ABCB1 est une protéine impliquée dans le transport des médicaments mais aussi probablement du cholestérol. Des phénomènes de résistance médicamenteuse sont associés à ses polymorphismes et à des modulations de son expression via le facteur PXR. Notre objectif était de réaliser une analyse génomique et transcriptomique d’ABCB1 basée sur ces hypothèses : 1) les variants d’ABCB1 expliquent-ils une part de la variabilité des taux de lipides et de lipoprotéines plasmatiques ? 2) le profil d’expression d’ABCB1 dans les cellules mononuclées du sang périphérique (PBMCs) constitue-t-il un biomarqueur cardiovasculaire nouveau ? Nous avons déterminé la prévalence de polymorphismes d’ABCB1 chez 371 sujets de la cohorte STANISLAS. Nous montrons que ces variants modulent les concentrations en lipides des sujets sains. Des associations significatives avec les lipides sont aussi notées chez des sujets à haut risque cardiovasculaire. Nous observons qu’une majorité d’enzymes du métabolisme des xénobiotes et de facteurs de transcription sont exprimés dans les PBMCs de sujets sains. Nous montrons par RTPCR qu’ABCB1 et PXR sont exprimés dans les PBMCs de 83 sujets de la cohorte. Enfin, il n’y a pas d’association entre l’expression d’ABCB1 dans les PBMCs et le taux de lipides plasmatiques chez le sujet sain. En conclusion, les polymorphismes d’ABCB1 peuvent moduler le taux de lipides et d’apolipoprotéines. Nous ne pouvons toutefois pas proposer l’expression d’ABCB1 dans les PBMCs comme biomarqueur du risque cardiovasculaire. Il serait intéressant de reproduire cette étude chez des sujets à risque cardiovasculaire élevé ou d’utiliser un modèle in vitro permettant d’induire l’expression d’ABCB1. / ABCB1 is an ubiquitously expressed membrane transporter. Resistance to drugs is associated with genetic variations of its gene and with modulation of its expression through the PXR transcription factor. Given that ABCB1 could also transport cholesterol, our goal was to conduct a genomic and transcriptomic analysis of ABCB1 based on the following hypotheses: 1) ABCB1 variants would partly explain plasma lipid and apolipoprotein concentrations, and 2) ABCB1 expression profile in PBMCs would be a new, and easily available, cardiovascular biomarker. We have determined frequency of ABCB1 variants in 371 subjects from the STANISLAS cohort. We have shown in these healthy people that ABCB1 variants modulate lipid concentrations, sometimes in a sex-dependant manner. Significant associations were also observed in subjects with a high cardiovascular risk. In addition, DNA microarray analysis showed that most of the xenobiotic metabolizing enzymes and transcription factors are constitutively expressed in PBMCs of healthy subjects. ABCB1 and PXR were measured by quantitative RT-PCR in 83 subjects from the STANISLAS cohort. They are both expressed in PBMCs but their expressions do not correlate. Finally, there is no association between ABCB1, or PXR, expression in PBMCs and lipid plasma concentrations in healthy subjects. To conclude, ABCB1 variants would modulate lipid and apolipoprotein concentrations. However, from our results, we cannot propose ABCB1 expression in PBMCs as a biomarker of cardiovascular risk. It would be of interest to reproduce this study in PBMCs of people at high cardiovascular risk or in an in vitro model of PBMCs with induction studies of ABCB1 expression.

Um dos principais desafios no tratamento quimioterápico em seres humanos e animais é a resistência que as células neoplásicas apresentam, sendo esse mecanismo responsável por falhas no tratamento e recidivas da doença. A resistência pode ser intrínseca ou adquirida e ocorre em função da expressão de transportadores de membrana ABC, como a glicoproteína P (ABCB1/MDR), proteínas de resistência a múltiplas drogas (ABCC1/MRP) e proteína de resistência do câncer de mama (ABCG2/BCRP). O linfoma é a neoplasia hematopoiética mais comum em cães, altamente responsiva à quimioterapia, mas que recidiva durante o tratamento antineoplásico, sendo a resistência das células neoplásicas aos quimioterápicos um fator responsável pela alta taxa de recidiva e óbito dos animais. Neste estudo avaliou-se a expressão de genes relacionados à resistência a múltiplas drogas em cães com linfoma, no diagnóstico e na recidiva da doença, em três diferentes protocolos quimioterápicos utilizados na rotina clínica. A expressão dos genes ABCB1, ABCC1, ACBG2 foi determinada por RT-PCR (PCR em tempo real) em 25 animais naturalmente acometidos pela doença, divididos aleatoriamente em 3 grupos tratados com os protocolos quimioterápicos COP, VCM e Short-Madison, além de um "pool" controle constituído por linfonodos normais de oito animais. A expressão dos genes foi detectada em todas as amostras, tanto de linfonodos normais quanto de animais com linfoma. No diagnóstico da doença, a expressão do gene ABCC1 foi relacionada negativamente com idade (p=0,008) e positivamente com duração da remissão (p=0,027) e sobrevida (p=0,007), entretanto para os genes ABCB1 e ABCG2 não houve diferença estatística significante. Na recidiva, a expressão dos genes não sofreu variação estatística significante em função do tipo e duração da remissão e sobrevida. Não houve variação na expressão dos genes ABCB1, ACBC1 e ABCG2 no momento da recidiva quando comparado ao protocolo quimioterápico utilizado. / One of the main challenges of the chemotherapy treatment in human and animals is the resistance of the neoplasic cells, being this mechanism responsible for failures in the treatment and relapse of the disease. The resistance could be intrinsic