Department of Pharmaceutical Sciences, College of Pharmacy,
University of Nebraska Medical Center, Omaha, Nebraska (H.S., W.F.E.);
and Drug Delivery and Kinetics Resource, Division of Bioengineering and
Physical Science, National Institutes of Health, Bethesda, Maryland
(P.M.B.)
Intracerebral microdialysis probe recovery (extraction fraction) may be
influenced by several mass transport processes in the brain, including
efflux and uptake exchange between brain and blood. Therefore, changes
in probe recovery under various experimental conditions can be useful
to characterize fundamental drug transport processes. Accordingly, the
effect of inhibiting transport on probe recovery was investigated for
two capillary efflux transporters with potentially different membrane
localization and transport mechanisms, P-glycoprotein and an organic
anion transporter. Fluorescein/probenecid and quinidine/LY-335979 were chosen as the substrate/inhibitor combinations for organic anion transport and P-glycoprotein-medicated transport, respectively. Probenecid decreased the probe recovery of fluorescein in frontal cortex, from 0.21 ± 0.017 to 0.17 ± 0.020 (p < 0.01). Quantitative microdialysis calculations indicated that
probenecid treatment reduced the total brain elimination rate constant
by 3-fold from 0.37 to 0.12 (ml/min · ml of extracellular
fluid). In contrast, the microdialysis recovery of quinidine, delivered
locally to the brain via the probe perfusate, was not sensitive to
P-glycoprotein inhibition by systemically administered LY-335979, a
potent and specific inhibitor of P-glycoprotein. Recovery of
difluorofluorescein, an analog of fluorescein, was also decreased by
probenecid in the frontal cortex but not in the ventricle cerebrospinal
fluid. These experimental observations are in qualitative agreement
with microdialysis theory incorporating mathematical models of
transporter kinetics. These studies suggest that only in certain
circumstances will efflux inhibition at the blood-brain barrier and
blood-cerebrospinal fluid barrier influence the microdialysis probe
recovery, and this may depend upon the substrate and inhibitor examined
and their routes of administration, the localization and mechanism of
the membrane transporter, as well as the microenvironment surrounding the probe.
 |
Introduction |
Microdialysis
is a powerful technique that enables continuous monitoring of drug
concentration in the extracellular space of various tissues in the same
animal. It is well suited for pharmacokinetic studies and has been
widely applied to assess drug distribution to target tissues
(Elmquist and Sawchuk, 1997
). Since microdialysis sampling is a non-equilibrium process, the drug concentration in the
dialysate is some fraction of the actual extracellular free drug
concentration, and the ratio of the concentration of the drug in the
dialysate to the concentration of drug in the extracellular fluid is
defined as the recovery (or extraction fraction) of the microdialysis
probe. This microdialysis probe recovery is influenced by experimental
factors such as the dialysate flow rate, dialysis membrane composition,
effective surface area, and probe geometry. For microdialysis in vivo,
the tissue environment can have additional effects on recovery.
Processes eliminating solutes from the extracellular fluid (metabolism
and brain-to-blood efflux), as well as diffusional properties
(diffusion coefficient, tortuosity, extracellular volume fraction),
determine the spatial concentration profile and the tissue mass
transfer resistance about the probe (Amberg and Lindefors,
1989
; Bungay, et al., 1990
; Morrison et
al., 1991
). For most compounds, the tissue mass transfer resistance plays a more important role than the resistance from the
probe membrane or dialysate in determining the extraction fraction in
vivo. Therefore, it may be possible to use probe recovery to examine
drug mass transfer processes, such as transporter-mediated drug
transport across the blood-brain barrier.
Brain microdialysis has been used to study the active transport
processes that influence drug distribution across the blood-brain barrier and BCSFB (Wong et al., 1993
; Wang et
al., 1995
; Desrayaud et al., 1997
; de
Lange et al., 1999
; Rao et al., 1999
). In these studies, the concentration of the drug in the brain extracellular fluid
or the cerebrospinal fluid was monitored by brain microdialysis and an
apparent drug brain/plasma distribution ratio was calculated. The role
of transporters at the blood-brain barrier and BCSFB in limiting the
transport of the solute into the CNS was examined by comparing the
brain/plasma distribution ratio when the transport protein was present
or genetically depleted/pharmacologically inhibited (Wong et
al., 1993
; de Lange et al., 1998
; Rao et
al., 1999
). However, the use of quantitative microdialysis to
study transport processes has not been restricted to the estimation of
brain extracellular fluid concentrations. Dykstra et al.
