1
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Wiegman A, Greber-Platzer S, Ali S, Reijman MD, Brinton EA, Charng MJ, Srinivasan S, Baker-Smith C, Baum S, Brothers JA, Hartz J, Moriarty PM, Mendell J, Bihorel S, Banerjee P, George RT, Hirshberg B, Pordy R. Evinacumab for Pediatric Patients With Homozygous Familial Hypercholesterolemia. Circulation 2024; 149:343-353. [PMID: 37860863 PMCID: PMC10814999 DOI: 10.1161/circulationaha.123.065529] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/07/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Homozygous familial hypercholesterolemia (HoFH) is a rare genetic disorder characterized by severely elevated low-density lipoprotein cholesterol (LDL-C) levels due to profoundly defective LDL receptor (LDLR) function. Given that severely elevated LDL-C starts in utero, atherosclerosis often presents during childhood or adolescence, creating a largely unmet need for aggressive LDLR-independent lipid-lowering therapies in young patients with HoFH. Here we present the first evaluation of the efficacy and safety of evinacumab, a novel LDLR-independent lipid-lowering therapy, in pediatric patients with HoFH from parts A and B of a 3-part study. METHODS The phase 3, part B, open-label study treated 14 patients 5 to 11 years of age with genetically proven HoFH (true homozygotes and compound heterozygotes) with LDL-C >130 mg/dL, despite optimized lipid-lowering therapy (including LDLR-independent apheresis and lomitapide), with intravenous evinacumab 15 mg/kg every 4 weeks. RESULTS Evinacumab treatment rapidly and durably (through week 24) decreased LDL-C with profound reduction in the first week, with a mean (SE) LDL-C reduction of -48.3% (10.4%) from baseline to week 24. ApoB (mean [SE], -41.3% [9.0%]), non-high-density lipoprotein cholesterol (-48.9% [9.8%]), and total cholesterol (-49.1% [8.1%]) were similarly decreased. Treatment-emergent adverse events were reported in 10 (71.4%) patients; however, only 2 (14.3%) reported events that were considered to be treatment-related (nausea and abdominal pain). One serious treatment-emergent adverse event of tonsillitis occurred (n=1), but this was not considered treatment-related. CONCLUSIONS Evinacumab constitutes a new treatment for pediatric patients with HoFH and inadequately controlled LDL-C despite optimized lipid-lowering therapy, lowering LDL-C levels by nearly half in these extremely high-risk and difficult-to-treat individuals. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04233918.
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Affiliation(s)
- Albert Wiegman
- Department of Paediatrics, Amsterdam University Medical Centers, Location University of Amsterdam, The Netherlands (A.W., M.D.R.)
| | - Susanne Greber-Platzer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Pulmonology, Allergology and Endocrinology, Medical University of Vienna, Austria (S.G.-P.)
| | - Shazia Ali
- Regeneron Pharmaceuticals, Inc, Tarrytown, NY (S.A., J.M., S.B., P.B., R.T.G., B.H., R.P.)
| | - M. Doortje Reijman
- Department of Paediatrics, Amsterdam University Medical Centers, Location University of Amsterdam, The Netherlands (A.W., M.D.R.)
| | | | - Min-Ji Charng
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (M.-J.C.)
| | - Shubha Srinivasan
- Institute of Endocrinology and Diabetes, Children’s Hospital at Westmead, Sydney, Australia (S.S.)
| | - Carissa Baker-Smith
- Pediatric Preventive Cardiology Program, Nemours Cardiac Center, Nemours Children’s Hospital, Wilmington, DE (C.B.-S.)
| | - Seth Baum
- Regeneron Pharmaceuticals, Inc, Tarrytown, NY (S.A., J.M., S.B., P.B., R.T.G., B.H., R.P.)
| | - Julie A. Brothers
- Division of Cardiology, Children’s Hospital of Philadelphia, PA (J.A.B.)
| | - Jacob Hartz
- Department of Cardiology, Boston Children’s Hospital, MA (J.H.)
