Determination of tazobactam and piperacillin in human plasma, serum, bile and urine by gradient elution reversed-phase high-performance liquid chromatography

A gradient elution high-performance liquid chromatographic method is described for the analysis of the beta-lactamase inhibitor tazobactam (YTR-830H) and a semi-synthetic parenteral penicillin, piperacillin, in human plasma, serum, bile and urine. The assay for plasma, serum and bile involves deproteinization with acetonitrile and the removal of lipids with dichloromethane; urine is diluted with buffer. Separation and quantitation are achieved using a mobile phase based on ion-suppression chromatography on a C18 reversed-phase column with ultraviolet detection at 220 nm. The limit of quantitation for both compounds is 1.0 microgram/ml in plasma, serum and bile using a 0.2-ml sample and 50.0 micrograms/ml in urine using a 0.1-ml sample. The method has been validated by preparing and analyzing a series of fortified samples (range 1.0-200 micrograms/ml for each compound in plasma, serum and bile and 50.0-10,000 micrograms/ml for each compound in urine). Excellent linearity, accuracy, precision and recovery were obtained. The method was not interfered with by other endogenous components, nor by other commonly administered antibiotics such as amoxicillin, mezlocillin, cefometazole and cefotaxime. The assay has been successfully applied to the analysis of samples from pharmacokinetic studies in man and animals.

Pharmacokinetics of ketoprofen enantiomers in cholecystectomy patients: influence of probenecid

Ketoprofen (KT), a 2-arylpropionic acid nonsteroidal antiinflammatory drug, is administered as a racemate. Previous reports suggest stereoselective biliary excretion of KT enantiomers. This hypothesis was tested by administering 50 mg racemic KT to five patients who required bile drainage following cholecystectomy surgery. Subsequently, to study the influence of probenecid (PB), an inhibitor of KT renal elimination, on the biliary excretion, 1000 mg PB was administered 1.5 h before KT to the same patients. The unchanged and conjugated (as glucuronides) KT enantiomers were measured in plasma, urine and bile. In general, KT enantiomers had different plasma concentration-time curves. As compared to normal subjects, these patients had comparable AUCs and shorter t1/2s. Biliary concentrations of conjugated S-KT were greater than R-KT. Nevertheless, the total cumulative biliary excretion of conjugated KT did not exceed 2% of the dose ruling out this pathway as a significant route of KT elimination. There was a positive and significant correlation between the cumulative urinary excretion of conjugated KT enantiomers and creatinine clearance. Although PB did not influence the pattern of stereoselectivity of KT, it increased AUC and prolonged t1/2 of the enantiomers. While reducing cumulative urinary excretion, PB increased total biliary elimination of conjugated KT enantiomers. This, however, did not totally compensate for the reduced urinary excretion. It is suggested that the impaired conjugation of KT caused by PB administration may result in the augmentation of other, otherwise minor, metabolic pathways.

Pathophysiology of tumor progression in human gallbladder: flow cytometry, CEA, and CA 19-9 levels in bile and serum in different stages of gallbladder disease

Gallbladder epithelium is unique among the gastrointestinal cell types because proteins and protein levels in the fluid bathing the luminal side of the cells (bile) are different from and can be compared with those in the fluid bathing the basal side (serum). To help identify cellular changes that occur during the development of gallbladder cancer, we obtained gallbladder tissue, serum, and bile specimens from 20 patients with invasive adenocarcinoma of the gallbladder, three with high-grade dysplasia (carcinoma in situ), six with low-grade dysplasia, 12 with hyperplasia, and 10 with acute or chronic cholecystitis. We obtained serum samples from 40 patients with invasive adenocarcinoma and bile samples from 29 of these patients; serum samples from three with high-grade dysplasia and bile specimens from two of these; serum and bile samples from five with low-grade dysplasia; serum or bile samples from 126 with metaplasia, hyperplasia, or cholecystitis, including serum samples from 121 and bile samples from 110; and serum and bile samples from eight with normal biliary tracts. The study was conducted in Mexico City, Mexico, and La Paz, Bolivia. We performed flow cytometric DNA analysis on gallbladder tissue specimens and measured levels of carcinoembryonic antigen (CEA) and CA 19-9 antigen in the serum and bile specimens. Analysis of the cell cycle compartments by flow cytometry revealed marked variations of the proliferation index for the different disease states (P less than .0001). The proliferation index increased with progression from cholecystitis to invasive adenocarcinoma. Of the bile and serum measurements, only serum CA 19-9 values were correlated with flow cytometry measurements (r = -.49, P = .005). Overall, the serum and bile measurements were in agreement (P less than .01). However, with the exception of the correlations among serum measurements for the patients with invasive adenocarcinoma, most of the correlations could be explained by differences in the disease state. In particular, the progression from normal tissue to invasive adenocarcinoma involved no change in bile CA 19-9 level and only a slight change in bile CEA level but much larger changes in serum CEA and CA 19-9 levels. It appears that the progression from normal tissue to invasive adenocarcinoma results in increased production of these antigens and often in loss of cell polarity as well, i.e., inability to prevent leakage of the antigens into the serum.

