La barrière hémato-encéphalique (BHE) représente la principale interface d'échange moléculaire entre la circulation sanguine et le système nerveux central (SNC), où elle joue un rôle essentiel sur le contrôle du passage bidirectionnel de composés endogènes et exogènes. À la BHE, la P-glycoprotéine (P-gp) et Breast Cancer Resistance Protein (BCRP) sont les transporteurs d’efflux ABC les plus importants, empêchant l'entrée de composés toxiques, des médicaments et des xénobiotiques circulant dans le sang dans le cerveau. Il y a un intérêt croissant pour la compréhension des mécanismes moléculaires sous-jacents à la modulation de l’expression et de la fonction de la P-gp et BCRP, afin de pouvoir contrôler l'accumulation de substances neurotoxiques dans le SNC et de surmonter les phénomènes de pharmaco-résistance. Des études récentes ont montré que la morphine, elle-même un substrat de la P-gp, est impliquée dans l’augmentation de l'expression de la P-gp, qui peuvent contribuer à sa faible pénétration dans le cerveau et pour le développement de la tolérance. Cependant, le mécanisme sous-jacent à l’induction de la P-gp par la morphine, bien comme son rôle sur l'expression de BCRP était inconnu. Des rats ont été utilisés comme modèle animal pour l'étude de l'amplitude et la cinétique de la modulation de la P-gp et Bcrp à la BHE, après un traitement morphinique subchronique, en utilisant un protocole d’escalade de doses. Des microvaisseaux cérébraux isolés ont été utilisés comme modèle pour étudier la BHE, et les contenus en P-gp et Bcrp après le traitement in vivo, tandis que la lignée cellulaire hCMEC/D3 a parfois été utilisé pour des études complémentaires. Nos résultats ont montré qu’un régime subchronique de traitement à la morphine pendant 5 jours a induit la P-gp et Bcrp 12 à 24 heures après la dernière dose de morphine, un effet qui n'a pas été enregistrée lors des précédentes temps de sacrifices des animaux, ni avec une traitement aigue à la morphine. Le traitement des animaux avec un antagoniste de du récepteur glutamatergique NMDA, ou avec un inhibiteur de la COX-2 a aboli l’induction protéique de la P-gp et Bcrp par la morphine-subchronique, ce qui suggère que les deux facteurs sont impliqués dans l’up-régulation morphine-dépendante de la P-gp et BCRP. Sachant que l’induction a été enregistrée seulement à partir de 12h après la dernière dose de morphine, nous avons examiné si elle était un effet direct de l'exposition continue à la morphine, ou plutôt une conséquence du sevrage à la morphine développé après l'arrêt du traitement. Les rats ont été traités soit avec une perfusion constante de morphine (5 jours), soit avec deux schémas chroniques de morphine lorsque le sevrage a été précipité par l'administration de naloxone: un régime de doses croissantes (5 jours) ou un régime de doses constantes de morphine. La perfusion en continue de morphine n'a pas changé les niveaux de P-gp et Bcrp dans les microvaisseaux cérébraux de rat, et du coup n'a pas une conséquence directe sur la cascade de régulation de ces transporteurs à la BHE. Le sevrage provoqué par la naloxone a augmenté les niveaux d’ARNm pour le Mdr1a et Bcrp, mais l'expression et de l'activité protéiques sont restées inchangées après l'administration de naloxone. Cette disparité peut être dû soit à un effet de la régulation post-traductionnelle, soit à l’action de la naloxone dans des récepteurs non-opioïdes, qui peut entraver l’induction de la P-gp et Bcrp. Par la suite, on a fait un large screening de l'expression de plusieurs récepteurs de neurotransmetteurs chez la BHE de rat, beaucoup d'entre eux impliqués dans la signalisation inflammatoire, et qui peut jouer un rôle dans la modulation de ces transporteurs ABC. (...) / The blood-brain barrier (BBB) is the main interface of molecular exchange between the bloodstream and the central nervous system (CNS), where it plays an essential role on the control over the bi-directional passage of endogenous and exogenous compounds. At the BBB, P-glycoprotein (P-gp) and Breast Cancer Resistance Protein (BCRP) are the most important ABC drug efflux transporters preventing the entry into the brain of toxic compounds, drugs and xenobiotics circulating in the blood. There is increasing interest in understanding the molecular mechanisms underlying the modulation of P-gp and BCRP expression and function in order to control CNS accumulation of neurotoxicants and to overcome pharmacoresistance phenomena. Recent studies showed that morphine, itself a substrate of P-gp, is implicated in the up-regulation of P-gp expression, which may contribute to its poor brain penetration and tolerance. However, it was unknown the mechanism underlying P-gp induction by morphine and its role on BCRP expression. Rats were used as an animal model for the study of the amplitude and the kinetics of the modulation of P-gp and Bcrp expressions at the BBB following a subchronic morphine treatment, in an escalating morphine dose regimen. Freshly isolated rat brain microvessels were used as BBB model to study P-gp and Bcrp contents following the in vivo treatment, while the hCMEC/D3 cell line was occasionally used for complementary studies. Our results demonstrated that a 5-day subchronic morphine regimen up-regulated both P-gp and Bcrp 12 to 24h after the last dose of morphine, which was not registered at earlier time-points of animal sacrifice, nor with a single dose of morphine. The animal treatment with a glutamatergic NMDA receptor antagonist, or a COX-2 inhibitor abolished the subchronic morphine-induced P-gp and Bcrp protein up-regulation, 24h after the last dose of morphine, suggesting that both are implicated in the morphine-dependent P-gp and Bcrp up-regulation. Since the registered up-regulation only occurred from 12h after the last dose of morphine-onwards, we investigated whether it was a direct effect of continued exposure to morphine, or rather a consequence of the morphine withdrawal developed after discontinuation of treatment. Rats were treated either with a constant morphine infusion (5 days), or two chronic morphine regimens where withdrawal was precipitated by naloxone administration: an escalating dose (5 days) or a constant dose morphine regimen followed by a withdrawal period (2 days) and resume of the treatment for 3 additional days. Continuous i.v. morphine did not change P-gp and Bcrp levels in rat brain microvessels, it does not have a direct consequence on the cascade of regulation of these transporters at the BBB. Naloxone-precipitated withdrawal after escalating or chronic morphine dose regimen increased Mdr1a and Bcrp mRNA levels, but protein expression and activity remained unchanged after naloxone administration. This latter result discrepancy may be due to posttranslational regulation or naloxone action at non-opioid receptors hampering P-gp and Bcrp up-regulation. Subsequently, we did a large screening of the expression of several neurotransmitter receptors at the rat BBB, many of them implicated in the inflammatory cell-cell signaling, and which may have a role in the modulation of these ABC transporters. Also, we compared two different approaches of isolation of rat brain microvessels, mechanical dissection and enzymatic digestion, to assess which yield the purest microvessel fraction for the BBB study. The enzymatic digestion provided the highest enrichment of endothelial cells and pericytes, and the least contamination with astrocyte and neuron markers. (...) / A barreira hemato-encefálica (BHE) representa