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Mahmood I. Prediction of total and renal clearance of renally secreted drugs in neonates and infants (≤3 months of age). J Clin Transl Res 2022; 8:445-452. [PMID: 36452002 PMCID: PMC9706311] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Renal excretion is a major route of elimination for many drugs. Renal clearance is the sum of three processes: glomerular filtration, tubular secretion, and tubular re-absorption. Tubular secretion is an active transport process and is immature at birth. In the neonates, renal tubular secretion can be important for the elimination of those drugs which are renally secreted, such as penicillins and cephalosporins. AIM The objective of this study was to evaluate the predictive performances of three models to predict total and renal clearance of renally secreted drugs in neonates (≤3 months of age). METHODS From the literature, clearance values for 12 renally secreted drugs for neonates and adults were obtained. Three models were used to predict the clearances of these drugs. The predictive performances of these models were evaluated by comparing the predicted values of total and renal clearance with the observed clearance values in the neonates. RESULTS There were 12 drugs with 22 observations (preterm and term neonates, ≤3 months of age) for total clearance and six drugs with eight observations for renal clearance. For both total and renal clearance, a prediction error of <50% was observed by all three models evaluated in this study. CONCLUSIONS The proposed models can predict mean total and renal clearances of renally secreted drugs in preterm and term neonates (≤3 months of age) with reasonable accuracy (50% prediction error) and are of practical value during neonatal drug development. RELEVANCE FOR PATIENTS The work may help in dose selection for neonates for medicines that are renally secreted.
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Affiliation(s)
- Iftekhar Mahmood
- Mahmood Clinical Pharmacology Consultancy, LLC, 1709, Piccard DR, Rockville, MD 20850, USA
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Masereeuw R. The Dual Roles of Protein-Bound Solutes as Toxins and Signaling Molecules in Uremia. Toxins (Basel) 2022; 14:toxins14060402. [PMID: 35737063 PMCID: PMC9230939 DOI: 10.3390/toxins14060402] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/24/2022] [Accepted: 06/10/2022] [Indexed: 01/25/2023] Open
Abstract
In patients with severe kidney disease, renal clearance is compromised, resulting in the accumulation of a plethora of endogenous waste molecules that cannot be removed by current dialysis techniques, the most often applied treatment. These uremic retention solutes, also named uremic toxins, are a heterogeneous group of organic compounds of which many are too large to be filtered and/or are protein-bound. Their renal excretion depends largely on renal tubular secretion, by which the binding is shifted towards the free fraction that can be eliminated. To facilitate this process, kidney proximal tubule cells are equipped with a range of transport proteins that cooperate in cellular uptake and urinary excretion. In recent years, innovations in dialysis techniques to advance uremic toxin removal, as well as treatments with drugs and/or dietary supplements that limit uremic toxin production, have provided some clinical improvements or are still in progress. This review gives an overview of these developments. Furthermore, the role protein-bound uremic toxins play in inter-organ communication, in particular between the gut (the side where toxins are produced) and the kidney (the side of their removal), is discussed.
