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Qin X, Wang Y, Ye Q, Hakenjos JM, Wang J, Teng M, Guo L, Tan Z, Young DW, MacKenzie KR, Li F. CYP3A Mediates an Unusual C(sp 2)-C(sp 3) Bond Cleavage via Ipso-Addition of Oxygen in Drug Metabolism. Angew Chem Int Ed Engl 2024; 63:e202405197. [PMID: 38574245 PMCID: PMC11126355 DOI: 10.1002/anie.202405197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/06/2024]
Abstract
Mammalian cytochrome P450 drug-metabolizing enzymes rarely cleave carbon-carbon (C-C) bonds and the mechanisms of such cleavages are largely unknown. We identified two unusual cleavages of non-polar, unstrained C(sp2)-C(sp3) bonds in the FDA-approved tyrosine kinase inhibitor pexidartinib that are mediated by CYP3A4/5, the major human phase I drug metabolizing enzymes. Using a synthetic ketone, we rule out the Baeyer-Villiger oxidation mechanism that is commonly invoked to address P450-mediated C-C bond cleavages. Our studies in 18O2 and H2 18O enriched systems reveal two unusual distinct mechanisms of C-C bond cleavage: one bond is cleaved by CYP3A-mediated ipso-addition of oxygen to a C(sp2) site of N-protected pyridin-2-amines, and the other occurs by a pseudo-retro-aldol reaction after hydroxylation of a C(sp3) site. This is the first report of CYP3A-mediated C-C bond cleavage in drug metabolism via ipso-addition of oxygen mediated mechanism. CYP3A-mediated ipso-addition is also implicated in the regioselective C-C cleavages of several pexidartinib analogs. The regiospecificity of CYP3A-catalyzed oxygen ipso-addition under environmentally friendly conditions may be attractive and inspire biomimetic or P450-engineering methods to address the challenging task of C-C bond cleavages.
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Affiliation(s)
- Xuan Qin
- Center for Drug Discovery, Department of Pathology and Immunology, Baylor College of Medicine, 1 Baylor Plaza, Houston, Texas, 77030, USA
| | - Yong Wang
- Center for Drug Discovery, Department of Pathology and Immunology, Baylor College of Medicine, 1 Baylor Plaza, Houston, Texas, 77030, USA
| | - Qiuji Ye
- Center for Drug Discovery, Department of Pathology and Immunology, Baylor College of Medicine, 1 Baylor Plaza, Houston, Texas, 77030, USA
| | - John M Hakenjos
- Center for Drug Discovery, Department of Pathology and Immunology, Baylor College of Medicine, 1 Baylor Plaza, Houston, Texas, 77030, USA
| | - Jin Wang
- Verna and Marrs McLean Department of Biochemistry and Molecular Pharmacology, Baylor College of Medicine, 1 Baylor Plaza, Houston, Texas, 77030, USA
| | - Mingxing Teng
- Center for Drug Discovery, Department of Pathology and Immunology, Baylor College of Medicine, 1 Baylor Plaza, Houston, Texas, 77030, USA
- Verna and Marrs McLean Department of Biochemistry and Molecular Pharmacology, Baylor College of Medicine, 1 Baylor Plaza, Houston, Texas, 77030, USA
| | - Lei Guo
- National Center for Toxicological Research, U.S. Food and Drug Administration, 3900 NCTR Rd, Jefferson, Arkansas, USA
| | - Zhi Tan
- Center for Drug Discovery, Department of Pathology and Immunology, Baylor College of Medicine, 1 Baylor Plaza, Houston, Texas, 77030, USA
- Verna and Marrs McLean Department of Biochemistry and Molecular Pharmacology, Baylor College of Medicine, 1 Baylor Plaza, Houston, Texas, 77030, USA
| | - Damian W Young
- Center for Drug Discovery, Department of Pathology and Immunology, Baylor College of Medicine, 1 Baylor Plaza, Houston, Texas, 77030, USA
- Verna and Marrs McLean Department of Biochemistry and Molecular Pharmacology, Baylor College of Medicine, 1 Baylor Plaza, Houston, Texas, 77030, USA
| | - Kevin R MacKenzie
- Center for Drug Discovery, Department of Pathology and Immunology, Baylor College of Medicine, 1 Baylor Plaza, Houston, Texas, 77030, USA
- Verna and Marrs McLean Department of Biochemistry and Molecular Pharmacology, Baylor College of Medicine, 1 Baylor Plaza, Houston, Texas, 77030, USA
- NMR and Drug Metabolism Core, Advanced Technology Cores, Baylor College of Medicine, 1 Baylor Plaza, Houston, Texas, 77030, USA
| | - Feng Li
- Center for Drug Discovery, Department of Pathology and Immunology, Baylor College of Medicine, 1 Baylor Plaza, Houston, Texas, 77030, USA
- Verna and Marrs McLean Department of Biochemistry and Molecular Pharmacology, Baylor College of Medicine, 1 Baylor Plaza, Houston, Texas, 77030, USA
- NMR and Drug Metabolism Core, Advanced Technology Cores, Baylor College of Medicine, 1 Baylor Plaza, Houston, Texas, 77030, USA
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2
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Zhang Y, Yin L, You C, Liu C, Dong P, Xu X, Zhang K. Efficacy and Safety of Methylphenidate and Atomoxetine in Medication-Naive Children with Attention-Deficit Hyperactivity Disorder in a Real-World Setting. Drugs R D 2024; 24:29-39. [PMID: 37982991 PMCID: PMC11035522 DOI: 10.1007/s40268-023-00445-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Methylphenidate (MPH) and atomoxetine (ATX) are the most common medications used to treat attention-deficit hyperactivity disorder (ADHD) in China; however, despite this, there is still a paucity of studies comparing their efficacy and safety, particularly for different characteristics. To address the lack of research, a real-world prospective cohort study was conducted to examine these properties of MPH and ATX, and to analyze correlations associated with age, sex, and different ADHD presentation. METHODS Children with ADHD meeting the eligibility criteria were recruited from January 2016 to July 2021. Study participants were treated with either MPH or ATX prescribed in the real-world setting, and were followed up for 26 weeks. Clinical efficacy response and adverse events (AEs) were recorded and measured. Subgroup analysis was performed to examine the efficacy response and AEs associated with age, sex, and different ADHD presentation. RESULTS A total of 1050 children were recruited and 29 children were lost to follow-up. Of the 1021 children remaining, 533 were treated with MPH and 488 were treated with ATX. No significant differences were found in intelligence quotient, age, sex, or ADHD presentation between the MPH- and ATX-treated groups (p > 0.05). The response rates were 84.6% in the MPH-treated group and 63.3% in the ATX-treated group. Subgroup analysis of response rate demonstrated that the treatment effect of MPH over ATX was consistent across subgroups except in the girls (odds ratio [OR] 2.09, 95% confidence interval [CI] 0.97-4.7) and the hyperactive/impulsive presentation group (OR 2.88, 95% CI 0.77-12.76). A total of 47.8% of children experienced AEs during MPH treatment, significantly lower than the rate of 56.8% during ATX treatment (p < 0.05). The incidence of AEs in the MPH-treated group was higher in young children (<8 years: 56.8%; 8-10 years: 47.2%) and lower in children over 10 years of age (29.0%). CONCLUSIONS Overall, MPH was more effective and better tolerated than ATX. The incidence of AEs in children treated with MPH varied with age, and was higher in young children and lower in children over 10 years of age.
