Human p-glycoprotein (P-gp) is an ATP-binding cassette transporter that actively transports a diverse set of substrates at the plasma membrane. Specifically, P-gp is expressed most highly at important blood tissue barriers on the lumenal side of endothelial cells and secretory tissues asymmetrically where it provides generalized protection against xenobiotics due to its promiscuous substrate binding pocket. Substrates typically interact with P-gp within the inner leaflet of the plasma membrane before being effluxed through large conformation changes driven by ATP binding and hydrolysis. Since many small molecule drugs are substrates of P-gp and P-gp has the ability to transport chemically and structurally diverse molecules, delivery of bioavailable small molecule therapies and treatment of diseases beyond blood-tissue barriers may be difficult. In cancer, expression of P-gp may confer a multidrug resistance phenotype due to upregulation of the MDR1 gene, which encodes P-gp, in response to treatment with chemotherapies. Treatments of diseases beyond blood-tissue barriers and some cancers may be more complex given the protective role of P-gp coupled with it promiscuous substrate binding site.<br>Many studies of P-gp have been centered around understanding the structure function relationship of how P-gp effluxes small molecules across the plasma membrane. Here we have used a transient Vaccinia virus expression system to rapidly express many mutants of P-gp in human cells for analysis. Transient expression using the Vaccinia system was optimized to produce a large amount of protein while avoiding significant cell death. Optimization of the Vaccinia expression system has also helped to show that changes in P-gp surface expression are not correlated to changes in substrate accumulation within cells expressing P-gp, a topic that has yet to be addressed within the field of P-gp study. Reduced surface expression of P-gp to 68% maintained the same level of reduced cellular accumulation of two substrates, calcein-AM and rhodamine 123, relative to a WT P-gp control. Further study of P-gp mutations revealed a Y998A mutation had a 90% reduction of surface expression but the same reduction of cellular accumulation of rhodamine 123 further supporting that changes in surface expression do not correlate to changes in substrate transport.<br>We then sought to demonstrate how flexibility in transmembrane helix (TMH) 12 of P-gp affected overall stability and transport ability in vitro. TMH 12 in inward facing conformations shows a region of decreased hydrogen bonding in the backbone of the helix leading to a “kink” present in many crystal structures of C. elegans and mouse P-gp as well as in an occluded structure of human P-gp. Outward facing crystal structures of C. elegans, mouse, and human P-gp show TMH 12 where the backbone of the helix is fully hydrogen bonded and ordered. The change in hydrogen bonding pattern and the presence of the kink in TMH 12 suggest the importance of flexibility in the function of TMH 12. Clustal Omega was used to align the primary structure of P-gp between 8 species and a conserved sequence of 996-PDYAKA-1001 was identified aligning with the kink observed in crystallographic data. The kinked nature of this region led to our development of a rigid poly-alanine mutation and a flexible poly-glycine mutation based on the propensity of these amnio acids to form helices. The more flexible poly-glycine mutation obtained no significant transport while the poly-alanine mutation maintained some ability to transport fluorescent substrate relative to a WT control. Crosslinking of the nucleotide binding domains (NBDs) revealed a decrease of NBD dimerization likely correlating to decreased transport. Thus, some degree of flexibility within the kink region is critical for substrate transport as rigid and flexible mutations of this region abrogate transport of fluorescent substrates.<br>While the substrate binding pocket it located towards the interior of P-gp within the lipid bilayer, it has been theorized that substrates may interact with P-gp at the lipid-protein interface of the inner leaflet near portals for substrate entry formed by pairs of helices either side of the protein. To test this hypothesis, aromatic residues on TMH 12 and adjacent elbow helix 2 near the interface region of the inner leaflet, that have also been observed to interact with a cyclic peptide in a crystal structure of P-gp, were mutated to alanine. Y998, on TMH 12, was shown to interact with the cyclic peptide and is ideally located at the protein-lipid interface near a surface formed by elbow helix 2 and TMH 9 and was observed to have the largest effect on substrate accumulation. Accumulation of fluorescent substrates, relative to WT P-gp, was increased though not all substrates were affected similarly. No increase of accumulation was observed with rhodamine 123 while accumulation of BD-prazosin increased 65% relative to WT P-gp. It is to be expected that the large diversity of substrates recognized by P-gp would interact preferentially with carrying residues at the protein-lipid interface similar to observations of substrate binding at the substrate binding pocket. Variability in accumulation signifies that substrates do interact with P-gp at the lipid-protein interface and substrates interact differently at this interface similarly to substrate interaction at the substrate biding pocket.<br>

