Thesis (M. Med. Sc.)--University of Hong Kong, 2001. / Includes bibliographical references (leaves 51-54).

Thesis (M.Med.Sc.)--University of Hong Kong, 2001. / Includes bibliographical references (leaves 51-54). Also available in print.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

A fexofenadina (FEX) tem sido o fármaco de primeira escolha no tratamento sintomático de manifestações alérgicas, por ser um anti-histamínico dos receptores H1 de 2ª geração não sedativo. É o metabólito ativo e quiral da terfenadina (TERF), medicamento cuja produção e comercialização foram suspensas em função dos eventos adversos apresentados. Fungos têm se apresentado como uma alternativa promissora na produção de compostos com atividade biológica. Dessa forma, o objetivo desse projeto foi avaliar a capacidade de fungos em biotransformar enantiosseletivamente a terfenadina em seu metabólito ativo, a fexofenadina empregando fungos como agentes catalisadores. Para a análise enantiosseletiva da fexofenadina foi desenvolvido um método de separação cromatográfica empregando a coluna quiral Lux® cellulose-1, fase móvel constituída de água: metanol (35:65, v/v) + 0,3% trietilamina + 0,4% ácido acético, vazão de 0,5 mL min-1, com detecção em 220nm. Duas microtécnicas de preparação de amostras foram avaliadas na extração dos analitos do meio de cultura: a microextração liquido-liquido dispersiva (DLLME) e a microextração em fase liquida empregando membranas cilíndricas ocas (HF-LPME). Entre essas, a DLLME foi a microtécnica de escolha, pois forneceu melhores resultados tais como, maior valor de recuperação, cromatogramas sem picos de possíveis interferentes, maior rapidez e facilidade de preparação das amostras. As condições otimizadas da DLLME foram: clorofórmio (300 ?L) como solvente extrator, isopropanol (300 ?L) como solvente dispersor. Após a formação do ponto nuvem, as amostras foram submetidas à agitação por vórtex durante 15 segundos e centrifugação durante 10 minutos a 3000 rpm. As recuperações foram de 43% para ambos enantiômeros. O método se mostrou linear na faixa de concentração 2.0 - 15.0 ?g mL-1 para cada enantiômero da FEX (r > 0,990). O limite de quantificação foi de 2 ?g mL-1 para os enantiômeros da FEX. Dentre os sete fungos estudados (Papulaspora immersa Hotson SS13, Penicillium crustosum VR4, Mucor rouxii, Nigrospora sphaerica SS67, Fusarium oxysporum SS50, Cunninghamella echinulata var. elegans ATCC 8688A e Cunninghamella elegans NRRL 1393 ATCC 10028B) somente o fungo Fusarium oxysporum SS50 e Cunninghamella echinulata var. elegans ATCC 8688A apresentaram potencial para biotransformação da terfenadina em fexofenadina nas condições de incubação empregadas nesse trabalho. / Fexofenadine (FEX) has been the drug of choice for the symptomatic treatment of allergic manifestations, being an antihistamine H1 receptor 2nd generation non-sedating. It is the active and chiral metabolite of terfenadine (TERF), a drug whose production and marketing was suspended as a result of adverse events. Fungi have been presented as a promising alternative for the production of compounds with biological activity. Thus, the goal of this project was to evaluate the ability of fungi to biotransform asymmetric terfenadine to its active metabolite, fexofenadine using fungi as agents catalysts. For enantioselective analysis of fexofenadine a method for chromatographic separation was developed employing a chiral column Lux® cellulose -1, mobile phase water : methanol (35:65,v/v) + 0.3% triethylamine + 0.4% acetic acid, flow rate of 0.5 mL min-1, with detection at 220nm. Two sample preparation microtechnology were evaluated in the extraction of analytes from the culture medium: the dispersive liquid-liquid microextraction (DLLME) and hollow fiber liquid phase microextraction (HF- LPME). Between the two, the DLLME was the microtechnic chosen because it provided better results such as higher recovery values, chromatograms with no possible interfering peaks, greater speed and ease of sample preparation. The optimized conditions of DLLME were: chloroform (300 ?L) as extractor solvent, isopropanol (300 ?L) as disperser solvent. After the formation of the cloud point, the samples were subjected to agitation by vortexing for 15 seconds and centrifuging for 10 minutes at 3000 rpm. The recoveries were 43 % for both enantiomers. The method was linear in the concentration range from 2.0 -15.0 ?g mL-1 for each enantiomer of FEX (r > 0.990). The limit of quantification was 2 ?g mL-1 for the enantiomers of FEX. Among the seven fungi studied (Papulaspora immersa Hotson SS13, Penicillium crustosum VR4, Mucor rouxii, Nigrospora sphaerica SS67, Fusarium oxysporum SS50, Cunninghamella echinulata var. elegans ATCC 8688A e Cunninghamella elegans NRRL 1393 ATCC 10028B), only the fungi Fusarium oxysporum SS50 e Cunninghamella echinulata var. elegans ATCC 8688A showed potential for biotransformation of terfenadine in fexofenadine in the incubation conditions employed in this work.

