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1 Role of ABC and solute carrier transporters 2 in the placental transport of lamivudine 3 Martina Ceckovaa , Josef Rezniceka, Zuzana Ptackovaa, Lukas Cervenya, Fabian Müllerb,*, 4 Marian Kacerovskyc, Martin F. Frommb, Jocelyn D. Glazierd, Frantisek Stauda,# 5 6 Charles University in Prague, Faculty of Pharmacy in Hradec Kralove, Department of 7 Pharmacology and Toxicology, Hradec Kralove, Czech Republica; Institute of Experimental 8 and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen- 9 Nürnberg, Erlangen, Germanyb; Department of Obstetrics and Gynecology, University 10 Hospital, Charles University in Prague, Hradec Kralove, Czech Republicc; Maternal and Fetal 11 Health Research Centre, Institute of Human Development, University of Manchester, St. 12 Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, 13 Manchester Academic Health Science Centre, Manchester, UKd 14 15 Running Head: Placental transport of lamivudine 16 17 # 18 *Present address: Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riß, 19 Germany. Address correspondence to Frantisek Staud, e-mail: [email protected] 20 21 1 22 ABSTRACT 23 Lamivudine is one of the antiretroviral drugs of choice for the prevention of mother-to-child 24 transmission (MTCT) in HIV-positive women. In this study, we investigated the relevance of 25 drug efflux transporters P-gp (MDR1, ABCB1), BCRP (ABCG2), MRP2 (ABCC2) and 26 MATE1 (SLC47A1) for the transmembrane transport and transplacental transfer of 27 lamivudine. 28 We employed in vitro accumulation and transport experiments on MDCK cells 29 overexpressing drug efflux transporters, in situ perfused rat term placenta and vesicular 30 uptake in microvillous plasma membrane (MVM) vesicles isolated from human term 31 placenta. MATE1 significantly accelerated lamivudine transport in MATE1-expressing 32 MDCK cells, whereas no transporter-driven efflux of lamivudine was observed in MDCK- 33 MDR1, MDCK-MRP2 and MDCK-BCRP monolayers. MATE1-mediated efflux of 34 lamivudine appeared to be a low affinity process (apparent Km = 4.21 mM, Vmax = 35 5.18 nmol/mg protein/min in MDCK-MATE1 cells). Consistent with in vitro transport 36 studies, the transplacental clearance of lamivudine was not affected by P-gp, BCRP or MRP2. 37 However, lamivudine transfer across dually perfused rat placenta and the uptake of 38 lamivudine into human placental MVM vesicles revealed pH dependency, indicating possible 39 involvement of MATE1 in the fetal-to-maternal efflux of the drug. 40 To conclude, placental transport of lamivudine does not seem to be affected by P-gp, MRP2 41 or BCRP, but a pH-dependent mechanism mediates transport of lamivudine in the fetal-to- 42 maternal direction. We suggest that MATE1 might be, at least partly, responsible for this 43 transport. 44 2 45 INTRODUCTION 46 More than 36 million people are infected with HIV worldwide today (1). Half of them are 47 women who, if pregnant, carry the risk of transferring the infection to their child in utero, at 48 delivery or during breastfeeding. Progress in preventing new HIV infections among children 49 has been dramatic in recent years as the number of children becoming infected with HIV each 50 year dropped from 520.000 to less than 240.000 between 2000 and 2014 (1), clearly 51 demonstrating that well-timed antiretroviral prophylaxis can reduce the risk of mother-to- 52 child transmission (MTCT) of HIV. Current guidelines (2, 3) recommend lamivudine ([-]-b- 53 L-2’,3’-dideoxy-3’-thiacytidine) as one of the antiretroviral drugs of choice in first line 54 therapy of HIV-positive pregnant women, including first trimester pregnancies. In addition to 55 diminishing the MTCT of HIV-1, lamivudine is also used to decrease the vertical 56 transmission of hepatitis B virus in pregnancy (4, 5). Lamivudine is known to cross placenta, 57 with the predicted fetal-to-maternal area under the concentration-time curve (AUC) reaching 58 86% in humans (6). However, detailed knowledge of mechanisms affecting lamivudine 59 transplacental transfer is still lacking. 60 The transplacental permeability of drugs predominantly depends on their physical-chemical 61 characteristics, which determine the rate of passive diffusion. However, it can also be 62 extensively influenced by transporter proteins expressed in the apical microvillous plasma 63 membrane (MVM) of polarized trophoblasts (7). Among them the ATP-dependent (ABC) 64 efflux transporters P-glycoprotein (P-gp, MDR1, ABCB1), breast cancer resistance protein 65 (BCRP, ABCG2) and multidrug resistance-associated protein 2 (MRP2, ABCC2) are well 66 confirmed active components of the placental barrier providing fetal protection against 67 potentially toxic compounds, including drugs (8-10). Besides ABC transport proteins, some 68 members of the SLC (solute carrier) transporter family can further modulate transplacental 69 drug transfer (7). MATE1 (SLC47A1), typically expressed in the apical membrane of 3 70 polarized cells, is an H+ - exchanger known to ensure the efflux of substrates that enter the 71 cells via organic cation transporters (OCTs, SLC22A) located in the basolateral membrane 72 (11). This OCT-MATE1 excretory pathway is typical for the kidneys and liver. Nevertheless, 73 recent studies indicate that this vectorial transport mechanism might also be relevant for the 74 placenta (12, 13). Expression of multidrug and toxin extrusion proteins MATE1/Mate1 75 (SLC47A1/Slc47a1) and MATE2/Mate2 (SLC47A2/Slc47a2)) has been recently studied in 76 human and rat first trimester and term placentas (13-15) and Mate1 was suggested as an 77 efflux component of vectorial fetal-to-maternal drug transfer of metformin and cationic 78 neurotoxin 1-methyl-4-phenylpyridinium (MPP+) in the dually perfused rat term placenta 79 model (12, 16). 80 Lamivudine was recently found to interact with MATE1 and its kidney variant MATE2-K 81 (17). Thus, we hypothesized that MATE1 could also affect the transplacental transport of 82 lamivudine by mediating the efflux from polarized trophoblast cells back to the maternal 83 blood. All three subtypes of human organic cation uptake transporters, OCT1 (SLC22A1), 84 OCT2 (SLC22A2) and OCT3 (SLC22A3), were shown to contribute to lamivudine uptake into 85 the cells, with decreasing efficacy in the following order: OCT1 > OCT2 > OCT3 (18, 19). 86 OCT3 is considered the predominant placental OCT transporter (12-14, 20) nevertheless 87 significant mRNA expression of OCT1 and OCT2 were also shown in first trimester as well 88 as term human placenta (13, 14). 89 To the best of our knowledge, the possible impact of drug efflux transporters on transplacental 90 pharmacokinetics of lamivudine has not previously been systematically evaluated. In the 91 present work, we investigated the affinity of lamivudine to efflux transporters MDR1, BCRP, 92 MRP2 and MATE1 and evaluated whether the maternal-to-fetal transfer of lamivudine could 93 be affected by any of these efflux transporters. To address these aims, we performed in vitro 94 transport and accumulation assays on cellular monolayers and the in situ method of dually 4 95 perfused rat term placenta. Additionally, we verified the results in human placenta by uptake 96 assay in microvillous placental membrane (MVM) vesicles. 97 98 METHODS 99 Materials and reagents 100 Lamivudine was kindly provided by the NIH as a part of the NIH AIDS Reagent Program. 101 Radiolabelled lamivudine ([3H]-lamivudine, 21.3 or 5.2 Ci/mmol) was purchased from 102 Moravek Biochemicals (California, USA). Mitoxantrone, ASP+ and fluorescein isothiocyanate 103 labelled dextran (MW=40 kDa) were obtained from Sigma Aldrich (St. Louis, MO, USA). 104 BCRP inhibitor Ko143 was purchased from Enzo Life Sciences AG (Lausen, Switzerland) 105 and pentobarbital (Nembutal) was purchased from Abbott Laboratories (Abbott Park, Illinois, 106 USA). Cell culture media and sera were obtained from Sigma-Aldrich (St. Louis, MO, USA) 107 and Gibco BRL Life Technologies (Rockville, MD, USA). All other chemicals were of 108 analytical grade and obtained from Sigma-Aldrich (St. Louis, MO, USA). The bicinchoninic 109 acid assay kit (BCA assay) was purchased from Thermo Scientific (Rockford, USA). 