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Blood-Brain Barrier P450 Enzymes and Multidrug Transporters in Drug Resistance: A Synergistic Role in Neurological Diseases

期刊

CURRENT DRUG METABOLISM
卷 12, 期 8, 页码 742-749

出版社

BENTHAM SCIENCE PUBL LTD
DOI: 10.2174/138920011798357051

关键词

Blood-brain barrier; drug resistant epilepsy; multidrug transporters proteins (MDT); P450 enzymes

资金

  1. Epilepsy Foundation
  2. Cleveland Clinic-Swedish Satellite Laboratory, Federal Appropriation Washington State
  3. [R21 HD057256]

向作者/读者索取更多资源

Drug penetration into the central nervous system (CNS) is controlled by the blood-brain barrier (BBB). Even though a number of strategies to circumvent the BBB and to improve drug access have been developed, drug resistance in CNS diseases remains an unmet clinical problem. We here review the mechanisms by which a healthy or pathological BBB influences drug distribution in the brain, with emphasis on the role of P450 metabolic enzymes and multi-drug transporter (MDT) proteins. In addition to the classic hepatic and gut biotransformation pathways, CNS expression of P450 enzymes may bear pharmacokinetic and pharmacodynamic significance exerting a metabolic activity and transforming parent drugs into specific products. We propose these mechanisms to play a major role in CNS drug resistant pathologies including refractory forms of epilepsy. Changes in the cerebrovascular hemodynamic conditions can affect expression of P450 enzymes and MDT proteins. This should be taken into account when developing in vitro experimental approaches to reproduce the physiological or pathological properties of the BBB. Finally, a link between P450 and MDT expression in the diseased brain and cell survival is discussed.

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