The implication of bilitranslocase function in the impaired rifamycin SV metabolism in Gilbert's syndrome

Inhibition of human organic anion transporting polypeptide OATP 1B1 as a mechanism of drug-induced hyperbilirubinemia

OATP1B1 (a.k.a. OATP-C, OATP2, LST-1, or SLC21A6) is a liver-specific organic anion uptake transporter and has been shown to be a higher affinity bilirubin uptake transporter than OATP1B3. Using human embryonic kidney (HEK 293) cells stably transfected with OATP1B1, we have studied the effects of indinavir, saquinavir, cyclosporin A, and rifamycin SV on human OATP1B1 transport function. These drugs are potent inhibitors of OATP1B1 transport activity in vitro. We further provide evidence that the calculated fraction of OATP1B1 inhibited at the clinical exposure level correlated very well with the observed hyperbilirubinemia outcome for these drugs in humans. Our data support the hypothesis that inhibition of OATP1B1 is an important mechanism for drug-induced unconjugated hyperbilirubinemia. Inhibition of OATPs may be an important mechanism in drug-drug and drug-endogenous substance interactions.

Gender differences in the membrane transport of endogenous and exogenous compounds

Gender differences have been well described in pharmacokinetics and contribute to the interindividual variation in drug disposition, therapeutic response, and drug toxicity. Sex-related differences in the membrane transport of endogenous substrates and xenobiotics have been reported in various organs of the body including kidney, liver, intestine, and brain. These gender-related differences in transport systems could also contribute to interindividual variability in pharmacokinetics and pharmacodynamics. This review will focus on current knowledge of gender-associated differences in the transport of endogenous and exogenous compounds in a variety of body organs and will discuss the implications and the clinical significance of these observations.

On the mechanism of bilitranslocase transport inactivation by phenylmethylsulphonyl fluoride

Bilitranslocase is a plasma membrane carrier involved in the uptake of bilirubin and other organic anions from the blood into the liver cell. In the membrane, the carrier occurs as two interchangeable metastable forms, with high and low affinity for the substrates, respectively. The latter form can be specifically produced by either cysteine- or arginine modification. In liver plasma membrane vesicles, the serine-specific reagent phenylmethylsulphonyl fluoride is a partial inhibitor of bilitranslocase-mediated BSP transport rate. In this work, phenylmethyl-sulphonyl fluoride is shown to reduce the carrier maximal transport rate, without affecting its affinity for that substrate. In addition, it is found that the chemical modification caused by this reagent neither influences the equilibrium between the high- and the low-affinity forms nor prevents their free interconversion. From the effects of combined derivatizations of cysteine(s), arginine(s) and serine(s), it is concluded that the functionally relevant aminoacid residues lie in a close spatial arrangement. Also, in this study, the PMSF-modified serine(s) is shown to be involved in bilirubin binding by bilitranslocase.

Gender-differential liver plasma membrane affinities in hepatic tetrabromosulfonephthalein (TBS) uptake

The sex difference in the hepatic uptake of tetrabromosulfonephthalein (TBS) was investigated in male and female rats in two different experimental models. In the intact animal, the initial plasma disappearance constant rate, the initial velocity of uptake, and the plasma clearance of TBS were significantly higher in females than in males. In sinusoidal liver plasma membrane vesicles, kinetic parameters of TBS uptake were investigated in both sexes. The Km was lower in females than in males (5.5 +/- 0.4 vs 17 +/- 4 microM, P < 0.05), whereas Vmax showed comparable values (544 +/- 15 vs 581 +/- 60 nmol TBS/min/mg protein, mean +/- SD, NS, females and males, respectively). Collectively, these data indicate that the sex difference in hepatic uptake of TBS is located at the sinusoidal liver plasma membrane and is due to a greater affinity of the electrogenic transport system(s) in females.

The association between rifamycin-SV (R-SV) related hyperbilirubinaemia and antipyrine clearance as a new test of liver function in cirrhosis

Several clearance tests have been used to assess the residual hepatic efficiency in liver cirrhosis. However, the altered clearance values found in cirrhotic patients may reflect not only the impairment in liver function but also a derangement in the hepatic blood-flow. Therefore, this study was designed to explore the possibility that the competition between Rifamycin-SV and bilirubin at the hepatic uptake site might be used as an index for quantitative assessment of residual hepatic efficiency in 48 patients with chronic liver disease. In this test, the interference of hepatic blood flow would be negligible. Antipyrine clearance was also evaluated in the same subjects in order to explore the cytoplasmic microsomal efficiency. Rifamycin-SV intravenous load was followed by a sustained increase in bilirubinaemia which significantly related with the degree of liver function as assessed by the Child-Pugh criteria. Also, antipyrine clearance was significantly altered in cirrhotic patients compared to controls. Moreover, a positive correlation was found between the Rifamycin-SV test and Antipyrine clearance. We suggest that a combination of these tests might be of use in the quantitative assessment of liver function.

