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Balkrishna A, Gohel V, Pathak N, Bhattacharya K, Dev R, Varshney A. Livogrit prevents Amiodarone-induced toxicity in experimental model of human liver (HepG2) cells and Caenorhabditis elegans by regulating redox homeostasis. Drug Chem Toxicol 2024:1-17. [PMID: 38425274 DOI: 10.1080/01480545.2024.2320189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/13/2024] [Indexed: 03/02/2024]
Abstract
Treatment with cationic amphiphilic drugs like Amiodarone leads to development of phospholipidosis, a type of lysosomal storage disorder characterized by excessive deposition of phospholipids. Such disorder in liver enhances accumulation of drugs and its metabolites, and dysregulates lipid profiles, which subsequently leads to hepatotoxicity. In the present study, we assessed pharmacological effects of herbal medicine, Livogrit, against hepatic phospholipidosis-induced toxicity. Human liver (HepG2) cells and in vivo model of Caenorhabditis elegans (N2 and CF1553 strains) were used to study effect of Livogrit on Amiodarone-induced phospholipidosis. In HepG2 cells, Livogrit treatment displayed enhanced uptake of acidic pH-based stains and reduced phospholipid accumulation, oxidative stress, AST, ALT, cholesterol levels, and gene expression of SCD-1 and LSS. Protein levels of LPLA2 were also normalized. Livogrit treatment restored Pgp functionality which led to decreased cellular accumulation of Amiodarone as observed by UHPLC analysis. In C. elegans, Livogrit prevented ROS generation, fat-6/7 gene overexpression, and lysosomal trapping of Amiodarone in N2 strain. SOD-3::GFP expression in CF1553 strain normalized by Livogrit treatment. Livogrit regulates phospholipidosis by regulation of redox homeostasis, phospholipid anabolism, and Pgp functionality hindered by lysosomal trapping of Amiodarone. Livogrit could be a potential therapeutic intervention for amelioration of drug-induced phospholipidosis and prevent hepatotoxicity.
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Affiliation(s)
- Acharya Balkrishna
- Drug Discovery and Development Division, Patanjali Research Foundation, Governed by Patanjali Research Foundation Trust, Haridwar, Uttarakhand, India
- Department of Allied and Applied Sciences, University of Patanjali, Haridwar, Uttarakhand, India
- Patanjali Yog Peeth (UK) Trust, Glasgow, UK
| | - Vivek Gohel
- Drug Discovery and Development Division, Patanjali Research Foundation, Governed by Patanjali Research Foundation Trust, Haridwar, Uttarakhand, India
| | - Nishit Pathak
- Drug Discovery and Development Division, Patanjali Research Foundation, Governed by Patanjali Research Foundation Trust, Haridwar, Uttarakhand, India
| | - Kunal Bhattacharya
- Drug Discovery and Development Division, Patanjali Research Foundation, Governed by Patanjali Research Foundation Trust, Haridwar, Uttarakhand, India
| | - Rishabh Dev
- Drug Discovery and Development Division, Patanjali Research Foundation, Governed by Patanjali Research Foundation Trust, Haridwar, Uttarakhand, India
| | - Anurag Varshney
- Drug Discovery and Development Division, Patanjali Research Foundation, Governed by Patanjali Research Foundation Trust, Haridwar, Uttarakhand, India
- Department of Allied and Applied Sciences, University of Patanjali, Haridwar, Uttarakhand, India
- Special Centre for Systems Medicine, Jawaharlal Nehru University, New Delhi, India
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2
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Singh B, Singh C. Bedaquiline in Drug-Resistant Tuberculosis: A Mini-Review. Curr Mol Pharmacol 2023; 16:243-253. [PMID: 36919348 DOI: 10.2174/1874467215666220421130707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 02/15/2022] [Accepted: 03/02/2022] [Indexed: 11/22/2022]
Abstract
Mycobacterium tuberculosis causes a contagious pulmonary disease with a high mortality rate in developing countries. However, the recommendation of DOTS (approved by WHO) was effective in treating tuberculosis, but nowadays, resistance from the first line (MDR-TB) and the second line (XDR-TB) drugs is highly common. Whereas, the resistance is a result of factors like poor patient constancy due to the long duration of therapy and co-infection with HIV. The approval of bedaquiline under an accelerated program for the treatment of MDR-TB has revealed its effectiveness in clinical trials as a therapeutic novel molecule. BDQ selectively inhibits the ATP synthase of bacterium and reduces ATP production. Additionally, the poor pharmacokinetic properties raised provocations in the MDR therapy, but the use of targeted drug delivery can solve the hurdles. While the preclinical and clinical studies included in this review are strongly suggesting the usefulness of BDQ in MDR-TB and XDR-TB, the repurposing of different drug classes in resistant TB is opening new opportunities to manage the disease conditions. In this review, we have summarized the examples of pipeline drugs and repurposed molecules with preclinical formulation developments.