a principal interface entre a corrente sanguínea e o sistema nervoso central (SNC), desempenhando um papel essencial no controlo da passagem sangue-cérebro de diversos compostos endógenos e exógenos. A glicoproteina P (P-gp) e a proteína de resistência ao cancro da mama (BCRP) são os principais transportadores de efluxo da família ABC presentes ao nível da BHE, limitando a passagem cerebral de compostos tóxicos, fármacos e xenobióticos circulantes na corrente sanguínea. Actualmente, regista-se um crescente interesse na comunidade científica para a melhor compreensão dos mecanismos moleculares subjacentes à modulação quer da expressão quer da função da P-gp e BCRP, no sentido de desenvolver medidas mais eficazes quer para prevenção da acumulação de compostos neurotóxicos no SNC, quer para superar fenómenos de farmacorresistência associados à terapêutica. Estudos recentes evidenciam que a morfina, por si só um substrato da P-gp, está envolvida na indução da expressão da P-gp, o que poderá contribuir para a sua menor penetração cerebral, bem como para o desenvolvimento de tolerância. No entanto, não se conhece o mecanismo subjacente a tal indução da P-gp pela morfina, nem o seu eventual papel na expressão da BCRP. Com efeito, na condução da presente dissertação, realizamos um estudo da amplitude e a cinética da regulação da expressão da P-gp e BCRP ao nível da BHE na sequência de um tratamento subcrónico com morfina, em regime de doses crescentes, usando o rato como modelo animal. Para o efeito, foram isolados os capilares cerebrais dos animais sujeitos a tratamento, in vivo, enquanto que a linha celular hCMEC/D3 foi ocasionalmente utilizada para estudos complementares. Os nossos resultados demonstraram que um tratamento subcrónico com morfina (5 dias) foi capaz de induzir tanto a P-gp como a Bcrp 12 a 24 horas após a última dose de morfina administrada, mas não para tempos de sacrifício anteriores, bem como tal indução não foi registada quando a morfina foi administrada de forma aguda. O tratamento animal com um antagonista do receptor glutamatérgico NMDA, ou com um inibidor da COX-2 anulou este efeito de indução da P-gp e Bcrp pela administraçãosubcrónica de morfina, o que sugere o envolvimento destes dois componentes na indução da P-gp e Bcrp dependente da morfina. Uma vez que este aumento da expressão só surgiu a partir de 12h após a última dose de morfina, decidimos investigar se tal seria um efeito direto da exposição continuada à morfina, ou por outro lado, uma consequência do síndrome de abstinência à morfina, desenvolvido após a descontinuação do tratamento. Desta forma, os animais foram tratados por um lado com uma infusão contínua de morfina (5 dias), ou sujeitos a dois diferentes regimes de exposição crónica à morfina, após os quais o síndrome de abstinência foi provocado pela administração de naloxona. A administração de morfina em contínuo, via i.v., não alterou os níveis de P-gp e BCRP nos capilares cerebrais de rato, o que indica a ausência de uma consequência directa da morfina na cascata de regulação destes transportadores ao nível da BHE. O síndrome de abstinência opióide provocado pela naloxona aumentou os níveis de mRNA Mdr1a e Bcrp, mas tanto a expressão e atividade proteicas mantiveram-se inalteradas após a administração de naloxona. Esta discrepância de resultados pode-se dever ou a um regulamento pós-translacional, ou a uma acção inespecífica da naloxona em receptores não opiáceos, impedindo a indução da P-gp e Bcrp. Num outro estudo, foi feito um screening da expressão de vários receptores de neurotransmissores na BHE de rato, muitos deles envolvidos na sinalização célula-célula em processos inflamatórios, e que podem ter um papel na modulação destes transportadores ABC. (...)

