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Ji C. Molecular Factors and Pathways of Hepatotoxicity Associated with HIV/SARS-CoV-2 Protease Inhibitors. Int J Mol Sci 2023; 24:ijms24097938. [PMID: 37175645 PMCID: PMC10178330 DOI: 10.3390/ijms24097938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
Antiviral protease inhibitors are peptidomimetic molecules that block the active catalytic center of viral proteases and, thereby, prevent the cleavage of viral polyprotein precursors into maturation. They continue to be a key class of antiviral drugs that can be used either as boosters for other classes of antivirals or as major components of current regimens in therapies for the treatment of infections with human immunodeficiency virus (HIV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, sustained/lifelong treatment with the drugs or drugs combined with other substance(s) often leads to severe hepatic side effects such as lipid abnormalities, insulin resistance, and hepatotoxicity. The underlying pathogenic mechanisms are not fully known and are under continuous investigation. This review focuses on the general as well as specific molecular mechanisms of the protease inhibitor-induced hepatotoxicity involving transporter proteins, apolipoprotein B, cytochrome P450 isozymes, insulin-receptor substrate 1, Akt/PKB signaling, lipogenic factors, UDP-glucuronosyltransferase, pregnane X receptor, hepatocyte nuclear factor 4α, reactive oxygen species, inflammatory cytokines, off-target proteases, and small GTPase Rab proteins related to ER-Golgi trafficking, organelle stress, and liver injury. Potential pharmaceutical/therapeutic solutions to antiviral drug-induced hepatic side effects are also discussed.
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Affiliation(s)
- Cheng Ji
- Research Center for Liver Disease, GI/Liver Division, Department of Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA 90089, USA
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2
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Joe MB, Roland L, Laurent C, Patrick LM, Sawoo O, Gaston TL, Bruno E, Gilles P, Philippe P. Concomitant Use of Cotrimoxazole and Atazanavir in HIV-infected Patients: A Therapeutic Drug Monitoring and Pharmacovigilance Based Dual Approach. ACTA ACUST UNITED AC 2020; 14:214-223. [PMID: 30961507 DOI: 10.2174/1574884714666190405160612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Cotrimoxazole is the main antibiotic used in primary prophylaxis for opportunistic infections in advanced HIV infection. This drug can inhibit one of the metabolic pathways of atazanavir (ATV), such as the cytochromes P450 (CYP) 2C8/2C9 and could interfere with its safety and efficacy. OBJECTIVE We studied the drug-drug interaction (DDI) between cotrimoxazole and ATV by using therapeutic drug monitoring (TDM) and pharmacovigilance (PV) approaches. METHODS We compared a group of patients treated with cotrimoxazole and receiving an ATV-based regimen to controls. This historical cohort analysis used data from Dat'AIDS in HIV-infected patients who had at least two lowest plasma concentrations (C-trough) of ATV during their outpatient follow-up. Likewise, we used the international pharmacovigilance data from VigiBase to evaluate the notifications of hyperbilirubinemia reported with ATV. RESULTS In the TDM analysis, the two groups of patients (treated with cotrimoxazole and controls) were almost homogeneous concerning the main baseline features. After at least six months of ATVbased regimen, there was no significant difference in the safety threshold of the ATV C-trough [with an adjusted odds ratio (aOR) of 1.4 (95% CI: 0.5 - 4.4)] compared to controls. We observed similar results with the efficacy thresholds of ATV C-trough. Regarding the PV analysis, there was no difference in hyperbilirubinemia occurring with ATV when cotrimoxazole was concomitant, with an adjusted reporting odds ratio (aROR) of 0.9 (95% CI: 0.6 to 1.2). CONCLUSION This study showed a relevant concomitant use between Cotrimoxazole and ATV based on TDM and PV approaches.
