Glucocorticoid effects on gastric peroxidase activity

Clinical, clinicopathologic, and gastrointestinal changes from aspirin, prednisone, or combination treatment in healthy research dogs: A double-blind randomized trial

Background

Dogs with immune‐mediated disease are often coadministered glucocorticoids and aspirin, but ulcerogenic effects of current protocols are unknown.

Objectives

To compare gastrointestinal changes among dogs administered aspirin, prednisone, and combination treatment.

Animals

Twenty‐four healthy research dogs.

Methods

Double‐blinded, placebo‐controlled randomized trial of dogs administered placebo, aspirin (2 mg/kg q24h), prednisone (2 mg/kg q24h), or combination treatment PO for 28 days. Clinical signs were recorded daily, with laboratory work performed at baseline and day 28. Gastrointestinal mucosal hemorrhages, erosions, and ulcers were numerated for endoscopic studies performed on days 0, 14, and 28; endoscopic mucosal lesion scores were calculated. Results were compared using mixed model repeated‐measures analyses of variance and generalized estimating equation proportional odds models. P < .05 was considered significant.

Results

Gastric mucosal lesion scores differed by treatment‐by‐time (F[6, 40] = 4.4, P = .002), treatment (F[3, 20] = 7.1, P = .002), and time (F[2, 40] = 18.9, P < .001). Post hoc analysis revealed increased scores in the aspirin (day 14 only), prednisone, and prednisone/aspirin groups during treatment. Ulcers were identified on 14 studies, representing 10 dogs. Dogs receiving prednisone and prednisone/aspirin had 11.1 times (95% CI, 1.7‐73.6) and 31.5 times (95% CI, 3.5‐288.0) higher odds, respectively, of having endoscopic mucosal lesion scores ≥4 than dogs receiving placebo (P ≤ .01).

Conclusions and Clinical Importance

Gastrointestinal bleeding occurs commonly in dogs administered aspirin, prednisone, or prednisone/aspirin treatment, with higher lesion scores for dogs receiving combination treatment. Even severe lesions are not accompanied by clinical signs.

Dexamethasone makes the gastric mucosa susceptible to ulceration by inhibiting prostaglandin synthetase and peroxidase--two important gastroprotective enzymes

The plausible mechanism by which dexamethasone makes the gastric mucosa susceptible to ulceration has been studied. As acid aggravates ulcer, the role of dexamethasone on acid secretion was first investigated. Dexamethasone stimulates both basal and drug (mercaptomethylimidazole)-induced gastric acid secretion by 100 and 50% respectively in male Wister rats 24 h after intramuscular administration at the dose of 1 mg/kg body wt. This stimulated acid secretion is 93% blocked by cimetidine indicating increased liberation of histamine in the process. Pretreatment of dexamethasone before 24 h produces ulcer in 30% of the pylorus- ligated rats and aggravates the ulcer index by 82% in both pylorus and esophagus ligated rats. The incidence of ulceration in the latter cases is also increased by 25%. As mucosal prostaglandin synthetase and peroxidase play an important role in gastroprotection through biosynthesis of prostaglandin and by scavenging endogenous H2O2 respectively, the effect of dexamethasone on the activities of these gastroprotective enzymes were studied. Prostaglandin synthetase and peroxidase activities of the mucosa are significantly inhibited by 87 and 83% respectively by 24-h pretreatment with dexamethasone. The results indicate that dexamethasone makes the mucosa prone to ulceration by inhibiting the activity of prostaglandin synthetase to block the gastroprotective action of prostaglandin and also by inhibiting the peroxidase, thereby elevating the endogenous H2O2 level to generate more reactive hydroxyl radical responsible for the mucosal damage.

Oxidative inactivation of gastric peroxidase by site-specific generation of hydroxyl radical and its role in stress-induced gastric ulceration

