P-Glycoprotein-Based Drug-Drug Interactions: Preclinical Methods and Relevance to Clinical Observations

  • Aszalos, Adorjan (Laboratory of Cell Biology, National Cancer Institute, National Institutes of Health)
  • Published : 2004.02.01

Abstract

Multiple drug administration is common in elderly, HIV, and cancer patients. Such treatments may result in drug-drug interactions due to interference at the metabolic enzyme level, and due to modulation of transporter protein functions. Both kinds of interference may result in altered drug distribution and toxicity in the human body. In this review, we have dealt with drug-drug interactions related to the most studied human transporter, P-glycoprotein. This transporter is constitutively expressed in several sites in the human body. Its function can be studied in vitro with different cell lines expressing P-glycoprotein in experiments using methods and equipment such as flow cytometry, cell proliferation, cell-free ATP as activity determination and Transwell culture equipment. In vivo experiments can be carried out by mdr1a(-/-) animals and by noninvasive methods such as NMR spectrometry. Some examples are also given for determination of possible drug-drug interactions using the above-mentioned cell lines and methods. Such preclinical studies may influence decisions concerning the fate of new drug candidates and their possible dosages. Some examples of toxicities obtained in clinics and summarized in this review indicate careful consideration in cases of polypharmacy and the requirement of preclinical studies in drug development activities.