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Affiliation(s)
- Baljinder Singh
- Department of Pharmaceutics, UIPS, Punjab University, Chandigarh 160014, India
| | - Charan Singh
- Department of Pharmaceutics, ISF College of Pharmacy, Moga, Punjab, 142001, India
- Department of Pharmaceutical Sciences, School of Sciences, Hemvati Nandan Bahuguna Garhwal University (A Central University), Srinagar, Uttarakhand, 246174, India
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3
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Haas DW, Abdelwahab MT, van Beek SW, Baker P, Maartens G, Bradford Y, Ritchie MD, Wasserman S, Meintjes G, Beeri K, Gandhi NR, Svensson EM, Denti P, Brust JCM. Pharmacogenetics of Between-Individual Variability in Plasma Clearance of Bedaquiline and Clofazimine in South Africa. J Infect Dis 2022; 226:147-156. [PMID: 35091749 PMCID: PMC9373148 DOI: 10.1093/infdis/jiac024] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/24/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Plasma bedaquiline clearance is reportedly more rapid with African ancestry. Our objective was to determine whether genetic polymorphisms explained between-individual variability in plasma clearance of bedaquiline, its M2 metabolite, and clofazimine in a cohort of patients treated for drug-resistant tuberculosis in South Africa. METHODS Plasma clearance was estimated with nonlinear mixed-effects modeling. Associations between pharmacogenetic polymorphisms, genome-wide polymorphisms, and variability in clearance were examined using linear regression models. RESULTS Of 195 cohort participants, 140 were evaluable for genetic associations. Among 21 polymorphisms selected based on prior genome-wide significant associations with any drug, rs776746 (CYP3A5∗3) was associated with slower clearance of bedaquiline (P = .0017) but not M2 (P = .25). CYP3A5∗3 heterozygosity and homozygosity were associated with 15% and 30% slower bedaquiline clearance, respectively. The lowest P value for clofazimine clearance was with VKORC1 rs9923231 (P = .13). In genome-wide analyses, the lowest P values for clearance of bedaquiline and clofazimine were with RFX4 rs76345012 (P = 6.4 × 10-7) and CNTN5 rs75285763 (P = 2.9 × 10-8), respectively. CONCLUSIONS Among South Africans treated for drug-resistant tuberculosis, CYP3A5∗3 was associated with slower bedaquiline clearance. Different CYP3A5∗3 frequencies among populations may help explain the more rapid bedaquiline clearance reported in Africans. Associations with RFX4 and CNTN5 are likely by chance alone.
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Affiliation(s)
- David W Haas
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Department of Internal Medicine, Meharry Medical College, Nashville, Tennessee, USA
| | - Mahmoud Tareq Abdelwahab
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, South Africa
| | - Stijn W van Beek
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Paxton Baker
- Vanderbilt Technologies for Advanced Genomics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, South Africa
| | - Yuki Bradford
- Department of Genetics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marylyn D Ritchie
- Department of Genetics and Institute for Biomedical Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sean Wasserman
- Division of Infectious Diseases, Department of Medicine, University of Cape Town, South Africa
| | - Graeme Meintjes
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Karen Beeri
- Vanderbilt Technologies for Advanced Genomics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Neel R Gandhi
- Departments of Epidemiology & Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Division of Infectious Diseases, Department of Medicine, Emory School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Elin M Svensson
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
| | - Paolo Denti
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, South Africa
| | - James C M Brust
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
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4
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Pamreddy A, Baijnath S, Naicker T, Ntshangase S, Mdanda S, Lubanyana H, Kruger HG, Govender T. Bedaquiline has potential for targeting tuberculosis reservoirs in the central nervous system. RSC Adv 2018; 8:11902-11907. [PMID: 35539382 PMCID: PMC9079262 DOI: 10.1039/c8ra00984h] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 03/05/2018] [Indexed: 01/01/2023] Open
Abstract
Bedaquiline (BDQ) is the first-in-class United States Food and Drug Administration (US FDA) approved anti-tuberculosis (anti-TB) drug, which is a novel diarylquinoline antibiotic that has recently been utilized as an effective adjunct to existing therapies for multidrug-resistant tuberculosis (MDR-TB). BDQ is especially promising due to its novel mechanism of action, activity against drug-sensitive and drug-resistant tuberculosis (TB) in addition to having the potential to shorten treatment duration. Drug delivery to the central nervous system (CNS) is a major concern in TB chemotherapy, especially with the increasing cases of CNS-TB. In this study, we investigated the CNS penetration of BDQ in healthy rodent brain. Male Sprague-Dawley rats (n = 27; 100 ± 20 g) received a single 25 mg kg-1 b.w dose of BDQ via intraperitoneal (i.p.) administration, over a 24 h period. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) was used to determine whole tissue drug concentrations and matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI MSI) was utilized to evaluate drug distribution in the brain. BDQ reached peak concentrations (C max) of 134.97 ng mL-1 in the brain at a T max of 4 h, which is within the range required for therapeutic efficacy. BDQ was widely distributed in the brain, with a particularly high intensity in the corpus callosum and associated subcortical white matter including the striatal, globus pallidus, corticofugal pathways, ventricular system, basal forebrain region and hippocampal regions. Using MALDI MSI, this study demonstrates that due to BDQ's distribution in the brain, it has the potential to target TB reservoirs within this organ.
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Affiliation(s)
- Annapurna Pamreddy
- Catalysis and Peptide Research Unit, School of Health Sciences, University of KwaZulu-Natal Westville Campus Durban 4000 South Africa
| | - Sooraj Baijnath
- Catalysis and Peptide Research Unit, School of Health Sciences, University of KwaZulu-Natal Westville Campus Durban 4000 South Africa
| | - Tricia Naicker
- Catalysis and Peptide Research Unit, School of Health Sciences, University of KwaZulu-Natal Westville Campus Durban 4000 South Africa
| | - Sphamandla Ntshangase
- Catalysis and Peptide Research Unit, School of Health Sciences, University of KwaZulu-Natal Westville Campus Durban 4000 South Africa
| | - Sipho Mdanda
- Catalysis and Peptide Research Unit, School of Health Sciences, University of KwaZulu-Natal Westville Campus Durban 4000 South Africa
| | - Hlengekile Lubanyana
- Catalysis and Peptide Research Unit, School of Health Sciences, University of KwaZulu-Natal Westville Campus Durban 4000 South Africa
| | - Hendrik G Kruger
- Catalysis and Peptide Research Unit, School of Health Sciences, University of KwaZulu-Natal Westville Campus Durban 4000 South Africa
| | - Thavendran Govender
- Catalysis and Peptide Research Unit, School of Health Sciences, University of KwaZulu-Natal Westville Campus Durban 4000 South Africa
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5
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Smyej I, De Jonghe S, Looszova A, Mannens G, Verhaeghe T, Thijssen S, Starckx S, Lampo A, Rouan MC. Dose- and Time-dependency of the Toxicity and Pharmacokinetic Profiles of Bedaquiline and Its N-desmethyl Metabolite in Dogs. Toxicol Pathol 2017; 45:663-675. [PMID: 28789609 DOI: 10.1177/0192623317723085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Bedaquiline (BDQ) is an antibiotic to treat pulmonary multidrug-resistant tuberculosis (MDR-TB). Studies up to 39 weeks were conducted orally in dogs to assess the toxicity and pharmacokinetics of BDQ and its N-desmethyl metabolite (D-BDQ). Phospholipidosis (PLD) seen in the monocytic phagocytic system was considered an adaptive change. Skeletal muscle, heart, stomach, liver, and pancreas toxicities with D-BDQ as the main contributor were associated with a less-than-dose-proportional increase in plasma exposure and an overproportional tissue uptake of BDQ and D-BDQ at high-dose levels. Tissue concentrations of BDQ and D-BDQ slowly decreased after lowering the dose, contributing to the recovery of the pathological findings. Treatment was better tolerated at mid-dose levels, characterized by a dose-proportional increase in plasma and tissue exposures. Treatment at a low dose, reaching exposures approximating therapeutic exposures, was without adverse effects and not associated with PLD. There was no evidence of delayed toxicities after treatment cessation. Intermittent dosing was better tolerated at high doses. Since MDR-TB patients are dosed within the linear plasma exposure range and plasma levels of BDQ and D-BDQ are similar or lower than in dogs, PLD and adverse findings related to tissue accumulation that occurred at high doses in dogs are unlikely to occur in humans.