110 111 Cell lines and cell culture 112 Madin–Darby canine kidney II (MDCKII) parental cell line and MDCKII cells stably 113 transduced for expression of human transporters P-gp, BCRP or MRP2 further designed as 114 MDCK-MDR1, MDCK-BCRP or MDCK-MRP2, were provided by Dr. Alfred Schinkel (The 115 Netherlands Cancer Institute, Amsterdam, The Netherlands). All the MDCK cell lines were 116 cultured in DMEM medium supplemented with 10% heat-inactivated FBS. Double- 117 transfected MDCKII cell lines stably expressing human OCT1 or OCT2 and MATE1 118 transporters (MDCK-OCT1-MATE1 and MDCK-OCT2-MATE1), as well as the respective 5 119 mono-transfected cells (MDCK-OCT1, MDCK-OCT2, MDCK-MATE1) and control vector 120 cells (MDCK-Co), were established and characterized as described previously (17, 21, 22). 121 Cells were cultured in MEM containing 10% heat-inactivated FBS. All cells used in our 122 experiments were routinely cultivated in antibiotic-free medium and periodically tested for 123 mycoplasma contamination. Stable expression of all inserted human transporters was verified 124 by qRT-PCR and uptake assays with appropriate fluorescence substrates. Cells from passages 125 10 to 25 were used in all in vitro studies. 126 127 Animals 128 Pregnant Wistar rats were purchased from MediTox s.r.o. (Konarovice, Czech Republic) and 129 maintained under 12/12-hours day/night standard conditions with pellets and water provided 130 ad libitum. Experiments were carried out on day 21 of gestation. Overnight-fasted rats were 131 anesthetized with pentobarbital (40 mg/kg body weight) administered into the tail vein. All 132 experiments were approved by the Ethical Committee of the Faculty of Pharmacy in Hradec 133 Kralove (Charles University in Prague, Czech Republic) and were performed in accordance 134 with the Guide for the Care and Use of Laboratory Animals (1996) and the European 135 Convention for the Protection of Vertebrate Animals Used for Experimental and Other 136 Scientific Purposes (Strasbourg, France, 1986). 137 138 Human tissue samples 139 All human tissue samples were obtained following written informed consent with the 140 approval of the Faculty hospital Research Ethics Committee. Placentas were collected from 141 uncomplicated pregnancies at term (38–40 weeks of gestation) delivered by Caesarean section 142 in the Department of Obstetrics and Gynaecology University Hospital in Hradec Kralove. 6 143 Human normal kidney samples were obtained after written informed consent from human 144 biopsy in the Hemodialysis Center, University Hospital in Hradec Kralove. 145 146 Transcellular transport assays in ABC transporter overexpressing MCDK cells 147 Transport assays employing MDCK parental and ABC transporter-expressing MDCK cells 148 were performed on microporous polycarbonate membrane filters (3.0 µm pore size, 24 mm 149 diameter; Transwell 3414; Costar, Corning, New York) as described previously (23, 24). 150 MDCK-MDR1, MDCK-BCRP, MDCK-MRP2 or MDCK-parent cells were seeded at a 151 density of 1.5 x 106 per insert and cultured 3-4 days until reaching confluency with daily 152 replacement of cell culture medium. Before starting the transport experiment, cells were 153 washed with pre-warmed phosphate buffered saline (PBS) on both the apical and basal sides 154 of monolayers and Opti-MEM with radiolabelled lamivudine was added to either the apical or 155 basolateral compartments. The lowest [3H]-lamivudine concentration used was 8 nM, as this 156 concentration achieved the minimal specific activity required for analysis (0.04 µCi/ml). The 157 experiments were run at 37 °C / 5% CO2, aliquots of 50 µl were collected at 2, 4 and 6 hours 158 from the opposite compartment and radioactivity was measured by liquid scintillation 159 counting (Tri-Carb 2900 TR Perkin Elmer). At the end of the experiment, leakage of 160 fluorescein isothiocyanate labelled dextran (MW = 40 kDa) was analyzed and accepted at up 161 to a rate of 1% per hour. The percentage of radioactivity appearing in the acceptor 162 compartment relative to the stock solution initially added to the donor compartment was 163 calculated. Transport ratios between basal-to-apical and apical-to-basal translocation after 6 164 hours’ incubation (rt) were calculated as described earlier (23) by dividing the percentage of 165 drug transported in the basolateral-to-apical direction by the percentage of drug crossing the 166 monolayer in the apical-to-basolateral direction. 7 167 Transcellular transport assays in SLC transporter overexpressing MCDK cells 168 Transport experiments employing mono-transfected MDCK-MATE1, MDCK-OCT1 and 169 MDCK-OCT2 cells, double-transfected MDCK-OCT1-MATE1 and MDCK-OCT2-MATE1 170 and the empty vector transfected control MDCK-Co cells were performed on Transwell 3402 171 cell culture inserts (3.0 µm pore size, 24 mm diameter Costar, Corning, NY). For all 172 experiments, 0.5 x 106 cells per well were used and incubated for 3 days to confluence in 173 standard cultivation medium MEM (Gibco) + 10% FBS. On the day of experiment, medium 174 was removed from both sides and the cellular monolayer was washed on both sides with pre- 175 warmed PBS. The experiment was started by addition of 0.8 ml HBSS buffer (pH 7.4) into the 176 apical compartment and 0.8 ml of HBSS buffer (pH 7.4) with [3H]-lamivudine to the 177 basolateral compartment. The [3H]-lamivudine concentration used was 100 nM, as this 178 concentration achieved the maximal sensitivity required for detection of interaction with drug 179 transporters and minimal specific activity required for final analysis in cell lysates. In the 180 inhibition experiments with mitoxantrone, the cellular monolayers were pre-incubated with 181 HBSS medium (pH 7.4) containing 2 µM mitoxantrone in both compartments 10 minutes 182 prior to initiation of the transport experiment. The experiments were run at 37 °C / 5% CO2 183 for 2 hours. Aliquots of 50 µl were sampled from the apical side at times 0.5, 1 and 2 hours. 184 At the end of the incubation period, the medium was immediately removed and cells were 185 washed twice with ice-cold PBS, then the inserts were excised and the cellular monolayer was 186 dissolved in 0.02% SDS solution. The radioactivity of the collected samples and lysed 187 monolayers was measured by liquid scintillation counting (Tri-Carb 2900 TR Perkin Elmer). 188 Protein concentration in the cell lysates was quantified using a BCA assay. Net transport was 189 obtained by subtraction of the transport by MDCK-Co cells from that by drug-transporter 190 overexpressing cells. The kinetics graph (transport velocity of lamivudine versus substrate 191 concentration) was fitted using the classic Michaelis-Menten equation, with Vmax representing 8 192 the maximal transport velocity (in nmol per mg of protein per minute) and Km representing 193 the substrate concentration at half-maximal transport velocity (micromolar), in GraphPad 194 Prism 6 software (GraphPad Software, Inc., San Diego, California, USA). 195 196 Quantitative RT-PCR 197 The mRNA expression of MATE1 was quantified in the mono-transfected MDCK-MATE1 198 cells, double-transfected MDCK-OCT1-MATE1 and MDCK-OCT2-MATE1 cell lines at the 199 passages 10-25, in which the cells were used for transport experiments, in the human 200 placental villous tissue and in human kidney medulla used as the comparator sample due to 201 the well confirmed expression of MATE1 (26). Total RNA was isolated from confluent 202 monolayers of the cells or small pieces of fresh tissue samples using the TRI Reagent (Sigma- 203 Aldrich, St. Louis, MO, USA) according to the manufacturer’s instructions. Isolated RNA 204 was dissolved in DEPC-treated water, and concentration and purity of each sample were 205 determined spectrophotometrically from A260/A280 measurements (NanoDrop, Thermo 206 Scientific, Wilmington, DE, USA). Integrity of RNA was checked by agarose gel 207 electrophoresis. cDNA was prepared from 1 μg extracted total RNA by MMLV reverse 208 transcriptase using oligo(dT) VN nucleotides (gb Reverse Transcription Kit, Generi Biotech, 209 Hradec Kralove, Czech Republic). PCR analysis was performed on QuantStudio 6 (Life 210 Technologies). cDNA (40 ng) was amplified using 2 × Probe Master Mix (Generi Biotech, 211 Hradec Kralove, Czech Republic) and predesigned PCR assay (hSLC47A1_Q2) for SLC 212 transporter MATE1, Generi Biotech, Hradec Kralove, Czech Republic). All the samples were 213 analysed three times in triplicate, Ct values were noted and averaged for each sample type. 214 Since there was no other gene besides human MATE1 shared among the analysed samples we 215 show the relevant Ct values and limit the comparison of the MATE1 expression to estimation 216 based on ΔCt to the comparator (kidney) and calculating the 2^ΔCt value. 