Determination of plasma-thiocyanate binding and the Donnan ratio under simulated physiological conditions

Cerebrovascular Disease, Cardiovascular Disease, and Chronic Kidney Disease: Interplays and Influences

PURPOSE OF REVIEW

We reviewed reasons for the high cardiovascular risk (CVD) of patients with chronic kidney disease (CKD), and explored alternatives to treatment of traditional risk factors to reduce CVD in CKD.

RECENT FINDINGS

Besides traditional risk factors, patients with CKD are exposed to uremic toxins of two kinds: systemically derived toxins include asymmetric dimethylarginine (ADMA), total homocysteine (tHcy), thiocyanate, tumor necrosis factor alpha, and interleukin 6. Gut-derived uremic toxins (GDUT), products of the intestinal microbiome, include hippuric acid, indoxyl sulfate, p-cresyl sulfate, p-cresyl glucuronide, phenylacetylglutamine, and trimethylamine N-oxide (TMAO). Cyanocobalamin is toxic in patients with CKD. Approaches to reducing plasma levels of these uremic toxins would include diet to reduce GDUT, kidney transplantation, more intensive dialysis, and vitamin therapy to lower tHcy with methylcobalamin rather than cyanocobalamin. The high CVD risk in CKD requires consideration of therapies beyond treatment of traditional risk factors.

The physiological consequences of ingesting a toxic plant (Diplotaxis tenuifolia) influence subsequent foraging decisions by sheep (Ovis aries)

Toxins and nutrients interact and define herbivores' experiences with toxic plants. However, there are still open questions about the mechanisms by which nutrient-toxin interactions affect experience and as a consequence foraging decisions by consumers. This study provides a deeper insight into such mechanisms by using supplemental nutrients, a toxic plant typically avoided by herbivores (wild rocket; Diplotaxis tenuifolia), and a small ruminant (sheep; Ovis aries) as models. Thirty-six sheep were randomly assigned to four treatments (n=9) where animals consumed: wild rocket ("DT"), wild rocket followed by a protein supplement ("DT+P"), wild rocket followed by a protein supplement+a mineral supplement containing iodine and copper ("DT+P+M"), or alfalfa pellets in amounts that paired the ingestion of wild rocket by DT ("CTRL"). Towards the end of the phase of exposure (day 35), DT showed the lowest intake of wild rocket, as well as reduced levels of plasma thyroid hormones (T3 and T4), alanine aminotransferase, and a trend towards reduced hemoglobin relative to DT+P and DT+P+M. Total concentration of serum proteins and albumins were greater in sheep fed the protein supplements, which have probably elicited a protective effect on toxin ingestion. Foraging behavior was then evaluated in an experimental arena where animals could select among randomly distributed buckets containing a fixed amount of wild rocket or variable amounts of barley grain (a preferred food). Regardless of barley grain availability, DT showed lower intake and lower times spent eating wild rocket than DT+P and DT+P+M. Unexpectedly, CTRL (without previous experience with wild rocket) ingested amounts of wild rocket comparable to those observed by DT+P and DT+P+M. A negative feeding experience with wild rocket is needed for animals to display the typical pattern of aversion commonly observed in grazing conditions.

Accumulation of cyanide and thiocyanate in haemodialysis patients

BACKGROUND

Cyanide is a toxic agent, and its detoxification product, thiocyanate, may be a major pathogenetic substance in uraemia. Recent studies examining the myeloperoxidase(MPO)/thiocyanate system have suggested a link between thiocyanate and atherosclerosis. However, inaccuracies in conventional assays for cyanide and thiocyanate have limited the understanding of their metabolism in haemodialysis (HD) patients.

METHODS

We used high-performance liquid chromatography to measure cyanide in erythrocytes and thiocyanate in plasma in 43 HD patients and in a group of 46 healthy controls that included 15 current smokers. To clarify the metabolic conversion of cyanide to thiocyanate in uraemic patients, we also measured cysteine and sulfate. We then used stepwise regression analysis to analyse factors that determine erythrocyte cyanide and plasma thiocyanate.

RESULTS

Mean cyanide and thiocyanate were significantly greater in HD patients than in non-smoking controls. However, cyanide was far below lethal concentrations in dialysis patients. Thiocyanate was six to seven times greater in HD patients than in non-smoking controls, and decreases in thiocyanate following dialysis were only 19.3+/-3.5%. Multiple regression analysis showed a positive correlation between cyanide and thiocyanate in controls, but a negative correlation in HD patients. In patients, an inverse relationship between thiocyanate and BUN was also observed.

CONCLUSIONS

The elevation of thiocyanate in patients undergoing dialysis probably is secondary to both limited efficiency of HD and deranged metabolism of cyanide and thiocyanate. Because thiocyanate is a preferred substrate for MPO, it may play a role in uraemic complications including cardiovascular events.

