Intracellular metabolism of 3'-azido-3'-deoxythymidine (AZT): a nuclear magnetic resonance study on T-lymphoblastoid cell lines with different resistance to AZT

Pattern expression of glycan residues in AZT-treated K562 cells analyzed by lectin cytochemistry

The present paper shows that human chronic myeloid (K562) cells exposed 3 h to 20 microM 3'-azido-3'-deoxythymidine (AZT) exhibit marked variations of the oligosaccharide moiety of glycoconjugates. These changes were analyzed by confocal fluorescence microscopy, upon incubation of control and AZT-treated cells with biotin-lectin conjugates to visualize cell surface glycans or total glycans after cells permeabilization. In addition, cell fluorescence distribution of the biotinylated lectins, localized with streptavidin conjugates labeled with Alexa Fluor 488, was analyzed by flow cytometry. The results obtained show significant variations on the expression/distribution of membrane surface glycans as detected by both WGA and SNA, two lectins that recognize primarily cellular internal membrane glycolipids. A further interesting result was the significant increase of N-acetylglucosamine linked glycans localized either at the cell surface or intracellularly but only in K562 cells exposed to AZT. On the whole, our data demonstrate that AZT alters both lipid and N-linked glycosylations thus confirming previous observations, from our laboratory and from other Authors, that the drug impair the nucleotide-sugar import in the Golgi's lumen. AZT does also alter the O-linked glycosylations that occur in the Golgi complex since these reactions require the incorporation of sialic acid, GlcNAc and GalNAc all of which are sensitive to the drug.

Zidovudine inhibits protein kinase C activity in human chronic myeloid (K562) cells

In this paper we show that human erythroleukaemia (K562) cells exhibited a significant inhibition of protein kinase C activity when cells were exposed to 40 micro M zidovudine in a time interval of 5-180 min., whereas prolonged treatment (24 hr) was uneffective. The addition of an excess of thymidine (125:1, mol:mol), in the cell suspension with or without zidovudine fully restored the protein kinase C activity. Interestingly, either in cell homogenates and in commercially purified rat brain protein kinase C, both zidovudine and its monophosphate derivative, caused inhibition that was higher than in intact cells. This inhibition reached a maximal value of 45% when zidovudine or zidovudine monophosphate were incubated with the pure commercial enzyme and in this case the addition of thymidine did not prevent the enzyme inhibition. The conclusions from these data are that either zidovudine or zidovudine monophosphate interact directly with the pure enzyme, causing inhibition, while in intact cells exposed to the drug, zidovudine monophosphate appears to be the main metabolite responsible for protein kinase C inhibition.

A computational model of mitochondrial AZT metabolism

The mechanisms of the mitochondrial toxicity of AZT (azidothymidine; zidovudine) are not clear. The two main contenders are the incorporation of phosphorylated AZT into the mtDNA (mitochondrial DNA) and the competitive inhibition of natural deoxynucleotide metabolism. We have built a computational model of AZT metabolism in mitochondria in order to better understand these toxicity mechanisms. The model includes the transport of non-phosphorylated and phosphorylated forms of AZT into mitochondria, phosphorylation, and incorporation into mtDNA. The model also includes the mitochondrial metabolism of the natural deoxynucleotides. We define three simulated cell types, i.e. rapidly dividing, slowly dividing and postmitotic cells. Our standard simulation indicates that incorporation of AZT into mtDNA is highest in rapidly dividing cells because of the higher mitochondrial AZTTP (3'-azidothymidine-5'-triphosphate)/dTTP ratio in this cell type. However, under these standard conditions the rate of incorporation into mtDNA is too low to be a major cause of toxicity. These simulations relied on the assumption that phosphorylated AZT is transported with the same kinetics as phosphorylated thymidine. In simulations with mitochondria set to have a limited ability to transport phosphorylated AZT, AZTTP accumulates to toxic levels in the mitochondria of postmitotic cells, while low levels are maintained in mitochondria from rapidly dividing cells. This result is more consistent with the tissue toxicities observed in patients. Our model also predicts that inhibition by AZT of mitochondrial deoxycytidine phosphorylation by thymidine kinase 2 may contribute to the mitochondrial toxicity, since in simulations using a typical peak plasma AZT level the mtDNA replication rate is decreased by 30% in postmitotic cell simulations.

