{"title":"The nuclear receptor REV-ERBα regulates coumarin hepatotoxicity via DBP-dependent repression of CYP2A5 in mice.","authors":"Yongbin Tong, Qi Zhang, Yutong Chen, Zhiqiang Zhao, Jingqi Li, Jinyi Wang, Haishan Xia, Danyi Lu, Yuyu Liu","doi":"10.1080/17425255.2025.2577675","DOIUrl":"https://doi.org/10.1080/17425255.2025.2577675","url":null,"abstract":"<p><strong>Introduction: </strong>Coumarin exhibit various biological activities, including anti-inflammatory, antioxidant and anxiolytic effects. However, its clinical application is restricted due to significant hepatotoxicity observed in multiple animal models. CYP2A5 is the primary enzyme responsible for metabolizing coumarin in the mouse liver, homologous to human CYP2A6.</p><p><strong>Methods: </strong>Acute toxicity and pharmacokinetic investigations were conducted on <i>Rev-erbα<sup>-/-</sup></i> and wild-type mice following coumarin administration. The regulatory effects of REV-ERBα on CYP2A5 expression were assessed both <i>in vivo</i> and <i>in vitro</i>. Western blotting and qPCR were used to measure the protein and mRNA levels, respectively.</p><p><strong>Results: </strong>Firstly, coumarin-induced hepatotoxicity was mitigated in <i>Rev-erbα</i><sup>-/-</sup> mice. Secondly, the systemic exposure of coumarin was lowered in <i>Rev-erbα<sup>-/-</sup></i> mice compared with wild-type mice. Thirdly, deletion of <i>Rev-erbα</i> resulted in significant upregulation of CYP2A5 mRNA and protein expression in mice. REV-ERBα negatively regulated CYP2A5/2A6 expression in Hepa-1c1c7 and HepG2 cells. Furthermore, luciferase reporter and chromatin immunoprecipitation (ChIP) assays indicated that REV-ERBα modulated <i>Cyp2a5</i> transcription and expression through the repression of DBP.</p><p><strong>Conclusions: </strong>The knockout of <i>Rev-erbα</i> significantly reduces the hepatotoxicity of coumarin by modulating CYP2A5. This research underscores the potential of targeting the REV-ERBα/CYP2A5 axis as a novel strategy for reducing coumarin-induced hepatotoxicity.</p>","PeriodicalId":94005,"journal":{"name":"Expert opinion on drug metabolism & toxicology","volume":" ","pages":"1-12"},"PeriodicalIF":3.4,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145350642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stefano Ferrea, Nazar Kuzo, Giancarlo Giupponi, Ester Messina, Agnese Raponi, Michael Paulzen, Christoph Hiemke, Andreas Conca, Georgios Schoretsanitis
{"title":"SARS-CoV-2 vaccination and plasma levels of psychotropic agents: a prospective cohort study.","authors":"Stefano Ferrea, Nazar Kuzo, Giancarlo Giupponi, Ester Messina, Agnese Raponi, Michael Paulzen, Christoph Hiemke, Andreas Conca, Georgios Schoretsanitis","doi":"10.1080/17425255.2025.2575386","DOIUrl":"10.1080/17425255.2025.2575386","url":null,"abstract":"<p><strong>Background: </strong>Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infections induce immunological and inflammatory reactions that may have an impact on cytochrome P450 activity, altering the metabolism of psychotropic drugs. In a cohort study, we prospectively investigated whether SARS-CoV-2 vaccination affects plasma levels of psychotropic agents in association with inflammatory parameter changes.</p><p><strong>Methods: </strong>We analyzed data from a cohort of 13 psychiatric inpatients receiving psychotropic treatment who underwent two inoculations of a SARS-CoV-2 mRNA vaccination. Plasma levels of psychotropic drugs and inflammatory markers were measured before and after vaccination.</p><p><strong>Results: </strong>In clozapine-treated patients, plasma levels remained by mean almost constant after both inoculations, although changes were larger in patients without vs. with co-medication with fluvoxamine (p < 0.001 at all timepoints except for timepoint T2; p = 0.9), with minor changes in interleukin 6 (IL-6) and C-reactive protein (CRP). For aripiprazole, quetiapine, olanzapine, lithium, sertraline, escitalopram, duloxetine, and paroxetine, no distinct plasma level patterns at post-vaccination emerged.</p><p><strong>Conclusion: </strong>SARS-CoV-2 vaccination was not associated with essential alterations of psychotropic drug levels. Observed CRP increases did not reach concentrations that may be associated with elevated drug levels. Nevertheless, monitoring of CRP and drug levels is recommended to capture post-vaccine plasma level changes, particularly in patients receiving clozapine.</p>","PeriodicalId":94005,"journal":{"name":"Expert opinion on drug metabolism & toxicology","volume":" ","pages":"1-6"},"PeriodicalIF":3.4,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145288057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rodrigo M Burgos, Yifan Wang, Jysheng Hou, Larry H Danziger
