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Bossennec M, Di Roio A, Caux C, Ménétrier-Caux C. MDR1 in immunity: friend or foe? Oncoimmunology 2018; 7:e1499388. [PMID: 30524890 PMCID: PMC6279327 DOI: 10.1080/2162402x.2018.1499388] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 07/08/2018] [Indexed: 02/09/2023] Open
Abstract
MDR1 is an ATP-dependent transmembrane transporter primarily studied for its role in the detoxification of tissues and for its implication in resistance of tumor cells to chemotherapy treatment. Several studies also report on its expression on immune cells where it plays a protective role from xenobiotics and toxins. This review provides an overview of what is known on MDR1 expression in immune cells in human, and its implications in different pathologies and their treatment options.
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Affiliation(s)
- Marion Bossennec
- Centre Léon Bérard, Cancer Research Center of Lyon (CRCL), Univ Lyon, Université Claude Bernard Lyon 1, Lyon France.,Immunology Virology Inflammation (IVI) department, Team "Therapeutic targeting of the tumor cells and their immune stroma", Lyon, France
| | - Anthony Di Roio
- Centre Léon Bérard, Cancer Research Center of Lyon (CRCL), Univ Lyon, Université Claude Bernard Lyon 1, Lyon France.,Immunology Virology Inflammation (IVI) department, Team "Therapeutic targeting of the tumor cells and their immune stroma", Lyon, France
| | - Christophe Caux
- Centre Léon Bérard, Cancer Research Center of Lyon (CRCL), Univ Lyon, Université Claude Bernard Lyon 1, Lyon France.,Immunology Virology Inflammation (IVI) department, Team "Therapeutic targeting of the tumor cells and their immune stroma", Lyon, France
| | - Christine Ménétrier-Caux
- Centre Léon Bérard, Cancer Research Center of Lyon (CRCL), Univ Lyon, Université Claude Bernard Lyon 1, Lyon France.,Immunology Virology Inflammation (IVI) department, Team "Therapeutic targeting of the tumor cells and their immune stroma", Lyon, France
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Wu D, Wei Y, Bleier BS. Emerging Role of Proteases in the Pathogenesis of Chronic Rhinosinusitis with Nasal Polyps. Front Cell Infect Microbiol 2018; 7:538. [PMID: 29376037 PMCID: PMC5770401 DOI: 10.3389/fcimb.2017.00538] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 12/26/2017] [Indexed: 12/17/2022] Open
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous upper airway disease with multiple etiologies. Clinically, CRSwNP can be classified into either eosinophilic or non-eosinophilic subtypes. The eosinophilic phenotype of CRSwNP is widely thought to be highly associated with recurrence of nasal polyps or surgical failure. Epithelial cells have a crucial role in the development of Th2-biased airway diseases. Recent studies have shown that a wide range of external stimuli such as allergens and microorganisms can elicit the release of epithelial-derived Th2-driving cytokines and chemokines. Protease activity is a feature common to these multiple environmental insults and there is growing evidence for the concept that an imbalance of proteases and protease inhibitors in the epithelial barrier leads to both the initiation and maintenance of chronic eosinophilic airway inflammation. In this review, we analyze recent work on the role of proteases in the development of the sinonasal mucosal type 2 immune response with an emphasis on the molecular pathways promoting adaptive Th2 cell immunity.
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Affiliation(s)
- Dawei Wu
- The Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States.,The Department of Otorhinolaryngology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yongxiang Wei
- The Department of Otorhinolaryngology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Benjamin S Bleier
- The Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States
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3
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Billat PA, Saint-Marcoux F. Liquid chromatography–mass spectrometry methods for the intracellular determination of drugs and their metabolites: a focus on antiviral drugs. Anal Bioanal Chem 2017; 409:5837-5853. [DOI: 10.1007/s00216-017-0449-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 05/24/2017] [Accepted: 06/01/2017] [Indexed: 01/11/2023]
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4
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D’Avolio A, Pensi D, Baietto L, Di Perri G. Therapeutic drug monitoring of intracellular anti-infective agents. J Pharm Biomed Anal 2014; 101:183-93. [DOI: 10.1016/j.jpba.2014.03.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 03/24/2014] [Indexed: 01/11/2023]
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Shibata A, McMullen E, Pham A, Belshan M, Sanford B, Zhou Y, Goede M, Date AA, Destache CJ, Destache CJ. Polymeric nanoparticles containing combination antiretroviral drugs for HIV type 1 treatment. AIDS Res Hum Retroviruses 2013; 29:746-54. [PMID: 23289671 DOI: 10.1089/aid.2012.0301] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The use of combination antiretroviral nanoparticles (cART NPs) was investigated as a novel treatment approach for the inhibition of HIV-1 replication. We developed nanoparticles of biodegradable polymer, poly-(dl-lactide-co-glycolic acid; PLGA) containing efavirenz (EFV) and boosted lopinavir (lopinavir/ritonavir; LPV/r) by a high-pressure homogenization method. The method resulted in >79% drug entrapment efficiency for each of the three drugs. The average size of cART NPs was 138.3±55.4 nm as measured by dynamic light scanning, confirmed by scanning electron microscopy (SEM) with an average surface charge of -13.7±4.5. Lissamine-rhodamine-labeled fluorescent PLGA NPs exhibited efficient uptake in nonimmune (HeLa cells) and immune (H9 T cells) cells as measured by confocal microscopy. Cells treated with cART NPs resulted in minimal loss of cell viability over 28 days. Subcellular fractionation studies demonstrated that HIV-1-infected H9 monocytic cells treated with cART NPs contained significantly (p<0.05) higher nuclear, cytoskeleton, and membrane antiretroviral drug levels compared to cells treated with drug solutions alone. Finally, cART NPs efficiently inhibited HIV-1 infection and transduction. The IC50 for each of the three drugs in the cART NPs was <31 nM. These experiments demonstrate the efficacy of a novel PLGA NPs formulation for the delivery of cART to inhibit HIV-1 replication.
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Affiliation(s)
| | - Emily McMullen
- Department of Biology, Creighton University, Omaha, Nebraska
| | - Alex Pham
- Department of Biology, Creighton University, Omaha, Nebraska
| | - Michael Belshan
- School of Medicine, Department of Medical Microbiology and Immunology, Creighton University, Omaha, Nebraska
| | - Bridget Sanford
- School of Medicine, Department of Medical Microbiology and Immunology, Creighton University, Omaha, Nebraska
| | - You Zhou
- Center for Biotechnology, University of Nebraska, Lincoln, Nebraska
| | - Michael Goede
- School of Pharmacy and Health Professions, Creighton University, Omaha, Nebraska
| | - Abhijit A. Date
- School of Pharmacy and Health Professions, Creighton University, Omaha, Nebraska
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CYP3A5, ABCB1, and SLCO1B1 polymorphisms and pharmacokinetics and virologic outcome of lopinavir/ritonavir in HIV-infected children. Ther Drug Monit 2012; 33:417-24. [PMID: 21743379 DOI: 10.1097/ftd.0b013e318225384f] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE CYP3A5, MDR1 (ABCB1), and OATP1 (SLCO1B1) polymorphisms have been associated with variability in the pharmacokinetics (PK) of protease inhibitors. The aim of this study was to investigate the influence of CYP3A5 A6986G, ABCB1 (C3435T and G2677T), and SLCO1B1 (T521C and A388AG) polymorphisms on the PK and virologic outcome of lopinavir/ritonavir (LPV/RTV) in HIV-infected children. DESIGN AND METHODS We conducted a prospective cohort study in children (4-18 years old) on stable antiretroviral therapy with LPV/RTV. CYP3A5, ABCB1, and SLCO1B1 genotypes were determined using polymerase chain reaction amplification with allelic discrimination assays. The 12-hour plasma area under the concentration-time curves (AUC) and clearances (CL) of LPV and RTV were estimated using noncompartmental models. HIV RNA viral load was evaluated every 12 weeks for a total study period of 52 weeks. Analysis of covariance models with adjustment for age and adherence and allometric adjustment of CL were used to assess associations between studied polymorphisms and AUC, CL, and HIV RNA. RESULTS Fifty children (median age 11.2 years) were enrolled. Allele frequencies of the genotypes studied were in Hardy-Weinberg equilibrium. There was no statistically significant association between LPV or RTV AUC or CL, and CYP3A5, ABCB1, or SLCO1B1 A388G polymorphisms. There was a significant association between SLCO1B1 T521C genotype and increased LPV AUC (P = 0.042) and a nearly significant association with decreased LPV CL (P = 0.063). None of the studied polymorphisms, including SLCO1B1 T521C, were associated with virologic outcome during 52 weeks of study follow-up. CONCLUSIONS There was no statistically significant influence of the CYP3A5, ABCB1, or SLCO1B1 A388AG polymorphisms on the PK and virologic outcome of LPV/RTV in HIV-infected children. SLCO1B1 T521C polymorphism was significantly associated with an increase in LPV AUC but was not associated with undetectable HIV RNA during the study period.