Monitoring the intracellular metabolism of nucleoside phosphoramidate pronucleotides by 31P NMR

The intracellular metabolism of 3'-azido-3'-deoxythymidine (AZT)-(L)-tryptophan methyl ester phosphoramidate (L-ATO) and AZT-(L)-phenylalanine methyl ester phosphoramidate (L-APO) by the human T-lymphoblastoid cell line CCRF-CEM (CEM-1.3) and peripheral blood mononuclear cell line (PBMC) was investigated with high field 31P NMR spectroscopy. The AZT amino acid phosphoramidates were shown to accumulate intracellularly and to be readily converted into AZT-MP by both tissues types. Thus, the efficient delivery of nucleoside monophosphates to cells can be facilitated by nucleoside phosphoramidate pronucleotides.

Protein glycans alteration and a different distribution of some enzymatic activities involved in the glycan processing are found in AZT-treated K562 cells

In this paper we report that 3'-azido-3'-deoxythymidine (AZT) treatment of human erythroleukemia (K562) cells greatly alters the pattern of protein glycans and significantly modifies beta,(1 --> 4)galactosyltransferase, beta-galactosidase, and alpha,(2 --> 8)sialyltransferase activities. In particular, AZT-treated K562 cells exhibited a decreased incorporation of sialic acid (86% of control) into protein glycans, being the reduced alpha,(2 --> 6) incorporation almost of the same magnitude with respect to that of alpha,(2 --> 3) (93 and 90% of control, respectively). Moreover, the drug exposure of cells induced a decrease of both mannose terminally linked and galactose linked as beta,(1 --> 4) (90 and 92% of control, respectively) and a significant increase of galactose beta,(1 --> 3) (112% of control). In addition, beta,(1 --> 4)galactosyltransferase and beta-galactosidase activities were found enhanced in K562-treated cells (30 and 12%, respectively), while alpha,(2-8 )sialyltransferase activity decreased (75% of control). Sialyltransferase activities of other types i.e. 30, 60, 3 N, 6 N, did not show any appreciable differences irrespective of AZT-treatment. Besides previous studies which report that AZT exposure of K562 cells, indirectly prevents nucleotide-sugar import into the Golgi complex, with consequent inhibition of glycosylation, our observations show for the first time that AZT affects several enzymatic activities involved in specific glycosylation reactions leading, in turn, to protein glycans alteration.

Azidothymidine promotes free radical generation by activated macrophages and hydrogen peroxide-iron-mediated oxidation in a cell-free system

Azidothymidine (AZT) and AZT monophosphate (AZT-MP) in concentrations as low as 10 and 50 microM, respectively, promote oxidation of chemically deacetylated 2',7'-dichlorodihydrofluorescein (DCDHF) to 2',7'-dichlorofluorescein (DCF) by rat peritoneal macrophages activated with latex. Cells were incubated with AZT and AZT-MP for 18 h, washed out from residual AZT or AZT-MP and activated with latex for 30 or 60 min in the presence of DCDHF. Latex-activated cells oxidize DCDHF extracellularly due to release of hydrogen peroxide and low-molecular iron complexes, which is verified using catalase, desferal and the peroxidase inhibitor sodium azide. AZT and AZT-MP increase DCDHF oxidation due to additional release of hydrogen peroxide as demonstrated by catalase inhibition of DCDHF oxidation and direct H(2)O(2) measurement. Thymidine and thymidine phosphates did not show any effect on macrophage activation. In separate experiments we evaluated the in vitro prooxidant activity of AZT, AZT-MP, AZT triphosphate (AZT-TP), AZT glucuronide (GAZT) and 3'-amino-3'-deoxythymidine (AMT) in a cell-free system using the hydrogen peroxide-iron-mediated oxidation of DCDHF. Under these conditions, AZT and AZT phosphates exhibit a prooxidant effect in concentrations as low as 100 microM. Furthermore, GAZT is a less effective prooxidant and AMT acts like an antioxidant. Thymidine did not show any effect.

