La mucoviscidose est une maladie génétique présentant des altérations ioniques causées par une protéine membranaire défectueuse ou inexistante la CFTR entraînant des perturbations métaboliques. Nous sommes intéressés à l’altération du métabolisme des acides gras polyinsaturés (AGPI) n-3 et n-6, caractérisé par une déficience en acides linoléique (LA) et docosahexaénoïque (DHA) et une élévation de l’acide arachidonique (AA). Ce déséquilibre peut être préjudiciable à l’état des patients du fait du rôle clé de certains AGPI à différents niveaux de la vie. Nos travaux ont portés sur la recherche des bénéfices d’un vecteur riche en un AGPI n-3 d’intérêt, le DHA, dans le contexte de la mucoviscidose à travers deux approches : une approche par supplémentation réalisée chez un modèle murin présentant la mutation la plus répandue chez les patients, et une approche sur un modèle d’entérocyte humain afin d’étudier de façon plus approfondie l’intérêt du supplément sur la fonctionnalité cellulaire (absorption des nutriments lipidiques). Nos résultats nous ont conduits à différentes conclusions : les souris delF508 nourries avec du Peptamen Junior présentent une perturbation du métabolisme des n-6 (LA, AA) dès l’âge de 3 mois ; cette altération apparaît mais plus tard sous régime standard. Par contre, quelque soit le régime alimentaire notre modèle ne développe pas de déficience en DHA jusqu’à l’âge d’1 an. L’évolution du statut en AGPI n-6 est donc dépendante du régime et de l’âge. L’apport de glycérophospholipides enrichis en DHA administré à faible dose permet de corriger les perturbations en AGPI n-6 et d’augmenter le rapport en DHA/AA dans la plupart des organes. Ce vecteur s’avère potentiellement intéressant en nutrithérapie chez le patient. Un enrichissement physiologique en DHA de l’entérocyte ne modifie pas ses capacités absorptives qui sont plutôt régulées par le type de particules véhiculant les produits de lipolyses, micelles de sels biliaires versus liposomes. / Cystic fibrosis is a genetic disease showing ionic alterations, caused by an absent or defective membrane protein CFTR leading to metabolic disturbances. We are interested in n-6 and n-3 polyunsaturated fatty acid (PUFA) metabolism alteration characterized by a linoleic (LA) and docosahexaenoic (DHA) acids deficiency and high level of arachidonic acid (AA). This imbalance can affect patient health due to the key role of some PUFAs in different levels of life. Our studies focused on finding the benefits of a vector enriched in one interesting n-3 PUFA, DHA, in context of cystic fibrosis, through two approaches: a nutritional supplementation conducted in a mouse model with the most common mutation of cystic fibrosis patients, and an approach on a model of human enterocyte to investigate more thoroughly the effect of the vector on cell functionality (absorption of lipid nutrients). Our results led us to different conclusions: del F508 mice fed with Peptamen Junior have a metabolic disorder of the n-6 PUFA (LA, AA) at the age of 3 months, but this alteration appears later under standard regime . But, whatever the diet, our model does not develop a DHA deficiency to the age of 1 year. The changing status of n-6 is dependent on diet and age. Glycerophospholipids enriched in DHA given at low doses can correct disturbances in PUFA n-6 and increase the DHA/AA ratio in most organs. This vector is potentially interesting for a patient nutritherapy. A physiological DHA enrichment of enterocyte does not alter its absorption capacity, which is rather regulated by the type of particles carrying the lipolysis products, bile salt micelles versus liposomes.

