Influence of barrier-crossing limitations on the amount of macromolecular drug taken up by its target.

Macromolecules (substitutive enzymes, polymeric prodrugs, immunotoxins, radiolabeled antibodies, or peptide hormones) are of interest in the treatment of several diseases. To reach the tissues, these macromolecular drugs have to cross the capillary wall, which represents an important transfer limitation. While pharmacokinetics usually studies the changes in drug concentration in different body compartments, analyzing the amount of drug gaining access to its target may be more relevant for assessing the efficiency of macromolecules than for low molecular mass drugs. To determine the influence of different parameters on the fraction of the injected dose gaining access to the pharmacologic target, we constructed pharmacokinetic models where two uptakes, both linear or nonlinear, work either in the same compartment (no transport limitation), or in compartments separated by a transport barrier. Numerical applications were carried out with parameters obtained either experimentally or from the literature. We conclude that it is of little use to increase the affinity (K(uptake)) of a macromolecular drug for its target when a transport limitation and an undesired elimination from the plasma space are both present. Likewise, an increase of the uptake (rate of uptake or maximal velocity) by the target is not very productive because permeability of the capillary wall is the factor limiting access of macromolecules to tissues. Maximal efficiency of therapeutic macromolecules could be achieved by increasing, where feasible, the transport across the barrier between the plasma and the target, and by preventing the undesired eliminations as much as possible.