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Tátrai P, Krajcsi P. Prediction of Drug-Induced Hyperbilirubinemia by In Vitro Testing. Pharmaceutics 2020; 12:pharmaceutics12080755. [PMID: 32796590 PMCID: PMC7465333 DOI: 10.3390/pharmaceutics12080755] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/28/2020] [Accepted: 08/07/2020] [Indexed: 12/23/2022] Open
Abstract
Bilirubin, the end product of heme catabolism, is produced continuously in the body and may reach toxic levels if accumulates in the serum and tissues; therefore, a highly efficient mechanism evolved for its disposition. Normally, unconjugated bilirubin enters hepatocytes through the uptake transporters organic anion transporting polypeptide (OATP) 1B1 and 1B3, undergoes glucuronidation by the Phase II enzyme UDP glucuronosyltransferase 1A1 (UGT1A1), and conjugated forms are excreted into the bile by the canalicular export pump multidrug resistance protein 2 (MRP2). Any remaining conjugated bilirubin is transported back to the blood by MRP3 and passed on for uptake and excretion by downstream hepatocytes or the kidney. The bile salt export pump BSEP as the main motor of bile flow is indirectly involved in bilirubin disposition. Genetic mutations and xenobiotics that interfere with this machinery may impede bilirubin disposition and cause hyperbilirubinemia. Several pharmaceutical compounds are known to cause hyperbilirubinemia via inhibition of OATP1Bs, UGT1A1, or BSEP. Herein we briefly review the in vitro prediction methods that serve to identify drugs with a potential to induce hyperbilirubinemia. In vitro assays can be deployed early in drug development and may help to minimize late-stage attrition. Based on current evidence, drugs that behave as mono- or multispecific inhibitors of OATP1B1, UGT1A1, and BSEP in vitro are at risk of causing clinically significant hyperbilirubinemia. By integrating inhibition data from in vitro assays, drug serum concentrations, and clinical reports of hyperbilirubinemia, predictor cut-off values have been established and are provisionally suggested in this review. Further validation of in vitro readouts to clinical outcomes is expected to enhance the predictive power of these assays.
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Affiliation(s)
- Péter Tátrai
- Solvo Biotechnology, Science Park, Building B1, 4-20 Irinyi József utca, H-1117 Budapest, Hungary;
| | - Péter Krajcsi
- Solvo Biotechnology, Science Park, Building B1, 4-20 Irinyi József utca, H-1117 Budapest, Hungary;
- Faculty of Health Sciences, Semmelweis University, H-1085 Budapest, Hungary
- Faculty of Information Technology and Bionics, Péter Pázmány Catholic University, H-1083 Budapest, Hungary
- Correspondence:
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Kogame A, Moriya Y, Mori I, Pan L, Morohashi A, Ebihara T, Fukui H, Tagawa Y, Benet LZ. Characterization of Fasiglifam-Related Liver Toxicity in Dogs. Drug Metab Dispos 2019; 47:525-534. [PMID: 30765394 DOI: 10.1124/dmd.118.084889] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 02/07/2019] [Indexed: 11/22/2022] Open
Abstract
Fasiglifam, a potent and highly selective agonist of G protein-coupled receptor 40, was developed for the treatment of type 2 diabetes mellitus. However, phase III clinical programs were terminated owing to liver safety concerns. Fasiglifam-related liver toxicity was also observed in repeat-dose dog toxicology studies, characterized by granulomatous inflammation with crystal formation in the liver and/or bile ducts. These histopathological changes were not observed in rat toxicology studies. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry analysis of dog liver sections obtained from a repeat-dose toxicology study indicated that the crystalline material in the affected dog liver contained fasiglifam and fasiglifam glucuronide (fasiglifam-G). Nonclinical mechanistic studies indicated that after 14 days of repeated oral dosing with [14C]fasiglifam at 200 mg/kg per day to dogs, the concentrations of fasiglifam and fasiglifam-G in the bile exceeded the solubility limit of these compounds in the bile (approximately 3000 µg/ml). After single oral 2- and 200-mg/kg doses administered to rats and dogs, fasiglifam and fasiglifam-G concentrations in dog bile were 5- to 10-fold higher than those in rat bile for the same dose of fasiglifam, while the bile flow rate adjusted by body weight was 4- to 8-fold lower in dogs than in rats. High fasiglifam and fasiglifam-G concentrations in dog bile together with lower bile flow rate could cause crystal formation in dog bile, resulting in secondary granulomatous inflammation in the dog liver.