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Affiliation(s)
- Miantezila B Joe
- EA4065 Ecosystème Intestinal, Probiotique, Antibiotiques, Université Paris Descartes SPC, Paris, France.,Unité de Pharmacologie Clinique, Université de Kinshasa, Kinshasa, RD, Congo.,Centre Régional de Pharmacovigilance, Hôpital Cochin, Assistance publique- Hopitaux de Paris, Paris, France
| | - Landman Roland
- Service des Maladies Infectieuses et Tropicales, Hôpital Bichat, Paris, France.,IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité and INSERM, Paris, France
| | - Chouchana Laurent
- Centre Régional de Pharmacovigilance, Hôpital Cochin, Assistance publique- Hopitaux de Paris, Paris, France.,EA7323 Evaluation thérapeutique et pharmacologie périnatale et pédiatrique, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Lê M Patrick
- IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité and INSERM, Paris, France.,AP-HP, Hôpital Bichat-Claude Bernard, Laboratoire de Pharmaco-Toxicologie, Paris, France
| | - Olivier Sawoo
- EA4065 Ecosystème Intestinal, Probiotique, Antibiotiques, Université Paris Descartes SPC, Paris, France.,Microbial Ecology Laboratory (MIEL), CNAM, Paris, France
| | - Tona L Gaston
- Unité de Pharmacologie Clinique, Université de Kinshasa, Kinshasa, RD, Congo
| | - Eto Bruno
- TBC TransCell-Lab, Faculté de Médecine Xavier Bichat, Paris, France
| | - Peytavin Gilles
- IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité and INSERM, Paris, France.,AP-HP, Hôpital Bichat-Claude Bernard, Laboratoire de Pharmaco-Toxicologie, Paris, France
| | - Pochart Philippe
- EA4065 Ecosystème Intestinal, Probiotique, Antibiotiques, Université Paris Descartes SPC, Paris, France.,Microbial Ecology Laboratory (MIEL), CNAM, Paris, France
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Basilua JM, Sawoo O, Mangin I, Dossou-Yovo F, Boussard A, Chevillard L, Lutete GT, Eto B, Peytavin G, Pochart P. Higher Atazanavir Plasma Exposure in Rats is Associated with Gut Microbiota Changes Induced by Cotrimoxazole. Curr Drug Metab 2019; 20:898-906. [PMID: 31702484 DOI: 10.2174/1389200220666191023105609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 10/02/2019] [Accepted: 10/16/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cotrimoxazole (TMP-SMX) is concomitantly used as a primary prophylaxis of opportunistic infections with antiretroviral agents, such as Atazanavir (ATV). Results from an ex vivo study showed changes in intestinal absorption of ATV when rats were pretreated with TMP-SMX. The objective of this in vivo study is to determine the effect of TMP-SMX on the pharmacokinetics of ATV in rats. We also studied changes in gut microbiota induced by TMP-SMX. METHODS We used the non-compartment analysis to compare the pharmacokinetics of ATV in a parallel group of rats treated with a low or therapeutic dose of TMP-SMX for nine days to untreated control rats. Gut microbiota was characterized using qPCR and High Throughput Sequencing of 16S rDNA. RESULTS Rats treated with TMP-SMX showed a much broader exposure to ATV compared to the control group (AUC0-8h (ng.mL-1.h), 25975.9±4048.7 versus 2587.6±546.9, p=0.001). The main observation regarding the gut microbiota was a lower proportion of enterobacteria related to the administration of TMP-SMX. Moreover, the Total Gastrointestinal Transit Time (TGTT) was longer in the TMP-SMX treated group. CONCLUSION Concomitant administration of TMP-SMX and ATV significantly increased ATV exposure in rats. This increase could be the result of a prolonged TGTT leading to an increase in the intestinal residence time of ATV favoring its absorption. Gut microbiota changes induced by TMP-SMX could be at the origin of this prolonged TGTT. If demonstrated in humans, this potential interaction could be accompanied by an increase in the adverse effects of ATV.
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Affiliation(s)
- Joe Miantezila Basilua
- EA4065 Intestinal Ecosystem, Probiotics, Antibiotics, Paris Descartes University SPC, Paris, France.,Clinical Pharmacology Unit, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Olivier Sawoo
- EA4065 Intestinal Ecosystem, Probiotics, Antibiotics, Paris Descartes University SPC, Paris, France.,Microbial Ecology Laboratory (MIEL), CNAM, F-75003 Paris, France
| | - Irène Mangin
- EA4065 Intestinal Ecosystem, Probiotics, Antibiotics, Paris Descartes University SPC, Paris, France.,Microbial Ecology Laboratory (MIEL), CNAM, F-75003 Paris, France
| | - Flore Dossou-Yovo
- EA4065 Intestinal Ecosystem, Probiotics, Antibiotics, Paris Descartes University SPC, Paris, France.,Microbial Ecology Laboratory (MIEL), CNAM, F-75003 Paris, France
| | - Aline Boussard
- UMR 1145 Food Process Engineering, AgroParisTech, INRA, Paris-Saclay University, Massy 91300, France.,CNAM, UMR1145 Food Process Engineering, Paris F-75003, France
| | - Lucie Chevillard
- UMR-S 1144 Therapeutic Optimization in Neuropsychopharmacology, Paris Descartes University, Paris, France
| | - Gaston T Lutete
- Clinical Pharmacology Unit, University of Kinshasa, Kinshasa, Congo
| | | | - Gilles Peytavin
- IAME, UMR 1137, INSERM, Paris Diderot University, Sorbonne Paris Cité, Paris, France.,Pharmaco-Toxicology Laboratory, Bichat Hospital, Paris, France
