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Miners JO, Polasek TM, Hulin JA, Rowland A, Meech R. Drug-drug interactions that alter the exposure of glucuronidated drugs: Scope, UDP-glucuronosyltransferase (UGT) enzyme selectivity, mechanisms (inhibition and induction), and clinical significance. Pharmacol Ther 2023:108459. [PMID: 37263383 DOI: 10.1016/j.pharmthera.2023.108459] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 06/03/2023]
Abstract
Drug-drug interactions (DDIs) arising from the perturbation of drug metabolising enzyme activities represent both a clinical problem and a potential economic loss for the pharmaceutical industry. DDIs involving glucuronidated drugs have historically attracted little attention and there is a perception that interactions are of minor clinical relevance. This review critically examines the scope and aetiology of DDIs that result in altered exposure of glucuronidated drugs. Interaction mechanisms, namely inhibition and induction of UDP-glucuronosyltransferase (UGT) enzymes and the potential interplay with drug transporters, are reviewed in detail, as is the clinical significance of known DDIs. Altered victim drug exposure arising from modulation of UGT enzyme activities is relatively common and, notably, the incidence and importance of UGT induction as a DDI mechanism is greater than generally believed. Numerous DDIs are clinically relevant, resulting in either loss of efficacy or an increased risk of adverse effects, necessitating dose individualisation. Several generalisations relating to the likelihood of DDIs can be drawn from the known substrate and inhibitor selectivities of UGT enzymes, highlighting the importance of comprehensive reaction phenotyping studies at an early stage of drug development. Further, rigorous assessment of the DDI liability of new chemical entities that undergo glucuronidation to a significant extent has been recommended recently by regulatory guidance. Although evidence-based approaches exist for the in vitro characterisation of UGT enzyme inhibition and induction, the availability of drugs considered appropriate for use as 'probe' substrates in clinical DDI studies is limited and this should be research priority.
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Affiliation(s)
- John O Miners
- Discipline of Clinical Pharmacology and Flinders Centre for Innovation in Cancer, Flinders University College of Medicine and Public Health, Flinders University, Adelaide, Australia.
| | - Thomas M Polasek
- Certara, Princeton, NJ, USA; Centre for Medicines Use and Safety, Monash University, Melbourne, Australia
| | - Julie-Ann Hulin
- Discipline of Clinical Pharmacology and Flinders Centre for Innovation in Cancer, Flinders University College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Andrew Rowland
- Discipline of Clinical Pharmacology and Flinders Centre for Innovation in Cancer, Flinders University College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Robyn Meech
- Discipline of Clinical Pharmacology and Flinders Centre for Innovation in Cancer, Flinders University College of Medicine and Public Health, Flinders University, Adelaide, Australia
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2
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Järvinen E, Deng F, Kiander W, Sinokki A, Kidron H, Sjöstedt N. The Role of Uptake and Efflux Transporters in the Disposition of Glucuronide and Sulfate Conjugates. Front Pharmacol 2022; 12:802539. [PMID: 35095509 PMCID: PMC8793843 DOI: 10.3389/fphar.2021.802539] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/06/2021] [Indexed: 12/11/2022] Open
Abstract
Glucuronidation and sulfation are the most typical phase II metabolic reactions of drugs. The resulting glucuronide and sulfate conjugates are generally considered inactive and safe. They may, however, be the most prominent drug-related material in the circulation and excreta of humans. The glucuronide and sulfate metabolites of drugs typically have limited cell membrane permeability and subsequently, their distribution and excretion from the human body requires transport proteins. Uptake transporters, such as organic anion transporters (OATs and OATPs), mediate the uptake of conjugates into the liver and kidney, while efflux transporters, such as multidrug resistance proteins (MRPs) and breast cancer resistance protein (BCRP), mediate expulsion of conjugates into bile, urine and the intestinal lumen. Understanding the active transport of conjugated drug metabolites is important for predicting the fate of a drug in the body and its safety and efficacy. The aim of this review is to compile the understanding of transporter-mediated disposition of phase II conjugates. We review the literature on hepatic, intestinal and renal uptake transporters participating in the transport of glucuronide and sulfate metabolites of drugs, other xenobiotics and endobiotics. In addition, we provide an update on the involvement of efflux transporters in the disposition of glucuronide and sulfate metabolites. Finally, we discuss the interplay between uptake and efflux transport in the intestine, liver and kidneys as well as the role of transporters in glucuronide and sulfate conjugate toxicity, drug interactions, pharmacogenetics and species differences.
