Charles University Faculty of Pharmacy in Hradec Králové Department of Pharmacology & Toxicology Student: Martin Huličiak Supervisor: PharmDr. Lukáš Červený, Ph.D Title of diploma thesis: Study of interactions of antiviral drugs with intestinal drug efflux ABC transporters P-gp, MRP2 and BCRP are efflux transporters, members of the family of ATP binding cassette (ABC) transporters. These transporters are located on the apical membrane of the intestinal epithelium, where they may limit absorption of orally administered drugs. Study of drug interactions with/on intestinal efflux transporters is necessary to provide safe and effective treatment. The Caco-2 cell line is FDA recommended in vitro model of intestinal barrier and it is used for bidirectional testing of substrates and inhibitors of ABC transporters in preclinical research. However, this methodology has several shortcomings, so the need of introduction of new experimental models is increasing and the ex vivo method based on human or rat intestine is a promising option. Precision-cut intestinal slices (PCIS) represent a mini-model of the organ and contain all types of cells of the tissue. We used both in vitro model using Caco-2 cell monolayers for drug transport study and in our lab established ex vivo method of PCIS for accumulation study...

Neste trabalho, esclarecemos tópicos da patogenicidade de EIEC que sustentam a sua menor virulência quando comparada à S. flexneri, e mostramos a importância das células dendríticas (CD) nesse processo. Estudou-se o comportamento de EIEC e S. flexneri quando em contato com células Caco-2, avaliando-se uma cinética de expressão dos genes envolvidos na invasão e disseminação bacteriana. Em geral, todos os genes foram menos expressos em EIEC, fato corroborado pelo fenótipo de disseminação bacteriana, onde EIEC foi menos eficiente do que Shigella. Também foi avaliada a modulação da resposta inflamatória de células dendríticas intestinais murinas pela produção de citocinas, expressão de moléculas co-estimulatórias e apresentação de antígenos, após desafio das células com as bactérias. Os resultados sugerem que EIEC induz a uma resposta protetora ao hospedeiro, enquanto que Shigella estaria \"driblando\" o sistema imune, além de provavelmente super-estimular o sistema imune adaptativo, fato que poderia levar a um agravamento da doença. As ações integradas das células Caco-2, células dendríticas e estímulos bacterianos foram estudadas em co-cultura celular. Observou-se que EIEC e suas proteínas secretadas induzem a migração das CDs ao compartimento apical da co-cultura; nada foi observado quando o desafio se deu com Shigella. Também foram avaliadas as concentrações de citocinas inflamatórias no microambiente infeccioso formado. A citocina TNF-α, bem como CCL20 e MCP-1 foram mais proeminentes após estímulo com EIEC, fato que poderia explicar parcialmente a migração das CDs ao lado apical da co-cultura após estímulo com EIEC e suas proteínas secretadas. Nossas evidências experimentais indicam que a doença desencadeada por EIEC é mais restrita a um determinado local da infecção, ou seja, não é capaz de se disseminar a ponto de estender a lesão tecidual de forma mais drástica, como Shigella. Esse fenômeno pode estar associado à menor expressão de seus dos fatores de virulência e à resposta imune inata induzida no sítio de infecção, o que levaria, fatalmente, à resolução da doença. / In this study, we clarify topics of pathogenicity from EIEC that support its lower level of virulence when it is compared to S. flexneri, and we have shown the importance of dendritic cells (DC) in this process. We studied the conduct of EIEC and S. flexneri when they were in contact with Caco-2 cells and we analyzed the kinetics of the genes expression that was involved in the spread and invasion of the bacteria. In general, all genes were expressed less in EIEC, as demonstrated by the phenotype of the bacterial spread, where EIEC was less efficient than Shigella. We also analyzed the modulation of the inflammatory response by the murine intestinal dendritic cells by the production of cytokine, expression of co-stimulators molecules and antigens presentation, after the interaction of the cells with the bacteria. The results showed that EIEC induces a response that protects the host while Shigella manipulate the host intestinal innate and adaptive immune system and it probably over-stimulates the adaptive immune system which could let the disease worse. The integrated actions of Caco-2 cells, dendritic cells and bacterial stimulus, were studied in a co-culture cell. We observed that EIEC and its secreted proteins induce the migration of the DCs to the apical compartment of the co-culture; nothing was observed related to Shigella. We also evaluated the concentrations of the inflammatory cytokines at the infective micro environment that was formed. The cytokine TNF-α, as CCL20 and MCP-1 were more prominent after been stimulated with EIEC, a fact that could partially explain the migration of DCs to the apical side of the co-culture after the stimulus with EIEC and its secreted proteins. Our experimental evidence shows that the disease triggered by the EIEC is more restricted at a definite infection place, which means that it is not capable of disseminating beyond a certain point to extend the tissue\'s injury and let it worsen, as Shigella do. This phenomenon can be associated with the lower level of expression of its virulence factors and to the immune response induced in the infection site, what could finally lead to the eradication of the disease.