Keywords

References

  1. Ambudkar, S., Drug-stimulated ATPase activity in crude membranes of human MDR1-transfected mammalian cells. Meth. Enzymol., 292, 504-514 (1998) https://doi.org/10.1016/S0076-6879(98)92039-0
  2. Booth, C. L., Brouwer, K. R., and Brouwer, K. L., Effect of multidrug resistance modulators on the hepatobiliary disposition of doxorubicin in the isolated perfused rat liver. Cancer Res., 58, 3641-3648 (1998)
  3. Borst, P. and Elferik, R. O., Mammalian ABC transporters in health and disease. Ann. Rev. Biochem., 71, 537-592 (2002) https://doi.org/10.1146/annurev.biochem.71.102301.093055
  4. De Lannoy, I. A. M., Mandin, R. S., and Silverman, M., Renal secretion of vinblastine, vincristine and colchicine in vivo. J. Pharmacol. Exp. Ther., 268, 388-395 (1994)
  5. Dorovini-Zis, K., Prameya, R., and Bowman, P. D., Culture and Characterization of microvascular endothelial cells derived from human brain. Lab. Invest., 64, 425-436 (1991)
  6. Floren, L. C., Bekersky, I., Benet, L. Z., Mekki, Q., Dressler, D., Lee, J. W., Roberts, J. P., and Herbert, M. F., Tacrolimus oral bioavailability doubles with coadministration of ketaconazole. Clin. Pharmacol. Ther., 62, 41-49 (1997) https://doi.org/10.1016/S0009-9236(97)90150-8
  7. Fromm, M. F., Kim, R. B., Stein, C. M., Wilkinson, G. R., and Roden, D. M., Inhibition of P-glycoprotein-mediated drug transport: A unifying mechanism to explain the interaction between digoxin and quinidine. Circulation, 99, 552-557 (1999) https://doi.org/10.1161/01.CIR.99.4.552
  8. Glynn, S. and Yazdanian, M., In vitro blood-brain barrier permeability of nevirapine compared to other HIV antire-troviral agents. J. Pharma. Sci., 87, 306-310(1998) https://doi.org/10.1021/js970291i
  9. Gottesman, M. M., Foho, T., and Bates, S. E., Multidrug resistance in cancer: role of ATP-dependent transporters. Nat. Rev. Cancer, 2, 48-58 (2002) https://doi.org/10.1038/nrc706
  10. Greiner, B., Eichelbaum, M., Fritz, P., Kreichgauer, H. P., von Richter, O., Zundler, J., and Kroemer, H. K., The role of intestinal P-glycoprotein in the interaction of digoxin and rifampin. J. Clin. Invest., 104, 147-153 (1999) https://doi.org/10.1172/JCI6663
  11. Gupta, S., Kim, C. H., Tsuruo, T, and Gollapudi, S., Preferential expression and activity of multidrug resistance gene 1 product (P-glycoprotein), a functionally active efflux pump, in human CD8+ cells: a role in cytotoxic effector function. J. Clin. Immunol., 12, 13-20 (1992)
  12. Hebert, M. F. and Lam, A. V., Diltiazem increases tacrolimus concentration. Ann. Pharmacother., 33, 680-682 (1999) https://doi.org/10.1345/aph.18356
  13. Hegmann, E. J., Bauer, H. C., and Kerbel, R. S., Expression and functional activity of P-glycoprotein in cultured cerebral capillary endothelial cells. Cancer Res., 52, 6969-6969 (1992)
  14. Hoffmeyer, S., Burk, O., Von Richter, O., Arnold, H. P., Brockmoller, J., Johne, A., Cascorli, I., Gerloff, T., Roots, I., Eichelbaume, M., and Brinkmann, U., Functionalpolymorphism of the human multidrug-resistant gene: multiple sequence variations and correlation of one allele with P-glycoprotein expression and activity in vivo. Proc. Natl. Acad. Sci., 97, 4373-3478 (2000)
  15. Horio, M., Chin, K. V.. Currier, S. J., Goldenberg, S., Williams, C., Pastan, I., Gottesman, M., and Handler, J., Transepithelial transport of drugs by the multidrug transporter in cultured Madin-Darby canine kidney cell epithelia. J. Biol. Chem., 264, 14880-14884 (1989)
  16. Ibrahim, S., Peggins, J., Knapton, A., Licht, T., and Aszalos, A., Influence of beta-adrenergic antagonists, H1-receptor blockers, analgesics, diuretics and quinolone antibiotics on the cellular accumulation of the anticancer drug, daunorubicine: P-glycoprotein modulation. Anticancer Res., 21, 847-856 (2001)
  17. Ibrahim, S., Peggins, J., Knapton, A., Licht, T., and Aszalos, A., Influence of antipsychotic, antiemetic and $Ca^{2+}$channel blocker drugs on the cellular accumulation of the anticancer drug daunorubicin: P-glycoprotein modulation. J. Pharmacal. Exp. Ther., 295, 1276-1283 (2000)
  18. Kamimoto, Y., Gatmaitan, Z., Hsu, J., and Arias, I. M., The function of Gp170, the multidrug resistance gene product, in rat liver canalicular membrane vesicles. J. Biol. Chem., 264, 11693-11698 (1989)
  19. Karlson, J., Kuo, S.-M., Ziemniak, J., and Artursson, P., Transport of celiprolol across human intestinal (Caco-2) cells: mediation of secretion by multiple transporters including P-glycoprotein. Br. J. Pharmacol., 10, 1009-1016 (1993)
  20. Kim, R. B., Fromm, M. F., Wandel, C., Leake, B., Wood, A. J. J., Roden, D. M., and Wilkinson, G. R., The drug transporter P-glycoprotein imits oral absorption and brain entry of HIV-1 rotease inhibitors. J. Clin. Invest., 101, 289-294 (1998) https://doi.org/10.1172/JCI1269
  21. Klimecki, W. T., Futscher, B. W., Grogen, T. M., and Dalton, W. S., P-glycoprotein expression and function in circulating blood cells from normal volunteers. Blood, 83, 2451-2458 (1994)
