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Dello Russo C, Bandiera T, Monici M, Surdo L, Yip VLM, Wotring V, Morbidelli L. Physiological adaptations affecting drug pharmacokinetics in space: what do we really know? A critical review of the literature. Br J Pharmacol 2022; 179:2538-2557. [PMID: 35170019 PMCID: PMC9314132 DOI: 10.1111/bph.15822] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 01/13/2022] [Accepted: 02/10/2022] [Indexed: 12/03/2022] Open
Abstract
As human spaceflight progresses with extended mission durations, the demand for effective and safe drugs will necessarily increase. To date, the accepted medications used during missions (for space motion sickness, sleep disturbances, allergies, pain, and sinus congestion) are administered under the assumption that they act as safely and efficaciously as on Earth. However, physiological changes have been documented in human subjects in spaceflight involving fluid shifts, muscle and bone loss, immune system dysregulation, and adjustments in the gastrointestinal tract and metabolism. These alterations may change the pharmacokinetics (PK) and pharmacodynamics of commonly used medications. Frustratingly, the information gained from bed rest studies and from in‐flight observations is incomplete and also demonstrates a high variability in drug PK. Therefore, the objectives of this review are to report (i) the impact of the space environmental stressors on human physiology in relation to PK; (ii) the state‐of‐the‐art on experimental data in space and/or in ground‐based models; (iii) the validation of ground‐based models for PK studies; and (iv) the identification of research gaps.
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Affiliation(s)
- Cinzia Dello Russo
- Università Cattolica del Sacro Cuore, Dept. of Healthcare Surveillance and Bioethics, Section of Pharmacology, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,MRC Centre for Drug Safety Science and Wolfson Centre for Personalised Medicine, Institute of Systems, Molecular and Integrative Biology (ISMIB), University of Liverpool, Liverpool, UK
| | - Tiziano Bandiera
- D3-PharmaChemistry Line, Istituto Italiano di Tecnologia (IIT), Genova, Italy
| | - Monica Monici
- ASAcampus Joint Laboratory, ASA Res. Div. & Dept. of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Leonardo Surdo
- Space Applications Services NV/SA for the European Space Agency, NL-2200AG, Noordwijk, The Netherlands
| | - Vincent Lai Ming Yip
- MRC Centre for Drug Safety Science and Wolfson Centre for Personalised Medicine, Institute of Systems, Molecular and Integrative Biology (ISMIB), University of Liverpool, Liverpool, UK
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2
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Liang D, Ma J, Wei B. Oral absorption and drug interaction kinetics of moxifloxacin in an animal model of weightlessness. Sci Rep 2021; 11:2605. [PMID: 33510326 PMCID: PMC7843972 DOI: 10.1038/s41598-021-82044-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 01/12/2021] [Indexed: 11/18/2022] Open
Abstract
To investigate the effect of simulated weightlessness on the pharmacokinetics of orally administered moxifloxacin and the antacid Maalox or the antidiarrheal Pepto-Bismol using a tail-suspended (TS) rat model of microgravity. Fasted control and TS, jugular-vein-cannulated, male Sprague-Dawley rats received either a single 5 mg/kg intravenous dose or a single 10 mg/kg oral dose of moxifloxacin alone or with a 0.625 mL/kg oral dose of Maalox or a 1.43 mL/kg oral dose of Pepto-Bismol. Plasma concentrations of moxifloxacin were measured by HPLC. Pharmacokinetic data were analyzed using WinNonlin. Simulated weightlessness had no effect on moxifloxacin disposition after intravenous administration but significantly decreased the extent of moxifloxacin oral absorption. The coadministration of moxifloxacin with Maalox to either control or TS rats caused significant reductions in the rate and extent of moxifloxacin absorption. In contrast, the coadministration of moxifloxacin with Pepto-Bismol to TS rats had no significant effect on either the rate or the extent of moxifloxacin absorption. These interactions showed dose staggering when oral administrations of Pepto-Bismol and moxifloxacin were separated by 60 min in control rats but not in TS rats. Dose staggering was more apparent after the coadministration of Maalox and moxifloxacin in TS rats.