P-Glykoprotein als Produkt des MDR1-Gens stellt einen gut untersuchten Mediator der Multidrugresistenz (MDR) in humanen Malignomen dar. Die Überexpression dieses ABC-Transporters steht in Korrelation zu einer erniedrigten Tumorremission und einer kürzeren Überlebensrate der Patienten. Bisherige Versuche, das Protein über niedermolekulare Substanzen (MDR-Modulatoren) zu inhibieren, vermochten in allen bisherigen klinischen Studien nicht zu überzeugen, so daß diese bis heute keinen Eingang in Standardtherapieschemata gefunden haben. Ziel dieser Arbeit war es, mittels RNA-Interferenz Strategien die Expression von MDR1 zu hemmen und eine Reversion der zellulären Chemoresistenz sowohl im Zellkultur- als auch im Tiermodell zu erreichen. Für die in vitro Untersuchungen an drei humanen multidrug-resistenten Karzinomzellinien wurden verschiedene siRNA (short interfering) Duplexe und shRNA (short hairpin)-exprimierende Vektoren gegen die MDR1 mRNA entwickelt. Die Behandlung der Zellen mit siRNAs führte zu einer bis zu 91 %igen Inhibition der MDR1 mRNA-Expression und zu einer Sensitivierung der Zellen gegenüber dem Anthrazyklin um 89 %. Diese Effekte konnte über einen Zeitraum von drei bis fünf Tagen aufrechterhalten werden. Die stabile Expression von anti-MDR1 shRNAs führte in zwei der untersuchten Zellmodelle zu einer dauerhaften und kompletten Überwindung des MDR1-abhängigen Resistenzphänotyps. Im Mausmodell konnte durch intratumorale Applikation des anti-MDR1 shRNA-kodierenden Vektors mittels low-volume Jet-Injektion eine komplette Reversion der MDR1-Überexpression sowie eine Wiederherstellung der Chemosensitivität gegenüber Doxorubicin in dem resistenten Tumormodell erreicht werden. Die Effizienz der kombinierten Gen- und Chemotherapie wird durch die Verminderung des in vivo Tumorwachstums auf das Volumen des von der sensiblen Zellinien-abgeleiteten Tumors reflektiert. / Multidrug resistance (MDR) is the major cause of failure of effective chemotherapeutic treatment of disseminated neoplasms. The "classical" MDR phenotype of human malignancies is mediated by drug extrusion by the adenosine triphosphate binding cassette (ABC)-transporter P-glycoprotein (MDR1/P-gp). For stable reversal of "classical" MDR in three human cancer cell lines by RNA interference (RNAi) technology, two small interfering RNA (siRNA) constructs and four H1-RNA gene promoter-driven expression vectors encoding anti-MDR1/P-gp short hairpin RNA (shRNA) molecules were constructed. In all cellular systems, siRNAs could specifically inhibit MDR1 expression up to 91% at the mRNA and protein levels. Resistance against daunorubicin was decreased to a maximum of 89%. The introduction of anti-MDR1/P-gp shRNA expression vectors leads in two of the three human cancer cell lines to a complete reversion of the MDR phenotype. The reversal of MDR was accompanied by a complete suppression of MDR1/P-gp expression on mRNA and protein level, and by a considerable increased intracellular anthracyline accumulation in the anti-MDR1/P-gp shRNA-treated cells. In a mouse xenograft model a complete in vivo restoration of MDR1 overexpression and chemosensitivity to doxorubicin could be obtained by intratumorally jet-injected anti-MDR1 shRNA in a multidrug resistant human cancer tumor model.

Para avaliar a influência dos polimorfismos de nucleotídeo único (SNPs) do CYP2B6, CYP3A5, GSTM1, GSTP1, GSTT1, PON1, NQO1 e MDR1 na resposta ao tratamento com R-CHOP e CHOP, 82 pacientes com Linfoma Difuso de Grandes Células B, sem evidências de infecção por HIV, foram selecionados nesse estudo. Amostras de sangue periférico foram coletadas para extração de DNA. Os SNPs foram analisados por PCR-RFLP. Em relação aos pacientes que apresentaram resposta completa (RC) ao tratamento (70%), 51% foram tratados com R-CHOP. Sobre o tratamento, 50% dos pacientes com RC apresentaram classificação de ECOG 0-1 (p=0,0193) e a maioria desses pacientes (41%) não apresentaram envolvimento extranodal (p=0,0377). Não houve associação entre os SNPs do CYP2B6, CYP3A5, GSTT1, NQO1 e MDR1 (C3435T) e as variáveis estudadas. Apenas CYP3A5 (sexo p=0,0519), GSTM1 (idade p=0,016; tratamento p=0,0372), GSTP1 (envolvimento extranodal p=0,0307), PON1 (sintomas B p=0,0201; Bulky p=0,0148) e MDR1 C1236T (sexo p=0,0316) mostraram associação. Em relação à sobrevida global, apenas tratamento (p=0,0129), IPI (p=0,000342), idade (p=0,0155), estadiamento (p=0,00281) e ECOG (p=0,00869) apresentaram resultados significantes. Quanto à sobrevida livre de doença (SLD), apenas idade (p=0,0292), estadiamento (p=0,0402) e ECOG (p=0,0142) apresentaram resultados significantes / To evaluated the influence of single nucleotide polymorphisms (SNPs) of CYP2B6, CYP3A5, GSTM1, GSTP1, GSTT1, PON1, NQO1 and MDR1 in the treatment response with R-CHOP and CHOP, 82 patients with Diffuse Large B-cell Lymphoma, without evidence of HIV infection, were enrolled in this study. Peripheral blood samples were collected for DNA extraction. The SNPs were