* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Man versus Beast: Pharmacokinetic Scaling in Mammals
Survey
Document related concepts
Transcript
Man versus Beast: Pharmacokinetic Scaling in Mammals Joyce Mordenti Received May 19, 1986, from the School of Pharmacy, University of California, San Francisco, CA 94143-0446. September 23, 1986. 3000-kg elephant. Despite this 10* range in weight, most land mammals have similar anatomy, physiology, biochemistry, and cellular structure. This similarity has allowed interspecies scaling of physiologic properties such as heart rate, blood flow, blood volume, organ size, and longevity. The equation that is the basis for scaling physiologic properties among mammals is the power equation Y = aW, where Y is the physiologic variable of interest, W is body weight, and log a is the y-intercept and b is the slope obtained from the plot of log Y versus log W. Animals commonly used in preclinical drug studies (i.e., mice, rats, rabbits, mnnkpws anri Hnnsl rin not eliminate druas at the same rate that with physiologic properties that are well described among species, it seems reasonable to surmise that drug elimination can be scaled among mammals. Analysis of drug pharmacokinetics in numerous species demonstrates that drug elimination among species is predict able and, in general, obeys the power equation Y = aWb. Early papers on interspecies pharmacokinetic scaling normalized the x- and y-axes to illustrate the superimposability of pharmacokinetic curves from different species. More recently, the x- and y-axes have been left in the common units of concentration and time, and individual pharmacokinetic varia bles have been adjusted to predict pharmacokinetic profiles in an untested species, usually humans. Two approaches to interspecies phannacokinetic scaling have emerged, an allometric approach and a physiologic approach. In the allometric approach, pharmacokinetic pro files in several animal species are described by a pharmacol r i n o t i p m n r l o l f r n t n n fl r t m p n t fl l n r n n n c n m n a r t r n e n t a l ) . a n d the pharmacokinetic parameters of the model are scaled by fV>rt nnmnr Qnnotinn V — nW" An ootimoto fnr onrh nhflrrtlfl. cokinetic parameter in humans is obtained by solving each nnwpr pmmrinn fnr 7fl ko- Tn this annrnarh. each soecies is viewed as a whole entity; no attempt is made to give Accepted for publication when organ size and organ function are studied as a function of species body weight. Huxley1 demonstrated that plots of organ size (Y) versus body weight (W) produce straight lines, on log-log paper. The equation for this straight line is log Yi = 6 log W + log a, where 6 is the slope and log a is'the y-, intercept. The antilog of this equation is the power equation Y = aW6, and it has come to be known as the allometric equation. Adolph2 compiled 33 equations which related quantitative quantity (i.e., body weight) are related to one another, h proposed that mathematical interrelationships could be d« veloped that equate one physiologic property to another a follows: Y- . = a-W61 (1) Y2 = azW62 (5 log W = (log Y-. - log aj/b! = (log Y2 - log a2)/62 (' log Yi = log ai + 61/62 dog Y2 - log ag) Y-. = a-.(Y2/a2)6l/62 Suppose one needs to calculate urine output is a functio 01 water mtaKe. using tne aata in muxe 1 iui-^iiuc uui (U) and water intake (I), one calculates IK= C-.46I0-93,' constant for the output of urine to the exponential ra co: means that the rate of urine production is less "than the ra iffiff-infgjraifii-1^ is established by reducing the pharmacokinetics of a drug in g iled data on the weight of principal organs 6 one animal species to physiologically, anatomically, and , , , , j'. , other mammals (Fig. 1). All primate data fell on a straig.a eliminating organs; tissue and fluid volumes; blood-to-plas- ,. .* . , ., r„ . . , :, Jl*a**>*a1[IKW"J|VA'i physiologic parameter in humans is then substituted into the ics of the drug in humans is thus obtained. «f-J*a»i«J:lii>i-f:lulQjl(lf-4-:-JiJ»):M*l.,/M'*W'KB:itl^^^:j#i<^*a^ Physical similarity, in the engineering sense, is dv criteria of similarity which are obtained by forming qi mmimmmmmmimmmm tion among species, to predict drug disposition in an untested species, to define pharmacokinetic equivalence in various species, and to design dosage regimens for experimental animal models. Physiologic Basis for Pharmacokinetic Scaling Despite obvious differences in outward appearance, most land mammals have similar anatomy, physiology, biochemis1028 /Journal of Pharmaceutical Sciences Vol. 75, No. 11, November 1986 renal blood flow/cardiac output x 100 = 43.06Wo:77/166W0'79 x 100 = 25.9% where the units of renal blood flow and cardiac output milliliters per minute and that of weight is kilograms. T relationship reveals that renal blood flow is approxims one-quarter of cardiac output regardless of mammali 0022-3549/86/1100-1028^1.0C © 1986, American Pharmace'uticarAssocieth .aq; (3) pus .j9;bm Apoq jb;o; o; [Bnb9 uoi;nqu;sip ia b SuiumssB Aq p9;BjnojBO aq pjnoo 9oubjb9jo 9;9uiBJBd pa^iodoa Ajuo aq; sbm ojij-jjBq qoiqM joj ■Buiusaqnd tunuaid 0861 iq6uAdoQ -g jaj uiojj uois uoipunj e se sieuiuieui ut mou pooiq opedaq pue }q6iaM JdAn—Z 3JnBy 0001 OOS 002 OOI (*».) 1H0I3M A008 OS 02 01 S 2 I S 2 I so 20 10 si poojq aq; ui uoi;objj punoqun oq; (p) ioouBJBap dibo jo uoi;Buiuuo;ap 9;bjuoob ;iujj9d o; sb os o&ibj 'K\ -ujns si 9oubjb9jo oi;Bd9q puB mou poojq opBdoq U99 aouaaajjip aq; (o) :sasop jsnsn ui soi;9ui3j j9pjo-;sju -ipui b;bp 8{qBTi;BAB ijb (?) IsaiqBUBA Suipunojuoo aonp Suimojjoj aq; aoj uoi;b3i;s8aui siq; joj 9uuAdi;uB pi -as an s93UB;sqns p9J9;smiuipB AjsnouoSoxg j9;jb o; . oq; jo A;ijiqB oq; jo 9jnsB9in b sb 9AJ9S pjnoo ;sq; punoc' b pgpgjgs umBqugxog 'uoipunj joaij ajBduioo oj, *;qJ aaAH J° x-S-l-t-Uiui.q gx~ sbm saioads jib ui moji j? oi;Bdaq 'AjjBuoi^ppv B;Bp asaq; Suiquosap ioj uoi;. aaMod aq; jo ssaua;BudojddB aq; 2ui;Bj;suouiap ?