(1993)
have shown, using quantitative autoradiography, that the
concentration-distance profile of zidovudine in brain tissue
surrounding the microdialysis probe was significantly altered by the
administration of probenecid. This change in the concentration-distance
profile was attributed to the inhibition of zidovudine capillary efflux
transport by probenecid and was accompanied by a decreased
microdialysis probe recovery. Furthermore, a new application of
quantitative microdialysis was also developed to estimate the
microvascular transport constants from in vivo microdialysis probe
recovery (Beagles et al., 1998
). Therefore, these
studies indicate that the in vivo microdialysis probe recovery can be
used to study active transport processes present in the brain
capillary. The appropriate application of this technique for this
purpose needs further examination.
The purpose of the present study was to investigate the effect of
transport inhibition at the blood-brain barrier and BCSFB on the brain
microdialysis probe recovery using the steady-state retrodialysis
method. A theoretical model is proposed to describe the transport
kinetics of two different transporters, such as P-glycoprotein and an
organic anion transporter, by using a simple steady-state model of
transport across a cell monolayer that can describe drug transport
across the capillaries of the blood-brain barrier (see
Appendix). In this model, a relationship between the mechanism of transport and the effect of inhibitors on capillary efflux
is presented. Coupled with the effects of capillary efflux exchange on
the microdialysis recovery (Bungay et al., 1990
), it is
suggested that the effect of transport inhibitors on microdialysis recovery can give insights into the mechanism of transport at the
blood-brain barrier.
To explore these relationships, two substrate/inhibitor pairs were
used. The effect of probenecid on the probe recovery of fluorescein was
determined as an example of organic anion transport and the effect of
LY-335979, a potent and specific P-glycoprotein inhibitor
(Dantzig et al., 1999
), on the probe recovery of
quinidine was determined as an example of P-glycoprotein-mediated
transport. In previous studies, these inhibitors were shown to
significantly enhance the brain distribution of the substrates
(Wang et al., 1996
; Huai-Yun et al.,
1998
; Sun et al., 1998
). In addition, the influence of other competing elimination processes, such as brain metabolism, on the influence of transport inhibition on probe recovery
was analyzed through simulations based on a mathematical model of
microdialysis sampling (Bungay, et al., 1990
).
 |
Experimental Procedures |
Experimental Methods
Chemicals.
Fluorescein and difluorofluorescein were
purchased from Molecular Probes (Eugene, OR). Probenecid and quinidine
were purchased from Sigma (St. Louis, MO) and Acros (Pittsburgh, PA),
respectively. LY-335979 was a gift from Eli Lilly (Indianapolis, IN).
Solvents were of HPLC grade, and all other chemicals were reagent grade or better.
Microdialysis Probe Placement.
Male Wistar rats weighing
between 260 and 340 g were used in this study. The surgical
procedures for implantation of the microdialysis probe guide cannula,
probe placement, and the cannulation of the femoral artery and vein
were similar to Yang et al. (1996)
with slight
modification. At all times, including the microdialysis sampling
period, the rats had free access to food and water. Surgical preparation of these rats was done using aseptic techniques, and all
surgical procedures were performed under anesthesia using an i.p. dose
of 50 mg/kg sodium pentobarbital (Abbott Laboratories, Chicago, IL). An
i.m. dose of 60,000 units of procaine penicillin G (Wyeth-Ayerst,
Princeton, NJ) was given after surgery.
The stereotaxic coordinates for probe placement in the frontal cortex
were 3.0 mm anterior and 1.5 mm lateral (left) to the bregma; the tip
of the guide cannula was 1 mm ventral from the brain surface. For probe
placement in the lateral ventricle, the coordinates were 0.8 mm
posterior and 1.5 mm lateral (right) to the bregma, and 3.0 mm ventral
from the brain surface. The rat was allowed to recover for 3 to 4 days
after placement of the guide cannula. The femoral artery and vein were
then cannulated for blood sampling and dose administration,
respectively. CMA/12 microdialysis probes (CMA-Microdialysis, Acton,
MA) of 3-mm and 1-mm membrane length were used for cortex extracellular
fluid and ventricle cerebrospinal fluid sampling, respectively, and the
probes were slowly implanted into the brain parenchyma and lateral
ventricle through the guide cannula approximately 18 to 24 h
before the initiation of sampling via the probe. These procedures adhered to the Principles of Animal Care outlined by
National Institutes of Health publication 85-23 and were approved by
the Institutional Animal Care and Use Committee of the University of
Nebraska Medical Center.
Microdialysis Sampling Procedure.
