1
|
Gao Y, Deng H, Zhao Y, Li M, Wang L, Zhang Y. Gene Expression of Abcc2 and Its Regulation by Chicken Xenobiotic Receptor. TOXICS 2024; 12:55. [PMID: 38251011 PMCID: PMC10818656 DOI: 10.3390/toxics12010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/26/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024]
Abstract
Membrane transporter multidrug resistance-associated protein 2 (MRP2/Abcc2) exhibits high pharmaco-toxicological relevance because it exports multiple cytotoxic compounds from cells. However, no detailed information about the gene expression and regulation of MRP2 in chickens is yet available. Here, we sought to investigate the expression distribution of Abcc2 in different tissues of chicken and then determine whether Abcc2 expression is induced by chicken xenobiotic receptor (CXR). The bioinformatics analyses showed that MRP2 transporters have three transmembrane structural domains (MSDs) and two highly conserved nucleotide structural domains (NBDs), and a close evolutionary relationship with turkeys. Tissue distribution analysis indicated that Abcc2 was highly expressed in the liver, kidney, duodenum, and jejunum. When exposed to metyrapone (an agonist of CXR) and ketoconazole (an antagonist of CXR), Abcc2 expression was upregulated and downregulated correspondingly. We further confirmed that Abcc2 gene regulation is dependent on CXR, by overexpressing and interfering with CXR, respectively. We also demonstrated the induction of Abcc2 expression and the activity of ivermectin, with CXR being a likely mediator. Animal experiments demonstrated that metyrapone and ivermectin induced Abcc2 in the liver, kidney, and duodenum of chickens. Together, our study identified the gene expression of Abcc2 and its regulation by CXR in chickens, which may provide novel targets for the reasonable usage of veterinary drugs.
Collapse
Affiliation(s)
- Yanhong Gao
- Jiangsu Key Laboratory of Sericultural Biology and Biotechnology, School of Biotechnology, Jiangsu University of Science and Technology, Zhenjiang 212100, China; (Y.G.); (H.D.); (Y.Z.); (M.L.)
| | - Huacheng Deng
- Jiangsu Key Laboratory of Sericultural Biology and Biotechnology, School of Biotechnology, Jiangsu University of Science and Technology, Zhenjiang 212100, China; (Y.G.); (H.D.); (Y.Z.); (M.L.)
| | - Yuying Zhao
- Jiangsu Key Laboratory of Sericultural Biology and Biotechnology, School of Biotechnology, Jiangsu University of Science and Technology, Zhenjiang 212100, China; (Y.G.); (H.D.); (Y.Z.); (M.L.)
| | - Mei Li
- Jiangsu Key Laboratory of Sericultural Biology and Biotechnology, School of Biotechnology, Jiangsu University of Science and Technology, Zhenjiang 212100, China; (Y.G.); (H.D.); (Y.Z.); (M.L.)
| | - Liping Wang
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China;
| | - Yujuan Zhang
- Jiangsu Key Laboratory of Sericultural Biology and Biotechnology, School of Biotechnology, Jiangsu University of Science and Technology, Zhenjiang 212100, China; (Y.G.); (H.D.); (Y.Z.); (M.L.)
| |
Collapse
|
2
|
Zaitoon H, Shnaider M, Shoris I, Khalil H, Riskin A, Gover A. Intrapartum Maternal Prophylactic Antimicrobial Treatment and Neonatal Jaundice. Clin Pediatr (Phila) 2023; 62:1562-1567. [PMID: 36999882 DOI: 10.1177/00099228231165879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
Intrapartum antibiotics are widely used and may potentially affect bilirubin levels and neurotoxicity in the newborn. The aim of this study was to examine the effect of intrapartum antibiotic exposure on neonatal jaundice. We retrospectively collected data from 972 neonates born to 963 mothers. Five hundred forty-five mothers (56.6%) received intrapartum antibiotics. There were no statistically significant differences in maximum bilirubin level (7.82 ± 3.65 vs 7.63 ± 3.71, P = .43) or need for phototherapy (9 [1.62%] vs 4 [0.94%], P = .52) between exposed and non-exposed newborns. The rate of phototherapy was significantly higher only in the group of infants born to mothers who received broad-spectrum antibiotics at 2 to 3.9 hours prior to delivery (χ2 = 10.453, P = .015) and was not higher in the group of exposure >4 hours, which may represent a short transient effect of antibiotics exposure on bilirubin turnover. Further studies are needed to validate this finding.
Collapse
Affiliation(s)
- Hussein Zaitoon
- Department of Pediatrics, Bnai Zion Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Morya Shnaider
- Department of Pediatrics, Bnai Zion Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Irit Shoris
- Department of Neonatology and Neonatal Intensive Care, Bnai Zion Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Arieh Riskin
- Department of Neonatology and Neonatal Intensive Care, Bnai Zion Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ayala Gover
- Department of Neonatology and Neonatal Intensive Care, Bnai Zion Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
3
|
Lee ZM, Chang LS, Kuo KC, Lin MC, Yu HR. Impact of Protein Binding Capacity and Daily Dosage of a Drug on Total Serum Bilirubin Levels in Susceptible Infants. CHILDREN (BASEL, SWITZERLAND) 2023; 10:926. [PMID: 37371159 DOI: 10.3390/children10060926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023]
Abstract
Hyperbilirubinemia is a common pathological condition in neonates. Free bilirubin can penetrate the blood-brain barrier (BBB), which can lead to bilirubin neurotoxicity. In the context of predicting the risk of bilirubin neurotoxicity, although the specificity and sensitivity of free bilirubin levels are higher than those of total serum bilirubin (TSB), free bilirubin is not widely monitored in clinical practice. The threshold TSB levels at which phototherapy must be administered have been established previously. However, TSB levels are not well correlated with neurodevelopmental outcomes. Currently, TSB levels are commonly used to guide phototherapy for neonatal hyperbilirubinemia. Some clinical drugs can displace bilirubin from its albumin-binding sites, and consequently upregulate plasma bilirubin. Daily dosages play a vital role in regulating bilirubin levels. A drug with both a high protein binding capacity and high daily dosage significantly increases bilirubin levels in infants. Premature or very low birth weight (VLBW) infants are vulnerable to the upregulation of bilirubin levels as they exhibit the lowest reserve albumin levels and consequently the highest bilirubin toxicity index. Because bilirubin is involved in maintaining the balance between pro-oxidant and antioxidant agents, the downregulation of bilirubin levels is not always desirable. This review provides insights into the impact of protein binding capacity and daily dosage of drugs on the bilirubin levels in susceptible infants.