{"title":"Pharmacokinetic drug evaluation of co-packaged sulbactam for injection and durlobactam for injection for the treatment of <i>Acinetobacter baumannii-calcoaceticus</i> complex in HABP/VABP.","authors":"Rodrigo M Burgos, Yifan Wang, Jysheng Hou, Larry H Danziger","doi":"10.1080/17425255.2025.2567533","DOIUrl":"10.1080/17425255.2025.2567533","url":null,"abstract":"<p><strong>Introduction: </strong>Carbapenem-resistant Acinetobacter baumannii (CRAB) is an urgent-priority pathogen that is associated with high mortality and leaves clinicians reliant on nephrotoxic salvage regimens. Sulbactam/durlobactam (S/D) pairs sulbactam's intrinsic anti-Acinetobacter activity with the broad Ambler class A/C/D β-lactamase inhibitor durlobactam, creating the first agent targeting CRAB.</p><p><strong>Areas covered: </strong>Literature and abstracts from 2013 to 2025 were retrieved through PubMed, Embase, and major infectious diseases conferences. This review synthesizes S/D's chemistry, mechanism of action, resistance pathways, <i>in vitro</i> activity, pharmacokinetics, and pharmacodynamics. Clinical data introduces its early efficacy and highlights a phase 3 pivotal clinical trial (ATTACK) in hospital-acquired bacterial and ventilator-associated bacterial pneumonia (HABP/VABP), and briefly summarizes case reports of compassionate use in meningitis. Safety findings in these studies are summarized as well.</p><p><strong>Expert opinion: </strong>S/D has the potential to replace polymyxin-based therapy for directed CRAB therapy due to its targeted spectrum of activity and renal safety. Notably, S/D is inappropriate for isolates harboring class B metallo-β-lactamases and/or certain penicillin-binding proteins-3 (PBP3) mutations, those with S/D minimum inhibitory concentration (MIC) ≥4 mcg/mL and in populations with data gaps. Pharmacovigilance, studies of use in broader populations, and cost-effectiveness will be critical to maximize its clinical and stewardship value.</p>","PeriodicalId":94005,"journal":{"name":"Expert opinion on drug metabolism & toxicology","volume":" ","pages":"1-15"},"PeriodicalIF":3.4,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pharmacokinetics and safety of the combination of KL130008 and methotrexate in rheumatoid arthritis patients: a multicenter, open-label phase Ib trial.","authors":"Yue Cheng, Man Chen, Jing Yu, Huiping Gong, Zunfang Xu, Yuan Li, Wenping Wang, Linzhong Cheng, Jieping Zeng, Honghu Tang, Shuangqing Du, Bingjie Wu, Yezhe Cheng, Xiaoping Jin, Junyou Ge, Yi Liu, Ping Feng","doi":"10.1080/17425255.2025.2568188","DOIUrl":"10.1080/17425255.2025.2568188","url":null,"abstract":"<p><strong>Background: </strong>The combination of the JAK1/2 inhibitor KL130008 with methotrexate (MTX) is expected to improve treatment outcomes in rheumatoid arthritis (RA). This study evaluated the pharmacokinetics and safety of this combination therapy.</p><p><strong>Research design and methods: </strong>In an open-label, multicenter trial, 31 patients with RA received KL130008 combined with MTX. Pharmacokinetic parameters (C<sub>max</sub>, AUC<sub>0-t</sub>, AUC<sub>0-∞</sub>, T<sub>max</sub>) were assessed and compared between combination and monotherapy. Safety was evaluated through treatment-emergent adverse events (TEAEs), laboratory tests, and ECGs. Primary endpoints were pharmacokinetic bioequivalence between combination and monotherapy. Secondary outcomes included safety and tolerability.</p><p><strong>Results: </strong>Geometric mean ratios and 90% confidence intervals for key pharmacokinetic parameters of KL130008 and MTX were within the 80-125% bioequivalence range, indicating no significant interaction. A slight increase in 7-OH-methotrexate exposure was observed but deemed clinically insignificant. TEAEs related to KL130008 occurred in 71.0% of patients, with anemia (25.8%) and increased platelet count (12.9%) most common. All abnormal laboratory or ECG findings were mild.</p><p><strong>Conclusions: </strong>KL130008 combined with MTX demonstrated favorable pharmacokinetics and acceptable safety in RA patients. These findings support further investigation of this combination. Limitations include the open-label design and small sample size.</p><p><strong>Trial registration: </strong>This trial was registered with the Chinese Clinical Trial Register (ChiCTR2100050764) on 4 September 2021.</p>","PeriodicalId":94005,"journal":{"name":"Expert opinion on drug metabolism & toxicology","volume":" ","pages":"1-9"},"PeriodicalIF":3.4,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145152350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Karolína Hronová, Irena Štenglová Netíková, Eva Meisnerová, František Novák, Petr Kozlík, Olga Bartošová, Ondřej Slanař, Elke H J Krekels, Danica Michaličková