Phosphorylation of nucleoside analog antiretrovirals: a review for clinicians

Nucleoside analogs (zidovudine, didanosine, zalcitabine, stavudine, abacavir, lamivudine) have been administered as antiretroviral agents for more than a decade. They undergo anabolic phosphorylation by intracellular kinases to form triphosphates, which inhibit human immunodeficiency virus replication by competitively inhibiting viral reverse transcriptase. Numerous methods are used to elucidate the intracellular metabolic pathways of these agents. Intracellular and extracellular factors affect intracellular phosphorylation. Lack of standardization and complexity of methods used to study phosphorylation in patients limit interpretation of study results and comparability of findings across studies. However, in vitro and in vivo studies give important insights into mechanisms of action, metabolic feedback mechanisms, antiviral effects, and mechanisms of toxicity, and have influenced dosing regimens of nucleoside analogs.

Evidences that zidovudine (AZT) could not be directly responsible for iron overload in AZT-treated patients: an in vitro study

Zidovudine (3'-azido-3'-deoxythymidine or azidothymidine, AZT) has been the first antiretroviral agent approved for clinical use, and it is still currently used in combination therapy of human immunodeficency virus (HIV) infection. On the basis of increasing clinical reports and in vitro studies, a strict correlation between AZT treatment of HIV positive patients and both the development of anemia and iron overload have been in evidence over the last few years. In this report, we have examined some features of zidovudine to better assess a likely implication of this drug in iron overload. For this purpose, we first determinated the iron chelating ability of both AZT and some of its phosphorylated derivatives in solution. The iron chelating ability of AZT toward the intracellular 'chelatable' iron pool was also evaluated. Finally, we investigated the effect of AZT on both iron and transferrin uptake. Our findings indicate that AZT per se cannot be directly responsible for the development of the iron overload found in human or animal models, for which other possible mechanisms are claimed to be involved.

LC determination of indinavir in biological matrices with electrochemical detection

A high performance liquid chromatographic (HPLC) method with electrochemical detection for the quantification of Indinavir in cell culture is described. The sample pre-treatment involved a protein precipitation procedure using acetonitrile. Chromatography was carried out on a base-deactivated reversed-phase column with an isocratic mobile phase. The method was validated with regard to specificity, linearity, limits of detection and quantitation, precision and accuracy, recovery and ruggedness. The proposed HPLC assay was utilised to directly evaluate the capability of P-glycoprotein expressing multidrug resistant cells in mediating the transport and efflux of protease inhibitor (PI) Indinavir, a basic compound in AIDS care.

Transport, metabolism and elimination mechanisms of anti-HIV agents

Currently available anti-HIV drugs can be classified into three categories: nucleoside analogue reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, and protease inhibitors. Knowledge of these anti-HIV drugs in various physiological or pharmacokinetic compartments is essential for design and development of drug delivery systems for the treatment of HIV infection. The input and output of anti-HIV drugs in the biological systems are described by their transport and metabolism/elimination in this review. Transport mechanisms of anti-HIV agents across various biological barriers, i.e., gastrointestinal wall, skin, mucosa, blood cerebrospinal barrier, blood-brain barrier, placenta, and cellular membranes, are discussed. Their fates during and after systemic absorption and their metabolism-related drug interactions are reviewed. Many anti-HIV drugs presently marketed in the US bear some significant drawbacks such as relatively short half-life, low bioavailability, poor penetration into the central nervous system, and undesirable side effects. Efforts have been made to design drug delivery systems for the anti-HIV agents to: (1) reduce the dosing frequency; (2) increase the bioavailability and decrease the degradation/metabolism in the gastrointestinal tract; (3) improve the CNS penetration and inhibit the CNS efflux; and (4) deliver them to target cells selectively with minimal side effects. We hope to stimulate further interests in the area of controlled delivery of anti-HIV agents by providing current status of transport and metabolism/elimination of these agents.