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Peter JU, Dieudonné P, Zolk O. Pharmacokinetics, Pharmacodynamics, and Side Effects of Midazolam: A Review and Case Example. Pharmaceuticals (Basel) 2024; 17:473. [PMID: 38675433 PMCID: PMC11054797 DOI: 10.3390/ph17040473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/27/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Midazolam, a short-acting benzodiazepine, is widely used to alleviate patient anxiety, enhance compliance, and aid in anesthesia. While its side effects are typically dose-dependent and manageable with vigilant perioperative monitoring, serious cardiorespiratory complications, including fatalities and permanent neurological impairment, have been documented. Prolonged exposure to benzodiazepines, such as midazolam, has been associated with neurological changes in infants. Despite attempts to employ therapeutic drug monitoring for optimal sedation dosing, its efficacy has been limited. Consequently, efforts are underway to identify alternative predictive markers to guide individualized dosing and mitigate adverse effects. Understanding these factors is crucial for determining midazolam's suitability for future administration, particularly after a severe adverse reaction. This article aims to elucidate the factors influencing midazolam's pharmacokinetics and pharmacodynamics, potentially leading to adverse events. Finally, a case study is presented to exemplify the complex investigation into the causative factors of midazolam-related adverse events.
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Affiliation(s)
- Jens-Uwe Peter
- Institute of Clinical Pharmacology, Immanuel Klinik Rüdersdorf, Brandenburg Medical School, 15562 Rüdersdorf, Germany;
| | - Peter Dieudonné
- Department of Anesthesiology, University Hospital Ulm, 89081 Ulm, Germany
| | - Oliver Zolk
- Institute of Clinical Pharmacology, Immanuel Klinik Rüdersdorf, Brandenburg Medical School, 15562 Rüdersdorf, Germany;
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2
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Zhang C, Su D, Choo EF, Liu L, Bobba S, Jorski JD, Ho Q, Wang J, Kenny JR, Khojasteh SC, Zhang D. Identification of a Discrete Diglucuronide of GDC-0810 in Human Plasma after Oral Administration. Drug Metab Dispos 2023; 51:1284-1294. [PMID: 37349116 DOI: 10.1124/dmd.122.001071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/24/2023] Open
Abstract
GDC-0810 is a small molecule therapeutic agent having potential to treat breast cancer. In plasma of the first-in-human study, metabolite M2, accounting for 20.7% of total drug-related materials, was identified as a discrete diglucuronide that was absent in rats. Acyl glucuronide M6 and N-glucuronide M4 were also identified as prominent metabolites in human plasma. Several in vitro studies were conducted in incubations of [14C]GDC-0810, synthetic M6 and M4 with liver microsomes, intestinal microsomes, and hepatocytes of different species as well as recombinant UDP-glucuronosyltransferase (UGT) enzymes to further understand the formation of M2. The results suggested that 1) M2 was more efficiently formed from M6 than from M4, and 2) acyl glucuronidation was mainly catalyzed by UGT1A8/7/1 that is highly expressed in the intestines whereas N-glucuronidation was mainly catalyzed by UGT1A4 that is expressed in the human liver. This complicated mechanism presented challenges in predicting M2 formation using human in vitro systems. The absence of M2 and M4 in rats can be explained by low to no expression of UGT1A4 in rodents. M2 could be the first discrete diglucuronide that was formed from both acyl- and N-glucuronidation on a molecule identified in human plasma. SIGNIFICANCE STATEMENT: A discrete diglucuronidation metabolite of GDC-0810, a breast cancer drug candidate, was characterized as a unique circulating metabolite in humans that was not observed in rats or little formed in human in vitro system.
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Affiliation(s)
- Chenghong Zhang
- Department of Drug Metabolism and Pharmacokinetics, Genentech Inc., South San Francisco, California (E.F.C., S.B., J.D.J., J.W., J.R.K., S.C.K., D.Z.); Pfizer, South San Francisco, California (C.Z.); Bicycle Therapeutics, Cambridge, Massachusetts (D.S.); Innovative Research BU, Yifan Pharmaceutical, Hangzhou, China (L.L.); and Abbvie Biotherapeutics Inc., South San Francisco, California (Q.H.)
| | - Dian Su
- Department of Drug Metabolism and Pharmacokinetics, Genentech Inc., South San Francisco, California (E.F.C., S.B., J.D.J., J.W., J.R.K., S.C.K., D.Z.); Pfizer, South San Francisco, California (C.Z.); Bicycle Therapeutics, Cambridge, Massachusetts (D.S.); Innovative Research BU, Yifan Pharmaceutical, Hangzhou, China (L.L.); and Abbvie Biotherapeutics Inc., South San Francisco, California (Q.H.)
| | - Edna F Choo
- Department of Drug Metabolism and Pharmacokinetics, Genentech Inc., South San Francisco, California (E.F.C., S.B., J.D.J., J.W., J.R.K., S.C.K., D.Z.); Pfizer, South San Francisco, California (C.Z.); Bicycle Therapeutics, Cambridge, Massachusetts (D.S.); Innovative Research BU, Yifan Pharmaceutical, Hangzhou, China (L.L.); and Abbvie Biotherapeutics Inc., South San Francisco, California (Q.H.)
| | - Lichuan Liu
- Department of Drug Metabolism and Pharmacokinetics, Genentech Inc., South San Francisco, California (E.F.C., S.B., J.D.J., J.W., J.R.K., S.C.K., D.Z.); Pfizer, South San Francisco, California (C.Z.); Bicycle Therapeutics, Cambridge, Massachusetts (D.S.); Innovative Research BU, Yifan Pharmaceutical, Hangzhou, China (L.L.); and Abbvie Biotherapeutics Inc., South San Francisco, California (Q.H.)
| | - Sudheer Bobba
- Department of Drug Metabolism and Pharmacokinetics, Genentech Inc., South San Francisco, California (E.F.C., S.B., J.D.J., J.W., J.R.K., S.C.K., D.Z.); Pfizer, South San Francisco, California (C.Z.); Bicycle Therapeutics, Cambridge, Massachusetts (D.S.); Innovative Research BU, Yifan Pharmaceutical, Hangzhou, China (L.L.); and Abbvie Biotherapeutics Inc., South San Francisco, California (Q.H.)
| | - Jamie D Jorski
- Department of Drug Metabolism and Pharmacokinetics, Genentech Inc., South San Francisco, California (E.F.C., S.B., J.D.J., J.W., J.R.K., S.C.K., D.Z.); Pfizer, South San Francisco, California (C.Z.); Bicycle Therapeutics, Cambridge, Massachusetts (D.S.); Innovative Research BU, Yifan Pharmaceutical, Hangzhou, China (L.L.); and Abbvie Biotherapeutics Inc., South San Francisco, California (Q.H.)
| | - Quynh Ho
- Department of Drug Metabolism and Pharmacokinetics, Genentech Inc., South San Francisco, California (E.F.C., S.B., J.D.J., J.W., J.R.K., S.C.K., D.Z.); Pfizer, South San Francisco, California (C.Z.); Bicycle Therapeutics, Cambridge, Massachusetts (D.S.); Innovative Research BU, Yifan Pharmaceutical, Hangzhou, China (L.L.); and Abbvie Biotherapeutics Inc., South San Francisco, California (Q.H.)
| | - Jing Wang
- Department of Drug Metabolism and Pharmacokinetics, Genentech Inc., South San Francisco, California (E.F.C., S.B., J.D.J., J.W., J.R.K., S.C.K., D.Z.); Pfizer, South San Francisco, California (C.Z.); Bicycle Therapeutics, Cambridge, Massachusetts (D.S.); Innovative Research BU, Yifan Pharmaceutical, Hangzhou, China (L.L.); and Abbvie Biotherapeutics Inc., South San Francisco, California (Q.H.)
| | - Jane R Kenny
- Department of Drug Metabolism and Pharmacokinetics, Genentech Inc., South San Francisco, California (E.F.C., S.B., J.D.J., J.W., J.R.K., S.C.K., D.Z.); Pfizer, South San Francisco, California (C.Z.); Bicycle Therapeutics, Cambridge, Massachusetts (D.S.); Innovative Research BU, Yifan Pharmaceutical, Hangzhou, China (L.L.); and Abbvie Biotherapeutics Inc., South San Francisco, California (Q.H.)
| | - S Cyrus Khojasteh
- Department of Drug Metabolism and Pharmacokinetics, Genentech Inc., South San Francisco, California (E.F.C., S.B., J.D.J., J.W., J.R.K., S.C.K., D.Z.); Pfizer, South San Francisco, California (C.Z.); Bicycle Therapeutics, Cambridge, Massachusetts (D.S.); Innovative Research BU, Yifan Pharmaceutical, Hangzhou, China (L.L.); and Abbvie Biotherapeutics Inc., South San Francisco, California (Q.H.)
| | - Donglu Zhang
- Department of Drug Metabolism and Pharmacokinetics, Genentech Inc., South San Francisco, California (E.F.C., S.B., J.D.J., J.W., J.R.K., S.C.K., D.Z.); Pfizer, South San Francisco, California (C.Z.); Bicycle Therapeutics, Cambridge, Massachusetts (D.S.); Innovative Research BU, Yifan Pharmaceutical, Hangzhou, China (L.L.); and Abbvie Biotherapeutics Inc., South San Francisco, California (Q.H.)
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Duthaler U, Bachmann F, Ozbey AC, Umehara K, Parrott N, Fowler S, Krähenbühl S. The Activity of Members of the UDP-Glucuronosyltransferase Subfamilies UGT1A and UGT2B is Impaired in Patients with Liver Cirrhosis. Clin Pharmacokinet 2023; 62:1141-1155. [PMID: 37328712 PMCID: PMC10386950 DOI: 10.1007/s40262-023-01261-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND AND OBJECTIVE The impact of liver cirrhosis on the activity of UDP-glucuronosyltransferases (UGTs) is currently not well characterized. We investigated the glucuronidation capacity and glucuronide accumulation in patients with liver cirrhosis. METHODS We administered the Basel phenotyping cocktail (caffeine, efavirenz, flurbiprofen, omeprazole, metoprolol, midazolam) to patients with liver cirrhosis (n = 16 Child A, n = 15 Child B, n = 5 Child C) and n = 12 control subjects and obtained pharmacokinetic profiles of substrates and primary metabolites and their glucuronides. RESULTS Caffeine and its metabolite paraxanthine were only slightly glucuronidated. The metabolic ratio (AUCglucuronide/AUCparent, MR) was not affected for caffeine but decreased by 60% for paraxanthine glucuronide formation in Child C patients. Efavirenz was not glucuronidated whereas 8-hydroxyefavirenz was efficiently glucuronidated. The MR of 8-hydroxyefavirenz-glucuronide formation increased three-fold in Child C patients and was negatively correlated with the glomerular filtration rate. Flurbiprofen and omeprazole were not glucuronidated. 4-Hydroxyflurbiprofen and 5-hydroxyomeprazole were both glucuronidated but the corresponding MRs for glucuronide formation were not affected by liver cirrhosis. Metoprolol, but not α-hydroxymetoprolol, was glucuronidated, and the MR for metoprolol-glucuronide formation dropped by 60% in Child C patients. Both midazolam and its metabolite 1'-hydroxymidazolam underwent glucuronidation, and the corresponding MRs for glucuronide formation dropped by approximately 80% in Child C patients. No relevant glucuronide accumulation occurred in patients with liver cirrhosis. CONCLUSIONS Detailed analysis revealed that liver cirrhosis may affect the activity of UGTs of the UGT1A and UGT2B subfamilies according to liver function. Clinically significant glucuronide accumulation did not occur in the population investigated. CLINICAL TRIAL REGISTRATION NCT03337945.
