Breastfeeding offers health and wellbeing benefits for both mother and child. Half of new mothers need medicines. Many medicines are likely to be safe, but human lactation studies are challenging to conduct. As a result, women often have to choose between continuing their medical treatment and breastfeeding their infant. In a recent Biomedicine & Pharmacotherapy publication, ConcePTION researchers provide an extensive overview of non-clinical and computational methods that can be used to inform human lactation studies. And how these methods can be combined to enable prediction of medicine transfer into breast milk when human lactation studies cannot be performed.
Human in vitro models can deliver essential data on the transport of medicines across cells at the blood-milk barrier. Importantly, such in vitro data can be used to ‘feed’ so-called physiologically-based pharmacokinetic (PBPK) models. These computational models enable conducting virtual clinical studies in mothers and their breastfeeding infants. Also, the combination of animal in vitro and in vivo methods can deliver pivotal information to establish accurate in vitro/in vivo extrapolation algorithms, as well as insight into the underlying mechanisms. ConcePTION is building a platform to further develop these non-clinical and computational tools. The power of this approach lays in the combination of complementary methods that can be used to predict if the mother’s medicine will reach the infant through breastfeeding. Eventually, exposure-based risk assessments can be performed.
“This iterative development of several non-clinical and computational tools will ultimately lead to more knowledge about medicines transferring to breast milk, and to what extent the child is exposed to the mother’s medicine or not. We do not know enough about this yet. Hopefully this will drive a paradigm shift making data available already from the moment that new medicines are brought to market, and in the end help care providers and women to make informed choices about the medicines they use, or choose not to use, during lactation,” says Nina Nauwelaerts, one of the authors of a recent Biomedicine & Pharmacotherapy paper.
By Anna Holm
Nauwelaerts N, Deferm N, Smits A, et al, A comprehensive review on non-clinical methods to study transfer of medication into breast milk – A contribution from the ConcePTION project, Biomedicine & Pharmacotherapy, 2021 (in press)
Glossary
In vitro models
In vitro means in the glass. These studies are performed with microorganisms, cells, or biological molecules outside their normal biological context (e.g. in a test tube or Petri dish).
In vivo models
In vivo means within the living. These studies are performed within living biological entities, and in this specific case in animals.
Physiologically-based pharmacokinetic models
Physiologically-based pharmacokinetic modelling is a so-called bottom-up mathematical technique for predicting the in vivo absorption, distribution, metabolism, and excretion (ADME) of chemical substances in humans and other animals. PBPK models rely on both the physiologic description of the target population or subject and also on medicine-specific physicochemical and (in vitro) ADME data.