Morphologic degeneration of human microvascular endothelial cells induced by iodinated contrast media

RATIONALE AND OBJECTIVES

The purpose of this study was to characterize the adverse effects of iohexol and ioxaglate on human microvascular endothelial cells, which may result in phlebitis, pain, and thrombosis.

MATERIALS AND METHODS

The degree of morphologic degeneration and of lactate dehydrogenase (LDH) efflux into the extracellular medium (as an index of cell viability) were determined in endothelial cell culture exposed for 10, 30, or 60 minutes to ioxaglate or iohexol (ionic and nonionic contrast media, respectively) at iodine concentrations of 100 or 150 mg/mL.

RESULTS

Ioxaglate induced concentration- and time-dependent morphologic degeneration, including shrinkage and loss of the cell tip in 20%-80% of endothelial cells; iohexol did not. After 60 minutes of exposure, ioxaglate at the higher concentration (150 mg iodine per milliliter) significantly increased the LDH signal (ie, the percentage of LDH released), to 20%.

CONCLUSION

The present findings demonstrate that ioxaglate but not iohexol causes morphologic degeneration of the microvascular endothelial cells. This direct cytotoxic action of ioxaglate probably causes endothelial cell dysfunction, closely associated with the occurrence of phlebitis, pain, and thrombosis.

Nitric oxide protects against contrast media-increased pulmonary vascular permeability in rats

RATIONALE AND OBJECTIVES

Nitric oxide (NO) regulation of endothelial function is involved in the development of acute lung injury. The role of NO in contrast media-induced increases in pulmonary vascular permeability was investigated in a rat model.

METHODS

Nonionic (iohexol) and ionic (ioxaglate) contrast media were intravenously injected at 1.5 mL/min in rats. Pulmonary vascular permeability was evaluated by measuring the amount of Evans blue dye uptake as a quantitative marker of albumin extravasation in lung tissue.

RESULTS

Intravenous injections of contrast media at doses of 4 and 6 g I/kg induced a dose-dependent increase in pulmonary vascular permeability. L-Arginine (an NO synthase substrate) and N(G)-nitro-L-arginine (L-NNA) (an NO synthase inhibitor) prevented and aggravated, respectively, the increase in pulmonary vascular permeability induced by the contrast medium. An aggravating action of L-NNA was confirmed by morphological and histological observations, this action being blocked by L-arginine (300 mg/kg) but not by D-arginine. Isosorbide dinitrate (1-20 mg/kg), an NO donor, had a dose-dependent protective effect on ioxaglate-increased vascular permeability.

CONCLUSIONS

Our experimental findings suggest that contrast media at high doses produce pulmonary edema by inhibiting endothelial NO production, and nitrovasodilators protect against this adverse effect in rats.

High speed injection of radiographic contrast media induces severe particulate contamination

In a study of exogenous particulate contamination during angiography, the effect of injection speed of four kinds of radiographic contrast media (RCM) was investigated. The particle count (> or = 10 microns) in all RCM increased in a speed-dependent manner and the increase was especially dramatic at 3 ml s-1. The extent of increase in particulate matter was higher for ioxaglate than for the other three RCM. As particulate matter is unwanted and unnecessary, to prevent the harmful effects in patients much attention should be paid to various factors generating particulate matters, such as characteristics of RCM and plastic syringe.

Contrast medium-induced pulmonary edema is aggravated by silicone contamination in rats

PURPOSE

To examine the effect of silicone contamination, which occurs in clinical settings during vial preparation with disposable syringes, on contrast medium-induced pulmonary edema in rats.

MATERIALS AND METHODS

Ioxaglate, ioversol, and iohexol, silicone-containing physiologic saline solutions, and three silicone-containing contrast media were separately, intravenously injected at 1.5 mL/min in rats. Pulmonary edema was evaluated as changes in the relative lung weight and in the water, sodium, and potassium contents of the lung.

RESULTS

Intravenous injection of ioxaglate induced marked pulmonary edema, even with a dose of only 4 g of iodine per kilogram of body weight. In contrast, ioversol and iohexol induced significant pulmonary edema only after the injection of large doses (6 g of iodine per kilogram; P < .05). The injection of 4 microL/mL silicone-containing physiologic saline at a dose of 18.75 mL/kg also produced marked pulmonary edema, whereas doses of 6.25 and 12.5 mL/kg showed no significant influence. The addition of an ineffective dose (12.5 mL of physiologic saline per kilogram of body weight) of silicone in contrast medium substantially aggravated the pulmonary edema induced by the contrast medium alone; this phenomenon was also confirmed with morphologic observation.