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Affiliation(s)
- Urs Duthaler
- Division of Clinical Pharmacology and Toxicology, University Hospital Basel, 4031, Basel, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Fabio Bachmann
- Division of Clinical Pharmacology and Toxicology, University Hospital Basel, 4031, Basel, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Agustos C Ozbey
- Pharmaceutical Sciences, Roche Pharma Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Kenichi Umehara
- Pharmaceutical Sciences, Roche Pharma Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Neil Parrott
- Pharmaceutical Sciences, Roche Pharma Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Stephen Fowler
- Pharmaceutical Sciences, Roche Pharma Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Stephan Krähenbühl
- Division of Clinical Pharmacology and Toxicology, University Hospital Basel, 4031, Basel, Switzerland.
- Department of Biomedicine, University of Basel, Basel, Switzerland.
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
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Ren K, Wang R, Fang S, Ren S, Hua H, Wang D, Pan Y, Liu X. Effect of CYP3A inducer/inhibitor and licorice on hepatotoxicity and in vivo metabolism of main alkaloids of Euodiae Fructus based on UPLC-Q-Exactive-MS. JOURNAL OF ETHNOPHARMACOLOGY 2023; 303:116005. [PMID: 36516906 DOI: 10.1016/j.jep.2022.116005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/27/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE As a traditional Chinese medicine, Euodiae Fructus (EF) has been used to treat stomachache, belching, and emesis for more than a thousand years. Ancient records and modern research have shown that EF has mild toxicity, which needs to be processed with licorice juice to reduce its toxicity. Research suggested that the toxicity of EF can be caused by in vivo metabolism, but whether its metabolites are related to hepatotoxicity and whether licorice can affect the metabolism of EF have not been reported, which needed an effective strategy to clarify the correlation between metabolites and toxicity and the attenuation mechanism of licorice processing. AIM OF THE STUDY The poisonous substances and metabolic pathways were clarified by comparing the mechanism in vivo process of the main alkaloids of EF in normal rats and rats treated with dexamethasone (DXMS), ketoconazole (KTC), and EF processed with licorice (EFP). MATERIALS AND METHODS Rats were given EF and EFP by oral administration, respectively. The EF + DXMS and EF + KTC groups were pretreated with DXMS and KTC, respectively, by i. p. for seven days, and their toxicity differences were compared. The comprehensive strategy based on UPLC-Q-Exactive-MS and Orthogonal Partial Least Squares Discriminant Analysis was developed to compare the types and contents of metabolites and clarify the metabolic pathways of alkaloids among EF, EFP, EF + KTC, and EF + DXMS groups. RESULTS EF + DXMS group significantly increased the hepatotoxicity, whereas the EF + KTC and EFP groups reduced the hepatotoxicity compared with the EF group. One hundred and thirty-five metabolites were detected, and the metabolic pathways of the main alkaloid components related to toxicity were inferred in the plasma, urine, feces, and bile of rats. KTC and licorice similarly inhibited the production of toxic metabolites, changed metabolism in vivo, and produced many new II and a few phases I metabolites, while the contents of toxic metabolites increased in the DXMS group. CONCLUSION Licorice and KTC could inhibit the production of metabolites of EF related to toxicity, increase the production of other metabolites and promote the excretion of alkaloids, which may be why licorice and KTC can minimize EF toxicity.
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Affiliation(s)
- Kun Ren
- School of Traditional Chinese Medicine, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, Liaoning, 110016, China.
| | - Ruijie Wang
- School of Traditional Chinese Medicine, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, Liaoning, 110016, China
| | - Shinuo Fang
- School of Traditional Chinese Medicine, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, Liaoning, 110016, China
| | - Shumeng Ren
- School of Traditional Chinese Medicine, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, Liaoning, 110016, China
| | - Huiming Hua
- School of Traditional Chinese Medicine, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, Liaoning, 110016, China
| | - Dongmei Wang
- School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, Liaoning, 110016, China.
| | - Yingni Pan
- School of Traditional Chinese Medicine, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, Liaoning, 110016, China.
| | - Xiaoqiu Liu
- School of Traditional Chinese Medicine, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, Liaoning, 110016, China.
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van Groen BD, Krekels EHJ, Mooij MG, van Duijn E, Vaes WHJ, Windhorst AD, van Rosmalen J, Hartman SJF, Hendrikse NH, Koch BCP, Allegaert K, Tibboel D, Knibbe CAJ, de Wildt SN. The Oral Bioavailability and Metabolism of Midazolam in Stable Critically Ill Children: A Pharmacokinetic Microtracing Study. Clin Pharmacol Ther 2021; 109:140-149. [PMID: 32403162 PMCID: PMC7818442 DOI: 10.1002/cpt.1890] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 04/15/2020] [Indexed: 12/21/2022]
Abstract
Midazolam is metabolized by the developmentally regulated intestinal and hepatic drug-metabolizing enzyme cytochrome P450 (CYP) 3A4/5. It is frequently administered orally to children, yet knowledge is lacking on the oral bioavailability in term neonates up until 1 year of age. Furthermore, the dispositions of the major metabolites 1-OH-midazolam (OHM) and 1-OH-midazolam-glucuronide (OHMG) after oral administration are largely unknown for the entire pediatric age span. We aimed to fill these knowledge gaps with a pediatric [14 C]midazolam microtracer population pharmacokinetic study. Forty-six stable, critically ill children (median age 9.8 (range 0.3-276.4) weeks) received a single oral [14 C]midazolam microtracer (58 (40-67) Bq/kg) when they received a therapeutic continuous intravenous midazolam infusion and had an arterial line in place enabling blood sampling. For midazolam, in a one-compartment model, bodyweight was a significant predictor for clearance (0.98 L/hour) and volume of distribution (8.7 L) (values for a typical individual of 5 kg). The typical oral bioavailability in the population was 66% (range 25-85%). The exposures of OHM and OHMG were highest for the youngest age groups and significantly decreased with postnatal age. The oral bioavailability of midazolam, largely reflective of intestinal and hepatic CYP3A activity, was on average lower than the reported 49-92% for preterm neonates, and higher than the reported 21% for children> 1 year of age and 30% for adults. As midazolam oral bioavailability varied widely, systemic exposure of other CYP3A-substrate drugs after oral dosing in this population may also be unpredictable, with risk of therapy failure or toxicity.
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Affiliation(s)
- Bianca D. van Groen
- Intensive Care and Pediatric SurgeryErasmus Medical Center – Sophia Children’s HospitalRotterdamThe Netherlands
| | - Elke H. J. Krekels
- Leiden Academic Center for Drug ResearchLeiden UniversityLeidenThe Netherlands
| | - Miriam G. Mooij
- Department of PediatricsLeiden University Medical CentreLeidenThe Netherlands
| | | | | | - Albert D. Windhorst
- Amsterdam University Medical Centers – Location VU Medical CenterAmsterdamThe Netherlands
| | - Joost van Rosmalen
- Department of BiostatisticsErasmus Medical CenterRotterdamthe Netherlands
| | - Stan J. F. Hartman
- Department of Pharmacology and ToxicologyRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands
| | - N. Harry Hendrikse
- Amsterdam University Medical Centers – Location VU Medical CenterAmsterdamThe Netherlands
| | - Birgit C. P. Koch
- Department of Hospital PharmacyErasmus Medical CenterRotterdamThe Netherlands
| | - Karel Allegaert
- Department of Hospital PharmacyErasmus Medical CenterRotterdamThe Netherlands
- Katholieke Universiteit LeuvenLeuvenBelgium
| | - Dick Tibboel
- Intensive Care and Pediatric SurgeryErasmus Medical Center – Sophia Children’s HospitalRotterdamThe Netherlands
| | - Catherijne A. J. Knibbe
- Leiden Academic Center for Drug ResearchLeiden UniversityLeidenThe Netherlands
- St Antonius HospitalNieuwegeinThe Netherlands
| | - Saskia N. de Wildt
- Intensive Care and Pediatric SurgeryErasmus Medical Center – Sophia Children’s HospitalRotterdamThe Netherlands
- Department of Pharmacology and ToxicologyRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands
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Zastrozhin MS, Skryabin VY, Torrado M, Petrovna A, Sorokin AS, Grishina EA, Ryzhikova KA, Bedina IA, Buzik OZ, Chumakov EM, Savchenko LM, Brun EA, Sychev DA. Effects of CYP2C19*2 polymorphisms on the efficacy and safety of phenazepam in patients with anxiety disorder and comorbid alcohol use disorder. Pharmacogenomics 2020; 21:111-123. [PMID: 31957548 DOI: 10.2217/pgs-2019-0019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Introduction: Phenazepam therapy can often be ineffective and some patients develop dose-related adverse drug reactions. Aim. The purpose of this research was to study the effect of the CYP2C19*2 (681G>A, rs4244285) in patients with anxiety disorders and alcohol dependence taking phenazepam therapy. Materials & methods: Patients (175 males, average age: 37.16 ± 7.84 years) received phenazepam in tablet form for 5 days. Genotyping was performed by real-time polymerase chain reaction. Results: The statistically significant differences in the UKU Side-Effect Rating Scale scores on the fifth day of therapy: (CYP2C19*1/*1) 2.00 [1.00; 2.00), (CYP2C19*1/*2) 7.00 (7.00; 7.00), (CYP2C19*2/*2) 9.00 (8.00; 9.00), p < 0.001. Conclusion: This study demonstrated the different efficacy and safety of phenazepam in patients with different genotypes of CYP2C19*2.
