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Strategies to Overcome Efflux Pumps

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Oral Delivery of Macromolecular Drugs

Abstract

Intestinal efflux pumps such as P-glycoprotein play a significant role in altering the absorption of a wide range of drugs. Anticancer agents, antibiotics, antivirals, calcium channel blockers, immunosuppressive agents, peptide drugs and several other therapeutic compounds have been reported to be substrates of one or more transmembrane efflux transporters.

Inhibition of these efflux pumps by various compounds can lead to enhanced absorption of several drugs across the intestine.

In this chapter, several efflux pump inhibitors such as low molecular mass inhibitors, polymeric inhibitors and advanced formulation approaches on how to overcome drug efflux are discussed.

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References

  • Al-Shawi M.K., Urbatsch I.L., Senior A.E. (1994) Covalent inhibitors of P-glycoprotein ATPase activity, J Biol Chem 269(12):8986–8992.

    PubMed  CAS  Google Scholar 

  • Balayssac D., Authier N., Cayre A., Coudore F. (2005) Does inhibition of P-glycoprotein lead to drug-drug interactions? Toxicol Lett, 156(3):319–329.

    Article  PubMed  CAS  Google Scholar 

  • Bardelmeijer H.A., Beijnen J.H., Brouwer K.R., Rosing H., Nooijen W.J., Schellens J.H., van Tellingen O. (2000). Increased oral bioavailability of paclitaxel by GF120918 in mice through selective modulation of P-glycoprotein. Clin Cancer Res, 6:4416–4421.

    PubMed  CAS  Google Scholar 

  • Batrakova E.V., Han H.Y., Alakhov V.Y., Miller D.W., Kabanov A.V. (1998) Effects of pluronic block copolymers on drug absorption in Caco-2 cell monolayers. Pharm Res, 15(6):850–855.

    Article  PubMed  CAS  Google Scholar 

  • Bogman K., Zysset Y., Degen L., Hopfgartner G., Gutmann H., Alsenz J., Drewe J. (2005) P-glycoprotein and surfactants: effect on intestinal talinolol absorption. Clin Pharmacol Ther, 77(1):24–32.

    Article  PubMed  CAS  Google Scholar 

  • Carreno-Gomez B. and Duncan R. Compositions with enhanced oral bioavailability. US patent, 2002.

    Google Scholar 

  • Choi J.S. and Jo B.W. (2004) Enhanced paclitaxel bioavailability after oral administration of pegylated paclitaxel prodrug for oral delivery in rats. Int J Pharm, 280:221–722.

    Article  PubMed  CAS  Google Scholar 

  • Collnot E.M., Baldes C., Wempe M.F., Hyatt J., Navarro L., Edgar K.J., Schaefer U.F., Lehr C.M. (2006) Influence of vitamin E TPGS poly(ethlyene glycol) chain length on apical efflux transporters in Caco-2 cell monolayers. J Control Release, 111:35–40.

    Article  PubMed  CAS  Google Scholar 

  • Fisher M., Abramov M., Van Aerschot A., Xu D., Juliano R.L., Herdewijn P. (2007) Inhibition of MDR1 expression with altritol-modified siRNAs. Nucleic Acids Res, 35(4):1064–1074.

    Article  PubMed  CAS  Google Scholar 

  • Floren L.C., Bekersky I., Benet L.Z., Mekki Q., Dressler D., Lee J.W., Roberts J.P., Hebert M.F. (2001) Tacrolimus oral bioavailability doubles with coadministration of ketoconazole. Clin Pharmacol Ther, 62:41–49.

    Article  Google Scholar 

  • Föger F., Hoyer H., Kafedjiiski K., Thaurer M., Bernkop-Schnürch A. (2006a) In vivo comparison of various polymeric and low molecular mass inhibitors of intestinal P-glycoprotein. Biomaterials, 27, (34), 5855–5860.

    Article  PubMed  Google Scholar 

  • Föger F., Kafedjiiski K., Hoyer H., Loretz B., Bernkop-Schnürch A. (2006b) Enhanced transport of P-glycoprotein substrate saquinavir in presence of thiolated chitosan. J Drug Targ, 15, (2), 132–139.

    Article  Google Scholar 

  • Föger, F., Schmitz T. and Bernkop-Schnürch A. (2006c) In vivo evaluation of an oral delivery system for P-gp substrates based on thiolated chitosan. Biomaterials, 27, (23), 4250–4255.

    Article  PubMed  Google Scholar 

  • Föger F., Malaivijitnond S., Wannaprasert T., Huck C., Bernkop-Schnürch A., Werle M. (2008) Effect of oral paclitaxel in presence of a thiolated polymer on absorption and tumor growth in rats. J Drug Targeting, 16, (2), 149–55.

