Clinical relevance of P-glycoprotein in drug therapy

The drug efflux transporter P-glycoprotein (P-gp) is known to confer multidrug resistance in cancer chemotherapy. The P-gp is highly expressed in many types of tumor cells, as well as many normal tissues, including the apical surface of intestinal epithelial cells, and the luminal surface of capillary endothelial cells in the brain. Because of its expression and localization, it has been suggested that P-gp plays an important role in cancer chemotherapy, intestinal absorption, and brain uptake. This review addresses the significance of the role of P-gp in cancer chemotherapy, drug absorption, and brain uptake. Based on the clinical and animal studies with P-gp modulators, it has become apparent that the role of P-gp in multidrug resistance is far less important compared to other biological factors. Although P-gp is highly expressed in both intestinal epithelial cells and endothelial cells of brain capillaries and functions as an efflux transporter in both organs, the magnitude of P-gp's impact on intestinal absorption and brain uptake of drugs is quantitatively very different. From animal and clinical studies, it is evident that P-gp plays a very important role in CNS penetration of drugs, whereas the effect of P-gp on drug absorption is not as important as generally believed.