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Affiliation(s)
- Ying Zhang
- Department of Child Healthcare, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Li Yin
- Department of Pediatrics, Taixing People's Hospital, Taizhou, China
| | - Cun You
- Department of Pediatrics, Fudan University Minhang Hospital, Shanghai, China
| | - Chunxue Liu
- Department of Child Healthcare, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Ping Dong
- Department of Child Healthcare, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Xiu Xu
- Department of Child Healthcare, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
| | - Kaifeng Zhang
- Department of Child Healthcare, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
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Khalil SM, MacKenzie KR, Maletic-Savatic M, Li F. Metabolic bioactivation of antidepressants: advance and underlying hepatotoxicity. Drug Metab Rev 2024; 56:97-126. [PMID: 38311829 PMCID: PMC11118075 DOI: 10.1080/03602532.2024.2313967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/30/2024] [Indexed: 02/06/2024]
Abstract
Many drugs that serve as first-line medications for the treatment of depression are associated with severe side effects, including liver injury. Of the 34 antidepressants discussed in this review, four have been withdrawn from the market due to severe hepatotoxicity, and others carry boxed warnings for idiosyncratic liver toxicity. The clinical and economic implications of antidepressant-induced liver injury are substantial, but the underlying mechanisms remain elusive. Drug-induced liver injury may involve the host immune system, the parent drug, or its metabolites, and reactive drug metabolites are one of the most commonly referenced risk factors. Although the precise mechanism by which toxicity is induced may be difficult to determine, identifying reactive metabolites that cause toxicity can offer valuable insights for decreasing the bioactivation potential of candidates during the drug discovery process. A comprehensive understanding of drug metabolic pathways can mitigate adverse drug-drug interactions that may be caused by elevated formation of reactive metabolites. This review provides a comprehensive overview of the current state of knowledge on antidepressant bioactivation, the metabolizing enzymes responsible for the formation of reactive metabolites, and their potential implication in hepatotoxicity. This information can be a valuable resource for medicinal chemists, toxicologists, and clinicians engaged in the fields of antidepressant development, toxicity, and depression treatment.
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Affiliation(s)
- Saleh M. Khalil
- Center for Drug Discovery, Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Kevin R. MacKenzie
- Center for Drug Discovery, Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX 77030, USA
- NMR and Drug Metabolism Core, Advanced Technology Cores, Baylor College of Medicine, Houston, TX 77030, USA
| | - Mirjana Maletic-Savatic
- Department of Pediatrics, Baylor College of Medicine; Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, TX 77030, USA
| | - Feng Li
- Center for Drug Discovery, Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX 77030, USA
- NMR and Drug Metabolism Core, Advanced Technology Cores, Baylor College of Medicine, Houston, TX 77030, USA
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You Q, Lan XB, Liu N, Du J, Ma L, Yang JM, Niu JG, Peng XD, Jin GL, Yu JQ. Neuroprotective strategies for neonatal hypoxic-ischemic brain damage: Current status and challenges. Eur J Pharmacol 2023; 957:176003. [PMID: 37640219 DOI: 10.1016/j.ejphar.2023.176003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023]
Abstract
Neonatal hypoxic-ischemic brain damage (HIBD) is a prominent contributor to both immediate mortality and long-term impairment in newborns. The elusive nature of the underlying mechanisms responsible for neonatal HIBD presents a significant obstacle in the effective clinical application of numerous pharmaceutical interventions. This comprehensive review aims to concentrate on the potential neuroprotective agents that have demonstrated efficacy in addressing various pathogenic factors associated with neonatal HIBD, encompassing oxidative stress, calcium overload, mitochondrial dysfunction, endoplasmic reticulum stress, inflammatory response, and apoptosis. In this review, we conducted an analysis of the precise molecular pathways by which these drugs elicit neuroprotective effects in animal models of neonatal hypoxic-ischemic brain injury (HIBD). Our objective was to provide a comprehensive overview of potential neuroprotective agents for the treatment of neonatal HIBD in animal experiments, with the ultimate goal of enhancing the feasibility of clinical translation and establishing a solid theoretical foundation for the clinical management of neonatal HIBD.
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Affiliation(s)
- Qing You
- Department of Pharmacology, School of Pharmacy, Ningxia Medical University, 1160 Shengli Street, Yinchuan, 750004, China.
| | - Xiao-Bing Lan
- Department of Pharmacology, School of Pharmacy, Ningxia Medical University, 1160 Shengli Street, Yinchuan, 750004, China.
| | - Ning Liu
- Department of Pharmacology, School of Pharmacy, Ningxia Medical University, 1160 Shengli Street, Yinchuan, 750004, China; Ningxia Special Traditional Medicine Modern Engineering Research Center and Collaborative Innovation Center, Ningxia Medical University, 1160 Shengli Street, Yinchuan, 750004, China.
| | - Juan Du
- Department of Pharmacology, School of Pharmacy, Ningxia Medical University, 1160 Shengli Street, Yinchuan, 750004, China.
| | - Lin Ma
- Department of Pharmacology, School of Pharmacy, Ningxia Medical University, 1160 Shengli Street, Yinchuan, 750004, China.