Collapse
Affiliation(s)
- Zon-Min Lee
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
- Department of Pharmacy, Tajen University, Pingtung 907, Taiwan
| | - Ling-Sai Chang
- Kawasaki Disease Center and Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Kuang-Che Kuo
- Division of Pediatric Infection, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Meng-Chiao Lin
- Department of Pharmacy, St Joseph's hospital, Yunlin 632401, Taiwan
| | - Hong-Ren Yu
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Graduate Institute of Clinical Medical Science, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| |
Collapse
|
4
|
Lee ZM, Yang YH, Chang LS, Chen CC, Yu HR, Kuo KC. Increased Total Serum Bilirubin Level Post-Ibuprofen Use Is Inversely Correlated with Neonates' Body Weight. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9081184. [PMID: 36010074 PMCID: PMC9406485 DOI: 10.3390/children9081184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022]
Abstract
Backgrounds: Drugs with the ability to displace bilirubin from albumin-binding sites subsequently leading to an increased bilirubin level may cause hyperbilirubinemia in neonates. Ibuprofen is commonly used to treat patent ductus arteriosus (PDA) in neonates, yet the use of ibuprofen has drawn mixed conclusions. We performed a retrospective study to determine how ibuprofen use influences the total serum bilirubin (TSB) level in neonates of differing birth weight (BW). Materials and methods: Neonates (including premature infants) born at Chang Gung Memorial Hospital, Taiwan during January 2004 to July 2020 were entered into this study. We recorded the phototherapy duration, including the initial day and end day, and determined the average influence of one-day phototherapy on TSB level. The highest monitored TSB level post-ibuprofen use minus the one measured prior to ibuprofen use was considered the TSB change following ibuprofen administration in this study, and the above-mentioned influence of daily phototherapy on the TSB level was used to correlate the results. Neonates with any of the following conditions were excluded: those who received ceftriaxone, those with intraventricular hemorrhage, and those infected with TORCH. Results: The average daily influence of phototherapy on the TSB level of neonates was −0.20 (−0.57~0.05) mg/dL, −0.28 (−0.84~0.13) mg/dL, −0.75 (−1.77~0.10) mg/dL, and −1.60 (−2.70~−0.50) mg/dL in neonates with BWs of <1 kg, 1−1.49 kg, 1.5−2.49 kg, and ≥2.5 kg, respectively, indicating that neonates with a BW ≥ 1.5 kg experienced a greater reduction in TSB level following phototherapy as compared with those with a BW < 1.5 kg. The average TSB increase following ibuprofen use in neonates was 3.38 ± 2.77 mg/dL, 2.04 ± 2.53 mg/dL, and 1.34 ± 2.24 mg/dL in neonates with BWs of <1 kg, 1−1.49 kg, and ≥1.5 kg, respectively, i.e., an elevated TSB change with a decreased neonate BW was noted post-ibuprofen use (p = 0.026, one-way analysis of variance (ANOVA)). Conclusions: As ibuprofen use is correlated with an apparent increase in TSB level in neonates with a lower BW, especially in those with a BW < 1 kg, iv acetaminophen can be an appropriate alternative to ibuprofen for ELBW neonates for the treatment of PDA if they are experiencing severe unconjugated hyperbilirubinemia.
Collapse
Affiliation(s)
- Zon-Min Lee
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
- Department of Pharmacy, Tajen University, Pingtung 90741, Taiwan
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi 61344, Taiwan
- Health Informatics and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi 61344, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan
| | - Ling-Sai Chang
- Department of Pediatrics and Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Chih-Cheng Chen
- Department of Pediatrics, Chiayi Chang Gung Memorial Hospital, Chiayi 61344, Taiwan
- College of Medicine, Chang Gung University, Kaohsiung 83301, Taiwan
- Section of Neonatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
- Department of Early Childhood Care and Education, Cheng-Shiu University, Kaohsiung 83301, Taiwan
| | - Hong-Ren Yu
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Kuang-Che Kuo
- College of Medicine, Chang Gung University, Kaohsiung 83301, Taiwan
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
- Correspondence: ; Tel.: +886-7-7317123; Fax: +886-7-7338009
| |
Collapse
|
5
|
Zarif-Yeganeh M, Kargar M. Comparison of the effect of different methods of cyclosporine infusion on transplant-related outcomes in allogeneic transplant recipients. J Oncol Pharm Pract 2021; 27:778-779. [PMID: 33626988 DOI: 10.1177/1078155221996761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Morvarid Zarif-Yeganeh
- Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mona Kargar
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
6
|
Tátrai P, Krajcsi P. Prediction of Drug-Induced Hyperbilirubinemia by In Vitro Testing. Pharmaceutics 2020; 12:pharmaceutics12080755. [PMID: 32796590 PMCID: PMC7465333 DOI: 10.3390/pharmaceutics12080755] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/28/2020] [Accepted: 08/07/2020] [Indexed: 12/23/2022] Open
Abstract
Bilirubin, the end product of heme catabolism, is produced continuously in the body and may reach toxic levels if accumulates in the serum and tissues; therefore, a highly efficient mechanism evolved for its disposition. Normally, unconjugated bilirubin enters hepatocytes through the uptake transporters organic anion transporting polypeptide (OATP) 1B1 and 1B3, undergoes glucuronidation by the Phase II enzyme UDP glucuronosyltransferase 1A1 (UGT1A1), and conjugated forms are excreted into the bile by the canalicular export pump multidrug resistance protein 2 (MRP2). Any remaining conjugated bilirubin is transported back to the blood by MRP3 and passed on for uptake and excretion by downstream hepatocytes or the kidney. The bile salt export pump BSEP as the main motor of bile flow is indirectly involved in bilirubin disposition. Genetic mutations and xenobiotics that interfere with this machinery may impede bilirubin disposition and cause hyperbilirubinemia. Several pharmaceutical compounds are known to cause hyperbilirubinemia via inhibition of OATP1Bs, UGT1A1, or BSEP. Herein we briefly review the in vitro prediction methods that serve to identify drugs with a potential to induce hyperbilirubinemia. In vitro assays can be deployed early in drug development and may help to minimize late-stage attrition. Based on current evidence, drugs that behave as mono- or multispecific inhibitors of OATP1B1, UGT1A1, and BSEP in vitro are at risk of causing clinically significant hyperbilirubinemia. By integrating inhibition data from in vitro assays, drug serum concentrations, and clinical reports of hyperbilirubinemia, predictor cut-off values have been established and are provisionally suggested in this review. Further validation of in vitro readouts to clinical outcomes is expected to enhance the predictive power of these assays.
