Received for publication May 9, 2005.
Revised August 18, 2005.
Accepted for publication August 22, 2005.

In vitro inhibition of UDP-glucuronosyltransferases by atazanavir and other HIV protease inhibitors and the relationship of this property to in vivo bilirubin glucuronidation

Abstract

Several HIV protease inhibitors, including atazanavir, indinavir, lopinavir, nelfinavir, ritonavir, and saquinavir, were tested for their potential to inhibit UGT activity. Experiments were performed with human cDNA-expressed enzymes (UGT1A1, 1A3, 1A4, 1A6, 1A9, and 2B7) as well as human liver microsomes. All of the protease inhibitors tested were inhibitors of UGT1A1, UGT1A3, and UGT1A4 with IC₅₀ values that ranged from 2 to 87 microM. The IC₅₀ values found for all compounds for UGT1A6, 1A9, and 2B7 were >100 microM. The inhibition (IC₅₀) of UGT1A1 was similar when tested against the human cDNA-expressed enzyme or human liver microsomes for atazanavir, indinavir, and saquanavir (2.4, 87, and 7.3 microM vs. 2.5, 68, and 5.0 microM, respectively). By analysis of the double-reciprocal plots of bilirubin glucuronidation activities at different bilirubin concentrations in the presence of fixed concentrations of inhibitors, the UGT1A1 inhibition by atazanavir and indinavir was demonstrated to follow a linear-mixed type inhibition mechanism (K_i = 1.9 and 47.9 microM, respectively). These results suggest that a direct inhibition of UGT1A1 mediated bilirubin glucuronidation may provide a mechanism for the reversible hyperbilirubinemia associated with administration of atazanavir as well as indinavir. An in vitro-in vivo scaling with [I]/K_i predicts that atazanavir and indinavir are more likely to induce hyperbilirubinemia than other HIV protease inhibitors studied when a free C_max drug concentration was used. Current study provides a unique example of in vitro-in vivo correlation for an endogenous UGT mediated metabolic pathway.

Key words: drug-drug interactions, in vitro-in vivo scaling, UDP glucuronyltransferases

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