Enzyme induction (second of three parts)

A prospective study of rectal methohexital: efficacy and side effects in 648 cases

Rectal methohexital has been used for nearly 30 yr in pediatric anesthesia. Despite this long and increasingly varied use, no large prospective series has been published detailing safety and efficacy. This study prospectively evaluated the efficacy, safety, and side effects of this medication in a series of 648 cases. On 553 of 648 occasions (85%), the child fell asleep after a single 30-mg/kg dose of 10% methohexital. Sleep was less likely in patients with myelomeningocele or who were receiving oral phenobarbital or phenytoin. When sleep occurred, the average time to onset of sleep was 6 min. Most patients who remained awake 15 min after drug were sedated. Defecation (10%) and hiccups (13%) were common but benign side effects. Partial airway obstruction and/or desaturation to Spo2 < or = 93% occurred in 26 patients (4%), but was resolved with blow-by oxygen and/or jaw-thrust in all but two cases. These two patients (0.3% of total) required aggressive airway intervention by the supervising anesthesiologist. Apnea did not occur in any patient. Methohexital has a high efficacy rate for sleep (85%) or sedation (96%), and has a relatively rapid onset. Significant respiratory side effects occur infrequently, but can be life threatening if not properly managed.

Kinetic models of induction: I. Persistence of the inducing substance

A kinetic model for induction is presented which includes the pharmacokinetics of the inducing agent. When simulations based on this model are carried out, they demonstrate situations where the observed rate constant governing the change from the basal to the induced state, or from the induced to the basal state, differs substantially from the true turnover rate constant. This arises from the confounding influences of the accumulation or persistence of either the inducing agent itself or some intermediary metabolic process. Depending on the relationships between the kinetic constants, there are four experimental subsets which require various interpretative schemes to obtain a correct estimate of the turnover rate constant. These interpretive schemes point out the necessity of measuring the pharmacokinetics of the inducer in all experiments.

The disposition of bupropion and its metabolites in healthy male volunteers after single and multiple doses

The pharmacokinetics of bupropion and 3 of its basic metabolites were determined in 8 young, healthy, male volunteers after single and multiple oral doses of bupropion. Plasma profiles were obtained: 1) after a single 100 mg oral dose of bupropion hydrochloride, 2) following administration of 100 mg 8-hourly for 14 days and 3) again after a single 100 mg dose 14 days later. Plasma concentrations of the parent drug and metabolites were determined by high-performance liquid chromatography. Saliva secretion and pupil diameters were measured, subjective assessments of sleep made using visual analogue scales and side effects, blood counts and biochemistry were monitored. After the first dose mean elimination half lives (t1/2) of bupropion, and metabolites I and II were 8, 19 and 19 h respectively. On repeated administration there was little accumulation of the parent drug and no evidence for induction of its own metabolism. Accumulation of I was consistent with its rate of elimination after single doses while that of II was greater than predicted with prolongation of t1/2 to 35 h. Metabolite III was barely detectable after single doses but its accumulation on multiple dosing was consistent with its long half life (35 h) determined on occasion 2. Saliva secretion was significantly reduced during the multiple dosing period but there were no complaints of dry mouth. Subjective assessments of sleep were not significantly altered though one subject reported vivid dreams. There were no other adverse reactions.

dCMP-aminohydrolase activity during early sea urchin development. An example of negative enzyme control during embryogenesis

In sea urchin, unfertilized eggs have a very high level of dCMP-aminohydrolase (dCMPase) activity, which decreases gradually and at the pluteus stage it is only about a quarter of that found in the unfertilized egg. But in abnormal embryos and in disaggregated cells from embryos, no decrease in the dCMPase activity takes place. To understand the control mechanism involved in this enzyme activity during development, we have analyzed the effect of various drugs which interfere with information transfer, such as actinomycin C, puromycin, 5-azacytidine, 2-thio-uracil and p-fluoro-DL-phenylalanine on dCMPase activity in embryos of Paracentrotus lividus and Sphaerechinus granularis. Among these drugs only actinomycin induces a remarkable increase of the dCMPase activity in embryos with respect to unfertilized eggs. Puromycin has a differential and dose-dependent effect. Other drugs, although they affect normal development and macromolecular synthesis, do not significantly alter the dCMPase activity. On the basis of these results we suggest the presence of a repressor mechanism in the control of dCMP-aminohydrolase level during early embryogenesis of sea urchin.

