Koehn Liam, Habgood Mark, Huang Yifan, Dziegielewska Katarzyna, Saunders Norman
Department of Pharmacology & Therapeutics, University of Melbourne, Parkville, Victoria, 3010, Australia.
F1000Res. 2019 Aug 7;8:1372. doi: 10.12688/f1000research.20078.1. eCollection 2019.
: A major concern for clinicians in prescribing medications to pregnant women and neonates is the possibility that drugs might have damaging effects, particularly on long-term brain development. Current understanding of drug permeability at placental and blood-brain barriers during development is poor. In adults, ABC transporters limit many drugs from entering the brain; however, little is known about their function during development. : The transfer of clinically relevant doses of paracetamol (acetaminophen), digoxin and cimetidine into the brain and cerebrospinal fluid (CSF) was estimated using radiolabelled drugs in Sprague Dawley rats at three developmental stages: E19, P4 and adult. Drugs were applied intraperitoneally either acutely or following chronic exposure (for five days). Entry into brain, CSF and transfer across the placenta was measured and compared to three markers (L-glucose, sucrose, glycerol) that cross barriers by "passive diffusion". The expression of ABC transporters in the brain, choroid plexus and placenta was estimated using RT-qPCR. : All three drugs entered the developing brain and CSF in higher amounts than the adult brain and CSF. Comparisons with "passive" permeability markers suggested that this might be due to age-related differences in the functional capacity of ABC-efflux mechanisms. In adult animals, chronic treatment reduced digoxin (12% to 5%, p<0.01) and paracetamol (30% to 21%, p<0.05) entry compared to acute treatment, with the decrease in digoxin entry correlating with up-regulation of efflux transporter (PGP). In fetal and newborn animals, no gene up-regulation or transfer decreases were observed. Instead, chronic paracetamol treatment resulted in increased transfer into the fetal brain (66% to 104%, p<0.001). : These results suggest that the developing brain may be more at risk from acute drug exposure than the adult brain due to reduced efflux capacity and at greater risk from chronic treatment due to a lack of efflux mechanism regulatory capacity.
临床医生在给孕妇和新生儿开药时主要担心的是药物可能产生有害影响,尤其是对长期脑发育的影响。目前对于发育过程中胎盘和血脑屏障处药物通透性的了解很少。在成年人中,ABC转运蛋白限制许多药物进入大脑;然而,对于它们在发育过程中的功能却知之甚少。
使用放射性标记药物在三个发育阶段(E19、P4和成年)的Sprague Dawley大鼠中估计了临床相关剂量的对乙酰氨基酚(扑热息痛)、地高辛和西咪替丁向大脑和脑脊液(CSF)的转运。药物通过急性或慢性暴露(持续五天)腹腔内给药。测量进入大脑、脑脊液的情况以及跨胎盘的转运,并与通过“被动扩散”穿过屏障的三种标志物(L-葡萄糖、蔗糖、甘油)进行比较。使用RT-qPCR估计大脑、脉络丛和胎盘中ABC转运蛋白的表达。
所有三种药物进入发育中的大脑和脑脊液的量都高于成人大脑和脑脊液。与“被动”通透性标志物的比较表明,这可能是由于ABC外排机制功能能力的年龄相关差异。在成年动物中,与急性治疗相比,慢性治疗使地高辛(从12%降至5%,p<0.01)和对乙酰氨基酚(从30%降至21%,p<0.05)的进入量减少,地高辛进入量的减少与外排转运蛋白(PGP)的上调相关。在胎儿和新生动物中,未观察到基因上调或转运减少。相反,慢性对乙酰氨基酚治疗导致向胎儿大脑的转运增加(从66%增至104%,p<0.001)。
这些结果表明,由于外排能力降低,发育中的大脑可能比成人大脑更容易受到急性药物暴露的风险,并且由于缺乏外排机制调节能力,慢性治疗的风险更大。
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