A fexofenadina (FEX) tem sido o fármaco de primeira escolha no tratamento sintomático de manifestações alérgicas, por ser um anti-histamínico dos receptores H1 de 2ª geração não sedativo. É o metabólito ativo e quiral da terfenadina (TERF), medicamento cuja produção e comercialização foram suspensas em função dos eventos adversos apresentados. Fungos têm se apresentado como uma alternativa promissora na produção de compostos com atividade biológica. Dessa forma, o objetivo desse projeto foi avaliar a capacidade de fungos em biotransformar enantiosseletivamente a terfenadina em seu metabólito ativo, a fexofenadina empregando fungos como agentes catalisadores. Para a análise enantiosseletiva da fexofenadina foi desenvolvido um método de separação cromatográfica empregando a coluna quiral Lux® cellulose-1, fase móvel constituída de água: metanol (35:65, v/v) + 0,3% trietilamina + 0,4% ácido acético, vazão de 0,5 mL min-1, com detecção em 220nm. Duas microtécnicas de preparação de amostras foram avaliadas na extração dos analitos do meio de cultura: a microextração liquido-liquido dispersiva (DLLME) e a microextração em fase liquida empregando membranas cilíndricas ocas (HF-LPME). Entre essas, a DLLME foi a microtécnica de escolha, pois forneceu melhores resultados tais como, maior valor de recuperação, cromatogramas sem picos de possíveis interferentes, maior rapidez e facilidade de preparação das amostras. As condições otimizadas da DLLME foram: clorofórmio (300 ?L) como solvente extrator, isopropanol (300 ?L) como solvente dispersor. Após a formação do ponto nuvem, as amostras foram submetidas à agitação por vórtex durante 15 segundos e centrifugação durante 10 minutos a 3000 rpm. As recuperações foram de 43% para ambos enantiômeros. O método se mostrou linear na faixa de concentração 2.0 - 15.0 ?g mL-1 para cada enantiômero da FEX (r > 0,990). O limite de quantificação foi de 2 ?g mL-1 para os enantiômeros da FEX. Dentre os sete fungos estudados (Papulaspora immersa Hotson SS13, Penicillium crustosum VR4, Mucor rouxii, Nigrospora sphaerica SS67, Fusarium oxysporum SS50, Cunninghamella echinulata var. elegans ATCC 8688A e Cunninghamella elegans NRRL 1393 ATCC 10028B) somente o fungo Fusarium oxysporum SS50 e Cunninghamella echinulata var. elegans ATCC 8688A apresentaram potencial para biotransformação da terfenadina em fexofenadina nas condições de incubação empregadas nesse trabalho. / Fexofenadine (FEX) has been the drug of choice for the symptomatic treatment of allergic manifestations, being an antihistamine H1 receptor 2nd generation non-sedating. It is the active and chiral metabolite of terfenadine (TERF), a drug whose production and marketing was suspended as a result of adverse events. Fungi have been presented as a promising alternative for the production of compounds with biological activity. Thus, the goal of this project was to evaluate the ability of fungi to biotransform asymmetric terfenadine to its active metabolite, fexofenadine using fungi as agents catalysts. For enantioselective analysis of fexofenadine a method for chromatographic separation was developed employing a chiral column