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Affiliation(s)
- Akifumi Kogame
- Drug Metabolism and Pharmacokinetics Research Laboratories (A.K., Y.M., A.M., T.E., Y.T.) and Drug Safety Research Laboratories (I.M., H.F.), Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited, Fujisawa, Kanagawa, Japan; Takeda Development Center Americas, Inc., Deerfield, Illinois (L.P.); and Department of Bioengineering and Therapeutic Sciences, Schools of Pharmacy and Medicine, University of California San Francisco, San Francisco, California (L.Z.B.)
| | - Yuu Moriya
- Drug Metabolism and Pharmacokinetics Research Laboratories (A.K., Y.M., A.M., T.E., Y.T.) and Drug Safety Research Laboratories (I.M., H.F.), Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited, Fujisawa, Kanagawa, Japan; Takeda Development Center Americas, Inc., Deerfield, Illinois (L.P.); and Department of Bioengineering and Therapeutic Sciences, Schools of Pharmacy and Medicine, University of California San Francisco, San Francisco, California (L.Z.B.)
| | - Ikuo Mori
- Drug Metabolism and Pharmacokinetics Research Laboratories (A.K., Y.M., A.M., T.E., Y.T.) and Drug Safety Research Laboratories (I.M., H.F.), Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited, Fujisawa, Kanagawa, Japan; Takeda Development Center Americas, Inc., Deerfield, Illinois (L.P.); and Department of Bioengineering and Therapeutic Sciences, Schools of Pharmacy and Medicine, University of California San Francisco, San Francisco, California (L.Z.B.)
| | - Liping Pan
- Drug Metabolism and Pharmacokinetics Research Laboratories (A.K., Y.M., A.M., T.E., Y.T.) and Drug Safety Research Laboratories (I.M., H.F.), Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited, Fujisawa, Kanagawa, Japan; Takeda Development Center Americas, Inc., Deerfield, Illinois (L.P.); and Department of Bioengineering and Therapeutic Sciences, Schools of Pharmacy and Medicine, University of California San Francisco, San Francisco, California (L.Z.B.)
| | - Akio Morohashi
- Drug Metabolism and Pharmacokinetics Research Laboratories (A.K., Y.M., A.M., T.E., Y.T.) and Drug Safety Research Laboratories (I.M., H.F.), Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited, Fujisawa, Kanagawa, Japan; Takeda Development Center Americas, Inc., Deerfield, Illinois (L.P.); and Department of Bioengineering and Therapeutic Sciences, Schools of Pharmacy and Medicine, University of California San Francisco, San Francisco, California (L.Z.B.)
| | - Takuya Ebihara
- Drug Metabolism and Pharmacokinetics Research Laboratories (A.K., Y.M., A.M., T.E., Y.T.) and Drug Safety Research Laboratories (I.M., H.F.), Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited, Fujisawa, Kanagawa, Japan; Takeda Development Center Americas, Inc., Deerfield, Illinois (L.P.); and Department of Bioengineering and Therapeutic Sciences, Schools of Pharmacy and Medicine, University of California San Francisco, San Francisco, California (L.Z.B.)
| | - Hideo Fukui
- Drug Metabolism and Pharmacokinetics Research Laboratories (A.K., Y.M., A.M., T.E., Y.T.) and Drug Safety Research Laboratories (I.M., H.F.), Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited, Fujisawa, Kanagawa, Japan; Takeda Development Center Americas, Inc., Deerfield, Illinois (L.P.); and Department of Bioengineering and Therapeutic Sciences, Schools of Pharmacy and Medicine, University of California San Francisco, San Francisco, California (L.Z.B.)
| | - Yoshihiko Tagawa
- Drug Metabolism and Pharmacokinetics Research Laboratories (A.K., Y.M., A.M., T.E., Y.T.) and Drug Safety Research Laboratories (I.M., H.F.), Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited, Fujisawa, Kanagawa, Japan; Takeda Development Center Americas, Inc., Deerfield, Illinois (L.P.); and Department of Bioengineering and Therapeutic Sciences, Schools of Pharmacy and Medicine, University of California San Francisco, San Francisco, California (L.Z.B.)
| | - Leslie Z Benet
- Drug Metabolism and Pharmacokinetics Research Laboratories (A.K., Y.M., A.M., T.E., Y.T.) and Drug Safety Research Laboratories (I.M., H.F.), Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited, Fujisawa, Kanagawa, Japan; Takeda Development Center Americas, Inc., Deerfield, Illinois (L.P.); and Department of Bioengineering and Therapeutic Sciences, Schools of Pharmacy and Medicine, University of California San Francisco, San Francisco, California (L.Z.B.)
