ABSTRACT:Darunavir is a second-generation protease inhibitor designed to have antiviral efficacy against HIV-1 with multiple resistance mutations to protease inhibitors. It is always coadministered with a subtherapeutic dose of ritonavir. It has been shown that darunavir and ritonavir are substrates of P-glycoprotein (P-gp). We explored the contribution of P-gp to the transport characteristics of darunavir (up to 100 M) using Caco-2 monolayers and the recently developed in situ intestinal perfusion technique using wild-type and mdr1a/1b(؊/؊) mice. We observed that, in vitro, P-gp has a modulatory effect on the absorption of darunavir, even at a concentration of 100 M (efflux ratio ؍ 25). Simulated intestinal fluids partially inhibited P-gp functionality, which was further inhibited by adding the P-gp inhibitors verapamil, 6-[(2S,4R,6E)-4-methyl-2-(methylamino)-3-oxo-6-octenoic acid]cyclosporine D (PSC833), N-(4-[2-(1,2,3,4-tetrahydro-6,7-dimethoxy-2-isoquinolinyl) ethyl]-phenyl)-9,10-dihydro-5-methoxy-9-oxo-4-acridine carboxamide (GF120918), or ritonavir. Using the in situ intestinal perfusion technique, we demonstrated that coperfusion with ritonavir resulted in a similar apparent permeability coefficient to that observed using P-gp knockout mice, which was 2.7-fold higher than in control mice. We conclude that, in mice, even at a relevant intraluminal concentration of darunavir, P-gp has a modulatory effect on the absorption of darunavir. However, this P-gp-mediated darunavir transport is inhibited when it is combined with ritonavir.
IntroductionThe combination of multiple antiretroviral drugs with different modes of action (highly active antiretroviral therapy) has contributed to a spectacular progress in the fight against HIV (Hammer et al., 2008). The standard regimen for newly diagnosed patients usually includes two nucleoside reverse transcriptase inhibitors combined with either a protease inhibitor [boosted with ritonavir (RTV)] or a non-nucleoside reverse transcriptase inhibitor. Darunavir [(DRV) Prezista; Tibotec Pharmaceuticals, Cork, Ireland] is a second-generation protease inhibitor (PI) designed to have antiviral efficacy against HIV-1 with multiple resistance mutations to protease inhibitors (Busse and Penzak, 2007;Tremblay, 2008). RTV is always coadministered in a subtherapeutic dose as a pharmacokinetic booster of DRV.In vitro and in vivo studies have demonstrated that all HIV PI are high-affinity substrates for P-glycoprotein [(P-gp) multidrug resistance 1 (MDR1)], which can significantly influence the disposition of antiretroviral drugs (Kis et al., 2009). P-gp is widely distributed with a high level of expression in the small intestine, liver, kidney, and brain (Ho and Kim, 2005). Presently, however, there is still uncertainty about the role of intestinal P-gp in vivo. It is not sure whether P-gp plays a pivotal role as a biochemical barrier for compounds at concentrations relevant for the intraluminal environment, because of a possible saturation of the efflux system. In addition, it has b...