(1.39)
To ensure equivalent performance of different batches of drug formulations, regulatory agencies require bioequivalence studies to be performed. To establish bioequivalence, the 90% confidence interval about the geometric mean test/reference ratios for both AUC and Cmax must fall within the bioequivalence range, which is 80–125%.
1.2.7 Role of Transporters in ADME
Transporters (Figure 1.7a) play an important role in enhancing or limiting the disposition of drugs (Ho and Kim, 2005) in plasma, target issue, as well as in blood–brain barrier (Shen and Zhang, 2010) as shown in Table 1.2. About 400 genes code for transporters in human and animals and these are classified into two large super‐families – the solute carrier or SLC superfamily containing 364 proteins in 48 subfamilies (Fredriksson et al., 2008) and the ATP‐binding cassette or ABC transporters of 49 proteins in 7 subfamilies. The SLC transporters mediate cellular influx of substrates either by facilitated diffusion or by secondary active transport, driven by co‐transport (symport or antiport) of endogenous organic ions (Zhang et al., 2002; Hediger et al., 2004; Hagenbuch and Gui, 2008; Duan and You, 2010). ABC transporters mediate the primary active transport of unidirectional efflux of drugs often against a steep diffusion gradient, deriving energy from ATP hydrolysis (Van De Water et al., 2005; Szakács et al., 2008; Schinkel and Jonker, 2012). The transporters that play an important role in human disposition are the active SLC transporters OATP1B1, 1B3 and 2B1, SLC transporters that mediate facilitated diffusion OCTs 1 and 2, SLC antiport transporters MATE1 and MATE2K, and the ABC efflux transporters P‐gp (MDR1), MRP2 (important in the transport of glucuronide and glutathione conjugates), BCRP and BSEP. ATP‐independent secondary efflux transporters are probably present an additional mechanism for toxin extrusion even if cells are energy‐deprived. The different types of transporters are shown in (Figure 1.7b).
Figure 1.7. (a) Uptake and efflux drug transporters in intestine, liver, kidney, and brain. OAT, organic anion transporter; OATP, organic anion‐transporting polypeptide; NTCP, sodium taurocholate cotransporting peptide; OCT, organic cation transporter; OCTN, novel‐type OCT; PEPT, oligopeptide transporter; ASBT, apical sodium‐dependent bile acid transporter; MDR, multidrug‐resistant (or resistance); MRP, multidrug resistance‐associated protein; BCRP, breast cancer resistance protein; MATE, multidrug and toxin extrusion; MCT, monocarboxylate transporter; OST, organic solute transport; URAT, urate transporter. (b) Primary active ATP‐Binding Cassette (ABC) efflux transporters derive energy from the hydrolysis of ATP to ADP and are shown in dark shade. The secondary active transporter families or solute carrier (SLC) uptake transporters, utilize either ion gradients across membranes or cotransport with intracellular and/extracellular ions. These are either symports (unshaded) or antiports (lightly shaded). Multi‐drug efflux pump, MATE is a cation‐coupled family of transporters. OST α/β is a heterodimer that together transports bile acids, conjugated steroids, and structurally related molecules. Clinically relevant transporters are shown in bold (Source: Ho and Kim 2005).
TABLE 1.2. Role of transporters in ADME.
| ADME | Transporter | Example | Role |
|---|---|---|---|
| Absorption | Carriers | PEPT | Enhances absorption by transporting hydrophilic compounds with specific groups like peptide linkages |
| Absorption | Efflux | P‐gp BCRP MRP2 | Limits absorption of large lipophilic molecules. P‐gp has broad specificity |
| Absorption | Uptake | OATP | Uptake of organic ions |
| Distribution | Uptake, efflux | Various | Increases or decreases tissue distribution |
| Metabolism | Uptake | OATP1B1 OATP1B3 OATP2B1 | Increases or decreases exposure to drug‐metabolizing enzymes thereby increasing or decreasing metabolism |
| Biliary elimination | Efflux | P‐gp BCRP | Increases biliary elimination of lipophilic, amphiphilic compounds |
| Renal elimination | Uptake | OAT 1,2,3 OCT2 OATP4C1 | Increases uptake and elimination of hydrophilic compounds |
| Renal elimination | Efflux | P‐gp, MATE1, MATE2‐K MRP2, 4 | Removal (active secretion) of toxins |
The role of the efflux transporter P‐gp in restricting absorption, transporting amphiphilic compounds into bile and keeping out lipophilic compounds from the brain has long been recognized. It is difficult to predict the disposition of compounds that are transported, as the substrate specificity to most transporters are dependent on the chemical structure of the drug. However, there are some general principles for identifying transporter substrates (Wright and Dantzler, 2004; El‐Sheikh et al., 2008; Nies et al., 2008; Ahn and Nigam, 2009; Kusuhara and Sugiyama, 2009). For example, P‐gp substrates are mostly large and lipophilic. Substrates of the uptake transporter OATP1B1 are mostly carboxylic acids and so on. Efflux transporters like MRP2 and BCRP have similar substrate specificity to uptake transporters, reducing the possibility for toxin accumulation.
Absorption, distribution, renal elimination, and biliary elimination are all dependent on physicochemical properties of the drug, particularly lipophilicity and acid/base/neutral characteristics and physiology of the species like blood flow, organ volumes, transit rates etc. The chemical structure of a drug dictates its rate and extent of biotransformation as well as affinity to transporters.
Although in vitro assays may identify potential substrates of transporters, their relevance in vivo depends very much on the expression