探针药物咪哒唑仑有限采样法预测抑制状态大鼠肝脏CYP3A代谢活性的研究

本研究以细胞色素P450(CYP)3A探针药物咪哒唑仑的系统清除率(CL_s)为指标，评价有限采样法(LSS)预测肝脏CYP3A抑制状态的可行性。采用系列剂量的CYP3A选择性抑制剂酮康唑预处理大鼠，静脉注射咪哒唑仑(MDZ)后若干时间点收集血浆样品并检测MDZ浓度，经逐步回归分析和Jack-knife验证建立LSS模型。对经相同处理的另一随机群体进行验证分析，评价该LSS模型方程的准确性和重现性。通过绘制Bland-Altman散点图对由两点(60和90 min)或三点(30、60和90 min，或30、60和120 min)血浆药物浓度建立的LSS预测模型得到的CL_s估计值(CL_est)与二房室模型拟合值(观察值，CL_obs)进行偏差分析并计算95%可信区间，表明两种方法得到的CL_s具有较好的一致性，LSS法预测误差小，特别是两点LSS预测模型更为准确且简便。结果表明：以咪哒唑仑清除率为指标，采用有限采样法评价大鼠肝脏CYP3A抑制状态下的代谢活性是一种准确而简便的方法，为今后推广到临床评价肝脏代谢功能从而制定和调整治疗药物的给药方案提供了理论依据和实验室证据。     

含Cremophor RH40的自微乳化给药系统对大鼠体内CYP3A酶的抑制作用

［摘要］目的考察包含表面活性剂Cremophor RH40的自微乳化给药系统（SMEDDS）对大鼠体内细胞色素P450（CYP3A)活性的影响。方法以咪达唑仑（MDZ）为模型药物,采用高效液相色谱（HPLC）法测定MDZ及其活性代谢物1’ 羟基咪达唑仑在大鼠体内的血药浓度,并计算其药动学参数,考察MDZ自乳化微乳对大鼠体内CYP3A活性的影响,同时采用蛋白免疫印迹法检测上述制剂对大鼠肠黏膜上CYP3A蛋白表达的影响。 结果MDZ微乳的口服生物利用度为MDZ片 的3.14倍,且显著降低1′ 羟基咪达唑仑与咪达唑仑血浆浓度 时间曲线下面积（AUC）0 ∞的比值（由0.25减少到0.11,P＜0.05）;MDZ自微乳化制剂还可显著延长MDZ在体内的平均滞留时间（MRT）及半衰期（t1/2）［MRT由（0.63±0.13） h延长至（1.23±0.38） h; t1/2由（0.33±0.11） h 延长至（0.65±0.25） h, P＜0.05］;相对于MDZ片,SMEDDS口服给药后,肠道CYP3A的蛋白表达水平显著降低。结论含有Cremophor RH40的SMEDDS能抑制大鼠体内CYP3A的代谢,从而提高CYP3A底物药物的口服生物利用度。     

探针药咪哒唑仑评价肝药酶抑制状态下CYP3A体内外代谢活性的实验研究

目的 以咪哒唑仑为探针药，研究大鼠肝药酶CYP3A抑制状态下对药物体内外代谢活性的影响，以建立评价CYP3A药物代谢功能的药动学指标。方法 ①体内实验：以咪哒唑仑（MDZ）为CYP3A底物，酮康唑（KTZ）为CYP3A选择性抑制剂，通过静脉注射负荷剂量（1．2、10、30mg／kg）与恒速滴注（0．7、2．0、3．0mg／hr／ks）相结合的方法，使KTZ达到不同的稳态血药浓度（约1．49、7．16、36．25μg／ml），以实现对CYP3A的持续抑制。恒速滴注开始后2h，大鼠舌静脉注射MDZ10mg／kg，在不同时间点采集血和肝样品；     

