L'obésité et les maladies du foie associées (NAFLD) augmentent le risque et la sévérité de l’hépatotoxicité induite par certains xénobiotiques, mais les mécanismes impliqués sont encore mal compris. Pour l'éthanol et le paracétamol (APAP), le rôle du cytochrome P450 2E1 (CYP2E1) hépatique est suspecté car l'activité de cette enzyme est augmentée au cours de ces pathologies dysmétaboliques. Le 1er objectif de notre travail expérimental a été de mettre au point un modèle cellulaire de NAFLD caractérisé non seulement par l'accumulation de triglycérides mais aussi par l’augmentation de l'activité du CYP2E1. Pour cela, des cellules humaines HepaRG différenciées ont été incubées pendant une semaine avec de l'acide stéarique ou de l'acide oléique, en présence de 3 concentrations différentes d'insuline. Les triglycérides cellulaires et l'expression de gènes induits au cours de la stéatose étaient similaires avec les deux acides gras. Cependant, l'activité du CYP2E1 était significativement augmentée uniquement par le stéarate et ceci était associé à une diminution de l'activité du CYP3A4, une autre caractéristique des NAFLD. L’activité du CYP2E1 dans les cellules HepaRG était réduite par l'insuline d'une manière concentration-dépendante et cet effet était reproduit sur des hépatocytes humains en culture primaire. Ainsi, l'activité du CYP2E1 était la plus élevée dans les cellules HepaRG cultivées avec du stéarate et sans insuline. Le 2ème but de notre étude était ensuite d'évaluer la cytotoxicité de l’APAP sur des cellules HepaRG présentant ou non une stéatose et une induction du CYP2E1. Des expériences avec une large gamme de concentrations d’APAP (de 1 à 20 mM) indiquaient que la perte cellulaire d'ATP et du glutathion (GSH) était presque toujours plus forte en présence de stéarate. Dans les cellules prétraitées avec le chlorméthiazole (CMZ, un inhibiteur du CYP2E1), la moindre diminution d’ATP était plus importante en présence de stéarate, avec de faibles (2,5 mM) ou de fortes (20 mM) concentrations d’APAP. Cependant, en l'absence d'insuline, la moindre chute d’ATP induite par le CMZ était significativement plus forte uniquement pour 20 mM d’APAP. Étonnamment, suite au prétraitement par le CMZ, il n'y avait pas de protection vis-à-vis de la diminution du GSH et de la formation des adduits APAP-protéines. Enfin, les concentrations du métabolite APAP-glucuronide étaient significativement augmentées en présence d'insuline. Ainsi, lorsqu’elle est étudiée dans des conditions spécifiques de culture, la lignée cellulaire HepaRG semble être un modèle intéressant de NAFLD, notamment en ce qui concerne les activités du CYP2E1 et du CYP3A4. Nos données suggèrent aussi que l’induction du CYP2E1 observée au cours des NAFLD pourrait être secondaire à l'accumulation de certains acides gras et à la présence d’une faible signalisation insulinique dans le foie. Ainsi, ce modèle cellulaire peut être utilisé pour mettre en évidence les principaux facteurs métaboliques et hormonaux favorisant hépatotoxicité de l’APAP chez les personnes obèses. Cette thèse inclut également une revue de la littérature sur l’hépatotoxicité de l’APAP dans le contexte de l’obésité et des NAFLD (Michaut et al., Liver Int 2014). / Obesity and nonalcoholic fatty liver disease (NAFLD) are able to increase the risk and the severity of hepatotoxicity induced by some xenobiotics including drugs, but the involved mechanisms are still poorly understood. For toxic compounds such as ethanol and acetaminophen (APAP), a role of hepatic cytochrome P450 2E1 (CYP2E1) is suspected since the activity of this enzyme is consistently enhanced during obesity and NAFLD. The first aim of our experimental study was to set up a cellular model of NAFLD characterized not only by triglyceride accumulation but also by higher CYP2E1 activity. To this end, differentiated human HepaRG cells were incubated during one week with stearic acid, or oleic acid, in the presence of 3 different concentrations of insulin. Cellular triglycerides and the expression of lipid-responsive genes were similar with both fatty acids. However, CYP2E1 activity was significantly increased only by stearate and this was associated with lower CYP3A4 activity, another metabolic feature reported in NAFLD. CYP2E1 activity in HepaRG cells was reduced by insulin in a concentration-dependent manner and this effect was reproduced in cultured primary human hepatocytes. Hence, the highest CYP2E1 activity was observed in HepaRG cells with stearate and without insulin. Next, the second aim of our study was to assess APAP cytotoxicity in HepaRG cells presenting or not lipid accretion and CYP2E1 induction. Experiments with a large range of APAP concentrations (1 to 20 mM) showed that the cellular loss of ATP and glutathione (GSH) was almost always stronger in the presence of stearic acid. In cells pretreated with the CYP2E1 inhibitor chlormethiazole (CMZ), recovery of cellular ATP was significantly higher in the presence of stearic acid with both low (2.5 mM) and high (20 mM) concentrations of APAP. However, in the absence of insulin, CMZ-induced ATP recovery was significantly greater only for 20 mM of APAP. Surprisingly, there was no recovery of cellular GSH and no reduction of APAP-protein adducts following CMZ pretreatment. Finally, levels of APAP-glucuronide were significantly enhanced in the presence of insulin. Hence, when studied in specific conditions of culture, the HepaRG cell line can be a valuable model of human NAFLD, especially regarding CYP2E1 and CYP3A4 activity. Our data also suggest that higher CYP2E1 activity in NAFLD could be secondary to the hepatic accumulation of some fatty acids and to the presence of low insulin signaling. This cellular model can be thus used to unveil the main metabolic and hormonal factors favoring APAP hepatotoxicity in obese individuals. This thesis also includes a review on APAP hepatotoxicity in the context of obesity and NAFLD (Michaut et al., Liver Int 2014).