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Yilmaz A, Price RW, Gisslen M. Antiretroviral drug treatment of CNS HIV-1 infection. J Antimicrob Chemother 2011; 67:299-311. [DOI: 10.1093/jac/dkr492] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Weiss J, Haefeli WE. Impact of ATP-binding cassette transporters on human immunodeficiency virus therapy. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2010; 280:219-79. [PMID: 20797684 DOI: 10.1016/s1937-6448(10)80005-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Even though potent antiretrovirals are available against human immunodeficiency virus (HIV)-1 infection, therapy fails in a significant fraction of patients. Among the most relevant reasons for treatment failure are drug toxicity and side effects, but also the development of viral resistance towards the drugs applied. Efflux by ATP-binding cassette (ABC-) transporters represents one major mechanism influencing the pharmacokinetics of antiretroviral drugs and particularly their distribution, thus modifiying the concentration within the infected cells, that is, at the site of action. Moreover, drug-drug interactions may occur at the level of these transporters and modulate their activity or expression thus influencing the efficacy and toxicity of the substrate drugs. This review summarizes current knowledge on the interaction of antiretrovirals used for HIV-1 therapy with ABC-transporters and highlights the impact of ABC-transporters for cellular resistance and therapeutic success. Moreover, the suitability of different cell models for studying the interaction of antiretrovirals with ABC-transporters is discussed.
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Affiliation(s)
- Johanna Weiss
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
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Valentin A, Morrow M, Poirier RH, Aleman K, Little R, Yarchoan R, Pavlakis GN. Identification of a potential pharmacological sanctuary for HIV type 1 in a fraction of CD4(+) primary cells. AIDS Res Hum Retroviruses 2010; 26:79-88. [PMID: 20059395 DOI: 10.1089/aid.2009.0044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
We have identified a subset of HIV-susceptible CD4(+)CCR5(+) cells in human PBMCs that can efficiently exclude protease inhibitors (PI) due to high P-glycoprotein (P-gp) efflux activity. Phenotypically these cells are heterogeneous, include both T and non-T cells, and some display markers of memory cells. Cells with high P-gp represent 16-56% (median = 37.3) of all CD4(+)CCR5(+) cells in healthy donors, and are selectively depleted in HIV-1-infected individuals (4.1-33%, median = 10.1). A fraction of primary cells productively infected by HIV-1, in vitro, have high P-gp pump activity, demonstrating that infection does not inhibit P-gp function. In agreement with these data, HIV-susceptible cells expressing high levels of P-gp require higher levels of PI for complete inhibition of virus spread. We conclude that the PI concentrations achieved in plasma could be suboptimal for full inhibition of virus spread in high P-gp cells, indicating that they may represent a pharmacological sanctuary for HIV-1.
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Affiliation(s)
- Antonio Valentin
- Human Retrovirus Section, Vaccine Branch, Center for Cancer Research, National Cancer Institute-Frederick, Frederick, Maryland 21702-1201
| | - Matthew Morrow
- Human Retrovirus Section, Vaccine Branch, Center for Cancer Research, National Cancer Institute-Frederick, Frederick, Maryland 21702-1201
| | - Richard H. Poirier
- Human Retrovirus Section, Vaccine Branch, Center for Cancer Research, National Cancer Institute-Frederick, Frederick, Maryland 21702-1201
| | - Karen Aleman
- HIV and AIDS Malignancy Branch, National Cancer Institute, Bethesda, Maryland 20895
| | - Richard Little
- HIV and AIDS Malignancy Branch, National Cancer Institute, Bethesda, Maryland 20895
| | - Robert Yarchoan
- HIV and AIDS Malignancy Branch, National Cancer Institute, Bethesda, Maryland 20895
| | - George N. Pavlakis
- Human Retrovirus Section, Vaccine Branch, Center for Cancer Research, National Cancer Institute-Frederick, Frederick, Maryland 21702-1201
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Bazzoli C, Jullien V, Le Tiec C, Rey E, Mentré F, Taburet AM. Intracellular Pharmacokinetics of Antiretroviral Drugs in HIV-Infected Patients, and their Correlation with Drug Action. Clin Pharmacokinet 2010; 49:17-45. [DOI: 10.2165/11318110-000000000-00000] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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11
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Validation and clinical application of a high performance liquid chromatography tandem mass spectrometry (LC-MS/MS) method for the quantitative determination of 10 anti-retrovirals in human peripheral blood mononuclear cells. J Chromatogr B Analyt Technol Biomed Life Sci 2009; 877:1805-14. [DOI: 10.1016/j.jchromb.2009.04.046] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Revised: 03/16/2009] [Accepted: 04/29/2009] [Indexed: 12/27/2022]
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12
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Rhee MS, Greenblatt DJ. Pharmacologic consideration for the use of antiretroviral agents in the elderly. J Clin Pharmacol 2009; 48:1212-25. [PMID: 18812611 DOI: 10.1177/0091270008322177] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The prevalence of human immunodeficiency virus (HIV) infection among people older than 50 years is increasing. HIV-infected patients require lifelong treatment with antiretroviral agents to suppress viral replication and maintain immune function. The use of antiretroviral agents in the elderly can be complicated by multiple chronic comorbidities and coadministered non-HIV medications. The pharmacokinetics of antiretroviral agents may be altered due to age-related decrements in hepatic and renal function. The elderly may be more sensitive than younger people to antiretroviral drug toxicity. A better understanding of the pharmacokinetics of antiretroviral agents in the elderly is of importance for the successful management of complex antiretroviral regimens in this population.
