Example 8
Characterization of Absorption, Distribution, Metabolism, and Excretion of Oral [14C]Vorasidenib with Concomitant Intravenous Microdose Administration of [13C315N3]Vorasidenib in Humans
Metabolite profiling and identification of vorasidenib (AG-881) was performed in plasma, urine, and fecal samples collected from five healthy subjects after a single 50-mg (100 μCi) oral dose of [14C]AG-881 and concomitant intravenous microdose of [13C3 15N3]AG-881.
Plasma samples collected at selected time points from 0 through 336 hour postdose were pooled across subjects to generate 0—to 72 and 96-336-hour area under the concentration-time curve (AUC)-representative samples. Urine and feces samples were pooled by subject to generate individual urine and fecal pools. Plasma, urine, and feces samples were extracted, as appropriate, the extracts were profiled using high performance liquid chromatography (HPLC), and metabolites were identified by liquid chromatography-mass spectrometry (LC-MS and/or LC-MS/MS) analysis and by comparison of retention time with reference standards, when available.
Due to low radioactivity in samples, plasma metabolite profiling was performed by using accelerator mass spectrometry (AMS). In plasma, AG-881 was accounted for 66.24 and 29.47% of the total radioactivity in the pooled AUC0-72 h and AUC96-336 h plasma, respectively. The most abundant radioactive peak (P7; M458) represented 0.10 and 43.92% of total radioactivity for pooled AUC0-72 and AUC96-336 h plasma, respectively. All other radioactive peaks accounted for less than 6% of the total plasma radioactivity and were not identified.
The majority of the radioactivity recovered in feces was associated with unchanged AG-881 (55.5% of the dose), while no AG-881 was detected in urine. In comparison, metabolites in excreta accounted for approximately 18% of dose in feces and for approximately 4% of dose in urine. M515, M460-1, M499, M516/M460-2, and M472/M476 were the most abundant metabolites in feces, and each accounted for approximately 2 to 5% of the radioactive dose, while M266 was the most abundant metabolite identified in urine and accounted for a mean of 2.54% of the dose. The remaining radioactive components in urine and feces each accounted for <1% of the dose.
Overall, the data presented indicate [14C]AG-881 underwent moderate metabolism after a single oral dose of 50-mg (100 μCi) and was eliminated in humans via a combination of metabolism and excretion of unchanged parent. AG-881 metabolism involved the oxidation and conjugation with glutathione (GSH) by displacement of the chlorine at the chloropyridine moiety. Subsequent biotransformation of GSH intermediates resulted in elimination of both glutamic acid and glycine to form the cysteinyl conjugates (M515 and M499). The cysteinyl conjugates were further converted by a series of biotransformation reactions such as oxidation, S-dealkylation, S-methylation, S-oxidation, S-acetylation and N-dealkylation resulting in the formation multiple metabolites.
A summary of the metabolites observed is included in Table 2
TABLE 2
Retention
ComponentTimeMatrix
designation(Minutes)[M + H]+Type of BiotransformationPlasmaUrineFeces
Unidentified 17.00UnknownX
M2667.67a267N-dealkylationX
Unidentified 2UnknownX
Unidentified 3UnknownX
Unidentified 4UnknownX
Unidentified 5UnknownX
M51519.79b516OxidationX
M460-120.76b461OxidationX
M49921.22b500Dechloro-glutathioneXX
conjugation + hydrolysis
M51621.89b517Oxidative-deaminationX
M460-221.98b461OxidationX
M47222.76b473S-dealkylation + S-X
acetylation + reduction
M47622.76b477OxidationX
Unidentified 6UnknownX
M47423.63b475OxidationX
Unidentified 7UnknownX
M43025.88b431AG-881-oxidationX
M42630.62b427S-dealkylation + methylationX
M45831.03c459AG-69460X*
AG-88139.41b415AG-881XX
M42847.40b429S-dealkylation + oxidationX
Table 3 contains a summary of protonated molecular ions and characteristic product ions for AG-881 and identified metabolites
TABLE 3
RetentionCharacteristic
MetaboliteTimeProposed MetaboliteProduct Ions
designation(Minutes)[M + H]+Identification(m/z)Matrix
M266 7.88a267[Figure (not displayed)]
188, 187Urine
M51519.79b516[Figure (not displayed)]
429, 260, 164, 153Feces
M460-120.76b461[Figure (not displayed)]
379, 260, 164Feces
M49921.22b500[Figure (not displayed)]
437, 413, 260, 164, 137Urine Feces
M51621.89b517[Figure (not displayed)]
427, 260, 164, 153Feces
M460-221.98b461[Figure (not displayed)]
369, 260, 164, 139, 121, 93Feces
M47222.76b473[Figure (not displayed)]
429, 260, 179, 164, 153Feces
M47622.76b477[Figure (not displayed)]
395, 260, 164, 139, 119Feces
M47423.63b475[Figure (not displayed)]
260, 164, 68Feces
M43025.88b431[Figure (not displayed)]
260, 164, 155, 68Feces
M42630.62b427[Figure (not displayed)]
260, 164, 151Feces
M45831.03b459[Figure (not displayed)]
380, 311, 260, 183, 164, 130Plasma Fecesd
AG-88139.41b415[Figure (not displayed)]
319, 277, 260, 240, 164, 139, 119, 68Plasma Fecesd
M42847.40b429[Figure (not displayed)]
260, 164, 153Feces
Notes
aRetention time from analysis of a urine sample
bRetention time from analysis of a feces sample
cRetention time from analysis of a plasma sample
dM458 was only detected in feces by mass spectrometry, not by radioprofiling.
The proposed (theoretical) biotransformation pathways leading to the observed metabolites are shown in FIG. 1.