Orientador: Carmen Silvia Passos Lima / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T21:59:05Z (GMT). No. of bitstreams: 1 Numa_IramaiaAngelicaNeri_M.pdf: 4547636 bytes, checksum: 22548046dff40a3bb4e586230e3f13b7 (MD5) Previous issue date: 2012 / Resumo: O mesilato de imatinibe (MI) é o tratamento de escolha para pacientes com leucemia mielóide crônica (LMC) em fase crônica, mas a resposta ao medicamento é variável em indivíduos distintos. A CYP3A4 é a principal enzima responsável pelo metabolismo hepático do MI. O alelo variante G do polimorfismo CYP3A4 A-290G codifica menor quantidade de enzima do que o alelo selvagem A, mas o papel do referido polimorfismo em pacientes com LMC tratados com MI é desconhecido. Os objetivos deste trabalho foram os de avaliar a eficácia, a toxicidade a sobrevida livre de progressão (SLP) e global (SG) de pacientes com LMC durante a administração de MI e verificar se estes parâmetros são alterados pela variabilidade interindividual no metabolismo do fármaco, relacionada ao polimorfismo CYP3A4 A-290G. Foram avaliados 100 pacientes com LMC em FC precoce atendidos no Centro de Hematologia e Hemoterapia da UNICAMP. O diagnóstico da LMC, o exame hematológico, o cariótipo, a pesquisa do gene BCR-ABL e os genótipos do polimorfismo CYP3A4 A-290G foram realizados por métodos convencionais. Os pacientes receberam o MI na dose de 400mg e a resposta ao tratamento foi avaliada segundo os critérios do European Leukemia Net. Identificamos respostas hematológicas, citogenética e molecular similares às previamente descritas. A taxa de resposta hematológica foi de 95% ao longo do estudo. Aos doze meses, as respostas citogenética completa ou parcial foram de 72% e 11% respectivamente. Já as taxas de respostas moleculares completas e maiores aos 22 meses foram de 28% e 26%, respectivamente. A sobrevida global foi de 94% aos 92 meses bem como a sobrevida livre de progressão para as fases avançadas da doença. Observamos que pacientes com resposta citogenética completa ou parcial e molecular xiv completa ou maior apresentaram maior SLP e SG do que os demais. Cerca de 13% dos pacientes era portadores do genótipo AG do polimorfismo CYP3A4 A-290G, o qual esteve associado à obtenção de resposta molecular completa tardia e tendência à menor SLP e SG. Apesar da hipótese do alelo variante (G) exibir um fenótipo metabolizador lento associado a uma menor taxa de biotransformação do MI e portando maior risco de reações tóxicas, não observamos diferenças entre as toxicidades hematológicas e não hematológica (P= 0,28). Assim, concluímos que nossos pacientes respondem de forma similar ao MI do que os demais e que o polimorfismo CYP3A4 A-290G pode vir a funcionar como biomarcador de resposta ao fármaco / Abstract: Imatinib (IM) is widely recognized as the standard of care in the first-line treatment of CML but the response to the drug is variable in different subjects. CYP3A4 is the main enzyme responsible for the hepatic metabolism of Imatinib. The G variant allele of the polymorphism A-290G encoding least amount of enzyme than the wild-type allele, but the role of this polymorphism in CML patients treated with Imatinib is unknown. The aims of this study were to assess the efficacy, toxicity, progression-free survival (PFS) and overall survival (OS) of patients with CML during the administration of Imatinib and check if these parameters are affected y interindividual variability in drug metabolism, the polymorphism related to CYP3A4 A-290G. We evaluated 100 patients with CML newly diagnosed at Center of Hematology and Hemoterapy of UNICAMP. The diagnosis of CML, hematology, karyotyping, research the BCR-ABL gene polymorphism and CYP3A4 genotypes A-290G were performed by conventional methods. Patients received a dose of 400mg IM and treatment response was assessed according to the criteria of the European Leukemia Net responses identified hematologic, cytogenetic and molecular similar to those previously described. The hematologic response rate was 95% throughout the study. At 22 months the complete or partial cytogenetic responses were 72% and 11% respectively. The complete molecular response rates at 22 months were 28% and 26%, respectively. Overall survival (OS) was 94% at 92 months and the progression-free survival (PFS) for advanced stages of the disease. We observed that patients with partial or complete cytogenetic response and major molecular and complete PFS and OS showed higher than other. We observed that patients with partial or complete cytogenetic response and major molecular xvi and complete PFS and OS showed higher than others. About 13% of patients were of AG genotype polymorphism of the CYP3A4 -290A>G, which was associated with achieving complete molecular response and late tendency to lower PFS and OS. Despite the possibility of variant allele (G) display a slow metabolizer phenotype associated with a lower rate of biotransformation of IM and carrying greater risk of toxic reactions, no significant differences between hematological and non hematological toxicities (P= 0,28). Thus, we conclude that our patients respond similary to IM than others and that the polymorphism CYP3A4 -290A>G might function as a biomarker of response to the drug / Mestrado / Ciencias Basicas / Mestra em Clínica Médica

