Utility of unbound plasma drug levels and P-glycoprotein transport data in prediction of central nervous system exposure.

1. Drug concentrations in cerebrospinal fluid have been assumed to be a natural surrogate for total drug exposures in the central nervous system. The present communication reports a data set from a study of 30 compounds in mice. An attempt was made to correlate cerebrospinal fluid and unbound plasma drug concentrations via incorporation of in vitro P-glycoprotein (Pgp)-mediated transport data. 2. Pgp-deficient (Pgp -/-) and wild-type mice were dosed with compounds of interest by oral gavage (orally) at 5 mg kg(-1). Plasma and cerebrospinal fluid samples were collected at 1 h post-dosing, and analysed by liquid chromatography-tandem mass spectrometry (LC-MS/MS) for drug concentrations. Mouse and human Pgp-mediated transport were evaluated in vitro by a bi-directional (B to A and A to B) transport assay using LLC-PK1 cells expressing mouse (mdr1a) and human (MDR1) forms of Pgp, respectively. 3. Compounds with B to A/A to B transport ratios < 2 were defined as non-substrates of Pgp, whereas those exhibiting B to A/A to B transport ratios > or =2 were considered Pgp substrates. Plasma protein binding was also determined in vitro via equilibrium dialysis. Of the 30 compounds, 13 were identified to be mouse Pgp substrates, all of which were also human Pgp substrates, demonstrating a good agreement between mouse and human data. 4. In Pgp wild-type mice, the unbound plasma and cerebrospinal fluid concentrations of the non-Pgp substrates correlated well, with a regression slope of approximately 1.0. A similar relationship existed for Pgp substrates in Pgp -/- mice. On the other hand, an improved correlation of cerebrospinal fluid and systemic exposures of the Pgp substrates in Pgp wild-type mice was observed when the unbound plasma concentrations were normalized to the corresponding B to A/A to B transport ratios. 5. These results reinforce the premise that a combined use of unbound plasma drug concentrations and in vitro Pgp transport data may be of value for the estimation of central nervous system exposures.