酮康唑对大鼠肝脏CYP450酶系的影响*

目的:观察酮康唑对大鼠肝细胞色素P450及其主要亚型的影响。方法:Sprague-Dawley大鼠用140,280,420μmol.kg-1.d-1酮康唑连续灌胃7 d,测定肝脏微粒体中总CYP450含量和CYP1A1,1A2,1B1,2B1/2,2E1和3A亚型活性。结果:不同剂量酮康唑给药后大鼠肝脏脏器系数、CYP1A1和1B1亚型活性明显增高(P<0.05,P<0.01);总CYP450含量和CYP3A活性显著降低(P<0.01);低剂量的酮康唑抑制CYP1A2和CYP2B1/2亚型的活性,高剂量却出现了诱导作用(P<0.05,P<0.01)。各剂量组对CYP2E1均无明显影响。结论:酮康唑对大鼠肝脏CYP450及主要药物代谢亚型CYP1A1,1A2,1B1,2B1/2和3A有影响,临床长期用药或与经肝脏CYP450代谢的药物联合应用时要注意监测血药浓度和肝脏功能,防止药物代谢减缓出现蓄积中毒或药物代谢加快而降低药效。     

钝化NF-κB的活化对酒精性肝损伤大鼠CYP3A的影响

目的研究核转录因子-κB(nuclear fastor kappa B,NF-κB)在酒精性肝损伤大鼠模型中的作用及对细胞色素P4503A(cytochrome P450 3A,CYP3A)代谢活力的影响。方法采用白酒灌胃法复制大鼠酒精性肝损伤模型,肝脏组织HE染色和血清中ALT和AST水平测定观测大鼠肝损伤情况,采用免疫组化法检测肝脏NF-κB的蛋白表达,通过HPLC法检测CYP3A的探针药物咪哒唑仑的血浆药物浓度,采用热板法观察大鼠舔足反应来体现咪哒唑仑的代谢情况,从而反映咪哒唑仑特异性代谢酶CYP3A的代谢活力。结果酒精性肝损伤模型组表现为轻度脂肪变性和炎症坏死,NF-κB明显活化,CYP3A代谢活力增强(P<0.05);钝化NF-κB的活化后,肝脏脂肪变性程度明显减轻,CYP3A代谢活力下调(P<0.05)。结论钝化NF-κB活化,可以减轻酒精性肝损伤的程度,并下调酒精性肝损伤导致的CYP3A代谢活性的增强。     

酒精性肝损伤大鼠细胞色素P450 CYP2E1和细胞色素P450 CYP3A的代谢活性

目的观察酒精性肝损伤对大鼠细胞色素P450CYP3A(CYP3A)和细胞色素P450CYP2E1(CYP2E1)代谢活性的影响。方法采用ig给予白酒制备大鼠酒精性肝损伤模型,检测血清中谷丙转氨酶(GPT)和谷草转氨酶(GOT)活性,采用HE染色法光镜下观测酒精对肝脏损伤程度。大鼠ip给予CYP3A探针药物咪达唑仑10mg·kg-1或ig给予CYP2E1探针药物氯唑沙宗50mg·kg-1后,采用高效液相色谱法测定不同时间点大鼠血浆中咪达唑仑和氯唑沙宗的血药浓度,并应用3P87软件计算其药代动力学参数,以考察CYP2E1和CYP3A的代谢活性的变化。大鼠ig给予氯唑沙宗80mg·kg-1后,热板方法测定大鼠添足次数和添足反射潜伏期。结果酒精性肝损伤可致大鼠肝小叶结构不清,肝索排列紊乱,肝细胞体积增大,呈弥漫性中度水变性,肝窦受压,大部分肝细胞胞浆内见大小不等的脂肪空泡;与正常对照组相比,酒精性肝损伤组大鼠GPT和GOT活性分别增加了16.0%和20.0%(P<0.05,P<0.01)。酒精性肝损伤致大鼠CYP2E1对探针药物氯唑沙宗的代谢活性增强,AUC,t1/2和cmax分别降低了38.0%,30.5%和35.0%(P<0.05);酒精肝损伤组大鼠氯唑沙宗镇痛效果明显降低;酒精性肝损伤致大鼠CYP3A对探针药物咪达唑仑的代谢活性增强,AUC,t1/2和cmax分别降低了122.6%,54.9%和56.9%(P<0.01,P<0.05)。结论酒精性肝损伤可使大鼠CYP2E1和CYP3A代谢活性增强。     