9 217 218 ASP+ uptake experiments 219 Uptake experiments were performed using control MDCK-Co and OCT1-, OCT2- and 220 MATE1- monotransfected MDCK cells in order to quantify the inhibitory effect of 221 mitoxantrone to the particular SLC transporters. The aim of these experiments was to show 222 that mitoxantrone could be used as a model inhibitor that selectively inhibits MATE1 in the 223 subsequent transport studies using OCT-MATE double-transfected cells. Mitoxantrone was 224 chosen as the model inhibitor because it has been shown to preferentially inhibit MATE1 over 225 OCT1 and OCT2 according to the half-maximal inhibitory concentration (IC50) values in 226 other cellular models (27). MATE1 is a pH-dependent carrier that is able to act as an uptake 227 transporter in experimental settings (28) but mediates efflux in physiological ones. Hence, 228 extracellular alkalinization was used to promote MATE1-mediated uptake (29, 30). The single 229 SLC transporter-transfected MDCK cells were seeded on a 96-well plate at a density of 45 x 230 103 cells per well and cultivated in standard cultivation medium (MEM + 10% FBS). Twenty- 231 four hours after seeding, uptake experiments with ASP+, a common fluorescence substrate of 232 OCT1, OCT2 and MATE1, were performed. Cells were washed twice with 100 µl pre- 233 warmed HBSS buffer (pH 7.4). Cell lines containing MATE1 were pre-incubated with 100 µl 234 20 mM NH4Cl (pH 7.4) for 30 min. After washing the cells twice with 100 µl pre-warmed 235 HBSS buffer (pH 8.0), solutions of mitoxantrone with 1µM ASP+ were added and incubated 236 for 20 minutes. After washing the cells twice with 100 µl pre-warmed HBSS buffer pH 8.0, 237 solutions of mitoxantrone with 1µM ASP+ were added for 20 minutes. At the end of the 238 incubation period, the medium was removed and cells were rinsed thrice with ice-cold HBSS 239 buffer (pH 7.4). Then, fluorescence was measured at a wavelength of 485 nm for excitation 240 and 585 nm for emission. Substrate uptake was normalized with to the protein concentration 241 of the cell lysate measured by BCA assay. 10 242 243 Dual perfusion of rat term placenta 244 The method of dually perfused rat term placenta was used as described previously (31). 245 Open-circuit perfusion system 246 An open-circuit perfusion system was employed to study fetal-to-maternal (F→M) and 247 maternal-to-fetal (M→F) lamivudine clearance. [3H]-lamivudine at 12 nM concentration was 248 added to either the maternal (M→F studies) or fetal (F→M studies) reservoirs immediately 249 after successful surgery. M→F transplacental clearance (Clmf) normalized to placenta weight 250 was calculated according to Equation. 1: 251 𝐶𝑙mf = (𝐶fv . 𝑄f )/( 𝐶ma . 𝑊p ) (1) 252 where Cfv is the drug concentration in the umbilical vein effluent [nmol/l], Qf is the umbilical 253 flow rate [ml/min], Cma is concentration in the maternal reservoir [nmol/l], and Wp is the wet 254 weight of the placenta [g]. F→M transplacental clearance (Clfm) was calculated according to 255 Equation 2. 256 𝐶𝑙fm = (𝐶fa − 𝐶fv )𝑄f /(𝐶fa . 𝑊p ) 257 where Cfa is the drug concentration [nmol/l] in the fetal reservoir entering the perfused 258 placenta via the umbilical artery. 259 Closed-circuit (recirculation) perfusion system 260 A closed circuit (recirculation) perfusion system was employed to study the effect of pH on 261 the fetal/maternal lamivudine concentration ratio at equilibrium. Both the maternal and fetal 262 sides of the placenta were infused with 9 nM [3H]-lamivudine and after a short-time 263 stabilization period, the fetal perfusate (10 ml) was recirculated for 60 minutes. In the fetal (2) 11 264 recirculating reservoir, a pH of 7.4 was maintained throughout the experiments, whereas the 265 pH in the maternal reservoir was adjusted by HCl/NaOH to 6.5, 7.4 or 8.5. Samples (250 µl) 266 were collected every 10 minutes from the maternal and fetal reservoirs and the 267 [3H]-lamivudine concentration was measured. This experimental setup ensured a steady 268 concentration on the maternal side of the placenta and enabled investigation of the 269 fetal/maternal ratio; any net transfer of the substrate would imply transfer against a 270 concentration gradient and provide evidence of active transport. 271 272 Uptake assay in human placental microvillous plasma membrane vesicles 273 MVM vesicles were isolated from human term placentas using Mg2+ precipitation and 274 differential centrifugation as described previously (32). The final MVM pellet was 275 resuspended in an intravesicular buffer (IVB) at two different pH values adjusted by changing 276 the HEPES to Tris ratio (IVB 7.4: 290 mM sucrose, 5 mM HEPES and 5 mM Tris, pH 7.4 or 277 IVB 6.2: 290 mM sucrose, 9.5 mM HEPES and 0.5 mM Tris, pH 6.2), vesiculated by passing 278 15 times through a 25-gauge needle and stored at -70 °C until use in the uptake experiments. 279 MVM protein concentration was determined using the BCA assay and purity was confirmed 280 by measuring the enrichment of MVM alkaline phosphatase activity compared with the 281 placental homogenate. The alkaline phosphatase enrichment factor was 21.8 ± 5.6 (mean ± 282 SD, n = 7). 283 284 Uptake of [3H]-lamivudine into MVM vesicles was measured at room temperature using rapid 285 vacuum filtration (33). MVM vesicles (10 mg protein/ml) were equilibrated to room 286 temperature (21–25 °C) prior to uptake. Uptake of [3H]-lamivudine was initiated by mixing 287 10 µl MVM vesicles with 10 µl 100 nM [3H]-lamivudine in extravesicular buffer (EVB) at pH 12 288 7.4 or 8.4 (145 mM KCl, 10 mM Na+-HEPES/HCl-Tris, pH 7.4 or IVB 8.4). After 1 minute, 289 uptake was stopped by addition of 2 ml ice-cold stop buffer (130 mM NaCl, 10 mM 290 Na2HPO4, 4.2 mM KCl, 1.2 mM MgSO4, and 0.75 mM CaCl2, pH 7.4) and filtered through a 291 0.45 µM mixed cellulose ester filter (MF-Millipore membrane filter HAWP02500) under 292 vacuum. Filters were washed with 10 ml of stop buffer and the filter-associated radioactivity 293 was determined by liquid scintillation counting. No protein controls (replacement of MVM 294 vesicle protein by relevant IVB) were included in parallel to determine tracer binding to the 295 filter, which was subtracted from the total vesicle count. 296 297 Statistical analysis 298 All data were assessed and statistically analyzed using GraphPad Prism 6.0 software 299 (GraphPad Software, Inc., San Diego, California, USA). Statistical significance was 300 investigated using Student’s t-test, the Kruskal-Wallis test or two-way ANOVA followed by 301 Bonferroni’s multiple comparison post-test as applicable and described in the figure legends. 302 A P value ≤ 0.05 was taken to be statistically significant. Data are presented as the mean ± 303 standard deviation (SD) or with the 95% confidence interval (CI) where appropriate. Half- 304 maximal inhibitory concentration (IC50) values for mitoxantrone were calculated by non- 305 linear regression using sigmoidal Hill kinetics using GraphPad Prism 6.0 software. 