| | - Jia-Mei Yang
- Department of Pharmacology, School of Pharmacy, Ningxia Medical University, 1160 Shengli Street, Yinchuan, 750004, China.
| | - Jian-Guo Niu
- Ningxia Key Laboratory of Craniocerebral Diseases of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan, 750004, China.
| | - Xiao-Dong Peng
- Department of Pharmacology, School of Pharmacy, Ningxia Medical University, 1160 Shengli Street, Yinchuan, 750004, China.
| | - Gui-Lin Jin
- Fujian Key Laboratory of Drug Target Discovery and Structural and Functional Research, Fuzhou, 350108, Fujian, China; Department of Pharmacology, College of Pharmacy, Fujian Medical University, Fuzhou, 350108, Fujian, China.
| | - Jian-Qiang Yu
- Department of Pharmacology, School of Pharmacy, Ningxia Medical University, 1160 Shengli Street, Yinchuan, 750004, China; Ningxia Special Traditional Medicine Modern Engineering Research Center and Collaborative Innovation Center, Ningxia Medical University, 1160 Shengli Street, Yinchuan, 750004, China.
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5
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Han X, Wang W, Ma LH, AI-Ramahi I, Botas J, MacKenzie K, Allen GI, Young DW, Liu Z, Maletic-Savatic M. SPA-STOCSY: an automated tool for identifying annotated and non-annotated metabolites in high-throughput NMR spectra. Bioinformatics 2023; 39:btad593. [PMID: 37792497 PMCID: PMC10568371 DOI: 10.1093/bioinformatics/btad593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 07/31/2023] [Accepted: 10/02/2023] [Indexed: 10/06/2023] Open
Abstract
MOTIVATION Nuclear magnetic resonance spectroscopy (NMR) is widely used to analyze metabolites in biological samples, but the analysis requires specific expertise, it is time-consuming, and can be inaccurate. Here, we present a powerful automate tool, SPatial clustering Algorithm-Statistical TOtal Correlation SpectroscopY (SPA-STOCSY), which overcomes challenges faced when analyzing NMR data and identifies metabolites in a sample with high accuracy. RESULTS As a data-driven method, SPA-STOCSY estimates all parameters from the input dataset. It first investigates the covariance pattern among datapoints and then calculates the optimal threshold with which to cluster datapoints belonging to the same structural unit, i.e. the metabolite. Generated clusters are then automatically linked to a metabolite library to identify candidates. To assess SPA-STOCSY's efficiency and accuracy, we applied it to synthesized spectra and spectra acquired on Drosophila melanogaster tissue and human embryonic stem cells. In the synthesized spectra, SPA outperformed Statistical Recoupling of Variables (SRV), an existing method for clustering spectral peaks, by capturing a higher percentage of the signal regions and the close-to-zero noise regions. In the biological data, SPA-STOCSY performed comparably to the operator-based Chenomx analysis while avoiding operator bias, and it required <7 min of total computation time. Overall, SPA-STOCSY is a fast, accurate, and unbiased tool for untargeted analysis of metabolites in the NMR spectra. It may thus accelerate the use of NMR for scientific discoveries, medical diagnostics, and patient-specific decision making. AVAILABILITY AND IMPLEMENTATION The codes of SPA-STOCSY are available at https://github.com/LiuzLab/SPA-STOCSY.
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Affiliation(s)
- Xu Han
- Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital, Houston, TX 77030, United States
- Department of Pediatrics-Neurology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Wanli Wang
- Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital, Houston, TX 77030, United States
- Graduate Program of Quantitative & Computational Biosciences, Baylor College of Medicine, Houston, TX 77030, United States
| | - Li-Hua Ma
- Advanced Technology Cores, Baylor College of Medicine, Houston, TX 77030, United States
| | - Ismael AI-Ramahi
- Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital, Houston, TX 77030, United States
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, United States
| | - Juan Botas
- Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital, Houston, TX 77030, United States
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, United States
| | - Kevin MacKenzie
- Advanced Technology Cores, Baylor College of Medicine, Houston, TX 77030, United States
- Center for Drug Discovery, Baylor College of Medicine, Houston, TX 77030, United States
| | - Genevera I Allen
- Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital, Houston, TX 77030, United States
- Department of Electrical and Computer Engineering, Statistics, and Computer Science, Rice University, Houston, TX 77005-1827, United States
| | - Damian W Young
- Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital, Houston, TX 77030, United States
- Center for Drug Discovery, Baylor College of Medicine, Houston, TX 77030, United States
| | - Zhandong Liu
- Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital, Houston, TX 77030, United States
- Department of Pediatrics-Neurology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Mirjana Maletic-Savatic
- Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital, Houston, TX 77030, United States
- Department of Pediatrics-Neurology, Baylor College of Medicine, Houston, TX 77030, United States
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6
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Qin X, Wang Y, MacKenzie KR, Hakenjos JM, Chen S, Khalil SM, Jung SY, Young DW, Guo L, Li F. Identifying the Reactive Metabolites of Tyrosine Kinase Inhibitor Pexidartinib In Vitro Using LC-MS-Based Metabolomic Approaches. Chem Res Toxicol 2023; 36:1427-1438. [PMID: 37531179 PMCID: PMC10445284 DOI: 10.1021/acs.chemrestox.3c00164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Indexed: 08/03/2023]
Abstract
Pexidartinib (PEX, TURALIO), a selective and potent inhibitor of the macrophage colony-stimulating factor-1 receptor, has been approved for the treatment of tenosynovial giant cell tumor. However, frequent and severe adverse effects have been reported in the clinic, resulting in a boxed warning on PEX for its risk of liver injury. The mechanisms underlying PEX-related hepatotoxicity, particularly metabolism-related toxicity, remain unknown. In the current study, the metabolic activation of PEX was investigated in human/mouse liver microsomes (HLM/MLM) and primary human hepatocytes (PHH) using glutathione (GSH) and methoxyamine (NH2OMe) as trapping reagents. A total of 11 PEX-GSH and 7 PEX-NH2OMe adducts were identified in HLM/MLM using an LC-MS-based metabolomics approach. Additionally, 4 PEX-GSH adducts were detected in the PHH. CYP3A4 and CYP3A5 were identified as the primary enzymes responsible for the formation of these adducts using recombinant human P450s and CYP3A chemical inhibitor ketoconazole. Overall, our studies suggested that PEX metabolism can produce reactive metabolites mediated by CYP3A, and the association of the reactive metabolites with PEX hepatotoxicity needs to be further studied.
