P-glycoprotein, a gatekeeper in the blood-brain barrier

The blood-brain barrier is a major impediment to the entry of many therapeutic drugs into the brain. P-Glycoprotein is an ATP-dependent drug transport protein that is predominantly found in the apical membranes of a number of epithelial cell types in the body, including the blood luminal membrane of the brain capillary endothelial cells that make up the blood-brain barrier. Since P-glycoprotein can actively transport a huge variety of hydrophobic amphipathic drugs out of the cell, it was hypothesized that it might be responsible for the very poor penetration of many relatively large (> 400 Da) hydrophobic drugs in the brain, by performing active back-transport of these drugs to the blood. Extensive experiments with in vitro models and with knockout mice lacking blood-brain barrier P-glycoprotein or other animal models treated with blockers of P-glycoprotein have fully confirmed this hypothesis. Absence of functional P-glycoprotein in the blood-brain barrier leads to highly increased brain penetration of a number of important drugs. Depending on the pharmacological target of these drugs in the central nervous system (CNS), this can result in dramatically increased neurotoxicity, or fundamentally altered pharmacological effects of the drug. Given the variety of drugs affected by P-glycoprotein transport, it may be of tremendous therapeutic value to apply these insights to the development of drugs that should have either very poor or very good brain penetration, whichever is preferred for pharmacotherapeutic purposes. The clinical application of P-glycoprotein blockers should also be considered in order to improve the blood-brain barrier permeability of certain drugs that currently display insufficient brain penetration for effective therapy. (C) 1999 Elsevier Science B.V. All rights reserved.