Paul Priyanka R, Mishra Manish K, Bora Shivangi, Kukal Samiksha, Singh Anju, Kukreti Shrikant, Kukreti Ritushree
Genomics and Molecular Medicine Unit, Institute of Genomics and Integrative Biology (IGIB), Council of Scientific and Industrial Research (CSIR), New Delhi, India.
Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India.
J Biochem Mol Toxicol. 2025 Mar;39(3):e70190. doi: 10.1002/jbt.70190.
Resistance against CNS drugs may arise from various mechanisms, with limited drug penetration across the blood-brain barrier (BBB) being a significant contributing factor. The BBB employs efflux transporters like P-glycoprotein (P-gp) to safeguard the brain by removing toxins and xenobiotics, however, P-gp also pumps out therapeutic drugs, and its upregulation in disease states can contribute to variability in drug response. While inhibiting P-gp to prevent drug efflux seems appealing, it could lead to toxicity since P-gp is also important for expulsion of toxins from the brain. This necessitates the incorporation of P-gp substrate liability assessment into early drug discovery stages using appropriate experimental approaches. Therefore, this review aims to draw interest in this crucial area by analyzing the existing research on P-gp's impact on brain distribution of major CNS drugs and exploring the detection methods for identifying P-gp substrates. By identifying confirmed P-gp substrates and evaluating effective detection methods, this work emphasizes the continued importance of monitoring P-gp-mediated CNS drug efflux out of the brain tissue. This knowledge can empower clinicians to anticipate potential treatment inefficacy and guide therapeutic decision-making, ultimately leading to improved patient treatment outcomes.
对中枢神经系统(CNS)药物产生耐药性可能源于多种机制,血脑屏障(BBB)药物渗透率有限是一个重要因素。血脑屏障利用如P-糖蛋白(P-gp)等外排转运蛋白通过清除毒素和外源性物质来保护大脑,然而,P-gp也会排出治疗药物,并且其在疾病状态下的上调会导致药物反应的变异性。虽然抑制P-gp以防止药物外排似乎很有吸引力,但这可能会导致毒性,因为P-gp对于从大脑中排出毒素也很重要。这就需要在药物发现早期阶段使用适当的实验方法纳入P-gp底物责任评估。因此,本综述旨在通过分析关于P-gp对主要中枢神经系统药物脑分布影响的现有研究以及探索识别P-gp底物的检测方法,来引起人们对这一关键领域的关注。通过识别已确认的P-gp底物并评估有效的检测方法,这项工作强调了监测P-gp介导的中枢神经系统药物从脑组织中外排的持续重要性。这些知识可以使临床医生预测潜在的治疗无效性并指导治疗决策,最终改善患者的治疗结果。