五味子甲素对大鼠肝微粒体CYP3A活性的影响

目的：通过体外药物代谢实验探讨五味子甲素对CYP3A活性的影响。方法：以大鼠肝微粒体为载体,选取咪达唑仑（MDZ）作为药物“探针”,建立高效液相色谱（HPLC）检测方法,体外给药测定五味子甲素对MDZ的IC50值以及相关酶动力学参数。结果：孵育体系内源性物质不干扰测定,方法快捷、稳定、灵敏度高。在肝微粒中,五味子甲素对MDZ的IC50浓度为6．26μmol／mL,相关酶动力学参数：Km=15．77μmol／L,K1=5．50μmol／mL。结论：五味子甲素对大鼠肝微粒体CYP3A活性具有抑制作用,其抑制作用为混合型,即：非竞争与反竞争抑制。     

五味子甲素对大鼠肝微粒体CYP3A活性的影响

目的：通过体外药物代谢实验探讨五味子甲素对CYP3A活性的影响。方法：以大鼠肝微粒体为载体,选取咪达唑仑（MDZ）作为药物“探针”,建立高效液相色谱（HPLC）检测方法,体外给药测定五味子甲素对MDZ的IC50值以及相关酶动力学参数。结果：孵育体系内源性物质不干扰测定,方法快捷、稳定、灵敏度高。在肝微粒中,五味子甲素对MDZ的IC50浓度为6．26μmol／mL,相关酶动力学参数：Km=15．77μmol／L,Ki=5．50μmol／mL。结论：五味子甲素对大鼠肝微粒体CYP3A活性具有抑制作用,其抑制作用为混合型,即：非竞争与反竞争抑制。     

心血管药物速效救心丸和通心络胶囊对大鼠细胞色素P450酶的影响

目的:观察速效救心丸和通心络胶囊对大鼠药物代谢酶细胞色素P450(CYP450)的影响。方法:给予大鼠试验药物后制备肝及小肠微粒体,CO还原差示光谱法测定肝微粒体CYP450含量,蛋白免疫印迹法检测肝微粒体中CYP1A2、CYP2C11、CYP2E1、CYP3A和肠微粒体中CYP3A蛋白的表达量。结果:速效救心丸组和通心络胶囊组与空白对照组比较,大鼠肝脏CYP450含量无显著变化(P>0.05);但是West-ern blotting实验对肝脏和肠道中多种CYP450酶表达量测定的结果显示,速效救心丸可诱导肝脏CYP1A2表达,但抑制肝脏CYP2C11和肠道CYP3A表达(P<0.05);通心络胶囊可诱导大鼠肝脏CYP1A2、CYP2E1蛋白表达(P<0.05)。结论:速效救心丸和通心络胶囊对大鼠肝脏CYP450酶总量无影响,但是,在蛋白质水平对特定亚型蛋白的表达量有影响,由此可能引发的药物相互作用不容忽视。     

那格列奈在大鼠游离肝细胞中的代谢特点

目的:研究新型非磺酰脲类降血糖药那格列奈(nateglinide)在大鼠游离肝细胞的代谢特点.方法:为考察该药的体外代谢和参与代谢的CYP450同工酶的种类,167μmol·L-1 的CYP450同工酶抑制剂或底物(奎尼丁、磺胺嘧啶、奥美拉唑、普奈洛尔、西米替丁、左氧氟沙星、红霉素)和那格列奈在8×106个肝细胞*mL-1的混悬液中37℃时孵育60min,并于10,20,30,40,60min取样,HPLC法测定其中母体药物--那格列奈的浓度,并同空白对照组比较.结果:那格列奈的体外代谢迅速,10min内细胞悬液中原形药物仅占初始浓度的10%;奎尼丁、奥美拉唑、西米替丁能明显抑制那格列奈的肝脏代谢,使混悬液中母体药物浓度明显提高(P<0.01),磺胺嘧啶和普奈洛尔的加入,也使母体药物浓度显著提高(P<0.05).结论:CYP450同工酶CYP2D6和CYP2C9在那格列奈羟化过程中起重要作用.CYP1A2,CYP2C19和CYP3A4同工酶是否参与代谢尚需进一步实验研究.     

