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Tremmel R, Hofmann U, Haag M, Schaeffeler E, Schwab M. Circulating Biomarkers Instead of Genotyping to Establish Metabolizer Phenotypes. Annu Rev Pharmacol Toxicol 2024; 64:65-87. [PMID: 37585662 DOI: 10.1146/annurev-pharmtox-032023-121106] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Pharmacogenomics (PGx) enables personalized treatment for the prediction of drug response and to avoid adverse drug reactions. Currently, PGx mainly relies on the genetic information of absorption, distribution, metabolism, and excretion (ADME) targets such as drug-metabolizing enzymes or transporters to predict differences in the patient's phenotype. However, there is evidence that the phenotype-genotype concordance is limited. Thus, we discuss different phenotyping strategies using exogenous xenobiotics (e.g., drug cocktails) or endogenous compounds for phenotype prediction. In particular, minimally invasive approaches focusing on liquid biopsies offer great potential to preemptively determine metabolic and transport capacities. Early studies indicate that ADME phenotyping using exosomes released from the liver is reliable. In addition, pharmacometric modeling and artificial intelligence improve phenotype prediction. However, further prospective studies are needed to demonstrate the clinical utility of individualized treatment based on phenotyping strategies, not only relying on genetics. The present review summarizes current knowledge and limitations.
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Affiliation(s)
- Roman Tremmel
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany;
- University of Tuebingen, Tuebingen, Germany
| | - Ute Hofmann
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany;
- University of Tuebingen, Tuebingen, Germany
| | - Mathias Haag
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany;
- University of Tuebingen, Tuebingen, Germany
| | - Elke Schaeffeler
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany;
- University of Tuebingen, Tuebingen, Germany
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies," University of Tuebingen, Tuebingen, Germany
| | - Matthias Schwab
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany;
- University of Tuebingen, Tuebingen, Germany
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies," University of Tuebingen, Tuebingen, Germany
- Departments of Clinical Pharmacology, and Pharmacy and Biochemistry, University of Tuebingen, Tuebingen, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center Heidelberg (DKFZ), Partner Site, Tübingen, Germany
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2
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Fendt R, Ghallab A, Myllys M, Hofmann U, Hassan R, Hobloss Z, González D, Brackhagen L, Marchan R, Edlund K, Seddek AL, Abdelmageed N, Blank LM, Schlender JF, Holland CH, Hengstler JG, Kuepfer L. Increased sinusoidal export of drug glucuronides is a compensative mechanism in liver cirrhosis of mice. Front Pharmacol 2023; 14:1279357. [PMID: 38053838 PMCID: PMC10694292 DOI: 10.3389/fphar.2023.1279357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/01/2023] [Indexed: 12/07/2023] Open
Abstract
Rationale: Liver cirrhosis is known to affect drug pharmacokinetics, but the functional assessment of the underlying pathophysiological alterations in drug metabolism is difficult. Methods: Cirrhosis in mice was induced by repeated treatment with carbon tetrachloride for 12 months. A cocktail of six drugs was administered, and parent compounds as well as phase I and II metabolites were quantified in blood, bile, and urine in a time-dependent manner. Pharmacokinetics were modeled in relation to the altered expression of metabolizing enzymes. In discrepancy with computational predictions, a strong increase of glucuronides in blood was observed in cirrhotic mice compared to vehicle controls. Results: The deviation between experimental findings and computational simulations observed by analyzing different hypotheses could be explained by increased sinusoidal export and corresponded to increased expression of export carriers (Abcc3 and Abcc4). Formation of phase I metabolites and clearance of the parent compounds were surprisingly robust in cirrhosis, although the phase I enzymes critical for the metabolism of the administered drugs in healthy mice, Cyp1a2 and Cyp2c29, were downregulated in cirrhotic livers. RNA-sequencing revealed the upregulation of numerous other phase I metabolizing enzymes which may compensate for the lost CYP isoenzymes. Comparison of genome-wide data of cirrhotic mouse and human liver tissue revealed similar features of expression changes, including increased sinusoidal export and reduced uptake carriers. Conclusion: Liver cirrhosis leads to increased blood concentrations of glucuronides because of increased export from hepatocytes into the sinusoidal blood. Although individual metabolic pathways are massively altered in cirrhosis, the overall clearance of the parent compounds was relatively robust due to compensatory mechanisms.