(g ■ sauii ;qSr.Bj;s paonpojd ;qSiaM Apoq snsjaA mou poojq iqa ;q3iaM aaAij jo s;ojd Soj-Soq -Moy poojq oi;Bdeq pire ;qJ J8AIJ ui suoi;buba sapadsja;ui paipn;s granBquax( uoi;Bnba aq; uiojj pa;Buiuiija si puB A;iun uiojj ;uaj Aj;uBogiu§is ;ou si '6roAV/iroA\ 'ssbui jBnpisaj auj^ > M 'IM6|9M Apog0 z i^i ujoj lEiMs-OL x 6'€ 66o msloo *.80Mt._Ol x I 8ooMe-0l. x j."8 ego M 009 Z 10J./IA c-OL x 2*g ■ooueps p luaui -ooubapv am jo/ uoiiejoossy ueouauiy qq61 iq6uAdoo £iaj uioif uois -siuuad ifljM patuuday ■aiqeqsinBuiisipw ///eo/'s/je's aie sauij aieuiud pue ueneuiuieLu aq± 'fy 001 o; 6 ot- luoji iq6idM ut 6ui6ueJ saimuud IZZ uo paseq auij pauu ///eo/'s/'e-s e st aui) pausep aq± -(zg f&i) bBuw ia6ie\ jo jaajs 0} asnoui aqi ui sieuiujeui joj uoyenba uogojpejd outauione aq) s,uasajdaj aun ptjos aq± -pauieu ateuiud ;o puiy qoea joj sazjs Apoq io aBuej a/qejapisuoo e apn/out pue 'sieuiiue fo spuy ;ou 'efep{0 sjoqine A}i)uapt siuiod aq± •sajeuiud ut S)q6taM ueaH—I a'n6|-j !&».) SSVW X008 10 100 es o M SSOO woMZWO woM -a-01. x SL ze-oMe-OL x l'l os oM „-0l x 2"2 ioo M Z80"0 66'OMWIO'O 86-oMe-Ol x 9"9 i0 M 1-800 ssoM ZIZO'O pa sauiisajui. pue qoBuii Ajejin wo M 9-01 x U'l k|/6 'jnjins jo jn 6-0*9-01 X 60' r zroMs-OI- x S't> qe/oMs-01 x VI jndjno ue6oj}!u euiuijBS (jndjno snou96opue) uaBoj (indmo |bjoi) ue6oj y/6 'ueBoJi-iu p m ie'oMs-01 x e"6 uojiBjnp jseq u B2-oMs-Ol x z> ,2oM5-ol x en uotjBjnp qjB€ UOjlBjnp JB9Q1JB . q 'spoued ojBopj (lt-61) •»u||'M PUO P<ouu»x . o Of6l)'*J''"'0 Pub »1'"D • os o M i7 S 680 M WZ 69 0 M Z'V zz-o M t-Z-1 2/ o M 6S- L (S26I) oioi|p<H t (t96l)l0iauupuJ'i»w -' (S96I) 3.k»»ux o (5961) 10 |* «joui|Ow 6 'iq6!a/v\ uiqo|Bp 6 'mDi9A\ uiqoiBou. 6 'jqfyaM aujojqoo* ujo 'epsndjoo |euaj jajsuj _jequjnu Bjgd -]uj-"euiniOA (B snoauBH? S|BU9.J f S P '•°s6i a JJB 6 'ii ;6i9M jueujueci ejBjndc JSBJDC euiuijee u!l ee q/lUJ '90UBJ zzo MEC vzi-o M 88 S90!|S ja IBS M/dlS I*--* 'uoijdiunsuc / . / OII.JOQ , . a W I S j ■( * > » « - • - ( S t - 6 1 - ' o>g)»|oujujoi«(:»in|OH atoH 6*SJ 'I6) W wo M 02128 o M WOOO ss-o M lO'O eiBJ uo!JB|i]U pdjnoetj jejBMpaj-B qquj !S9}BJ OlSopi ,uoijBnb3 ou}9ujo||v jgjeiLre jed oiBopisAyd »s|biuiubw Buouie s:q Apog quM saiVJddoJd 0|Bo|0|sAqd 6ui)eptl suotisnb; function of body weight on log-log coordinates, the data for all species except humans fell on a straight line (Fig. 3). Boxenbaum concluded that the 7-fold difference between expected antipyrine clearance and reported antipyrine clear ance for humans made them unique in that they "lacked the quantitative capacities of other mammalian species," a state ment which has not been widely accepted.6 When the data were replotted as unbound antipyrine intrinsic clearance per maximum lifespan potential (L/MLP) versus body weight on log-log coordinates (Fig. 4), superposition ofthe pharmacoki netic data from the different species was achieved.7 Yates and Kugler8 have presented an alternate hypothesis to explain why data for humans sometimes appear as outlying data points on simple allometric plots, specifically, the phe nomena of neoteny. The effects of neoteny are manifest in both brain mass and lifespan. As a result of scaling antipy rine intrinsic clearance of unbound drug across species, using maximum lifespan potential7 or brain weight,9 the antipy rine data for humans were brought more closely in line with that of the other mammals. For more information on the use of allometry in the biological sciences, the reader is referred to texts on interspe cies scaling.610-12 Similarities in Pharmacokinetics CL .. * 00483 B + 000335 CL ..■ 008I6 B CL • 008I6 I 02 1 05 I ' 2 1 5 L I I I I I I 12 5 10 20 50 100 200 BOOY WEIGHT (kg) I I'll 500 1000 Figure 3—Antipyrine intrinsic clearance in mammals as a function of body weight. Dashed line is the least-squares fit of nonlogarithmically transformed data weighted by the factor 1/y2. The solid line is from the equation fitted using the method of least squares on unweighted, logarithmically transformed data. Reprinted with permission from ref 5. Copyright 1980 Plenum Publishing Corp. 1030 /Journal of Pharmaceutical Sciences Vol. 75, No. 11, November 1986 Goot /f* Mon 20 r = 0.989 10 Monkey 2 2 — / .2 / d .1 •c = « 05 - 02 h 01 / Rabbit %X i s ■ s / Sheep / Dog p < 0.01 s f / • Guinea Rat (liters CLum, = (0.331 Pig x JO per « ) in* B MLP) / Mouja1/ .005 002 Small mammals can be regarded as true physical models of large mammals (in the engineering sense ofthe term), and a formal scheme to describe drug concentration might be suitable for either. Dedrick et al.13 demonstrated that drug concentrations in several laboratory animals could be corre lated as a function of dose and body weight. They plotted methotrexate plasma (or serum) concentrations from mice, rats, monkeys, dogs, and humans on one semilogarithmic plot (Fig. 5a). The pharmacokinetic profiles for the different 0001 01 Pig-/ / . ■ .. / - '■'■ - «- ■ ■ J- ^ ,1 .2 .5 12 5 10 20 50 100 200 Body Weight, B (kg) Y>*-».