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Affiliation(s)
- Michael S Zastrozhin
- Moscow Research & Practical Centre on Addictions of the Moscow Department of Healthcare, 37/1 Lyublinskaya Street, Moscow 109390, Russian Federation.,Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, 2/1 Barrikadnaya Street, Moscow 123995, Russian Federation
| | - Valentin Y Skryabin
- Moscow Research & Practical Centre on Addictions of the Moscow Department of Healthcare, 37/1 Lyublinskaya Street, Moscow 109390, Russian Federation
| | - Marco Torrado
- University of Lisbon, Faculty of Medicine, ISAMB (Instituto de Saúde Ambiental) venida Professor Egas Moniz (Edifício comum ao Hospital de Santa Maria), 1649-028 Lisboa, Portugal
| | - Anastasiya Petrovna
- Moscow Research & Practical Centre on Addictions of the Moscow Department of Healthcare, 37/1 Lyublinskaya Street, Moscow 109390, Russian Federation
| | - Alexander S Sorokin
- Moscow Research & Practical Centre on Addictions of the Moscow Department of Healthcare, 37/1 Lyublinskaya Street, Moscow 109390, Russian Federation
| | - Elena A Grishina
- Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, 2/1 Barrikadnaya Street, Moscow 123995, Russian Federation
| | - Kristina A Ryzhikova
- Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, 2/1 Barrikadnaya Street, Moscow 123995, Russian Federation
| | - Inessa A Bedina
- Moscow Research & Practical Centre on Addictions of the Moscow Department of Healthcare, 37/1 Lyublinskaya Street, Moscow 109390, Russian Federation
| | - Oleg Z Buzik
- Moscow Research & Practical Centre on Addictions of the Moscow Department of Healthcare, 37/1 Lyublinskaya Street, Moscow 109390, Russian Federation
| | - Egor M Chumakov
- Saint-Petersburg State University, Department of Psychiatry & Addictions, Saint-Petersburg, Russian Federation.,Saint-Petersburg Psychiatric Hospital No. 1 named after PP Kaschenko, Day In-Patient Department, Saint-Petersburg, Russian Federation
| | - Ludmila M Savchenko
- Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, 2/1 Barrikadnaya Street, Moscow 123995, Russian Federation
| | - Evgeny A Brun
- Moscow Research & Practical Centre on Addictions of the Moscow Department of Healthcare, 37/1 Lyublinskaya Street, Moscow 109390, Russian Federation.,Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, 2/1 Barrikadnaya Street, Moscow 123995, Russian Federation
| | - Dmitry A Sychev
- Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, 2/1 Barrikadnaya Street, Moscow 123995, Russian Federation
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7
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Togao M, Kawakami K, Otsuka J, Wagai G, Ohta-Takada Y, Kado S. Effects of gut microbiota on in vivo metabolism and tissue accumulation of cytochrome P450 3A metabolized drug: Midazolam. Biopharm Drug Dispos 2020; 41:275-282. [PMID: 32562497 PMCID: PMC7497050 DOI: 10.1002/bdd.2244] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/21/2020] [Accepted: 06/03/2020] [Indexed: 12/04/2022]
Abstract
The link between drug‐metabolizing enzymes and gut microbiota is well established. In particular, hepatic cytochrome P450 (CYP) 3A activities are presumed to be affected by gut microbiota. However, there is no direct evidence that the gut microbiota affects CYP3A metabolism or the clearance of clinically relevant drugs in vivo. Our purpose was to evaluate the effects of gut microbiota on in vitro and in vivo drug metabolism and on the clearance of midazolam, which is a standard CYP3A metabolized drug. Hepatic Cyp3a activity and in vitro midazolam hydroxylase activity were compared using specific pathogen‐free (SPF) and germ‐free (GF) mice. In a pharmacokinetics (PK) study, SPF and GF mice were intraperitoneally injected with 60 mg/kg of midazolam, and plasma and tissue concentrations were measured. Hepatic Cyp3a activity and midazolam hydroxylase activity were significantly lower in GF mice than in SPF mice. Notably, in the PK study, the area under the plasma concentration–time curve from time zero to infinity and the elimination half‐life were approximately four‐fold higher in GF mice compared with SPF mice. Furthermore, the concentration of midazolam in the brain 180 min after administration was about 14‐fold higher in GF mice compared with SPF mice. Together, our results demonstrated that the gut microbiota altered the metabolic ability of Cyp3a and the tissue accumulation of midazolam.
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Affiliation(s)
- Masao Togao
- Safety Research Department, Yakult Central Institute, Kunitachi-shi, Tokyo, Japan
| | - Koji Kawakami
- Safety Research Department, Yakult Central Institute, Kunitachi-shi, Tokyo, Japan
| | - Jun Otsuka
- Safety Research Department, Yakult Central Institute, Kunitachi-shi, Tokyo, Japan
| | - Gaku Wagai
- Safety Research Department, Yakult Central Institute, Kunitachi-shi, Tokyo, Japan
| | - Yuki Ohta-Takada
- Safety Research Department, Yakult Central Institute, Kunitachi-shi, Tokyo, Japan
| | - Shoichi Kado
- Safety Research Department, Yakult Central Institute, Kunitachi-shi, Tokyo, Japan
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8
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Lammers LA, Achterbergh R, Mathôt RAA, Romijn JA. The effects of fasting on drug metabolism. Expert Opin Drug Metab Toxicol 2019; 16:79-85. [PMID: 31851534 DOI: 10.1080/17425255.2020.1706728] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: There is considerable variability in the rates and extent of drug metabolism between patients due to physiological, genetic, pharmacologic, environmental and nutritional factors such as fasting. This variability in drug metabolism may result in treatment failure or, conversely, in increased side effects or toxicity. Preclinical studies have shown that fasting alters drug metabolism by modulating the activity of drug metabolizing enzymes involved. However, until recently little was known about the effects of fasting on drug metabolism in humans.Areas covered: This review describes the effects of fasting on drug metabolism based on both preclinical studies and studies performed in humans.Expert opinion: A better understanding of the effects of fasting may improve the efficacy and safety of pharmacotherapy for individual patients. Fasting contributes to variability in human drug metabolism by differentially affecting drug metabolizing enzymes. Although the effects of fasting on drug metabolism appear to be small (between 10-20%), fasting may be relevant for drugs with a small therapeutic range and/or in combination with other factors that contribute to variability in drug metabolism such as physiological, genetic or pharmacological factors. Therefore, additional research on this topic is warranted.
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Affiliation(s)
- Laureen A Lammers
- Department of Hospital Pharmacy, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roos Achterbergh
- Department of Medicine, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Ron A A Mathôt
- Department of Hospital Pharmacy, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Johannes A Romijn
- Department of Medicine, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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9
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Ross DH, Seguin RP, Xu L. Characterization of the Impact of Drug Metabolism on the Gas-Phase Structures of Drugs Using Ion Mobility-Mass Spectrometry. Anal Chem 2019; 91:14498-14507. [PMID: 31613088 DOI: 10.1021/acs.analchem.9b03292] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Conventional strategies for drug metabolite identification employ a combination of liquid chromatography-mass spectrometry (LC-MS), which offers higher throughput but provides limited structural information, and nuclear magnetic resonance spectroscopy, which can achieves the most definitive identification but lacks throughput. Ion mobility-mass spectrometry (IM-MS) is a rapid, two-dimensional analysis that separates ions on the basis of their gas-phase size and shape (reflected by collision cross section, CCS) and their mass-to-charge (m/z) ratios. The rapid nature of IM separation combined with the structural information provided by CCS make IM-MS a promising technique for obtaining more structural information on drug metabolites without sacrificing analytical throughput. Here, we present an in vitro biosynthesis coupled with IM-MS strategy for rapid generation and analysis of drug metabolites. Drug metabolites were generated in vitro using pooled subcellular fractions derived from human liver and analyzed using a rapid flow injection-IM-MS method. We measured CCS values for 19 parent drugs and their 37 metabolites generated in vitro (78 values in total), representing a wide variety of metabolic modifications. Post-IM fragmentation and computational modeling were used to support metabolite identifications and explore the structural characteristics driving behaviors observed in IM separation. Overall, we found the effects of metabolic modifications on the gas-phase structures of the metabolites to be highly dependent upon the structural characteristics of the parent compounds and the specific position of the modification. This in vitro biosynthesis coupled with rapid IM-MS analysis workflow represents a promising platform for rapid and high-confidence identification of drug metabolites, applicable at a large scale.
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Affiliation(s)
- Dylan H Ross
- Department of Medicinal Chemistry , University of Washington , Seattle , Washington 98195 , United States
| | - Ryan P Seguin
- Department of Medicinal Chemistry , University of Washington , Seattle , Washington 98195 , United States
| | - Libin Xu
- Department of Medicinal Chemistry , University of Washington , Seattle , Washington 98195 , United States
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10
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Tian DD, Leonowens C, Cox EJ, González-Pérez V, Frederick KS, Scarlett YV, Fisher MB, Paine MF. Indinavir Increases Midazolam N-Glucuronidation in Humans: Identification of an Alternate CYP3A Inhibitor Using an In Vitro to In Vivo Approach. Drug Metab Dispos 2019; 47:724-731. [PMID: 31028057 DOI: 10.1124/dmd.119.087007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 04/24/2019] [Indexed: 11/22/2022] Open
Abstract
Midazolam is a widely used index substrate for assessing effects of xenobiotics on CYP3A activity. A previous study involving human hepatocytes showed the primary route of midazolam metabolism, 1'-hydroxylation, shifted to N-glucuronidation in the presence of the CYP3A inhibitor ketoconazole, which may lead to an overprediction of the magnitude of a xenobiotic-midazolam interaction. Because ketoconazole is no longer recommended as a clinical CYP3A inhibitor, indinavir was selected as an alternate CYP3A inhibitor to evaluate the contribution of the N-glucuronidation pathway to midazolam metabolism. The effects of indinavir on midazolam 1'-hydroxylation and N-glucuronidation were first characterized in human-derived in vitro systems. Compared with vehicle, indinavir (10 μM) inhibited midazolam 1'-hydroxylation by recombinant CYP3A4, human liver microsomes, and high-CYP3A activity cryopreserved human hepatocytes by ≥70%; the IC50 obtained with hepatocytes (2.7 μM) was within reported human unbound indinavir Cmax (≤5 μM). Midazolam N-glucuronidation in hepatocytes increased in the presence of indinavir in both a concentration-dependent (1-33 μM) and time-dependent (0-4 hours) manner (by up to 2.5-fold), prompting assessment in human volunteers (n = 8). As predicted by these in vitro data, indinavir was a strong inhibitor of the 1'-hydroxylation pathway, decreasing the 1'-hydroxymidazolam/midazolam area under the plasma concentration versus time curve (AUC)0-12h ratio by 80%. Although not statistically significant, the midazolam N-glucuronide/midazolam AUC0-12h ratio increased by 40%, suggesting a shift to the N-glucuronidation pathway. The amount of midazolam N-glucuronide recovered in urine increased 4-fold but remained <10% of the oral midazolam dose (2.5 mg). A powered clinical study would clarify whether N-glucuronidation should be considered when assessing the magnitude of a xenobiotic-midazolam interaction.
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Affiliation(s)
- Dan-Dan Tian
- Department of Pharmaceutical Sciences, Washington State University, Spokane, Washington (D.-D.T., E.J.C., V.G.-P., M.F.P.); Division of Gastroenterology and Hepatology, School of Medicine (Y.V.S.) and Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy (C.L.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and Boehringer-Ingelheim Pharmaceuticals, Ridgefield, Connecticut (K.S.F., M.B.F.)
| | - Cathrine Leonowens
- Department of Pharmaceutical Sciences, Washington State University, Spokane, Washington (D.-D.T., E.J.C., V.G.-P., M.F.P.); Division of Gastroenterology and Hepatology, School of Medicine (Y.V.S.) and Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy (C.L.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and Boehringer-Ingelheim Pharmaceuticals, Ridgefield, Connecticut (K.S.F., M.B.F.)
| | - Emily J Cox
- Department of Pharmaceutical Sciences, Washington State University, Spokane, Washington (D.-D.T., E.J.C., V.G.-P., M.F.P.); Division of Gastroenterology and Hepatology, School of Medicine (Y.V.S.) and Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy (C.L.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and Boehringer-Ingelheim Pharmaceuticals, Ridgefield, Connecticut (K.S.F., M.B.F.)
| | - Vanessa González-Pérez
- Department of Pharmaceutical Sciences, Washington State University, Spokane, Washington (D.-D.T., E.J.C., V.G.-P., M.F.P.); Division of Gastroenterology and Hepatology, School of Medicine (Y.V.S.) and Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy (C.L.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and Boehringer-Ingelheim Pharmaceuticals, Ridgefield, Connecticut (K.S.F., M.B.F.)
| | - Kosea S Frederick
- Department of Pharmaceutical Sciences, Washington State University, Spokane, Washington (D.-D.T., E.J.C., V.G.-P., M.F.P.); Division of Gastroenterology and Hepatology, School of Medicine (Y.V.S.) and Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy (C.L.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and Boehringer-Ingelheim Pharmaceuticals, Ridgefield, Connecticut (K.S.F., M.B.F.)
| | - Yolanda V Scarlett
- Department of Pharmaceutical Sciences, Washington State University, Spokane, Washington (D.-D.T., E.J.C., V.G.-P., M.F.P.); Division of Gastroenterology and Hepatology, School of Medicine (Y.V.S.) and Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy (C.L.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and Boehringer-Ingelheim Pharmaceuticals, Ridgefield, Connecticut (K.S.F., M.B.F.)
| | - Michael B Fisher
- Department of Pharmaceutical Sciences, Washington State University, Spokane, Washington (D.-D.T., E.J.C., V.G.-P., M.F.P.); Division of Gastroenterology and Hepatology, School of Medicine (Y.V.S.) and Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy (C.L.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and Boehringer-Ingelheim Pharmaceuticals, Ridgefield, Connecticut (K.S.F., M.B.F.)
| | - Mary F Paine
- Department of Pharmaceutical Sciences, Washington State University, Spokane, Washington (D.-D.T., E.J.C., V.G.-P., M.F.P.); Division of Gastroenterology and Hepatology, School of Medicine (Y.V.S.) and Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy (C.L.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and Boehringer-Ingelheim Pharmaceuticals, Ridgefield, Connecticut (K.S.F., M.B.F.)