For both in vitro and in
vivo microdialysis sampling, CMA/12 probes were perfused with
artificial cerebrospinal fluid [119.5 mM NaCl, 4.75 mM KCl, 1.27 mM
CaCl2, 1.19 mM KH2PO4, 1.19 mM
MgSO4, 1.6 mM Na2HPO4 (pH 7.2)]
(Benveniste and Huttemeier, 1990
) using a
microprocessor-controlled syringe pump (Harvard 22, Harvard Apparatus,
Natick, MA). The perfusate flow rate through both the ventricle probe
(1 mm) and the cortical probe (3 mm) was 0.5 µl/min. Microdialysates
were collected over 20-min intervals directly into the injection loops
of a multiport valve (E-36; Valco, Houston, TX), controlled by a
digital valve sequence programmer (DVSP2, Valco). Microdialysates were
then directly injected into the HPLC for analysis (see below).
Sample Analysis.
The determination of fluorescein and
difluorofluorescein concentration in microdialysate was done using HPLC
with fluorescence detection. The HPLC system consisted of a LC-10AD
pump, RF-10A fluorometric detector, and CR501 integrator (Shimadzu,
Kyoto, Japan). Separations were carried out on a BDS-Hypersil C-18
column (2.0 × 150 mm, 5 µm) (Keystone Scientific, Inc.,
Bellefonte, PA). The mobile phase was an acetonitrile:buffer mix
(13.6:86.4, w/w) with a buffer composition of 10 mM ammonium phosphate
and 10 mM sodium citrate (pH 6). The mobile phase flow rate was 0.25 ml/min, and the column eluate was monitored at excitation and emission wavelengths of 488 and 510 nm, respectively.
The HPLC system and column for the analysis of quinidine concentration
in microdialysate was the same as described above. Analytes were eluted
by a mixture of 20 mM ammonium monobasic phosphate and 20 mM tartaric
acid, adjusted to pH 3.6 with sodium hydroxide, and acetonitrile
(86.6:14.4, w/w), with the excitation wavelength of 260 nm, the
emission wavelength of 430 nm, and a mobile phase flow rate of 0.25 ml/min.
Determination of Probe Recovery in Vitro.
A CMA/12 3-mm
microdialysis probe was placed in a 2-ml vial containing well stirred
drug-free artificial cerebrospinal fluid at 37°C. Artificial
cerebrospinal fluid containing fluorescein, difluorofluorescein, or
quinidine was placed into a gas tight syringe and perfused through the
probe at a flow rate of 0.5 µl/min. The same perfusate and flow rate
were used in vivo to allow for direct comparison of the recoveries
(eqs. 3 and 4). Microdialysate samples from the microdialysis probe
were collected every 20 min. The concentration of the compound of
interest in the microdialysate was used to calculate in vitro
microdialysis probe recovery (eq. 1).
Study Design and Drug Administration.
The effect of
probenecid on the in vivo probe recovery of fluorescein and/or
difluorofluorescein, a fluorinated analog of fluorescein (Fig.
1), was studied using the following two
study designs.
Longitudinal study.
Fluorescein and difluorofluorescein
(0.02 µg/ml) in artificial cerebrospinal fluid were perfused through
a microdialysis probe in the cortex without (first phase) or with
(second phase) systemic intravenous administration of probenecid to
five rats. In a repeated control group (n = 3), animals
received probenecid vehicle (8.4% NaHCO3 in saline) in the
second phase.
Balanced-crossover study.
Difluorofluorescein (0.02 µg/ml)
in artificial cerebrospinal fluid was perfused through microdialysis
probe in cortex and ventricle to six rats, with or without the systemic
administration of probenecid. In this study, rats were equally
divided into two groups. Group A received treatment with
probenecid in phase one and without probenecid in phase two. Group B
received the opposite treatment order. In the above two studies,
probenecid was given 100 mg/kg intravenous bolus followed by an
infusion of 30 mg/kg/h.
The effect of LY-335979 on the probe recovery of quinidine
(n = 3).
Quinidine (0.03 µg/ml) in artificial cerebrospinal
fluid was perfused through microdialysis probes without (first phase)
or with (second phase) systemic administration of LY-335979. LY-335979 was given as a 10 mg/kg intravenous bolus followed by an infusion of
1.25 mg/kg/h.
Microdialysis sampling.
Microdialysate samples from the
frontal cortex or the lateral ventricle were continuously collected
every 20 min for approximately 20 h. The concentration of the
compound of interest in the microdialysate was used to calculate
microdialysis probe recovery (eq. 1).
Microdialysis Calculations
Probe Recovery in Vitro and in Vivo.
The recovery of the
probes was determined using the method of retrodialysis (Wang et
al., 1993
). The solute of interest (i.e., fluorescein,
difluorofluorescein, or quinidine) was added to the perfusion fluid,
and their relative loss was used to determine the recovery through the
following relationship.
|
(1)
|
where PA(out) and
PA(in) were the HPLC chromatographic peak areas
of the solute of interest in the dialysate leaving the probe and in the
perfusate entering the probe, respectively.
