Tillmann Annika C, Peters Dorien J M, Rostami-Hodjegan Amin, Wilson Patricia, Norman Jill, Barber Jill, Al-Majdoub Zubida M
Centre for Applied Pharmacokinetic Research, University of Manchester, Manchester, UK.
Department of Human Genetics, Leiden University Medical Center, Leiden, Netherlands.
Clin Pharmacol Ther. 2025 Sep;118(3):682-692. doi: 10.1002/cpt.3715. Epub 2025 May 15.
Autosomal dominant polycystic kidney disease is the most prevalent inherited kidney disease and leads to bilateral kidney enlargement and progressive loss of renal function, often over decades. Comorbidities include hypertension, flank pain, and bacterial infections. The condition often necessitates prolonged multidrug therapy. Given the kidneys' critical role in drug excretion, the progressive functional impairment in the disease can lead to complications such as drug overdosing and unexpected levels of drug-drug interactions. Studies of drug-metabolizing enzyme and transporter expression in this patient group remain scarce. We conducted comprehensive global liquid chromatography-tandem mass spectrometry proteomic analyses of microsomal and cytosolic fractions from early-stage (chronic kidney disease stage: 13, n = 16) and end-stage autosomal dominant polycystic kidney disease patients (chronic kidney disease stage: 5, n = 14), comparing them with age-matched healthy controls (n = 11). In the early-stage ADPKD samples, most drug-metabolizing enzymes and drug transporters did not differ significantly from the healthy controls. Exceptions were EPHX2 and SULT1C2 in the cytosolic fraction, which showed a more than 2-fold decrease in abundance (P < 0.05). In contrast, the end-stage ADPKD kidney samples showed a decrease in the abundance of most measured proteins. Several drug-metabolizing enzymes, including CYP4F2, UGT1A6, UGT1A9, and UGT2B7, exhibited statistically significant reductions (P < 0.05). Among the drug transporters, OAT1, OAT3, and OCT2 were below the limit of quantification in most ES-ADPKD samples. MDR1 was the only efflux drug transporter consistently measured, with an average abundance of 1.24 pmol/mg microsomal protein across all samples.
常染色体显性多囊肾病是最常见的遗传性肾病,会导致双侧肾脏肿大和肾功能逐渐丧失,这个过程通常会持续数十年。其合并症包括高血压、胁腹疼痛和细菌感染。这种疾病常常需要长期的多药治疗。鉴于肾脏在药物排泄中起关键作用,该疾病中逐渐出现的功能损害会导致药物过量及意外的药物相互作用水平等并发症。对该患者群体中药物代谢酶和转运蛋白表达的研究仍然很少。我们对早期(慢性肾病分期:1-3期,n = 16)和终末期常染色体显性多囊肾病患者(慢性肾病分期:5期,n = 14)的微粒体和胞质部分进行了全面的全球液相色谱-串联质谱蛋白质组分析,并将其与年龄匹配的健康对照(n = 11)进行比较。在早期常染色体显性多囊肾病样本中,大多数药物代谢酶和药物转运蛋白与健康对照相比无显著差异。胞质部分的EPHX2和SULT1C2是例外,其丰度下降超过2倍(P < 0.05)。相比之下,终末期常染色体显性多囊肾病肾脏样本中大多数被测蛋白质的丰度降低。包括CYP4F2、UGT1A6、UGT1A9和UGT2B7在内的几种药物代谢酶表现出统计学上的显著降低(P < 0.05)。在药物转运蛋白中,大多数终末期常染色体显性多囊肾病样本中的OAT1、OAT3和OCT2低于定量限。MDR1是唯一持续测得的外排药物转运蛋白,所有样本中微粒体蛋白的平均丰度为1.24 pmol/mg。