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Affiliation(s)
- Martin S Rhee
- Tufts Medical Center, 800 Washington Street, Box 41, Boston, MA 02111; e-mail:
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Eilers M, Roy U, Mondal D. MRP (ABCC) transporters-mediated efflux of anti-HIV drugs, saquinavir and zidovudine, from human endothelial cells. Exp Biol Med (Maywood) 2008; 233:1149-60. [PMID: 18535159 DOI: 10.3181/0802-rm-59] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The constituents of highly active anti-retroviral therapy (HAART) include HIV-1 protease inhibitors (HPIs) and nucleoside reverse transcriptase inhibitors (NRTIs). Endothelial cell (EC) barriers, especially the blood-brain-barrier (BBB) suppresses the entry of HAART drugs to subendothelial HIV-1 reservoirs. The ATP binding cassette (ABC) transporter family members, multidrug resistant-1 (MDR-1) and multidrug resistance-associated proteins (MRPs) can efflux both HPIs and NRTIs from intracellular compartments. Using brain derived ECs from non-human sources, previous studies suggested a dominant role for MDR-1 in HAART efflux from the BBB. However, due to species variations in ABC-transporter expression, drug-efflux functions using human brain ECs need to be investigated. Furthermore, roles of ABC-transporters in drug-efflux from systemic EC barriers need to be studied. We monitored the expression of ABC-transporters in primary human ECs obtained from brain (HBMVECs), aorta (HAECs), pulmonary-artery (HPAECs), dermal-microvessel (HDMVECs) and umbilical vein (HUVECs). Gene expression for MDR-1 and MRPs (MRP-1 to MRP-5) were analyzed by reverse transcriptase polymerase chain reaction (RT-PCR). Drug efflux functions were determined by calcein retention assays. Intracellular accumulation of both 3H-saquinavir (an HPI) and 3H-zidovudine (an NRTI) were also monitored in HAECs and HBMVECs. Both assays were carried out in presence of verapamil (20-60 microM) or MK-571 (12.5-50 microM) inhibitors of MDR-1 and MRPs, respectively in presence of verapamil or MK-571. The HBMVECs expressed higher levels of MRPs than MDR-1 and only MK-571 significantly (P<0.01) suppressed calcein efflux from these cells. However, both HAECs and HPAECs showed MDR-1 and MRP expression and calcein efflux was inhibited by both verapamil and MK-571. Both inhibitors suppressed 3H-saqubinavir efflux from HAECs, but only MK-571 suppressed saquinavir efflux from HBMVECs. In both ECs, 3H-zidovudine efflux was only suppressed by MK-571. Thus, primary human ECs, especially brain derived ECs, predominantly express MRPs and their specific inhibition may enhance HAART efficacy in subendothelial HIV-1 reservoirs.
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Affiliation(s)
- Mark Eilers
- Department of Pharmacology, Tulane University Health Sciences Center, 1430 Tulane Avenue, SL-83, New Orleans, LA 70112, USA
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Peralta G, Blanca Sánchez M, Echevarría S, María Valdizán E, Antonio Armijo J. Glucoproteína P e infección por el virus de la inmunodeficiencia humana. Enferm Infecc Microbiol Clin 2008; 26:150-9. [DOI: 10.1157/13116752] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Rodríguez-Nóvoa S, Martín-Carbonero L, Barreiro P, González-Pardo G, Jiménez-Nácher I, González-Lahoz J, Soriano V. Genetic factors influencing atazanavir plasma concentrations and the risk of severe hyperbilirubinemia. AIDS 2007; 21:41-6. [PMID: 17148966 DOI: 10.1097/qad.0b013e328011d7c1] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Hyperbilirubinemia is frequently seen in patients treated with atazanavir (ATV). Polymorphisms at the uridin-glucoronosyl-transferase 1A1 (UGT1A1) and multidrug resistance 1 (MDR1) genes may influence, respectively, bilirubin and ATV plasma concentrations. PATIENTS AND METHODS HIV-infected individuals receiving ATV 300 mg daily plus ritonavir 100 mg daily at one clinic were examined. ATV plasma concentrations were measured at steady state. MDR1-3435C>T and UGT1A1 polymorphisms were examined in DNA extracted from blood mononuclear cells. RESULTS A total of 118 patients (all Caucasian) were analysed. The median ATV plasma concentration was 465 ng/ml [interquartile range (IQR), 233-958]. MDR1-3435 genotypes were as follows: CC (32%), CT (47%) and TT (21%). CC patients showed higher ATV minimum concentration than those with CT/TT genotypes: 939 ng/ml (IQR, 492-1266) versus 376 ng/ml (IQR, 221-722) (P = 0.001). In multivariate analyses, having at least one T allele at MDR1-3435 was independently associated with lower ATV plasma concentrations (beta: -427 [95% confidence interval (CI), -633 to -223]; P < 0.001). The proportion of patients with grade 3-4 hyperbilirubinemia varied with distinct UGT1A1 genotypes: 80% for 7/7, 29% for 6/7 and 18% for 6/6 (P = 0.012). In the multivariate analysis, having at least one 7 allele at UGT1A1 was independently associated with severe hyperbilirubinemia (odds ratio, 2.96; 95% CI, 1.29-6.78; P = 0.01). CONCLUSIONS Polymorphisms at MDR1-3435 significantly influence ATV plasma concentrations, as does being Caucasian patients with CT/TT genotypes, having lower ATV levels, even using ritonavir boosting. On the other hand, although ATV plasma concentrations directly correlate with bilirubin levels, the risk of severe hyperbilirubinemia is further increased in the presence of the UGT1A1-TA7 allele.
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Yu C, Kastin AJ, Tu H, Waters S, Pan W. TNF activates P-glycoprotein in cerebral microvascular endothelial cells. Cell Physiol Biochem 2007; 20:853-8. [PMID: 17982267 DOI: 10.1159/000110445] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Multidrug resistance proteins (MDRs, including P-glycoproteins) are efflux pumps that serve important biological functions but hinder successful drug delivery to the CNS. Many chemotherapeutic agents, anti-epileptics, anti-HIV drugs, and opiates are substrates for MDRs. Therefore, understanding the regulation of MDRs in the endothelial cells composing the blood-brain barrier has therapeutic implications. METHODS We used microarray, real time RT-PCR, Western blotting, and uptake of vinblastine by RBE4 cerebral endothelial cells to test the effects of tumor necrosis factor alpha (TNF) on the expression and functions of P-glycoprotein (MDR1). RESULTS The proinflammatory cytokine TNF specifically induced the expression and enhanced the function of MDR1 in RBE4 cells. The persistent upregulation of MDR1 mRNA was shown by cDNA microarray at 6, 12, and 24 h after TNF treatment. This was confirmed by real-time RT-PCR between 2 and 24 h. MDR1 protein expression was increased 6 to 24 h after TNF treatment and resulted in a significant reduction in the cellular uptake of (3)H-vinblastine. CONCLUSION The drug efflux transporter in cerebral endothelial cells can be upregulated by TNF. This suggests that adjunctive anti-TNF treatment has novel therapeutic potential in conditions such as brain cancer, epilepsy, neuroAIDS, and chronic pain.
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Affiliation(s)
- Chuanhui Yu
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
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Kajiwara K, Kodama E, Matsuoka M. A novel colorimetric assay for CXCR4 and CCR5 tropic human immunodeficiency viruses. Antivir Chem Chemother 2006; 17:215-23. [PMID: 17066899 DOI: 10.1177/095632020601700405] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The majority of HIV isolated from infected patients uses CCR5 as a coreceptor (R5-HIV). Although R5-HIV fails to replicate efficiently in human transformed T-cell lines, HIV using CXCR4 (X4-HIV) can replicate well in such cell lines. Therefore, most of screening systems using the T-cell lines detect only X4-HIV replication. Here we report a new assay to monitor the replication of R5- as well as X4-HIV. An MTT assay using CD4-, CXCR4-, and CCR5-transduced human glioma NP-2 cells (NCK45 cells) was established and then compared with the representative assays including multinuclear activation of a galactosidase indicator assay (MAGI assay). The antiviral activities of not only an adsorption inhibitor and reverse transcriptase inhibitors but also a Tat antagonist in the NCK45 cells, were comparable to those obtained from the MTT assay using MT-4 cells or the MAGI assay. However, the activity of protease inhibitors (PIs) was underestimated, even though expressions of major multidrug resistant genes involved in efflux of PIs were comparable in MT-2, NP-2, and NCK45 cells. After cultivation of more than 6 months, NCK45 cells remained susceptible to HIV infection since NCK45 cells consistently expressed CD4, CXCR4, and CCR5. On the other hand, MAGI cells lost the CD4 expression during culture. Thus, this assay system can stably detect the replication of both X4- and R5-HIV, indicating that it should be useful for the evaluation of HIV replication and drug susceptibility.
