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Carr LM, Mustafa S, Care A, Collins-Praino LE. More than a number: Incorporating the aged phenotype to improve in vitro and in vivo modeling of neurodegenerative disease. Brain Behav Immun 2024; 119:554-571. [PMID: 38663775 DOI: 10.1016/j.bbi.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 03/04/2024] [Accepted: 04/22/2024] [Indexed: 04/29/2024] Open
Abstract
Age is the number one risk factor for developing a neurodegenerative disease (ND), such as Alzheimer's disease (AD) or Parkinson's disease (PD). With our rapidly ageing world population, there will be an increased burden of ND and need for disease-modifying treatments. Currently, however, translation of research from bench to bedside in NDs is poor. This may be due, at least in part, to the failure to account for the potential effect of ageing in preclinical modelling of NDs. While ageing can impact upon physiological response in multiple ways, only a limited number of preclinical studies of ND have incorporated ageing as a factor of interest. Here, we evaluate the aged phenotype and highlight the critical, but unmet, need to incorporate aspects of this phenotype into both the in vitro and in vivo models used in ND research. Given technological advances in the field over the past several years, we discuss how these could be harnessed to create novel models of ND that more readily incorporate aspects of the aged phenotype. This includes a recently described in vitro panel of ageing markers, which could help lead to more standardised models and improve reproducibility across studies. Importantly, we cannot assume that young cells or animals yield the same responses as seen in the context of ageing; thus, an improved understanding of the biology of ageing, and how to appropriately incorporate this into the modelling of ND, will ensure the best chance for successful translation of new therapies to the aged patient.
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Affiliation(s)
- Laura M Carr
- School of Biomedicine, University of Adelaide, Adelaide, SA, Australia
| | - Sanam Mustafa
- School of Biomedicine, University of Adelaide, Adelaide, SA, Australia; Australian Research Council Centre of Excellence for Nanoscale Biophotonics, The University of Adelaide, Adelaide, SA, Australia; Davies Livestock Research Centre, The University of Adelaide, Roseworthy, SA, Australia
| | - Andrew Care
- School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - Lyndsey E Collins-Praino
- School of Biomedicine, University of Adelaide, Adelaide, SA, Australia; Australian Research Council Centre of Excellence for Nanoscale Biophotonics, The University of Adelaide, Adelaide, SA, Australia.
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2
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Arce-López B, Coton M, Coton E, Hymery N. Occurrence of the two major regulated mycotoxins, ochratoxin A and fumonisin B1, in cereal and cereal-based products in Europe and toxicological effects: A review. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2024; 109:104489. [PMID: 38844151 DOI: 10.1016/j.etap.2024.104489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/25/2024] [Accepted: 05/30/2024] [Indexed: 06/14/2024]
Abstract
Among cereal contaminants, mycotoxins are of concern due to their importance in terms of food and feed safety. The difficulty in establishing a diagnosis for mycotoxicosis relies on the fact that the effects are most often subclinical for chronic exposure and the most common scenario is multi-contamination by various toxins. Mycotoxin co-occurrence is a major food safety concern as additive or even synergic toxic impacts may occur, but also regarding current regulations as they mainly concern individual mycotoxin levels in specific foods and feed in the food chain. However, due to the large number of possible mycotoxin combinations, there is still limited knowledge on co-exposure toxicity data, which depends on several parameters. In this context, this systematic review aims to provide an overview of the toxic effects of two regulated mycotoxins, namely ochratoxin A and fumonisin B1. This review focused on the 2012-2022 period and analysed the occurrence in Europe of the selected mycotoxins in different food matrices (cereals and cereal-derived products), and their toxic impact, alone or in combination, on in vitro intestinal and hepatic human cells. To better understand and evaluate the associated risks, further research is needed using new approach methodologies (NAM), such as in vitro 3D models. KEY CONTRIBUTION: Cereals and their derived products are the most important food source for humans and feed for animals worldwide. This manuscript is a state of the art review of the literature over the last ten years on ochratoxin A and fumonisin B1 mycotoxins in these products in Europe as well as their toxicological effects, alone and in combination, on human cells. Future perspectives and some challenges regarding the assessment of toxicological effects of mycotoxins are also discussed.
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Affiliation(s)
- Beatriz Arce-López
- Univ. Brest, INRAE, Laboratoire Universitaire de Biodiversité et Ecologie Microbienne, Plouzané F-29280, France
| | - Monika Coton
- Univ. Brest, INRAE, Laboratoire Universitaire de Biodiversité et Ecologie Microbienne, Plouzané F-29280, France
| | - Emmanuel Coton
- Univ. Brest, INRAE, Laboratoire Universitaire de Biodiversité et Ecologie Microbienne, Plouzané F-29280, France
| | - Nolwenn Hymery
- Univ. Brest, INRAE, Laboratoire Universitaire de Biodiversité et Ecologie Microbienne, Plouzané F-29280, France.
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Scherf-Clavel M, Baumann P, Hart XM, Schneider H, Schoretsanitis G, Steimer W, Zernig G, Zurek G. Behind the Curtain: Therapeutic Drug Monitoring of Psychotropic Drugs from a Laboratory Analytical Perspective. Ther Drug Monit 2024; 46:143-154. [PMID: 36941240 DOI: 10.1097/ftd.0000000000001092] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
PURPOSE Therapeutic drug monitoring (TDM) is a well-established tool for guiding psychopharmacotherapy and improving patient care. Despite their established roles in the prescription of psychotropic drugs, the "behind the curtain" processes of TDM requests are invariably obscure to clinicians, and literature addressing this topic is scarce. METHODS In the present narrative review, we provide a comprehensive overview of the various steps, starting from requesting TDM to interpreting TDM findings, in routine clinical practice. Our goal was to improve clinicians' insights into the numerous factors that may explain the variations in TDM findings due to methodological issues. RESULTS We discussed challenges throughout the TDM process, starting from the analyte and its major variation forms, through sampling procedures and pre-analytical conditions, time of blood sampling, sample matrices, and collection tubes, to analytical methods, their advantages and shortcomings, and the applied quality procedures. Additionally, we critically reviewed the current and future advances in the TDM of psychotropic drugs. CONCLUSIONS The "behind the curtain" processes enabling TDM involve a multidisciplinary team, which faces numerous challenges in clinical routine. A better understanding of these processes will allow clinicians to join the efforts for achieving higher-quality TDM findings, which will in turn improve treatment effectiveness and safety outcomes of psychotropic agents.
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Affiliation(s)
- Maike Scherf-Clavel
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Work Group on "Therapeutic Drug Monitoring" (Chair: Prof. Dr Med. Dipl.-Psych. Stefan Unterecker, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany)
| | - Pierre Baumann
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Work Group on "Therapeutic Drug Monitoring" (Chair: Prof. Dr Med. Dipl.-Psych. Stefan Unterecker, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany)
- German Society for Clinical Chemistry and Laboratory Medicine e. V. (DGKL), Section Therapeutic Drug Monitoring and Clinical Toxicology, Berlin/Bonn, Germany
| | - Xenia M Hart
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Work Group on "Therapeutic Drug Monitoring" (Chair: Prof. Dr Med. Dipl.-Psych. Stefan Unterecker, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany)
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Heike Schneider
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Work Group on "Therapeutic Drug Monitoring" (Chair: Prof. Dr Med. Dipl.-Psych. Stefan Unterecker, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany)
- Institute of Clinical Chemistry and Pathobiochemistry, Technical University Munich, Munich, Germany
- German Society for Clinical Chemistry and Laboratory Medicine e. V. (DGKL), Section Therapeutic Drug Monitoring and Clinical Toxicology, Berlin/Bonn
- INSTAND e.V. Society for Promoting Quality Assurance in Medical Laboratories, Duesseldorf, Germany
- German Society for Clinical Chemistry and Laboratory Medicine e. V. (DGKL), Section Therapeutic Drug Monitoring and Clinical Toxicology, Berlin/Bonn, Germany
| | - Georgios Schoretsanitis
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Work Group on "Therapeutic Drug Monitoring" (Chair: Prof. Dr Med. Dipl.-Psych. Stefan Unterecker, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany)
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York
- Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, New York
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Werner Steimer
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Work Group on "Therapeutic Drug Monitoring" (Chair: Prof. Dr Med. Dipl.-Psych. Stefan Unterecker, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany)
- Institute of Clinical Chemistry and Pathobiochemistry, Technical University Munich, Munich, Germany
- German Society for Clinical Chemistry and Laboratory Medicine e. V. (DGKL), Section Therapeutic Drug Monitoring and Clinical Toxicology, Berlin/Bonn
| | - Gerald Zernig
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Work Group on "Therapeutic Drug Monitoring" (Chair: Prof. Dr Med. Dipl.-Psych. Stefan Unterecker, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany)
- Department of Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
- Private Practice for Psychotherapy and Court-certified Expert Witness, Hall in Tirol, Austria; and
| | - Gabriela Zurek
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Work Group on "Therapeutic Drug Monitoring" (Chair: Prof. Dr Med. Dipl.-Psych. Stefan Unterecker, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany)
- Medical Laboratory Bremen, Bremen, Germany
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Hulin A, Gelé T, Fenioux C, Kempf E, Sahali D, Tournigand C, Ollero M. Pharmacology of Tyrosine Kinase Inhibitors: Implications for Patients with Kidney Diseases. Clin J Am Soc Nephrol 2023:01277230-990000000-00305. [PMID: 38079278 DOI: 10.2215/cjn.0000000000000395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Tyrosine kinase inhibitors (TKI) have introduced a significant advancement in cancer management. These compounds are administered orally, and their absorption holds a pivotal role in determining their variable efficacy. They exhibit extensive distribution within the body, binding strongly to both plasma and tissue proteins. Often reliant on efflux and influx transporters, TKI undergo primary metabolism by intestinal and hepatic cytochrome P450 enzymes, with nonkidney clearance being predominant. Owing to their limited therapeutic window, many TKI display considerable intraindividual and interindividual variability. This review offers a comprehensive analysis of the clinical pharmacokinetics of TKI, detailing their interactions with drug transporters and metabolic enzymes, while discussing potential clinical implications. The prevalence of kidney conditions, such as AKI and CKD, among patients with cancer is explored in their effect on TKI pharmacokinetics. Finally, the potential nephrotoxicity associated with TKI is also examined.
