NC
| | - K.L. Mealey
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine, Washington State University; Pullman; WA
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Zhang C, Kwan P, Zuo Z, Baum L. The transport of antiepileptic drugs by P-glycoprotein. Adv Drug Deliv Rev 2012; 64:930-42. [PMID: 22197850 DOI: 10.1016/j.addr.2011.12.003] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Revised: 12/05/2011] [Accepted: 12/07/2011] [Indexed: 01/16/2023]
Abstract
Epilepsy is the most common serious chronic neurological disorder. Current data show that one-third of patients do not respond to anti-epileptic drugs (AEDs). Most non-responsive epilepsy patients are resistant to several, often all, AEDs, even though the drugs differ from each other in pharmacokinetics, mechanisms of action, and interaction potential. The mechanisms underlying drug resistance of epilepsy patients are still not clear. In recent years, one of the potential mechanisms interesting researchers is over-expression of P-glycoprotein (P-gp, also known as ABCB1 or MDR1) in endothelial cells of the blood-brain barrier (BBB) in epilepsy patients. P-gp plays a central role in drug absorption and distribution in many organisms. The expression of P-gp is greater in drug-resistant than in drug-responsive patients. Some studies also indicate that several AEDs are substrates or inhibitors of P-gp, implying that P-gp may play an important role in drug resistance in refractory epilepsy. In this article, we review the clinical and laboratory evidence that P-gp expression is increased in epileptic brain tissues and that AEDs are substrates of P-gp in vitro and in vivo. We discuss criteria for identifying the substrate status of AEDs and use structure-activity relationship (SAR) models to predict which AEDs act as P-gp substrates.
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Affiliation(s)
- Heidrun Potschka
- Institute of Pharmacology, Toxicology, and Therapeutics, Ludwig-Maximilians-University, Munich, Germany.
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Potschka H. Transporter hypothesis of drug-resistant epilepsy: challenges for pharmacogenetic approaches. Pharmacogenomics 2011; 11:1427-38. [PMID: 21047204 DOI: 10.2217/pgs.10.126] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Drug resistance in epilepsy is considered a complex and multifactorial problem. Overexpression of efflux transporters at the blood-brain barrier is discussed as one factor that might limit brain penetration and efficacy of antiepileptic drugs. Whereas experimental data render support for this hypothesis, there is still a lack of sufficient clinical evidence indicating a functional role of efflux transporters. Pharmacogenetic analysis has been considered as one approach in the evaluation of a putative link between transporters and drug-resistant epilepsy. However, the likelihood of a multifactorial nature of drug resistance and the complexity of the events regulating transporters pose a major challenge to any attempt at linking selected genetic polymorphisms to the outcome of drug therapy. In this article, the evidence for an impact of efflux transporters on the response to antiepileptic drugs is discussed, focusing in particular on the different issues presenting a challenge for pharmacogenetic approaches in this field.
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Affiliation(s)
- Heidrun Potschka
- Institute of Pharmacology, Toxicology & Pharmacy, Ludwig-Maximilians-University, Koeniginstr. 16, D-80539 Munich, Germany.
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Boison D, Masino SA, Geiger JD. Homeostatic bioenergetic network regulation - a novel concept to avoid pharmacoresistance in epilepsy. Expert Opin Drug Discov 2011; 6:713-724. [PMID: 21731576 DOI: 10.1517/17460441.2011.575777] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION: Despite epilepsy being one of the most prevalent neurological disorders, one third of all patients with epilepsy cannot adequately be treated with available antiepileptic drugs. One of the significant causes for the failure of conventional pharmacotherapeutic treatment is the development of pharmacoresistance in many forms of epilepsy. The problem of pharmacoresistance has called for the development of new conceptual strategies that improve future drug development efforts. AREAS COVERED: A thorough review of the recent literature on pharmacoresistance in epilepsy was completed and select examples were chosen to highlight the mechanisms of pharmacoresistance in epilepsy and to demonstrate how those mechanistic findings might lead to improved treatment of pharmacoresistant epilepsy. The reader will gain a thorough understanding of pharmacoresistance in epilepsy and an appreciation of the limitations of conventional drug development strategies. EXPERT OPINION: Conventional drug development efforts aim to achieve specificity of symptom control by enhancing the selectivity of drugs acting on specific downstream targets; this conceptual strategy bears the undue risk of development of pharmacoresistance. Modulation of homeostatic bioenergetic network regulation is a novel conceptual strategy to affect whole neuronal networks synergistically by mobilizing multiple endogenous biochemical and receptor-dependent molecular pathways. In our expert opinion we conclude that homeostatic bioenergetic network regulation might thus be used as an innovative strategy for the control of pharmacoresistant seizures. Recent focal adenosine augmentation strategies support the feasibility of this strategy.