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Affiliation(s)
- Rebekka Fendt
- Institute for Systems Medicine with Focus on Organ Interaction, University Hospital RWTH Aachen, Aachen, Germany
| | - Ahmed Ghallab
- Leibniz Research Centre for Working Environment and Human Factors, Technical University Dortmund, Dortmund, Germany
- Department of Forensic Medicine and Toxicology, Faculty of Veterinary Medicine, South Valley University, Qena, Egypt
| | - Maiju Myllys
- Leibniz Research Centre for Working Environment and Human Factors, Technical University Dortmund, Dortmund, Germany
| | - Ute Hofmann
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology and University of Tübingen, Stuttgart, Germany
| | - Reham Hassan
- Leibniz Research Centre for Working Environment and Human Factors, Technical University Dortmund, Dortmund, Germany
- Department of Forensic Medicine and Toxicology, Faculty of Veterinary Medicine, South Valley University, Qena, Egypt
| | - Zaynab Hobloss
- Leibniz Research Centre for Working Environment and Human Factors, Technical University Dortmund, Dortmund, Germany
| | - Daniela González
- Leibniz Research Centre for Working Environment and Human Factors, Technical University Dortmund, Dortmund, Germany
| | - Lisa Brackhagen
- Leibniz Research Centre for Working Environment and Human Factors, Technical University Dortmund, Dortmund, Germany
| | - Rosemarie Marchan
- Leibniz Research Centre for Working Environment and Human Factors, Technical University Dortmund, Dortmund, Germany
| | - Karolina Edlund
- Leibniz Research Centre for Working Environment and Human Factors, Technical University Dortmund, Dortmund, Germany
| | - Abdel-Latif Seddek
- Department of Forensic Medicine and Toxicology, Faculty of Veterinary Medicine, South Valley University, Qena, Egypt
| | - Noha Abdelmageed
- Department of Pharmacology, Faculty of Veterinary Medicine, Sohag University, Sohag, Egypt
| | - Lars M. Blank
- Institute of Applied Microbiology—iAMB, Aachen Biology and Biotechnology—ABBt, RWTH Aachen University, Aachen, Germany
| | - Jan-Frederik Schlender
- Pharmacometrics, Research and Development, Pharmaceuticals, Bayer AG, Leverkusen, Germany
| | - Christian H. Holland
- Leibniz Research Centre for Working Environment and Human Factors, Technical University Dortmund, Dortmund, Germany
| | - Jan G. Hengstler
- Leibniz Research Centre for Working Environment and Human Factors, Technical University Dortmund, Dortmund, Germany
| | - Lars Kuepfer
- Institute for Systems Medicine with Focus on Organ Interaction, University Hospital RWTH Aachen, Aachen, Germany
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3
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Demeester C, Robins D, Edwina AE, Tournoy J, Augustijns P, Ince I, Lehmann A, Vertzoni M, Schlender JF. Physiologically based pharmacokinetic (PBPK) modelling of oral drug absorption in older adults - an AGePOP review. Eur J Pharm Sci 2023; 188:106496. [PMID: 37329924 DOI: 10.1016/j.ejps.2023.106496] [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: 03/28/2023] [Revised: 06/06/2023] [Accepted: 06/14/2023] [Indexed: 06/19/2023]
Abstract
The older population consisting of persons aged 65 years or older is the fastest-growing population group and also the major consumer of pharmaceutical products. Due to the heterogenous ageing process, this age group shows high interindividual variability in the dose-exposure-response relationship and, thus, a prediction of drug safety and efficacy is challenging. Although physiologically based pharmacokinetic (PBPK) modelling is a well-established tool to inform and confirm drug dosing strategies during drug development for special population groups, age-related changes in absorption are poorly accounted for in current PBPK models. The purpose of this review is to summarise the current state-of-knowledge in terms of physiological changes with increasing age that can influence the oral absorption of dosage forms. The capacity of common PBPK platforms to incorporate these changes and describe the older population is also discussed, as well as the implications of extrinsic factors such as drug-drug interactions associated with polypharmacy on the model development process. The future potential of this field will rely on addressing the gaps identified in this article, which can subsequently supplement in-vitro and in-vivo data for more robust decision-making on the adequacy of the formulation for use in older adults and inform pharmacotherapy.