Collapse
Affiliation(s)
- Péter Tátrai
- Solvo Biotechnology, Science Park, Building B1, 4-20 Irinyi József utca, H-1117 Budapest, Hungary;
| | - Péter Krajcsi
- Solvo Biotechnology, Science Park, Building B1, 4-20 Irinyi József utca, H-1117 Budapest, Hungary;
- Faculty of Health Sciences, Semmelweis University, H-1085 Budapest, Hungary
- Faculty of Information Technology and Bionics, Péter Pázmány Catholic University, H-1083 Budapest, Hungary
- Correspondence:
| |
Collapse
|
7
|
Industrial Approach to Determine the Relative Contribution of Seven Major UGT Isoforms to Hepatic Glucuronidation. J Pharm Sci 2020; 109:2309-2320. [DOI: 10.1016/j.xphs.2020.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 02/28/2020] [Accepted: 03/23/2020] [Indexed: 01/19/2023]
|
8
|
Collins KS, Metzger IF, Gufford BT, Lu JB, Medeiros EB, Pratt VM, Skaar TC, Desta Z. Influence of Uridine Diphosphate Glucuronosyltransferase Family 1 Member A1 and Solute Carrier Organic Anion Transporter Family 1 Member B1 Polymorphisms and Efavirenz on Bilirubin Disposition in Healthy Volunteers. Drug Metab Dispos 2020; 48:169-175. [PMID: 31888882 DOI: 10.1124/dmd.119.089052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/20/2019] [Indexed: 12/12/2022] Open
Abstract
Chronic administration of efavirenz is associated with decreased serum bilirubin levels, probably through induction of UGT1A1 We assessed the impact of efavirenz monotherapy and UGT1A1 phenotypes on total, conjugated, and unconjugated serum bilirubin levels in healthy volunteers. Healthy volunteers were enrolled into a clinical study designed to address efavirenz pharmacokinetics, drug interactions, and pharmacogenetics. Volunteers received multiple oral doses (600 mg/day for 17 days) of efavirenz. Serum bilirubin levels were obtained at study entry and 1 week after completion of the study. DNA genotyping was performed for UGT1A1 [*80 (C>T), *6 (G>A), *28 (TA7), *36 (TA5), and *37 (TA8)] and for SLCO1B1 [*5 (521T>C) and *1b (388A>G] variants. Diplotype predicted phenotypes were classified as normal, intermediate, and slow metabolizers. Compared with bilirubin levels at screening, treatment with efavirenz significantly reduced total, conjugated, and unconjugated bilirubin. After stratification by UGT1A1 phenotypes, there was a significant decrease in total bilirubin among all phenotypes, conjugated bilirubin among intermediate metabolizers, and unconjugated bilirubin among normal and intermediate metabolizers. The data also show that UGT1A1 genotype predicts serum bilirubin levels at baseline, but this relationship is lost after efavirenz treatment. SLCO1B1 genotypes did not predict bilirubin levels at baseline or after efavirenz treatment. Our data suggest that efavirenz may alter bilirubin disposition mainly through induction of UGT1A1 metabolism and efflux through multidrug resistance-associated protein 2. SIGNIFICANCE STATEMENT: Efavirenz likely alters the pharmacokinetics of coadministered drugs, potentially causing lack of efficacy or increased adverse effects, as well as the disposition of endogenous compounds relevant in homeostasis through upregulation of UGT1A1 and multidrug resistance-associated protein 2. Measurement of unconjugated and conjugated bilirubin during new drug development may provide mechanistic understanding regarding enzyme and transporters modulated by the new drug.
Collapse
Affiliation(s)
- Kimberly S Collins
- Department of Medicine, Division of Clinical Pharmacology (K.S.C., I.F.M., B.T.G., J.L., T.C.S., Z.D.), and Department of Medical and Molecular Genetics (E.B.M., V.M.P.), Indiana University School of Medicine, Indianapolis, Indiana
| | - Ingrid F Metzger
- Department of Medicine, Division of Clinical Pharmacology (K.S.C., I.F.M., B.T.G., J.L., T.C.S., Z.D.), and Department of Medical and Molecular Genetics (E.B.M., V.M.P.), Indiana University School of Medicine, Indianapolis, Indiana
| | - Brandon T Gufford
- Department of Medicine, Division of Clinical Pharmacology (K.S.C., I.F.M., B.T.G., J.L., T.C.S., Z.D.), and Department of Medical and Molecular Genetics (E.B.M., V.M.P.), Indiana University School of Medicine, Indianapolis, Indiana
| | - Jessica B Lu
- Department of Medicine, Division of Clinical Pharmacology (K.S.C., I.F.M., B.T.G., J.L., T.C.S., Z.D.), and Department of Medical and Molecular Genetics (E.B.M., V.M.P.), Indiana University School of Medicine, Indianapolis, Indiana
| | - Elizabeth B Medeiros
- Department of Medicine, Division of Clinical Pharmacology (K.S.C., I.F.M., B.T.G., J.L., T.C.S., Z.D.), and Department of Medical and Molecular Genetics (E.B.M., V.M.P.), Indiana University School of Medicine, Indianapolis, Indiana
| | - Victoria M Pratt
- Department of Medicine, Division of Clinical Pharmacology (K.S.C., I.F.M., B.T.G., J.L., T.C.S., Z.D.), and Department of Medical and Molecular Genetics (E.B.M., V.M.P.), Indiana University School of Medicine, Indianapolis, Indiana
| | - Todd C Skaar
- Department of Medicine, Division of Clinical Pharmacology (K.S.C., I.F.M., B.T.G., J.L., T.C.S., Z.D.), and Department of Medical and Molecular Genetics (E.B.M., V.M.P.), Indiana University School of Medicine, Indianapolis, Indiana
| | - Zeruesenay Desta
- Department of Medicine, Division of Clinical Pharmacology (K.S.C., I.F.M., B.T.G., J.L., T.C.S., Z.D.), and Department of Medical and Molecular Genetics (E.B.M., V.M.P.), Indiana University School of Medicine, Indianapolis, Indiana
| |
Collapse
|
9
|
Stephanou C, Tamana S, Minaidou A, Papasavva P, Kleanthous M, Kountouris P. Genetic Modifiers at the Crossroads of Personalised Medicine for Haemoglobinopathies. J Clin Med 2019; 8:E1927. [PMID: 31717530 PMCID: PMC6912721 DOI: 10.3390/jcm8111927] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/25/2019] [Accepted: 11/05/2019] [Indexed: 12/20/2022] Open
Abstract
Haemoglobinopathies are common monogenic disorders with diverse clinical manifestations, partly attributed to the influence of modifier genes. Recent years have seen enormous growth in the amount of genetic data, instigating the need for ranking methods to identify candidate genes with strong modifying effects. Here, we present the first evidence-based gene ranking metric (IthaScore) for haemoglobinopathy-specific phenotypes by utilising curated data in the IthaGenes database. IthaScore successfully reflects current knowledge for well-established disease modifiers, while it can be dynamically updated with emerging evidence. Protein-protein interaction (PPI) network analysis and functional enrichment analysis were employed to identify new potential disease modifiers and to evaluate the biological profiles of selected phenotypes. The most relevant gene ontology (GO) and pathway gene annotations for (a) haemoglobin (Hb) F levels/Hb F response to hydroxyurea included urea cycle, arginine metabolism and vascular endothelial growth factor receptor (VEGFR) signalling, (b) response to iron chelators included xenobiotic metabolism and glucuronidation, and (c) stroke included cytokine signalling and inflammatory reactions. Our findings demonstrate the capacity of IthaGenes, together with dynamic gene ranking, to expand knowledge on the genetic and molecular basis of phenotypic variation in haemoglobinopathies and to identify additional candidate genes to potentially inform and improve diagnosis, prognosis and therapeutic management.