or acquired and it occurs due to the expression of ABC membrane transporters, such as p-glycoprotein (ABCB1/MDR), resistance protein to multiple drugs (ABCC1/MRP) and resistance protein of breast cancer (ABCG2/BCRP). Lymphoma is the most common hematopoietic cancer disease in dogs, highly responsive to chemotherapy, but relapse during chemotherapy treatment, being the resistance of neoplastic cells to chemotherapy drugs the responsible factor for the high rate of relapse and death of animals. In this study, genes expression related to multiples drugs resistance it was evaluated in dogs with lymphoma, in the diagnosis and in the relapse of the disease in three different chemotherapy protocols used in the clinical routine. The genes expression ABCB1, ABCC1, ACBG2 was determined by RT-PCR (real time PCR) in 25 animals naturally undertaken by the illness, randomly divided into 3 groups treated with the chemotherapy protocols COP, VCM and Short-Madison, besides a "pool" control constituted by normal lymph node of eight animals. The genes expression was detected in all the samples, both in the normal lymph node and in the animals with lymphoma. In the diagnosis of the disease, the gene expression ABCC1 was negatively related with age (p=0,008) and positively with the duration of remission (p=0,027) and survival (p=0,007); however, for ABCB1 and ABCG2 there was no statiscally significant difference. In the relapse, the genes expression had no statiscally significant difference due to the type and duration of remission and survival. There was no variation in the genes expression ABCB1, ACBC1 and ABCG2 in the moment of relapse when compared to the chemotherapy protocol used.

Um dos principais desafios no tratamento quimioterápico em seres humanos e animais é a resistência que as células neoplásicas apresentam, sendo esse mecanismo responsável por falhas no tratamento e recidivas da doença. A resistência pode ser intrínseca ou adquirida e ocorre em função da expressão de transportadores de membrana ABC, como a glicoproteína P (ABCB1/MDR), proteínas de resistência a múltiplas drogas (ABCC1/MRP) e proteína de resistência do câncer de mama (ABCG2/BCRP). O linfoma é a neoplasia hematopoiética mais comum em cães, altamente responsiva à quimioterapia, mas que recidiva durante o tratamento antineoplásico, sendo a resistência das células neoplásicas aos quimioterápicos um fator responsável pela alta taxa de recidiva e óbito dos animais. Neste estudo avaliou-se a expressão de genes relacionados à resistência a múltiplas drogas em cães com linfoma, no diagnóstico e na recidiva da doença, em três diferentes protocolos quimioterápicos utilizados na rotina clínica. A expressão dos genes ABCB1, ABCC1, ACBG2 foi determinada por RT-PCR (PCR em tempo real) em 25 animais naturalmente acometidos pela doença, divididos aleatoriamente em 3 grupos tratados com os protocolos quimioterápicos COP, VCM e Short-Madison, além de um "pool" controle constituído por linfonodos normais de oito animais. A expressão dos genes foi detectada em todas as amostras, tanto de linfonodos normais quanto de animais com linfoma. No diagnóstico da doença, a expressão do gene ABCC1 foi relacionada negativamente com idade (p=0,008) e positivamente com duração da remissão (p=0,027) e sobrevida (p=0,007), entretanto para os genes ABCB1 e ABCG2 não houve diferença estatística significante. Na recidiva, a expressão dos genes não sofreu variação estatística significante em função do tipo e duração da remissão e sobrevida. Não houve variação na expressão dos genes ABCB1, ACBC1 e ABCG2 no momento da recidiva quando comparado ao protocolo quimioterápico utilizado. / One of the main challenges of the chemotherapy treatment in human and animals is the resistance of the neoplasic cells, being this mechanism responsible for failures in the treatment and relapse of the disease. The resistance could be intrinsic or acquired and it occurs due to the expression of ABC membrane transporters, such as p-glycoprotein (ABCB1/MDR), resistance protein to multiple drugs (ABCC1/MRP) and resistance protein of breast cancer (ABCG2/BCRP). Lymphoma is the most common hematopoietic cancer disease in dogs, highly responsive to chemotherapy, but relapse during chemotherapy treatment, being the resistance of neoplastic cells to chemotherapy drugs the responsible factor for the high rate of relapse and death of animals. In this study, genes expression related to multiples drugs resistance it was evaluated in dogs with lymphoma, in the diagnosis and in the relapse of the disease in three different chemotherapy protocols used in the clinical routine. The genes expression ABCB1, ABCC1, ACBG2 was determined by RT-PCR (real time PCR) in 25 animals naturally undertaken by the illness, randomly divided into 3 groups treated with the chemotherapy protocols COP, VCM and Short-Madison, besides a "pool" control constituted by normal lymph node of eight animals. The genes expression was detected in all the samples, both in the normal lymph node and in the animals with lymphoma. In the diagnosis of the disease, the gene expression ABCC1 was negatively related with age (p=0,008) and positively with the duration of remission (p=0,027) and survival (p=0,007); however, for ABCB1 and ABCG2 there was no statiscally significant difference. In the relapse, the genes expression had no statiscally significant difference due to the type and duration of remission and survival. There was no variation in the genes expression ABCB1, ACBC1 and ABCG2 in the moment of relapse when compared to the chemotherapy protocol used.