Tobacco smoking and drugs: a clinically important interaction?

Tobacco smoking may interact with the metabolism of a number of drugs. This has been demonstrated clearly in pharmacokinetic studies in animals and man. HOwever, tobacco smoking as a variant has been studied with relatively few clinically essential drugs and these studies do not always demonstrate a consistent effect of smoking. This review therefore not only records what data have emerged from pharmacokinetic or other studies, but it also attempts to determine whether such interactions have clinical significance. The main finding of this review is that, in the majority of examples, there is little evidence that there is a recognizable hazard from the interaction per se. The exceptions to this general conclusion are limited to four drugs: insulin, propoxyphene, propranolol, and theophylline preparations. With these drugs, there is some evidence of clinical importance of an interaction with tobacco smoking.

Comparative effects of insulin and hydrocortisone on glycogen content of fetal and newborn rat liver cultures

Organ cultures prepared from 18- to 19-day fetal and 3- to 6-day-old newborn rat liver were maintained for 2 days in Trowell's T8 medium without insulin and supplemented with 0.1% albumin and 300 mg% glucose. The atmosphere for culture was 95% O2 and 5% CO2. Medium alone was used for control cultures, whereas insulin, hydrocortisone, or insulin plus hydrocortisone were used in experimental groups. Explant glycogen stores were maintained better in cultures grown in hormone-supplemented media than in control cultures. Fetal explants were found to have higher levels of glycogen than controls in the insulin or insulin plus hydrocortisone groups. Postnatal explants did not have higher levels of glycogen in the hormone-treated groups. Gestational age appeared to determine whether the liver explants reacted to hydrocortisone or insulin to maintain glycogen stores. Enzymatic assays, in vitro of glycogen synthetase and phosphorylase, indicated that the fetal liver response to insulin plus hydrocortisone by increasing the total and independent form of glycogen synthetase; but similar enzyme studies on postnatal rat liver did not show convincing differences as to an effect on synthetase. No definite in vitro temporal relationships could be identified. Late in gestation, the effect of hydrocortisone on glycogen synthesis is apparently dependent on the presence of insulin. Insulin appears to be required for glycogen storage in vitro in the cultures of postnatal rat liver.

Enhancement of delayed hypersensitivity reaction with varieties of anti-cancer drugs. A common biological phenomenon

Delayed hypersensitivity reaction in mice was commonly enhanced with various anti-cancer agents administered as single or intermittent high doses but not consecutive divided doses. The effect of anti-cancer agents on the delayed hypersensitivity reaction was thought to be due to elimination of suppressor T cell activity.

Thyroid status in chronic alcoholics

Serum thyroxine (T4), triiodothyronine (T3) and thyrotrophin (TSH) were measured by radioimmunoassay in 39 chronic alcoholics on admission. Two patients had a reduced circulating serum T4 and eight showed a low serum T3 level but basal TSH was not raised in any of the 39 patients. Interestingly, low T4 and T3 levels returned to normal after abstinence and high protein and vitamin supplemented diet for one week. It is clear from our observations that a normo- or hypo- rather than a hypermetabolic or hyperthyroid state is more common in drinking chronic alcoholics. Ethanol-induced "low T3 syndrome" has also been described and a mechanism of its pathogenesis is suggested.

