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INH is mainly cleared by N\u2010acetyltransferase 2 (NAT2) but the pharmacokinetics (PK) of INH in different NAT2 phenotypes during pregnancy is not well characterized. To address this knowledge gap, we used physiologically based pharmacokinetic (PBPK) modeling to evaluate NAT2 phenotype\u2010specific effects of pregnancy on INH disposition. A whole\u2010body PBPK model for INH was developed and verified for non\u2010pregnant NAT2 fast (FA), intermediate (IA), and slow (SA) acetylators. Model predictive performance was assessed using a drug\u2010specific model acceptance criterion for mean plasma area under the curve (AUC) and peak plasma concentration (<jats:italic>C<\/jats:italic><jats:sub>max<\/jats:sub>), and the absolute average fold error (AAFE) for individual plasma concentrations. The verified model was extended to simulate INH disposition during pregnancy in NAT2 SA, IA, and FA populations. A sensitivity analysis was conducted using the verified PBPK model and known changes in INH disposition during pregnancy to determine whether NAT2 activity changes during pregnancy or other INH clearance pathways are altered. This analysis suggested that NAT2 activity is unchanged while other INH clearance pathways increase by ~80% during pregnancy. The model was applied to explore the effect of pregnancy on INH disposition in two ethnic populations with different NAT2 phenotype distributions and with high TB burden. Our PBPK model can be used to predict INH disposition during pregnancy in diverse populations and expanded to other drugs cleared by NAT2 during pregnancy.<\/jats:p>","DOI":"10.1111\/cts.13614","type":"journal-article","created":{"date-parts":[[2023,9,15]],"date-time":"2023-09-15T11:08:58Z","timestamp":1694776138000},"page":"2163-2176","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Application of a physiologically based pharmacokinetic model to predict isoniazid disposition during pregnancy"],"prefix":"10.1111","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3348-7700","authenticated-orcid":false,"given":"Ogochukwu U.","family":"Amaeze","sequence":"first","affiliation":[{"name":"Department of Pharmaceutics University of Washington, School of Pharmacy  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9548-3126","authenticated-orcid":false,"given":"Nina","family":"Isoherranen","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutics University of Washington, School of Pharmacy  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,9,15]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201106-1083OC"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/pathogens11121481"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11904-022-00641-x"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis732"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1128\/microbiolspec.tnmi7\u20100016\u20102016"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003890"},{"key":"e_1_2_10_8_1","unstructured":"World Health Organization.WHO consolidated guidelines on tuberculosis: module 1: prevention: tuberculosis preventive treatment.2020World Health Organization. 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