Xylitol mediated amelioration of acetylphenylhydrazine-induced hemolysis in rabbits

Xylitol was investigated for its ability to ameliorate hemolytic anemia induced by acetylphenylhydrazine in rabbits. Animal experiments were performed using two different concentrations of xylitol, a 5% and a 10% solution with a total dose of 2 g/kg body weight and infusion rates of 10 mg and 20 mg xylitol per kg body weight per minute respectively. Two doses of acetylphenylhydrazine (APH), 5 and 10 mg per kg, were injected intraperitoneally as hemolytic inducers in different groups of rabbits. All the rabbits infused with xylitol showed significantly less acute APH-induced hemolysis. The isotonic 5% xylitol solution was found to maintain and restore the hematological parameters (packed cell volume, hemoglobin concentration, reduced glutathione (GSH) content, and reticulocyte counts) better than the 10% xylitol solution. Increased 51CR-red cell survival confirmed the beneficial effect of xylitol. The survival of erythrocytes as represented by chromium-labeling in rabbits infused with 5% xylitol after treatment with 10 mg/kg APH increased from about 33% (the survival of red cells in rabbits injected with APH alone) to 67% of normal rabbits' red cell survival. Erythrocytes in APH-treated animals took up xylitol more readily than erythrocytes from control animals. Our results in rabbits suggest that (1) non-toxic dosage of xylitol is effective in ameliorating the hemolytic episode induced by APH, (2) there is a dose relationship between the hemolytic effect induced by APH and the preventive effect offered by xylitol, (3) drug-challenged cells effectively acquired two to three fold more xylitol to compensate for the cellular needs than that of the normal cells, and (4) sufficient xylitol (55 mg/dl) to act as substrate for xylitol dehydrogenase was recovered intracellularly in drug-challenged rabbit erythrocyte in vivo, in spite of a low plasma (less than 30 mg/dl) concentration of the substrate. This antihemolytic affect of xylitol is likely accomplished through NADPH generation, which maintains the level of GSH and protects the hemoglobin and other structural and functional proteins against peroxidative damage.

Metabolism of xylitol and glucose in rats bearing hepatocellular

The variation in metabolism of glucose and xylitol by diverse rat hepatocellular carcinomas and partially hepatectomized rat livers was studied. The AS-30D and FB56 tumors demonstrated a significantly different degree of utilization of glucose and xylitol in vitro. This correlated partially with the low activity of polyol dehydrogenase when xylitol was used as a substrate. The activity ofa nicotinamide adenine dinucleotide-dependent polyol dehydrogenase in various hepatomas ranged from nondetectable to 30 nmol/min/mg protein, with the lower activities in FB56 and AS-30D tumors at 0 and 0.22 nmol/min/mg, respectively; while nicotinamide adenine dinucleotide phosphate-dependent xylitol dehydrogenase activities ranged from 0 to FB56 to 3.31 nmol/min/mg protein in liver regenerated for 1 week. The activities of nicotinamide adenine dinucleotide phosphate-dependent enzyme for normal liver and AS-30D tumors measured 2.2 and 0.14 nmol/min/mg protein, respectively. Although only the 311C tumor had an activity equivalent to that of normal liver, the range of the nicotinamide adenine dinucleotide phosphate-dependent polyol dehydrogenase activities among the cell lines studies is narrow. The ratios of metabolites of [14C]glucose or [14C]xylitol were determined in rats bearing AS-30D tumors. Animals were given i.v. injections of a 10% solution of [14C]glucose or [14C]xylitol, 2 g/kg body weight. Assays of neutral sugar metabolites from each substrate in the acid-soluble fraction of liver or AS-30D tumor showed that xylitol in the liver was converted primarily into glucose while in the tumor 80 to 90% of the xylitol remained unchanged. This hepatocellular carcinoma is also markedly deficient in the ability to synthesize acid-insoluble glycogen and glycoprotein from xylitol as compared to the liver.

