1
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McFeely SJ, Ritchie TK, Yu J, Nordmark A, Berglund EG, Levy RH, Ragueneau‐Majlessi I. Inhibitors of Organic Anion‐Transporting Polypeptides 1B1 and 1B3: Clinical Relevance and Regulatory Perspective. J Clin Pharmacol 2020; 60:1087-1098. [DOI: 10.1002/jcph.1604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/11/2020] [Indexed: 12/22/2022]
Affiliation(s)
| | - Tasha K. Ritchie
- University of Washington Drug Interaction Solutions Seattle Washington USA
| | - Jingjing Yu
- University of Washington Drug Interaction Solutions Seattle Washington USA
| | | | - Eva Gil Berglund
- Certara Strategic ConsultingIntegrated Drug Development Oss The Netherlands
| | - Rene H. Levy
- University of Washington Drug Interaction Solutions Seattle Washington USA
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2
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McFeely SJ, Ritchie TK, Yu J, Nordmark A, Levy RH, Ragueneau-Majlessi I. Identification and Evaluation of Clinical Substrates of Organic Anion Transporting Polypeptides 1B1 and 1B3. Clin Transl Sci 2019; 12:379-387. [PMID: 30706983 PMCID: PMC6662428 DOI: 10.1111/cts.12623] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 01/04/2019] [Indexed: 12/25/2022] Open
Abstract
Organic anion transporting polypeptides (OATPs) 1B1 and 1B3 facilitate the uptake of drugs and endogenous compounds into the liver. In recent years, the impact of these transporters on drug–drug interactions (DDIs) has become a focus of research, and the evaluation of their role in drug disposition is recommended by regulatory agencies worldwide.1–3 Although sensitive substrates of OATP1B1/1B3 have been identified in the literature and probe drugs have been proposed by regulatory agencies, there is no general consensus on the ideal in vivo substrate for clinical DDI studies as analysis may be confounded by contribution from other metabolic and/or transport pathways.1–3 A thorough analysis of the available in vitro and in vivo data regarding OATP1B1/1B3 substrates was performed using the in vitro, clinical, and pharmacogenetic modules in the University of Washington Drug Interaction Database. A total of 34 compounds were identified and further investigated as possible clinical substrates using a novel indexing system. By analyzing the compounds for in vivo characteristics, including sensitivity to inhibition by known OATP1B1/1B3 inhibitors, selectivity for OATP1B1/1B3 compared with other transport and metabolic pathways, and safety profiles, a total of six compounds were identified as potential clinical markers of OATP1B1/1B3 activity.
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Affiliation(s)
| | - Tasha K Ritchie
- School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Jingjing Yu
- School of Pharmacy, University of Washington, Seattle, Washington, USA
| | | | - René H Levy
- School of Pharmacy, University of Washington, Seattle, Washington, USA
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3
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Suarez-Sharp S, Cohen M, Kesisoglou F, Abend A, Marroum P, Delvadia P, Kotzagiorgis E, Li M, Nordmark A, Bandi N, Sjögren E, Babiskin A, Heimbach T, Kijima S, Mandula H, Raines K, Seo P, Zhang X. Applications of Clinically Relevant Dissolution Testing: Workshop Summary Report. AAPS J 2018; 20:93. [DOI: 10.1208/s12248-018-0252-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 08/06/2018] [Indexed: 11/30/2022]
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4
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Manolis E, Brogren J, Cole S, Hay JL, Nordmark A, Karlsson KE, Lentz F, Benda N, Wangorsch G, Pons G, Zhao W, Gigante V, Serone F, Standing JF, Dokoumetzidis A, Vakkilainen J, van den Heuvel M, Mangas Sanjuan V, Taminiau J, Kerwash E, Khan D, Musuamba FT, Skottheim Rusten I. Commentary on the MID3 Good Practices Paper. CPT Pharmacometrics Syst Pharmacol 2017; 6:416-417. [PMID: 28653481 PMCID: PMC5529732 DOI: 10.1002/psp4.12223] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 06/20/2017] [Indexed: 12/31/2022] Open
Abstract
During the last 10 years the European Medicines Agency (EMA) organized a number of workshops on modeling and simulation, working towards greater integration of modeling and simulation (M&S) in the development and regulatory assessment of medicines. In the 2011 EMA - European Federation of Pharmaceutical Industries and Associations (EFPIA) Workshop on Modelling and Simulation, European regulators agreed to the necessity to build expertise to be able to review M&S data provided by companies in their dossier. This led to the establishment of the EMA Modelling and Simulation Working Group (MSWG). Also, there was agreement reached on the need for harmonization on good M&S practices and for continuing dialog across all parties. The MSWG acknowledges the initiative of the EFPIA Model-Informed Drug Discovery and Development (MID3) group in promoting greater consistency in practice, application, and documentation of M&S and considers the paper is an important contribution towards achieving this objective.