The Estimation of Mass Transfer Resistance.
According to
Bungay et al. (1990)
, the probe recovery or the
dialysate extraction fraction (Ed) at steady
state is equal to
|
(2)
|
where Cout and Cin
denote the outlet and inlet dialysate concentration, respectively.
Ce
is the extracellular concentration far
from the probe. Qd is the flow rate of the
perfusate, and R stands for the mass transfer resistance for
dialysate (Rd), microdialysis membrane
(Rm) and surrounding tissue
(Re). The mass transfer resistance expresses the
proportionality between the driving force concentration difference and
the resultant mass flow rate in this environment of three resistances
in series. The mass transfer resistances associated with the probe can
be determined from in vitro probe recovery. When there is no tissue resistance,
|
(3)
|
The total mass transfer resistance can be estimated from in vivo
probe recovery,
|
(4)
|
Thus, Re can be obtained by subtracting
the in vitro mass transfer resistance from in vivo values.
Penetration Distance and Microvascular Efflux Rate
Constants.
The resistance in the tissue is defined as
|
(5)
|
where K0 and K1
are the modified Bessel functions of the second kind with dimensionless
argument ro/
, De is the diffusion coefficient in brain extracellular fluid, L is the length of
dialysis membrane, ro is the outer radius of
dialysis membrane,
e is the extracellular
volume fraction near the probe, and
is the penetration distance.
The microdialysis probe parameter values that were used for recovery
model simulations (e.g., Fig. 2), and for
the fluorescein and quinidine mass transport parameter calculations,
are listed in Table 1. The penetration
distance is related to the diffusion coefficient and several first
order rate constants as follows
|
(6)
|
and is defined as the distance from probe surface to the point
where the concentration is roughly half its far-field value (i.e.,
Ce
). k is the first order rate constant
representing efflux to the microvasculature
(k
), irreversible extracellular
metabolism (k
), and the composite of
irreversible intracellular metabolism and extracellular-intracellular
exchange (k
) (Bungay et al.,
1990
).

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Fig. 2.
Predicted sensitivity of steady-state probe recovery
(Ed) to variation in the rate constant for
transport from the brain to the microvasculature
(k ) under different values of competing
elimination processes (kr = k + k , eq. 6, in units of ml/(min · ml
extracellular fluid)). The values are representative of drugs of
molecular weight of about 300 daltons. The solid circle represents the
in vivo recovery value for fluorescein measured under control
conditions and the corresponding calculated clearance rate constant of
k = 0.37 of ml/(min · ml
extracellular fluid). The simulations employed the measured well
stirred in vitro recovery for fluorescein of E = 0.47.
|
|
Simulation for the Effect of First Order Elimination on Probe
Recovery.
Simulations according to the above microdialysis probe
recovery mathematical model (eqs. 2-6) were performed using the
Microsoft Excel spreadsheet software. There are existing subroutines in the Excel program to calculate the modified Bessel functions of an
argument. A parameter sensitivity analysis was performed using estimated and known parameters of the microdialysis recovery
experiments to determine the relative importance of various model
parameters on the resultant microdialysis recovery.
 |
Results |
Sensitivity Analysis for the Effect of First Order Elimination on
Probe Recovery.
Except for certain limiting cases, such as solutes
subject to very rapid tissue elimination, the tissue resistance
(Re) is the largest contributor to the overall
mass transfer resistance. As a result, Re is
important in determining in vivo probe recovery (Ed). Key factors affecting the level of
Re and Ed are the
elimination rate constants (k
,
k
and k
parameters
in eq. 6), since these vary over several orders of magnitude among
solutes. Simulations were performed to better understand the influence of the efflux rate constant, k
, on the
microdialysis behavior of drugs transported across the blood-brain
barrier. The simulation considered hypothetical drugs with the same
interstitial diffusion coefficient but differing efflux and non-efflux
elimination rates. The diffusion coefficient was fixed at the value
estimated for fluorescein (332.3 daltons) from a measured value for
sucrose (342.3 daltons) in brain interstitium (Patlak and
Fenstermacher, 1975
). The extracellular volume fraction,
e, was set at the value of 0.35 previously
estimated for brain parenchyma in the vicinity of acutely implanted
probes (Dykstra et al., 1992
). Probe geometric
parameters were chosen to represent a CMA/12 probe with a 3-mm membrane length.