The effects of dexamethasone on metabolic activity of hepatocytes in primary monolayer culture

The effects of dexamethasone on multiple metabolic functions of adult rat hepatocytes in monolayer culture were studied. Adult rat liver parenchymal cells were isolated by collagenase perfusion and cultured as a primary monolayer in HI/WO/BA, a serum free, completely defined, synthetic culture medium. Cells inoculated into the culture medium formed a monolayer within 24 hr. Electron microscopy showed that the cells in primary culture had a fine structure identical to liver parenchymal cells in vivo, including the observation of desmosomes and bile canaliculi in intercellular space. There was significant gluconeogenesis by the cells 24 hr postinoculation but it had decreased markedly by 48 hr. There was a marked induction of tyrosine aminotransferase (TAT) by dexamethasone, which was maintained for up to 72 hr postinoculation of cells. The transport of alpha-aminoisobutyric acid into the cells in monolayer culture was stimulated by dexamethasone and was dependent on the concentration of dexamethasone. Albumin synthesis and secretion by the cells was measured by a quantitative electroimmunoassay. Albumin production was shown to increase linearly over an incubation period of 24 to 48 hr postinoculation. Dexamethasone depressed the albumin synthesis. The effects of dexamethasone are slow, and at times require more than 6 hr to show variation from the control, indicating that dexamethasone is not a single controlling hormone. Possibly it functions in a cooperative and coordinating role in the regulation of cell metabolism.

[Increased demethylation of aminopyrine under long-term treatment with anticonvulsive drugs (author's transl)]

Demethylation of aminopyrine was measured in 25 healthy controls and 19 epileptics on long-term treatment with anticonvulsants by the 14C-aminopyrine breath test. Compared to controls epileptics exhibited increased cumulative 14CO2-exhalation rates (88.7% at 30 min, 62.6% at 2 h and 24.8% at 8h) following ingestion of 2 mu Ci 14C-aminopyrine. The results suggest that long-term treatment with antiepileptic drugs results in increased demethylating function of the liver which can be easily detected by a simple breath analysis technique like decreased demethylation in chronic liver disease.

Intestinal calcium absorption in exogenous hypercortisonism. Role of 25-hydroxyvitamin D and corticosteroid dose

Pharmacologic doses of corticosteroids impair intestinal calcium absorption and contribute to negative calcium balance. However, the relationship between the impaired calcium absorption and a possible defect in the conversion of vitamin D to its physiologically active form, 1,25-dihydroxyvitamin D, is unknown. We compared fractional calcium absorption (double-isotope method, 100-mg carrier) and serum 25-hydroxyvitamin D (25-OH-D) (Haddad method) in 27 patients receiving pharmacologic doses of prednisone with 27 age-, sex-, and season-matched normal subjects. In patients receiving high daily doses of prednisone (15-100 mg/day), calcium absorption (P < 0.02) and serum 25-OH-D (P < 0.001) were decreased. However, in patients receiving low doses (8-10 mg/day) or high doses (30-100 mg) of prednisone on an alternate-day schedule, both of these parameters were normal. Calcium absorption in the patients treated with daily prednisone correlated inversely with the dose of corticosteroids (r = -0.52, P < 0.025) and, in all steroid-treated patients, correlated directly with serum 25-OH-D (r = 0.58, P < 0.01). In four patients who received high-dose corticosteroid therapy for an average of 4 wk, serum 25-OH-D decreased by 35.5% from pretreatment values. Administration of a physiologic or near-physiologic dose of synthetic 1,25-dihydroxyvitamin D(3) (0.4 mug daily for 7 days) to patients receiving high-dose corticosteroids led to an increase in calcium absorption in all patients. These results suggest that calcium malabsorption in the corticosteroid-treated patients is due to a dose-related abnormality of vitamin D metabolism and not to a direct effect of corticosteroids on depressing transmucosal intestinal absorption of calcium.

The scientific foundations of clinical enzymology

Clinical enzymology is the study of the activity and properties of enzymes in specimens (usually of blood) taken from patients, as an aid to the diagnosis and understanding of disease. Research in many areas of enzymology is undertaken to strengthen the foundations on which the clinical interpretation of such enzyme measurements rests. Some aspects of this research are briefly described.