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Affiliation(s)
- Efthymios Manolis
- European Medicines Agency, London, UK.,EMA Modelling and Simulation Working Group
| | - Jacob Brogren
- EMA Modelling and Simulation Working Group.,Medical Products Agency, Uppsala, Sweden
| | - Susan Cole
- EMA Modelling and Simulation Working Group.,Medicines & Healthcare Products Regulatory Agency, London, UK
| | - Justin L Hay
- EMA Modelling and Simulation Working Group.,Medicines & Healthcare Products Regulatory Agency, London, UK
| | - Anna Nordmark
- EMA Modelling and Simulation Working Group.,Medical Products Agency, Uppsala, Sweden
| | - Kristin E Karlsson
- EMA Modelling and Simulation Working Group.,Medical Products Agency, Uppsala, Sweden
| | - Frederike Lentz
- EMA Modelling and Simulation Working Group.,Federal Institute for Drugs and Medical Devices, Bonn, Germany
| | - Norbert Benda
- EMA Modelling and Simulation Working Group.,Federal Institute for Drugs and Medical Devices, Bonn, Germany
| | - Gaby Wangorsch
- EMA Modelling and Simulation Working Group.,Paul Ehrlich Institute, Langen (Hessen), Germany
| | - Gerard Pons
- EMA Modelling and Simulation Working Group.,University Paris-Descartes, Paris, France
| | - Wei Zhao
- EMA Modelling and Simulation Working Group.,Robert Debre University Hospital of Paris, France.,Shandong University, Jinan, China
| | - Valeria Gigante
- EMA Modelling and Simulation Working Group.,Italian Medicines Agency, Rome, Italy
| | - Francesca Serone
- EMA Modelling and Simulation Working Group.,Italian Medicines Agency, Rome, Italy
| | - Joseph F Standing
- EMA Modelling and Simulation Working Group.,University College London, UK
| | - Aris Dokoumetzidis
- EMA Modelling and Simulation Working Group.,University of Athens, Greece
| | - Juha Vakkilainen
- EMA Modelling and Simulation Working Group.,Finnish Medicines Agency, Helsinki, Finland
| | - Michiel van den Heuvel
- EMA Modelling and Simulation Working Group.,Medicines Evaluation Board, Utrecht, Netherlands
| | | | - Johannes Taminiau
- EMA Modelling and Simulation Working Group.,Antwerp University Hospital, Antwerp, Netherlands
| | - Essam Kerwash
- EMA Modelling and Simulation Working Group.,Medicines & Healthcare Products Regulatory Agency, London, UK
| | - David Khan
- EMA Modelling and Simulation Working Group.,Medical Products Agency, Uppsala, Sweden
| | - Flora Tshinanu Musuamba
- EMA Modelling and Simulation Working Group.,Federal Agency for Medicines and Health Products, Brussels, Belgium
| | - Ine Skottheim Rusten
- EMA Modelling and Simulation Working Group.,The Norwegian Medicines Agency, Oslo, Norway
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5
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Lennernäs H, Lindahl A, Van Peer A, Ollier C, Flanagan T, Lionberger R, Nordmark A, Yamashita S, Yu L, Amidon GL, Fischer V, Sjögren E, Zane P, McAllister M, Abrahamsson B. In Vivo Predictive Dissolution (IPD) and Biopharmaceutical Modeling and Simulation: Future Use of Modern Approaches and Methodologies in a Regulatory Context. Mol Pharm 2017; 14:1307-1314. [DOI: 10.1021/acs.molpharmaceut.6b00824] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- H. Lennernäs
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
| | - A. Lindahl
- Medical Products Agency, Uppsala, Sweden
| | - A. Van Peer
- Janssen
Research and Development, Janssen Pharmaceutica NV, Turnhoutseweg 30, 2340, Beerse, Belgium
| | - C. Ollier
- Sanofi US, 55 Corporate Drive, Bridgewater, New Jersey 08807, United States
| | | | - R. Lionberger
- Office of Research
and Standards, Office of Generic Drugs, Center for Drug Evaluation
and Research, Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, Maryland 20993, United States
| | | | - S. Yamashita
- Faculty
of Pharmaceutical Sciences, Setsunan University, Nagaotoge-cho 45-1, Hirakata, Osaka 573-0101, Japan
| | - L. Yu
- Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, Maryland 20993, United States
| | - G. L. Amidon
- College of Pharmacy, University of Michigan, Ann Arbor, Michigan 48109-1065, United States
| | - V. Fischer
- Drug Metabolism and Pharmacokinetics, Research & Development, AbbVie, North Chicago, Illinois 60064, United States
| | - E. Sjögren
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
| | - P. Zane
- Sanofi US, 55 Corporate Drive, Bridgewater, New Jersey 08807, United States
| | - M. McAllister
- Pharmaceutical Development, GlaxoSmithKline, New
Frontiers Science Park, Harlow, Essex CM19
5AW, United Kingdom
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Luzon E, Blake K, Cole S, Nordmark A, Versantvoort C, Berglund EG. Physiologically based pharmacokinetic modeling in regulatory decision-making at the European Medicines Agency. Clin Pharmacol Ther 2016; 102:98-105. [PMID: 27770430 DOI: 10.1002/cpt.539] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/11/2016] [Accepted: 10/14/2016] [Indexed: 12/19/2022]
Abstract
Physiologically based pharmacokinetic (PBPK) modeling is a valuable tool in drug development and regulatory assessment, as it offers the opportunity to simulate the pharmacokinetics of a compound, with a mechanistic understanding, in a variety of populations and situations. This work reviews the use and impact of such modeling in selected regulatory procedures submitted to the European Medicines Agency (EMA) before the end of 2015, together with its subsequent reflection in public documents relating to the assessment of these procedures. It is apparent that the reference to PBPK modeling in regulatory public documents underrepresents its use. A positive trend over time of the number of PBPK models submitted is shown, and in a number of cases the results of these may impact the decision-making process or lead to recommendations in the product labeling. These results confirm the need for regulatory guidance in this field, which is currently under development by the EMA.
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Affiliation(s)
- E Luzon
- European Medicines Agency (EMA), London, UK
| | - K Blake
- European Medicines Agency (EMA), London, UK
| | - S Cole
- Medicines and Healthcare products Regulatory Agency (MHRA), London, UK.,Pharmacokinetics Working Party (PKWP), EMA, London, UK.,Modelling and Simulation Working Group (MSWG), EMA, London, UK
| | - A Nordmark
- Modelling and Simulation Working Group (MSWG), EMA, London, UK.,Medical Products Agency (MPA), Uppsala, Sweden
| | - C Versantvoort
- Pharmacokinetics Working Party (PKWP), EMA, London, UK.,Medicines Evaluation Board (MEB), Utrecht, Netherlands
| | - E Gil Berglund
- Pharmacokinetics Working Party (PKWP), EMA, London, UK.,Medical Products Agency (MPA), Uppsala, Sweden
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7
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Rosén T, Einarsson J, Nordmark A, Aidun CK, Lundell F, Mehlig B. Numerical analysis of the angular motion of a neutrally buoyant spheroid in shear flow at small Reynolds numbers. Phys Rev E Stat Nonlin Soft Matter Phys 2015; 92:063022. [PMID: 26764819 DOI: 10.1103/physreve.92.063022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Indexed: 06/05/2023]
Abstract
We numerically analyze the rotation of a neutrally buoyant spheroid in a shear flow at small shear Reynolds number. Using direct numerical stability analysis of the coupled nonlinear particle-flow problem, we compute the linear stability of the log-rolling orbit at small shear Reynolds number Re(a). As Re(a)→0 and as the box size of the system tends to infinity, we find good agreement between the numerical results and earlier analytical predictions valid to linear order in Re(a) for the case of an unbounded shear. The numerical stability analysis indicates that there are substantial finite-size corrections to the analytical results obtained for the unbounded system. We also compare the analytical results to results of lattice Boltzmann simulations to analyze the stability of the tumbling orbit at shear Reynolds numbers of order unity. Theory for an unbounded system at infinitesimal shear Reynolds number predicts a bifurcation of the tumbling orbit at aspect ratio λ(c)≈0.137 below which tumbling is stable (as well as log rolling). The simulation results show a bifurcation line in the λ-Re(a) plane that reaches λ≈0.1275 at the smallest shear Reynolds number (Re(a)=1) at which we could simulate with the lattice Boltzmann code, in qualitative agreement with the analytical results.