Nutritional significance of fructose and sugar alcohols

Human metabolism of D-fructose, D-sorbitol, D-mannitol, and xylitol has been documented. In humans, sorbitol and xylitol at a single oral dose of 20 g or less and fructose at 70 g or less most likely can be fully absorbed. These there sugars can maintain, either independently or nearly independently, the integrity or the carbohydrate requirement for the growth of cells and animals. The absorption of D-mannitol is no more than 80% and is more laxative. In general, there is no adverse effect other than osmotic diarrhea after oral administration of these sugars. Transient hyperuricemia was seen in some humans. The chronic toxicity of life-long usage of these sugars in humans or other primates is not known. However, a 2-year Turku sugar studies suggested the safety of fructose and xylitol. Two-year feeding experiments in mice and rats indicated possible carcinogenicity of a high-percentage xylitol diet. Abnormalities of cellular growth were also documented in animals fed high percentages of sorbitol and sucrose. Long-term mannitol feeding experiments also revealed an increased incidence of benign thymic tumors in rats. Intravenous feeding of fructose, xylitol, and sorbitol causes major concern. The toxicity is total-dose and infusion-rate dependent. The physical toxicity induced by hyperosmolar effect of the concentrated infusion solutions can be lethal. The primary metabolic toxicities, mainly lactic acidosis and hypruricemia, are reversible. The suggested safe infusion rate of these sugars is 0.25 g/kg/h; sporadic toxic observations have been reported at this or lower doses (0.125 g/kg/h). The combination of glucose, fructose, xylitol, and sorbitol mixture intravenously is in use in Europe due to the critical threshold of each element. There are positive findings from the use of the combination in human illness (114). The beneficial effect of xylitol, mannitol, sorbitol, and fructose in decreasing order has been well documented in the prevention of dental caries in animals and in humans. Oral organisms do not appear to metabolically adapt to xylitol even after 4 years of in vivo exposure. This was based on the quantitation of xylitol dehydrogenase activity in saliva and oral organisms. In addition, a therapeutic and preventive effect for xylitol in human and animal dental caries has been demonstrated. There appears to be at least a theoretical edge in the dietary use of fructose, xylitol, and sorbitol in diabetics.(ABSTRACT TRUNCATED AT 400 WORDS)

Mass spectrometry of permethylated folic acid analogs

Folic acid and several analogs have been characterized as their permethylated derivatives. These derivatives are readily evaporated from the solid probe and provide spectra with abundant molecular ions and characteristic fragment ions. This method has been used to confirm the identities of the two methotrexate metabolites, 7-hydroxymethotrexate and 4-amino-4-deoxy-N(10)-methylpteroic acid, which have been isolated from human urine. The permethylation products of the folate cofactors, dihydrofolic acid, tetrahydrofolic acid and leucovorin, are also characterized.

Effect of ascorbic acid in vitro on lymphocyte reactivity to mitogens

The direct effects of ascorbic acid and dehydroascorbic acid in vitro on human lymphocyte proliferation to phytohemagglutinin (PHA) and concanavalin A (Con A) stimulation were determined. Cells exposed to physiologic and high concentrations of ascorbic acid and dehydroascorbic acid showed poorer tritiated thymidine ([3H]TdR) incorporation than controls without the vitamin. The inhibitory effect was dose-dependent, with the greatest inhibition occurring as the concentration of ascorbic acid and dehydroascorbic acid was increased. At supraoptimal concentrations of PHA and Con A, there was no recovery of the mitogen response, indicating that ascorbic acid did not inhibit the response by competition. Viability studies of cells in culture showed that concentrations of ascorbic acid and dehydroascorbic acid, which consistently inhibited mitogenic stimulation of lymphocytes, were noncytotoxic throughout the culture period. Timed addition of ascorbic acid to PHA-stimulated lymphocytes in culture demonstrated inhibition of [3H]TdR incorporation when ascorbic acid was added as late as 96 hours after initiation of culture. However, the greatest inhibitory effect was observed when ascorbic acid was added at initiation or early in culture. Inhibition was also evident when RNA and protein synthesis were determined. The results suggest that physiologic and high concentrations of ascorbic and dehydroascorbic acid affect early metabolic events in the process of mitogen-stimulated lymphocyte activation.

