Abstract

BackgroundThe therapeutic effect of inhaled corticosteroids (ICS) may be affected by the metabolism of the drug in the target organ. We investigated the in vitro metabolism of beclomethasone dipropionate (BDP), budesonide (BUD), ciclesonide (CIC), and fluticasone propionate (FP) in human lung precision-cut tissue slices. CIC, a new generation ICS, is hydrolyzed by esterases in the upper and lower airways to its pharmacologically active metabolite desisobutyryl-ciclesonide (des-CIC).MethodsLung tissue slices were incubated with BDP, BUD, CIC, and FP (initial target concentration of 25 μM) for 2, 6, and 24 h. Cellular viability was assessed using adenosine 5'-triphosphate content and protein synthesis in lung slices. Metabolites and remaining parent compounds in the tissue samples were analyzed by HPLC with UV detection.ResultsBDP was hydrolyzed to the pharmacologically active metabolite beclomethasone-17-monopropionate (BMP) and, predominantly, to inactive beclomethasone (BOH). CIC was hydrolyzed initially to des-CIC with a slower rate compared to BDP. A distinctly smaller amount (approximately 10-fold less) of fatty acid esters were formed by BMP (and/or BOH) than by BUD or des-CIC. The highest relative amounts of fatty acid esters were detected for BUD. For FP, no metabolites were detected at any time point. The amount of drug-related material in lung tissue (based on initial concentrations) at 24 h was highest for CIC, followed by BUD and FP; the smallest amount was detected for BDP.ConclusionThe in vitro metabolic pathways of the tested ICS in human lung tissue were differing. While FP was metabolically stable, the majority of BDP was converted to inactive polar metabolites. The formation of fatty acid conjugates was confirmed for BMP (and/or BOH), BUD, and des-CIC.

Highlights

  • The therapeutic effect of inhaled corticosteroids (ICS) may be affected by the metabolism of the drug in the target organ

  • In the present study we investigated the in vitro metabolism of beclomethasone dipropionate (BDP), BUD, CIC, and fluticasone propionate (FP) in the target organ lung, using human lung precision-cut tissue slices, to evaluate the major factors influencing the retention time of these ICS in the lung

  • Fisher and colleagues have reported that adenosine 5'-triphosphate (ATP) content should exceed 10 nmol/mg protein and protein synthesis should be linear over time in viable human lung tissue [26]

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Summary

Introduction

The therapeutic effect of inhaled corticosteroids (ICS) may be affected by the metabolism of the drug in the target organ. Inhaled corticosteroids (ICS) are the standard first-line anti-inflammatory therapy for the management of persistent asthma [1]. The preferred way to administer a corticosteroid in asthma therapy is by inhalation. This route delivers drug straight to the lung for local activity and minimizes the systemic side effects associated with oral administration. Even treatment with ICS may cause both local and systemic side effects. Deposition of the drug in the oropharynx may cause local side effects, including oropharyngeal candidiasis, dysphonia, reflex cough, bronchospasm, and pharyngitis [6,7]. Cataracts, growth retardation, accelerated bone loss, and hypothalamic-pituitary-adrenal axis suppression have been observed in patients receiving long-term, high-dose ICS treatment [8,9]

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