Collapse
Affiliation(s)
| | | | | | | | - Marina Kleanthous
- Correspondence: (M.K.); (P.K.); Tel.:+357-2239-2652 (M.K.); +357-2239-2623 (P.K.)
| | - Petros Kountouris
- Correspondence: (M.K.); (P.K.); Tel.:+357-2239-2652 (M.K.); +357-2239-2623 (P.K.)
| |
Collapse
|
10
|
Qosa H, Avaritt BR, Hartman NR, Volpe DA. In vitro UGT1A1 inhibition by tyrosine kinase inhibitors and association with drug-induced hyperbilirubinemia. Cancer Chemother Pharmacol 2018; 82:795-802. [PMID: 30105461 DOI: 10.1007/s00280-018-3665-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/03/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE Hyperbilirubinemia has been observed in patients treated with tyrosine kinase inhibitor (TKI) drugs. Therefore, it would be beneficial to understand whether there is a relationship between inhibition of uridine-5'-diphosphate glucuronosyltransferase (UGT) 1A1 activity and observed bilirubin elevations in TKI drug-treated patients. UGT1A1 is responsible for the glucuronidation of bilirubin which leads to its elimination in the bile. METHODS To examine this question, an in vitro glucuronidation assay was developed to determine the inhibitory effect of TKI drugs employing human liver microsomes (HLM) with varying UGT1A1 activity. Utilizing β-estradiol as the UGT1A1 probe substrate, 20 TKI drugs were evaluated at concentrations that represent clinical plasma levels. Adverse event reports were searched to generate an empirical Bayes geometric mean (EGBM) score for clinical hyperbilirubinemia with the TKI drugs. RESULTS Erlotinib, nilotinib, regorafenib, pazopanib, sorafenib and vemurafenib had IC50 values that were lower than their clinical steady-state Cmax concentrations. These TKI drugs had high incidences of hyperbilirubinemia and higher EBGM scores. The IC50 values and Cmax/IC50 ratios correlated well with EBGM scores for hyperbilirubinemia (P < 0.005). For the TKI drugs with higher incidence of hyperbilirubinemia in Gilbert syndrome patients, who have reduced UGT1A1 activity, six of eight had smaller ratios in the low UGT1A1 activity microsomes than the wild-type microsomes for drugs, indicating greater sensitivity to the drugs in this phenotype. CONCLUSIONS These results suggest that in vitro UGT1A1 inhibition assays have the potential to predict clinical hyperbilirubinemia.
Collapse
Affiliation(s)
- Hisham Qosa
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, MD, 20993, USA
| | - Brittany R Avaritt
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, MD, 20993, USA
- Office of Generic Drugs, Center for Drug Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, MD, 20993, USA
| | - Neil R Hartman
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, MD, 20993, USA
| | - Donna A Volpe
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, MD, 20993, USA.
| |
Collapse
|
11
|
Fu J, Becker C, Cao L, Capparelli M, Denay R, Fujimoto R, Gai Y, Gao Z, Guenat C, Karur S, Kim H, Li W, Li X, Li W, Lochmann T, Lu A, Lu P, Luneau A, Meier N, Mergo W, Ng S, Parker D, Peng Y, Riss B, Rivkin A, Roggo S, Schroeder H, Schuerch F, Simmons RL, Sun F, Sweeney ZK, Tjandra M, Wang M, Wang R, Weiss AH, Wenger N, Wu Q, Xiong X, Xu S, Xu W, Yifru A, Zhao J, Zhou J, Zürcher C, Gallou F. Development of a cyclosporin A derivative with excellent anti-hepatitis C virus potency. Bioorg Med Chem 2018; 26:957-969. [DOI: 10.1016/j.bmc.2017.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 08/21/2017] [Accepted: 09/06/2017] [Indexed: 12/27/2022]
|
12
|
Choi YH, Lee CH, Ko MS, Han HJ, Kim SG. Lamivudine Therapy Exacerbates Bilirubinemia in Patients Underlying Severely Advanced Hepatitis. Toxicol Res 2017; 33:343-350. [PMID: 29071019 PMCID: PMC5654198 DOI: 10.5487/tr.2017.33.4.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 09/21/2017] [Accepted: 09/25/2017] [Indexed: 11/20/2022] Open
Abstract
Lamivudine belongs to the set of antiviral agents effective against hepatitis B virus infection. Given case reports on liver injuries after certain antiviral agent treatments, this study examined the effects of lamivudine on alanine aminotransferase (ALT) and total bilirubin (TB) using a medical system database. A total of 1,321 patients taking lamivudine alone or with others were evaluated using laboratory hits in an electronic medical system at Seoul National University Hospital from 2005 through 2011. The patients were grouped according to prior ALT results: G#1, ALT < 40 IU/L; G#2, 40 IU/L ≤ ALT < 120 IU/L; G#3, 120 IU/L ≤ ALT < 240 IU/L; and G#4, ALT ≥ 240 IU/L. In G#1 and G#2 patients, lamivudine or adefovir treatment decreased ALT and TB compared to prior values. In G#3 and G#4 patients with three times the upper limit of normal (ULN) ≤ ALT < 15 times the ULN, both ALT and TB were decreased after treatment with lamivudine alone, or adefovir following lamivudine therapy, indicating that lamivudine therapy ameliorated liver functions. However, in G#4 patients who experienced severely advanced hepatitis (ALT ≥ 15 times the ULN, or ≥ 600 IU/L), lamivudine augmented TBmax (6.3→13.3 mg/dL) despite a slight improvement in ALT (839→783 IU/L), indicative of exacerbation of bilirubinemia. Patients who used adefovir after lamivudine also showed a high incidence of hyperbilirubinemia when they experienced severely advanced hepatitis. Treatment with adefovir alone did not show the effect. In conclusion, lamivudine may increase the risk of hyperbilirubinemia in patients with severely advanced hepatitis, implying that caution should be exercised when using lamivudine therapy in certain patient populations.
