Transporter-mediated efflux

Figure 12.2. Interrelationships among Phase I (hydroxylation). Phase II (glucuronic acid, sulfate, and glutathione conjugation), and Phase III (ABC transporter-mediated efflux) detoxification processes leading to the inactivation and elimination of xenobiotics.

Direct excretion of metabolites into the bile via transporter-mediated efflux can be an important determinant of clearance and first-pass extraction.79-81 This phenomenon is probably much more common than it would seem from the literature, at least in part because there are no facile ways to study the effect other than in vivo using bile duct cannulated rats. 

Increasing its oral absorption this could occur if the perpetrator slowed intestinal metabolism of the victim or blocked transporter-mediated efflux of the victim back from intestinal epithelial cells into the lumen of the intestine... 

The use of different in vitro and in vivo models depends largely on the objective of the studies. Multiple methodologies are often needed for better understanding of a transporter-mediated efflux or uptake of drug molecules. To address the potential DDI in humans, currently FDA suggests the use of the bidirectional transport assays in human transporter expressing cells in their draft guidance. 

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.)...

Intracellular transport and efflux from cells of lipophilic molecules can be mediated by several members of the ATP-binding cassette (ABC) transporters family, some of which have been identified in the brain, including the retina (Kim et al., 2008 Sarkadi et al., 2006). 

Hidalgo, I. J., Li, J., Carrier-mediated transport and efflux mechanisms in Caco-2 cells, Adv. Drug Delivery Rev. 1996, 22, 53-66. 

Carrier-mediated transport, Active Efflux, Passive (trans and para cellular) diffusion... 

Saitoh, H., Aungst, B. J., Possible involvement of multiple P-glyco-protein-mediated efflux systems in the transport of verapamil and other organic cations across rat intestine, Pharm. Res. 1995, 12, 1304-1310. 

A more recent example of this technique has been the study on human absorption characteristics of fexofenadine [109], Fexofenadine has been shown to be a substrate for P-gp in the in vitro cell lines its disposition is altered in knockout mice lacking the gene for MDRla, and co-administration of P-gp inhibitors (e.g. ketoconazole and verapamil) was shown to increase the oral bioavailability of fexofenadine [110-113], Hence, it is suggested that the pharmacokinetics of fexofenadine appears to be determined by P-gp activity. In the human model, the intestinal permeability estimated on the basis of disappearance kinetics from the jejunal segment is low, and the fraction absorbed is estimated to be 2% [114], Co-administration of verapamil/ketoconazole did not affect the intestinal permeability estimates however, an increased extent of absorption (determined by de-convolution) was demonstrated. The increased absorption of fexofenadine was not directly related to inhibition of P-gp-mediated efflux at the apical membrane of intestinal cells as intestinal Peff was unchanged. Furthermore, the effect cannot be explained by inhibition of intestinal based metabolism, as fexofenadine is not metabolised to any major extent. It was suggested that this may reflect modulation of efflux transporters in hepatocyte cells, thereby reducing hepatobiliary extraction of fexofenadine. 

Tsuji A (1998) P-glycoprotein-mediated efflux transport of anticancer drugs at the blood- Van Bree rain barrier. Therap Drug Monitor 20 588-590... 

Major transport pathways in Caco-2 monolayers. A Passive transcellular B Passive paracellular C Transporter-mediated apical uptake D Transporter-mediated apical efflux E Transporter-mediated basolateral efflux F Transporter-mediated basolateral uptake. 

P-glycoprotein-mediated efflux is a potential source of pecuHarities in drag pharmacokinetics, such as non-Hnearity. This includes dose-dependent absorption, drug-drag interactions, intestinal secretion and limited access to the brain. Assays are in development to quantify the interaction between transporters and drugs. One of the first is a 96-weU plate assay for P-gp binding [33, 34] and an MDRl ATPase test [35]. 

Other mechanisms of interaction have also been reported, such as altered activity of other enzymes within the CYP450 family (14—17). Moreover, GFJ may also inhibit the intestinal P-glycoprotein (P-gp)-mediated efflux transport of drugs such as cyclosporine to increase its oral bioavailability (18-21). GFJ and other fruit juices have recently been shown to be potent in vitro inhibitors of a number of organic anion-transporting polypeptides (OATPs) (22,23). 

Quercetin has been found to inhibit P-gp-mediated efflux of ritonavir in Caco-2 cells (47), to reduce the oxidation of acetaminophen in rat liver microsomes and HepG2 cells (48), and to inhibit the metabolism of midazolam and quinidine in human liver microsomes (49). It did not have an effect on CYP3A4-mediated metabolism and P-gp-mediated transport of saquinavir (41). Rutin was demonstrated to moderately increase the uptake of idar-ubicin in an isolated perfused rat lung model, and also the outflow recovery of the major metabolite idarubicinol, possibly by affecting P-gp (45). Nobe-litin and tangeretin were shown to inhibit OATP-B-mediated uptake of estrone-3-sulfate into human embryonic kidney cells (23). 

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