Assessment of tacrolimus absorption from the human intestinal tract

Open-label, randomized, 4-way crossover study

Daisuke Tsunashima, Akio Kawamura, Manabu Murakami, Taiji Sawamoto, Nas Undre, Malcolm Brown, Albert Groenewoud, James J. Keirns, John Holman, Alyson Connor, Hannah Wylde, Ian Wilding, Ken Ichi Ogawara, Kazuhiro Sako, Kazutaka Higaki, Roy First

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background Tacrolimus is an established immunosuppressant used for the prevention and treatment of allograft rejection in solid organ transplantation. An immediate-release oral formulation of tacrolimus has been commercially available since 1994 that is administered orally BID. To improve the compliance and quality of life of transplant patients, a once-daily modified release (MR) formulation is an attractive option. However, to be successful, the drug of interest must be sufficiently well absorbed from the distal region of the gastrointestinal tract. Objective To facilitate the development of an MR formulation, we investigated the absorption of tacrolimus from different regions of the human gastrointestinal tract, proximal and distal small bowels, and ascending colon. Methods The study was performed as an open-label, randomized, 4-way crossover design in 6 healthy white male subjects. For each subject, 1 mg (2 mg/mL) of tacrolimus solution in polyethylene glycol 400 was administered to each location in the gastrointestinal tract via a site-specific radiolabeled delivery capsule, which can release tacrolimus solution at specific sites of the gastrointestinal tract. Real-time visualization of capsule location and tacrolimus release at each target site was performed by using γ-scintigraphy. Blood samples were collected to determine tacrolimus levels in the blood. The pharmacokinetic parameters Cmax, T max after the capsule activation, AUC0-24, and mean residence time were determined from the concentration-time profiles. Results Ten healthy male subjects underwent dosing. Six subjects completed all 4 treatments. Three adverse events (mild headache [n = 1], small amount of blood in stool [n = 1], and mild syncopal episode [n = 1]) that were possibly study drug related were reported in 3 different subjects. Tacrolimus was absorbed from not only the small intestine but also from the colonic region of the gastrointestinal tract. Although AUC0-24 values revealed some site-specific absorption tendencies, the mean AUC0-24 values obtained were similar regardless of the location of tacrolimus release from the capsule. Conclusions Tacrolimus was absorbed from the duodenum to the colon in these male subjects, although differences were observed in the value of AUC 0-24, possibly due to variation in cytochrome P450 3A4 activity in the intestine. Although this study was conducted in small group of healthy fasting men, the present results indicate that tacrolimus is suitable for MR formulation development due to a wide absorption window throughout the intestine in humans.

Original languageEnglish
Pages (from-to)748-759
Number of pages12
JournalClinical Therapeutics
Volume36
Issue number5
DOIs
Publication statusPublished - May 1 2014

Fingerprint

Intestinal Absorption
Tacrolimus
Cross-Over Studies
Gastrointestinal Tract
Capsules
Intestines
Ascending Colon
Cytochrome P-450 CYP3A
Syncope
Organ Transplantation
Immunosuppressive Agents
Duodenum
Radionuclide Imaging
Pharmaceutical Preparations
Compliance
Small Intestine
Area Under Curve
Allografts
Headache
Fasting

Keywords

  • gastrointestinal
  • modified release
  • once daily
  • regional absorption
  • tacrolimus
  • γ-scintigraphy

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Medicine(all)

Cite this

Tsunashima, D., Kawamura, A., Murakami, M., Sawamoto, T., Undre, N., Brown, M., ... First, R. (2014). Assessment of tacrolimus absorption from the human intestinal tract: Open-label, randomized, 4-way crossover study. Clinical Therapeutics, 36(5), 748-759. https://doi.org/10.1016/j.clinthera.2014.02.021

Assessment of tacrolimus absorption from the human intestinal tract : Open-label, randomized, 4-way crossover study. / Tsunashima, Daisuke; Kawamura, Akio; Murakami, Manabu; Sawamoto, Taiji; Undre, Nas; Brown, Malcolm; Groenewoud, Albert; Keirns, James J.; Holman, John; Connor, Alyson; Wylde, Hannah; Wilding, Ian; Ogawara, Ken Ichi; Sako, Kazuhiro; Higaki, Kazutaka; First, Roy.