{"title":"Pharmacokinetics of apixaban in patients with short bowel syndrome: a Bayesian re-estimation approach.","authors":"Karolína Hronová, Irena Štenglová Netíková, Eva Meisnerová, František Novák, Petr Kozlík, Olga Bartošová, Ondřej Slanař, Elke H J Krekels, Danica Michaličková","doi":"10.1080/17425255.2025.2562047","DOIUrl":"https://doi.org/10.1080/17425255.2025.2562047","url":null,"abstract":"<p><strong>Background: </strong>Short bowel syndrome (SBS) is a malabsorptive condition that may impair drug absorption, including direct oral anticoagulants such as apixaban. This study aimed to assess whether the pharmacokinetics (PK) of apixaban in patients with SBS differs from those observed in individuals with an intact gastrointestinal (GI) tract, using Bayesian re-estimation with an existing population PK (pop PK) model.</p><p><strong>Research design and methods: </strong>Thirteen patients with SBS (7 males, 6 females; median age 79 years, weight 76 kg, eGFR 53 mL/min) receiving apixaban (2.5-7.5 mg twice daily) contributed 69 steady-state plasma concentrations. Bayesian re-estimation was performed using a previously published pop PK model in NONMEM v7.4. Model fit was evaluated using goodness-of-fit (GOF) plots and the trends in the distribution of individual ETA-values. Fractional differences in absorption parameters - ka and F<sub>rel</sub>-between the SBS cohort and the reference population were explored.</p><p><strong>Results: </strong>GOF plots showed no significant bias, and the published model predicted apixaban concentrations in the SBS cohort with acceptable accuracy. Estimated absorption parameters in SBS patients were comparable to those in the original population.</p><p><strong>Conclusion: </strong>In stabilized SBS patients, the absorption of apixaban may not be significantly altered. Standard dosing of apixaban is expected to be appropriate in this population.</p><p><strong>Clinical trial registration: </strong>The https://www.isrctn.com/ identifier is ISRCTN80601124.</p>","PeriodicalId":94005,"journal":{"name":"Expert opinion on drug metabolism & toxicology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145188155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marika Alborghetti, Maria Antonietta Barbieri, Ferdinando Nicoletti, Edoardo Spina
{"title":"Exploring drug interactions between newer antidepressants and medications used to treat neurological disorders.","authors":"Marika Alborghetti, Maria Antonietta Barbieri, Ferdinando Nicoletti, Edoardo Spina","doi":"10.1080/17425255.2025.2566692","DOIUrl":"10.1080/17425255.2025.2566692","url":null,"abstract":"<p><strong>Introduction: </strong>This review examines clinically relevant drug interactions (DIs) between newer antidepressants and medications used to manage neurological disorders frequently comorbid with depression, including Parkinson's disease, Alzheimer's disease, migraine, multiple sclerosis, and neuropathic pain.</p><p><strong>Areas covered: </strong>Articles were obtained from PubMed®, Web of Science, SCOPUS, and Google Scholar searches performed for each of the newer antidepressants and neurological medications. The pharmacokinetic (PK) and pharmacodynamic (PD) mechanisms underlying these DIs were summarized. Some newer antidepressants, such as fluoxetine, paroxetine, fluvoxamine, duloxetine, and bupropion, are moderate to potent inhibitors of various cytochrome P450 (CYP) isoenzymes and can produce clinically relevant interactions with neurologic drugs metabolized by these pathways. In addition, serotonergic antidepressants can precipitate potentially fatal serotonin syndrome when co-administered with monoamine-oxidase-B inhibitors or triptans; these interactions are noted as warnings or contraindications in product labeling.</p><p><strong>Expert opinion: </strong>Clinicians must remain alert to possible DIs between antidepressants and neurological medications. Understanding PK and PD principles, coupled with proactive measures, such as pharmacogenetic testing, therapeutic drug monitoring, use of drug-interaction databases, and close clinical observation, can help to predict, prevent, and manage adverse interactions. Avoiding unnecessary polypharmacy, together with regular medication reviews and deprescribing, is particularly important for older adults with multiple comorbidities.</p>","PeriodicalId":94005,"journal":{"name":"Expert opinion on drug metabolism & toxicology","volume":" ","pages":"1-25"},"PeriodicalIF":3.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vivia Ochmann, Christos Gkoltsos, Chiara Gastaldon, Corrado Barbui, Erich Seifritz, Olav Spigset, Torbjörn Tomson, Georgios Schoretsanitis
