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Zabel RR, Favaro RR, Groten T, Brownbill P, Jones S. Ex vivo perfusion of the human placenta to investigate pregnancy pathologies. Placenta 2022; 130:1-8. [DOI: 10.1016/j.placenta.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 08/26/2022] [Accepted: 10/08/2022] [Indexed: 11/07/2022]
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Shuster DL, Shireman LM, Ma X, Shen DD, Flood Nichols SK, Ahmed MS, Clark S, Caritis S, Venkataramanan R, Haas DM, Quinney SK, Haneline LS, Tita AT, Manuck TA, Thummel KE, Morris Brown L, Ren Z, Brown Z, Easterling TR, Hebert MF. Pharmacodynamics of Metformin in Pregnant Women With Gestational Diabetes Mellitus and Nonpregnant Women With Type 2 Diabetes Mellitus. J Clin Pharmacol 2019; 60:540-549. [PMID: 31742716 DOI: 10.1002/jcph.1549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/14/2019] [Indexed: 11/07/2022]
Abstract
Gestational diabetes mellitus is a condition similar to type 2 diabetes mellitus (T2DM) in that patients are unable to compensate for the degree of insulin resistance, and both conditions are often treated with metformin. The comparative pharmacodynamic response to metformin in these 2 populations has not been studied. This study characterized insulin sensitivity, β-cell responsivity, and disposition index following a mixed-meal tolerance test utilizing a minimal model of glucose, insulin, and C-peptide kinetics before and during treatment with metformin. The study included women with gestational diabetes mellitus (n = 34), T2DM (n = 14), and healthy pregnant women (n = 30). Before treatment, the gestational diabetes mellitus group had significantly higher baseline (45%), dynamic (68%), static (71%), and total β-cell responsivity (71%) than the T2DM group. Metformin significantly increased insulin sensitivity (51%) as well as disposition index (97%) and decreased mixed-meal tolerance test peak glucose concentrations (8%) in women with gestational diabetes mellitus after adjustment for gestational age-dependent effects; however, in women with T2DM metformin only significantly affected peak glucose concentrations (22%) and had no significant effect on any other parameters. Metformin had a greater effect on the change in disposition index (Δ disposition index) in women with gestational diabetes mellitus than in those with T2DM (P = .01). In conclusion, response to metformin in women with gestational diabetes mellitus is significantly different from that in women with T2DM, which is likely related to the differences in disease severity.
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Affiliation(s)
- Diana L Shuster
- PRA Health Sciences, Clinical Pharmacology-Scientific Affairs, Lenexa, Kansas, USA
| | - Laura M Shireman
- University of Washington, Departments of Pharmaceutics, Obstetrics & Gynecology, and Pharmacy, Seattle, Washington, USA
| | - Xiaosu Ma
- Global PK/PD & Pharmacometrics, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Danny D Shen
- University of Washington, Departments of Pharmaceutics, Obstetrics & Gynecology, and Pharmacy, Seattle, Washington, USA
| | - Shannon K Flood Nichols
- Madigan Army Medical Center, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tacoma, Washington, USA
| | - Mahmoud S Ahmed
- University of Texas Medical Branch in Galveston, Department of Obstetrics & Gynecology, Galveston, Texas, USA
| | - Shannon Clark
- University of Texas Medical Branch in Galveston, Department of Obstetrics & Gynecology, Galveston, Texas, USA
| | - Steve Caritis
- University of Pittsburgh, Department of Obstetrics & Gynecology, Pittsburgh, Pennsylvania, USA
| | - Raman Venkataramanan
- University of Pittsburgh, Departments of Pharmacy, Pharmaceutical Sciences and Pathology, Pittsburgh, Pennsylvania, USA
| | - David M Haas
- Indiana University, Departments of Obstetrics & Gynecology and Pediatrics, Indianapolis, Indiana, USA
| | - Sara K Quinney
- Indiana University, Departments of Obstetrics & Gynecology and Pediatrics, Indianapolis, Indiana, USA
| | - Laura S Haneline
- Indiana University, Departments of Obstetrics & Gynecology and Pediatrics, Indianapolis, Indiana, USA
| | - Alan T Tita
- University of Alabama at Birmingham, Department of Obstetrics & Gynecology, Birmingham, Alabama, USA
| | - Tracy A Manuck
- University of North Carolina, Department of Obstetrics & Gynecology, Chapel Hill, North Carolina, USA
| | - Kenneth E Thummel
- University of Washington, Departments of Pharmaceutics, Obstetrics & Gynecology, and Pharmacy, Seattle, Washington, USA
| | - Linda Morris Brown
- RTI International, Environmental and Health Science Unit, Biostatistics and Epidemiology Division, Rockville, Maryland, USA
| | - Zhaoxia Ren
- Obstetric and Pediatric Pharmacology and Therapeutic Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Zane Brown