Inhibiting any of the elimination processes (efflux transport or intra-
and extracellular metabolism), will reduce the corresponding rate
constant (k
, k
, or
k
). This would result in an increased
tissue resistance (eqs. 5 and 6) and therefore a decreased in vivo
probe recovery (eq. 2). In examining the influence of capillary efflux
on the in vivo probe recovery, the effect of efflux transport
inhibition (i.e., reduced k
) alone can be
estimated by holding k
and
k
constant, assuming no effects on
metabolism by efflux inhibition or deletion (as in a transport gene
knockout model). From Fig. 2 we can see that Ed
is most sensitive to variation in k
when
there are no other competing mechanisms for removal from the
extracellular fluid (kr = k
+ k
= 0) and when the transport process itself is
slow (i.e., k
is small). In this case,
Ed drops significantly with a slight decrease in
k
. On the other hand, there are limiting
situations in which Ed is insensitive to
inhibition of capillary efflux. In these situations,
Re is too low to contribute significantly to the
total diffusional resistance. One is the situation in which competing
elimination processes (metabolism) are rapid and dominant (i.e.,
kr is large), so that Ed
loses sensitivity to any changes in k
. The other is the limit of rapid efflux (i.e.,
k
is large) for which small changes in
k
do not appreciably affect
Ed.
The Influence of Probenecid on in Vivo Probe Recovery of
Fluorescein and Its Microdialysis Calibrator Difluorofluorescein in the
Longitudinal Study.
Previous studies have shown that the in vitro
and in vivo probe recovery of difluorofluorescein was similar to that
of fluorescein (Sun et al., 1998
). Therefore,
difluorofluorescein has been used as the retrodialysis calibrator in
the study of the transport of fluorescein across the blood-brain
barrier and BCSFB. The influence of probenecid on probe recovery of
both fluorescein and difluorofluorescein was then examined. Fluorescein
and difluorofluorescein were perfused through the probe implanted in
rat frontal cortex for 8 h before the start of the systemic
administration of probenecid. The in vivo microdialysis probe recovery
of fluorescein and difluorofluorescein significantly decreased
following the administration of probenecid. A representative recovery
versus time profile is shown in Fig. 3A.
To see if there is a treatment order effect, a repeated control was
performed and a representative recovery versus time profile is shown in
Fig. 3B. After 10 to 12 h of probenecid infusion, the average
probe recovery for both fluorescein and difluorofluorescein was
significantly less than control, p < 0.01 (Fig.
4). Importantly, this reduction in
difluorofluorescein recovery was not significantly different than the
reduction in fluorescein recovery, indicating that this would be a
suitable retrodialysis calibrator under the condition of efflux
transport inhibition. There was no significant difference in the in
vivo recoveries for both fluorescein and difluorofluorescein between
the two phases in the repeated control study.

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Fig. 3.
The retrodialysis probe recovery versus time profiles
of fluorescein and difluorofluorescein in cortical extracellular fluid
in representative rats. The solid and open circles represent the probe
recovery of fluorescein and difluorofluorescein, respectively, in the
control condition. The solid and open triangles represent the probe
recovery of fluorescein and difluorofluorescein, respectively, in the
probenecid-treated condition (A) or in the repeated-control condition
(B).
|
|

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Fig. 4.
The effect of probenecid on the retrodialysis probe
recovery of fluorescein and difluorofluorescein in cortical
extracellular fluid (mean ± S.D., n = 5).
PBD-txt, probenecid-treated phase, rats were given probenecid
intravenously. , Student's t test p < 0.01, significantly different from control phase.
|
|
The Influence of Probenecid on Probe Recovery of
Difluorofluorescein in the Balanced Crossover Study.
A balanced
crossover study was performed with a 24-h washout between the control
and probenecid-treated phases. In this study, the retrodialysis probe
recovery of difluorofluorescein in both the frontal cortex and lateral
ventricle was monitored simultaneously. Figure
5 shows that in the probenecid treatment
phase, the recovery of difluorofluorescein was significantly reduced
(p < 0.01) in frontal cortex. However, no difference
was observed in the ventricle probe recovery between the control and
probenecid-treated phases.

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Fig. 5.
Effect of probenecid on the retrodialysis
probe recovery of difluorofluorescein in cortical extracellular fluid
and ventricle cerebrospinal fluid in the balanced crossover study
(mean ± S.D., n = 6). , Student's
t test, p < 0.01, significantly less than
control phase.
|
|
Microdialysis Model Parameters for Fluorescein in the Cortex.
