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Zhang X, Pan J, Ye X, Chen Y, Wang L, Meng X, Chen W, Wang F. Activation of CYP3A by Accelerated Blood Clearance Phenomenon Potentiates the Hepatocellular Carcinoma-Targeting Therapeutic Effects of PEGylated Anticancer Prodrug Liposomes. Drug Metab Dispos 2023; 51:1651-1662. [PMID: 37775330 DOI: 10.1124/dmd.123.001496] [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: 08/09/2023] [Revised: 09/14/2023] [Accepted: 09/25/2023] [Indexed: 10/01/2023] Open
Abstract
Reduced enzyme activity in hepatocellular carcinoma (HCC) and poor targeting limit the application of enzyme-activating prodrugs, which is also detrimental to the effective treatment of HCC. Here, we investigated whether accelerated blood clearance (ABC) phenomenon occurs in HCC models following repeated injections of PEGylated liposomes (PEG-L), thus inducing prodrug accumulation and activation in the liver and exerting highly effective and low-toxicity therapeutic effects on HCC. First, PEGylated liposomal cyclophosphamide was prepared by solvent injection and characterized. Importantly, preinjection of PEG-L induced the ABC phenomenon and activation of CYP3A in both HCC rats and HCC mice by studying the effects of repeated injections of PEG-L on pharmacokinetics and tissue distribution. Next, the efficacy and toxicity of repeated injections of PEG-L in HCC mice were examined, and our data indicate that repeated injections are administered in a manner that significantly enhances the antitumor effect compared with controls, with little or no toxicity to other organs. To further reveal the pharmacokinetic mechanism of PEG-L repeated administration for the treatment of HCC, the protein expression of hepatic CYP3A and the concentration of cyclophosphamide in the liver and spleen of HCC mice by inhibiting CYP3A were analyzed. These results revealed that inducing CYP3A to accelerate the rapid conversion of prodrugs that accumulate significantly in the liver is a key mechanism for the treatment of HCC with repeated injections of PEG-L. Collectively, this work taps into the application potential of the ABC phenomenon and provides new insights into the clinical application of PEGylated nanoformulations. SIGNIFICANCE STATEMENT: This study revealed that repeated injections of PEGylated liposomes could induce the accelerated blood clearance (ABC) phenomenon characterized by hepatic accumulation and CYP3A activation based on hepatocellular carcinoma (HCC) rats and HCC mice. Furthermore, it was verified that induction of the ABC phenomenon dependent on hepatic accumulation and CYP3A activation could enhance the antihepatocellular carcinoma effects of PEGylated anticancer prodrugs in HCC mice. This elucidated the relevant pharmacokinetic mechanisms and unearthed new clues for solving the clinical application of PEGylated nanoparticles.
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Affiliation(s)
- Xue Zhang
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei, China (X.Z., J.P., L.W., W.C., F.W.); Hefei Hospital Affiliated to Anhui Medical University (The Second People's Hospital of Hefei), Hefei, China (X.Y., X.M., F.W.); School of Pharmacy, Anhui Medical University, Hefei, China (F.W.); The Second People's Hospital of Hefei, Affiliated to Bengbu Medical College, Hefei, China (F.W.); and Ministry of Education and Key Laboratory of Molecular Biology (Brain diseases), Anhui University of Chinese Medicine, Hefei, China (Y.C.)
| | - Jianquan Pan
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei, China (X.Z., J.P., L.W., W.C., F.W.); Hefei Hospital Affiliated to Anhui Medical University (The Second People's Hospital of Hefei), Hefei, China (X.Y., X.M., F.W.); School of Pharmacy, Anhui Medical University, Hefei, China (F.W.); The Second People's Hospital of Hefei, Affiliated to Bengbu Medical College, Hefei, China (F.W.); and Ministry of Education and Key Laboratory of Molecular Biology (Brain diseases), Anhui University of Chinese Medicine, Hefei, China (Y.C.)
| | - Xi Ye
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei, China (X.Z., J.P., L.W., W.C., F.W.); Hefei Hospital Affiliated to Anhui Medical University (The Second People's Hospital of Hefei), Hefei, China (X.Y., X.M., F.W.); School of Pharmacy, Anhui Medical University, Hefei, China (F.W.); The Second People's Hospital of Hefei, Affiliated to Bengbu Medical College, Hefei, China (F.W.); and Ministry of Education and Key Laboratory of Molecular Biology (Brain diseases), Anhui University of Chinese Medicine, Hefei, China (Y.C.)