  22. Lazarou, J., Pomeranz, B. H., and Corey, P. N., Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA, 279, 1200-1205(1998) https://doi.org/10.1001/jama.279.15.1200
  23. Mayer, U., Wagenaar, E., Beijnen, J. H., Smit, J. W., Meijer, D. K. van Aspen, J., Borst, P., and Schinkel, A. H., Substantial excretion of digoxin via the intestinal mucosa and prevention of long-term digoxin accumulation in the brain by mdr 1a P-glycoprotein. Br.J. Pharmacol., 119, 1038-1044 (1996) https://doi.org/10.1111/j.1476-5381.1996.tb15775.x
  24. Malorni, W., Lucia, M. B., Rainaldi, G., Cauda, R., Cianfriglia, M., Donelli, G., and Ortona, L., Intracellular expression of P-170 glycoprotein in peripheral blood mononuclear cell subsets from healthy donors and HIV-infected patients. Haematologica, 83, 13-20 (1988)
  25. Muruganandam, A., Herx, M. L., Monette, R., Durkin, J. P., and Stanimirovic, D. B., Development of immortalized human cerebromicrovascular endothelial cell line as an in vitro model of the human blood-brain barrier. FASEB J., 11, 1187-1197 (1997)
  26. Pastan, I., Gottesman, M. M., Ueda, K., Lovelace, E., Rutherford, A., and Willingham, M., A retrovirus carrying MDR1 cDNA confers multiple drug resistance and polarized expression of P-glycoprotein in MDCK cells. Proc. Natl. Acad. Sci., 85, 9486-9490 (1988)
  27. Rao, V. V.. Dahlheimer, J. L., Bardget, M. E., Snyder, A. Z., Finch, R. A., Sartorelli, A. C., and Piwnica-Worms, D., Choroid plexus epithelial expression of MDR1 P-glycoprotein and multidrug resistance-associated protein contribute to the blood-cerebrospinal-fluid drug-permeability barrier. Proc.Natl. Acad. Sci., 96, 3900-3905 (1999) https://doi.org/10.1073/pnas.96.7.3900
  28. Sachs, M. K., Blanchard, L. M., and Green, P. J., Interaction of itraconazole and digoxin. Clin.lnt. Dis., 16, 400-403 (1993) https://doi.org/10.1093/clind/16.3.400
  29. Schinkel, A. H., Smit, J. J. M., van Tellingen, O., Beijnen, J. H., Wagenaar, E., van Deemter, L., Mol, C. A. A. M., van der Valk, M. A., Robanus-Maandag, E. C., te Riele, H. P. J., Berns, A. J. M., and Borst, P., Disruption of the mouse mdr1a P-glycoprotein gene leads to a deficiency in the blood-brain barrier and to increased sensitivity to drugs. Cell, 77, 491-502 (1994) https://doi.org/10.1016/0092-8674(94)90212-7
  30. Schutz, M. and Friedel, P., Isolation and cultivation of endothelial cells derived from human placenta. Eur. J. Cell Biol., 71, 395-401 (1996)
  31. Sparreboom, A., Van Asperen, J., Mayer, U., Schinkel, A. H., Smit, J. W., Meijer, D. K., Borst, P., Nooijen, W. J., Beijnen, J. H., and van Tellingen, O., Limited oral bioavailability and active epithelial excretion of paclitaxel (Taxol) caused by Pglycoprotein in the intestine. Proc. Natl. Acad. Sci., 94, 2031-2035 (1997) https://doi.org/10.1073/pnas.94.5.2031
  32. Speeg, K. V. and Maldonodo, A. L., Effect of nonimmuno-suppressive cyclosporin analog SDZ PSC-833 on colchicine and doxorubicin biliary secretion by the rat in vivo. Cancer Chemother. Pharmacol., 34, 133-136 (1994) https://doi.org/10.1007/BF00685930
  33. Tanigawara, Y., Okamura, N., Hirai, M., Yasuhara, M., Ueda, K., Kioka, N., Komano, T., and Hori, R., Transport of digoxin by human P-glycoprotein expressed in a porcine kidney epithelial cell line (LLC_PH1). J. Pharmacol. Exp. Tner., 263, 840-845 (1992)
  34. Tatsura, T., Naito, M., Oh-hara, T., Sugawara, I., and Tsutuo, T., Functional involvement of P-glycoprotein in Blood-brain barrier. J. Biol. Chem., 276, 20383-20391 (1992)
  35. Teifel, M. and Friedel, P., Establishment of the permanent microvascular endothelial cell line PBMEC/C1-2 from porcine brains. Exper. Cell Res., 338, 50-57 (1996)
  36. Tsuji, A., Terasaki, T., Takabatake, Y., Tenda, Y., Tamai, I., Yamashima, T., Moritani, S., Tsuruo, T., and Yamashida, J., P-glycoprotein as the drug efflux pump in primary bovine capillary endothelial cells. Life Sci., 51, 1427-1437 (1992) https://doi.org/10.1016/0024-3205(92)90537-Y
  37. Van Asperen, J., Van Tellingen, O., Sparreboom, A., Schinkel, A. H., Borst, P., Nooijen, W. J., and Beijnen, J. H., Enhanced oral bioavailability of paclitaxel in mice treated with the P-glycoprotein blocker SDZ PSC833. Br. J. Cancer, 76, 1181-1185 (1997) https://doi.org/10.1038/bjc.1997.530
  38. Wang, P. C., Aszalos, A., and Vick, J. A., F19 NMR study of trifuoroperazine crossing blood-brain barrier due to P-glycoprotein modulation. Proceeding of International Society for Magnetic Resonance 8th Scientific Meeting, p. 66 (2000)
  39. Weber, S. J., Abbruscato, T. J., Browson, E. A., Lipkowski, A. W., Polt, R., Misicka, A., Hasseth, R. C., Bartosz, H., Hruby, V. J., and Davis, T. P., Assessment of an in vitro blood-brain barrier model using several $[Met^5]$enkephalin opioid analogs. J. Pharmacol. Exper. Ther., 266, 1649-1655 (1993)