Modelling of tolerance and rebound in normal and diseased rats

Abstract

The development of rebound and tolerance is an important consideration when optimizing medical therapy, both with respect to drug dosing and adverse effects. By using quantitative approaches to study these processes, potential risks can be minimized. In this thesis nicotinic acid (NiAc)-induced changes in non-esterified fatty acids (NEFA) were used as a tool to investigate key determinants of tolerance and rebound in normal Sprague Dawley and in obese Zucker rats, a disease model of dyslipidaemia. The aim of the studies was to develop and challenge a model that described tolerance and rebound following different durations, rates and routes of NiAc administration.

In normal rats, administration of NiAc resulted in a rapid decrease in NEFA plasma concentration, followed by rebound, the extent of which depended on both the level and duration of drug exposure. Rebound oscillations followed long duration of NiAc exposure. During constant drug exposure, increasing NEFA concentrations indicated tolerance development. The pharmacodynamic characteristics of NiAc-induced changes in NEFA differed in normal and diseased rats, with NEFA baseline concentrations being increased, rebound diminished, and tolerance develop¬ment more pronounced in the diseased animals.

The non-intuitive pattern of NiAc-induced changes in NEFA was captured by a feedback model with a moderator distributed over a series of transit compartments, where the first compartment inhibited the formation of response and the last stimulated the loss of response. The model was based on mechanistic principles, mimicking the dual actions of insulin in inhibiting the hydrolysis of triglycerides to NEFA and glycerol, and stimulating the re-esterification of NEFA. In both the normal and diseased rats, the model described the pharmacodynamic characteristics adequately.

The concentration-response relationship at steady state was shifted upwards and to the right, and was shallower, in diseased rats compared to normal rats. The extent of such shifts demonstrates the impact of disease at equilibrium in the system.

These studies have shown that by eliciting different exposure patterns and taking into account both the washout dynamics of the administered drug and the pharmacodynamic characteristics of normal and diseased animals, a mechanistically-based feedback model was able to tease out important information about tolerance and rebound.