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Miners JO, Polasek TM, Hulin JA, Rowland A, Meech R. Drug-drug interactions that alter the exposure of glucuronidated drugs: Scope, UDP-glucuronosyltransferase (UGT) enzyme selectivity, mechanisms (inhibition and induction), and clinical significance. Pharmacol Ther 2023:108459. [PMID: 37263383 DOI: 10.1016/j.pharmthera.2023.108459] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 06/03/2023]
Abstract
Drug-drug interactions (DDIs) arising from the perturbation of drug metabolising enzyme activities represent both a clinical problem and a potential economic loss for the pharmaceutical industry. DDIs involving glucuronidated drugs have historically attracted little attention and there is a perception that interactions are of minor clinical relevance. This review critically examines the scope and aetiology of DDIs that result in altered exposure of glucuronidated drugs. Interaction mechanisms, namely inhibition and induction of UDP-glucuronosyltransferase (UGT) enzymes and the potential interplay with drug transporters, are reviewed in detail, as is the clinical significance of known DDIs. Altered victim drug exposure arising from modulation of UGT enzyme activities is relatively common and, notably, the incidence and importance of UGT induction as a DDI mechanism is greater than generally believed. Numerous DDIs are clinically relevant, resulting in either loss of efficacy or an increased risk of adverse effects, necessitating dose individualisation. Several generalisations relating to the likelihood of DDIs can be drawn from the known substrate and inhibitor selectivities of UGT enzymes, highlighting the importance of comprehensive reaction phenotyping studies at an early stage of drug development. Further, rigorous assessment of the DDI liability of new chemical entities that undergo glucuronidation to a significant extent has been recommended recently by regulatory guidance. Although evidence-based approaches exist for the in vitro characterisation of UGT enzyme inhibition and induction, the availability of drugs considered appropriate for use as 'probe' substrates in clinical DDI studies is limited and this should be research priority.
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Affiliation(s)
- John O Miners
- Discipline of Clinical Pharmacology and Flinders Centre for Innovation in Cancer, Flinders University College of Medicine and Public Health, Flinders University, Adelaide, Australia.
| | - Thomas M Polasek
- Certara, Princeton, NJ, USA; Centre for Medicines Use and Safety, Monash University, Melbourne, Australia
| | - Julie-Ann Hulin
- Discipline of Clinical Pharmacology and Flinders Centre for Innovation in Cancer, Flinders University College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Andrew Rowland
- Discipline of Clinical Pharmacology and Flinders Centre for Innovation in Cancer, Flinders University College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Robyn Meech
- Discipline of Clinical Pharmacology and Flinders Centre for Innovation in Cancer, Flinders University College of Medicine and Public Health, Flinders University, Adelaide, Australia
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2
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Abildgaard J, Petersen JH, Bang AK, Aksglaede L, Christiansen P, Juul A, Jørgensen N. Long-term testosterone undecanoate treatment in the elderly testosterone deficient male: An observational cohort study. Andrology 2021; 10:322-332. [PMID: 34743411 DOI: 10.1111/andr.13124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Quarterly intramuscular injections with long-acting testosterone undecanoate (TU) provide stable serum testosterone concentrations over time and are therefore preferred by many testosterone-deficient patients. However, the use of long-acting TU in elderly patients is limited due to lack of safety and feasibility studies. OBJECTIVE To investigate long-acting TU pharmacokinetics and assess differences in treatment regimens and risk of adverse outcomes in younger versus elderly testosterone-deficient patients. MATERIALS AND METHODS Single-center longitudinal observational study. Patients who initiated long-acting TU treatment between 2005 and 2010 were included. Elderly patients were born before 1956 and younger patients between 1965 and 1985. TU dose was adjusted yearly through shortening or prolongation of time between injections. Treatment targets were as follows: (1) free testosterone between 0 and -1 SD from the age-adjusted mean, (2) no symptoms of testosterone deficiency, and (3) hematocrit within the normal range. RESULTS The study population consisted of 63 elderly and 63 younger patients. Median follow-up time during testosterone replacement was 12.1 years. Increasing intervals between TU injections were performed 44% more often in the elderly compared to younger patients and time between TU injections were prolonged 4% more in the elderly patients. The hematocrit, as well as the hematocrit for a given serum testosterone (hematocrit: testosterone ratio), increased with treatment time but did not differ between age groups. During follow-up, 40% of patients-both elderly and younger-experienced polycythemia. Risk of polycythemia did not differ with age. DISCUSSION AND CONCLUSION An increased number of adjustments of TU dose are necessary in elderly patients in order to reach treatment targets. TU treatment in elderly testosterone-deficient patients is not associated with an increased risk of polycythemia compared to younger patients if age-adjusted treatment targets are reached.