analyzed by PCR-RFLP. In relation the patients that showed complete response (CR) to the treatment (70%), 51% were treated with R-CHOP. About the treatment, 50% of the patients with CR showed ECOG classification of 0-1 and the most of these patients (41%) did not showed extranodal involvement (p=0,0377). There was no association between CYP2B6, CYP3A5, GSTT1, NQO1 and MDR1 (C3435T) SNPs and the variables studied. Only CYP3A5 (gender p=0,0519), GSTM1 (age p=0,016; treatment p=0,0372), GSTP1 (extranodal involvement p=0,0307), PON1 (B symptoms p=0,0201; Bulky p=0,0148) e MDR1 C1236T (gender p=0,0316) showed association. In relation to overall survival, only treatment (p=0,0129), IPI (p=0,000342), age (p=0,0155), stadiament (p=0,00281) and ECOG (p=0,00869) showed significant results. To disease-free survival, only age (p=0,0292), stadiament (p=0,0402) e ECOG (p=0,0142) showed significant results

<p>Transport into and across the cells of the human body is a prerequisite for the pharmacological action of drugs. Passive membrane permeability and active transport mechanisms are major determinants of the intestinal absorption of drugs, as well as of the distribution to target tissues and the subsequent metabolism and excretion from the body. In this thesis, the role of ATP-binding cassette (ABC) transporters and passive permeability on drug absorption and disposition was investigated. Particular emphasis was placed on defining the molecular properties important for these transport mechanisms. </p><p>The influence of different transport pathways on predictions of intestinal drug absorption was investigated using experimental models of different complexity. Experimental models that include the paracellular pathway gave improved predictions of intestinal drug absorption, especially for incompletely absorbed drugs. Further, the inhibition of the ABC transporters breast cancer resistance protein (BCRP/ABCG2) and multidrug-resistance associated protein 2 (MRP2/ABCC2) was experimentally investigated using structurally diverse datasets that were representative of orally administered drugs. A large number of previously unknown inhibitors were identified among registered drugs, but their clinical relevance for drug-drug interactions and drug-induced toxicity remains to be determined. The majority of the inhibitors affected all three major ABC transporters BCRP, MRP2 and P-glycoprotein (P gp/ABCB1), and these multi-specific inhibitors were found to be enriched in highly lipophilic weak bases. </p><p>To summarize, the present work has led to an increased knowledge of the molecular features of importance for ABC transporter inhibition and passive membrane permeability. Previously unknown ABC transporter inhibitors were identified and predictive computational models were developed for the different drug transport mechanisms. These could be valuable tools to assist in the prioritization of experimental efforts in early drug discovery.</p>

Transport into and across the cells of the human body is a prerequisite for the pharmacological action of drugs. Passive membrane permeability and active transport mechanisms are major determinants of the intestinal absorption of drugs, as well as of the distribution to target tissues and the subsequent metabolism and excretion from the body. In this thesis, the role of ATP-binding cassette (ABC) transporters and passive permeability on drug absorption and disposition was investigated. Particular emphasis was placed on defining the molecular properties important for these transport mechanisms. The influence of different transport pathways on predictions of intestinal drug absorption was investigated using experimental models of different complexity. Experimental models that include the paracellular pathway gave improved predictions of intestinal drug absorption, especially for incompletely absorbed drugs. Further, the inhibition of the ABC transporters breast cancer resistance protein (BCRP/ABCG2) and multidrug-resistance associated protein 2 (MRP2/ABCC2) was experimentally investigated using structurally diverse datasets that were representative of orally administered drugs. A large number of previously unknown inhibitors were identified among registered drugs, but their clinical relevance for drug-drug interactions and drug-induced toxicity remains to be determined. The majority of the inhibitors affected all three major ABC transporters BCRP, MRP2 and P-glycoprotein (P gp/ABCB1), and these multi-specific inhibitors were found to be enriched in highly lipophilic weak bases. To summarize, the present work has led to an increased knowledge of the molecular features of importance for ABC transporter inhibition and passive membrane permeability. Previously unknown ABC transporter inhibitors were identified and predictive computational models were developed for the different drug transport mechanisms. These could be valuable tools to assist in the prioritization of experimental efforts in early drug discovery.