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Affiliation(s)
- Rosalinde Masereeuw
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands
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Tomita Y, Hansson E, Mazuir F, Wellhagen G, Ooi QX, Mezzalana E, Kitamura A, Nemoto D, Bolze S. Imeglimin population pharmacokinetics and dose adjustment predictions for renal impairment in Japanese and Western patients with type 2 diabetes. Clin Transl Sci 2021; 15:1014-1026. [PMID: 34962074 PMCID: PMC9010270 DOI: 10.1111/cts.13221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/20/2021] [Revised: 11/21/2021] [Accepted: 12/10/2021] [Indexed: 11/03/2022] Open
Abstract
Imeglimin is an orally administered first-in-class drug to treat type 2 diabetes mellitus (T2DM) and is mainly excreted unchanged by the kidneys. The present study aimed to define the pharmacokinetic (PK) characteristics of imeglimin using population PK analysis and to determine the optimal dosing regimen for Japanese patients with T2DM and chronic kidney disease (CKD). Imeglimin plasma concentrations in Japanese and Western healthy volunteers, and patients with T2DM, including patients with mild to severe CKD with an estimated glomerular filtration rate (eGFR) > 14 mL/min/1.73 m2 were included in a population PK analysis. Pharmacokinetic simulations were conducted using a population PK model, and the area under concentration-time curve (AUC) was extrapolated with power regression analysis to lower eGFR. The influence of eGFR, weight, and age on apparent clearance and of dose on relative bioavailability were quantified by population PK analysis. Simulations and extrapolation revealed that the recommended dosing regimen based on the AUC was 500 mg twice daily (b.i.d.) for patients with eGFR 15-45 mL/min/1.73 m2 , and 500 mg with a longer dosing interval was suggested for those with eGFR < 15. Simulations revealed that differences in plasma AUCs between Japanese and Western patients at the same dose were mainly driven by a difference in the eGFR and that the plasma AUC after 1,000 and 1,500 mg b.i.d. in Japanese and Western patients, respectively, was comparable in the phase IIb studies. These results indicate suitable dosages of imeglimin in the clinical setting of T2DM with renal impairment.
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Affiliation(s)
- Yoshiko Tomita
- Drug Development Division, Sumitomo Dainippon Pharma Co., Ltd, Osaka, Japan
| | | | | | | | | | | | - Atsushi Kitamura
- Drug Development Division, Sumitomo Dainippon Pharma Co., Ltd, Osaka, Japan
| | - Daisuke Nemoto
- Drug Development Division, Sumitomo Dainippon Pharma Co., Ltd, Osaka, Japan
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Lalanne S, Le Vée M, Lemaitre F, Le Corre P, Verdier MC, Fardel O. Differential interactions of the β-lactam cloxacillin with human renal organic anion transporters (OATs). Fundam Clin Pharmacol 2020; 34:476-483. [PMID: 32100322 DOI: 10.1111/fcp.12541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/20/2019] [Revised: 01/27/2020] [Accepted: 01/31/2020] [Indexed: 01/17/2023]
Abstract
The β-lactam penicillin antibiotic cloxacillin (CLX) presents wide inter-individual pharmacokinetics variability. To better understand its molecular basis, the precise identification of the detoxifying actors involved in CLX disposition and elimination would be useful, notably with respect to renal secretion known to play a notable role in CLX elimination. The present study was consequently designed to analyze the interactions of CLX with the solute carrier transporters organic anion transporter (OAT) 1 and OAT3, implicated in tubular secretion through mediating drug entry at the basolateral pole of renal proximal cells. CLX was first shown to block OAT1 and OAT3 activity in cultured OAT-overexpressing HEK293 cells. Half maximal inhibitory concentration (IC50 ) value for OAT3 (13 µm) was however much lower than that for OAT1 (560 µm); clinical inhibition of OAT activity and drug-drug interactions may consequently be predicted for OAT3, but not OAT1. OAT3, unlike OAT1, was next shown to mediate CLX uptake in OAT-overexpressing HEK293 cells. Kinetic parameters for this OAT3-mediated transport of CLX (Km = 10.7 µm) were consistent with a possible in vivo saturation of this process for high CLX plasma concentrations. OAT3 is consequently likely to play a pivotal role in renal CLX secretion and consequently in total renal CLX elimination, owing to the low plasma unbound fraction of the antibiotic. OAT3 genetic polymorphisms as well as co-administered drugs inhibiting in vivo OAT3 activity may therefore be considered as potential sources of CLX pharmacokinetics variability.