- University of Washington, Departments of Pharmaceutics, Obstetrics & Gynecology, and Pharmacy, Seattle, Washington, USA
| | - Thomas R Easterling
- University of Washington, Departments of Pharmaceutics, Obstetrics & Gynecology, and Pharmacy, Seattle, Washington, USA
| | - Mary F Hebert
- University of Washington, Departments of Pharmaceutics, Obstetrics & Gynecology, and Pharmacy, Seattle, Washington, USA
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Abstract
BACKGROUND Women are commonly prescribed a variety of medications during pregnancy. As most organ systems are affected by the substantial anatomical and physiological changes that occur during pregnancy, it is expected that pharmacokinetics (PK) (absorption, distribution, metabolism, and excretion of drugs) would also be affected in ways that may necessitate changes in dosing schedules. The objective of this study was to systematically identify existing clinically relevant evidence on PK changes during pregnancy. METHODS AND FINDINGS Systematic searches were conducted in MEDLINE (Ovid), Embase (Ovid), Cochrane Central Register of Controlled Trials (Ovid), and Web of Science (Thomson Reuters), from database inception to August 31, 2015. An update of the search from September 1, 2015, to May 20, 2016, was performed, and relevant data were added to the present review. No language or date restrictions were applied. All publications of clinical PK studies involving a group of pregnant women with a comparison to nonpregnant participants or nonpregnant population data were eligible to be included in this review. A total of 198 studies involving 121 different medications fulfilled the inclusion criteria. In these studies, commonly investigated drug classes included antiretrovirals (54 studies), antiepileptic drugs (27 studies), antibiotics (23 studies), antimalarial drugs (22 studies), and cardiovascular drugs (17 studies). Overall, pregnancy-associated changes in PK parameters were often observed as consistent findings among many studies, particularly enhanced drug elimination and decreased exposure to total drugs (bound and unbound to plasma proteins) at a given dose. However, associated alterations in clinical responses and outcomes, or lack thereof, remain largely unknown. CONCLUSION This systematic review of pregnancy-associated PK changes identifies a significant gap between the accumulating knowledge of PK changes in pregnant women and our understanding of their clinical impact for both mother and fetus. It is essential for clinicians to be aware of these unique pregnancy-related changes in PK, and to critically examine their clinical implications.
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Shuster DL, Risler LJ, Liang CKJ, Rice KM, Shen DD, Hebert MF, Thummel KE, Mao Q. Maternal-fetal disposition of glyburide in pregnant mice is dependent on gestational age. J Pharmacol Exp Ther 2014; 350:425-34. [PMID: 24898265 DOI: 10.1124/jpet.114.213470] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Gestational diabetes mellitus is a major complication of human pregnancy. The oral clearance (CL) of glyburide, an oral antidiabetic drug, increases 2-fold in pregnant women during late gestation versus nonpregnant controls. In this study, we examined gestational age-dependent changes in maternal-fetal pharmacokinetics (PK) of glyburide and metabolites in a pregnant mouse model. Nonpregnant and pregnant FVB mice were given glyburide by retro-orbital injection. Maternal plasma was collected over 240 minutes on gestation days (gd) 0, 7.5, 10, 15, and 19; fetuses were collected on gd 15 and 19. Glyburide and metabolites were quantified using high-performance liquid chromatography-mass spectrometry, and PK analyses were performed using a pooled data bootstrap approach. Maternal CL of glyburide increased approximately 2-fold on gd 10, 15, and 19 compared with nonpregnant controls. Intrinsic CL of glyburide in maternal liver microsomes also increased as gestation progressed. Maternal metabolite/glyburide area under the curve ratios were generally unchanged or slightly decreased throughout gestation. Total fetal exposure to glyburide was <5% of maternal plasma exposure, and was doubled on gd 19 versus gd 15. Fetal metabolite concentrations were below the limit of assay detection. This is the first evidence of gestational age-dependent changes in glyburide PK. Increased maternal glyburide clearance during gestation is attributable to increased hepatic metabolism. Metabolite elimination may also increase during pregnancy. In the mouse model, fetal exposure to glyburide is gestational age-dependent and low compared with maternal plasma exposure. These results indicate that maternal glyburide therapeutic strategies may require adjustments in a gestational age-dependent manner if these same changes occur in humans.