Relationships between Endogenous Plasma Biomarkers of Constitutive Cytochrome P450 3A Activity and Single‐Time‐Point Oral Midazolam Microdose Phenotype in Healthy Subjects

Due to high basal interindividual variation in cytochrome P450 3A (CYP3A) activity and susceptibility to drug interactions, there has been interest in the application of efficient probe drug phenotyping strategies, as well as endogenous biomarkers for assessment of in vivo CYP3A activity. The biomarkers 4β‐hydroxycholesterol (4βHC) and 6β‐hydroxycortisol (6βHCL) are sensitive to CYP3A induction and inhibition. However, their utility for the assessment of constitutive CYP3A activity remains uncertain. We investigated whether endogenous plasma biomarkers (4βHC and 6βHCL) are associated with basal CYP3A metabolic activity in healthy subjects assessed by a convenient single‐time‐point oral midazolam (MDZ) phenotyping strategy. Plasma 4βHC and 6βHCL metabolic ratios (MRs) were analysed in 51 healthy adult participants. CYP3A activity was determined after administration of an oral MDZ microdose (100 μg). Simple linear and multiple linear regression analyses were performed to assess relationships between MDZ oral clearance, biomarkers and subject covariates. Among study subjects, basal MDZ oral clearance, 4βHC and 6βHCL MRs ranged 6.5‐, 10‐ and 13‐fold, respectively. Participant age and alcohol consumption were negatively associated with MDZ oral clearance (p = 0.03 and p = 0.045, respectively), while weight and female sex were associated with lower plasma 4βHC MR (p = 0.0003 and p = 0.032, respectively). Neither 4βHC nor 6βHCL MRs were associated with MDZ oral clearance. Plasma 4βHC and 6βHCL MRs do not relate to MDZ single‐time‐point metabolic phenotype in the assessment of constitutive CYP3A activity among healthy individuals.     

Pharmacokinetics of midazolam and metabolites in a patient with refractory status epilepticus treated with extraordinary doses of midazolam

The authors present a patient with refractory epilepsy who was treated with very high doses (up to 4 mg/min) of intravenous midazolam, phenytoin, carbamazepine, and other antiepileptics. Because it was known from the literature that the half-life of midazolam can increase at high dosage, the kinetics of midazolam (MDZ), 1'-hydroxymidazolam, and 4-hydroxymidazolam were assessed at steady state (dosage 1 mg/min) and after stopping treatment. Total body clearance of MDZ (33 L/kg) and intrinsic hepatic clearance (19 mL/min/kg) at steady state were both five to 10 times higher than after normal therapeutic doses, demonstrating hepatic cytochrome (CYP) 3A induction. Despite the high body clearance, the half-life of MDZ was in the range of 24 hours, approximately 10 times higher than after normal therapeutic doses. The volume of distribution at steady state was 33 L/kg, approximately 50 times higher than after normal therapeutic doses. The free fraction of MDZ was 58% at steady state, much higher than the 3% to 6% at normal therapeutic doses. The kinetics of intravenous MDZ is strongly dependent on its dose and on hepatic CYP3A activity. Even in patients with hepatic CYP3A induction, the half-life of MDZ increases with high doses as a result of a rise in its volume of distribution, which is a consequence of an increase in the free fraction of MDZ.     

In vitro and in vivo CYP3A64 induction and inhibition studies in rhesus monkeys: a preclinical approach for CYP3A-mediated drug interaction studies.