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Affiliation(s)
- Dong Liang
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Texas Southern University, 3100 Cleburne Street, Houston, TX, 77004, USA.
| | - Jing Ma
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Texas Southern University, 3100 Cleburne Street, Houston, TX, 77004, USA
| | - Bo Wei
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, 77030, TX, USA
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Blue RS, Bayuse TM, Daniels VR, Wotring VE, Suresh R, Mulcahy RA, Antonsen EL. Supplying a pharmacy for NASA exploration spaceflight: challenges and current understanding. NPJ Microgravity 2019; 5:14. [PMID: 31231676 PMCID: PMC6565689 DOI: 10.1038/s41526-019-0075-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 04/26/2019] [Indexed: 02/05/2023] Open
Abstract
In order to maintain crew health and performance during long-duration spaceflight outside of low-Earth orbit, NASA and its international partners must be capable of providing a safe and effective pharmacy. Given few directed studies of pharmaceuticals in the space environment, it is difficult to characterize pharmaceutical effectiveness or stability during spaceflight; this in turn makes it challenging to select an appropriate formulary for exploration. Here, we present the current state of literature regarding pharmaceutical stability, metabolism, and effectiveness during spaceflight. In particular, we have attempted to highlight the gaps in current knowledge and the difficulties in translating terrestrial-based drug studies to a meaningful interpretation of drug stability, safety, and effectiveness in space. We hope to identify high-yield opportunities for future research that might better define and mitigate pharmaceutical risk for exploration missions.
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Affiliation(s)
- Rebecca S Blue
- 1Aerospace Medicine and Vestibular Research Laboratory, The Mayo Clinic Arizona, Scottsdale, AZ 85054 USA.,2GeoControl Systems, Inc, Houston, TX 77058 USA
| | | | | | - Virginia E Wotring
- 4Department of Pharmacology and Chemical Biology and Center for Space Medicine, Baylor College of Medicine, Houston, TX 77030 USA
| | - Rahul Suresh
- 5Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX 77555-1110 USA
| | - Robert A Mulcahy
- 6National Aeronautics and Space Administration (NASA), Johnson Space Center, Houston, TX 77058 USA
| | - Erik L Antonsen
- 6National Aeronautics and Space Administration (NASA), Johnson Space Center, Houston, TX 77058 USA.,7Department of Emergency Medicine and Center for Space Medicine, Baylor College of Medicine, Houston, TX 77030 USA
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Tomas A, Stilinović N, Sabo A, Tomić Z. Use of microdialysis for the assessment of fluoroquinolone pharmacokinetics in the clinical practice. Eur J Pharm Sci 2019; 131:230-242. [PMID: 30811969 DOI: 10.1016/j.ejps.2019.02.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 02/22/2019] [Accepted: 02/22/2019] [Indexed: 12/12/2022]
Abstract
Antibacterial drugs, including fluoroquinolones, can exert their therapeutic action only with adequate penetration at the infection site. Multiple factors, such as rate of protein binding, drug liposolubility and organ blood-flow all influence ability of antibiotics to penetrate target tissues. Microdialysis is an in vivo sampling technique that has been successfully applied to measure the distribution of fluoroquinolones in the interstitial fluid of different tissues both in animal studies and clinical setting. Tissue concentrations need to be interpreted within the context of the pathogenesis and causative agents implicated in infections. Integration of microdialysis -derived tissue pharmacokinetics with pharmacodynamic data offers crucial information for correlating exposure with antibacterial effect. This review explores these concepts and provides an overview of tissue concentrations of fluoroquinolones derived from microdialysis studies and explores the therapeutic implications of fluoroquinolone distribution at various target tissues.
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Affiliation(s)
- Ana Tomas
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Serbia.
| | - Nebojša Stilinović
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Serbia
| | - Ana Sabo
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Serbia
| | - Zdenko Tomić
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Serbia
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Linakis MW, Job KM, Liu X, Collingwood SC, Pangburn HA, Ott DK, Sherwin CMT. Riding (High) into the danger zone: a review of potential differences in chemical exposures in fighter pilots resulting from high altitude and G-forces. Expert Opin Drug Metab Toxicol 2017; 13:925-934. [PMID: 28772091 DOI: 10.1080/17425255.2017.1360867] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION When in flight, pilots of high performance aircraft experience conditions unique to their profession. Training flights, performed as often as several times a week, can expose these pilots to altitudes in excess of 15 km (~50,000 ft, with a cabin pressurized to an altitude of ~20,000 ft), and the maneuvers performed in flight can exacerbate the G-forces felt by the pilot. While the pilots specifically train to withstand these extreme conditions, the physiologic stress could very likely lead to differences in the disposition of chemicals in the body, and consequently, dangerously high exposures. Unfortunately, very little is known about how the conditions experienced by fighter pilots affects chemical disposition. Areas covered: The purpose of this review is to present information about the effects of high altitude, G-forces, and other conditions experienced by fighter pilots on chemical disposition. Using this information, the expected changes in chemical exposure will be discussed, using isopropyl alcohol as an example. Expert opinion: There is a severe lack of information concerning the effects of the fighter pilot environment on the pharmacokinetics and pharmacodynamics of chemicals. Given the possibility of exposure prior to or during flight, it is important that these potential effects be investigated further.