| | - Yunna Chen
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei, China (X.Z., J.P., L.W., W.C., F.W.); Hefei Hospital Affiliated to Anhui Medical University (The Second People's Hospital of Hefei), Hefei, China (X.Y., X.M., F.W.); School of Pharmacy, Anhui Medical University, Hefei, China (F.W.); The Second People's Hospital of Hefei, Affiliated to Bengbu Medical College, Hefei, China (F.W.); and Ministry of Education and Key Laboratory of Molecular Biology (Brain diseases), Anhui University of Chinese Medicine, Hefei, China (Y.C.)
| | - Lei Wang
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei, China (X.Z., J.P., L.W., W.C., F.W.); Hefei Hospital Affiliated to Anhui Medical University (The Second People's Hospital of Hefei), Hefei, China (X.Y., X.M., F.W.); School of Pharmacy, Anhui Medical University, Hefei, China (F.W.); The Second People's Hospital of Hefei, Affiliated to Bengbu Medical College, Hefei, China (F.W.); and Ministry of Education and Key Laboratory of Molecular Biology (Brain diseases), Anhui University of Chinese Medicine, Hefei, China (Y.C.)
| | - Xiangyun Meng
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei, China (X.Z., J.P., L.W., W.C., F.W.); Hefei Hospital Affiliated to Anhui Medical University (The Second People's Hospital of Hefei), Hefei, China (X.Y., X.M., F.W.); School of Pharmacy, Anhui Medical University, Hefei, China (F.W.); The Second People's Hospital of Hefei, Affiliated to Bengbu Medical College, Hefei, China (F.W.); and Ministry of Education and Key Laboratory of Molecular Biology (Brain diseases), Anhui University of Chinese Medicine, Hefei, China (Y.C.)
| | - Weidong Chen
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei, China (X.Z., J.P., L.W., W.C., F.W.); Hefei Hospital Affiliated to Anhui Medical University (The Second People's Hospital of Hefei), Hefei, China (X.Y., X.M., F.W.); School of Pharmacy, Anhui Medical University, Hefei, China (F.W.); The Second People's Hospital of Hefei, Affiliated to Bengbu Medical College, Hefei, China (F.W.); and Ministry of Education and Key Laboratory of Molecular Biology (Brain diseases), Anhui University of Chinese Medicine, Hefei, China (Y.C.).
| | - Fengling Wang
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei, China (X.Z., J.P., L.W., W.C., F.W.); Hefei Hospital Affiliated to Anhui Medical University (The Second People's Hospital of Hefei), Hefei, China (X.Y., X.M., F.W.); School of Pharmacy, Anhui Medical University, Hefei, China (F.W.); The Second People's Hospital of Hefei, Affiliated to Bengbu Medical College, Hefei, China (F.W.); and Ministry of Education and Key Laboratory of Molecular Biology (Brain diseases), Anhui University of Chinese Medicine, Hefei, China (Y.C.).
