Rapid quantitative determination of four anthracyclines and their main metabolites in human nucleated haematopoietic cells

Barminomycin functions as a potent pre-activated analogue of Adriamycin

The anthracycline Adriamycin is known to form adducts with DNA, but requires prior activation by formaldehyde. In contrast, the anthracycline barminomycin is also able to form adducts with DNA, but does not require activation by formaldehyde. Barminomycin, therefore, appears to function as a pre-activated form of Adriamycin. The DNA adducts formed by both anthracyclines are bound covalently to only one strand of DNA, but both also stabilise duplex DNA sufficiently that they can be detected as virtual interstrand crosslinks in heat denaturation electrophoretic crosslinking assays. The barminomycin-DNA adducts form extremely rapidly with DNA, and at exceedingly low concentrations (approximately 50-fold lower than with Adriamycin in the presence of excess formaldehyde), both characteristics consistent with barminomycin being in a pre-activated state, hence, undergoing a bimolecular reaction with DNA compared with the trimolecular reaction (drug, formaldehyde and DNA) required with Adriamycin. Surprisingly, barminomycin-DNA adducts are substantially more stable (essentially irreversible) than Adriamycin-DNA adducts (half life of approximately 25 h at 37 degrees C). Due to this understanding of the reactivity of barminomycin and its exceptional cytotoxicity (1000-fold more cytotoxic than Adriamycin), detailed structural studies of barminomycin-DNA adducts are now warranted, both in vitro and in tumour cells.

Interstrand cross-linking by adriamycin in nuclear and mitochondrial DNA of MCF-7 cells

Activation of Adriamycin by formaldehyde leads to the formation of drug-DNA adducts in vitro and these adducts stabilise the DNA to such a degree that they function as virtual interstrand cross-links. The formation of these virtual interstrand cross-links by Adriamycin was investigated in MCF-7 cells using a gene-specific interstrand cross-linking assay. Cross-linking was measured in both the nuclear-encoded DHFR gene and in mitochondrial DNA (mtDNA). Cross-link formation increased linearly with Adriamycin concentration following a 4 h exposure to the drug. The rate of formation of Adriamycin cross-links in each of the genomes was similar, reaching maximal levels of 0.55 and 0.4 cross-links/10 kb in the DHFR gene and mtDNA respectively, following exposure to 20 micro M Adriamycin for 8 h. The interstrand cross-link was short lived in both DNA compartments, with a half-life of 4.5 and 3.3 h in the DHFR gene and mtDNA respectively. The kinetics of total Adriamycin adduct formation, detected using [(14)C]Adriamycin, was similar to that of cross-link formation. Maximal adduct levels (30 lesions/10 kb) were observed following incubation at 20 micro M drug for 8 h. The formation of such high levels of adducts and cross-links could therefore be expected to contribute to the mechanism of action of Adriamycin.

Quantitation of cell-associated doxorubicin by high-performance liquid chromatography after enzymatic desequestration

A method for measuring cellular concentrations of the anthracycline doxorubicin was developed. The assay involves cell lysis and protein degradation by detergent and proteinase K treatment followed by DNA hydrolysis using DNase I. Prior to high-performance liquid chromatography, samples are deproteinized by the addition of ZnSO4 and methanol. The assay is linear with respect to both the cellular drug content and the number of cells assayed over the ranges tested, and drug recovery is close to 100%. The method has a limit of detection of 50 fmol injected doxorubicin. Within run and between-day coefficients of variation have consistently been found to be in the 5% and 10% range, respectively, in different cell lines exposed to doxorubicin in vitro. The method has been evaluated in analyses of doxorubicin levels in mononuclear blood cells of patients. The assay offers several advantages over commonly used organic extraction techniques and may improve cellular drug monitoring during anthracycline therapy in patients.