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11
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Lammers LA, Achterbergh R, Romijn JA, Mathôt RAA. Nutritional Status Differentially Alters Cytochrome P450 3A4 (CYP3A4) and Uridine 5'-Diphospho-Glucuronosyltransferase (UGT) Mediated Drug Metabolism: Effect of Short-Term Fasting and High Fat Diet on Midazolam Metabolism. Eur J Drug Metab Pharmacokinet 2019; 43:751-767. [PMID: 29876844 PMCID: PMC6244726 DOI: 10.1007/s13318-018-0487-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Previous studies have shown that nutritional status can alter drug metabolism which may result in treatment failure or untoward side effects. This study assesses the effect of two nutritional conditions, short-term fasting, and a short-term high fat diet (HFD) on cytochrome P450 3A4 (CYP3A4) and uridine 5'-diphospho-glucuronosyltransferase (UGT) mediated drug metabolism by studying the pharmacokinetics of midazolam and its main metabolites. METHODS In a randomized-controlled cross-over trial, nine healthy subjects received a single intravenous administration of 0.015 mg/kg midazolam after: (1) an overnight fast (control); (2) 36 h of fasting; and (3) an overnight fast after 3 days of a HFD consisting of 500 ml of cream supplemented to their regular diet. Pharmacokinetic parameters were analyzed simultaneously using non-linear mixed-effects modeling. RESULTS Short-term fasting increased CYP3A4-mediated midazolam clearance by 12% (p < 0.01) and decreased UGT-mediated metabolism apparent 1-OH-midazolam clearance by 13% (p < 0.01) by decreasing the ratio of clearance and the fraction metabolite formed (ΔCL1-OH-MDZ/f1-OH-MDZ). Furthermore, short-term fasting decreased apparent clearance of 1-OH-midazolam-O-glucuronide (CL1-OH-MDZ-glucuronide/(f1-OH-MDZ-glucuronide × f1-OH-MDZ)) by 20% (p < 0.01). The HFD did not affect systemic clearance of midazolam or metabolites. CONCLUSIONS Short-term fasting differentially alters midazolam metabolism by increasing CYP3A4-mediated metabolism but by decreasing UGT-mediated metabolism. In contrast, a short-term HFD did not affect systemic clearance of midazolam.
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Affiliation(s)
- Laureen A Lammers
- Department of Hospital Pharmacy, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Roos Achterbergh
- Department of Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Johannes A Romijn
- Department of Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ron A A Mathôt
- Department of Hospital Pharmacy, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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12
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Pettersson Bergstrand M, Richter LHJ, Maurer HH, Wagmann L, Meyer MR. In vitro
glucuronidation of designer benzodiazepines by human UDP-glucuronyltransferases. Drug Test Anal 2018; 11:45-50. [DOI: 10.1002/dta.2463] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 06/25/2018] [Accepted: 07/03/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Madeleine Pettersson Bergstrand
- Department of Laboratory Medicine, Division of Clinical Pharmacology; Karolinska Institutet; Stockholm Sweden
- Department of Laboratory Medicine, Division of Clinical Chemistry; Karolinska Institutet; Stockholm Sweden
- Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Center for Molecular Signaling (PZMS); Saarland University; Homburg Germany
| | - Lilian H. J. Richter
- Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Center for Molecular Signaling (PZMS); Saarland University; Homburg Germany
| | - Hans H. Maurer
- Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Center for Molecular Signaling (PZMS); Saarland University; Homburg Germany
| | - Lea Wagmann
- Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Center for Molecular Signaling (PZMS); Saarland University; Homburg Germany
| | - Markus R. Meyer
- Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Center for Molecular Signaling (PZMS); Saarland University; Homburg Germany
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13
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Koyama S, Arakawa H, Itoh M, Masuda N, Yano K, Kojima H, Ogihara T. Evaluation of the metabolic capability of primary human hepatocytes in three-dimensional cultures on microstructural plates. Biopharm Drug Dispos 2018; 39:187-195. [PMID: 29469947 DOI: 10.1002/bdd.2125] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 02/09/2018] [Accepted: 02/10/2018] [Indexed: 01/08/2023]
Abstract
The NanoCulture Plate (NCP) is a novel microstructural plate designed as a base for the three-dimensional culture of cells/tissues. This study examined whether or not the metabolic capability of human primary hepatocytes is well maintained during culture on NCPs. The hepatocytes formed aggregates after seeding and their ATP content was well maintained during culture for 21 days. Expression of CYP1A2, 2B6, 2C9, 2C19, 2D6, 2E1 and 3A4 mRNAs was detected throughout the 21-day culture period. Addition of CYP substrate drugs (midazolam, diclofenac, lamotrigine and acetaminophen) resulted in the formation of multiple metabolites with a corresponding decrease in the amounts of the unchanged compounds. The inducers omeprazole, phenobarbital and rifampicin increased the levels of CYP1A2, 2B6 and 3A4 mRNAs by 110-fold, 12.5-fold and 5.4-fold, respectively, at day 2, compared with control human hepatocytes. CYP activities were also increased at 2 days after inducer treatment (CYP1A2, 2.2-fold; CYP2B6, 20.6-fold; CYP3A4, 3.3-fold). The results indicate that the hepatocyte spheroids on NCP have detectable and inducible metabolic abilities during the 7-day culture period.
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Affiliation(s)
- Satoshi Koyama
- Laboratory of Biopharmaceutics, Faculty of Pharmacy, Taksaki University of Health and Welfare, 60 Nakaorui-machi, Takasaki, Gunma, 370-0033, Japan
| | - Hiroshi Arakawa
- Faculty of Pharmacy, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kakuma-machi, Kanazawa, Ishikawa, 920-1192, Japan
| | - Manabu Itoh
- JSR Life Sciences, 25 Miyukigaoka, Tsukuba, Ibaraki, 305-0841, Japan
| | - Norio Masuda
- JSR Life Sciences, 25 Miyukigaoka, Tsukuba, Ibaraki, 305-0841, Japan
| | - Kentaro Yano
- Laboratory of Biopharmaceutics, Faculty of Pharmacy, Taksaki University of Health and Welfare, 60 Nakaorui-machi, Takasaki, Gunma, 370-0033, Japan
| | - Hajime Kojima
- Division of Risk Assessment, Biological Safety Research Center, National Institute of Health Sciences, 1-18-1 Kamiyoga, Setagaya, Tokyo, 158-8501, Japan
| | - Takuo Ogihara
- Laboratory of Biopharmaceutics, Faculty of Pharmacy, Taksaki University of Health and Welfare, 60 Nakaorui-machi, Takasaki, Gunma, 370-0033, Japan.,Laboratory of Clinical Pharmacokinetics, Graduate School of Pharmaceutical Sciences, Takasaki University of Health and Welfare, 60 Nakaorui-machi, Takasaki, Gunma, 370-0033, Japan
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14
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Pettersson Bergstrand M, Meyer MR, Beck O, Helander A. Human urinary metabolic patterns of the designer benzodiazepines flubromazolam and pyrazolam studied by liquid chromatography-high resolution mass spectrometry. Drug Test Anal 2017; 10:496-506. [DOI: 10.1002/dta.2243] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 06/29/2017] [Accepted: 07/03/2017] [Indexed: 01/12/2023]
Affiliation(s)
- Madeleine Pettersson Bergstrand
- Department of Laboratory Medicine, Division of Clinical Pharmacology; Karolinska Institutet; Stockholm Sweden
- Department of Laboratory Medicine, Division of Clinical Chemistry; Karolinska Institutet; Stockholm Sweden
| | - Markus R. Meyer
- Department of Laboratory Medicine, Division of Clinical Pharmacology; Karolinska Institutet; Stockholm Sweden
- Department of Experimental and Clinical Toxicology; Institute of Experimental and Clinical Pharmacology and Toxicology, Saarland University; Homburg Germany
| | - Olof Beck
- Department of Laboratory Medicine, Division of Clinical Pharmacology; Karolinska Institutet; Stockholm Sweden
- Department of Clinical Pharmacology; Karolinska University Laboratory; Stockholm Sweden
| | - Anders Helander
- Department of Laboratory Medicine, Division of Clinical Pharmacology; Karolinska Institutet; Stockholm Sweden
- Department of Laboratory Medicine, Division of Clinical Chemistry; Karolinska Institutet; Stockholm Sweden
- Department of Clinical Pharmacology; Karolinska University Laboratory; Stockholm Sweden
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15
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An ultra-sensitive LC–MS/MS method to determine midazolam levels in human plasma: development, validation and application to a clinical study. Bioanalysis 2017; 9:297-312. [DOI: 10.4155/bio-2016-0191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Aim: Midazolam is a commonly used marker substrate for the in vivo assessment of CYP3A activity. Reliable pharmacokinetic assessment at sub-pharmacological doses of midazolam requires an ultra-sensitive analytical method. Methods: A new, ultra-sensitive LC–MS/MS method for the determination of midazolam in human plasma using SPE was developed and fully validated. The lowest limit of quantitation is 0.1 pg/ml with a sample volume of 500 μl. Results/conclusion: The following parameters were validated: sensitivity, assay accuracy and precision, linearity, selectivity, and stability of midazolam at pertinent analytical and storage conditions. The validated method was utilized successfully for the sample assay during a midazolam microdosing study for the evaluation of CYP3A4 activity of a clinical candidate.
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16
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Iga K, Kiriyama A. Simulations of Cytochrome P450 3A4-Mediated Drug-Drug Interactions by Simple Two-Compartment Model-Assisted Static Method. J Pharm Sci 2017; 106:1426-1438. [PMID: 28089686 DOI: 10.1016/j.xphs.2017.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/04/2017] [Accepted: 01/05/2017] [Indexed: 12/31/2022]
Abstract
In order to predict cytochrome P450 3A4 (CYP3A4)-mediated drug-drug interactions (DDIs), a simple 2-compartment model-assisted, overall inhibition activity (Ai,overall) method was derived based on 2 concepts. One concept was that the increase in blood victim level and fold increase in the area under the blood victim level curve produced by DDI are determined entirely by Ai,overall, the hepatic availability of the victim and fraction of urinary excreted unchanged victim, where Ai,overall is determined by the perpetrator-specific CYP isoform inhibition activities (Ai,CYPs, DDI predictor-1) and victim-specific fractional CYP isoform contributions (fm,CYPs, predictor-2). The other concept was that a DDI can be bridged to other DDIs, so that any possible DDI produced by a given victim or a given perpetrator can be predicted by using these predictors. The Ai,CYP3A4s of 12 common CYP3A4 inhibitors were able to be determined and shown to be useful for the prediction of CYP3A4-mediated DDIs wherein victims were metabolized by multiple CYP isoforms. Additionally, it was demonstrated that fm,CYP values with high confidence can be estimated by bridging DDIs produced by the same victim and different perpetrators. This bridging approach will accelerate prediction of DDIs produced by new chemical entities from the existing DDI database.