Les différences de réponse médicamenteuse entre patients sont fréquentes, conduisant souvent à des difficultés à cibler la fenêtre thérapeutique et optimiser le traitement. Les médicaments courants sont efficaces pour seulement 25% à 60% des patients. Deux facteurs majeurs impliqués dans l’efficacité des médicaments sont leur métabolisme et clairance. Notamment, le CYP3A4 est la principale enzyme responsable du métabolisme des médicaments dans les hépatocytes ; des variations dans son activité entraînent une incertitude de dose. Pour améliorer l'efficacité du médicament, ce travail de thèse se concentre sur le développement de nano-transporteurs chargés avec des molécules naturelles inhibant le CYP3A4 et ciblant les hépatocytes, à administrer avant le médicament pour minimiser son métabolisme. Une méthodologie pour examiner les composés inhibiteurs du CYP3A4, fixer leur dose et leur temps d’administration pour une utilisation in vivo a été développée. Une première preuve de concept a été démontrée en utilisant une micelle chargée de furanocoumarine comme composé inhibiteur de CYP3A4 : des études d'efficacité antitumorale et la quantification dans la tumeur du médicament cytotoxique docetaxel, injecté après les micelles chargées de furanocoumarine, ont été engagés sur deux modèles de tumeurs xénogreffées chez la souris. Une deuxième génération de nano-transporteurs a été développée, avec des propriétés physico-chimiques optimisées pour cibler spécifiquement les hépatocytes. La démonstration de leur accumulation spécifique dans les hépatocytes et de l'amélioration supplémentaire de l’efficacité du docetaxel a été menée. Une perspective sur l'utilisation d'une telle approche pour améliorer l'efficacité des médicaments existants en oncologie est discutée, notamment pour le carcinome hépatocellulaire différencié. / Differences in drug response among patients are common, often leading to challenges in targeting the therapeutic window and optimizing the treatment. Major drugs are reported to be effective in only 25% to 60% of patients. Two important factors responsible for the effective dose of drug are drug metabolism and clearance. Notably, CYP3A4 is the main enzyme responsible for drug metabolism in hepatocytes; variations in its activity result in dose uncertainty. To improve drug’s effectiveness, this thesis work focuses on the development of nanocarriers loaded with natural CYP3A4-inhibiting molecules and targeting hepatocytes, to be administered prior to the drug to minimize its metabolism. A methodology to systematically screen CYP3A4-inhibiting compounds and set the dose and schedule for in vivo use was developed. A first proof-of-concept was demonstrated using a furanocoumarin-loaded micelle as CYP3A4-inhibiting compound: anti-tumor efficacy studies and quantification within tumor of the cytotoxic drug docetaxel, injected after furanocoumarin-loaded micelle, were engaged on two xenografted tumor models in mice. A second generation of nanocarriers was developed, with optimised physico-chemical properties to target specifically hepatocytes. The demonstration of their specific accumulation in hepatocytes and additional improvement in boosting of docetaxel was conducted. A perspective in using such an approach to enhance the effectiveness of existing drugs in oncology is discussed, notably for differentiated hepatocellular carcinoma.

A furosemida é um fármaco de ação diurética e amplamente utilizado em tratamentos de doenças renais, cardíacas e pulmonares. Sua absorção é problemática e de alta variabilidade inter e intraindividual. Este fármaco tem sido classificado como pertencente às classes II (baixa solubilidade e alta permeabilidade) ou IV (baixa permeabilidade e baixa solubilidade) do Sistema de Classificação de Biofarmacêutica (SCB). Em estudos anteriores da equipe de pesquisa, SPRICIGO e colaboradores (2008) e SILVA (2014) desenvolveram complexos de furosemida com hidroxipropil-&#946;-ciclodextrina que permitiram a otimização da solubilidade deste fármaco. Entretanto, dados sobre a sua permeabilidade intestinal, quando complexado, não foram determinados. Somando-se a isto, a literatura apresenta informações distintas em relação a este parâmetro, o que corrobora a importância de se avaliar a permeabilidade deste fármaco. Diversas técnicas têm sido empregadas para a avaliação da permeabilidade intestinal dos fármacos. No presente trabalho empregou-se o modelo de perfusão in situ de passagem tripla, cuja técnica possibilita avaliar a permeabilidade em três segmentos diferentes em um mesmo animal e ainda, apresenta características