306 307 RESULTS 308 Transcellular transport of lamivudine across ABC transporter expressing MDCK 309 monolayers 310 Transcellular transport of [3H]-lamivudine (8 nM) across the polarized monolayers of MDCK 311 parental and MDR1-, BCRP- and MRP2-overexpressing cells was studied using the 13 312 conventional bi-directional (concentration gradient) transport assay. No difference between 313 basal to apical (BA) and apical to basal (AB) transfer of the drug was observed at time points 314 2, 4 hours and transport ratios (rt) close to 1 were observed after 6 hours of transport 315 (Table 1). The rt value obtained in MDCK-BCRP cells (1.25 ± 0.0277) was significantly 316 higher than that measured in MDCK-parent cells (0.923 ± 0.195). However, the cut-off value 317 for BCRP substrates (rt ≥ 2) set by the International Transporter Consortium was not reached 318 (34). These data indicate that lamivudine is not a substrate of P-gp or MRP2, whereas BCRP 319 might to some extent be responsible for acceleration of lamivudine transport in the BA 320 direction. 321 322 Expression of MATE1 mRNA in the relevant MDCK cell lines and in human placentas 323 In order to confirm the expression of MATE1 mRNA in the cell lines and human placentas 324 used in the subsequent functional studies, RT-PCR approach was employed. Since there was 325 no other gene shared among the analysed samples we limited the comparison of the 326 expression to showing the mean Ct values (Table 2). The MATE1 expression was confirmed 327 in MDCK-MATE1 and MDCK-OCT2-MATE1 cell lines with the same level of MATE1 328 transcripts (Ct values), while lower level (higher average Ct) was detected in MDCK-OCT1- 329 MATE1 cells (Table 2). Nevertheless, the expressions in all the cell lines exceeded 330 significantly that of kidney mainly due to the lack of non-MATE1 expressing cells that are 331 present in the whole tissue samples. MATE1 expression in human placental villous tissue was 332 highly variable and was found only in 7 out of 10 analysed human placentas. The average Ct 333 for the MATE1-expressing placentas was about 10 cycles higher (Table 2) than that in kidney 334 medulla tissue indicating approximately 2^10 = 1000 times lower MATE1 expression. 335 14 336 MATE1-mediated transfer of lamivudine across cellular monolayers 337 After addition of 100 nM lamivudine to the basolateral compartment, all three MATE1 338 expressing cell lines, i.e. MDCK-MATE1, MDCK-OCT1-MATE1 and MDCK-OCT2- 339 MATE1, showed significantly higher transcellular transfer of [3H]-lamivudine from the basal 340 to the apical compartment compared with MDCK-Co cells (increase to 262.4% , 196.8% and 341 250.9%, respectively, P ≤ 0.01, Student´s t-test) and their respective non-MATE1 expressing 342 control cells (MDCK-Co, MDCK-OCT1 and MDCK-OCT2, respectively, Fig. 1 A,B,C). The 343 rate of lamivudine transcellular transport was lowest in the MDCK-OCT1/MATE1 344 monolayers among MATE1-expressing cells, in agreement with the lowest gene expression of 345 hMATE1 in this cell line shown by qRT-PCR (Table 2). 346 Intracellular concentrations of lamivudine in the monolayers of MDCK–MATE1, MDCK- 347 OCT1-MATE1 and MDCK-OCT2-MATE1 cells were significantly lower than in the 348 respective MATE1-free control cell lines (decrease to 7.31%, 62.1% and 24.6% compared to 349 MDCK-Co, MDCK-OCT1 and MDCK-OCT2, respectively, P < 0.001, Student´s t-test, Fig. 1 350 D,E,F). As expected, monolayers of MDCK-OCT1 and MDCK-OCT2 in the transport 351 experiment accumulated significantly higher amount of lamivudine compared to MDCK-Co 352 cells (P < 0.05, Student´s t-test). Interestingly, the transcellular transfer of lamivudine across 353 MDCK-MATE1 cells was not significantly different from that in double-transfected MDCK- 354 OCT2-MATE1 cells that express the same level of hMATE1 mRNA (Table 2) but 355 accumulated a higher amount of lamivudine due to OCT2-mediated uptake (Fig 2 D, F). 356 357 The apparent affinity of lamivudine to the MATE1 transporter was further evaluated by 358 transport assays in MDCK-MATE1 monolayers using lamivudine concentrations ranging 359 from 100 nM to 10 mM. The Km value for transfer of lamivudine across MDCK-MATE1 15 360 monolayers was 4213 ± 558.2 µM (Fig. 2), indicating that MATE1-mediated transfer of 361 lamivudine is a low affinity process. 362 363 Mitoxantrone-mediated MATE1 inhibition of lamivudine transport 364 To further test the contribution of MATE1 to the transcellular transfer of lamivudine, a potent 365 inhibitor of MATE1, mitoxantrone, was employed. First, ASP+ uptake was investigated in 366 MDCK-OCT1, MDCK-OCT2 and MDCK-MATE1 cells to assess the inhibitory potency of 367 mitoxantrone to the different SLC transporters (accumulation buffer of pH 7.4 was used in 368 both OCT-expressing cells, whereas pH 8.4 was used for the MDCK-MATE1 cells to reverse 369 the direction of the ASP+ transport to uptake). When comparing IC50 values, the observed 370 selectivity for MATE1 inhibition was 4.8 and 9.1 times higher than that for OCT1 and OCT2 371 (P < 0.001), respectively (Fig. 3A). Based on these results and the dose dependency inhibition 372 curve of ASP+ uptake, 2 µM mitoxantrone was chosen for the subsequent transport assay to 373 predominantly inhibit MATE1 over OCTs in MATE1/OCT transporters expressing cellular 374 monolayers (Fig. 3B,C). 375 Addition of mitoxantrone (2 µM) to the cellular monolayers reduced the basolateral to apical 376 transport of lamivudine in all the MATE1 expressing cells (MDCK-MATE1, MDCK-OCT1- 377 MATE1 and MDCK-OCT2-MATE1) to the level of MDCK-Co control cell line (P < 0.001, 378 two-way ANOVA, Fig. 3B) and showed no statistically significant difference in lamivudine 379 transport among the mitoxantrone inhibited cell lines. No effect of mitoxantrone on the 380 transcellular transport across MDCK-OCT1 and MDCK-OCT2 monolayers was observed 381 (data not shown). Consistent with these data, addition of mitoxantrone significantly increased 382 lamivudine accumulation in the monolayers of MATE1-, OCT1-MATE1- and OCT2-MATE1 16 383 expressing cells (P < 0.01, two-way ANOVA), whereas no increase was observed in MDCK- 384 Co cells (Fig. 3C). 385 386 Lamivudine transport across the perfused rat placenta; effect of pH 387 The ratio between F→M and M→F clearances found in the perfusion studies, in which [3H]- 388 lamivudine ( 12 nM) was applied from maternal or fetal side of the placenta was 1.8, 389 indicating possible active transplacental transport of lamivudine from the fetal to maternal 390 side. Nevertheless, the differences between M→F and F→M clearances did not reach 391 statistical significance (P = 0.096, Student´s t-test). Less than 1% of the lamivudine dose was 392 detected in the placenta after the perfusion experiments, suggesting limited tissue binding or 393 accumulation in trophoblasts and negligible effect on the clearance calculation. To further 394 study lamivudine transplacental transport, both sides of the placenta were perfused with the 395 same concentration of [3H]-lamivudine (12 nM) in a closed circuit experimental setup. We 396 observed a slight decrease of lamivudine concentration in the fetal perfusate, achieving 95.3 ± 397 2.46 % of the initial concentrations over 60 min perfusion. This decline might indicate a small 398 contribution of an active transport against the concentration gradient from the fetal to the 399 maternal side of the placenta. To study the effect of pH on lamivudine fetal-to-maternal 400 transport, which could reflect involvement of MATE1-mediated efflux, the pH in the maternal 401 reservoir was set to 6.5 or 8.5, while the pH in the fetal reservoir was set to 7.4. The fetal 402 lamivudine concentration changed significantly between the experiments with pH 6.5 and 8.5 403 (Fig. 4), suggesting involvement of proton-dependent transport of lamivudine across the 404 placenta. 405 17 406 Uptake of [3H]-lamivudine into human placenta MVM vesicles: effect of pH 407 To determine the relevance of MATE1-mediated transport for the transplacental transfer of 408 lamivudine in human placenta, and, more specifically, MATE1 involvement in the transport 409 of lamivudine across the MVM of human placenta, uptake of lamivudine into MVM vesicles 410 isolated from human term placenta of uncomplicated pregnancies was measured. The 411 lamivudine accumulation into the vesicles was stimulated by a higher extravesicular pH. 412 However, the magnitude of the increase in response to the imposed outwardly directed proton 413 gradient was rather variable between MVM vesicle isolates and reached the statistical 414 significance only with the pH gradient of 2.2 units (pH 6.2-8.4), but not with the 1 unit (pH 415 7.4-8.4) gradient (Fig. 5). 