MICRORNAS AS REGULATORS OF DRUG METABOLISM AND TRANSPORT IN PREGNANT AND LACTATING WOMEN

Physiological changes during pregnancy result in altered maternal drug metabolism that impacts efficacy and safety of therapeutics in pregnant women. Pregnancy induced hormonal, immunologic, or metabolic changes may also influence and alter drug disposition. Despite research efforts focused on pharmacokinetics of medications used in pregnant women in the past decade, knowledge gaps exist in understanding how pregnancy influences drug disposition and placental drug transporters. Moreover, there is a scarcity of research in understanding the safety and effectiveness of therapeutics in lactating women. This study aimed to determine the effect of pregnancy on levels of miRNAs regulating drug metabolizing enzymes and transporters (DMET).

We utilized longitudinal serum specimens collected in 3-month intervals from 88 women who became pregnant during follow-up in a large prospective study of hormonal contraception and HIV acquisition in Uganda and Zimbabwe. We used the HTG EdgeSeq platform coupled with Illumina sequencing to obtain the global miRNA transcriptome in paired specimens collected before, during and after pregnancy. To identify differentially expressed (DE) miRNAs that distinguish pregnancy from pre-conception or breastfeeding we used mixed effect model accounting for multiple samples from the pregnancy event and controlling for fixed effects of batch, country, Nugent score category and sexually transmitted infections. To identify hormonally regulated miRNAs independently associated with Box-Cox-transformed levels of progesterone (P4), β-estradiol (E2), and sex-hormone binding protein (SHBG) we controlled in addition for age, pregnancy and breastfeeding P-values were corrected using the Benjamini-Hochberg false discovery rate (FDR). DMET-targeting miRNAs were identified using miRTarBase focusing on interactions verified by 3'-UTR luciferase reporter assay and overlapped with DE miRNAs with FDR < 0.05.

Of 140 DMET-targeting miRNAs among the 2079 miRNAs in the global peripheral blood transcriptome, 41 unique DMET-targeting miRNAs were found to be DE during pregnancy - 38 differentiating pregnancy from preconception and 9 differentiating pregnancy from breastfeeding. The 56 DMETs confirmed as targets of the DE miRNAs included 8 members of the ABC (ATP-binding cassette) transporter family, all abundantly expressed in the placenta, and 4 members of the cytochrome P450 Phase 1 enzyme family with major role in xenobiotics detoxification. The study also revealed a strong (FDR<0.05), predominantly positive association between specific DMET-targeting miRNAs and sex hormone-binding globulin (SHBG) levels, suggesting a miRNA-mediated downregulation of DMETs as SHBG levels rise during pregnancy.

This research provides crucial insights into the molecular mechanisms underlying altered drug disposition in pregnant and lactating women, paving the way for improved therapeutic management and personalized medicine in these populations.