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Affiliation(s)
- Xuan Qin
- Center
for Drug Discovery, Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas 77030, United States
| | - Yong Wang
- Center
for Drug Discovery, Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas 77030, United States
| | - Kevin R. MacKenzie
- Center
for Drug Discovery, Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas 77030, United States
- NMR
and Drug Metabolism Core, Advanced Technology Cores, Baylor College of Medicine, Houston, Texas 77030, United States
- Department
of Pharmacology & Chemical Biology, Baylor College of Medicine, Houston, Texas 77030, United States
| | - John M. Hakenjos
- Center
for Drug Discovery, Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas 77030, United States
| | - Si Chen
- Division
of Biochemical Toxicology, National Center
for Toxicological Research/U.S. Food and Drug Administration (FDA), Jefferson, Arkansas 72079, United States
| | - Saleh M. Khalil
- Center
for Drug Discovery, Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas 77030, United States
| | - Sung Yun Jung
- Department
of Molecular & Cellular Biology, Baylor
College of Medicine, Houston, Texas 77030, United States
| | - Damian W. Young
- Center
for Drug Discovery, Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas 77030, United States
- Department
of Pharmacology & Chemical Biology, Baylor College of Medicine, Houston, Texas 77030, United States
| | - Lei Guo
- Division
of Biochemical Toxicology, National Center
for Toxicological Research/U.S. Food and Drug Administration (FDA), Jefferson, Arkansas 72079, United States
| | - Feng Li
- Center
for Drug Discovery, Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas 77030, United States
- NMR
and Drug Metabolism Core, Advanced Technology Cores, Baylor College of Medicine, Houston, Texas 77030, United States
- Department
of Pharmacology & Chemical Biology, Baylor College of Medicine, Houston, Texas 77030, United States
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7
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Sun L, Mi K, Hou Y, Hui T, Zhang L, Tao Y, Liu Z, Huang L. Pharmacokinetic and Pharmacodynamic Drug-Drug Interactions: Research Methods and Applications. Metabolites 2023; 13:897. [PMID: 37623842 PMCID: PMC10456269 DOI: 10.3390/metabo13080897] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
Because of the high research and development cost of new drugs, the long development process of new drugs, and the high failure rate at later stages, combining past drugs has gradually become a more economical and attractive alternative. However, the ensuing problem of drug-drug interactions (DDIs) urgently need to be solved, and combination has attracted a lot of attention from pharmaceutical researchers. At present, DDI is often evaluated and investigated from two perspectives: pharmacodynamics and pharmacokinetics. However, in some special cases, DDI cannot be accurately evaluated from a single perspective. Therefore, this review describes and compares the current DDI evaluation methods based on two aspects: pharmacokinetic interaction and pharmacodynamic interaction. The methods summarized in this paper mainly include probe drug cocktail methods, liver microsome and hepatocyte models, static models, physiologically based pharmacokinetic models, machine learning models, in vivo comparative efficacy studies, and in vitro static and dynamic tests. This review aims to serve as a useful guide for interested researchers to promote more scientific accuracy and clinical practical use of DDI studies.
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Affiliation(s)
- Lei Sun
- National Reference Laboratory of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan 430000, China; (L.S.); (K.M.); (Y.H.); (T.H.); (L.Z.); (Y.T.)
- MAO Key Laboratory for Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan 430000, China;
| | - Kun Mi
- National Reference Laboratory of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan 430000, China; (L.S.); (K.M.); (Y.H.); (T.H.); (L.Z.); (Y.T.)
- MOA Laboratory for Risk Assessment of Quality and Safety of Livestock and Poultry Products, Huazhong Agricultural University, Wuhan 430000, China
| | - Yixuan Hou
- National Reference Laboratory of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan 430000, China; (L.S.); (K.M.); (Y.H.); (T.H.); (L.Z.); (Y.T.)
- MAO Key Laboratory for Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan 430000, China;
| | - Tianyi Hui
- National Reference Laboratory of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan 430000, China; (L.S.); (K.M.); (Y.H.); (T.H.); (L.Z.); (Y.T.)
- MAO Key Laboratory for Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan 430000, China;
| | - Lan Zhang
- National Reference Laboratory of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan 430000, China; (L.S.); (K.M.); (Y.H.); (T.H.); (L.Z.); (Y.T.)
- MAO Key Laboratory for Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan 430000, China;
| | - Yanfei Tao
- National Reference Laboratory of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan 430000, China; (L.S.); (K.M.); (Y.H.); (T.H.); (L.Z.); (Y.T.)
- MAO Key Laboratory for Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan 430000, China;
| | - Zhenli Liu
- MAO Key Laboratory for Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan 430000, China;
- MOA Laboratory for Risk Assessment of Quality and Safety of Livestock and Poultry Products, Huazhong Agricultural University, Wuhan 430000, China
| | - Lingli Huang
- National Reference Laboratory of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan 430000, China; (L.S.); (K.M.); (Y.H.); (T.H.); (L.Z.); (Y.T.)
- MAO Key Laboratory for Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan 430000, China;
- MOA Laboratory for Risk Assessment of Quality and Safety of Livestock and Poultry Products, Huazhong Agricultural University, Wuhan 430000, China
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8
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Ren Z, Chen S, Qin X, Li F, Guo L. Study of the roles of cytochrome P450 (CYPs) in the metabolism and cytotoxicity of perhexiline. Arch Toxicol 2022; 96:3219-3231. [PMID: 36083301 PMCID: PMC10395006 DOI: 10.1007/s00204-022-03369-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/25/2022] [Indexed: 12/21/2022]
Abstract
Perhexiline is a prophylactic antianginal agent developed in the 1970s. Although, therapeutically, it remained a success, the concerns of its severe adverse effects including hepatotoxicity caused the restricted use of the drug, and eventually its withdrawal from the market in multiple countries. In the clinical setting, cytochrome P450 (CYP) 2D6 is considered as a possible risk factor for the adverse effects of perhexiline. However, the role of CYP-mediated metabolism in the toxicity of perhexiline, particularly in the intact cells, remains unclear. Using our previously established HepG2 cell lines that individually express 14 CYPs (1A1, 1A2, 1B1, 2A6, 2B6, 2C8, 2C9, 2C18, 2C19, 2D6, 2E1, 3A4, 3A5, and 3A7) and human liver microsomes, we identified that CYP2D6 plays a major role in the hydroxylation of perhexiline. We also determined that CYP1A2, 2C19, and 3A4 contribute to the metabolism of perhexiline. The toxic effect of perhexiline was reduced significantly in CYP2D6-overexpressing HepG2 cells, in comparison to the control cells. In contrast, overexpression of CYP1A2, 2C19, and 3A4 did not show a significant protective effect against the toxicity of perhexiline. Pre-incubation with quinidine, a well-recognized CYP2D6 inhibitor, significantly attenuated the protective effect in CYP2D6-overexpressing HepG2 cells. Furthermore, perhexiline-induced mitochondrial damage, apoptosis, and ER stress were also attenuated in CYP2D6-overexpressing HepG2 cells. These findings suggest that CYP2D6-mediated metabolism protects the cells from perhexiline-induced cytotoxicity and support the clinical observation that CYP2D6 poor metabolizers may have higher risk for perhexiline-induced hepatotoxicity.