Le rein est particulièrement exposé à de nombreux composés chimiques dont des médicaments, potentiellement néphrotoxiques. Parmi-eux, le Tacrolimus, un anti-calcineurine largement utilisé en transplantation rénale, est associé à l’apparition plus ou moins rapide de lésions histologique de toxicité conduisant à la fibrose rénale et, à terme, à la perte de fonction du greffon. Des systèmes enzymatiques et protéiques impliqués dans la prise en charge cellulaire des xénobiotiques, ainsi que des protéines aux propriétés anti-fibrosantes, telles que la cavéoline-1, lui permettent de se défendre contre ce type d’agression locale prolongée. La mesure de l’expression de 380 gènes impliqués dans la prise en charge des xénobiotiques dans des échantillons de tissu rénal humain sain nous a permis de confirmer que le rein possède un arsenal de défense important et complet. Ces différents systèmes de défense étant hautement polymorphes, le principal objectif de notre travail était de déterminer l’impact de certains polymorphismes génétiques sur la susceptibilité individuelle à la néphrotoxicité du Tacrolimus.Dans un premier temps, l’impact sur les paramètres pharmacocinétiques du Tacrolimus et le devenir du greffon de deux polymorphismes génétiques affectant les CYP3A5 et ABCB1, deux protéines participant au transport et au métabolisme du Tacrolimus, a été évalué dans une cohorte de 209 patients transplantés rénaux. Le génotypage a été réalisé à la fois sur l’ADN des receveurs et des donneurs. Les patients ont été suivis jusqu'à 2 ans après transplantation rénale. Cette étude a confirmé que les receveurs sous Tacrolimus (Prograf) porteurs d’au moins un allèle CYP3A5*1 fonctionnel nécessitent, quelque soit le moment de la greffe, des posologies de Tacrolimus plus élevées. Malgré ces doses, leur taux résiduel de Tacrolimus (C0) reste plus faible. Cependant, l’analyse de la distribution des rapports résiduelles/posologies de Tacrolimus montre qu’il existe une forte zone de chevauchement entre les deux populations *1/- vs *3/*3. Ainsi, certains patients ayant un CYP3A5 génétiquement déficitaire se comportent phénotypiquement comme des patients fonctionnels. D’autres polymorphismes génétiques sont probablement à l’origine de ce phénomène. En ce qui concerne le devenir du greffon, malgré son impact sur la pharmacocinétique du Tacrolimus, le polymorphisme génétique du CYP3A5 du donneur ou du receveur n’est statistiquement pas associé à la survenue de rejet, de retard de fonctionnement de greffon, ou n’a d’impact direct sur la fonction rénale (MDRD) et la survie du greffon. La mutation 3435C>T affectant le gène ABCB1 du donneur ou du receveur n’influence ni les paramètres pharmacocinétiques, ni le devenir clinique du greffon. Par ailleurs, le Tacrolimus est désormais disponible sous une forme à libération prolongée (Advagraf), permettant une prise unique journalière. Des pharmacocinétiques sur 24h ont été réalisées chez 32 patients (17 fonctionnels et 15 non fonctionnels pour le CYP3A5) avant conversion et quinze jours après conversion Prograf-Advagraf. Les résultats ont montré que, après conversion, l’exposition au Tacrolimus diminue de manière significative pour les patients CYP3A5 fonctionnelsEnfin, l’influence d’un polymorphisme génétique, rs4730751, affectant le gène CAV1 (codant la cavéoline-1, une protéine inhibitrice de la fibrose tissulaire) sur la survie du greffon rénal a récemment été rapporté. Nous avons confirmé dans une cohorte de 475 transplantés rénaux que les patients porteurs de ce polymorphisme génétique à l’état homozygote (ADN du greffon rénale) ont une altération de la fonction rénale significativement plus rapide. / Tacrolimus is highly effective in preventing acute rejection after renal transplantation, but displays a narrow therapeutic index and high inter-individual pharmacokinetic variations. As Tacrolimus is a substrate of CYP3A and ABCB1, the effect of potentially relevant genetic polymorphisms, CYP3A5 6986A>G and ABCB1 3435C>T, in both donors and recipients on Tacrolimus pharmacokinetics and clinical outcome was investigated in 209 kidney transplant patients. Methodology/Principal Findings:The mean duration follow-up was 21.8±9 months. Tacrolimus dose, trough blood levels (C0) and C0/dose ratio were statistically correlated with only the recipient CYP3A5 genotype. Concerning the allograft clinical outcome, CYP3A5 and ABCB1 genotypes exhibit no influence on the incidence of Biopsy Proven Acute Rejection and Delayed Graft Function. Renal function was not affected by CYP3A5 and ABCB1 genotypes. Histological evaluation of biopsies revealed also no significant association between Tacrolimus toxicity features and donor or recipient CYP3A5 and ABCB1 polymorphisms. Tacrolimus and steroids sparing was similar in groups of patients according to their genotypes. Conclusions/Significance: Recipient CYP3A5 6986A>G polymorphism explains part of the inter-individual variability in the pharmacokinetics of Tacrolimus. At two years, clinical outcome does not appear to be related to either donor’s or recipient’s CYP3A5 6986A>G and ABCB1 3435C>T polymorphisms. Interestingly, tapering of immunosuppressive therapy may be achieved even for patients experiencing extensive Tacrolimus metabolism, independently of CYP3A5 genotype.