| | - Patrick M. Moriarty
- Department of Medicine, University of Kansas Medical Center, Kansas City (P.M.M.)
| | - Jeanne Mendell
- Regeneron Pharmaceuticals, Inc, Tarrytown, NY (S.A., J.M., S.B., P.B., R.T.G., B.H., R.P.)
| | | | - Poulabi Banerjee
- Regeneron Pharmaceuticals, Inc, Tarrytown, NY (S.A., J.M., S.B., P.B., R.T.G., B.H., R.P.)
| | - Richard T. George
- Regeneron Pharmaceuticals, Inc, Tarrytown, NY (S.A., J.M., S.B., P.B., R.T.G., B.H., R.P.)
| | - Boaz Hirshberg
- Regeneron Pharmaceuticals, Inc, Tarrytown, NY (S.A., J.M., S.B., P.B., R.T.G., B.H., R.P.)
| | - Robert Pordy
- Regeneron Pharmaceuticals, Inc, Tarrytown, NY (S.A., J.M., S.B., P.B., R.T.G., B.H., R.P.)
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Bihorel S, Cao Y, Chawla A, Birger R, Maas BM, Gao W, Roepcke S, Sardella S, Humphrey R, Kondragunta S, Jayaraman B, Martinho M, Painter W, Painter G, Holman W, De Anda C, Brown ML, Johnson MG, Paschke A, Rizk ML, Stone JA. Population pharmacokinetics of molnupiravir in adults with COVID-19: Lack of clinically important exposure variation across individuals. CPT Pharmacometrics Syst Pharmacol 2023; 12:1859-1871. [PMID: 37798914 PMCID: PMC10725262 DOI: 10.1002/psp4.13031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 10/07/2023] Open
Abstract
Effective antiviral treatments for coronavirus disease 2019 (COVID-19) are needed to reduce the morbidity and mortality associated with severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection, particularly in patients with risk factors for severe disease. Molnupiravir (MK-4482, EIDD-2801) is an orally administered, ribonucleoside prodrug of β-D-N4-hydroxycytidine (NHC) with submicromolar potency against SARS-CoV-2. A population pharmacokinetic (PopPK) analysis for molnupiravir exposure was conducted using 4202 NHC plasma concentrations collected in 1207 individuals from a phase I trial in healthy participants, a phase IIa trial in non-hospitalized participants with COVID-19, a phase II trial in hospitalized participants with COVID-19, and a phase II/III trial in non-hospitalized participants with COVID-19. Molnupiravir pharmacokinetics (PK) was best described by a two-compartment model with a transit-compartment absorption model and linear elimination. Molnupiravir apparent elimination clearance increased with body weight less-than-proportionally (power 0.412) and was estimated as 70.6 L/h in 80-kg individuals with a moderate interindividual variability (43.4% coefficient of variation). Additionally, effects of sex and body mass index on apparent central volume and food status and formulation on the absorption mean transit time were identified as statistically significant descriptors of variability in these PK parameters. However, none of the identified covariate effects caused clinically relevant changes in the area under the NHC concentration versus time curve between doses, the exposure metric most closely related to clinical response. Overall, the PopPK model indicates that molnupiravir can be administered in adults without dose adjustment based on age, sex, body size, food, and mild-to-moderate renal or mild hepatic impairment.