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Affiliation(s)
- Zhen Ren
- Division of Biochemical Toxicology, HFT-110, National Center for Toxicological Research (NCTR), U.S. Food and Drug Administration (FDA), 3900 NCTR Road, Jefferson, AR, 72079, USA
| | - Si Chen
- Division of Biochemical Toxicology, HFT-110, National Center for Toxicological Research (NCTR), U.S. Food and Drug Administration (FDA), 3900 NCTR Road, Jefferson, AR, 72079, USA
| | - Xuan Qin
- Department of Pathology and Immunology, Center for Drug Discovery, Baylor College of Medicine, Houston, TX77030, USA
| | - Feng Li
- Department of Pathology and Immunology, Center for Drug Discovery, Baylor College of Medicine, Houston, TX77030, USA
| | - Lei Guo
- Division of Biochemical Toxicology, HFT-110, National Center for Toxicological Research (NCTR), U.S. Food and Drug Administration (FDA), 3900 NCTR Road, Jefferson, AR, 72079, USA.
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Doran AC, Dantonio AL, Gualtieri GM, Balesano A, Landers C, Burchett W, Goosen TC, Obach RS. An improved method for cytochrome p450 reaction phenotyping using a sequential qualitative-then-quantitative approach. Drug Metab Dispos 2022; 50:DMD-AR-2022-000883. [PMID: 35777845 DOI: 10.1124/dmd.122.000883] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/08/2022] [Accepted: 05/11/2022] [Indexed: 11/22/2022] Open
Abstract
Cytochrome P450 reaction phenotyping to determine the fraction of metabolism values (fm) for individual enzymes is a standard study in the evaluation of a new drug. However, there are technical challenges in these studies caused by shortcomings in the selectivity of P450 inhibitors and unreliable scaling procedures for recombinant P450 (rCYP) data. In this investigation, a two-step "qualitative-then-quantitative" approach to P450 reaction phenotyping is described. In the first step, each rCYP is tested qualitatively for potential to generate metabolites. In the second step, selective inhibitors for the P450s identified in step1 are tested for their effects on metabolism using full inhibition curves. Forty-eight drugs were evaluated in step 1 and there were no examples of missing an enzyme important to in vivo clearance. Five drugs (escitalopram, fluvastatin, pioglitazone, propranolol, and risperidone) were selected for full phenotyping in step2 to determine fm values, with findings compared to fm values estimated from single inhibitor concentration data and rCYP with intersystem-extrapolation-factor corrections. The two-step approach yielded fm values for major drug clearing enzymes that are close to those estimated from clinical data: escitalopram and CYP2C19 (0.42 vs 0.36-0.82), fluvastatin and CYP2C9 (0.76 vs 0.76), pioglitazone and CYP2C8 (0.72 vs 0.73), propranolol and CYP2D6 (0.68 vs 0.37-0.56) and risperidone and CYP2D6 (0.60 vs 0.66-0.88). Reaction phenotyping data generated in this fashion should offer better input to physiologically-based pharmacokinetic models for prediction of DDI and impact of genetic polymorphisms on drug clearance. The qualitative-then-quantitative approach is proposed as a replacement to standard reaction phenotyping strategies. Significance Statement P450 reaction phenotyping is important for projecting drug-drug interactions and interpatient variability in drug exposure. However, currently recommended practices can frequently fail to provide reliable estimates of the fractional contributions of specific P450 enzymes (fm) to drug clearance. In this report, we describe a two-step qualitative-then-quantitative reaction phenotyping approach that yields more accurate estimates of fm.
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Affiliation(s)
| | | | | | | | | | | | - Theunis C Goosen
- Pharmacokinetics, Dynamics & Metabolism, Pfizer, Inc, United States
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10
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Qin X, Hakenjos JM, MacKenzie KR, Barzi M, Chavan H, Nyshadham P, Wang J, Jung SY, Guner JZ, Chen S, Guo L, Krishnamurthy P, Bissig KD, Palmer S, Matzuk MM, Li F. Metabolism of a Selective Serotonin and Norepinephrine Reuptake Inhibitor Duloxetine in Liver Microsomes and Mice. Drug Metab Dispos 2022; 50:128-139. [PMID: 34785568 PMCID: PMC8969139 DOI: 10.1124/dmd.121.000633] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/12/2021] [Indexed: 11/25/2022] Open
Abstract
Duloxetine (DLX) is a dual serotonin and norepinephrine reuptake inhibitor, widely used for the treatment of major depressive disorder. Although DLX has shown good efficacy and safety, serious adverse effects (e.g., liver injury) have been reported. The mechanisms associated with DLX-induced toxicity remain elusive. Drug metabolism plays critical roles in drug safety and efficacy. However, the metabolic profile of DLX in mice is not available, although mice serve as commonly used animal models for mechanistic studies of drug-induced adverse effects. Our study revealed 39 DLX metabolites in human/mouse liver microsomes and mice. Of note, 13 metabolites are novel, including five N-acetyl cysteine adducts and one reduced glutathione (GSH) adduct associated with DLX. Additionally, the species differences of certain metabolites were observed between human and mouse liver microsomes. CYP1A2 and CYP2D6 are primary enzymes responsible for the formation of DLX metabolites in liver microsomes, including DLX-GSH adducts. In summary, a total of 39 DLX metabolites were identified, and species differences were noticed in vitro. The roles of CYP450s in DLX metabolite formation were also verified using human recombinant cytochrome P450 (P450) enzymes and corresponding chemical inhibitors. Further studies are warranted to address the exact role of DLX metabolism in its adverse effects in vitro (e.g., human primary hepatocytes) and in vivo (e.g., Cyp1a2-null mice). SIGNIFICANCE STATEMENT: This current study systematically investigated Duloxetine (DLX) metabolism and bioactivation in liver microsomes and mice. This study provided a global view of DLX metabolism and bioactivation in liver microsomes and mice, which are very valuable to further elucidate the mechanistic study of DLX-related adverse effects and drug-drug interaction from metabolic aspects.
