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Increased plasma volume, changes in blood protein binding, and fat accumulation during the first two trimesters could increase the volume of distribution of many compounds (Anderson 2005), resulting in decreased blood concentrations at a given exposure level.
While molecular structure mostly influences the stability of the molecule, with macrocyclic GBCA being more stable than acyclic linear GBCA; the in vivo relaxivity of the contrast agent depends on the physiological environment (i.e., blood, interstitial fluids, intracellular space), as well as the capacity of the contrast agent to interact with macromolecules in the blood (protein binding).
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Changes in systemic clearance may result from changes in hepatic blood flow, protein binding, or CYP3A intrinsic clearance.
Singh et al. investigated the blood uptake characteristics, protein binding, pharmacokinetics and metabolism of formononetin by this system.
When drugs are absorbed into the blood, drug-plasma protein binding (PPB) is a common and reversible dynamic process [2].
Counteracting influences that may slow diffusion include pH, temperature (unlikely to be of pharmacological importance in the mammalian brain) and retention in the blood due to protein binding [97].
Altered tissue blood flow and protein binding represent some of these factors.
The parameters of the model are optimized using midazolam clinical pharmacokinetic data in pregnancy; sensitivity analyses are performed to illustrate the impact of fetal metabolism, changes in hepatic blood flow, plasma protein binding, and CYP3A activity on plasma midazolam concentrations.
Given that changes in liver blood flow and protein binding do not completely account for increased midazolam clearance, it is possible that altered metabolism, either in the liver or fetal/placental unit, may play a role.
These ontogeny profiles are incorporated in the used modeling tools, and employed along age-specific differences in bodyweight, eliminating organs weight and blood flow, and protein binding in order to scale adult clearance value (model input) to children of different age.
Beyond plasma glucocorticoid levels and cellular GR and MR density, target tissue availability of glucocorticoids is also regulated in blood by their plasma protein binding, largely to corticosteroid-binding globulin (CBG) as well as albumin.
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