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Affiliation(s)
- Erkka Järvinen
- Clinical Pharmacology, Pharmacy, and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Feng Deng
- Department of Clinical Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Individualized Drug Therapy Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Wilma Kiander
- Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Alli Sinokki
- Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Heidi Kidron
- Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Noora Sjöstedt
- Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
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3
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Seneviratne HK, Hamlin AN, Li S, Grinsztejn B, Dawood H, Liu AY, Kuo I, Hosseinipour MC, Panchia R, Cottle L, Chau G, Adeyeye A, Rinehart AR, McCauley M, Eron JS, Cohen MS, Landovitz RJ, Hendrix CW, Bumpus NN. Identification of Novel UGT1A1 Variants Including UGT1A1 454C>A through the Genotyping of Healthy Participants of the HPTN 077 Study. ACS Pharmacol Transl Sci 2021; 4:226-239. [PMID: 33615175 PMCID: PMC7888308 DOI: 10.1021/acsptsci.0c00181] [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: 10/27/2020] [Indexed: 11/30/2022]
Abstract
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Cabotegravir (CAB) is an integrase strand-transfer inhibitor of HIV that has proven
effective for HIV treatment and prevention in a long-acting injectable formulation,
typically preceded by an oral formulation lead-in phase. Previous in
vitro studies have demonstrated that CAB is primarily metabolized via
glucuronidation by uridine diphosphate glucuronosyltransferase (UGT) 1A1 and 1A9. In
this study, we performed next-generation sequencing of genomic DNA isolated from the
HPTN 077 participants to explore the variants within UGT1A1 and
UGT1A9. Additionally, to enable correlation of
UGT1A1 and UGT1A9 genotypes with plasma
CAB-glucuronide levels, we quantified glucuronidated CAB following both oral
administration of CAB and intramuscular injection of long-acting CAB. From these
studies, 48 previously unreported variants of UGT1A1 and
UGT1A9 were detected. Notably, 5/68 individuals carried a
UGT1A1 454C>A variant that resulted in amino acid substitution
P152T, and the use of in silico tools predicted a deleterious effect of
the P152T substitution. Thus, the impact of this mutant on a range of UGT1A1 substrates
was tested using a COS-7 cell-based assay. The glucuronide conjugates of CAB,
dolutegravir, and raltegravir, were not formed in the COS-7 cells expressing the UGT1A1
P152T mutant. Further, formation of glucuronides of raloxifene and
7-ethyl-10-hydroxycamptothecin were reduced in the cells expressing the UGT1A1 P152T
mutant. Using the same approach, we tested the activities of two UGT1A9 mutants, UGT1A9
H217Y and UGT1A9 R464G, and found that these mutations were tolerated and decreased
function, respectively. These data provide insight into previously unreported genetic
variants of UGT1A1 and UGT1A9.
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Affiliation(s)
- Herana Kamal Seneviratne
- Department of Medicine, Division of Clinical Pharmacology, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, United States
| | - Allyson N Hamlin
- Department of Medicine, Division of Clinical Pharmacology, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, United States
| | - Sue Li
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, United States
| | - Beatriz Grinsztejn
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, Brazil
| | - Halima Dawood
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu Natal, Durban 4041, South Africa
| | - Albert Y Liu
- Bridge HIV, Population Health Division, San Francisco Department of Health, San Francisco, California 94102, United States
| | - Irene Kuo
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia 20052, United States
| | | | - Ravindre Panchia
- Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, Soweto 1864, South Africa
| | - Leslie Cottle
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, United States
| | - Gordon Chau
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, United States
| | - Adeola Adeyeye
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland 20852, United States
| | - Alex R Rinehart
- ViiV Healthcare, Durham, North Carolina 27709, United States
| | | | - Joseph S Eron
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Myron S Cohen
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Raphael J Landovitz
- UCLA Center for Clinical AIDS Research and Education, Los Angeles, California 90035, United States
| | - Craig W Hendrix
- Department of Medicine, Division of Clinical Pharmacology, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, United States
| | - Namandjé N Bumpus
- Department of Pharmacology and Molecular Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, United States
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4
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Kovač L, Časar Z. A literature review of the patent application publications on cabotegravir - an HIV integrase strand transfer inhibitor. Expert Opin Ther Pat 2020; 30:195-208. [PMID: 31944142 DOI: 10.1080/13543776.2020.1717470] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Studies presented in the patent applications demonstrate that a new integrase strand transfer inhibitor cabotegravir might be used as long-acting antiretroviral formulation or delivery system that reduces dosing frequency and may therefore increase adherence and thus pre-exposure prophylaxis (PrEP) and treatment efficacy against HIV. As announced in 2019, the developer ViiV Healthcare seeks US and EU approval of long-acting, injectable HIV treatment.Area covered: This review covers all the patent applications published until October 2019 with cabotegravir in the examples or claim section of the patent application document. The patent applications cover drug substance synthesis, solid-state forms, therapeutic applications, in vitro and in vivo efficacy as well as the potential formulations of cabotegravir alone or in combination with other anti-HIV agents.Expert opinion: The results from multiple clinical studies suggest that cabotegravir can be used as PrEP agent and treatment agent against HIV. Multiple studies use cabotegravir in combination with other anti-HIV agents such as rilpivirine. Cabotegravir in combination with rilpivirine is an interesting therapeutic, due to the possibility of formulating long-acting formulation with dosing interval of every 4 weeks or less, thus reducing daily pill burden and improving patient's compliance.
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Affiliation(s)
- Lidija Kovač
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia.,Analytics Department, Lek Pharmaceuticals d.d., Sandoz Development Center Slovenia, Ljubljana, Slovenia
| | - Zdenko Časar
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia.,Analytics Department, Lek Pharmaceuticals d.d., Sandoz Development Center Slovenia, Ljubljana, Slovenia
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