    Google Scholar 

  • Germann U.A., Shlyakhter D., Mason V.S., Zelle R.E., Duffy J.P., Galullo V., Armistead D.M., Saunders J.O., Boger J., Harding M.W. (1997) Cellular and biochemical characterization of VX-710 as a chemosensitizer: Reversal of P-glycoprotein-mediated multidrug resistance in vitro. Anticancer Drugs, 8:125–140.

    Article  PubMed  CAS  Google Scholar 

  • Gerrard G., Payne E., Baker R.J., Jones D.T., Potter M., Prentice H.G. (2004) Clinical effects and P-glycoprotein inhibition in patients with acute myeloid leukaemia treated with zosuquidar trihydrochloride, daunorubicin and cytarabine, Haematologica 89:782–790.

    PubMed  CAS  Google Scholar 

  • Grabovac V., Bernkop-Schnürch A. (2006) Thiolated polymers as effective inhibitors of intestinal Mrp2 efflux pump transporters. Sci Pharm, 74.

    Google Scholar 

  • Hugger E.D., Audus K.L., and Borchardt R.T. (2002) Effects of poly(ethylene glycol) on efflux transporter activity in Caco-2 cell monolayers. J Pharm Sci, 91:1980–1990.

    Article  PubMed  CAS  Google Scholar 

  • Hunter J., Hirst B.H. (1997) Intestinal secretion of drugs. The role of P-glycoprotein and related drug efflux systems in limiting oral drug absorption, Adv Drug Deliv Rev 25:129–157.

    Article  CAS  Google Scholar 

  • Jain R., Majumdar S., Nashed Y., Pal D., Mitra A.K. (2004) Circumventing P-glycoprotein-mediated cellular efflux of quinidine by prodrug derivatization. Mol Pharm, 1(4):290–299.

    Article  PubMed  CAS  Google Scholar 

  • Jain R., Duvvuri S., Kansara V., Mandava N.K., Mitra A.K. (2007) Intestinal absorption of novel-dipeptide prodrugs of saquinavir in rats. Int J Pharm, 336: 233–240.

    Article  PubMed  CAS  Google Scholar 

  • Johnson B.M., Charman W.N., Porter C.J.H. (2002) An in vitro examination of the impact of polyehtylene glycol 400, pluronic P85 and vitamin E D-a-tocopheryl polyethylene glycol 1000 succinate on p-glycoprotein efflux and enterocyte-based metabolism in excised rat intestine. AAPS PharmSci, 4: 1–13.

    Article  Google Scholar 

  • Kim R.B. (2002) Drugs as P-glycoprotein substrates, inhibitors, and inducers, Drug Metab Rev, 34:47–54.

    Article  PubMed  CAS  Google Scholar 

  • Kimura Y., Aoki J., Kohno M., Ooka H., Tsuruo T., Nakanishi O. (2002) P-glycoprotein inhibition by the multidrug resistance-reversing agent MS-209 enhances bioavailability and antitumor efficacy of orally administered paclitaxel. Cancer Chemother Pharmacol, 49:322–328.

    Article  PubMed  CAS  Google Scholar 

  • Kuppens I.E., Bosch T.M., van Maanen M.J., Rosing H., Fitzpatrick A., Beijnen J.H., Schellens J.H. (2005) Oral bioavailability of docetaxel in combination with OC144-093 (ONT-093). Cancer Chemother Pharmacol, 55:72–78.

    Article  PubMed  CAS  Google Scholar 

  • Lacombe O., Woodley J., Solleux C., Delbos J.M., Boursier-Neyret C., Houin G. (2004) Localisation of drug permeability along the rat small intestine, using markers of the paracellular, transcellular and some transporter routes. Eur J Pharm Sci, 23:385–391.

    Article  PubMed  CAS  Google Scholar 

  • Lennernas H. (2003) Clinical pharmacokinetics of atorvastatin. Clin Pharmacokinet, 42:1141–1160.

    Article  PubMed  Google Scholar 

  • Leu B.L., Huang J.D. (1995) Inhibition of intestinal Pglycoprotein and effects on etoposide absorption. Cancer Chemother Pharmacol, 35:432–436.

    Article  PubMed  CAS  Google Scholar 

  • Lin Y., Shen Q., Katsumi H., Okada N., Fujita T., Jiang X., Yamamoto A. (2007) Effects of Labrasol and Other Pharmaceutical Excipients on the Intestinal Transport and Absorption of Rhodamine123, a P-Glycoprotein Substrate, in Rats. Biol Pharm Bull, 30(7) 1301–1307.

    Article  PubMed  CAS  Google Scholar 

  • Liu C., Wu J., Shi B., Zhang Y., Gao T., Pei Y. (2006) Enhancing the bioavailability of cyclosporine a using solid dispersion containing polyoxyethylene (40) stearate. Drug Dev Ind Pharm, 32:115–123.