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Affiliation(s)
- Anne Hulin
- Pharmacology Laboratory, University Medicine Department of Biology-Pathology, AP-HP, GH Henri Mondor, University Paris-Est Creteil, Créteil, France
- University Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
| | - Thibaut Gelé
- Pharmacology Laboratory, University Medicine Department of Biology-Pathology, AP-HP, GH Henri Mondor, University Paris-Est Creteil, Créteil, France
- University Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
| | - Charlotte Fenioux
- Oncology Unit, University Medicine Department of Cancer, AP-HP, GH Henri Mondor, University Paris-Est Creteil, Créteil, France
| | - Emmanuelle Kempf
- University Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
- Oncology Unit, University Medicine Department of Cancer, AP-HP, GH Henri Mondor, University Paris-Est Creteil, Créteil, France
| | - Dil Sahali
- University Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
- Nephrology Unit, University Medicine Department of Medicine, AP-HP, GH Henri Mondor, University Paris-Est Creteil, Créteil, France
| | - Christophe Tournigand
- University Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
- Oncology Unit, University Medicine Department of Cancer, AP-HP, GH Henri Mondor, University Paris-Est Creteil, Créteil, France
| | - Mario Ollero
- University Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
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Torres-Carrillo N, Martínez-López E, Torres-Carrillo NM, López-Quintero A, Moreno-Ortiz JM, González-Mercado A, Gutiérrez-Hurtado IA. Pharmacomicrobiomics and Drug-Infection Interactions: The Impact of Commensal, Symbiotic and Pathogenic Microorganisms on a Host Response to Drug Therapy. Int J Mol Sci 2023; 24:17100. [PMID: 38069427 PMCID: PMC10707377 DOI: 10.3390/ijms242317100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023] Open
Abstract
Microorganisms have a close relationship with humans, whether it is commensal, symbiotic, or pathogenic. Recently, it has been documented that microorganisms may influence the response to drug therapy. Pharmacomicrobiomics is an emerging field that focuses on the study of how variations in the microbiome affect the disposition, action, and toxicity of drugs. Two additional sciences have been added to complement pharmacomicrobiomics, namely toxicomicrobiomics, which explores how the microbiome influences drug metabolism and toxicity, and pharmacoecology, which refers to modifications in the microbiome as a result of drug administration. In this context, we introduce the concept of "drug-infection interaction" to describe the influence of pathogenic microorganisms on drug response. This review analyzes the current state of knowledge regarding the relevance of microorganisms in the host's response to drugs. It also highlights promising areas for future research and proposes the term "drug-infection interaction" as an extension of pharmacomicrobiomics.
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Affiliation(s)
- Norma Torres-Carrillo
- Departamento de Microbiología y Patología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (N.T.-C.); (N.M.T.-C.)
| | - Erika Martínez-López
- Instituto de Nutrigenética y Nutrigenómica Traslacional, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico;
- Departamento de Biología Molecular y Genómica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico;
| | - Nora Magdalena Torres-Carrillo
- Departamento de Microbiología y Patología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (N.T.-C.); (N.M.T.-C.)
| | - Andres López-Quintero
- Departamento de Biología Molecular y Genómica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico;
| | - José Miguel Moreno-Ortiz
- Instituto de Genética Humana “Dr. Enrique Corona Rivera”, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (J.M.M.-O.); (A.G.-M.)
| | - Anahí González-Mercado
- Instituto de Genética Humana “Dr. Enrique Corona Rivera”, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (J.M.M.-O.); (A.G.-M.)
| | - Itzae Adonai Gutiérrez-Hurtado
- Departamento de Biología Molecular y Genómica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico;
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Li L, Sassen S, Hunfeld N, Smeets T, Ewoldt T, van den Berg SAA, Koch BCP, Endeman H. Population pharmacokinetics of dexamethasone in critically ill COVID-19 patients: Does inflammation play a role? J Crit Care 2023; 78:154395. [PMID: 37542750 DOI: 10.1016/j.jcrc.2023.154395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/12/2023] [Accepted: 07/22/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE The aim of this study is to design a population pharmacokinetic study to gain a deeper understanding of the pharmacokinetics of dexamethasone in critically ill COVID-19 patients in order to identify relevant covariates that can be used to personalize dosing regimens. METHODS Blood samples from critically ill patients receiving fixed-dose intravenous dexamethasone (6 mg/day) for the treatment of COVID-19 were sampled in a retrospective pilot study. The data were analyzed using Nonlinear Mixed Effects Modeling (NONMEM) software for population pharmacokinetic analysis and clinically relevant covariates were selected and evaluated. RESULTS A total of 51 dexamethasone samples from 18 patients were analyzed and a two-compartment model fit the data best. The mean population estimates were 2.85 L/h (inter-individual-variability 62.9%) for clearance, 15.4 L for the central volume of distribution, 12.3 L for the peripheral volume of distribution and 2.1 L/h for the inter-compartmental distribution clearance. The covariate analysis showed a significant negative correlation between dexamethasone clearance and CRP. CONCLUSIONS Dexamethasone PK parameters in ICU COVID patients were substantially different from those from non-ICU non-COVID patients, and inflammation may play an important role in dexamethasone exposure. This finding suggests that fixed-dose dexamethasone over several days may not be appropriate for ICU COVID patients.
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Affiliation(s)
- Letao Li
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Sebastiaan Sassen
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Nicole Hunfeld
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Intensive Care Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Tim Smeets
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Intensive Care Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Tim Ewoldt
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Intensive Care Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Sjoerd A A van den Berg
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Birgit C P Koch
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Henrik Endeman
- Department of Intensive Care Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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7
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Kuzin M, Gardin F, Götschi M, Xepapadakos F, Kawohl W, Seifritz E, Trauzeddel A, Paulzen M, Schoretsanitis G. Changes in Psychotropic Drug Blood Levels After SARS-CoV-2 Vaccination: A Two-Center Cohort Study. Ther Drug Monit 2023; 45:792-796. [PMID: 37296505 DOI: 10.1097/ftd.0000000000001118] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/27/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Limited evidence from case reports suggests that coronavirus disease 2019 (COVID-19) vaccination may interact with the treatment outcomes of psychiatric medications. Apart from clozapine, reports on the effect of COVID-19 vaccination on other psychotropic agents are scarce. This study aimed to investigate the impact of COVID-19 vaccination on the plasma levels of different psychotropic drugs using therapeutic drug monitoring. METHODS Plasma levels of psychotropic agents, including agomelatine, amisulpride, amitriptyline, escitalopram, fluoxetine, lamotrigine, mirtazapine, olanzapine, quetiapine, sertraline, trazodone, and venlafaxine, from inpatients with a broad spectrum of psychiatric diseases receiving COVID-19 vaccinations were collected at 2 medical centers between 08/2021 and 02/2022 under steady-state conditions before and after vaccination. Postvaccination changes were estimated as a percentage of baseline. RESULTS Data from 16 patients who received COVID-19 vaccination were included. The largest changes in plasma levels were reported for quetiapine (+101.2%) and trazodone (-38.5%) in 1 and 3 patients, respectively, 1 day postvaccination compared with baseline levels. One week postvaccination, the plasma levels of fluoxetine (active moiety) and escitalopram increased by 31% and 24.9%, respectively. CONCLUSIONS This study provides the first evidence of major changes in the plasma levels of escitalopram, fluoxetine, trazodone, and quetiapine after COVID-19 vaccination. When planning COVID-19 vaccination for patients treated with these medications, clinicians should monitor rapid changes in bioavailability and consider short-term dose adjustments to ensure safety.
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Affiliation(s)
- Maxim Kuzin
- Clienia Schloessli, Private Psychiatric Hospital and Academic Teaching Hospital of the University of Zurich, Oetwil am See, Zurich, Switzerland
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP)-Work Group "Therapeutic Drug Monitoring", Nürnberg, Germany
- University of Nicosia Medical School, Nicosia, Cyprus
| | - Fabian Gardin
- Clienia Schloessli, Private Psychiatric Hospital and Academic Teaching Hospital of the University of Zurich, Oetwil am See, Zurich, Switzerland
| | - Markus Götschi
- Clienia Schloessli, Private Psychiatric Hospital and Academic Teaching Hospital of the University of Zurich, Oetwil am See, Zurich, Switzerland
| | - Franziskos Xepapadakos
- Clienia Schloessli, Private Psychiatric Hospital and Academic Teaching Hospital of the University of Zurich, Oetwil am See, Zurich, Switzerland
- University of Nicosia Medical School, Nicosia, Cyprus
| | - Wolfram Kawohl
- Clienia Schloessli, Private Psychiatric Hospital and Academic Teaching Hospital of the University of Zurich, Oetwil am See, Zurich, Switzerland
- University of Nicosia Medical School, Nicosia, Cyprus
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | | | - Michael Paulzen
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP)-Work Group "Therapeutic Drug Monitoring", Nürnberg, Germany
- Alexianer Hospital Aachen, Aachen, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, and JARA-Translational Brain Medicine, Aachen, Germany
| | - Georgios Schoretsanitis
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP)-Work Group "Therapeutic Drug Monitoring", Nürnberg, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Northwell Health, The Zucker Hillside Hospital, New York, New York; and
- Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, New York
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Tachet J, Versace F, Mercier T, Buclin T, Decosterd LA, Choong E, Girardin FR. Development and validation of a multiplex HPLC-MS/MS assay for the monitoring of JAK inhibitors in patient plasma. J Chromatogr B Analyt Technol Biomed Life Sci 2023; 1230:123917. [PMID: 37956468 DOI: 10.1016/j.jchromb.2023.123917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023]
Abstract
Janus kinase inhibitors (JAKi) are oral small molecules used in the treatment of a broad spectrum of autoimmune and myeloproliferative diseases. JAKi exhibit significant intra- and inter-individual pharmacokinetic variabilities, due to fluctuations in compliance with oral treatments and their metabolism essentially driven by cytochrome P450 enzymes. Intrinsically, JAKi have dose-response relationship and narrow therapeutic index: therapeutic drug monitoring (TDM) is expected to optimize and adapt their dosage regimen in order to resolve problems of efficacy and tolerance linked to dose and safety. A sensitive analytical method using multiplex high-performance liquid-chromatography coupled to tandem mass spectrometry (HPLC-MS/MS) was developed and validated for the simultaneous quantification in plasma of the 6 major currently used JAKi, namely abrocitinib, baricitinib, fedratinib, ruxolitinib, tofacitinib, and upadacitinib. Plasma samples are subjected to protein precipitation with MeOH, using stable isotopically labelled internal standards. The separation of JAKi in supernatants diluted 1:1 with ultrapure H2O was performed using a C18 column Xselect HSS T3 2.5 µm, 2.1x150 mm using a mobile phase composed of formic acid (FA) 0.2% and acetonitrile (+FA 0.1%) in gradient mode. The analytical run time for the multiplex assay was 7 min. JAKi drugs were monitored by electrospray ionization in the positive mode followed by triple-stage quadrupole MS/MS analysis. The method was validated according to SFSTP and ICH guidelines over the clinically relevant concentration ranges (0.5-200 ng/mL for abrocitinib, baricitinib and upadacitinib; 1-400 ng/mL for tofacitinib; 0.5-400 ng/mL for ruxolitinib, and 10-800 ng/mL for fedratinib). This multiplex HPLC-MS/MS assay achieved good performances in term of trueness (91.1-113.5%), repeatability (3.0-9.9%), and intermediate precision (4.5-11.3%). We developed and validated a highly sensitive method for the multiplex quantification of the JAKi abrocitinib, baricitinib, fedratinib, ruxolitinib, tofacitinib, and upadacitinib in human plasma. The method will be applied for prospective clinical pharmacokinetic studies to determine whether TDM programs for JAKi based on residual drug concentrations can be recommended using disease-specific therapeutic ranges.