Plasma methotrexate as determined by liquid chromatography, enzyme-inhibition assay, and radioimmunoassay after high-dose infusion

Three techniques for measuring methotrexate show various cross reactivities with methotrexate-related compounds: “high-pressure” liquid chromatography, by principle, is virtually specific for methotrexate; the enzyme-inhibition assay quantitates methotrexate, methotrexate diglutamate, and methotrexate triglutamate equally well, but has a 10% cross reactivity with 4-amino-4-deoxy-N10-methylpteroic acid and 1% with 7-hydroxymethotrexate; radioimmunoassay shows an equal cross reactivity with methotrexate, 4-amino-4-deoxy-N10-methylpteroic acid, methotrexate diglutamate and triglutamate, and a 5 to 10% cross reactivity with 7-hydroxymethotrexate. Radioimmunoassay almost always yielded the highest values for methotrexate, followed by enzyme-inhibition assay then liquid chromatography. The presence of two methotrexate-related compounds, 7-hydroxymethotrexate and 4-amino-4-deoxy-N10-methylpteroic acid, was confirmed in human urine samples and quantitated in patients’ plasma by liquid chromatography, the respective maximum plasma concentrations being 250 and 16 mumol/L. Materials cross reacting with methotrexate in radioimmunoassay of chromatographic fractions from plasma were also noted in fractions corresponding to methotrexate diglutamate and triglutamate peaks, in quantities estimated to be 47 and 30 nmol/L methotrexate equivalents, respectively. 7-Hydroxymethotrexate is eliminated more slowly than methotrexate and its production increases with dosages of methotrexate.

Plasma methotrexate as determined by liquid chromatography, enzyme-inhibition assay, and radioimmunoassay after high-dose infusion

Three techniques for measuring methotrexate show various cross reactivities with methotrexate-related compounds: "high-pressure" liquid chromatography, by principle, is virtually specific for methotrexate; the enzyme-inhibition assay quantitates methotrexate, methotrexate diglutamate, and methotrexate triglutamate equally well, but has a 10% cross reactivity with 4-amino-4-deoxy-N10-methylpteroic acid and 1% with 7-hydroxymethotrexate; radioimmunoassay shows an equal cross reactivity with methotrexate, 4-amino-4-deoxy-N10-methylpteroic acid, methotrexate diglutamate and triglutamate, and a 5 to 10% cross reactivity with 7-hydroxymethotrexate. Radioimmunoassay almost always yielded the highest values for methotrexate, followed by enzyme-inhibition assay then liquid chromatography. The presence of two methotrexate-related compounds, 7-hydroxymethotrexate and 4-amino-4-deoxy-N10-methylpteroic acid, was confirmed in human urine samples and quantitated in patients' plasma by liquid chromatography, the respective maximum plasma concentrations being 250 and 16 mumol/L. Materials cross reacting with methotrexate in radioimmunoassay of chromatographic fractions from plasma were also noted in fractions corresponding to methotrexate diglutamate and triglutamate peaks, in quantities estimated to be 47 and 30 nmol/L methotrexate equivalents, respectively. 7-Hydroxymethotrexate is eliminated more slowly than methotrexate and its production increases with dosages of methotrexate.

Age-related pharmacokinetics of high-dose methotrexate in patients with osteosarcoma

Plasma methotrexate (MTX) concentrations were determined in 52 patients after 409 infusions of high-dose (HD) (50-250 mg/kg) MTX with citrovorum factor (CF) rescue. In addition, detailed pharmacokinetic studies were conducted in nine of these patients. Plasma drug levels were compared at 6, 24, 48, and 72 hours from the start of MTX infusions in four different age groups (less than or equal to 10, 11-14, 15-17, and greater than or equal to 18 years of age). At the same drug dose, the younger patients had lower plasma MTX levels than the older patients at 6 and 24 hours. This difference increased in significance with increasing MTX dose. However, MTX plasma levels became similar at 48 and 72 hours, regardless of age. The half-life for the first phase of biphasic MTX clearance in children was shorter than that in adults. In addition, the urinary excretion of MTX was faster in younger children at all doses. The younger patients had a greater apparent volume of distribution of MTX after HD infusion. These results indicate that the age-dependent pharmacokinetics can be attributed to greater distribution and elimination of MTX in the younger patients. The potential difference in the metabolism of MTX between children and adults is currently under investigation. Our observations suggest that age exerts a dominant effect on the pharmacokinetics of HD-MTX.