No description available.

A leucemia mieloide crônica (LMC) é uma expansão clonal da célula tronco hematopoética, traduzindo-se por hiperplasia mieloide, leucocitose, neutrofilia, basofilia e esplenomegalia. O cromossomo Filadélfia é característico da doença, sendo produto da translocação t(9:22)(q34;q11), resultando na fusão dos genes ABL e BCR. Esta fusão gera um gene híbrido que codifica uma proteína com elevada atividade tirosinoquinase e tem um papel central na patogenia da LMC. O mesilato de imatinibe (MI) é um derivado da fenilaminopirimidina que inibe a proteína tirosinoquinase BCR-ABL1 in vitro e in vivo. O MI interage com transportadores de membrana de influxo, como o organic carion solute carrier 22 ,member 1 (SLC22A1,hOCT1); e de efluxo, como ATP binding cassette B1 (ABCB1, MDR1, P-gp). Os polimorfismos ABCB1 c.1236C>T, C.3435C>T e c.2677G>T/A têm sido associados com a alteração da função da P-gp. Este estudo teve por objetivo investigar a relação da expressão do RNAm de ABCB1 e SLC22A1 com marcadores de resposta ao tratamento com MI e avaliar a atividade funcional da P-gp em células mononucleares de pacientes com diferentes haplótipos para os polimorfismos ABCB1 c.1236C>T, c.3435C>T e c.2677G>T/A. Foram incluídos 118 pacientes com LMC para o estudo da expressão do RNAm de SLC22A1 e ABCB1 e para o estudo da atividade da P-gp foram selecionados 28 pacientes de acordo com os haplótipos dos polimorfismos ABCB1 c.1236C>T, c.3435C>T e c.2677G>T/A. Para o estudo da expressão do RNAm de SLC22A1 e ABCB1 foram constituídos dois grupos: Grupo 1 com 70 pacientes com resposta citogenética completa com a dose padrão de MI (400 mg/dia de MI) em até 18 meses e, Grupo 2 com 48 pacientes sem resposta citogenética completa com a dose inicial de 400 mg/dia de MI ou que perderam esta resposta ao longo do tratamento. Para o estudo da atividade funcional da P-gp, dos 118 pacientes incluídos, foram selecionados 10 pacientes que apresentaram o haplótipo 1236CC/3435CC/2677GG, 10 pacientes que apresentaram o haplótipo 1236CT/3435CT/2677GT e 8 pacientes que apresentaram o haplótipo 1236TT/3435TT/2677TT. A resposta ao tratamento foi avaliada segundo os critérios da European LeukemiaNet. Amostras de sangue foram obtidas para: quantificação de BCR-ABL1, extração do RNAm total, análise citogenética de banda G, dosagem da concentração plasmática de MI e análise da atividade e expressão da P-gp. A análise da expressão dos genes ABCB1 e SLC22A1 foi feita por PCR em tempo real, a análise da atividade e expressão da P-gp foram feitas por citometria de fluxo e a dosagem da concentração plasmática de MI foi realizada por eletroforese capilar. Resultados: A expressão de ABCB1 e SLC22A1 foi analisada nos 118 pacientes incluídos e foi similar entre os grupos de resposta. A elevada expressão do gene SLC22A1 foi associada àqueles pacientes que alcançaram a resposta molecular maior (RMM) no grupo respondedor (P=0,009). Não houve associação entre a expressão de ABCB1 e a resposta ao MI. Nenhum dos genes foi associado à resposta molecular completa (RMC). No estudo da atividade da P-gp foi observada uma maior atividade nos pacientes que apresentavam o haplótipo 1236CC/3435CC/2677GG quando comparado àqueles que possuíam o haplótipo com alelo mutado. Não houve diferença na expressão do RNAm dos genes SLC22A1 e ABCB1, expressão da P-gp e concentração plasmástica de MI entre os grupos de haplótipos. Os pacientes que não alcançaram a RMM apresentaram uma maior taxa de efluxo mediado pela P-gp quando comparado aos indivíduos que alcançaram esta resposta (64,7% vs. 45,7%; P=0,001). Os indivíduos que alcançaram a RMM e RMC apresentaram maior mediana de expressão do gene SLC22A1. Os pacientes sem RMM apresentaram menor concentração plasmática de MI quando comparados aos que alcançaram esta resposta (0,51 µg/mL vs. 1,42 µg/mL; P=0,001). Não foi observada associação entre a concentração plasmática de MI e a RMC. Em conclusão os pacientes respondedores a dose padrão de 400mg/dia de MI e que alcançaram a RMM apresentam maior expressão de RNAm de SLC22A1 e os portadores dos haplótipos 1236CT/3435CT/2677GT e 1236TT/3435TT/2677TT exibem menor efluxo mediado pela P-gp apresentando maior frequência de RMM. / Chronic myeloid leukemia (CML) is a clonal expansion of hematopoietic stem cell, translating into myeloid hyperplasia, leukocytosis, neutrophilia, basophilia and splenomegaly. The Philadelphia chromosome is characteristic of the disease, being the product of the translocation t(9:22)( q34,q11), resulting in the fusion of the BCR and ABL genes. This fusion generates a hybrid gene that encodes a protein with elevated tyrosine kinase activity and plays a central role in the pathogenesis of CML. Imatinib mesylate (IM) is a derivative of fenilaminopirimidine that inhibits BCR-ABL1 fusion protein tyrosine kinase in vitro and in vivo. IM interacts with uptake membrane transporters, such as cation organic solute carrier 22, member 1 (SLC22A1, hOCT1) and efflux as ATP binding cassette B1 (ABCB1, MDR1,P-gp). ABCB1 polymorphisms c.1236C>T,c.3435C>T and c.2677G>T/A have been associated with altered function of P-gp. This study aimed to investigate the relationship between mRNA expression of ABCB1 and SLC22A1 with markers of response to treatment with IM and evaluate the functional activity of P-gp in mononuclear cells of patients with different haplotypes for ABCB1 c.1236C>T, c.3435C>T and