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Affiliation(s)
- Sébastien Bihorel
- Simulation Plus, Cognigen DivisionBuffaloNew YorkUSA
- Present address:
Regeneron Pharmaceuticals, Inc.TarrytownNew YorkUSA
| | - Youfang Cao
- Merck & Co., Inc.RahwayNew JerseyUSA
- Present address:
Eisai Inc.NutleyNew JerseyUSA
| | | | | | | | - Wei Gao
- Merck & Co., Inc.RahwayNew JerseyUSA
- Present address:
EMD Serono Research & Development Institute, Inc.BillericaMassachusettsUSA
| | | | | | | | - Sindhuri Kondragunta
- Simulation Plus, Cognigen DivisionBuffaloNew YorkUSA
- Present address:
CertaraPrincetonNew JerseyUSA
| | | | | | | | - George Painter
- Department of Pharmacology and Chemical BiologyEmory University School of MedicineAtlantaGeorgiaUSA
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Wang X, Raoufinia A, Bihorel S, Passarell J, Mallikaarjun S, Phillips L. Population Pharmacokinetic Modeling and Exposure-Response Analysis for Aripiprazole Once Monthly in Subjects With Schizophrenia. Clin Pharmacol Drug Dev 2022; 11:150-164. [PMID: 34979059 PMCID: PMC10026531 DOI: 10.1002/cpdd.1022] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 08/13/2021] [Indexed: 11/07/2022]
Abstract
An intramuscular formulation of aripiprazole monohydrate dosed once monthly (AOM) was developed to address nonadherence with the approved oral tablets. A 3-compartment linear population pharmacokinetic model for oral and AOM doses was developed; relative bioavailability was estimated for AOM relative to oral dosing and body mass index and sex were significant predictors of AOM absorption rate constant (longer absorption half-life for women and absorption half-life increases with increasing body mass index). Aripiprazole apparent oral clearance for subjects with cytochrome P450 (CYP) 2D6 poor metabolizer status and in the presence of strong CYP2D6 inhibitors was approximately half that of subjects with CYP2D6 extensive metabolizer status and 24% lower in the presence of strong CYP3A4 inhibitors. Simulations of the population pharmacokinetics were conducted to evaluate the effect of different dose initiation strategies for AOM, the effects of CYP2D6 metabolizer status, coadministration of CYP2D6 and CYP3A4 inhibitors, and missed doses. An exposure-response model with an exponential hazard function of the model-predicted minimum concentration (Cmin ) described the time to relapse. The hazard ratio (95% confidence interval) was 4.41 (2.89-6.75). Thus, a subject with a diagnosis of schizophrenia and Cmin ≥ 95 ng/mL is 4.41 times less likely to relapse relative to a subject with Cmin < 95 ng/mL.
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Affiliation(s)
- Xiaofeng Wang
- Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, Maryland, USA
| | - Arash Raoufinia
- Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, Maryland, USA
| | - Sébastien Bihorel
- Cognigen Corporation, a SimulationsPlus Company, Buffalo, New York, USA
| | - Julie Passarell
- Cognigen Corporation, a SimulationsPlus Company, Buffalo, New York, USA
| | - Suresh Mallikaarjun
- Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, Maryland, USA
- Fellow of the American College of Clinical Pharmacology (FCP)
| | - Luann Phillips
- Cognigen Corporation, a SimulationsPlus Company, Buffalo, New York, USA
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4
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Bihorel S, Singhal S, Shevell D, Sun H, Xie J, Basdeo S, Liu A, Dutta S, Ludwig E, Huang H, Lin KJ, Fura A, Throup J, Girgis IG. Population Pharmacokinetic Analysis of BMS-986166, a Novel Selective Sphingosine-1-Phosphate-1 Receptor Modulator, and Exposure-Response Assessment of Lymphocyte Counts and Heart Rate in Healthy Participants. Clin Pharmacol Drug Dev 2020; 10:8-21. [PMID: 33090733 PMCID: PMC7821288 DOI: 10.1002/cpdd.878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 09/08/2020] [Indexed: 11/09/2022]
Abstract
Sphingosine‐1‐phosphate (S1P) binding to the S1P‐1 receptor (S1P1R) controls the egress of lymphocytes from lymphoid organs and targets modulation of immune responses in autoimmune diseases. Pharmacologic modulation of S1P receptors has been linked to heart rate reduction. BMS‐986166, a prodrug of the active phosphorylated metabolite BMS‐986166‐P, presents an improved cardiac safety profile in preclinical studies compared to other S1P1R modulators. The pharmacokinetics, safety, and pharmacodynamics of BMS‐986166 versus placebo after single (0.75–5.0 mg) and repeated (0.25–1.5 mg/day) oral administration were assessed in healthy participants after a 1‐day lead‐in placebo period. A population model was developed to jointly describe BMS‐986166 and BMS‐986166‐P pharmacokinetics and predict individual exposures. Inhibitory sigmoid models described the relationships between average daily BMS‐986166‐P concentrations and nadir of time‐matched (day –1) placebo‐corrected heart rate on day 1 (nDDHR, where DD represents ∆∆) and nadir of absolute lymphocyte count (nALC). Predicted decreases in nDDHR and nALC were 9 bpm and 20% following placebo, with maximum decreases of 10 bpm in nDDHR due to drug effect, and approximately 80% in nALC due to drug and placebo. A 0.5‐mg/day dose regimen achieves the target 65% reduction in nALC associated with a 2‐bpm decrease in nDDHR over placebo.
