Compared with the significant number
of studies reporting altered
abundance and function of drug transporters at the blood–brain
barrier (BBB) in Alzheimer’s disease (AD), the impact of AD
on the abundance of intestinal drug transporters and the subsequent
effects on oral drug absorption have received little attention. We
have reported the altered abundance of some small intestinal drug
transporters in a familial mouse model of AD; however, whether this
leads to altered oral drug absorption is unknown. The current study
examined plasma concentrations of caffeine and diazepam (markers for
transcellular passive transport), digoxin (P-glycoprotein substrate),
and valsartan (multidrug resistance-associated protein 2 substrate)
following oral administration to 8–10 month old female wild-type
(WT) and APPswe/PSEN1dE9 (APP/PS1) transgenic mice, a commonly used
mouse model of familial AD. The plasma exposure of valsartan and digoxin
was significantly (p < 0.05) lower in APP/PS1
animals compared with WT mice, whereas the plasma concentrations of
the passive transcellular markers caffeine and diazepam did not significantly
differ between the two genotypes. To assess whether the reduced oral
absorption of valsartan and digoxin was due to decreased intestinal
transport, the ex vivo transport of the previously
mentioned drugs and mannitol (a marker of paracellular transport)
across the jejunum of WT and APP/PS1 mice was assessed over 120 min.
In line with the in vivo absorption studies, the
permeability of caffeine and diazepam did not significantly differ
between WT and APP/PS1 mice. The permeability of 3H-digoxin
through the APP/PS1 mouse jejunum was lower than that measured through
the WT jejunum; the average amount (relative to dose applied) permeating
the tissue over 120 min was 0.22 ± 0.11% (mean ± SD) for
the APP/PS1 jejunum and 0.85 ± 0.3% for the WT jejunum. A 1.9-fold
reduction in the average amount of valsartan permeating the jejunum
of APP/PS1 mice relative to that of WT mice was also detected. Although
no apparent morphological alterations were observed in the jejunal
tissue of APP/PS1 mice, the permeability of 14C-mannitol
across the jejunum from APP/PS1 mice was lower than that across the
WT jejunum (P
app= 10.7 ± 3.7 ×
10–6 and 6.0 ± 3.4 × 10–6 cm/s, respectively), suggesting tightened paracellular junctions
in APP/PS1 mice. These studies are the first to demonstrate, in APP/PS1
mice, reduced intestinal permeability and the absorption of drugs
commonly prescribed to people with AD for their comorbidities. If
these findings translate to people with AD, then modified dosing regimens
may be necessary for selected drugs to ensure that their plasma concentrations
remain in the effective range.