Age-associated decline of hepatic handling of cholephilic anions in humans is reverted by S-adenosylmethionine (SAMe)

Decreased fluidity of hepatocyte plasma membrane may contribute to the age-associated changes of liver function. This study aimed at investigating whether the hepatic clearance of organic anions declines with age and whether S-adenosylmethionine (SAMe), a substance proven to be effective in reversing the age-related decrease of membrane fluidity, might influence this process. Nicotinic acid (NA) half-life and serum bilirubin pharmacokinetics after NA load (5.9 mumol/kg body weight i.v.) were studied in 10 healthy young males (YM) aged 14-28 years and in 10 healthy elderly males (EM) aged 65-81 years, before and after SAMe administration (800 mg/day intravenously for 10 days). At baseline, EM showed serum total bilirubin (STB) levels significantly higher than YM. Similarly, the bilirubinaemic mean curves, STB peak and STB time curve concentration after NA load, expressed as area under the curve (AUC), were significantly higher in EM than in YM (p less than 0.01). NA half-life was also significantly prolonged in the aged group (p less than 0.001). SAMe treatment was followed by a significant decrease of basal STB, STB peak and AUC of STB after NA load in EM (p less than 0.01 vs pre-treatment values) while NA half-life was significantly shortened in both groups (p less than 0.001). As NA and bilirubin share a common carrier protein for hepatic uptake, bilitranslocase, the changes observed in EM may be attributed to the reduced lateral mobility of hepatocyte plasma membrane proteins occurring with age. SAMe, by improving membrane fluidity, may increase the diffusion coefficient of bilitranslocase restoring the hepatic handling of organic anions.

Abnormal hepatic uptake of low doses of sulfobromophthalein in Gilbert's syndrome: the role of reduced affinity of the plasma membrane carrier of organic anions

The plasma disappearance rate of sulfobromophthalein (VBSP; mumol/kg/min) was measured in 15 Gilbert's syndrome patients and 12 control subjects after intravenous injection of two different doses (0.59 and 5.90 mumol/kg) of the dye. Plasma disappearance rate was significantly reduced in Gilbert's syndrome patients after administration of 0.59 mumol sulfobromophthalein/kg (0.119 +/- 0.016 vs. 0.146 +/- 0.018 mumol/kg/min; mean +/- S.D.; p less than 0.001), whereas no difference was found with the higher dose (0.754 +/- 0.040 vs. 0.767 +/- 0.072 mumol/kg/min). Significant reduction was also found after administration to four Gilbert's syndrome patients and four control subjects of 0.29 and 2.95 mumol sulfobromophthalein (0.060 +/- 0.005 mumol/kg/min vs. 0.077 +/- 0.07 mumol/kg/min and 0.480 +/- 0.012 mumol/kg/min vs. 0.591 +/- 0.015 mumol/kg/min, respectively; p less than 0.01). Competition studies with combined administration of sulfobromophthalein (0.59 mumol/kg) and different doses of rifamycin SV (0.59, 1.47 and 2.95 mumol/kg) showed a significant (p less than 0.001) reduction in plasma disappearance rate in Gilbert's syndrome patients but not in controls. The rifamycin SV dose at which a 50% inhibition in plasma disappearance rate was observed was 0.8 mumol/kg. The apparent affinity (Km) of the hepatic transport was higher in Gilbert's syndrome patients than in control subjects (3.61 +/- 0.37 mumol sulfobromophthalein/kg vs. 2.76 +/- 0.29 mumol sulfobromophthalein/kg, mean +/- S.D.; p less than 0.01), whereas no difference was found in Vmax (0.95 +/- 0.11 mumol sulfobromophthalein/kg vs. 0.93 +/- 0.10 mumol sulfobromophthalein/kg/min, mean +/- S.D.; N.S.).(ABSTRACT TRUNCATED AT 250 WORDS)

The quinoid structure is the molecular requirement for recognition of phthaleins by the organic anion carrier at the sinusoidal plasma membrane level in the liver

Sulfobromophthalein electrogenic uptake into rat liver plasma membrane vesicles was shown to admit only the quinoid, trivalent anion. The minimum requirement for this electrogenic process has been investigated in rat liver plasma membrane vesicles by using Thymol blue, a pH-indicator phthalein occurring either as a neutral, phenolic molecule or as a quinoid, monovalent anion. It has been found that Thymol blue is taken up electrogenically, in accordance with Michaelis-Menten kinetics. Parallel inhibition experiments have shown that both sulfobromophthalein and Thymol blue electrogenic uptakes are performed by the same carrier. It is, therefore, concluded that the phthalein structure recognized for transport is the quinoid molecule, with the dissociated acidic function on the benzene ring. Moreover, inhibitions by rifamycin-SV and bilirubin suggest that there exists a common uptake system for bilirubin, phthaleins and other anions. Taurocholate, on the contrary, does not appear to be involved in the same process.

Serum free fatty acids and bilirubin concentration during fasting in patients with Gilbert's syndrome and normal controls

The increments in serum concentrations of unconjugated bilirubin and free fatty acids (FFA) were measured 24 and 48 h after reduction of the caloric intake (400 cal/day) in 17 patients with Gilbert's syndrome (GS) and in 12 healthy control subjects. In males, both normal and with GS, the rise in serum bilirubin was statistically higher (p less than 0.01) as compared to females. On the contrary, no sex difference was found in FFA concentrations. A linear correlation (p less than 0.01) between bilirubin and FFA serum levels was present in normal males and in patients with Gilbert's syndrome of both sexes. Because bilirubin and FFA partly share a common, bilitranslocase-mediated, hepatic uptake mechanism, data reported support the hypothesis that a bilitranslocase function may be one of the metabolic defects in Gilbert's syndrome.

Cellular localization of sulfobromophthalein transport activity in rat liver

The movement of sulfobromophthalein is measured in rat liver plasma-membrane vesicles by direct dual-wavelength spectrophotometry. The technique is based on the principle that the dye, when entering a more acidic compartment, changes its absorption in the visible region. From this study it may be concluded that, among the different cellular subfractions, only liver plasma-membrane vesicles can catalyze electrogenic transport of sulfobromophthalein. Plasma membranes from erythrocytes are unable to perform such a function. The movement follows the distribution pattern of (Na+ + K+)-ATPase and it is therefore concluded that this process occurs exclusively at the sinusoidal membrane level. Inhibition studies confirm that the process is catalyzed by bilitranslocase.