| | - Philippe Pochart
- EA4065 Intestinal Ecosystem, Probiotics, Antibiotics, Paris Descartes University SPC, Paris, France.,Microbial Ecology Laboratory (MIEL), CNAM, F-75003 Paris, France
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Kala S, Watson B, Zhang JG, Papp E, Guzman Lenis M, Dennehy M, Cameron DW, Harrigan PR, Serghides L. Improving the clinical relevance of a mouse pregnancy model of antiretroviral toxicity; a pharmacokinetic dosing-optimization study of current HIV antiretroviral regimens. Antiviral Res 2018; 159:45-54. [PMID: 30236532 DOI: 10.1016/j.antiviral.2018.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/05/2018] [Accepted: 09/14/2018] [Indexed: 12/16/2022]
Abstract
Animal models can be useful tools for the study of HIV antiretroviral (ARV) safety/toxicity in pregnancy and the mechanisms that underlie ARV-associated adverse events. The utility and translatability of animal model-based ARV safety/toxicity data is improved if ARVs are tested in clinically relevant concentrations. The objective of this work was to improve the clinical relevance of our mouse pregnancy model of ARV toxicity, by determining the doses of currently prescribed ARV regimens that would yield human therapeutic plasma concentrations. Pregnant mice were administered increasing doses of ARV combinations by oral gavage, followed by measurement of drug concentrations in the maternal plasma and amniotic fluid. Concentrations of ten different ARVs in maternal plasma and amniotic fluid samples of pregnant mice are presented, with dosing optimization to yield human pregnancy-relevant plasma drug concentrations. We have proposed optimal dosing for different regimen component drugs to achieve human therapeutic plasma levels, so that a clinically relevant standard dosing is established. A review of related ARV pharmacokinetic studies in (pregnant/non-pregnant) rodents and human pregnancy is also shown. We hope these data will inform and encourage the use of mouse pregnancy models in the study of ARV safety/toxicity.
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Affiliation(s)
- Smriti Kala
- Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, Canada
| | - Birgit Watson
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Jeremy Guijun Zhang
- Clinical Investigation Unit at the Ottawa Hospital Research Institute, Ottawa, Canada; Department of Medicine, University of Ottawa at the Ottawa Hospital / Research Institute, Ottawa, Canada
| | - Eszter Papp
- Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, Canada
| | - Monica Guzman Lenis
- Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, Canada
| | - Michelle Dennehy
- Clinical Investigation Unit at the Ottawa Hospital Research Institute, Ottawa, Canada; Department of Medicine, University of Ottawa at the Ottawa Hospital / Research Institute, Ottawa, Canada
| | - D William Cameron
- Clinical Investigation Unit at the Ottawa Hospital Research Institute, Ottawa, Canada; Department of Medicine, University of Ottawa at the Ottawa Hospital / Research Institute, Ottawa, Canada
| | - P Richard Harrigan
- Division of AIDS, Department of Medicine, University of British Columbia, Vancouver Canada
| | - Lena Serghides
- Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, Canada; Department of Immunology and Institute of Medical Sciences, University of Toronto, Toronto, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Canada.
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Lee U, Kwon MH, Kang HE. Pharmacokinetic alterations in poloxamer 407-induced hyperlipidemic rats. Xenobiotica 2018; 49:611-625. [PMID: 29658375 DOI: 10.1080/00498254.2018.1466212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
1. Plasma lipid profile abnormalities in hyperlipidemia can potentially alter the pharmacokinetics of a drug in a complex manner. To evaluate these pharmacokinetic alterations in hyperlipidemia and to determine the underlying mechanism(s), poloxamer 407-induced hyperlipidemic rats (HL rats), a well-established animal model of hyperlipidemia have been used. 2. In this review, we summarize findings on the pathophysiological and gene expression changes in drug-metabolizing enzymes and transporters in HL rats. We discuss pharmacokinetic changes in drugs metabolized primarily via hepatic cytochrome P450 (CYPs) in terms of alterations in hepatic intrinsic clearance (CL'int), free fraction in plasma (fu) and hepatic blood flow rate (QH), depending on the hepatic excretion ratio, as well as drugs eliminated primarily by mechanisms other than hepatic CYPs. 3. For lipoprotein-bound drugs, increased binding to lipoproteins resulted in lower fu values and volumes of distribution, with some exceptions. Generally, slower non-renal clearance (or total body clearance) of drugs that are substrates of hepatic CYP3A and CYP2C is well explained by the following factors: alterations in CL'int (due to down-regulation of hepatic CYPs), decreased fu and/or possible decreased QH. 4. These consistent findings across studies in HL rats suggest more studies are needed at the clinical level for optimal pharmacotherapies for hyperlipidemia.