CONCLUSION

Ionic contrast media are more toxic to the endothelial cells than are nonionic contrast media. Silicone contamination might be one of the causes of pulmonary edema after intravenous injection. However, caution must be exercised in extrapolating these results to humans.

Quality evaluation of radiographic contrast media in large-volume prefilled syringes and vials

RATIONALE AND OBJECTIVES

The authors compared the particle contaminations of radiographic contrast media packaged in large-volume prefilled syringes and vials.

MATERIALS AND METHODS

Particle counting was performed for four contrast media packaged in large-volume prefilled syringes (iohexol, ioversol, ioversol for angiography, and ioxaglate) and three contrast media packaged in vials (iohexol, ioversol, and ioxaglate). X-ray emission spectrometry was performed to characterize the individual particles. The amount of silicone oil in the syringe was quantified with infrared spectrophotometry.

RESULTS

The particle contamination in syringes containing ioversol was higher than that in syringes containing iohexol or ioxaglate. Particle contamination in the vials was relatively low, except with ioxaglate. X-ray emission spectrometry of the components of the syringe and vial showed that the source of particles was internal material released from the rubber stopper or inner surface.

CONCLUSION

The particle counts for contrast media packaged in syringes and vials varied considerably among the different contrast media and were related to the amount of silicone oil on the inner surface and rubber piston of the syringe.

In-line filter occlusion during intravenous delivery of injectable menatetrenone (vitamin K2)

Filter occlusion during intravenous infusion of injectable menatetrenone in an electrolyte fluid was examined. The menatetrenone concentration and its emulsion droplet size were not changed by in-line filtration. However, particle counts in the admixed solution and examination of scanning electron micrographs of the surface of the filter membrane indicated that particle formation occurred immediately after the admixture of menatetrenone injection with Hicaliq No. 2, but not with 5% glucose injection. This may be due to the interaction of excess lecithin in the emulsion with the electrolyte. Filter occlusion also occurred with the admixture of menatetrenone-free emulsion and Hicaliq No. 2, but not with 5% glucose injection. These findings indicate that injectable menatetrenone should not be admixed with electrolyte fluids.

Vitamin K prodrugs: 2. water-soluble prodrugs of menahydroquinone-4 for systemic site-specific delivery

PURPOSE

The hydrochloride salts of the N,N-dimethylglycine esters of menahydroquinone-4 (1-mono, 1; 4-mono, 2; and 1,4-bis, 3) were assessed in vivo as prodrug for the systemic site-specific delivery system of menahydroquinone-4 (MKH), the active form of menaquinone-4 (MK-4, vitamin K2(20)).

METHODS

The disposition of MK-4 and menaquinone-4 epoxide (MKO) following the intravenous administration of the prodrugs and MK-4 preparation solubilized with surfactant (H-MK-4) were studied in vitamin K cycle inhibited rats. The relative bioavailability of MKH after the administration of the prodrugs was assessed from the area under the plasma concentration of MKO vs. time curve (AUCMKO). The specific delivery of MKH to its active site (liver) and coagulation activity after the administration of selected prodrug 1 were then compared with those of H-MK-4 in warfarin poisoned rats.

RESULTS

All compounds showed linear pharmacokinetics, and significant bioavailability of MKH was also observed following the administration of 1 (188%), 2 (87%) and 3 (135%). Prodrug 1 caused the following increases; AUCliver of MKO from 70.7 +/- 5.77 (H-MK-4) to 167 +/- 7.89 nmol.h/g, MRTliver of MKO, from 3.87 +/- 0.307 to 8.57 +/- 0.432 h. The liver accumulation of intrinsic 1 reached a maximum (88% of dose) by 0.25 h. The rapid and liver-selective uptake and liver esterase mediated MKH regeneration characteristics of 1 enhanced the delivery of MKH to its active site and the selective advantage was increased 5.7 fold. The coagulation activity was extended 1.9 fold by 1 administration.