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Affiliation(s)
- Sébastien Bihorel
- Cognigen Corporation, a SimulationsPlus Company, Buffalo, New York, USA
| | | | | | - Huadong Sun
- Previously employed at Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Jenny Xie
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | | | - Ang Liu
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | | | - Elizabeth Ludwig
- Cognigen Corporation, a SimulationsPlus Company, Buffalo, New York, USA
| | - Hannah Huang
- Cognigen Corporation, a SimulationsPlus Company, Buffalo, New York, USA
| | - Kuan-Ju Lin
- Previously employed at Cognigen Corporation, a SimulationPlus Company, Buffalo, New York, USA
| | - Aberra Fura
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | - John Throup
- Bristol Myers Squibb, Princeton, New Jersey, USA
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5
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Jaworowicz D, Bihorel S, Zajic S, Stoch SA, Humphrey R, McCrea JB, Stone JA. Population Pharmacokinetic Analysis of the Cathepsin K Inhibitor Odanacatib: Insights Into Intrinsic and Extrinsic Factor Effects on Exposure in Postmenopausal and Elderly Women. J Clin Pharmacol 2020; 60:1107-1123. [PMID: 32302427 DOI: 10.1002/jcph.1606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/21/2020] [Indexed: 11/07/2022]
Abstract
This analysis developed a population pharmacokinetic (PK) model for odanacatib, characterized demographic and concomitant medication covariates effect, and provided odanacatib exposure estimates for subjects in phase 2/3 studies. Data from multiple phase 1 (P005, P025, and P014), phase 2b (P004 and P022), and phase 3 (Long-Term Odanacatib Fracture Trial; P018) studies were pooled to create a data set of 1280 postmenopausal women aged 45 to 91 years (102 from phase 1, 514 from phase 2b, and 664 from phase 3) who received weekly oral odanacatib doses ranging from 3 to 100 mg. A 1-compartment model with first-order absorption, dose-dependent relative bioavailability (F1), and first-order elimination best described odanacatib PK. F1 decreased from the 100% reference bioavailability for a 3-mg oral dose to 24.5% for a 100-mg dose. Eight statistically significant covariates were included in the final PK model: body weight, age, race, and concomitant cytochrome P450 (CYP)3A inhibitors on apparent clearance; body weight on apparent central volume of distribution; and concomitant hydrochlorothiazide, high-fat breakfast, and a study effect on F1. All fixed- and random-effects parameters were estimated with good precision (%standard error of the mean ≤29.5%). This population PK analysis provides insights into intrinsic- and extrinsic-factor effects on odanacatib exposure in postmenopausal and elderly women with osteoporosis. The magnitude of the intrinsic-factor effects was generally modest (odanacatib exposure geometric mean ratios, 0.80-1.21) even in subjects aged >80 years, or in subsets with multiple combinations of factors.