Occurrence of bilirubin-IX beta in the gallbladder bile of eel, Anguilla japonica

Bilirubin-IX beta isomer was detected in the bile of eel, Anguilla japonica, as evidenced by high-performance liquid chromatography (HPLC) analysis of free acid and its ethyl anthranilate diazo derivatives. Bilirubin-IX beta accounted for 16.7 +/- 6.0 (mean +/- S.D.) percent of the total bilirubins in the bile of 40 eels analysed, and the percentage was much higher than that reported in the biles of mammals.

Morphology of the prairie dog gallbladder: normal characteristics and changes during early lithogenesis

Studies were undertaken to describe the normal structure of the prairie dog gallbladder and adjacent cystic duct, and then to determine sequential changes that occurred as abnormalities in bile composition developed during high cholesterol feeding. Control animals were fed a diet with trace cholesterol, while experimental animals were fed a diet enriched with 1.2% cholesterol for 1, 2, 3, or 4 weeks. Light microscopy and scanning and transmission electron microscopy were used to characterize morphologic changes at each time interval. Biliary lipid composition was altered in all experimental groups, evidenced by significant decreases in bile-acid-to-cholesterol ratios. Cholesterol crystals appeared in experimental bile at 1 and 2 weeks, while stones formed at 3 and 4 weeks. The cystic duct and neck of the gallbladder occasionally displayed goblet cells. Little mucus was demonstrable in principal cells of the gallbladder, but much more in those lining the cystic duct. After 2 weeks of lithogenic diet, there was an increase in mucus content and secretion from all areas, as well as an influx of polymorphonuclear and mononuclear leukocytes. Accumulation of plasma cells in the lamina propria was an especially prominent feature of experimental tissues. These results suggest that 1) there is regional heterogeneity in the mucus content of the gallbladder and cystic duct of the prairie dog, and 2) both regions respond to lithogenesis with mucus hypersecretion and acute and chronic inflammatory changes prior to the appearance of cholesterol gallstones.

Relationship between colorectal liver metastases and CEA levels in gallbladder bile

While computerized tomographic (CT) scanning and intraoperative exploration are both considered accurate measures of liver involvement with metastatic disease, 10% to 30% of colorectal liver metastases remain undetected. Attempting to improve current methods for detecting colorectal liver metastases, CEA levels in gallbladder bile and serum from patients with known liver metastases were determined. One hundred per cent of patients with single and multiple metastases of various dimensions were observed to have gallbladder bile CEA levels strikingly higher than serum values (4.7 to 259 times greater, p = 0.0009). Linear regression analysis of estimated tumor volume and surface area versus gallbladder bile CEA levels predicted that very small tumors (less than or equal to 1 cm3 in volume) might produce detectable levels (9 to 41 ng/mL) of biliary CEA. For this reason, patients who lack clinical and radiologic evidence of distant metastases at the time of primary colorectal resection but who do have elevated gallbladder bile CEA levels (greater than or equal to 10 ng/mL) are being followed for the appearance of occult hepatic metastases.

