Dose-response studies of gentamicin nephrotoxicity in rats with experimental renal dysfunction. II. Polyvinyl alcohol glomerulopathy

Final Report On the Safety Assessment of Polyvinyl Alcohol

Polyvinyl Alcohol is a synthetic alcohol used as a binder, film former, and viscosity increasing agent in a wide range of cosmetic formulations at concentrations up to 13%. Typical molecular weights range from 25,000 to 300,000. The acute oral LD50 in rats is reported to be >10 g/kg in one study and >21.5 g/kg in another. Dermal exposures of 5 and 13 weeks (the latter using 13% Polyvinyl Alcohol) produced no significant effects in rats. Various organ lesions and hypertension were noted in rats following repeated subcutaneous or intravenous dosing. Central nervous system depression and anemia, followed by renal damage, was seen in beagle dogs given daily intravenous injections of Polyvinyl Alcohol for a week. Several studies tested the carcinogenicity of subcutaneous implants of Polyvinyl Alcohol sponges or powder. Although the majority of these studies were positive, tumors were localized to the site of implantation. In another study in which Polyvinyl Alcohol was used as the vehicle for another agent and tested itself as the vehicle control, Polyvinyl Alcohol had no effect on the incidence of histiocytic sarcoma. Although no data were available assessing the reproductive or developmental toxicity, these endpoints were not considered to be likely with external exposure to this polymer. Polyvinyl Alcohol was not an ocular irritant in animal or clinical studies, nor was it a sensitizer. Some evidence of dermal irritation in animal and clinical studies was seen, but in the clinical studies it was not considered clinically significant. Based on these data, it was concluded that Polyvinyl Alcohol is safe as used in cosmetic formulations.

Cryptic MHC class I-binding peptides are revealed by aminoglycoside-induced stop codon read-through into the 3' UTR

Aminoglycosides have been proposed as therapies for genetic disorders caused by nonsense mutations, because of their capacity to enhance translational read-through of premature termination codons (PTCs), thereby permitting expression of functional full-length protein. However, a potential consequence of this strategy is the development of an autoimmune response to HLA-presented epitopes encoded downstream of the PTC or other stop codons. Using a recombinant virus-expression system in tissue culture and in mice, we demonstrate that gentamicin can induce expression and MHC class I presentation of a model epitope encoded downstream of a PTC at levels sufficient to activate CD8(+) T cells. The degree of read-through-derived peptide presentation varies with the sequence of the stop codon and +1 nucleotide. Additionally, we applied a mass spectrometry exploration of the HLA class I peptide repertoire of gentamicin-treated cells and identified multiple peptides derived from read-through of conventional stop codons. These results substantiate the possibility of self-reactivity to cryptic epitopes revealed by stop codon read-through therapies and potentially other therapeutic approaches involving compounds that alter translational fidelity.

Urinary biomarkers in assessing the nephrotoxic potential of gentamicin in solitary kidney patients after 7 days of therapy

INTRODUCTION

The solitary kidney (SK) may present increased vulnerability to nephrotoxicity because of adaptive phenomena.

AIMS

Assessing the vulnerability of the SK with urinary tract infections (UTI) to gentamicin by means of urinary biomarkers (N-acetyl-beta-D-glucosaminidase (NAG) and urinary alpha-1-microglobulin), as well as glomerular filtration rate (GFR).

METHODS

We studied 14 patients with SK with UTI (group A) (mean age 58.07 ± 13.61 years, mean duration of SK 13.55 ± 12.33 years) who were administered gentamicin for 7 days. Group B consisted by 17 patients with SK without any other associated renal pathology (average age 51.17 ± 9.39 years, average existence period of a single kidney 33.23 ± 21.73 years). We also included a third group (group C) represented by nine healthy individuals, with two kidneys.

RESULTS

Increased values of urinary NAG were found in group B as compared to group C and alpha-1 microglobulin in group A as compared to group B. During treatment with gentamicin, increased values of both NAG and alpha-1-microglobulin in group A were found on day 7 as compared to values before treatment (day 7 NAG=18.99 ± 14.07 U/g creat versus day 0, NAG=5.15 ± 6.54 U/g creat, p=0.004; day 7 alpha-1-microglobulin=20.88 ± 18.84 mg/g creat versus day 0, urinary alpha-1-microglobulin=4.96 ± 6.57 mg/g creat, p=0.003). No statistically significant alterations of GFR were noticed after 7 days of treatment.

CONCLUSIONS

We found the nephrotoxic effects of gentamicin at tubular level, but not at glomerular level. The nephrotoxic potential of gentamicin in patients with a SK can be monitored by assessing urinary biomarkers during treatment of UTI.

Effect of various formulation parameters on the properties of polymeric nanoparticles prepared by multiple emulsion method

This work evaluates and interprets underlying mechanisms behind various aspects related to preparation and physical characteristics of polymeric nanoparticles (NP). These were prepared from different biodegradable polymers according to a water-in-oil-in-water emulsion solvent evaporation method. Polymers used were poly(lactic-co-glycolic) acid (PLGA), poly (lactic acid) (PLA), (PLA-PEG-PLA) triblock and (PLA-PEG-PLA)n multi-block co-polymers. A model DNA, as an example of a hydrophilic drug, was encapsulated in the internal aqueous phase. The primary emulsion was prepared using a high shear turbine mixer. The secondary emulsion was prepared by high-pressure homogenization. Surface morphology and internal structure were characterized by scanning electron microscopy (SEM) and atomic force microscopy (AFM). Influence of process variables on the physical properties of NP has been studied. Release of DNA was evaluated. In addition, changes occurring to NP porosity and surface area during degradation were followed. Nanoparticle size was ranging between 200-700 nm, according to the preparation conditions. Homogenizing pressure, concentration of the emulsifying agent used, polymer concentration and type and the concentration of a cryoprotectant had variable effects on NP size, surface area and porosity. Batches of NP where no emulsifying agent was added were obtained successfully. The release rate of the DNA from NP was mainly dependent on porosity, which varied significantly among used polymers. The preparation technique was efficient in encapsulating the model DNA and will be used for plasmid encapsulation in a future work.