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Abbott K, Salamat JM, Flannery PC, Chaudhury CS, Chandran A, Vishveshwara S, Mani S, Huang J, Tiwari AK, Pondugula SR. Gefitinib Inhibits Rifampicin-Induced CYP3A4 Gene Expression in Human Hepatocytes. ACS OMEGA 2022; 7:34034-34044. [PMID: 36188260 PMCID: PMC9520547 DOI: 10.1021/acsomega.2c03270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/02/2022] [Indexed: 06/16/2023]
Abstract
During multidrug combination chemotherapy, activation of the nuclear receptor and the transcription factor human pregnane xenobiotic receptor (hPXR) has been shown to play a role in the development of chemoresistance. Mechanistically, this could occur due to the cancer drug activation of hPXR and the subsequent upregulation of hPXR target genes such as the drug metabolism enzyme, cytochrome P450 3A4 (CYP3A4). In the context of hPXR-mediated drug resistance, hPXR antagonists would be useful adjuncts to PXR-activating chemotherapy. However, there are currently no clinically approved hPXR antagonists in the market. Gefitinib (GEF), a tyrosine kinase inhibitor used for the treatment of advanced non-small-cell lung cancer and effectively used in combinational chemotherapy treatments, is a promising candidate owing to its hPXR ligand-like features. We, therefore, investigated whether GEF would act as an hPXR antagonist when combined with a known hPXR agonist, rifampicin (RIF). At therapeutically relevant concentrations, GEF successfully inhibited the RIF-induced upregulation of endogenous CYP3A4 gene expression in human primary hepatocytes and human hepatocells. Additionally, GEF inhibited the RIF induction of hPXR-mediated CYP3A4 promoter activity in HepG2 human liver carcinoma cells. The computational modeling of molecular docking predicted that GEF could bind to multiple sites on hPXR including the ligand-binding pocket, allowing for potential as a direct antagonist as well as an allosteric inhibitor. Indeed, GEF bound to the ligand-binding domain of the hPXR in cell-free assays, suggesting that GEF directly interacts with the hPXR. Taken together, our results suggest that GEF, at its clinically relevant therapeutic concentration, can antagonize the hPXR agonist-induced CYP3A4 gene expression in human hepatocytes. Thus, GEF could be a potential candidate for use in combinational chemotherapies to combat hPXR agonist-induced chemoresistance. Further studies are warranted to determine whether GEF has sufficient hPXR inhibitor abilities to overcome the hPXR agonist-induced chemoresistance.
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Affiliation(s)
- Kodye
L. Abbott
- Department
of Anatomy, Physiology and Pharmacology, Auburn University, Auburn, Alabama 36849, United States
- Auburn
University Research Initiative in Cancer, Auburn University, Auburn, Alabama 36849, United States
- Salk
Institute for Biological Studies, La Jolla, California 92037, United States
| | - Julia M. Salamat
- Department
of Anatomy, Physiology and Pharmacology, Auburn University, Auburn, Alabama 36849, United States
- Auburn
University Research Initiative in Cancer, Auburn University, Auburn, Alabama 36849, United States
| | - Patrick C. Flannery
- Department
of Anatomy, Physiology and Pharmacology, Auburn University, Auburn, Alabama 36849, United States
- Auburn
University Research Initiative in Cancer, Auburn University, Auburn, Alabama 36849, United States
- Salk
Institute for Biological Studies, La Jolla, California 92037, United States
| | - Chloe S. Chaudhury
- Department
of Anatomy, Physiology and Pharmacology, Auburn University, Auburn, Alabama 36849, United States
- Auburn
University Research Initiative in Cancer, Auburn University, Auburn, Alabama 36849, United States
| | - Aneesh Chandran
- Department
of Biotechnology and Microbiology, Kannur
University, Kannur, Kerala 670661, India
| | | | - Sridhar Mani
- Albert Einstein
Cancer Center, Albert Einstein College of
Medicine, New York 10461, United States
| | - Jianfeng Huang
- Salk
Institute for Biological Studies, La Jolla, California 92037, United States
| | - Amit K. Tiwari
- Center
of Medical Bio-Allied Health Sciences Research, Ajman University, Ajman 306, United Arab Emirates
- Department
of Pharmacology and Experimental Therapeutics, University of Toledo, Toledo, Ohio 43606, United States
- Department
of Cell and Cancer Biology, University of
Toledo, Toledo, Ohio 43614, United
States
| | - Satyanarayana R. Pondugula
- Department
of Anatomy, Physiology and Pharmacology, Auburn University, Auburn, Alabama 36849, United States
- Auburn
University Research Initiative in Cancer, Auburn University, Auburn, Alabama 36849, United States