Collapse
Affiliation(s)
- Young Hee Choi
- College of Pharmacy, Dongguk University_Seoul, Seoul,
Korea
| | - Chang Ho Lee
- Department of Pharmacology, College of Medicine, Hanyang University, Seoul,
Korea
| | - Myong Suk Ko
- Korea Intellectual Property Strategy Agency, Business Cooperation Team, Seoul,
Korea
| | - Hyun Joo Han
- Department of Pharmacy, Seoul National University Hospital, Seoul,
Korea
| | - Sang Geon Kim
- Department of Pharmacy, Seoul National University Hospital, Seoul,
Korea
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul,
Korea
| |
Collapse
|
13
|
Zwirtes R, Narasimhan P, Wind-Rotolo MM, Xu D, Hruska MW, Kishnani N, Colston EM, Srinivasan S. Mechanisms of Hyperbilirubinemia During Peginterferon Lambda-1a Therapy for Chronic Hepatitis C Infection: A Retrospective Investigation. J Interferon Cytokine Res 2016; 36:644-651. [PMID: 27710263 DOI: 10.1089/jir.2015.0153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The phase 2b EMERGE study compared the efficacy/safety of peginterferon lambda-1a (Lambda) and peginterferon alfa-2a (Alfa), both with ribavirin (RBV), for treatment of chronic hepatitis C virus (HCV) infection. A key safety finding was a higher frequency of hyperbilirubinemia with Lambda/RBV versus Alfa/RBV. To characterize mechanisms of hyperbilirubinemia associated with Lambda/RBV, we conducted a retrospective analysis of safety data from the HCV genotype 1 and genotype 4 cohort of the EMERGE study. Subjects were randomized to once-weekly Lambda (120/180/240 μg) or Alfa (180 μg), with daily RBV, for 48 weeks. Early-onset Lambda/RBV-related hyperbilirubinemia events (6-12 weeks) resulted mostly from RBV-induced hemolysis evidenced by sustained reticulocytosis and a predominantly unconjugated pattern of hyperbilirubinemia. The higher hyperbilirubinemia frequency with Lambda/RBV versus Alfa/RBV was attributed to bone marrow suppression known to occur with Alfa but not Lambda. Late-onset (>12 weeks) Lambda/RBV-related hyperbilirubinemia events occurred most frequently with higher Lambda doses and were associated with increased levels of hepatic transaminase and direct bilirubin fractions compared with early events. This dual pattern of hyperbilirubinemia observed while on Lambda/RBV treatment is thought to be caused by exaggerated RBV-induced hemolysis in early-onset events compared with possible direct Lambda-induced hepatocellular toxicity in late-onset events.
Collapse
Affiliation(s)
- Ricardo Zwirtes
- 1 Research and Development, Bristol-Myers Squibb Company , Wallingford, Connecticut
| | - Premkumar Narasimhan
- 2 Research and Development, Bristol-Myers Squibb Company , Princeton, New Jersey
| | - Megan M Wind-Rotolo
- 2 Research and Development, Bristol-Myers Squibb Company , Princeton, New Jersey
| | - Dong Xu
- 1 Research and Development, Bristol-Myers Squibb Company , Wallingford, Connecticut
| | - Matthew W Hruska
- 2 Research and Development, Bristol-Myers Squibb Company , Princeton, New Jersey
| | - Narendra Kishnani
- 2 Research and Development, Bristol-Myers Squibb Company , Princeton, New Jersey
| | - Elizabeth M Colston
- 2 Research and Development, Bristol-Myers Squibb Company , Princeton, New Jersey
| | - Subasree Srinivasan
- 1 Research and Development, Bristol-Myers Squibb Company , Wallingford, Connecticut
| |
Collapse
|
14
|
Fu J, Tjandra M, Becker C, Bednarczyk D, Capparelli M, Elling R, Hanna I, Fujimoto R, Furegati M, Karur S, Kasprzyk T, Knapp M, Leung K, Li X, Lu P, Mergo W, Miault C, Ng S, Parker D, Peng Y, Roggo S, Rivkin A, Simmons RL, Wang M, Wiedmann B, Weiss AH, Xiao L, Xie L, Xu W, Yifru A, Yang S, Zhou B, Sweeney ZK. Potent nonimmunosuppressive cyclophilin inhibitors with improved pharmaceutical properties and decreased transporter inhibition. J Med Chem 2014; 57:8503-16. [PMID: 25310383 DOI: 10.1021/jm500862r] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Nonimmunosuppressive cyclophilin inhibitors have demonstrated efficacy for the treatment of hepatitis C infection (HCV). However, alisporivir, cyclosporin A, and most other cyclosporins are potent inhibitors of OATP1B1, MRP2, MDR1, and other important drug transporters. Reduction of the side chain hydrophobicity of the P4 residue preserves cyclophilin binding and antiviral potency while decreasing transporter inhibition. Representative inhibitor 33 (NIM258) is a less potent transporter inhibitor relative to previously described cyclosporins, retains anti-HCV activity in cell culture, and has an acceptable pharmacokinetic profile in rats and dogs. An X-ray structure of 33 bound to rat cyclophilin D is reported.
Collapse
Affiliation(s)
- Jiping Fu
- Novartis Institutes for Biomedical Research , 4560 Horton Street, Emeryville, California 94608, United States
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Sane RS, Steinmann GG, Huang Q, Li Y, Podila L, Mease K, Olson S, Taub ME, Stern JO, Nehmiz G, Böcher WO, Asselah T, Tweedie D. Mechanisms underlying benign and reversible unconjugated hyperbilirubinemia observed with faldaprevir administration in hepatitis C virus patients. J Pharmacol Exp Ther 2014; 351:403-12. [PMID: 25204339 DOI: 10.1124/jpet.114.218081] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Faldaprevir, an investigational agent for hepatitis C virus treatment, is well tolerated but associated with rapidly reversible, dose-dependent, clinically benign, unconjugated hyperbilirubinemia. Multidisciplinary preclinical and clinical studies were used to characterize mechanisms underlying this hyperbilirubinemia. In vitro, faldaprevir inhibited key processes involved in bilirubin clearance: UDP glucuronosyltransferase (UGT) 1A1 (UGT1A1) (IC50 0.45 µM), which conjugates bilirubin, and hepatic uptake and efflux transporters, organic anion-transporting polypeptide (OATP) 1B1 (IC50 0.57 µM), OATP1B3 (IC50 0.18 µM), and multidrug resistance-associated protein (MRP) 2 (IC50 6.2 µM), which transport bilirubin and its conjugates. In rat and human hepatocytes, uptake and biliary excretion of [(3)H]bilirubin and/or its glucuronides decreased on coincubation with faldaprevir. In monkeys, faldaprevir (≥20 mg/kg per day) caused reversible unconjugated hyperbilirubinemia, without hemolysis or hepatotoxicity. In clinical studies, faldaprevir-mediated hyperbilirubinemia was predominantly unconjugated, and levels of unconjugated bilirubin correlated with the UGT1A1*28 genotype. The reversible and dose-dependent nature of the clinical hyperbilirubinemia was consistent with competitive inhibition of bilirubin clearance by faldaprevir, and was not associated with liver toxicity or other adverse events. Overall, the reversible, unconjugated hyperbilirubinemia associated with faldaprevir may predominantly result from inhibition of bilirubin conjugation by UGT1A1, with inhibition of hepatic uptake of bilirubin also potentially playing a role. Since OATP1B1/1B3 are known to be involved in hepatic uptake of circulating bilirubin glucuronides, inhibition of OATP1B1/1B3 and MRP2 may underlie isolated increases in conjugated bilirubin. As such, faldaprevir-mediated hyperbilirubinemia is not associated with any liver injury or toxicity, and is considered to result from decreased bilirubin elimination due to a drug-bilirubin interaction.