Modulation of multidrug-resistant multiple myeloma by cyclosporin. The Leukaemia Group of the EORTC and the HOVON

Resistance to chemotherapy in refractory multiple myeloma is frequently associated with expression of multidrug resistance (MDR). In resistant cells, intracellular accumulation of doxorubicin and vincristine does not occur because the MDR-1 gene product, a membrane glycoprotein (PgP), is an energy-dependent efflux pump. Cyclosporin is one of several non-cytotoxic drugs that can block the function of PgP. In a prospective study, we assessed the possibility that cyclosporin could be used clinically to modulate MDR. We studied 21 patients with multiple myeloma; disease had progressed during primary chemotherapy in 6 and was resistant to VAD (vincristine, doxorubicin, dexamethasone) in 15. The patients received cyclosporin by continuous infusion during VAD treatment; there were three cyclosporin dosage groups (5, 7.5, 10 mg/kg daily). Serum cyclosporin concentrations adequate for MDR modulation were reached in all patients receiving 7.5 or 10 mg/kg daily. 47% (7) of the VAD-refractory patients and 48% (10) of the whole group responded to VAD. Before treatment, MDR-1 expression was present in 12 patients. After VAD plus cyclosporin, no MDR-1-positive plasma cells were present in 6 of 8 patients tested. The response rate in MDR-1-positive patients was 58% compared with 33% in all our patients. Toxic effects were mild and reversible and did not include nephrotoxic or serious cardiovascular side-effects. 12 months after the start of treatment, survival was 85%, and disease-free survival at a median of 9 months after the response was 65%. Thus, in multiple myeloma clinical resistance to VAD can be circumvented by cyclosporin, which enables the cytotoxic drugs to eliminate resistant myeloma cells.

Reversal of typical multidrug resistance by cyclosporin and its non-immunosuppressive analogue SDZ PSC 833 in Chinese hamster ovary cells expressing themdr1 phenotype

The new non-immunosuppressive cyclosporin derivative SDZ PSC 833 (PSC) is a potent agent used to overcome typical multidrug resistance (MDR) associated with overexpression of the mdr1 gene encoding for a P-170 glycoprotein. In the present study, the efficacy of PSC as compared with cyclosporin was determined in Chinese hamster ovary cell lines exhibiting different levels of resistance to colchicine (0, 0.1, 0.2 and 10 micrograms/ml, respectively). Low concentrations of PSC (8.2 nM) increased the cytotoxicity of colchicine in cell lines expressing low levels of drug resistance. The concentration resulting in 50% cell survival (LC50 value) found for colchicine alone or in combination with PSC in the CHO-A3 cell line that was resistant to 100 ng colchicine/ml decreased from greater than 500 to 200 ng/ml at 8.2 nM PSC and to less than 100 ng/ml at 82 and 820 nM PSC. In the CHO-A3 cell line that was resistant to 200 ng colchicine/ml, the LC50 values decreased from greater than 500 ng/ml for colchicine alone to 500 ng/ml for colchicine used in combination with 8.2 nM PSC and to less than 100 ng/ml for colchicine combined with 82 or 820 nM PSC. At a concentration of 82 nM PSC, the maximal effect in MDR reversal was observed in the cell lines exhibiting moderate resistance. In the highly resistant cell line, PSC (820 nM) also reversed colchicine resistance. In drug-accumulation experiments, we obtained a 4-fold increase in intracellular doxorubicin accumulation using 820 nM PSC. A comparison of PSC with cyclosporin revealed that a cyclosporin concentration 20-fold that of PSC was required to obtain the same sensitising effect. On the basis of these data, it may be concluded that PSC is a most promising chemosensitiser.

Determination of adriamycin in plasma and tissue biopsies

A simple, rapid and sensitive method for the extraction and high-performance liquid chromatographic analysis of adriamycin in tissue and plasma is described. Tissue (5-100 mg) and plasma (1 ml) samples underwent a C18 Sep-Pak extraction into methanol. Chromatography was performed on a muBondapakphenyl column using a mobile phase of acetonitrile-0.1 M ammonium formate (pH 4.0) with a flow-rate of 2 ml/min. Fluorometric detection was used with an excitation of 480 nm and an emission of 550 nm. The procedure produced a linear curve for the concentration range 25-1000 ng/ml. The development of the assay produced rapid, repeatable and accurate results for both small tissue samples and plasma.