CONCLUSIONS

The results indicated that these highly water-soluble and liver-esterase hydrolyzable ester derivatives of MKH are potential candidates for parenteral prodrugs which can thus achieve the systemic site-specific delivery of MKH. Such effective and selective delivery of MKH to its active site can therefore lead to enhanced pharmacological efficacy and can also avoid the toxicity induced by the solubilizing agent used in the H-MK-4 preparation.

Quality evaluation of commercial lyophilized human growth hormone preparations

The quality of three commercial injections (Genotropin, Humatrope and Norditropin) of lyophilized recombinant human growth hormone (r-hGH) was evaluated in tests by visual inspection, high-performance gel permeation chromatography, polyacrylamide gel electrophoresis, scanning electron microscopy and energy dispersion X-ray microanalysis. The influence of the reconstitution method on gel formation was examined as follows: rapid injection of the diluting solution into a vial against the wall, slow injection onto the surface of the content, and rapid injection onto the surface of the content. The degree of gel formation differed among reconstitution methods. Moreover, fibrous particulate matter in addition to degradation products of r-hGH were evident in all preparations. The quality of r-hGH injection differed among commercial products. Norditropin included the least particulate matter when examined immediately after reconstitution, but it was easily denatured after storage in solution. We advise medical specialists to reconstitute a preparation by the optimal method.

The evaluation of sizing accuracy of particle counters for parenteral drugs

Our evaluation of electronic liquid-borne particle counter systems has shown that, for accurate measurement of particulate matter in injections, the half count values of voltage thresholds from the particle counter itself should be used in the calibration for the particle sizes being evaluated. The manual method which uses the half count values in the USP XXIII<788> was improved, and the validity of our calibration method was supported by the results based on the ratio test, at 10 microns to those obtained at 15 microns is between 1.5 and 3.5, as per the Seventh Supplement of USP XXII <788>. Additionally, computer-based systems with automated calibration routines which solve the approximate Gaussian distribution of calibration particles have advantages. For the proper determination of the sizing accuracy of a particle counter, criteria of the ratio test at 10 microns and 15 microns as per the Seventh Supplement of USP XXII <788> should be applied at all critical particle sizes.

Vitamin K prodrugs: 1. Synthesis of amino acid esters of menahydroquinone-4 and enzymatic reconversion to an active form

The efficacy and toxicity of vitamin K depends on the pathway and the extent of enzymatic reductive activation to vitamin K hydroquinone, which is an essential cofactor for the synthesis of clotting factors. Parenteral use of vitamin K is impaired by its water insolubility. With the aim to improve delivery problems associated with menahydroquinone-4 (MKH, 2), an active form of menaquinone-4, N,N-dimethylglycine esters of 2 (1-mono, 4-mono, and 1,4-bis) were synthesized and assessed as potential water-soluble prodrugs for parenteral use. The esters can deliver the hydroquinone to its active site without a quinone reductive activation step. The hydrochloride salts of the esters were found to be quite soluble in water. The hydrolysis of the esters in 20% rat liver homogenate 9000 x g supernatant, rat plasma and phosphate buffer, pH 7.4, at 37 degrees C was kinetically studied in the presence and absence of an esterase inhibitor. The hydrolysis was catalyzed by esterases located in the rat liver and rat plasma and quantitatively yielded 2. These results suggest that esterification of 2 with N,N-dimethylglycine is a promising way for obtaining water-soluble prodrug forms of 2. Based on the high susceptibility to liver esterase, the esters are potential prodrugs for achieving the site-specific delivery of 2.

Application site dependent ocular absorption of timolol

Ocular absorption of timolol in rabbits was studied after topical ocular administration of 3H-timolol in an eyedrop or in silicone cylindrical devices that released timolol at 7.2 micrograms/h. The devices were applied in either the inferior or superior conjunctival sac. Timolol concentrations were nearly equal in the inferior and superior portions of ocular tissues when the drug was administered in an eyedrop. Administration in the devices resulted in unequal timolol distribution in the cornea, conjunctiva, sclera, and iris-ciliary body. Timolol concentrations were higher in the part of each tissue that was closer to the site of the device application. Unequal concentrations of timolol in the superior and inferior part of the eye and very low timolol concentrations in the aqueous humor indicated that timolol was absorbed mainly via a noncorneal route from the device placed in the inferior conjunctival sac. Induced blinking at one minute intervals did not change ocular absorption of timolol. Compared with inferior conjunctival sac applications, placement of the devices in the superior conjunctival sac resulted in increased corneal and total ocular absorption of timolol as indicated by higher timolol concentrations in the aqueous humor and by a smaller difference between concentrations in the superior and inferior portions of the examined tissues. The application site dependent ocular absorption indicated that controlled release of timolol in the tear fluid did not result in a uniform timolol distribution in the preocular tear fluid of rabbit eyes.