Collapse
Affiliation(s)
- Rucha S Sane
- Boehringer Ingelheim Pharma Inc., Ridgefield, Connecticut (R.S.S., Q.H., Y.L., L.P., K.M., S.O., M.E.T., J.O.S., D.T.); Boehringer Ingelheim Pharma GmbH&Co. KG, Biberach, Germany (G.G.S., G.N.); Boehringer Ingelheim Pharma GmbH, Ingelheim, Germany (W.O.B.); and Hôpital Beaujon and INSERM UMR773, Université Denis Diderot Paris 7, Paris, France (T.A.)
| | - Gerhard G Steinmann
- Boehringer Ingelheim Pharma Inc., Ridgefield, Connecticut (R.S.S., Q.H., Y.L., L.P., K.M., S.O., M.E.T., J.O.S., D.T.); Boehringer Ingelheim Pharma GmbH&Co. KG, Biberach, Germany (G.G.S., G.N.); Boehringer Ingelheim Pharma GmbH, Ingelheim, Germany (W.O.B.); and Hôpital Beaujon and INSERM UMR773, Université Denis Diderot Paris 7, Paris, France (T.A.)
| | - Qihong Huang
- Boehringer Ingelheim Pharma Inc., Ridgefield, Connecticut (R.S.S., Q.H., Y.L., L.P., K.M., S.O., M.E.T., J.O.S., D.T.); Boehringer Ingelheim Pharma GmbH&Co. KG, Biberach, Germany (G.G.S., G.N.); Boehringer Ingelheim Pharma GmbH, Ingelheim, Germany (W.O.B.); and Hôpital Beaujon and INSERM UMR773, Université Denis Diderot Paris 7, Paris, France (T.A.)
| | - Yongmei Li
- Boehringer Ingelheim Pharma Inc., Ridgefield, Connecticut (R.S.S., Q.H., Y.L., L.P., K.M., S.O., M.E.T., J.O.S., D.T.); Boehringer Ingelheim Pharma GmbH&Co. KG, Biberach, Germany (G.G.S., G.N.); Boehringer Ingelheim Pharma GmbH, Ingelheim, Germany (W.O.B.); and Hôpital Beaujon and INSERM UMR773, Université Denis Diderot Paris 7, Paris, France (T.A.)
| | - Lalitha Podila
- Boehringer Ingelheim Pharma Inc., Ridgefield, Connecticut (R.S.S., Q.H., Y.L., L.P., K.M., S.O., M.E.T., J.O.S., D.T.); Boehringer Ingelheim Pharma GmbH&Co. KG, Biberach, Germany (G.G.S., G.N.); Boehringer Ingelheim Pharma GmbH, Ingelheim, Germany (W.O.B.); and Hôpital Beaujon and INSERM UMR773, Université Denis Diderot Paris 7, Paris, France (T.A.)
| | - Kirsten Mease
- Boehringer Ingelheim Pharma Inc., Ridgefield, Connecticut (R.S.S., Q.H., Y.L., L.P., K.M., S.O., M.E.T., J.O.S., D.T.); Boehringer Ingelheim Pharma GmbH&Co. KG, Biberach, Germany (G.G.S., G.N.); Boehringer Ingelheim Pharma GmbH, Ingelheim, Germany (W.O.B.); and Hôpital Beaujon and INSERM UMR773, Université Denis Diderot Paris 7, Paris, France (T.A.)
| | - Stephen Olson
- Boehringer Ingelheim Pharma Inc., Ridgefield, Connecticut (R.S.S., Q.H., Y.L., L.P., K.M., S.O., M.E.T., J.O.S., D.T.); Boehringer Ingelheim Pharma GmbH&Co. KG, Biberach, Germany (G.G.S., G.N.); Boehringer Ingelheim Pharma GmbH, Ingelheim, Germany (W.O.B.); and Hôpital Beaujon and INSERM UMR773, Université Denis Diderot Paris 7, Paris, France (T.A.)
| | - Mitchell E Taub
- Boehringer Ingelheim Pharma Inc., Ridgefield, Connecticut (R.S.S., Q.H., Y.L., L.P., K.M., S.O., M.E.T., J.O.S., D.T.); Boehringer Ingelheim Pharma GmbH&Co. KG, Biberach, Germany (G.G.S., G.N.); Boehringer Ingelheim Pharma GmbH, Ingelheim, Germany (W.O.B.); and Hôpital Beaujon and INSERM UMR773, Université Denis Diderot Paris 7, Paris, France (T.A.)
| | - Jerry O Stern
- Boehringer Ingelheim Pharma Inc., Ridgefield, Connecticut (R.S.S., Q.H., Y.L., L.P., K.M., S.O., M.E.T., J.O.S., D.T.); Boehringer Ingelheim Pharma GmbH&Co. KG, Biberach, Germany (G.G.S., G.N.); Boehringer Ingelheim Pharma GmbH, Ingelheim, Germany (W.O.B.); and Hôpital Beaujon and INSERM UMR773, Université Denis Diderot Paris 7, Paris, France (T.A.)
| | - Gerhard Nehmiz
- Boehringer Ingelheim Pharma Inc., Ridgefield, Connecticut (R.S.S., Q.H., Y.L., L.P., K.M., S.O., M.E.T., J.O.S., D.T.); Boehringer Ingelheim Pharma GmbH&Co. KG, Biberach, Germany (G.G.S., G.N.); Boehringer Ingelheim Pharma GmbH, Ingelheim, Germany (W.O.B.); and Hôpital Beaujon and INSERM UMR773, Université Denis Diderot Paris 7, Paris, France (T.A.)
| | - Wulf O Böcher
- Boehringer Ingelheim Pharma Inc., Ridgefield, Connecticut (R.S.S., Q.H., Y.L., L.P., K.M., S.O., M.E.T., J.O.S., D.T.); Boehringer Ingelheim Pharma GmbH&Co. KG, Biberach, Germany (G.G.S., G.N.); Boehringer Ingelheim Pharma GmbH, Ingelheim, Germany (W.O.B.); and Hôpital Beaujon and INSERM UMR773, Université Denis Diderot Paris 7, Paris, France (T.A.)
| | - Tarik Asselah
- Boehringer Ingelheim Pharma Inc., Ridgefield, Connecticut (R.S.S., Q.H., Y.L., L.P., K.M., S.O., M.E.T., J.O.S., D.T.); Boehringer Ingelheim Pharma GmbH&Co. KG, Biberach, Germany (G.G.S., G.N.); Boehringer Ingelheim Pharma GmbH, Ingelheim, Germany (W.O.B.); and Hôpital Beaujon and INSERM UMR773, Université Denis Diderot Paris 7, Paris, France (T.A.)
| | - Donald Tweedie
- Boehringer Ingelheim Pharma Inc., Ridgefield, Connecticut (R.S.S., Q.H., Y.L., L.P., K.M., S.O., M.E.T., J.O.S., D.T.); Boehringer Ingelheim Pharma GmbH&Co. KG, Biberach, Germany (G.G.S., G.N.); Boehringer Ingelheim Pharma GmbH, Ingelheim, Germany (W.O.B.); and Hôpital Beaujon and INSERM UMR773, Université Denis Diderot Paris 7, Paris, France (T.A.)
