PT - JOURNAL ARTICLE AU - Kimoto, Emi AU - Vourvahis, Manoli AU - Scialis, Renato J. AU - Eng, Heather AU - Rodrigues, A. David AU - Varma, Manthena V. S. TI - Mechanistic Evaluation of the Complex Drug-Drug Interactions of Maraviroc: Contribution of Cytochrome P450 3A, P-Glycoprotein and Organic Anion Transporting Polypeptide 1B1 AID - 10.1124/dmd.118.085241 DP - 2019 May 01 TA - Drug Metabolism and Disposition PG - 493--503 VI - 47 IP - 5 4099 - http://dmd.aspetjournals.org/content/47/5/493.short 4100 - http://dmd.aspetjournals.org/content/47/5/493.full SO - Drug Metab Dispos2019 May 01; 47 AB - The aim of the present study was to quantitatively evaluate the drug-drug interactions (DDIs) of maraviroc (MVC) with various perpetrator drugs, including telaprevir (TVR), using an in vitro data-informed physiologically based pharmacokinetic (PBPK) model. MVC showed significant active uptake and biliary excretion in sandwich-cultured human hepatocytes, and biphasic organic anion transporting polypeptide (OATP)1B1-mediated uptake kinetics in transfected cells (high-affinity Km ∼5 µM). No measureable active uptake was noted in OATP1B3- and OATP2B1-transfceted cells. TVR inhibited OATP1B1-mediated MVC transport in vitro, and also exhibited CYP3A time-dependent inhibition in human hepatocytes (inactivation constant, KI = 2.24 µM, and maximum inactivation rate constant, kinact = 0.0112 minute−1). The inactivation efficiency (kinact/KI) was approximately 34-fold lower in human hepatocytes compared with liver microsomes. A PBPK model accounting for interactions involving CYP3A, P-glycoprotein (P-gp), and OATP1B1 was developed based on in vitro mechanistic data. MVC DDIs with ketoconazole (inhibition of CYP3A and P-gp), ritonavir (inhibition of CYP3A and P-gp), efavirenz (induction of CYP3A), rifampicin (induction of CYP3A and P-gp; inhibition of OATP1B1), and TVR (inhibition of CYP3A, P-gp, and OATP1B1) were well described by the PBPK model with optimized transporter Ki values implying that OATP1B1-mediated uptake along with CYP3A metabolism determines the hepatic clearance of MVC, and P-gp–mediated efflux limits its intestinal absorption. In summary, MVC disposition involves intestinal P-gp/CYP3A and hepatic OATP1B1/CYP3A interplay, and TVR simultaneously inhibits these multiple mechanisms leading to a strong DDI—about 9.5-fold increase in MVC oral exposure.