食物-药物相互作用的机制:抑制肠道代谢和转运。
Mechanisms underlying food-drug interactions: inhibition of intestinal metabolism and transport.
机构信息
Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7569, USA.
出版信息
Pharmacol Ther. 2012 Nov;136(2):186-201. doi: 10.1016/j.pharmthera.2012.08.001. Epub 2012 Aug 4.
Food-drug interaction studies are critical to evaluate appropriate dosing, timing, and formulation of new drug candidates. These interactions often reflect prandial-associated changes in the extent and/or rate of systemic drug exposure. Physiologic and physicochemical mechanisms underlying food effects on drug disposition are well-characterized. However, biochemical mechanisms involving drug metabolizing enzymes and transport proteins remain underexplored. Several plant-derived beverages have been shown to modulate enzymes and transporters in the intestine, leading to altered pharmacokinetic (PK) and potentially negative pharmacodynamic (PD) outcomes. Commonly consumed fruit juices, teas, and alcoholic drinks contain phytochemicals that inhibit intestinal cytochrome P450 and phase II conjugation enzymes, as well as uptake and efflux transport proteins. Whereas myriad phytochemicals have been shown to inhibit these processes in vitro, translation to the clinic has been deemed insignificant or undetermined. An overlooked prerequisite for elucidating food effects on drug PK is thorough knowledge of causative bioactive ingredients. Substantial variability in bioactive ingredient composition and activity of a given dietary substance poses a challenge in conducting robust food-drug interaction studies. This confounding factor can be addressed by identifying and characterizing specific components, which could be used as marker compounds to improve clinical trial design and quantitatively predict food effects. Interpretation and integration of data from in vitro, in vivo, and in silico studies require collaborative expertise from multiple disciplines, from botany to clinical pharmacology (i.e., plant to patient). Development of more systematic methods and guidelines is needed to address the general lack of information on examining drug-dietary substance interactions prospectively.
食物-药物相互作用研究对于评估新候选药物的适当剂量、时间和配方至关重要。这些相互作用通常反映了与进食相关的全身药物暴露程度和/或速率的变化。食物对药物处置的影响的生理和物理化学机制已经得到很好的描述。然而,涉及药物代谢酶和转运蛋白的生化机制仍未得到充分探索。一些植物源性饮料已被证明可以调节肠道中的酶和转运蛋白,导致药代动力学(PK)改变,并可能导致药效学(PD)结果负面。常见的水果汁、茶和酒精饮料含有可抑制肠道细胞色素 P450 和 II 相结合酶以及摄取和外排转运蛋白的植物化学物质。虽然有无数的植物化学物质已被证明可以在体外抑制这些过程,但在临床上的应用被认为是微不足道或未确定的。阐明食物对药物 PK 的影响的一个被忽视的前提是对引起食物效应的生物活性成分有透彻的了解。给定膳食物质的生物活性成分组成和活性的巨大差异给进行强有力的食物-药物相互作用研究带来了挑战。通过识别和表征特定成分,可以解决这个混杂因素,这些成分可以用作标记化合物,以改善临床试验设计并定量预测食物的影响。来自体外、体内和计算机模拟研究的数据的解释和整合需要来自多个学科的协作专业知识,从植物学到临床药理学(即从植物到患者)。需要制定更系统的方法和准则,以解决普遍缺乏关于前瞻性检查药物-膳食物质相互作用的信息的问题。