Teratogenic effects of chlorambucil on in vivo and in vitro organogenesis in mice

Pattern of Response of Intact Drosophila to Known Teratogens

Drosophila, as the test organism, was used to assess 17 chemicals. The teratogenic potential of 15 of these chemicals is well established from animal studies or human epidemiology. The test involves examination of adult flies following treatment during larval stages of development. Flies are examined for abnormal external morphology. The incidence of abnormalities in treated and control populations is compared using the Chi-square test. All 17 chemicals were active to varying degrees in the test system. Most chemicals produced a unique response yielding individual patterns of abnormalities. These results suggest that Drosophila may have the potential to become a valuable teratogen screen, but further, more rigorous examination–particularly with nonteratogens–is required.

How I treat acute and chronic leukemia in pregnancy

The prevalence of pregnancy associated leukemia is approximately 1 case out of 10,000 pregnancies. This rare occurrence precludes the conducting of large, prospective studies to examine diagnostic, management and outcome issues. The treatment of a pregnant woman with leukemia may be associated with severe adverse fetal outcome including death and malformations, and therefore poses a difficult challenge for both the patient and the attending physician. Chemotherapy during the 1st trimester is associated with an increased risk for congenital malformations. However, this risk diminishes as pregnancy advances. When acute leukemia is diagnosed during the 1st trimester, patients should be treated promptly similar to non-pregnant patients. However, the aggressive induction therapy should follow pregnancy termination. When the diagnosis is made later in pregnancy standard chemotherapy regimen should be considered and usually pregnancy termination is not mandatory. However, both the mother and the fetus should be under close observation and delivery should be postponed to a non-cytopenic period. Pregnancy associated chronic myelogenous leukemia (CML) can be treated with interferon throughout pregnancy with no apparent increase in adverse fetal outcome. In the very rare case of chronic lymphocytic leukemia (CLL) during pregnancy treatment can usually be delayed until after delivery.

Chlorambucil-induced postclosure exencephaly and axial skeletal abnormalities in rat fetuses

Open neural tube defects (NTD) are reported to arise from failure of the embryonic neural folds to close or rupture of a previously closed neural tube. The critical period for dysmorphogenesis of the neural tube by either mechanism is of clinical importance. We had previously reported that single doses of cyclophosphamide (CPA), administered to pregnant rats resulted in reopening of the closed neural tube. The objective of the present study was to determine if other antineoplastic drugs also had similar ability to cause rupture of the closed neural tube. Therefore, single doses of chlorambucil dissolved in bicarbonate buffer were administered to Wistar rats on one of gestation days (GD) 11 through 14 (i.e., well after closure of the neural tube) and fetuses were examined on GD 20. It was observed that the window of susceptibility extended from GD 11 through 14 and that a single dose of 10 mg/kg of the drug was most effective. The affected fetuses had the prosencephalon and mesencephalon parts of the brain protruding through a wide opening of the cranial roof. The exposed brain tissue was hemorrhagic and covered by a thin, transparent and often porous membrane. The cranial vault was missing. Numerous malformations of the axial skeleton and of several nonneural organs were found to accompany the brain defect. Electron microscopic and light microscopic studies revealed extensive cell death, fragmentation, and phagocytosis of dead cells and vacuolization of the neuroepithelium (NE) within 12 h of the drug treatment. Cell death per se was not pronounced in the cranial mesenchyme (ME). The vacuoles in the NE coalesced into small cavities. The ME failed to proliferate adequately and organize itself into the cranial vault primordium. Hemorrhage and disorganization of the NE was progressive. The fluid that escaped into the interstitium seemed to extend into the cysts that developed in the ME externally and into the ventricular system internally. The edema of the ME thus might have contributed to disruption of precursor mesenchymal tissue and consequently to malformation of the cranial bones. Large hematomas and cysts also developed on the basal aspect of the crumbling brain vesicles and appeared to lift the neural tissue out of the shallow cranial cavity. As previously reported for CPA, these data provide evidence for the ability of chlorambucil to cause postclosure exencephaly in rat fetuses for a susceptible period that is considerably long.

Stage-specific effects of teratogens on sea urchin embryogenesis

The effect of direct (chlorambucil and allopurinol) and indirect (cyclophosphamide) teratogens on the fertilization and early development of sea urchin embryos has been investigated. Fertilization was affected by none of the drugs tested. Continuous exposure of embryos to chlorambucil (10(-6) to 3 x 10(-4) M) starting after fertilization delayed the first cleavage and hatching. Developmental defects in chlorambucil-treated embryos consisted mainly of blastula and gastrula-arrested embryos and in a limited number (25%) of plutei with malformed gut or skeleton. Post-hatching exposure to chlorambucil led to malformed plutei only. Early (pre-hatching) exposure to allopurinol (10(-6) to 10(-3) M) did not affect cleavage but induced developmental defects in a ratio comparable to chlorambucil. Post-hatching exposure to allopurinol failed to affect the embryogenesis. The indirect teratogen cyclophosphamide (10(-6) to 3 x 10(-5) M) had no effect on the early embryogenesis. Results were discussed in view of using sea urchin embryos to detect and analyze the early mechanisms of teratogenic action.