c.2677G>T/A polymorphisms. This study included 118 patients with CML to study the mRNA expression of SLC22A1 and ABCB1 and to study the P-gp activity, 28 patients were selected according to the haplotypes of ABCB1 c.1236C>T, c.3435C>T and c.2677G>T/A polymorphisms. To study the mRNA expression of SLC22A1 and ABCB1, two groups were constituted: Group 1 with 70 patients with a complete cytogenetic response with standard-dose IM (400 mg/day) in 18 months, and group 2 with 48 patients without complete cytogenetic response with the initial dose of IM (400 mg/day) or have lost this response during treatment. To study the P-gp functional activity, 10 patients with haplotype 1236CC/3435CC/2677GG, 10 patients with haplotype 1236CT/3435CT/2677GT and 8 patients with haplotype 1236TT/3435TT/2677TT were enrolled. Treatment response was assessed according to European LeukemiaNet criteria. Blood samples were obtained for: quantification of BCR-ABL1, mRNA extraction, G band cytogenetic analysis, measurement of IM plasma levels and P-gp activity and expression. The ABCB1 and SLC22A1 gene expression analysis was made by real-time PCR, analysis of P-gp activity and protein expression were performed by flow cytometry and determination of plasma Levels of IM was performed by capillary electrophoresis. Results: Expression of ABCB1 and SLC22A1 were analyzed in 118 patients included and was similar between the response groups. Higher expression of the SLC22A1 gene was associated with those patients who achieved a major molecular response (MMR) in the responder group (P=0.009). There was no association between ABCB1 expression and IM response. None of the studied genes was associated with complete molecular response (CMR). In the study of P-gp activity we observed greater activity mediated by P-gp in patients with 1236CC/3435CC/2677GG haplotype when compared to those with the mutated allele. There was no difference in mRNA expression of SLC22A1 and ABCB1 genes, P-gp expression and IM plasma levels between haplotypes groups. Patients who did not achieve MMR showed a higher rate of efflux mediated by P-gp compared to individuals who did achieve this response (64.7% vs. 45.7%, P=0.001). Individuals who achieved MMR and CMR had higher median of SLC22A1 expression. Patients without MMR had lower IM plasma levels compared with those who achieved this response (0.51 µg/mL vs. 1.42 µg/mL, P=0.001). No association was observed between IM plasma levels and CMR. In conclusion patients responders to standard dose of IM (400 mg/day) and who achieved MMR have higher SLC22A1 mRNA expression and the carriers of 1236CT/3435CT/2677GT 1236TT/3435TT/2677TT haplotypes exhibit lower efflux mediated by P-gp with higher frequency of MMR.

A leucemia mieloide crônica (LMC) é uma expansão clonal da célula tronco hematopoética, traduzindo-se por hiperplasia mieloide, leucocitose, neutrofilia, basofilia e esplenomegalia. O cromossomo Filadélfia é característico da doença, sendo produto da translocação t(9:22)(q34;q11), resultando na fusão dos genes ABL e BCR. Esta fusão gera um gene híbrido que codifica uma proteína com elevada atividade tirosinoquinase e tem um papel central na patogenia da LMC. O mesilato de imatinibe (MI) é um derivado da fenilaminopirimidina que inibe a proteína tirosinoquinase BCR-ABL1 in vitro e in vivo. O MI interage com transportadores de membrana de influxo, como o organic carion solute carrier 22 ,member 1 (SLC22A1,hOCT1); e de efluxo, como ATP binding cassette B1 (ABCB1, MDR1, P-gp). Os polimorfismos ABCB1 c.1236C>T, C.3435C>T e c.2677G>T/A têm sido associados com a alteração da função da P-gp. Este estudo teve por objetivo investigar a relação da expressão do RNAm de ABCB1 e SLC22A1 com marcadores de resposta ao tratamento com MI e avaliar a atividade funcional da P-gp em células mononucleares de pacientes com diferentes haplótipos para os polimorfismos ABCB1 c.1236C>T, c.3435C>T e c.2677G>T/A. Foram incluídos 118 pacientes com LMC para o estudo da expressão do RNAm de SLC22A1 e ABCB1 e para o estudo da atividade da P-gp foram selecionados 28 pacientes de acordo com os haplótipos dos polimorfismos ABCB1 c.1236C>T, c.3435C>T e c.2677G>T/A. Para o estudo da expressão do RNAm de SLC22A1 e ABCB1 foram constituídos dois grupos: Grupo 1 com 70 pacientes com resposta citogenética completa com a dose padrão de MI (400 mg/dia de MI) em até 18 meses e, Grupo 2 com 48 pacientes sem resposta citogenética completa com a dose inicial de 400 mg/dia de MI ou que perderam esta resposta ao longo do tratamento. Para o estudo da atividade funcional da P-gp, dos 118 pacientes incluídos, foram selecionados 10 pacientes que apresentaram o haplótipo 1236CC/3435CC/2677GG, 10 pacientes que apresentaram o haplótipo 1236CT/3435CT/2677GT e 8 pacientes que apresentaram o haplótipo 1236TT/3435TT/2677TT. A resposta ao tratamento foi avaliada segundo os critérios da European LeukemiaNet. Amostras de sangue foram obtidas para: quantificação de BCR-ABL1, extração do RNAm total, análise citogenética de banda G, dosagem da concentração plasmática de MI e análise da atividade e expressão da P-gp. A análise da expressão dos genes ABCB1 e SLC22A1 foi feita por PCR em tempo real, a análise da atividade e expressão da P-gp foram feitas por citometria de fluxo e a dosagem da concentração plasmática de MI foi realizada por eletroforese capilar. Resultados: A expressão de ABCB1 e SLC22A1 foi analisada nos 118 