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Wolenski FS, Zhu AZX, Johnson M, Yu S, Moriya Y, Ebihara T, Csizmadia V, Grieves J, Paton M, Liao M, Gemski C, Pan L, Vakilynejad M, Dragan YP, Chowdhury SK, Kirby PJ. Fasiglifam (TAK-875) Alters Bile Acid Homeostasis in Rats and Dogs: A Potential Cause of Drug Induced Liver Injury. Toxicol Sci 2018; 157:50-61. [PMID: 28108665 PMCID: PMC5414857 DOI: 10.1093/toxsci/kfx018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Fasiglifam (TAK-875), a Free Fatty Acid Receptor 1 (FFAR1) agonist in development for the treatment of type 2 diabetes, was voluntarily terminated in phase 3 due to adverse liver effects. A mechanistic investigation described in this manuscript focused on the inhibition of bile acid (BA) transporters as a driver of the liver findings. TAK-875 was an in vitro inhibitor of multiple influx (NTCP and OATPs) and efflux (BSEP and MRPs) hepatobiliary BA transporters at micromolar concentrations. Repeat dose studies determined that TAK-875 caused a dose-dependent increase in serum total BA in rats and dogs. Additionally, there were dose-dependent increases in both unconjugated and conjugated individual BAs in both species. Rats had an increase in serum markers of liver injury without correlative microscopic signs of tissue damage. Two of 6 dogs that received the highest dose of TAK-875 developed liver injury with clinical pathology changes, and by microscopic analysis had portal granulomatous inflammation with neutrophils around a crystalline deposition. The BA composition of dog bile also significantly changed in a dose-dependent manner following TAK-875 administration. At the highest dose, levels of taurocholic acid were 50% greater than in controls with a corresponding 50% decrease in taurochenodeoxycholic acid. Transporter inhibition by TAK-875 may cause liver injury in dogs through altered bile BA composition characteristics, as evidenced by crystalline deposition, likely composed of test article, in the bile duct. In conclusion, a combination of in vitro and in vivo evidence suggests that BA transporter inhibition could contribute to TAK-875-mediated liver injury in dogs.
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Affiliation(s)
| | - Andy Z X Zhu
- Takeda Pharmaceuticals International Co, Cambridge, Massachusetts, USA
| | - Mike Johnson
- Takeda Pharmaceuticals International Co, Cambridge, Massachusetts, USA
| | - Shaoxia Yu
- Takeda Pharmaceuticals International Co, Cambridge, Massachusetts, USA
| | - Yuu Moriya
- Takeda Pharmaceutical Company Limited, Fujisawa, Kanagawa, Japan
| | - Takuya Ebihara
- Takeda Pharmaceutical Company Limited, Fujisawa, Kanagawa, Japan
| | - Vilmos Csizmadia
- Takeda Pharmaceuticals International Co, Cambridge, Massachusetts, USA
| | - Jessica Grieves
- Takeda Pharmaceuticals International Co, Cambridge, Massachusetts, USA
| | - Martin Paton
- Takeda Pharmaceuticals International Co, Cambridge, Massachusetts, USA
| | - Mingxiang Liao
- Takeda Pharmaceuticals International Co, Cambridge, Massachusetts, USA
| | | | - Liping Pan
- Takeda Pharmaceuticals International Co, Deerfield, Illinois, USA
| | | | - Yvonne P Dragan
- Takeda Pharmaceuticals International Co, Cambridge, Massachusetts, USA
| | | | - Patrick J Kirby
- Takeda Pharmaceuticals International Co, Cambridge, Massachusetts, USA
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4
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Milligan G, Alvarez-Curto E, Hudson BD, Prihandoko R, Tobin AB. FFA4/GPR120: Pharmacology and Therapeutic Opportunities. Trends Pharmacol Sci 2017; 38:809-821. [PMID: 28734639 PMCID: PMC5582618 DOI: 10.1016/j.tips.2017.06.006] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/14/2017] [Accepted: 06/19/2017] [Indexed: 01/02/2023]
Abstract