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Affiliation(s)
- Detlev Boison
- RS Dow Neurobiology Laboratories, Legacy Research Institute, Portland, OR 97232, USA
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31
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Potschka H. Modulating P-glycoprotein regulation: future perspectives for pharmacoresistant epilepsies? Epilepsia 2010; 51:1333-47. [PMID: 20477844 DOI: 10.1111/j.1528-1167.2010.02585.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Enhanced brain efflux of antiepileptic drugs by the blood-brain barrier transporter P-glycoprotein is discussed as one mechanism contributing to pharmacoresistance of epilepsies. P-glycoprotein overexpression has been proven to occur as a consequence of seizure activity. Therefore, blocking respective signaling events should help to improve brain penetration and efficacy of P-glycoprotein substrates. A series of recent studies revealed key signaling factors involved in seizure-associated transcriptional activation of P-glycoprotein. These data suggested several interesting targets, including the N-methyl-d-aspartate (NMDA) receptor, the inflammatory enzyme cyclooxygenase-2, and the prostaglandin E2 EP1 receptor. These targets have been further evaluated in rodent models, demonstrating that targeting these factors can control P-glycoprotein expression, improve antiepileptic drug brain penetration, and help to overcome pharmacoresistance. In general, the approach offers particular advantages over transporter inhibition as it preserves basal transporter function. In this review the different strategies for blocking P-glycoprotein upregulation, including their therapeutic promise and drawbacks are discussed. Moreover, pros and cons of the approach are compared to those of alternative strategies to overcome transporter-associated resistance. Regarding future perspectives of the novel approach, there is an obvious need to more clearly define the clinical relevance of transporter overexpression. In this context current efforts are discussed, including the development of imaging tools that allow an evaluation of P-glycoprotein function in individual patients.
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Affiliation(s)
- Heidrun Potschka
- Institute of Pharmacology, Toxicology, and Pharmacy, Ludwig-Maximilians-University, Munich, Germany.
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32
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Association between temporal lobe P-glycoprotein expression and seizure recurrence after surgery for pharmacoresistant temporal lobe epilepsy. Neurobiol Dis 2010; 39:192-7. [PMID: 20403441 DOI: 10.1016/j.nbd.2010.04.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 03/29/2010] [Accepted: 04/07/2010] [Indexed: 01/16/2023] Open
Abstract
Surgery is recommended for pharmacoresistant temporal lobe epilepsy (TLE), but seizures recur in approximately one third of patients postsurgery. P-glycoprotein is an efflux multidrug transporter that is overexpressed in a range of epileptogenic pathologies. We hypothesized that increased expression of P-glycoprotein in the epileptogenic temporal lobe might be a marker for recurrence of pharmacoresistant seizures postsurgery. We performed immunohistochemistry on temporal lobe tissues resected from 69 patients who underwent anterior temporal lobectomy for pharmacoresistant TLE with histopathological proven hippocampal sclerosis. P-glycoprotein expression was rated by three pathologists independently. Patients with seizure recurrence (n=22) had greater number of positively stained capillaries (p=0.001) and higher P-glycoprotein immunoreactive score in capillaries (p=0.002) in the white matter of resected temporal lobe. The differences remained significant in multivariate analysis (p=0.002 and 0.006, respectively). The results suggest that P-glycoprotein expression in temporal lobe may be associated with seizure recurrence after surgery for pharmacoresistant TLE.
