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. 2023 Jun 1:14:1142003.
doi: 10.3389/fphar.2023.1142003. eCollection 2023.

Mechanistic evaluation of the inhibitory effect of four SGLT-2 inhibitors on SGLT 1 and SGLT 2 using physiologically based pharmacokinetic (PBPK) modeling approaches

Affiliations

Mechanistic evaluation of the inhibitory effect of four SGLT-2 inhibitors on SGLT 1 and SGLT 2 using physiologically based pharmacokinetic (PBPK) modeling approaches

Yu Zhang et al. Front Pharmacol. .

Abstract

Sodium-glucose co-transporter type 2 (SGLT 2, gliflozins) inhibitors are potent orally active drugs approved for managing type 2 diabetes. SGLT 2 inhibitors exert a glucose-lowering effect by suppressing sodium-glucose co-transporters 1 and 2 in the intestinal and kidney proximal tubules. In this study, we developed a physiologically based pharmacokinetic (PBPK) model and simulated the concentrations of ertugliflozin, empagliflozin, henagliflozin, and sotagliflozin in target tissues. We used the perfusion-limited model to illustrate the disposition of SGLT 2 inhibitors in vivo. The modeling parameters were obtained from the references. Simulated steady-state plasma concentration-time curves of the ertugliflozin, empagliflozin, henagliflozin, and sotagliflozin are similar to the clinically observed curves. The 90% prediction interval of simulated excretion of drugs in urine captured the observed data well. Furthermore, all corresponding model-predicted pharmacokinetic parameters fell within a 2-fold prediction error. At the approved doses, we estimated the effective concentrations in intestinal and kidney proximal tubules and calculated the inhibition ratio of SGLT transporters to differentiate the relative inhibition capacities of SGLT1 and 2 in each gliflozin. According to simulation results, four SGLT 2 inhibitors can nearly completely inhibit SGLT 2 transporter at the approved dosages. Sotagliflozin exhibited the highest inhibition activity on SGLT1, followed by ertugliflozin, empagliflozin, and henagliflozin, which showed a lower SGLT 1 inhibitory effect. The PBPK model successfully simulates the specific target tissue concentration that cannot be measured directly and quantifies the relative contribution toward SGLT 1 and 2 for each gliflozin.

Keywords: SGLT2 inhibitors; inhibitory effect; physiologically-based pharmacokinetic model; sodium-glucose cotransporter 1 and 2; type 2 diabetes mellitus (T2DM).

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Schematic representation of workflow of this study and a basic framework of the developed SGLT 2 inhibitors PBPK model. This schematic diagram shows the mechanistic perfusion-limited models contained in this study (Emami Riedmaier et al., 2016). The perfusion-limited models were added in this extended SGLT 2 inhibitor model used in this study to describe glucose filtration, reabsorption, and excretion. SGLT 2 is expressed in the S1 and S2 segments of the proximal tubule. SGLT 1 is expressed in the S3 segment of the proximal tubule. Phys-chem, physicochemical; Q, Plasma flows rate to tissue; QH, Blood flows in the hepatic vein; QHa, Blood flows in the hepatic artery; ACAT, Advanced compartmental absorption and transit; PT, Proximal tubule; HL, Henle’s loop; DT, Distal tubule; Me-du-CD, Medullary collecting duct.
FIGURE 2
FIGURE 2
Chemical structures of ertugliflozin, empagliflozin, henagliflozin, and sotagliflozin.
FIGURE 3
FIGURE 3
Predicted (lines) and observed (symbol) plasma concentration-time profiles after a single dose with the updated PBPK model. (A) Ertuglifozin; (B) Empagliflozin; (C) Henagliflozin; (D) Sotagliflozin. PBPK, Physiologically based pharmacokinetic.
FIGURE 4
FIGURE 4
Simulated (lines) and observed (symbols) plasma concentrations for 2.5 mg single dose of henagliflozin with the original PBPK model.
FIGURE 5
FIGURE 5
Parameter sensitivity analysis for 2.5 mg henagliflozin single oral administration. Peff, Permeability; Rbp, Blood to plasma ratio.
FIGURE 6
FIGURE 6
Simulated (lines) and observed (symbols) plasma concentrations for 200 mg single doses of sotagliflozin with the original PBPK model. (A) The origin PBPK model; (B) Optimized the gut first-pass effect; (C) Optimized the stomach transit time.
FIGURE 7
FIGURE 7
Parameter sensitivity analysis for 200 mg sotagliflozin single oral administration. PSA, Parameter sensitivity analysis; StTransTime, Stomach transit time; SITT, Small intestine transit time; Ref Sol, Reference solubility; CTranT, Colon transit time. (A) Parameter sensitivity analysis of the Cmax; (B) Parameter sensitivity analysis of the Tmax.
FIGURE 8
FIGURE 8
Simulated plasma concentrations of multiple doses (8 days doses) of sotagliflozin. (A) 200 mg once daily; (B) 400 mg once daily.
FIGURE 9
FIGURE 9
Observed urinary excretion (red) of gliflozins after administration and the 90th confidence interval of the virtual population simulation (green shadow, n = 100). (A) 5 mg ertugliflozin; (B) 15 mg ertugliflozin; (C) 10 mg empagliflozin; (D) 25 mg empagliflozin; (E) 5 mg henagliflozin; (F) 10 mg henagliflozin; (G) 200 mg sotagliflozin; (H) 400 mg sotagliflozin.
FIGURE 10
FIGURE 10
Simulation of inhibitory effects on sodium-glucose co-transporter1 (SGLT 1 s) in duodenum segment at approved doses. (A) Ertugliflozin; (B) Empagliflozin; (C) Henagliflozin; (D) Sotagliflozin.
FIGURE 11
FIGURE 11
Simulation of inhibitory effects on sodium-glucose co-transporter1 (SGLT 1 s) in Jejunum I segment at approved doses. (A) Ertugliflozin; (B) Empagliflozin; (C) Henagliflozin; (D) Sotagliflozin.
FIGURE 12
FIGURE 12
Simulation of inhibitory effects on sodium-glucose co-transporter2 (SGLT 2 s) in kidney proximal tubules at approved doses. (A) Ertugliflozin; (B) Empagliflozin; (C) Henagliflozin; (D) Sotagliflozin.
FIGURE 13
FIGURE 13
Simulation of inhibitory effects on sodium-glucose co-transporter1 (SGLT 1 s) in kidney proximal tubules at approved doses. (A) Ertugliflozin; (B) Empagliflozin; (C) Henagliflozin; (D) Sotagliflozin.

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Grants and funding

This work was supported by National High Level Hospital Clinical Research Funding (BJ-2022-132).

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