Lux® cellulose -1, mobile phase water : methanol (35:65,v/v) + 0.3% triethylamine + 0.4% acetic acid, flow rate of 0.5 mL min-1, with detection at 220nm. Two sample preparation microtechnology were evaluated in the extraction of analytes from the culture medium: the dispersive liquid-liquid microextraction (DLLME) and hollow fiber liquid phase microextraction (HF- LPME). Between the two, the DLLME was the microtechnic chosen because it provided better results such as higher recovery values, chromatograms with no possible interfering peaks, greater speed and ease of sample preparation. The optimized conditions of DLLME were: chloroform (300 ?L) as extractor solvent, isopropanol (300 ?L) as disperser solvent. After the formation of the cloud point, the samples were subjected to agitation by vortexing for 15 seconds and centrifuging for 10 minutes at 3000 rpm. The recoveries were 43 % for both enantiomers. The method was linear in the concentration range from 2.0 -15.0 ?g mL-1 for each enantiomer of FEX (r > 0.990). The limit of quantification was 2 ?g mL-1 for the enantiomers of FEX. Among the seven fungi studied (Papulaspora immersa Hotson SS13, Penicillium crustosum VR4, Mucor rouxii, Nigrospora sphaerica SS67, Fusarium oxysporum SS50, Cunninghamella echinulata var. elegans ATCC 8688A e Cunninghamella elegans NRRL 1393 ATCC 10028B), only the fungi Fusarium oxysporum SS50 e Cunninghamella echinulata var. elegans ATCC 8688A showed potential for biotransformation of terfenadine in fexofenadine in the incubation conditions employed in this work.

Antihistamines are a group of pharmaceuticals that enter the environment and may affect microorganisms that regulate decomposing of organic matter and the release of carbon and nitrogen from soils. In this study I investigated if the antihistamine fexofenadine decreases the concentration of dissolved organic carbon (DOC) and dissolved organic nitrogen (DON) from humus. I used humus from two vegetation types (heath and meadow), and used a batch experiment approach, where humus was mixed with fexofenadine solutions (2000 ng/L and 20 000 ng/L). After ten days in room temperature, the samples with fexofenadine were compared with batches containing pure water solutions (control). I found differences in the concentration of DOC, DON and pH that were dependent on the studied vegetation types. There were higher concentrations of DOC and DON in heath (35.9 mg/L and 2.0 mg/L) than in the more nutrient rich meadow (9.2 mg/L and 0.5 mg/L). The latter vegetation type did also have a higher pH. In contrast to my hypothesis, the concentration of DOC and DON was not significantly affected by the fexofenadine. However, if considering a 90%-level of significance, there were a significant interaction effect where concentration of DOC decreased in meadow and increased it in heath. A possible vegetation specific effect of fexofenadin seems plausible as microbial biomass and activity in the vegetation types are known to differ. My findings cannot exclude that fexofenadine stimulates degradation of DOC in the more microbial active meadow humus, but not in the humus of heath where activities are lower.