interessantes, pois trata-se de um método que proporciona, durante todo o experimento, condições mais próximas daquelas encontradas durante o processo in vivo de absorção de fármacos no intestino tais como: suprimento sanguíneo, inervação intacta, preservação das proteínas transportadoras de membranas e presença da camada de muco. O presente trabalho foi dividido nas seguintes etapas: (i) obtenção da furosemida complexada com hidroxipropil-&#946;-ciclodextrina, (ii) caracterização dos fármacos utilizando técnicas de análises térmicas, (iii) estudo de perfusão in situ de passagem tripla nos três segmentos intestinais (duodeno, jejuno e íleo) de ratos machos Wistar na ausência e na presença de inibidores da glicoproteína P e de enzimas metabolizadoras CYP3A4 com posterior análise estatística do impacto da ciclodextrina e inibidores na permeabilidade da furosemida e; (iv) análise histológica das microvilosidades intestinais após o ensaio de perfusão in situ nos três segmentos intestinais. Os valores encontrados em cada segmento para furosemida complexada foram: 8,58 ± 0,002 x 10-5 cm.s-1; 9,15 ± 0,003 x10-5 cm.s-1 e; 8,06 ± 0,002 x 10-5 cm.s-1, respectivamente para duodeno, jejuno e íleo enquanto que para furosemida pura encontraram-se os seguintes: 3,42 ± 0,08 x 10-5 cm.s-1 para duodeno; 3,87 ± 0,11 x 10-5 cm.s-1 para jejuno e 3,08 ± 0,001 x 10-5 cm.s-1 para íleo. Assim sendo, os valores obtidos para a permeabilidade da furosemida complexada foram significativamente superiores (p < 0,05) aos da furosemida pura, sugerindo que, a ciclodextrina pode ter influência no mecanismo de transporte da furosemida, que é via passiva paracelular. Quanto aos mecanismos envolvidos na permeabilidade da furosemida através dos enterócitos, pode-se sugerir que observou-se pouca influência dos inibidores da glicoproteína P (P-gp) e da enzima CYP3A4, sugerindo que não há uma participação importante destes mecanismos em sua absorção intestinal. / Furosemide, which is a diuretic drug, is widely used in heart, kidney and pulmonary disease treatments. The absorption is problematic with high variability inter and intra individuals. This drug has been classified as belonging to class II (low solubility and high permeability) or IV (low permeability and low solubility) of the Biopharmaceutical Classification System (BCS). In previous studies of the research team, Spricigo and colleagues (2008) and Silva (2014) developed complex of furosemide with hydroxypropyl-&#946;-cyclodextrin which allowed the optimization of the solubility of this drug. However, datas concerning it\'s intestinal permeability, when complexed, have not been determined. Addicted to this, the literature shows many information regarding to this parameter, which confirms the importance of the evaluation of the permeability of this drug. Some techniques have been employed in order to evaluate the intestinal permeability of drugs. In the present work, a triple single-pass intestinal perfusion technique was used for three different segments. This technique enables the evaluation of the permeability of different segments in the same animal and also has interesting features such as: it provides during all the experiment conditions closer to those found in in vivo process of a drug absorption in the gut; blood supply; intact innervations; preservation of membrane transporter proteins and presence of mucus layer. This study was divided into the following steps: (i) obtaining furosemide complexed with hydroxypropyl-&#946;-cyclodextrin, (ii) characterization of drugs using techniques of thermal analysis, (iii) perfusion study in situ triple passage in three segments (duodenum, jejunum and ileum) from male Wistar rats in the absence and presence of inhibitors of P-glycoprotein and metabolizing enzymes CYP3A4 and subsequential statistical analysis of the impact of the cyclodextrin and the inhibitors in the permeability of furosemide and (iv) histological analysis of intestinal microvilli after in situ perfusion assay in three segments. The values found in each segment for complexed furosemide were: 8,58 ± 0,002 x 10-5 cm.s-1; 9,15 ± 0,003 x 10-5 cm.s-1; 8,06 ± 0,002 x 10-5 cm.s-1, respectively for duodenum, jejunum and ileum while for pure furosemide, the values were: 3,42 ± 0,08 x 10-5 cm.s-1 to duodenum; 3,87 ± 0,11 x 10-5 cm.s-1 to jejunum and 3,08 ± 0,001 x 10-5 cm.s-1 to ileum. Thus, the values obtained for the permeability of the complexed furosemide were significantly higher (p < 0,05) than those found for pure furosemide, suggesting that the cyclodextrin might have an influence on the transport mechanism of furosemide, which is passive paracellular route. About the mechanisms involved in the permeability of furosemide through the enterocytes, it can be suggested that there was little effect of P-glycoprotein (P-gp) inhibitors and CYP3A4 enzyme, suggesting that there is an important role of these mechanisms in the furosemide intestinal absorption.