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Affiliation(s)
- T Rosén
- KTH Mechanics, Royal Institute of Technology, SE-100 44 Stockholm, Sweden
- Wallenberg Wood Science Center, Royal Institute of Technology, SE-100 44 Stockholm, Sweden
| | - J Einarsson
- Department of Physics, Gothenburg University, SE-41296 Gothenburg, Sweden
| | - A Nordmark
- KTH Mechanics, Royal Institute of Technology, SE-100 44 Stockholm, Sweden
| | - C K Aidun
- George W. Woodruff School of Mechanical Engineering and Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, Georgia 30332-0405, USA
| | - F Lundell
- KTH Mechanics, Royal Institute of Technology, SE-100 44 Stockholm, Sweden
- Wallenberg Wood Science Center, Royal Institute of Technology, SE-100 44 Stockholm, Sweden
| | - B Mehlig
- Department of Physics, Gothenburg University, SE-41296 Gothenburg, Sweden
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8
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Shepard T, Scott G, Cole S, Nordmark A, Bouzom F. Physiologically Based Models in Regulatory Submissions: Output From the ABPI/MHRA Forum on Physiologically Based Modeling and Simulation. CPT Pharmacometrics Syst Pharmacol 2015; 4:221-5. [PMID: 26225245 PMCID: PMC4429575 DOI: 10.1002/psp4.30] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 02/21/2015] [Indexed: 11/12/2022] Open
Abstract
Under the remit of the Ministerial Industry Strategy Group (MISG), the Association of the British Pharmaceutical Industry (ABPI) and Medicines and Healthcare products Regulatory Agency (MHRA) hosted a meeting to explore physiologically based pharmacokinetic modeling and simulation, focusing on the clinical component of regulatory applications. The meeting took place on 30 June 2014 with international representatives from industry, academia, and regulatory agencies. Discussion topics were selected to be complementary to those discussed at an earlier US Food and Drug Administration (FDA) meeting. This report summarizes the meeting outcomes, focusing on the European regulatory perspective.
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Affiliation(s)
- T Shepard
- Medicines and Healthcare products Regulatory Agency (MHRA)London, UK
| | - G Scott
- Takeda Development Centre EuropeLondon, UK
| | - S Cole
- Medicines and Healthcare products Regulatory Agency (MHRA)London, UK
| | - A Nordmark
- Swedish Medical Products Agency (MPA)Uppsala, Sweden
| | - F Bouzom
- Technologie ServierOrleans, France
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Hsu V, de L T Vieira M, Zhao P, Zhang L, Zheng JH, Nordmark A, Berglund EG, Giacomini KM, Huang SM. Towards quantitation of the effects of renal impairment and probenecid inhibition on kidney uptake and efflux transporters, using physiologically based pharmacokinetic modelling and simulations. Clin Pharmacokinet 2014; 53:283-293. [PMID: 24214317 PMCID: PMC3927056 DOI: 10.1007/s40262-013-0117-y] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background and Objectives The kidney is a major drug-eliminating organ. Renal impairment or concomitant use of transporter inhibitors may decrease active secretion and increase exposure to a drug that is a substrate of kidney secretory transporters. However, prediction of the effects of patient factors on kidney transporters remains challenging because of the multiplicity of transporters and the lack of understanding of their abundance and specificity. The objective of this study was to use physiologically based pharmacokinetic (PBPK) modelling to evaluate the effects of patient factors on kidney transporters. Methods Models for three renally cleared drugs (oseltamivir carboxylate, cidofovir and cefuroxime) were developed using a general PBPK platform, with the contributions of net basolateral uptake transport (Tup,b) and apical efflux transport (Teff,a) being specifically defined. Results and Conclusion We demonstrated the practical use of PBPK models to: (1) define transporter-mediated renal secretion, using plasma and urine data; (2) inform a change in the system-dependent parameter (≥10-fold reduction in the functional ‘proximal tubule cells per gram kidney’) in severe renal impairment that is responsible for the decreased secretory transport activities of test drugs; (3) derive an in vivo, plasma unbound inhibition constant of Tup,b by probenecid (≤1 μM), based on observed drug interaction data; and (4) suggest a plausible mechanism of probenecid preferentially inhibiting Tup,b in order to alleviate cidofovir-induced nephrotoxicity. Electronic supplementary material The online version of this article (doi:10.1007/s40262-013-0117-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vicky Hsu
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
| | - Manuela de L T Vieira
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
- College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ping Zhao
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA.