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Affiliation(s)
- Keiko Kajiwara
- Laboratory of Virus Immunology, Institute for Virus Research, Kyoto University, Shogoin, Sakyo-ku, Kyoto, Japan
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Colombo S, Telenti A, Buclin T, Furrer H, Lee BL, Biollaz J, Decosterd LA. Are Plasma Levels Valid Surrogates for Cellular Concentrations of Antiretroviral Drugs in HIV-infected Patients? Ther Drug Monit 2006; 28:332-8. [PMID: 16778716 DOI: 10.1097/01.ftd.0000211807.74192.62] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Total plasma concentrations are currently measured for therapeutic drug monitoring of HIV protease inhibitors (PIs) and nonnucleoside reverse transcriptase inhibitors (NNRTIs). However, the pharmacological target of antiretroviral drugs reside inside cells. To study the variability of their cellular accumulation, and to determine to which extent total plasma concentrations (TPC) correlate with cellular concentrations (CC), plasma and peripheral blood mononuclear cells (PBMCs) were simultaneously collected at single random times after drug intake from 133 HIV infected patients. TPC levels were analysed by high-performance liquid chromatography with ultraviolet detection and CC by LC-MS/MS from peripheral blood mononuclear cells. The best correlations between TPC and CC were observed for nelfinavir (NFV, slope=0.93, r=0.85), saquinavir (SQV, slope=0.76, r=0.80) and lopinavir (LPV, slope=0.87, r=0.63). By contrast, TPC of efavirenz (EFV) exhibited a moderate correlation with CC (slope=0.69, r=0.58), while no correlation was found for nevirapine (NVP, slope=-0.3, r=0.1). Interindividual variability in the CC/TPC ratio was lower for protease inhibitors (coefficients of variation 76%, 61%, and 80% for SQV, NFV and LPV, respectively) than for nonnucleoside reverse transcriptase inhibitors (coefficients of variation 101% and 318%, for EFV and NVP). As routine CC measurement raises practical difficulties, well-correlated plasma concentrations (ie, NFV, SQV and LPV) can probably be considered as appropriate surrogates for cellular drug exposure. For drugs such as EFV or NVP, there may be room for therapeutic drug monitoring improvement using either direct CC determination or other predictive factors such as genotyping of transporters or metabolizing enzyme genes.
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Affiliation(s)
- Sara Colombo
- Division of Clinical Pharmacology and Toxicology, University Hospital of Bern, Switzerland
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Woodahl EL, Yang Z, Bui T, Shen DD, Ho RJY. MDR1 G1199A polymorphism alters permeability of HIV protease inhibitors across P-glycoprotein-expressing epithelial cells. AIDS 2005; 19:1617-25. [PMID: 16184031 DOI: 10.1097/01.aids.0000183626.74299.77] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To evaluate the impact of the human multidrug resistance gene (MDR1) G1199A polymorphism (amino acid change Ser400Asn) on P-glycoprotein (P-gp)-dependent transepithelial permeability and uptake kinetics of HIV protease inhibitors (PI), by using recombinant epithelial cells expressing wild-type MDR1 (MDR1wt) or the G1199A variant (MDR1(1199A)). METHODS Using a recombinant expression system developed previously, the transepithelial permeability and uptake kinetic parameters of five PI, amprenavir, indinavir, lopinavir, ritonavir, and saquinavir were estimated across polarized epithelial cells. RESULTS For all PI, the transepithelial permeability ratio (basolateral-to-apical transport divided by apical-to-basolateral transport) was significantly greater in MDR1(1199A) cells than MDR1wt cells: amprenavir (1.7-fold), indinavir (1.8-fold), lopinavir (1.5-fold), ritonavir (2.8-fold), and saquinavir (2.1-fold). However, the impact of G1199A on P-gp activity appeared to primarily influence drug permeability in the apical-to-basolateral direction. Kinetic analysis of ritonavir and saquinavir uptake by MDR1wt- and MDR1(1199A)-expressing cells showed that Vmax was similar, while uptake Km was significantly higher in cells expressing the G1199A variant suggesting that alterations in P-gp-dependent efflux mediated by G1199A were due to changes in transporter affinity. CONCLUSIONS Alterations in transepithelial permeability of HIV PI due to the G1199A polymorphism may impact oral bioavailability of PI and penetration into cells and tissues of the lymphoid and central nervous systems.
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Affiliation(s)
- Erica L Woodahl
- Department of Pharmaceutics, University of Washington, Seattle, Washington 98195-7610, USA
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20
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Autar RS, Boffito M, Hassink E, Wit FWNM, Ananworanich J, Siangphoe U, Pozniak A, Cooper DA, Phanuphak P, Lange JMA, Ruxrungtham K, Burger DM. Interindividual variability of once-daily ritonavir boosted saquinavir pharmacokinetics in Thai and UK patients. J Antimicrob Chemother 2005; 56:908-13. [PMID: 16204340 DOI: 10.1093/jac/dki354] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Differential exposure to saquinavir/ritonavir may lead to therapy failure. The objective was to identify factors that influence variability of saquinavir/ritonavir plasma concentrations. METHODS Saquinavir/ritonavir data, dosed as 1600/100 mg once daily, from three separate pharmacokinetic studies, in 45 patients from Thailand and the UK, were pooled. Pharmacokinetic parameters were based on non-compartmental analysis. Univariate analysis was performed with saquinavir as the dependent variable, and ritonavir area under the curve (AUC), gender, body weight, body mass index (BMI) and study site as independent variables. Variables with a P value <0.10 were included in a multivariate linear regression analysis. RESULTS Higher saquinavir AUCs, maximum concentrations (Cmax) and minimum concentrations (Cmin) were seen in Thai patients than in UK patients. Univariate analysis showed associations between body weight, gender, study site and ritonavir AUC and saquinavir AUC (P < 0.05), whereas BMI (P = 0.13) did not. In the multivariate analysis, ritonavir AUC (P = 0.0001) and study site (P = 0.0021) were significantly related to saquinavir AUC (R2 = 0.50). CONCLUSIONS The ritonavir AUC and study site appeared to be related to exposure of saquinavir. Study site should be viewed as the total of country- and study-specific differences--such as differences in lifestyle, environment, genetic background and dietary composition--between the analysed studies.
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Affiliation(s)
- Reshma Saskia Autar
- The HIV Netherlands Australia Thailand Research Collaboration, Thai Red Cross Aids Research Centre, Bangkok, 104 Rajdumri Road, 10330 Pathumwan, Bangkok, Thailand.