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Affiliation(s)
- Katsumi Iga
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Doshisha Women's College of Liberal Arts, Kodo Kyotanabe-shi, Kyoto 610-0395, Japan.
| | - Akiko Kiriyama
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Doshisha Women's College of Liberal Arts, Kodo Kyotanabe-shi, Kyoto 610-0395, Japan
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17
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Humanizing the zebrafish liver shifts drug metabolic profiles and improves pharmacokinetics of CYP3A4 substrates. Arch Toxicol 2016; 91:1187-1197. [PMID: 27485346 DOI: 10.1007/s00204-016-1789-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 07/05/2016] [Indexed: 12/29/2022]
Abstract
Understanding and predicting whether new drug candidates will be safe in the clinic is a critical hurdle in pharmaceutical development, that relies in part on absorption, distribution, metabolism, excretion and toxicology studies in vivo. Zebrafish is a relatively new model system for drug metabolism and toxicity studies, offering whole organism screening coupled with small size and potential for high-throughput screening. Through toxicity and absorption analyses of a number of drugs, we find that zebrafish is generally predictive of drug toxicity, although assay outcomes are influenced by drug lipophilicity which alters drug uptake. In addition, liver microsome assays reveal specific differences in metabolism of compounds between human and zebrafish livers, likely resulting from the divergence of the cytochrome P450 superfamily between species. To reflect human metabolism more accurately, we generated a transgenic "humanized" zebrafish line that expresses the major human phase I detoxifying enzyme, CYP3A4, in the liver. Here, we show that this humanized line shows an elevated metabolism of CYP3A4-specific substrates compared to wild-type zebrafish. The generation of this first described humanized zebrafish liver suggests such approaches can enhance the accuracy of the zebrafish model for toxicity prediction.
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18
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Fan HC, Lee HS, Chang KP, Lee YY, Lai HC, Hung PL, Lee HF, Chi CS. The Impact of Anti-Epileptic Drugs on Growth and Bone Metabolism. Int J Mol Sci 2016; 17:E1242. [PMID: 27490534 PMCID: PMC5000640 DOI: 10.3390/ijms17081242] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/20/2016] [Accepted: 07/28/2016] [Indexed: 12/13/2022] Open
Abstract
Epilepsy is a common neurological disorder worldwide and anti-epileptic drugs (AEDs) are always the first choice for treatment. However, more than 50% of patients with epilepsy who take AEDs have reported bone abnormalities. Cytochrome P450 (CYP450) isoenzymes are induced by AEDs, especially the classical AEDs, such as benzodiazepines (BZDs), carbamazepine (CBZ), phenytoin (PT), phenobarbital (PB), and valproic acid (VPA). The induction of CYP450 isoenzymes may cause vitamin D deficiency, hypocalcemia, increased fracture risks, and altered bone turnover, leading to impaired bone mineral density (BMD). Newer AEDs, such as levetiracetam (LEV), oxcarbazepine (OXC), lamotrigine (LTG), topiramate (TPM), gabapentin (GP), and vigabatrin (VB) have broader spectra, and are safer and better tolerated than the classical AEDs. The effects of AEDs on bone health are controversial. This review focuses on the impact of AEDs on growth and bone metabolism and emphasizes the need for caution and timely withdrawal of these medications to avoid serious disabilities.
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Affiliation(s)
- Hueng-Chuen Fan
- Department of Pediatrics, Tungs' Taichung Metroharbor Hospital, Wuchi, 435 Taichung, Taiwan.
- Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, 356 Miaoli, Taiwan.
| | - Herng-Shen Lee
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, 813 Kaohsiung, Taiwan.
| | - Kai-Ping Chang
- Department of Pediatrics, Taipei Veterans General Hospital, 112 Taipei, Taiwan.
| | - Yi-Yen Lee
- Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, 112 Taipei, Taiwan.
- Faculty of Medicine, National Yang-Ming University, 112 Taipei, Taiwan.
| | - Hsin-Chuan Lai
- Department of Pediatrics, Tungs' Taichung Metroharbor Hospital, Wuchi, 435 Taichung, Taiwan.
- Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, 356 Miaoli, Taiwan.
| | - Pi-Lien Hung
- Department of Pediatrics, Kaohsiung Chang Gung Medical Center, 833 Kaohsiung, Taiwan.
| | - Hsiu-Fen Lee
- Department of Pediatrics, Taichung Veterans General Hospital, 407 Taichung, Taiwan.
| | - Ching-Shiang Chi
- Department of Pediatrics, Tungs' Taichung Metroharbor Hospital, Wuchi, 435 Taichung, Taiwan.
- Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, 356 Miaoli, Taiwan.
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19
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Nguyen HQ, Kimoto E, Callegari E, Obach RS. Mechanistic Modeling to Predict Midazolam Metabolite Exposure from In Vitro Data. ACTA ACUST UNITED AC 2016; 44:781-91. [PMID: 26956641 DOI: 10.1124/dmd.115.068601] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 03/07/2016] [Indexed: 12/12/2022]
Abstract
Methods to predict the pharmacokinetics of drugs in humans from in vitro data have been established, but corresponding methods to predict exposure to circulating metabolites are unproven. The objective of this study was to use in vitro methods combined with static and dynamic physiologically based pharmacokinetic (PBPK) models to predict metabolite exposures, using midazolam and its major metabolites as a test system. Intrinsic clearances (CLint) of formation of individual metabolites were determined using human liver microsomes. Metabolic CLintof hydroxymidazolam metabolites via oxidation and glucuronidation were also determined. Passive diffusion intrinsic clearances of hydroxymidazolam metabolites were determined using sandwich cultured human hepatocytes and the combination of this term along with the metabolic CLint, and liver blood flow was used to estimate the fraction of the metabolite that can enter the systemic circulation after formation in the liver. The metabolite/parent drug area under the plasma concentration-time curve ratio (AUCm/AUCp) was predicted using a static model relating the fraction of midazolam clearance to each metabolite, the clearance rates of midazolam and hydroxymidazolam metabolites, and the availability of the metabolites. Additionally, the human disposition of midazolam metabolites was simulated using a SimCYP PBPK model. Both approaches yielded AUCm/AUCpratios that were in agreement with the in vivo ratios. This study shows that in vivo midazolam metabolite exposure can be predicted from in vitro data and PBPK modeling. This study emphasized the importance of metabolite systemic availability from its tissue of formation, which remains a challenge to quantitative prediction.
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Affiliation(s)
- Hoa Q Nguyen
- Pfizer Global Research and Development, Department of Pharmacokinetics, Dynamics, and Metabolism, Groton, Connecticut
| | - Emi Kimoto
- Pfizer Global Research and Development, Department of Pharmacokinetics, Dynamics, and Metabolism, Groton, Connecticut
| | - Ernesto Callegari
- Pfizer Global Research and Development, Department of Pharmacokinetics, Dynamics, and Metabolism, Groton, Connecticut
| | - R Scott Obach
- Pfizer Global Research and Development, Department of Pharmacokinetics, Dynamics, and Metabolism, Groton, Connecticut
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20
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Vivares A, Salle-Lefort S, Arabeyre-Fabre C, Ngo R, Penarier G, Bremond M, Moliner P, Gallas JF, Fabre G, Klieber S. Morphological behaviour and metabolic capacity of cryopreserved human primary hepatocytes cultivated in a perfused multiwell device. Xenobiotica 2014; 45:29-44. [PMID: 25068923 DOI: 10.3109/00498254.2014.944612] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
1. The quantitative prediction of the pharmacokinetic parameters of a drug from data obtained using human in vitro systems remains a significant challenge i.e. prediction of metabolic clearance in humans and estimation of the relative contribution of enzymes involved in the clearance. This has become particularly problematic for low turnover compounds. 2. Having human hepatocytes with stable cellular function over several days that adequately mimic the complexity of the physiological environment would be a major advance. Thus, we evaluated human hepatocytes, maintained in culture during 7 days in the microfluidic LiverChip™ system, in terms of morphological appearance, relative mRNA expression of phase I and II enzymes and transporters as a function of time, and metabolic capacity using probe substrates. 3. The results showed that mRNA levels of the major genes for enzymes involved in drug metabolism were well-maintained over a 7-day period of culture. Furthermore, after 4 days of culture, in the Liverchip™ device, human hepatocytes exhibited higher or similar CYPs activities compared to 1 day of culture in 2D-static conditions. 4. The functional data were supported by light/electron microscopies and immunohistochemistry showing viable tissue structure and well-differentiated human hepatocytes: presence of cell junctions, glycogen storage, and bile canaliculi.
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Affiliation(s)
- Aurelie Vivares
- Drug Disposition Domain, Disposition, Safety and Animal Research Scientific Core Plateform, SANOFI R&D , Montpellier , France
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Klieber S, Arabeyre-Fabre C, Moliner P, Marti E, Mandray M, Ngo R, Ollier C, Brun P, Fabre G. Identification of metabolic pathways and enzyme systems involved in the in vitro human hepatic metabolism of dronedarone, a potent new oral antiarrhythmic drug. Pharmacol Res Perspect 2014; 2:e00044. [PMID: 25505590 PMCID: PMC4186413 DOI: 10.1002/prp2.44] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 02/18/2014] [Accepted: 03/04/2014] [Indexed: 11/10/2022] Open
Abstract
The in vitro metabolism of dronedarone and its major metabolites has been studied in human liver microsomes and cryopreserved hepatocytes in primary culture through the use of specific or total cytochrome P450 (CYP) and monoamine oxidase (MAO) inhibitors. The identification of the main metabolites and enzymes participating in their metabolism was also elucidated by using rhCYP, rhMAO, flavin monooxygenases (rhFMO) and UDP-glucuronosyltransferases (rhUGT) and liquid chromatography/tandem mass spectrometry (LC/MS-MS) analysis. Dronedarone was extensively metabolized in human hepatocytes with a metabolic clearance being almost completely inhibited (98 ± 2%) by 1-aminobenzotriazole. Ketoconazole also inhibited dronedarone metabolism by 89 ± 7%, demonstrating the crucial role of CYP3A in its metabolism. CYP3A isoforms mostly contributed to N-debutylation while hydroxylation on the butyl-benzofuran moiety was catalyzed by CYP2D6. However, hydroxylation on the dibutylamine moiety did not appear to be CYP-dependent. N-debutyl-dronedarone was less rapidly metabolized than dronedarone, the major metabolic pathway being catalyzed by MAO-A to form propanoic acid-dronedarone and phenol-dronedarone. Propanoic acid-dronedarone was metabolized at a similar rate to that of N-debutyl-dronedarone and was predominantly hydroxylated by CYP2C8 and CYP1A1. Phenol-dronedarone was extensively glucuronidated while C-dealkyl-dronedarone was metabolized at a slow rate. The evaluation of the systemic clearance of each metabolic process together with the identification of both the major metabolites and predominant enzyme systems and isoforms involved in the formation and subsequent metabolism of these metabolites has enhanced the overall understanding of metabolism of dronedarone in humans.