The mass transport parameters of fluorescein in rat brain cortex are
shown in Table 2. These parameters were
calculated using the experimentally determined in vitro and in vivo
extraction fractions (probe recovery). The in vitro extraction fraction
of fluorescein at 37°C (well stirred) and under the same
microdialysis conditions as used in vivo, was 0.47. Using eq. 3, the
calculated in vitro mass transfer resistance from both the
microdialysate and probe membrane (Rd + Rm) was 3.2 min/µl. In the control group, the
average in vivo recovery of fluorescein was 0.21 ± 0.017, resulting in a total mass transfer resistance (
R) of 8.5 min/µl. Using eq. 4, after subtraction of Rd + Rm, the calculated tissue mass transfer resistance
(Re) was 5.3 min/µl. In the probenecid-treated phase, the average in vivo recovery of fluorescein was 0.17 ± 0.02, which resulted in an increase in the tissue mass transfer resistance to 7.9 min/µl. The fluorescein penetration distance in the
cortex (
), was calculated using eq. 5. In this calculation, the
values for the argument of the Bessel functions (i.e.,
ro/
) are determined by trial and error
iteration to achieve equality between the experimentally determined
Re and the right-hand side of eq. 5. As would be
anticipated when there is an increased mass transfer resistance, the
probenecid treatment resulted in an increase in the penetration
distance,
. Table 2 also shows that probenecid caused a 3-fold
decrease in the sum of the elimination rate constants (
k)
of fluorescein from the cortex, as calculated from eq. 6.
The fluorescein effective diffusion coefficient
(De) in the brain extracellular fluid was
estimated from the previously determined brain extracellular fluid
diffusion coefficient of sucrose (Patlak and Fenstermacher,
1975
), assuming that diffusivity is inversely related to the
square root of solute molecular weight (Table 1). This scaling of the
diffusivity has been previously used to estimate the
microdialysis-derived mass transport parameters of quinolinic acid
(Beagles et al., 1998
).
The Influence of LY-335979 on Probe Recovery of Quinidine.
Perfusion of a 30 ng/ml solution of quinidine through the microdialysis
probe in rat cortex resulted in an in vivo retrodialysis probe recovery
(extraction fraction) of 0.26 ± 0.067 (control phase). After
8 h, the quinidine probe perfusion continued, and the rat received
a LY-335979 bolus followed by an infusion for 12 h (treated
phase). Figure 6 shows the in vivo
quinidine recovery versus time profile in a representative rat.
The systemic administration of LY-335979 did not significantly change
the in vivo recovery of quinidine. The in vivo probe recovery of
quinidine in the treated phase is 0.24 ± 0.054. The in vitro
recovery of quinidine was determined to be 0.68, using the same
microdialysis conditions (i.e., probe geometry, perfusate flow rate,
temperature) as in the in vivo case. Therefore, the mass transfer
parameters of quinidine in rat cortex were calculated using eqs. 2
through 6 in the same manner as described above for fluorescein, and
these parameters are listed in Table 2. The total elimination rate
constant (
k) of quinidine is 0.46 and 0.33 ml/(min
· ml extracellular fluid) in the control and treated phases,
respectively, indicating that LY-335979 has a minimal effect on the
elimination of quinidine from the brain to plasma.

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Fig. 6.
The retrodialysis probe recovery versus time profile
of quinidine in two phases in a representative rat. The effect of
LY-335979 on the retrodialysis probe recovery of quinidine in cortical
extracellular fluid is shown. In the treated phase, rats were given
LY-335979 intravenously.
|
|
 |
Discussion |
The results outlined in this report further illustrate the
relationship between the in vivo microdialysis probe recovery
(extraction fraction) and efflux transport processes in the CNS. The
influence of the inhibition of an efflux transporter on the probe
recovery will vary depending on the different transport substrates and inhibitors examined, the localization and mechanism of an efflux transport system, the magnitude of the elimination process in the
brain, as well as the microenvironment surrounding the probe (e.g., the
cerebrospinal fluid versus the cortical extracellular fluid).
Efflux transport systems at the blood-brain barrier affect the brain
distribution of a variety of compounds into the brain. The membrane
location and the mechanisms of these transporters are likely to have
important pharmacological and toxicological consequences. Efforts to
understand these consequences can be aided by taking advantage of the
differences in transport kinetics conferred by such restrictions in
transporter location and mechanism. In this study, we proposed a
theoretical transport kinetic model to study the characteristics of the
transport behavior of P-glycoprotein and an organic anion transport
system. P-glycoprotein is an efflux transport protein located in the
apical membrane of the blood-brain barrier endothelial cells
(Cordon-Cardo et al., 1989
) and is well known as an
effective efflux transport system in the brain (Fromm, 2000
). Our theoretical model (see Appendix) of
solute flux across the blood-brain barrier indicates that, for certain
substrates, the inhibition of P-glycoprotein increases brain-to-blood
distribution ratio of the substrate but has no effect on the efflux
rate constant (eqs. T-12 and T-13) and, therefore, no effect on the
microdialysis probe recovery. On the other hand, for a transporter
localized to the basolateral membrane of the blood-brain barrier, the
inhibition of the transporter will result in an increase in the
brain-to-blood ratio as well as a decrease in efflux rate constant
(eqs. T-18 and T-19), resulting in a decrease in microdialysis probe recovery.