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21
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Almond LM, Hoggard PG, Edirisinghe D, Khoo SH, Back DJ. Intracellular and plasma pharmacokinetics of efavirenz in HIV-infected individuals. J Antimicrob Chemother 2005; 56:738-44. [PMID: 16141277 DOI: 10.1093/jac/dki308] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The site of action of efavirenz is inside HIV-infected cells. Measurement of intracellular (IC) concentrations of efavirenz may therefore provide further understanding of therapeutic failure, especially where virological rebound occurs despite adequate plasma levels, and a lack of detectable viral resistance. Here, we determined IC and plasma pharmacokinetics of efavirenz and their relationship with plasma protein binding and P-glycoprotein (P-gp, an active drug efflux transporter) expression. PATIENTS AND METHODS Venous blood samples from 10 HIV-infected patients receiving efavirenz (600 mg once a day plus two nucleoside reverse transcriptase inhibitors) were collected over the 24 h dosing interval. Plasma and peripheral blood mononuclear cells (PBMCs) were isolated. Plasma protein bound and unbound efavirenz were separated using ultrafiltration. IC (or cell-associated), total plasma and unbound plasma efavirenz levels were quantified using HPLC-UV. P-gp expression was measured by flow cytometry. Area under the concentration-time curves (AUC0-24) were then calculated using non-compartmental analyses and the IC accumulation expressed as a ratio of IC to plasma AUC0-24. RESULTS The median (range) % unbound and IC accumulation ratio was 0.6% (0.4-1.5%) and 1.3 (0.7-3.3), respectively. There was a linear relationship between IC and total AUC0-24 (r2= 0.59, P = 0.01) but not unbound AUC0-24 (r2= 0.13, P = 0.75). An inverse correlation between IC AUC0-24 and % unbound was observed (r2= 41, P = 0.05). There was no relationship between IC AUC0-24 and P-gp expression on the cell surface (r2< 0.01, P = 0.98). CONCLUSIONS There was a direct relationship between % bound efavirenz in plasma and IC accumulation implying that the IC accumulation of efavirenz is related to binding to IC proteins or other cellular constituents. Studies investigating the unbound concentration of antiretrovirals inside the cell are now required.
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Affiliation(s)
- Lisa M Almond
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK.
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22
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Crommentuyn KML, Huitema ADR, Beijnen JH. Bioanalysis of HIV protease inhibitors in samples from sanctuary sites. J Pharm Biomed Anal 2005; 38:139-47. [PMID: 15907632 DOI: 10.1016/j.jpba.2004.12.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2004] [Revised: 12/09/2004] [Accepted: 12/10/2004] [Indexed: 10/25/2022]
Abstract
The human immunodeficiency virus (HIV) is present in several sites inside the human body, which are hardly accessible to antiretroviral drugs, the so-called sanctuary sites. The most important sanctuary sites are cerebrospinal fluid (CSF), peripheral blood mononuclear cells (PBMCs) and seminal plasma. The determination of drug concentrations in these sanctuary sites may form an important step in treatment optimisation of HIV-infected individuals. However, bioanalysis in these sites is hampered by several factors with regard to sample preparation, chromatography and detection. In this review, we will discuss these issues and give an overview of published methods using high-performance liquid chromatography (HPLC) for the bioanalysis of HIV protease inhibitors in CSF, PBMCs and seminal plasma.
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Affiliation(s)
- K M L Crommentuyn
- Slotervaart Hospital, Department of Pharmacy and Pharmacology, Louwesweg 6, 1066 EC Amsterdam, The Netherlands.
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23
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Colombo S, Beguin A, Telenti A, Biollaz J, Buclin T, Rochat B, Decosterd LA. Intracellular measurements of anti-HIV drugs indinavir, amprenavir, saquinavir, ritonavir, nelfinavir, lopinavir, atazanavir, efavirenz and nevirapine in peripheral blood mononuclear cells by liquid chromatography coupled to tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2005; 819:259-76. [PMID: 15833290 DOI: 10.1016/j.jchromb.2005.02.010] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2004] [Revised: 02/01/2005] [Accepted: 02/10/2005] [Indexed: 11/25/2022]
Abstract
A sensitive and accurate liquid chromatography-tandem mass spectrometric (LC-MS/MS) method for the intracellular determination of nine antiretroviral drugs in human peripheral blood mononuclear cells (PBMCs) is proposed. PBMCs are isolated by density gradient centrifugation using Vacutainer CPT tubes and cell count is performed with a Coulter instrument. Single-step extraction of drugs from PBMCs pellets is performed with MeOH 50% (with clozapine added as internal standard, I.S.) and the supernatant is injected onto a 2.1 mm x 30 mm SymmetryShield 3.5 microm-RP18 column equipped with a 2.1 x 10 mm guard column. Chromatographic separations are performed using a gradient program with a mixture of 2 mM ammonium acetate containing 0.1% formic acid and acetonitrile with 0.1% formic acid. Analytes quantification is performed by electro-spray ionisation-triple quadrupole mass spectrometry using the selected reaction monitoring (SRM) detection mode. The positive mode is used for the HIV protease inhibitors (PIs) indinavir, amprenavir, saquinavir, ritonavir, nelfinavir, lopinavir, atazanavir and the non-nucleoside reverse transcriptase inhibitors (NNRTIs) nevirapine, and the negative mode is applied for efavirenz. The calibration curves are prepared using blank PBMCs spiked with antiretroviral drugs at concentrations ranging from 0.5 to 100 ng/ml of cell extracts and fitted to a quadratic regression model weighted by 1/(concentration)(2). The lower limit of quantification is less than 0.5 ng/ml. The mean extraction recovery for all PIs/NNRTIs is always above 88%. The method is precise, with mean inter-day CV% within 0.6-10.2%, and accurate (range of inter-day deviation from nominal values -7.2 to +8.3%). This analytical method can be conveniently used in clinical research for the assessment of intracellular levels of all PIs/NNRTIs commercially available at present using a simple one-step cell extraction of PBMCs followed by liquid chromatography coupled with tandem triple quadripole mass detection.
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Affiliation(s)
- S Colombo
- Division de Pharmacologie clinique, Laboratoire BH 18-218, Département de Médecine, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne CHUV, Switzerland
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24
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Abstract
Highly active anti-retroviral therapy (HAART) has drastically altered the course of HIV-1 infection, resulting in a major decrease in morbidity and mortality. However, adverse drug reactions and long-term toxicities associated with HAART are now a concern. A major toxicity that has been highlighted by the increased use of HAART is related to mitochondrial side-effects. At the same time, analysis of the biochemical pathways involved in programmed cell death has revealed that mitochondria are main sensors in this process. In this article, the regulation of mitochondrial damage following the use of nucleoside analogue reverse transcriptase inhibitors (NRTIs) and protease inhibitors is discussed, with a particular focus on the putative molecular mechanisms involved.
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Affiliation(s)
- Frédéric Petit
- Unité de Physiopathologie des Infections Lentivirales, Institut Pasteur, 28 rue du Dr Roux, 75724 Paris cedex 15, France
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25
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Ford J, Khoo SH, Back DJ. The intracellular pharmacology of antiretroviral protease inhibitors. J Antimicrob Chemother 2004; 54:982-90. [PMID: 15537695 DOI: 10.1093/jac/dkh487] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Therapeutic drug monitoring (TDM) of antiretroviral protease inhibitors (PIs) has been suggested to have the potential to both reduce toxicity and optimize individual therapy. However, the major target of PIs is within cells infected with HIV. Therefore clinical outcome ultimately must be related to intracellular drug concentrations since antiviral activity of PIs is highly correlated with intracellular concentrations in vitro. Intracellular pharmacokinetics provides information regarding drug disposition in a compartment where HIV replication occurs and combined with plasma data may be useful in understanding therapeutic failure in relation to cellular resistance. In order to improve therapeutic efficacy, it is therefore important that the intracellular pharmacokinetics of drugs, such as PIs, is studied in addition to plasma pharmacokinetics. Multidrug resistance transporters may result in a lower cellular concentration of drug via an efflux mechanism, thus contributing to sanctuary site formation. However, conclusive proof that transporters contribute to clinical drug resistance is still lacking, although recent studies have attempted to address this issue. In relation to host and cellular factors, this review considers several issues involved in influencing intracellular drug concentrations and discusses the intracellular levels of PIs recently published from cellular studies.