| | - Lei Zhang
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
| | - Jenny Huimin Zheng
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
| | | | | | - Kathleen M Giacomini
- Department of Bioengineering and Therapeutic Sciences, Schools of Pharmacy and Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Shiew-Mei Huang
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
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10
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Nordmark A, Andersson A, Baranczewski P, Wanag E, Ståhle L. Assessment of interaction potential of AZD2066 using in vitro metabolism tools, physiologically based pharmacokinetic modelling and in vivo cocktail data. Eur J Clin Pharmacol 2013; 70:167-78. [PMID: 24186263 DOI: 10.1007/s00228-013-1603-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 01/25/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE Static and dynamic (PBPK) prediction models were applied to estimate the drug-drug interaction (DDI) risk of AZD2066. The predictions were compared to the results of an in vivo cocktail study. Various in vivo measures for tolbutamide as a probe agent for cytochrome P450 2C9 (CYP2C9) were also compared. METHODS In vitro inhibition data for AZD2066 were obtained using human liver microsomes and CYP-specific probe substrates. DDI prediction was performed using PBPK modelling with the SimCYP simulator™ or static model. The cocktail study was an open label, baseline, controlled interaction study with 15 healthy volunteers receiving multiple doses of AD2066 for 12 days. A cocktail of single doses of 100 mg caffeine (CYP1A2 probe), 500 mg tolbutamide (CYP2C9 probe), 20 mg omeprazole (CYP2C19 probe) and 7.5 mg midazolam (CYP3A probe) was simultaneously applied at baseline and during the administration of AZD2066. Bupropion as a CYP2B6 probe (150 mg) and 100 mg metoprolol (CYP2D6 probe) were administered on separate days. The pharmacokinetic parameters for the probe drugs and their metabolites in plasma and urinary recovery were determined. RESULTS In vitro AZD2066 inhibited CYP1A2, CYP2B6, CYP2C9, CYP2C19 and CYP2D6. The static model predicted in vivo interaction with predicted AUC ratio values of >1.1 for all CYP (except CYP3A4). The PBPK simulations predicted no risk for clinical relevant interactions. The cocktail study showed no interaction for the CYP2B6 and CYP2C19 enzymes, a possible weak inhibition of CYP1A2, CYP2C9 and CYP3A4 activities and a slight inhibition (29 %) of CYP2D6 activity. The tolbutamide phenotyping metrics indicated that there were significant correlations between CLform and AUCTOL, CL, Aemet and LnTOL24h. The MRAe in urine showed no correlation to CLform. CONCLUSIONS DDI prediction using the static approach based on total concentration indicated that AZD20066 has a potential risk for inhibition. However, no DDI risk could be predicted when a more in vivo-like dynamic prediction method with the PBPK with SimCYP™ software based on early human PK data was used and more parameters (i.e. free fraction in plasma, no DDI risk) were taken into account. The clinical cocktail study showed no or low risks for clinical relevant DDI interactions. Our findings are in line with the hypothesis that the dynamic prediction method predicts DDI in vivo in humans better than the static model based on total plasma concentrations.
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Affiliation(s)
- Anna Nordmark
- Clinical Pharmacology Science, AstraZeneca RD Södertälje, Södertälje, Sweden,
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11
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Raboisson P, Breitholtz-Emanuelsson A, Dahllöf H, Edwards L, Heaton WL, Isaac M, Jarvie K, Kers A, Minidis AB, Nordmark A, Sheehan SM, Slassi A, Ström P, Terelius Y, Wensbo D, Wilson JM, Xin T, McLeod DA. Discovery and characterization of AZD9272 and AZD6538—Two novel mGluR5 negative allosteric modulators selected for clinical development. Bioorg Med Chem Lett 2012; 22:6974-9. [DOI: 10.1016/j.bmcl.2012.08.100] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 08/26/2012] [Accepted: 08/27/2012] [Indexed: 11/15/2022]
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12
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Sigfridsson K, Nordmark A, Theilig S, Lindahl A. A formulation comparison between micro- and nanosuspensions: the importance of particle size for absorption of a model compound, following repeated oral administration to rats during early development. Drug Dev Ind Pharm 2010; 37:185-92. [PMID: 20653464 DOI: 10.3109/03639045.2010.504209] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM The aim of this study was to maximize the exposure of a model compound (MC) for forthcoming high-dose toxicological studies with the physical form of the original compound unaffected. METHOD The two evaluated formulation approaches for the present poorly water-soluble compound were micro- and nanosuspensions. RESULTS The particle size was about 280 nm for the nanosuspensions and about 4 μm for the microsuspensions. The crystallinity and the crystalline form of the ground samples were conserved. The physical and the chemical stabilities of the two kinds of suspensions were unaffected during the investigated time period. The in vivo results of the study showed that the pharmacokinetic parameters investigated were comparable at the low-dose level (6 μmol/kg) for both formulations after single administration. However, at the two higher doses (60 and 300 μmol/kg), a significant difference in exposure was observed between the two suspensions with an improved exposure for smaller particles. After Day 7 of repeated administration, a significant difference in exposure was observed at all dose levels. The overall exposures were higher on Day 7, compared to the exposures on Day 1 (most significant for nanoparticles), due to an accumulation of compound in the body. CONCLUSIONS The nanoparticles have a larger surface, resulting in faster in vivo dissolution rate, faster absorption, and increased bioavailability, compared to microparticles. The differences in systemic exposure of model compound, following oral administration of nano- or microparticles of the drug substance, are probably caused by differences in the in vivo dissolution rate and possibly further enhanced by saturation of the systemic elimination.
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Affiliation(s)
- Kalle Sigfridsson
- Pharmaceutical Development, AstraZeneca R&D Mölndal, Mölndal, Sweden.
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13
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Canaparo R, Finnström N, Serpe L, Nordmark A, Muntoni E, Eandi M, Rane A, Zara GP. Expression of CYP3A isoforms and P-glycoprotein in human stomach, jejunum and ileum. Clin Exp Pharmacol Physiol 2007; 34:1138-44. [PMID: 17880367 DOI: 10.1111/j.1440-1681.2007.04691.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
1. CYP3A isoforms metabolise a diverse array of clinically important drugs and P-glycoprotein (P-gp), a transmembrane efflux pump, can extrude a wide variety of drugs from the cell. It has been suggested that the function of CYP3A4 is complementary to that of P-gp along the gastrointestinal (GI) tract, together forming a coordinated intestinal barrier against xenobiotics. Therefore, the expression of CYP3A4, CYP3A5, CYP3A7 and ABCB1 (P-gp) genes were quantified in five normal samples from the human stomach, seven from the jejunum and eight from the ileum by real-time reverse transcription-polymerase chain reaction and western blot analysis. 2. In the tissues examined, measurable mRNA expression of CYP3A was found in almost all samples from the stomach, jejunum and ileum. The rank order for CYP3A mRNA expression was CYP3A4 > CYP3A5 > CYP3A7 in the GI tract studied, whereas median mRNA CYP3A4 expression was highest in the small intestine and lowest in the stomach. Expression of ABCB1 mRNA was found in almost all samples and the median mRNA expression level was comparable in the jejunum and ileum, but lower in the stomach. Our data also show a significant correlation between all mRNA transcripts studied and a wide interindividual variation. 3. At the protein level, CYP3A4 was detected in all stomach and small intestine samples, the levels being substantially higher in the small intestine than in the stomach. P-Glycoprotein was detected in all GI samples, but no statistically significant difference was found along the GI tract considered. 4. Collectively, these results demonstrate that CYP3A4 is the main CYP3A expressed in the GI tract investigated, an extensive interindividual variability in the expression of the different CYP3A isoforms in all tissues examined and P-gp apoprotein levels similar in the stomach, jejunum and ileum.