Effects of doxorubicin on maturation of human monocytes in adherent and non-adherent cultures

Purified human monocytes were cultured for 2 h, 88 h, and 10 days in plastic tubes (adherent) and for 10 days in Teflon foil bags (non-adherent). Monocytes were incubated with doxorubicin by two short-term exposures (750 or 1500 ng/ml) for 1 h or by continuous exposure (75 ng/ml). Maturation was monitored by measuring the intracellular activity of three metabolic enzymes and two acid hydrolases. Expression of receptors for the Fc moiety of immunoglobulin G (FcRI, FcRII, FcRIII), CD14, and HLA-DR was assayed by indirect immunofluorescence with monoclonal antibodies. In the presence of doxorubicin, the adherent capacity, the yield, and the enzyme activities reflecting growth and intermediary metabolism were similar to the control groups. However, doxorubicin reduced the expression of FcRI (32-45%), FcRII (10-26%), CD14 (20-37%), and HLA-DR (25-34%) on the monocyte-derived macrophages. Expression of FcRIII was not detectable after 10 days of culture.

In vivo cellular adriamycin concentrations related to growth inhibition of normal and leukemic human bone marrow cells

Inhibition of clonogenicity of normal and leukemic human hematopoietic progenitor cells was studied after in vivo and in vitro exposure of bone marrow to adriamycin (ADM). Flow cytometric determination of cellular ADM concentrations in blast cells, expressed in fluorescence units/cell (FU/cell), correlated well with the extent of cytotoxicity. After 2 h in vitro exposure to 500 ng ADM/ml, the ADM concentration of leukemic (n = 7) and normal (n = 4) bone marrow blast cells amounted to 231 +/- 180 and 249 +/- 53 FU/cell respectively, producing moderate decreases in clonogenicity by 44 +/- 30 and 54 +/- 27%. Exposure to 2000 ng/ml produced ADM concentrations of 1184 +/- 472 FU/cell for leukemic blast cells and 1024 +/- 281 FU/cell for normal blast cells. Inhibition of clonogenicity was 96 +/- 7% in leukemic blasts and 99 +/- 1% in normal blasts. In vivo ADM concentrations in leukemic blast cells at 1-2 h after administration were 216 +/- 98 FU/cell (n = 8 patients). This implies that inhibition of clonogenicity after administration of conventional dosages of ADM will be approx. 60-70% for both leukemic and normal bone marrow progenitor cells. Such values were noted in four patients of whom bone marrow was cultured, which was obtained shortly after ADM monotherapy.

New method for the determination of doxorubicin, 4'-epidoxorubicin and all known metabolites in cardiac tissue

4'-Epidoxorubicin, doxorubicin (internal standard) and eight metabolites were extracted from heart tissue homogenate by a mixture of tetrahydrofuran-water (1:2, v/v) and purified by C18 Sep-Pak cartridges. The buffer used to prepare the homogenate contained glucaric acid-1,4-lactone and glucose, to prevent decomposition of the 4'-epidoxorubicin glucuronides. Anthracyclines were separated by high-performance liquid chromatography within 14 min and detected by fluorescence. Recoveries ranged from 49 to 75%. The detection limits of the individual anthracyclines ranged from 0.5.10(-11) to 2.5.10(-11) mol/g wet weight. The peak-height ratios of the fluorescence intensities of the anthracyclines versus doxorubicin were linear from 2.5.10(-11) to 250.10(-11) mol/g wet weight. Within- and between-day precisions of the assay varied between the anthracyclines and were in the ranges 3-12% (n = 6) and 2-11% (n = 6), respectively.

High-performance liquid chromatographic bioanalysis of anthracycline cytostatic drugs

In the past decade high-performance liquid chromatography (HPLC) has developed into the most powerful tool available for the analysis of anthracycline antitumour drugs in all kinds of biological matrices. The results of drug level monitoring studies have contributed significantly to a better understanding of the pharmacokinetics and metabolic disposition of these drugs. Some aspects of anthracycline HPLC analysis in plasma samples are discussed, including the chromatographic separation and detection, sampling procedures, storage of plasma samples and sample pre-treatment.