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Lu Y, Wang Y, He Y, Pan J, Jin Y, Zheng L, Huang Y, Li Y, Liu W. Aidi injection altered the activity of CYP2D4, CYP1A2, CYP2C19, CYP3A2, CYP2E1 and CYP2C11 in normal and diethylnitrosamine-induced hepatocellular carcinoma in rats. JOURNAL OF ETHNOPHARMACOLOGY 2022; 286:114930. [PMID: 34952190 DOI: 10.1016/j.jep.2021.114930] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/16/2021] [Accepted: 12/16/2021] [Indexed: 06/14/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Aidi injection (ADI), a traditional chinese medicine preparation, is widely used in combination with chemotherapy for the treatment of various malignant tumors, such as hepatocellular carcinoma (HCC). Studies have shown that changes in cytochrome P450 (CYP450) activity in disease states would affect the metabolism of drugs in vivo, especially liver diseases. However, the changes of Aidi injection on the activities of CYP2D4, CYP1A2, CYP2C19, CYP3A2, CYP2E1 and CYP2C11 in normal and HCC states are still unknown. AIM OF THE STUDY The cocktail probe drugs method was used to investigate the effects of ADI on the activity of CYP2D4, CYP1A2, CYP2C19, CYP3A2, CYP2E1 and CYP2C11 in normal and HCC rats. MATERIALS AND METHODS The HCC rats was induced by diethylnitrosamine (DEN). Then, both normal and HCC rats were randomly divided into 2 groups (n = 6). They were given saline or ADI (10 mL/kg/d, i.p) for 2 weeks, respectively. On the fifteenth day, cocktail probe mixing solution, including metoprolol (10 mg/kg), caffeine (1.0 mg/kg), omeprazole (2.0 mg/kg), midazolam (2.0 mg/kg), chlorzoxazone (4.0 mg/kg) and tolbutamide (0.5 mg/kg), was injected into tail vein of all rats in each group. The blood sample was obtained at specified time. After the protein is precipitated, six probe drugs are analyzed by ultra performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS). RESULTS Compared with control group, the activity of CYP3A2 and CYP2E1 was significantly lower in the ADI group. Compared with the model group, the activities of CYP1A2, CYP3A2, CYP2E1, and CYP2C11 enzymes in the ADI model group were significantly reduced. Additionally, the activity of CYP2D4, CYP1A2, CYP2C19, CYP3A2, CYP2E1 and CYP2C11 enzymes in model group was significantly lower than control group. CONCLUSIONS ADI can inhibit a lot of CYP450 enzyme, so it may reduce the dosage of chemotherapeutic drugs to reach the required plasma concentration of chemotherapeutic drugs, which is of great significance for the combination of anti-tumor chemotherapeutic drugs and is worthy of further in-depth study and clinical attention.
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Affiliation(s)
- Yuan Lu
- The Affiliated Hospital of Guizhou Medical University, 28(#) Guiyi Road, Guiyang, 550004, Guizhou, China; State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Provincial Key Laboratory of Pharmaceutics, Guizhou Medical University, Guiyang, 550004, China; School of Pharmacy, Guizhou Medical University, No.9, Beijing Road, Yunyan District, Guiyang, 550004, China
| | - Yanli Wang
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Provincial Key Laboratory of Pharmaceutics, Guizhou Medical University, Guiyang, 550004, China; School of Pharmacy, Guizhou Medical University, No.9, Beijing Road, Yunyan District, Guiyang, 550004, China
| | - Yan He
- The Affiliated Hospital of Guizhou Medical University, 28(#) Guiyi Road, Guiyang, 550004, Guizhou, China
| | - Jie Pan
- Engineering Research Center for the Development and Application of Ethnic Medicine and TCM (Ministry of Education), Guizhou Medical University, Guiyang, 550004, China
| | - Yang Jin
- School of Pharmacy, Guizhou Medical University, No.9, Beijing Road, Yunyan District, Guiyang, 550004, China
| | - Lin Zheng
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Provincial Key Laboratory of Pharmaceutics, Guizhou Medical University, Guiyang, 550004, China
| | - Yong Huang
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Provincial Key Laboratory of Pharmaceutics, Guizhou Medical University, Guiyang, 550004, China
| | - Yongjun Li
- Engineering Research Center for the Development and Application of Ethnic Medicine and TCM (Ministry of Education), Guizhou Medical University, Guiyang, 550004, China; School of Pharmacy, Guizhou Medical University, No.9, Beijing Road, Yunyan District, Guiyang, 550004, China
| | - Wen Liu
- The Affiliated Hospital of Guizhou Medical University, 28(#) Guiyi Road, Guiyang, 550004, Guizhou, China; School of Pharmacy, Guizhou Medical University, No.9, Beijing Road, Yunyan District, Guiyang, 550004, China.