Charles University Faculty of Pharmacy in Hradec Králové Department of Pharmacology & Toxicology Student: Dominika Bezděková Supervisor: doc. PharmDr. Lukáš Červený, Ph.D. Title of diploma thesis: IN VITRO STUDY OF DRUG-DRUG INTERACTIONS OF HIV PROTEASE INHIBITOR DARUNAVIR ON EFFLUX ABC TRANSPORTERS Abstract: Darunavir is a drug used in the therapy of HIV belonging to the group of protease inhibitors. These protease inhibitors are used as a part of the combination antiretroviral therapy. For the increase of bioavailability, darunavir is always used in combination with ritonavir or cobicistat. As the CYP3A4 and ABCB1 (P-glycoprotein) transporter substrate, darunavir is a drug with a high potential to drug interactions. Considering the amount of adverse effects that can be caused by darunavir, it is necessary to know these drug interactions for the safety of therapy. Inhibition of the intestinal ABCB1 by the co-administrated drugs could also lead to the increased bioavailability of darunavir and to reduction of frequency of administration leading to a cheaper therapy. This thesis studies the drug-drug interactions of darunavir with in vitro methods using two cell lines - MDCKII and Caco-2 cells. The results from the transport of darunavir across the MDCKII cell monolayer indicates that darunavir is a ABCB1...

Patients on anti-retroviral (ARV) drug treatment are sometimes simultaneously taking other prescribed drugs and/or over-the-counter drugs and/or herbal remedies. Pharmacokinetic drug-drug or herb-drug interactions can occur in these patients, which might be synergistic or antagonistic in nature leading to increased or decreased bioavailability of the ARV. Consequences of bioavailability changes may either be adverse effects due to increased plasma levels, or lack of pharmacological responses due to decreased plasma levels. The aim of this study is to determine if pharmacokinetic interactions exist between selected commercially available herbal products, namely Linctagon Forte®, Viral Choice® and Canova® and the ARV, indinavir, in terms of transport and metabolism in cell culture models. Bi-directional transport of indinavir was evaluated across Caco-2 cell monolayers in four experimental groups, namely indinavir alone (200 μM, negative control group), indinavir in combination with Linctagon Forte®, indinavir in combination with Viral Choice® and indinavir in combination with Canova® at three different concentrations. Verapamil (100 μM), a known P-gp inhibitor, was combined with indinavir in the positive control group. Samples obtained from the transport studies were analysed by means of a validated high performance liquid chromatography (HPLC) method. The apparent permeability coefficient (Papp) values were calculated from the transport results in both directions and the efflux ratio (ER) values were calculated from these Papp values. The metabolism of indinavir was determined in LS180 cells in the same groups as mentioned for the transport study but with ketoconazole (40 μM), a known CYP3A4 inhibitor, as the positive control group. Indinavir and its predominant metabolite (M6) were analysed in the metabolism samples by means of liquid chromatography linked to mass spectroscopy (LC/MS/MS) to determine the effect of the herbal products on the biotransformation of indinavir. The BL-AP transport of indinavir increased in a concentration dependent way in the presence of Linctagon Forte® and Viral Choice® when compared to that of indinavir alone (control group). Canova® only slightly affected the efflux of indinavir compared to that of the control group. Noticeable increases in the efflux ratio values of indinavir were found for Linctagon Forte® and Viral Choice®, whilst the effect of Canova® on the efflux ratio value was negligible. There was a pronounced inhibition of the metabolism of indinavir in LS180 cells over the entire concentration range for all the herbal products investigated in this study. These in vitro pharmacokinetic interactions indicate the selected herbal products may affect indinavir’s bioavailability, but the clinical significance needs to be confirmed with in vivo studies before final conclusions can be made. / MSc (Pharmaceutics), North-West University, Potchefstroom Campus, 2015