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Affiliation(s)
- Xuan Qin
- Center for Drug Discovery, Department of Pathology & Immunology (X.Q., J.M.H., K.R.M., P.N., J.Z.G., S.P., M.M.M., F.L.), NMR and Drug Metabolism Core, Advanced Technology Cores (K.R.M., F.L.), Department of Pharmacology & Chemical Biology (K.R.M., J.W., M.M.M., F.L.), and Department of Molecular & Cellular Biology (S.Y.J., K.-D.B., F.L.), Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Duke University Medical Center, Durham, North Carolina (M.B., K.-D.B.); Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas Medical Center, Kansas City, Kansas (H.C., P.K.); and Division of Biochemical Toxicology, National Center for Toxicological Research/US Food and Drug Administration (FDA), Jefferson, Arkansas (S.C., L.G.)
| | - John M Hakenjos
- Center for Drug Discovery, Department of Pathology & Immunology (X.Q., J.M.H., K.R.M., P.N., J.Z.G., S.P., M.M.M., F.L.), NMR and Drug Metabolism Core, Advanced Technology Cores (K.R.M., F.L.), Department of Pharmacology & Chemical Biology (K.R.M., J.W., M.M.M., F.L.), and Department of Molecular & Cellular Biology (S.Y.J., K.-D.B., F.L.), Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Duke University Medical Center, Durham, North Carolina (M.B., K.-D.B.); Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas Medical Center, Kansas City, Kansas (H.C., P.K.); and Division of Biochemical Toxicology, National Center for Toxicological Research/US Food and Drug Administration (FDA), Jefferson, Arkansas (S.C., L.G.)
| | - Kevin R MacKenzie
- Center for Drug Discovery, Department of Pathology & Immunology (X.Q., J.M.H., K.R.M., P.N., J.Z.G., S.P., M.M.M., F.L.), NMR and Drug Metabolism Core, Advanced Technology Cores (K.R.M., F.L.), Department of Pharmacology & Chemical Biology (K.R.M., J.W., M.M.M., F.L.), and Department of Molecular & Cellular Biology (S.Y.J., K.-D.B., F.L.), Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Duke University Medical Center, Durham, North Carolina (M.B., K.-D.B.); Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas Medical Center, Kansas City, Kansas (H.C., P.K.); and Division of Biochemical Toxicology, National Center for Toxicological Research/US Food and Drug Administration (FDA), Jefferson, Arkansas (S.C., L.G.)
| | - Mercedes Barzi
- Center for Drug Discovery, Department of Pathology & Immunology (X.Q., J.M.H., K.R.M., P.N., J.Z.G., S.P., M.M.M., F.L.), NMR and Drug Metabolism Core, Advanced Technology Cores (K.R.M., F.L.), Department of Pharmacology & Chemical Biology (K.R.M., J.W., M.M.M., F.L.), and Department of Molecular & Cellular Biology (S.Y.J., K.-D.B., F.L.), Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Duke University Medical Center, Durham, North Carolina (M.B., K.-D.B.); Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas Medical Center, Kansas City, Kansas (H.C., P.K.); and Division of Biochemical Toxicology, National Center for Toxicological Research/US Food and Drug Administration (FDA), Jefferson, Arkansas (S.C., L.G.)
| | - Hemantkumar Chavan
- Center for Drug Discovery, Department of Pathology & Immunology (X.Q., J.M.H., K.R.M., P.N., J.Z.G., S.P., M.M.M., F.L.), NMR and Drug Metabolism Core, Advanced Technology Cores (K.R.M., F.L.), Department of Pharmacology & Chemical Biology (K.R.M., J.W., M.M.M., F.L.), and Department of Molecular & Cellular Biology (S.Y.J., K.-D.B., F.L.), Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Duke University Medical Center, Durham, North Carolina (M.B., K.-D.B.); Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas Medical Center, Kansas City, Kansas (H.C., P.K.); and Division of Biochemical Toxicology, National Center for Toxicological Research/US Food and Drug Administration (FDA), Jefferson, Arkansas (S.C., L.G.)
| | - Pranavanand Nyshadham
- Center for Drug Discovery, Department of Pathology & Immunology (X.Q., J.M.H., K.R.M., P.N., J.Z.G., S.P., M.M.M., F.L.), NMR and Drug Metabolism Core, Advanced Technology Cores (K.R.M., F.L.), Department of Pharmacology & Chemical Biology (K.R.M., J.W., M.M.M., F.L.), and Department of Molecular & Cellular Biology (S.Y.J., K.-D.B., F.L.), Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Duke University Medical Center, Durham, North Carolina (M.B., K.-D.B.); Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas Medical Center, Kansas City, Kansas (H.C., P.K.); and Division of Biochemical Toxicology, National Center for Toxicological Research/US Food and Drug Administration (FDA), Jefferson, Arkansas (S.C., L.G.)
| | - Jin Wang
- Center for Drug Discovery, Department of Pathology & Immunology (X.Q., J.M.H., K.R.M., P.N., J.Z.G., S.P., M.M.M., F.L.), NMR and Drug Metabolism Core, Advanced Technology Cores (K.R.M., F.L.), Department of Pharmacology & Chemical Biology (K.R.M., J.W., M.M.M., F.L.), and Department of Molecular & Cellular Biology (S.Y.J., K.-D.B., F.L.), Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Duke University Medical Center, Durham, North Carolina (M.B., K.-D.B.); Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas Medical Center, Kansas City, Kansas (H.C., P.K.); and Division of Biochemical Toxicology, National Center for Toxicological Research/US Food and Drug Administration (FDA), Jefferson, Arkansas (S.C., L.G.)
