Lipophilic drug absorption barriers

To enhance absorption, it is important to identify the rate-limiting step in this process and to counter the relevant barrier in each case. The possible solutions for the absorption barriers facing lipophilic drug absorption are presented according to their physiological order, i.e., issues concerning the GI lumen (preenterocyte), followed by issues associated with the enterocyte and onward. However, it should be noted that a few concepts affect more than one step of the absorption process. 

Apart from being a diffusional barrier, mucin can also interact with drugs to decrease their bioavailability, as has been shown with tetracycline [106], phenylbutazone, and warfarin [107]. On the other hand, studies in rats showed that binding of some water-soluble drugs to intestinal mucus was essential for their absorption and that damage to the mucus significantly reduced absorption [108], The acidic mucus is essential for lipid absorption and could be important for the diffusion of lipophilic drugs (see below). 

FIGURE 6.1 The barriers that a lipophilic drug has to transverse along the intestinal absorption process (1) dissolution and solubilization in the intestinal milieu, (2) narrow absorption window, (3) unstirred water layer, (4) efflux pumps, (5) intra-enterocyte metabolism, and (6) first pass hepatic metabolism. 

The layer of water adjacent to the absorptive membrane of the enterocyte is essentially unstirred. It can be visualized as a series of water lamellas, each progressively more stirred from the gut wall toward the lumen bulk. For BCS class 2 compounds the rate of permeation through the brush border is fast and the diffusion across the unstirred water layer (UWL) is the rate-limiting step in the permeation process. The thickness of the UWL in human jejunum was measured and found to be over 500 pm [3]. Owing to its thickness and hydrophilicity, the UWL may represent a major permeability barrier to the absorption of lipophilic compounds. The second mechanism by which the UWL functions act as a barrier to drug absorption is its effective surface area. The ratio of the surface area of the UWL to that of the underlying brush border membrane is at least 1 500 [4], i.e., this layer reduces the effective surface area available for the absorption of lipophilic compounds and hence impairs its bioavailability. 

Theoretically, a lipophilic drug may pass through the cell or go around it. If drug has a low molecular weight and is lipophilic, the lipid cell membrane is not a barrier to drug diffusion and absorption. In the intestine, molecules smaller than 500 MW may be absorbed by... 

Absorption barriers are related to the permeability of drug molecules across the gastrointestinal membrane including the colonic membrane. There are two distinct mechanisms for molecules to cross the membrane via paracellular transport and transcellular transport (Fig. 5). Para-cellular transport involves only passive diffusion where the molecules pass through the tight junctions between the epithelial cells. In contrast, transcellular transport can occur by passive diffusion as well as by active transport, or endocytosis. In general, the hydrophilic molecules diffuse predominantly through the paracellular route, whereas the lipophilic... 

The permeability and PAMPA assays as described are robust and reproducible assays for determining passive, transcellular compound permeability. Permeability and PAMPA are automation compatible, relatively fast (4-16 hours), inexpensive, straightforward, and their results correlate with human drug absorption values from published methods. The PAMPA assay provides the benefits of a more biologically relevant system. It is also possible to tailor the lipophilic constituents so that they mimic specific membranes, such as the blood-brain barrier (BBB). Optimization of incubation time, lipid mixture, and lipid concentration will also enhance the assay s ability to predict compound permeability. 

Figure 5,4 Pharmacokinetics. The absorption distribution and fate of drugs in the body. Routes of administration are shown on the left, excretion in the urine and faeces on the right. Drugs taken orally are absorbed from the stomach and intestine and must first pass through the portal circulation and liver where they may be metabolised. In the plasma much drug is bound to protein and only that which is free can pass through the capillaries and into tissue and organs. To cross the blood brain barrier, however, drugs have to be in an unionised lipid-soluble (lipophilic) form. This is also essential for the absorption of drugs from the intestine and their reabsorption in the kidney tubule. See text for further details...

---