Enhanced hexachloro-1:3-butadiene nephrotoxicity in rats with a preexisting adriamycin-induced nephrotic syndrome

Renal damage was assessed by histopathology and urinalysis in male Wistar rats treated with either hexachloro-1:3-butadiene (HCBD; a single 170-mg/kg ip dose that caused proximal tubule necrosis), adriamycin (ADR; a single 5-mg/kg ip dose that caused minimal glomerular changes up to 35 days), or HCBD given 2 wk after ADR and compared with age-matched control rats for 21 days. Urinalysis values in ADR-treated rats showed minimal renal changes. HCBD significantly elevated urine volume (10-fold), protein (5-fold), glucose (175-fold), and brush border enzymes (10-600-fold), indicating severe proximal tubular damage, but most parameters returned to pretreatment levels 6 days after treatment. In ADR-pretreated rats subsequently given HCBD, both the urinary alkaline phosphatase and the ratio of kidney: body weight were significantly higher for longer periods. Histopathology demonstrated that the HCBD-induced proximal tubular lesion was confined to the outer stripe of the outer medulla. Advanced regeneration and repair was evident 21 days after HCBD treatment. In the ADR-pretreated rats the HCBD-induced lesion was more severe and affected the entire cortex and was characterized by marked tubular epithelial calcification, with little evidence of repair and tubular restitution 21 days after treatment. Enzyme histochemistry showed gamma-glutamyltranspeptidase localized to the proximal tubules. After HCBD treatment the enzyme staining was lost and subsequently returned in parallel with histological recovery up to 21 days. The distribution and intensity of gamma-glutamyltranspeptidase was unchanged in ADR-treated rats. The distribution and intensity of gamma-glutamyltranspeptidase in kidneys of ADR-pretreated rats given HCBD had not returned to normal by day 21. The results of this study indicate that pretreatment with ADR increases HCBD-induced nephrotoxic damage and decreases renal cortical repair capacity.

Protection against gentamicin nephrotoxicity by daptomycin in nephrectomized rats

Daptomycin was previously shown to reduce gentamicin renal toxicity and this toxicity was not delayed by the concomitant injection of daptomycin (Thibault N., L. Grenier, M. Simard, M. G. Bergeron, and D. Beauchamp, Antimicrob. Agents Chemother., 38 1027-1035 (1994)). The protective effect of daptomycin against gentamicin toxicity was evaluated in 96 female Sprague-Dawley rats. Normal and nephrectomized rats were treated with saline (NaCl, 0.9%), gentamicin (30 mg/kg/12 hrs, i.p.), daptomycin (10 mg/kg/12 hrs, s.c.) or with a combination of daptomycin plus gentamicin during 4 and 10 days. On day 4, gentamicin and daptomycin cortical levels were higher in nephrectomized gentamicin-daptomycin-treated rats (p < 0.05) as compared to all other groups. The accumulation of gentamicin or daptomycin in nephrectomized gentamicin-daptomycin-treated or gentamicin-saline-treated rats was higher on day 4 (p < 0.01) than on day 10. Other parameters such as the sphingomyelinase activity in the renal cortex, the serum creatinine, and the histopathology showed significantly fewer changes in daptomycin-gentamicin-treated rats as compared to animals given gentamicin alone. On the other hand, the protection of daptomycin was less extensive in nephrectomized rats as compared to normal rats. Daptomycin and gentamicin were localized in the lysosomes of proximal tubular cells of animals treated with daptomycin and gentamicin given alone or in combination. These results suggest that daptomycin protects against gentamicin toxicity in nephrectomized rats but to a lesser extent than in normal rats.

Arteriovenous malformations of the brain: choosing embolic materials to enhance safety and ease of excision

The authors report their experience with surgical resection of 108 previously embolized arteriovenous malformations (AVM's). Embolization was performed via only transfemoral catheterization in 70 lesions and via the surgical exposure of feeding vessels in 32. The remaining six patients were referred for resection following silicone sphere embolization elsewhere. Materials used included polyvinyl alcohol (PVA) foam, platinum microcoils, detachable silicone balloons, surgical silk, a mixture of 33% ethanol and microfibrillar collagen, and isobutyl cyanoacrylate (IBCA). It is believed that proximal arterial occlusion with balloons is an inferior choice for preresection embolization, because the technical difficulty of placement is high and the nidus of the AVM is unaffected. Vascular coagulation and section and AVM retraction are more difficult with IBCA; therefore, this is also considered an inferior choice. Among the materials studied, the combination of PVA for distal occlusion and microcoils for proximal occlusion appears to be the superior choice. Fewer complications (stroke or hemorrhage) are seen when intraarterial Amytal (amobarbital) testing is used to guide the embolization. Data regarding toxicity, oncogenicity, and vascular metabolism or recanalization associated with PVA, IBCA, and n-butyl cyanoacrylate are reviewed.