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Affiliation(s)
- Cleo Demeester
- Systems Pharmacology & Medicine, Pharmaceuticals, Bayer AG, Leverkusen 51373, Germany; Drug Delivery and Disposition, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Gasthuisberg O&N II, Leuven, Belgium
| | - Donnia Robins
- Global CMC Development, Merck KGaA, Frankfurter Straße 250, Darmstadt, Germany; Department of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, Zografou, Greece
| | - Angela Elma Edwina
- Gerontology and Geriatrics Unit, Department of Public Health and Primary care, KU Leuven - University of Leuven, Leuven, Belgium
| | - Jos Tournoy
- Gerontology and Geriatrics Unit, Department of Public Health and Primary care, KU Leuven - University of Leuven, Leuven, Belgium; Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Patrick Augustijns
- Drug Delivery and Disposition, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Gasthuisberg O&N II, Leuven, Belgium
| | - Ibrahim Ince
- Systems Pharmacology & Medicine, Pharmaceuticals, Bayer AG, Leverkusen 51373, Germany
| | - Andreas Lehmann
- Global CMC Development, Merck KGaA, Frankfurter Straße 250, Darmstadt, Germany
| | - Maria Vertzoni
- Department of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, Zografou, Greece
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Catozzi S, Hill R, Li X, Dulong S, Collard E, Ballesta A. Interspecies and in vitro-in vivo scaling for quantitative modeling of whole-body drug pharmacokinetics in patients: Application to the anticancer drug oxaliplatin. CPT Pharmacometrics Syst Pharmacol 2022; 12:221-235. [PMID: 36537068 PMCID: PMC9931436 DOI: 10.1002/psp4.12895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/02/2022] [Accepted: 11/05/2022] [Indexed: 12/24/2022] Open
Abstract
Quantitative systems pharmacology holds the promises of integrating results from laboratory animals or in vitro human systems into the design of human pharmacokinetic/pharmacodynamic (PK/PD) models allowing for precision and personalized medicine. However, reliable and general in vitro-to-in vivo extrapolation and interspecies scaling methods are still lacking. Here, we developed a translational strategy for the anticancer drug oxaliplatin. Using ex vivo PK data in the whole blood of the mouse, rat, and human, a model representing the amount of platinum (Pt) in the plasma and in the red blood cells was designed and could faithfully fit each dataset independently. A "purely physiologically-based (PB)" scaling approach solely based on preclinical data failed to reproduce human observations, which were then included in the calibration. Investigating approaches in which one parameter was set as species-specific, whereas the others were computed by PB scaling laws, we concluded that allowing the Pt binding rate to plasma proteins to be species-specific permitted to closely fit all data, and guaranteed parameter identifiability. Such a strategy presenting the drawback of including all clinical datasets, we further identified a minimal subset of human data ensuring accurate model calibration. Next, a "whole body" model of oxaliplatin human PK was inferred from the ex vivo study. Its three remaining parameters were estimated, using one third of the available patient data. Remarkably, the model achieved a good fit to the training dataset and successfully reproduced the unseen observations. Such validation endorsed the legitimacy of our scaling methodology calling for its testing with other drugs.