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Affiliation(s)
- Roberto Canaparo
- Department of Anatomy, Pharmacology and Forensic Medicine, Division of Pharmacology and Experimental Therapeutics, University of Torino, Torino, Italy.
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Canaparo R, Nordmark A, Finnström N, Lundgren S, Seidegård J, Jeppsson B, Edwards RJ, Boobis AR, Rane A. Expression of Cytochromes P450 3A and P-Glycoprotein in Human Large Intestinse in Paired Tumour and Normal Samples. Basic Clin Pharmacol Toxicol 2007; 100:240-8. [PMID: 17371528 DOI: 10.1111/j.1742-7843.2006.00023.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Our objective was to investigate the expression of different cytochromes P450 3A (CYP3A4, CYP3A5, and CYP3A7) and P-glycoprotein (ABCB1) genes along the human large intestine in paired tumour and normal samples. Real-time reverse transcriptase-polymerase chain reaction was used to measure CYP3A4-, CYP3A5-, CYP3A7- and ABCB1-specific mRNA expression, and Western blot analysis was used to measure membrane protein levels of CYP3A4/7, CYP3A5 and P-glycoprotein. Levels of mRNA and membrane protein fractions in the large intestine were compared with those of normal human liver. The mRNA expressions of CYP3A4, CYP3A5, CYP3A7 and ABCB1 in the large intestine were found to be highly variable, but overall the levels were significantly lower than those measured in liver (P < 0.0001, P < 0.001, P < 0.0001 and P < 0.01, respectively). At the membrane protein level, CYP3A4/7 was detected in all large intestine samples examined and the levels were substantially higher than those of the liver (P < 0.01). Although expression of CYP3A5 was detected in all large intestine samples, in most the levels were too low to allow quantification. P-glycoprotein was readily detected at levels slightly higher than those of liver (P < 0.05). Comparison between paired samples of normal and tumour in large intestine showed no significant differences in either the mRNA or membrane protein levels of these genes. In conclusion, this work suggests a potential role of the large intestine in the absorption and metabolism of xenobiotics and nutrients and no difference in the CYP3A and P-glycoprotein membrane protein fractions and mRNA expression between normal and tumour tissues.
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Affiliation(s)
- Roberto Canaparo
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden.
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Karypidis AH, Söderström T, Nordmark A, Granath F, Cnattingius S, Rane A. Association of cytochrome P450 1B1 polymorphism with first-trimester miscarriage. Fertil Steril 2006; 86:1498-503. [PMID: 16978616 DOI: 10.1016/j.fertnstert.2006.03.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2005] [Revised: 03/27/2006] [Accepted: 03/27/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine whether the cytochrome P450 1B1 (CYP1B1) Val432Leu polymorphism is associated with risk of miscarriage. We also analyzed the possible interaction between this polymorphism and caffeine intake. DESIGN The population-based case-control study included 507 women with miscarriage in the first trimester of pregnancy and 908 controls with a normal first-trimester pregnancy. The controls were frequency matched to cases. The material was analyzed taking maternal age, smoking habits, alcohol intake, caffeine intake, fetal karyotype, nausea, and vomiting into consideration. SETTING University hospital and primary care facility. MAIN OUTCOME MEASURE(S) CYP1B1 Val432Leu genotype frequencies in cases and controls. RESULT(S) Carriers of the CYP1B1 432 Val/Val genotype were at a higher risk of miscarriage in the first trimester of pregnancy (odds ratio = 1.46; 95% confidence interval, 1.02-2.08). We also found a significant interaction between genotype and caffeine intake. CONCLUSION(S) CYP1B1 Val432Leu polymorphism is associated with first-trimester miscarriage, and it may also modify the risk among coffee drinkers.
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Affiliation(s)
- Anna-Helena Karypidis
- Department of Medical Laboratory Sciences and Technology, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital (Huddinge), Stockholm, Sweden.
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Wennerholm A, Nordmark A, Pihlsgård M, Mahindi M, Bertilsson L, Gustafsson LL. Amodiaquine, its desethylated metabolite, or both, inhibit the metabolism of debrisoquine (CYP2D6) and losartan (CYP2C9) in vivo. Eur J Clin Pharmacol 2006; 62:539-46. [PMID: 16783563 DOI: 10.1007/s00228-006-0121-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2005] [Accepted: 03/03/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To study the extent of in vivo inhibition by the antimalarial drug amodiaquine, its active metabolite N-desethylamodiaquine, or both, of the metabolism of four probe drugs of the enzymes CYP2D6, CYP2C19, CYP2C9 and CYP1A2. METHODS Twelve healthy Swedish volunteers received a cocktail of four probe drugs (debrisoquine, omeprazole, losartan and caffeine) to determine their baseline metabolic capacities. After a washout period, they received a 600 mg oral dose of amodiaquine hydrochloride; and 2-3 h later the cocktail was administered again. One week after the intake of amodiaquine, the subjects received the cocktail a third time. The levels of probe drugs and their metabolites as well as amodiaquine and its metabolite were determined by HPLC. RESULTS Plasma levels of amodiaquine and N-desethylamodiaquine could be followed in all subjects for 6 h and 28 days, respectively. Among the 12 subjects, a 3-fold variation in amodiaquine AUC and a 2-fold variation in N-desethylamodiaquine AUC, were observed. The CYP2D6 and CYP2C9 activities of the subjects were measured by debrisoquine and losartan phenotyping tests, respectively. There were significant mean increases in debrisoquine metabolic ratio (MR) between baseline and the second cocktail [MR(2 h)-MR(baseline) 1.426 (95% confidence interval 1.159, 1.755), P=0.002; ANOVA, Fisher LSD test] and in mean losartan MR between baseline and the second cocktail [MR(2 h)-MR(baseline) 1.724 (95% confidence interval 1.076, 2.762), P=0.026; ANOVA, Fisher LSD test]. The effects on CYP2D6 and CYP2C9 activities subsided within a week after intake of amodiaquine as tested by the phenotyping cocktail. The changes in omeprazole MRs and caffeine MRs were not statistically significant between any of the study phases. CONCLUSION A single dose of amodiaquine decreased CYP2D6 and CYP2C9 activities significantly compared to baseline values. Amodiaquine has the potential to cause drug-drug interactions and should be further investigated in malarial patients treated with drug combinations containing amodiaquine.