416 417 DISCUSSION 418 Lamivudine is considered a first line antiretroviral drug to prevent MTCT in HIV-positive 419 pregnant women (35). The concentrations of lamivudine found in cord blood at delivery have 420 been reported to reach maternal levels, suggesting that the drug can freely cross the placenta 421 by passive diffusion (36, 37). Nevertheless, a fetal-to-maternal area under the concentration- 422 time curve (AUC) ratio of 0.86 (6) indicates that transplacental crossing of lamivudine is not 423 entirely passive. One explanation is that a fetal-to-maternal directed transport mechanism is 424 involved which diminishes the transplacental passage of lamivudine from mother to fetus. 425 Such information would be of considerable importance for optimizing the pharmacotherapy of 426 pregnant women because placental drug transporters could be involved in pharmacokinetic 427 drug-drug interactions (DDI) affecting fetal drug exposure of concomitantly administered 428 drugs and leading to impaired treatment outcome or adverse effects (7, 38). This issue is of 18 429 particular importance in anti-HIV therapy, where combination of two or more antiretroviral 430 drugs is recommended (35). 431 Several drug efflux transporters are functionally expressed in the apical microvillous plasma 432 membrane of human syncytiotrophoblast (8-10). In the present project, we aimed to assess 433 whether lamivudine is a substrate of placental drug transport proteins and address whether 434 transplacental transfer of lamivudine is affected by drug efflux transporters. 435 Interaction of lamivudine with P-gp was evaluated by de Souza et al (40), using transport 436 assay in P-gp expressing monolayers. Based on the lack of interaction of lamivudine with a 437 potent P-gp inhibitor (GG 918), the authors concluded that P-gp does not significantly affect 438 the transport of lamivudine (40). Correspondingly, we did not observe any P-gp-accelerated 439 transport of lamivudine (8 nM) across the MDCK-MDR1 monolayers, confirming the lack of 440 relevant P-gp involvement in lamivudine transport. 441 Transport of lamivudine by BCRP was suggested by Kim et al., who observed decreased 442 lamivudine uptake in MDCK-BCRP cells and saturable lamivudine transport across BCRP 443 expressing monolayers in a 60 minutes-experiment (41). Nevertheless, functionally relevant 444 polymorphic variants of BCRP had no effect on lamivudine disposition in healthy volunteers, 445 indicating that BCRP is unlikely to make a relevant contribution to lamivudine 446 pharmacokinetics. To further address this issue, we performed transport study with a low 447 lamivudine concentration in MDCK-BCRP cells in a bidirectional concentration gradient 448 setup. The lamivudine transport ratio (rt) in MCDK-BCRP significantly exceeded that in the 449 parental MDCK cells (Table 1), however, it did not reach the value of 2, which is considered 450 by the International Transporter Consortium guidelines as a cut-off level for classifying a drug 451 as a transporter substrate (34). We therefore hypothesize that lamivudine might be only very 452 low affinity BCRP substrate questioning the transport of lamivudine by BCRP observed by 19 453 Kim et al in a short time set up assay (41). Similarly to the results in MDCK-MDR1 and 454 MDCK-BCRP cells, no active transporter-driven transfer of lamivudine was observed in 455 MDCK-MRP2 cells, showing that lamivudine is not significantly transported by any of the 456 three main placental ABC transporters. 457 In situ dually perfused rat term placenta represents a valuable alternative model to study 458 placental pharmacology and physiology. Using this approach, we have previously identified 459 ABC transporter-mediated placental passage of several compounds, including antiretrovirals 460 (23, 24, 31, 43). In the present study, we showed that the fetal-to-maternal clearance of 461 lamivudine was not significantly higher than the maternal-to-fetal clearance and that the 462 decrease of lamivudine concentration in fetal compartment during recirculation experiment 463 was insignificant (Fig. 4). These observations are in agreement with the above-discussed in 464 vitro transport experiments and indicate no, or only minor involvement of active transporter- 465 mediated fetus-to-mother directed efflux of lamivudine. 466 Lamivudine has recently been shown as a substrate of human MATE1 and the kidney-specific 467 MATE2-K transporters and MATEs-mediated pH-dependent efflux was suggested to 468 contribute to renal tubular excretion of lamivudine (17). This antiretroviral has also been 469 shown to be a substrate of all three subtypes of human organic cation transporter, with 470 efficacy dependent on kinetic parameters and Vmax/Km ratio decreasing in the following order: 471 OCT1 > OCT2 > OCT3 (18, 19). In the present study, we evaluated the affinity of lamivudine 472 to the MATE1 transporter and aimed to address in detail the role of OCTs in the transcellular 473 transfer of lamivudine using double-transfected MDCK-OCT1-MATE1 and MDCK- 474 OCT2/MATE2 cell lines and relevant mono-transfected and vector control MDCK cells. By 475 applying low concentrations of lamivudine to increase the sensitivity of the assay, we 476 confirmed that MATE1 significantly increases the transcellular passage of lamivudine whilst 477 decreasing intracellular accumulation of the drug (Fig. 1). Monolayers of OCT1- and OCT220 478 single-transfected cells accumulated higher levels of lamivudine but retained a similar 479 transcellular transport efficacy to that in vector control cells, confirming that OCT 480 transporters affect the influx of lamivudine into the cells. In agreement with previous 481 observations with 10 µM lamivudine (17), lamivudine transfer across MDCK-OCT2-MATE1 482 monolayers did not differ significantly from that in MDCK-MATE1 cells expressing the same 483 level of MATE1 mRNA (Table 2). Mitoxantrone used at a concentration preferentially 484 inhibiting MATE1 over OCT1 and OCT2 (2 µM) significantly decreased the lamivudine 485 transcellular transfer in all the MATE1 expressing cells to the level of control cells but 486 increased the cellular accumulation in all the MATE1-expressing cell lines (Fig. 3). Our data 487 thereby suggest that lamivudine transcellular transfer is controlled mainly by MATE1- 488 mediated efflux and is not significantly affected by OCT-mediated uptake. 489 Kinetic analysis of the MATE1-mediated transport of lamivudine revealed a rather low 490 affinity and transport capacity of MATE1 to the antiretroviral (Km = 4.21 mM, Vmax = 5.18 491 nmol/mg protein/min). The transport efficacies of OCT1 and OCT2 transporters to 492 lamivudine have been reported as Vmax/Km (OCT1) = 8.03 (18) or 8.0(19) µl/mg protein/min and 493 Vmax/Km (OCT2) = 4.1 (18) or 4.4(19) µl/mg protein/min, respectively, exceeding the efficacy of 494 MATE1 in the transport of lamivudine found in the present study (Vmax/Km = 1.23 µl/mg 495 protein/min). We therefore suggest that MATE1-mediated efflux might be the rate-limiting 496 step in the transcellular transfer of lamivudine, which is consistent with the results of our 497 transport studies showing that the transport rate of lamivudine across MDCK-MATE1 cells 498 did not differ from that across MDCK-OCT2-MATE1 cells (Results 3.1). Nevertheless, the in 499 vitro determined Km values do not necessary preclude kinetic impacts of the transporter in 500 vivo. For instance, some drugs of high Km values determined in vitro play a significant role in 501 MATE1 excretory pathways in vivo (44). 