Investigation of the arcane inhibition of human organic anion transporter 3 by benzofuran antiarrhythmic agents

Heng Lin Tan; Lloyd Wei Tat Tang; Sheng Yuan Chin; Eric Chun Yong Chan

doi:10.1016/j.dmpk.2021.100390

Investigation of the arcane inhibition of human organic anion transporter 3 by benzofuran antiarrhythmic agents

Drug Metab Pharmacokinet. 2021 Jun:38:100390. doi: 10.1016/j.dmpk.2021.100390. Epub 2021 Mar 20.

Authors

Heng Lin Tan¹, Lloyd Wei Tat Tang¹, Sheng Yuan Chin¹, Eric Chun Yong Chan²

Affiliations

¹ Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore.
² Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore. Electronic address: phaccye@nus.edu.sg.

PMID: 33836300
DOI: 10.1016/j.dmpk.2021.100390

Abstract

The combination of antiarrhythmic agents, amiodarone or dronedarone, with the anticoagulant rivaroxaban is used clinically in the management of atrial fibrillation for rhythm control and secondary stroke prevention respectively. Renal drug-drug interactions (DDIs) between amiodarone or dronedarone and rivaroxaban were previously ascribed to inhibition of rivaroxaban secretion by P-glycoprotein at the apical membrane of renal proximal tubular epithelial cells. Benzbromarone, a known inhibitor of organic anion transporter 3 (OAT3), shares a benzofuran scaffold with amiodarone and dronedarone. However, inhibitory activity of amiodarone and dronedarone against OAT3 remains arcane. Here, we conducted in vitro transporter inhibition assays in OAT3-transfected HEK293 cells which revealed amiodarone, dronedarone and their respective major pharmacologically-active metabolites N-desethylamiodarone and N-desbutyldronedarone possess inhibitory activity against OAT3, with corrected K_i values of 0.042, 0.019, 0.028 and 0.0046 μM respectively. Protein binding effects and probe substrate dependency were accounted for in our assays. Static modelling predicted 1.29-, 1.01-, 1.29- and 1.16-fold increase in rivaroxaban exposure, culminating in a predicted 1.29-, 1.01-, 1.28- and 1.15-fold increase in major bleeding risk respectively, suggesting potential OAT3-mediated DDI between amiodarone and rivaroxaban. Future work involving physiologically-based pharmacokinetic modelling is crucial in holistically predicting the complex DDIs between the benzofuran antiarrhythmic agents and rivaroxaban.

Keywords: Amiodarone; Amiodarone hydrochloride (PubChem CID: 441325); Benzbromarone (PubChem CID: 2333); Dronedarone; Dronedarone hydrochloride (PubChem CID: 219025); Drug-drug interaction; Estrone-3-sulfate (PubChem CID: 20056857); Mechanistic static modelling; N-desbutyldronedarone; N-desbutyldronedarone hydrochloride (PubChem CID: 71315590); N-desethylamiodarone; N-desethylamiodarone hydrochloride (PubChem CID: 178801); Organic anion transporter 3; Pregnenolone sulfate sodium (PubChem CID: 23689388); Rivaroxaban; Rivaroxaban (PubChem CID: 9875401); Testosterone-2,3,4–(13)C(3) (PubChem CID: 12304601).

MeSH terms

ATP Binding Cassette Transporter, Subfamily B, Member 1 / metabolism
Amiodarone / analogs & derivatives
Amiodarone / pharmacology
Anti-Arrhythmia Agents / pharmacology*
Atrial Fibrillation / drug therapy
Atrial Fibrillation / metabolism
Benzofurans / pharmacology*
Cell Line
Dronedarone / pharmacology
Drug Interactions / physiology
HEK293 Cells
Humans
Organic Anion Transporters, Sodium-Independent / antagonists & inhibitors*
Rivaroxaban / pharmacology

Substances

ATP Binding Cassette Transporter, Subfamily B, Member 1
Anti-Arrhythmia Agents
Benzofurans
N-desbutyldronedarone
Organic Anion Transporters, Sodium-Independent
organic anion transport protein 3
Rivaroxaban
Dronedarone
benzofuran
Amiodarone