We have shown earlier that restraint-cold stress-induced gastric ulceration in rats is caused by metal ion-dependent generation of hydroxyl radical (OH.) and oxidative inactivation of the gastric peroxidase (GPO), an important H2O2 scavenging enzyme. To study the mechanism of the oxidative damage of GPO, the purified enzyme was exposed to an OH. generating system containing Cu2+, ascorbate, and H2O2. Kinetic studies indicate that the enzyme is inactivated in a time-dependent process showing saturation with respect to Cu2+ concentration. The enzyme specifically requires Cu2+ and is not inactivated by the same concentration of Fe2+, Mn2+, or Zn2+. Sensitivity to catalase indicates the critical role of H2O2 in the inactivation. Inactivation is insensitive to superoxide dismutase, suggesting no role of superoxide. The rate of inactivation is not increased in D2O excluding the involvement of singlet oxygen in the process. However, OH. scavengers such as benzoate or mannitol cannot prevent inactivation. The results indicate a plausible generation of OH. within the enzyme molecule as the cause of inactivation. Fragmentation of peptide linkage or intramolecular crosslinking, gross change of tertiary structure, or change in intrinsic tryptophan fluorescence which occurs in "global" oxidation are not evident. Inactivation is dependent on pH and from a plot of K(obs) of inactivation against pH, the controlling role of an ionizable group of the enzyme having a pka of 7.8 could be suggested, deprotonation of which favors inactivation. Amino acid analysis shows a specific loss of two lysine residues in the inactivated enzyme. Competitive kinetic studies indicate that pyridoxal phosphate, a specific modifier of the lysine residue, prevents inactivation by competing with Cu2+ for binding at the GPO. A Cu2+ binding motif consisting at least of two lysine residues exists in GPO, which specifically binds Cu2+ and generates OH.. The radical oxidizes the lysine residues and perturbs the heme environment to cause inactivation. We suggest that oxidative damage of GPO is mediated by site-specific generation of OH. and not by the OH. generated in the bulk phase.

Thiocyanate, a plausible physiological electron donor of gastric peroxidase

Gastric peroxidase (GPO) was purified to apparent homogeneity to characterize its major physiological electron donor. The enzyme (RZ = 0.7), with a subunit molecular mass of 50 kDa, is a glycoprotein, with a relative abundance of aspartic and glutamic acid over arginine and lysine. It has a Soret maximum at 412 nm, which is shifted to 426 nm by H2O2 due to formation of compound II. Although the physiological electron donors I-, Br- and SCN-, but not Cl-, are oxidized by GPO optimally at acid pH, only I- and SCN- are oxidized appreciably at physiological pH. Considering that the I- concentration in stomach is less than 1 microM, whereas the SCN- concentration is about 250 microM, SCN- may act as a major electron donor for GPO. Moreover, SCN- oxidation remains unaltered in the presence of physiological concentrations of other halides. The second-order rate constant for the reaction of GPO with H2O2 (k1) and compound I with SCN- (k2) at pH 7 was found to be 8 x 10(7) M-1.s-1 and 2 x 10(5) M-1.s-1 respectively. GPO has significant pseudocatalase activity also in the presence of I- or Br-, but it is blocked by SCN-. The SCN- oxidation product OSCN- may be reduced back to SCN- by cellular GSH, and GSSG may be reduced back to GSH by glutathione reductase and NADPH. In a system reconstituted with pure glutathione reductase, NADPH, GSH, SCN- and H2O2. GPO-catalysed SCN- oxidation could be coupled to NADPH oxidation. This system where GPO utilizes SCN- as the major physiological electron donor may operate efficiently to scavenge intracellular H2O2.

Mechanism-based inactivation of gastric peroxidase by mercaptomethylimidazole

The mechanism of inhibition of gastric peroxidase (GPO) activity by mercaptomethylimidazole (MMI), an inducer of gastric acid secretion, has been investigated. Incubation of purified GPO with MMI in the presence of H2O2 results in irreversible inactivation of the enzyme. No significant inactivation occurs in the absence of H2O2 or MMI, suggesting the involvement of peroxidase-catalysed oxidized MMI (MMIOX.) in the inactivation process. The inactivation follows pseudo-first-order kinetics consistent with a mechanism-based (suicide) mode. The pseudo-first-order kinetic constants at pH 8 are ki = 111 microM, k(inact.) = 0.55 min-1 and t1/2 = 1.25 min, and the second-order rate constant is 0.53 x 10(4) M-1 x min-1. Propylthiouracil also inactivates GPO activity in the same manner but its efficiency (k(inact./ki = 0.46 mM-1 x min-1) is about 10 times lower than that of MMI (k(inact./ki = 5 mM-1 x min-1). The rate of inactivation with MMI shows pH-dependence with an inflection point at 7.3, indicating the involvement in the inactivation process of an ionizable group on the enzyme with a pKa of 7.3. The enzyme is remarkably protected against inactivation by micromolar concentrations of electron donors such as iodide and bromide but not by chloride. Although GPO oxidizes MMI slowly, iodide stimulates it through enzymic generation of I+ which is reduced back to I- by MMI. Although MMIOX. is formed at a much higher rate in the presence of I-, a constant concentration of I- maintained via the reduction of I+ by MMI, protects the active site of the enzyme against inactivation. We suggest that MMI inactivates catalytically active GPO by acting as a suicidal substrate.