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Abstract
Multidrug resistance protein 1 (MRP1, ABCC1) transports antidepressive agents in the endothelial cells of the blood-brain barrier. Therefore, polymorphisms in the MRP1 gene may affect the treatment response of antidepressants. This study was aimed to identify the association between genetic variations in MRP1/ABCC1 and the therapeutic response to the antidepressant citalopram. One hundred and twenty-three patients who had been treated with citalopram monotherapy to control their major depressive disorder were recruited, and genotype data from 64 patients who had completed their 8-week follow-up were evaluated together with those from 100 controls. Nine MRP1 single nucleotide polymorphisms (SNPs) showing more than 5% allele frequency in the Korean population were analyzed. The c.4002G>A, a synonymous SNP in exon 28, showed a strong association with the remission state at 8 weeks (P = 0.005, odds ratio [OR], 4.7, 95% confidence interval [CI], 1.5 approximately 14.7). The c.4002G>A forms a linkage disequilibrium block with 3 other SNPs including c.5462T>A in the 3' untranslated region. Accordingly, the haplotype showed a significant association with the remission state (P = 0.014). Subsequent molecular studies also supported the association between these MRP1 polymorphisms and the citalopram response. Thus, kinetic studies using MRP1-enriched membrane vesicles revealed that citalopram is a substrate of MRP1 (Km = 1.99 microM, Vmax = 137 pmol/min per milligram protein). In addition, individuals with c.4002G>A or c.5462T>A polymorphisms showed higher MRP1 mRNA levels in peripheral blood cells. These results suggest that MRP1 polymorphisms may be a predictive marker of citalopram treatment in major depression.
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Jose M, Thomas SV. Role of multidrug transporters in neurotherapeutics. Ann Indian Acad Neurol 2010; 12:89-98. [PMID: 20142853 PMCID: PMC2812747 DOI: 10.4103/0972-2327.53076] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2009] [Revised: 05/14/2009] [Accepted: 06/02/2009] [Indexed: 11/30/2022] Open
Abstract
Acquired resistance to antibiotics and other chemotherapeutic agents is a major problem in the practice of neurology and other branches of medicine. There are several mechanisms by which drug resistance is acquired. Multidrug transporters are important glycoproteins located in the cell membrane that actively transport small lipophilic molecules from one side of the cell membrane to the other, most often from the inside to the outside of a cell. They have important protective role yet may prove inconvenient in chemotherapy. In epilepsy and other disorders this mechanism augments the elimination of drugs from their target cells and leads to drug resistance. In this review, we have discussed the biochemical characteristics of multidrug transporters and the mechanisms by which these membrane bound proteins transport their target molecules from one side to the other side of the cell membrane. We have also briefly discussed the application of this knowledge in the understanding of drug resistance in various clinical situations with particular reference to neurological disorders. These proteins located in the placenta have important role in preventing the transplacental movement of drugs in to the fetus which may result in congenital malformations or other defects. The molecular genetic mechanisms that govern the expression of these important proteins are discussed briefly. The potential scope to develop targeted chemotherapeutic agents is also discussed.
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Affiliation(s)
- Manna Jose
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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35
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Potschka H. Targeting regulation of ABC efflux transporters in brain diseases: a novel therapeutic approach. Pharmacol Ther 2009; 125:118-27. [PMID: 19896502 DOI: 10.1016/j.pharmthera.2009.10.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Accepted: 10/16/2009] [Indexed: 01/16/2023]
Abstract
Blood-brain barrier efflux transporters limit the brain penetration and efficacy of various central nervous system drugs. In several CNS diseases, therapy- or pathophysiology-associated transcriptional activation of efflux transporters further strengthens the barrier function. Targeting the regulatory pathways that drive efflux transporter expression in different diseases represents an intriguing approach for prevention of these events thereby promoting delivery to the brain and enhancing or restoring drug efficacy. In particular, the approach holds the promise to preserve basal transporter expression and activity, which is of specific relevance in view of the protective function of efflux transport. The elucidation of the signaling cascades involved in transporter regulation is a major presupposition for the development of preventive strategies. Orphan nuclear receptors as well as the Wnt/beta-catenin signaling pathway have been implicated in drug-induced changes in transporter expression. Targeting these xenobiotic sensors is therefore discussed as a means to optimize brain delivery and therapeutic outcome. Relevant progress has also been made with the identification of key signaling events that drive P-glycoprotein expression in response to pathophysiological mechanisms. In the epileptic brain, complex signaling events involving cyclooxygenase-2 activity trigger P-glycoprotein expression in response to glutamate release and activation of endothelial NMDA receptors. Moreover, reactive oxygen species and inflammatory cytokines have been identified as regulatory factors which might affect P-glycoprotein in several CNS diseases. Recent data substantiated several interesting targets in the respective signaling cascades thereby rendering a basis for the ongoing development of innovative approaches to optimize central nervous system drug brain penetration and efficacy.