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Affiliation(s)
- Sébastien Lalanne
- Laboratory of Experimental and Clinical Pharmacology, Faculty of Medicine, Univ Rennes, CHU Rennes, 2 avenue du Professeur Léon Bernard, F-35000, Rennes, France
| | - Marc Le Vée
- Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Univ Rennes, 2 avenue du Professeur Léon Bernard, F-35000, Rennes, France
| | - Florian Lemaitre
- Laboratory of Experimental and Clinical Pharmacology, Faculty of Medicine, Univ Rennes, CHU Rennes, 2 avenue du Professeur Léon Bernard, F-35000, Rennes, France
| | - Pascal Le Corre
- Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, CHU Rennes, Univ Rennes, 2 avenue du Professeur Léon Bernard, F-35000, Rennes, France
| | - Marie-Clémence Verdier
- Laboratory of Experimental and Clinical Pharmacology, Faculty of Medicine, Univ Rennes, CHU Rennes, 2 avenue du Professeur Léon Bernard, F-35000, Rennes, France
| | - Olivier Fardel
- Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, CHU Rennes, Univ Rennes, 2 avenue du Professeur Léon Bernard, F-35000, Rennes, France
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Müller F, Weitz D, Derdau V, Sandvoss M, Mertsch K, König J, Fromm MF. Contribution of MATE1 to Renal Secretion of the NMDA Receptor Antagonist Memantine. Mol Pharm 2017; 14:2991-2998. [PMID: 28708400 DOI: 10.1021/acs.molpharmaceut.7b00179] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The weak base memantine is actively secreted into urine, however the underlying mechanisms are insufficiently understood. Potential candidates involved in memantine renal secretion are organic cation transporter 2 (OCT2) and multidrug and toxin extrusion proteins (MATE1, MATE2-K). The aim of this in vitro study was the examination of the interaction of memantine with OCT2 and MATEs. Memantine transporter inhibition and transport were examined in HEK cells expressing human OCT2, MATE1, or MATE2-K. Monolayers of single- (MDCK-OCT2, MDCK-MATE1) and double-transfected MDCK cells (MDCK-OCT2-MATE1) were used for studies on vectorial, basal to apical memantine transport. Memantine inhibited OCT2-, MATE1-, and MATE2-K-mediated metformin transport with IC50 values of 3.2, 40.9, and 315.3 μM, respectively. In HEK cells, no relevant memantine uptake by OCT2, MATE1, or MATE2-K was detected. Vectorial transport experiments, however, indicated a role of MATE1 for memantine export: After memantine administration to the basal side of the monolayers, memantine cellular accumulation was considerably lower (MDCK-MATE1 vs MDCK control cells, P < 0.01) and memantine transcellular, basal to apical transport was higher in MATE1 expressing cells (MDCK-MATE1 vs MDCK control cells, P < 0.001 at 60 and 180 min). Both effects were abolished upon addition of the MATE inhibitor cimetidine. These experiments suggest a relevant role of MATE1 for renal secretion of memantine. In the clinical setting, renal elimination of memantine could be impaired by coadministration of MATE inhibitors.
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Affiliation(s)
- Fabian Müller
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg , Fahrstrasse 17, 91054 Erlangen, Germany
| | - Dietmar Weitz
- R&D, Drug Metabolism and Pharmacokinetics, Sanofi-Aventis Deutschland GmbH , 65926 Frankfurt am Main, Germany
| | - Volker Derdau
- R&D, Integrated Drug Discovery, Sanofi-Aventis Deutschland GmbH , 65926 Frankfurt am Main, Germany
| | - Martin Sandvoss
- R&D, Integrated Drug Discovery, Sanofi-Aventis Deutschland GmbH , 65926 Frankfurt am Main, Germany
| | - Katharina Mertsch
- R&D, Drug Metabolism and Pharmacokinetics, Sanofi-Aventis Deutschland GmbH , 65926 Frankfurt am Main, Germany
| | - Jörg König
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg , Fahrstrasse 17, 91054 Erlangen, Germany
| | - Martin F Fromm
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg , Fahrstrasse 17, 91054 Erlangen, Germany
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Islam Z, Hayashi N, Yamamoto Y, Doi H, Romero MF, Hirose S, Kato A. Identification and proximal tubular localization of the Mg²⁺ transporter, Slc41a1, in a seawater fish. Am J Physiol Regul Integr Comp Physiol 2013; 305:R385-96. [PMID: 23761638 DOI: 10.1152/ajpregu.00507.2012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The second most abundant cation in seawater (SW), Mg²⁺, is present at concentrations of ~53 mM. Marine teleosts maintain plasma Mg²⁺ concentration at 1-2 mM by excreting Mg²⁺ into the urine. Urine Mg²⁺ concentrations of SW teleosts exceed 70 mM, most of which is secreted by the renal tubular epithelial cells. However, molecular mechanisms of the Mg²⁺ secretion have yet to be clarified. To identify transporters involved in Mg²⁺ secretion, we analyzed the expression of fish homologs of the Slc41 Mg²⁺ transporter family in various tissues of SW pufferfish torafugu (Takifugu rubripes) and its closely related euryhaline species mefugu (Takifugu obscurus). Takifugu genome contained five members of Slc41 genes, and only Slc41a1 was highly expressed in the kidney. Renal expression of Slc41a1 was markedly elevated when mefugu were transferred from fresh water (FW) to SW. In situ hybridization analysis and immunohistochemistry at the light and electron microscopic levels revealed that Slc41a1 is localized to vacuoles in the apical cytoplasm of the proximal tubules. These results suggest that pufferfish Slc41a1 is a Mg²⁺ transporter involved in renal tubular transepithelial Mg²⁺ secretion by mediating Mg²⁺ transport from the cytosol to the vacuolar lumen, and support the hypothesis that Mg²⁺ secretion is mediated by exocytosis of Mg²⁺-rich vacuoles to the lumen.
