The Cytochrome P450 family of enzymes is responsible for the majority of Phase I metabolism, and has been identified as an important source of pharmacokinetic variation in therapeutic responses. CYP2C19 and CYP2D6, metabolising >35% of commonly prescribed medications, are two of the most important pharmacogenetic markers that have been studied with the aim of improving treatment response and reducing adverse drug reactions. The Food and Drug Administration (FDA) approved AmpliChip CYP450 Test (AmpliChip) was compared to a previously developed PCR-RFLP platform and a newly developed XLPCR+ Sequencing platform for the ability to identifying genotype and predicting phenotype for CYP2C19 and CYP2D6 respectively. The AmpliChip was found not to be genotypically comprehensive enough for evaluating CYP2C19 genotype, not robust enough for determining CYP2D6 genotype and inaccurate in predicting phenotype for both. The XLPCR+ Sequencing method identified three novel alleles and one sub-variant. Advances in online column-switching solid phase extraction generated a rapid and robust LCMS/ MS method for simultaneously quantifying the probe drugs omeprazole (CYP2C19 substrate), dextromethorphan (CYP2D6 substrate) and their metabolites. Antimodes were identified for phenotypic cut-offs which offered measured phenotype for comparison to predicted phenotype. Omeprazole metabolism by CYP2C19 correlated well with predicted phenotype in a demographically representative South African cohort. There are concerns regarding the use of omeprazole as a probe drug as participants predicted to be ultrarapid metabolisers for CYP2C19 had similar rates to extensive metabolisers. Regardless of this concern, decreased metabolism was assigned to the CYP2C19*15 for the first time. CYP2D6 predicted phenotype correlated very well with measured phenotype, validating the suitability of dextromethorphan use for measuring CYP2D6 metabolism. Substrate modified activity score using 0.5 to predict intermediate metabolisers fine-tuned the XLPCR+ Sequencing platform for phenotype prediction. This finding, along with observations in CYP2C19 metabolism of omeprazole, highlights the importance of substrate specific phenotype prediction strategies. Controversially, attempts to associate CYP2D6 phenotype prediction with risperidone-related adverse drug reactions has yielded conflicting results. The XL-PCR+Sequencing platform was able to discount this association by predicting a variety of metabolisers in a pilot cohort selected to be experiencing risperidone-related adverse drug reactions. The comprehensive capability of the XL-PCR+Sequencing allowed for the identification of an additional novel allele in this cohort. The data presented in thisthesis has provided insight into the relationship between predicted and measured phenotype for CYP2C19 and CYP2D6 in the South African population. The XL-PCR+Sequencing platform can be used for future research or can be applied to improve treatment outcome. The LC-MS/MS method developed could be used for future evaluations of predicted and measured phenotype with the ability to be adjusted for therapeutic drug monitoring. This thesis advances pharmacogenetics of CYP2C19 and CYP2D6 for use in the South African population. / Thesis (PhD)--University of Pretoria, 2013. / gm2014 / Pharmacology / unrestricted