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Affiliation(s)
- Jérémie Tachet
- Service and Laboratory of Clinical Pharmacology, Department of Laboratory Medicine and Pathology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - François Versace
- Service and Laboratory of Clinical Pharmacology, Department of Laboratory Medicine and Pathology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thomas Mercier
- Service and Laboratory of Clinical Pharmacology, Department of Laboratory Medicine and Pathology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thierry Buclin
- Service and Laboratory of Clinical Pharmacology, Department of Laboratory Medicine and Pathology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Laurent A Decosterd
- Service and Laboratory of Clinical Pharmacology, Department of Laboratory Medicine and Pathology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Eva Choong
- Service and Laboratory of Clinical Pharmacology, Department of Laboratory Medicine and Pathology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - François R Girardin
- Service and Laboratory of Clinical Pharmacology, Department of Laboratory Medicine and Pathology, University Hospital and University of Lausanne, Lausanne, Switzerland.
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9
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Chen X, Yu G, Li GF. Use of Clearance Concepts to Simulate Impact of Interleukin-6 on Drug Elimination Governed by Cytochromes P450 3A4 and Glomerular Filtration Rate. Eur J Drug Metab Pharmacokinet 2023; 48:619-621. [PMID: 37792131 DOI: 10.1007/s13318-023-00859-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/05/2023]
Affiliation(s)
- Xiang Chen
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, Jiangsu, China
| | - Guo Yu
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, Jiangsu, China
| | - Guo-Fu Li
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, Jiangsu, China.
- Subei People's Hospital, Yangzhou, China.
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10
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Zou H, Hao P, Cao Y, Li L, Ding R, Bai X, Xue Y. Hippophae rhamnoides reverses decreased CYP2D6 expression in rats with BCG-induced liver injury. Sci Rep 2023; 13:17425. [PMID: 37833431 PMCID: PMC10575986 DOI: 10.1038/s41598-023-44590-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/10/2023] [Indexed: 10/15/2023] Open
Abstract
In this study, we investigated the effect of Hippophae rhamnoides L. (HRP) on the activity of CYP2D6 via the CAMP/PKA/NF-κB pathway in rats with Bacille Calmette-Guerin (BCG)-induced immunological liver injury. BCG (125 mg/kg) was injected to establish the rat model of liver injury. HRP was administered intragastrically for one week as the intervention drug. Proteomics techniques were used to analyze protein expression levels, obtaining a comprehensive understanding of the liver injury process. ELISA or western blotting was used to detect specific protein levels. Dextromethorphan was detected using high-performance liquid chromatography to reflect the metabolic activity of CYP2D6. BCG downregulated the expression of CYP2D6, cAMP, PKA, IκB, and P-CREB and upregulated that of NF-κB, IL-1β, TNF-α, and CREB in the liver; HRP administration reversed these effects. Therefore, HRP may restore the metabolic function of the liver by reversing the downregulation of CYP2D6 through inhibition of NF-κB signal transduction and regulation of the cAMP/PKA/CREB/CYP2D6 pathway. These findings highlight the role of HRP as an alternative clinical drug for treating hepatitis B and other immune-related liver diseases.
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Affiliation(s)
- Huiqiong Zou
- Institute of Pharmacokinetics and Liver Molecular Pharmacology, Department of Pharmacology, Baotou Medical College, No. 31 Jianshe Road, Donghe District, Baotou, 014060, China
| | - Peipei Hao
- Institute of Pharmacokinetics and Liver Molecular Pharmacology, Department of Pharmacology, Baotou Medical College, No. 31 Jianshe Road, Donghe District, Baotou, 014060, China
| | - Yingying Cao
- Institute of Pharmacokinetics and Liver Molecular Pharmacology, Department of Pharmacology, Baotou Medical College, No. 31 Jianshe Road, Donghe District, Baotou, 014060, China
| | - Li Li
- Institute of Pharmacokinetics and Liver Molecular Pharmacology, Department of Pharmacology, Baotou Medical College, No. 31 Jianshe Road, Donghe District, Baotou, 014060, China
| | - Ruifeng Ding
- Department of Gastroenterology, First Affiliated Hospital, Baotou Medical College, Baotou, China
| | - Xuefeng Bai
- Department of Pathology, Baotou Cancer Hospital, Baotou, China
| | - Yongzhi Xue
- Institute of Pharmacokinetics and Liver Molecular Pharmacology, Department of Pharmacology, Baotou Medical College, No. 31 Jianshe Road, Donghe District, Baotou, 014060, China.
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11
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Benzi JRDL, Melli PPDS, Duarte G, Unadkat JD, Lanchote VL. The Impact of Inflammation on the In Vivo Activity of the Renal Transporters OAT1/3 in Pregnant Women Diagnosed with Acute Pyelonephritis. Pharmaceutics 2023; 15:2427. [PMID: 37896187 PMCID: PMC10610490 DOI: 10.3390/pharmaceutics15102427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023] Open
Abstract
Inflammation can regulate hepatic drug metabolism enzymes and transporters. The impact of inflammation on renal drug transporters remains to be elucidated. We aimed to quantify the effect of inflammation (caused by acute pyelonephritis) on the in vivo activity of renal OAT1/3, using the probe drug furosemide. Pregnant women (second or third trimester) received a single oral dose of furosemide 40 mg during acute pyelonephritis (Phase 1; n = 7) and after its resolution (Phase 2; n = 7; by treatment with intravenous cefuroxime 750 mg TID for 3-7 days), separated by 10 to 14 days. The IL-6, IFN-γ, TNF-α, MCP-1, and C-reactive protein plasma concentrations were higher in Phase I vs. Phase II. The pregnant women had a lower geometric mean [CV%] furosemide CLsecretion (3.9 [43.4] vs. 6.7 [43.8] L/h) and formation clearance to the glucuronide (1.1 [85.9] vs. 2.3 [64.1] L/h) in Phase 1 vs. Phase 2. Inflammation reduced the in vivo activity of renal OAT1/3 (mediating furosemide CLsecretion) and UGT1A9/1A1 (mediating the formation of furosemide glucuronide) by approximately 40% and 54%, respectively, presumably by elevating the plasma cytokine concentrations. The dosing regimens of narrow therapeutic window OAT drug substrates may need to be adjusted during inflammatory conditions.
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Affiliation(s)
- Jhohann Richard de Lima Benzi
- Department of Clinical Analyses, Toxicology and Food Science, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-903, São Paulo, Brazil;
| | - Patrícia Pereira dos Santos Melli
- Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, São Paulo, Brazil; (P.P.d.S.M.)
| | - Geraldo Duarte
- Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, São Paulo, Brazil; (P.P.d.S.M.)
| | - Jashvant D. Unadkat
- Department of Pharmaceutics, University of Washington, Seattle, WA 98195, USA
| | - Vera Lucia Lanchote
- Department of Clinical Analyses, Toxicology and Food Science, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-903, São Paulo, Brazil;
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12
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Ding Y, Liu H, Wang F, Fu L, Zhu H, Fu S, Wang N, Zhuang X, Lu Y. Coadministration of bedaquiline and pyrifazimine reduce exposure to toxic metabolite N-desmethyl bedaquiline. Front Pharmacol 2023; 14:1154780. [PMID: 37860115 PMCID: PMC10582325 DOI: 10.3389/fphar.2023.1154780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023] Open
Abstract
Background: A new, effective anti-tuberculosis (TB) regimen containing bedaquiline (BDQ) and pyrifazimine (TBI-166) has been recommended for a phase IIb clinical trial. Preclinical drug-drug interaction (DDI) studies of the combination of BDQ and TBI-166 have been designed to support future clinical trials. In this study, we investigated whether a DDI between BDQ and TBI-166 affects the pharmacokinetics of BDQ. Methods: We performed in vitro quantification of the fractional contributions of the fraction of drug metabolism by individual CYP enzymes (f m) of BDQ and the inhibition potency of key metabolic pathways of TBI-166. Furthermore, we conducted an in vivo steady-state pharmacokinetics study in a murine TB model and healthy BALB/c mice. Results: The in vitro f m value indicated that the CYP3A4 pathway contributed more than 75% to BDQ metabolism to N-desmethyl-bedaquiline (M2), and TBI-166 was a moderate (IC50 2.65 µM) potential CYP3A4 inhibitor. Coadministration of BDQ and TBI-166 greatly reduced exposure to metabolite M2 (AUC0-t 76310 vs 115704 h ng/mL, 66% of BDQ alone), whereas the exposure to BDQ and TBI-166 did not changed. The same trend was observed both in healthy and TB model mice. The plasma concentration of M2 decreased significantly after coadministration of BDQ and TBI-166 and decreased further during treatment in the TB model. Conclusions: In conclusion, our results showed that the combination of BDQ and TBI-166 significantly reduced exposure to the toxic metabolite M2 by inhibiting the activity of the CYP3A4 pathway. The potential safety and efficacy benefits demonstrated by the TB treatment highly suggest that coadministration of BDQ and TBI-166 should be studied further.
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Affiliation(s)
- Yangming Ding
- Department of Pharmacology, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Haiting Liu
- Department of Pharmacology, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Furun Wang
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Lei Fu
- Department of Pharmacology, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Hui Zhu
- Department of Pharmacology, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Shuang Fu
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Ning Wang
- Department of Pharmacology, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Xiaomei Zhuang
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Yu Lu
- Department of Pharmacology, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
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13
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Fujino C, Kuzu T, Kubo Y, Hayashi K, Ueshima S, Katsura T. Attenuation of phenobarbital-induced cytochrome P450 expression in carbon tetrachloride-induced hepatitis in mice models. Biopharm Drug Dispos 2023; 44:351-357. [PMID: 37032489 DOI: 10.1002/bdd.2356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/13/2023] [Accepted: 03/23/2023] [Indexed: 04/11/2023]
Abstract
Certain pathological conditions, such as inflammation, are known to affect basal cytochrome P450 (CYP) expression by modulating transcriptional regulation, and the pharmacokinetics of drugs can vary among patients. However, changes in drug-induced CYP expression under pathological conditions have not been elucidated in detail. Here, we investigated the effects of hepatic inflammation and injury on phenobarbital-induced expression of CYP isoforms in mice. Phenobarbital was administered once as a CYP inducer in the carbon tetrachloride-induced hepatitis model mice. The mRNA expression levels of Cyp3a11 and Cyp2b10 in the liver and small intestine were measured using reverse transcription polymerase chain reaction. The enzymatic activity of CYP3A in liver S9 was evaluated using midazolam as the substrate. Phenobarbital increased the mRNA expression of Cyp3a11 and Cyp2b10 in the liver of healthy mice, but not in the small intestine. Increased mRNA expression of hepatic Cyp3a11 and Cyp2b10 by phenobarbital was significantly suppressed in the hepatitis model mice. Hepatitis also suppressed the increased CYP3A enzymatic activity induced by phenobarbital in liver S9, consistent with the results of Cyp3a11 mRNA expression. These results suggest that the inducibility of CYP by phenobarbital may vary in patients with hepatitis, indicating that pharmacokinetic drug-drug interactions can be altered under certain pathological conditions.