| |
Collapse
|
16
|
Thulin P, Nordahl G, Gry M, Yimer G, Aklillu E, Makonnen E, Aderaye G, Lindquist L, Mattsson CM, Ekblom B, Antoine DJ, Park BK, Linder S, Harrill AH, Watkins PB, Glinghammar B, Schuppe-Koistinen I. Keratin-18 and microRNA-122 complement alanine aminotransferase as novel safety biomarkers for drug-induced liver injury in two human cohorts. Liver Int 2014; 34:367-78. [PMID: 24118944 DOI: 10.1111/liv.12322] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 08/31/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND & AIMS There is a demand for more sensitive, specific and predictive biomarkers for drug-induced liver injury (DILI) than the gold standard used today, alanine aminotransferase (ALT). The aim of this study was to qualify novel DILI biomarkers (keratin-18 markers M65/M30, microRNA-122, glutamate dehydrogenase and alpha-foetoprotein) in human DILI. METHODS Levels of the novel biomarkers were measured by enzyme-linked immunosorbent assay or real-time quantitative reverse-transcription PCR (qRT-PCR) in two human DILI cohorts: a human volunteer study with acetaminophen and a human immunodeficiency virus (HIV)/tuberculosis (TB) study. RESULTS In the acetaminophen study, serum M65 and microRNA-122 levels were significantly increased at an earlier time point than ALT. Furthermore, the maximal elevation of M65 and microRNA-122 exceeded the increase in ALT. In the HIV/TB study, all the analysed novel biomarkers increased after 1 week of treatment. In contrast to ALT, the novel biomarkers remained stable in a human cohort with exercise-induced muscular injury. CONCLUSIONS M65 and microRNA-122 are potential biomarkers of DILI superior to ALT with respect to sensitivity and specificity.
Collapse
Affiliation(s)
- Petra Thulin
- AstraZeneca R&D, Innovative Medicines Personalised Healthcare & Biomarkers, Science for Life Laboratory, Solna, Sweden
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Ulloa JL, Stahl S, Yates J, Woodhouse N, Kenna JG, Jones HB, Waterton JC, Hockings PD. Assessment of gadoxetate DCE-MRI as a biomarker of hepatobiliary transporter inhibition. NMR IN BIOMEDICINE 2013; 26:1258-1270. [PMID: 23564602 PMCID: PMC3817526 DOI: 10.1002/nbm.2946] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 02/14/2013] [Accepted: 02/18/2013] [Indexed: 06/02/2023]
Abstract
Drug-induced liver injury (DILI) is a clinically important adverse drug reaction, which prevents the development of many otherwise safe and effective new drugs. Currently, there is a lack of sensitive and specific biomarkers that can be used to predict, assess and manage this toxicity. The aim of this work was to evaluate gadoxetate-enhanced MRI as a potential novel biomarker of hepatobiliary transporter inhibition in the rat. Initially, the volume fraction of extracellular space in the liver was determined using gadopentetate to enable an estimation of the gadoxetate concentration in hepatocytes. Using this information, a compartmental model was developed to characterise the pharmacokinetics of hepatic uptake and biliary excretion of gadoxetate. Subsequently, we explored the impact of an investigational hepatobiliary transporter inhibitor on the parameters of the model in vivo in rats. The investigational hepatobiliary transporter inhibitor reduced both the rate of uptake of gadoxetate into the hepatocyte, k1 , and the Michaelis-Menten constant, Vmax , characterising its excretion into bile, whereas KM values for biliary efflux were increased. These effects were dose dependent and correlated with effects on plasma chemistry markers of liver dysfunction, in particular bilirubin and bile acids. These results indicate that gadoxetate-enhanced MRI provides a novel functional biomarker of inhibition of transporter-mediated hepatic uptake and clearance in the rat. Since gadoxetate is used clinically, the technology has the potential to provide a translatable biomarker of drug-induced perturbation of hepatic transporters that may also be useful in humans to explore deleterious functional alterations caused by transporter inhibition.
Collapse
Affiliation(s)
- Jose L Ulloa
- Science and Validation, Personalised Healthcare and BiomarkersAstraZeneca, Macclesfield, UK
| | - Simone Stahl
- Molecular Toxicology, Safety Assessment UKAstraZeneca, Macclesfield, UK
| | - James Yates
- DMPK, Oncology iMedAstraZeneca, Macclesfield, UK
| | - Neil Woodhouse
- Science and Validation, Personalised Healthcare and BiomarkersAstraZeneca, Macclesfield, UK
| | - J Gerry Kenna
- Molecular Toxicology, Safety Assessment UKAstraZeneca, Macclesfield, UK
| | - Huw B Jones
- Pathology, Safety Assessment UKAstraZeneca, Macclesfield, UK
| | - John C Waterton
- Science and Validation, Personalised Healthcare and BiomarkersAstraZeneca, Macclesfield, UK
| | - Paul D Hockings
- Science and Validation, Personalised Healthcare and BiomarkersAstraZeneca, Mölndal, Sweden
- MedTech West, Chalmers University of TechnologyGothenburg, Sweden
| |
Collapse
|
18
|
Chiou WJ, de Morais SM, Kikuchi R, Voorman RL, Li X, Bow DAJ. In vitro OATP1B1 and OATP1B3 inhibition is associated with observations of benign clinical unconjugated hyperbilirubinemia. Xenobiotica 2013; 44:276-82. [PMID: 23886114 DOI: 10.3109/00498254.2013.820006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
1. Transient benign unconjugated hyperbilirubinemia has been observed clinically with several drugs including indinavir, cyclosporine, and rifamycin SV. Genome-wide association studies have shown significant association of OATP1B1 and UGT1A1 with elevations of unconjugated bilirubin, and OATP1B1 inhibition data correlated with clinical unconjugated hyperbilirubinemia for several compounds. 2. In this study, inhibition of OATP1B3 and UGT1A1, in addition to OATP1B1, was explored to determine whether one measure offers value over the other as a potential prospective tool to predict unconjugated hyperbilirubinemia. OATP1B1 and OATP1B3-mediated transport of bilirubin was confirmed and inhibition was determined for atazanavir, rifampicin, indinavir, amprenavir, cyclosporine, rifamycin SV and saquinavir. To investigate the intrinsic inhibition by the drugs, both in vivo Fi (fraction of intrinsic inhibition) and R-value (estimated maximum in vivo inhibition) for OATP1B1, OATP1B3 and UGT1A1 were calculated. 3. The results indicated that in vivo Fi values >0.2 or R-values >1.5 for OATP1B1 or OATP1B3, but not UGT1A1, are associated with previously reported clinical cases of drug-induced unconjugated hyperbilirubinemia. 4. In conclusion, inhibition of OATP1B1 and/or OATP1B3 along with predicted human pharmacokinetic data could be used pre-clinically to predict potential drug-induced benign unconjugated hyperbilirubinemia in the clinic.