L’objectif principal de nos études a été de caractériser la pharmacocinétique du baclofène chez le patient alcoolo-dépendant et d’étudier la variation du craving en fonction de l'exposition au baclofène pour objectif de comprendre s’il existait des sujets répondeurs et des sujets non répondeurs. Nous nous sommes intéressés à la sécurité d’emploi du baclofène, à l’influence que pourraient avoir les paramètres démographiques et biologiques ainsi que la consommation de tabac concomitante. Nous avons pu mettre en évidence que le baclofène présentait une pharmacocinétique linéaire avec une relation proportionnelle de 30 à 240 mg par jour avec une importante variabilité interindividuelle. Une modélisation pharmacocinétique/pharmacodynamique par approche de population nous a permis de définir la relation entre l’exposition au baclofène et le craving à l’alcool. Nous avons constaté que le baclofène permettait de diminuer le craving à l’alcool pour l’ensemble des patients traités, et nous avons pu élaborer l’hypothèse qu’il existait deux sous-populations de patients différenciés par leur rapidité de réponse. Bien que chez les patients non-répondeurs (répondeurs tardifs) les taux sanguins de créatinine et de phosphatases alcalines étaient significativement plus élevés laissant supposer que les patients sévèrement malades répondaient moins au traitement, le faible nombre de patients (n=50) et l’absence de placebo ne permettent pas de conclure. Des analyses préliminaires des données de craving à l’alcool et de consommation d’alcool suggèrent qu’il existe une relation entre craving et consommation d’alcool. Des analyses complémentaires sont nécessaires pour confirmer ces résultats. / The main objective of our studies was to characterize the pharmacokinetics of baclofen in alcohol-dependent patients and to investigate the variation of craving as a function of exposure with a secondary objective which was to explore the possible existence of baclofen responders and non-responders. We investigated baclofen safety, the potential influence of demographic and biological parameters as well as the concomitant use of tobacco. We observed that baclofen showed linear pharmacokinetics with a proportional relationship from 30 to 240 mg per day with a high inter-individual variability. A pharmacokinetic/pharmacodynamic population approach has enabled us to define the relationship between baclofen exposure and alcohol craving. A wide inter-individual variability in response was depicted but could not be explained by any of the covariates studied. We found that baclofen could possibly reduce alcohol craving in all the patients treated, and we drew up the hypothesis of two subpopulations of patients differentiated by their speed of response. Although in non-responders (late responders) blood levels of creatinine and alkaline phosphatase were significantly higher than in responders, suggesting that seriously ill patients could be less responsive to baclofen treatment, the low number of patients (n = 50) and the absence of a placebo group renders this results inconclusive. Preliminary analyzes of alcohol craving and alcohol consumption data suggest that a relationship exists between craving and alcohol consumption. Additional analyzes are needed to confirm these results.

Afin d'analyser les données in vitro de l'effet de l'erlotinib sur la croissance des cellules A431 suivie par impédance-métrie, nous avons développé un modèle pharmacocinétique - pharmacodynamique non linéaire décrivant simultanément la diminution de la concentration d'erlotinib et son effet sur la croissance cellulaire au cours du temps. La non-linéarité du modèle imposant le recours à des méthodes itératives pour l'estimation des paramètres, plusieurs étapes de la procédure d'identification du modèle ont été étudiées et des solutions proposées, avec des exemples d'application à des molécules utilisées en oncologie:Choix du critère d'optimisation à employer - supériorité de la relation fonctionnelle de la moyenne géométrique pour l'identification de modèles non linéaires. Application données réelles: courbe de calibration d'une expérience de dosage ELISA du bevacizumab. Choix de l'algorithme d'optimisation le plus approprié au problème d'identification du processus pharmacocinétique. Les algorithmes dérivatifs sont les plus performants. Application données réelles: estimation simultanée des paramètres du modèle pharmacocinétique du 5-fluorouracile et de son métabolite principal.Transformation de la forme différentielle initiale du modèle en temps continu vers un modèle récursif en temps discret. Par ce moyen le modèle devient linéaire en ses paramètres, ce qui permet d'estimer directement les paramètres sans utiliser d'algorithme d'optimisation. Il devient également possible de suivre les variations des paramètres au cours du temps. Application données réelles: pharmacocinétique de la fotemustine, de la mitoxantrone et du 5-fluorouracile. / A nonlinear pharmacokinetic-pharmacodynamic model has been devised do simultaneously describe the loss of erlotinib and its effect on the cell growth over time, in order to analyze impedance-based data of erlotinib effect on A431 cells growth in vitro over time. The model non-linearity requiring the use of iterative methods for parameter estimation, several steps of the model identification were studied, and solutions proposed, with application examples to cancer drugs :Choice of the optimization criterion - superiotity of the geometric mean functionnal relationship for non-linear model identification. Real data application : calibration curve of a bevacizumab ELISA quantification experiment.Choice of the most appropriate algorithm for the pharmacokinetic process identification problem. The derivative algorithms perform better. Real data application : simultaneous identification of the 5-fluorouracil and of its main metabolite pharmacokinetic system.Transform of the differential initial continuous-time model in a recursive discrete time model. The transformed model becomes linear with respect to its parameters, allowing straightforward parameter estimation without using any optimization algorithm. It is then also possible to track the parameter variations over time. Real data application : pharmacokinetic model parameter estimation of fotemustine, mitoxantrone and 5-fluorouracil.