21 502 Moreover, the concentration of half maximal velocity lamivudine transport by MATE1 is 503 about three orders of magnitude higher than the maximal therapeutic concentration (≈ 3-11 504 µM) achieved in the plasma of pregnant women (37, 45), thus making saturation of MATE1 505 in vivo unlikely. 506 The involvement of pH-dependent transport in the transplacental pharmacokinetics of 507 lamivudine was further evaluated in situ by employing dually perfused rat term placenta. 508 Whereas expression of Mate1 appears to be absent in murine placenta (46, 47) abundant 509 placental expression has been found in rats (12, 14, 15) and the transporter was found to 510 mediate the pH-dependent fetal-to-maternal transfer of MPP+ (12) and metformin (16) in the 511 perfused rat placenta(12, 14). Using the same placental model the ratio between F→M and 512 M→F clearances of 12 nM lamivudine reached the value of 1.8, indicated possible active 513 transplacental transport of lamivudine from the fetal to maternal side. However, this value 514 was much lower than that measured for 10 nM MPP+ (123) and 100 nM metformin (7.3) in 515 previous studies (12, 16) and did not reach statistical significance. We observed that 516 decreasing the maternal pH increased the fetal-to-maternal transfer of lamivudine in the 517 closed circuit setup, indicating involvement of a pH-dependent transport mechanism on the 518 maternal facing side of trophoblasts in the transplacental transfer of lamivudine. 519 In contrast to rat, human placenta seems to express only low and highly variable levels of 520 hMATE1 mRNA (12, 14). Accordingly, we observed hMATE1 mRNA expression only in 7 521 of 10 analyzed placentas showing the level of MATE1 mRNA transcripts about 1000 times 522 lower when compared with human kidney medulla tissue (Table 2). To address the relevance 523 of MATE1 for transplacental transfer of lamivudine in humans, we additionally evaluated the 524 pH-dependent transport of lamivudine directly on microvillous plasma membrane (MVM) 525 vesicles isolated from the MATE1-expressing human term placental trophoblast. The uptake 526 of lamivudine across MVM appears to be sensitive to the imposed H+ gradient, suggesting 22 527 that MATE1-mediated H+/lamivudine exchange contribute to the transfer of lamivudine 528 across human placenta. However, the results were variable and achieved statistical 529 significance only with higher pH gradient (2.2 pH units) but not with lower pH gradient (1 pH 530 unit). It is possible that temporal dissipation of the H+ gradient across the MVM plasma 531 membrane contributed to the variability in the capacity of MATE1 to accumulate lamivudine 532 as substrate (32). The imposition of a steeper transmembrane H+ gradient across the MVM 533 plasma membrane may help clarify this further. 534 The maternal-fetal interface does not offer such a steep pH gradient as proximal tubules in the 535 kidney favouring the MATE1-mediated efflux, but it cannot be excluded that MATE1- 536 mediated transport in the placenta is linked also to another H+ transferring transporter(s) 537 providing a sufficient H+ ion gradient to drive the efflux such as Na+/H+ exchanger and ATP- 538 dependent H+ pump that were found functionally expressed in human placenta (48-50). It has 539 been also suggested that MATE-driven organic cation excretion may occur independently of a 540 pH gradient across the brush-border membrane (51) supporting the possible physiological role 541 of MATE1 in the placenta. Nevertheless, contribution of other pH-dependent transport 542 mechanism, such as MATE2 (13) in transfer of lamivudine across the MVM cannot be 543 excluded. In addition, higher portion of unionized form of lamivudine available for passive 544 diffusion into the vesicles provided by the pH gradient should be also taken into account. We 545 therefore suggest that MATE1 might represent one of the mechanisms mediating the 546 maternal-to-fetal transfer of lamivudine in human placenta; however its contribution to this 547 transfer is probably rather limited. The low impact of the MATE1 efflux transporters in the 548 transplacental transfer of lamivudine may be also caused by high transplacental passage of 549 lamivudine, driven by passive diffusion or any concentration gradient-driven mechanisms, 550 such nucleoside transport proteins (52-54). Nevertheless, since the human placenta tends to 551 express higher levels of MATE1 in the first trimester compared with term (13) it is feasible to 23 552 hypothesize that the MATE1-mediated transplacental transport of lamivudine might be of 553 higher importance in earlier phases of pregnancy. 554 To conclude, we have shown here that P-gp, MRP2 and BCRP do not affect the transplacental 555 transfer of lamivudine, making the risk of pharmacokinetic DDI between lamivudine and 556 other antiretroviral substrates of the ABC transporters in the placenta unlikely. On the other 557 hand, we demonstrated a low affinity efflux of lamivudine by MATE1, which seems to act 558 independently of the OCT-mediated cellular uptake of lamivudine. We further showed that a 559 pH-dependent mechanism mediates transport of lamivudine in the fetal-to-maternal direction 560 in rat as well as human placenta and concluded that MATE1 might be at least partly 561 responsible for this transport. However, further research is needed to address the role MATE1 562 may play in human placenta during pregnancy and to elucidate the risk of MATE1-mediated 563 DDI in the transplacental pharmacokinetics of lamivudine in humans. 564 565 ACKNOWLEDGEMENT 566 We wish to thank Dana Souckova and Renata Exnarova for their skilful assistance with the 567 perfusion experiments and Martina Hudeckova for her help with the collection and sampling 568 of human placentas. We also thank Dr. Roman Safranek, Ph.D. for providing us with the 569 kidney biopsy samples. 570 571 FUNDING INFORMATION 572 This work was supported by the Czech Science Foundation (Projects GACR P303-120850 573 and GACR 13-31118P) and the Grant Agency of Charles University in Prague 574 (SVV/2016/260 293). 575 24 576 TRANSPARENCY DECLARATIONS 577 FM holds a minor share of stock in Novartis, received research funding from Sanofi-Aventis 578 Deutschland and is an employee of Boehringer Ingelheim Pharma GmbH & Co. KG. 579 580 REFERENCES 581 1. 582 583 584 2. WHO. 2013. Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach. . 585 586 587 588 589 590 3. AIDSinfo. Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV1- Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/PerinatalGL.pdf. 591 592 593 4. Lamberth JR, SC Reddy, JJ Pan and KJ Dasher. 2015. Chronic hepatitis B infection in pregnancy, vol 7, p 1233-1237. 594 595 596 597 5. Wong F, R Pai, J Van Schalkwyk and EM Yoshida. 2014. Hepatitis B in pregnancy: a concise review of neonatal vertical transmission and antiviral prophylaxis, vol 13, p 187-195. 598 599 600 601 6. Benaboud S, JM Treluyer, S Urien, S Blanche, N Bouazza, H Chappuy, E Rey, E Pannier, G Firtion, O Launay and D Hirt. 2012. Pregnancy-related effects on lamivudine pharmacokinetics in a population study with 228 women, vol 56, p 776-782. 602 603 604 605 7. Staud F, L Cerveny and M Ceckova. 2012. Pharmacotherapy in pregnancy; effect of ABC and SLC transporters on drug transport across the placenta and fetal drug exposure, vol 20, p 736-763. 606 607 608 8. Ceckova-Novotna M, P Pavek and F Staud. 2006. P-glycoprotein in the placenta: Expression, localization, regulation and function, vol 22, p 400-410. 609 610 611 612 9. Hahnova-Cygalova L, M Ceckova and F Staud. 2011. Fetoprotective activity of breast cancer resistance protein (BCRP, ABCG2): expression and function throughout pregnancy, vol 43, p 53-68. UNAIDS. 2015. Global statistics 2014. 25 613 614 615 616 617 10. Meyer zu Schwabedissen HE, G Jedlitschky, M Gratz, S Haenisch, K Linnemann, C Fusch, I Cascorbi and HK Kroemer. 2005. Variable expression of MRP2 (ABCC2) in human placenta: influence of gestational age and cellular differentiation, vol 33, p 896-904. 618 619 620 11. Staud F, L Cerveny, D Ahmadimoghaddam and M Ceckova. 2013. Multidrug and toxin extrusion proteins (MATE/SLC47); role in pharmacokinetics, vol 45, p 2007-2011. 