De plus en plus d’inhibiteurs de kinase (IKs) sont testés dans le cancer de la prostate qui représente chez l’homme un enjeu de santé publique majeur de par son incidence (1er cancer) et sa mortalité (4ème cancer). Les essais cliniques pour évaluer l'efficacité des IKs dans cette indication ont donné des résultats mitigés malgré la présence de leurs cibles pharmacologiques dans les tumeurs de prostate (VEGF, EGFR, CMET..), pouvant faire penser que l’inefficacité serait en partie liée à la molécule elle-même et à sa pharmacocinétique/pharmacodynamie. En effet, les IKs sont sujets à un métabolisme et un transport intense via des enzymes de phase I et II et des transporteurs contrôlés pour la majorité par le récepteur nucléaire PXR (Pregnane X Receptor, gène NR1I2). En plus d’être abondamment exprimé dans le foie et le long du tractus gastro-intestinal, PXR est également exprimé dans certaines tumeurs épithéliales et pourrait être impliqué dans la résistance aux chimiothérapies par augmentation du catabolisme et de l’efflux de ces agents anticancéreux. A ce jour une seule étude a révélé l’expression de PXR dans le cancer de la prostate sans en avoir évalué l’impact sur la réponse aux traitements utilisés dans cette indication. En collaboration avec le Pr G. Fromont, nous avons observé dans une cohorte de 449 patients que l’expression de PXR était plus fréquemment retrouvée dans les cancers résistants à la castration et les métastases, par rapport aux cancers cliniquement localisés dans lesquels l’expression de PXR était corrélée avec le stade TNM et le score ISUP. Ces résultats confirment donc l’intérêt d’étudier le rôle que peut jouer PXR et les gènes du métabolisme et du transport qu’il régule, dans la sensibilité aux IKs dans les cancers de la prostate.Nous avons mesuré l’expression de PXR et de ses gènes cibles dans les lignées de cancer de la prostate 22RV1, LnCap, PC3 et DU145. Les résultats montrent une expression significative des enzymes et transporteurs responsables de la détoxication des IKs mais une faible expression de PXR liée à des phénomènes d’hyperméthylation NR1I2 dans nos lignées Cela nous a conduit à établir des modèles de surexpression stable de PXR dans lesquels l’agoniste SR12813 est capable d’induire l’activité transcriptionnelle de ce xénorécepteur, indiquant la compétence métabolique de ces lignées. À l'aide de ces modèles, nous avons démontré que la surexpression de PXR module la réponse à l’erlotinib, le dasatinib, le dabrafénib et l’afatinib démontrant que PXR joue un rôle fonctionnel dans la sensibilité à ces IKs. Nous avons également démontré que certains inhibiteurs avaient des propriétés agonistes de PXR, notamment le dabrafénib qui montre un effet agoniste plus marqué que le composé de référence SR12813, ce qui n’a jamais été démontré. Cette découverte originale nous a conduit à engager une collaboration pour tenter de cristalliser le complexe PXR/dabrafénib et à tester l’hypothèse que l’induction de l’activité PXR pouvait entraîner une modification du métabolisme et/ou du transport d’autres médicaments co-administrés. Or, nous avons observé dans la lignée 22RV1 un effet additif entre le dabrafénib et le tramétinib, une combinaison approuvée dans le traitement du mélanome, qui devient antagoniste lorsque PXR est surexprimé, résultat qui va effectivement dans le sens de notre hypothèse même s’il reste à démontrer que cet effet est bien lié à une altération du métabolisme de ces IKs, ce que nous sommes en train d’évaluer en dosant les métabolites de ces IKs. L’ensemble de nos données pourraient servir de rationnel biologique dans le choix des IKs ou de leurs combinaisons à tester avec les hormonothérapies et chimiothérapies déjà utilisés dans le traitement du cancer de la prostate, afin de potentialiser la réponse tumorale. / More and more kinase inhibitors (KIs) are tested in prostate cancer that represents a major health issue in men with its incidence and mortality rates. Clinical trials to evaluate KIs efficacy in prostate cancer gave disapointing results depsite the presence of KIs pharmacological targets in prostate tumors (VEGF, EGFR, CMET..), suggesting that inefficiency of these drugs would be at least in part linked to the inhibitor itself or its pharmacodynamics/pharmacokinetics parameters. Indeed KIs are metabolized and transported via phase I and II enzymes that are mainly controlled by the xenoreceptor PXR (Pregnane X Receptor, gène NR1I2). It is mainly expressed in liver and gastro-intestinal tract but also in epithelial tumors. PXR is also involved in the resistance to chemotherapies by increasing the catabolism and the efflux of these anticancer agents. To date only one study evaluated PXR expression in prostate cancer without evaluating its impact on treatment efficacy. In collaboration with Pr G. Fromont we analyzed a cohort of 449 prostate tumors and observed that PXR was more frequently detected in castration resistant or metastatic tumors as compared to clinically localized forms in which PXR expression was significantly correlated with TNM and ISUP Score. These results confirmed the interest to study the potential role of PXR and its target genes in the sensitivity to kinase inhibitors in prostate cancer models.We measured the expression of PXR and its target genes in prostate cancer cell lines 22RV1, LnCap, PC3 and DU145. The results showed that enzymes and transporters involved in KI detoxification was significantly expressed in these cells whereasPXR was poorly expressed due to hypermethylation of NR1I2 in our cells. This lead us to develop specific prostate cancer cell models stably overexpressing PXR in which transcriptional activity of PXR can be induced by its known agonist SR12813 further indicating that prostate cancer cells are metabolically competent. Using these models we showed that PXR overexpression modulates the sensitivity of 22RV1 cells to erlotinib, dasatinib, dabrafenib and afatinib, demonstrating that PXR plays a functional role in the sensitivity to KIs. We also demonstrated that several KIs were PXR agonists, including dabrafenib that displayed enhanced agonistic properties as compared to SR12813, a result that was never published before. This original finding led us to engage the cristalization of PXR/dabrafenib complex and to test whether induction of PXR could lead to an alteration of metabolism and transport of other drugs that are co-administered. In this line we have observed that in 22RV1 cells the additive effect of the combination of dabrafenib with trametinib that is already approved in the treatment of melanomas, became antagonistic when PXR was overexpressed in these cells. This result is supporting our hypothesis though we still need to demonstrate that this effect is linked to a change in drugs metabolism, which is currently under investigation by the measurement of the known metabolites of these KIs.Altogether, our data could serve as rational basis for the choice of kinase inhibitors or their potential combinations that could be tested in further clinical trials alone or in association with hormone therapies or with chemotherapies that are currently prescribed in the treatment of advanced prostate cancers, in order to potentiate tumor response.