„ Figure 4—Allometric relationship between intrinsic clearance of r bound antipyrine per maximum lifespan potential (MLP) and be weight. Reprinted with permission from ref 7. Copyright 1982 Plenut. Publishing Corp. gation ofthe underlying relationships in methotrexate p macokinetics, the half-life of methotrexate in each sp* was plotted as a function of body weight on log-log ecu nates (Fig. 6). The slope of the graph was 0.2 (i.e., exponent of W), which is in reasonable agreement with i value of 0.25 chosen empirically. These authors were the first to recommend the use "equivalent time" in the analysis of pharmacokinetic di obtained from different species. They suggested that cb elimination could be correlated between species if one ui an intrinsic biological property (creatinine clearance, bli circulation velocity, or mean residence time of blood com nents in the vascular system) as anv equivalent time-scali factor. This approach is advisable for dynamic systems cause similarity in these systems does not occur as 1 comparison of simultaneous events. Instead, two dynan systems are similar at corresponding (but different) instant of time.15 In other words, two species obeying the sai dynamics of drug elimination are in a similar temporal sta at equal instances of intrinsic (biologic) time even though/i events appear to transpire at unequal rates when measur with an extrinsic (chronological) time scale. Boxenbaum7 used data from the same sources as Dedri et al.13 to calculate the methotrexate plasma .clears (CLmtx) and volume of distribution (Vdj in five sped When these pharmacokinetic parameters were plotted aa function of species body weight on log-log coordinates, bo were linearly related to body weight. Boxenbaum d strated the use of engineering dimensional analysis by f< ing a quotient between the allometric equation for methc \ <. v\^"\ v ft N *V \ ^"*- £ 2 0.081 x\ x X V \ 100 150 200 250 300 350 400 450 TIME AFTER INJECTION, min 0 DIMENSIONLESS TIME (equivalent to minutes in Mon ) 200 400 600 800 1000 H , 1 1 H ' 10 20 30 40 TIME/ (body weight)''**, min/g,/« Figure 5—-Plasma (or serum) concentrations of methotrexate in the mouse ( ), rat ( ), monkey ( ), dog ( ), and human ( ) after rv or ip injection (the symbols refer to dil °rent dose levels and routes of administration): (a) semilogarithmic plots of methotrexate concentration versus time and (b) semilogarithmic plot ob ined after normalization of the axes. From ref 13. trexate clearance (CLMtx) and the allometric equation for creatinine clearance (CLCr) as follows: Vd/TBW = 0.859W°-918/0.703W0-963 = 1.22W-0045 = 1.22 (8) QWCLc, = 10.9W-/8.2W- = 1.33 (7) where yd ^ TBW „ .„ ^ ^ w., h ^^ ^ 'here clearance is in milliliters per minute and W is in analysis suggests that methotrexate Vd is 1.22 times larger _ ilograms.Thus, CZ-mtx is 1.33CLC„ and this relationship is than tota.1 bo(?v water in all species. The residual mass independent of species and species size. In a sense, all species exponent in this calculation (-0.045) is small and essentially are alike, excreting methotrexate from their bodies at a rate zero' indicating that body weight has little or no effect on this rwhich correlates with their physiology. Similar analysis was ratio[performed for methotrexate volume of distribution (Vd) and total body water (TBW) as follows. Kallynochrons, Apolysichrons, Dienetichrons, ,000r Pharmacokinetic Syndesichrons, and the Concept of Time Smaller, short-lived animals generally clear drugs from * the.ir bodies more rapidly (chronological time) per unit body I weight than larger, long-lived animals. When drug removal ? I00- ^———*~ 1S measured according to each species' own internal (biologi| ^ cal) clock, animals tend to clear drugs at a similar pace.7 I ^ ■ Each species is endowed with a distinctive pharmacokinetic J^——- . clock in accord with its own particular ideal space-time continuum. Since pharmacokinetic and physiologic events I are correlated with body weight, it is possible to use body [? , 0 " w e i e h t a s p a r t o f a c o o r d if nu an tcet i o s yn s. t e m o n w h i c h t o b a s e a t i m e Consider antipyrine elimination in the human and the dog (Fig. 7a) The dog clears antipyrine 9 times faster than the human. The allometric equation for antipyrine clearance in > * - ' -■ ^ j t h l s e x a m p l e i s C L = 7 7 . 1 W - 0 1 5 . B o x e n b a u m a n d R o n f e l d " 1000 BOOY WEIGHT , g SSiSSSSSSSSSSSISSS- ^2—SHSir Journal of Pharmaceutical Sciences /1031 Human Dose =10 mg/kg 076«i , ,, ,—-0009581 c = 9.8ie"'"" +16.ie "v.n- 723 min 10 C L l — . j t mi *— = / min / i. Scj9 m /min/lco ^ — Vi =.386 l/kg Vp =.616 l/kg Vss=.612 l/kg .4 .3 • .2 ^a>. Dog Dose = 0.1 mg/kg .1 ■ V,. c = .06i5e "9* + .\s7e00t7i' 07 ^ ^ * ! ^ f y, p = 7 9 . 2 m i n 05 .04 03 .02 .01 007 \ ^S^>*1_ V, = . 4 5 8 VB=.629 Vss=.620 CL l/kg = 5.5ml/min/kg ^ S V. D0ia = 0 1 mU/kg Dot* = 10 mg/kg V, =0 4581/1.9 V, =0386l/kg Vp = 0 629 l/kg Vg= 0.616 l/kg V„=0620l/kg Vss = 0 612 l/kg Cl= 5 5ml/min/kg Cl = 0 59 ml/. l/kg ^\^ l/kg ^s. • ^*** 005 004 n) l/j(= 79.2 min (dog) Time (min) Figure 7—Antipyrine disposition in dogs and humans after rapid iv injection: (a) biexponential antipyrine concentration-time curves and (b) elementary Dedrick plot of antipyrine data illustrated in Fig. 7a. "Kallynochron": The first element of this neologism is taken from the word "Kallyno," a transliteration of the classical Greek word meaning "to beautify, to look becoming, to make clean." The suffix "-chron" comes from "Cronus". ("Kronos"), a word for the Greek God of time. As such, this neologism refers to the time required to clear drug from the body. Reprinted yrith permission from ref 16. Copyright 1983 The American Physiological S o c i e t y. ( duced by normalizing the antipyrine data as follows: The plasma concentrations were normalized by dividing each concentration by dose per unit body weight. And chronologi cal time was transformed to pharmacokinetic time (kally nochrons) by dividing it by W115. Boxenbaum called this transformation an elementary Dedrick plot in honor of Rob ert Dedrick's pioneering work in interspecies scaling. When viewed in this fashion, the antipyrine data were superimposable (Fig. 7b). Similar transformation of chlordiazepoxide pharmacoki netic data obtained for a dog and a human did not produce superimposable profiles, indicating that these data are illconditioned for such a plot (Fig. 8a). Further analysis re vealed that the dog has a greater relative volume of distribu tion than the human. To account for this difference, the allometric equation for volume of distribution (W058) needed to be included in the transformation of each- axis. The inclusion of W068 in the