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Affiliation(s)
- David Jaworowicz
- Cognigen Corporation (a SimulationsPlus Company), Buffalo, New York, USA
| | - Sébastien Bihorel
- Cognigen Corporation (a SimulationsPlus Company), Buffalo, New York, USA
| | | | | | - Rebecca Humphrey
- Cognigen Corporation (a SimulationsPlus Company), Buffalo, New York, USA
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6
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Bihorel S, Raddad E, Fiedler-Kelly J, Stille JR, Hing J, Ludwig E. Population Pharmacokinetic and Pharmacodynamic Modeling of LY2510924 in Patients With Advanced Cancer. CPT Pharmacometrics Syst Pharmacol 2017. [PMID: 28643374 PMCID: PMC5613202 DOI: 10.1002/psp4.12221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The objectives of this study were to characterize the pharmacokinetics (PK) of LY2510924, a potent peptide antagonist of the CXCR4 receptor, after subcutaneous administration in patients with advanced cancer forms and quantify LY2510924 stimulatory effects on the mobilization of cells bearing the cluster of differentiation 34 (CD34) as an indirect reflection of the chemokine C-X-C motif ligand 12/CXCR4 axis inhibition. LY2510924 PK were best characterized by a two-compartment model with first-order absorption and dose-dependent clearance predicting steady state after three daily doses and little accumulation (accumulation ratio <1.17). The dynamics of CD34+ cell counts were best characterized with a precursor model with reversible transfer from the precursor to the central compartment and LY2510924-driven stimulation of cell mobilization. Model-based simulations show that once-daily doses of 20 mg LY2510924 produce maximum CD34+ cell response and that peak effect typically occurs after three daily doses and slowly wanes over time.
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Affiliation(s)
- S Bihorel
- Cognigen Corporation, a Simulations Plus Company, Buffalo, New York, USA
| | - E Raddad
- Chorus, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - J Fiedler-Kelly
- Cognigen Corporation, a Simulations Plus Company, Buffalo, New York, USA
| | - J R Stille
- Chorus, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - J Hing
- Cognigen Corporation, a Simulations Plus Company, Buffalo, New York, USA
| | - E Ludwig
- Cognigen Corporation, a Simulations Plus Company, Buffalo, New York, USA
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Bihorel S, Fiedler-Kelly J, Ludwig E, Sloan-Lancaster J, Raddad E. Population pharmacokinetic modeling of LY2189102 after multiple intravenous and subcutaneous administrations. AAPS J 2014; 16:1009-17. [PMID: 24912797 DOI: 10.1208/s12248-014-9623-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 05/17/2014] [Indexed: 01/08/2023]
Abstract
Interleukin-1 beta (IL-1β) is an inflammatory mediator which may contribute to the pathophysiology of rheumatoid arthritis (RA) and type 2 diabetes mellitus (T2DM). Population pharmacokinetics (PK) of LY2189102, a high affinity anti-IL-1β humanized monoclonal immunoglobulin G4 evaluated for efficacy in RA and T2DM, were characterized using data from 79 T2DM subjects (Study H9C-MC-BBDK) who received 13 weekly subcutaneous (SC) doses of LY2189102 (0.6, 18, and 180 mg) and 96 RA subjects (Study H9C-MC-BBDE) who received five weekly intravenous (IV) doses (0.02-2.5 mg/kg). Frequency of anti-drug antibody (ADA) development appears dose-dependent and is different between studies (36.7% in Study H9C-MC-BBDK vs. 2.1% in Study H9C-MC-BBDE), likely due to several factors, including differences in patient population and background medications, administration routes, and assays. A two-compartment model with dose-dependent bioavailability best characterizes LY2189102 PK following IV and SC administration. Typical elimination and distribution clearances, central and peripheral volumes of distribution are 0.222 L/day, 0.518 L/day, 3.08 L, and 1.94 L, resulting in a terminal half-life of 16.8 days. Elimination clearance increased linearly, yet modestly, with baseline creatinine clearance and appears 37.6% higher in subjects who developed ADA. Bioavailability (0.432-0.721) and absorption half-life (94.3-157 h) after SC administration are smaller with larger doses. Overall, LY2189102 PK is consistent with other therapeutic humanized monoclonal antibodies and is likely to support convenient SC dosing.