Antihistamines are a group of pharmaceuticals that enter the environment and may affect microorganisms that regulate decomposing of organic matter and the release of carbon and nitrogen from soils. In this study I investigated if the antihistamine fexofenadine decreases the concentration of dissolved organic carbon (DOC) and dissolved organic nitrogen (DON) from humus. I used humus from two vegetation types (heath and meadow), and used a batch experiment approach, where humus was mixed with fexofenadine solutions (2000 ng/L and 20 000 ng/L). After ten days in room temperature, the samples with fexofenadine were compared with batches containing pure water solutions (control). I found differences in the concentration of DOC, DON and pH that were dependent on the studied vegetation types. There were higher concentrations of DOC and DON in heath (35.9 mg/L and 2.0 mg/L) than in the more nutrient rich meadow (9.2 mg/L and 0.5 mg/L). The latter vegetation type did also have a higher pH. In contrast to my hypothesis, the concentration of DOC and DON was not significantly affected by the fexofenadine. However, if considering a 90%-level of significance, there were a significant interaction effect where concentration of DOC decreased in meadow and increased it in heath. A possible vegetation specific effect of fexofenadin seems plausible as microbial biomass and activity in the vegetation types are known to differ. My findings cannot exclude that fexofenadine stimulates degradation of DOC in the more microbial active meadow humus, but not in the humus of heath where activities are lower.

Interações medicamentosas envolvendo a glicoproteína-P (P-gp) intestinal e placentária são determinantes na disposição cinética e transferência placentária de medicamentos durante a gestação. A fexofenadina, fármaco anti-histamínico, está disponível na clínica como racemato com indicação de uso durante a gravidez para o tratamento da rinite alérgica sazonal e urticária crônica. Considerando a fexofenadina como um substrato da P-gp e a fluoxetina, fármaco antidepressivo indicado durante a gravidez, um inibidor da P-gp, o presente estudo investiga a influência da fluoxetina na disposição cinética enantiosseletiva da fexofenadina em parturientes e suas relações com a transferência placentária in vivo e ex vivo. No estudo in vivo foram investigadas 16 parturientes, sendo 8 incluídas no grupo Controle e 8 incluídas no grupo Interação. Todas as parturientes investigadas receberam dose única oral de 60mg de fexofenadina racêmica, enquanto as parturientes do grupo Interação receberam também dose única oral de 40mg de fluoxetina racêmica 3 h antes da administração da fexofenadina. As amostras seriadas de sangue e urina foram colhidas até 48 h após a administração da fexofenadina. Na resolução do parto (2-3 h após a administração da fexofenadina) foram coletadas simultaneamente amostras de sangue materno, venoso e arterial do cordão umbilical e do espaço interviloso placentário. No modelo ex vivo, a farmacocinética transplacentária dos enantiômeros da fexofenadina foi avaliada em 4 lóbulos de placenta humana. Os enantiômeros da fexofenadina foram determinados nas amostras de plasma, urina e solução de perfusão placentária por LC-MS/MS acoplado a coluna de fase estacionária quiral Chirobiotic® V. A análise farmacocinética foi realizada empregando o programa WinNonlin e os testes estatísticos foram realizados com o auxílio do programa R. A disposição cinética da fexofenadina é enantiosseletiva no plasma materno com maiores valores de AUC0-? (423,20 vs 267,67 ng×h/mL) e menores valores de volume de distribuição aparente (621,37 vs 889,83 L), clearance total aparente (66,20 vs 105,05 L/h) e clearance renal aparente (5,25 vs 8,78 L/h) para o distômero (R)-(+)-fexofenadina. A transferência placentária da fexofenadina é limitada com razões de concentrações plasmáticas veia umbilical/veia materna de aproximadamente 0,16 para ambos os enantiômeros. As razões enantioméricas R-(+)/S-(-) de aproximadamente 1,7 nos compartimentos materno e fetal sugerem que a P-gp placentária não discrimina entre os enantiômeros da fexofenadina. A administração de dose única oral de 40 mg de fluoxetina racêmica 3 h