Effect of dexamethasone on the peptic activity of gastric lumen and mucosa

Dexamethasone (9 alpha-fluoro-16 alpha methyl-11 beta,17 alpha,21-trihydroxy-1,4-pregnadiene-3,20-dione-21-phosphate), a synthetic glucocorticoid, has a dual role on pepsinogen content of the gastric lumen and mucosa as measured by its peptic activity. Following stimulation the luminal peptic activity gradually decreases after 6 hr, then returns to basal levels at 18 hr and by 24 hr is inhibited by 50%. The luminal peptic activity induced by the secretory compound mercaptomethylimidazole (MMI) is also decreased. Dexamethasone effect on both basal and MMI-induced peptic activity can be reproduced by cycloheximide or puromycin, translational blockers of protein synthesis. This drug also has an independent time and dose-dependent inhibitory effect on gastric mucosal peptic activity which does not correlate with increased peptic activity of the lumen. Dexamethasone appears to be more effective than hydrocortisone and corticosterone in inhibiting the basal peptic activity of both lumen and mucosa. The inhibitory effect of this drug on tissue peptic activity is not mediated through induction of any inhibitory protein as evidenced by the insensitivity of the effect to actinomycin D. Studies on [14C]phenylalanine incorporation into gastric protein indicate that the effect of dexamethasone on tissue pepsinogen content is not due to a generalized block of protein synthesis.

Localization of gastric peroxidase and its inhibition by mercaptomethylimidazole, an inducer of gastric acid secretion

Mercaptomethylimidazole (MMI) is a potent inducer of gastric acid secretion which is associated with significant inhibition of peroxidase activity of rat gastric mucosa in vivo. A time-dependent increase in acid secretion correlates well with time-dependent decrease in the peroxidase activity. In a chamber experiment in vitro using isolated gastric mucosa, MMI stimulates acid secretion, showing an almost linear response up to 600 microM. The time-dependent increase in acid secretion is also correlated with time-dependent inhibition of the peroxidase activity. This effect is not mediated through oxidation of MMI by flavin-containing mono-oxygenase, which is absent from gastric mucosa. The peroxidase has been localized mainly in parietal cells isolated and purified from gastric mucosa by controlled digestion with collagenase followed by Percoll-density-gradient centrifugation. Peroxidase activity was further localized in the outer membrane of the purified mitochondria of the parietal cell by some membrane-impermeant reagents, indicating outward orientation of the enzyme. MMI can inhibit the peroxidase activity of both the parietal cell and its mitochondria in a concentration-dependent manner. The possible involvement of the parietal-cell peroxidase-H2O2 system in MMI-induced acid secretion may be suggested.

Nonsteroidal anti-inflammatory drugs inhibit gastric peroxidase activity

The peroxidase activity of the mitochondrial fraction of rat gastric mucosa was inhibited with various nonsteroidal anti-inflammatory drugs (NSAIDs) in vitro. Indomethacin was found to be more effective than phenylbutazone (PB) or acetylsalicylic acid (ASA). Mouse gastric peroxidase was also very sensitive to indomethacin inhibition. Indomethacin has no significant effect on submaxillary gland peroxidase activity of either of the species studied. Purified rat gastric peroxidase activity was inhibited 75% with 0.15 mM indomethacin showing half-maximal inhibition at 0.04 mM. The inhibition could be withdrawn by increasing the concentration of iodide but not by H2O2. NSAIDs inhibit gastric peroxidase activity more effectively at acid pH (pH 5.2) than at neutral pH. Spectral studies showed a bathochromic shift of the Soret band of the enzyme with indomethacin indicating its interaction at or near the heme part of the enzyme.