Collapse
Affiliation(s)
- William J Chiou
- Department of Drug Metabolism and Pharmacokinetics, Division of Development Sciences, Global Pharmaceutical Research and Development, AbbVie, Inc. , North Chicago, IL 60064 , USA
| | | | | | | | | | | |
Collapse
|
19
|
De Bruyn T, Chatterjee S, Fattah S, Keemink J, Nicolaï J, Augustijns P, Annaert P. Sandwich-cultured hepatocytes: utility for in vitro exploration of hepatobiliary drug disposition and drug-induced hepatotoxicity. Expert Opin Drug Metab Toxicol 2013; 9:589-616. [PMID: 23452081 DOI: 10.1517/17425255.2013.773973] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The sandwich-cultured hepatocyte (SCH) model has become an invaluable in vitro tool for studying hepatic drug transport, metabolism, biliary excretion and toxicity. The relevant expression of many hepatocyte-specific functions together with the in vivo-like morphology favor SCHs over other preclinical models for evaluating hepatobiliary drug disposition and drug-induced hepatotoxicity. AREAS COVERED In this review, the authors highlight recommended procedures required for reproducibly culturing hepatocytes in sandwich configuration. It also provides an overview of the SCH model characteristics as a function of culture time. Lastly, the article presents a summary of the most prominent applications of the SCH model, including hepatic drug clearance prediction, drug-drug interaction potential and drug-induced hepatotoxicity. EXPERT OPINION When human (cryopreserved) hepatocytes are used to establish sandwich cultures, the model appears particularly valuable to quantitatively investigate clinically relevant mechanisms related to in vivo hepatobiliary drug disposition and hepatotoxicity. Nonetheless, the SCH model would largely benefit from better insight into the fundamental cell signaling mechanisms that are critical for long-term in vitro maintenance of the hepatocytic phenotype. Studies systematically exploring improved cell culture conditions (e.g., co-cultures or extracellular matrix modifications), as well as in vitro work identifying key transcription factors involved in hepatocyte differentiation are currently emerging.
Collapse
Affiliation(s)
- Tom De Bruyn
- Drug Delivery and Disposition, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, O&N2, Herestraat 49-bus-921, 3000 Leuven, Belgium
| | | | | | | | | | | | | |
Collapse
|
20
|
Corsini A, Bortolini M. Drug-induced liver injury: the role of drug metabolism and transport. J Clin Pharmacol 2013; 53:463-74. [PMID: 23436293 DOI: 10.1002/jcph.23] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 07/17/2012] [Indexed: 12/11/2022]
Abstract
Many studies have pinpointed the significant contribution of liver-mediated drug metabolism and transport to the complexity of drug-induced liver injury (DILI). Phase I cytochrome P450 (CYP450) enzymes can lead to altered drug metabolism and formation of toxic metabolites, whilst Phase II enzymes are also associated with DILI. The emerging role of hepatic transporters in regulating the movement of endogenous and exogenous chemicals (e.g., bile acids and drugs) across cellular and tissue membranes is critical in determining the pathophysiology of liver disease as well as drug toxicity and efficacy. Genetic and environmental factors can have a significant impact on drug metabolism and transporter proteins, consequently increasing the risk of DILI in susceptible individuals. The assessment of these factors therefore represents an important approach for predicting and preventing DILI, by better understanding the pharmacological profile of a specific drug. This review focuses on the mechanisms of DILI associated with drug metabolism and hepatic transport, and how they can be influenced by underlying factors.
Collapse
Affiliation(s)
- Alberto Corsini
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy.
| | | |
Collapse
|
21
|
Rafter I, Gråberg T, Kotronen A, Strömmer L, Mattson CM, Kim RW, Ehrenborg E, Andersson HB, Yki-Järvinen H, Schuppe-Koistinen I, Ekblom B, Cotgreave I, Glinghammar B. Isoform-specific alanine aminotransferase measurement can distinguish hepatic from extrahepatic injury in humans. Int J Mol Med 2012; 30:1241-9. [PMID: 22922605 DOI: 10.3892/ijmm.2012.1106] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 06/13/2012] [Indexed: 01/11/2023] Open
Abstract
Serum alanine aminotransferase (ALT) is used as a clinical marker to detect hepatic damage and hepatoxicity. Two isoforms of ALT have been identified, ALT1 and ALT2, which have identical enzymatic capacities and are detected simultaneously in human serum/plasma using classical clinical chemical assays. Differences exist in the expression patterns of the ALT1 and ALT2 proteins in different organs which suggest that changes in the proportion of ALT1 and ALT2 in plasma may arise and reflect damage to different human organs. However, this has not been previously studied due to the lack of a selective methodology that can quantify both ALT1 and ALT2 isoforms in the total ALT activity normally measured in clinical samples. To the best of our knowledge, our current study reveals for the first time, that under 3 different conditions of liver damage (non-alcoholic fatty liver disease, hepatitis C and during liver surgery) the leakage of ALT1 activity into plasma greatly exceeds that of ALT2, and that the measurement of ALT1 during liver damage is equal to the measurement of total ALT activity. By contrast, during skeletal muscle injury, induced in volunteers by physical exertion, the leakage of ALT2 exceeds that of ALT1 and the proportion of circulating ALT isoforms changes accordingly. The ALT isoform changes occurring in plasma reflect previously demonstrated relative contents of ALT1 and ALT2 activities in human liver and skeletal muscle. These data suggest that assessing the percentage contribution of ALT1 and ALT2 activities to total ALT activity in plasma may distinguish hepatic from extrahepatic injury using the same standard analytical platform.
Collapse
|
22
|
Iusuf D, van de Steeg E, Schinkel AH. Functions of OATP1A and 1B transporters in vivo: insights from mouse models. Trends Pharmacol Sci 2011; 33:100-8. [PMID: 22130008 DOI: 10.1016/j.tips.2011.10.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 10/12/2011] [Accepted: 10/14/2011] [Indexed: 01/16/2023]
Abstract
Organic anion-transporting polypeptides (OATPs) are a superfamily of uptake transporters that mediate the cellular uptake of a broad range of endogenous and exogenous compounds. Of these OATP transporters, members of the 1A and 1B subfamilies have broad substrate specificities. Because they are mainly expressed in liver, kidney and small intestine, OATP1A and 1B transporters can have a major impact on the pharmacokinetics of many drugs. To study their role in physiology and drug disposition, several mouse models lacking functional expression of one or more OATPs have been generated. This review discusses recent findings for these models that have led to new insights into the impact of OATP1A and 1B transporters on pharmacokinetics and toxicokinetics, and on bilirubin detoxification and bile acid handling in normal liver physiology.
Collapse
Affiliation(s)
- Dilek Iusuf
- Division of Molecular Biology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | | | | |
Collapse
|
23
|
Application of pharmacogenetics: UGT1A1*28 and nilotinib-induced unconjugated hyperbilirubinaemia in a patient with chronic myeloid leukaemia. Pathology 2011; 43:273-4. [PMID: 21436639 DOI: 10.1097/pat.0b013e328343f0b4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
24
|
Kim MK, Cho HS, Bae YK, Lee KH, Chung HS, Lee SY, Hyun MS. Nilotinib-induced hyperbilirubinemia: is it a negligible adverse event? Leuk Res 2009; 33:e159-61. [PMID: 19493567 DOI: 10.1016/j.leukres.2009.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 02/25/2009] [Accepted: 04/11/2009] [Indexed: 10/20/2022]
|
25
|
Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2009. [DOI: 10.1002/pds.1647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|