Les céréales et les produits issus de leur transformation sont susceptibles d’être contaminés par des espèces fongiques capables de produire des mycotoxines. L’Homme est ainsi exposé tout au long de sa vie à travers son alimentation à ces contaminants naturels, généralement à de faibles doses et en mélange. Cependant, l’incidence de la présence simultanée de ces toxines sur notre santé, à court terme comme à plus long terme, ainsi que les mécanismes responsables de leur toxicité sont encore peu ou mal caractérisés. L’utilisation de modèles cellulaires humains pertinents et adaptés est particulièrement importante pour de telles études. L’épithélium intestinal et le système immunitaire, qui constituent la première barrière de défense de l’hôte suite à l’ingestion de contaminants alimentaires, ainsi que le foie, de par son rôle majeur dans la biotransformation des xénobiotiques, représentent des modèles d’étude pertinents en toxicologie. Dans le cadre de cette étude, des modèles cellulaires humains d’origine intestinale (Caco-2), immunitaire (THP-1) et hépatique (HepaRG) ont été employés pour évaluer le risque associé à la co-exposition aux mycotoxines de Fusarium (appelées fusariotoxines) qui sont parmi les plus problématiques dans nos régions. Différents types d’interactions, tels que de l’antagonisme et du synergisme, ont pu être observés sur la viabilité cellulaire en fonction de la nature du mélange, des doses testées, de la lignée cellulaire étudiée et du modèle mathématique utilisé pour prédire les effets combinés. Des interactions ont également été observées à l’échelle moléculaire, les effets des mélanges étant très différents de ceux induits par les toxines individuellement sur le protéome des cellules. D’autres résultats obtenus interrogent sur la façon dont les mycotoxines déclenchent réellement la réponse cellulaire. De plus, les interactions entre cellules cocultivées semblent capables de modifier la réponse cellulaire suite à l’exposition à ces toxines. Ces résultats soulignent l’importance de développer des modèles in vitro de plus en plus sophistiqués et s’approchant des conditions in vivo pour permettre une meilleure caractérisation du risque « mycotoxine ». / Cereals and cereal-based products are susceptible to be contaminated by mycotoxin-producing fungi.Thus, through their diet, humans are exposed throughout their life to these natural food contaminants, mostly at low doses and in mixture. However, the health impact of the simultaneous exposure to these toxins, in acute and chronic conditions, as well as the mechanism related to their toxicity, are still poorly characterized. The use of relevant and suitable human cell models is therefore of particular importance for such studies. The intestinal epithelium and immune system, which constitute the first host defense barrier following the food contaminant uptake, as well as the liver, due to its major function in xenobiotic biotransformation, are relevant for toxicity studies. In the framework of study, the intestinal (Caco-2), immune (THP-1) and hepatic (HepaRG) human cell models were used for risk assessment associated with co-exposure to Fusarium mycotoxins (called fusariotoxins) which are the most problematic in our regions. Different type of interactions, such as antagonism and synergism, were observed on cell viability depending on the nature of the mixture, tested concentration, studied cell line and used mathematical model to predict the combined effects. Interactions were also highlighted at the molecular level, the effects of mixtures being very different from those induced by the toxins alone on the cell proteome. Other results raised the question about how mycotoxins actually trigger the cellular response. In addition, cell-cell interactions in co-cultured systems appeared to modify the cellular response following exposures to these toxins. Overall, the obtained results highlighted the relevance of developing in vitro models increasingly sophisticated and closer to in vivo conditions to allow for a better characterization of the "mycotoxin" risk.