Effect of secretin on bile formation in rats with cirrhosis of the liver: structure-function relationship

To investigate whether the hypercholeresis seen in cirrhotic humans and animals is due to ductular proliferation or altered inactivation of secretin, or both, we studied the response of bile flow and biliary erythritol clearance to synthetic porcine secretin in rats rendered cirrhotic by chronic exposure to phenobarbital/carbon tetrachloride (n = 11) and untreated control rats (n = 5). Bile duct mass was determined morphometrically. Furthermore, plasma disappearance of secretin was measured by radioimmunoassay. Basal bile flow did not differ between the two groups. Whereas secretin had no effect in the control group, it stimulated bile flow by 49% +/- 33% in the cirrhotic group (p less than 0.001). Erythritol bile-to-plasma ratio was lower and biliary bicarbonate concentration higher in the cirrhotic rats, suggesting some ductular contribution to bile flow even in the absence of secretin. Biliary bicarbonate concentration did not increase further during secretin administration, whereas bile salt concentration decreased from 27 +/- 6 to 18 +/- 4 mM. The elimination half-life of secretin was not affected by cirrhosis, averaging 5 +/- 2 min in both groups. Bile duct volume was increased in cirrhotics (2.9% +/- 1.4% vs. 0.2% +/- 0.1%; p less than 0.01) and showed an excellent correlation with the maximal secretin-induced increment of bile flow. Our results suggest that the proliferating ductules contribute to bile flow and that increased secretin responsiveness is not due to altered pharmacokinetics in cirrhotic rat liver.

[Lithogenic properties of bile in cholelithiasis]

To specify lithogenic properties of bile in cholelithiasis as well as the effect of cholecystectomy on biochemical composition of bile, 168 patients with cholelithiasis have been examined. Fifty patients underwent preoperative investigation, some of them were followed up for 1-2 years after cholecystectomy (group 1). The rest postcholecystectomy patients were followed up for 10 years (group 2). Bile levels of cholesterol were evaluated by absolute and relative lipid concentrations. The conclusion is made on the absence of a direct correlation between bile cholesterol supersaturation and cholelithiasis as the above supersaturation occurs in healthy subjects as well. It is noticed that cholecystectomy does not warrant discontinuation of cholesterol supersaturation of bile.

Sensitive analysis of the mycotoxin zearalenone and its metabolites in biological fluids by high-performance liquid chromatography alpha

A method is described for the analysis of zearalenone and its metabolites, alpha- and beta-zearalenol, in small volumes (0.5-2.0 ml) of biological fluids including milk, blood, plasma, urine and bile, using high-performance liquid chromatography with fluorescence detection. Isolation of the toxins from biological fluids was achieved using a series of pH-controlled solvent extractions. Detection limits for zearalenone and alpha-zearalenol were 1 ng/ml, and for beta-zearalenol ca. 5 ng/ml, both at a signal-to-noise ratio of 3. In bile, however, the detection was ca. five times less sensitive owing to interfering substances. Recoveries at low ng/ml concentrations were highest from urine (87-94%) and plasma (85-93%), slightly lower from whole blood (78-88%) and milk (75-84%), and lowest from bile (66-77%).

The kinetics of papillotoxic doses of 3H-N-phenylanthranilic acid in rats

N-phenylanthranilic acid (N-PAA; 4 mmol/kg/day p.o.) causes a diffuse renal papillary necrosis and a polyuria in 7 days. A single dose of 3H-N-PAA was widely distributed with second-order elimination kinetics, t1/2 +/- 50 h for stomach, heart, kidney, and bladder and t1/2 greater than or equal to 90 h for liver, spleen, muscle and lung. The estimated plasma t1/2 = 10.2 h, and over 75% was excreted via urine in 36 h and 13% via faeces in 72 h. In chronically cannulated animals 29% of N-PAA-derived material was in bile and 24% in urine at 36 h, which suggests enterohepatic circulation. Bile and urine contained several metabolites but no parent compound. Multiple doses for 8 and 16 days increased urinary N-PAA excretion to 90% in 36 h, but faecal contents decreased to 6-8% in 72 h and plasma t1/2 to less than or equal to 7.5 h.

