Abstract
Only partial deficiency/inhibition of P-glycoprotein (P-gp, ABCB1) function at the blood-brain barrier (BBB) is likely to occur in pathophysiological situations or drug-drug interactions. This raises questions regarding the sensitivity of available PET imaging probes to detect moderate changes in P-gp function at the living BBB. In vitro, the half-maximum inhibitory concentration (IC(50)) of the potent P-gp inhibitor tariquidar in P-gp-overexpressing cells was significantly different using either [(11)C]verapamil (44 nM), [(11)C]N-desmethyl-loperamide (19 nM) or [(11)C]metoclopramide (4 nM) as substrate probes. In vivo PET imaging in rats showed that the half-maximum inhibition of P-gp-mediated efflux of [(11)C]metoclopramide, achieved using 1 mg/kg tariquidar (in vivo IC(50) = 82 nM in plasma), increased brain exposure by 2.1-fold for [(11)C]metoclopramide (p < 0.05, n = 4) and 2.4-fold for [(11)C]verapamil (p < 0.05, n = 4), whereby cerebral uptake of the "avid" substrate [(11)C]N-desmethyl-loperamide was unaffected (p > 0.05, n = 4). This comparative study points to differences in the "vulnerability" to P-gp inhibition among radiolabeled substrates, which were apparently unrelated to their "avidity" (maximal response to P-gp inhibition). Herein, we advocate that partial inhibition of transporter function, in addition to complete inhibition, should be a primary criterion of evaluation regarding the sensitivity of radiolabeled substrates to detect moderate but physiologically-relevant changes in transporter function in vivo.