No description available.

A furosemida é um fármaco de ação diurética e amplamente utilizado em tratamentos de doenças renais, cardíacas e pulmonares. Sua absorção é problemática e de alta variabilidade inter e intraindividual. Este fármaco tem sido classificado como pertencente às classes II (baixa solubilidade e alta permeabilidade) ou IV (baixa permeabilidade e baixa solubilidade) do Sistema de Classificação de Biofarmacêutica (SCB). Em estudos anteriores da equipe de pesquisa, SPRICIGO e colaboradores (2008) e SILVA (2014) desenvolveram complexos de furosemida com hidroxipropil-&#946;-ciclodextrina que permitiram a otimização da solubilidade deste fármaco. Entretanto, dados sobre a sua permeabilidade intestinal, quando complexado, não foram determinados. Somando-se a isto, a literatura apresenta informações distintas em relação a este parâmetro, o que corrobora a importância de se avaliar a permeabilidade deste fármaco. Diversas técnicas têm sido empregadas para a avaliação da permeabilidade intestinal dos fármacos. No presente trabalho empregou-se o modelo de perfusão in situ de passagem tripla, cuja técnica possibilita avaliar a permeabilidade em três segmentos diferentes em um mesmo animal e ainda, apresenta características interessantes, pois trata-se de um método que proporciona, durante todo o experimento, condições mais próximas daquelas encontradas durante o processo in vivo de absorção de fármacos no intestino tais como: suprimento sanguíneo, inervação intacta, preservação das proteínas transportadoras de membranas e presença da camada de muco. O presente trabalho foi dividido nas seguintes etapas: (i) obtenção da furosemida complexada com hidroxipropil-&#946;-ciclodextrina, (ii) caracterização dos fármacos utilizando técnicas de análises térmicas, (iii) estudo de perfusão in situ de passagem tripla nos três segmentos intestinais (duodeno, jejuno e íleo) de ratos machos Wistar na ausência e na presença de inibidores da glicoproteína P e de enzimas metabolizadoras CYP3A4 com posterior análise estatística do impacto da ciclodextrina e inibidores na permeabilidade da furosemida e; (iv) análise histológica das microvilosidades intestinais após o ensaio de perfusão in situ nos três segmentos intestinais. Os valores encontrados em cada segmento para furosemida complexada foram: 8,58 ± 0,002 x 10-5 cm.s-1; 9,15 ± 0,003 x10-5 cm.s-1 e; 8,06 ± 0,002 x 10-5 cm.s-1, respectivamente para duodeno, jejuno e íleo enquanto que para furosemida pura encontraram-se os seguintes: 3,42 ± 0,08 x 10-5 cm.s-1 para duodeno; 3,87 ± 0,11 x 10-5 cm.s-1 para jejuno e 3,08 ± 0,001 x 10-5 cm.s-1 para íleo. Assim sendo, os valores obtidos para a permeabilidade da furosemida complexada foram significativamente superiores (p < 0,05) aos da furosemida pura, sugerindo que, a ciclodextrina pode ter influência no mecanismo de transporte da furosemida, que é via passiva paracelular. Quanto aos mecanismos envolvidos na permeabilidade da furosemida através dos enterócitos, pode-se sugerir que observou-se pouca influência dos inibidores da glicoproteína P (P-gp) e da enzima CYP3A4, sugerindo que não há uma participação importante destes mecanismos em sua absorção intestinal. / Furosemide, which is a diuretic drug, is widely used in heart, kidney and pulmonary disease treatments. The absorption is problematic with high variability inter and intra individuals. This drug has been classified as belonging to class II (low solubility and high permeability) or IV (low permeability and low solubility) of the Biopharmaceutical Classification System (BCS). In previous studies of the research team, Spricigo and colleagues (2008) and Silva (2014) developed complex of furosemide with hydroxypropyl-&#946;-cyclodextrin which allowed the optimization of the solubility of this drug. However, datas concerning it\'s intestinal permeability, when complexed, have not been determined. Addicted to this, the literature shows many information regarding to this parameter, which confirms the importance of the evaluation of the permeability of this drug. Some techniques have been employed in order to evaluate the intestinal permeability of drugs. In the present work, a triple single-pass intestinal perfusion technique was used for three different segments. This technique enables the evaluation of the permeability of different segments in the same animal and also has interesting features such as: it provides during all the experiment conditions closer to those found in in vivo process of a drug absorption in the gut; blood supply; intact innervations; preservation of membrane transporter proteins and presence of mucus layer. This study was divided into the following steps: (i) obtaining furosemide complexed with hydroxypropyl-&#946;-cyclodextrin, (ii) characterization of drugs using techniques of thermal analysis, (iii) perfusion study in situ triple passage in three segments (duodenum, jejunum and ileum) from male Wistar rats in the absence and presence of inhibitors of P-glycoprotein and metabolizing enzymes CYP3A4 and subsequential statistical analysis of the impact of the cyclodextrin and the inhibitors in the permeability of furosemide and (iv) histological analysis of intestinal microvilli after in situ perfusion assay in three segments. The values found in each segment for complexed furosemide were: 8,58 ± 0,002 x 10-5 cm.s-1; 9,15 ± 0,003 x 10-5 cm.s-1; 8,06 ± 0,002 x 10-5 cm.s-1, respectively for duodenum, jejunum and ileum while for pure furosemide, the values were: 3,42 ± 0,08 x 10-5 cm.s-1 to duodenum; 3,87 ± 0,11 x 10-5 cm.s-1 to jejunum and 3,08 ± 0,001 x 10-5 cm.s-1 to ileum. Thus, the values obtained for the permeability of the complexed furosemide were significantly higher (p < 0,05) than those found for pure furosemide, suggesting that the cyclodextrin might have an influence on the transport mechanism of furosemide, which is passive paracellular route. About the mechanisms involved in the permeability of furosemide through the enterocytes, it can be suggested that there was little effect of P-glycoprotein (P-gp) inhibitors and CYP3A4 enzyme, suggesting that there is an important role of these mechanisms in the furosemide intestinal absorption.