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Affiliation(s)
- Sébastien Bihorel
- Cognigen Corporation, 1780 Wehrle Drive - Suite 110, Buffalo, NY, 14221-7000, USA
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8
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Gao W, Bihorel S, DuBois DC, Almon RR, Jusko WJ. Mechanism-based disease progression modeling of type 2 diabetes in Goto-Kakizaki rats. J Pharmacokinet Pharmacodyn 2010; 38:143-62. [PMID: 21127951 DOI: 10.1007/s10928-010-9182-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Accepted: 11/04/2010] [Indexed: 11/25/2022]
Abstract
The dynamics of aging and type 2 diabetes (T2D) disease progression were investigated in normal [Wistar-Kyoto (WKY)] and diabetic [Goto-Kakizaki (GK)] rats and a mechanistic disease progression model was developed for glucose, insulin, and glycosylated hemoglobin (HbA1c) changes over time. The study included 30 WKY and 30 GK rats. Plasma glucose and insulin, blood glucose and HbA1c concentrations and hematological measurements were taken at ages 4, 8, 12, 16 and 20 weeks. A mathematical model described the development of insulin resistance (IR) and β-cell function with age/growth and diabetes progression. The model utilized transit compartments and an indirect response model to quantitate biomarker changes over time. Glucose, insulin and HbA1c concentrations in WKY rats increased to a steady-state at 8 weeks due to developmental changes. Glucose concentrations at 4 weeks in GK rats were almost twice those of controls, and increased to a steady-state after 8 weeks. Insulin concentrations at 4 weeks in GK rats were similar to controls, and then hyperinsulinemia occurred until 12-16 weeks of age indicating IR. Subsequently, insulin concentrations in GK rats declined to slightly below WKY controls due to β-cell failure. HbA1c showed a delayed increase relative to glucose. Modeling of HbA1c was complicated by age-related changes in hematology in rats. The diabetes model quantitatively described the glucose/insulin inter-regulation and HbA1c production and reflected the underlying pathogenic factors of T2D--IR and β-cell dysfunction. The model could be extended to incorporate other biomarkers and effects of various anti-diabetic drugs.
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Affiliation(s)
- Wei Gao
- Department of Pharmaceutical Sciences, State University of New York, 565 Hochstetter Hall, Buffalo, NY, USA
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Declèves X, Bihorel S, Debray M, Yousif S, Camenisch G, Scherrmann JM. ABC transporters and the accumulation of imatinib and its active metabolite CGP74588 in rat C6 glioma cells. Pharmacol Res 2008; 57:214-22. [DOI: 10.1016/j.phrs.2008.01.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2007] [Revised: 12/10/2007] [Accepted: 01/21/2008] [Indexed: 11/26/2022]
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Bihorel S, Camenisch G, Lemaire M, Scherrmann JM. Influence of breast cancer resistance protein (Abcg2) and p-glycoprotein (Abcb1a) on the transport of imatinib mesylate (Gleevec) across the mouse blood-brain barrier. J Neurochem 2007; 102:1749-1757. [PMID: 17696988 DOI: 10.1111/j.1471-4159.2007.04808.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Imatinib, a protein tyrosine kinase inhibitor, may prevent the growth of glioblastoma cells. Unfortunately, its brain distribution is restricted by p-glycoprotein (p-gp or multidrug resistance protein Mdr1a), and probably by breast cancer resistance protein (Bcrp1), two efflux pumps expressed at the blood-brain barrier (BBB). We have used in situ brain perfusion to investigate the mechanisms of imatinib transport across the mouse BBB. The brain uptake of imatinib in wild-type mice was limited by saturable efflux processes. The inhibition of p-gp, by valspodar and zosuquidar, increased imatinib uptake (2.5-fold), as did the deficiency of p-gp in Mdr1a/1b(-/-) mice (5.5-fold). Perfusing imatinib with the p-gp/Bcrp1 inhibitor, elacridar, enhanced the brain uptake of imatinib in wild-type (4.1-fold) and Mdr1a/1b(-/-) mice (1.2-fold). However, the brain uptake of imatinib was similar in wild-type and Bcrp1(-/-) mice when it was perfused at a non-saturating concentration. The brain uptake of CGP74588, an active metabolite of imatinib, was low. It was increased by perfusion with elacridar (twofold), but not with valspodar and zosuquidar. CGP74588 uptake was 1.5 times greater in Bcrp1(-/-) mice than in wild-type mice. These data suggest that imatinib transport at the mouse BBB is limited by p-gp and probably by Bcrp1, and that CGP74588 transport is restricted by Bcrp1.