Les propriétés pharmacocinétiques d’un nouveau médicament et les risques d’interactions médicamenteuses doivent être investigués très tôt dans le processus de recherche et développement. L’objectif principal de cette thèse était de concevoir des approches prédictives de modélisation du devenir du médicament dans l’organisme en présence et en absence de modulation d’activité métabolique et de transport. Le premier volet de recherche consistait à intégrer dans un modèle pharmacocinétique à base physiologique (PBPK), le transport d’efflux membranaire gouverné par les glycoprotéines-P (P-gp) dans le cœur et le cerveau. Cette approche, basée sur des extrapolations in vitro-in vivo, a permis de prédire la distribution tissulaire de la dompéridone chez des souris normales et des souris déficientes pour les gènes codant pour la P-gp. Le modèle a confirmé le rôle protecteur des P-gp au niveau cérébral, et a suggéré un rôle négligeable des P-gp dans la distribution tissulaire cardiaque pour la dompéridone. Le deuxième volet de cette recherche était de procéder à l’analyse de sensibilité globale (ASG) du modèle PBPK précédemment développé, afin d’identifier les paramètres importants impliqués dans la variabilité des prédictions, tout en tenant compte des corrélations entre les paramètres physiologiques. Les paramètres importants ont été identifiés et étaient principalement les paramètres limitants des mécanismes de transport à travers la membrane capillaire. Le dernier volet du projet doctoral consistait à développer un modèle PBPK apte à prédire les profils plasmatiques et paramètres pharmacocinétiques de substrats de CYP3A administrés par voie orale à des volontaires sains, et de quantifier l’impact d’interactions médicamenteuses métaboliques (IMM) sur la pharmacocinétique de ces substrats. Les prédictions des profils plasmatiques et des paramètres pharmacocinétiques des substrats des CYP3A ont été très comparables à ceux mesurés lors d’études cliniques. Quelques écarts ont été observés entre les prédictions et les profils plasmatiques cliniques mesurés lors d’IMM. Cependant, l’impact de ces inhibitions sur les paramètres pharmacocinétiques des substrats étudiés et l’effet inhibiteur des furanocoumarins contenus dans le jus de pamplemousse ont été prédits dans un intervalle d’erreur très acceptable. Ces travaux ont contribué à démontrer la capacité des modèles PBPK à prédire les impacts pharmacocinétiques des interactions médicamenteuses avec une précision acceptable et prometteuse. / Early knowledge of pharmacokinetic properties of a new drug candidate and good characterization of the impact of drug-drug interaction (DDI) on those properties is of crucial importance in the process of drug research and development. The main objective of this thesis consisted in the conception of PBPK models able to predict the drug disposition in the absence and presence of metabolic and transport activity modulation. The first part of this work aimed to develop a PBPK model that incorporates the efflux function of P-gp expressed in various tissues, in order to predict the impact of P-gp activity modulation on drug distribution. This approach, based on in vivo-in vitro extrapolation for estimating the transport-related parameters, allowed the prediction of domperidone distribution in heart and brain of wild-type mice and P-gp deficient mice. The model pointed out the protective function of P-gp in brain whereas it showed the negligible protective effect of P-gp in heart. The second part of the project aimed to perform the global sensitivity analysis of the previous PBPK model, in order to investigate how the uncertainly and variability of the correlated physiological parameters influence the outcome of the drug distribution process. While a moderate variability of the model predictions was observed, this analysis confirmed the importance for a better quantitative characterization of parameters related to the transport processes trough the blood-tissue membrane. Accounting for the input correlation allowed the delineation of the true contribution of each input to the variability of the model outcome. The last part of the project consisted in predicting the pharmacokinetics of selected CYP3A substrates administered at a single oral dose to human, alone or with an inhibitor. Successful predictions were obtained for a single administration of the CYP3A substrates. Some deviations were observed between the predictions and in vivo plasma profiles in the presence of DDI. However, the impact of inhibition on the PK parameters of the selected substrates and the impact of grapefruit juice-mediated inhibition on the extent of intestinal pre-systemic elimination were predicted within a very acceptable error range. Overall, this thesis demonstrated the ability of PBPK models to predict DDI with promising accuracy.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

