1. Revisiting the nature and pharmacodynamics of tacrolimus metabolites.
- Author
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Mevizou R, Aouad H, Sauvage FL, Arnion H, Pinault E, Bernard JS, Bertho G, Giraud N, Alves de Sousa R, Lopez-Noriega A, Di Meo F, Campana M, and Marquet P
- Subjects
- Humans, Cytochrome P-450 CYP3A metabolism, Molecular Dynamics Simulation, Tacrolimus Binding Protein 1A metabolism, Tacrolimus pharmacology, Immunosuppressive Agents pharmacology, Leukocytes, Mononuclear drug effects, Leukocytes, Mononuclear metabolism
- Abstract
The toxicity of tacrolimus metabolites and their potential pharmacodynamic (PD) interactions with tacrolimus might respectively explain the surprising combination of higher toxicity and lower efficacy of tacrolimus despite normal blood concentrations, described in extensive metabolizers. To evaluate such interactions, we produced tacrolimus metabolites in vitro and characterized them by high resolution mass spectrometry (HRMS, for all) and nuclear magnetic resonance (NMR, for the most abundant, M-I). We quantified tacrolimus metabolites and checked their structure in patient whole blood and peripheral blood mononuclear cells (PBMC). We explored the interactions of M-I with tacrolimus in silico, in vitro and ex vivo. In vitro metabolization produced isoforms of tacrolimus and of its metabolites M-I and M-III, whose HRMS fragmentation suggested an open-ring structure. M-I and M-III open-ring isomers were also observed in patient blood. By contrast, NMR could not detect these open-ring forms. Transplant patients expressing CYP3A5 exhibited higher M-I/TAC ratios in blood and PBMC than non-expressers. Molecular Dynamics simulations showed that: all possible tacrolimus metabolites and isomers bind FKPB12; and the hypothetical open-ring structures induce looser binding between FKBP12 and calcineurins, leading to lower CN inhibition. In vitro, tacrolimus bound FKPB12 with more affinity than purified M-I, and the pool of tacrolimus metabolites and purified M-I had only weak inhibitory activity on IL2 secretion and not at all on NFAT nuclear translocation. M-I showed no competitive effect with tacrolimus on either test. Finally, M-I or the metabolite pool did not significantly interact with tacrolimus MLR suppression, thus eliminating a pharmacodynamic interaction., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Melanie Campana reports administrative support and equipment, drugs, or supplies were provided by MedinCell SA. Rudy Mevizou reports administrative support and equipment, drugs, or supplies were provided by MedinCell SA. Pierre Marquet reports a relationship with MedinCell SA that includes: consulting or advisory, equity or stocks, and funding grants. Melanie Campana reports a relationship with MedinCell SA that includes: employment and equity or stocks. Alfonso Lopez-Noriega reports a relationship with MedinCell SA that includes: employment and equity or stocks. Pierre Marquet reports a relationship with Sandoz France that includes: consulting or advisory and funding grants. Pierre Marquet reports a relationship with Chiesi SA France that includes: consulting or advisory and funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2024
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