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Affiliation(s)
- Simona Catozzi
- Institut Curie, Inserm U900, MINES ParisTech, CBIO ‐ Centre for Computational BiologyPSL Research UniversitySaint‐CloudFrance
| | - Roger Hill
- EPSRC and MRC Centre for Doctoral Training in Mathematics for Real‐World SystemsUniversity of WarwickCoventryUK
| | - Xiao‐Mei Li
- UPR “Chronotherapy, Cancers and Transplantation,” Faculty of MedicineUniversité Paris‐SaclayVillejuifFrance
| | - Sandrine Dulong
- Institut Curie, Inserm U900, MINES ParisTech, CBIO ‐ Centre for Computational BiologyPSL Research UniversitySaint‐CloudFrance,UPR “Chronotherapy, Cancers and Transplantation,” Faculty of MedicineUniversité Paris‐SaclayVillejuifFrance
| | - Elodie Collard
- CEA, CNRS, NIMBEUniversité Paris‐SaclayGif‐sur‐YvetteFrance
| | - Annabelle Ballesta
- Institut Curie, Inserm U900, MINES ParisTech, CBIO ‐ Centre for Computational BiologyPSL Research UniversitySaint‐CloudFrance
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5
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Fendt R, Hofmann U, Schneider ARP, Schaeffeler E, Burghaus R, Yilmaz A, Blank LM, Kerb R, Lippert J, Schlender JF, Schwab M, Kuepfer L. Data-driven personalization of a physiologically based pharmacokinetic model for caffeine: A systematic assessment. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2021; 10:782-793. [PMID: 34053199 PMCID: PMC8302243 DOI: 10.1002/psp4.12646] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/17/2021] [Accepted: 04/29/2021] [Indexed: 12/18/2022]
Abstract
Physiologically based pharmacokinetic (PBPK) models have been proposed as a tool for more accurate individual pharmacokinetic (PK) predictions and model‐informed precision dosing, but their application in clinical practice is still rare. This study systematically assesses the benefit of using individual patient information to improve PK predictions. A PBPK model of caffeine was stepwise personalized by using individual data on (1) demography, (2) physiology, and (3) cytochrome P450 (CYP) 1A2 phenotype of 48 healthy volunteers participating in a single‐dose clinical study. Model performance was benchmarked against a caffeine base model simulated with parameters of an average individual. In the first step, virtual twins were generated based on the study subjects' demography (height, weight, age, sex), which implicated the rescaling of average organ volumes and blood flows. The accuracy of PK simulations improved compared with the base model. The percentage of predictions within 0.8‐fold to 1.25‐fold of the observed values increased from 45.8% (base model) to 57.8% (Step 1). However, setting physiological parameters (liver blood flow determined by magnetic resonance imaging, glomerular filtration rate, hematocrit) to measured values in the second step did not further improve the simulation result (59.1% in the 1.25‐fold range). In the third step, virtual twins matching individual demography, physiology, and CYP1A2 activity considerably improved the simulation results. The percentage of data within the 1.25‐fold range was 66.15%. This case study shows that individual PK profiles can be predicted more accurately by considering individual attributes and that personalized PBPK models could be a valuable tool for model‐informed precision dosing approaches in the future.
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Affiliation(s)
- Rebekka Fendt
- Systems Pharmacology & Medicine, Bayer AG, Leverkusen, Germany.,Institute of Applied Microbiology, Aachen Biology and Biotechnology, Rheinisch-Westfaelische Technische Hochschule Aachen University, Aachen, Germany
| | - Ute Hofmann
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany.,University of Tuebingen, Tuebingen, Germany
| | - Annika R P Schneider
- Systems Pharmacology & Medicine, Bayer AG, Leverkusen, Germany.,Institute of Applied Microbiology, Aachen Biology and Biotechnology, Rheinisch-Westfaelische Technische Hochschule Aachen University, Aachen, Germany
| | - Elke Schaeffeler
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany.,University of Tuebingen, Tuebingen, Germany
| | - Rolf Burghaus
- Systems Pharmacology & Medicine, Bayer AG, Leverkusen, Germany
| | - Ali Yilmaz
- Department of Cardiology I, University Hospital Muenster, Münster, Germany
| | - Lars Mathias Blank
- Institute of Applied Microbiology, Aachen Biology and Biotechnology, Rheinisch-Westfaelische Technische Hochschule Aachen University, Aachen, Germany
| | - Reinhold Kerb
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany.,University of Tuebingen, Tuebingen, Germany
| | - Jörg Lippert
- Systems Pharmacology & Medicine, Bayer AG, Leverkusen, Germany
| | | | - Matthias Schwab
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany.,Departments of Clinical Pharmacology and Biochemistry and Pharmacy, University of Tuebingen, Tuebingen, Germany
| | - Lars Kuepfer
- Systems Pharmacology & Medicine, Bayer AG, Leverkusen, Germany.,Institute for Systems Medicine With Focus on Organ Interactions, University Hospital RWTH Aachen, Aachen, Germany
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6