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily B/antagonists & inhibitors
- ATP Binding Cassette Transporter, Subfamily B/genetics
- ATP Binding Cassette Transporter, Subfamily B/metabolism
- ATP Binding Cassette Transporter, Subfamily B, Member 1
- ATP Binding Cassette Transporter, Subfamily G, Member 2
- ATP-Binding Cassette Transporters/antagonists & inhibitors
- ATP-Binding Cassette Transporters/genetics
- ATP-Binding Cassette Transporters/metabolism
- Acridines/pharmacology
- Animals
- Antineoplastic Agents/metabolism
- Benzamides
- Biological Transport, Active/drug effects
- Biological Transport, Active/physiology
- Blood-Brain Barrier/drug effects
- Blood-Brain Barrier/metabolism
- Brain/blood supply
- Brain/drug effects
- Brain/metabolism
- Cyclosporins/pharmacology
- Dibenzocycloheptenes/pharmacology
- Dose-Response Relationship, Drug
- Enzyme Inhibitors/pharmacology
- Imatinib Mesylate
- Immunosuppressive Agents/pharmacology
- Male
- Mice
- Mice, Knockout
- Piperazines/metabolism
- Piperazines/pharmacokinetics
- Pyrimidines/metabolism
- Pyrimidines/pharmacokinetics
- Quinolines/pharmacology
- Tetrahydroisoquinolines/pharmacology
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Affiliation(s)
- Sébastien Bihorel
- Université Paris Descartes, Faculté de Pharmacie, Neuropsychopharmacologie des addictions, CNRS, UMR7157 et Université Paris 7, FranceINSERMS U705, Paris, FranceDepartment of Drug Metabolism and Pharmacokinetics, Novartis Pharma AG, Basel, SwitzerlandAP-HP, Hôpital Fernand Widal, Paris, France
| | - Gian Camenisch
- Université Paris Descartes, Faculté de Pharmacie, Neuropsychopharmacologie des addictions, CNRS, UMR7157 et Université Paris 7, FranceINSERMS U705, Paris, FranceDepartment of Drug Metabolism and Pharmacokinetics, Novartis Pharma AG, Basel, SwitzerlandAP-HP, Hôpital Fernand Widal, Paris, France
| | - Michel Lemaire
- Université Paris Descartes, Faculté de Pharmacie, Neuropsychopharmacologie des addictions, CNRS, UMR7157 et Université Paris 7, FranceINSERMS U705, Paris, FranceDepartment of Drug Metabolism and Pharmacokinetics, Novartis Pharma AG, Basel, SwitzerlandAP-HP, Hôpital Fernand Widal, Paris, France
| | - Jean-Michel Scherrmann
- Université Paris Descartes, Faculté de Pharmacie, Neuropsychopharmacologie des addictions, CNRS, UMR7157 et Université Paris 7, FranceINSERMS U705, Paris, FranceDepartment of Drug Metabolism and Pharmacokinetics, Novartis Pharma AG, Basel, SwitzerlandAP-HP, Hôpital Fernand Widal, Paris, France
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Bihorel S, Camenisch G, Lemaire M, Scherrmann JM. Modulation of the brain distribution of imatinib and its metabolites in mice by valspodar, zosuquidar and elacridar. Pharm Res 2007; 24:1720-8. [PMID: 17380257 DOI: 10.1007/s11095-007-9278-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Accepted: 02/20/2007] [Indexed: 01/02/2023]
Abstract
PURPOSE The selective protein tyrosine kinase inhibitor, imatinib, inhibits the growth of glioma cells in preclinical models, but its poor brain distribution limits its efficacy in patients. P-glycoprotein (P-gp, rodent Mdr1a/1b or Abcb1a/1b) and Breast cancer resistance protein (rodent Bcrp1 or Abcg2) were suggested to restrict the delivery of imatinib to the brain. This study evaluates the effect of administering selective inhibitors of these transporters together with imatinib on the systemic and cerebral disposition of imatinib in mice. MATERIALS AND METHODS Wild-type, Mdr1a/1b(-/-) and Bcrp1(-/-) mice were given