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Huang S, Song W, Jiang S, Li Y, Wang M, Yang N, Zhu H. Pharmacokinetic interactions between tacrolimus and Wuzhi capsule in liver transplant recipients: Genetic polymorphisms affect the drug interaction. Chem Biol Interact 2024; 391:110906. [PMID: 38340974 DOI: 10.1016/j.cbi.2024.110906] [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: 12/15/2023] [Revised: 01/21/2024] [Accepted: 02/07/2024] [Indexed: 02/12/2024]
Abstract
Wuzhi capsule (WZC), a commonly used Chinese patent medicine to treat various types of liver dysfunction in China, increases the exposure of tacrolimus (TAC) in liver transplant recipients. However, this interaction has inter-individual variability, and the underlying mechanism remains unclear. Current research indicates that CYP3A4/5 and drug transporters influence the disposal of both drugs. This study aims to evaluate the association between TAC dose-adjusted trough concentration (C/D) and specific genetic polymorphisms of CYP3A4/5, drug transporters and pregnane x receptor (PXR), and plasma levels of major WZC components, deoxyschisandrin and γ-schisandrin, in liver transplant patients receiving both TAC and WZC. Liquid chromatography-tandem-mass spectrometry was used to detect the plasma levels of deoxyschisandrin and γ-schisandrin, and nine polymorphisms related to metabolic enzymes, transporters and PXR were genotyped by sequencing. A linear mixed model was utilized to assess the impact of the interaction between genetic variations and WZC components on TAC lnC/D. Our results indicate a significant association of TAC lnC/D with the plasma levels of deoxyschisandrin and γ-schisandrin. Univariate analysis demonstrated three polymorphisms in the genes ABCB1 (rs2032582), ABCC2 (rs2273697), ABCC2 (rs3740066), and PXR (rs3842689) interact with both deoxyschisandrin and γ-schisandrin, influencing the TAC lnC/D. In multiple regression model analysis, the interactions between deoxyschisandrin and both ABCB1 (rs2032582) and ABCC2 (rs3740066), post-operative day (β < 0.001, p < 0.001), proton pump inhibitor use (β = -0.152, p = 0.008), body mass index (β = 0.057, p < 0.001), and ABCC2 (rs717620, β = -0.563, p = 0.041), were identified as significant factors of TAC lnC/D, accounting for 47.89% of the inter-individual variation. In summary, this study elucidates the influence of the interaction between ABCB1 and ABCC2 polymorphisms with WZC on TAC lnC/D. These findings offer a scientific basis for their clinical interaction, potentially aiding in the individualized management of TAC therapy in liver transplant patients.
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Affiliation(s)
- Siqi Huang
- Department of Pharmacy, Nanjing Drum Tower Hospital, Nanjing Drum Tower Hospital Clinical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Wei Song
- Department of Pharmacy, Wuhan No. 1 Hospital, Wuhan, China
| | - Shuangmiao Jiang
- Department of Pharmacy, Nanjing Drum Tower Hospital, Nanjing Drum Tower Hospital Clinical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yuanchen Li
- Department of Pharmacy, China Pharmaceutical University Nanjing Drum Tower Hospital, Nanjing, China
| | - Min Wang
- Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China; Nanjing Medical Center for Clinical Pharmacy, Nanjing, China
| | - Na Yang
- Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China; Nanjing Medical Center for Clinical Pharmacy, Nanjing, China.
| | - Huaijun Zhu
- Department of Pharmacy, Nanjing Drum Tower Hospital, Nanjing Drum Tower Hospital Clinical College, Nanjing University of Chinese Medicine, Nanjing, China; Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China; Nanjing Medical Center for Clinical Pharmacy, Nanjing, China.
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Scarpa J. Improving liver transplant outcomes with transplant-omics and network biology. Curr Opin Organ Transplant 2023; 28:412-418. [PMID: 37706301 DOI: 10.1097/mot.0000000000001100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
PURPOSE OF REVIEW Molecular omics data is increasingly ubiquitous throughout medicine. In organ transplantation, recent large-scale research efforts are generating the 'transplant-ome' - the entire set of molecular omics data, including the genome, transcriptome, proteome, and metabolome. Importantly, early studies in anesthesiology have demonstrated how perioperative interventions alter molecular profiles in various patient populations. The next step for anesthesiologists and intensivists will be to tailor perioperative care to the transplant-ome of individual liver transplant patients. RECENT FINDINGS In liver transplant patients, elements of the transplant-ome predict complications and point to novel interventions. Importantly, molecular profiles of both the donor organ and recipient contribute to this risk, and interventions like normothermic machine perfusion influence these profiles. As we can now measure various omics molecules simultaneously, we can begin to understand how these molecules interact to form molecular networks and emerging technologies offer noninvasive and continuous ways to measure these networks throughout the perioperative period. Molecules that regulate these networks are likely mediators of complications and actionable clinical targets throughout the perioperative period. SUMMARY The transplant-ome can be used to tailor perioperative care to the individual liver transplant patient. Monitoring molecular networks continuously and noninvasively would provide new opportunities to optimize perioperative management.