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Affiliation(s)
- Chieri Fujino
- College of Pharmaceutical Sciences, Ritsumeikan University, Kusatsu-shi, Shiga, Japan
| | - Taiki Kuzu
- College of Pharmaceutical Sciences, Ritsumeikan University, Kusatsu-shi, Shiga, Japan
| | - Yukine Kubo
- College of Pharmaceutical Sciences, Ritsumeikan University, Kusatsu-shi, Shiga, Japan
| | - Kurumi Hayashi
- College of Pharmaceutical Sciences, Ritsumeikan University, Kusatsu-shi, Shiga, Japan
| | - Satoshi Ueshima
- College of Pharmaceutical Sciences, Ritsumeikan University, Kusatsu-shi, Shiga, Japan
| | - Toshiya Katsura
- College of Pharmaceutical Sciences, Ritsumeikan University, Kusatsu-shi, Shiga, Japan
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14
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Patanwala AE, Jager NGL, Radosevich JJ, Brüggemann R. An update on drug-drug interactions for care of the acutely ill in the era of COVID-19. Am J Health Syst Pharm 2023; 80:1301-1308. [PMID: 37368815 PMCID: PMC10516707 DOI: 10.1093/ajhp/zxad152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Indexed: 06/29/2023] Open
Abstract
PURPOSE To provide key pharmacological concepts underlying drug-drug interactions (DDIs), a decision-making framework, and a list of DDIs that should be considered in the context of contemporary acutely ill patients with COVID-19. SUMMARY DDIs are frequently encountered in the acutely ill. The implications of DDIs include either increased risk of drug toxicity or decreased effectiveness, which may have severe consequences in the acutely ill due to lower physiological and neurocognitive reserves in these patients. In addition, an array of additional therapies and drug classes have been used for COVID-19 that were not typically used in the acute care setting. In this update on DDIs in the acutely ill, we provide key pharmacological concepts underlying DDIs, including a discussion of the gastric environment, the cytochrome P-450 (CYP) isozyme system, transporters, and pharmacodynamics in relation to DDIs. We also provide a decision-making framework that elucidates the identification of DDIs, risk assessment, selection of alternative therapies, and monitoring. Finally, important DDIs pertaining to contemporary acute care clinical practice related to COVID-19 are discussed. CONCLUSION Interpreting and managing DDIs should follow a pharmacologically based approach and a systematic decision-making process to optimize patient outcomes.
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Affiliation(s)
- Asad E Patanwala
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, New South Wales, and Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Nynke G L Jager
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, and Radboudumc Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - John J Radosevich
- Department of Pharmacy Services, Dignity Health–St. Joseph’s Hospital & Medical Center, Phoenix, AZ, USA
| | - Roger Brüggemann
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, and Radboudumc Institute for Health Sciences Center of Expertise in Mycology Radboudumc/CWZ, Radboud University Medical Center, Nijmegen, the Netherlands
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15
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Klöditz K, Tewolde E, Nordling Å, Ingelman-Sundberg M. Mechanistic, Functional, and Clinical Aspects of Pro-inflammatory Cytokine Mediated Regulation of ADME Gene Expression in 3D Human Liver Spheroids. Clin Pharmacol Ther 2023; 114:673-685. [PMID: 37307233 DOI: 10.1002/cpt.2969] [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: 12/22/2022] [Accepted: 06/05/2023] [Indexed: 06/14/2023]
Abstract
During systemic inflammation, pro-inflammatory cytokines alter metabolism and transport of drugs affecting the clinical outcome. We used an in vivo like human 3D liver spheroid model to study the effects and mechanisms of pro-inflammatory cytokines on the expression of 9 different genes encoding enzymes responsible for the metabolism of > 90% of clinically used drugs. Treatment of spheroids with pathophysiologically relevant concentrations of IL-1β, IL-6, or TNFα resulted in a pronounced decrease in mRNA expression of CYP3A4 and UGT2B10 within 5 hours. The reduction of CYP1A2, CYP2C9, CYP2C19, and CYP2D6 mRNA expression was less pronounced, whereas the pro-inflammatory cytokines caused increased CYP2E1, and UGT1A3 mRNA expression. The cytokines did not influence expression of key nuclear proteins, nor the activities of specific kinases involved in the regulation of genes encoding drug metabolizing enzymes. However, ruxolitinib, a JAK1/2 inhibitor, inhibited the IL-6 dependent increase in CYP2E1 and the decrease in CYP3A4 and UGT2B10 mRNA expression. We evaluated the effect of TNFα in hepatocytes in 2D plates and found a rapid decrease in drug-metabolizing enzyme mRNA both in the absence or presence of the cytokines. Taken together, these data suggest that pro-inflammatory cytokines regulate multiple gene- and cytokine-specific events seen in in vivo and in 3D but not in 2D liver models. We propose that the 3D spheroid system is suitable for the prediction of drug metabolism under conditions of inflammation and constitutes a versatile system for short- and long-term preclinical and mechanistic studies of cytokine-induced changes in drug metabolism.
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Affiliation(s)
- Katharina Klöditz
- Section of Pharmacogenetics, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Eida Tewolde
- Section of Pharmacogenetics, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Åsa Nordling
- Section of Pharmacogenetics, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Ingelman-Sundberg
- Section of Pharmacogenetics, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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16
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Schiffman SS, Scholl EH, Furey TS, Nagle HT. Toxicological and pharmacokinetic properties of sucralose-6-acetate and its parent sucralose: in vitro screening assays. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2023; 26:307-341. [PMID: 37246822 DOI: 10.1080/10937404.2023.2213903] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The purpose of this study was to determine the toxicological and pharmacokinetic properties of sucralose-6-acetate, a structural analog of the artificial sweetener sucralose. Sucralose-6-acetate is an intermediate and impurity in the manufacture of sucralose, and recent commercial sucralose samples were found to contain up to 0.67% sucralose-6-acetate. Studies in a rodent model found that sucralose-6-acetate is also present in fecal samples with levels up to 10% relative to sucralose which suggest that sucralose is also acetylated in the intestines. A MultiFlow® assay, a high-throughput genotoxicity screening tool, and a micronucleus (MN) test that detects cytogenetic damage both indicated that sucralose-6-acetate is genotoxic. The mechanism of action was classified as clastogenic (produces DNA strand breaks) using the MultiFlow® assay. The amount of sucralose-6-acetate in a single daily sucralose-sweetened drink might far exceed the threshold of toxicological concern for genotoxicity (TTCgenotox) of 0.15 µg/person/day. The RepliGut® System was employed to expose human intestinal epithelium to sucralose-6-acetate and sucralose, and an RNA-seq analysis was performed to determine gene expression induced by these exposures. Sucralose-6-acetate significantly increased the expression of genes associated with inflammation, oxidative stress, and cancer with greatest expression for the metallothionein 1 G gene (MT1G). Measurements of transepithelial electrical resistance (TEER) and permeability in human transverse colon epithelium indicated that sucralose-6-acetate and sucralose both impaired intestinal barrier integrity. Sucralose-6-acetate also inhibited two members of the cytochrome P450 family (CYP1A2 and CYP2C19). Overall, the toxicological and pharmacokinetic findings for sucralose-6-acetate raise significant health concerns regarding the safety and regulatory status of sucralose itself.
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Affiliation(s)
- Susan S Schiffman
- Joint Department of Biomedical Engineering, University of North Carolina/North Carolina State University, Raleigh, NC, USA
| | | | - Terrence S Furey
- Departments of Genetics and Biology, University of North Carolina, Chapel Hill, NC, USA
| | - H Troy Nagle
- Joint Department of Biomedical Engineering, University of North Carolina/North Carolina State University, Raleigh, NC, USA
- Department of Electrical and Computer Engineering, North Carolina State University, Raleigh, NC, USA
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17
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Muth KN, Rech J, Losch FO, Hoerning A. Reversing the Inflammatory Process-25 Years of Tumor Necrosis Factor-α Inhibitors. J Clin Med 2023; 12:5039. [PMID: 37568441 PMCID: PMC10419406 DOI: 10.3390/jcm12155039] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Immune-mediated inflammatory diseases, such as rheumatoid arthritis, psoriatic arthritis, peripheral and/or axial spondyloarthritis, Crohn's disease, and ulcerative colitis, are characterized by molecular and cellular changes in the immune system. Due to the systemic nature of these diseases, organs such as the liver or cardiovascular system are often affected by the inflammatory process. Tumor necrosis factor-α inhibitor therapy reduces the activation of pro-inflammatory signaling cascades, mitigates the chronic inflammatory process by restoring cellular balance, and alleviates clinical consequences, such as pain and tissue damage.
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Affiliation(s)
| | - Juergen Rech
- Department of Internal Medicine III, Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | | | - André Hoerning
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
- Clinic for Children and Adolescent Medicine, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
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18
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Kvitne KE, Drevland OM, Haugli N, Skadberg E, Zaré HK, Åsberg A, Robertsen I. Intraindividual Variability in Absolute Bioavailability and Clearance of Midazolam in Healthy Individuals. Clin Pharmacokinet 2023; 62:981-987. [PMID: 37162619 PMCID: PMC10338616 DOI: 10.1007/s40262-023-01257-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Midazolam is the preferred clinical probe drug for assessing CYP3A activity. We have previously shown substantial intraindividual variability in midazolam absolute bioavailability and clearance in patients with obesity before and after weight loss induced by gastric bypass or a strict diet. The objective was to describe intraindividual variability in absolute bioavailability and clearance of midazolam in healthy individuals without obesity. METHODS This study included 33 healthy volunteers [28 ± 8 years, 21% males, body mass index (BMI) 23 ± 2.5 kg/m2] subjected to four pharmacokinetic investigations over a 2-month period (weeks 0, 2, 4, and 8). Semi-simultaneous oral (0 h) and intravenous (2 h later) midazolam dosing was used to assess absolute bioavailability and clearance of midazolam. RESULTS At baseline, mean absolute bioavailability and clearance were 46 ± 18% and 31 ± 10 L/h, respectively. The mean coefficient of variation (CV, %) for absolute bioavailability and clearance of midazolam was 26 ± 15% and 20 ± 10%, respectively. Approximately one-third had a CV > 30% for absolute bioavailability, while 13% had a CV > 30% for clearance. CONCLUSIONS On average, intraindividual variability in absolute bioavailability and clearance of midazolam was low to moderate; however, especially absolute bioavailability showed considerable variability in a relatively large proportion of the individuals.
