The roles of vascular binding, flow, transporters, and enzymes as determinants of the clearance of digoxin were examined in the rat liver. Digoxin is metabolized by Cyp3a and utilizes the organic anion transporting polypeptide 2 (Oatp2) and P-glycoprotein (Pgp) for influx and excretion, respectively. Uptake of digoxin was found to be similar among rat periportal (PP) and perivenous (PV) hepatocytes isolated by the digitonin-collagenase method. The K m values for uptake were 180 Ϯ 112 and 390 Ϯ 406 nM, V max values were 13 Ϯ 8 and 18 Ϯ 4.9 pmol/min/mg protein, and nonsaturable components were 9.2 Ϯ 1.3 and 10.7 Ϯ 2.5 l/min/mg for PP and PV, respectively. The evenness of distribution of Oatp2 and Pgp was confirmed by Western blotting and confocal immunofluorescent microscopy. When digoxin was recirculated to the rat liver preparation in Krebs-Henseleit bicarbonate (KHB) for 3 h in absence or presence of 1% bovine serum albumin (BSA) and 20% red blood cell (rbc) at flow rates of 40 and 10 ml/min, respectively, biexponential decays were observed. Fitted results based on compartmental analyses revealed a higher clearance (0.244 Ϯ 0.082 ml/min/g) for KHB-perfused livers over the rbc-albuminperfused livers (0.114 Ϯ 0.057 ml/min/g) (P Ͻ 0.05). We further found that binding of digoxin to 1% BSA was modest (unbound fraction ϭ 0.64), whereas binding to rbc was associated with slow on (0.468 Ϯ 0.021 min
Ϫ1) and off (1.81 Ϯ 0.12 min Ϫ1 ) rate constants. We then used a zonal, physiologically based pharmacokinetic model to show that the difference in digoxin clearance was attributed to binding to BSA and rbc and not to the difference in flow rate and that clearance was unaffected by transporter or enzyme heterogeneity.Digoxin, an important cardiotonic drug of narrow therapeutic index, is cleared by both the kidney and liver, and exhibits a long half-life in vivo due to the large volume of distribution (Kramer et al., 1974;Rodin and Johnson, 1988). In the rat liver, digoxin is primarily metabolized by cytochrome P450 3a to the didigitoxoside and monodigitoxoside as well as digitoxigenin (Harrison and Gibaldi, 1976; Sal-
ABBREVIATIONS:Pgp, P-glycoprotein; Oatp, rat organic anion transporting polypeptide; OAT, organic anion transporter; PP, periportal; PV, perivenous; rbc, red blood cell; KHB, Krebs-Henseleit bicarbonate buffer; BSA, bovine serum albumin; PBPK, physiologically based pharmacokinetic; Dg3, unlabeled digoxin; Dg2, digitoxigenin bis-digitoxoside; Dg1, digitoxigenin monodigitoxoside; Dg0, digitoxigenin; HPLC, high-performance liquid chromatography; HRP, horseradish peroxidase; Hct, hematocrit; AUC, area under the curve; A 2 , Dg3 amount in peripheral compartment; A bile and A met , amounts of Dg3 excreted into bile and metabolized, respectively; C 1 , Dg3 concentration in central compartment (compartmental modeling); C R (or Dg3 R ), Dg3 concentration in the reservoir; C rbc,R (or Dg3 rbc,R ), Dg3 concentration in rbc in the reservoir; C p,R (or Dg3 p,R ), Dg3 concentration in plasma, in the reservoir; C rbci...