Free analyte is measured to be able to understand the pharmacological effects of a drug in the body, the binding to its ligand, and the effective drug level among other things. Thereby, it is important with correct measurements of free analyte, although it is not that easy to achieve since overestimations can occur. In this project, several immunoassays were developed for the bioanalytical methods Gyrolab and ELISA to measure free analyte, where the biotherapeutics Avastin® and Lucentis®, and the ligand VEGF were used as analytes. One difference between the methods is the short contact time of just a few seconds for Gyrolab compared to the sample incubation time of a couple of hours for ELISA. One difference between the antibodies is that Lucentis is an affinity-matured Fab region, and therefore, has a stronger affinity to VEGF compared to Avastin. When free Avastin was measured, the difference was significant, with ELISA estimating higher concentrations compared to Gyrolab. However, this was not the case for all assays. In some cases, this was probably due to differences between the methods that could not be seen. Otherwise, the results with no difference between the methods, when measuring free analyte with Lucentis as the drug, were expected due to the stronger affinity and longer halftime of dissociation. However, the difference with the longer sample incubation time for ELISA compared to the short contact time for Gyrolab seems to influence the measurement of free analyte, depending on the affinity of the components being measured.

Le traitement par éfavirenz, un médicament antirétroviral, a été associé avec des changements de profil lipidique potentiellement défavorables. Ce travail a abordé la question de savoir si ces effets dépendent des concentrations plasmatiques d’éfavirenz et, dans ce cas, si sa posologie pourrait être optimisée sans perte d'efficacité.Un modèle de pharmacocinétique de population a été développé à partir de données d’enfants infectés par le VIH. La simulation d’une population normalisée sous éfavirenz aux posologies recommandées montre que 15 % des enfants auraient des concentrations insuffisantes 12 heures après la prise, ce qui serait associé à un risque de la réplication virale de 23 %.Pour décrire la relation entre taux plasmatiques d'éfavirenz et changements de taux de cholestérol, des modèles de pharmacocinétique-pharmacodynamique (PK-PD) de réponse indirecte ont été développés. Le modèle sélectionné prédit que les taux d’éfavirenz individuels sont associés à une augmentation des lipoprotéines de haute densité sur 5 ans, et des lipoprotéines de basse densité durant 4 mois avec un retour progressif aux valeurs de base.Pour évaluer l’impact des concentrations d'éfavirenz sur l'efficacité, un modèle dynamique PK-PD a décrit la relation entre ces concentrations et l’évolution de la charge virale VIH et du taux de CD4. Un score d’efficacité a été développé sur la base d’hypothèses pharmacodynamiques pour prédire le risque de la réplication virale.L’utilisation de l’éfavirenz aux posologiques recommandées par la Food and Drug Administration aux Etats-Unis semble assurer une efficacité optimale et des changements potentiellement favorables dans les fractions de cholestérol. / As other antiretroviral drugs, treatment with efavirenz has been associated with potentially unfavorable lipid profile changes in adults and in children. The thesis addressed the question of whether these changes depend on efavirenz plasma concentrations and if dose adjustments could be envisioned without loss of efficacy.To estimate individual efavirenz exposure over 24 hours, a population pharmacokinetic model was developed using data from HIV infected children. Simulations for a normalized population receiving efavirenz dosed according recommendations predicted that 15% of children would have insufficient mid dose concentrations, associated with a 23% risk of viral replication.To describe the relationship between efavirenz concentrations and cholesterol changes, population pharmacokinetic-pharmacodynamic (PK-PD) indirect response models were developed. The selected model predicted that individual efavirenz concentrations were associated with an increase in high-density lipoprotein concentrations over 5 years but with an increase in low-density lipoprotein concentrations only during the first 4 months of treatment followed by a gradual return to baseline.To study the importance of efavirenz concentrations with regard to efficacy, a PK-PD dynamics model was developed to describe the relationship between concentrations and HIV RNA load and CD4 cell count evolutions. A score was defined based on a pharmacodynamic hypothesis to predict the risk of viral replication.Using US Food and Drug Administration dosing recommendations in children ensure optimal efficacy and potentially favorable changes in cholesterol fractions.

