TPV metabolism in vitro and inhibition by RTV. Duplicate incubations were conducted in 1× PBS (pH 7.4) containing TPV (50 μM), NADPH (1.0 mM), HLM (0.5 g protein/l) or MLM (0.5 g protein/l), or cDNA-expressed CYP3A4 (10 nM), CYP2D6 (10 nM), and CYP2C19 (10 nM), with coincubation of RTV (RTV co), or preincubation of RTV (RTV pre) respectively. Metabolites II, III, IV, V, and VI were analyzed by UPLC-TOFMS. A, effect of RTV (0–100 μM) on TPV metabolism in HLM. B, effect of preincubation of RTV and coincubation of RTV (1 μM) on TPV metabolism in HLM. C, effect of preincubation of RTV and coincubation of RTV (1 μM) on TPV metabolism in cDNA-expressed CYP3A4. D, effect of coincubation of 1 and 50 μM RTV on TPV metabolism in cDNA-expressed CYP2C19 and CYP2D6. E, effect of preincubation of RTV and coincubation of RTV (50 μM) on TPV metabolism in cDNA-expressed CYP2C19 and CYP2D6 (10 nM). F, comparison of TPV metabolism in HLM and MLM. The overall abundance of TPV metabolites was set as 100% in the incubation of HLM and MLM. The relative abundance of each metabolite was compared and is presented as relative ratio (MLM versus HLM). G, effect of preincubation of RTV and coincubation of RTV (20 μM) on TPV metabolism in HLM. H, effect of preincubation of RTV and coincubation of RTV (20 μM) on TPV metabolism in MLM (10 nM). The data are expressed as means. For each metabolic pathway, the incubation without RTV was set as 100%. N.D., not detected. The metabolite identification was accordant with that in Figs. 2 and 6.