In this study, induction and inhibition of rhesus monkey CYP3A64 versus human CYP3A4 were characterized in vitro, and the corresponding pharmacokinetic consequences were evaluated in rhesus monkeys. In monkey hepatocytes, rifampin markedly induced CYP3A64 mRNA (EC50 = 0.5 microM; Emax = 6-fold) and midazolam (MDZ) 1'-hydroxylase activity (EC50 = 0.2 microM; Emax = 2-fold). Compound A (N-[2(R)-hydroxy-1(S)-indanyl-5-[2(S)-(1,1-dimethylethylaminocarbonyl)-4-[(furo[2,3-b]pyridin-5-yl)-methyl]piperazin-1-yl]-4(S)-hydroxy-2(R)-phenylmethylpentanamide), a known potent and mechanism-based inhibitor of CYP3A4, strongly inhibited the formation of 1'-hydroxy MDZ by recombinant CYP3A64 in a concentration- and time-dependent manner (KI = 0.25 microM; k(inact) = 0.4 min(-1)). Similar corresponding results also were obtained with human CYP3A4 in the presence of rifampin or compound A. In rhesus monkeys, MDZ exhibited a relatively high metabolic clearance (primarily via 1'-hydroxylation followed by glucuronidation) and a low hepatic availability (Fh = 16%). Consistent with the induction of hepatic metabolism of a high-clearance compound, pretreatment with rifampin (18 mg/kg p.o. for 5 days) did not significantly affect the i.v. kinetics of MDZ, but caused a pronounced reduction (approximately 10-fold) in the systemic exposure to MDZ and, consequently, its Fh following intrahepatic portal vein administration (i.pv.) of MDZ. A comparable extent of the pharmacokinetic interaction also was obtained after a 1.8 mg/kg rifampin dose. Also consistent with the in vitro CYP3A64 inhibition finding, compound A (6 mg/kg i.v.) markedly increased (10-fold) the i.pv. administered MDZ exposure. At the doses studied, plasma concentrations of rifampin or compound A reached or exceeded their respective in vitro EC50 or KI values. These findings suggest the potential applicability of the in vitro-in vivo relationship approach in rhesus monkeys for studying CYP3A-mediated interactions in humans.     

Conflicting alterations in hepatic expression of CYP3A and enzyme kinetics in rats exposed to 5-fluorouracil: relevance to pharmacokinetics of midazolam

Abstract

1. 5-Fluorouracil (5-FU) is a pyrimidine derivative widely used for the treatment of cancer. In this study, we investigated the effects of 5-FU on the protein expression of hepatic CYP3A and their enzyme activity for metabolizing midazolam (MDZ), a typical substrate of CYP3A, in rat liver microsomes. We also examined the pharmacokinetic behavior of intravenously administered MDZ in rats treated with 5-FU (120?mg/kg, ip).

2. 5-FU was shown to induce hepatic CYP3A2 protein 2?days after administration without changing the expression of CYP3A1/3A23. However, affinity of 5-FU-inducible CYP3A protein to MDZ for its 4- and 1′-hydroxylation was decreased. Furthermore, the susceptibility of MDZ hydroxylation activity to a CYP3A inhibitor differed between the control and 5-FU groups.

3. Pharmacokinetic analysis of the MDZ disposition demonstrated no significant differences in the total clearance (CL_tot) and elimination rate constant (k_e) between the control and 5-FU-treated rats. Lack of alteration in the metabolic clearance of MDZ may be attributable to the induction of CYP3A protein with reduced affinity for the substrate of CYP3A enzymes.

4. Our findings provide novel information regarding the manifestation of inductive and interfering actions of 5-FU toward hepatic CYP3A to help in assessing the pharmacokinetics of CYP3A substrate drugs.     