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Benet LZ, Sodhi JK. Investigating the Theoretical Basis for In Vitro-In Vivo Extrapolation (IVIVE) in Predicting Drug Metabolic Clearance and Proposing Future Experimental Pathways. AAPS JOURNAL 2020; 22:120. [PMID: 32914238 DOI: 10.1208/s12248-020-00501-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/13/2020] [Indexed: 02/04/2023]
Abstract
Extensive studies have been conducted to predict in vivo metabolic clearance from in vitro human liver metabolism parameters (i.e., in vitro-in vivo extrapolation (IVIVE)) with little success. Here, deriving IVIVE from first principles, we show that the product of fraction unbound in the blood and the predicted in vivo intrinsic clearance determined from hepatocyte or microsomal incubations is the lower boundary condition for in vivo hepatic clearance and the prerequisite for IVIVE predictions to be valid, regardless of extraction ratio. For 60-80% of drugs evaluated here, this product is markedly less than the in vivo measured clearance, a result that violates the lower boundary of the predictive relationship. This can only be explained by (a) suboptimal in vitro metabolic stability assay conditions, (b) significant error in the assumption that in vitro intrinsic clearance determinations will predict in vivo intrinsic clearance simply by scaling-up the amount of enzyme (in vitro incubation to in vivo liver), and/or (c) the methods of determining fraction unbound are incorrect. We further suggest that widely employed organ blood flow values underpredict the effective blood flow within the organ by approximately 2.5-fold, thus impacting IVIVE of high clearance compounds. We propose future pathways that should be investigated in terms of the relationship to experimentally measured clearance values, rather than model-dependent intrinsic clearance. IVIVE outcome can be improved by estimating the ratio of unbound drug concentration in the liver tissue to the liver plasma, examining the assumption of the free drug theory (i.e., there are no transporter effects at the blood cell membrane) and the finding that the upper limit of organ clearance may be greater than blood flow entering the organ.
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Affiliation(s)
- Leslie Z Benet
- Department of Bioengineering and Therapeutic Sciences, Schools of Pharmacy and Medicine, University of California San Francisco, 513 Parnassus Ave Rm HSE 1164, UCSF Box 0912, San Francisco, California, 94143, USA.
| | - Jasleen K Sodhi
- Department of Bioengineering and Therapeutic Sciences, Schools of Pharmacy and Medicine, University of California San Francisco, 513 Parnassus Ave Rm HSE 1164, UCSF Box 0912, San Francisco, California, 94143, USA
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7
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Deepika D, Sharma RP, Schuhmacher M, Kumar V. An integrative translational framework for chemical induced neurotoxicity – a systematic review. Crit Rev Toxicol 2020; 50:424-438. [DOI: 10.1080/10408444.2020.1763253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Deepika Deepika
- Environmental Engineering Laboratory, Departament d’ Enginyeria Quimica, Universitat Rovira i Virgili, Tarragona, Catalonia, Spain
| | - Raju Prasad Sharma
- Environmental Engineering Laboratory, Departament d’ Enginyeria Quimica, Universitat Rovira i Virgili, Tarragona, Catalonia, Spain
| | - Marta Schuhmacher
- Environmental Engineering Laboratory, Departament d’ Enginyeria Quimica, Universitat Rovira i Virgili, Tarragona, Catalonia, Spain
| | - Vikas Kumar
- Environmental Engineering Laboratory, Departament d’ Enginyeria Quimica, Universitat Rovira i Virgili, Tarragona, Catalonia, Spain
- IISPV, Hospital Universitari Sant Joan de Reus, Universitat Rovira I Virgili, Reus, Spain
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8
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Velarde F, Castañeda V, Morales E, Ortega M, Ocaña E, Álvarez-Barreto J, Grunauer M, Eguiguren L, Caicedo A. Use of Human Umbilical Cord and Its Byproducts in Tissue Regeneration. Front Bioeng Biotechnol 2020; 8:117. [PMID: 32211387 PMCID: PMC7075856 DOI: 10.3389/fbioe.2020.00117] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 02/06/2020] [Indexed: 12/13/2022] Open
Abstract
The fresh or cryopreserved human umbilical cord (HUC) and its byproducts, such as cells and extracts, have different uses in tissue regeneration. Defining what HUC byproduct is more effective in a particular application is a challenge. Furthermore, the methods of isolation, culture and preservation, may affect cell viability and regenerative properties. In this article, we review the HUC and its byproducts' applications in research and clinical practice. We present our results of successful use of HUC as a patch to treat gastroschisis and its potential to be applied in other conditions. Our in vitro results show an increase in proliferation and migration of human fibroblasts by using an acellular HUC extract. Our goal is to promote standardization of procedures and point out that applications of HUC and its byproducts, as well as the resulting advances in regenerative medicine, will depend on rigorous quality control and on more research in this area.
