title: Breast cancer resistance protein (ABCG2) in clinical pharmacokinetics and drug interactions: practical recommendations for clinical victim and perpetrator drug-drug interaction study design.
abstract: Breast cancer resistance protein (BCRP; ABCG2) limits intestinal absorption of low-permeability substrate drugs and mediates biliary excretion of drugs and metabolites. Based on clinical evidence of BCRP-mediated drug-drug interactions (DDIs) and the c.421C>A functional polymorphism affecting drug efficacy and safety, both the US Food and Drug Administration and European Medicines Agency recommend preclinical evaluation and, when appropriate, clinical assessment of BCRP-mediated DDIs. Although many BCRP substrates and inhibitors have been identified in vitro, clinical translation has been confounded by overlap with other transporters and metabolic enzymes. Regulatory recommendations for BCRP-mediated clinical DDI studies are challenging, as consensus is lacking on the choice of the most robust and specific human BCRP substrates and inhibitors and optimal study design. This review proposes a path forward based on a comprehensive analysis of available data. Oral sulfasalazine (1000 mg, immediate-release tablet) is the best available clinical substrate for intestinal BCRP, oral rosuvastatin (20 mg) for both intestinal and hepatic BCRP, and intravenous rosuvastatin (4 mg) for hepatic BCRP. Oral curcumin (2000 mg) and lapatinib (250 mg) are the best available clinical BCRP inhibitors. To interrogate the worst-case clinical BCRP DDI scenario, study subjects harboring the BCRP c.421C/C reference genotype are recommended. In addition, if sulfasalazine is selected as the substrate, subjects having the rapid acetylator phenotype are recommended. In the case of rosuvastatin, subjects with the organic anion-transporting polypeptide 1B1 c.521T/T genotype are recommended, together with monitoring of rosuvastatin's cholesterol-lowering effect at baseline and DDI phase. A proof-of-concept clinical study is being planned by a collaborative consortium to evaluate the proposed BCRP DDI study design.
authors.affiliation: Drug Metabolism and Pharmacokinetics, QPS LLC, Research Triangle Park, North Carolina (C.A.L.); Drug Metabolism and Pharmacokinetics, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut (M.A.O., M.E.T.); Centre for Applied Pharmacokinetic Research, Manchester Pharmacy School, The University of Manchester, Manchester, United Kingdom (A.G.); Pharmacokinetics and Drug Metabolism (B.F.) and Clinical Pharmacology, Global Innovative Pharma Business (J.A.C.), Pfizer Inc., Groton, Connecticut; School of Pharmacy, University of Washington, Seattle, Washington (I.R.-M., T.K.R.); Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Research Triangle Park, North Carolina (M.J.Z.-G., J.W.P.) and King of Prussia, Pennsylvania (H.E.); College of Pharmacy, Washington State University, Spokane, Washington (M.F.P.); and Clinical Pharmacology, Genentech, South San Francisco, California (J.A.W.).
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Lee
authors.affiliation: Drug Metabolism and Pharmacokinetics, QPS LLC, Research Triangle Park, North Carolina (C.A.L.); Drug Metabolism and Pharmacokinetics, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut (M.A.O., M.E.T.); Centre for Applied Pharmacokinetic Research, Manchester Pharmacy School, The University of Manchester, Manchester, United Kingdom (A.G.); Pharmacokinetics and Drug Metabolism (B.F.) and Clinical Pharmacology, Global Innovative Pharma Business (J.A.C.), Pfizer Inc., Groton, Connecticut; School of Pharmacy, University of Washington, Seattle, Washington (I.R.-M., T.K.R.); Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Research Triangle Park, North Carolina (M.J.Z.-G., J.W.P.) and King of Prussia, Pennsylvania (H.E.); College of Pharmacy, Washington State University, Spokane, Washington (M.F.P.); and Clinical Pharmacology, Genentech, South San Francisco, California (J.A.W.).
