考察 CYP3A4/5 对五味子甲素/五味子乙素与他克莫司(FK-506)药物相互作用的影响:基于生理的药代动力学建模方法。

Examination of the Impact of CYP3A4/5 on Drug-Drug Interaction between Schizandrol A/Schizandrol B and Tacrolimus (FK-506): A Physiologically Based Pharmacokinetic Modeling Approach.

机构信息

Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai 201203, China.

Clinical Research Centre, Hospital Pulau Pinang, Pinang 10450, Malaysia.

出版信息

Int J Mol Sci. 2022 Apr 19;23(9):4485. doi: 10.3390/ijms23094485.

Abstract

Schizandrol A (SZA) and schizandrol B (SZB) are two active ingredients of Wuzhi capsule (WZC), a Chinese proprietary medicine commonly prescribed to alleviate tacrolimus (FK-506)-induced hepatoxicity in China. Due to their inhibitory effects on cytochrome P450 (CYP) 3A enzymes, SZA/SZB may display drug-drug interaction (DDI) with tacrolimus. To identify the extent of this DDI, the enzymes' inhibitory profiles, including a 50% inhibitory concentration (IC) shift, reversible inhibition (RI) and time-dependent inhibition (TDI) were examined with pooled human-liver microsomes (HLMs) and CYP3A5-genotyped HLMs. Subsequently, the acquired parameters were integrated into a physiologically based pharmacokinetic (PBPK) model to quantify the interactions between the SZA/SZB and the tacrolimus. The metabolic studies indicated that the SZB displayed both RI and TDI on CYP3A4 and CYP3A5, while the SZA only exhibited TDI on CYP3A4 to a limited extent. Moreover, our PBPK model predicted that multiple doses of SZB would increase tacrolimus exposure by 26% and 57% in CYP3A5 expressers and non-expressers, respectively. Clearly, PBPK modeling has emerged as a powerful approach to examine herb-involved DDI, and special attention should be paid to the combined use of WZC and tacrolimus in clinical practice.

摘要

五味子甲素 (SZA) 和五味子乙素 (SZB) 是五酯胶囊 (WZC) 的两种有效成分,WZC 是一种中国特有的药物,常用于缓解中国患者使用他克莫司 (FK-506) 引起的肝毒性。由于 SZA/SZB 对细胞色素 P450 (CYP) 3A 酶具有抑制作用,因此可能与他克莫司发生药物相互作用 (DDI)。为了确定这种 DDI 的程度,使用人肝微粒体 (HLM) 和 CYP3A5 基因分型 HLMs 检查了酶的抑制谱,包括 50%抑制浓度 (IC) 移位数、可逆抑制 (RI) 和时间依赖性抑制 (TDI)。随后,将获得的参数整合到基于生理学的药代动力学 (PBPK) 模型中,以定量 SZA/SZB 与他克莫司之间的相互作用。代谢研究表明,SZB 对 CYP3A4 和 CYP3A5 均显示出 RI 和 TDI,而 SZA 仅对 CYP3A4 表现出有限的 TDI。此外,我们的 PBPK 模型预测,多剂量 SZB 会使 CYP3A5 表达者和非表达者的他克莫司暴露量分别增加 26%和 57%。显然,PBPK 建模已成为研究草药相关 DDI 的有力方法,在临床实践中应特别注意 WZC 和他克莫司的联合使用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/960a/9103789/11d8a48c2b5b/ijms-23-04485-g001.jpg

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