Abstract

Pharmacokinetics of SN-38 in patients with end-stage kidney disease (ESKD) is partially varied because of fluctuations in transporters expression and/or function by high protein bound-uremic toxins concentration. The fluctuations may induce variations in anticancer drugs sensitivity to cancer cells. We aimed to clarify the variations in sensitivity of SN-38 to cancer patients with ESKD and investigate this mechanism, by human colon cancer cells exposed to uremic serum residue. LS180 cells were exposed to normal or uremic serum residue (LS/NSR or LS/USR cells) for a month. IC50 values of SN-38 in LS/NSR or LS/USR cells were calculated from viability of each cells treated SN-38. mRNA expression and intracellular SN-38 accumulation was evaluated by RT-PCR and HPLC-fluorescence methods, respectively. The IC50 value in LS/USR cells was higher than that in LS/NSR cells. Organic anion transporter polypeptide (OATP) 2B1 mRNA expression was lower in LS/USR cells than in LS/NSR cells, and SN-38 accumulation in LS/USR cells was lower than that in LS/NSR cells. Only co-treatment baicalin, which is OATP2B1 inhibitor, almost negated the difference in SN-38 accumulation between LS/NSR and LS/USR. Anticancer effects of substrates of OATP2B1, such as SN-38, were reduced in ESKD patients at the same plasma substrate concentration.

Highlights

  • Irinotecan tend to be prescribed to colorectal cancer patients with renal failure because irinotecan is known as type of metabolite medicine by liver

  • We have reported that serum residue in patients with end-stage kidney disease (ESKD) inhibits the uptake of SN-38 through organic anion transporter polypeptide (OATP) 1B13

  • We reported that the simultaneous treatment of serum and digoxin in patients with ESKD inhibits the uptake of digoxin into isolated human hepatocytes[6], and that pretreatment of human hepatocellular carcinoma Hep3B cells with serum from patients with ESKD decreases the initial uptake of pravastatin and the expression of OATP2B1 mRNA7

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Summary

Introduction

Irinotecan tend to be prescribed to colorectal cancer patients with renal failure because irinotecan is known as type of metabolite medicine by liver. We reported that the simultaneous treatment of serum and digoxin in patients with ESKD inhibits the uptake of digoxin into isolated human hepatocytes[6], and that pretreatment of human hepatocellular carcinoma Hep3B cells with serum from patients with ESKD decreases the initial uptake of pravastatin and the expression of OATP2B1 mRNA7. These reports indicate that the variation in hepatic clearance was partially induced by fluctuations in transporter expression and/or function in patients with ESKD. The aim of this study was to clarify the effects of variations in SN-38 sensitivity in patients with ESKD and cancer; we evaluated the variations in SN-38 sensitivity and the mechanisms in human colon cancer cells exposed to uremic serum residue

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