Lincomycin treatment of guinea pigs causes formation of pigmented phosphate containing gallbladder sludge and stones

We studied the mechanism of gallbladder sludge formation in guinea pigs (n = 30) treated with lincomycin (80 mg/kg/day) for 7 consecutive days. At sacrifice (day 8) gallbladders of treated animals contained turbid bile, sludge and in one animal a single gallstone. The precipitates were amorphous on X-ray diffraction. Infra-red spectroscopy revealed calcium phosphate as the major component. Compared to saline-treated controls (n = 15) concentrations of total protein, total phosphate and total bilirubin in gallbladder bile were significantly increased (P less than 0.05). The increase in total phosphate was due to the inorganic component, since phospholipid phosphorus was unchanged. The relative amounts of unconjugated bilirubin and of bilirubin mono- and diconjugates in gallbladder bile were unaffected by treatment as was beta-glucuronidase activity. However, sludge was enriched in unconjugated bilirubin compared to gallbladder bile. This was most probably caused by alkaline hydrolysis of bilirubin monoconjugates. To some extent, disproportionation of bilirubin monoconjugates in bile or sludge, either in vivo or during sample preparation, might also have led to increased unconjugated pigment.

Enzymatic determination of lipids in human bile without bilirubin interference: reliable assessment of the cholesterol saturation index (CSI)

We describe a simple and rapid, but nevertheless precise and accurate method for the enzymatic determination of the main lipid constituents in human bile. Interfering bile pigments, especially bilirubin are eliminated by the use of aminopropyl bonded phase columns ("Bond-Elut") prior to the enzymatic measurement of cholesterol and lecithin. Intra-assay imprecision was between 3.1 and 4.9% CV, while the inter-assay figures were rather higher at 4.6 to 7.5% CV. Recoveries of bile salts, lecithin and cholesterol were between 94 and 103%. In contrast, the direct enzymatic determination in native bile produces falsely low results: lecithin from 5 to 20%, cholesterol from 25 to 40% of the true value. The results of both enzymatic methods correlated well with commonly accepted procedures for phospholipid and cholesterol determination. When compared with methods of bile lipid analysis involving solvent extraction, the column separation followed by enzymatic determination has the advantage of being simpler and less time consuming, without need of high-cost equipment, e.g. gas chromatography.

The effects of lithogenic bile on gallbladder epithelium

Prairie dogs were fed a 1.2% cholesterol diet for up to 24 weeks to evaluate the effects of lithogenic bile on the mucosa of the gallbladder. There was a progressive increase in the lithogenic index of the gallbladder bile (1.44 +/- 0.15 at 4 weeks, p less than 0.05). Fifty-five of 70 animals developed gallstones between the second and fourth week. Increasing stone burden was associated with a 27% (p less than 0.05) decrease in the electrical resistance of the epithelium and a 60% (p less than 0.05) decrease in net sodium transport when measured isotopically in an Ussing chamber (3 weeks). After 4 months, seven of ten animals developed inflammatory mucosal polyps characterized by a heavy infiltration of plasma cells into an expanded matrix. Cellular infiltration began as early as 2 weeks. These changes occurred without alterations in the ultrastructural appearance of the epithelium.

Identification of sulfate and glucuronic acid conjugates of the 5-hydroxy derivative as major metabolites of 2-amino-3-methylimidazo[4,5-f]quinoline in rats

New metabolites of 2-amino-3-methylimidazo[4,5-f]quinoline (IQ), a potent mutagen and carcinogen formed during cooking of meat or fish, have been identified and quantitated in the urine and bile of rats. Administration was either by a pulse gavage dose of 40 mg/kg [2-14C]IQ or by dietary intake of 300 ppm IQ for 6 weeks. The metabolites were isolated by high-performance liquid chromatography and quantitated by radioactivity. They were then characterized by their resistance or sensitivity to hydrolytic enzymes or acid hydrolysis, by nuclear magnetic resonance and mass spectrometry, or coinjection with a synthetic sample. A minor metabolite was the IQ N-glucuronide. A major metabolite was formed by hydroxylation of IQ at the 5-position; it was present in urine and bile and was conjugated as the glucuronide or sulfate ester, which together accounted for about 40% of urinary or biliary metabolites. The unconjugated compound partially adsorbs onto the high-performance liquid chromatographic columns used. The amounts of 5-OH-IQ present as conjugates in urine or bile were similar, irrespective of mode of administration. Thus, hydroxylation of IQ on carbon 5 followed by type II conjugation reactions yields quantitatively important metabolic products.