There is a global rise in the use of herbal products in combination with allopathic medicines, while most patients do not inform their health care providers of the use of these natural products. Both pharmacodynamic and pharmacokinetic interactions between herbal products and conventional drugs must be avoided for the wellbeing of the patient. Increasing evidence from in vitro and in vivo studies indicate that changed drug pharmacokinetics by co-administered herbs may be attributed to modulation of efflux drug transporters such as P-glycoprotein (P-gp). Garlic (Allium sativum), lemon (Citrus limonum) and beetroot (Beta vulgaris) are widely used by human immunodeficiency virus (HIV) patients, especially following the pronouncement by a former President of South Africa and the Ministers of Health at that time who promoted the use of these botanicals in HIV patients. The aim of this study was to measure the bi-directional in vitro transport of indinavir, a protease inhibitor, in the presence of crude extracts and pure phytoconstituents of A. sativum (L-alliin and diallyl disulphide), C. limonum (hesperidin and eriocitrin) and B. vulgaris (betaine monohydrate and ß-carotene) across excised porcine intestinal tissue in Sweetana-Grass diffusion chambers. In the negative control group, the transport of indinavir alone (200 M) was determined with no modulator added. In the positive control group, the transport of indinavir was determined in the presence of verapamil (100 M), a known P-gp related efflux inhibitor. The control experiments were used to indicate that the effects of the test compounds were caused by their action and not by chance interferences or external factors. Samples collected at pre-determined time intervals were analysed by means of a validated high performance liquid chromatography (HPLC) method and the transport was expressed as the apparent permeability coefficient (Papp) and the transepithelial flux (J) from which the efflux ratio (ER) and the net flux (Jnet) values were calculated. Statistical analysis was used to compare the results of the test compounds with the control groups in order to indicate significant differences. The mean ER value for indinavir in the negative control group was 1.41 ± 0.170 and in the positive control group it was 0.56 ± 0.0426. Statistically significant (p < 0.05) inhibition of indinavir efflux as indicated by reduced ER values was obtained for L-alliin (ER = 0.280 ± 0.030), diallyl disulphide (ER = 0.505 ± 0.034) and ß-carotene (ER = 0.664 ± 0.075). Inhibition of indinavir efflux will lead to increased transport and therefore a potentially higher bioavailability. Statistically significant (p < 0.05) promotion of indinavir efflux as indicated by increased ER values was obtained for C. limonum crude extract (ER = 5.551 ± 0.575) and hesperidin (ER = 3.385 ± 0.477), which potentially may lead to lower bioavalability. B. vulgaris crude extract (p = 0.8452), betaine monohydrate (p = 0.9982), A. sativum crude extract (p = 0.7161) and eriocitrin (p = 0.4431) displayed no statistically significant effect compared to the negative control group on indinavir transport across excised porcine intestinal tissue. The results from this study demonstrate that L-alliin, diallyl disulphide and ß-carotene have an inhibitory effect on indinavir efflux, which may significantly increase indinavir plasma levels after oral administration. C. limonum crude extract and hesperidin promote indinavir efflux, which may significantly reduce indinavir plasma levels. These pharmacokinetic interactions between certain drugs and plant extracts may negatively affect the anti-retroviral treatment of HIV patients, but deliberate and controlled inclusion of L-alliin, diallyl disulphide and ß-carotene in dosage forms may possibly cause more effective delivery of protease inhibitors after oral administration resulting in less frequent dosing intervals. / Thesis (MSc (Pharmaceutics))--North-West University, Potchefstroom Campus, 2013.