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Affiliation(s)
- Sylvie Klieber
- SANOFI-AVENTIS Recherche & Development Disposition, Safety and Animal Research Scientific Core Platform, Drug Disposition Domain 371 Rue du Professeur Joseph Blayac, 34184 Montpellier, Cedex 4, France
| | - Catherine Arabeyre-Fabre
- SANOFI-AVENTIS Recherche & Development Disposition, Safety and Animal Research Scientific Core Platform, Drug Disposition Domain 371 Rue du Professeur Joseph Blayac, 34184 Montpellier, Cedex 4, France
| | - Patricia Moliner
- SANOFI-AVENTIS Recherche & Development Disposition, Safety and Animal Research Scientific Core Platform, Drug Disposition Domain 371 Rue du Professeur Joseph Blayac, 34184 Montpellier, Cedex 4, France
| | - Eric Marti
- SANOFI-AVENTIS Recherche & Development Disposition, Safety and Animal Research Scientific Core Platform, Drug Disposition Domain 371 Rue du Professeur Joseph Blayac, 34184 Montpellier, Cedex 4, France
| | - Martine Mandray
- SANOFI-AVENTIS Recherche & Development Disposition, Safety and Animal Research Scientific Core Platform, Drug Disposition Domain 371 Rue du Professeur Joseph Blayac, 34184 Montpellier, Cedex 4, France
| | - Robert Ngo
- SANOFI-AVENTIS Recherche & Development Disposition, Safety and Animal Research Scientific Core Platform, Drug Disposition Domain 371 Rue du Professeur Joseph Blayac, 34184 Montpellier, Cedex 4, France
| | - Céline Ollier
- SANOFI-AVENTIS Recherche & Development Disposition, Safety and Animal Research Scientific Core Platform, Drug Disposition Domain 371 Rue du Professeur Joseph Blayac, 34184 Montpellier, Cedex 4, France
| | - Priscilla Brun
- SANOFI-AVENTIS Recherche & Development Disposition, Safety and Animal Research Scientific Core Platform, Drug Disposition Domain 371 Rue du Professeur Joseph Blayac, 34184 Montpellier, Cedex 4, France
| | - Gérard Fabre
- SANOFI-AVENTIS Recherche & Development Disposition, Safety and Animal Research Scientific Core Platform, Drug Disposition Domain 371 Rue du Professeur Joseph Blayac, 34184 Montpellier, Cedex 4, France
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Ohkura T, Ohta K, Nagao T, Kusumoto K, Koeda A, Ueda T, Jomura T, Ikeya T, Ozeki E, Wada K, Naitoh K, Inoue Y, Takahashi N, Iwai H, Arakawa H, Ogihara T. Evaluation of human hepatocytes cultured by three-dimensional spheroid systems for drug metabolism. Drug Metab Pharmacokinet 2014; 29:373-8. [PMID: 24695277 DOI: 10.2133/dmpk.dmpk-13-rg-105] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We investigated the utility of three-dimensional (3D) spheroid cultures of human hepatocytes in discovering drug metabolites. Metabolites of acetaminophen, diclofenac, lamotrigine, midazolam, propranolol and salbutamol were analyzed by liquid chromatography-tandem mass spectrometry (LC/MS/MS) to measure enzyme activities in this system cultured for 2 and 7 days. Sequential metabolic reactions by Phase I and then Phase II enzymes were found in diclofenac [CYP2C9 and UDP-glucuronyltransferases (UGTs)], midazolam (CYP3A4 and UGTs) and propranolol (CYP1A2/2D6 and UGTs). Moreover, lamotrigine and salbutamol were metabolized to lamotrigine-N-glucuronide and salbutamol 4-O-sulfate, respectively. These metabolites, which are human specific, could be observed in clinical studies, but not in conventional hepatic culture systems as in previous reports. Acetaminophen was metabolized to glucuronide and sulfate conjugates, and N-acetyl-p-benzo-quinoneimine (NAPQI) and its metabolites were not observed. In addition, mRNA of drug-metabolism enzymes [CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP2E1, CYP3A4, UGT1A1, UGT2B7, sulfotransferase 1A1 (SULT1A1) and glutathione S-transferase pi 1 (GSTP1)], which were measured by qRT-PCR, were expressed in the human hepatocyte spheroids. In conclusion, these results suggest that human hepatocyte spheroids are useful in discovering drug metabolites.
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A semiphysiological population pharmacokinetic model for dynamic inhibition of liver and gut wall cytochrome P450 3A by voriconazole. Clin Pharmacokinet 2014; 52:763-81. [PMID: 23653047 DOI: 10.1007/s40262-013-0070-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Accurate predictions of cytochrome P450 (CYP) 3A-mediated drug-drug interactions (DDIs) account for dynamic changes of CYP3A activity at both major expression sites (liver and gut wall) by considering the full pharmacokinetic profile of the perpetrator and the substrate. Physiological-based in vitro-in vivo extrapolation models have become of increasing interest. However, due to discrepancies between the predicted and observed magnitude of DDIs, the role of models fully based on in vivo data is still essential. OBJECTIVE The primary objective of this study was to develop a coupled dynamic model for the interaction of the CYP3A inhibitor voriconazole and the prototypical CYP3A substrate midazolam. METHODS Raw concentration data were obtained from a DDI study. Ten subjects were given either no pretreatment (control) or voriconazole twice daily orally. Midazolam was given either intravenously or orally after the last voriconazole dose and during control phases. Data analysis was performed by the population pharmacokinetic approach using non-linear mixed effects modelling (NONMEM 7.2.0). Model evaluation was performed using visual predictive checks and bootstrap analysis. RESULTS A semiphysiological model was able to describe the pharmacokinetics of midazolam, its major metabolite and voriconazole simultaneously. By considering the temporal disposition of all three substances in the liver and gut wall, a time-varying CYP3A inhibition process was implemented. Only the incorporation of hypothetical enzyme site compartments resulted in an adequate fit, suggesting a sustained inhibitory effect through accumulation. Novel key features of this analysis are the identification of (1) an apparent sustained inhibitory effect by voriconazole due to a proposed quasi accumulation at the enzyme site, (2) a significantly reduced inhibitory potency of intravenous voriconazole for oral substrates, (3) voriconazole as a likely uridine diphosphate glucuronosyltransferase (UGT) 2B inhibitor and (4) considerable sources of interindividual variability. CONCLUSION The proposed semiphysiological modelling approach generated a mechanistic description of the complex DDI occurring at major CYP3A expression sites and thus may serve as a powerful tool to maximise information acquired from clinical DDI studies. The model has been shown to draw precise and accurate predictions. Therefore, simulations based on this kind of models may be used for various clinical scenarios to improve pharmacotherapy.
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Wu J, Cao Y, Zhang Y, Liu Y, Hong JY, Zhu L, Ge G, Yang L. Deoxyschizandrin, a naturally occurring lignan, is a specific probe substrate of human cytochrome P450 3A. Drug Metab Dispos 2013; 42:94-104. [PMID: 24131672 DOI: 10.1124/dmd.113.053884] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
To accurately predict the modifications done during metabolic processes by cytochrome P450 (P450) 3A enzyme, selecting substrates that best represent a broad range of substrate substitutions and that follow the Michaelis-Menten kinetic properties is highly necessary. In the present study, the oxidative pathways of deoxyschizandrin (DS), the most abundant lignan in Fructus Schisandrae fruit extract, were characterized with liver microsomes from human (HLM) and rat (RLM). Only one monohydroxylated metabolite 7(S)-hydroxylated metabolite (isoschizandrin, ISZ), was identified using liquid chromatography-mass spectrometry and nuclear magnetic resonance techniques. CYP3A4 and CYP3A5 were found to be the major isoforms involved in the monohydroxylation of DS. Also, the kinetic studies showed that DS hydroxylation obeyed Michaelis-Menten kinetics both in HLM and in RLM. However, the subsequent metabolism of ISZ was nearly nonexistent when DS was present. More importantly, the interactions between DS and three well characterized CYP3A probe substrates, testosterone (TST), midazolam (MDZ), and nifedipine (NIF), were studied. TST and MDZ were shown to compete with DS for the mutual binding site, causing Km to be increased. The presence of DS also lowered the binding affinities for MDZ and TST. However, DS showed only slight inhibitory effects on nifedipine (NIF) oxidation even though NIF was able to inhibit DS hydroxylation in a noncompetitive fashion. These results show that DS is a good representative substrate of MDZ and TST primarily due to their shared, large binding regions on CYP3A. Therefore, DS is an attractive candidate as a novel CYP3A probe substrate for predicting the metabolic modifications in CYP3A activity.
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Affiliation(s)
- Jingjing Wu
- Laboratory of Pharmaceutical Resource Discovery, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, China (J.W., Y.C., Y.Z., Y.L., L.Z., G.G., L.Y.); Department of Biopharmaceutical Sciences, University of Illinois, Chicago, Illinois (J.Y.H.); Graduate University of Chinese Academy of Sciences, Beijing, China (J.W., L.Z.); Shanghai Institute of Planned Parenthood Research, Shanghai, China (Y.C.)
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Grimsley A, Gallagher R, Hutchison M, Pickup K, Wilson ID, Samuelsson K. Drug-drug interactions and metabolism in cytochrome P450 2C knockout mice: application to troleandomycin and midazolam. Biochem Pharmacol 2013; 86:529-38. [PMID: 23732297 DOI: 10.1016/j.bcp.2013.05.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 05/22/2013] [Accepted: 05/22/2013] [Indexed: 12/11/2022]
Abstract
Drug-drug interactions (DDIs) may cause serious drug toxicity and delay development of candidate drugs. Screening using human liver microsomes and hepatocytes can help predict DDIs but do not always provide the degree of certainty required for confident progression of a candidate drug. Thus a suitable in vivo test system could be of great value. Here a Cyp2c knockout (KO) mouse was investigated for studying DDIs using midazolam (MDZ) a standard human CYP3A4 substrate and troleandomycin (TAO) a potent human CYP3A4 inhibitor. Pharmacokinetics (PK) and biotransformation of MDZ were investigated following dosing to Cyp2c KO and wild type mice before and after TAO treatment. The noteworthy differences in the metabolism of MDZ in Cyp2c KO compared to wild type mice confirms the important role that Cyp2c enzymes play in the murine metabolism of MDZ in vivo. The impact of Cyp3a inhibition produced a further increase in circulating MDZ concentrations in all individuals from both strains of mice though the impact of the elimination of the Cyp2c pathway in the KO mice on the AUC was less than perhaps expected. We have shown that TAO produces an increase in the MDZ concentration and a reduction in the 1'hydroxymidazolam/midazolam formation ratio but the expected difference in the magnitude of this effect between the wild type and the Cyp2c KO mice was not seen. The magnitude of the TAO effect was also smaller than is reported in humans. Hence further work is required before this animal model could be used to predict clinical interactions.