Review of drug-induced limb defects in mammals

The objective of this paper was to illustrate the spectrum of possible limb malformations in mammals resulting from drug exposure. A bibliography of 171 papers from 20 journals was generated from which pertinent data (drug used, limb defects reported, predominant defect location) were tabulated. These data should provide a basis for predictions about types of defects that might be expected in further studies and for judging postulated drug-induced human limb defects. However, direct extrapolation to humans is inappropriate. The following trends were observed: 1) Distal limb defects (autopod) are almost twice as common as proximal limb defects (stylopod and zygopod). 2) Ectrodactyly is the single most common type of limb defect, accounting for over half of the autopod defects. 3) Ectrodactyly is almost twice as common in the hindlimb as in the forelimb. 4) Postaxial ectrodactyly is over twice as common as preaxial ectrodactyly in the forelimb, but preaxial ectrodactyly is four times more common in the hindlimbs. 5) Polydactyly occurs with approximately equal frequency in forelimbs and hindlimbs, and preaxial polydactyly is most common in both fore and hindlimbs. 6) Polymelia (supernumerary limbs) occurred in one case, and may have been a spurious result. 7) Either transverse hemimelia is greatly underreported in teratology studies or it essentially does not occur. We have concluded that, at least in some cases, acetazolamide, adenine, 1,7-dimethylxanthine, and xanthine derivative aminophylline, retinoic acid, acetoxy-methyl-methylnitrosamine, aspirin, and cadmium can all cause unilateral defects.

Evaluation of the embryotoxic potential of ten chemicals in the whole mouse embryo culture

Ten widely different chemicals, actinomycin D, mithramycin, podophyllotoxin, vincristine sulfate, triaziquone, chlorambucil, mercaptopurine riboside, methyl-mercaptopurine riboside, dimethylsulfoxide, and L-lysine were tested in the whole mouse embryo culture system. The highest concentration was always the concentration that induced 100% lethality (ELC100). The lowest concentration varied from 1/2 to 1/10 of the ELC100. The chemicals that had the most noxious effect on embryonic growth and differentiation were actinomycin D, triaziquone, and mercaptopurine riboside. Podophyllotoxin, methyl-mercaptopurine riboside, and L-lysine were the less embryotoxic. As a whole, no significant discrepancies were observed between the results and the teratological data obtained from the literature. These observations support the assumption that the whole murine embryo culture system can give valuable information on the teratogenicity of chemicals.

Potentiating effects of caffeine on teratogenicity of alkylating agents in mice

Teratogenic to subteratogenic doses of x-ray, mitomycin C, MNNG, thio-TEPA, cyclophosphamide, and chlorambucil were administered to pregnant ICR mice together with caffeine at doses of 12.5, 25, or 50 mg/kg on day 11 of gestation. Fetuses were examined for gross malformations on day 18 of gestation. The teratogenicity of mitomycin C was significantly potentiated by caffeine at a dose as low as 12.5 mg/kg. The teratogenicity of chlorambucil was also significantly potentiated by caffeine at 50 mg/kg, but similar potentiation was not observed for x-ray, MNNG, thio-TEPA, and cyclophosphamide.

A selection of candidate compounds for in vitro teratogenesis test validation

The Consensus Workshop on In Vitro Teratogenesis Testing recommended that test validation be facilitated by a listing of agents with defined teratogenicity; subsequently, a panel was convened to review and select such agents. This communication established a list of 47 compounds or conditions which demonstrate a wide range of teratogenicity in vivo. The agents were chosen primarily on the strength of the literature base denoting their in vivo effects. The tables note a number of general biological and toxicological characteristics for each agent, and the details of representative in vivo teratology studies are summarized and referenced. This list is intended to serve as a base for in vitro teratogenesis test validation and should prove useful in developing and identifying those systems which will contribute to a more effective testing program.

Teratogenicity of chlorambucil in rat embryos in vitro

Chlorambucil, a bifunctional alkylating agent and antitumor drug, is a potent teratogen in rodents and possibly teratogenic in humans. Unlike cyclophosphamide, a related bifunctional alkylating agent, chlorambucil is a direct-acting cytotoxic agent. However, several studies indicate that the cytotoxic potential of chlorambucil is enhanced by metabolism of the parent compound. Using day-10 rat embryos cultured in vitro, we have demonstrated that chlorambucil is a direct acting teratogen but that its teratogenicity can be enhanced by the addition of rat liver S-9 preparations to culture medium containing the drug. Our data also suggest that this enhancement is not related to cytochrome P-450 monooxygenases. This conclusion is based upon three lines of evidence. First, enhancement occurs under culture conditions which lack cofactors necessary for cytochrome P-450 monooxygenases. Second, metyrapone, a known inhibitor of cytochrome P-450, did not abolish the enhancement. Third, induction of cytochrome P-450 by two specific inducers of monoxygenase activity had no effect on the observed enhancement. We postulate that the observed enhancement of chlorambucil teratogenicity is related to the beta-oxidation of the butyric acid side chain of chlorambucil generating the more cytotoxic (teratogenic) metabolite, phenylacetic acid mustard. Finally, our data indicate that the teratogenic effects elicited by chlorambucil are indistinguishable from those elicited by cyclophosphamide.

Morphological alterations in the developing fetal rat limb due to maternal injection of chlorambucil

On day 14 of pregnancy, rats were injected i.p. with 9.5 mg/kg of chlorambucil. At term, all the fetuses were stunted and had obvious skeletal malformations. From days 15-20 of gestation there was a steady progression of cell death and histologic derangement in long bone formation. This began on day 15, the day following exposure to chlorambucil, with extensive cell death of chondroblasts in the long bone primordia. By day 16, dead or dying cells were located in the cartilage model and became associated with a higher than normal matrix to cell ratio. In day 17 limbs, many cells of the cartilage model were irregular in size and shape so that the normally precise cellular arrangement was lacking. On day 18, periosteal and enchondrial calcification was delayed and scanty. The fibular hemimelia observed in all drug-treated term fetuses stained with alizarin appeared to result from lack of development of the proximal half of the cartilage model. The observed alterations, particularly bowing of the ulna, in the teratogen-treated fetuses appeared to result primarily from specific cell death and formation of aberrant cell types but abnormal cell products may also play a role.