pacientes incluídos e foi similar entre os grupos de resposta. A elevada expressão do gene SLC22A1 foi associada àqueles pacientes que alcançaram a resposta molecular maior (RMM) no grupo respondedor (P=0,009). Não houve associação entre a expressão de ABCB1 e a resposta ao MI. Nenhum dos genes foi associado à resposta molecular completa (RMC). No estudo da atividade da P-gp foi observada uma maior atividade nos pacientes que apresentavam o haplótipo 1236CC/3435CC/2677GG quando comparado àqueles que possuíam o haplótipo com alelo mutado. Não houve diferença na expressão do RNAm dos genes SLC22A1 e ABCB1, expressão da P-gp e concentração plasmástica de MI entre os grupos de haplótipos. Os pacientes que não alcançaram a RMM apresentaram uma maior taxa de efluxo mediado pela P-gp quando comparado aos indivíduos que alcançaram esta resposta (64,7% vs. 45,7%; P=0,001). Os indivíduos que alcançaram a RMM e RMC apresentaram maior mediana de expressão do gene SLC22A1. Os pacientes sem RMM apresentaram menor concentração plasmática de MI quando comparados aos que alcançaram esta resposta (0,51 µg/mL vs. 1,42 µg/mL; P=0,001). Não foi observada associação entre a concentração plasmática de MI e a RMC. Em conclusão os pacientes respondedores a dose padrão de 400mg/dia de MI e que alcançaram a RMM apresentam maior expressão de RNAm de SLC22A1 e os portadores dos haplótipos 1236CT/3435CT/2677GT e 1236TT/3435TT/2677TT exibem menor efluxo mediado pela P-gp apresentando maior frequência de RMM. / Chronic myeloid leukemia (CML) is a clonal expansion of hematopoietic stem cell, translating into myeloid hyperplasia, leukocytosis, neutrophilia, basophilia and splenomegaly. The Philadelphia chromosome is characteristic of the disease, being the product of the translocation t(9:22)( q34,q11), resulting in the fusion of the BCR and ABL genes. This fusion generates a hybrid gene that encodes a protein with elevated tyrosine kinase activity and plays a central role in the pathogenesis of CML. Imatinib mesylate (IM) is a derivative of fenilaminopirimidine that inhibits BCR-ABL1 fusion protein tyrosine kinase in vitro and in vivo. IM interacts with uptake membrane transporters, such as cation organic solute carrier 22, member 1 (SLC22A1, hOCT1) and efflux as ATP binding cassette B1 (ABCB1, MDR1,P-gp). ABCB1 polymorphisms c.1236C>T,c.3435C>T and c.2677G>T/A have been associated with altered function of P-gp. This study aimed to investigate the relationship between mRNA expression of ABCB1 and SLC22A1 with markers of response to treatment with IM and evaluate the functional activity of P-gp in mononuclear cells of patients with different haplotypes for ABCB1 c.1236C>T, c.3435C>T and c.2677G>T/A polymorphisms. This study included 118 patients with CML to study the mRNA expression of SLC22A1 and ABCB1 and to study the P-gp activity, 28 patients were selected according to the haplotypes of ABCB1 c.1236C>T, c.3435C>T and c.2677G>T/A polymorphisms. To study the mRNA expression of SLC22A1 and ABCB1, two groups were constituted: Group 1 with 70 patients with a complete cytogenetic response with standard-dose IM (400 mg/day) in 18 months, and group 2 with 48 patients without complete cytogenetic response with the initial dose of IM (400 mg/day) or have lost this response during treatment. To study the P-gp functional activity, 10 patients with haplotype 1236CC/3435CC/2677GG, 10 patients with haplotype 1236CT/3435CT/2677GT and 8 patients with haplotype 1236TT/3435TT/2677TT were enrolled. Treatment response was assessed according to European LeukemiaNet criteria. Blood samples were obtained for: quantification of BCR-ABL1, mRNA extraction, G band cytogenetic analysis, measurement of IM plasma levels and P-gp activity and expression. The ABCB1 and SLC22A1 gene expression analysis was made by real-time PCR, analysis of P-gp activity and protein expression were performed by flow cytometry and determination of plasma Levels of IM was performed by capillary electrophoresis. Results: Expression of ABCB1 and SLC22A1 were analyzed in 118 patients included and was similar between the response groups. Higher expression of the SLC22A1 gene was associated with those patients who achieved a major molecular response (MMR) in the responder group (P=0.009). There was no association between ABCB1 expression and IM response. None of the studied genes was associated with complete molecular response (CMR). In the study of P-gp activity we observed greater activity mediated by P-gp in patients with 1236CC/3435CC/2677GG haplotype when compared to those with the mutated allele. There was no difference in mRNA expression of SLC22A1 and ABCB1 genes, P-gp expression and IM plasma levels between haplotypes groups. Patients who did not achieve MMR showed a higher rate of efflux mediated by P-gp compared to individuals who did achieve this response (64.7% vs. 45.7%, P=0.001). Individuals who achieved MMR and CMR had higher median of SLC22A1 expression. Patients without MMR had lower IM plasma levels compared with those who achieved this response (0.51 µg/mL vs. 1.42 µg/mL, P=0.001). No association was observed between IM plasma levels and CMR. In conclusion patients responders to standard dose of IM (400 mg/day) and who achieved MMR have higher SLC22A1 mRNA expression and the carriers of 1236CT/3435CT/2677GT 1236TT/3435TT/2677TT haplotypes exhibit lower efflux mediated by P-gp with higher frequency of MMR.

