Transporters efflux

ATP-binding cassette (ABC) transporters are efflux pumps that derive the energy needed for drug extrusion from the hydrolysis of ATP. Bacterial ABC antibiotic efflux transporter encoded on plasmids is a significant... 

Both influx and efflux transporters are located in intestinal epithelial cells and can either increase or decrease oral absorption. Influx transporters such as human peptide transporter 1 (hPEPTl), apical sodium bile acid transporter (ASBT), and nucleoside transporters actively transport drugs that mimic their native substrates across the epithelial cell, whereas efflux transporters such as P-glycoprotein (P-gp), multidrug resistance-associated protein (MRP), and breast cancer resistance protein (BCRP) actively pump absorbed drugs back into the intestinal lumen. 

Breast cancer resistance protein (BCRP) is another ATP-dependent efflux transporter that confers resistance to a variety of anticancer agents, including... 

Taylor EM. The impact of efflux transporters in the brain on the development of drugs for CNS disorders. Clin Pharmacokinet 2002 41 81-92. 

Fig. 9 Schematic representation depicting the movement of molecules from the absorbing (mucosal or apical) surface of the GIT to the basolateral membrane and from there to blood. (A) transcellular movement through the epithelial cell. (B) Paracellular transport via movement between epithelial cells. (Q Specialized carrier-mediated transport into the epithelial cell. (D) Carrier-mediated efflux transport of drug out of the epithelial cell. (Copyright 2000 Saguaro Technical Press, Inc., used with permission.)...

Another limitation is that there is no quantitative relationship between active drug transport in the cell culture models and in vivo e.g. [92, 93]. The reason may be that the expression level of the transporter in Caco-2 cells is not comparable to that in vivo or that there is a difference in effective surface area (see Section 4.3.2.2 below). One solution to this problem is to determine the apparent transport constants, Km and Vmax, for each transporter and subsequently, to determine a scaling factor. However, this is not readily done. In addition these studies are further complicated by the lack of specific substrates. For example, there are almost no specific substrates for the drug efflux transporters [18]. Therefore, other epithelial... 

Luo, F., P. Paranjpe, A. Guo, E. Rubin, and P. Sinko. Intestinal transport of irinotecan in Caco-2 cells and MDCK II cells overexpressing efflux transporters Pgp, cMOAT, and MRP1., Drug Metab. Dispos. 2002, 30, 763-770... 

R. T. Borchardt. Effects of poly( ethylene glycol) on efflux transporter activity in Caco-2 cell monolayers,/. Pharm. Sci. 2002, 91, 1980-1990... 

Compounds absorbed by active uptake mechanisms (e.g., glucose and Gly-Pro) and compounds known to be substrates for efflux transport (e.g., digoxin, verapamil) were also included in the list. The applied concentration (10-500 pM) only had minor effects on the permeability values. Thus, the choice of concentration was not critical for this set of compounds with respect to the relationship between permeability and fraction absorbed in humans. Changing the pH on the apical donor side had significant effects on the Papp values of several compounds, the effects being in agreement with the acid-base properties of the compounds. The... 

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. 

Cummins, C. L., Mangravite, L. M., Benet, L. Z., Characterizing the expression of CYP3A4 and efflux transporters (P-gp, MRP, and MRP2) in CYP3A4-transfected Caco-2 cells... 

Suzuki, H., Sugiyama, Y., Role of metabolic enzymes and efflux transporters in the absorption of drugs from the small intestine. Mini review, Ear. J. Pharm. Sci. 2000, 32, 3-12. 

It is also important to predict the in vivo biliary excretion clearance in humans, and for this purpose MDCK II cell lines expressing both uptake and efflux transporters may be used (Fig. 12.3) [92, 93]. It has been shown that MRP2 is expressed on the apical membrane, whereas OATP2 and 8 are expressed on the basolateral membrane after cDNA transfection (Fig. 12.3) [92, 93]. The transcellular transport across such double-transfected cells may correspond to the excretion of ligands from blood into bile across hepatocytes. Indeed, the vectorial transport from the basal to apical side was observed for pravastatin only in OATP2- and MRP2-expressing... 

From the above, it is clear that the gut wall represents more than just a physical barrier to oral drug absorption. In addition to the requirement to permeate the membrane of the enterocyte, the drug must avoid metabolism by the enzymes present in the gut wall cell as well as counter-absorptive efflux by transport proteins in the gut wall cell membrane. Metabolic enzymes expressed by the enterocyte include the cytochrome P450, glucuronyltransferases, sulfotransferases and esterases. The levels of expression of these enzymes in the small intestine can approach that of the liver. The most well-studied efflux transporter expressed by the enterocyte is P-gp. 

The expression of metabolic enzymes in the enterocyte can lead to a profound gut wall first-pass extraction ratio for substrate drugs. In addition, efflux transporters can slow the passage of drugs across the enterocyte in a cycling fashion. This allows the metabolic enzymes several opportunities to metabolize their substrates, and in this way a low expression level of an enzyme can exhibit a significant extraction. 

The extent to which the cell line supports appropriate expression of the cDNA. The level of expression achieved is determined by interactions of the vector/ expressed protein with the cell. These interactions include the strength of the promoter (weaker promoters can be compensated for by using a vector which is present at high copy number), the adequacy of the selective agent (not all agents are toxic to all cells), the stability of the expressed protein (some proteins may be rapidly degraded in some cells), and whether the expressed protein exerts any deleterious effects on the viability of host cells (some efflux transporters could deplete the cell of essential components). Finally, transporters must be expressed in a polarized manner in the host cell (i.e., preferentially on either the basolateral or apical side of the cell). 

Systems to study the role of intestinal oxidative metabolism (CYP3A4) have been developed and appear to have adequate enzyme activity levels. Although there appears to be a relatively limited need for additional system development in this area, there is still a fundamental question as to whether any synergistic interplay exists between metabolic enzymes and transporters (i.e., does the presence of an efflux transporter influence the extent of metabolism ) and co-expression of CYP3A4 and transporters provides a pivotal experimental model. 

---