The Effect of Nizatidine, a MATE2K Selective Inhibitor, on the Pharmacokinetics and Pharmacodynamics of Metformin in Healthy Volunteers.
OBJECTIVE
In the proximal tubule, basic drugs are transported from the renal cells to the tubule lumen through the concerted action of the H(+)/organic cation antiporters, multidrug and toxin extrusion (MATE) 1 and MATE2K. Dual inhibitors of the MATE transporters have been shown to have a clinically relevant effect on the pharmacokinetics of concomitantly administered basic drugs. However, the clinical impact of selective renal organic cation transport inhibition on the pharmacokinetics and pharmacodynamics of basic drugs, such as metformin, is unknown. This study sought to identify a selective MATE2K inhibitor in vitro and to determine its clinical impact on the pharmacokinetics and pharmacodynamics of metformin in healthy subjects.


METHODS
Strategic cell-based screening of 71 US Food and Drug Administration (FDA)-approved medications was conducted to identify selective inhibitors of renal organic cation transporters that are capable of inhibiting at clinically relevant concentrations. From this screen, nizatidine was identified and predicted to be a clinically potent and selective inhibitor of MATE2K-mediated transport. The effect of nizatidine on the pharmacokinetics and pharmacodynamics of metformin was evaluated in 12 healthy volunteers in an open-label, randomized, two-phase crossover drug-drug interaction (DDI) study.


RESULTS
In healthy volunteers, the MATE2K-selective inhibitor nizatidine significantly increased the apparent volume of distribution, half-life, and hypoglycemic activity of metformin. However, despite achieving unbound maximum concentrations greater than the in vitro inhibition potency (concentration of drug producing 50% inhibition [IC50]) of MATE2K-mediated transport, nizatidine did not affect the renal clearance (CLR) or net secretory clearance of metformin.


CONCLUSIONS
This study demonstrates that a selective inhibition of MATE2K by nizatidine affected the apparent volume of distribution, tissue concentrations, and peripheral effects of metformin. However, nizatidine did not alter systemic concentrations or the CLR of metformin, suggesting that specific MATE2K inhibition may not be sufficient to cause renal DDIs with metformin.
Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA.|Department of Clinical Pharmacology, Genentech, Inc., South San Francisco, CA, USA.
Kari M
KM
Morrissey
Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA.|Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, Australia.
Sophie L
SL
Stocker
Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA.|Department of Drug Metabolism and Pharmacokinetics, Genentech, Inc., South San Francisco, CA, USA.
Eugene C
EC
Chen
Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA.
Richard A
RA
Castro
Department of Anesthesiology, University of California, San Francisco, CA, USA.
Claire M
CM
Brett
Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA. kathy.giacomini@ucsf.edu.
Kathleen M
KM
Giacomini
D000293:Adolescent; D000328:Adult; D002460:Cell Line; D018592:Cross-Over Studies; D004347:Drug Interactions; D005260:Female; D057809:HEK293 Cells; D006207:Half-Life; D006801:Humans; D007004:Hypoglycemic Agents / Q000493:pharmacokinetics / Q000494:pharmacology; D007668:Kidney / Q000187:drug effects / Q000378:metabolism; D008297:Male; D008687:Metformin / Q000493:pharmacokinetics* / Q000494:pharmacology*; D008875:Middle Aged; D016567:Nizatidine / Q000494:pharmacology*; D027701:Organic Cation Transport Proteins / Q000037:antagonists & inhibitors*; D055815:Young Adult
D007004:Hypoglycemic Agents; D027701:Organic Cation Transport Proteins; C521870:SLC47A2 protein, human; D008687:Metformin; D016567:Nizatidine