@phdthesis{Gnadt2010,
  author    = {Gnadt, Mirjam},
  title     = {Pharmacokinetic and pharmacodynamic characterization of inhaled β2 - agonists using the isolated human lung perfusion model},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-53910},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2010},
  abstract  = {The inhaled pharmacotherapy is fundamental in the management of obstructive lung diseases such as asthma bronchiale or chronic obstructive pulmonary disease. In this context short- and long-acting β2-agonists play a prominent role as relieve and control medication. Regarding the risk-benefit profile of an inhaled drug, the pattern of pulmonary deposition and the rate and extent of absorption into systemic circulation are essential parameters. New developments of drugs are characterized by high lung retention and improved efficacy. The aim of the present thesis was the parallel evaluation the pharmacokinetic (PK) and -dynamic (PD) properties of inhaled β2-agonists employing an isolated human lung perfusion model (IPL). The short-acting β2-agonist salbutamol and the newly developed ultra long-acting β2-agonist GW597901 were chosen for the analysis of pulmonary drug absorption and bronchodilation. In a pharmacokinetic enabling study an established human IPL setting was modified to monitor the pharmacokinetics of the β2-agonists by measuring the concentrations in perfusion fluid, lung tissue and BAL samples obtained during and after the experiments. The IPL model revealed differences in the pulmonary absorption behaviour of GW597901 and salbutamol. The lipophilic compound GW597901 was distributed to a lower extent into the perfusion fluid compared to the more hydrophilic compound salbutamol. The analyzed time profiles of nebulized salbutamol in the perfusate were consistent to with a clinical study if considering experimental conditions as the actual deposited doses and the differing volume of distribution. Thus, the suitability of the IPL model for the PK analysis of inhaled β2-agonists was confirmed. In a PK/PD study the human ex vivo model was employed for the first time for the evaluation of the clinical relevant bronchodilating effect induced by inhaled β2-agonists in addition to the analysis of their pharmacokinetics. Thereby the focus was to determine the onset and extent of bronchodilation. A new method was established to monitor changes in lung function parameters due to pharmacodynamic interventions over the duration of the experiment that allowed permanent online recording of the ventilation volume and lung mechanic parameters. Bronchial challenges with aerolised MCh were performed successfully in isolated ventilated human lung lobes, even though the responder rate was lower than expected despite high administered doses. The administration of the short acting agent salbutamol led to an immediate onset of action recognized as a sudden increase of the ventilation volumes. The bronchodilation following the application of GW597901 was observed delayed after about 6 min. Monitored lung function parameters considerably improved by both β2 - agonists in the IPL setting but not significantly different. Thus, in regard of the different applied doses GW597901 had a higher intrinsic activity and bronchodilating potency than salbutamol. The concentrations of salbutamol and GW597901 in the perfusate determined in the PK/PD study were significantly lower than those observed in the pharmacokinetic enabling study, while the tmax values and the course of the distribution profiles remained similar. Most likely, the application of nebulized MCh prior to the administration of the β2 - agonists had a substantial influence on their pharmacokinetic behaviour. It is yet not clear whether pharmacodynamic effects or molecular competition processes for the passage to the systemic circulation or both influenced the redistribution of the β2 - agonists as seen in the PK/PD study. The potential clinical relevance of this observation has to be further investigated. The development of pulmonary edema during the experiment was one limitation of the IPL model. For the determination of the onset of edema formation four potential biochemical markers, specifically surfactant-protein A (SP-A), angiotensin-converting enzyme (ACE), urea and lactate dehydrogenase, were measured in perfusion fluids. In this context, an ELISA method for the quantification of human SP-A in biological matrices was successfully established. The investigations showed that the concentrations of SP-A and ACE in the perfusate increased over time as a sign for lung tissue damage and correlated with the degree of edema formation. For the first time the IPL model was used for the evaluation of potential pulmonary edema marker and the results have shown that it is valuable tool for further investigations in this field. In conclusion, the pharmacokinetic and pharmacodynamic characterization of GW597901 and salbutamol was successfully achieved using the IPL model. This ex vivo methodology may contribute to further insights and understanding of the complex pharmacokinetic processes of inhaled β2 - agonists in the lung.},
  subject      = {Beta-2-Rezeptor},
  language  = {en}
}