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Affiliation(s)
- Kine Eide Kvitne
- Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy, University of Oslo, Blindern, P.O. Box 1068, 0316, Oslo, Norway.
| | - Ole Martin Drevland
- Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy, University of Oslo, Blindern, P.O. Box 1068, 0316, Oslo, Norway
| | - Nora Haugli
- Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy, University of Oslo, Blindern, P.O. Box 1068, 0316, Oslo, Norway
| | - Eline Skadberg
- Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy, University of Oslo, Blindern, P.O. Box 1068, 0316, Oslo, Norway
| | | | - Anders Åsberg
- Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy, University of Oslo, Blindern, P.O. Box 1068, 0316, Oslo, Norway
- Department of Transplant Medicine, Oslo University Hospital, Oslo, Norway
| | - Ida Robertsen
- Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy, University of Oslo, Blindern, P.O. Box 1068, 0316, Oslo, Norway
- Department of Pharmacology, Oslo University Hospital, Oslo, Norway
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19
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Obradovic B, Roberts O, Owen A, Milosevic I, Milic N, Ranin J, Dragovic G. Expression of CYP2B6 Enzyme in Human Liver Tissue of HIV and HCV Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1207. [PMID: 37512019 PMCID: PMC10385124 DOI: 10.3390/medicina59071207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/15/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections present significant public health challenges worldwide. The management of these infections is complicated by the need for antiviral and antiretroviral therapies, which are influenced by drug metabolism mediated by metabolic enzymes and transporters. This study focuses on the gene expression of CYP2B6, CYP3A4, and ABCB1 transporters in patients with HIV, HCV, and HIV/HCV co-infection, aiming to assess their potential association with the choice of therapy, patohistological and clinical parameters of liver damage such as the stage of liver fibrosis, serum levels of ALT and AST, as well as the grade of liver inflammation and other available biochemical parameters. Materials and Methods: The study included 54 patients who underwent liver biopsy, divided into HIV-infected, HCV-infected, and co-infected groups. The mRNA levels of CYP2B6, CYP3A4, and ABCB1 was quantified and compared between the groups, along with the analysis of liver fibrosis and inflammation levels. Results: The results indicated a significant increase in CYP2B6 mRNA levels in co-infected patients, a significant association with the presence of HIV infection with an increase in CYP3A4 mRNA levels. A trend towards downregulation of ABCB1 expression was observed in patients using lamivudine. Conclusions: This study provides insight into gene expression of CYP2B6 CYP3A4, and ABCB1 in HIV, HCV, and HIV/HCV co-infected patients. The absence of correlation with liver damage, inflammation, and specific treatment interventions emphasises the need for additional research to elucidate the complex interplay between gene expression, viral co-infection, liver pathology, and therapeutic responses in these particular patients population.
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Affiliation(s)
- Bozana Obradovic
- University of Belgrade, Faculty of Medicine, Department of Pharmacology, Clinical Pharmacology and Toxicology, 11000 Belgrade, Serbia
| | - Owain Roberts
- University of Buckingham Medical School, Faculty of Medicine and Health Sciences, University of Buckingham, Buckingham MK18 1EG, UK
| | - Andrew Owen
- Centre of Excellence in Long-Acting Therapeutics (CELT), Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L69 3BX, UK
| | - Ivana Milosevic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic of Infectious and Tropical Diseases, Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Natasa Milic
- University of Belgrade, Faculty of Medicine, Department of Medical Statistics & Informatics, 11000 Belgrade, Serbia
| | - Jovan Ranin
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic of Infectious and Tropical Diseases, Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Gordana Dragovic
- University of Belgrade, Faculty of Medicine, Department of Pharmacology, Clinical Pharmacology and Toxicology, 11000 Belgrade, Serbia
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20
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Sim J, Ahn JW, Park J, Kim YJ, Jeong JY, Lee JM, Cho K, Ahn HJ, Sung KS, Moon JS, Moon JH, Lim J. Non-canonical NLRC4 inflammasomes in astrocytes contribute to glioma malignancy. Inflamm Res 2023; 72:813-827. [PMID: 36899084 DOI: 10.1007/s00011-023-01710-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/09/2023] [Accepted: 02/15/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND The present study was designed to explore the pathological role of non-canonical NLRC4 inflammasome in glioma. METHODS This retrospective study included bioinformatical analysis, including survival, gene ontology, ssGSEA, cox regression, IPA and drug repositioning with TCGA and DepMap database. Experimental validations were conducted in glioma patient's sample and evaluated with histological or cellular functional analysis. RESULT Clinical dataset analysis revealed that non-canonical NLRC4 inflammasomes significantly contribute to glioma progression and poor survival rates. Experimental validation was revealed that the expression of non-canonical NLRC4 inflammasomes were co-localized with astrocytes in malignant gliomas, with a sustained clinical correlation observed between astrocytes and inflammasome signatures. Indeed, the formation of an inflammatory microenvironment increased in malignant gliomas, leading to pyroptosis, known as inflammatory cell death. Molecular interaction analysis revealed that NF-κB pathways potentially serve as the connecting point between the canonical and noncanonical pathways of the NLRC4 inflammasome. Finally, drug repositioning analysis of non-canonical NLRC4 inflammasome-associated molecules revealed that MK-5108, PF4981517, and CTEP may represent effective options for glioma therapy. CONCLUSION The findings of this study suggest that non-canonical NLRC4 inflammasomes contribute to poor prognosis in patients with glioma and induce an inflammatory microenvironment. We propose the pathological phenomenon of non-canonical NLRC4 inflammasomes and several therapeutic strategies based on the modulation of the inflammatory tumor microenvironment.
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Affiliation(s)
- JeongMin Sim
- Department of Neurosurgery, Bundang CHA Medical Center, CHA University College of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam, 13496, Republic of Korea.,Department of Biomedical Science, College of Life Science, CHA University, Seongnam, Republic of Korea
| | - Ju Won Ahn
- Department of Neurosurgery, Bundang CHA Medical Center, CHA University College of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam, 13496, Republic of Korea.,Department of Biomedical Science, College of Life Science, CHA University, Seongnam, Republic of Korea
| | - JeongMan Park
- Department of Neurosurgery, Bundang CHA Medical Center, CHA University College of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam, 13496, Republic of Korea.,Department of Biomedical Science, College of Life Science, CHA University, Seongnam, Republic of Korea
| | - Yu Jin Kim
- Department of Neurosurgery, Bundang CHA Medical Center, CHA University College of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam, 13496, Republic of Korea.,Department of Biomedical Science, College of Life Science, CHA University, Seongnam, Republic of Korea
| | - Ju-Yeon Jeong
- CHA Future Medicine Research Institute, CHA Bundang Medical Center, Seongnam, Korea
| | - Ji Min Lee
- CHA Future Medicine Research Institute, CHA Bundang Medical Center, Seongnam, Korea
| | - Kyunggi Cho
- Department of Neurosurgery, Bundang CHA Medical Center, CHA University College of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam, 13496, Republic of Korea
| | - Hee Jung Ahn
- CHA Future Medicine Research Institute, CHA Bundang Medical Center, Seongnam, Korea.,Department of Pathology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Korea
| | - Kyoung Su Sung
- Department of Neurosurgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Jong-Seok Moon
- Soonchunhyang Institution of Medi-Bio Science (SIMS), Soonchunhyang University, Cheonan, Korea
| | - Ju Hyung Moon
- Department of Neurosurgery, Brain Tumor Center, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03772, Republic of Korea.
| | - Jaejoon Lim
- Department of Neurosurgery, Bundang CHA Medical Center, CHA University College of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam, 13496, Republic of Korea. .,Department of Biomedical Science, College of Life Science, CHA University, Seongnam, Republic of Korea.
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21
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Neyshaburinezhad N, Shirzad N, Rouini M, Namazi S, Khoshayand M, Esteghamati A, Nakhjavani M, Ghasim H, Gloor Y, Daali Y, Ardakani YH. Evaluation of important human CYP450 isoforms and P-glycoprotein phenotype changes and genotype in type 2 diabetic patients, before and after intensifying treatment regimen using Geneva cocktail. Basic Clin Pharmacol Toxicol 2023; 132:487-499. [PMID: 36734157 DOI: 10.1111/bcpt.13840] [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: 12/05/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023]
Abstract
The present study evaluates the influence of type 2 diabetes (T2D) on important CYP450 (CYP) isoforms and P-glycoprotein (Pgp) transporter activities before and 3 months after an intensifying treatment regimen involving 40 patients. Results have been compared with 21 non-T2D healthy participants (the control group). CYPs and Pgp activities were assessed after administering the Geneva cocktail. The mean metabolic ratios (MR) for CYP2B6 (1.81 ± 0.93 versus 2.68 ± 0.87), CYP2C19 (0.420 ± 0.360 versus 0.687 ± 0.558) and CYP3A4/5 (0.487 ± 0.226 versus 0.633 ± 0.254) significantly decreased in T2D patients compared to the control group (p < 0.05). CYP2C9 (0.089 ± 0.037 versus 0.069 ± 0.017) activities slightly increased in diabetic patients, and no difference was observed regarding CYP1A2 (0.154 ± 0.085 versus 0.136 ± 0.065), CYP2D6 (1.17 ± 0.56 versus 1.24 ± 0.83), and Pgp activities in comparison to the control group. Three months after the intensifying treatment regimen, MRs of CYP2C9 (0.080 ± 0.030) and CYP3A4/5 (0.592 ± 0.268) improved significantly and were not statistically different compared to the control group (P > 0.05). Several covariables, such as inflammatory markers (IL-1β and IL-6), genotypes, diabetes and demographic-related factors, were considered in the analyses. The results indicate that chronic inflammatory status associated with T2D modulates CYP450 activities in an isoform-specific manner.