transformation of the y-axis is straightforward (i.e., plasma concentration/dose per W^58), For the transformation of the x-axis, Boxenbaum and Ronfeld16 introduced another unit of pharmacokinetic time, the apolysichron, which they defined as iVW6' " 6, in which b' and 6 are the allometric exponents relating volume of distribu tion and clearance to body weight, respectively. In one apoly sichron, species have eliminated the same fraction of drug from their bodies and have cleared the same volume of plasma per kilogram b' of body weight. Obviously, the kallyn ochron and the apolysichron are equivalent when b' = 1 or £ Dog - 10 5 kg Hu non - 89 4 kg Dow =10 mg/kg Do * = 0 2 9 9 m g / k g V, =0 497 l/kg Vi 01851/kg = 0330l/kg V0 =0 762 l/kg Vo Vss-0 714 l/kg V4V = 0 321 l/kg Cl = 6S 5B°"° Cl Cl = 43 9ml/min Cl 30 5ml/min Cl = 4 IB ml/mm/kg Cl 0 34lml/m,n/k» -65 5B°"° ?j 7 ■ Is 4 C 0 □ F o 3 !■/, p = 1 Mesochron = 24.5 Apolysichrons " ca \ 0 01 0 1 0 07 Cl = 65.5B-0" a a V, =1.48B05< Vp. =191B0<" OS VSS=1.72B063 O 10 JO 30 *0 5.0 60 70 Apolysichrons (Tim«/B07S) Dog lime (minj Dog Jim. (m,n) 400 loo Human Time (min) ^!^^^e^^^x S&5?^^ *£* ff ofchtordiatepoxide plasm* neologism is from the word "apolysis/a transliteraL oA/h^S^ The ftrst element of thi release or deliverance from (a thing).". The suffi 1032 /Journal of Pharmaceutical Sciences Vol. 75, No. 11, November 1986 tion is directly proportional to f weight. This double transformation, or complex Dedrick ot, produced pharmacokinetic profiles that were superim>sable (Fig. 8b). Boxenbaum has defined two additional pharmacokinetic lace-time continua: dienetichrons17 and syndesichrons.18 lese units of pharmacokinetic space—time are similar to ▶olysichrons except that maximum life potential (MLP, g. 9) and brain: weight (BW; Fig. 10) are incorporated in e scaling paradigms. • Human './,= 723 min B = 70kg 002 .001 0007 •■ Ral 1.4= 70 min B = 0.25 kg V^***" "^V^^ ■ y - = 0.963 X t'/,= 156min B = 50kg ^""""""^""S^-a = —i 10 0001 Interspecies Pharmacokinetic Scaling Sheep ^ " ^ > - ^ \ 0005 0002 ° 1.039 i 20 i 30 i 40 --^^^ i m i *n i Dienetichrons The collapse of pharmacokinetic profiles from different animal species into a unique species-independent profile demonstrates the similarity of pharmacokinetics among spe cies, introduces the concept of biologic (or equivalent) time in interspecies pharmacokinetic comparisons, and provides the foundation for interspecies pharmacokinetic scaling. Two approaches to interspecies pharmacokinetic scaling have lometric equations which represent individual pharmacoEaerged, an allometric (based the formulationo.-.of *iAtir nnrarno+orcA ariA approach O TiVi\-air«lnrrif» (nron »-a»liinfi«-i--.i'o4-\ , rach (based on the scale-up of physiologic flow models). Allometric Approach j The allometric approach to interspecies scaling is a black Human Time (min) Sheep Time (min) Ral Time (min) Figure 9—Semilogarithmic dienetichron plot for antipyrine disposition in t*Ji:liNil^/iTitJiBBWIIiumiie^m:it-niun)m^miil, neologism is from the word "dienec," a transliteration of the classical Greek word meaning "continuous, unbroken." The suffix "-chron" comes from "Cronus" ("Kronos"), a word for the Greek God of time. The prefix comes from the view that space experience and temporal seauence form an intp.nratpii nnntiniium ArmrHinn in thie \iiaiu tho entire organism is merely a section of a certain magnitude from birth to the pharmacokinetic parameters. Frequently, there is no ed to know the details of drug distribution in many tissues. t is sufficient to know and be able to control the concentra- _ ,.._.,„„ ..,„ i.nnmiinaii rnv f/uiv-uiiui l^u-l iiyvi ICI nj.j I icuillll permission from ref 17. Copyright 1983 Marcel Dekker, Inc. & _ •» . 0 0 3 r* \ j» 002 - 5 ft I ^L> — OOI « 0005 . i Syndesichrons B295xBW-6'5 x time xlO"2 . 0) 0003 *-*•*> °»'^ 0002 B Baboon D Dog C Cynomolgus Monkey P Pig S Sheep {J\ CQ .000071 Q .00005 R Rat Z Human F Cow (Friesian Breed) M Rhesus Monkey E Horse (Equine) H Rabbit (Hare) c , Syndesichrons . , -* JU 5*. 60 B295xBW-6,sx time xlO2 BP /"fc-r^n^o-i Si 'ZS' J transllter3tion of the classical Greek word mea, Journal of Pharmaceutical Sciences /1033 tion of drug in the plasma. In these instances, the allometric approach is the method of choice and can be applied to the data, provided that the pharmacokinetics are first order in each species, the percentage of protein binding is similar and linear over the concentration range of interest, the elimina tion processes are physical (i.e., renal or biliary), and enough data are available for satisfactory linear regressions. Numerous examples in the literature demonstrate the suitability of the allometric equation for predicting pharma cokinetic parameters in humans. Sawada et al.19 predicted total body clearance, renal clearance, hepatic clearance, volume of distribution, intrinsic clearance of unbound drug, volume of distribution of unbound drug, and elimination half-life for six /3-lactam antibiotics in humans. Data from mice, rats, rabbits, dogs, and monkeys were used in the extrapolations. Discrepancies between the observed and pre dicted values for volume of distribution and hepatic clear ance were attributed to differences in the plasma-free frac tion in each species and uncertain hepatic clearance (the observed hepatic clearance was calculated as the difference between plasma clearance and renal clearance, and it may have included some extrahepatic metabolism). Sawada et al.20 investigated the effect of species differences in the extent of protein binding of 10 basic drugs on the apparent volume of distribution (after distribution equilibri um) and the ratio of distributive tissue volume to unbound fraction in the tissue (VT/fuT). Small differences in tissue distribution of the drugs between animals and humans were detected, suggesting that uptake by the tissues