Erythrocyte uptake and protein binding of cyclosporin A (CyA) in human blood: factors affecting CyA concentration in erythrocytes.

To further the understanding of the complexity of cyclosporin A (CyA) pharmacokinetics, we conducted an erythrocyte uptake and efflux study, and a protein binding study in human blood. The uptake study showed that the transport of CyA from the extracellular fraction to erythrocytes was retarded by increased human serum albumin (HSA) and lipid levels in this fraction. In addition, the concentration of CyA in erythrocytes increased with increases in CyA concentration in blood and reductions in hematocrit. The efflux study showed that the transport of CyA from erythrocytes to the extracellular fraction was essentially enhanced by increases of HSA and lipid levels in that fraction, but that these effects were relatively small. There were two affinity binding sites for CyA in ghost-free erythrocyte hemolysate, but not in the plasma fraction. The affinity binding constants for these binding sites were reduced by elevations in temperature, and under physiological conditions, 37 degrees C, almost all the CyA in erythrocytes was bound to a CyA binding protein, namely, cyclophillin. These findings suggest that CyA distribution in blood is of two different types which are present in the erythrocyte and plasma fractions, respectively. Monitoring of blood biochemistry variables showed that the concentration of CyA in erythrocytes had an interlocking relationship with these physiological factors, which were related to patient disease state, i.e., hematocrit, lipids, albumin, and total protein; the concentration of CyA in erythrocytes could be predicted from these physiological factors.