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Affiliation(s)
- Navid Neyshaburinezhad
- Biopharmaceutics and Pharmacokinetic Division, Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Nooshin Shirzad
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Rouini
- Biopharmaceutics and Pharmacokinetic Division, Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Soha Namazi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Khoshayand
- Department of Drug and Food Control, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Manouchehr Nakhjavani
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hengameh Ghasim
- Biopharmaceutics and Pharmacokinetic Division, Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Yvonne Gloor
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Youssef Daali
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Yalda H Ardakani
- Biopharmaceutics and Pharmacokinetic Division, Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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22
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Ceban F, Subramaniapillai M, Rosenblat JD, Mansur RB, McIntyre RS. Can COVID-19 have a clinically significant effect on drug metabolism? Expert Opin Drug Saf 2023; 22:1-3. [PMID: 36691834 DOI: 10.1080/14740338.2023.2172158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Felicia Ceban
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.,Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.,Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | | | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.,Brain and Cognition Discovery Foundation, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
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23
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McColl ER, Croyle MA, Zamboni WC, Honer WG, Heise M, Piquette-Miller M, Goralski KB. COVID-19 Vaccines and the Virus: Impact on Drug Metabolism and Pharmacokinetics. Drug Metab Dispos 2023; 51:130-141. [PMID: 36273826 PMCID: PMC11022893 DOI: 10.1124/dmd.122.000934] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/07/2022] [Accepted: 09/30/2022] [Indexed: 01/08/2023] Open
Abstract
This article reports on an American Society of Pharmacology and Therapeutics, Division of Drug Metabolism and Disposition symposium held at Experimental Biology on April 2, 2022, in Philadelphia. As of July 2022, over 500 million people have been infected with SARS-CoV-2 (the virus causing COVID-19) and over 12 billion vaccine doses have been administered. Clinically significant interactions between viral infections and hepatic drug metabolism were first recognized over 40 years ago during a cluster of pediatric theophylline toxicity cases attributed to reduced hepatic drug metabolism amid an influenza B outbreak. Today, a substantive body of research supports that the activated innate immune response generally decreases hepatic cytochrome P450 activity. The interactions extend to drug transporters and other organs and have the potential to impact drug absorption, distribution, metabolism, and excretion (ADME). Based on this knowledge, altered ADME is predicted with SARS-CoV-2 infection or vaccination. The report begins with a clinical case exploring the possibility of SARS-CoV-2 vaccination increasing clozapine levels. This is followed by discussions of how SARS-CoV-2 infection or vaccines alter the metabolism and disposition of complex drugs, such as nanoparticles and biologics and small molecule therapies. The review concludes with a discussion of the effects of viral infections on placental amino acid transport and their potential to impact fetal development. The session improved our understanding of the impact of emerging viral infections and vaccine technologies on drug metabolism and disposition, which will help mitigate drug toxicity and improve drug and vaccine safety and effectiveness. SIGNIFICANCE STATEMENT: Altered pharmacokinetics of small molecule and complex molecule drugs and fetal brain distribution of amino acids following SARS-CoV-2 infection or immunization are possible. The proposed mechanisms involve decreased liver cytochrome P450 metabolism of small molecules, enhanced innate immune system metabolism of complex molecules, and altered placental and fetal blood-brain barrier amino acid transport, respectively. Future research is needed to understand the effects of these interactions on adverse drug responses, drug and vaccine safety, and effectiveness and fetal neurodevelopment.
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Affiliation(s)
- Eliza R McColl
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada (E.R.M., M.P-M.); Department of Molecular Pharmaceutics and Drug Delivery and LaMontagne Center for Infectious Disease, University of Texas at Austin, College of Pharmacy, Austin, Texas (M.A.C.); Eshelman School of Pharmacy (W.C.Z.) and Department of Genetics, Department of Microbiology and Immunology, and The Rapidly Emerging Antiviral Drug Development Initiative (READDI) (M.H.), University of North Carolina, Chapel Hill, North Carolina; Department of Psychiatry, University of British Columbia and British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada (W.G.H.); and College of Pharmacy, Faculty of Health and Department of Pharmacology and Department of Pediatrics, Faculty of Medicine, Dalhousie University (K.B.G.); Division of Pediatric Hematology and Oncology, Department of Pediatrics, IWK Health Centre (K.B.G.); and Beatrice Hunter Cancer Research Institute (K.B.G.), Halifax, Nova Scotia, Canada
| | - Maria A Croyle
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada (E.R.M., M.P-M.); Department of Molecular Pharmaceutics and Drug Delivery and LaMontagne Center for Infectious Disease, University of Texas at Austin, College of Pharmacy, Austin, Texas (M.A.C.); Eshelman School of Pharmacy (W.C.Z.) and Department of Genetics, Department of Microbiology and Immunology, and The Rapidly Emerging Antiviral Drug Development Initiative (READDI) (M.H.), University of North Carolina, Chapel Hill, North Carolina; Department of Psychiatry, University of British Columbia and British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada (W.G.H.); and College of Pharmacy, Faculty of Health and Department of Pharmacology and Department of Pediatrics, Faculty of Medicine, Dalhousie University (K.B.G.); Division of Pediatric Hematology and Oncology, Department of Pediatrics, IWK Health Centre (K.B.G.); and Beatrice Hunter Cancer Research Institute (K.B.G.), Halifax, Nova Scotia, Canada
| | - William C Zamboni
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada (E.R.M., M.P-M.); Department of Molecular Pharmaceutics and Drug Delivery and LaMontagne Center for Infectious Disease, University of Texas at Austin, College of Pharmacy, Austin, Texas (M.A.C.); Eshelman School of Pharmacy (W.C.Z.) and Department of Genetics, Department of Microbiology and Immunology, and The Rapidly Emerging Antiviral Drug Development Initiative (READDI) (M.H.), University of North Carolina, Chapel Hill, North Carolina; Department of Psychiatry, University of British Columbia and British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada (W.G.H.); and College of Pharmacy, Faculty of Health and Department of Pharmacology and Department of Pediatrics, Faculty of Medicine, Dalhousie University (K.B.G.); Division of Pediatric Hematology and Oncology, Department of Pediatrics, IWK Health Centre (K.B.G.); and Beatrice Hunter Cancer Research Institute (K.B.G.), Halifax, Nova Scotia, Canada
| | - William G Honer
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada (E.R.M., M.P-M.); Department of Molecular Pharmaceutics and Drug Delivery and LaMontagne Center for Infectious Disease, University of Texas at Austin, College of Pharmacy, Austin, Texas (M.A.C.); Eshelman School of Pharmacy (W.C.Z.) and Department of Genetics, Department of Microbiology and Immunology, and The Rapidly Emerging Antiviral Drug Development Initiative (READDI) (M.H.), University of North Carolina, Chapel Hill, North Carolina; Department of Psychiatry, University of British Columbia and British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada (W.G.H.); and College of Pharmacy, Faculty of Health and Department of Pharmacology and Department of Pediatrics, Faculty of Medicine, Dalhousie University (K.B.G.); Division of Pediatric Hematology and Oncology, Department of Pediatrics, IWK Health Centre (K.B.G.); and Beatrice Hunter Cancer Research Institute (K.B.G.), Halifax, Nova Scotia, Canada
| | - Mark Heise
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada (E.R.M., M.P-M.); Department of Molecular Pharmaceutics and Drug Delivery and LaMontagne Center for Infectious Disease, University of Texas at Austin, College of Pharmacy, Austin, Texas (M.A.C.); Eshelman School of Pharmacy (W.C.Z.) and Department of Genetics, Department of Microbiology and Immunology, and The Rapidly Emerging Antiviral Drug Development Initiative (READDI) (M.H.), University of North Carolina, Chapel Hill, North Carolina; Department of Psychiatry, University of British Columbia and British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada (W.G.H.); and College of Pharmacy, Faculty of Health and Department of Pharmacology and Department of Pediatrics, Faculty of Medicine, Dalhousie University (K.B.G.); Division of Pediatric Hematology and Oncology, Department of Pediatrics, IWK Health Centre (K.B.G.); and Beatrice Hunter Cancer Research Institute (K.B.G.), Halifax, Nova Scotia, Canada
| | - Micheline Piquette-Miller
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada (E.R.M., M.P-M.); Department of Molecular Pharmaceutics and Drug Delivery and LaMontagne Center for Infectious Disease, University of Texas at Austin, College of Pharmacy, Austin, Texas (M.A.C.); Eshelman School of Pharmacy (W.C.Z.) and Department of Genetics, Department of Microbiology and Immunology, and The Rapidly Emerging Antiviral Drug Development Initiative (READDI) (M.H.), University of North Carolina, Chapel Hill, North Carolina; Department of Psychiatry, University of British Columbia and British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada (W.G.H.); and College of Pharmacy, Faculty of Health and Department of Pharmacology and Department of Pediatrics, Faculty of Medicine, Dalhousie University (K.B.G.); Division of Pediatric Hematology and Oncology, Department of Pediatrics, IWK Health Centre (K.B.G.); and Beatrice Hunter Cancer Research Institute (K.B.G.), Halifax, Nova Scotia, Canada
| | - Kerry B Goralski
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada (E.R.M., M.P-M.); Department of Molecular Pharmaceutics and Drug Delivery and LaMontagne Center for Infectious Disease, University of Texas at Austin, College of Pharmacy, Austin, Texas (M.A.C.); Eshelman School of Pharmacy (W.C.Z.) and Department of Genetics, Department of Microbiology and Immunology, and The Rapidly Emerging Antiviral Drug Development Initiative (READDI) (M.H.), University of North Carolina, Chapel Hill, North Carolina; Department of Psychiatry, University of British Columbia and British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada (W.G.H.); and College of Pharmacy, Faculty of Health and Department of Pharmacology and Department of Pediatrics, Faculty of Medicine, Dalhousie University (K.B.G.); Division of Pediatric Hematology and Oncology, Department of Pediatrics, IWK Health Centre (K.B.G.); and Beatrice Hunter Cancer Research Institute (K.B.G.), Halifax, Nova Scotia, Canada
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24
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Cytochromes P450 and P-Glycoprotein Phenotypic Assessment to Optimize Psychotropic Pharmacotherapy: A Retrospective Analysis of Four Years of Practice in Psychiatry. J Pers Med 2022; 12:jpm12111869. [PMID: 36579580 PMCID: PMC9693601 DOI: 10.3390/jpm12111869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/24/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Abstract
Altered cytochromes P450 enzymes (CYP) and P-glycoprotein transporter (P-gp) activity may explain variabilities in drug response. In this study, we analyzed four years of phenotypic assessments of CYP/P-gp activities to optimize pharmacotherapy in psychiatry. A low-dose probe cocktail was administered to evaluate CYP1A2, 2B6, 2D6, 2C9, 2C19, 3A4, and P-gp activities using the probe/metabolite concentration ratio in blood or the AUC. A therapeutic adjustment was suggested depending on the phenotyping results. From January 2017 to June 2021, we performed 32 phenotypings, 10 for adverse drug reaction, 6 for non-response, and 16 for both reasons. Depending on the CYP/P-gp evaluated, only 23% to 56% of patients had normal activity. Activity was decreased in up to 57% and increased in up to 60% of cases, depending on the CYP/P-gp evaluated. In 11/32 cases (34%), the therapeutic problem was attributable to the patient's metabolic profile. In 10/32 cases (31%), phenotyping excluded the metabolic profile as the cause of the therapeutic problem. For all ten individuals for which we had follow-up information, phenotyping allowed us to clearly state or clearly exclude the metabolic profile as a possible cause of therapeutic failure. Among them, seven showed a clinical improvement after dosage adaptation, or drug or pharmacological class switching. Our study confirmed the interest of CYP and P-gp phenotyping for therapeutic optimization in psychiatry.