Le traitement des cancers constitue un problème de santé publique et repose entre autres sur la chirurgie, la radiothérapie, la chimiothérapie, l’hormonothérapie et les thérapies ciblées. Les progrès médicaux récents ont permis l’amélioration de la survie sans progression des patients atteints de cancer, ainsi que de la survie globale. Parmi les nouvelles stratégies thérapeutiques, le blocage de l’angiogenèse fait l’objet de nombreux essais cliniques.Cependant, l’intervention de transporteurs membranaires (influx et / ou efflux), joue un rôle important sur le plan pharmacocinétique, pharmacogénétique et dans la résistance aux médicaments anticancéreux.Nous avons observé chez des patients atteints de CHC une grande variabilité des paramètres pharmacocinétiques du sorafénib (inhibiteur de tyrosine kinase, anti-angiogénique et substrat de la P-gp et de la BCRP) et une tendance à une meilleure réponse clinique dans le groupe hétérozygote, ABCB1 3435 CT, ABCG2 34 GA, ABCG2 1143CT et ABCG2 421CA par rapport aux groupes homozygotes (type sauvage et mutant) avec une association significative aux concentrations plasmatiques normalisées aux poids.Nos travaux ont montré in vitro qu’un prétraitement avec des médicaments anti-angiogéniques tels que le bévacizumab et le sorafénib entrainait une réversion de la résistance à la doxorubicine (substrat de la P-gp) dans un modèle de cellules IGR OV1-DXR (résistantes à la doxorubicine et surexprimant la P-gp) par modulation de la fonctionnalité de la P-glycoprotéine. Cette réversion a été objectivée par l’augmentation significative des concentrations intracellulaires de la doxorubicine dans les cellules IGR OV1-DXR.In vivo chez la souris xénogreffée de cancer colorectal humain, un prétraitement par le bévacizumab a entrainé une augmentation significative des concentrations plasmatiques du SN38 (métabolite actif de l’irinotécan et substrat de la P-gp), de même que de l'AUC et de la Cmax plasmatique de l'irinotécan (susbtrat de la P-gp) après administration orale de l’irinotecan. Une augmentation significative de l'AUC plasmatique du sorafénib après un prétraitement par le bévacizumab a été également observée sur le même modèle expérimental.La connaissance et l’utilisation de la modulation d’activité des transporteurs d’efflux par les thérapies ciblées anti-angiogéniques seraient intéressantes à transposer en thérapeutique cancéreuse pour l’augmentation de la réponse clinique et pour la réversion de la résistance des cellules tumorales et endothéliales surexprimant les transporteurs d’efflux en particulier la P-gp. / Treatment of cancers is a public health problem and based on surgery, radiotherapy, chemotherapy, hormone therapy and targeted therapies. Recent medical advances allowed progression-free survival of cancer patients, and even their overall survival. Among the new therapeutic strategies, blocking of angiogenesis was the subject of several clinical trials.Intervention of membrane transporters (influx and / or efflux) plays an important pharmacokinetic and pharmacogenetic role in anticancer drugs resistance.We observed in patients with HCC, a great pharmacokinetics parameters variability of sorafenib (tyrosine kinase inhibitor, anti-angiogenic drug and P-gp and BCRP substrat) and a tendency to a better clinical response in the ABCB1 3435 CT, ABCG2 34 GA, ABCG2 1143CT and ABCG2 421CA heterozygous group than in the homozygous group (wild type and mutant).Our work showns in vitro that pretreatment with anti-angiogenic drugs such as bevacizumab and sorafenib resulted in a resistance reversion to doxorubicin (P-gp substrate) in an IGROV1 – DXR cells (resistant to doxorubicin and P-gp overexpressing cells) by modulating the functionality of P-glycoprotein. This reversion is measured by the significant increase in intracellular doxorubicin concentrations in IGR OV1-DXR cells.In vivo in human colorectal cancer xenograft mice, bevacizumab pretreatment led to a significant increase in plasma concentrations of SN38 (active metabolite of irinotecan and P-gp substrate), as well as plasma AUC and Cmax of irinotecan (P-gp substrate) after oral administration of irinotecan. Similarly, a significant increase in plasma AUC of sorafenib after bevacizumab pretreatment was observed on the same experimental model.Knowledge and use of activity modulation of efflux pumps by anti-angiogenic targeted therapies would be interesting to translate into cancer therapy for increased clinic response and resistance reversion of the tumor and endothelial cells overexpressing efflux transporters, particularly P-gp.