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Affiliation(s)
- Ilham Smyej
- 1 Janssen Research and Development, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Sandra De Jonghe
- 1 Janssen Research and Development, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Adriana Looszova
- 1 Janssen Research and Development, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Geert Mannens
- 1 Janssen Research and Development, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Tom Verhaeghe
- 1 Janssen Research and Development, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Sandy Thijssen
- 1 Janssen Research and Development, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Sofie Starckx
- 1 Janssen Research and Development, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Ann Lampo
- 1 Janssen Research and Development, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Marie-Claude Rouan
- 1 Janssen Research and Development, Janssen Pharmaceutica NV, Beerse, Belgium
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6
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Musuamba FT, Manolis E, Holford N, Cheung S, Friberg LE, Ogungbenro K, Posch M, Yates J, Berry S, Thomas N, Corriol-Rohou S, Bornkamp B, Bretz F, Hooker AC, Van der Graaf PH, Standing JF, Hay J, Cole S, Gigante V, Karlsson K, Dumortier T, Benda N, Serone F, Das S, Brochot A, Ehmann F, Hemmings R, Rusten IS. Advanced Methods for Dose and Regimen Finding During Drug Development: Summary of the EMA/EFPIA Workshop on Dose Finding (London 4-5 December 2014). CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2017; 6:418-429. [PMID: 28722322 PMCID: PMC5529745 DOI: 10.1002/psp4.12196] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 03/27/2017] [Accepted: 03/27/2017] [Indexed: 02/05/2023]
Abstract
Inadequate dose selection for confirmatory trials is currently still one of the most challenging issues in drug development, as illustrated by high rates of late‐stage attritions in clinical development and postmarketing commitments required by regulatory institutions. In an effort to shift the current paradigm in dose and regimen selection and highlight the availability and usefulness of well‐established and regulatory‐acceptable methods, the European Medicines Agency (EMA) in collaboration with the European Federation of Pharmaceutical Industries Association (EFPIA) hosted a multistakeholder workshop on dose finding (London 4–5 December 2014). Some methodologies that could constitute a toolkit for drug developers and regulators were presented. These methods are described in the present report: they include five advanced methods for data analysis (empirical regression models, pharmacometrics models, quantitative systems pharmacology models, MCP‐Mod, and model averaging) and three methods for study design optimization (Fisher information matrix (FIM)‐based methods, clinical trial simulations, and adaptive studies). Pairwise comparisons were also discussed during the workshop; however, mostly for historical reasons. This paper discusses the added value and limitations of these methods as well as challenges for their implementation. Some applications in different therapeutic areas are also summarized, in line with the discussions at the workshop. There was agreement at the workshop on the fact that selection of dose for phase III is an estimation problem and should not be addressed via hypothesis testing. Dose selection for phase III trials should be informed by well‐designed dose‐finding studies; however, the specific choice of method(s) will depend on several aspects and it is not possible to recommend a generalized decision tree. There are many valuable methods available, the methods are not mutually exclusive, and they should be used in conjunction to ensure a scientifically rigorous understanding of the dosing rationale.
