Many drugs have chiral
centers and are therapeutically applied
as racemates. Thus, the stereoselectivity in their interactions with
membrane transporters needs to be addressed. Here, we studied stereoselectivity
in inhibiting organic cation transporters (OCTs) 1, 2, and 3 and the
high-affinity monoamine transporters (MATs) NET and SERT. Selectivity
by the inhibition of 35 pairs of enantiomers significantly varied
among the three closely related OCTs. OCT1 inhibition was nonselective
in almost all cases, whereas OCT2 was stereoselectively inhibited
by 45% of the analyzed drugs. However, the stereoselectivity of the
OCT2 was only moderate with the highest selectivity observed for pramipexole.
The (R)-enantiomer inhibited OCT2 4-fold more than
the (S)-enantiomer. OCT3 showed the greatest stereoselectivity
in its inhibition. (R)-Tolterodine and (S)-zolmitriptan inhibited OCT3 11-fold and 25-fold more than their
respective counterparts. Interestingly, in most cases, the pharmacodynamically
active enantiomer was also the stronger OCT inhibitor. In addition,
stereoselectivity in the OCT inhibition appeared not to depend on
the transported substrate. For high-affinity MATs, our data confirmed
the stereoselective inhibition of NET and SERT by several antidepressants.
However, the stereoselectivity measured here was generally lower than
that reported in the literature. Unexpectedly, the high-affinity MATs
were not significantly more stereoselectively inhibited than the polyspecific
OCTs. Combining our in vitro OCT inhibition data with available stereoselective
pharmacokinetic analyses revealed different risks of drug–drug
interactions, especially at OCT2. For the tricyclic antidepressant
doxepine, only the (E)-isomer showed an increased
risk of drug–drug interactions according to guidelines from
regulatory authorities for renal transporters. However, most chiral
drugs show only minor stereoselectivity in the inhibition of OCTs
in vitro, which is unlikely to translate into clinical consequences.