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25
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Taugbøl A, Solbakken MH, Jakobsen KS, Vøllestad LA. Salinity-induced transcriptome profiles in marine and freshwater threespine stickleback after an abrupt 6-hour exposure. Ecol Evol 2022; 12:e9395. [PMID: 36311407 PMCID: PMC9596333 DOI: 10.1002/ece3.9395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 09/20/2022] [Indexed: 11/09/2022] Open
Abstract
Saltwater and freshwater environments have opposing physiological challenges, yet, there are fish species that are able to enter both habitats during short time spans, and as individuals they must therefore adjust quickly to osmoregulatory contrasts. In this study, we conducted an experiment to test for plastic responses to abrupt salinity changes in two populations of threespine stickleback, Gasterosteus aculeatus, representing two ecotypes (freshwater and ancestral saltwater). We exposed both ecotypes to abrupt native (control treatment) and non‐native salinities (0‰ and 30‰) and sampled gill tissue for transcriptomic analyses after 6 h of exposure. To investigate genomic responses to salinity, we analyzed four different comparisons; one for each ecotype (in their control and exposure salinity; (1) and (2), one between ecotypes in their control salinity (3), and the fourth comparison included all transcripts identified in (3) that did not show any expressional changes within ecotype in either the control or the exposed salinity (4)). Abrupt salinity transfer affected the expression of 10 and 1530 transcripts for the saltwater and freshwater ecotype, respectively, and 1314 were differentially expressed between the controls, including 502 that were not affected by salinity within ecotype (fixed expression). In total, these results indicate that factors other than genomic expressional plasticity are important for osmoregulation in stickleback, due to the need for opposite physiological pathways to survive the abrupt change in salinity.
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Affiliation(s)
- Annette Taugbøl
- Department of Biosciences, Centre for Ecological and Evolutionary Synthesis (CEES)University of OsloBlindernNorway,Norwegian Institute for Nature Research (NINA)LillehammerNorway
| | - Monica Hongrø Solbakken
- Department of Biosciences, Centre for Ecological and Evolutionary Synthesis (CEES)University of OsloBlindernNorway
| | - Kjetill S. Jakobsen
- Department of Biosciences, Centre for Ecological and Evolutionary Synthesis (CEES)University of OsloBlindernNorway
| | - Leif Asbjørn Vøllestad
- Department of Biosciences, Centre for Ecological and Evolutionary Synthesis (CEES)University of OsloBlindernNorway
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26
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Stuehr DJ, Dai Y, Biswas P, Sweeny EA, Ghosh A. New roles for GAPDH, Hsp90, and NO in regulating heme allocation and hemeprotein function in mammals. Biol Chem 2022; 403:1005-1015. [PMID: 36152339 PMCID: PMC10184026 DOI: 10.1515/hsz-2022-0197] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/17/2022] [Indexed: 12/23/2022]
Abstract
The intracellular trafficking of mitochondrial heme presents a fundamental challenge to animal cells. This article provides some background on heme allocation, discusses some of the concepts, and then reviews research done over the last decade, much in the author's laboratory, that is uncovering unexpected and important roles for glyceraldehyde 3-phosphate dehydrogenase (GAPDH), heat shock protein 90 (hsp90), and nitric oxide (NO) in enabling and regulating the allocation of mitochondrial heme to hemeproteins that mature and function outside of the mitochondria. A model for how hemeprotein functions can be regulated in cells through the coordinate participation of GAPDH, hsp90, and NO in allocating cellular heme is presented.
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Affiliation(s)
- Dennis J Stuehr
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Yue Dai
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Pranjal Biswas
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Elizabeth A Sweeny
- Department of Biochemistry, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Arnab Ghosh
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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27
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Grimsrud KN, Davis RR, Tepper CG, Palmieri TL. Pharmacogenetic Gene-Drug Associations in Pediatric Burn and Surgery Patients. J Burn Care Res 2022; 43:987-996. [PMID: 35639664 PMCID: PMC9435482 DOI: 10.1093/jbcr/irac062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Management of critically ill patients requires simultaneous administration of many medications. Treatment for patient comorbidities may lead to drug-drug interactions which decrease drug efficacy or increase adverse reactions. Current practices rely on a one-size-fits-all dosing approach. Pharmacogenetic testing is generally reserved for addressing problems rather than used proactively to optimize care. We hypothesized that burn and surgery patients will have one or more genetic variants in drug metabolizing pathways used by one or more medications administered during the patient's hospitalization. The aim of this study was to determine the frequency of variants with abnormal function in the primary drug pathways and identify which medications may be impacted. Genetic (19 whole exome and 11 whole genome) and medication data from 30 pediatric burn and surgery patients were analyzed to identify pharmacogene-drug associations. Nineteen patients were identified with predicted altered function in one or more of the following genes: CYP2C9, CYP2C19, CYP2D6, and CYP3A4. The majority had decreased function, except for several patients with CYP2C19 rapid or ultrarapid variants. Some drugs administered during hospitalization that rely on these pathways include hydrocodone, oxycodone, methadone, ibuprofen, ketorolac, celecoxib, diazepam, famotidine, diphenhydramine, and glycopyrrolate. Approximately one-third of the patients tested had functionally impactful genotypes in each of the primary drug metabolizing pathways. This study suggests that genetic variants may in part explain the vast variability in drug efficacy and suggests that future pharmacogenetics research may optimize dosing regimens.
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Affiliation(s)
- Kristin N Grimsrud
- Department of Pathology and Laboratory Medicine, School of Medicine, University of California, Davis, USA
| | - Ryan R Davis
- Department of Pathology and Laboratory Medicine, School of Medicine, University of California, Davis, USA
| | - Clifford G Tepper
- Department of Biochemistry and Molecular Medicine, School of Medicine, University of California, Davis, USA
| | - Tina L Palmieri
- Department of Surgery, School of Medicine, University of California, Davis, USA
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28
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Romaldini A, Spanò R, Catalano F, Villa F, Poggi A, Sabella S. Sub-Lethal Concentrations of Graphene Oxide Trigger Acute-Phase Response and Impairment of Phase-I Xenobiotic Metabolism in Upcyte® Hepatocytes. Front Bioeng Biotechnol 2022; 10:867728. [PMID: 35662849 PMCID: PMC9161028 DOI: 10.3389/fbioe.2022.867728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/27/2022] [Indexed: 11/21/2022] Open
Abstract
The impact of graphene oxide on hepatic functional cells represents a crucial evaluation step for its potential application in nanomedicine. Primary human hepatocytes are the gold standard for studying drug toxicity and metabolism; however, current technical limitations may slow down the large-scale diffusion of this cellular tool for in vitro investigations. To assess the potential hepatotoxicity of graphene oxide, we propose an alternative cell model, the second-generation upcyte® hepatocytes, which show metabolic and functional profiles akin to primary human hepatocytes. Cells were acutely exposed to sub-lethal concentrations of graphene oxide (≤80 μg/ml) for 24 h and stress-related cell responses (such as apoptosis, oxidative stress, and inflammatory response) were evaluated, along with a broad investigation of graphene oxide impact on specialized hepatic functions. Results show a mild activation of early apoptosis but not oxidative stress or inflammatory response in our cell model. Notably, while graphene oxide clearly impacted phase-I drug-metabolism enzymes (e.g., CYP3A4, CYP2C9) through the inhibition of gene expression and metabolic activity, conversely, no effect was observed for phase-II enzyme GST and phase-III efflux transporter ABCG2. The GO-induced impairment of CYP3A4 occurs concomitantly with the activation of an early acute-phase response, characterized by altered levels of gene expression and protein production of relevant acute-phase proteins (i.e., CRP, Albumin, TFR, TTR). These data suggest that graphene oxide induces an acute phase response, which is in line with recent in vivo findings. In conclusion, upcyte® hepatocytes appear a reliable in vitro model for assessing nanomaterial-induced hepatotoxicity, specifically showing that sub-lethal doses of graphene oxide have a negative impact on the specialized hepatic functions of these cells. The impairment of the cytochrome P450 system, along with the activation of an acute-phase response, may suggest potential detrimental consequences for human health, as altered detoxification from xenobiotics and drugs.
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Affiliation(s)
- A. Romaldini
- D3 PharmaChemistry, Istituto Italiano di Tecnologia, Genoa, Italy
| | - R. Spanò
- D3 PharmaChemistry, Istituto Italiano di Tecnologia, Genoa, Italy
| | - F. Catalano
- Electron Microscopy Facility, Istituto Italiano di Tecnologia, Genoa, Italy
| | - F. Villa
- Unit of Molecular Oncology and Angiogenesis, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - A. Poggi
- Unit of Molecular Oncology and Angiogenesis, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - S. Sabella
- D3 PharmaChemistry, Istituto Italiano di Tecnologia, Genoa, Italy
- *Correspondence: S. Sabella,
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29
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Klomp SD, Meziyerh S, Vissers MFJM, Moes DJAR, Arends EJ, Teng YKO, Swen JJ, de Vries APJ. Increased Tacrolimus Exposure in Kidney Transplant Recipients With COVID-19: Inflammation-Driven Downregulation of Metabolism as a Potential Mechanism. Transpl Int 2022; 35:10269. [PMID: 35651879 PMCID: PMC9148963 DOI: 10.3389/ti.2022.10269] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/21/2022] [Indexed: 11/13/2022]
Abstract
Kidney transplant recipients (KTRs) are at increased risk of severe COVID-19 disease compared to the general population. This is partly driven by their use of immunosuppressive therapy, which influences inflammatory responses and viral loads. Current guidelines suggest to withdraw mycophenolate while calcineurin inhibitors are often continued during a COVID-19 infection. However, clinical signs of calcineurin toxicity have been described in multiple COVID-19 positive KTRs. In this report we describe the course of tacrolimus exposure prior to, during, and post COVID-19 in observations from three clinical cases as well as four KTRs from a controlled trial population. We postulate inflammation driven downregulation of the CYP3A metabolism as a potential mechanism for higher tacrolimus exposure. To mitigate the risk of tacrolimus overexposure and toxicity therapeutic drug monitoring is recommended in KTRs with COVID-19 both in the in-, out-patient and home monitoring setting.