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Affiliation(s)
- F T Musuamba
- EMA Modelling and Simulation Working Group, London, UK.,Federal Agency for Medicines and Health Products, Brussels, Belgium.,UMR850 INSERM, Université de Limoges, Limoges, France
| | - E Manolis
- EMA Modelling and Simulation Working Group, London, UK.,European Medicines Agency, London, UK
| | - N Holford
- Department of Pharmacology & Clinical Pharmacology, University of Auckland, Auckland, New Zealand
| | | | | | | | - M Posch
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | | | - S Berry
- Berry consultants, Austin, Texas, USA
| | | | | | | | - F Bretz
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.,Novartis, London, UK
| | | | - P H Van der Graaf
- Leiden Academic Centre for Drug Research, Leiden, The Netherlands.,Certara QSP, Canterbury, UK
| | - J F Standing
- EMA Modelling and Simulation Working Group, London, UK.,University College London, London, UK
| | - J Hay
- EMA Modelling and Simulation Working Group, London, UK.,Medicines and Healthcare Products Regulatory Agency, London, UK
| | - S Cole
- EMA Modelling and Simulation Working Group, London, UK.,Medicines and Healthcare Products Regulatory Agency, London, UK
| | - V Gigante
- EMA Modelling and Simulation Working Group, London, UK.,Agenzia Italiana del Farmaco, Roma, Italy
| | - K Karlsson
- EMA Modelling and Simulation Working Group, London, UK.,Medical Products Agency, Uppsala, Sweden
| | | | - N Benda
- EMA Modelling and Simulation Working Group, London, UK.,Bundesinstitut für Arzneimittel und Medizinprodukte, Bonn, Germany
| | - F Serone
- EMA Modelling and Simulation Working Group, London, UK.,Agenzia Italiana del Farmaco, Roma, Italy
| | - S Das
- AstraZeneca UK Limited, London, UK
| | | | - F Ehmann
- European Medicines Agency, London, UK
| | - R Hemmings
- Medicines and Healthcare Products Regulatory Agency, London, UK
| | - I Skottheim Rusten
- EMA Modelling and Simulation Working Group, London, UK.,Norvegian Medicines Agency, Oslo, Norway
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7
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Ceccarelli M, Wagner B, Alvarez-Sánchez R, Cruciani G, Goracci L. Use of the Distribution Coefficient in Brain Polar Lipids for the Assessment of Drug-Induced Phospholipidosis Risk. Chem Res Toxicol 2017; 30:1145-1156. [DOI: 10.1021/acs.chemrestox.6b00459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- M. Ceccarelli
- Laboratory
for Chemoinformatics and Molecular Modelling, Department of Chemistry,
Biology and Biotechnology, University of Perugia, via Elce di Sotto 8, 06123 Perugia, Italy
| | - B. Wagner
- pRED,
Pharma Research and Early Development, Pharmaceutical Research, Innovation
Center Basel, F. Hoffmann-La Roche Ltd., CH-4070 Basel, Switzerland
| | - R. Alvarez-Sánchez
- pRED,
Pharma Research and Early Development, Pharmaceutical Research, Innovation
Center Basel, F. Hoffmann-La Roche Ltd., CH-4070 Basel, Switzerland
| | - G. Cruciani
- Laboratory
for Chemoinformatics and Molecular Modelling, Department of Chemistry,
Biology and Biotechnology, University of Perugia, via Elce di Sotto 8, 06123 Perugia, Italy
| | - L. Goracci
- Laboratory
for Chemoinformatics and Molecular Modelling, Department of Chemistry,
Biology and Biotechnology, University of Perugia, via Elce di Sotto 8, 06123 Perugia, Italy
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8
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Subcellular Partitioning and Intramacrophage Selectivity of Antimicrobial Compounds against Mycobacterium tuberculosis. Antimicrob Agents Chemother 2017; 61:AAC.01639-16. [PMID: 28052847 DOI: 10.1128/aac.01639-16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 12/30/2016] [Indexed: 12/14/2022] Open
Abstract
The efficacy of antimicrobial drugs against Mycobacterium tuberculosis, an intracellular bacterial pathogen, is generally first established by testing compounds against bacteria in axenic culture. However, inside infected macrophages, bacteria encounter an environment which differs substantially from broth culture and are subject to important host-dependent pharmacokinetic phenomena which modulate drug activity. Here, we describe how pH-dependent partitioning drives asymmetric antimicrobial drug distribution in M. tuberculosis-infected macrophages. Specifically, weak bases with moderate activity against M. tuberculosis (fluoxetine, sertraline, and dibucaine) were shown to accumulate intracellularly due to differential permeability and relative abundance of their ionized and nonionized forms. Nonprotonatable analogs of the test compounds did not show this effect. Neutralization of acidic organelles directly with ammonium chloride or indirectly with bafilomycin A1 partially abrogated the growth restriction of these drugs. Using high-performance liquid chromatography, we quantified the degree of accumulation and reversibility upon acidic compartment neutralization in macrophages and observed that accumulation was greater in infected than in uninfected macrophages. We further demonstrate that the efficacy of a clinically used compound, clofazimine, is augmented by pH-based partitioning in a macrophage infection model. Because the parameters which govern this effect are well understood and are amenable to chemical modification, this knowledge may enable the rational development of more effective antibiotics against tuberculosis.
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9
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Lenhard SC, Lev M, Webster LO, Peterson RA, Goulbourne CN, Miller RT, Jucker BM. Hepatic Phospholipidosis Is Associated with Altered Hepatobiliary Function as Assessed by Gadoxetate Dynamic Contrast–enhanced Magnetic Resonance Imaging. Toxicol Pathol 2015; 44:51-60. [DOI: 10.1177/0192623315608509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
To determine if amiodarone induces hepatic phospholipidosis (PLD) sufficient to detect changes in hepatobiliary transporter function as assessed by gadoxetate dynamic contrast–enhanced magnetic resonance imaging (DCE-MRI), rats were orally dosed with vehicle (1% methyl cellulose) or amiodarone (300 mg/kg/day) for 7 consecutive days. Gadoxetate DCE-MRI occurred at baseline, day 7, and following a 2-week washout of amiodarone. At day 7, the gadoxetate washout rate was significantly decreased compared to the vehicle group. Blood chemistry analysis revealed no significant changes in liver enzymes (alanine aminotransferase [ALT]/aspartate aminotransferase [AST]/alkaline phosphatase [ALP]), bilirubin, or bile acids between vehicle or amiodarone groups. Hepatic PLD was confirmed in all rats treated with amiodarone at day 7 by transmission electron microscopy. Following the 2-week washout, there was no ultrastructural evidence of hepatic PLD in rats and the gadoxetate washout rate returned to baseline levels. This is the first study to show the application of gadoxetate DCE-MRI to detect hepatobiliary functional changes associated with PLD and offer a potential new technique with clinical utility in patients suspected of having PLD. These results also suggest PLD itself has functional consequences on hepatobiliary function in the absence of biomarkers of toxicity, given the cause/effect relationship between PLD and function has not been fully established.