Evaluation of overall toxicity of high-dosage methotrexate regimens

The occurrence of overall toxicity was analyzed for 43 patients with osteosarcoma who received 349 high-dosage courses of methotrexate (HD-MTX) with citrovorum factor (Leukovorin) "rescue" (CF). The dosages of HD-MTX ranged from 50 to 350 mg/kg. Overall toxicity was assessed on the basis of five manifestations of toxicity: stomatitis, dermatitis, myelosuppression, liver dysfunction, and kidney function abnormalities. The great majority (91.4%) of the infusions were well tolerated, but 8.6% were associated with moderate or severe toxicity. Stomatitis and serum glutamic-oxaloacetic transaminase (SGOT) changes were the most frequent postinfusion findings. Three patients died from causes related to MTX toxicity. Dose, age, sex, and number of prior infusions were investigated by logistic regression analysis for prognostic effect on frequency of moderate to severe overall toxicity. Age and number of prior infusions had significant (P less than 0.06) effects on overall toxicity. Patients older than 15 years with greater than 10 prior infusions constituted the "high risk" group with a risk of moderate to severe toxicity 6.3 times that of the younger patients with fewer than 10 infusions.

Degradation and clearance of methotrexate in children with osteosarcoma receiving high-dose infusion

Plasma methotrexate (MTX) concentrations were quantitated in 34 patients after 127 high-dose (35--350 mg/kg) infusions with citrovorum factor rescue. Significant linear correlations have been obtained between methotrexate dosage and concentrations in plasma at 6 and 24 hours after the initiation of the therapy. However, similar trends have not been observed when 48- and 72-hour samples were analyzed. Clinical toxicity was not serious when the methotrexate level in plasma was less than 4.5 X 10(-6) M at 48 hours after the start of a six-hour infusion in children. A minimal four-hour steady-state methotrexate plasma level can be maintained during a six-hour infusion. Children excrete methotrexate at a faster rate than adults; the half-life of MTX during the first phase of plasma clearance curve is one hour shorter in children. Urinary analyses have indicated that substantial methotrexate is metabolized. The chemical nature of these components has not been identified. Further, the urinary metabolic profiles varied among patients.

Xylitol infusion and oxalate formation in rabbits

Oxalate levels in the plasma and urine fractions of fasted normal, oxythiamin treated (20 mg/kg) and 4-deoxypyridoxine treated (300 mg/kg) rabbits were determined following infusion with either xylitol or glucose at a dose of 2 g/kg body weight. Biochemical determinations showed that transient thiamin or pyridoxine deficient states had been induced in the antivitamin treated rabbits. In the first 24 hour following infusion with either carbohydrate, urinary oxalate levels remained within the normal range for all groups. Oxythiamin hastened the appearance of the transient, elevation in plasma oxalate concentrations seen in rabbits after infusion with glucose. After xylitol infusion, the elevation of plasma oxalate was not significnatly above normal. 4-Deoxypyridoxine enhanced peak plasma oxalate levels above those of controls for both sugars. Glucose, at an equivalent dose to xylitol, resulted in higher plasma oxalate levels than xylitol for all groups. Infusions of [U-14C]xylitol and [U-14C]glucose solutions into 4-deoxypyridoxine treated rabbits demonstrated a conversion of the administered radioactive carbon into 14C oxalate of 0.01% with a high dilution of the specific activity. The results suggest that oxalate production from xylitol is negligible; any toxicity related to xylitol administration is not a consequence of oxalate production.