| | - Sung Yun Jung
- Center for Drug Discovery, Department of Pathology & Immunology (X.Q., J.M.H., K.R.M., P.N., J.Z.G., S.P., M.M.M., F.L.), NMR and Drug Metabolism Core, Advanced Technology Cores (K.R.M., F.L.), Department of Pharmacology & Chemical Biology (K.R.M., J.W., M.M.M., F.L.), and Department of Molecular & Cellular Biology (S.Y.J., K.-D.B., F.L.), Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Duke University Medical Center, Durham, North Carolina (M.B., K.-D.B.); Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas Medical Center, Kansas City, Kansas (H.C., P.K.); and Division of Biochemical Toxicology, National Center for Toxicological Research/US Food and Drug Administration (FDA), Jefferson, Arkansas (S.C., L.G.)
| | - Joie Z Guner
- Center for Drug Discovery, Department of Pathology & Immunology (X.Q., J.M.H., K.R.M., P.N., J.Z.G., S.P., M.M.M., F.L.), NMR and Drug Metabolism Core, Advanced Technology Cores (K.R.M., F.L.), Department of Pharmacology & Chemical Biology (K.R.M., J.W., M.M.M., F.L.), and Department of Molecular & Cellular Biology (S.Y.J., K.-D.B., F.L.), Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Duke University Medical Center, Durham, North Carolina (M.B., K.-D.B.); Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas Medical Center, Kansas City, Kansas (H.C., P.K.); and Division of Biochemical Toxicology, National Center for Toxicological Research/US Food and Drug Administration (FDA), Jefferson, Arkansas (S.C., L.G.)
| | - Si Chen
- Center for Drug Discovery, Department of Pathology & Immunology (X.Q., J.M.H., K.R.M., P.N., J.Z.G., S.P., M.M.M., F.L.), NMR and Drug Metabolism Core, Advanced Technology Cores (K.R.M., F.L.), Department of Pharmacology & Chemical Biology (K.R.M., J.W., M.M.M., F.L.), and Department of Molecular & Cellular Biology (S.Y.J., K.-D.B., F.L.), Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Duke University Medical Center, Durham, North Carolina (M.B., K.-D.B.); Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas Medical Center, Kansas City, Kansas (H.C., P.K.); and Division of Biochemical Toxicology, National Center for Toxicological Research/US Food and Drug Administration (FDA), Jefferson, Arkansas (S.C., L.G.)
| | - Lei Guo
- Center for Drug Discovery, Department of Pathology & Immunology (X.Q., J.M.H., K.R.M., P.N., J.Z.G., S.P., M.M.M., F.L.), NMR and Drug Metabolism Core, Advanced Technology Cores (K.R.M., F.L.), Department of Pharmacology & Chemical Biology (K.R.M., J.W., M.M.M., F.L.), and Department of Molecular & Cellular Biology (S.Y.J., K.-D.B., F.L.), Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Duke University Medical Center, Durham, North Carolina (M.B., K.-D.B.); Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas Medical Center, Kansas City, Kansas (H.C., P.K.); and Division of Biochemical Toxicology, National Center for Toxicological Research/US Food and Drug Administration (FDA), Jefferson, Arkansas (S.C., L.G.)
| | - Partha Krishnamurthy
- Center for Drug Discovery, Department of Pathology & Immunology (X.Q., J.M.H., K.R.M., P.N., J.Z.G., S.P., M.M.M., F.L.), NMR and Drug Metabolism Core, Advanced Technology Cores (K.R.M., F.L.), Department of Pharmacology & Chemical Biology (K.R.M., J.W., M.M.M., F.L.), and Department of Molecular & Cellular Biology (S.Y.J., K.-D.B., F.L.), Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Duke University Medical Center, Durham, North Carolina (M.B., K.-D.B.); Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas Medical Center, Kansas City, Kansas (H.C., P.K.); and Division of Biochemical Toxicology, National Center for Toxicological Research/US Food and Drug Administration (FDA), Jefferson, Arkansas (S.C., L.G.)
| | - Karl-Dimiter Bissig
- Center for Drug Discovery, Department of Pathology & Immunology (X.Q., J.M.H., K.R.M., P.N., J.Z.G., S.P., M.M.M., F.L.), NMR and Drug Metabolism Core, Advanced Technology Cores (K.R.M., F.L.), Department of Pharmacology & Chemical Biology (K.R.M., J.W., M.M.M., F.L.), and Department of Molecular & Cellular Biology (S.Y.J., K.-D.B., F.L.), Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Duke University Medical Center, Durham, North Carolina (M.B., K.-D.B.); Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas Medical Center, Kansas City, Kansas (H.C., P.K.); and Division of Biochemical Toxicology, National Center for Toxicological Research/US Food and Drug Administration (FDA), Jefferson, Arkansas (S.C., L.G.)
| | - Stephen Palmer
- Center for Drug Discovery, Department of Pathology & Immunology (X.Q., J.M.H., K.R.M., P.N., J.Z.G., S.P., M.M.M., F.L.), NMR and Drug Metabolism Core, Advanced Technology Cores (K.R.M., F.L.), Department of Pharmacology & Chemical Biology (K.R.M., J.W., M.M.M., F.L.), and Department of Molecular & Cellular Biology (S.Y.J., K.-D.B., F.L.), Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Duke University Medical Center, Durham, North Carolina (M.B., K.-D.B.); Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas Medical Center, Kansas City, Kansas (H.C., P.K.); and Division of Biochemical Toxicology, National Center for Toxicological Research/US Food and Drug Administration (FDA), Jefferson, Arkansas (S.C., L.G.)
| | - Martin M Matzuk
- Center for Drug Discovery, Department of Pathology & Immunology (X.Q., J.M.H., K.R.M., P.N., J.Z.G., S.P., M.M.M., F.L.), NMR and Drug Metabolism Core, Advanced Technology Cores (K.R.M., F.L.), Department of Pharmacology & Chemical Biology (K.R.M., J.W., M.M.M., F.L.), and Department of Molecular & Cellular Biology (S.Y.J., K.-D.B., F.L.), Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Duke University Medical Center, Durham, North Carolina (M.B., K.-D.B.); Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas Medical Center, Kansas City, Kansas (H.C., P.K.); and Division of Biochemical Toxicology, National Center for Toxicological Research/US Food and Drug Administration (FDA), Jefferson, Arkansas (S.C., L.G.)
| | - Feng Li
- Center for Drug Discovery, Department of Pathology & Immunology (X.Q., J.M.H., K.R.M., P.N., J.Z.G., S.P., M.M.M., F.L.), NMR and Drug Metabolism Core, Advanced Technology Cores (K.R.M., F.L.), Department of Pharmacology & Chemical Biology (K.R.M., J.W., M.M.M., F.L.), and Department of Molecular & Cellular Biology (S.Y.J., K.-D.B., F.L.), Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Duke University Medical Center, Durham, North Carolina (M.B., K.-D.B.); Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas Medical Center, Kansas City, Kansas (H.C., P.K.); and Division of Biochemical Toxicology, National Center for Toxicological Research/US Food and Drug Administration (FDA), Jefferson, Arkansas (S.C., L.G.)