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Affiliation(s)
- Stephen C. Lenhard
- Preclinical and Translational Imaging, GlaxoSmithKline, King of Prussia, Pennsylvania, USA
- Laboratory Animal Sciences, GlaxoSmithKline, King of Prussia, Pennsylvania, USA
| | - Mally Lev
- Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, King of Prussia, Pennsylvania, USA
| | - Lindsey O. Webster
- Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | - Richard A. Peterson
- Safety Assessment, GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | | | - Richard T. Miller
- Laboratory Animal Sciences, GlaxoSmithKline, King of Prussia, Pennsylvania, USA
| | - Beat M. Jucker
- Preclinical and Translational Imaging, GlaxoSmithKline, King of Prussia, Pennsylvania, USA
- Laboratory Animal Sciences, GlaxoSmithKline, King of Prussia, Pennsylvania, USA
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10
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Svensson EM, Murray S, Karlsson MO, Dooley KE. Rifampicin and rifapentine significantly reduce concentrations of bedaquiline, a new anti-TB drug. J Antimicrob Chemother 2014; 70:1106-14. [PMID: 25535219 PMCID: PMC4356204 DOI: 10.1093/jac/dku504] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives Bedaquiline is the first drug of a new class approved for the treatment of TB in decades. Bedaquiline is metabolized by cytochrome P450 (CYP) 3A4 to a less-active M2 metabolite. Its terminal half-life is extremely long (5–6 months), complicating evaluations of drug–drug interactions. Rifampicin and rifapentine, two anti-TB drugs now being optimized to shorten TB treatment duration, are potent inducers of CYP3A4. This analysis aimed to predict the effect of repeated doses of rifampicin or rifapentine on the steady-state pharmacokinetics of bedaquiline and its M2 metabolite from single-dose data using a model-based approach. Methods Pharmacokinetic data for bedaquiline and M2 were obtained from a Phase I study involving 32 individuals each receiving two doses of bedaquiline, alone or together with multiple-dose rifampicin or rifapentine. Sampling was performed over 14 days following each bedaquiline dose. Pharmacokinetic analyses were performed using non-linear mixed-effects modelling. Models were used to simulate potential dose adjustments. Results Rifamycin co-administration increased bedaquiline clearance substantially: 4.78-fold [relative standard error (RSE) 9.10%] with rifampicin and 3.96-fold (RSE 5.00%) with rifapentine. Induction of M2 clearance was equally strong. Average steady-state concentrations of bedaquiline and M2 are predicted to decrease by 79% and 75% when given with rifampicin or rifapentine, respectively. Simulations indicated that increasing the bedaquiline dosage to mitigate the interaction would yield elevated M2 concentrations during the first treatment weeks. Conclusions Rifamycin antibiotics reduce bedaquiline concentrations substantially. In line with current treatment guidelines for drug-susceptible TB, concomitant use is not recommended, even with dose adjustment.
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Affiliation(s)
- Elin M Svensson
- Department of Pharmaceutical Biosciences, Uppsala University, PO Box 591, 751 24 Uppsala, Sweden
| | - Stephen Murray
- Department of Clinical Research, Global Alliance for TB Drug Development, New York, NY, USA
| | - Mats O Karlsson
- Department of Pharmaceutical Biosciences, Uppsala University, PO Box 591, 751 24 Uppsala, Sweden
| | - Kelly E Dooley
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Worley MV, Estrada SJ. Bedaquiline: a novel antitubercular agent for the treatment of multidrug-resistant tuberculosis. Pharmacotherapy 2014; 34:1187-97. [PMID: 25203970 DOI: 10.1002/phar.1482] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Bedaquiline is a diarylquinoline antitubercular drug with a novel mechanism of action against Mycobacterium tuberculosis. Bedaquiline works by inhibiting bacterial adenosine triphosphate (ATP) synthase and represents the first novel class of antituberculosis agents in more than 40 years. Bedaquiline is indicated for the treatment of multidrug-resistant tuberculosis (MDR TB) in combination with at least three other antitubercular drugs when no other effective regimen is available. The recommended bedaquiline dosage is 400 mg orally once/day for 2 weeks followed by 200 mg orally 3 times/week for 22 weeks. Bedaquiline should be administered with food, which increases the bioavailability 2-fold. Bedaquiline is metabolized by cytochrome P450 isoenzyme 3A4 and is impacted by both inducers and inhibitors of this isoenzyme. Concentration-dependent bactericidal activity was observed in laboratory and murine studies. Accelerated approval was granted in the United States and European Union based on the results of two phase IIb clinical studies that used sputum culture clearance as a surrogate end point for clinical efficacy. These studies showed greater sputum culture clearance up to week 24 for the bedaquiline group compared with placebo. Common adverse events in clinical trials included nausea, arthralgia, and headache. Serious adverse events included elevated serum transaminase levels and rate-corrected QT-interval prolongation. Unexplained higher mortality was seen in patients receiving bedaquiline versus those receiving placebo. Bedaquiline is a novel agent with a unique mechanism of action and has the potential to meet a great need in patients with MDR TB who have no other treatment options. Due to safety concerns and limited clinical information, phase III trials are needed to fully determine its place in therapy.
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Affiliation(s)
- Marylee V Worley
- Department of Pharmacy, Lee Memorial Health System, Fort Myers, Florida
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Impact of lopinavir-ritonavir or nevirapine on bedaquiline exposures and potential implications for patients with tuberculosis-HIV coinfection. Antimicrob Agents Chemother 2014; 58:6406-12. [PMID: 25114140 DOI: 10.1128/aac.03246-14] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Concomitant treatment of tuberculosis (TB) and HIV is recommended and improves outcomes. Bedaquiline is a novel drug for the treatment of multidrug-resistant (MDR) TB; combined use with antiretroviral drugs, nevirapine, or ritonavir-boosted lopinavir (LPV/r) is anticipated, but no clinical data from coinfected patients are available. Plasma concentrations of bedaquiline and its M2 metabolite after single doses were obtained from interaction studies with nevirapine or LPV/r in healthy volunteers. The antiretrovirals' effects on bedaquiline and M2 pharmacokinetics were assessed by nonlinear mixed-effects modeling. Potential dose adjustments were evaluated with simulations. No significant effects of nevirapine on bedaquiline pharmacokinetics were identified. LPV/r decreased bedaquiline and M2 clearances to 35% (relative standard error [RSE], 9.2%) and 58% (RSE, 8.4%), respectively, of those without comedication. As almost 3-fold (bedaquiline) and 2-fold (M2) increases in exposures during chronic treatment with LPV/r are expected, dose adjustments are suggested for evaluation. Efficacious, safe bedaquiline dosing for MDR-TB patients receiving antiretrovirals is important. Modeling results suggest that bedaquiline can be coadministered with nevirapine without dose adjustments. The predicted elevation of bedaquiline and M2 levels during LPV/r coadministration may be a safety concern, and careful monitoring is recommended. Further data are being collected in coinfected patients to determine whether dose adjustments are needed. (These studies have been registered at ClinicalTrials.gov under registration numbers NCT00828529 [study C110] and NCT00910806 [study C117].).