A crucial step in the drug discovery and development process is the assessment of membrane permeability properties of new chemical entities and researchers are constantly searching for cost-effective, high through-put models with as high as possible predictive value. In addition, a thorough understanding of the membrane permeability pathways and metabolism mechanisms are required when evaluating drug disposition and pharmacokinetics. Various in vitro methods/techniques are available to measure the rate of permeation of compounds across epithelial cell membranes to estimate oral drug absorption in humans. The aim of this study is to compare three in vitro models (i.e. excised rat intestinal tissue, excised pig intestinal tissue and Caco-2 human cell cultures) in terms of drug permeability characteristics by means of different techniques including the Ussing type Sweetana-Grass diffusion chamber apparatus, everted sac glass apparatus and the Transwell® plate apparatus. The transport of abacavir sulphate was determined in two directions (i.e. apical-to-basolateral or AP - BL and basolateral-to-apical or BL - AP) across excised rat intestinal tissue, excised pig intestinal tissue and Caco-2 cell monolayers. The test solution was applied to the donor side and samples (200 μl) were drawn from the acceptor side at 20 min intervals for a period of 2 h. The concentration of abacavir in the samples was then measured by means of a validated high performance liquid chromatography (HPLC) method. The transepithelial electrical resistance (TEER) was measured before and after each transport experiment to give an indication of the integrity of the cell membranes. The apparent permeability coefficient (Papp) and efflux ratio (ER) values were calculated and used to compare the different methods and techniques in terms of drug permeation characteristics. All three of the in vitro methods, in all of the techniques employed, showed higher transport of abacavir in the BL - AP direction than in the AP - BL direction. This indicates that all three in vitro methods had intact active efflux transporters over the entire study period. The excised rat intestinal method showed similar drug permeability characteristics in both techniques compared to that of the Caco-2 cell monolayers. In contrast, the excised pig intestinal method only showed similar drug permeability characteristics in the Sweetana-Grass diffusion apparatus when compared to the Caco-2 cell monolayers. This phenomenon can possibly be explained by the relatively large surface area of the pig tissue used in the everted sac technique where the role of physiological and other factors take effect. These factors may include the thickness of the membrane and mucus layer as well as variables such as diet, age, gender and size of the pigs obtained from the abattoir that cannot be controlled. / MSc (Pharmaceutics), North-West University, Potchefstroom Campus, 2015

Patients on anti-retroviral (ARV) drug treatment are sometimes simultaneously taking other prescribed drugs and/or over-the-counter drugs and/or herbal remedies. Pharmacokinetic drug-drug or herb-drug interactions can occur in these patients, which might be synergistic or antagonistic in nature leading to increased or decreased bioavailability of the ARV. Consequences of bioavailability changes may either be adverse effects due to increased plasma levels, or lack of pharmacological responses due to decreased plasma levels. The aim of this study is to determine if pharmacokinetic interactions exist between selected commercially available herbal products, namely Linctagon Forte®, Viral Choice® and Canova® and the ARV, indinavir, in terms of transport and metabolism in cell culture models. Bi-directional transport of indinavir was evaluated across Caco-2 cell monolayers in four experimental groups, namely indinavir alone (200 μM, negative control group), indinavir in combination with Linctagon Forte®, indinavir in combination with Viral Choice® and indinavir in combination with Canova® at three different concentrations. Verapamil (100 μM), a known P-gp inhibitor, was combined with indinavir in the positive control group. Samples obtained from the transport studies were analysed by means of a validated high performance liquid chromatography (HPLC) method. The apparent permeability coefficient (Papp) values were calculated from the transport results in both directions and the efflux ratio (ER) values were calculated from these Papp values. The metabolism of indinavir was determined in LS180 cells in the same groups as mentioned for the transport study but with ketoconazole (40 μM), a known CYP3A4 inhibitor, as the positive control group. Indinavir and its predominant metabolite (M6) were analysed in the metabolism samples by means of liquid chromatography linked to mass spectroscopy (LC/MS/MS) to determine the effect of the herbal products on the biotransformation of indinavir. The BL-AP transport of indinavir increased in a concentration dependent way in the presence of Linctagon Forte® and Viral Choice® when compared to that of indinavir alone (control group). Canova® only slightly affected the efflux of indinavir compared to that of the control group. Noticeable increases in the efflux ratio values of indinavir were found for Linctagon Forte® and Viral Choice®, whilst the effect of Canova® on the efflux ratio value was negligible. There was a pronounced inhibition of the metabolism of indinavir in LS180 cells over the entire concentration range for all the herbal products investigated in this study. These in vitro pharmacokinetic interactions indicate the selected herbal products may affect indinavir’s bioavailability, but the clinical significance needs to be confirmed with in vivo studies before final conclusions can be made. / MSc (Pharmaceutics), North-West University, Potchefstroom Campus, 2015