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Affiliation(s)
- Diana L Shuster
- Departments of Pharmaceutics (D.L.S., L.J.R., D.D.S., K.E.T., Q.M.) and Pharmacy (D.D.S., M.F.H.), School of Pharmacy, University of Washington, Seattle, Washington; Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington (C.-K.J.L., K.M.R.); and Department of Obstetrics and Gynecology, School of Medicine (M.F.H.), University of Washington, Seattle, Washington
| | - Linda J Risler
- Departments of Pharmaceutics (D.L.S., L.J.R., D.D.S., K.E.T., Q.M.) and Pharmacy (D.D.S., M.F.H.), School of Pharmacy, University of Washington, Seattle, Washington; Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington (C.-K.J.L., K.M.R.); and Department of Obstetrics and Gynecology, School of Medicine (M.F.H.), University of Washington, Seattle, Washington
| | - Chao-Kang J Liang
- Departments of Pharmaceutics (D.L.S., L.J.R., D.D.S., K.E.T., Q.M.) and Pharmacy (D.D.S., M.F.H.), School of Pharmacy, University of Washington, Seattle, Washington; Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington (C.-K.J.L., K.M.R.); and Department of Obstetrics and Gynecology, School of Medicine (M.F.H.), University of Washington, Seattle, Washington
| | - Kenneth M Rice
- Departments of Pharmaceutics (D.L.S., L.J.R., D.D.S., K.E.T., Q.M.) and Pharmacy (D.D.S., M.F.H.), School of Pharmacy, University of Washington, Seattle, Washington; Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington (C.-K.J.L., K.M.R.); and Department of Obstetrics and Gynecology, School of Medicine (M.F.H.), University of Washington, Seattle, Washington
| | - Danny D Shen
- Departments of Pharmaceutics (D.L.S., L.J.R., D.D.S., K.E.T., Q.M.) and Pharmacy (D.D.S., M.F.H.), School of Pharmacy, University of Washington, Seattle, Washington; Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington (C.-K.J.L., K.M.R.); and Department of Obstetrics and Gynecology, School of Medicine (M.F.H.), University of Washington, Seattle, Washington
| | - Mary F Hebert
- Departments of Pharmaceutics (D.L.S., L.J.R., D.D.S., K.E.T., Q.M.) and Pharmacy (D.D.S., M.F.H.), School of Pharmacy, University of Washington, Seattle, Washington; Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington (C.-K.J.L., K.M.R.); and Department of Obstetrics and Gynecology, School of Medicine (M.F.H.), University of Washington, Seattle, Washington
| | - Kenneth E Thummel
- Departments of Pharmaceutics (D.L.S., L.J.R., D.D.S., K.E.T., Q.M.) and Pharmacy (D.D.S., M.F.H.), School of Pharmacy, University of Washington, Seattle, Washington; Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington (C.-K.J.L., K.M.R.); and Department of Obstetrics and Gynecology, School of Medicine (M.F.H.), University of Washington, Seattle, Washington
| | - Qingcheng Mao
- Departments of Pharmaceutics (D.L.S., L.J.R., D.D.S., K.E.T., Q.M.) and Pharmacy (D.D.S., M.F.H.), School of Pharmacy, University of Washington, Seattle, Washington; Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington (C.-K.J.L., K.M.R.); and Department of Obstetrics and Gynecology, School of Medicine (M.F.H.), University of Washington, Seattle, Washington
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Shuster DL, Bammler TK, Beyer RP, Macdonald JW, Tsai JM, Farin FM, Hebert MF, Thummel KE, Mao Q. Gestational age-dependent changes in gene expression of metabolic enzymes and transporters in pregnant mice. Drug Metab Dispos 2012; 41:332-42. [PMID: 23175668 DOI: 10.1124/dmd.112.049718] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Pregnancy-induced changes in drug pharmacokinetics can be explained by changes in expression of drug-metabolizing enzymes and transporters and/or normal physiology. In this study, we determined gestational age-dependent expression profiles for all metabolic enzyme and transporter genes in the maternal liver, kidney, small intestine, and placenta of pregnant mice by microarray analysis. We specifically examined the expression of genes important for xenobiotic, bile acid, and steroid hormone metabolism and disposition, namely, cytochrome P450s (Cyp), UDP-glucuronosyltranserases (Ugt), sulfotransferases (Sult), and ATP-binding cassette (Abc), solute carrier (Slc), and solute carrier organic anion (Slco) transporters. Few Ugt and Sult genes were affected by pregnancy. Cyp17a1 expression in the maternal liver increased 3- to 10-fold during pregnancy, which was the largest observed change in the maternal tissues. Cyp1a2, most Cyp2 isoforms, Cyp3a11, and Cyp3a13 expression in the liver decreased on gestation days (gd) 15 and 19 compared with nonpregnant controls (gd 0). In contrast, Cyp2d40, Cyp3a16, Cyp3a41a, Cyp3a41b, and Cyp3a44 in the liver were induced throughout pregnancy. In the placenta, Cyp expression on gd 10 and 15 was upregulated compared with gd 19. Notable changes were also observed in Abc and Slc transporters. Abcc3 expression in the liver and Abcb1a, Abcc4, and Slco4c1 expression in the kidney were downregulated on gd 15 and 19. In the placenta, Slc22a3 (Oct3) expression on gd 10 was 90% lower than that on gd 15 and 19. This study demonstrates important gestational age-dependent expression of metabolic enzyme and transporter genes, which may have mechanistic relevance to drug disposition in human pregnancy.