Le rein est particulièrement exposé à de nombreux composés chimiques dont des médicaments, potentiellement néphrotoxiques. Parmi-eux, le Tacrolimus, un anti-calcineurine largement utilisé en transplantation rénale, est associé à l'apparition plus ou moins rapide de lésions histologique de toxicité conduisant à la fibrose rénale et, à terme, à la perte de fonction du greffon. Des systèmes enzymatiques et protéiques impliqués dans la prise en charge cellulaire des xénobiotiques, ainsi que des protéines aux propriétés anti-fibrosantes, telles que la cavéoline-1, lui permettent de se défendre contre ce type d'agression locale prolongée. La mesure de l'expression de 380 gènes impliqués dans la prise en charge des xénobiotiques dans des échantillons de tissu rénal humain sain nous a permis de confirmer que le rein possède un arsenal de défense important et complet. Ces différents systèmes de défense étant hautement polymorphes, le principal objectif de notre travail était de déterminer l'impact de certains polymorphismes génétiques sur la susceptibilité individuelle à la néphrotoxicité du Tacrolimus.Dans un premier temps, l'impact sur les paramètres pharmacocinétiques du Tacrolimus et le devenir du greffon de deux polymorphismes génétiques affectant les CYP3A5 et ABCB1, deux protéines participant au transport et au métabolisme du Tacrolimus, a été évalué dans une cohorte de 209 patients transplantés rénaux. Le génotypage a été réalisé à la fois sur l'ADN des receveurs et des donneurs. Les patients ont été suivis jusqu'à 2 ans après transplantation rénale. Cette étude a confirmé que les receveurs sous Tacrolimus (Prograf) porteurs d'au moins un allèle CYP3A5*1 fonctionnel nécessitent, quelque soit le moment de la greffe, des posologies de Tacrolimus plus élevées. Malgré ces doses, leur taux résiduel de Tacrolimus (C0) reste plus faible. Cependant, l'analyse de la distribution des rapports résiduelles/posologies de Tacrolimus montre qu'il existe une forte zone de chevauchement entre les deux populations *1/- vs *3/*3. Ainsi, certains patients ayant un CYP3A5 génétiquement déficitaire se comportent phénotypiquement comme des patients fonctionnels. D'autres polymorphismes génétiques sont probablement à l'origine de ce phénomène. En ce qui concerne le devenir du greffon, malgré son impact sur la pharmacocinétique du Tacrolimus, le polymorphisme génétique du CYP3A5 du donneur ou du receveur n'est statistiquement pas associé à la survenue de rejet, de retard de fonctionnement de greffon, ou n'a d'impact direct sur la fonction rénale (MDRD) et la survie du greffon. La mutation 3435C>T affectant le gène ABCB1 du donneur ou du receveur n'influence ni les paramètres pharmacocinétiques, ni le devenir clinique du greffon. Par ailleurs, le Tacrolimus est désormais disponible sous une forme à libération prolongée (Advagraf), permettant une prise unique journalière. Des pharmacocinétiques sur 24h ont été réalisées chez 32 patients (17 fonctionnels et 15 non fonctionnels pour le CYP3A5) avant conversion et quinze jours après conversion Prograf-Advagraf. Les résultats ont montré que, après conversion, l'exposition au Tacrolimus diminue de manière significative pour les patients CYP3A5 fonctionnelsEnfin, l'influence d'un polymorphisme génétique, rs4730751, affectant le gène CAV1 (codant la cavéoline-1, une protéine inhibitrice de la fibrose tissulaire) sur la survie du greffon rénal a récemment été rapporté. Nous avons confirmé dans une cohorte de 475 transplantés rénaux que les patients porteurs de ce polymorphisme génétique à l'état homozygote (ADN du greffon rénale) ont une altération de la fonction rénale significativement plus rapide.

The ABC protein P-glycoprotein (Pgp, ABCB1) transports many structurally diverse substrates from the lipid bilayer. Previous studies demonstrated the importance of the membrane environment, but few have quantified these effects. In the present work, purified Pgp reconstituted into defined lipid systems was employed. Drug binding affinities were determined using Trp quenching, and drug-lipid partitioning by equilibrium dialysis. Pgp bound substrates from the bilayer with affinities in the millimolar range; both drug-Pgp and drug-lipid interactions were important. The kinetics of Pgp-mediated drug transport were sensitive to drug structure and lipid environment. The rate of transport is proposed to depend on the affinity of Pgp for substrate and conformational changes. The lipid bilayer affected the stability of Pgp catalytic activity which provided evidence for distinct basal and drug-stimulated ATPase cycles. Overall, the lipid environment had pronounced effects on Pgp-mediated drug binding, transport and catalytic functions. / Canadian Cancer Society