Midazolam and cortisol metabolism before and after CYP3A induction in humans

INTRODUCTION: CYP3A is responsible for the metabolism of numerous endogenous and exogenous compounds. Several substrates of CYP3A have been investigated to assess the CYP3A-metabolizing capacity of an individual in an attempt to predict the rate of metabolism of other CYP3A substrates. Two such tests of CYP3A activity are the midazolam plasma clearance after its intravenous administration and the 6beta-OH cortisol urinary ratio. Possible correlations between these 2 tests were investigated before and after treatment with rifampin in a group of healthy volunteers. METHODS: Pharmacokinetic parameters of midazolam and 6beta-OH cortisol urinary ratio were evaluated in 8 volunteers before and after 6 days treatment with rifampin, a potent inducer of CYP3A, and after cessation of rifampin treatment. RESULTS: Midazolam systemic clearance and the 6beta-OH cortisol urinary ratio were significantly higher at Days 7 and 10 than at Day 0. There was a strong positive correlation between these 2 parameters (r = 0.70, p < 0.001). In contrast, no correlation was observed between the ratio of the AUCs of 1'-OH midazolam vs. midazolam (AUC0-1(1'-OH)/AUC0-t(MDZ)) or the ratio of plasma concentration of 1'-OH midazolam vs. midazolam (C30 min(1'-OH)/C30 min(MDZ)) and the 6beta-OH cortisol urinary ratio (r = 0.05, p = 0.82; r = 0.04, p = 0.88, respectively). Considering only data obtained before or after treatment with rifampin, however, no correlation was observed between midazolam systemic clearance and the 6beta-OH cortisol urinary ratio. CONCLUSIONS: These data demonstrate that there is a strong positive correlation between systemic midazolam clearance and 6beta-OH cortisol urinary ratio before and after induction. This suggests that the 6beta-OH cortisol urinary ratio test is a non-invasive alternative to the use of systemic midazolam clearance for monitoring the time-course of CYP3A induction.     

Limited sampling models for oral midazolam: midazolam plasma concentrations, not the ratio of 1-hydroxymidazolam to midazolam plasma concentrations, accurately predicts AUC as a biomarker of CYP3A activity

Oral midazolam is used as a phenotyping probe for cytochrome P450 (CYP) 3A activity and requires multiple plasma samples to measure drug exposure. Limited sampling is a useful strategy for optimizing sampling and reducing costs and labor. We studied limited sampling models using multiple linear regressions to predict the area under the concentration versus time curve (AUC) of midazolam using either midazolam plasma concentrations or the ratio of 1-hydroxymidazolam (1-OH MDZ) to midazolam plasma concentrations. CYP3A baseline activity data for oral midazolam from previous studies were used (45 healthy adults for models using midazolam plasma concentrations and 41 healthy adults for models using the ratios of 1-OH MDZ to midazolam plasma concentrations). Limited sampling models were derived, validated, and evaluated for precision and bias. Two equations using the time points at 0.5 and 6 hours and 0.5, 2, and 6 hours were acceptable and predictive of midazolam AUC using midazolam plasma concentrations. No 1-OH MDZ to midazolam plasma concentration ratios accurately predicted midazolam AUC.     

Limited sampling strategy to predict AUC of the CYP3A phenotyping probe midazolam in adults: application to various assay techniques

Midazolam clearance is used to phenotype hepatic CYP3A activity but requires multiple plasma samples following a single intravenous dose. The authors evaluated the use of a limited sampling scheme, using different assay techniques to determine the reproducibility of such a strategy in estimating midazolam AUC. Seventy-three healthy adults received midazolam as a single intravenous bolus dose. At least eight plasma samples were collected from each subject and were assayed using either LC/MS/MS or electron capture gas chromatography. Eleven subjects were randomly selected for the training set using stepwise linear regression to determine relationships between midazolam plasma concentrations and AUC. Validation of the predictive equations was done using the remaining 62 subjects. Mean percent error (MPE), mean absolute error (MAE), and root mean square error (RMSE) were calculated to determine bias and precision. Based on the training set, five models were generated with coefficients of determination ranging from 0.87 to 0.95. Validation showed that MPE, MAE, and RMSE values were acceptable for three of the models. Intrasubject reproducibility was good. In addition, training set datafrom one institution were able to predict data from the other two institutions using other assay techniques. Minimized plasma sampling mayprovide a simpler method for estimating midazolam AUC for CYP3A phenotyping. A limited sampling strategy is more convenient and cost-effective than standard sampling strategies and is applicable to more than one assay technique.     