A crucial step in the drug discovery and development process is the assessment of membrane permeability properties of new chemical entities and researchers are constantly searching for cost-effective, high through-put models with as high as possible predictive value. In addition, a thorough understanding of the membrane permeability pathways and metabolism mechanisms are required when evaluating drug disposition and pharmacokinetics. Various in vitro methods/techniques are available to measure the rate of permeation of compounds across epithelial cell membranes to estimate oral drug absorption in humans. The aim of this study is to compare three in vitro models (i.e. excised rat intestinal tissue, excised pig intestinal tissue and Caco-2 human cell cultures) in terms of drug permeability characteristics by means of different techniques including the Ussing type Sweetana-Grass diffusion chamber apparatus, everted sac glass apparatus and the Transwell® plate apparatus. The transport of abacavir sulphate was determined in two directions (i.e. apical-to-basolateral or AP - BL and basolateral-to-apical or BL - AP) across excised rat intestinal tissue, excised pig intestinal tissue and Caco-2 cell monolayers. The test solution was applied to the donor side and samples (200 μl) were drawn from the acceptor side at 20 min intervals for a period of 2 h. The concentration of abacavir in the samples was then measured by means of a validated high performance liquid chromatography (HPLC) method. The transepithelial electrical resistance (TEER) was measured before and after each transport experiment to give an indication of the integrity of the cell membranes. The apparent permeability coefficient (Papp) and efflux ratio (ER) values were calculated and used to compare the different methods and techniques in terms of drug permeation characteristics. All three of the in vitro methods, in all of the techniques employed, showed higher transport of abacavir in the BL - AP direction than in the AP - BL direction. This indicates that all three in vitro methods had intact active efflux transporters over the entire study period. The excised rat intestinal method showed similar drug permeability characteristics in both techniques compared to that of the Caco-2 cell monolayers. In contrast, the excised pig intestinal method only showed similar drug permeability characteristics in the Sweetana-Grass diffusion apparatus when compared to the Caco-2 cell monolayers. This phenomenon can possibly be explained by the relatively large surface area of the pig tissue used in the everted sac technique where the role of physiological and other factors take effect. These factors may include the thickness of the membrane and mucus layer as well as variables such as diet, age, gender and size of the pigs obtained from the abattoir that cannot be controlled. / MSc (Pharmaceutics), North-West University, Potchefstroom Campus, 2015

In the gastrointestinal tract, probiotics have been shown to promote host immunity and to regulate immune signaling pathways. This study used Caco-2 cell line to examine the effects of a Lactobacillus rhamnosus isolate from “amabere amaruranu” a Kenyan traditional cultured milk, on the production inflammatory cytokines in enterocytes. Live Lactobacillus rhamnosus (MRS6AN), its cytoplasmic fraction (CF), filtered spent broth (FSB) or heat inactivated FSB (HIB) were used as treatments on differentiated Caco-2 cell monolayer in transwells. Cytokine content in the cell lysates, apical and basolateral supernatants were determined using ELISA. Caco-2 cell lysate treatments showed significantly increased anti-inflammatory TGF-β (ng/ml) levels on average about 100x more compared to the increase in pro-inflammatory IL-8 (pg/ml) levels. These levels were significantly reduced after inhibition of NF-κB. In conclusion, live Lactobacillus rhamnosus, its CF, FSB or HIB seemed to modulate the production of inflammatory cytokines in enterocytes partly via the NF-κB signaling pathway.

