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Vol. 28, Issue 6, 655-660, June 2000
Departments of Medicine and Pharmacology, Division of
Clinical Pharmacology, Vanderbilt University School of Medicine,
Nashville, Tennessee
HIV protease inhibitors have proven remarkably effective in
treating HIV-1 infection. However, some tissues such as the brain and
testes (sanctuary sites) are possibly protected from exposure to HIV
protease inhibitors due to drug entry being limited by the membrane
efflux transporter P-glycoprotein, located in the capillary
endothelium. Intravenous administration of the novel and potent
P-glycoprotein inhibitor LY-335979 to mice (1-50 mg/kg) increased
brain and testes concentration of [14C]nelfinavir, up to
37- and 4-fold, respectively, in a dose-dependent fashion. Similar
effects in brain levels were also observed with 14C-labeled
amprenavir, indinavir, and saquinavir. Because
[14C]nelfinavir plasma drug levels were only modestly
increased by LY-335979, the increase in brain/plasma and testes/plasma
ratios of 14- to 17- and 2- to 5-fold, respectively, was due to
increased tissue penetration. Less potent P-glycoprotein inhibitors
like valspodar (PSC-833), cyclosporin A, and ketoconazole, as well as
quinidine and verapamil, had modest or little effect on brain/plasma ratios but increased plasma nelfinavir concentrations due to inhibition of CYP3A-mediated metabolism. Collectively, these findings provide "proof-of-concept" for increasing HIV protease inhibitor
distribution into pharmacologic sanctuary sites by targeted inhibition
of P-glycoprotein using selective and potent agents and suggest a new
therapeutic strategy to reduce HIV-1 viral replication.
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