authors.forename: Meeghan A
authors.initials: MA
authors.lastname: O'Connor
authors.affiliation: Drug Metabolism and Pharmacokinetics, QPS LLC, Research Triangle Park, North Carolina (C.A.L.); Drug Metabolism and Pharmacokinetics, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut (M.A.O., M.E.T.); Centre for Applied Pharmacokinetic Research, Manchester Pharmacy School, The University of Manchester, Manchester, United Kingdom (A.G.); Pharmacokinetics and Drug Metabolism (B.F.) and Clinical Pharmacology, Global Innovative Pharma Business (J.A.C.), Pfizer Inc., Groton, Connecticut; School of Pharmacy, University of Washington, Seattle, Washington (I.R.-M., T.K.R.); Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Research Triangle Park, North Carolina (M.J.Z.-G., J.W.P.) and King of Prussia, Pennsylvania (H.E.); College of Pharmacy, Washington State University, Spokane, Washington (M.F.P.); and Clinical Pharmacology, Genentech, South San Francisco, California (J.A.W.).
authors.forename: Tasha K
authors.initials: TK
authors.lastname: Ritchie
authors.affiliation: Drug Metabolism and Pharmacokinetics, QPS LLC, Research Triangle Park, North Carolina (C.A.L.); Drug Metabolism and Pharmacokinetics, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut (M.A.O., M.E.T.); Centre for Applied Pharmacokinetic Research, Manchester Pharmacy School, The University of Manchester, Manchester, United Kingdom (A.G.); Pharmacokinetics and Drug Metabolism (B.F.) and Clinical Pharmacology, Global Innovative Pharma Business (J.A.C.), Pfizer Inc., Groton, Connecticut; School of Pharmacy, University of Washington, Seattle, Washington (I.R.-M., T.K.R.); Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Research Triangle Park, North Carolina (M.J.Z.-G., J.W.P.) and King of Prussia, Pennsylvania (H.E.); College of Pharmacy, Washington State University, Spokane, Washington (M.F.P.); and Clinical Pharmacology, Genentech, South San Francisco, California (J.A.W.).
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Galetin
authors.affiliation: Drug Metabolism and Pharmacokinetics, QPS LLC, Research Triangle Park, North Carolina (C.A.L.); Drug Metabolism and Pharmacokinetics, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut (M.A.O., M.E.T.); Centre for Applied Pharmacokinetic Research, Manchester Pharmacy School, The University of Manchester, Manchester, United Kingdom (A.G.); Pharmacokinetics and Drug Metabolism (B.F.) and Clinical Pharmacology, Global Innovative Pharma Business (J.A.C.), Pfizer Inc., Groton, Connecticut; School of Pharmacy, University of Washington, Seattle, Washington (I.R.-M., T.K.R.); Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Research Triangle Park, North Carolina (M.J.Z.-G., J.W.P.) and King of Prussia, Pennsylvania (H.E.); College of Pharmacy, Washington State University, Spokane, Washington (M.F.P.); and Clinical Pharmacology, Genentech, South San Francisco, California (J.A.W.).
authors.forename: Jack A
authors.initials: JA
authors.lastname: Cook
authors.affiliation: Drug Metabolism and Pharmacokinetics, QPS LLC, Research Triangle Park, North Carolina (C.A.L.); Drug Metabolism and Pharmacokinetics, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut (M.A.O., M.E.T.); Centre for Applied Pharmacokinetic Research, Manchester Pharmacy School, The University of Manchester, Manchester, United Kingdom (A.G.); Pharmacokinetics and Drug Metabolism (B.F.) and Clinical Pharmacology, Global Innovative Pharma Business (J.A.C.), Pfizer Inc., Groton, Connecticut; School of Pharmacy, University of Washington, Seattle, Washington (I.R.-M., T.K.R.); Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Research Triangle Park, North Carolina (M.J.Z.-G., J.W.P.) and King of Prussia, Pennsylvania (H.E.); College of Pharmacy, Washington State University, Spokane, Washington (M.F.P.); and Clinical Pharmacology, Genentech, South San Francisco, California (J.A.W.).