Charles University Faculty of Pharmacy in Hradec Kralove Department of Pharmacology & Toxicology Student: Gabriela Burianova Supervisor: RNDr. Jakub Hofman, Ph.D. Title of diploma thesis: Flow-cytometric analysis of inhibitory effect of novel targeted drugs on the activity of ABC drug efflux transporters Cancer is the second leading cause of death. Cancer treatment often combines conventional chemotherapy, radiation therapy and surgery. More recent approach to treatment is the use of targeted cancer therapy with a greater specificity towards cancer cells. Development of resistance is a major obstacle in the success of chemotherapy. Multidrug resistance (MDR) can be acquired through various mechanisms e.g. overexpression of efflux transporters. ATP binding cassette (ABC) transporters represents a large family of transmembrane proteins that use ATP to pump molecules across the membrane. The three main ABC proteins related to MDR are: P-glycoprotein (ABCB1), multidrug resistance-associated protein 1 (ABCC1) and breast cancer resistance protein (ABCG2). Use of ABC transporter inhibitors increases the amount of chemotherapeutical substrates accumulated within the cells. In this study we evaluated interactions of six synthetic small molecule inhibitors (alisertib, ensartinib, entrectinib, talazoparib,...

Charles University Faculty of Pharmacy in Hradec Králové Department of Pharmacology & Toxicology Student: Lucia Dziaková Supervisor: RNDr. Jakub Hofman, Ph.D. Title of diploma thesis: Study on interactions of PARP inhibitors with ABC drug efflux transporters. ATP-binding cassette (ABC) transporters are integral membrane proteins that use the energy obtained from ATP to carry transport of numerous endogenous substrances out of the cells, but attention is drawn primarily to the fact that they transfer also xenobiotics. Their overexpression in tumor tissue contributes to multidrug resistance (MDR), which in most cases leads to therapy failure. Poly(ADP-ribose)polymerase inhibitors (PARPi) represent a promising therapeutic approach in the treatment of cancers that exhibit defects in homologous recombination (HR). This work focuses on four selected PARPi (olaparib, rucaparib, niraparib, veliparib) and their interaction potential towards ABC drug efflux transporters (ABCB, ABCC1, ABCG2). In our work, we worked with MDCKII cells (parent, transduced by the transporters of interest) and utilized the principle of accumulation studies based on the measurement of fluorescence intensity of specific model substrates (hoechst33342, calcein AM, daunorubicin, mitoxantrone). We used established inhibitors of studied...

Charles University Faculty of Pharmacy in Hradec Králové Department of Pharmacology & Toxicology Student: Júlia Jurčáková Supervisor: RNDr. Jakub Hofman PhD. Title of diploma thesis: The assessment of inhibitory effects of selected targeted anticancer drugs on the activity of ABC drug eflux trasporters. Lung cancer is the leading cause of death within oncological diseases. Non-small cell lung carcinoma (NSCLC) accounts for about 85% of all lung cancer, and its major subtypes include adenocarcinoma and squamous cell carcinoma. In addition to surgery, radiotherapy and chemotherapy, the use of targeted low-molecular substances, which target tumor cells with higher specificity, has recently been used in treatment. The two main causes of death in cancer patients are the formation of metastases and the development of multidrug resistance (MDR). This may also be caused by overexpression of the efflux transporters. ATP-binding cassette (ABC) transporters are groups of transmembrane pumps that use energy in the form of ATP to transfer a wide range of substrates. In particular, P-glycoprotein (ABCB1), breast cancer-resistance protein (ABCG2) and multidrug resistance-associated protein 1 (ABCC1) are associated with MDR. Inhibition of these transporters increases the amount of cytostatic substrate within the...

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