and binding to tissue components did not display significant interspecies variation. Despite this similarity in the tissues, it was not possible to predict volume of distribution in humans from the animal data unless the plasma-free fraction was included in the analysis. Interspecies differences in binding to plasma proteins were variable and appeared to coincide with the variable distribution of binding constituents in plasma (i.e., albumin, ax-acid glycoprotein, and ^-lipoprotein). The postdistribution half-lives (ty2) of 10 cephalosporin and 2 monobactam antibiotics in humans were predicted from data obtained from mice, rats, rabbits, monkeys, and dogs.21 This forecasting was accomplished with the allome tric equation tyz = aWb (Fig. 11). Only one antibiotic, Observed (tronge)- cefotetan, did not scale well among the smaller animals humans. The disparity between the predicted and observ half-life values for cefotetan may be the result of tl antibiotic's existence in tautomeric forms. The allometric equation was used to establish an empiric relationship between the pharmacokinetic parameters ' macrolide antibiotics (erythromycin, oleandomycin, and tyl sin) and body weight.22 Despite agreement between t" observed and predicted human pharmacokinetic values fi. erythromycin and oleandomycin, the allometric model di not discriminate between the pharmacokinetics of these tw antibiotics in humans. For some compounds, the usefulnea of the allometric relationship may reside in predictin, whether large interspecies differences in animal pharmacc kinetics will translate to meaningful differences in humans Another area in which the allometric equation may proij| valuable is the prediction of toxicologic endpoints. Althoug limited data are available, log-log plots of minimally^ toxi dose (lethal dose in 10% of small animals and maximui tolerated dose in large animals) versus weight for man anticancer agents are linear, meaning that these data ai well described by the allometric equation23 (Fig. 12). I general, small animals require larger doses to approximat the lethal dose in humans. If toxicity is due to a metaboliti the converse may be true24; however, without some inform' tion about the bioactivation and degradation process in eac species, it is more difficult to extrapolate toxicity data f( compounds that undergo metabolism. | The allometric approach can be used to predict entii pharmacokinetic profiles for humans from animal dati These predictions are obtained as follows: 1. Determine discrete pharmacokinetic parameters fc the drug in young adult animals of four or mca species (compartmental or noncompartmental metl ods can be used). 2. Perform linear regression analysis on the relatioi ship log pharmacokinetic parameter versus log, we;gi to obtain allometric equations for each parameter .(. necessary, longevity, brain weight, or other signif cant physiologic parameters can be incorporated int the regression). 3. Solve each allometric equation for the average youn adult human, that is, substitute 70 kg for weight i predict average pharmacokinetic parameters. ■'4. Use the predicted pharmacokinetic parameters t write pharmacokinetic equations for drug dispositio in humans. 5. Check the prediction by administering the drug t young adult humans or obtain experimental dat from the literature. Swabb and Bonner25 used a one-compartment model an MAXIMUM TOLERATED DOSE Swiss mouse f o> c oj 1 oE BODY WEIGHT (kg) Figure 11—Log-log plot of half-life versus body weight for ceftizoxime. The solid circles represent the values reported in the literature for each species. The solid line is the least-squares linear regression line for the animals, excluding humans. The prediction for antibiotic half-life in Weight (kg) ttlUlmth bars represent the range of values from the literature. Numbers in from ref 21. Copyright 1985 American Society for Microbiology. 1034 /Journal of Pharmaceutical Sciences Vol. 75, No. 11, November 1986 a^/^lM3a8//7K-^ Wff»aaT>'«ra*a*f«Jl llffr'ff.'f"! ) LD10; (■) maximum tolerated dose. Reprinted with permission fro Vlti'JltillimKI.l^±Ttit:lit»KliM2ikUtik7s!:iViilttWLlAJJ^uT\TWFl>. from ref 53. Dose Predicled Observed CEFTIZOXIME, 4 GRAM I.V. INFUSION 1000 hund f Infuaio TIME (hours) Time, hr Figure 14—Comparison between predicted and observed serum con centrations for ceftizoxime given as a 4-g, 30-min iv infusion to healthy male subjects. Key: ( ) Method I; ( ) Method II; ( ) Method | centrations for aztreonam given as 500- and 1000-mg iv infusions over 3 mm io neanny mate suujttuis. vettuos aiv means iui mu yiuuLia ui I■subjects. with permission from ref 25. Copyright 1983 Plenum PublishingReprinted Corp. data from four species to predict aztreonam pharmacokinet ics-in humans (Fig. 13). These predictions were helpful in choosing doses and serum sampling times for the first kinetic study in healthy male volunteers and agreed well with subsequently measured concentrations in humans. Mordenti26 used three methods of pharmacokinetic scaling and data from mice, rats, monkeys, and dogs to predict biexponential disposition profiles for ceftizoxime in humans. Method I scaled the coefficients (A,B) and exponents (a,/3) of the biexponential equation from each species; Method II scaled the microconstants (ki2, k2\, k\$) and volume of distri bution (Vdi) from the two-compartment model; and Method HI scaled' volume of distribution (Vd*., Vdss, Vdarea) and clearance. Irrespective of the method chosen to produce the biexponential equations, there was close agreement between CHRONOLOGICAL CLOCK human' dog monkey rat Ceftizoxime Half-Life (Minutes) from ref 26. Copyright 1985 American Pharmaceutical Assoc. the predicted concentrations of ceftizoxime in human serum and the concentrations in serum reported in the literature (Fig. 14). This finding is important because it means that the pharmaceutical