Histamine H2-receptor mediated stimulation of gastric acid secretion by mercaptomethylimidazole

Intraperitoneal administration of mercaptomethylimidazole (methimazole), a potent antithyroid drug belonging to the thionamide group, caused a significant increase in gastric secretion both in control and pylorus-ligated mice. The drug also induced significant stimulation of gastric acid and pepsinogen secretion in both the animal systems studied. The dose-response curve indicated a nearly 10-fold increase in acid output by injection of 0.55 mg mercaptomethylimidazole per 25 g body weight. The duration profile of the drug response at the dose mentioned showed acid secretion almost at a linear rate up to 2.5 hr, after which the response decreased to some extent. Of the other antithyroid drugs of the same family, only thiourea activated acid secretion but the response was much smaller than mercaptomethylimidazole. Histamine, one of the physiological secretagogues of gastric acid secretion, was found to be less active than mercaptomethylimidazole. Mercaptomethylimidazole-induced stimulation of acid secretion could be effectively blocked by prior administration of cimetidine and completely by omeprazole and not by atropine. Verapamil and nifedipine had also some inhibitory effect. These observations indicate that mercaptomethylimidazole stimulates HCl secretion through the involvement of H2-receptor and through the functioning of the H+-K+-ATPase of the parietal cells. The bulk movement of water during increased HCl secretion was partially sensitive to cimetidine and omeprazole and was also associated with an increased secretion of Na+ and K+ in the gastric juice. This indicates that mercaptomethylimidazole also induced water transport through a separate mechanism.

Membrane peroxidases

It is well known that the partial reduction of oxygen can result in the formation of highly reactive oxygen products. Hydrogen peroxide is one of these metabolites of oxygen. Peroxidases utilize this metabolite for a variety of functions. It is the purpose of this treatise to review the nature and function of various membrane peroxidases in the body.

Glucocorticoid-induced gastric mucosal damage: inhibition of leukotriene, but not prostaglandin biosynthesis

The effects of daily administration of ulcerogenic doses of the glucocorticoids, dexamethasone and prednisolone, on gastric prostaglandin and leukotriene synthesis were examined in the rat. Significant gastric damage was not observed until the fourth day of treatment with dexamethasone and until the sixth day of treatment with prednisolone. However, the onset of gastric damage was not accompanied by any significant effect of these drugs on gastric 6-keto prostaglandin Fl alpha synthesis. Conversely, both drugs caused a reduction in gastric leukotriene C4 synthesis, with dexamethasone producing a highly significant (p less than 0.001) effect. Furthermore, there was a highly significant (p less than 0.001) correlation between the ability of these drugs to inhibit gastric leukotriene C4 synthesis, and their ability to reduce gastric tissue levels of the neutrophilic enzyme myeloperoxidase. Thus, glucocorticoid-induced gastric damage does not appear to be related to inhibitory effects of these drugs on prostaglandin synthesis. Whether or not effects of these drugs on gastric leukotriene C4 synthesis and myeloperoxidase activity are relevant to the mechanism of ulceration is unclear.

Purification, characterization and origin of rat gastric peroxidase

A membrane-bound peroxidase (EC 1.11.1.7) from rat stomach has been solubilized by 0.2% cetyltrimethylammonium bromide in the presence of 1.2 M NH4Cl. The enzyme was purified 3355-fold to apparent homogeneity as judged by acid polyacrylamide gel electrophoresis and appears to be a cationic protein. In sodium dodecyl sulfate gel electrophoresis, the enzyme shows single polypeptide band of Mr 45,000. In gel permeation, the Mr has been estimated as 47,000. Spectral properties indicate the presence of Soret band at 412 nm which shifts to 425 nm on complexation with CN- and to 430 nm on reduction with dithionite. The velocity constant, k1 for the reaction of the peroxidase with H2O2 is 1.38 X 10(7) M-1 s-1 and Km for H2O2 is 0.1 mM. The enzyme contains active sulphydryl groups and is inhibited by sulphydryl reagents of which p-hydroxymercuribenzoate is more reactive than mersalyl or N-ethylmaleimide. The enzyme is very resistant to thermal denaturation up to 65 degrees C and also to chaotropic reagents at least up to 2 M above which it is inactivated. The enzyme shows similarity with the intestinal eosinophil peroxidase as regards the molecular mass, spectral, kinetic and some of the catalytic properties. However, they differ significantly in terms of their interaction with fluoride ion, sulphydryl reagents, chaotropic reagent and also with the antiserum against the gastric peroxidase. Histochemically, the gastric peroxidase is shown to be localised in the gastric gland proper of the fundic stomach, rich in parietal and chief cells.