{"title":"Paternal exposure to antiseizure medications and offspring outcomes: a systematic review and meta-analysis of observational studies.","authors":"Vivia Ochmann, Christos Gkoltsos, Chiara Gastaldon, Corrado Barbui, Erich Seifritz, Olav Spigset, Torbjörn Tomson, Georgios Schoretsanitis","doi":"10.1080/17425255.2025.2556409","DOIUrl":"10.1080/17425255.2025.2556409","url":null,"abstract":"<p><strong>Introduction: </strong>To assess the risk of adverse offspring outcomes related to paternal antiseizure treatment during conception.</p><p><strong>Methods: </strong>We identified studies of offspring outcomes for fathers with vs. without antiseizure medication(s) during conception in Embase/Medline in 01/2025. Study quality was evaluated using the Newcastle-Ottawa-Scale. Our primary outcome was the odds ratio (OR, 95% confidence intervals [95%CI]) of offspring outcomes in fathers with vs. without antiseizure medication(s). A subgroup analysis assessing the study design impact and sensitivity analyses after excluding poor-quality studies, and sequentially each study, were performed.</p><p><strong>Results: </strong>Of the six studies included (k = 6, n = 17,974), two and four were rated as good- and poor-quality studies, respectively. There were no differences regarding risk of major congenital malformations in offsprings with vs. without paternal antiseizure medication(s) (OR = 1.22, 95%CI = 0.55 to 2.68, <i>p</i> = 0.63), with substantial heterogeneity (I<sup>2</sup> = 93.0%). In six studies (k = 6, n = 17,604) there were no differences regarding risk of neurodevelopmental disorders in offsprings with vs. without paternal antiseizure medication(s) (OR = 1.21, 95%CI = 0.73 to 1.99, <i>p</i> = 0.46, I<sup>2</sup> = 95.6%); ORs of paternal antiseizure medication-related neurodevelopmental disorders were higher in cross-sectional (n = 3) vs. cohort studies (n = 3) (<i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>There is no evidence of elevated risk of adverse outcomes for offsprings with vs. without paternal antiseizure treatment, although heterogeneity was substantial.</p><p><strong>Protocol registration: </strong>www.crd.york.ac.uk/prospero identifier is CRD42025635478.</p>","PeriodicalId":94005,"journal":{"name":"Expert opinion on drug metabolism & toxicology","volume":" ","pages":"1-8"},"PeriodicalIF":3.4,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144983567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Margaux Teil, Jawad Al-Kassmy, Mohammed Alsalmi, Badriya Al-Rawahi, Philippe Huot
{"title":"The on-going quest for a long-acting oral form of levodopa.","authors":"Margaux Teil, Jawad Al-Kassmy, Mohammed Alsalmi, Badriya Al-Rawahi, Philippe Huot","doi":"10.1080/17425255.2025.2535177","DOIUrl":"10.1080/17425255.2025.2535177","url":null,"abstract":"<p><strong>Introduction: </strong>Levodopa is the gold standard symptomatic treatment for Parkinson's Disease (PD). However, its oral formulations lead to fluctuating plasma concentrations with delayed absorption in the stomach and low distribution in the brain due to its metabolism.</p><p><strong>Areas covered: </strong>In this article, we first discuss the pharmacokinetics and pharmacodynamics of levodopa, exposing the problematics of the current levodopa formulations. We then discuss the more recent oral formulations designed to relieve these setbacks, including the development of controlled- and extended-release formulations. Finally, we expose the different alternative routes of administration that can be used, specifically in the case of patients with advanced PD.</p><p><strong>Expert opinion: </strong>With the progression of PD from early to advanced stages, levodopa doses must often be increased with concentrations that remain unstable, leading to sub-optimal symptomatic control and motor complications. Remedying this requires a shift in treatments from the classic oral formulations to more long-acting oral formulations or the use of different administration routes. Among these new administration routes, inhaled levodopa and continuous subcutaneous foslevodopa/foscarbidopa stand out as the most studied and less invasive options. However, with adverse effects associated with each solution, it is important to find approaches that are adapted to each patient.</p>","PeriodicalId":94005,"journal":{"name":"Expert opinion on drug metabolism & toxicology","volume":" ","pages":"1049-1058"},"PeriodicalIF":3.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144639062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Psychedelics, psychiatry and pharmacokinetics - where are we now?","authors":"Alice Caulfield, Elliot Hampsey, Allan H Young","doi":"10.1080/17425255.2025.2549987","DOIUrl":"10.1080/17425255.2025.2549987","url":null,"abstract":"","PeriodicalId":94005,"journal":{"name":"Expert opinion on drug metabolism & toxicology","volume":" ","pages":"1023-1026"},"PeriodicalIF":3.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144877542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}