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Affiliation(s)
- Diana L Shuster
- Department of Pharmaceutics, School of Pharmacy, University of Washington, Seattle, WA 98195-7610, USA
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Giaginis C, Theocharis S, Tsantili-Kakoulidou A. Current toxicological aspects on drug and chemical transport and metabolism across the human placental barrier. Expert Opin Drug Metab Toxicol 2012; 8:1263-75. [PMID: 22780574 DOI: 10.1517/17425255.2012.699041] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Placenta plays an obligatory role in fetal growth and development by performing a multitude of functions, including embryo implantation, transport of nutrients and elimination of metabolic waste products and endocrine activity. Drugs and chemicals can transfer across the placental barrier from mother to fetus either by passive diffusion mechanisms and/or via a network of active transporters, which may lead to potential fetotoxicity effects. Placenta also expresses a wide variety of enzymes, being capable of metabolizing a large diversity of drugs and chemicals to metabolites of lower or even higher toxicity than parent compounds. AREAS COVERED The present review aims to summarize the current toxicological aspects in the emerging topic of drug transport and metabolism across the human placental barrier. EXPERT OPINION There is an emerging demand for accurate assessment of drug transport and metabolism across the human placental barrier, on the basis of a high throughput screening process in the early stages of drug design, to avoid drug candidates from potential fetotoxicity effects. In this aspect, combined studies, which take into account in vivo and in vitro investigations, as well as the ex vivo perfusion method and the recently developed computer-aided technologies, may significantly contribute to this direction.
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Affiliation(s)
- Constantinos Giaginis
- University of the Aegean, Department of Food Science and Nutrition, 2 Mitropoliti Ioakeim Street, Myrina, Lemnos 81400, Greece.
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Morello CM. Pharmacokinetics and pharmacodynamics of insulin analogs in special populations with type 2 diabetes mellitus. Int J Gen Med 2011; 4:827-35. [PMID: 22267935 PMCID: PMC3258012 DOI: 10.2147/ijgm.s26889] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction The goal of insulin therapy in patients with either type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) is to match as closely as possible normal physiologic insulin secretion to control fasting and postprandial plasma glucose. Modifications of the insulin molecule have resulted in two long-acting insulin analogs (glargine and detemir) and three rapid-acting insulins (aspart, lispro, and glulisine) with improved pharmacokinetic/pharmacodynamic (PK/PD) profiles. These agents can be used together in basal-bolus therapy to more closely mimic physiologic insulin secretion patterns. Methods This study reviews effects of the multiple demographic and clinical parameters in the insulin analogs glargine, detemir, lispro, aspart, and glulisine in patients with T2DM. A search was conducted on PubMed for each major topic considered (effects of injection site, age, race/ethnicity, obesity, renal or hepatic dysfunction, pregnancy, exercise, drug interactions) using the topic words and name of each type of insulin analog. Information was also obtained from the prescribing information for each insulin analog. Results The PK/PD profiles for insulin analogs may be influenced by many variables including age, weight, and hepatic and renal function. However, these variables do not have equivalent effects on all long-acting or rapid-acting insulin analogs. Conclusion Rapid-acting and long-acting insulin analogs represent major advances in treatment for patients with T2DM who require insulin therapy. However, there are potentially important PK and PD differences between the two long-acting agents and among the three rapid-acting insulin analogs, which should be considered when designing treatment regimens for special patient groups.
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Affiliation(s)
- Candis M Morello
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego. USA
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Internet resources. J Perinat Neonatal Nurs 2011; 25:310-1. [PMID: 22071613 DOI: 10.1097/jpn.0b013e318234ac94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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