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Affiliation(s)
- Aidan Grimsley
- Global DMPK, AstraZeneca UK Ltd., Alderley Park, Macclesfield SK10 4TG, United Kingdom
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26
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Kato Y, Izukawa T, Oda S, Fukami T, Finel M, Yokoi T, Nakajima M. Human UDP-Glucuronosyltransferase (UGT) 2B10 in DrugN-Glucuronidation: Substrate Screening and Comparison with UGT1A3 and UGT1A4. Drug Metab Dispos 2013; 41:1389-97. [DOI: 10.1124/dmd.113.051565] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Na DH, Ji HY, Park EJ, Kim MS, Liu KH, Lee HS. Evaluation of metabolism-mediated herb-drug interactions. Arch Pharm Res 2011; 34:1829-42. [DOI: 10.1007/s12272-011-1105-0] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 09/06/2011] [Accepted: 09/06/2011] [Indexed: 11/29/2022]
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Marvalin C, Denoux M, Pérard S, Roy S, Azerad R. Microbial production of phase I and phase II metabolites of midazolam. Xenobiotica 2011; 42:285-93. [DOI: 10.3109/00498254.2011.622417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Svanström C, Hansson GP, Svensson LD, Sennbro CJ. Development and validation of a method using supported liquid extraction for the simultaneous determination of midazolam and 1'-hydroxy-midazolam in human plasma by liquid chromatography with tandem mass spectrometry detection. J Pharm Biomed Anal 2011; 58:71-7. [PMID: 21993197 DOI: 10.1016/j.jpba.2011.09.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 09/02/2011] [Accepted: 09/17/2011] [Indexed: 12/23/2022]
Abstract
The metabolic conversion of midazolam (MDZ) to its main metabolite 1'-hydroxy-midazolam (1-OH-MDZ) can be used as a probe drug for cytochrome P450 3A (CYP3A) activity. A sensitive method for the simultaneous determination of MDZ and its metabolite 1-OH-MDZ in human plasma using supported liquid extraction (SLE) in combination with liquid chromatography-tandem mass spectrometry (LC-MS/MS) detection was developed and validated. Plasma samples (100 μL) were diluted with 0.5M NH(3) (aq) containing deuterated internal standards. The samples were extracted with ethyl acetate on a 96-well SLE-plate. Separation was performed on a Symmetry Shield RP18 column using an acidic gradient running from 2% to 95% methanol in 3 min. Detection was performed using a triple quadrupole mass spectrometer running in positive electrospray selected reaction monitoring (SRM) mode. The validated dynamic range was 0.2-100 nmol/L for both analytes. In the concentration range 0.6-75 nmol/L the extraction recoveries were in the ranges 91.2-98.6% and 94.5-98.3% for MDZ and 1-OH-MDZ, respectively. Matrix effects were more pronounced for MDZ than for 1-OH-MDZ but the response was still 75.4% or higher compared to a reference. The overall repeatability was within 2.2-7.6% for both analytes, the overall reproducibility was within 3.1-10.2% for both analytes and the overall accuracy bias was within -1.1 to 7.5% for both analytes. The method was successfully applied to determine the plasma concentrations of MDZ and 1-OH-MDZ in 14 healthy volunteers up to 24h after administration of a single oral dose of 2mg MDZ. The SLE technology was found to be convenient and suitable for sample preparation, and the developed method was found to be rapid, selective and reproducible for the simultaneous determination of MDZ and 1-OH-MDZ in human plasma.
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Affiliation(s)
- Camilla Svanström
- Department of Chemistry and Pharmaceutics, Active Biotech AB, Box 724, SE-22007 Lund, Sweden.
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Vinci B, Duret C, Klieber S, Gerbal-Chaloin S, Sa-Cunha A, Laporte S, Suc B, Maurel P, Ahluwalia A, Daujat-Chavanieu M. Modular bioreactor for primary human hepatocyte culture: medium flow stimulates expression and activity of detoxification genes. Biotechnol J 2011; 6:554-64. [PMID: 21259441 PMCID: PMC3123466 DOI: 10.1002/biot.201000326] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 12/02/2010] [Accepted: 12/05/2010] [Indexed: 01/19/2023]
Abstract
Down-regulation of detoxification genes, notably cytochrome P450 (CYPs), in primary hepatocyte cultures is a long-standing and major concern. We evaluated the influence of medium flow in this model. Hepatocytes isolated from 12 different liver donors were cultured either in a multichamber modular bioreactor (MCmB, flow rate 250-500 μL/min) or under standard/static conditions, and the expression of 32 genes, enzyme activities and biological parameters were measured 7-21 days later. mRNA expression of genes involved in xenobiotic/drug metabolism and transport, including CYP1A1, 1A2, 2B6, 2C9, 3A4 (and activities for some of them), UDP-glucuronosyltransferase (UGT) 1A1, UGT2B4, UGT2B7, glutathione S-transferase (GSTα), and multidrug resistance protein 1 (MDR1) and MRP2, were specifically up-regulated by medium flow as compared with static controls in all cultures tested. In 2-week-old cultures, expression of detoxification genes reached levels close to or higher than those measured in freshly isolated hepatocytes. In contrast, CYP2D6 and most of other tested genes were not affected by medium flow. We conclude that medium flow specifically interferes with, and up-regulates, the activity of xenosensors and/or the expression of detoxification genes in primary human hepatocytes. Down-regulation of detoxification genes in conventional (static) cultures is therefore partly a consequence of the absence of medium circulation.
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Affiliation(s)
- Bruna Vinci
- Centro Interdipartimentale di Ricerca E. Piaggio, Faculty of Engineering, University of Pisa, Pisa, Italy
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Kaivosaari S, Finel M, Koskinen M. N-glucuronidation of drugs and other xenobiotics by human and animal UDP-glucuronosyltransferases. Xenobiotica 2011; 41:652-69. [PMID: 21434773 DOI: 10.3109/00498254.2011.563327] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Metabolic disposition of drugs and other xenobiotics includes glucuronidation reactions that are catalyzed by the uridine diphosphate glucuronosyltransferases (UGTs). The most common glucuronidation reactions are O- and N-glucuronidation and in this review, we discuss both, while the emphasis is on N-glucuronidation. Interspecies difference in glucuronidation is another central issue in this review due to its importance in drug development. Accordingly, the available data on glucuronidation in different animals comes mainly from the species that are used in preclinical studies to assess the safety of drugs under development. Both O- and N-glucuronidation reactions are chemically diverse. Different O-glucuronidation reactions are described and discussed, and many drugs that undergo such reactions are indicated. The compounds that undergo N-glucuronidation include primary aromatic amines, hydroxylamines, amides, tertiary aliphatic amines, and aromatic N-heterocycles. The interspecies variability in N-glucuronidation is particularly high, above all when it comes to aliphatic tertiary amines and aromatic N-heterocycles. The N-glucuronidation rates in humans are typically much higher than in animals, largely due to the activity of two enzymes, the extensively studied UGT1A4, and the more recently identified as a main player in N-glucuronidation, UGT2B10. We discuss both enzymes and review the findings that revealed the role of UGT2B10 in N-glucuronidation.
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Affiliation(s)
- Sanna Kaivosaari
- Research and Development, Orion Corporation Orion Pharma, Espoo, Finland
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Darnell M, Schreiter T, Zeilinger K, Urbaniak T, Söderdahl T, Rossberg I, Dillnér B, Berg AL, Gerlach JC, Andersson TB. Cytochrome P450-Dependent Metabolism in HepaRG Cells Cultured in a Dynamic Three-Dimensional Bioreactor. Drug Metab Dispos 2011; 39:1131-8. [DOI: 10.1124/dmd.110.037721] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Guest EJ, Rowland-Yeo K, Rostami-Hodjegan A, Tucker GT, Houston JB, Galetin A. Assessment of algorithms for predicting drug-drug interactions via inhibition mechanisms: comparison of dynamic and static models. Br J Clin Pharmacol 2011; 71:72-87. [PMID: 21143503 DOI: 10.1111/j.1365-2125.2010.03799.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT The prediction of drug-drug interactions (DDIs) from in vitro data usually utilizes an average dosing interval estimate of inhibitor concentration in an equation-based static model. Simcyp®, a population-based ADME simulator, is becoming widely used for the prediction of DDIs and has the ability to incorporate the time-course of inhibitor concentration and hence generate a temporal profile of the inhibition process within a dynamic model. WHAT THIS PAPER ADDS Prediction of DDIs for 35 clinical studies incorporating a representative range of drug-drug interactions, with multiple studies across different inhibitors and victim drugs. Assessment of whether the inclusion of the time course of inhibition in the dynamic model improves prediction in comparison with the static model. Investigation of the impact of different inhibitor and victim drug parameters on DDI prediction accuracy including dosing time and the inclusion of active metabolites. Assessment of ability of the dynamic model to predict inter-individual variability in the DDI magnitude. AIMS Static and dynamic models (incorporating the time course of the inhibitor) were assessed for their ability to predict drug-drug interactions (DDIs) using a population-based ADME simulator (Simcyp®V8). The impact of active metabolites, dosing time and the ability to predict inter-individual variability in DDI magnitude were investigated using the dynamic model. METHODS Thirty-five in vivo DDIs involving azole inhibitors and benzodiazepines were predicted using the static and dynamic model; both models were employed within Simcyp for consistency in parameters. Simulations comprised of 10 trials with matching population demographics and dosage regimen to the in vivo studies. Predictive utility of the static and dynamic model was assessed relative to the inhibitor or victim drug investigated. RESULTS Use of the dynamic and static models resulted in comparable prediction success, with 71 and 77% of DDIs predicted within two-fold, respectively. Over 40% of strong DDIs (>five-fold AUC increase) were under-predicted by both models. Incorporation of the itraconazole metabolite into the dynamic model resulted in increased prediction accuracy of strong DDIs (80% within two-fold). Bias and imprecision in prediction of triazolam DDIs were higher in comparison with midazolam and alprazolam; >50% of triazolam DDIs were under-predicted regardless of the model used. Predicted inter-individual variability in the AUC ratio (coefficient of variation of 45%) was consistent with the observed variability (50%). CONCLUSIONS High prediction accuracy was observed using both the Simcyp dynamic and static models. The differences observed with the dose staggering and the incorporation of active metabolite highlight the importance of these variables in DDI prediction.
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Affiliation(s)
- Eleanor J Guest
- School of Pharmacy and Pharmaceutical Sciences, University of Manchester, Oxford Road, Manchester, UK
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Saari TI, Uusi-Oukari M, Ahonen J, Olkkola KT. Enhancement of GABAergic activity: neuropharmacological effects of benzodiazepines and therapeutic use in anesthesiology. Pharmacol Rev 2011; 63:243-67. [PMID: 21245208 DOI: 10.1124/pr.110.002717] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
GABA is the major inhibitory neurotransmitter in the central nervous system (CNS). The type A GABA receptor (GABA(A)R) system is the primary pharmacological target for many drugs used in clinical anesthesia. The α1, β2, and γ2 subunit-containing GABA(A)Rs located in the various parts of CNS are thought to be involved in versatile effects caused by inhaled anesthetics and classic benzodiazepines (BZD), both of which are widely used in clinical anesthesiology. During the past decade, the emergence of tonic inhibitory conductance in extrasynaptic GABA(A)Rs has coincided with evidence showing that these receptors are highly sensitive to the sedatives and hypnotics used in anesthesia. Anesthetic enhancement of tonic GABAergic inhibition seems to be preferentially increased in regions shown to be important in controlling memory, awareness, and sleep. This review focuses on the physiology of the GABA(A)Rs and the pharmacological properties of clinically used BZDs. Although classic BZDs are widely used in anesthesiological practice, there is a constant need for new drugs with more favorable pharmacokinetic and pharmacodynamic effects and fewer side effects. New hypnotics are currently developed, and promising results for one of these, the GABA(A)R agonist remimazolam, have recently been published.
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Affiliation(s)
- Teijo I Saari
- Department of Anesthesiology, Intensive Care, Emergency Care and Pain Medicine, Turku University Hospital, P.O. Box 52 (Kiinamyllynkatu 4-8), FI-20520 Turku, Finland.