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van Heeswijk RPG, Dannemann B, Hoetelmans RMW. Bedaquiline: a review of human pharmacokinetics and drug-drug interactions. J Antimicrob Chemother 2014; 69:2310-8. [DOI: 10.1093/jac/dku171] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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14
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Brown DG, Bernstein PR, Griffin A, Wesolowski S, Labrecque D, Tremblay MC, Sylvester M, Mauger R, Edwards PD, Throner SR, Folmer JJ, Cacciola J, Scott C, Lazor LA, Pourashraf M, Santhakumar V, Potts WM, Sydserff S, Giguère P, Lévesque C, Dasser M, Groblewski T. Discovery of Spirofused Piperazine and Diazepane Amides as Selective Histamine-3 Antagonists with in Vivo Efficacy in a Mouse Model of Cognition. J Med Chem 2014; 57:733-58. [DOI: 10.1021/jm4014828] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Dean G. Brown
- AstraZeneca CNS Discovery Research, 1800 Concord Pike, Wilmington, Delaware 19850, United States
| | - Peter R. Bernstein
- AstraZeneca CNS Discovery Research, 1800 Concord Pike, Wilmington, Delaware 19850, United States
| | - Andrew Griffin
- AstraZeneca Montréal, 7171
Frédérick-Banting, Montréal, Québec H4S 1Z9, Canada
| | - Steve Wesolowski
- AstraZeneca CNS Discovery Research, 1800 Concord Pike, Wilmington, Delaware 19850, United States
| | - Denis Labrecque
- AstraZeneca Montréal, 7171
Frédérick-Banting, Montréal, Québec H4S 1Z9, Canada
| | - Maxime C. Tremblay
- AstraZeneca Montréal, 7171
Frédérick-Banting, Montréal, Québec H4S 1Z9, Canada
| | - Mark Sylvester
- AstraZeneca CNS Discovery Research, 1800 Concord Pike, Wilmington, Delaware 19850, United States
| | - Russell Mauger
- AstraZeneca CNS Discovery Research, 1800 Concord Pike, Wilmington, Delaware 19850, United States
| | - Phillip D. Edwards
- AstraZeneca CNS Discovery Research, 1800 Concord Pike, Wilmington, Delaware 19850, United States
| | - Scott R. Throner
- AstraZeneca CNS Discovery Research, 1800 Concord Pike, Wilmington, Delaware 19850, United States
| | - James J. Folmer
- AstraZeneca CNS Discovery Research, 1800 Concord Pike, Wilmington, Delaware 19850, United States
| | - Joseph Cacciola
- AstraZeneca CNS Discovery Research, 1800 Concord Pike, Wilmington, Delaware 19850, United States
| | - Clay Scott
- AstraZeneca CNS Discovery Research, 1800 Concord Pike, Wilmington, Delaware 19850, United States
| | - Lois A. Lazor
- AstraZeneca CNS Discovery Research, 1800 Concord Pike, Wilmington, Delaware 19850, United States
| | - Mehrnaz Pourashraf
- AstraZeneca CNS Discovery Research, 1800 Concord Pike, Wilmington, Delaware 19850, United States
| | - Vijayaratnam Santhakumar
- AstraZeneca CNS Discovery Research, 1800 Concord Pike, Wilmington, Delaware 19850, United States
| | - William M. Potts
- AstraZeneca CNS Discovery Research, 1800 Concord Pike, Wilmington, Delaware 19850, United States
| | - Simon Sydserff
- AstraZeneca CNS Discovery Research, 1800 Concord Pike, Wilmington, Delaware 19850, United States
| | - Pascall Giguère
- OmegaChem, 480 Rue Perreault, Saint-Romuald, Québec G6W 7 V6, Canada
| | - Carine Lévesque
- OmegaChem, 480 Rue Perreault, Saint-Romuald, Québec G6W 7 V6, Canada
| | - Mohammed Dasser
- OmegaChem, 480 Rue Perreault, Saint-Romuald, Québec G6W 7 V6, Canada
| | - Thierry Groblewski
- AstraZeneca Montréal, 7171
Frédérick-Banting, Montréal, Québec H4S 1Z9, Canada
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Ahuja V, Sharma S. Drug safety testing paradigm, current progress and future challenges: an overview. J Appl Toxicol 2013; 34:576-94. [PMID: 24777877 DOI: 10.1002/jat.2935] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 08/08/2013] [Accepted: 08/22/2013] [Indexed: 12/29/2022]
Abstract
Early assessment of the toxicity potential of new molecules in pharmaceutical industry is a multi-dimensional task involving predictive systems and screening approaches to aid in the optimization of lead compounds prior to their entry into development phase. Due to the high attrition rate in the pharma industry in last few years, it has become imperative for the nonclinical toxicologist to focus on novel approaches which could be helpful for early screening of drug candidates. The need is that the toxicologists should change their classical approach to a more investigative approach. This review discusses the developments that allow toxicologists to anticipate safety problems and plan ways to address them earlier than ever before. This includes progress in the field of in vitro models, surrogate models, molecular toxicology, 'omics' technologies, translational safety biomarkers, stem-cell based assays and preclinical imaging. The traditional boundaries between teams focusing on efficacy/ safety and preclinical/ clinical aspects in the pharma industry are disappearing, and translational research-centric organizations with a focused vision of bringing drugs forward safely and rapidly are emerging. Today's toxicologist should collaborate with medicinal chemists, pharmacologists, and clinicians and these value-adding contributions will change traditional toxicologists from side-effect identifiers to drug development enablers.