This theoretical model (see Appendix) was supported by the
study of two substrate/inhibitor combinations using in vivo
quantitative microdialysis, quinidine/LY-335979 for P-glycoprotein, and
fluorescein/probenecid for an organic anion transport protein.
Quinidine is a substrate of P-glycoprotein, and previous studies have
shown that LY-335979, a potent and specific P-glycoprotein inhibitor
(Dantzig et al., 1996
, 1999
), increased quinidine brain distribution as much as 7-fold when quinidine and the inhibitor were given intravenously (Wang et al., 1996
; Starling et al.,
1997
). According to the microdialysis model, a reduction in the
in vivo quinidine recovery is anticipated if the increase in
brain-to-blood ratio of quinidine is also accompanied by a reduced
efflux constant from brain-to-blood. However, the microdialysis results
show no change in the quinidine in vivo recovery (Fig. 6). The
quantitative microdialysis calculation (eqs. 2-6) suggests a minor
change of the efflux transport constant of quinidine from
brain-to-blood (Table 2). This result is consistent with the work of
Kusuhara et al. (1997)
. In their study, when quinidine
was given intravenously, systemically administered PSC-833, another
potent P-glycoprotein inhibitor, increased the net brain uptake of
quinidine by approximately 15-fold. In contrast, when quinidine was
given intracerebrally, systemically administered PSC-833 had no
significant effect on the efflux rate of quinidine as measured by the
brain efflux index (Kusuhara et al., 1997
). This
apparent contradiction could be explained by the theoretical model of
P-glycoprotein-mediated flux across the blood-brain barrier proposed in
this study, where the inhibition of P-glycoprotein will enhance the
brain distribution of systemically administered substrates but will not
influence the efflux rate of substrates directly introduced into the
brain extracellular fluid.
The in vivo microdialysis study of fluorescein showed that the in vivo
recovery of fluorescein was reduced by probenecid. Fluorescein is an
organic anion that is actively transported by organic anion transport
systems (Engler et al., 1994
; Huai-Yun et al.,
1998
). In a previous study in our laboratory (Sun et
al., 1998
), probenecid, well known as an organic anion
transport inhibitor, inhibited the active efflux of fluorescein at the
blood-brain barrier and BCSFB. Probenecid treatment resulted in an
enhanced net transport of systemically administered fluorescein into
brain tissue, i.e., the apparent tissue (cortical extracellular fluid and ventricle cerebrospinal fluid) to plasma equilibrium distribution coefficient of fluorescein was increased by approximately 2-fold (Sun et al., 1998
). In the present study, quantitative
microdialysis (eqs. 2-6) revealed that the reduced microdialysis
recovery was associated with a decrease in the overall cortical
elimination rate constant of fluorescein by approximately 3-fold (Table
2). These results are in agreement with the predications from the present theoretical model of transporter-mediated flux. The model indicates that the inhibition of the transporter located at the basolateral membrane of the barrier should result in a similar magnitude of decrease in the efflux rate constant and increase in the
apparent tissue-to-plasma equilibrium distribution coefficient (eqs.
T-18 and T-19).
Using the microdialysis recovery approach to study the transport
kinetics in CNS has a significant advantage, because in certain circumstances, the influence of a systemically administered inhibitor on the blood concentrations of a substrate can be excluded. In this
study, a simulation according to the quantitative microdialysis model
of Bungay et al. (1990)
was performed to have a better
understanding of the relationship between the change of the efflux
transport constant and the change of recovery. For most compounds, the
mass transfer resistance from tissue probably accounts for the major part of the resistance in vivo, and thus it has been assumed that factors that influence the tissue mass transfer resistance, such as
elimination rate constant, will be important in determining the in vivo
probe recovery. However, it is unlikely that this is a valid assumption
for all compounds. Simulations from the microdialysis mathematical
model (eqs. 2-6) show that the recovery is not sensitive to small
changes in the elimination rate of the compound from the brain, if the
overall elimination rate is fast (Fig. 2). This indicates that either
the overall elimination rate needs to be sufficiently slow for the
recovery to be influenced by an altered elimination process or the
alteration must be large. Therefore, in the case where there is a fast
elimination process from the brain, which can be expected from some
rapidly cleared compounds, such as neurotransmitters, significant
changes in recovery may be anticipated only when the clearance
mechanism is greatly inhibited (Smith and Justice, 1994
;
Cosford et al., 1996
; Vinson and Justice,
1997
). In addition, during the quantitative microdialysis calculation, ignoring the probe mass transfer resistances could result
in erroneous conclusions. In the case of fluorescein, the contribution
of mass transfer resistances from dialysate and probe membrane accounts
for more than 35% of the total resistance in the control condition in
vivo (Table 2). A change in the in vivo probe recovery, caused by an
increased tissue mass transfer resistance (for instance, when an efflux
process is inhibited), will be attenuated when the mass transfer
resistances from dialysate and probe membrane account for a large
proportion of the total resistance. It should be noticed that the
elimination rate of both fluorescein and quinidine from brain
extracellular fluid to plasma are in the range where the recovery
should be sensitive to an inhibition of the efflux process, suggesting
that for both compounds, a change in the probe recovery would be
observed if there would be a decrease in the efflux transport constant.