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Affiliation(s)
- Joseph Scarpa
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
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Joncquel M, Labasque J, Demaret J, Bout MA, Hamroun A, Hennart B, Tronchon M, Defevre M, Kim I, Kerckhove A, George L, Gilleron M, Dessein AF, Zerimech F, Grzych G. Targeted Metabolomics Analysis Suggests That Tacrolimus Alters Protection against Oxidative Stress. Antioxidants (Basel) 2023; 12:1412. [PMID: 37507951 PMCID: PMC10376759 DOI: 10.3390/antiox12071412] [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: 06/23/2023] [Revised: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
Tacrolimus (FK506) is an immunosuppressant that is experiencing a continuous rise in usage worldwide. The related side effects are known to be globally dose-dependent. Despite numerous studies on FK506, the mechanisms underlying FK506 toxicity are still not well understood. It is therefore essential to explore the toxicity mediated by FK506. To accomplish this, we conducted a targeted metabolomic analysis using LC-MS on the plasma samples of patients undergoing FK506 treatment. The aim was to identify any associated altered metabolic pathway. Another anti-calcineurin immunosuppressive therapy, ciclosporin (CSA), was also studied. Increased plasma concentrations of pipecolic acid (PA) and sarcosine, along with a decrease in the glycine/sarcosine ratio and a tendency of increased plasma lysine was observed in patients under FK506 compared to control samples. Patients under CSA do not show an increase in plasma PA compared to the control samples, which does not support a metabolic link between the calcineurin and PA. The metabolomics changes observed in patients under FK506 highlight a possible link between FK506 and the action of an enzyme involved in both PA and sarcosine catabolism and oxidative pathway, the Peroxisomal sarcosine oxidase (PIPOX). Moreover, PA could be investigated as a potential biomarker of early nephrotoxicity in the follow-up of patients under FK506.
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Affiliation(s)
- Marie Joncquel
- CHU Lille, Centre de Biologie Pathologie Génétique, Service Hormonologie Métabolisme Nutrition Oncologie, F-59000 Lille, France
| | - Julie Labasque
- CHU Lille, Centre de Biologie Pathologie Génétique, Service Hormonologie Métabolisme Nutrition Oncologie, F-59000 Lille, France
| | - Julie Demaret
- CHU Lille, Centre de Biologie Pathologie Génétique, Institut d'Immunologie, F-59000 Lille, France
| | - Marie-Adélaïde Bout
- CHU Lille, Centre de Biologie Pathologie Génétique, Service Hormonologie Métabolisme Nutrition Oncologie, F-59000 Lille, France
| | - Aghilès Hamroun
- UMR1167 RIDAGE, Institut Pasteur de Lille, Inserm, Université de Lille, CHU Lille, F-59000 Lille, France
| | - Benjamin Hennart
- CHU Lille, Centre de Biologie Pathologie Génétique, Service Toxicologie et Génopathies, F-59000 Lille, France
| | - Mathieu Tronchon
- CHU Lille, Centre de Biologie Pathologie Génétique, Institut d'Immunologie, F-59000 Lille, France
| | - Magali Defevre
- CHU Lille, Centre de Biologie Pathologie Génétique, Service Hormonologie Métabolisme Nutrition Oncologie, F-59000 Lille, France
| | - Isabelle Kim
- CHU Lille, Centre de Biologie Pathologie Génétique, Service Hormonologie Métabolisme Nutrition Oncologie, F-59000 Lille, France
| | - Alain Kerckhove
- CHU Lille, Centre de Biologie Pathologie Génétique, Service Hormonologie Métabolisme Nutrition Oncologie, F-59000 Lille, France
| | - Laurence George
- CHU Lille, Centre de Biologie Pathologie Génétique, Service Hormonologie Métabolisme Nutrition Oncologie, F-59000 Lille, France
| | - Mylène Gilleron
- CHU Lille, Centre de Biologie Pathologie Génétique, Service Hormonologie Métabolisme Nutrition Oncologie, F-59000 Lille, France
| | - Anne-Frédérique Dessein
- CHU Lille, Centre de Biologie Pathologie Génétique, Service Hormonologie Métabolisme Nutrition Oncologie, F-59000 Lille, France
| | - Farid Zerimech
- CHU Lille, Centre de Biologie Pathologie Génétique, Service Hormonologie Métabolisme Nutrition Oncologie, F-59000 Lille, France
- Institut Pasteur de Lille, Université de Lille, ULR 4483, IMPECS, F-59000 Lille, France
| | - Guillaume Grzych
- CHU Lille, Centre de Biologie Pathologie Génétique, Service Hormonologie Métabolisme Nutrition Oncologie, F-59000 Lille, France
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