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Affiliation(s)
- Francesca Velarde
- Colegio de Ciencias de la Salud, Escuela de Medicina, Universidad San Francisco de Quito, Quito, Ecuador
- Instituto de Investigaciones en Biomedicina, Universidad San Francisco de Quito, Quito, Ecuador
| | - Verónica Castañeda
- Colegio de Ciencias de la Salud, Escuela de Medicina, Universidad San Francisco de Quito, Quito, Ecuador
- Instituto de Investigaciones en Biomedicina, Universidad San Francisco de Quito, Quito, Ecuador
- Colegio de Ciencias Biológicas y Ambientales, Escuela de Biotecnología, Universidad San Francisco de Quito, Quito, Ecuador
| | - Emilia Morales
- Colegio de Ciencias de la Salud, Escuela de Medicina, Universidad San Francisco de Quito, Quito, Ecuador
- Instituto de Investigaciones en Biomedicina, Universidad San Francisco de Quito, Quito, Ecuador
- Colegio de Ciencias Biológicas y Ambientales, Escuela de Biotecnología, Universidad San Francisco de Quito, Quito, Ecuador
| | - Mayra Ortega
- Colegio de Ciencias de la Salud, Escuela de Medicina, Universidad San Francisco de Quito, Quito, Ecuador
- Instituto de Investigaciones en Biomedicina, Universidad San Francisco de Quito, Quito, Ecuador
- Colegio de Ciencias Biológicas y Ambientales, Escuela de Biotecnología, Universidad San Francisco de Quito, Quito, Ecuador
| | - Edwin Ocaña
- Hospital Carlos Andrade Marín, Quito, Ecuador
| | - Jose Álvarez-Barreto
- Instituto para el Desarrollo de Energías y Materiales Alternativos (IDEMA), Colegio de Ciencias e Ingenierías (Politécnico), Universidad San Francisco de Quito, Quito, Ecuador
| | - Michelle Grunauer
- Colegio de Ciencias de la Salud, Escuela de Medicina, Universidad San Francisco de Quito, Quito, Ecuador
- Unidad de Cuidados Intensivos Pediátricos, Hospital de los Valles, Quito, Ecuador
| | - Luis Eguiguren
- Colegio de Ciencias de la Salud, Escuela de Medicina, Universidad San Francisco de Quito, Quito, Ecuador
- Sistemas Médicos, SIME, Universidad San Francisco de Quito, Quito, Ecuador
| | - Andrés Caicedo
- Colegio de Ciencias de la Salud, Escuela de Medicina, Universidad San Francisco de Quito, Quito, Ecuador
- Instituto de Investigaciones en Biomedicina, Universidad San Francisco de Quito, Quito, Ecuador
- Sistemas Médicos, SIME, Universidad San Francisco de Quito, Quito, Ecuador
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9
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Tirona RG, Kassam Z, Strapp R, Ramu M, Zhu C, Liu M, Schwarz UI, Kim RB, Al-Judaibi B, Beaton MD. Apixaban and Rosuvas--tatin Pharmacokinetics in Nonalcoholic Fatty Liver Disease. Drug Metab Dispos 2018; 46:485-492. [PMID: 29472495 DOI: 10.1124/dmd.117.079624] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 02/19/2018] [Indexed: 12/22/2022] Open
Abstract
