Pharmacokinetics of Monoclonal Antibodies Throughout Pregnancy: A Systematic Literature Review.

BACKGROUND AND OBJECTIVE: Although little information is available on the pharmacokinetics (PK) of monoclonal antibodies (mAbs) during pregnancy, multiple mAbs are being used during pregnancy for various indications. The aim of this systematic literature review was to characterize the PK of mAbs throughout pregnancy. METHODS: A systematic literature search was carried out in PubMed and Embase on 21 April 2023. Articles were included when information on PK or exposure parameters of mAbs in pregnant women was available. RESULTS: A total of 42 relevant articles were included, of which eight discussed adalimumab, three certolizumab pegol, five eculizumab, one golimumab, 12 infliximab (IFX), two natalizumab, one canakinumab, one omalizumab, five tocilizumab, eight ustekinumab, and five vedolizumab. One of the 42 studies reported information on clearance (CL) and volume of distribution (VD) of IFX; all other studies only reported on serum concentrations in the pre-pregnancy state, different trimesters, and the postpartum period. For all of the assessed mAbs except IFX, serum concentrations were similar to concentrations in the pre-pregnancy state or modestly decreased. In contrast, IFX trough concentrations generally increased in the second and third trimesters in comparison to the non-pregnant state. CONCLUSION: Available information suggests that the anatomical and physiological changes throughout pregnancy may have meaningful effects on the PK of mAbs. For most mAbs (not IFX), modestly higher dosing (per mg) maybe needed during pregnancy to sustain a similar serum exposure compared to pre-pregnancy.

Rhodamine 123 as a probe of transmembrane potential in isolated rat-liver mitochondria: spectral and metabolic properties.

The spectral and metabolic properties of Rhodamine 123, a fluorescent cationic dye used to label mitochondria in living cells, were investigated in suspensions of isolated rat-liver mitochondria. A red shift of Rhodamine 123 absorbance and fluorescence occurred following mitochondrial energization. Fluorescence quenching of as much as 75% also occurred. The red shift and quenching varied linearly with the potassium diffusion potential, but did not respond to delta pH. These energy-linked changes were accompanied by dye uptake into the matrix space. Concentration ratios, in-to-out, approached 4000:1. A large fraction of internalized dye was bound. At concentrations higher than those needed to record these spectral changes, Rhodamine 123 inhibited ADP-stimulated (State 3) respiration of mitochondria (Ki = 12 microM) and ATPase activity of inverted inner membrane vesicles (Ki = 126 microM) and partially purified F1-ATPase (Ki = 177 microM). The smaller Ki for coupled mitochondria was accounted for by energy-dependent Rhodamine 123 uptake into the matrix. Above about 20 nmol/mg protein (10 microM), Rhodamine 123 caused rapid swelling of energized mitochondria. Effects on electron-transfer reactions and coupling were small or negligible even at the highest Rhodamine 123 concentrations employed. delta psi-dependent Rhodamine 123 uptake together with Rhodamine 123 binding account for the intense fluorescent staining of mitochondria in living cells. Inhibition of mitochondria ATPase likely accounts for the cytotoxicity of Rhodamine 123. At concentrations which do not inhibit mitochondrial function, Rhodamine 123 is a sensitive and specific probe of delta psi in isolated mitochondria.

A biosynthetic role for carnitine in the yeast Torulopsis bovina.