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Affiliation(s)
- J Ford
- Department of Pharmacology and Therapeutics, University of Liverpool, 70 Pembroke Place, Liverpool L69 3GF, UK.
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26
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Ford J, Boffito M, Wildfire A, Hill A, Back D, Khoo S, Nelson M, Moyle G, Gazzard B, Pozniak A. Intracellular and plasma pharmacokinetics of saquinavir-ritonavir, administered at 1,600/100 milligrams once daily in human immunodeficiency virus-infected patients. Antimicrob Agents Chemother 2004; 48:2388-93. [PMID: 15215085 PMCID: PMC434222 DOI: 10.1128/aac.48.7.2388-2393.2004] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Ritonavir-boosted saquinavir (SQV/r) is currently licensed as a twice-daily regimen. Reducing the pill burden with once-daily dosing may improve adherence. Intracellular concentrations of drugs must be related to the clinical efficacy of protease inhibitors. The aims of the study were to determine the cellular and plasma saquinavir and ritonavir concentrations, to determine the half-lives (t(1/2)s) of the drugs in each compartment, and to examine relationships between drug accumulation and lymphocyte subset P glycoprotein (P-gp) expression. Venous blood samples from 12 human immunodeficiency virus-infected patients receiving a hard-gel formulation of SQV/r (1,600/100 mg once daily) were collected at 2, 6, 12, and 24 h after dosing. Peripheral blood mononuclear cells were separated by density gradient centrifugation, and P-gp expression was measured by dual-color flow cytometry. Plasma and intracellular (cell-associated) drug concentrations were measured by high-performance liquid chromatography-tandem mass spectrometry. The ratio of the intracellular drug area under the concentration-time curve from 0 to 24 h (AUC(0-24 h)) to plasma drug AUC(0-24 h) was calculated to determine cellular drug accumulation. The median (range) AUC(0-24 h) of saquinavir in plasma was 16.2 (5.7 to 39.3) mg. h. liter(-1), and that in cells was 46.3 (24.7 to 114.6) mg. h. liter(-1). Corresponding ritonavir values were 7.5 (1.5 to 14.6) mg. h. liter(-1) and 10.4 (3.2 to 13.7) mg. h. liter(-1), respectively. The median accumulation ratios of cellular AUC to plasma AUC for saquinavir and ritonavir were 3.31 (range, 1.49 to 6.69) and 1.46 (range, 0.83 to 4.15), respectively. Significant differences between the plasma and intracellular saquinavir t(1/2)s (4.5 h [range, 2.5 to 9.3 h] and 5.9 h [range, 4.0 to 17.7 h]; P = 0.034) and between the plasma and intracellular ritonavir t(1/2)s (4.1 h [range, 2.6 to 8.3 h] and 6.2 h [range, 3.9 to 18.6 h]; P = 0.032) were observed. No relationship was observed between the accumulation of saquinavir or ritonavir and lymphocyte subset P-gp expression. The intracellular t(1/2)s of saquinavir and ritonavir were longer than the plasma t(1/2)s, indicating that intracellular drug may be available at a time when concentrations in plasma are below the minimum effective concentration.
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Affiliation(s)
- Jennifer Ford
- Department of Pharmacology and Therapeutics, University of Liverpool, 70 Pembroke Pl., Block H, First Floor, Liverpool L69 3GF, United Kingdom.
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27
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Zhu D, Taguchi-Nakamura H, Goto M, Odawara T, Nakamura T, Yamada H, Kotaki H, Sugiura W, Iwamoto A, Kitamura Y. Influence of Single-Nucleotide Polymorphisms in the Multidrug Resistance-1 Gene on the Cellular Export of Nelfinavir and Its Clinical Implication for Highly Active Antiretroviral Therapy. Antivir Ther 2004. [DOI: 10.1177/135965350400900610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Protease inhibitors (PIs) such as nelfinavir (NFV) suppress HIV replication. PIs are substrates of P-glycoprotein (P-gp), the product of the multidrug-resistance-1 ( MDR1) gene. Three single-nucleotide polymorphisms (SNPs) are present in exons of the MDR1 gene: MDR1 1236, MDR1 2677 and MDR1 3435. We speculated that these genetic polymorphisms affected PI concentration in the cell. To verify this hypothesis, we first genotyped these SNPs in 79 Japanese patients by the SNaPshot method and found incomplete linkage disequilibrium between the SNPs. Because the SNP at MDR1 3435 has been reported to be associated with P-gp expression, we evaluated the effect of that SNP on the export of NFV from HIV-positive patients’ lymphoblastoid cell lines by measuring time-dependent decrease in the amount of intracellular NFV by high-performance liquid chromatography. We found the intracellular concentration of NFV in lymphoblastoid cell lines (LCLs) with the homozygous T/T genotype at MDR1 3435 were higher than that with C/C genotype with statistical significance. This suggests that the activity of P-gp in patients’ LCL cells with the MDR1 3435 T/T genotype was lower. In a retrospective study we evaluated the effect of the SNPs on CD4 cell count recovery in response to antiretroviral treatment with PIs, and obtained statistically significant evidence that suggested marginal association of the SNP at MDR1 1236 but not at MDR1 2677 or MDR1 3435. As in vitro results were not consistent with the clinical evaluation, clinical importance of MDR1 genotyping for antiretroviral therapy remains to be investigated in a larger, case-controlled study.
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Affiliation(s)
- Dayong Zhu
- Division of Infectious Diseases, Advanced Clinical Research Centre, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Hitomi Taguchi-Nakamura
- Division of Infectious Diseases, Advanced Clinical Research Centre, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Mieko Goto
- Division of Infectious Diseases, Advanced Clinical Research Centre, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Takashi Odawara
- Department of Infectious Diseases and Applied Immunology, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Tetsuya Nakamura
- Department of Infectious Diseases and Applied Immunology, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Harumi Yamada
- Department of Pharmacy, Research Hospital, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Hajime Kotaki
- Department of Pharmacy, Research Hospital, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | | | - Aikichi Iwamoto
- Division of Infectious Diseases, Advanced Clinical Research Centre, Institute of Medical Science, University of Tokyo, Tokyo, Japan
- Department of Infectious Diseases and Applied Immunology, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Yoshihiro Kitamura
- Division of Infectious Diseases, Advanced Clinical Research Centre, Institute of Medical Science, University of Tokyo, Tokyo, Japan
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28
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Penzak SR, Shen JM, Alfaro RM, Remaley AT, Natarajan V, Falloon J. Ritonavir Decreases the Nonrenal Clearance of Digoxin in Healthy Volunteers with Known MDR1 Genotypes. Ther Drug Monit 2004; 26:322-30. [PMID: 15167636 DOI: 10.1097/00007691-200406000-00018] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Our objective was to examine the influence of ritonavir on P-glycoprotein (P-gp) activity in humans by characterizing the effect of ritonavir on the pharmacokinetics of the P-gp substrate digoxin in individuals with known MDR1 genotypes. Healthy volunteers received a single dose of digoxin 0.4 mg orally before and after 14 days of ritonavir 200 mg twice daily. After each digoxin dose blood and urine were collected over 72 hours and analyzed for digoxin. Digoxin pharmacokinetic parameter values were determined using noncompartmental methods. MDR1 genotypes at positions 3435 and 2677 in exons 26 and 21, respectively, were determined using PCR-RFLP analysis. Ritonavir increased the digoxin AUC(0-72) from 26.20 +/- 8.67 to 31.96 +/- 11.24 ng x h/mL (P = 0.03) and the AUC(0-8) from 6.25 +/- 1.8 to 8.04 +/- 2.22 ng x h/mL (P = 0.02) in 12 subjects. Digoxin oral clearance decreased from 149 +/- 101 mL/h x kg to 105 +/- 57 mL/h x kg (P = 0.04). Other digoxin pharmacokinetic parameter values, including renal clearance, were unaffected by ritonavir. Overall, 75% (9/12) of subjects had higher concentrations of digoxin after ritonavir administration. The majority of subjects were heterozygous at position 3435 (C/T) (6 subjects) and position 2677 (G/T,A) (7 subjects); although data are limited, the effect of ritonavir on digoxin pharmacokinetics appears to occur across all tested MDR1 genotypes. Concomitant low-dose ritonavir reduced the nonrenal clearance of digoxin, thereby increasing its systemic availability. The most likely mechanism for this interaction is ritonavir-associated inhibition of P-gp. Thus, ritonavir can alter the pharmacokinetics of coadministered medications that are P-gp substrates.