<p>The subject of this thesis was to study two intestinal barriers to oral drug bioavailability, drug efflux proteins of the ABC-transporter family, and in particular ABCB1/P-glycoprotein (Pgp), and the drug metabolizing enzyme cytochrome P450 (CYP) 3A4. At the onset of this thesis, similarities between CYP3A4 and Pgp in terms of their tissue distribution and gene regulation, along with overlapping substrate specificities, had generated the hypothesis that CYP3A4 and Pgp may have a complementary function and thus form a coordinated intestinal barrier to drug absorption and gut wall metabolism.</p><p>In the first part of this thesis, a cell culture model of the intestinal epithelium that expressed both functional Pgp and CYP3A4 was developed. This model was then used to investigate the steroselective drug efflux and metabolism of R/S-verapamil. In summary, the results indicated that the two barriers in the cell culture model were in agreement with those in the human intestine.</p><p>Both ABC-transporters and CYPs are regulated by drugs that interact with nuclear receptors. However, while the regulation of CYPs is quite well understood, less is known about how repeated drug administration regulates the most abundantly expressed ABC-transporters. Therefore, in the second part of this thesis, the effects of repeated drug administration on the gene regulation of four ABC-transporters and CYP3A4 were studied in intestinal epithelial cell lines in vitro and in the perfused human jejunum in vivo. The in vitro studies revealed that the ABC-transporters are induced by drugs that interact with slightly different sets of nuclear receptors. The in vivo study showed that repeated oral administration of St John’s wort decreased the bioavailability of verapamil, predominantly by induction of intestinal CYP3A4. This part of the thesis provides new information about the regulation of ABC-transporters, shows that the intestinal metabolism is the most significant barrier to oral bioavailability of verapamil and provides evidence for a clinically significant interaction between verapamil and St John’s wort in vivo.</p>

<p>The main objective of this thesis was to investigate the in vivo relevance of membrane transporters and cytochrome P450 (CYP) 3A4-mediated metabolism in the intestine and liver for the bioavailability of drugs in humans after oral administration.</p><p>In the first part of the thesis, the main transport mechanisms involved in the intestinal absorption and bioavailability were investigated for fexofenadine, a minimally metabolized drug, which is a substrate for P-glycoprotein (P-gp) and members of organic anion transporting polypeptide (OATP) family. Jejunal perfusion studies revealed that co-perfusion with verapamil increased the bioavailability of fexofenadine by decreasing the first-pass liver extraction as the low intestinal permeability was unchanged by the transport inhibitors studied. The mechanism behind the interaction probably involves inhibition of OATP-mediated sinusoidal uptake and/or P-gp-mediated canalicular secretion of fexofenadine. Results from the Caco-2 model supported that the intestinal absorption of fexofenadine is mainly determined by the low passive permeability of the drug, even though fexofenadine clearly is a P-gp substrate. </p><p>In the second part of the thesis, the effect of repeated oral administration of the P-gp and CYP3A4 inducer St. John’s wort on the in vivo intestinal permeability and presystemic metabolism of the dual P-gp and CYP3A4 substrate verapamil was investigated in a jejunal perfusion study. St. John’s wort decreased the bioavailability of the enantiomers of verapamil by inducing the CYP3A4-mediated presystemic metabolism, probably mainly in the gut. It was also concluded that induction of efflux transporters, such as P-gp, does not affect the intestinal transport or the gut wall extraction of high permeability substrates like verapamil. Data from Caco-2 cells with induced CYP3A4-activity supported these findings. The plasma levels of the enantiomers of norverapamil also decreased despite an increased formation, which was attributed to induction of CYP3A4 and/or other metabolic routes. </p>

<p>The aim of this study was to investigate the effect the plant matrix and the structure of the flavonoid (i.e. whether aglycone or glycoside) may have on the gastrointestinal uptake and metabolism of luteolin derivatives from Artemisia afra traditional plant medicine. Specifically, how these two factors influenced the intestinal uptake and disposition of luteolin derivatives in pure and in Artemisia afra plant extract forms were to be assessed by investigating the uptake and metabolism of the luteolin derivatives in human intestinal epithelial Caco-2 cells and the perfused rat intestinal loop. To realize this aim, the following were determined: (1) identification and characterization of major luteolin derivatives found in Artemisia afra, (2) the effect of the plant matrix on the uptake of luteolin derivatives in Artemisia afra aqueous-extract forms across the Caco-2 cell monolayer, (3) the effect of the plant matrix on the absorption and metabolism of luteolin derivatives in Artemisia afra aqueous-extract forms in the perfused rat small intestine, (4) the effect of gut contents on the uptake and metabolism of luteolin derivatives in intestinal loop and (5) the metabolic profiles of luteolin derivatives obtained for the pure solutions versus plant aqueous extract solutions in Caco-2 cells and the rat intestine.</p>