imatinib intravenously, either alone, or with valspodar, zosuquidar (P-gp inhibitors), or elacridar (a P-gp and Bcrp1 inhibitor). The blood and brain concentrations of [(14)C]imatinib and its radioactive metabolites were determined. RESULTS The blockade of P-gp by valspodar or zosuquidar (>3 mg/kg) enhanced the brain uptake of imatinib ( approximately 4-fold) in wild-type mice, but not that of its metabolites. Blockade of both P-gp and Bcrp1 by elacridar (>3 mg/kg) produced significantly greater brain penetration of imatinib (9.3-fold) and its metabolites (2.8-fold). In contrast, only the lack of P-gp enhanced imatinib brain penetration (6.4-fold) in knockout mice. These results of brain uptake correlated reasonably well with those obtained previously by our group using in situ brain perfusion. CONCLUSIONS Imatinib and its metabolites penetrate into the brain poorly and their penetration is limited by P-gp and (probably) Bcrp1. Administering imatinib together with P-gp (and Bcrp1) transporter inhibitors such as elacridar may improve the delivery of imatinib to the brain, making it potentially more effective against malignant gliomas.
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Affiliation(s)
- Sébastien Bihorel
- INSERM, U705, CNRS, UMR 7157, Université Paris 7, Université Paris 5, Faculté de Pharmacie, Laboratoire de Pharmacocinétique, Paris, France
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Bihorel S, Camenisch G, Gross G, Lemaire M, Scherrmann JM. Influence of hydroxyurea on imatinib mesylate (gleevec) transport at the mouse blood-brain barrier. Drug Metab Dispos 2006; 34:1945-9. [PMID: 16936068 DOI: 10.1124/dmd.106.010975] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The combination of imatinib mesylate and hydroxyurea provides a therapeutic benefit in patients with glioblastoma, although each drug is not effective when used alone. The increase of brain delivery of one or both drugs has been suggested to be a potential cause of this therapeutic benefit. The cross-influence of hydroxyurea and imatinib on their respective brain distribution was examined in mice and rats. We used in situ brain perfusion in mice to determine whether these two drugs have an influence on their respective initial transport across the blood-brain barrier. The brain penetration of hydroxyurea, assessed by its brain uptake clearance, Knet, was low in mice (approximately 0.10 microl/g/s) and not modified by coperfusion of imatinib (0.5-500 microM). Likewise, the brain penetration of imatinib was low (Knet, 1.39 +/- 0.17 microl/g/s) and not modified by direct coperfusion of hydroxyurea (0.2-1000 microM) or by intravenous pretreatment with 15 or 1000 mg/kg hydroxyurea. We also examined a potential time-dependent influence of hydroxyurea on imatinib brain distribution after sustained subcutaneous administration in rats using an implantable osmotic pump. The brain penetration of imatinib in rats increased with time, approximately 1.6-fold (p < 0.01) after 7 and 14 days' infusion of imatinib (3 mg/day) with or without hydroxyurea (15 mg/day), and was not influenced by hydroxyurea. The results of these two sets of experiments indicate that hydroxyurea has no significant influence on the brain distribution of imatinib in mice and rats.
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Affiliation(s)
- Sébastien Bihorel
- Institut National de la Santé et de la Recherche Médicale, INSERM U705, Université Paris 7, Paris, France
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