Effect of multiple dosing of ketoconazole on pharmacokinetics of midazolam, a cytochrome P-450 3A substrate in beagle dogs.

To evaluate effects of multiple dosing of ketoconazole (KTZ) on hepatic CYP3A, the pharmacokinetics of intravenous midazolam (MDZ, 0.5 mg/kg) before and during multiple dosing of KTZ were investigated in beagle dogs. KTZ tablets were given orally to dogs (n = 4) for 30 days (200 mg b.i.d.). With coadministration of KTZ, t(1/2beta) of MDZ were significantly increased both on day 1 (2-fold) and on day 30 (3-fold). Total body clearance (CL(tot)) of MDZ declined gradually during the first 5 days after the start of KTZ treatment, and thereafter CL(tot) appeared to reach a plateau phase (one-fourth), depending on plasma KTZ concentrations. The effects of KTZ on the biotransformation of MDZ were also investigated using dog liver microsomes (n = 5). The K(i) values of KTZ for MDZ 1'-hydroxylation and 4-hydroxylation were 0.0237 and 0.111 microM, respectively, indicating that KTZ extensively inhibits hepatic CYP3A activity in dogs. CL(tot) values estimated from in vitro K(i) values corrected by unbound fraction of KTZ and unbound concentrations of the drug in plasma were consistent with in vivo CL(tot) of MDZ. The results in this study suggest that KTZ treatment is necessary until plasma concentrations of the drug reach a steady state to evaluate the effect of multiple dosing of the drug on hepatic CYP3A in vivo. In addition, it is suggested that K(i) values corrected by unbound fraction of KTZ and unbound concentrations of the drug in plasma enable precise in vitro-in vivo scaling.     

Probe of CYP3A by a single-point blood measurement after oral administration of midazolam in healthy elderly volunteers

Background Midazolam (MDZ) is used as an assessment of human cytochrome P450 3A (CYP3A) activity. A single blood measurement is used as a marker of its activity based on an observed correlation between MDZ clearance and the 1′-hydroxymidazolam (1′-OH-MDZ): MDZ plasma ratio is assessed at 0.5 h followig the intake of a single 7.5 mg oral dose of MDZ in healthy young volunteers. In addition, a 4-h plasma MDZ measurement has been found to be an excellent predictor of AUC and CYP3A activity.Objectives The main aim of this study was to define a single-point blood sampling in healthy elderly volunteers. The secondary objective was to investigate the pharmacological effects of a low oral dose of MDZ (5 mg) and its potential psychometric changes.Methods Eight healthy elderly Caucasian volunteers participated in a single-dose, open-label, non-comparative study. Each subject received a single 5 mg oral dose of MDZ. Plasma concentrations of MDZ and its major metabolite, 1′-OH-MDZ, were assayed over 12 h. Secondary assessments of critical flicker fusion (CFF), body sway and mini-mental state examination were also carried out during the 12-h post-administration period.Results A moderate correlation was observed between MDZ clearance and the 1′-OH-MDZ: MDZ plasma concentration ratio at 9 h post-dosing (Rho=0.81; p=0.04), but an even better correlation (Rho=0.99; p<0.009) was found between MDZ AUC and MDZ plasma concentration at 6 h post-dosing, with the latter value corresponding approximately to the average mean residence time (MRT) determined in our trial. This study was well-tolerated despite a significant transitory decrease (relative to baseline) in cortical arousal at 1 h post-dosing, as assessed by CFF, and a non-significant decrease (relative to baseline) in balance and vigilance also measured at 1 h and assessed on body sway, compared to baseline values.Conclusion Despite the small sample size, based on the results of healthy, elderly volunteers, a single MDZ plasma measurement taken at 6 h post-oral administration may represent an accurate marker of CYP3A phenotype. This single-time-point method could be used safely for predicting drug-drug or diet interactions and identifying individuals with genetic polymorphism that affect CYP3A activity.In memoriam: S. Bouquet