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Affiliation(s)
- Heidrun Potschka
- Institute of Pharmacology, Toxicology, and Pharmacy, Ludwig-Maximilians-University, Koeniginstr. 16, D-80539 Munich, Germany.
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von Wedel-Parlow M, Wölte P, Galla HJ. Regulation of major efflux transporters under inflammatory conditions at the blood-brain barrier in vitro. J Neurochem 2009; 111:111-8. [PMID: 19656257 DOI: 10.1111/j.1471-4159.2009.06305.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
ATP-driven efflux transport proteins at the blood-brain barrier protect the healthy brain but impede pharmacotherapy of the disordered CNS. To investigate the question how ATP-binding cassette (ABC)-transporters are regulated during inflammation or infection we analysed the effects of the cytokines tumour necrosis factor-alpha (TNF-alpha) and interleukin-1beta (IL-1beta) on the expression of brain multidrug resistance proteins in primary cultures of porcine brain capillary endothelial cells. We found that TNF-alpha and IL-1beta rapidly decrease Abcg2 (BMDP/BCRP) mRNA expression within 6 h. After 24 and 48 h the mRNA level came back to control values. The mRNA reduction at 6 h was counter-regulated by the anti-inflammatory glucocorticoid hydrocortisone. Abcg2 protein levels were suppressed at prolonged stimulations but not after 6 h of stimulation which correlates with Abcg2 specific substrate uptake measurements. Abcb1 (p-glycoprotein) protein expression was transiently increased after TNF-alpha addition within 6 h of incubation followed by a reduction after 24 and 48 h whereas the Abcb1 mRNA levels were not changed. IL-1beta caused a continuous decrease in protein expression of both ABC-transporters. Long-term treatment with an assumed TNF-alpha-downstream agent, the vasoconstrictor endothelin-1, induced Abcg2 protein expression but suppressed Abcb1. Other efflux pumps like multidrug resistance-associated proteins/Abcc were rarely affected. The present results imply a complex regulation of the two most abundant ABC-transporters at the blood-brain barrier during early inflammation stages suggesting that Abcb1 (p-glycoprotein) is an early target of TNF-alpha-signalling counterbalanced by Abcg2.
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Lim JC, Mickute Z, Zaman M, Hopkins S, Wijesuriya H, Steckler T, Moechars D, Van Leuven F, Sarnyai Z, Hladky SB, Barrand MA. Decreased expression of multidrug efflux transporters in the brains of GSK-3beta transgenic mice. Brain Res 2009; 1276:1-10. [PMID: 19393634 DOI: 10.1016/j.brainres.2009.04.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Revised: 03/20/2009] [Accepted: 04/13/2009] [Indexed: 01/16/2023]
Abstract
Multidrug efflux transporters protect cells in the brain from potentially harmful substances but also from therapeutically useful drugs. Thus any condition that causes changes in their expression is of some importance with regard to drug access. In this study, changes in efflux transporter expression are investigated in mice containing a mutant constitutively active glycogen synthase kinase-3 (GSK-3beta) transgene, driven by the Thy-1 promoter so limiting its localization predominantly to neurons and some glial cells. As expected, decreases in beta-catenin were evident via Western blot analyses of cortical homogenates prepared from brains of these transgenic mice. As assessed by real time qRT-PCR, decreased transcript levels of the mdr1b isoform of P-glycoprotein, Mrp1 and Mrp4, (transporters associated with neurons and/or glial cells) were observed in the cortex but not the subventricular zone or hippocampus of the transgenic compared to wild type mouse brains. By contrast, no such decreases were evident with the mdr1a isoform of P-glycoprotein and Bcrp, transporters predominantly found in brain endothelium. Such transporter expression changes could not be accounted for by alterations in blood vessel density or neuronal to glial cell ratios as analyzed both from immunocytochemical staining and from RT-PCR. These observations support previous in vitro data showing that manipulations to GSK-3beta activity that alter signaling via beta-catenin can influence the expression of efflux transporters. Implications from this are that drug distribution into cells within the brain of these transgenic mice could be enhanced, hence warranting further investigation.
