PET studies on P-glycoprotein function in the blood-brain barrier: How it affects uptake and binding of drugs within the CNS

Permeability of the blood-brain barrier (BBB) is one of the factors determining the bioavailability of therapeutic drugs. The BBB only allows entry of lipophilic compounds with low molecular weights by passive diffusion. However, many lipophilic drugs show negligible brain uptake. They are substrates for transporters such as P-glycoprotein (P-gp), multidrug-resistance associated protein (MRP) and organic anion transporting polypeptides (OATPs). The action of these carrier systems results in rapid efflux of xenobiotics from the central nervous system (CNS). Classification of candidate drugs as substrates or inhibitors of such carrier proteins is of crucial importance in drug development. Positron emission tomography (PET) can play an important role in the screening process by providing in vivo information, after the putative drug has passed in vitro tests. Although radiolabeled probes for MRP and OATP function are not yet available, many radiotracers have been prepared to study P-glycoprotein function in vivo with PET. These include alkaloids (¹¹C-colchicine), antineoplastic agents (¹¹C-daunorubicin, ¹⁸F-paclitaxel), modulators of L-type calcium channels (¹¹C-(±)verapamil, ¹¹C-R(+)-verapamil), β-adrenoceptor antagonists (¹¹C-(S)-carazolol, ¹⁸F-(S -1′-fluorocarazolol, ¹¹C-carvedilol), serotonin 5-HT_1A receptor antagonists (¹⁸F-MPPF), opioid receptor antagonists (¹¹C-loperamide, ¹¹C-carfentanyl), and various ⁶⁴Cu-labeled copper complexes. Studies in experimental animals have indicated that it is possible to assess P-glycoprotein function in the BBB and its effect on the uptake and binding of drugs within the intact CNS, using suitable P-gp modulators labeled with positron emitters. Provided that radiopharmaceuticals (and P-gp modulators) can be developed for human use, several exciting fields of study may be explored, viz. (i) direct evaluation of the effect of modulators on the cerebral uptake of therapeutic drugs; (ii) assessment of mechanisms underlying drug resistance in epilepsy; (iii) examination of the role of the BBB in the pathophysiology of neurodegenerative and affective disorders; and (iv) exploration of the relationship between polymorphisms of transporter genes and the pharmacokinetics of test compounds within the CNS.