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Fujino C, Sanoh S, Katsura T. Variation in Expression of Cytochrome P450 3A Isoforms and Toxicological Effects: Endo- and Exogenous Substances as Regulatory Factors and Substrates. Biol Pharm Bull 2021; 44:1617-1634. [PMID: 34719640 DOI: 10.1248/bpb.b21-00332] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The CYP3A subfamily, which includes isoforms CYP3A4, CYP3A5, and CYP3A7 in humans, plays important roles in the metabolism of various endogenous and exogenous substances. Gene and protein expression of CYP3A4, CYP3A5, and CYP3A7 show large inter-individual differences, which are caused by many endogenous and exogenous factors. Inter-individual differences can cause negative outcomes, such as adverse drug events and disease development. Therefore, it is important to understand the variations in CYP3A expression caused by endo- and exogenous factors, as well as the variation in the metabolism and kinetics of endo- and exogenous substrates. In this review, we summarize the factors regulating CYP3A expression, such as bile acids, hormones, microRNA, inflammatory cytokines, drugs, environmental chemicals, and dietary factors. In addition, variations in CYP3A expression under pathological conditions, such as coronavirus disease 2019 and liver diseases, are described as examples of the physiological effects of endogenous factors. We also summarize endogenous and exogenous substrates metabolized by CYP3A isoforms, such as cholesterol, bile acids, hormones, arachidonic acid, vitamin D, and drugs. The relationship between the changes in the kinetics of these substrates and the toxicological effects in our bodies are discussed. The usefulness of these substrates and metabolites as endogenous biomarkers for CYP3A activity is also discussed. Notably, we focused on discrimination between CYP3A4, CYP3A5, and CYP3A7 to understand inter-individual differences in CYP3A expression and function.
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Affiliation(s)
- Chieri Fujino
- Laboratory of Clinical Pharmaceutics and Therapeutics, College of Pharmaceutical Sciences, Ritsumeikan University
| | - Seigo Sanoh
- Graduate School of Biomedical and Health Sciences, Hiroshima University.,School of Pharmaceutical Sciences, Wakayama Medical University
| | - Toshiya Katsura
- Laboratory of Clinical Pharmaceutics and Therapeutics, College of Pharmaceutical Sciences, Ritsumeikan University
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Interpreting the Molecular Mechanisms of Yinchenhao Decoction on Hepatocellular Carcinoma through Absorbed Components Based on Network Pharmacology. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6616908. [PMID: 34104649 PMCID: PMC8159653 DOI: 10.1155/2021/6616908] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/23/2021] [Accepted: 05/07/2021] [Indexed: 12/13/2022]
Abstract
To investigate the mechanisms through which Yinchenhao decoction (YCHD) inhibits hepatocellular carcinoma (HCC), we analyzed YCHD ingredients absorbed into the bloodstream by using network pharmacology. We conducted a weighted gene coexpression network analysis on gene expression data collected from the Gene Expression Omnibus and The Cancer Genome Atlas databases to derive an HCC gene set; moreover, we used four online prediction system databases to predict the potential targets of YCHD ingredients absorbed into the bloodstream. We discovered that YCHD directly interfered with 17 HCC-related disease targets. Subsequent gene ontology enrichment analyses of these 17 disease targets revealed that YCHD exhibited effects through 17 biological processes, 7 molecular functions, and 9 cellular components. Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses indicated 14 pathways through which YCHD inhibits HCC. We observed similar trends in how the 17 small molecules interfered with the key target set. We surmised that YCHD inhibits HCC by regulating inflammatory and metabolic pathways. Network pharmacological analysis of YCHD ingredients absorbed into the bloodstream may provide new insights and serve as a new method for discovering the molecular mechanisms through which YCHD inhibits HCC.
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Farooqi HMU, Kang B, Khalid MAU, Salih ARC, Hyun K, Park SH, Huh D, Choi KH. Real-time monitoring of liver fibrosis through embedded sensors in a microphysiological system. NANO CONVERGENCE 2021; 8:3. [PMID: 33528697 PMCID: PMC7855143 DOI: 10.1186/s40580-021-00253-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/18/2021] [Indexed: 05/03/2023]
Abstract
Hepatic fibrosis is a foreshadowing of future adverse events like liver cirrhosis, liver failure, and cancer. Hepatic stellate cell activation is the main event of liver fibrosis, which results in excessive extracellular matrix deposition and hepatic parenchyma's disintegration. Several biochemical and molecular assays have been introduced for in vitro study of the hepatic fibrosis progression. However, they do not forecast real-time events happening to the in vitro models. Trans-epithelial electrical resistance (TEER) is used in cell culture science to measure cell monolayer barrier integrity. Herein, we explored TEER measurement's utility for monitoring fibrosis development in a dynamic cell culture microphysiological system. Immortal HepG2 cells and fibroblasts were co-cultured, and transforming growth factor β1 (TGF-β1) was used as a fibrosis stimulus to create a liver fibrosis-on-chip model. A glass chip-based embedded TEER and reactive oxygen species (ROS) sensors were employed to gauge the effect of TGF-β1 within the microphysiological system, which promotes a positive feedback response in fibrosis development. Furthermore, albumin, Urea, CYP450 measurements, and immunofluorescent microscopy were performed to correlate the following data with embedded sensors responses. We found that chip embedded electrochemical sensors could be used as a potential substitute for conventional end-point assays for studying fibrosis in microphysiological systems.