scientist is at liberty to choose any method of pharmacokinetic m< :eling and still obtain reasonable esti mates in humans w.th che allometric approach. Dimensionless criteria of similarity are obtained from the ceftizoxime data by allometric cancellation as follows: ceftizoxime half-life/time for heartbeat = 30.1Wa248/4.15 x 10"3W0'25 = 7253 (! where ceftizoxime half-life and time for heartbeat are mea sured in minutes. In other words, 50% of a dose of ceftizoxime is eliminated in -7,300 heartbeats, regardless of animal BIOLOGICAL CLOCK human dog monkey Ceftizoxime Half-Life (Heartbeats) Society for Microbiology. Journal of Pharmaceutical Sciences /1035 \ / r s l 7 / - M r s 11 M r s s e c s r r s h r s r 1 0 Q £ species. This quantity, -7300 heartbeats, represents a unit of interspecies equivalent time. To forecast each half-life of ceftizoxime in other animal species, multiply the time for one heartbeat (in minutes) by 7300. The similarity in ceftizoxime half-life in different animal species is not apparent when the reference time is extrinsic, chronological time (minutes; Fig. 15a); however, the similarity is apparent when the reference time is intrinsic, biologic time (heartbeats; Fig. 15b). The complexity of the scheme depends on the pattern of d distribution, available data, and the insight ofthe investiga tor. The mathematical pharmacokinetic model is obtained by writing mass balance equations for the sum of the processes occurring in each compartment, and the resultant differen tial equations are solved simultaneously. Once the pharma cokinetics of the drug are defined in one animal species, predictions for humans are obtained by replacing the values for the physiological, anatomical, and biochemical parame-ters of the test species with the values for corresponding parameters of humans. These values can be obtained from 4 . 1 l ' A J - J - J * J C * _ _ ' _ •■_ _ _ _ / ' • • Physiologic Approach The physiologic approach is based on physiologic flow • i i w u > ~ i o " i i i v. i i a i c o u a i u i u i t i u i v, c " - * V o i \ J l \ l g l \ . a i i y, C U 1 U U i U - estim chemically correct.27-29 One must consider blood flow to The physiologic approach is the method of choice when the binding; and enzyme kinetics. The models are drawn as a connected via the circulatory system as in the body (Fig. 16). netic data can be obtained from only one animal species. In formulation of a physiologic flow model for species fo: which few physiologic data are known, allometric relation ships can be used to provide reasonable estimates of these data. In an illustration of this concept, physiologic parame ters for seven animal species, representing a IO3 range of weights, were taken from the literature27 (Table II). Allome tric equations were fitted to the physiologic data by using t^he method of least squares on unweighted, logarithmically transformed data (Table III). In all cases, statistically signifi cant associations were obtained. Predictions of theae physio* logic parameters in an unlisted species can be obtained by substituting the weight of the unlisted species into the allometric equation. Allometric equations for tissue volumeB and flow rates can be incorporated directly into the flow model. Physiologic flow models are developed in laboratory ani mals, then scaled up (in the engineering sense) to make a priori predictions of drug disposition in humans. The anticancer agent methotrexate has been the most extensive ly studied drug, and details of the development of the physio logic model for methotrexate can be found in major review articles.27-29 The physiologic model for methotrexate is multicompartmental and includes linear protein binding, strong, saturable protein binding, and enterohepatic circulation.; -x Blood flow Figure 16—Schematic of a physiologic flow model. Table II—Physiologic Parameters" Parameter Mouse Body weight, g 22 Compartment volumes, mL Plasma Muscle Kidney Liver Gut Gut lumen Heart Lungs Spleen Marrow 1.0 10 0.34 1.3 1.5 1.5 0.095 0.12 0.1 0.6 Plasma flow rate, mL/min Plasma Muscle Kidney Liver Gut Heart Lungs Spleen Marrow a Data from ref 27. 4.38 0.5 0.8 1.1 0.9 0.28 4.38 0.05 0.17 1036 / Journal of Pharmaceutical Sciences Vol. 75, No. 11, November 1986 Hamster 150 6.48 1.36 6.89 12.23 0.63 0.74 0.54 40.34 5.27 6.5 5.3 0.14 28.4 0.25 Monkey 500 2330 19.6 245 3.65 19.55 11.25 8.8 1.15 2.1 1.3 70 1350 15 100 120 84.6 22.4 12.8 4.7 14.6 1.6 2.25 0.95 520 155 6 •4 T 17 1 47 flfl 177 111 16 520 9.0 ■i« Human 5005530 Kl!al 480 480 ■— 120 120 36 120 512 138 90 60 81.5 60 512 13.5 20 3000! .-35000' 280 1350 21002100 300 — 160 1400 3670 420 700 800 700 150- — 240 120 imimtm 1 • METHOTREXATE, --g/g 1" ■: ; to Ol CO CO KJ « -4 co en -*• c?S|l _ CD co a 1 .-* *«• o N I 8 I' 8 | 3 ;2L B- i {DpEJ.Q- ▶*5it*j'-»'t'; *™~* i-*• i**"I ifa »-- , 3 CD 1 -o £ ro°J 5= rourompoiurjip UQ-^'--bb(*l(DCO (O ^UCOUKDOOU -r^ en co co co ro co ro •-*. -»•-' -» ro en co j». ojcopcop^cop-vjco mcoco-->jJ».co----^--g--g ocDcococncnrococno) S, o' 3 aq 3r;cD o s-cd -* j3-^ <» Co -a. METHOTREXATE, u,g/ml CO S. cB CU S-. -^ !*3 2 co =■ ,3 I ]_^ CD ^CQ | METHOTREXATE. Mg/g alffiSa -», - • r- _ O CD I ooati- t> 1 ' Q. ?