Relationship between oxidative metabolites of hydrazine and hydrazine-induced mutagenicity

Hydrazine (Hz) mutagenicity was observed in a test using Escherichia coli B/r strain, WP2 uvrA and was enhanced by the addition of rat liver microsomal fraction containing a generating system, while the enhanced mutagenicity was diminished by the addition of metyrapone to the microsome-free levels. On the other hand, an NADPH-dependent difference spectrum of the metabolic intermediate of Hz-complex, characterized by a maximum level of 448 nm, was also inhibited by metyrapone. The results show that the oxidative intermediates, which are diimide and its precursor, hydrazine free radical [Biochem. Biophys. Res. Commun., 133 (1986) 1086], are responsible not only for hepatotoxicity but also for the enhancement of genotoxicity or mutagenicity.

Spin trapping of a free radical intermediate formed during microsomal metabolism of hydrazine

A radical formed during oxidative metabolism of hydrazine in rat liver microsomes was spin-trapped with alpha-phenyl-t-butylnitrone. The trapped species was identified as hydrazine radical by comparison of its ESR parameters and mass spectrum with those of the adduct formed during CuCl2 catalyzed oxidation of hydrazine. The requirement for oxygen and NADPH in the microsomal oxidation and the occurrence of a typical binding spectrum by difference spectroscopy suggest the involvement of the participation of the cytochrome P-450 enzyme system in the formation of hydrazine radical which must be a precursor of diimide during microsomal oxidation of hydrazine.

Effects of rifampicin and phenobarbital on the fate of isoniazid and hydrazine in vivo in rats

After the intraperitoneal (i.p.) administration of isoniazid (INH) to male Wistar rats, the liver and plasma levels of hydrazine (Hz) and acetylhydrazine (AcHz), which are hazardous metabolites of INH and well known as mutagens, carcinogens and hepatotoxins, were determined by gas chromatography-mass spectrometry (GC-MS). The levels of Hz in rifampicin (RMP)- or phenobarbital (PB)-pretreated groups were lower than those in the control group, while the amount of AcHz was scarcely altered. In each of the pretreated groups a pronounced increase in the oxidative elimination rate of Hz was observed. These results are of important toxicological significance in INH therapy with RMP, since an active intermediate of Hz seems to be a hepatotoxin.

Metabolic hydrolysis of isoniazid by subcellular fractions of rat liver

The characteristics of isoniazid amidase which hydrolyzes isoniazid to isonicotinic acid and hydrazine was examined in vitro using rat liver subcellular fractions. The activity of isoniazid amidase was estimated from the amount of hydrazine produced from a substrate, isoniazid, by means of GC-MS. High activity of the amidase was observed in the microsomal and lysosomal fractions, and at pH 7.4-7.8 in the microsomal fraction. The amidase was not inhibited by acetanilide, but by procaine and bis(p-nitrophenyl)phosphate. As expected, acetylisoniazid, a main metabolite of isoniazid, also inhibited the amidase. Not only the microsomal monooxygenase but also amidase was strongly induced by pretreatment with phenobarbital, 3-methylcholanthrene and rifampicin, respectively.

Brain distribution of hydrazine and its GABA elevating effect in rats

After the intravenous administration of isoniazid (INH; 0.37 mmol/kg) or hydrazine (Hz; 0.16 mmol/kg), the minor metabolite of INH, gamma-aminobutyric acid (GABA) and Hz were measured by means of gas chromatograph-mass spectrometer (GC-MS) using deuterium labeled GABA (d2-GABA) and nitrogen fifteen labeled Hz (15N-Hz) as internal standards. In both cases, we successfully detected Hz and GABA in the brain. The brain GABA elevating effect of Hz was much higher than that of INH in spite of low dose.