Multidrug resistance (MDR) in breast cancer treatment is the major cause leading to the failure of chemotherapy. P-glycoprotein (P-gp), the product of the human MDR1 gene, plays a key role in resistance to chemotherapy and confers cross-resistance to many structurally unrelated anticancer drugs. We have previously reported that integrin αvβ6 plays a critical role in breast cancer invasion and metastasis. However, whether and how αvβ6 is associated with P-gp and regulated by potential genetic mechanisms in breast cancer remains unclear. In the present study, we further investigated the reversal effect and underlying mechanisms of MDR in breast cancer. Two small interfering RNA constructs (pSUPER-β6shRNAs) targeting two different regions of the β6 gene have been designed to inhibit αvβ6 expression by transfecting them into adriamycin-resistant MCF-7/ADR cell lines. Suppression of αvβ6 dramatically downregulated the levels of MDR1 gene mRNA and P-gp. In particular, β6shRNA-mediated silencing of αvβ6 gene increased significantly the cellular accumulation of Rhodamine 123 and markedly decreased drug efflux ability, suggesting that β6shRNAs indeed inhibit P-gp mediated drug efflux and effectively overcome drug resistance. In addition, inhibition of integrin αvβ6 suppressed the expression of ERK1/2. Interestingly, our data demonstrate that suppression of integrin αvβ6 caused significant downregulation of Bcl-2, Bcl-xL and upregulation of caspase 3, Bad, accompanied by increasing activity of cytochrome C. A possible connection between αvβ6 and P-gp in drug resistance biology is suggested. Taken together, β6shRNA could efficiently inhibit αvβ6 and MDR1 expression in vitro and these findings may offer specifically useful means to reverse MDR in breast cancer therapy.

No description available.

No / Inadequate drug delivery to tumours is now recognised as a key factor that limits the efficacy of anticancer drugs. Extravasation and penetration of therapeutic agents through avascular tissue are critically important processes if sufficient drug is to be delivered to be therapeutic. The purpose of this study is to develop an in silico model that will simulate the transport of the clinically used cytotoxic drug doxorubicin across multicell layers (MCLs) in vitro. Three cell lines were employed: DLD1 (human colon carcinoma), MCF7 (human breast carcinoma) and NCI/ADR-Res (doxorubicin resistant and P-glycoprotein [Pgp] overexpressing ovarian cell line). Cells were cultured on transwell culture inserts to various thicknesses and doxorubicin at various concentrations (100 or 50 microM) was added to the top chamber. The concentration of drug appearing in the bottom chamber was determined as a function of time by HPLC-MS/MS. The rate of drug penetration was inversely proportional to the thickness of the MCL. The rate and extent of doxorubicin penetration was no different in the presence of NCI/ADR-Res cells expressing Pgp compared to MCF7 cells. A mathematical model based upon the premise that the transport of doxorubicin across cell membrane bilayers occurs by a passive "flip-flop" mechanism of the drug between two membrane leaflets was constructed. The mathematical model treats the transwell apparatus as a series of compartments and the MCL is treated as a series of cell layers, separated by small intercellular spaces. This model demonstrates good agreement between predicted and actual drug penetration in vitro and may be applied to the prediction of drug transport in vivo, potentially becoming a useful tool in the study of optimal chemotherapy regimes.