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11
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Xia Y, Guo HL, Hu YH, Long JY, Chen J, Chen F, Ji X. Determination of atomoxetine levels in human plasma using LC-MS/MS and clinical application to Chinese children with ADHD based on CPIC guidelines. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2021; 13:2434-2441. [PMID: 33998618 DOI: 10.1039/d1ay00521a] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The Clinical Pharmacogenetic Implementation Consortium (CPIC) guidelines for personalized atomoxetine therapy are based on the CYP2D6 genotype information and the peak plasma concentrations of atomoxetine. Therefore, a highly rapid, sensitive, and reproducible method is critical for the clinical implementation of the guidelines. In this study, an LC-MS/MS approach was developed and validated for the determination of atomoxetine levels in human plasma using atomoxetine-d3 as the internal standard. Samples were prepared by simple protein precipitation method with MeOH. The analyte was separated using a Kinetex C18 column (2.1 mm × 50 mm, 2.6 μm, Phenomenex) with a flow rate of 0.25 mL min-1, using a gradient elution. A MeOH and water solution containing 5 mM ammonium acetate and 0.1 mM formic acid (pH 6.26) was used as the mobile phase and successfully solved the problem of inconsistent retention time between the plasma samples and the solution samples of atomoxetine. Detection was performed under positive-electrospray-ion multiple reaction-monitoring mode using the 256.4 → 43.8 and 259.3 → 47.0 transitions for atomoxetine and atomoxetine-d3, respectively. Linearity was achieved using an extremely wide range, from 0.500 to 2000 ng mL-1 in plasma. The intra- and inter-batch precision and accuracy, dilution accuracy, recovery, and stability of the method were all within the acceptable limits and no matrix effect was observed. With a complex needle wash solution containing ACN : MeOH : isopropanol : H2O (4 : 4:1 : 1, v/v/v/v), carryover contamination was eliminated successfully. This method was successfully implemented on pediatric patients with attention-deficit/hyperactivity disorder and provided valuable information to enable clinicians to do dose selection and titration.
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Affiliation(s)
- Ying Xia
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing 210008, China.
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12
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Atomoxetine-Associated Eyebrow Alopecia in a Girl With Attention-Deficit/Hyperactivity Disorder. J Clin Psychopharmacol 2021; 41:605-606. [PMID: 34369904 PMCID: PMC8407445 DOI: 10.1097/jcp.0000000000001454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Fu D, Wu DD, Guo HL, Hu YH, Xia Y, Ji X, Fang WR, Li YM, Xu J, Chen F, Liu QQ. The Mechanism, Clinical Efficacy, Safety, and Dosage Regimen of Atomoxetine for ADHD Therapy in Children: A Narrative Review. Front Psychiatry 2021; 12:780921. [PMID: 35222104 PMCID: PMC8863678 DOI: 10.3389/fpsyt.2021.780921] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/28/2021] [Indexed: 12/12/2022] Open
Abstract
Atomoxetine, a selective norepinephrine (NE) reuptake inhibitor, was approved for attention deficit/hyperactivity disorder (ADHD) treatment in children, adolescents and adults. We searched the database PubMed/MEDLINE (2000 to October 1, 2021). Only publications in English were considered. Atomoxetine inhibits the presynaptic norepinephrine transporter (NET), preventing the reuptake of NE throughout the brain along with inhibiting the reuptake of dopamine in specific brain regions such as the prefrontal cortex (PFC). The novel mechanism of atomoxetine also includes several new brain imaging studies and animal model studies. It is mainly metabolized by the highly polymorphic drug metabolizing enzyme cytochrome P450 2D6 (CYP2D6). Atomoxetine is effective and generally well tolerated. ADHD is often accompanied by multiple comorbidities. A series of studies have been published suggesting that atomoxetine is effective in the treatment of ADHD symptoms for children with various types of comorbidity. In some cases, it is possible that atomoxetine may have a positive influence on the symptoms of comorbidities. Atomoxetine can be administered either as a single daily dose or split into two evenly divided doses, and has a negligible risk of abuse or misuse. The latest guideline updated that clinical dose selection of atomoxetine was recommended based on both CYP2D6 genotype and the peak concentration. To have a more comprehensive understanding of atomoxetine, this review sets the focus on the mechanism, clinical efficacy and dosage regimen in detail, and also touches on those studies regarding adverse reactions of atomoxetine.
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Affiliation(s)
- Di Fu
- Department of Pharmacy, Pharmaceutical Sciences Research Center, Children's Hospital of Nanjing Medical University, Nanjing, China.,School of Basic Medical Sciences and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Dan-Dan Wu
- Department of Children Health Care, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Hong-Li Guo
- Department of Pharmacy, Pharmaceutical Sciences Research Center, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Ya-Hui Hu
- Department of Pharmacy, Pharmaceutical Sciences Research Center, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Ying Xia
- Department of Pharmacy, Pharmaceutical Sciences Research Center, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xing Ji
- Department of Pharmacy, Pharmaceutical Sciences Research Center, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Wei-Rong Fang
- School of Basic Medical Sciences and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Yun-Man Li
- School of Basic Medical Sciences and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Jing Xu
- Department of Pharmacy, Pharmaceutical Sciences Research Center, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Feng Chen
- Department of Pharmacy, Pharmaceutical Sciences Research Center, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Qian-Qi Liu
- Department of Children Health Care, Children's Hospital of Nanjing Medical University, Nanjing, China
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