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首页> 外文期刊>The Journal of Clinical Pharmacology: Official Journal of the American College of Clinical Pharmacology >Causes and Consequences of Variability in Drug Transporter Activity in Pediatric Drug Therapy
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Causes and Consequences of Variability in Drug Transporter Activity in Pediatric Drug Therapy

机译:小儿药物治疗中药物转运蛋白活性变化的原因和后果

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Drug transporters play a key role in mediating the uptake of endo-and exogenous substances into cells as well as their efflux. Therefore, variability in drug transporter activity can influence pharmaco- and toxicokinetics and be a determinant of drug safety and efficacy. In children, particularly in neonates and young infants, the contribution of tissue-specific drug transporters to drug absorption, distribution, and excretion may differ from that in adults. In this review 5 major factors and their interdependence that may influence drug transporter activity in children are discussed: developmental differences, genetic polymorphisms, pediatric comorbidities, interacting comedication, and environmental factors. Even if data are sparse, altered drug transporter activity due to those factors have been associated with clinically relevant differences in drug disposition, efficacy, and safety in pediatric patients. Single nucleotide polymorphisms in drug transporter-encoding genes were the most studied source of drug transporter variability in children. However, in the age group where drug transporter activity has been reported to differ from that in adults, namely neonates and young infants, hardly any studies have been performed. Longitudinal studies in this young population are required to investigate the age-and disease-dependent genotype-phenotype relationships and relevance of drug transporter drug-drug interactions. Physiologically based pharmacokinetic modeling approaches can integrate drug-and patient-specific parameters, including drug transporter ontogeny, and may further improve in silico predictions of pediatric-specific pharmacokinetics.
机译:药物转运蛋白在介导内源性物质和外源性物质向细胞的吸收及其流出中起着关键作用。因此,药物转运蛋白活性的变化会影响药代动力学和毒代动力学,并成为药物安全性和有效性的决定因素。在儿童中,尤其是在新生儿和幼儿中,组织特异性药物转运蛋白对药物吸收,分布和排泄的贡献可能与成年人不同。在这篇综述中,讨论了可能影响儿童药物转运蛋白活动的5个主要因素及其相互依赖性:发育差异,遗传多态性,小儿合并症,相互作用的喜剧和环境因素。即使数据稀疏,由于这些因素导致的药物转运蛋白活性改变,仍与儿科患者药物处置,疗效和安全性的临床相关差异有关。药物转运蛋白编码基因中的单核苷酸多态性是儿童中药物转运蛋白变异性研究最多的来源。但是,在据报道药物转运蛋白活性与成年人不同的年龄组,即新生儿和幼儿,几乎没有进行任何研究。需要在这个年轻人口中进行纵向研究,以调查年龄和疾病相关基因型-表型的关系以及药物转运蛋白与药物相互作用的相关性。基于生理学的药代动力学建模方法可以整合药物和患者特定的参数,包括药物转运体的个体发育,并且可以进一步改善计算机模拟的儿科特异性药物动力学的预测。

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