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Affiliation(s)
- Agneta Wennerholm
- Division of Clinical Pharmacology C1:68, Karolinska University Hospital - Huddinge, SE-141 86, Stockholm, Sweden
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Essén H, Nordmark A. Hamiltonian of a homogeneous two-component plasma. Phys Rev E Stat Nonlin Soft Matter Phys 2004; 69:036404. [PMID: 15089412 DOI: 10.1103/physreve.69.036404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2003] [Indexed: 05/24/2023]
Abstract
The Hamiltonian of one- and two-component plasmas is calculated in the negligible radiation Darwin approximation. Since the Hamiltonian is the phase space energy of the system its form indicates, according to statistical mechanics, the nature of the thermal equilibrium that plasmas strive to attain. The main issue is the length scale of the magnetic interaction energy. In the past a screening length lambda=1/square root of r(e)n], with n number density and r(e) classical electron radius, has been derived. We address the question whether the corresponding longer screening range obtained from the classical proton radius is physically relevant and the answer is affirmative. Starting from the Darwin Lagrangian it is nontrivial to find the Darwin Hamiltonian of a macroscopic system. For a homogeneous system we resolve the difficulty by temporarily approximating the particle number density by a smooth constant density. This leads to Yukawa-type screened vector potential. The nontrivial problem of finding the corresponding, divergence free, Coulomb gauge version is solved.
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Affiliation(s)
- Hanno Essén
- Department of Mechanics, KTH, 100 44 Stockholm, Sweden.
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Härtter S, Nordmark A, Rose DM, Bertilsson L, Tybring G, Laine K. Effects of caffeine intake on the pharmacokinetics of melatonin, a probe drug for CYP1A2 activity. Br J Clin Pharmacol 2003; 56:679-82. [PMID: 14616429 PMCID: PMC1884289 DOI: 10.1046/j.1365-2125.2003.01933.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2003] [Accepted: 06/06/2003] [Indexed: 11/20/2022] Open
Abstract
AIMS The aim of this study was to assess the influence of concomitant caffeine intake on the pharmacokinetics of oral melatonin, a probe drug for CYP1A2 activity. METHODS Twelve healthy subjects, six smokers and six nonsmokers, were given melatonin (6 mg) either alone or in combination with caffeine (3 x 200 mg). Blood samples for the analysis of melatonin or caffeine and paraxanthine were taken from 1 h before until 6 h after intake of melatonin. Subjects were genotyped with respect to the CYP1A2*1F (C734A) polymorphism. RESULTS When caffeine was coadministered the Cmax and AUC of melatonin were increased on average by 142% (P = 0.001, confidence interval on the difference 44, 80%) and 120% (P < 0.001, confidence interval on the difference 63, 178%), respectively. The inhibitory effect of caffeine was more pronounced in nonsmokers and in individuals with the *1F/*1F genotype. CONCLUSION The results of this study revealed a pronounced effect of caffeine on the bioavailability of orally given melatonin, most probably due to inhibition of CYP1A2 activity.
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Affiliation(s)
- Sebastian Härtter
- Department of Psychiatry and Institute of Occupational, Social and Environmental Medicine University of Mainz, Mainz, Germany.
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Christensen M, Andersson K, Dalén P, Mirghani RA, Muirhead GJ, Nordmark A, Tybring G, Wahlberg A, Yaşar U, Bertilsson L. The Karolinska cocktail for phenotyping of five human cytochrome P450 enzymes. Clin Pharmacol Ther 2003; 73:517-28. [PMID: 12811361 DOI: 10.1016/s0009-9236(03)00050-x] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Our objectives were (1) to determine whether the drugs caffeine, losartan, omeprazole, debrisoquin (INN, debrisoquine), and quinine can be given simultaneously in low doses as a cocktail for the phenotyping of cytochrome P450 (CYP) 1A2, 2C9, 2C19, 2D6, and 3A4, respectively, and (2) to design an administration schedule to give as few sampling occasions as possible. METHODS Twenty-four subjects were given oral doses of 100 mg caffeine, 25 mg losartan, 20 mg omeprazole, 10 mg debrisoquin, and 250 mg quinine on separate days. After a washout period of at least 4 days, all drugs were given simultaneously except for quinine, which was given 8 hours after the other drugs. Blood and urine samples were collected to determine parent drug and metabolite concentrations for assessment of phenotyping indices. Any difference between both single and cocktail doses was tested on a log-normal distribution. RESULTS The phenotypic indices of CYP1A2 (paraxanthine/caffeine in 4-hour plasma), CYP2C9 (losartan/E-3174 [metabolite of losartan] in 0- to 8-hour urine), CYP2C19 (omeprazole/5-hydroxyomeprazole in 3-hour plasma), and CYP3A4 (quinine/3-hydroxyquinine in 16-hour plasma) were not significantly changed when probe drugs were administered alone compared with together, although a tendency toward higher concentrations of losartan was seen during simultaneous administration (95% confidence interval, 0.51-1.002; P =.051). The CYP2D6 phenotypic index (debrisoquin/4-hydroxydebrisoquin in 0- to 8-hour urine) was significantly changed when drugs were given together (95% confidence interval, 0.45-0.87; P =.007), indicating an inhibition of the debrisoquin metabolism. The within-subject coefficients of variation (8%-25%) were much lower than the between-subject coefficients of variation (34%-79%). CONCLUSIONS The administration of drugs together suggests an inhibition of debrisoquin metabolism caused by the concurrent drugs given. By separating debrisoquin from the other cocktail drugs, this method is likely to be used as a tool to phenotype the enzymes CYP1A2, CYP2C9, CYP2C19, CYP2D6, and CYP3A4 with only 2 urinary collections and 2 blood-sampling occasions.
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Affiliation(s)
- Magnus Christensen
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden.
