Epacadostat (
EPAC) is a first-in-class, orally active inhibitor of the
enzyme indoleamine 2,3-dioxygenase 1 and has demonstrated promising clinical activity. In humans, three major plasma metabolites have been identified: M9 (a
glucuronide-conjugate), M11 (a gut microbiota metabolite), and M12 (a secondary metabolite formed from M11). It is proposed, based on the human pharmacokinetics of
EPAC, that the biliary excretion of M9, the most abundant metabolite, leads to the enterohepatic circulation of
EPAC. Using various in vitro systems, we evaluated in the present study the vitro interactions of
EPAC and its major metabolites with major drug transporters involved in drug absorption and disposition.
EPAC is a substrate for efflux transporters
P-glycoprotein (P-gp) and
breast cancer resistance
protein (BCRP), but it is not a substrate for hepatic uptake
transporters [organic anion transporting
polypeptides OATP1B1 and OATP1B3]. The low permeability of M9 suggests an essential role for transporters in its disposition. M9 is likely excreted from hepatocytes into bile via
multidrug resistance-associated protein 2 (MRP2) and BCRP, excreted into blood via MRP3, and transported from blood back into hepatocytes via OATP1B1 and OATP1B3. M11 and M12 are not substrates for P-gp, OATP1B1 or OATP1B3, and M11, but not M12, is a substrate for BCRP. With respect to inhibition of drug transporters, the potential of
EPAC, M9, M11, and M12 to cause clinical drug-drug interactions via inhibition of P-gp, BCRP, OATP1B1, OATP1B3, OAT1, OAT3, or
organic cation transporter 2 was estimated to be low. The current investigation underlines the importance of metabolite-transporter interactions in the disposition of clinically relevant metabolites, which may have implications for the pharmacokinetics and drug interactions of parent drugs.