Efflux, generally transporters

The use of Caco-2 cell monolayers has gained in popularity as an in vivo human absorption surrogate moreover, the monolayers are generally accepted as a primary absorption screening tool by several pharmaceutical companies [10]. However, Caco-2 cell permeability measurements exhibit certain limitations due to the mechanisms involved. Both passive and active pathways exist active transport tends to increase the absorption across the cells and, since Caco-2 cells overexpress the P-glycoprotein (P-gp) efflux pump, the absorption of some compounds across these cells may be underestimated. 

A variety of in vitro assays are available to identify compounds as substrates and inhibitors of P-gp. These assays, which have been reviewed elsewhere in great detail [20-24], can be classified into three general categories (1) transport, (2) accumulation/ efflux and (3) ATPase activity [20-28]. It is important to note that these in vitro model systems can be adapted for measuring the interaction of dmgs with other important drug transporter systems [22]. 

This permeability barrier shows selectivity in that small hydrophobic molecules can partition into and diffuse across the lipid bilayer of the cell membrane, whereas small hydrophilic molecules can only diffuse between cells (i.e., through the intercellular junctions). In addition, the presence of uptake and efflux transporters complicates our ability to predict intestinal permeability based on physicochemical properties alone because transporters may increase or decrease absorptive flux. The complexity of the permeability process makes it difficult to elucidate permeability pathways in complex biological model systems such as animals and tissues. For this reason, cultured cells in general, and Caco-2 cells in particular, have been used extensively to investigate the role of specific permeability pathways in drug absorption. 

Active transporters are thought to play an important role in the pharmacokinetics of drugs, not only because they can regulate the permeability of drugs as substrate-specific efflux or influx pumps, but also because of their widespread presence across in vivo membrane systems, from the intestinal epithelia to the BBB. Generally speaking, the absorption direction transporters tend to have narrower substrate specificity than the excretion direction transporters. Active transporters also play a significant role in biliary and renal excretion. 

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. 

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