Active uptake or efflux

Tab. 18.2. Drugs with some evidence of active uptake or efflux.

The use of in vitro models for prediction of compounds that are predominantly absorbed passively by the transcellular route is generally good with these models. Predicting compounds which are absorbed paracellularly or via active uptake or efflux mechanisms is more difficult. There is a lack of understanding of expression levels of transporters in the gut, which makes in vivo predictions difficult. 

PAMPA is typically used to make a prediction of the passive, transcellular absorption of a compound. Compounds which may be absorbed by a paracellular mechanism or may be substrates for active transport (uptake or efflux) are usually better assessed in a cell based system. A combination of assays can be applied to gain a greater understanding of the permeability and transport properties of a compound. 

Several attempts have been made to estimate the dose required in humans in relation to a drug s potency, and to put this into the context of solubility and permeability for an optimal oral drug [2, 3]. A relatively simple example of this is where a 1.0 mg kg-1 dose is required in humans, then 52 pg mL"1 solubility is needed if the permeability is intermediate (20-80%) [3]. This solubility corresponds approximately to 100 pM of a compound with a MW of 400 g mol-1. Most screening activities for permeability determinations in, e.g., Caco-2, are made at a concentration of 10 pM or lower due to solubility restrictions. The first implication of this is that the required potency for these compounds needs to correspond to a dose of <0.1 mg kg-1 in humans if the drug should be considered orally active. Another implication would be the influence of carrier-mediated transport (uptake or efflux), which is more evident at low concentrations. This could result in low permeability coefficients for compounds interacting with efflux transporters at the intestinal membrane and which could either be saturated or of no clinical relevance at higher concentrations or doses. 

The availability of human Pgfr data is more limited than Fa% data and is biased towards highly absorbed compounds. Therefore, the use of in vivo P ff data is more limited for understanding incompletely absorbed compounds which may be subject to paracellular transport or active uptake and efflux mechanisms. 

The second general mechanism to cause resistance to antibacterial agents is to prevent the drug from reaching its target site. This is either achieved by altered rates of entry (reduced uptake) or by the active removal of the dtug (active efflux) [4]. 

Cocaine and desipramine inhibit the reuptake of monoamine neurotransmitters whereas amphetamine, which is a phenylalkylamine - similar in structure to the catecholamines, see Fig. 4 - competes for uptake and more importantly, evokes efflux of the monoamine neurotransmitters. All of them exert antidepressant effects. Cocaine and amphetamine are addictive whereas tricyclic antidepressants and their modern successors are not. The corollaty of the addictive properties is interference with DAT activity. Blockade of DAT by cocaine or efflux elicited by amphetamine produces a psychostimulant effect despite the different mechanisms even the experienced individual can hardly discern their actions. Because of the risk associated with inhibiting DAT mediated dopamine clearance the antidepressant effects of psychostimulants has not been exploited. 

The history of observations of efflux associated with PTS carriers is nearly as old as PTS itself. Gachelin [82] reported that A -ethylmaleimide inactivation of a-methyl-glucoside transport and phosphorylation in E. coli was accompanied by the appearance of a facilitated diffusion movement of both a-methylglucoside and glucose in both directions, uptake and efflux. His results could not discriminate, however, between one carrier operating in two different modes, active transport for the native carrier and facilitated diffusion for the alkylated carrier, or two distinct carriers. Haguenauer and Kepes [83] went on to show that alkylation of the carrier was not even necessary to achieve efflux NaF treatment which inhibits P-enolpyruvate synthesis was sufficient but this study did not address the question of one carrier or two. 

Table 18.2 lists 30 of the molecules used in this study that are known to be substrates for active transport or active efflux. The mechanistic ACAT model was modified to accommodate saturable uptake and saturable efflux using standard Michaelis-Menten equations. It was assumed that enzymes responsible for active uptake of drug molecules from the lumen and active efflux from the enterocytes to the lumen were homogeneously dispersed within each luminal compartment and each corresponding enterocyte compartment, respectively. Equation (5) is the overall mass balance for drug in the enterocyte compartment lining the intestinal wall. 

Discrimination of efflux, active or passive transport is already feasible by suitable in vitro experiments. For instance, the PAMPA assay detects passive transport only, while Caco-2 cells include transporters. A comparison between transport in PAMPA and Caco-2 cells by a calibration plot reveals compounds with greater or less transport in Caco-2 cells than in PAMPA. These compounds should be tested in uptake and efflux transport assays in order to gain deeper insight into absorption fate. 

As mentioned above, hydrogen bonding and molecular size, in combination with lipophilicity have an important influence on oral absorption. A number of methods are available to compute these properties. A further example of the correlation between H-bonding, expressed as polar surface area, is found in Figure 3.12 [24,25]. Such a sigmoidal relationship is found for compounds which are absorbed by passive diffusion only and not hindered by efflux or metabolism, and which are not involved in active uptake. Otherwise deviations will be foimd [25]. 

Important limitations of the PBPK approach are realized for class 3 and 4 compounds with significant active distribution/absorption processes, where biliary elimination is a major component of the elimination process or where the assumptions of flow-limited distribution and well mixed compartments are not valid and permeability-limited distribution is apparent. These drawbacks could be addressed by the addition of permeability barriers for some tissues and by the incorporation of a more complex liver model which addresses active uptake into the liver, active efflux into the bile, biliary elimination and enterohepatic recirculation. However, this improvement to current methodologies requires the availability of the appropriate input data for quantification of the various processes involved as well as validation of the corresponding in vitro to in vivo scaling approaches. 

In addition to passive transport, active transport can occur with proteins lodged in the BBB that facilitate uptake and efflux of compounds into and out of the CNS. Therefore, compounds can be modified to enhance their affinity for uptake transporters or reduce their affinity for efflux transporters (e.g., R-glycoprotein) to improve BBB permeability [37]. However, these strategies required major structural transformations thus, we focused on strategies related to changing the physicochemical properties of NTI, as mentioned below. 

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