This is an open access article under the terms of the Creat ive Commo ns Attri butio n-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.Abbreviations: ACD, acid citrate dextrose; aCSF, artificial cerebrospinal fluids; ATP, adenosine triphosphate; BBB, blood-brain barrier; BCRP, breast cancer resistance protein; C csf , concentration in cerebrospinal fluids; CL, clearance; C m,blood/brain , unbound concentration in blood/brain measured by microdialysis; CNS, central nervous system; CSF, cerebrospinal fluids; C ss , steady-state concentration; C u,brain , unbound concentration in brain measured by equilibrium dialysis; DMEM, Dulbecco's Modified Eagle's Medium; DMSO, dimethyl sulfoxide; EDTA-K 2 , ethylenediaminetetraacetic acid dipotassium; ER, efflux ratio; FBS, Fetal bovine serum; f u,brain , unbound fraction in brain; HBSS, Hank's balanced salt solution;HPLC/MS/MS, high-performance liquid chromatography combined with tandem mass spectrometry; HP-β-CD, hydroxypropyl-β-cyclodextrin; IACUC, institutional animal care and use committee; ISF, interstitial fluids; K p,uu,brain , ratio of unbound brain concentration to unbound blood
AbstractIn clinical pharmacology, the free drug hypothesis has been widely applied in the interpretation of the relationship between pharmacokinetics and pharmacodynamics (PK/ PD). The free drug hypothesis assumes that the unbound drug concentration in blood is the same as that in the site of action at steady state. The objective of this study is to demonstrate whether the free drug hypothesis is universally applicable for all drugs.The unbound concentrations of the 18 compounds in blood and in brain interstitial fluids (ISF) at steady state following constant intravenous infusion were simultaneously monitored up to 6 hours via in vivo microdialysis technique. Based on the permeability and efflux ratio (ER), the test compounds can be divided into two classes.Class I includes the compounds with good membrane permeability that are not substrates of efflux transporters (eg, P-gp, BCRP, and MRPs), whereas Class II includes the compounds that are substrates of efflux transporters. The steady-state unbound drug concentrations in blood, brain, and CSF are quantitatively very similar for Class I compounds, whereas the steady-state unbound concentrations in the brain and CSF are significantly lower than those in blood for Class II compounds. These results strongly suggest that the free drug hypothesis is not universal for all drugs but is only applicable for drugs with good permeability that are not substrates of efflux transporters.
K E Y W O R D SBBB, efflux transporter, microdialysis, permeability, unbound concentration