La transplantation hépatique est une technique chirurgicale maîtrisée, mais le devenir à long terme du greffon et de l’hôte doit encore être amélioré. L’étude pharmacogénétique des inhibiteurs de la calcineurine (CNI) devrait permettre de comprendre la variabilité de leurs effets thérapeutiques et toxiques. Dans un premier temps, nous avons réalisé une revue de la littérature concernant la pharmacogénétique des CNI en greffe d’organe et surtout hépatique en particulier les trois polymorphismes les plus impliqués dans la pharmacocinétique des CNI (CYP3A4*22, CYP3A5*3 et ABCB1 exons 12, 21, 26) et leurs éventuelles associations avec le devenir clinique du patient. L’état actuel des connaissances valide l’intérêt du génotype CYP3A5*3 pour adapter au mieux la posologie précoce de tacrolimus seulement en greffe rénale. Dans un second temps, nous avons mené une étude de cohorte rétrospective visant à étudier la pertinence et l’intérêt des génotypes du donneur et du receveur d’organe mentionnés précédemment, intervenant dans le métabolisme (CYP3A4*22, CYP3A5*3) et le transport membranaire (ABCB1 exons 12, 21 et 26) de la cyclosporine et du tacrolimus en transplantation hépatique. 170 patients avec un suivi de plus de 10 ans en moyenne ont été inclus. Les principaux résultats montrent que : l’allèle CYP3A5 *1 du receveur était associé significativement à un risque plus élevé de perte de greffon à long terme comparé à l’allèle CYP3A5 *3 ; l’allèle TT de l’exon 12 d’ABCB1 du receveur était associé à un risque moins élevé de rejet chronique ; et l’exposition à des doses élevées de CNI, la valeur initiale de la fonction rénale et l’âge du receveur étaient également indépendamment associés au risque d’altération de la fonction rénale. La caractérisation de ces marqueurs pharmacogénétiques en transplantation hépatique pourrait permettre d’adapter les traitements immunosuppresseurs pour chaque patient transplanté. D’autres voies de recherche (pharmacogénétique de la voie calcineurine, biomarqueurs précoces des lésions du greffon, ...) seront nécessaires pour identifier un profil personnalisé pour chaque greffé afin d’adapter au mieux la stratégie thérapeutique à long terme. / Liver transplantation is now a well mastered surgery with standardized procedures, but the long-term clinical outcomes of the graft and the patient remain uncertain. The pharmacogenetic study of the calcineurin inhibitors (CNI) cyclosporine and tacrolimus should help to understand the variability of their pharmacokinetics and therapeutic or side effects. In the first part of this work, we reviewed the main pharmacogenetic studies of CNI in liver transplantation, focusing on the three polymorphisms mostly involved in CNI pharmacokinetics (CYP3A4*22, CYP3A5*3 et ABCB1 exons 12, 21, 26) and their possible associations with clinical outcomes. To date, the only pharmacogenetic test consensually recommended in organ transplantation is the CYP3A5*3 variant for a better selection of the initial tacrolimus dose in kidney transplantation. The second part of this work was a retrospective cohort study in liver transplantation to investigate the influence of the above mentioned donor’s and recipient’s genotypes, involved in the metabolism (CYP3A4*22, CYP3A5*3) and the membrane transport (ABCB1 exons 12, 21 and 26) of cyclosporine and tacrolimus. 170 patients were enrolled in this study with a mean follow-up of more than ten years. Our main results are that: the recipient CYP3A5*1 allele was associated with a higher risk of graft loss than the CYP3A5*3 allele; the recipient ABCB1 exon 12 TT genotype was associated with a lower risk of chronic rejection than the CC genotype; overexposure to CNI, initial renal function and recipient age were associated with a higher risk of post-transplantation renal dysfunction. No genetic factor was associated with patient survival, acute rejection, liver function tests, recurrence of viral or other initial liver disease, or nephrotoxicity. Prospective characterization of both recipient and donor CYP3A4, CYP3A5 and ABCB1 polymorphisms could help to optimize immunosuppressive therapy for each candidate to liver transplantation. Further studies (pharmacogenetics of calcineurin pathway, early biomarkers of graft dysfunction, ...), should help to define a personalized profile for each transplant patient in order to best adapt the immunosuppressive strategy on the long term.