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Affiliation(s)
- Julie Abildgaard
- Department of Growth and Reproduction, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,The Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Holm Petersen
- Department of Growth and Reproduction, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Anne Kirstine Bang
- Department of Growth and Reproduction, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lise Aksglaede
- Department of Growth and Reproduction, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Peter Christiansen
- Department of Growth and Reproduction, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Anders Juul
- Department of Growth and Reproduction, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Niels Jørgensen
- Department of Growth and Reproduction, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Determination of anabolic steroids in dried blood using microsampling and gas chromatography-tandem mass spectrometry: Application to a testosterone gel administration study. J Chromatogr A 2020; 1628:461445. [DOI: 10.1016/j.chroma.2020.461445] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 12/18/2022]
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Lood Y, Aardal-Eriksson E, Webe C, Ahlner J, Ekman B, Wahlberg J. Relationship between testosterone in serum, saliva and urine during treatment with intramuscular testosterone undecanoate in gender dysphoria and male hypogonadism. Andrology 2017; 6:86-93. [DOI: 10.1111/andr.12435] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 09/08/2017] [Accepted: 09/20/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Y. Lood
- National Board of Forensic Medicine; Department of Forensic Genetics and Forensic Toxicology; Linköping Sweden
- Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - E. Aardal-Eriksson
- Division of Clinical Chemistry; Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
| | - C. Webe
- Department of Endocrinology; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - J. Ahlner
- National Board of Forensic Medicine; Department of Forensic Genetics and Forensic Toxicology; Linköping Sweden
- Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - B. Ekman
- Department of Endocrinology; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - J. Wahlberg
- Department of Endocrinology; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
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Androgen actions on endothelium functions and cardiovascular diseases. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2016; 13:183-96. [PMID: 27168746 PMCID: PMC4854959 DOI: 10.11909/j.issn.1671-5411.2016.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
The roles of androgens on cardiovascular physiology and pathophysiology are controversial as both beneficial and detrimental effects have been reported. Although the reasons for this discrepancy are unclear, multiple factors such as genetic and epigenetic variation, sex-specificity, hormone interactions, drug preparation and route of administration may contribute. Recently, growing evidence suggests that androgens exhibit beneficial effects on cardiovascular function though the mechanism remains to be elucidated. Endothelial cells (ECs) which line the interior surface of blood vessels are distributed throughout the circulatory system, and play a crucial role in cardiovascular function. Endothelial progenitor cells (EPCs) are considered an indispensable element for the reconstitution and maintenance of an intact endothelial layer. Endothelial dysfunction is regarded as an initiating step in development of atherosclerosis and cardiovascular diseases. The modulation of endothelial functions by androgens through either genomic or nongenomic signal pathways is one possible mechanism by which androgens act on the cardiovascular system. Obtaining insight into the mechanisms by which androgens affect EC and EPC functions will allow us to determine whether androgens possess beneficial effects on the cardiovascular system. This in turn may be critical in the prevention and therapy of cardiovascular diseases. This article seeks to review recent progress in androgen regulation of endothelial function, the sex-specificity of androgen actions, and its clinical applications in the cardiovascular system.
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Ferrati S, Nicolov E, Bansal S, Zabre E, Geninatti T, Ziemys A, Hudson L, Ferrari M, Goodall R, Khera M, Palapattu G, Grattoni A. Delivering enhanced testosterone replacement therapy through nanochannels. Adv Healthc Mater 2015; 4:446-51. [PMID: 25274059 DOI: 10.1002/adhm.201400348] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 07/21/2014] [Indexed: 11/08/2022]
Abstract
Primary or secondary hypogonadism results in a range of signs and symptoms that compromise quality of life and requires life-long testosterone replacement therapy. In this study, an implantable nanochannel system is investigated as an alternative delivery strategy for the long-term sustained and constant release of testosterone. In vitro release tests are performed using a dissolution set up, with testosterone and testosterone:2-hydroxypropyl-β-cyclodextrin (TES:HPCD) 1:1 and 1:2 molar ratio complexes release from the implantable nanochannel system and quantify by HPLC. 1:2 TES:HPCD complex stably achieve 10-15 times higher testosterone solubility with 25-30 times higher in vitro release. Bioactivity of delivered testosterone is verified by LNCaP/LUC cell luminescence. In vivo evaluation of testosterone, luteinizing hormone (LH), and follicle stimulating hormone (FSH) levels by liquid chromatography mass spectrometry (LC/MS) and multiplex assay is performed in castrated Sprague-Dawley rats over 30 d. Animals are treated with the nanochannel implants or degradable testosterone pellets. The 1:2 TES:HPCD nanochannel implant exhibits sustained and clinically relevant in vivo release kinetics and attains physiologically stable plasma levels of testosterone, LH, and FSH. In conclusion, it is demonstrated that by providing long-term steady release 1:2 TES:HPCD nanochannel implants may represent a major breakthrough for the treatment of male hypogonadism.