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Affiliation(s)
- Unji Lee
- a Department of Pharmacy , Ewha Womans University Medical Center , Seoul , South Korea
| | - Mi Hye Kwon
- b College of Pharmacy and Integrated Research Institute of Pharmaceutical Sciences , The Catholic University of Korea , Bucheon , South Korea
| | - Hee Eun Kang
- b College of Pharmacy and Integrated Research Institute of Pharmaceutical Sciences , The Catholic University of Korea , Bucheon , South Korea
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Cheng BH, Zhou X, Wang Y, Chan JYW, Lin HQ, Or PMY, Wan DCC, Leung PC, Fung KP, Wang YF, Lau CBS. Herb-drug interaction between an anti-HIV Chinese herbal SH formula and atazanavir in vitro and in vivo. JOURNAL OF ETHNOPHARMACOLOGY 2015; 162:369-376. [PMID: 25614104 DOI: 10.1016/j.jep.2015.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 01/09/2015] [Accepted: 01/12/2015] [Indexed: 06/04/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE With the prevalent use of highly active antiretroviral therapy (HAART) for AIDS patients since 1996, the mortality of HIV/AIDS patients has been remarkably decreased. With long-term use of HAART, drug resistance and side effects of antiretrovirals have been frequently reported, which not only reduce the efficacy, but also decreases the tolerance of patients. Traditional herbal medicine has become more popular among HIV/AIDS patients as adjuvant therapy to reduce these adverse effects of HAART. SH formula is a Chinese herbal formula consisting of five traditional Chinese herbs including Morus alba L., Glycyrrhiza glabra L., Artemisia capillaris Thumb., Astragalus membranaceus Bge., and Carthamus tinctorius L. SH formula is clinically used for HIV treatment in Thailand. However, the possible pharmacokinetic interactions between these Chinese herbs and antiretroviral drugs have not been well documented. The aim of this study was to investigate the potential herb-drug interaction between SH herbal Chinese formula and the antiretroviral drug atazanavir (ATV). MATERIALS AND METHODS The combination effect of SH formula and ATV on HIV protease was studied in HIV-1 protease inhibition assay in vitro. The inhibition of SH formula on rat CYP3A2 was assessed by detecting the formation of 1'-OH midazolam from midazolam in rat liver microsomes in vitro. The in vivo pharmacokinetic interaction between SH formula and ATV was investigated by measuring time-dependent plasma concentrations of ATV in male Sprague-Dawley rats with liquid chromatography-mass spectrometry. RESULTS Through the in vitro HIV-1 protease inhibition assay, combination of SH formula (41.7-166.7 μg/ml) and ATV (16.7-33.3 ng/ml) showed additive inhibition on HIV-1 protease activity than SH formula or ATV used alone. In vitro incubation assay indicated that SH formula showed a weak inhibition (IC50=231.2 µg/ml; Ki=98.2 µg/ml) on CYP3A2 activity in rat liver microsomes. In vivo pharmacokinetic study demonstrated that SH formula did not affect the metabolism of ATV in rats. CONCLUSIONS Our study demonstrated for the first time that there is no metabolism-based herb-drug interaction between SH formula and ATV in rats, but this combination enhances the inhibition potentials against HIV protease activity. This observation may support the combinational use of anti-HIV treatment in human.
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Affiliation(s)
- Bao-Hui Cheng
- Institute of Chinese Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China; State Key Laboratory of Phytochemistry and Plant Resources in West China, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Xuelin Zhou
- Institute of Chinese Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China; State Key Laboratory of Phytochemistry and Plant Resources in West China, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Yan Wang
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences, Beijing 100050, China
| | - Judy Yuet-Wa Chan
- Institute of Chinese Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China; State Key Laboratory of Phytochemistry and Plant Resources in West China, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Huang-Quan Lin
- Institute of Chinese Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China; State Key Laboratory of Phytochemistry and Plant Resources in West China, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Penelope M Y Or
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - David Chi-Cheong Wan
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Ping-Chung Leung
- Institute of Chinese Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China; State Key Laboratory of Phytochemistry and Plant Resources in West China, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Kwok-Pui Fung
- Institute of Chinese Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China; State Key Laboratory of Phytochemistry and Plant Resources in West China, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China; School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Yi-Fen Wang
- State Key Laboratory of Phytochemistry and Plant Resources in West China, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming 650201, China
| | - Clara Bik-San Lau
- Institute of Chinese Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China; State Key Laboratory of Phytochemistry and Plant Resources in West China, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China.
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Kobuchi S, Fukushima K, Maeda Y, Kokuhu T, Ushigome H, Yoshimura N, Sugioka N, Takada K. Effects of bile duct stricture on the pharmacokinetics of the immunosuppressant tacrolimus in rats. ACTA ACUST UNITED AC 2013. [DOI: 10.7243/2053-7107-1-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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