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Affiliation(s)
- Scott R Penzak
- Warren G. Magnuson Clinical Center, Pharmacy Department, National Institutes of Health, Bethesda, Maryland 20892, USA
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29
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Sankatsing SUC, Beijnen JH, Schinkel AH, Lange JMA, Prins JM. P glycoprotein in human immunodeficiency virus type 1 infection and therapy. Antimicrob Agents Chemother 2004; 48:1073-81. [PMID: 15047504 PMCID: PMC375313 DOI: 10.1128/aac.48.4.1073-1081.2004] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Sanjay U C Sankatsing
- Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, University of Amsterdam, The Netherlands
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30
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Ronaldson PT, Bendayan M, Gingras D, Piquette-Miller M, Bendayan R. Cellular localization and functional expression of P-glycoprotein in rat astrocyte cultures. J Neurochem 2004; 89:788-800. [PMID: 15086534 DOI: 10.1111/j.1471-4159.2004.02417.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We investigated the cellular/subcellular localization and functional expression of P-glycoprotein, an ATP-dependent membrane-associated efflux transporter, in astrocytes, a brain parenchyma compartment that is poorly characterized for the expression of membrane drug transporters. Analyses were carried out on primary cultures of astrocytes isolated from the cerebral cortex of neonatal Wistar rats and CTX TNA2, an immortalized rat astrocyte cell line. Both cell cultures display morphological features typical of type I astrocytes. RT-PCR analysis revealed mdr1a and mdr1b mRNA in primary cultures of astrocytes and in CTX TNA2 cells. Western blot analysis using the P-glycoprotein monoclonal C219 antibody detected a single band of appropriate size in both cell systems. Immunocytochemical analysis using the monoclonal antibodies C219 and MRK16 labeled P-glycoprotein along the plasma membrane, caveolae, coated vesicles and nuclear envelope. Immunoprecipitation studies using the caveolin-1 polyclonal H-97 antibody demonstrated that P-glycoprotein is physically associated with caveolin-1 in both cell culture systems. The accumulation of [(3)H]digoxin (an established P-glycoprotein substrate) by the astrocyte cultures was significantly enhanced in the presence of standard P-glycoprotein inhibitors and an ATP depleting agent. These results demonstrate the cellular/subcellular location and functional expression of P-glycoprotein in rat astrocytes and suggest that this glial compartment may play an important role in the regulation of drug transport in the CNS.
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily B, Member 1/antagonists & inhibitors
- ATP Binding Cassette Transporter, Subfamily B, Member 1/biosynthesis
- ATP Binding Cassette Transporter, Subfamily B, Member 1/genetics
- Animals
- Astrocytes/cytology
- Astrocytes/metabolism
- Astrocytes/ultrastructure
- Biological Transport/drug effects
- Blotting, Western
- Caveolin 1
- Caveolins/biosynthesis
- Cells, Cultured
- Digoxin/pharmacokinetics
- Enzyme Inhibitors/pharmacology
- Immunohistochemistry
- Precipitin Tests
- RNA, Messenger/biosynthesis
- Rats
- Rats, Wistar
- Reverse Transcriptase Polymerase Chain Reaction
- Subcellular Fractions/metabolism
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Affiliation(s)
- Patrick T Ronaldson
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
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31
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Azoulay S, Nevers MC, Créminon C, Heripret L, Durant J, Dellamonica P, Grassi J, Guedj R, Duval D. Sensitive enzyme immunoassay for measuring plasma and intracellular nevirapine levels in human immunodeficiency virus-infected patients. Antimicrob Agents Chemother 2004; 48:104-9. [PMID: 14693526 PMCID: PMC310181 DOI: 10.1128/aac.48.1.104-109.2004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We have developed an enzyme immunoassay to measure nevirapine (NVP) in plasma and peripheral blood mononuclear cells. Anti-NVP polyclonal antibodies were raised in rabbits by using a synthetic NVP derivative coupled to keyhole limpet hemocyanin as the immunogen, and the enzyme tracer was prepared by chemically coupling the NVP derivative with acetylcholinesterase. These reagents were used to develop a sensitive competitive enzyme immunoassay performed in microtitration plates with a 100-pg ml(-1) limit of detection and thus approximately 100 times more sensitive than previously published techniques. The plasma assay was performed directly without extraction (in this case, a 500-pg ml(-1) limit of detection was observed) on a minimum of 30 micro l of plasma. This assay shows good precision and efficiency, since recovery from human plasma and cell extracts spiked with NVP ranged between 87 and 104%, with coefficients of variation of <10%. A pharmacokinetic analysis of plasma NVP was performed for seven patients infected with human immunodeficiency virus (HIV), and it gave results similar to published findings. Intracellular concentrations of NVP were measured in cultured human T-lymphoblastoid cells and peripheral blood mononuclear cells from HIV-infected patients. The results indicated a very low intracellular/extracellular concentration ratio (0.134), thus demonstrating the absence of intracellular drug accumulation. This is the first intracellular assay of a nonnucleoside reverse-transcriptase inhibitor, and this method could be useful in monitoring plasma and intracellular NVP levels in HIV-infected patients.
