RESUMEN
OBJECTIVE: Tacrolimus is used clinically for the long-term treatment of antirejection of transplanted organs in liver and kidney transplant recipients, although dose optimization is poorly managed. The aim of this study was to examine the association between tacrolimus pharmacokinetic variability and CYP3A4 and CYP3A5 genotypes by a population pharmacokinetic analysis based on routine drug monitoring data in adult renal transplant recipients. MATERIALS AND METHODS: Trough tacrolimus concentrations were obtained from 161 adult kidney transplant recipients after transplantation. The population pharmacokinetic analysis was carried out using the nonlinear mixed-effect modeling software NONMEM version 7.2. The CYP3A4*1G and CYP3A5*3 genetic polymorphisms from the patients studied were determined by direct sequencing using a validated automated genetic analyzer. RESULTS: A one-compartment model with first-order absorption and elimination adequately described the pharmacokinetics of tacrolimus. Covariates including CYP3A5*3 and CYP3A4*1G alleles and hematocrit were retained in the final model. The apparent clearance of tacrolimus was about two-fold higher in kidney transplant patients with higher enzymatic activity of CYP3A5*1 and CYP3A4*1G (with the CYP3A5*1/*1 or *1/*3 and CYP3A4*1/*1G or CYP3A4*1G/*1G) compared with those with lower enzymatic activity (CYP3A5*3/*3 and CYP3A4*1/*1). CONCLUSION: This is the first study to extensively determine the effect of CYP3A4*1G and CYP3A5*3 genetic polymorphisms and hematocrit value on tacrolimus pharmacokinetics in Chinese renal transplant recipients. The findings suggest that CYP3A5*3 and CYP3A4*1G polymorphisms and hematocrit are determinant factors in the apparent clearance of tacrolimus. The initial dose design is mainly based on CYP3A5 and CYP3A4 genotypes as well as hematocrit. This result may also be useful for maintenance tacrolimus dose optimization and may help to avoid fluctuating tacrolimus levels and improve the efficacy and tolerability of tacrolimus in kidney transplant recipients.
Asunto(s)
Citocromo P-450 CYP3A/genética , Rechazo de Injerto/genética , Trasplante de Riñón , Tacrolimus/administración & dosificación , Adolescente , Adulto , Anciano , Alelos , China , Femenino , Genotipo , Rechazo de Injerto/tratamiento farmacológico , Hematócrito , Humanos , Inmunosupresores/administración & dosificación , Inmunosupresores/farmacocinética , Riñón/efectos de los fármacos , Riñón/inmunología , Riñón/patología , Masculino , Tasa de Depuración Metabólica/efectos de los fármacos , Tasa de Depuración Metabólica/genética , Persona de Mediana Edad , Polimorfismo Genético , Tacrolimus/farmacocinéticaRESUMEN
A new rhodamine-based probe 1 was designed and synthesized as a new fluorescent molecular probe for HClO in PBS buffer at physiological condition. The free probe 1 almost nonfluorescence, however, a drastic enhancement of fluorescence intensity was observed in the presence of HClO. The new probe 1 exhibits good sensitivity and selectivity for HClO over other reactive oxygen and/or nitrogen species in PBS buffer, and the probe was successfully applied to image endogeneous HClO in the living cells.