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Affiliation(s)
| | - Bohye Kang
- Department of Mechatronics Engineering, Jeju National University, Jeju-si, Republic of Korea
| | | | | | - Kinam Hyun
- Department of Mechatronics Engineering, Jeju National University, Jeju-si, Republic of Korea
| | - Sung Hyuk Park
- Department of Mechatronics Engineering, Jeju National University, Jeju-si, Republic of Korea
| | - Dongeun Huh
- Department of Bioengineering, University of Pennsylvania, Philadelphia, USA
| | - Kyung Hyun Choi
- Department of Mechatronics Engineering, Jeju National University, Jeju-si, Republic of Korea.
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Abbott KL, Flannery PC, Gill KS, Boothe DM, Dhanasekaran M, Mani S, Pondugula SR. Adverse pharmacokinetic interactions between illicit substances and clinical drugs. Drug Metab Rev 2019; 52:44-65. [PMID: 31826670 DOI: 10.1080/03602532.2019.1697283] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Adverse pharmacokinetic interactions between illicit substances and clinical drugs are of a significant health concern. Illicit substances are taken by healthy individuals as well as by patients with medical conditions such as mental illnesses, acquired immunodeficiency syndrome, diabetes mellitus and cancer. Many individuals that use illicit substances simultaneously take clinical drugs meant for targeted treatment. This concomitant usage can lead to life-threatening pharmacokinetic interactions between illicit substances and clinical drugs. Optimal levels and activity of drug-metabolizing enzymes and drug-transporters are crucial for metabolism and disposition of illicit substances as well as clinical drugs. However, both illicit substances and clinical drugs can induce changes in the expression and/or activity of drug-metabolizing enzymes and drug-transporters. Consequently, with concomitant usage, illicit substances can adversely influence the therapeutic outcome of coadministered clinical drugs. Likewise, clinical drugs can adversely affect the response of coadministered illicit substances. While the interactions between illicit substances and clinical drugs pose a tremendous health and financial burden, they lack a similar level of attention as drug-drug, food-drug, supplement-drug, herb-drug, disease-drug, or other substance-drug interactions such as alcohol-drug and tobacco-drug interactions. This review highlights the clinical pharmacokinetic interactions between clinical drugs and commonly used illicit substances such as cannabis, cocaine and 3, 4-Methylenedioxymethamphetamine (MDMA). Rigorous efforts are warranted to further understand the underlying mechanisms responsible for these clinical pharmacokinetic interactions. It is also critical to extend the awareness of the life-threatening adverse interactions to both health care professionals and patients.
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Affiliation(s)
- Kodye L Abbott
- Department of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, AL, USA.,Auburn University Research Initiative in Cancer, Auburn University, Auburn, AL, USA
| | - Patrick C Flannery
- College of Osteopathic Medicine, Rocky Vista University, Parker, CO, USA
| | - Kristina S Gill
- Department of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, AL, USA.,Auburn University Research Initiative in Cancer, Auburn University, Auburn, AL, USA
| | - Dawn M Boothe
- Department of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, AL, USA.,Auburn University Research Initiative in Cancer, Auburn University, Auburn, AL, USA
| | - Muralikrishnan Dhanasekaran
- Auburn University Research Initiative in Cancer, Auburn University, Auburn, AL, USA.,Department of Drug Discovery and Development, Harrison School of Pharmacy, Auburn University, AL, USA
| | - Sridhar Mani
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Satyanarayana R Pondugula
- Department of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, AL, USA.,Auburn University Research Initiative in Cancer, Auburn University, Auburn, AL, USA
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