Leukemic cell and plasma daunomycin concentrations after bolus injection and 72 h infusion

The effect of the duration of daunomycin (DNM) infusion on leukemic cell drug concentrations was evaluated. Cellular and plasma DNM concentrations were measured in 20 patients with acute non-lymphocytic leukemia. DNM 45 mg/m2 was administered either as a bolus injection or as a 4-, 8- or 72-h constant-rate infusion during 3 consecutive days. Peak plasma DNM levels amounted to 227 +/- 116 ng/ml after bolus injection and were only 16 +/- 6 ng/ml after 72-h DNM infusions. Terminal plasma DNM half-lives were 14 +/- 4 h. Peak leukemic cell DNM concentrations at the 3rd day of administration were 16810 +/- 2580 ng/10(9) cells (bolus injections) and 10310 +/- 5510 ng/10(9) cells (72-h infusions). The areas under the cellular curve were similar and independent of the duration of the DNM infusion. Peak leukemic cell daunomycinol (DNMol) concentrations were respectively 3500 +/- 1600 ng/10(9) cells and 2850 +/- 1720 ng/10(9) cells. Cellular DNM terminal half-life was 13 +/- 4 h. DNM concentrations in nucleated blood and bone marrow cells correlated well (r = 0.93, n = 26). Long-term infusion produced less severe side effects. Therapeutic efficacy was maintained during long-term infusion.

Cellular and plasma adriamycin concentrations in long-term infusion therapy of leukemia patients

To determine whether long-term adriamycin (ADM) infusions resulted in cellular ADM concentrations at least comparable to those observed after bolus injections, ADM cellular and plasma concentrations were measured in 18 patients with leukemia. ADM was administered at 30 mg/m2 per day for 3 days, either as bolus injections or as 4-, 8-, or 72-h infusions. Negligible accumulation of plasma ADM was observed. Peak plasma ADM concentrations after bolus injections were 1640 +/- 470 ng/ml (n = 7). Maximum levels were 176 +/- 34 ng/ml during 4-h infusion (n = 5); 85 +/- 50 ng/ml during 8-h infusion (n = 4); and 47 +/- 5 ng/ml (n = 2) after 72-h infusion. ADM concentrations in nucleated blood and bone marrow cells correlated well (r = 0.82, n = 47). ADM accumulated in leukemic cells up to 30-100 times the plasma concentrations. The shorter the administration time-span, the higher the peak leukemic cell concentration and the greater the loss of drug immediately after the end of the administration. The final cellular ADM half-life was approximately 85-110 h. After long-term infusion and bolus injection of the same dose, similar areas under the curve for plasma or leukemic blast cell ADM concentrations were attained. Since comparable therapeutic efficacy was observed in all regimens, the antileukemic effect appeared not to be related to the peak plasma concentrations, while acute toxicity phenomena decreased with increasing duration of the infusion. Long-term ADM infusion deserves more attention in the treatment of patients with anthracyclines.

Infusion-rate independent cellular adriamycin concentrations and cytotoxicity to human bone marrow clonogenic cells (CFU-GM)

The effect of adriamycin (ADM) infusion-rate on cellular ADM concentrations and on clonogenicity of human haematopoietic cells was studied in vivo and in vitro. In patients an ADM dose of 30 mg m-2 was administered as a bolus injection, or as a 4 h or a 24 h infusion. In vitro the effect of ADM on clonogenic cell growth was determined after exposure during 5 min, 2 h and 24 h of human bone marrow cells to increasing ADM concentrations. ADM showed rapid intracellular accumulation, to levels 100-fold the plasma concentration in vivo or the incubation medium concentration in the in vitro experiments. After a bolus injection or 5 min exposure only approximately 10% of the cellular peak ADM was retained after elimination of the drug from the plasma or the incubation medium. Ninety percent of the ADM was apparently 'loosely' bound. After 4 h and 24 h constant-rate infusions and also after 2 h and 24 h incubations in vitro, the cells accumulated ADM gradually, and the subsequent washing-out of the cellular ADM was substantially less, most of the ADM being 'tightly' bound. Despite these different patterns of uptake and retention after in vivo short- and long-lasting infusion of the same total dose, the 'tightly-bound' cellular ADM concentrations were the same. Moreover, comparable cellular ADM concentrations, retained after efflux of the 'loosely-bound' cellular ADM fraction were equally cytotoxic to normal human clonogenic cells. Short-lasting cellular peak ADM concentrations which occur after a bolus injection or after short exposure to high ADM concentrations are not essential for the cytotoxic effect, in contrast to the retained, 'tightly-bound' cellular ADM levels.