Background: Abdominal solid organ transplantation has evolved from an experimental procedure to a well-established therapy within a few decades. This success is largely due to the introduction of calcineurin inhibitor immunosuppression. Tacrolimus is the most widely used calcineurin inhibitor but has a narrow therapeutic range which requires close drug monitoring to prevent both toxicity and inadequate immunosuppression. Previous studies in renal transplantation have shown that genetic polymorphisms, CYP3A5, CYP3A4*22 and ABCB1 can influence the bioavailability and pharmacokinetics of tacrolimus. These polymorphisms are closely linked to ethnicity and have never been studied in a Scottish population before. Additionally, increasing evidence suggests that high variability of tacrolimus is linked to increased graft loss in kidney transplant patients. Methods: 5889 subjects were genotyped for the genetic polymorphisms CYP3A5 A > G allele transition, CYP3A4*22 C > T and ABCB1 C > T transition. This included 4899 healthy individuals from Generation Scotland bio-resource and 990 patients who underwent renal, liver, or simultaneous pancreas kidney transplants or were organ donors. Tacrolimus dose, trough level and renal function were measured at 11 time points from date of transplant up to and including 12 months post-transplant. Clinical data including episodes of acute rejection, graft and patient survival were compared between the different genotypes. Separate analyses were undertaken for kidney, SPK transplants, as well as liver transplants, the latter looking at recipient and liver donor genotype. A separate cohort of 103 renal transplant patients converted from twice-daily to once-daily tacrolimus had their tacrolimus variability calculated and compared with graft survival. Results: The distribution of the 3 different genotypes of CYP3A5, CYP3A4*22 and ABCB1 were comparable with other Caucasian populations studied previously. In renal transplant recipient expression of the A allele (GA/AA) led to significantly increased dose requirements of tacrolimus and initially lower tacrolimus trough levels. The different genotypes of ABCB1 had no effect. Expression of a CYP3A4*22 T allele trended towards a lower tacrolimus dose requirement but this was not significant. There was no difference in renal function, graft survival or patient survival with any of the polymorphisms. SPK patients had comparable results. In the liver transplant patients, the donor genotype had a greater influence than the recipient one. The donors with CYP3A5 A allele expression had significantly higher tacrolimus dose requirements and lower initial tacrolimus levels. This was apparent to a lesser extent with the recipient expression of CYP3A5 and did not reach statistical significance at all time points. There was no significant difference in tacrolimus dose requirements or level with either donor or recipient expression of ABCB1 or CYP3A4*22. There was a significantly higher incidence of acute rejection in donor CYP3A5 A allele expressers of liver transplant patients in univariate and multivariate analysis. There was no significant different in acute rejection with ABCB1 or CYP3A4*22 genotype. No differences in graft or patient survival with either donor or recipient genotype of any of the 3 polymorphisms were noted. Conversion from twice-daily to once-daily tacrolimus in the first 12 months post-transplant reduced tacrolimus variability. Patients with high tacrolimus variability pre and post conversion had significantly greater graft loss than patients with low tacrolimus variability. Conclusion: CYP3A5 expression results in increased tacrolimus requirements to achieve adequate immunosuppression in renal transplant and SPK patients. Donor rather than recipient CYP3A5 expression is relevant for liver transplantation and dose requirements. There may be an association with donor CYP3A5 expression in liver transplant patients and acute rejection which needs further evaluation. ABCB1 and CYP3A4*22 do not appear to have a significant impact in any of the organ transplants. High tacrolimus variability is associated increased graft loss in renal transplant patients.

The bioavailability of a drug can be described as the fraction of an orally administered dose that reaches the systemic circulation and is often limited by first-pass metabolism in the gut and the liver. It is important to have knowledge about these processes since the systemic blood drug concentration is tightly connected to the effect of the drug. The general aim of this project was to quantitatively examine the role of the intestine in relation to the liver in first-pass metabolism of orally administered drugs. The first-pass metabolism of verapamil and raloxifene was investigated in detail with in vivo, in vitro and simulation studies, using the pig as an experimental model. The intestine contributed to the same extent as the liver to first-pass metabolism of R/S-verapamil in vivo in pigs. The S-isomer of verapamil was found in lower plasma concentrations compared to the R-isomer after oral dosing. The in vitro metabolism of verapamil in pig and human liver showed interspecies similarity and indicated equal intrinsic clearance for R- and S-verapamil. Through physiologically based pharmacokinetic modeling the stereoselectivity was explained by a combination of several processes, including enantioselective plasma protein binding, blood-to-plasma partition, and gut and liver tissue distribution. For raloxifene the intestine was the dominating organ in first-pass glucuronidation in vivo in pigs. Furthermore, the raloxifene concentration entering the intestine or the dose administered in the gut did not influence the plasma PK of raloxifene and indicated that the intestinal metabolism was not saturable with clinical relevant doses. For both verapamil and raloxifene, a time-dependent hepatic metabolism was noted with major consequences to the pharmacokinetic of the drugs. This project has pointed out the importance of intestinal metabolism in the overall first-pass extraction of drugs and indicates that intestinal metabolism should be considered and evaluated early in drug development.