There is little known about the impact of nonalcoholic fatty liver disease (NAFLD) on drug metabolism and transport. We examined the pharmacokinetics of oral apixaban (2.5 mg) and rosuvastatin (5 mg) when administered simultaneously in subjects with magnetic resonance imaging-confirmed NAFLD (N = 22) and healthy control subjects (N = 12). The area under the concentration-time curve to the last sampling time (AUC0-12) values for apixaban were not different between control and NAFLD subjects (671 and 545 ng/ml × hour, respectively; P = 0.15). Similarly, the AUC0-12 values for rosuvastatin did not differ between the control and NAFLD groups (25.4 and 20.1 ng/ml × hour, respectively; P = 0.28). Furthermore, hepatic fibrosis in NAFLD subjects was not associated with differences in apixaban or rosuvastatin pharmacokinetics. Decreased systemic exposures for both apixaban and rosuvastatin were associated with increased body weight (P < 0.001 and P < 0.05, respectively). In multivariable linear regression analyses, only participant weight but not NAFLD, age, or SLCO1B1/ABCG2/CYP3A5 genotypes, was associated with apixaban and rosuvastatin AUC0-12 (P < 0.001 and P = 0.06, respectively). NAFLD does not appear to affect the pharmacokinetics of apixaban or rosuvastatin.
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Affiliation(s)
- Rommel G Tirona
- Department of Physiology and Pharmacology (R.G.T., C.Z., U.I.S, R.B.K.), Division of Clinical Pharmacology, Department of Medicine (R.G.T., C.Z., M.L., U.I.S., R.B.K.), Department of Medical Imaging (Z.K.), Division of Gastroenterology, Department of Medicine (B.A.-J., M.D.B.), and Lawson Health Research Institute (R.G.T., Z.K., R.S., M.R., U.I.S., R.B.K., M.D.B.), University of Western Ontario, London, Ontario, Canada; and Department of Medicine, University of Rochester, Rochester, New York (B.A.-J.)
| | - Zahra Kassam
- Department of Physiology and Pharmacology (R.G.T., C.Z., U.I.S, R.B.K.), Division of Clinical Pharmacology, Department of Medicine (R.G.T., C.Z., M.L., U.I.S., R.B.K.), Department of Medical Imaging (Z.K.), Division of Gastroenterology, Department of Medicine (B.A.-J., M.D.B.), and Lawson Health Research Institute (R.G.T., Z.K., R.S., M.R., U.I.S., R.B.K., M.D.B.), University of Western Ontario, London, Ontario, Canada; and Department of Medicine, University of Rochester, Rochester, New York (B.A.-J.)
| | - Ruth Strapp
- Department of Physiology and Pharmacology (R.G.T., C.Z., U.I.S, R.B.K.), Division of Clinical Pharmacology, Department of Medicine (R.G.T., C.Z., M.L., U.I.S., R.B.K.), Department of Medical Imaging (Z.K.), Division of Gastroenterology, Department of Medicine (B.A.-J., M.D.B.), and Lawson Health Research Institute (R.G.T., Z.K., R.S., M.R., U.I.S., R.B.K., M.D.B.), University of Western Ontario, London, Ontario, Canada; and Department of Medicine, University of Rochester, Rochester, New York (B.A.-J.)
| | - Mala Ramu
- Department of Physiology and Pharmacology (R.G.T., C.Z., U.I.S, R.B.K.), Division of Clinical Pharmacology, Department of Medicine (R.G.T., C.Z., M.L., U.I.S., R.B.K.), Department of Medical Imaging (Z.K.), Division of Gastroenterology, Department of Medicine (B.A.-J., M.D.B.), and Lawson Health Research Institute (R.G.T., Z.K., R.S., M.R., U.I.S., R.B.K., M.D.B.), University of Western Ontario, London, Ontario, Canada; and Department of Medicine, University of Rochester, Rochester, New York (B.A.-J.)