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Affiliation(s)
- Varun Ahuja
- Drug Safety Assessment, Novel Drug Discovery and Development, Lupin Limited (Research Park), 46A/47A, Nande Village, MulshiTaluka, Pune, 412 115, India
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Choi SS, Kim JS, Valerio LG, Sadrieh N. In silico modeling to predict drug-induced phospholipidosis. Toxicol Appl Pharmacol 2013; 269:195-204. [DOI: 10.1016/j.taap.2013.03.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Revised: 03/01/2013] [Accepted: 03/03/2013] [Indexed: 11/26/2022]
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Petersson KJ, Vermeulen AM, Friberg LE. Predictions of in vivo prolactin levels from in vitro K(i) values of D(2) receptor antagonists using an agonist-antagonist interaction model. AAPS JOURNAL 2013; 15:533-41. [PMID: 23392818 DOI: 10.1208/s12248-012-9450-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 12/20/2012] [Indexed: 11/30/2022]
Abstract
Prolactin elevation is a side effect of all currently available D(2) receptor antagonists used in the treatment of schizophrenia. Prolactin elevation is the result of a direct antagonistic D(2) effect blocking the tonic inhibition of prolactin release by dopamine. The aims of this work were to assess the correlation between in vitro estimates of D(2) receptor affinity and pharmacokinetic-pharmacodynamic model-based estimates obtained from analysis of clinical data using an agonist-antagonist interaction (AAI) model and to assess the value of such a correlation in early prediction of full prolactin time profiles. A population model describing longitudinal prolactin data was fitted to clinical data from 16 clinical phases 1 and 3 trials including five different compounds. Pharmacokinetic data were modeled for each compound and the prolactin model was both fitted in per-compound fits as well as simultaneously to all prolactin data. Estimates of prolactin elevating potency were compared to corresponding in vitro values and their predictability was evaluated through model-based simulations. The model successfully described the prolactin time course for all compounds. Estimates derived from experimental preclinical data and the model fit of the clinical data were strongly correlated (p<0.001), and simulations adequately predicted the prolactin elevation in five out of six compounds. The AAI model has the potential to be used in drug development to predict prolactin response for a given exposure of D(2) antagonists using routinely produced preclinical data.
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Affiliation(s)
- Klas J Petersson
- Department of Pharmaceutical Biosciences, Uppsala University, Box 591751 24, Uppsala, Sweden.
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Muehlbacher M, Tripal P, Roas F, Kornhuber J. Identification of drugs inducing phospholipidosis by novel in vitro data. ChemMedChem 2012; 7:1925-34. [PMID: 22945602 PMCID: PMC3533795 DOI: 10.1002/cmdc.201200306] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Indexed: 11/15/2022]
Abstract
Drug-induced phospholipidosis (PLD) is a lysosomal storage disorder characterized by the accumulation of phospholipids within the lysosome. This adverse drug effect can occur in various tissues and is suspected to impact cellular viability. Therefore, it is important to test chemical compounds for their potential to induce PLD during the drug design process. PLD has been reported to be a side effect of many commonly used drugs, especially those with cationic amphiphilic properties. To predict drug-induced PLD in silico, we established a high-throughput cell-culture-based method to quantitatively determine the induction of PLD by chemical compounds. Using this assay, we tested 297 drug-like compounds at two different concentrations (2.5 μM and 5.0 μM). We were able to identify 28 previously unknown PLD-inducing agents. Furthermore, our experimental results enabled the development of a binary classification model to predict PLD-inducing agents based on their molecular properties. This random forest prediction system yields a bootstrapped validated accuracy of 86 %. PLD-inducing agents overlap with those that target similar biological processes; a high degree of concordance with PLD-inducing agents was identified for cationic amphiphilic compounds, small molecules that inhibit acid sphingomyelinase, compounds that cross the blood-brain barrier, and compounds that violate Lipinski's rule of five. Furthermore, we were able to show that PLD-inducing compounds applied in combination additively induce PLD.
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Affiliation(s)
- Markus Muehlbacher
- Department for Psychiatry and Psychotherapy, University Hospital, Friedrich Alexander University Erlangen Nuremberg, Schwabachanlage 6, 91054 Erlangen (Germany); Computer Chemistry Center, Friedrich Alexander University Erlangen Nuremberg, Nägelsbachstr. 25, 91052 Erlangen (Germany)
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Randomized pilot trial of eight weeks of bedaquiline (TMC207) treatment for multidrug-resistant tuberculosis: long-term outcome, tolerability, and effect on emergence of drug resistance. Antimicrob Agents Chemother 2012; 56:3271-6. [PMID: 22391540 DOI: 10.1128/aac.06126-11] [Citation(s) in RCA: 271] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The 2-year follow-up results for a randomized placebo-controlled study of 47 patients with multidrug-resistant pulmonary tuberculosis treated with either the new diarylquinoline TMC207, recently renamed bedaquiline, or placebo, added to the first 8 weeks of a background regimen, are presented. Bedaquiline significantly reduced the time to culture conversion over 24 weeks (hazard ratio, 2.253; 95% confidence interval, 1.08 to 4.71; P = 0.031). With the exception of nausea reported in 26% of patients receiving bedaquiline and none receiving placebo, adverse events occurred at similar frequencies in both groups of patients: bilateral hearing impairment, extremity pain, acne, and noncardiac chest pain occurred in 13 and 21%, 17 and 13%, 9 and 17%, and 4 and 17% of patients, respectively, receiving bedaquiline or placebo. Excluding resistance to ethambutol and ethionamide, only one patient receiving bedaquiline acquired resistance to companion drugs, but five patients receiving placebo (4.8% versus 21.7%; P = 0.18) acquired resistance to companion drugs, and resistance to ofloxacin was acquired in four patients receiving placebo and none receiving bedaquiline (0% versus 22%; 0 = 0.066). In all, 23 patients (49%), including 13 receiving placebo (54%) and 10 receiving bedaquiline (44%), discontinued the study prior to its completion, 12 during the first 24 weeks of treatment. Eight subjects were withdrawn for noncompliance or default, and seven withdrew consent, citing the rigorous program of investigations for safety and pharmacokinetic monitoring. Bedaquiline may contribute to the management of multidrug-resistant tuberculosis by effecting more rapid sputum culture negativity and by preventing acquired resistance to companion drugs.