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Affiliation(s)
- Silvia Ferrati
- The Department of Nanomedicine; Houston Methodist Research Institute; 6670 Bertner Avenue Houston TX 77030 USA
| | - Eugenia Nicolov
- The Department of Nanomedicine; Houston Methodist Research Institute; 6670 Bertner Avenue Houston TX 77030 USA
| | - Shyam Bansal
- The Department of Nanomedicine; Houston Methodist Research Institute; 6670 Bertner Avenue Houston TX 77030 USA
- Division of Cardiovascular Diseases The University of Alabama at Birmingham; 1530 3 Avenue South Birmingham AL 35294 USA
| | - Erika Zabre
- The Department of Nanomedicine; Houston Methodist Research Institute; 6670 Bertner Avenue Houston TX 77030 USA
| | - Thomas Geninatti
- The Department of Nanomedicine; Houston Methodist Research Institute; 6670 Bertner Avenue Houston TX 77030 USA
| | - Arturas Ziemys
- The Department of Nanomedicine; Houston Methodist Research Institute; 6670 Bertner Avenue Houston TX 77030 USA
| | - Lee Hudson
- NanoMedical Systems Inc.; Austin, TX, 4401 Freidrich Ln 307 Austin TX 78744 USA
| | - Mauro Ferrari
- The Department of Nanomedicine; Houston Methodist Research Institute; 6670 Bertner Avenue Houston TX 77030 USA
| | - Randal Goodall
- NanoMedical Systems Inc.; Austin, TX, 4401 Freidrich Ln 307 Austin TX 78744 USA
| | - Mohit Khera
- Department of Urology; Baylor College of Medicine; 7200 Cambridge Street Houston TX 77030 USA
| | - Ganesh Palapattu
- Department of Urology; University of Michigan; 1500 E Medical Center Drive SPC 5913 Ann Arbor MI 48109 USA
| | - Alessandro Grattoni
- The Department of Nanomedicine; Houston Methodist Research Institute; 6670 Bertner Avenue Houston TX 77030 USA
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Schulze JJ, Ekström L. Editorial: Variation in Phase II Metabolism of Sex Steroids - Causes and Consequences. Front Endocrinol (Lausanne) 2015; 6:50. [PMID: 25972839 PMCID: PMC4412131 DOI: 10.3389/fendo.2015.00050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 03/28/2015] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Lena Ekström
- Karolinska Institutet, Stockholm, Sweden
- *Correspondence:
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Handelsman DJ, Idan A, Grainger J, Goebel C, Turner L, Conway AJ. Detection and effects on serum and urine steroid and LH of repeated GnRH analog (leuprolide) stimulation. J Steroid Biochem Mol Biol 2014; 141:113-20. [PMID: 24495617 DOI: 10.1016/j.jsbmb.2014.01.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 01/21/2014] [Accepted: 01/27/2014] [Indexed: 12/14/2022]
Abstract
Non-steroidal drugs that increase endogenous testosterone (T) may be used to exploit ergogenic effects of androgens in power sports. While superactive GnRH analog use is suspected, neither screening nor detection tests are developed. This study aimed to determine if (a) stimulation for 5 days by leuprolide (a superactive GnRH analog) of serum and urine steroids and urine LH is reproducible at a 2 week interval, (b) nandrolone decanoate (ND) co-administration masks responses to leuprolide administration, (c) performance of urine measurement of leuprolide and M1, its major metabolite, as a detection test. Healthy men were randomized into a 4 week parallel group, open label clinical study in which all men had daily sc injections of leuprolide (1mg) for 4 days in the 1st and 3rd weeks with hormone-free 2nd and 4th weeks. In the 3rd week, men were randomized to either ND injections or no extra treatment. Serum steroids were determined by liquid chromatography, tandem mass spectrometry (LC-MS), urine steroids by gas chromatography, mass spectrometry (GC-MS), urine leuprolide and M1 by high resolution LC-MS and urine LH by immunoassay. Leuprolide stimulated striking, reproducible increases in serum and urine LH and steroids (serum T, dihydroT (DHT), 3α diol; urine T, epitestosterone (E) and androsterone (A). ND suppressed basal serum T, E2, 3α diol, and urinary E but did not mask or change the magnitude of responses to leuprolide. Urine leuprolide and M1 measurement had 100% sensitivity and specificity in detecting leuprolide administration up to one day after cessation of injections with the detection window between 1 and 3 days after last dose. Screening using urine steroid and LH measurements, optimally by urinary log10(LHxT), correctly classified 82% of urine samples. It is concluded that leuprolide stimulation of endogenous testosterone is reproducible after a 10-day interval, is not masked by ND and is reliably detected by urine leuprolide or M1 measurement for at least 1 day after administration.
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Affiliation(s)
- David J Handelsman
- Andrology Department, Concord Hospital, Sydney, NSW 2139, Australia; ANZAC Research Institute, University of Sydney, Sydney, NSW 2139, Australia.
| | - Amanda Idan
- Andrology Department, Concord Hospital, Sydney, NSW 2139, Australia
| | - Janelle Grainger
- Australian Sports Drug Testing Laboratory, National Measurement Institute, Sydney, NSW 2139, Australia
| | - Catrin Goebel
- Australian Sports Drug Testing Laboratory, National Measurement Institute, Sydney, NSW 2139, Australia
| | - Leo Turner
- Andrology Department, Concord Hospital, Sydney, NSW 2139, Australia
| | - Ann J Conway
- Andrology Department, Concord Hospital, Sydney, NSW 2139, Australia; ANZAC Research Institute, University of Sydney, Sydney, NSW 2139, Australia
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