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Prediction of the dose range for adverse neurological effects of amiodarone in patients from an in vitro toxicity test by in vitro-in vivo extrapolation.
- Source :
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Archives of toxicology [Arch Toxicol] 2021 Apr; Vol. 95 (4), pp. 1433-1442. Date of Electronic Publication: 2021 Feb 19. - Publication Year :
- 2021
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Abstract
- Amiodarone is an antiarrhythmic agent inducing adverse effects on the nervous system, among others. We applied physiologically based pharmacokinetic (PBPK) modeling combined with benchmark dose modeling to predict, based on published in vitro data, the in vivo dose of amiodarone which may lead to adverse neurological effects in patients. We performed in vitro-in vivo extrapolation (IVIVE) from concentrations measured in the cell lysate of a rat brain 3D cell model using a validated human PBPK model. Among the observed in vitro effects, inhibition of choline acetyl transferase (ChAT) was selected as a marker for neurotoxicity. By reverse dosimetry, we transformed the in vitro concentration-effect relationship into in vivo effective human doses, using the calculated in vitro area under the curve (AUC) of amiodarone as the pharmacokinetic metric. The upper benchmark dose (BMDU) was calculated and compared with clinical doses eliciting neurological adverse effects in patients. The AUCs in the in vitro brain cell culture after 14-day repeated dosing of nominal concentration equal to 1.25 and 2.5 µM amiodarone were 1.00 and 1.99 µg*h/mL, respectively. The BMDU was 385.4 mg for intravenous converted to 593 mg for oral application using the bioavailability factor of 0.65 as reported in the literature. The predicted dose compares well with neurotoxic doses in patients supporting the hypothesis that impaired ChAT activity may be related to the molecular/cellular mechanisms of amiodarone neurotoxicity. Our study shows that predicting effects from in vitro data together with IVIVE can be used at the initial stage for the evaluation of potential adverse drug reactions and safety assessment in humans.
- Subjects :
- Amiodarone administration & dosage
Amiodarone pharmacokinetics
Animals
Anti-Arrhythmia Agents administration & dosage
Anti-Arrhythmia Agents pharmacokinetics
Area Under Curve
Biological Availability
Brain drug effects
Brain metabolism
Dose-Response Relationship, Drug
Humans
In Vitro Techniques
Neurotoxicity Syndromes physiopathology
Rats
Tissue Distribution
Toxicity Tests
Amiodarone toxicity
Anti-Arrhythmia Agents toxicity
Models, Biological
Neurotoxicity Syndromes etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1432-0738
- Volume :
- 95
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Archives of toxicology
- Publication Type :
- Academic Journal
- Accession number :
- 33606068
- Full Text :
- https://doi.org/10.1007/s00204-021-02989-2