antes da administração da fexofenadina aumentou os valores de AUC0-? (376,09 vs 267,67 ng×h/mL) e reduziu os valores de clearance total aparente (74,37 vs 105,05 L/h) e clearance renal aparente (3,50 vs 8,78 L/h) somente para o eutômero (S)-(-)-fexofenadina, inferindo inibição enantiosseletiva da P-gp intestinal. A administração de dose única oral de 40 mg de fluoxetina racêmica 3 h antes da administração da fexofenadina [concentrações plasmáticas materna no momento da extração fetal de 11, 9, 7 e 3 ng/mL, respectivamente para os enantiômeros (S)-(+)-fluoxetina, (R)-(-)-fluoxetina, (S)-(+)-norfluoxetina e (R)-(-)-norfluoxetina] não altera as razões de concentrações plasmáticas veia umbilical/veia materna e as razões enantioméricas R-(+)/S-(-) nos compartimentos materno e fetal. No modelo ex vivo, a transferência placentária da fexofenadina é lenta e limitada com razões de concentrações reservatório ii fetal/reservatório materno de aproximadamente 0,18 para ambos os enantiômeros. As razões enantioméricas R-(+)/S-(-) de aproximadamente 1,0 nos compartimentos materno e fetal confirmam que a P-gp placentária não discrimina entre os enantiômeros da fexofenadina. As concentrações clinicamente relevantes de 50 ng de cada enantiômero da fluoxetina/mL não alteram as razões de concentrações reservatório fetal/reservatório materno, a velocidade de transferência placentária e as razões enantioméricas R-(+)/S-(-) nos compartimentos materno e fetal. As razões de concentrações dos enantiômeros da fexofenadina reservatório fetal/reservatório materno obtidas no modelo ex vivo são similares às razões obtidas no estudo clínico de concentrações plasmáticas veia umbilical/veia materna, inferindo a validade do modelo ex vivo de predição da transferência placentária in vivo dos enantiômeros da fexofenadina. Concluindo, os estudos in vivo e ex vivo permitem inferir que a fluoxetina inibe de maneira enantiosseletiva a P-gp intestinal e não inibe a P-gp placentária em concentrações clinicamente relevantes / Drug-drug interaction on the intestinal and placental P-glycoprotein (P-gp) plays an important role in the kinetics disposition and placental transfer of drugs during pregnancy. Fexofenadine is an antihistamine drug for seasonal allergic rhinitis and chronic urticaria treatment during pregnancy and it is available as a racemic mixture. Taken together fexofenadine as a P-gp substrate and fluoxetine, antidepressant drug used in pregnancy, as a P-gp inhibitor, this study asses the effect of fluoxetine on the enantioselective kinetic disposition of fexofenadine in pregnant women at term and their relationships with in vivo and ex vivo transplacental transfer. The in vivo study investigated 16 parturients, 8 included in Control group and 8 included in Interaction group. All of parturients received 60 mg of racemic fexofenadine in a single oral dose, while Interaction group subjects were also given 40 mg of racemic fluoxetine in a single oral dose 3 h before fexofenadine administration. Serial blood and urine samples were collected for 48 h after fexofenadine administration. Maternal blood, venous and arterial umbilical cord blood, as well as placental intervillous space blood samples were simultaneously collected at delivery (2-3 h after fexofenadine administration). The transplacental pharmacokinetics of fexofenadine enantiomers was assayed in 4 placental lobule using ex vivo placental perfusion model. Fexofenadine enantiomers were determined in plasma, urine and placental perfusate samples by LC-MS/MS equipped with the chiral column Chirobiotic® V. Pharmacokinetic parameters were determined using WinNonlin and statistical analyses were performed using R statistical software. Fexofenadine kinetics disposition is enantioselective in maternal plasma with higher AUC0-? values (423.20 vs. 267.67 ng×h/mL) and lower apparent volume of distribution values (621.37 vs. 889.83 L), apparent total clearance (66.20 vs. 105.05 L/h) and apparent renal clearance (5.25 vs. 8.78 L/h) for (R)-(+)-fexofenadine distomer. Fexofenadine placental transfer is limited, with umbilical vein/maternal vein plasma concentration ratios of approximately 0.16 for both enantiomers. R-(+)/S-(-) enantiomeric ratios of