Thiocyanate in smokers interferes with the Nova magnesium ion-selective electrode

Thiocyanate found in serum ordinarily is the metabolite of cyanide that is inhaled with tobacco smoke and ingested with cyanogenic foods. We investigated the effect of the thiocyanate ion (SCN−) on the ionized magnesium (iMg) and ionized calcium (iCa) results determined with the AVL and Nova magnesium and calcium ion-selective electrodes (ISEs). We analyzed saline and pooled serum with added SCN−, and serum from apparently healthy nonsmokers (n = 20) and smokers (n = 20). The mean (and range) of the measured serum SCN− concentration was 0.019 (0.008–0.046) mmol/L for nonsmokers and 0.077 (0.020–0.138) mmol/L for smokers. Only the Nova iMg results decreased with increasing SCN−concentration, and the change was dependent on the baseline iMg concentration. In the absence of Mg, SCN− decreased the voltage response of the Nova Mg ISE to calcium ions. At apparently normal serum iMg and iCa concentrations, the interference by SCN− appeared to be equimolar (iMg = −1.04 × SCN− + 0.52). Thus, the serum SCN− commonly found in smokers causes a significant (P <0.0001) decrease in the Nova iMg results.

An improved method for determination of thiocyanate in plasma and urine

An improved spectrophotometric method is described for the determination of thiocyanate in plasma and urine. Thiocyanate is adsorbed on a weak anion-exchange resin with strong affinity for chaotropic ions, and eluted with perchlorate. Thiocyanate is then chlorinated by hypochlorite and quantified according to the König (J Prakt Chem 1904; 69:105-37) reaction by use of isonicotinic acid and 1,3-dimethyl-barbituric acid. The method affords a simple, rapid and sensitive assay for thiocyanate and has a detection limit of 0.93 mumol/l. At thiocyanate concentrations of 107.1 and 167.4 mumol/l in plasma and urine the within-day CVs were 0.69% and 1.1% respectively, and the total imprecision measured for a period of 65 days was 0.98%. Analytical recoveries were quantitative both with urine and plasma samples.

Determination of oxidizable inorganic anions by high-performance liquid chromatography with fluorescence detection and application to the determination of salivary nitrite and thiocyanate and serum thiocyanate

A sensitive method for the simultaneous determination of oxidizable inorganic anions (sulphide, thiocyanate, thiosulphate and nitrite) was developed by use of high-performance liquid chromatography and fluorimetric detection based on the formation of fluorescent cerium(III) by a redox reaction with cerium(IV). The detection limits are 0.1 nmol for both thiocyanate and nitrite, 0.3 nmol for thiosulphate and 0.8 nmol for sulphide per 10-microliters injection volume. This system can be utilized for the determination of salivary thiocyanate and nitrite and serum thiocyanate.

Transfer of thiocyanate into chicken eggs

Laying hens were fed thiocyanate (SCN) as a solution of potassium thiocyanate (KSCN) in their drinking water to determine whether dietary SCN was transferred into eggs. The thiocyanate content of their eggs was measured before and during thiocyanate administration. Egg thiocyanate content increased from 6 micrograms SCN/g albumen to 31 micrograms SCN/g (a 400% increase) in the period immediately following thiocyanate administration and then fell progressively, seeming to stabilize much closer to but still well above control levels.

Effect of antagonists on the physiologic disposition of sodium cyanide

Attempts were made to evaluate the effects of pretreatment with air and oxygen either alone or in various combinations with sodium nitrite and/or sodium thiosulfate on the physiological disposition of 14C-labeled sodium cyanide in mice. The radioactive respiratory excretion was studied by radiorespirometry, and the effects of various combinations of cyanide antagonists were compared. Oxygen either alone or in combination with sodium thiosulfate significantly enhanced the respiratory excretion when compared with air. Sodium thiosulfate accelerated the initial rate, but not the total amount of radioactivity excreted. The cumulative recovery of radioactive gases was significantly greater with groups receiving oxygen either alone or with sodium thiosulfate. When sodium nitrite was employed as an antidote either alone or with sodium thiosulfate, no difference in the respiratory excretion was noted between air and oxygen. The use of the sodium nitrite-sodium thiosulfate combination either with air or oxygen resulted in a marked decrease in the initial rate as well as the total amount of respiratory radioactivity excreted. No significant differences between various experimental groups were noted in the total amount of urinary radioactivity excreted or the total body retention of radioactivity.

Interaction of the anticoagulant drug warfarin and its metabolites with human plasma albumin

The interaction of the anticoagulant drug warfarin and its metabolites with human plasma albumin was studied by equilibrium dialysis. A 20-fold variation of buffer ionic strength (0.017-0.340) caused no significant change in the warfarin association constant. But the binding strength rose significantly as the pH was increased from 6.0 to 9.0 and then declined at pH 10.0. The 6-, 7-, and 8-hydroxywarfarin metabolites showed a 7- to 23-fold reduction in binding strength at pH 10.0. These data indicate that the molecular basis of the interaction is nonelectrostatic and that the introduction of polar hydroxyl groups on the coumarin nucleus by metabolism reduces its hydrophobic binding surface. The interaction was markedly exothermic and showed a positive entropy (increased molecular disorder), which suggests cooperative hydrogen and hydrophobic bonding as the molecular basis for the binding of warfarin to albumin. The marked albumin binding and nonpolar character of warfarin explains the respective absence and presence of the unchanged drug in urine and plasma of warfarintreated patients, while the more polar character and lesser albumin binding of the metabolites probably determines their absence in plasma and presence in urine. The relatively marked binding to albumin of the 4'-hydroxywarfarin metabolite suggests that it may occur in the plasma of warfarin-treated patients. The data suggest that a direct correlation exists between the interaction of warfarin with plasma albumin and the interaction with the warfarin receptor site.