    Article  PubMed  CAS  Google Scholar 

  • Lo Y.L. (2003) Relationships between the hydrophilic–lipophilic balance values of pharmaceutical excipients and their multidrug resistance modulating effect in Caco-2 cells and rat intestines. J Control Release, 90:37–48.

    Article  PubMed  CAS  Google Scholar 

  • Malingre M.M., Ten Bokkel Huinink W.W., Mackay M., Schellens J.H., Beijnen J.H. (2001) Pharmacokinetics of oral cyclosporin A when co-administered to enhance the absorption of orally administered docetaxel. Eur J Clin Pharmacol, 57:305–307.

    Article  PubMed  CAS  Google Scholar 

  • Palmberger T.F., Hombach J., Bernkop-Schnürch A. (2008) Thiolated chitosan: Development and in vitro evaluation of an oral delivery system for acyclovir. Int J Pharm, 348(1–2):79–85.

    Google Scholar 

  • Shen Q., Lin Y., Handa T., Doi M., Sugie M., Wakayama K., Okada N., Fujita T., Yamamoto A. (2006) Modulation of intestinal P-glycoprotein function by polyethylene glycols and their derivatives by in vitro transport and in situ absorption studies. Int J Pharm, 313:49–56.

    Article  PubMed  CAS  Google Scholar 

  • Shono Y., Nishihara H., Matsuda Y., Furukawa S., Okada N., Fujita T., Yamamoto A. (2004) Modulation of intestinal P- glycoprotein function by cremophor EL and other surfactants by an in vitro diffusion chamber method using the isolated rat intestinal membranes. J Pharm Sci, 93:877–885.

    Article  PubMed  CAS  Google Scholar 

  • Twentyman P.R., Bleehen N.M. (1991) Resistance modification by PSC-833, a novel non-immunosuppressive cyclosporin. Eur J Cancer, 27:1639–1642.

    Article  PubMed  CAS  Google Scholar 

  • van Asperen J., van Tellingen O., Sparreboom A., Schinkel A.H., Borst P., Nooijen W.J., Beijnen J.H. (1997) Enhanced oral bioavailability of paclitaxel in mice treated with the P-glycoprotein blocker SDZ PSC 833. Br J Cancer, 76:1181–1183.

    Article  PubMed  Google Scholar 

  • Varma M.V., Ashokraj Y., Dey C.S., Panchagnula R. (2003) P-glycoprotein inhibitors and their screening: A perspective from bioavailability enhancement. Pharmacol Res, 48:347–359.

    Article  PubMed  CAS  Google Scholar 

  • Varma M.V., Panchagnula R. (2005) Enhanced oral paclitaxel absorption with vitamin E-TPGS: effect on solubility and permeability in vitro, in situ and in vivo. Eur J Pharm Sci, 25:445–453.

    Article  PubMed  CAS  Google Scholar 

  • Varma M.V., Perumal O.P., Panchagnula R. (2006) Functional role of P-glycoprotein in limiting peroral drug absorption: optimizing drug delivery. Curr Opin Chem Biol, 10:367–373.

    Article  PubMed  CAS  Google Scholar 

  • Werle M., Hoffer M. (2006) Glutathione and thiolated chitosan inhibit multidrug resistance P-glycoprotein activity in excised small intestine. J Control Rel, 111, (1–2), 41–46.

    Article  CAS  Google Scholar 

  • Werle M. (2008a) Polymeric and low molecular mass efflux pump inhibitors for oral drug delivery. J Pharm Sci, 97, (1), 60–70.

    Google Scholar 

  • Werle M. (2008b) Natural and synthetic polymers as inhibitors of drug efflux pumps. Pharm Res, 25, (3), 500–11.

    Google Scholar 

  • Woo J.S., Lee C.H., Shim C.K., Hwang S.J. (2003) Enhanced oral bioavailability of paclitaxel by coadministration of the P-glycoprotein inhibitor KR30031. Pharm Res, 20:24–30.

    Article  PubMed  CAS  Google Scholar 

  • Yumoto R., Murakami T., Nakamoto Y., Hasegawa R., Nagai J., Takano M. (1999) Transport of rhodamine 123, a P-glycoprotein substrate, across rat intestine and Caco-2 cell monolayers in the presence of cytochrome P-450 3A-related compounds. J Pharmacol Exp Ther, 289:149–155.

    PubMed  CAS  Google Scholar 

  • Zhang H., Yao M., Morrison R.A., Chong S. (2003) Commonly used surfactant, Tween 80, improves absorption of P-glycoprotein substrate, digoxin, in rats. Arch Pharm Res, 26:768–772.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Florian Föger .

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Föger, F. (2009). Strategies to Overcome Efflux Pumps. In: Bernkop-Schnürch, A. (eds) Oral Delivery of Macromolecular Drugs. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-0200-9_7

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