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Affiliation(s)
- Stéphane Azoulay
- Laboratoire de Chimie Bio-Organique, Université de Nice-Sophia Antipolis, Hôpital Archet, Nice, France
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33
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Hennessy M, Clarke S, Spiers JP, Kelleher D, Mulcahy F, Hoggard P, Back D, Barry M. Intracellular Accumulation of Nelfinavir and Its Relationship to P-Glycoprotein Expression and Function in HIV-Infected Patients. Antivir Ther 2004. [DOI: 10.1177/135965350400900103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Objective To compare plasma and intracellular nelfinavir pharmacokinetics, and determine their relationship to P-glycoprotein (P-gp) expression and function in lymphocytes of HIV-infected patients. Methods A pharmacokinetic study of 12 patients receiving nelfinavir plus dual nucleoside analogue therapy. Blood samples were taken at intervals to 12 h. Peripheral blood mononuclear cells (PBMCs) were isolated by density gradient centrifugation, and nelfinavir extracted from cells in the presence of 60% methanol and evaporated to dryness. Both plasma and intracellular nelfinavir samples were assayed by high performance liquid chromatography linked to mass spectrometry. P-gp expression and function were measured by flow cytometric analysis. Data were analysed by non-compartmental analysis using WinNonLin pharmacokinetic software. Results The mean intracellular nelfinavir AUC0–12 (mean ±SE) was about ninefold higher than that of plasma (264 200 ±63420 vs 29250 ±6629 ng/ml/h; P<0.001, and intracellular Cmin and C0 values for nelfinavir were five- to sixfold higher than that of plasma (Cmin: 5712 ±2156 vs 1062 ±357 ng/ml; C0: 15860 ±3662 vs 2553 ±539 ng/ml; P<0.0005). The intracellular nelfinavir Cmax was 15-fold higher than plasma (59420 ±13940 vs 3986 ±822 ng/ml; P<0.0005). There were no differences between plasma and intracellular values for Tmax, elimination half-life or mean residence time. In patients chronically treated with nelfinavir mean P-gp expression was 8.85 ±1.3 MFI, there was no correlation between Pgp expression and either intracellular AUC0–12 (r=–0.35; P=0.29) or intracellular C0 values. There was a correlation between intracellular nelfinavir concentrations and P-gp function at baseline (r=0.59; P<0.05). Basal P-gp-mediated rhodamine efflux was 61.0 ±4.2%. In the presence of ritonavir, cellular rhodamine efflux decreased to 25.6 ±5.5% ( P=0.001), representing an additional reversible efflux potential of 56.1 ±9.78%. There was a strong correlation between plasma and intracellular AUC0–12 for nelfinavir (r=0.75; P=0.011). Conclusions Nelfinavir undergoes significant intracellular accumulation within the PBMCs of HIV-infected patients, which may be in part related to its moderate ability to inhibit P-gp-mediated drug efflux. The addition of ritonavir further reduced P-gp function. Intracellular accumulation of nelfinavir correlated with P-gp function but not P-gp expression, suggesting pump activity is substrate concentration-dependant. There was a significant correlation between plasma and intracellular nelfinavir concentrations, suggesting one is a good surrogate marker of the other.
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Affiliation(s)
- Martina Hennessy
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland
| | - Susan Clarke
- Department of Genito Urinary Medicine, St James's Hospital, Dublin, Ireland
| | - J Paul Spiers
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland
| | - Dermot Kelleher
- Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Fiona Mulcahy
- Department of Genito Urinary Medicine, St James's Hospital, Dublin, Ireland
| | - Patrick Hoggard
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - David Back
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Michael Barry
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland
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Ford J, Cornforth D, Hoggard PG, Cuthbertson Z, Meaden ER, Williams I, Johnson M, Daniels E, Hsyu P, Back DJ, Khoo SH. Intracellular and Plasma Pharmacokinetics of Nelfinavir and M8 in HIV-Infected Patients: Relationship with P-Glycoprotein Expression. Antivir Ther 2004. [DOI: 10.1177/135965350400900101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
One of the targets of antiretroviral therapy is within cells infected with HIV. In order to improve therapeutic efficacy, it is therefore important that the intracellular pharmacokinetics of drugs, such as nelfinavir mesylate and its active metabolite M8, are studied in addition to plasma pharmacokinetics. Previously, the intracellular accumulation of protease inhibitors has been reported in vivo, displaying the following hierarchy: nelfinavir > saquinavir > ritonavir > indinavir. Multidrug resistance transporters, such as P-glycoprotein (P-gp), may result in a lower intracellular concentration of drug via an efflux mechanism, thus contributing to sanctuary site formation. The objective of this study was to determine concentrations of nelfinavir and M8 in plasma and peripheral blood mononuclear cells from HIV-infected patients, and to ascertain the relationship between intracellular accumulation and lymphocyte P-gp expression. Venous blood samples from 12 HIV-infected patients (viral load <50 copies/ml) receiving nelfinavir (1250 mg twice daily) and dual nucleoside reverse transcriptase inhibitor therapy were collected over a full dosage interval (0, 2, 4, 8 and 12 h). Plasma and intracellular (cell-associated) drug concentrations were measured by HPLC-MS/MS. Drug exposure in plasma and cells was expressed as the area under the concentration–time curve (AUC0-12h), derived from non-compartmental modelling. The ratio of intracellular AUC0-12h/total plasma AUC0-12h was calculated to determine cellular drug accumulation. P-gp expression on lymphocytes was determined by flow cytometry. The median (range) AUC0-12h of nelfinavir in plasma and cellular compartments was 21.8 mg.h.l-1 (5.64–50.8) and 104.6 mg.h.l-1 (23.1–265.7), respectively. Corresponding values for M8 in plasma and cells were 6.60 mg.h.l–1 (2.16–17.3) and 19.6 mg.h.l–1 (5.14–60.8). A ratio of plasma M8/plasma nelfinavir (AUC0–12h) and intracellular M8/intracellular nelfinavir (AUC0–12h) gave median values of 0.32 and 0.17, respectively. The cellular accumulations [median; (range)] of nelfinavir and M8 were 5.30 (2.28–16.2) and 2.32 (1.01–10.7), respectively. A significant correlation between plasma and intracellular nelfinavir minimum concentration (Cmin) (r2=0.34; P=0.049), but not between plasma and intracellular M8 Cmin was observed. C0h concentrations were higher than C12h for both nelfinavir and M8. No relationship was observed between nelfinavir or M8 accumulation and lymphocyte cell surface expression of P-gp. This study illustrates that intracellular concentrations were higher than plasma concentrations for both nelfinavir and M8, suggesting lymphocyte accumulation. The mechanism of differential intracellular accumulation of nelfinavir and M8 remains to be elucidated. It may be that affinities for influx transporters or fundamental drug characteristics play a major role in the greater accumulation of nelfinavir than M8.
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Affiliation(s)
- Jennifer Ford
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - David Cornforth
- Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, University College London, London, UK
| | - Patrick G Hoggard
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Zoe Cuthbertson
- Department of Thoracic Medicine, Royal Free Hospital, London, UK
| | - E Rhiannon Meaden
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Ian Williams
- Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, University College London, London, UK
| | - Margaret Johnson
- Department of Thoracic Medicine, Royal Free Hospital, London, UK
| | | | - Poe Hsyu
- Agouron Pharmaceuticals, Inc., San Diego, Calif., USA
| | - David J Back
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Saye H Khoo
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
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35
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Cooper CL, van Heeswijk RPG, Gallicano K, Cameron DW. A review of low-dose ritonavir in protease inhibitor combination therapy. Clin Infect Dis 2003; 36:1585-92. [PMID: 12802760 DOI: 10.1086/375233] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2002] [Accepted: 02/14/2003] [Indexed: 11/03/2022] Open
Abstract
The pharmacokinetics of protease inhibitors center around the microsomal enzyme cytochrome P-450 3A4. As a potent inhibitor of this enzyme, ritonavir can increase the bioavailability and half-life of coadministered protease inhibitors. Evidence suggests that increased exposure to protease inhibitors is clinically relevant. Antiretroviral treatment with low-dose ritonavir-boosted lopinavir, indinavir, and saquinavir has durable virological activity and shows impressive immune reconstitution. Although tolerable in most cases, gastrointestinal side effects, hepatotoxicity, and blood lipid abnormalities remain relevant issues. Additional study will elucidate the advantages and disadvantages of twice-daily, low-dose ritonavir-boosted regimens and determine whether once-daily regimens based on this principle will have a lasting role in clinical practice.
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Affiliation(s)
- C L Cooper
- Division of Infectious Diseases, The Ottawa Hospital-General Campus, Ottawa, ON, Canada K1H 8L6.
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