621 622 623 624 625 12. Ahmadimoghaddam D, J Hofman, L Zemankova, P Nachtigal, E Dolezelova, L Cerveny, M Ceckova, S Micuda and F Staud. 2012. Synchronized activity of Organic Cation Transporter 3 (Oct3/SLC22A3) and Multidrug and Toxin Extrusion 1 (Mate1/SLC47A1) transporter in transplacental passage of MPP+ in rat. 626 627 628 629 630 631 13. Ahmadimoghaddam D, L Zemankova, P Nachtigal, E Dolezelova, Z Neumanova, L Cerveny, M Ceckova, M Kacerovsky, S Micuda and F Staud. 2013. Organic cation transporter 3 (OCT3/SLC22A3) and multidrug and toxin extrusion 1 (MATE1/SLC47A1) transporter in the placenta and fetal tissues: expression profile and fetus protective role at different stages of gestation, vol 88, p 55. 632 633 634 635 14. Lee N, MF Hebert, B Prasad, TR Easterling, EJ Kelly, JD Unadkat and J Wang. 2013. Effect of gestational age on mRNA and protein expression of polyspecific organic cation transporters during pregnancy, vol 41, p 2225-2232. 636 637 638 639 15. Terada T, S Masuda, J Asaka, M Tsuda, T Katsura and K Inui. 2006. Molecular cloning, functional characterization and tissue distribution of rat H+/organic cation antiporter MATE1, vol 23, p 1696-1701. 640 641 642 643 16. Ahmadimoghaddam D and F Staud. 2013. Transfer of metformin across the rat placenta is mediated by organic cation transporter 3 (OCT3/SLC22A3) and multidrug and toxin extrusion 1 (MATE1/SLC47A1) protein, vol 39, p 17-22. 644 645 646 647 17. Müller F, J König, E Hoier, K Mandery and MF Fromm. 2013. Role of organic cation transporter OCT2 and multidrug and toxin extrusion proteins MATE1 and MATE2-K for transport and drug interactions of the antiviral lamivudine, vol 86, p 808-815. 648 649 650 651 652 653 18. Minuesa G, C Volk, M Molina-Arcas, V Gorboulev, I Erkizia, P Arndt, B Clotet, M Pastor-Anglada, H Koepsell and J Martinez-Picado. 2009. Transport of lamivudine [(-)beta-L-2',3'-dideoxy-3'-thiacytidine] and high-affinity interaction of nucleoside reverse transcriptase inhibitors with human organic cation transporters 1, 2, and 3, vol 329, p 252261. 654 655 656 19. Jung N, C Lehmann, A Rubbert, M Knispel, P Hartmann, J van Lunzen, HJ Stellbrink, G Faetkenheuer and D Taubert. 2008. Relevance of the organic cation 26 657 658 transporters 1 and 2 for antiretroviral drug therapy in human immunodeficiency virus infection, vol 36, p 1616-1623. 659 660 661 662 663 20. Sata R, H Ohtani, M Tsujimoto, H Murakami, N Koyabu, T Nakamura, T Uchiumi, M Kuwano, H Nagata, K Tsukimori, H Nakano and Y Sawada. 2005. Functional analysis of organic cation transporter 3 expressed in human placenta, vol 315, p 888-895. 664 665 666 667 21. König J, O Zolk, K Singer, C Hoffmann and MF Fromm. 2011. Doubletransfected MDCK cells expressing human OCT1/MATE1 or OCT2/MATE1: determinants of uptake and transcellular translocation of organic cations, vol 163, p 546-555. 668 669 670 671 22. Müller F, J König, H Glaeser, I Schmidt, O Zolk, MF Fromm and R Maas. 2011. Molecular mechanism of renal tubular secretion of the antimalarial drug chloroquine, vol 55, p 3091-3098. 672 673 674 675 23. Neumanova Z, L Cerveny, M Ceckova and F Staud. 2014. Interactions of tenofovir and tenofovir disoproxil fumarate with drug efflux transporters ABCB1, ABCG2, and ABCC2; role in transport across the placenta, vol 28, p 9-17. 676 677 678 679 24. Neumanova Z, L Cerveny, SL Greenwood, M Ceckova and F Staud. 2015. Effect of drug efflux transporters on placental transport of antiretroviral agent abacavir, 10.1016/j.reprotox.2015.07.070. 680 681 682 683 684 25. Pavek P, G Merino, E Wagenaar, E Bolscher, M Novotna, JW Jonker and AH Schinkel. 2005. Human breast cancer resistance protein: interactions with steroid drugs, hormones, the dietary carcinogen 2-amino-1-methyl-6-phenylimidazo(4,5-b)pyridine, and transport of cimetidine, vol 312, p 144-152. 685 686 687 688 26. Otsuka M, T Matsumoto, R Morimoto, S Arioka, H Omote and Y Moriyama. 2005. A human transporter protein that mediates the final excretion step for toxic organic cations, vol 102, p 17923-17928. 689 690 691 692 693 27. Wittwer MB, AA Zur, N Khuri, Y Kido, A Kosaka, X Zhang, KM Morrissey, A Sali, Y Huang and KM Giacomini. 2013. Discovery of potent, selective multidrug and toxin extrusion transporter 1 (MATE1, SLC47A1) inhibitors through prescription drug profiling and computational modeling, vol 56, p 781-795. 694 695 696 28. Dangprapai Y and SH Wright. 2011. Interaction of H+ with the extracellular and intracellular aspects of hMATE1, vol 301, p F520-528. 697 27 698 699 700 29. Astorga B, S Ekins, M Morales and SH Wright. 2012. Molecular determinants of ligand selectivity for the human multidrug and toxin extruder proteins MATE1 and MATE2K, vol 341, p 743-755. 701 702 703 704 30. Tsuda M, T Terada, J Asaka, M Ueba, T Katsura and K Inui. 2007. Oppositely directed H+ gradient functions as a driving force of rat H+/organic cation antiporter MATE1, vol 292, p F593-598. 705 706 707 708 709 31. Staud F, Z Vackova, K Pospechova, P Pavek, M Ceckova, A Libra, L Cygalova, P Nachtigal and Z Fendrich. 2006. Expression and transport activity of breast cancer resistance protein (Bcrp/Abcg2) in dually perfused rat placenta and HRP-1 cell line, vol 319, p 53-62. 710 711 712 713 32. Glazier JD, CJ Jones and CP Sibley. 1988. Purification and Na+ uptake by human placental microvillus membrane vesicles prepared by three different methods, vol 945, p 127134. 714 715 716 33. Glazier JD and CP Sibley. 2006. In vitro methods for studying human placental amino acid transport: placental plasma membrane vesicles, vol 122, p 241-252. 717 718 719 720 721 722 34. International Transporter C, KM Giacomini, SM Huang, DJ Tweedie, LZ Benet, KL Brouwer, X Chu, A Dahlin, R Evers, V Fischer, KM Hillgren, KA Hoffmaster, T Ishikawa, D Keppler, RB Kim, CA Lee, M Niemi, JW Polli, Y Sugiyama, PW Swaan, JA Ware, SH Wright, SW Yee, MJ Zamek-Gliszczynski and L Zhang. 2010. Membrane transporters in drug development, vol 9, p 215-236. 723 724 725 726 727 728 729 730 731 35. NIH. 2015. Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1 Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States. Accessed 36. Chappuy H, JM Treluyer, V Jullien, J Dimet, E Rey, M Fouche, G Firtion, G Pons and L Mandelbrot. 2004. Maternal-fetal transfer and amniotic fluid accumulation of nucleoside analogue reverse transcriptase inhibitors in human immunodeficiency virusinfected pregnant women, vol 48, p 4332-4336. 732 733 734 735 37. Moodley D, K Pillay, K Naidoo, J Moodley, MA Johnson, KH Moore, PN Mudd, Jr. and GE Pakes. 2001. Pharmacokinetics of zidovudine and lamivudine in neonates following coadministration of oral doses every 12 hours, vol 41, p 732-741. 736 737 738 739 740 38. Daud AN, JE Bergman, MK Bakker, H Wang, WS Kerstjens-Frederikse, HE de Walle, H Groen, JH Bos, E Hak and B Wilffert. 2015. P-Glycoprotein-Mediated Drug Interactions in Pregnancy and Changes in the Risk of Congenital Anomalies: A CaseReference Study, vol 38, p 651-659. 741 28 742 743 744 39. Neumanova Z, L Cerveny, M Ceckova and F Staud. 2015. Role of ABCB1, ABCG2, ABCC2 and ABCC5 transporters in placental passage of zidovudine, 10.1002/bdd.1993. 745 746 747 748 40. de Souza J, LZ Benet, Y Huang and S Storpirtis. 2009. Comparison of bidirectional lamivudine and zidovudine transport using MDCK, MDCK-MDR1, and Caco-2 cell monolayers, vol 98, p 4413-4419. 749 750 751 752 41. Kim HS, YE Sunwoo, JY Ryu, HJ Kang, HE Jung, IS Song, EY Kim, JC Shim, JH Shon and JG Shin. 2007. The effect of ABCG2 V12M, Q141K and Q126X, known functional variants in vitro, on the disposition of lamivudine, vol 64, p 645-654. 753 754 755 756 42. Cerveny L, P Pavek, J Malakova, F Staud and Z Fendrich. 2006. Lack of interactions between breast cancer resistance protein (bcrp/abcg2) and selected antiepileptic agents, vol 47, p 461-468. 757 758 759 760 43. Cygalova LH, J Hofman, M Ceckova and F Staud. 2009. Transplacental pharmacokinetics of glyburide, rhodamine 123, and BODIPY FL prazosin: effect of drug efflux transporters and lipid solubility, vol 331, p 1118-1125. 