No / The in vitro measurement of drug-induced apoptosis provides a mechanism-based test for the chemosensitivity of tumor cells isolated from a patient or from a specific cell line. The goal of this study was to investigate the effects of p-glycoprotein reversal agents on apoptosis and necrosis in Burkitt lymphoma cells. These effects were determined by microscopic observation and by electrophoretic separation of DNA fragments. We demonstrated induction of apoptosis in Burkitt lymphoma Raji Thymidine Kinase+ (TK+)and TK- cells using different subclasses of p-glycoprotein reversal agents. A low dose of doxorubicin was also used. The selective clonal expansion of mutant lymphocytes is based upon the phenotypic properties of TK-deficient cells. The first phase of the present study involved morphological analyses and DNA degradation on agarose gel electrophoresis. The second phase analyzed DNA damage using the Comet assay and tail moments calculated with Komet imaging software. Electrophoretic separation resulted in a ladder pattern, indicating that the p-glycoprotein reversal agents were able to induce apoptosis and necrosis. The morphological frequency of apoptosis and necrosis in the cells was significantly increased. Most p-glycoprotein reversal agents showed an increase in tail moments in the Comet assay. The results indicate that indomethacin and quercetin may help to overcome chemoresistance in Burkitt’s lymphoma.

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

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

Statins, common cholesterol control drugs, are appreciated to have promising anticancer activity through inhibition of the mevalonate pathway. Several lines of evidence suggest that certain tumours are susceptible to statins, but the underlying molecular features arbitrating this sensitivity remain unknown. We hypothesize that (i) not all statins will behave equivalently in the context of anticancer therapy, and (ii) a molecularly-defined subset of tumours are intrinsically sensitive to statins. My objectives have therefore been to further our understanding of functional differences between statins influencing their anticancer effects, and to investigate molecular features associated with statin sensitivity in breast cancer. Specifically, this thesis addresses two aims: (i) to characterize differential interactions between four statins and the xenobiotic transporter P-glycoprotein (P-gp; also known as ABCB1), and (ii) to identify molecular features associated with fluvastatin and lovastatin sensitivity in breast tumour cell lines. We first characterized the interactions of statins with P-gp in vitro and in multidrug-resistant (MDR) tumour cells. While lovastatin could directly bind to P-gp and modulate MDR, no significant interactions were observed with fluvastatin. Fluvastatin may therefore be appropriate for use in unselected patients, to avoid adverse drug interactions with coadministered P-gp substrate chemotherapeutics. Fluvastatin has also shown promise in breast cancer treatment, where molecular features predictive of statin sensitivity would be particularly valuable. A panel of 19 immortalized breast cell lines was therefore characterized for sensitivity to fluvastatin and lovastatin. Relatively statin-sensitive cells underwent apoptosis upon statin treatment, and were more likely to have an estrogen receptor alpha (ERα)-negative, basal-like phenotype. By mining available baseline gene expression data, a candidate 10-gene signature predictive of fluvastatin sensitivity was also generated. Taken together, this research provides insight into molecular markers of statin sensitivity that may facilitate fast-tracking of these drugs to clinical trials in subsets of cancer patients most likely to respond.