In: Clinical Therapeutics, Vol. 36, No. 5, 01.05.2014, p. 748-759.

Research output: Contribution to journalArticle

Tsunashima, D, Kawamura, A, Murakami, M, Sawamoto, T, Undre, N, Brown, M, Groenewoud, A, Keirns, JJ, Holman, J, Connor, A, Wylde, H, Wilding, I, Ogawara, KI, Sako, K, Higaki, K & First, R 2014, 'Assessment of tacrolimus absorption from the human intestinal tract: Open-label, randomized, 4-way crossover study', Clinical Therapeutics, vol. 36, no. 5, pp. 748-759. https://doi.org/10.1016/j.clinthera.2014.02.021
Tsunashima, Daisuke ; Kawamura, Akio ; Murakami, Manabu ; Sawamoto, Taiji ; Undre, Nas ; Brown, Malcolm ; Groenewoud, Albert ; Keirns, James J. ; Holman, John ; Connor, Alyson ; Wylde, Hannah ; Wilding, Ian ; Ogawara, Ken Ichi ; Sako, Kazuhiro ; Higaki, Kazutaka ; First, Roy. / Assessment of tacrolimus absorption from the human intestinal tract : Open-label, randomized, 4-way crossover study. In: Clinical Therapeutics. 2014 ; Vol. 36, No. 5. pp. 748-759.
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AU - Tsunashima, Daisuke

AU - Kawamura, Akio

AU - Murakami, Manabu

AU - Sawamoto, Taiji

AU - Undre, Nas

AU - Brown, Malcolm

AU - Groenewoud, Albert

AU - Keirns, James J.

AU - Holman, John

AU - Connor, Alyson

AU - Wylde, Hannah

AU - Wilding, Ian

AU - Ogawara, Ken Ichi

AU - Sako, Kazuhiro

AU - Higaki, Kazutaka

AU - First, Roy

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N2 - Background Tacrolimus is an established immunosuppressant used for the prevention and treatment of allograft rejection in solid organ transplantation. An immediate-release oral formulation of tacrolimus has been commercially available since 1994 that is administered orally BID. To improve the compliance and quality of life of transplant patients, a once-daily modified release (MR) formulation is an attractive option. However, to be successful, the drug of interest must be sufficiently well absorbed from the distal region of the gastrointestinal tract. Objective To facilitate the development of an MR formulation, we investigated the absorption of tacrolimus from different regions of the human gastrointestinal tract, proximal and distal small bowels, and ascending colon. Methods The study was performed as an open-label, randomized, 4-way crossover design in 6 healthy white male subjects. For each subject, 1 mg (2 mg/mL) of tacrolimus solution in polyethylene glycol 400 was administered to each location in the gastrointestinal tract via a site-specific radiolabeled delivery capsule, which can release tacrolimus solution at specific sites of the gastrointestinal tract. Real-time visualization of capsule location and tacrolimus release at each target site was performed by using γ-scintigraphy. Blood samples were collected to determine tacrolimus levels in the blood. The pharmacokinetic parameters Cmax, T max after the capsule activation, AUC0-24, and mean residence time were determined from the concentration-time profiles. Results Ten healthy male subjects underwent dosing. Six subjects completed all 4 treatments. Three adverse events (mild headache [n = 1], small amount of blood in stool [n = 1], and mild syncopal episode [n = 1]) that were possibly study drug related were reported in 3 different subjects. Tacrolimus was absorbed from not only the small intestine but also from the colonic region of the gastrointestinal tract. Although AUC0-24 values revealed some site-specific absorption tendencies, the mean AUC0-24 values obtained were similar regardless of the location of tacrolimus release from the capsule. Conclusions Tacrolimus was absorbed from the duodenum to the colon in these male subjects, although differences were observed in the value of AUC 0-24, possibly due to variation in cytochrome P450 3A4 activity in the intestine. Although this study was conducted in small group of healthy fasting men, the present results indicate that tacrolimus is suitable for MR formulation development due to a wide absorption window throughout the intestine in humans.

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