\ tu OJ O O 'o» o» -»*■ ?i i O CD co 3* 3 -^ CD CD OO CO 'O ~°>o / equivalent time between species by viewing the methotrex ate plasma concentrations for mice and stingrays in two ways. When the time scale (x-axis) was an extrinsic time scale (minutes), the concentration profiles appeared dissimi lar (Fig. 18a). When the time scale was made proportional to the blood circulation velocity for each species, the concentra tion profiles were superimposable (Fig. 18b). These figures emphasize the importance of using intrinsic clocks for mea suring pharmacokinetic events. For drugs that are metabolized, physiologic models can be combined with in vitro estimates of intrinsic clearance33 or in vitro estimates of enzyme activity (Vmax and Km) to obtain reasonable estimates of drug disposition in different species. The anticancer drug cytarabine hydrochloride (Ara-C) is converted to uracil arabinoside (Ara-U) by pyrimidine nucle oside deaminase. This enzyme is distributed differently in each species, and it is highly variable in kinetic characteris tics (Vmax and Km). A physiologic model for Ara-C disposition was developed for humans by using in vitro values for enzyme activity and Michaelis constants.34 The model pre dicted the plasma concentrations of Ara-C and Ara-U in humans after a single intravenous dose of the parent com pound (Fig. 19). Using enzyme kinetics determined in vitro, this model was extended to mice, monkeys, and dogs to produce accurate pharmacokinetic profiles for each species.35 The model was then expanded for the mouse to include the intracellular metabolism ofthe drug to the active metabolite, arabinoside cytosine triphosphate.36 The variable distribution and kinetic activities of the deaminase enzymes make direct scale-up of Ara-C among species difficult unless in vitro data are available for each tissue. The anticancer agent ds-dichlorodiammineplatinum (cisplatin) binds irreversibly to low molecular weight nucleophiles and macromolecules to form mobile and fixed metabo lites at rates which are tissue specific. Biochemically, cis- dichlorodiammineplatinum is an unusual di*ug because rates of its biotransformation do not appear to be enzyma cally mediated. A physiologic flow model for the dispositio of cis-dichlorodiammineplatinum and its biotransformation products was developed for female rats bearing Walker 256 carcinoma.37 The model was scaled up to rabbits, dogs, and humans by using an interesting set of assumptions, approxi mations, in vitro estimations, and allometric extrapolations to provide the necessary biochemical and physiologic param eters.38 Accurate predictions ofthe plasma concentrations, of cis-dichlorodiammineplatinum, the total filterable platinum, and the total platinum in humans were obtained (Fig. 20). Ethoxybenzamide is oxidized to salicylamide primarily by liver microsomal enzymes. A good correlation between in vitro and in vivo drug metabolism rates has been demon strated . for the rat.39 The physiologic flow model for ethoxybenzamide in the rat was successfully scaled up for the rabbit40 by incorporating the in vitro Michaelis-Menten constants for ethoxybenzamide de-ethylation into the model (Fig. 21). The metabolism of diazepam in various rat tissues was determined in vitro using microsomal fractions from each tissue.41 The resultant values were incorporated into a phys iologic flow model and used to predict diazepam pharmacoki netics in a 10-compartment physiologic rat model. When the model was scaled up to humans by using literature values for the metabolism of diazepam in humans, an accurate assess ment of diazepam plasma disposition was obtained.-4.2 Other examples ofthe successful scale-up of animal physio logic models to humans include digoxin (rat to dog to hu man),43 doxorubicin (rabbit to human),44-45 lidocaine (mon key to human),46 mercaptopurine (rat to human),*7 pentazo cine (rabbit to human),48 and hexobarbital, phenytoin, phenobarbital, and quinidine (rat to human).49 Scale-up of u 0.8 o O 20 40 60 80 100 120 140 TIME (minules) Figure 19—Prediction of cytarabine (Ara-C) and uracil arabinoside (Ara-U) plasma concentrations in humans, using a physiologic model that included in vitro values for enzyme activity and Michaelis-Menten with permis [}fflMM!\Wtmmlffii 1038 / Journal of Pharmaceutical Sciences Vol. 75, No. 11, November 1986 TIME HOURS Figure 20— Prediction of cisplatin (DDP), total filterable platinum (total filterable Pt), and total platinum (total Pt) in humans fnllnwihn sn iv/*«■«■ Was Wmmmmmmm i. Reprinted with. 100.0 ATD=4.33 B-°A12 (r=0.985) *U I monkey rabbit w . 30 60 90 120 TIME,min Figure 21—Prediction of ethoxybenzamide plasma concentrations in rabbits based on scale-up of a rat physiologic model. The symbols mnmsnnt ohsfin/fid snnim concentrations fnllnwino iv doses of 10 mg/kg (O), 20 mg/kg (■), and 80 mg/kg (•). Reprinted with permission from ref 40. Copyright 1982 Plenum Publishing Corp. Body weight, B (kg) Figure 22—Apparent threshold dose (ATD) of nipradilol in mammals as Copyright 1985 Pharmaceutical Society of Japan. spectively. The B- and y-globulin concentration terms did not i pam was not successful (rat to human).49 Oral Drug Administration i Although the prediction of intravenous pharmacokinetics has been successful, predicting the plasma concentration curves for humans after oral dosing is more difficult. One application of interspecies scaling that may prove useful for orally administered drugs is the estimation of the apparent threshold dose, that is, the dose of a high extraction ratio drug necessary to saturate elimination pathways, allowing drug to reach the systemic circulation. This application is illustrated by nipradilol, an antihypertensive and antian ginal agent. Nipradilol is metabolized by different mecha nisms and to different extents in the rat, rabbit, monkey, and dog.60 In spite of complete absorption of orally administered doses, first-pass metabolism leads to low bioavailability, and thfi svstftmic* availahilitv fnr all snppips inrrsasoe wif-V» rlnoo Marked species difference is seen in the apparent threshold dose, with the larger animals requiring smaller doses to saturate presystemic drug metabolizing enzymes (Fig. 22). The apparent threshold dose (ATD) of nipradilol relates to species body weight (B) as follows: ATD (mg/kg) = 4.33B-0472. Protein Binding Although binding to plasma proteins seems unpredictable across species, interspecies scaling ofthe extent of camptothcally determined plasma protein fraction concentrations as independent variables.51 Data from 