Correlation between pharmacokinetics of tacrolimus and pharmacodynamics on NFATregulated gene expression in stable kidney transplant recipients

Frieder Keller, Claudia Sommerer, Thomas Giese, Martin Zeier, Bernd Schröppel

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Gene expression regulated by the transcription factor NFAT (nuclear factor of activated T-cells) has been proposed for monitoring the pharmacodynamic effect of calcineurin inhibitors. We aimed to correlate the pharmacokinetics of tacrolimus with the suppression of NFAT-regulated gene expression. Tacrolimus trough (Ctrough) and peak concentrations (Cpeak) were measured by LC-MS. The effect on NFAT-regulated gene expression at trough (Etrough) and at peak levels (Epeak) were determined by qRT-PCR. The pharmacodynamic concentration producing the half-maximum effect (CE50) and the Hill coefficient (H) were estimated from Etrough and from Epeak. Ten stable kidney transplant recipients on triple immunosuppression with prednisolone, mycophenolate, and tacrolimus were analyzed. Median age was 58 years, median time since transplant was 84 months, and median serum creatinine was 249 mol/L. The immunosuppressive effect on NFAT-regulated genes at trough concentrations was 38% (Etrough), and the effect at peak concentrations was 59% (Epeak) of maximum immunosuppression (Emax). The pharmacodynamic parameters of the action of tacrolimus were estimated with the Hill coefficient H at 1.5 and the CE50 at 6.7 ng/mL. Accordingly, the pharmacodynamic threshold concentration was estimated at 0.9 ng/mL and the ceiling concentration at 48 ng/mL, indicating a wide span between target trough and peak levels. The low Hill coefficient indicates concentration-dependent pharmacodynamics of tacrolimus on NFAT transcripts. Therefore, the extension of the administration interval to 24 hours is not likely to jeopardize the immunosuppressive effect of the prolonged-release tacrolimus preparations.

Original languageEnglish
Pages (from-to)93-99
Number of pages7
JournalClinical Nephrology
Volume87
Issue number2
DOIs
StatePublished - 2017
Externally publishedYes

Keywords

  • Kidney transplant
  • NFAT
  • Pharmacodynamics
  • Pharmacokinetics
  • Tacrolimus

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