approximately 1.7 in both maternal and fetal compartments indicate that placental P-gp might not have ability of fexofenadine\'s chiral discrimination. Single oral dose administration of 40 mg of racemic fluoxetine 3 h before fexofenadine administration increased AUC0-? values (376.09 vs. 267.67 ng×h/mL) and lowered both apparent total clearance values (74.37 vs. 105.05 L/h) and apparent renal clearance (3.50 vs. 8.78 L/h) only for (S)-(-)-fexofenadine eutomer, inferring intestinal P-gp enantioselective inhibition. Single oral dose administration of 40 mg of racemic fluoxetine 3 h before fexofenadine administration [maternal plasma concentrations at delivery of 11, 9, 7 and 3 ng/mL for (S)-(+)-fluoxetine, (R)-(-)-fluoxetine, (S)-(+)-norfluoxetine and (R)-(-)-norfluoxetine enantiomers, respectively] does not change either umbilical vein/maternal vein plasma concentration ratios or R-(+)/S-(-) enantiomeric ratios in maternal and fetal compartments. In the ex vivo model, placental transfer of fexofenadine is slow and limited, presenting fetal/maternal reservoirs concentration ratios of approximately 0.18 for both enantiomers. R-(+)/S-(-) enantiomeric ratios of approximately 1.0 on maternal and fetal compartments confirm placental P-gp does not have ability of fexofenadine\'s chiral discrimination. Clinically relevant concentrations of 50 ng of each fluoxetine enantiomer/mL neither alter fetal/maternal reservoirs concentration ratios, placental transfer rate nor R-(+)/S-(-) enantiomeric ratios in maternal and fetal iv compartments. Fetal/maternal reservoirs concentration ratios of fexofenadine enantiomers obtained in the ex vivo model are similar to those obtained in the clinical study of umbilical vein/maternal vein plasma concentrations, implying the validity of ex vivo model to predict placental transfer of fexofenadine enantiomers in vivo. In conclusion, both in vivo and ex vivo studies allow us to infer that fluoxetine enantioselectively inhibits intestinal P-gp and yet does not inhibit placental P-gp at clinically relevant concentrations.

<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 aims of this thesis were to study the in vivo relevance of membrane transporters for intestinal absorption and the hepatic disposition of drugs in humans and preclinical models. Fexofenadine is a substrate for ABCB1 (P-glycoprotein) and members of the organic anion transporting polypeptide (OATP/SLCO) family. It is marginally metabolised in humans. </p><p>The influence of known inhibitors of ABCB1 and OATPs on the membrane transport and pharmacokinetics of fexofenadine was investigated in Caco-2 and porcine models and in humans. The permeability of fexofenadine remained low, even when significantly altered by the addition of an inhibitor. Using the Loc-I-Gut^® technique in vivo in humans, it was possible to see that the jejunal effective permeability of fexofenadine was unchanged when given with verapamil. However, the systemic exposure and apparent absorption rate of fexofenadine increased. This suggests that the first-pass liver extraction of fexofenadine was reduced by verapamil, probably through the inhibition of sinusoidal OATP-mediated and/or canalicular ABCB1-mediated secretion. The unchanged permeability can be explained by simultaneous inhibition of jejunal apical OATP-uptake and ABCB1-efflux, which would leave fexofenadine to be transported by passive trancellular diffusion. A Loc-I-Gut^® perfusion in the porcine model enabling blood sampling in the portal and hepatic veins and bile collection revealed increased jejunal permeability, but no subsequent verapamil-induced elevation in the systemic exposure of fexofenadine. This indicates a species-related difference in the localisation of and/or the substrate specificity of fexofenadine for the transporters involved. The absence of an effect on the first-pass liver extraction in the porcine model might be caused by the observed lower liver exposure of verapamil.</p><p>Finally, a novel intubation technique enabling dosing of fexofenadine in the jejunum, ileum and the colon showed that fexofenadine was absorbed less along the length the intestine in agreement with the properties of a low permeability drug.</p>