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Affiliation(s)
- Sylvia D Klomp
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands
- Leiden Network for Personalised Therapeutics, Leiden University Medical Center, Leiden, Netherlands
| | - Soufian Meziyerh
- Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, Netherlands
- Leiden Transplant Center, Leiden University Medical Center, Leiden, Netherlands
| | - Maurits F J M Vissers
- Centre for Human Drug Research, Leiden, Netherlands
- Leiden University Medical Center, Leiden, Netherlands
| | - Dirk J A R Moes
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands
| | - Eline J Arends
- Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, Netherlands
- Leiden Transplant Center, Leiden University Medical Center, Leiden, Netherlands
| | - Y K Onno Teng
- Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, Netherlands
- Leiden Transplant Center, Leiden University Medical Center, Leiden, Netherlands
| | - Jesse J Swen
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands
- Leiden Network for Personalised Therapeutics, Leiden University Medical Center, Leiden, Netherlands
| | - Aiko P J de Vries
- Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, Netherlands
- Leiden Transplant Center, Leiden University Medical Center, Leiden, Netherlands
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30
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de Jong LM, Klomp SD, Treijtel N, Rissmann R, Swen JJ, Manson ML. A Systematic Review on Disease-Drug-Drug Interactions with immunomodulating drugs: A Critical Appraisal of Risk Assessment and Drug Labelling. Br J Clin Pharmacol 2022; 88:4387-4402. [PMID: 35484780 PMCID: PMC9545038 DOI: 10.1111/bcp.15372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 11/30/2022] Open
Abstract
Aim Use of immunomodulating therapeutics for immune‐mediated inflammatory diseases may cause disease‐drug‐drug interactions (DDDIs) by reversing inflammation‐driven alterations in the metabolic capacity of cytochrome P450 enzymes. European Medicine Agency (EMA) and US Food and Drug Administration (FDA) guidelines from 2007 recommend that the DDDI potential of therapeutic proteins should be assessed. This systematic analysis aimed to characterize the available DDDI trials with immunomodulatory drugs, experimental evidence for a DDDI risk and reported DDDI risk information in FDA/EMA approved drug labelling. Method For this systematic review, the EMA list of European Public Assessment Reports of human medicine was used to select immunomodulating monoclonal antibodies (mAbs) and tyrosine kinase inhibitors (TKIs) marketed after 2007 at risk for a DDDI. Selected drugs were included in PubMed and Embase searches to extract reported interaction studies. The Summary of Product Characteristics (SPCs) and the United States Prescribing Information (USPIs) were subsequently used for analysis of DDDI risk descriptions. Results Clinical interaction studies to evaluate DDDI risks were performed for 12 of the 24 mAbs (50%) and for none of the TKIs. Four studies identified a DDDI risk, of which three were studies with interleukin‐6 (IL‐6) neutralizing mAbs. Based on (non)clinical data, a DDDI risk was reported in 32% of the SPCs and in 60% of the USPIs. The EMA/FDA documentation aligned with the DDDI risk potential in 35% of the 20 cases. Conclusion This systematic review reinforces that the risk for DDDI by immunomodulating drugs is target‐ and disease‐specific. Drug labelling information designates the greatest DDDI risk to mAbs that neutralize the effects of IL‐6, Tumor Necrosis Factor alfa (TNF‐α) and interleukin‐1 bèta (IL‐1β) in diseases with systemic inflammation.
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Affiliation(s)
- Laura M de Jong
- Division of System Pharmacology and Pharmacy, Leiden Academic Centre for Drug Research (LACDR), Leiden University, the Netherlands.,Division of BioTherapeutics, Leiden Academic Centre for Drug Research (LACDR), Leiden University, The Netherlands
| | - Sylvia D Klomp
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nicoline Treijtel
- Centre for Human Drug Research, Leiden, the Netherlands.,Interact-Clinical Pharmacology, Dordrecht, The Netherlands
| | - Robert Rissmann
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research (LACDR), Leiden University, The Netherlands.,Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands.,Centre for Human Drug Research, Leiden, the Netherlands
| | - Jesse J Swen
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martijn L Manson
- Division of System Pharmacology and Pharmacy, Leiden Academic Centre for Drug Research (LACDR), Leiden University, the Netherlands.,Division of BioTherapeutics, Leiden Academic Centre for Drug Research (LACDR), Leiden University, The Netherlands
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31
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Lenoir C, Terrier J, Gloor Y, Gosselin P, Daali Y, Combescure C, Desmeules JA, Samer CF, Reny JL, Rollason V. Impact of the Genotype and Phenotype of CYP3A and P-gp on the Apixaban and Rivaroxaban Exposure in a Real-World Setting. J Pers Med 2022; 12:jpm12040526. [PMID: 35455642 PMCID: PMC9028714 DOI: 10.3390/jpm12040526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 02/04/2023] Open
Abstract
Apixaban and rivaroxaban are the two most prescribed direct factor Xa inhibitors. With the increased use of DOACs in real-world settings, safety and efficacy concerns have emerged, particularly regarding their concomitant use with other drugs. Increasing evidence highlights drug−drug interactions with CYP3A/P-gp modulators leading to adverse events. However, current recommendations for dose adjustment do not consider CYP3A/P-gp genotype and phenotype. We aimed to determine their impact on apixaban and rivaroxaban blood exposure. Three-hundred hospitalized patients were included. CYP3A and P-gp phenotypic activities were assessed by the metabolic ratio of midazolam and AUC0−6h of fexofenadine, respectively. Relevant CYP3A and ABCB1 genetic polymorphisms were also tested. Capillary blood samples collected at four time-points after apixaban or rivaroxaban administration allowed the calculation of pharmacokinetic parameters. According to the developed multivariable linear regression models, P-gp activity (p < 0.001) and creatinine clearance (CrCl) (p = 0.01) significantly affected apixaban AUC0−6h. P-gp activity (p < 0.001) also significantly impacted rivaroxaban AUC0−6h. The phenotypic switch (from normal to poor metabolizer) of P-gp led to an increase of apixaban and rivaroxaban AUC0−6h by 16% and 25%, respectively, equivalent to a decrease of 38 mL/min in CrCl according to the apixaban model. CYP3A phenotype and tested SNPs of CYP3A/P-gp had no significant impact. In conclusion, P-gp phenotypic activity, rather than known CYP3A/P-gp polymorphisms, could be relevant for dose adjustment.
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Affiliation(s)
- Camille Lenoir
- Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, 1205 Geneva, Switzerland; (C.L.); (J.T.); (Y.G.); (Y.D.); (J.A.D.); (C.F.S.)
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, 1206 Geneva, Switzerland
| | - Jean Terrier
- Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, 1205 Geneva, Switzerland; (C.L.); (J.T.); (Y.G.); (Y.D.); (J.A.D.); (C.F.S.)
- Department of Medicine, Division of General Internal Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (P.G.); (J.-L.R.)
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland
| | - Yvonne Gloor
- Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, 1205 Geneva, Switzerland; (C.L.); (J.T.); (Y.G.); (Y.D.); (J.A.D.); (C.F.S.)
| | - Pauline Gosselin
- Department of Medicine, Division of General Internal Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (P.G.); (J.-L.R.)
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland
| | - Youssef Daali
- Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, 1205 Geneva, Switzerland; (C.L.); (J.T.); (Y.G.); (Y.D.); (J.A.D.); (C.F.S.)
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, 1206 Geneva, Switzerland
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland
- Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland;
| | - Christophe Combescure
- Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland;
- Department of Health and Community Medicine, Division of Clinical Epidemiology, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Jules Alexandre Desmeules
- Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, 1205 Geneva, Switzerland; (C.L.); (J.T.); (Y.G.); (Y.D.); (J.A.D.); (C.F.S.)
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, 1206 Geneva, Switzerland
- Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland;
| | - Caroline Flora Samer
- Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, 1205 Geneva, Switzerland; (C.L.); (J.T.); (Y.G.); (Y.D.); (J.A.D.); (C.F.S.)
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland
- Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland;
| | - Jean-Luc Reny
- Department of Medicine, Division of General Internal Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (P.G.); (J.-L.R.)
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland
- Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland;
| | - Victoria Rollason
- Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, 1205 Geneva, Switzerland; (C.L.); (J.T.); (Y.G.); (Y.D.); (J.A.D.); (C.F.S.)
- Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland;
- Correspondence:
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32
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Gatti M, Pea F. The Cytokine Release Syndrome and/or the Proinflammatory Cytokines as Underlying Mechanisms of Downregulation of Drug Metabolism and Drug Transport: A Systematic Review of the Clinical Pharmacokinetics of Victim Drugs of this Drug-Disease Interaction Under Different Clinical Conditions. Clin Pharmacokinet 2022; 61:1519-1544. [PMID: 36059001 PMCID: PMC9441320 DOI: 10.1007/s40262-022-01173-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND OBJECTIVE An ever-growing body of evidence supports the impact of cytokine modulation on the patient's phenotypic drug response. The aim of this systematic review was to analyze the clinical studies that assessed the pharmacokinetics of victim drugs of this drug-disease interaction in the presence of different scenarios of cytokine modulation in comparison with baseline conditions. METHODS We conducted a systematic review by searching the PubMed-MEDLINE database from inception until February 2022 to retrieve prospective and/or retrospective observational studies, population pharmacokinetic studies, phase I studies, and/or case series/reports that investigated the impact of cytokine modulation on the pharmacokinetic behavior of victim drugs. Only studies providing quantitative pharmacokinetic data of victim drugs by comparing normal status versus clinical conditions with documented cytokine modulation or by assessing the influence of anti-inflammatory biological agents on metabolism and/or transport of victim drugs were included. RESULTS Overall, 26 studies were included. Rheumatoid arthritis (6/26; 23.1%) and sepsis (5/26; 19.2%) were the two most frequently investigated pro-inflammatory clinical scenarios. The victim drug most frequently assessed was midazolam (14/26; 53.8%; as a probe for cytochrome P450 [CYP] 3A4). Cytokine modulation showed a moderate inhibitory effect on CYP3A4-mediated metabolism (area under the concentration-time curve increase and/or clearance decrease between 1.98-fold and 2.59-fold) and a weak-to-moderate inhibitory effect on CYP1A2, CYP2C9, and CYP2C19-mediated metabolism (in the area under the concentration-time curve increase or clearance decrease between 1.29-fold and 1.97-fold). Anti-interleukin-6 agents showed remarkable activity in counteracting downregulation of CYP3A4-mediated activity (increase in the area under the concentration-time curve between 1.75-fold and 2.56-fold). CONCLUSIONS Cytokine modulation may cause moderate or weak-to-moderate downregulation of metabolism/transport of victim drugs, and this may theoretically have relevant clinical consequences.
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Affiliation(s)
- Milo Gatti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy ,Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy ,Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138 Bologna, Italy
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