This study shows that the recovery of the retrodialysis calibrator,
difluorofluorescein, was also decreased by probenecid (Figs. 3 and 4)
in parallel with the decrease in fluorescein recovery. A corresponding
change in the probe recovery of a retrodialysis calibrator, when
compared to the solute of interest, is important for accurate
estimation of brain extracellular fluid concentrations in the
microdialysis sampling when efflux transport is altered through
pharmacological inhibition. These results also indicate that, if
carefully chosen, a retrodialysis calibrator can reflect changes in
microdialysis probe recovery induced by a variety of interventions,
such as the coadministration of an efflux transport inhibitor, and
therefore the calibrator would be suitable for the study of transport
systems at the blood-brain barrier for the estimation of the
concentration of solute of interest in brain extracellular fluid.
Probenecid caused no change in the probe recovery of
difluorofluorescein in the ventricle cerebrospinal fluid (Fig. 5), even though there is a parallel change of the probe recovery of
difluorofluorescein with the probe recovery of fluorescein in the
cortical extracellular fluid. Our previous study (Sun et al.,
1998
) indicated that probenecid significantly enhanced
fluorescein distribution to the cerebrospinal fluid in the lateral
ventricle. The probenecid-induced increase in the cerebrospinal fluid
concentration of fluorescein is probably due to the inhibition of
efflux processes at the choroid plexus. However, the microenvironment
surrounding the probe in the ventricle is very different from that in
the cortex. If efflux transport at a capillary interface in close
proximity to the probe is an important determinant of microdialysis
recovery, then the recovery of probes placed in the fluid environment
of the ventricular cerebrospinal fluid would not be affected by the
inhibition of capillary efflux.
The current study was performed under steady-state conditions with
respect to the concentration in the extracellular fluid. This could be
important because during transient conditions, i.e., the solute
extracellular fluid concentration is changing with time, other factors
such as the intracellular-to-extracellular partition coefficient and
overall systemic elimination rate also influence probe recovery
(Morrison et al., 1991
; Bungay et al., 2001
). In the study by Morrison et al. (1999)
,
even though probenecid increased the accumulation of quinolinic acid in
the brain by inhibiting a microvascular acid transporter, no
significant changes were detected in the quinolinic acid microdialysis
recovery in the striatum. It is important to recognize that, in this
study, quinolinic acid brain concentrations changed significantly
within the 3-h experimental period, therefore, factors other than
capillary efflux may have had a dominant influence on determining the
microdialysis recovery of quinolinic acid. With respect to
retrodialysis under transient conditions, in general, the relative loss
of an analyte from the tissue and the relative recovery of a marker
solute from the perfusate follow different time courses, even though
the steady-state Ed may be the same for both
(Bungay et al., 2001
). Thus, transient calibration by
retrodialysis is problematic.
In summary, the use of the microdialysis extraction fraction (recovery)
to make conclusions about the mass transport processes in the CNS
requires a considerable understanding of the various processes that can
influence the probe recovery in the brain tissue and/or the
cerebrospinal fluid in the ventricles. In certain circumstances, the
recovery of the solute of interest may change with alterations in
capillary efflux inhibition, depending on the elimination rate of the
compound from the brain, the mechanism and location of the membrane
transporter, and the environment surrounding the probe. If carefully
chosen, a retrodialysis calibrator could monitor changes in
steady-state recovery brought about by various experimental treatments
and thus represent the true recovery under different situations. With
an understanding of the various influences on recovery, the use of
changes in microdialysis probe extraction fraction brought about by
experimental intervention can give important information about drug
mass transport in the CNS. This may be especially useful considering
these experiments can be performed without any systemic effect on the
disposition of the compound of interest.
This work was partially supported by Grant NIH-NCI CA-75466 (to
W.F.E.) from the National Institutes of Health. H.S. was supported by
Graduate Fellowships from the University of Nebraska Medical Center and
a Presidential Fellowship awarded by the University of Nebraska.
BCSFB, blood-cerebrospinal fluid barrier;
CNS, central nervous system;
HPLC, high performance liquid chromatography.