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Affiliation(s)
- Matthew W Linakis
- a Division of Clinical Pharmacology, Department of Pediatrics , University of Utah , Salt Lake City , UT , USA.,b Department of Pharmaceutics and Pharmaceutical Chemistry , University of Utah , Salt Lake City , UT , USA
| | - Kathleen M Job
- a Division of Clinical Pharmacology, Department of Pediatrics , University of Utah , Salt Lake City , UT , USA
| | - Xiaoxi Liu
- a Division of Clinical Pharmacology, Department of Pediatrics , University of Utah , Salt Lake City , UT , USA
| | - Scott C Collingwood
- a Division of Clinical Pharmacology, Department of Pediatrics , University of Utah , Salt Lake City , UT , USA
| | - Heather A Pangburn
- c Department of Aeromedical Research , United States Air Force School of Aerospace Medicine , Dayton , OH , USA
| | - Darrin K Ott
- c Department of Aeromedical Research , United States Air Force School of Aerospace Medicine , Dayton , OH , USA
| | - Catherine M T Sherwin
- a Division of Clinical Pharmacology, Department of Pediatrics , University of Utah , Salt Lake City , UT , USA
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Drugs in space: Pharmacokinetics and pharmacodynamics in astronauts. Eur J Pharm Sci 2017; 109S:S2-S8. [PMID: 28533143 DOI: 10.1016/j.ejps.2017.05.025] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 11/21/2022]
Abstract
Space agencies are working intensely to push the current boundaries of human spaceflight by sending astronauts deeper into space than ever before, including missions to Mars and asteroids. Spaceflight alters human physiology due to fluid shifts, muscle and bone loss, immune system dysregulation, and changes in the gastrointestinal tract and metabolic enzymes. These alterations may change the pharmacokinetics and/or pharmacodynamics of medications used by astronauts and subsequently might impact drug efficacy and safety. Most commonly, medications are administered during space missions to treat sleep disturbances, allergies, space motion sickness, pain, and sinus congestion. These medications are administered under the assumption that they act in a similar way as on Earth, an assumption that has not been investigated systematically yet. Few inflight pharmacokinetic data have been published, and pharmacodynamic and pharmacokinetic/pharmacodynamic studies during spaceflight are also lacking. Therefore, bed-rest models are often used to simulate physiological changes observed during microgravity. In addition to pharmacokinetic/pharmacodynamic changes, decreased drug and formulation stability in space could also influence efficacy and safety of medications. These alterations along with physiological changes and their resulting pharmacokinetic and pharmacodynamic effects must to be considered to determine their ultimate impact on medication efficacy and safety during spaceflight.
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Deitchman AN, Heinrichs MT, Khaowroongrueng V, Jadhav SB, Derendorf H. Utility of Microdialysis in Infectious Disease Drug Development and Dose Optimization. AAPS JOURNAL 2016; 19:334-342. [PMID: 27943149 DOI: 10.1208/s12248-016-0020-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 11/25/2016] [Indexed: 01/13/2023]
Abstract
Adequate drug penetration to a site of infection is absolutely imperative to ensure sufficient antimicrobial treatment. Microdialysis is a minimally invasive, versatile technique, which can be used to study the penetration of an antiinfective agent in virtually any tissue of interest. It has been used to investigate drug distribution and pharmacokinetics in variable patient populations, as a tool in dose optimization, a potential utility in therapeutic drug management, and in the study of biomarkers of disease progression. While all of these applications have not been fully explored in the field of antiinfectives, this review provides an overview of how microdialysis has been applied in various phases of drug development, a focus on the specific applications in the subspecialties of infectious disease (treatment of bacterial, fungal, viral, parasitic, and mycobacterial infections), and developing applications (biomarkers and therapeutic drug management).