Free Fatty Acid receptor 4 (FFA4), also known as GPR120, is a G-protein-coupled receptor (GPCR) responsive to long-chain fatty acids that is attracting considerable attention as a potential novel therapeutic target for the treatment of type 2 diabetes mellitus (T2DM). Although no clinical studies have yet been initiated to assess efficacy in this indication, a significant number of primary publications and patents have highlighted the ability of agonists with potency at FFA4 to improve glucose disposition and enhance insulin sensitivity in animal models. However, the distribution pattern of the receptor suggests that targeting FFA4 may also be useful in other conditions, ranging from cancer to lung function. Here, we discuss and contextualise the basis for these ideas and the results to support these conclusions. Substantial focus on the therapeutic potential of FFA4/GPR120 is currently directed towards type 2 diabetes. Progress in the identification and characterisation of FFA4/GPR120 agonist ligands is apparent in both the primary scientific and patent literatures. In models of glucose handling, FFA4/GPR120 agonists appear highly effective. Recent indications provide support for consideration of FFA4/GPR120 ligands in areas of cancer treatment. High levels of expression of FFA4/GPR120 in the lung suggest utility in analysis of the potential therapeutic roles of FFA4/GPR120 ligands in both acute and chronic airway inflammatory conditions.
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Affiliation(s)
- Graeme Milligan
- Centre for Translational Pharmacology, Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK.
| | - Elisa Alvarez-Curto
- Centre for Translational Pharmacology, Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Brian D Hudson
- Centre for Translational Pharmacology, Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Rudi Prihandoko
- Centre for Translational Pharmacology, Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Andrew B Tobin
- Centre for Translational Pharmacology, Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK.
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Li X, Zhong K, Guo Z, Zhong D, Chen X. Fasiglifam (TAK-875) Inhibits Hepatobiliary Transporters: A Possible Factor Contributing to Fasiglifam-Induced Liver Injury. Drug Metab Dispos 2015; 43:1751-9. [PMID: 26276582 DOI: 10.1124/dmd.115.064121] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 08/12/2015] [Indexed: 12/20/2022] Open
Abstract
Fasiglifam (TAK-875), a selective G-protein-coupled receptor 40 agonist, was developed for the treatment of type 2 diabetes mellitus; however, its development was terminated in phase III clinical trials because of liver safety concerns. Our preliminary study indicated that intravenous administration of 100 mg/kg of TAK-875 increased the serum total bile acid concentration by 3 to 4 times and total bilirubin levels by 1.5 to 2.6 times in rats. In the present study, we examined the inhibitory effects of TAK-875 on hepatobiliary transporters to explore the mechanisms underlying its hepatotoxicity. TAK-875 decreased the biliary excretion index and the in vitro biliary clearance of d₈-taurocholic acid in sandwich-cultured rat hepatocytes, suggesting that TAK-875 impaired biliary excretion of bile acids, possibly by inhibiting bile salt export pump (Bsep). TAK-875 inhibited the efflux transporter multidrug resistance-associated protein 2 (Mrp2) in rat hepatocytes using 5 (and 6)-carboxy-2',7'-dichlorofluorescein as a substrate. Inhibition of MRP2 was further confirmed by reduced transport of vinblastine in Madin-Darby canine kidney cells overexpressing MRP2 with IC₅₀ values of 2.41 μM. TAK-875 also inhibited the major bile acid uptake transporter Na(+)/taurocholate cotransporting polypeptide (Ntcp), which transports d₈-taurocholic acid into rat hepatocytes, with an IC₅₀ value of 10.9 μM. TAK-875 significantly inhibited atorvastatin uptake in organic anion transporter protein (OATP) 1B1 and OATP1B3 cells with IC₅₀ values of 2.28 and 3.98 μM, respectively. These results indicate that TAK-875 inhibited the efflux transporter MRP2/Mrp2 and uptake transporters Ntcp and OATP/Oatp, which may affect bile acid and bilirubin homeostasis, resulting in hyperbilirubinemia and cholestatic hepatotoxicity.
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Affiliation(s)
- Xiuli Li
- Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China
| | - Kan Zhong
- Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China
| | - Zitao Guo
- Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China
| | - Dafang Zhong
- Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China
| | - Xiaoyan Chen
- Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China
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