| | - Catherine Zhu
- Department of Physiology and Pharmacology (R.G.T., C.Z., U.I.S, R.B.K.), Division of Clinical Pharmacology, Department of Medicine (R.G.T., C.Z., M.L., U.I.S., R.B.K.), Department of Medical Imaging (Z.K.), Division of Gastroenterology, Department of Medicine (B.A.-J., M.D.B.), and Lawson Health Research Institute (R.G.T., Z.K., R.S., M.R., U.I.S., R.B.K., M.D.B.), University of Western Ontario, London, Ontario, Canada; and Department of Medicine, University of Rochester, Rochester, New York (B.A.-J.)
| | - Melissa Liu
- Department of Physiology and Pharmacology (R.G.T., C.Z., U.I.S, R.B.K.), Division of Clinical Pharmacology, Department of Medicine (R.G.T., C.Z., M.L., U.I.S., R.B.K.), Department of Medical Imaging (Z.K.), Division of Gastroenterology, Department of Medicine (B.A.-J., M.D.B.), and Lawson Health Research Institute (R.G.T., Z.K., R.S., M.R., U.I.S., R.B.K., M.D.B.), University of Western Ontario, London, Ontario, Canada; and Department of Medicine, University of Rochester, Rochester, New York (B.A.-J.)
| | - Ute I Schwarz
- Department of Physiology and Pharmacology (R.G.T., C.Z., U.I.S, R.B.K.), Division of Clinical Pharmacology, Department of Medicine (R.G.T., C.Z., M.L., U.I.S., R.B.K.), Department of Medical Imaging (Z.K.), Division of Gastroenterology, Department of Medicine (B.A.-J., M.D.B.), and Lawson Health Research Institute (R.G.T., Z.K., R.S., M.R., U.I.S., R.B.K., M.D.B.), University of Western Ontario, London, Ontario, Canada; and Department of Medicine, University of Rochester, Rochester, New York (B.A.-J.)
| | - Richard B Kim
- Department of Physiology and Pharmacology (R.G.T., C.Z., U.I.S, R.B.K.), Division of Clinical Pharmacology, Department of Medicine (R.G.T., C.Z., M.L., U.I.S., R.B.K.), Department of Medical Imaging (Z.K.), Division of Gastroenterology, Department of Medicine (B.A.-J., M.D.B.), and Lawson Health Research Institute (R.G.T., Z.K., R.S., M.R., U.I.S., R.B.K., M.D.B.), University of Western Ontario, London, Ontario, Canada; and Department of Medicine, University of Rochester, Rochester, New York (B.A.-J.)
| | - Bandar Al-Judaibi
- Department of Physiology and Pharmacology (R.G.T., C.Z., U.I.S, R.B.K.), Division of Clinical Pharmacology, Department of Medicine (R.G.T., C.Z., M.L., U.I.S., R.B.K.), Department of Medical Imaging (Z.K.), Division of Gastroenterology, Department of Medicine (B.A.-J., M.D.B.), and Lawson Health Research Institute (R.G.T., Z.K., R.S., M.R., U.I.S., R.B.K., M.D.B.), University of Western Ontario, London, Ontario, Canada; and Department of Medicine, University of Rochester, Rochester, New York (B.A.-J.)
| | - Melanie D Beaton
- Department of Physiology and Pharmacology (R.G.T., C.Z., U.I.S, R.B.K.), Division of Clinical Pharmacology, Department of Medicine (R.G.T., C.Z., M.L., U.I.S., R.B.K.), Department of Medical Imaging (Z.K.), Division of Gastroenterology, Department of Medicine (B.A.-J., M.D.B.), and Lawson Health Research Institute (R.G.T., Z.K., R.S., M.R., U.I.S., R.B.K., M.D.B.), University of Western Ontario, London, Ontario, Canada; and Department of Medicine, University of Rochester, Rochester, New York (B.A.-J.)
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