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1-Alpha, 25-dihydroxyvitamin D3 alters the pharmacokinetics of mycophenolic acid in renal transplant recipients by regulating two extrahepatic UDP-glucuronosyltransferases 1A8 and 1A10

Xiaoliang Wang, Hongwei Wang, Bing Shen, Brian R. Overholser, Bruce R. Cooper, Yinghao Lu, Huamei Tang, Chongzhi Zhou, Xing Sun, Lin Zhong, Murray J. Favus, Brian S. Decker (+2 others)
2016 Translational Research: The Journal of Laboratory and Clinical Medicine  

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Mycophenolic acid (MPA) is an important immunosuppressant broadly used in renal transplantation. However, the large inter-patient variability in mycophenolic acid (MPA) pharmacokinetics (PK) limits its use. We hypothesize that extrahepatic metabolism of MPA may have significant impact on MPA PK variability. Two intestinal UDP-glucuronosyltransferases 1A8 and 1A10 plays critical role in MPA metabolism. Both in silico and previous genome-wide analyses suggested that vitamin D (VD) may regulate
more » ... estinal UGT1A expression. We validated the VD response elements (VDREs) across the UGT1A locus with chromatin immunoprecipitation (ChIP) and luciferase reporter assays. The impact of 1-alpha,25-dihydroxyvitamin D3 (D3) on UGT1A8 and UGT1A10 transcription and on MPA glucuronidation was tested in human intestinal cell lines LS180, Caco-2 and HCT-116. The correlation between transcription levels of VD receptor (VDR) and the two UGT genes were examined in human normal colorectal tissue samples (n 5 73). PK alterations of MPA following the parent drug, mycophenolate mofetil (MMF), and D3 treatment was assessed among renal transplant recipients (n 5 10). Our ChIP assay validate three VDREs which were further demonstrated as transcriptional enhancers with the luciferase assays. D3 treatment significantly increased transcription of both UGT genes as well as MPA glucuronidation in cells. The VDR mRNA level was highly correlated with that of both UGT1A8 and UGT1A10 in human colorectal tissue. D3 treatment in patients led to 54 about 40% reduction in both AUC 0-12 and Cmax while over 70% elevation of total clearance of MPA. Our study suggested a significant regulatory role of VD on MPA metabolism and PK via modulating extrahepatic UGT activity. (Translational Research 2016;178:54-62)
doi:10.1016/j.trsl.2016.07.006 pmid:27496319 fatcat:o7fldmbelbamxibbdguxgpflye
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Xiaoliang Wang, Hongwei Wang, Bing Shen, Brian R. Overholser, Bruce R. Cooper, Yinghao Lu, Huamei Tang, Chongzhi Zhou, Xing Sun, Lin Zhong, Murray J. Favus, Brian S. Decker, Wanqing Liu, Zhihai Peng. "1-Alpha, 25-dihydroxyvitamin D3 alters the pharmacokinetics of mycophenolic acid in renal transplant recipients by regulating two extrahepatic UDP-glucuronosyltransferases 1A8 and 1A10." Translational Research: The Journal of Laboratory and Clinical Medicine (2016) 54-62.e6