Sanctuary sites and compartments: deciphering the enigma

Abstract

It has been a common observation that many drugs get accumulated in the body at certain sites labelled as anatomical or physiological compartments where they are not expected to exert their desired effect. While the field of pharmacology considers these so-called sites or imaginary compartments as “sanctuary compartments” which could comprise of specialised tissue system where drugs could bind to tissue proteins or nucleoproteins, adipose cells serving as reservoir for extensively lipid soluble drugs, aqueous humour, cerebrospinal fluid, bones, and even plasma proteins, the reach and impact of the sanctuary compartments or sanctuary sites (which is the more preferred and broader term) has grown beyond that and spread extensively. Now, it is not just about certain drugs finding safe haven in these sanctuary compartments but also about certain disease conditions like HIV infection and cancer doing the same. Evidence has been accumulating regarding the fact that human immunodeficiency virus and various type of cancer cells have been using these compartments or sites to avoid being exposed to drugs which cannot penetrate well into such sanctuary sites. This phenomenon over the period of time has culminated in the development of resistance towards anti-retroviral and anti-neoplastic drugs to name a few. This means of acquired resistance is proving to be a major barrier to providing effective treatment to the patients. This review focusses on sanctuary compartments, their basic idea, the benefits associated with them, the challenges it poses to modern day medicine and finally, the possible methods of overcoming those challenges by attempting to un-sanctify the sanctuary compartments.