Fluorometric assay of protein in native human bile

Proteins in human native bile samples were determined by a fluorometric assay. Results were compared to biliary proteins quantified by the Lowry and Bradford techniques. The mean protein concentrations in bile as determined by the Lowry, Bradford and fluorometric assays were respectively 7.26 +/- 4.52 (SD), 2.9 +/- 1.42, and 2.12 +/- 1.28 mg/ml (n = 27). Bilirubin was shown to significantly interfere with the Lowry and Bradford assays but not the fluorometric assay. Bile salts remaining in the trichloroacetic acid (TCA) precipitate did not interfere with the fluorometric assay. No cholesterol or phospholipid could be detected in the TCA preparation prior to protein analysis. Proteolytic digestion of proteins in native bile was shown to occur at 37 degrees C and to a lesser extent at 22 degrees C. The fluorometric protein assay is an easy and accurate method to quantitate proteins in native human bile.

Mercury-selenium interaction: distribution and excretion of 203Hg2+ in rats after simultaneous administration of selenite or selenate

In female rats intravenously injected with 203HgCl2 (0.6 mg Hg2+ per kg body wt.) the effect of intraperitoneal administration of selenite or selenate (0.525 mg Se per kg body wt.) on distribution and excretion of 203Hg was studied. The content of 203Hg was lower in kidney and higher in liver and blood in the groups treated with selenate or selenite when compared with rats which received only mercury. The brain content of 203Hg was significantly increased in rats injected with selenite. Both selenium compounds injected immediately after mercury significantly decreased urinary as well as biliary excretion of 203Hg. A transient increase in the rate of biliary excretion of 203Hg during the first 2 h after administration was observed in rats treated with selenate. This finding seems to support the idea that the reduction of selenate to selenite in the body is not rapid but takes at least several hours.

[Correction of disorders of bile lipid-mineral composition as a method of preventing cholelithiasis]

A study of 60 patients with biliary tract diseases revealed different disorders of the lipid and mineral composition of bile of monotypical character but different by severity in patients with dyskinesias, cholecystitis and cholelithiasis. Silibor favours normalization of the lipid composition of bile, a dry protein mixture--the mineral composition quadevit--the mineral and lipid composition of bile.

Bile composition after total proctocolectomy with interposed jejunal segment as neorectum

Changes of bile composition in gallbladder bile and serum chemistries were investigated in nine dogs after proctocolectomy and ileoanal anastomosis, using an interposed jejunal segment as a neorectum. A significant decrease in cholic acid and an increase in deoxycholic acid were observed 24 weeks after the operation, although there was no significant change of total bile acid and phospholipids in the bile. Concentration of cholesterol and cholesterol saturation index in bile increased after total proctocolectomy. Although serum triglyceride levels became lower compared with the nontreated control group, concentrations of total protein, serum cholesterol, total lipids, blood sugar, and electrolytes showed no significant difference. This operative procedure apparently did not impair intestinal absorption of bile acid, but did increase the biliary cholesterol saturation index.

High-performance liquid chromatography for the determination of three new fluoroquinolones, fleroxacin, temafloxacin and A-64730, in biological fluids

High-performance liquid chromatographic procedures have been developed for the measurement of three new fluoroquinolones, fleroxacin, temafloxacin and A-64730, in serum, urine and bile. The sample treatment consists of a two-step chemical extraction. The three molecules are chromatographed on a C18 reversed-phase analytical column with spectrofluorimetric detection. At a signal-to-noise ratio of 4, the detection limits in serum are 2.5, 10 and 20 ng/ml, for fleroxacin, temafloxacin and A-64730, respectively. The calibration curves are rectilinear between these detection limits and 20 micrograms/ml. The intra- and inter-assay coefficients of variation are in the ranges 0.8-5.4 and 2.2-7.6%, respectively. These simple and reliable assay procedures will be of great interest for further pharmacokinetic studies and drug monitoring in hospital use.