A signifficant obstacle facing the healthcare industry is the phenomenon of multidrug resistance (MDR) in which a cell acquires simultaneous resistance to many unrelated drugs that it has never been exposed to. At the molecular level, MDR can be characterised by a reduction of intracellular drug levels due to their active efflux by multidrug transporters such as P-glycoprotein (Pgp). Pgp is able to efflux a phenomenally wide variety of chemically unrelated drugs and causal relationships have been established between its expression and the acquisition of MDR to numerous anticancer and central nervous system (CNS) drugs. There has thus been much effort to understand the molecular biology of Pgp and how it functions. However, many aspects of its functioning remain unclear. From a drug discovery viewpoint, we have yet to fully understand what features make some drugs susceptible to Pgp-mediated efflux (substrates) and what makes others able to inhibit Pgp function (inhibitors). From a mechanistic viewpoint, it is still uncertain what the exact nature of Pgp's binding site is, the role of ATP binding and hydrolysis in transport and how both of these interplay with ligand binding. The work presented in this thesis attempts to answer these questions from two perspectives. Firstly the mouse Pgp crystal structure [PDB 3G60] was used as a unique starting point for molecular dynamics (MD) simulations to characterise the dynamics and conformational exibility of Pgp, properties believed to be integral to its function. The simulations revealed Pgp to be a highly dynamic molecule at both its transmembrane (TM) and nucleotide binding domains (NBDs). The latter exhibited a conformational asymmetry that supports the Constant Contact model of ATPase activity. In the presence of the Pgp substrate, daunorubicin, the NBDs exhibited tighter asymmetric dimerisation leading to increased affinity for ATP. In contrast, the presence of the Pgp inhibitor, QZ59-RRR led to NBD conformational changes that reduced their affinity for ATP. Thus providing an appealing mechanism for how QZ59-RRR inhibits Pgp ATPase activity. MD simulation was also used to provide atomic-detail interpretations of multiple binding stoichiometries of drug and lipid molecules observed by collaborator-led mass spectrometry experiments. This also provided opportunity to validate the Pgp simulations against novel experimental data. The second strand of the thesis explored the membrane permeation dynamics of CNS therapeutics in order to identify differences in protonation states, conformations, orientations and membrane localisation that might distinguish those that are Pgp substrates and from those that are not. These properties were studied using complementary MD simulation and nuclear magnetic resonance (NMR) techniques. The simulations revealed a novel set of criteria that in uence the likelihoodof a drug to 'flip-flop' across a membrane, a behaviour that may make drugs more susceptible to Pgp efflux. These observations were broadly consistent with the NMR experiments. However, the NMR data also highlighted limitations in the simulation approaches used in this thesis and emphasised the need to also consider the kinetics of permeation in addition to its thermodynamics.

L’efficacité des chimiothérapies est limitée par la surexpression de pompes d’efflux adressées à la membrane plasmique des cellules cibles. En effet, celles-ci réduisent le taux intracellulaire des médicaments anticancéreux, antiviraux, antifongiques et antibactériens. La P-gp/ABCB1 est la plus impliquée dans ce phénomène, suivie de MRP1/ABCC1 et de BCRP/ABCG2. Une approche pour surmonter ce phénomène est de développer des médicaments qui ne soient pas expulsés par ces pompes. Dans ce contexte, nous avons développé une nouvelle classe d’inhibiteurs de la protéase du VIH-1 qui ne sont ni transportés par P-gp ni par BCRP. Ils sont ainsi des candidats intéressants aux trithérapies contre le SIDA. Un point clé pour comprendre comment ces transporteurs font traverser les médicaments à travers la membrane est d’identifier des nouvelles structures. Ainsi, nous avons résolu trois structures de P-gp de souris. Une d’entre-elles est complexée à un nano-anticorps lié au premier NBD («nucleotide-binding domain»), qui fige la P-gp dans une nouvelle conformation ouverte vers l'intérieur. Pour finir, nous avons localisé deux sites de liaison de P-gp en caractérisant les modes d'inhibition de deux inhibiteurs précédemment cocristallises avec la pompe. Ceci permet de mieux comprendre le mécanisme de translocation et offre la possibilité de cibler plus précisément ces sites pour développer des modulateurs de cette pompe / Resistance to chemotherapy is partly due to efflux pumps expressed in the plasma membrane which prevents the accumulation of anticancer, antiviral, antifungal and antibacterial drugs in target cells. Three human ABC transporters are particularly involved in MDR phenotype: P-gp/ABCB1, MRP1/ABCC1 and BCRP/ABCG2. Among the different approaches used to overcome the resistance linked to these transporters, the development of non-substrate drugs MDR-ABC transporters has been described. Here, new class of HIV-1 protease inhibitors not recognized by P-gp/BCRP were identified, promising to be attractive candidates to HAART therapy. Since the determination of the X-ray structures in different conformations is a key point to understand how MDR-ABC transporters translocate drugs across the plasma membrane, the crystal structures of three inward-facing conformations of mouse P-gp were resolved. One structure has a camel nanobody bound to the C-terminal side of the first nucleotide-binding domain, revealing a unique epitope on P-gp and freezing a new open-inward conformation. Finally, the enzymatic characterization of two inhibitors co-crystallized with the mouse P-gp has allowed to localize two main binding sites by which drugs efflux occurs. These results bring new findings of the drug-efflux mechanism and offer the possibility to target more precisely those sites to develop modulators of this pump