Efflux and uptake transporters as determinants of statin response.
BACKGROUND
The important role of drug transporters in drug absorption and disposition has been well documented. Statins are subjected to active transport of membrane proteins of the superfamilies ATP-binding cassette and solute carrier, and there is limited understanding of the mechanisms by which differences in transporter expression and activity contributes to variability of pharmacokinetics (PKs)/pharmacodynamics (PDs) of statins.


METHODS
This review aims to discuss the roles of drug transporters in the PKs and PDs of statins, and in drug interactions with statins.


RESULTS
A comprehensive summary of the literature on this subject including in vitro and in vivo observations.


CONCLUSIONS
In vivo and in vitro studies have shown that efflux and uptake transporters modulate the PKs/PDs of statins. Until now organic anion transporting polypeptides (OATP)1B1 variants have been considered major factors in limiting the uptake of statins and increasing statin exposure, and, consequently, increasing risk of myopathy. Further studies in pharmacogenetics and in vitro models to assess statin disposition and toxicity are required to understand the contribution of others transporters, such as multidrug resistance-associated protein (MRP)1, MRP2, breast cancer resistance protein, OATP2B1, OAT1B3 and OATP1A2, in interindividual variability to statins efficacy and safety.
Rodrigues
Alice C
AC
University of Sao Paulo, Department of Clinical and Toxicological Analysis, Faculty of Pharmaceutical Sciences, Av. Prof. Lineu Prestes, 580, bl17s, Sao Paulo 05508-000, SP, Brazil. alice-rodrigues@usp.br
D018528:ATP-Binding Cassette Transporters / Q000378:metabolism; D000818:Animals; D050197:Atherosclerosis / Q000209:etiology / Q000517:prevention & control*; D004347:Drug Interactions; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology*; D000960:Hypolipidemic Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology*; D026901:Membrane Transport Proteins / Q000378:metabolism; D027361:Organic Anion Transporters / Q000378:metabolism
D018528:ATP-Binding Cassette Transporters; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D026901:Membrane Transport Proteins; D027361:Organic Anion Transporters