761 762 763 764 44. Watanabe S, M Tsuda, T Terada, T Katsura and K Inui. 2010. Reduced renal clearance of a zwitterionic substrate cephalexin in MATE1-deficient mice, vol 334, p 651656. 765 766 767 768 45. Mandelbrot L, G Peytavin, G Firtion and R Farinotti. 2001. Maternal-fetal transfer and amniotic fluid accumulation of lamivudine in human immunodeficiency virus-infected pregnant women, vol 184, p 153-158. 769 770 771 772 46. Aleksunes LM, Y Cui and CD Klaassen. 2008. Prominent expression of xenobiotic efflux transporters in mouse extraembryonic fetal membranes compared with placenta, vol 36, p 1960-1970. 773 774 775 776 47. Lickteig AJ, X Cheng, LM Augustine, CD Klaassen and NJ Cherrington. 2008. Tissue distribution, ontogeny and induction of the transporters Multidrug and toxin extrusion (MATE) 1 and MATE2 mRNA expression levels in mice, vol 83, p 59-64. 777 778 779 780 48. Balkovetz DF, FH Leibach, VB Mahesh, LD Devoe, EJ Cragoe, Jr. and V Ganapathy. 1986. Na+-H+ exchanger of human placental brush-border membrane: identification and characterization, vol 251, p C852-860. 781 782 783 784 49. Ganapathy V, DF Balkovetz, Y Miyamoto, ME Ganapathy, VB Mahesh, LD Devoe and FH Leibach. 1986. Inhibition of human placental Na+-H+ exchanger by cimetidine, vol 239, p 192-197. 29 785 786 787 788 50. Simon BJ, P Kulanthaivel, G Burckhardt, S Ramamoorthy, FH Leibach and V Ganapathy. 1992. Characterization of an ATP-driven H+ pump in human placental brushborder membrane vesicles, vol 287 ( Pt 2), p 423-430. 789 790 791 792 793 51. Meyer zu Schwabedissen HE, C Verstuyft, HK Kroemer, L Becquemont and RB Kim. 2010. Human multidrug and toxin extrusion 1 (MATE1/SLC47A1) transporter: functional characterization, interaction with OCT2 (SLC22A2), and single nucleotide polymorphisms, vol 298, p F997-F1005. 794 795 796 797 798 52. Cano-Soldado P, IM Lorrayoz, M Molina-Arcas, FJ Casado, J Martinez-Picado, MP Lostao and M Pastor-Anglada. 2004. Interaction of nucleoside inhibitors of HIV-1 reverse transcriptase with the concentrative nucleoside transporter-1 (SLC28A1), vol 9, p 993-1002. 799 800 801 802 53. Errasti-Murugarren E, P Diaz, V Godoy, G Riquelme and M Pastor-Anglada. 2011. Expression and distribution of nucleoside transporter proteins in the human syncytiotrophoblast, vol 80, p 809-817. 803 804 805 54. Molina-Arcas M, FJ Casado and M Pastor-Anglada. 2009. Nucleoside transporter proteins, vol 7, p 426-434. 806 807 FIGURE LEGENDS AND TABLES 808 30 809 Figure 1. Transport of lamivudine in single-transfected MDCK cells overexpressing OCT1, 810 OCT2 and MATE1, double-transfected MDCK-cells overexpressing OCT1 or OCT2 and 811 MATE1 (MDCK-OCT1-MATE1, MDCK-OCT2-MATE1) and vector control cells MDCK- 812 Co. Cells were seeded on Transwell semipermeable supports dividing a basal compartment 813 and an apical compartment. Lamivudine (100 nM) was added to the basal compartment and 814 sampled at time points 0.5, 1 and 2 h from the apical side of monolayers (A, B, C). 815 Intracellular accumulation of lamivudine in the monolayers was determined in cell lysates at 816 the end of the experiment (D, E, F). Data were analyzed by Student´s t-test (***P < 0.001 vs. 817 respective control, Co, OCT1 or OCT2) and are shown as means ± SD (n ≥ 3). 818 819 820 Figure 2. Concentration-dependent net transcellular transport of lamivudine by MATE1. 821 Basolateral-to-apical transport of lamivudine across MDCK-MATE1 and MDCK-Co cells 822 cultured as monolayers on Transwell membranes was investigated for increasing 823 concentrations of non-radiolabelled lamivudine (1 x 10-4; 1 x 10-3; 0.01; 0.1; 1.0; 2.0; 5.0 and 824 10 mM) with addition of tracer [3H]-lamivudine (16.7 nM) applied to the basolateral 825 compartment. The transcellular transport of lamivudine across MDCK-Co monolayers was 826 subtracted from that in MDCK-MATE1 cells at each concentration point. Kinetic parameters 827 (Km and Vmax) were estimated by fitting MATE-specific transport rates to a Michaelis-Menten 31 828 non-linear equation. Data (nmol/mg protein/min) represent the mean ± SD from three 829 independent experiments. 830 831 832 Figure 3. Inhibitory effect of mitoxantrone on lamivudine transport by MATE1. A: IC50 833 values reflecting inhibition of ASP+ uptake into OCT1-, OCT2-, and MATE1-expressing 834 MDCK cells by mitoxantrone. The IC50 values with 95% confidential interval were calculated 835 from three independent measurements. B, C: Effect of 2 µM mitoxantrone on transcellular 836 transport (B) and intracellular accumulation (C) of lamivudine (100 nM) in monolayers of 837 MATE1-expressing and control cells. Data were analyzed by two-way ANOVA with multiple 838 comparisons (**P < 0.01, ***P < 0.001 vs. respective non-inhibited controls) and are shown 839 as mean ± SD (n ≥ 3). 840 841 Figure 4. Effect of maternal pH on elimination of lamivudine from the fetal circulation. In the 842 closed-circuit perfusion setup, both the fetal and maternal sides of the placenta were 843 simultaneously infused with 12 nM [3H]-lamivudine. The fetal pH was set to 7.4, whereas the 32 844 pH in the maternal reservoir was set to 6.5, 7.4 or 8.5. The fetal perfusate was recirculated for 845 60 min and then, fetal and maternal concentrations of lamivudine were compared. A: 846 Lamivudine fetal concentration over 60 min perfusion at pH 6.5 and 8.5 applied on the 847 maternal site. B: Final ratio between fetal and maternal concentrations at equilibrium showing 848 statistically significant difference between ratios calculated for perfusions at pH 6.5 and pH 849 8.5 (P < 0.05; Kruskal-Wallis test), suggesting involvement of a proton-cation antiporter 850 system in lamivudine transplacental transport. Data are presented as means ± SD (n ≥ 3). 851 852 Figure 5. Effect of H+ gradient on [3H]-lamivudine uptake by MVM vesicles from human 853 term placentas. MVM vesicles were prepared in intravesicular buffer (IVB) at pH 6.2 or 7.4. 854 A: One minute uptake of [3H]-lamivudine was examined in extravesicular buffer (EVB) 855 containing 100 nM [3H]-lamivudine at pH 7.4 or 8.4. B: Paired measurements for pH 6.2 IVB 856 MVM vesicles showing stimulation of [3H]-lamivudine uptake in the presence of an increased 857 pH gradient (change = 422 ± 276%, mean ± SD, n=6; P=0.044, paired t-test). Data are 858 presented as means ± SD of experiments obtained from 5-7 placentas. 859 33 860 Table 1. Lamivudine transport across monolayers of MDCK parent and human MDR1-, 861 BCRP- and MRP2-transporter expressing MDCK cells Cell line Transport ratio (rt) (basal-to-apical/apical-to-basal) MDCK parent 0.923 ± 0.195 MDCK-MDR1 0.930 ± 0.140 MDCK-BCRP 1.25* ± 0.0277 MDCK-MRP2 1.03 ± 0.131 862 Cells were seeded on Transwell semipermeable supports and grown as monolayers dividing, 863 similarly to a polarized trophoblast layer, the basal compartment (corresponding to fetal side) 864 and apical compartments (corresponding to maternal compartment). The transport ratios (rt) 865 for translocation of lamivudine (8 nM) across monolayers of ABC-transporter expressing cells 866 and parent MDCK cells after 6 h are shown. Data are presented as means ± SD of ratios 867 obtained in at least four independent experiments (n ≥ 4). Student´s t-test was employed to 868 compare the ratios of particular ABC-transporter expressing cells to the respective ratio in 869 MDCK parent control cells and results were considered statistically significant when P ≤ 870 0.05(*). 871 872 Table 2. qRT-PCR for human MATE1 (SLC47A1) mRNA expression in MATE1 transfected 873 MDCK cell lines, placenta and kidney MDCK-MATE1 Ct 17.4 ± 0.277 MDCK-OCT1/MATE1 21.3 ± 0.364 MDCK-OCT2/MATE1 MDCK-Co 17.3 ± 0.294 ND Human placenta Human kidney 33.4 ± 5.86 23.6 ± 1.00 874 RNA isolated from cells and tissues was reverse-transcribed and resulting cDNA (40 ng) was 875 quantified for expression of hMATE1 (SLC47A1) using the QuantStudio 6 detector. Mean Ct 876 values of two independent experiments performed in triplicate for each sample are shown for 34 877 cell lines, human term placenta villous tissue (n = 7) and human kidney medulla samples (n = 878 2). ND no expression detected. 879 880 881 882 35