The mode of action of carnitine on the growth of the yeast Torulopsis bovina ATCC 26014 was investigated. When 0.5-5 microM L-carnitine was added to the medium, the growth rate doubled for both aerobic and anaerobic cultures. Cells grown in the absence of carnitine contain 0.4 nmol of L-carnitine/g, wet weight, but with 5 microM L-carnitine in the media, cells contain 1400 nmol of carnitine/g, wet weight, by the end of exponential growth. When [1-14C]acetyl-L-carnitine was added to growth media, almost all of the radioactivity became cell-associated. Most of the 14C was incorporated into cell protein although considerable 14C was recovered in the fatty acid fraction of saponified cells. Analyses of the amino acids derived from radiolabeled protein showed that the acetyl[14C] of acetylcarnitine was in glutamate, arginine, proline, leucine, and lysine. In contrast, [1-14C]acetate labeled leucine and lysine. Isopycnic density gradient analysis demonstrated that carnitine acetyltransferase was primarily associated with mitochondria, while acetyl-CoA synthetase and acetyl-CoA hydrolase were cytosolic. Isolated mitochondria incorporated [14C]acetylcarnitine radioactivity into citrate and 2-oxoglutarate. The data are consistent with carnitine facilitating the transfer of acetyl groups from the cytosol into mitochondria for synthesis of citrate and its metabolites. These results demonstrate a role for carnitine in biosyntheses in the yeast T. bovina.

Thermodynamic limits to the ATP/site stoichiometries of oxidative phosphorylation by rat liver mitochondria.

From measurements of reactants, products, and the oxidation-reduction state of cytochrome c + c1 during 3-hydroxybutyrate-supported oxidative phosphorylation by rat liver mitochondria at static head (state 4), we determined the free energy change of ATP formation from ADP and Pi (phosphorylation potential or delta GP) and the oxidation-reduction free energy changes (redox potentials or delta GR values) across Sites 1 + 2 (delta GR1 + 2), across Site 3 (delta GR3), and across Sites 1 + 2 + 3 (delta GR). At pH 7.4, -delta GR1 + 2/delta GP, -delta GR3/delta GP, and -delta GR/delta GP were maximally 1.80, 1.56, and 3.37. These can be taken as thermodynamic upper limits to the ATP/Sites 1 + 2, ATP/Site 3, and ATP/O stoichiometry of 3-hydroxybutyrate-supported oxidative phosphorylation. The theory of linear nonequilibrium thermodynamics were employed to estimate lower limits to the ATP/site stoichiometries. The lower limit is given by the expression, q2(-delta GRsite/delta GP). The degree of coupling, q, was 0.977 as determined from the dependence of respiratory rate on delta GP. Determined in this way, lower limits of the ATP/Sites 1 + 2, ATP/Site 3, and ATP/O stoichiometries were 1.67, 1.44, and 3.11, respectively. ADP addition to mitochondria incubated at static head lowered delta GP by 1.1 kcal/mol and stimulated respiration by a factor of about 2.5 but caused negligible changes in delta GR1 + 2 and delta GR3. This observation demonstrates that the respiratory reactions from substrate to cytochrome c and from cytochrome c to oxygen both move away from thermodynamic equilibrium with delta GP during the transition from resting to active oxidative phosphorylation. The findings are discussed in terms of current schemes of chemiosmotic coupling.

Possible functions of short-chain and medium-chain carnitine acyltransferases.

Several mammalian tissue contain water-soluble, branched chain acylcarnitines and other short-chain aliphatic acylcarnitines and also contain a broad spectrum of short-chain and medium-chain carnitine acyltransferase (CAT) activities. Although carnitine can stimulate the oxidation of branched chain alpha-ketoacids, it has not been established that carnitine is required for the oxidation of the alpha-ketoacids in the matrix of mitochondria. Rather it probably acts as a reversible sink for acyl residues, thereby generating CoASH, which can be used to maintain normal metabolism; thus carnitine would have a facilitative rather than an obligatory role. Microsomes and peroxisomes contain medium- and short-chain CATs. This occurrence is short- and medium-chain CATs in peroxisomes is consistent with carnitine's being involved in shuttling the chain-shortened products of beta-oxidation out of peroxisomes. Human urine contains a spectrum of short-chain acylcarnitines and data are presented that show a large amount of propionylcarnitine in the urine of the individual with a metabolic problem. The cumulative data are consistent with the conclusion that carnitine has multiple roles in mammalian metabolism, including the shuttling of beta-oxidation chain-shortened products out of peroxisomes in liver, the modulation of the acyl-CoA/CoASH ratio in mammalian cells, and the translocation of acetyl units for selective synthesis in a yeast.