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Affiliation(s)
- Zinia Islam
- Department of Biological Sciences, Tokyo Institute of Technology, Yokohama, Japan
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Abstract
1. Transepithelial transport of a fluorescent derivative of octreotide (NBD-octreotide) was studied in freshly isolated, functionally intact renal proximal tubules from killifish (Fundulus heteroclitus). 2. Drug accumulation in the tubular lumen was visualized by means of confocal microscopy and was measured by image analysis. Secretion of NBD-octreotide into the tubular lumen was demonstrated and exhibited the all characteristics of specific and energy-dependent transport. Steady state luminal fluorescence averaged about five times cellular fluorescence and was reduced to cellular levels when metabolism was inhibited by NaCN. 3. NBD-octreotide secretion was inhibited in a concentration-dependent manner by unlabelled octreotide, verapamil and leukotriene C(4) (LTC(4)). Conversely, unlabelled octreotide reduced in a concentration dependent manner the p-glycoprotein (Pgp)-mediated secretion of a fluorescent cyclosporin A derivative (NBDL-CS) and the mrp2-mediated secretion of fluorescein methotrexate (FL-MTX). 4. This inhibition was not due to impaired metabolism or toxicity since octreotide had no influence on the active transport of fluorescein (FL), a substrate for the classical renal organic anion transport system. 5. The data are consistent with octreotide being transported across the brush border membrane of proximal kidney tubules by both Pgp and mrp2.
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Affiliation(s)
- Heike Gutmann
- Mount Desert Island Biological Laboratory, Salsbury Cove, Maine, ME, 04672 U.S.A
- Division of Clinical Pharmacology, Department of Internal Medicine and Department of Research, University Clinic (Kantonsspital), Basel, Switzerland
| | - David S Miller
- Mount Desert Island Biological Laboratory, Salsbury Cove, Maine, ME, 04672 U.S.A
- National Institutes of Environmental Health Sciences, Research Triangle Park, North Carolina, U.S.A
| | - Agathe Droulle
- Mount Desert Island Biological Laboratory, Salsbury Cove, Maine, ME, 04672 U.S.A
- Lycee Roosevelt, 51100 Reims, France
| | - Jürgen Drewe
- Division of Clinical Pharmacology, Department of Internal Medicine and Department of Research, University Clinic (Kantonsspital), Basel, Switzerland
| | - Alfred Fahr
- Mount Desert Island Biological Laboratory, Salsbury Cove, Maine, ME, 04672 U.S.A
- Institute for Pharmaceutics and Biopharmacy, University of Marburg, D-35032 Marburg, Germany
| | - Gert Fricker
- Mount Desert Island Biological Laboratory, Salsbury Cove, Maine, ME, 04672 U.S.A
- Institute for Pharmaceutics and Biopharmacy, University of Heidelberg, D-69120 Heidelberg, Germany
- Author for correspondence:
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