Prediction of Drug-Induced Hyperbilirubinemia by In Vitro Testing
Bilirubin, the end product of heme catabolism, is produced continuously in the body and may reach toxic levels if accumulates in the serum and tissues; therefore, a highly efficient mechanism evolved for its disposition. Normally, unconjugated bilirubin enters hepatocytes through the uptake transpor...
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-08-01
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| Series: | Pharmaceutics |
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| Online Access: | https://www.mdpi.com/1999-4923/12/8/755 |
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| author | Péter Tátrai Péter Krajcsi |
| author_facet | Péter Tátrai Péter Krajcsi |
| author_sort | Péter Tátrai |
| collection | DOAJ |
| description | Bilirubin, the end product of heme catabolism, is produced continuously in the body and may reach toxic levels if accumulates in the serum and tissues; therefore, a highly efficient mechanism evolved for its disposition. Normally, unconjugated bilirubin enters hepatocytes through the uptake transporters organic anion transporting polypeptide (OATP) 1B1 and 1B3, undergoes glucuronidation by the Phase II enzyme UDP glucuronosyltransferase 1A1 (UGT1A1), and conjugated forms are excreted into the bile by the canalicular export pump multidrug resistance protein 2 (MRP2). Any remaining conjugated bilirubin is transported back to the blood by MRP3 and passed on for uptake and excretion by downstream hepatocytes or the kidney. The bile salt export pump BSEP as the main motor of bile flow is indirectly involved in bilirubin disposition. Genetic mutations and xenobiotics that interfere with this machinery may impede bilirubin disposition and cause hyperbilirubinemia. Several pharmaceutical compounds are known to cause hyperbilirubinemia via inhibition of OATP1Bs, UGT1A1, or BSEP. Herein we briefly review the in vitro prediction methods that serve to identify drugs with a potential to induce hyperbilirubinemia. In vitro assays can be deployed early in drug development and may help to minimize late-stage attrition. Based on current evidence, drugs that behave as mono- or multispecific inhibitors of OATP1B1, UGT1A1, and BSEP in vitro are at risk of causing clinically significant hyperbilirubinemia. By integrating inhibition data from in vitro assays, drug serum concentrations, and clinical reports of hyperbilirubinemia, predictor cut-off values have been established and are provisionally suggested in this review. Further validation of in vitro readouts to clinical outcomes is expected to enhance the predictive power of these assays. |
| first_indexed | 2024-03-10T17:39:04Z |
| format | Article |
| id | doaj.art-d89ce57255ab4a87816984ee558609cc |
| institution | Directory Open Access Journal |
| issn | 1999-4923 |
| language | English |
| last_indexed | 2024-03-10T17:39:04Z |
| publishDate | 2020-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Pharmaceutics |
| spelling | doaj.art-d89ce57255ab4a87816984ee558609cc2023-11-20T09:46:11ZengMDPI AGPharmaceutics1999-49232020-08-0112875510.3390/pharmaceutics12080755Prediction of Drug-Induced Hyperbilirubinemia by In Vitro TestingPéter Tátrai0Péter Krajcsi1Solvo Biotechnology, Science Park, Building B1, 4-20 Irinyi József utca, H-1117 Budapest, HungarySolvo Biotechnology, Science Park, Building B1, 4-20 Irinyi József utca, H-1117 Budapest, HungaryBilirubin, the end product of heme catabolism, is produced continuously in the body and may reach toxic levels if accumulates in the serum and tissues; therefore, a highly efficient mechanism evolved for its disposition. Normally, unconjugated bilirubin enters hepatocytes through the uptake transporters organic anion transporting polypeptide (OATP) 1B1 and 1B3, undergoes glucuronidation by the Phase II enzyme UDP glucuronosyltransferase 1A1 (UGT1A1), and conjugated forms are excreted into the bile by the canalicular export pump multidrug resistance protein 2 (MRP2). Any remaining conjugated bilirubin is transported back to the blood by MRP3 and passed on for uptake and excretion by downstream hepatocytes or the kidney. The bile salt export pump BSEP as the main motor of bile flow is indirectly involved in bilirubin disposition. Genetic mutations and xenobiotics that interfere with this machinery may impede bilirubin disposition and cause hyperbilirubinemia. Several pharmaceutical compounds are known to cause hyperbilirubinemia via inhibition of OATP1Bs, UGT1A1, or BSEP. Herein we briefly review the in vitro prediction methods that serve to identify drugs with a potential to induce hyperbilirubinemia. In vitro assays can be deployed early in drug development and may help to minimize late-stage attrition. Based on current evidence, drugs that behave as mono- or multispecific inhibitors of OATP1B1, UGT1A1, and BSEP in vitro are at risk of causing clinically significant hyperbilirubinemia. By integrating inhibition data from in vitro assays, drug serum concentrations, and clinical reports of hyperbilirubinemia, predictor cut-off values have been established and are provisionally suggested in this review. Further validation of in vitro readouts to clinical outcomes is expected to enhance the predictive power of these assays.https://www.mdpi.com/1999-4923/12/8/755OATP1B1UGT1A1hyperbilirubinemiain vitrorisk assessment |
| spellingShingle | Péter Tátrai Péter Krajcsi Prediction of Drug-Induced Hyperbilirubinemia by In Vitro Testing Pharmaceutics OATP1B1 UGT1A1 hyperbilirubinemia in vitro risk assessment |
| title | Prediction of Drug-Induced Hyperbilirubinemia by In Vitro Testing |
| title_full | Prediction of Drug-Induced Hyperbilirubinemia by In Vitro Testing |
| title_fullStr | Prediction of Drug-Induced Hyperbilirubinemia by In Vitro Testing |
| title_full_unstemmed | Prediction of Drug-Induced Hyperbilirubinemia by In Vitro Testing |
| title_short | Prediction of Drug-Induced Hyperbilirubinemia by In Vitro Testing |
| title_sort | prediction of drug induced hyperbilirubinemia by in vitro testing |
| topic | OATP1B1 UGT1A1 hyperbilirubinemia in vitro risk assessment |
| url | https://www.mdpi.com/1999-4923/12/8/755 |
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