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Affiliation(s)
- Amelia N Deitchman
- Department of Pharmaceutics, University of Florida, 1345 Center Drive, PO Box 100494, Gainesville, Florida, 32610, USA
| | - M Tobias Heinrichs
- Department of Pharmaceutics, University of Florida, 1345 Center Drive, PO Box 100494, Gainesville, Florida, 32610, USA
| | - Vipada Khaowroongrueng
- Department of Pharmaceutics, University of Florida, 1345 Center Drive, PO Box 100494, Gainesville, Florida, 32610, USA
| | - Satyawan B Jadhav
- Department of Pharmaceutics, University of Florida, 1345 Center Drive, PO Box 100494, Gainesville, Florida, 32610, USA
| | - Hartmut Derendorf
- Department of Pharmaceutics, University of Florida, 1345 Center Drive, PO Box 100494, Gainesville, Florida, 32610, USA.
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Barbour A, Scaglione F, Derendorf H. Class-dependent relevance of tissue distribution in the interpretation of anti-infective pharmacokinetic/pharmacodynamic indices. Int J Antimicrob Agents 2010; 35:431-8. [PMID: 20219329 DOI: 10.1016/j.ijantimicag.2010.01.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Revised: 01/19/2010] [Accepted: 01/21/2010] [Indexed: 10/19/2022]
Abstract
The pharmacokinetic/pharmacodynamic (PK/PD) indices useful for predicting antimicrobial clinical efficacy are well established. The most common indices include the time free drug concentration in plasma is above the minimum inhibitory concentration (MIC) (fT(>MIC)) expressed as a percent of the dosing interval, the ratio of maximum concentration to MIC (C(max)/MIC), and the ratio of the area under the 24-h concentration-time curve to MIC (AUC(0-24)/MIC). A single PK/PD index may correlate well with an entire antimicrobial class. For example, the beta-lactams correlate well with the fT(>MIC). However, other classes may be more complex and a single index cannot be generalised to the class, e.g. the macrolides. The rationale behind which PK/PD index best correlates with efficacy depends on several factors, including the mechanism of action, the microbial kill kinetics, the degree of protein binding and the degree of tissue distribution. Studies have traditionally emphasised the first two factors, whilst the significance of protein binding and tissue distribution is increasingly appreciated. In fact, the latter two factors may partially elucidate why the magnitude of reported target indices are not always as expected. For example, tigecycline and telithromycin are clinically efficacious with average serum concentrations below their MICs over a 24-h period. Therefore, to understand more fully the PK/PD relationship of antibiotics and to better predict the clinical efficacy of antibiotic dosing regimens, assessment of free drug concentrations at the site of action is warranted.
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Sammeta SM, Vaka SRK, Murthy SN. Dermal drug levels of antibiotic (cephalexin) determined by electroporation and transcutaneous sampling (ETS) technique. J Pharm Sci 2010; 98:2677-85. [PMID: 19067398 DOI: 10.1002/jps.21642] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of this project was to assess the validity of a novel Electroporation and transcutaneous sampling (ETS) technique for sampling cephalexin from the dermal extracellular fluid (ECF). This work also investigated the plausibility of using cephalexin levels in the dermal ECF as a surrogate for the drug levels in the synovial fluid. In vitro and in vivo studies were carried out using hairless rats to assess the workability of ETS. Cephalexin (20 mg/kg) was administered (i.v.) through tail vein and the time course of drug concentration in the plasma was determined. In the same rats, cephalexin concentration in the dermal ECF was determined by ETS and microdialysis techniques. In a separate set of rats, only intraarticular microdialysis was carried out to determine the time course of cephalexin concentration in synovial fluid. The drug concentration in the dermal ECF determined by ETS and microdialysis did not differ significantly from each other and so as were the pharmacokinetic parameters. The results provide validity to the ETS technique. Further, there was a good correlation ( approximately 0.9) between synovial fluid and dermal ECF levels of cephalexin indicating that dermal ECF levels could be used as a potential surrogate for cephalexin concentration in the synovial fluid.
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Affiliation(s)
- S M Sammeta
- Department of Pharmaceutics, The University of Mississippi, University Mississippi 38677, USA
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