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Liu Y, She M, Wu Z, Dai R. The inhibition study of human UDP-glucuronosyltransferases with cytochrome P450 selective substrates and inhibitors. J Enzyme Inhib Med Chem 2010; 26:386-93. [PMID: 20939765 DOI: 10.3109/14756366.2010.518965] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Human uridine-5'-diphosphoglucuronosyltransferases (UGTs) are the major phase II metabolizing enzymes. In the present study, five human UGTs (UGT1A1, 1A4, 1A6, 2B7, and 2B10) were individually expressed and used to examine the inhibition IC(50) values of 20 selective substrates and inhibitors of major cytochromes P450 (CYPs). The inhibition kinetics of UGT1A1 was also analyzed. The results showed that some compounds like α-naphthoflavone, paclitaxel, midazolam, cyclosporine A, and ketoconazole displayed strong inhibitions on UGT activities with their IC(50) values in a range of 4.1-26 µM. Especially, the IC(50) values were 4.1 ± 0.8 µM for ketoconazole in inhibiting UGT1A1-mediated β-estradiol-3-glucuronidation, and 4.9 ± 0.3 µM for paclitaxel towards UGT1A4-mediated midazolam-N-glucuronidation. Additionally, the IC(50) values of bupropion, tolbutamide, and testosterone in inhibiting UGT-mediated metabolisms were similar with the K(m) values of respective CYPs. Some kinetic behaviours of UGTs were following Michaelis-Menten kinetics, while some were not.
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Affiliation(s)
- Yuping Liu
- Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Laboratory of Drug Metabolism & Pharmacokinetics, Science Park, Luo Gang District, Guangzhou, China
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Attkins N, Betts A, Hepworth D, Heatherington AC. Pharmacokinetics and elucidation of the rates and routes of N-glucuronidation of PF-592379, an oral dopamine 3 agonist in rat, dog, and human. Xenobiotica 2010; 40:730-42. [DOI: 10.3109/00498254.2010.514961] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Looking back through the MIST: a perspective of evolving strategies and key focus areas for metabolite safety analysis. Bioanalysis 2010; 2:1235-48. [DOI: 10.4155/bio.10.71] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The publication of the US FDA MIST guidance document in 2008 reignited the debate around the most appropriate strategies to underwrite metabolite safety for novel compounds. Whilst some organizations have suggested that the guidelines necessitate a paradigm shift to more thorough metabolite analysis during early development, an evaluation of historical practices shows that the principles of the guidelines have always largely underpinned metabolism studies within the pharmaceutical industry. Therefore, it is argued that existing practices, when coupled to appropriate emerging analytical tools and a case-by-case consideration of the relevance of the generated metabolism data in terms of structure, physicochemisty, abundance and activity, represent a fit-for-purpose approach to metabolite-safety assessments.
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Miners JO, Mackenzie PI, Knights KM. The prediction of drug-glucuronidation parameters in humans: UDP-glucuronosyltransferase enzyme-selective substrate and inhibitor probes for reaction phenotyping and in vitro-in vivo extrapolation of drug clearance and drug-drug interaction potential. Drug Metab Rev 2010; 42:196-208. [PMID: 19795925 DOI: 10.3109/03602530903210716] [Citation(s) in RCA: 188] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Major advances in the characterization of uridine diphosphate (UDP)-glucuronosyltransferase (UGT) enzyme substrate and inhibitor selectivities and the development of experimental paradigms to investigate xenobiotic glucuronidation in vitro now permit the prediction of a range of drug-glucuronidation parameters in humans. In particular, the availability of substrate and inhibitor "probes" for the major hepatic drug metabolizing UGTs together with batteries of recombinant enzymes allow the reaction phenotyping of drug glucuronidation reactions. Additionally, in vitro experimental approaches and scaling strategies have been successfully applied to the quantitative prediction of in vivo clearance via glucuronidation and drug-drug interaction potential.
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Affiliation(s)
- John O Miners
- Department of Clinical Pharmacology, Flinders University School of Medicine, Adelaide, Australia.
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Bourcier K, Hyland R, Kempshall S, Jones R, Maximilien J, Irvine N, Jones B. Investigation into UDP-Glucuronosyltransferase (UGT) Enzyme Kinetics of Imidazole- and Triazole-Containing Antifungal Drugs in Human Liver Microsomes and Recombinant UGT Enzymes. Drug Metab Dispos 2010; 38:923-9. [DOI: 10.1124/dmd.109.030676] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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de Wildt SN, Kearns GL, Murry DJ, Koren G, van den Anker JN. Ontogeny of midazolam glucuronidation in preterm infants. Eur J Clin Pharmacol 2009; 66:165-70. [PMID: 19838691 PMCID: PMC2805794 DOI: 10.1007/s00228-009-0741-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Accepted: 09/17/2009] [Indexed: 11/25/2022]
Abstract
Purpose In preterm infants, the biotransformation of midazolam (M) to 1-OH-midazolam (OHM) by cytochrome P450 3A4 (CYP3A4) is developmentally immature, but it is currently unknown whether the glucuronidation of OHM to 1-OH-midazolam glucuronide (OHMG) is also decreased. The aim of our study was to investigate the urinary excretion of midazolam and its metabolites OHM and OHMG in preterm neonates following the intravenous (IV) or oral (PO) administration of a single M dose. Methods Preterm infants (post-natal age 3–13 days, gestational age 26–34 4/7 weeks) scheduled to undergo a stressful procedure received a 30-min IV infusion (n = 15) or a PO bolus dose (n= 7) of 0.1 mg/kg midazolam. The percentage of midazolam dose excreted in the urine as M, OHM and OHMG up to 6 h post-dose was determined. Results The median percentage of the midazolam dose excreted as M, OHM and OHMG in the urine during the 6-h interval after the IV infusion was 0.44% (range 0.02–1.39%), 0.04% (0.01–0.13%) and 1.57% (0.36–7.7%), respectively. After administration of the PO bolus dose, the median percentage of M, OHM and OHMG excreted in the urine was 0.11% (0.02–0.59%), 0.02% (0.00–0.10%) and 1.69% (0.58–7.31%), respectively. The proportion of the IV midazolam dose excreted as OHMG increased significantly with postconceptional age (r = 0.73, p < 0.05). Conclusion The glucuronidation of OHM appears immature in preterm infants less than 2 weeks of age. The observed increase in urinary excretion of OHMG with postconceptional age likely reflects the combined maturation of glucuronidation and renal function.
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Affiliation(s)
- Saskia N de Wildt
- Department of Paediatrics and Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
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Hyland R, Osborne T, Payne A, Kempshall S, Logan YR, Ezzeddine K, Jones B. In vitro and in vivo glucuronidation of midazolam in humans. Br J Clin Pharmacol 2009; 67:445-54. [PMID: 19371318 DOI: 10.1111/j.1365-2125.2009.03386.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIMS Midazolam (MDZ) is a benzodiazepine used as a CYP3A4 probe in clinical and in vitro studies. A glucuronide metabolite of MDZ has been identified in vitro in human liver microsome (HLM) incubations. The primary aim of this study was to understand the in vivo relevance of this pathway. METHODS An authentic standard of N-glucuronide was generated from microsomal incubations and isolated using solid-phase extraction. The structure was confirmed using proton nuclear magnetic resonance (NMR) and (1)H-(13)C long range correlation experiments. The metabolite was quantified in vivo in human urine samples. Enzyme kinetic behaviour of the pathway was investigated in HLM and recombinant UGT (rUGT) enzymes. Additionally, preliminary experiments were performed with 1'-OH midazolam (1'-OH MDZ) and 4-OH-midazolam (4-OH MDZ) to investigate N-glucuronidation. RESULTS NMR data confirmed conjugation of midazolam N-glucuronide (MDZG) standard to be on the alpha-nitrogen of the imidazole ring. In vivo, MDZG in the urine accounted for 1-2% of the administered dose. In vitro incubations confirmed UGT1A4 as the enzyme of interest. The pathway exhibited atypical kinetics and a substrate inhibitory cooperative binding model was applied to determine K(m) (46 microM, 64 microM), V(max) (445 pmol min(-1) mg(-1), 427 pmol min(-1) mg(-1)) and K(i) (58 microM, 79 microM) in HLM and rUGT1A4, respectively. From incubations with HLM and rUGT enzymes, N-glucuronidation of 1'-OH MDZ and 4-OH MDZ is also inferred. CONCLUSIONS A more complete picture of MDZ metabolism and the enzymes involved has been elucidated. Direct N-glucuronidation of MDZ occurs in vivo. Pharmacokinetic modelling using Simcyp illustrates an increased role for UGT1A4 under CYP3A inhibited conditions.
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Affiliation(s)
- Ruth Hyland
- Pharmacokinetics Dynamics and Metabolism, Pfizer Global R&D, Ramsgate Road, Sandwich, Kent, CT13 9NJ, UK.
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Synthesis and evaluation of N-[(1S,2S)-3-(4-chlorophenyl)-2-(3-cyanophenyl)-1-methylpropyl]-2-methyl-2-aminopropanamide as human cannabinoid-1 receptor (CB1R) inverse agonists. Bioorg Med Chem Lett 2009; 19:5195-9. [DOI: 10.1016/j.bmcl.2009.07.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 06/29/2009] [Accepted: 07/02/2009] [Indexed: 11/17/2022]
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Smith DA, Obach RS. Metabolites in safety testing (MIST): considerations of mechanisms of toxicity with dose, abundance, and duration of treatment. Chem Res Toxicol 2009; 22:267-79. [PMID: 19166333 DOI: 10.1021/tx800415j] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In previous papers, we have offered a strategic framework regarding metabolites of drugs in humans and the need to assess these in laboratory animal species (also termed Metabolites in Safety Testing or MIST; Smith and Obach, Chem. Res. Toxicol. (2006) 19, 1570-1579). Three main tenets of this framework were founded in (i) comparisons of absolute exposures (as circulating concentrations or total body burden), (ii) the nature of the toxicity mechanism (i.e., reversible interaction at specific targets versus covalent binding to multiple macromolecules), and (iii) the biological matrix in which the metabolite was observed (circulatory vs excretory). In the present review, this framework is expanded to include a fourth tenet: considerations for the duration of exposure. Basic concepts of pharmacology are utilized to rationalize the relationship between exposure (to parent drug or metabolite) and various effects ranging from desired therapeutic effects through to severe toxicities. Practical considerations of human ADME (absorption-distribution-metabolism-excretion) data, to determine which metabolites should be further evaluated for safety, are discussed. An analysis of recently published human ADME studies shows that the number of drug metabolites considered to be important for MIST can be excessively high if a simple percentage-of-parent-drug criterion is used without consideration of the aforementioned four tenets. Concern over unique human metabolites has diminished over the years as experience has shown that metabolites of drugs in humans will almost always be observed in laboratory animals, although the proportions may vary. Even if a metabolite represents a high proportion of the dose in humans and a low proportion in animals, absolute abundances in animals frequently exceed that in humans because the doses used in animal toxicology studies are much greater than therapeutic doses in humans. The review also updates the enzymatic basis for the differences between species and how these relate to MIST considerations.
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Affiliation(s)
- Dennis A Smith
- Pharmacokinetics, Dynamics, and Metabolism, Pfizer Inc., Sandwich, Kent, UK.
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Kilford PJ, Stringer R, Sohal B, Houston JB, Galetin A. Prediction of Drug Clearance by Glucuronidation from in Vitro Data: Use of Combined Cytochrome P450 and UDP-Glucuronosyltransferase Cofactors in Alamethicin-Activated Human Liver Microsomes. Drug Metab Dispos 2008; 37:82-9. [DOI: 10.1124/dmd.108.023853] [Citation(s) in RCA: 150] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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