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20
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Granhall C, Floby E, Nordmark A, Orzechowski A, Thörne A, Tybring G, Sohlenius-Sternbeck AK. Characterization of testosterone metabolism and 7-hydroxycoumarin conjugation by rat and human liver slices after storage in liquid nitrogen for 1 h up to 6 months. Xenobiotica 2002; 32:985-96. [PMID: 12487728 DOI: 10.1080/0049825021000012646] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
1. Slices of human and rat liver were cryopreserved in 18% dimethyl sulphoxide (DMSO) and subsequently stored in liquid nitrogen for periods up to as long as 6 months. After thawing, the metabolism of testosterone to hydroxylated products and conjugation of 7-hydroxycoumarin were investigated. 2. Rat liver slices stored in liquid nitrogen for 6 months exhibited rates of formation of 7alpha-, 6beta- 16alpha- and 2alpha-hydroxytestosterone, and of androstenedione that did not differ significantly from those observed with fresh slices. 3. No formation of 2alpha-hydroxytestosterone was detected with slices of human liver. However, in contrast with the rat, human slices produced 2beta-hydroxytestosterone. The rates of formation of 7alpha-, 6beta-, 16alpha- and 2beta-hydroxytestosterone and of androstenedione by human liver slices after 6 months of storage in liquid nitrogen were 82, 71, 236, 66 and 92%, respectively, of the corresponding rates by fresh slices. 4. The rates of sulphation and glucuronidation of 7-hydroxycoumarin by slices from rat liver were 97 and 119%, respectively, of the corresponding fresh values after 6 months of storage in liquid nitrogen. 5. 7-Hydroxycoumarin glucuronidation by human liver slices was 53% of the corresponding fresh values after 6 months of storage. However, human slices showed little or no capacity to conjugate 7-hydroxycoumarin with sulphate. 6. It was demonstrated that slices of both human and rat liver can be cryopreserved and stored in liquid nitrogen for at least 6 months without major changes in their rates of metabolism of testosterone to its hydroxylated products and of 7-hydroxycoumarin conjugation. These findings further emphasize that cryopreservation of liver slices can be an effective tool in the use of biological material of limited availability.
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Affiliation(s)
- C Granhall
- Research DMPK, AstraZeneca R&D Södertälje, S-151 85 Södertälje, Sweden
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Abstract
AIMS To investigate the influence of the CYP1A2*1F mutation on CYP1A2 activity in smoking and nonsmoking pregnant women. METHODS Pregnant women (n = 904) who served as control subjects in a case-control study of early fetal loss were investigated. They were phenotyped for CYP1A2 using dietary caffeine and the urinary ratio AFMU + 1X + 1 U/1,7 U. An assay for CYP1A2*1F using 5'-nuclease assay (Taqman) was developed to genotype the population. RESULTS The frequencies of *1 A and *1F alleles among Swedish women were 0.29 and 0.71, respectively. There was no statistically significant difference in CYP1A2 activity between the genotypes, although a trend towards enhanced activity was observed in *1F/*1F (log MRc 0.77) and *1F/*1 A (log MRc 0.82) genotypes compared with the *1 A/*1 A genotype (log MRc 0.71) (anovaP = 0.07). The mean difference between the *1 A homozygotes and the heterozygotes was 0.11 [95% confidence interval of the difference: (-0.21, -0.01)] and that between the *1 A and *1F homozygotes was 0.05 [95% confidence interval of the difference: (-0.13, 0.03)]. No significant effect (P = 0.22) of the *1F on CYP1A2 activity was observed in smokers, tested using an interaction term (smoking * genotype) in the anova model (*1F/*1F log MRc 0.79, *1F/*1 A log MRc 0.86, and *1 A/*1 A log MRc 0.73). In smokers, there was no difference in ratio between homozygotes for the *1 A and *1F alleles [mean difference -0.06; 95% confidence interval of the difference: -0.22, 0.11] or between *1 A/*1 A and *1 A/*1F genotypes [mean difference -0.13; 95% confidence interval of the difference: -0.29, 0.04]. CONCLUSIONS The effect of the CYP1A2*1F mutation on CYP1A2 activity in smoking pregnant women could not be confirmed.
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Affiliation(s)
- Anna Nordmark
- Department of Medical Laboratory Science and Technology, Division of Clinical Pharmacology, Karolinska Institutet, C-168, Huddinge University Hospital, SE-141 86 Stockholm, Sweden.
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Abstract
CONTEXT Both folate deficiency and folic acid supplements have been reported to increase the risk of spontaneous abortion. The results are inconclusive, however, and measurements of folate have not been available in all studies. OBJECTIVE To study the association between plasma folate levels and the risk of spontaneous abortion. DESIGN, SETTING, AND POPULATION Population-based, matched, case-control study of case women with spontaneous abortion and control women from January 1996 through December 1998 in Uppsala County, Sweden. Plasma folate measurements were available for 468 cases and 921 controls at 6 to 12 gestational weeks. MAIN OUTCOME MEASURE Risk of spontaneous abortion vs maternal plasma folate level. RESULTS Compared with women with plasma folate levels between 2.20 and 3.95 ng/mL (5.0 and 8.9 nmol/L), women with low (< or =2.19 ng/mL [< or =4.9 nmol/L]) folate levels were at increased risk of spontaneous abortion (adjusted odds ratio [OR], 1.47; 95% confidence interval [CI], 1.01-2.14), whereas women with higher folate levels (3.96-6.16 ng/mL [9.0-13.9 nmol/L] and > or =6.17 ng/mL [> or =14.0 nmol/L]) showed no increased risk of spontaneous abortion (OR, 0.84; 95% CI, 0.59-1.20; and OR, 0.74; 95% CI, 0.47-1.16, respectively). Low folate levels were associated with a significantly increased risk when the fetal karyotype was abnormal (OR, 1.95; 95% CI, 1.09-3.48) but not when the fetal karyotype was normal (OR, 1.11; 95% CI, 0.55-2.24) or unknown (OR, 1.45; 95% CI, 0.90-2.33). CONCLUSION Low plasma folate levels were associated with an increased risk of early spontaneous abortion.
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Affiliation(s)
- Lena George
- Department of Medical Epidemiology, Huddinge University Hospital, Karolinska Institutet, PO Box 281, SE-171 77 Stockholm, Sweden
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Clausson B, Granath F, Ekbom A, Lundgren S, Nordmark A, Signorello LB, Cnattingius S. Effect of caffeine exposure during pregnancy on birth weight and gestational age. Am J Epidemiol 2002; 155:429-36. [PMID: 11867354 DOI: 10.1093/aje/155.5.429] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Epidemiologic studies have been unable to conclusively evaluate whether caffeine intake during pregnancy is associated with reduced birth weight and/or fetal growth restriction. The authors conducted a prospective, population-based cohort study to investigate the effect of caffeine on birth weight, gestational age, and birth weight standardized for gestational age (birth weight ratio). Of 953 women recruited in early pregnancy in Uppsala County, Sweden, from 1996 to 1998, 873 women delivering liveborn singleton infants were included in the analysis. Caffeine exposures were ascertained from in-person interviews at 6-12 and 32-34 completed gestational weeks, and maternal plasma was analyzed for cotinine levels as an indicator of smoking. Analysis of variance was used to estimate the effect of caffeine on birth weight, gestational age at delivery, and birth weight ratio after accounting for the effects of other covariates, such as maternal sociodemographic characteristics, plasma cotinine, and pregnancy symptoms. There were no associations between caffeine consumption and birth weight, gestational age, and birth weight ratio, neither when caffeine exposure was averaged from conception to the 32nd to 34th gestational weeks, nor when caffeine exposure was stratified by trimesters of pregnancy. These results do not support an association between moderate caffeine consumption and reduced birth weight, gestational age, or fetal growth.
