Non-surmountable antagonism: transcending steady state

Long-lasting target binding and rebinding as mechanisms to prolong in vivo drug action

An increasing number of examples in the literature suggest that the in vivo duration of drug action not only depends on macroscopic pharmacokinetic properties like plasma half-life and the time needed to equilibrate between the plasma and the effect compartments, but is also influenced by long-lasting target binding and rebinding. The present review combines information from different research areas and simulations to explore the nature of these mechanisms and the conditions in which they are most prevalent. Simulations reveal that these latter phenomena become especially influential when there is no longer sufficient free drug around to maintain high levels of receptor occupancy. There is not always a direct link between slow dissociation and long-lasting in vivo target protection, as the rate of free drug elimination from the effect compartment is also a key influencing factor. Local phenomena that hinder the diffusion of free drug molecules away from their target may allow them to consecutively bind to the same target and/or targets nearby (denoted as 'rebinding') even when their concentration in the bulk phase has already dropped to insignificant levels. The micro-anatomic properties of many effect compartments are likely to intensify this phenomenon. By mimicking the complexity of tissues, intact cells offer the opportunity to investigate both mechanisms under the same, physiologically relevant conditions.

The two-state model of antagonist-AT1 receptor interaction: an hypothesis defended but not tested

A correlation between insurmountable antagonism and slow dissociation has been observed for the non-peptidic AT1 receptor antagonists. This commentary examines the validity of conclusions regarding a two stage binding mechanism that has been proposed in order to account for both the slow dissociation and insurmountable antagonism. Support for that hypothetical mechanism is in the form of the goodness of fit between experimental data and modelled data in a number of papers from the same laboratory. We challenge the idea that a simple match of model and data is an adequate test of an hypothesis by showing that a simpler model matches the data equally well. We conclude that two stage binding is not necessary to explain the behaviour of AT1 receptor antagonists.