authors.forename: Isabelle
authors.initials: I
authors.lastname: Ragueneau-Majlessi
authors.affiliation: Drug Metabolism and Pharmacokinetics, QPS LLC, Research Triangle Park, North Carolina (C.A.L.); Drug Metabolism and Pharmacokinetics, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut (M.A.O., M.E.T.); Centre for Applied Pharmacokinetic Research, Manchester Pharmacy School, The University of Manchester, Manchester, United Kingdom (A.G.); Pharmacokinetics and Drug Metabolism (B.F.) and Clinical Pharmacology, Global Innovative Pharma Business (J.A.C.), Pfizer Inc., Groton, Connecticut; School of Pharmacy, University of Washington, Seattle, Washington (I.R.-M., T.K.R.); Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Research Triangle Park, North Carolina (M.J.Z.-G., J.W.P.) and King of Prussia, Pennsylvania (H.E.); College of Pharmacy, Washington State University, Spokane, Washington (M.F.P.); and Clinical Pharmacology, Genentech, South San Francisco, California (J.A.W.).
authors.forename: Harma
authors.initials: H
authors.lastname: Ellens
authors.affiliation: Drug Metabolism and Pharmacokinetics, QPS LLC, Research Triangle Park, North Carolina (C.A.L.); Drug Metabolism and Pharmacokinetics, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut (M.A.O., M.E.T.); Centre for Applied Pharmacokinetic Research, Manchester Pharmacy School, The University of Manchester, Manchester, United Kingdom (A.G.); Pharmacokinetics and Drug Metabolism (B.F.) and Clinical Pharmacology, Global Innovative Pharma Business (J.A.C.), Pfizer Inc., Groton, Connecticut; School of Pharmacy, University of Washington, Seattle, Washington (I.R.-M., T.K.R.); Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Research Triangle Park, North Carolina (M.J.Z.-G., J.W.P.) and King of Prussia, Pennsylvania (H.E.); College of Pharmacy, Washington State University, Spokane, Washington (M.F.P.); and Clinical Pharmacology, Genentech, South San Francisco, California (J.A.W.).
authors.forename: Bo
authors.initials: B
authors.lastname: Feng
authors.affiliation: Drug Metabolism and Pharmacokinetics, QPS LLC, Research Triangle Park, North Carolina (C.A.L.); Drug Metabolism and Pharmacokinetics, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut (M.A.O., M.E.T.); Centre for Applied Pharmacokinetic Research, Manchester Pharmacy School, The University of Manchester, Manchester, United Kingdom (A.G.); Pharmacokinetics and Drug Metabolism (B.F.) and Clinical Pharmacology, Global Innovative Pharma Business (J.A.C.), Pfizer Inc., Groton, Connecticut; School of Pharmacy, University of Washington, Seattle, Washington (I.R.-M., T.K.R.); Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Research Triangle Park, North Carolina (M.J.Z.-G., J.W.P.) and King of Prussia, Pennsylvania (H.E.); College of Pharmacy, Washington State University, Spokane, Washington (M.F.P.); and Clinical Pharmacology, Genentech, South San Francisco, California (J.A.W.).
authors.forename: Mitchell E
authors.initials: ME
authors.lastname: Taub
authors.affiliation: Drug Metabolism and Pharmacokinetics, QPS LLC, Research Triangle Park, North Carolina (C.A.L.); Drug Metabolism and Pharmacokinetics, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut (M.A.O., M.E.T.); Centre for Applied Pharmacokinetic Research, Manchester Pharmacy School, The University of Manchester, Manchester, United Kingdom (A.G.); Pharmacokinetics and Drug Metabolism (B.F.) and Clinical Pharmacology, Global Innovative Pharma Business (J.A.C.), Pfizer Inc., Groton, Connecticut; School of Pharmacy, University of Washington, Seattle, Washington (I.R.-M., T.K.R.); Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Research Triangle Park, North Carolina (M.J.Z.-G., J.W.P.) and King of Prussia, Pennsylvania (H.E.); College of Pharmacy, Washington State University, Spokane, Washington (M.F.P.); and Clinical Pharmacology, Genentech, South San Francisco, California (J.A.W.).