24 species were used to produce the equation that describes the percent of camptothecin which is unbound in plasma [fu(%)]. This equation is written as follows: log fu (%) = 2.12 + 0.0628 log (a{) + 0.895 log (a2) - 3.30 log (albumin) - 0.651 log (albumin) log (ax) - 1.93 log (albumin) log (a2) (1()) where albumin, a-, and a2 refer to albumin, a--globulin, and a2-globulin protein fraction concentrations (g/100 mL), re- aigim-uani-iy uu'imuuLt: lu explaining tne variance Ol tne dependent variable and were not included in the equation. Equations such as this one may prove helpful when protein binding has a significant impact on interspecies pharmacoki netic scaling. Conclusions Animal data may be used to predict pharmacokinetic and toxicologic endpoints in humans. Two approaches are pre sented in this paper: the allometric approach and the physio logic approach. The approach that one selects to scale up animal data to humans depends on the nature of the com pound and the desired mathematical output. The allometric approach is empirical, but easy, and best suited for renally excreted compounds or linear pharmacokinetic data. The physiologic approach is detailed, but difficult, and best suited ■ui lucbctuuiiz-eu (jump-juiius ur numinear pnarcnacoKineuc data. Both approaches allow us to extrapolate outside the range of data with some confidence if the dominant mecha nisms of transport are sufficiently well understood. A priori predictions are possible for many drugs, based on limited available data. Animals live in different pharmacokinetic space-time continua. Use of an internal, or biological, clock in pharmacoki netic data analyses removes the superficial differences im posed by an external, or chronological, clock. In general, small animals require more drug, administered scaling can guide us in selecting equivalent dosage regimens. References and Notes 1. Huxley, J. S. "Problems of Relative Growth"; Methuen: London, 1932. 2. Adolph, E. F. Science 1949, 109, 579-585. 3. Stahl, W. R. Science 1965, 150, 1039-1041. 4. Edwards, N. A. Comp. Biochem. Physiol. A 1975, 52, 63-66. 5. Boxenbaum, Harold J. Pharmacokinet. Biopharm. 1980, 8, 165175. 6. Calabrese E. J. "Principles of Animal Extrapolation"; John Wiley and Sons: New York, 1983; p 518. 7. Boxenbaum, Harold J. Pharmacokinet. Biopharm. 1982, 10, Journal of Pharmaceutical Sciences /1039 Vol. 75, No. 11, November 1986 8' YnajtQS'1n97Eugene; Ku^ler' Peter N- J- Pharm. Sci. 1986, 75, 9. Boxenbaum, Harold; Fertig, Joanne B. Eur. J. Drue Metab Pharmacokinet. 1984, 9, 177-183. 10. Calder William A., Ill "Size, Function, and Life History"; Harvard University Press: Cambridge, MA, 1984. 11. McMahon, Thomas A.; Bonner, John Tyler "On Size and Life"Scientific American Books: New York, 1983. 12. Schmidt-Nielsen, Knut "Scaling. Why is animal size so impor tant? ; Cambridge University Press: New York, 1984 l.-l noHrfot R T ■ THc.~Ur.tF V TJ . -7-1 i__ t-» r. s~, „'. Rep., Part 1 1970, 54, 95-101. 14. Stahl, W. R. Science 1962, 137, 205-212. 15. Richardson, I. W.; Rosen, Robert J. Theor. Biol. 1979, 79, 415"VatuOi R768-R774. Physiol. A 1972, 42, 183-194. 33. Rane, A.; Wilkinson, G. R.; Shand, D. G. J. Pharmacol. Exp. Ther. 1977, 200, 420-424. 34. Dedrick R L.; Forrester, D. D.; Ho, D. H. W. Biochem. Pharma col. 1972, 21, 1-16. 35. Dedrick, R. L.; Forrester, D. D.; Cannon, J. N.; El Dareer, S. M.Muellett, L. B. Biochem. Pharmacol. 1973, 22, 2405-2417 36. Morrison P F.; Lincoln, T. L.: Aroesty, J. Cancer Chemother. Rep. 1975, 59, 861-76. 37. Farris, F. F.; King, F. G.; Dedrick, R. L.; Litterst, C. L. J. Phar macokinet. Biopharm. 1985, 13, 13-40. 38. King F. G; Dedrick, R. L.; Farris, F. F. J. Pharmacokinet. Biopharm. 1986, 14, 131-156. 39. Lin, J.H.; Hayashi, M.; Awazu, S.; Hanano, M. J. Pharmaco kinet. Biopharm. 1978, 6, 327-337. kinet. Biopharm. 1982,10, 649-661. J. Pharm. Sci. 1984, 73, 826-828 ari. Y • Slicrivnma V • Qomo, J. Pharmacokinet. Biopharm. 1983,11, 577-593. 21. Mordenti, Joyce Antimicrob. Agents Chemother. 1985, 27, 887891. 22. Duthu, Gwen S. J. Pharm. Sci. 1985, 74, 943-946 23. Mordenti, Joyce J. Pharm. Sci. 1986, 75, 852-857 24. Ramsey, J. C; Gehring, P. J. Fed. Proc, Fed. Am. Soc. Exp. Biol. 1980, 39, 60—65. 25. Swabb, Edward A.; Bonner, Daniel P. J. Pharmacokinet. Bio pharm. 1983, 11, 215-223. 26. Mordenti, Joyce J. Pharm. Sci. 1985, 74, 1097-1099. 27. Gerlowski, Leonard E.; Jain, Rakesh K. J. Pharm. Sci. 1983 72 11 0 3 - 11 2 7 . ' ' 28. Chen, H.-S. G.; Gross, J. F. Cancer Chemother. Pharmacol. 1979, 2, 85-94. 29. Himmelstein, K. J.; Lutz, R. J. J. Pharmacokinet. Biopharm 1979, 7, 127-145. 30. Bischoff, K. B.; Dedrick, R. L.; Zaharko, D. S. J. Pharm. Sci 1970, 59, 149-154. 31. Bischoff, K. B.; Dedrick, R. L.: Zaharko, D. S.; Longstreth, J A J. Pharm. Sci. 1971, 60, 1129-1133. 32. Zaharko, D. S.; Dedrick, R. L.; Oliverio, V. T. Comp. Biochem. 1040 /Journal of Pharmaceutical Sciences Vol. 75, No. 11, November 1986 -•*. xicuntj, r. a.; uross, «J. r. ui 59, 819-825. 45. Chan, K. K.; Cohen, J. L.; Gross, J. F.; Himmelstein, K.J.; Bateman J. R; Tsu-Lee, Y; Marlis, A. S. Cancer Chemother. Rep. 1978, f32, 1161. 46. Benowitz. N.: Forsvth. R. P ■ Mplmnn K ■ Rn™Jo--,-j m r>;,-„ 47' HXP-iS?. L>; 0rtega. E-: Solomon, R.; Day, j. L. J. Pharm. Sci. 1977, 6t>, 1454—1557. 48. Ichimura, F.; Yokogawa, K.; Yamana, T.; Tsuji, A.; Yamamoto, K.; Murakami, S.; Mizukami, Y. Int. J. Pharm. 1984,19, 75—88. 49. Sawada, Y.; Harashima, H.; Hanano, M.; Sugiyama, Y.: lea; T J. Pharmacobio-Dyn. 1985, 8, 757-766. 50. Yoshimura, M.; Kojima, J.; Ito, T.; Suzuki, J. J. PharmacobioDyn. 198o, 8, 738-750. 5L ?«?of nl?aum> Harold; Fertig, Joanne B. Biopharm. Drug Dispos. 1984, 5, 405—408. 52. Brody, S. "Bioenergetics and Growth"; Reinhold: New York 1945. 53. Freireich, E. J.; Gehan, E. A.; Rail, D. P.; Schmidt, L. H.: Skip per, H. E. Cancer Chemother. Rep. 1966, 50, 219---244.