Pharmacokinetic principles of dose adjustment of<scp>mTOR</scp>inhibitors in solid organ transplanted patients

Hartinger, Jan Miroslav; Ryšánek, Pavel; Slanař, Ondřej; Šíma, Martin

doi:10.1111/jcpt.13753

Cited by 5 publications

(1 citation statement)

References 48 publications

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“…The most important and studied clinical applications of rapamycin and rapalogs are based on their immunosuppressant activity in the treatment of patients undergoing organ allotransplantation. Several experimental studies and review articles are available on this issue [ 25 , 41 , 42 , 43 , 44 , 45 , 46 ]. Sirolimus (rapamycin) is approved by Food and Drug Administration and other regulatory authorities to prevent organ rejection in patients receiving renal transplantation [ 44 , 45 , 46 ].…”

Section: Rapamycin In Organ and Tissue Transplantationmentioning

confidence: 99%

The Long Scientific Journey of Sirolimus (Rapamycin): From the Soil of Easter Island (Rapa Nui) to Applied Research and Clinical Trials on β-Thalassemia and Other Hemoglobinopathies

Gambari,

Zuccato,

Cosenza

et al. 2023

Biology

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In this review article, we present the fascinating story of rapamycin (sirolimus), a drug able to induce γ-globin gene expression and increased production of fetal hemoglobin (HbF) in erythroid cells, including primary erythroid precursor cells (ErPCs) isolated from β-thalassemia patients. For this reason, rapamycin is considered of great interest for the treatment of β-thalassemia. In fact, high levels of HbF are known to be highly beneficial for β-thalassemia patients. The story of rapamycin discovery began in 1964, with METEI, the Medical Expedition to Easter Island (Rapa Nui). During this expedition, samples of the soil from different parts of the island were collected and, from this material, an antibiotic-producing microorganism (Streptomyces hygroscopicus) was identified. Rapamycin was extracted from the mycelium with organic solvents, isolated, and demonstrated to be very active as an anti-bacterial and anti-fungal agent. Later, rapamycin was demonstrated to inhibit the in vitro cell growth of tumor cell lines. More importantly, rapamycin was found to be an immunosuppressive agent applicable to prevent kidney rejection after transplantation. More recently, rapamycin was found to be a potent inducer of HbF both in vitro using ErPCs isolated from β-thalassemia patients, in vivo using experimental mice, and in patients treated with this compound. These studies were the basis for proposing clinical trials on β-thalassemia patients.

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Section: Rapamycin In Organ and Tissue Transplantationmentioning

confidence: 99%

The Long Scientific Journey of Sirolimus (Rapamycin): From the Soil of Easter Island (Rapa Nui) to Applied Research and Clinical Trials on β-Thalassemia and Other Hemoglobinopathies

Gambari,

Zuccato,

Cosenza

et al. 2023

Biology

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The bioavailability of compounded and generic rapamycin in normative aging individuals: A retrospective study and review with clinical implications

Harinath,

Lee,

Nyquist

et al. 2024

Preprint

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Rapamycin, also known as sirolimus, has demonstrated great potential for application in longevity medicine. However, the bioavailability of generic and compounded rapamycin at longevity doses in normative aging individuals remains unknown. We conducted a retrospective, real-world study determining the 24-hour blood rapamycin levels to establish the relative bioavailability, dose-to-blood level linearity and inter-individual heterogeneity in a normative aging cohort. Participants received either compounded rapamycin (n = 23, dosages 5, 10, or 15 mg) or generic rapamycin (n= 44, dosages 2, 3, 6, or 8 mg) once per week, and were asked to obtain a sirolimus level blood draw 24 hours after dose self-administration. Similar blood rapamycin levels and a linear dose-to-blood level relationship were observed for both formulations, although a higher bioavailability per milligram of rapamycin was noted for the generic formulation (compounded averaged 0.287 (28.7%) bioavailability relative to generic rapamycin in (ng/mL) / mg rapamycin). While substantial inter-individual heterogeneity in blood rapamycin levels was observed for both formulations, repeat tests for individuals demonstrated high test-retest reliability. As we detected no significant association between bioavailability and measures of body mass index (BMI), sex, age, or length of time taking rapamycin, we suggest that individualized dosing and routine monitoring of blood rapamycin levels should be applied to ensure optimal longevity efficacy. Finally, we contextualize our data with a brief review of the literature on the currently available knowledge of rapamycin's bioavailability in normative aging populations, and provide implications for the clinical use of rapamycin in longevity medicine moving forward.

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Dosing‐time, feeding, and sex‐dependent variations of everolimus pharmacokinetics in mice

Ozturk Civelek,

Ozturk Seyhan,

Akyel

et al. 2024

Fundamemntal Clinical Pharma

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BackgroundEverolimus is an oral mammalian target of rapamycin (mTOR) inhibitor used as an immunosuppressant and anticancer. Its pharmacokinetics is highly variable, it has a narrow therapeutic window and shows chronotoxicity with the best time at ZT13 and worst time at ZT1 (ZT; Zeitgeber time, time after light onset) in the preclinical setting.ObjectivesIn the present study, we aimed to investigate whether the pharmacokinetics of everolimus vary according to dosing time and whether sex and feeding status interfere with the chronopharmacokinetics.MethodA single dosage of 5 mg/kg everolimus was administered orally to C57BL/6J male and female mice, in fed or fasted states at ZT1‐rest and ZT13‐activity times and blood and tissue samples were collected at 0.5, 1, 2, 4, 12, and 24 h following drug administration. Ileum, liver, plasma, and thymus concentrations of everolimus were determined.ResultsFemales had a greater ileum AUC0–24h than males when fed (P = 0.043). Everolimus AUC0–24h in the liver was substantially greater at ZT1 than at ZT13 in a fasted state (P = 0.001). Plasma Cmax, AUC0–24h, and AUCtotal were not statistically significant between the groups (P = 0.098). In one of the target organs of everolimus, the thymus, males had considerably higher amounts at ZT1 than females (P = 0.029).ConclusionOur findings imply that the pharmacokinetics of everolimus in mice may differ according to dosing time, sex, and feeding. Greater tissue distribution of everolimus at ZT1 may be associated with the worst tolerated time of everolimus. Our research suggests that oral chronomodulated everolimus therapy may be more effective and safer for cancer patients.

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Pharmacokinetic principles of dose adjustment ofmTORinhibitors in solid organ transplanted patients

Abstract: What Is Known and Objectives: mTOR inhibitors possess narrow therapeutic range and substantial pharmacokinetic variability and the consequences from suboptimal dosing are serious. The aim of this review is to summarize the current knowledge

Cited by 5 publications

References 48 publications

The Long Scientific Journey of Sirolimus (Rapamycin): From the Soil of Easter Island (Rapa Nui) to Applied Research and Clinical Trials on β-Thalassemia and Other Hemoglobinopathies

The Long Scientific Journey of Sirolimus (Rapamycin): From the Soil of Easter Island (Rapa Nui) to Applied Research and Clinical Trials on β-Thalassemia and Other Hemoglobinopathies

The bioavailability of compounded and generic rapamycin in normative aging individuals: A retrospective study and review with clinical implications

Dosing‐time, feeding, and sex‐dependent variations of everolimus pharmacokinetics in mice

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