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Mesens N, Desmidt M, Verheyen GR, Starckx S, Damsch S, De Vries R, Verhemeldonck M, Van Gompel J, Lampo A, Lammens L. Phospholipidosis in rats treated with amiodarone: serum biochemistry and whole genome micro-array analysis supporting the lipid traffic jam hypothesis and the subsequent rise of the biomarker BMP. Toxicol Pathol 2012; 40:491-503. [PMID: 22291062 DOI: 10.1177/0192623311432290] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To provide mechanistic insight in the induction of phospholipidosis and the appearance of the proposed biomarker di-docosahexaenoyl (C22:6)-bis(monoacylglycerol) phosphate (BMP), rats were treated with 150 mg/kg amiodarone for 12 consecutive days and analyzed at three different time points (day 4, 9, and 12). Biochemical analysis of the serum revealed a significant increase in cholesterol and phospholipids at the three time points. Bio-analysis on the serum and urine detected a time-dependent increase in BMP, as high as 10-fold compared to vehicle-treated animals on day 12. Paralleling these increases, micro-array analysis on the liver of treated rats identified cholesterol biosynthesis and glycerophospholipid metabolism as highly modulated pathways. This modulation indicates that during phospholipidosis-induction interactions take place between the cationic amphiphilic drug and phospholipids at the level of BMP-rich internal membranes of endosomes, impeding cholesterol sorting and leading to an accumulation of internal membranes, converting into multilamellar bodies. This process shows analogy to Niemann-Pick disease type C (NPC). Whereas the NPC-induced lipid traffic jam is situated at the cholesterol sorting proteins NPC1 and NPC2, the amiodarone-induced traffic jam is thought to be located at the BMP level, demonstrating its role in the mechanism of phospholipidosis-induction and its significance for use as a biomarker.
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Affiliation(s)
- Natalie Mesens
- Genetic and Exploratory Toxicology, Drug Safety Sciences, Janssen Pharmaceutical Companies of Johnson & Johnson, 2340 Beerse, Belgium.
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Pharmacokinetics and pharmacodynamics of TMC207 and its N-desmethyl metabolite in a murine model of tuberculosis. Antimicrob Agents Chemother 2011; 56:1444-51. [PMID: 22155815 DOI: 10.1128/aac.00720-11] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TMC207 is a first-in-class diarylquinoline with a new mode of action against mycobacteria targeting the ATP synthase. It is metabolized to an active derivative, N-desmethyl TMC207, and both compounds are eliminated with long terminal half-lives (50 to 60 h in mice) reflecting slow release from tissues such as lung and spleen. In vitro, TMC207 is 5-fold more potent against Mycobacterium tuberculosis than N-desmethyl TMC207, and the effects of the two compounds are additive. The pharmacokinetic and pharmacodynamic (PK-PD) response was investigated in the murine model of tuberculosis (TB) infection following oral administration of different doses of TMC207 or N-desmethyl TMC207 at 5 days per week for 4 weeks starting the day after intravenous infection with M. tuberculosis and following administration of different doses of TMC207 at various dosing frequencies for 6 weeks starting 2 weeks after infection. Upon administration of N-desmethyl TMC207, maximum plasma concentration (C(max)), area under the plasma concentration-time curve from time zero to 168 h postdose (AUC(168h)), and minimum plasma concentration (C(min)) were approximately dose proportional between 8 and 64 mg/kg, and the lung CFU counts were strongly correlated with these pharmacokinetic parameters using an inhibitory sigmoid maximum effect (E(max)) model. Administration of the highest dose (64 mg/kg) produced a 4.0-log(10) reduction of the bacillary load at an average exposure (average concentration [C(avg)] or AUC(168h) divided by 168) of 2.7 μg/ml. Upon administration of the highest dose of TMC207 (50 mg/kg) 5 days per week for 4 weeks, the total reduction of the bacillary load was 4.7 log(10). TMC207 was estimated to contribute to a 1.8-log(10) reduction and its corresponding exposure (C(avg)) was 0.5 μg/ml. Optimal bactericidal activity with N-desmethyl TMC207 was reached at a high exposure compared to that achieved in humans, suggesting a minor contribution of the metabolite to the overall bactericidal activity in TB-infected patients treated with TMC207. Following administration of TMC207 at a total weekly dose of 15, 30, or 60 mg/kg fractionated for either 5 days per week, twice weekly, or once weekly, the bactericidal activity was correlated to the total weekly dose and was not influenced by the frequency of administration. Exposures (AUC(168h)) to TMC207 and N-desmethyl TMC207 mirrored this dose response, indicating that the bactericidal activity of TMC207 is concentration dependent and that AUC is the main PK-PD driver on which dose optimization should be based for dosing frequencies up to once weekly. The PK-PD profile supports intermittent administration of TMC207, in agreement with its slow release from tissues.
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van de Water F, Havinga J, Ravesloot W, Horbach G, Schoonen W. High content screening analysis of phospholipidosis: Validation of a 96-well assay with CHO-K1 and HepG2 cells for the prediction of in vivo based phospholipidosis. Toxicol In Vitro 2011; 25:1870-82. [DOI: 10.1016/j.tiv.2011.05.026] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 05/23/2011] [Accepted: 05/23/2011] [Indexed: 11/27/2022]
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Tilmant K, Gerets H, Dhalluin S, Hanon E, Depelchin O, Cossu-Leguille C, Vasseur P, Atienzar F. Comparison of a genomic and a multiplex cell imaging approach for the detection of phospholipidosis. Toxicol In Vitro 2011; 25:1414-24. [DOI: 10.1016/j.tiv.2011.04.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 02/10/2011] [Accepted: 04/07/2011] [Indexed: 11/24/2022]
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Przybylak KR, Cronin MTD. In Silico Studies of the Relationship Between Chemical Structure and Drug Induced Phospholipidosis. Mol Inform 2011; 30:415-29. [DOI: 10.1002/minf.201000164] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 02/18/2011] [Indexed: 11/06/2022]
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