Abstract

Direct oral anticoagulants (DOAC) are substrates for the ABCB1 transporter (also called P-glycoprotein), an active efflux pump. ABCB1 polymorphisms have been previously reported to influence the pharmacokinetics of several drugs such as immunosuppressants and tyrosine kinase inhibitors. Recently, in vivo studies have suggested that genetic variants might contribute to the inter-individual variability in DOAC plasma concentrations. Therefore, we evaluated the in vitro effect of the most common coding ABCB1 single nucleotide polymorphisms (SNP), 1236 C > T-2677G > T-3435C > T, and the coding ABCB1 1199 G > A SNP on the transport activity towards rivaroxaban. HEK293 cells were transfected to overexpress the ABCB1 wild-type (1236C-2677G-3435C, 1199 G) or variant proteins (1236C-2677G-3435T, 1236T-2677T-3435T or 1199 A). ABCB1 expression decreased the intracellular accumulation of rivaroxaban, when compared to control cells. This confirms the involvement of ABCB1 in the active transport of rivaroxaban. However, the ABCB1 1236 C > T-2677G > T-3435C > T and 1199 G > A SNPs had no significant influence on the intracellular accumulation of rivaroxaban when compared to the wild-type protein. These results suggest that the ABCB1 coding SNPs investigated in the present study are unlikely to contribute to the inter-individual variability in rivaroxaban plasma concentrations.

Highlights

  • The landscape of oral anticoagulant therapy has significantly changed in the last years

  • To ensure similar ABCB1 surface expression among the different cell lines, cells were sorted using fluorescence activated cell sorting (FACS) with fluorescence parameters gated on the same level of intensity

  • We investigated the in vitro impact of ABCB1 genetic polymorphisms on the transport activity towards rivaroxaban

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Summary

Introduction

The landscape of oral anticoagulant therapy has significantly changed in the last years. Direct oral anticoagulants (DOAC) have been approved for stroke prevention in non-valvular atrial fibrillation and the treatment as well as the secondary prevention of venous thromboembolism. They are increasingly used in clinical practice, partly due to their higher convenience for clinicians and patients (fixed-dose regimen, fewer interactions with drugs and food) compared with vitamin K antagonists (VKA)[1]. The three most common SNPs in the coding region are rs1128503 (1236 C > T, Gly412Gly), rs2032582 (2677 G > T, Ala893Ser) and rs1045642 (3435 C > T, Ile1145Ile) They are in strong linkage disequilibrium and present a minor allelic frequency around 50% in the Caucasian population. This study aimed to evaluate the in vitro effect of the ABCB1 1236 C > T-2677G > T-3435C > T and 1199 G > A SNPs on the transport activity towards rivaroxaban

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