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

Die Durchfallerkrankung Giardiasis wird durch den Protisten Giardia duodenalis ausgelöst. Die Infektion erfolgt fäkal-oral, meist über kontaminiertes Trinkwasser. Der Parasit kolonisiert den oberen Bereich des Dünndarms und heftt sich an das Epithel, wodurch es die Krankheitsbeschwerden auslöst. Allerdings sind Details über die Mechanismen der Pathogenese unbekannt. Dazu kommt, dass der Ausgang einer Infektion fallspezifisch starken Schwankungen unterworfen ist, von selbst-limitierend bis chronisch und asymptomatischer Kolonisierung bis hin zur schweren Enteritis. Ein möglicher Pathomechanismus ist der Wegfall der Barrierefunktion des Dünndarmepithels, z.B. durch Beeinträchtigung von tight junctions oder Zelltod. In dieser Arbeit wurden Effekte von G. duodenalis auf in vitro Modellsysteme des humanen Dünndarmepithels untersucht. Dazu wurden hauptsächlich Daten über die Barrierefunktion sowohl von der weit verbreiteten Caco-2 Zelllinie, als auch über ein neu etabliertes humanes Dünndarmorganoidsystem, erhoben. Es konnte gezeigt werden, dass mehrere - mitunter in der Literatur als hochvirulent beschriebene - G. duodenalis Isolate zu keinerlei Beeinträchtigung der Barrierefunktion oder irgendeiner anderen untersuchten potenziellen Schädigung an zwei unterschiedlichen Caco-2 Zelllinien unter diversen Infektions- und Kulturbedingungen führte. Jedoch andererseits das neu entwickelte Dünndarmorganoidsystem mit pseudo-luminalem Medium TYI S 33 reproduzierbar die Zerstörung des Epithelmodells mit Zellverlust, Zelltod (apoptotisch und nicht-apoptotisch), Störung der tight junctions (Abbau und Dislokation von Claudinen und ZO-1) und den Verlust von Mikrovilli innerhalb ein bis zwei Tage nach Parasiteninfektion zeigen konnte. Zudem wurde das Auftauchen von ClCa-1-Signalen unter andauerndem Infektionsstress beobachtet, was die Differenzierung bzw. Metaplasie zu Becherzellen nahelegt, jedoch keine Wirtsreaktion auf die Gewebszerstörung zu sein scheint. / The protozoan parasite Giardia duodenalis is the etiological agent for the intestinal diarrheal disease giardiasis. Infections are acquired via the fecal-oral route, mostly via uptake of cysts from contaminated drinking water. The colonization of the hosts’ duodenum and upper jejunum and the attachment of Giardia trophozoites onto the epithelium is the cause of a variety of gastrointestinal complaints but the exact pathomechanisms are unknown. Furthermore, the outcome of Giardia infections varies greatly between individuals, ranging from self-limiting to chronic, and asymptomatic to severe enteritis. One proposed mechanism for the pathogenesis is the breakdown of intestinal barrier function, e.g. by tight junction impairment or induction of cell death. In this work, effects of G. duodenalis on in vitro models of the human small intestinal epithelium were investigated by studying mainly barrier-related properties and changes of widely used Caco-2 cells as well as newly established human small intestinal organoid-derived monolayers (ODMs). It could be shown that several isolates of G. duodenalis, some described as highly virulent, fail to induce barrier dysfunction or any other investigated pathological effect on two Caco-2 cell lines under various infection and culturing conditions. On the other side, by developing a new organoid-based model system and the use of luminal mock medium TYI-S-33, considerable epithelial disruption (including loss of cells), cell death (apoptosis and non-apoptotic), tight junction impairment (degradation and dislocation of claudins and ZO-1), and microvilli depletion reproducibly induced by G. duodenalis trophozoites between one and two days after infection could be observed. Moreover, emergence of ClCa-1 positive cells with ongoing parasite infections suggest epithelial differentiation or metaplasia towards goblet cells, which is furthermore not associated to tissue damage.

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

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

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

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

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