authors.forename: Mary F
authors.initials: MF
authors.lastname: Paine
authors.affiliation: Drug Metabolism and Pharmacokinetics, QPS LLC, Research Triangle Park, North Carolina (C.A.L.); Drug Metabolism and Pharmacokinetics, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut (M.A.O., M.E.T.); Centre for Applied Pharmacokinetic Research, Manchester Pharmacy School, The University of Manchester, Manchester, United Kingdom (A.G.); Pharmacokinetics and Drug Metabolism (B.F.) and Clinical Pharmacology, Global Innovative Pharma Business (J.A.C.), Pfizer Inc., Groton, Connecticut; School of Pharmacy, University of Washington, Seattle, Washington (I.R.-M., T.K.R.); Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Research Triangle Park, North Carolina (M.J.Z.-G., J.W.P.) and King of Prussia, Pennsylvania (H.E.); College of Pharmacy, Washington State University, Spokane, Washington (M.F.P.); and Clinical Pharmacology, Genentech, South San Francisco, California (J.A.W.).
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Polli
authors.affiliation: Drug Metabolism and Pharmacokinetics, QPS LLC, Research Triangle Park, North Carolina (C.A.L.); Drug Metabolism and Pharmacokinetics, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut (M.A.O., M.E.T.); Centre for Applied Pharmacokinetic Research, Manchester Pharmacy School, The University of Manchester, Manchester, United Kingdom (A.G.); Pharmacokinetics and Drug Metabolism (B.F.) and Clinical Pharmacology, Global Innovative Pharma Business (J.A.C.), Pfizer Inc., Groton, Connecticut; School of Pharmacy, University of Washington, Seattle, Washington (I.R.-M., T.K.R.); Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Research Triangle Park, North Carolina (M.J.Z.-G., J.W.P.) and King of Prussia, Pennsylvania (H.E.); College of Pharmacy, Washington State University, Spokane, Washington (M.F.P.); and Clinical Pharmacology, Genentech, South San Francisco, California (J.A.W.).
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Ware
authors.affiliation: Drug Metabolism and Pharmacokinetics, QPS LLC, Research Triangle Park, North Carolina (C.A.L.); Drug Metabolism and Pharmacokinetics, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut (M.A.O., M.E.T.); Centre for Applied Pharmacokinetic Research, Manchester Pharmacy School, The University of Manchester, Manchester, United Kingdom (A.G.); Pharmacokinetics and Drug Metabolism (B.F.) and Clinical Pharmacology, Global Innovative Pharma Business (J.A.C.), Pfizer Inc., Groton, Connecticut; School of Pharmacy, University of Washington, Seattle, Washington (I.R.-M., T.K.R.); Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Research Triangle Park, North Carolina (M.J.Z.-G., J.W.P.) and King of Prussia, Pennsylvania (H.E.); College of Pharmacy, Washington State University, Spokane, Washington (M.F.P.); and Clinical Pharmacology, Genentech, South San Francisco, California (J.A.W.) maciej.x.zamek-gliszczynski@gsk.com.
authors.forename: Maciej J
authors.initials: MJ
authors.lastname: Zamek-Gliszczynski
mesh_terms: D000070997:ATP Binding Cassette Transporter, Subfamily G, Member 2; D018528:ATP-Binding Cassette Transporters / Q000037:antagonists & inhibitors* / Q000235:genetics; D002986:Clinical Trials as Topic; D004347:Drug Interactions; D018432:Drug Resistance, Multiple; D064420:Drug-Related Side Effects and Adverse Reactions / Q000235:genetics / Q000378:metabolism*; D006801:Humans; D009363:Neoplasm Proteins / Q000037:antagonists & inhibitors* / Q000235:genetics; D004364:Pharmaceutical Preparations / Q000378:metabolism*; D010599:Pharmacokinetics; D020641:Polymorphism, Single Nucleotide; D017410:Practice Guidelines as Topic; D012107:Research Design; D013379:Substrate Specificity
chemical_list: C116614:ABCG2 protein, human; D000070997:ATP Binding Cassette Transporter, Subfamily G, Member 2; D018528:ATP-Binding Cassette Transporters; D009363:Neoplasm Proteins; D004364:Pharmaceutical Preparations