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Affiliation(s)
- Joseph C Lim
- Department of Pharmacology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1PD, UK
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38
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Daood MJ, Tsai C, Ahdab-Barmada M, Watchko JF. ABC transporter (P-gp/ABCB1, MRP1/ABCC1, BCRP/ABCG2) expression in the developing human CNS. Neuropediatrics 2008; 39:211-8. [PMID: 19165709 PMCID: PMC2821654 DOI: 10.1055/s-0028-1103272] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
P-glycoprotein (P-gp/ABCB1), multidrug resistance associated protein 1 (MRP1/ABCC1), and breast cancer resistance protein (BCRP/ABCG2) are plasma membrane efflux pumps that limit the intracellular uptake and retention of numerous lipophilic, amphipathic xeno- and endobiotics. Little is known about the neonatal and developmental expression of P-gp/ABCB1, MRP1/ABCC1, and BCRP/ABCG2 in the human central nervous system (CNS), therefore post-mortem CNS tissue from infants born at 22 (0/7)-42 (0/7) weeks of gestation and adults was immunostained to determine their ontogeny and cellular localization. P-gp/ABCB1 immunostaining was observed in microvessel endothelial cells as early as 22 (0/7) weeks, increasing in prevalence and intensity with maturation, and later in gestation in large pyramidal neurons. MRP1/ABCC1 immunostaining was prominent early in the choroid plexus and ventricular ependyma, and noted later in large pyramidal neurons. BCRP/ABCG2 expression was limited to microvessel endothelial cells. P-gp/ABCB1, MRP1/ABCC1 and BCRP/ABCG2 in adult brain matched term newborn CNS but with more intense immunostaining. We conclude that P-gp/ABCB1, MRP1/ABCC1, and BCRP/ABCG2 are expressed in a developmental, cell specific, fashion in the human CNS. The complementary pattern of P-gp/ABCB1 and BCRP/ABCG2 at the blood-brain with MRP1/ABCC1 at the blood-CSF barriers may limit CNS uptake and retention of drugs and toxins in neonates.
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Affiliation(s)
- Monica J. Daood
- Division of Newborn Medicine Department of Pediatrics University of Pittsburgh School of Medicine Magee-Womens Research Institute Pittsburgh, Pennsylvania USA
| | - Cathy Tsai
- Division of Newborn Medicine Department of Pediatrics University of Pittsburgh School of Medicine Magee-Womens Research Institute Pittsburgh, Pennsylvania USA
| | | | - Jon F. Watchko
- Division of Newborn Medicine Department of Pediatrics University of Pittsburgh School of Medicine Magee-Womens Research Institute Pittsburgh, Pennsylvania USA
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Robey RW, Lazarowski A, Bates SE. P-glycoprotein--a clinical target in drug-refractory epilepsy? Mol Pharmacol 2008; 73:1343-6. [PMID: 18314494 DOI: 10.1124/mol.108.046680] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
ATP-binding cassette transporters such as P-glycoprotein (Pgp), multidrug resistance-associated protein, and breast cancer resistance protein are known to transport a wide range of substrates and are highly expressed in the capillary endothelial cells that form part of the blood-brain barrier. It is noteworthy that P-glycoprotein has been shown to be up-regulated in animal models of refractory epilepsy, and adding a Pgp inhibitor to treatment regimens has been shown to reverse the drug-resistant phenotype. Limited data have suggested a role for Pgp in epilepsy in humans as well. However, few epilepsy drugs have been shown to be transported by Pgp, leading to controversy over whether Pgp actually plays a role in drug-resistant epilepsy. In this issue of Molecular Pharmacology, Bauer et al. (p. 1444) demonstrate that glutamate can cause localized up-regulation of Pgp via cyclooxygenase-2 (COX-2) and that this phenomenon can be prevented with COX-2 inhibitors. Localized rather than global up-regulation of Pgp may explain some of the difficulty investigators have had in proving a role for Pgp in epilepsy. The results add new support for future clinical trials targeting Pgp expression in drug-refractory epilepsy.
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Affiliation(s)
- Robert W Robey
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
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