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Affiliation(s)
- Britt Clausson
- Department of Medical Epidemiology, Karolinska Institutet, SE-171 77 Stockholm, Sweden
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Signorello LB, Nordmark A, Granath F, Blot WJ, McLaughlin JK, Annerén G, Lundgren S, Ekbom A, Rane A, Cnattingius S. Caffeine metabolism and the risk of spontaneous abortion of normal karyotype fetuses. Obstet Gynecol 2001; 98:1059-66. [PMID: 11755554 DOI: 10.1016/s0029-7844(01)01575-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate whether the rate of caffeine metabolism influences spontaneous abortion risk. METHODS We studied 101 women with normal karyotype spontaneous abortions and 953 pregnant women at 6-12 gestational weeks. Participants reported on caffeine intake and provided urine for phenotyping cytochrome P4501A2 (CYP1A2) activity and blood for genotyping N-acetylation (NAT2) status. We calculated odds ratios (OR) and 95% confidence intervals (CI) to evaluate the association between each of the two metabolic indices and spontaneous abortion risk and also the potential interaction between caffeine intake and metabolic activity on such risk. In calculating the associations between the metabolic indices and risk of spontaneous abortion, we had 80% power to detect an OR of 2.1, with a Type I error of 0.05. RESULTS Slow acetylators had a nonsignificantly increased risk for spontaneous abortion (OR 1.36, 95% CI 0.84, 2.21) and recurrent spontaneous abortion (OR 2.51, 95% CI 0.81, 7.76). In contrast, low CYP1A2 activity was associated with a significantly decreased risk for spontaneous abortion (OR 0.35, 95% CI 0.20, 0.63). Caffeine was a risk factor for spontaneous abortion among women with high, but not low, CYP1A2 activity (OR 2.42, 95% CI 1.01, 5.80 for 100-299 mg/day; OR 3.17, 95% CI 1.22, 8.22 for 300 mg/day or more, among women with high CYP1A2 activity). CONCLUSION The findings indicate that high CYP1A2 activity may increase the risk of spontaneous abortion, independently or by modifying the effect of caffeine. The results regarding NAT2 are less conclusive but suggest that slow acetylators may be at elevated risk of spontaneous abortion.
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Affiliation(s)
- L B Signorello
- International Epidemiology Institute, Rockville, Maryland 20850, USA.
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Nordmark A, Lundgren S, Cnattingius S, Rane A. Dietary caffeine as a probe agent for assessment of cytochrome P4501A2 activity in random urine samples. Br J Clin Pharmacol 1999; 47:397-402. [PMID: 10233204 PMCID: PMC2014237 DOI: 10.1046/j.1365-2125.1999.00918.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AIMS To validate the use of randomly collected urine samples for assessment of cytochrome P4501A2 (CYP1A2) activity based on dietary caffeine (caffeine metabolic ratio, MRcaff ), and to relate the MRcaff to caffeine intake and smoking habits in a larger group of individuals. METHODS Nineteen healthy volunteers were included in the validation study. Caffeine (100 mg) was ingested and a urine sample was collected after 6 h. Within the following week a random urine sample was collected in the individuals without a preceding test dose of caffeine. Urine samples were analysed for caffeine and its metabolites by h.p.l.c. and the (AFMU+1U+1X)/1,7U metabolic ratio was used to reflect CYP1A2 activity. In an extended investigation of 522 healthy pregnant women the MRcaff was related to intake of caffeine from various sources, and to smoking. RESULTS The results from the random and standardised sampling methods correlate with each other (correlation coefficient of MRcaff was 0. 91). The MRcaff as assessed by the random sampling method in a larger population was not affected by source or amount of caffeine ingested. Significantly higher MRcaff was found in smokers compared to non-smokers. In the large group of individuals the random sampling method was possible to use in 80% of the cases. In the residual 20% one or several of the metabolite concentrations were too low or unmeasurable. CONCLUSIONS Our study demonstrates that the random urine caffeine phenotyping method is possible to use in as many as 80% of the individuals when based on dietary caffeine. Our approach should prove applicable in most countries with widely spread caffeine consumption. The method is useful in larger studies of drug metabolising enzyme activities and minimises the time consumption and costs.
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Affiliation(s)
- A Nordmark
- Department of Medical Sciences, Clinical Pharmacology, University Hospital, Uppsala University, S-751 85 Uppsala
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Affiliation(s)
- A. Nordmark
- Department of Mechanics, KTH, SE-100 44 Stockholm, Sweden
| | - Hanno Essén
- Department of Mechanics, KTH, SE-100 44 Stockholm, Sweden
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Hallberg IR, Holst G, Nordmark A, Edberg AK. Cooperation during morning care between nurses and severely demented institutionalized patients. Clin Nurs Res 1995; 4:78-104. [PMID: 7703879 DOI: 10.1177/105477389500400108] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Nurse-patient cooperation during morning care in two wards for the care of severely demented patients (107 observations) were analyzed by using a hermeneutic-phenomenological approach. Nurse-patient cooperation was found to be characterized by their acting in mutuality or unilaterality and in or out of pace with each other. When acting iri pace and mutuality, the nurse and patient turned to each other as persons as well as to the task. This theme related to confirming nurse actions and actions that provided opportunities for the patient to participate. When acting out of pace and unilaterality, cooperation was mainly task oriented and related to acts of resistance, the use of force, loss of attention or turning to others, or the patient wanted to escape. The findings were interpreted within the contexts of power, empowerment, and powerlessness and may serve as indicators of low- or high-quality nurse-patient cooperation during morning care provided for demented patients.
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Nordmark A. [Experiences in a missionary hospital in Tanzania]. Lakartidningen 1978; 75:3907-9. [PMID: 703440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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