There is a global rise in the use of herbal products in combination with allopathic medicines, while most patients do not inform their health care providers of the use of these natural products. Both pharmacodynamic and pharmacokinetic interactions between herbal products and conventional drugs must be avoided for the wellbeing of the patient. Increasing evidence from in vitro and in vivo studies indicate that changed drug pharmacokinetics by co-administered herbs may be attributed to modulation of efflux drug transporters such as P-glycoprotein (P-gp). Garlic (Allium sativum), lemon (Citrus limonum) and beetroot (Beta vulgaris) are widely used by human immunodeficiency virus (HIV) patients, especially following the pronouncement by a former President of South Africa and the Ministers of Health at that time who promoted the use of these botanicals in HIV patients. The aim of this study was to measure the bi-directional in vitro transport of indinavir, a protease inhibitor, in the presence of crude extracts and pure phytoconstituents of A. sativum (L-alliin and diallyl disulphide), C. limonum (hesperidin and eriocitrin) and B. vulgaris (betaine monohydrate and ß-carotene) across excised porcine intestinal tissue in Sweetana-Grass diffusion chambers. In the negative control group, the transport of indinavir alone (200 M) was determined with no modulator added. In the positive control group, the transport of indinavir was determined in the presence of verapamil (100 M), a known P-gp related efflux inhibitor. The control experiments were used to indicate that the effects of the test compounds were caused by their action and not by chance interferences or external factors. Samples collected at pre-determined time intervals were analysed by means of a validated high performance liquid chromatography (HPLC) method and the transport was expressed as the apparent permeability coefficient (Papp) and the transepithelial flux (J) from which the efflux ratio (ER) and the net flux (Jnet) values were calculated. Statistical analysis was used to compare the results of the test compounds with the control groups in order to indicate significant differences. The mean ER value for indinavir in the negative control group was 1.41 ± 0.170 and in the positive control group it was 0.56 ± 0.0426. Statistically significant (p < 0.05) inhibition of indinavir efflux as indicated by reduced ER values was obtained for L-alliin (ER = 0.280 ± 0.030), diallyl disulphide (ER = 0.505 ± 0.034) and ß-carotene (ER = 0.664 ± 0.075). Inhibition of indinavir efflux will lead to increased transport and therefore a potentially higher bioavailability. Statistically significant (p < 0.05) promotion of indinavir efflux as indicated by increased ER values was obtained for C. limonum crude extract (ER = 5.551 ± 0.575) and hesperidin (ER = 3.385 ± 0.477), which potentially may lead to lower bioavalability. B. vulgaris crude extract (p = 0.8452), betaine monohydrate (p = 0.9982), A. sativum crude extract (p = 0.7161) and eriocitrin (p = 0.4431) displayed no statistically significant effect compared to the negative control group on indinavir transport across excised porcine intestinal tissue. The results from this study demonstrate that L-alliin, diallyl disulphide and ß-carotene have an inhibitory effect on indinavir efflux, which may significantly increase indinavir plasma levels after oral administration. C. limonum crude extract and hesperidin promote indinavir efflux, which may significantly reduce indinavir plasma levels. These pharmacokinetic interactions between certain drugs and plant extracts may negatively affect the anti-retroviral treatment of HIV patients, but deliberate and controlled inclusion of L-alliin, diallyl disulphide and ß-carotene in dosage forms may possibly cause more effective delivery of protease inhibitors after oral administration resulting in less frequent dosing intervals. / Thesis (MSc (Pharmaceutics))--North-West University, Potchefstroom Campus, 2013.