Ocular effects of adrenergic stereoisomers in the rabbit

Chirality in ocular agents

PURPOSE OF REVIEW

To review the role of chirality in current ocular pharmacology. The importance of stereo-isomeric purity has frequently been emphasized in recent years. Development of chirally pure medications can lead to improved efficacy and side-effect profiles. Practitioners prescribing ocular agents may benefit from understanding the effects of chirality in their evaluation of old and new medications.

RECENT FINDINGS

Chirality can affect multiple classes of ocular agents. Although the ways in which stereo-isomers influence the properties of a drug differ, this review illustrates the benefit of knowledge of individual isomers' effects in clinical decision making. The variety of possible effects stereo-isomers produce further underlines the importance of purification and in-depth analysis of chiral compounds.

SUMMARY

Many important agents exist as a mixture of two different stereoisomers. Both isomers may produce a pharmacological effect; however, these effects may be different from one another and one isomer may even give a result opposite from the desired pharmacological effect. Here we examine published findings on ocular medications relating to their chiral nature and summarize the possible ways chirality affects the activity of a few ocular agents. Many more ocular medications have not been investigated to ascertain their chiral properties. This review adds to the recent emphasis on investigating stereo-isomers for individual selectivity of beneficial and adverse profiles.

Ocular effects of dipivalyl esters of epinephrine and alpha-methylepinephrine

The intraocular pressure (IOP) and pupillary effects of dipivalyl esters of epinephrine and alpha-methylepinephrine were compared after topical application in conscious rabbits. Both dipivalyl-alpha-methylepinephrine (DP alpha meE) and dipivalylepinephrine (DPE) produced a dose-dependent pupillary dilation (PD) and decrease in IOP. The onset of PD was approximately 30 min for both agents and reached maximal plateau within 1 and 2 hr for DPE and DP alpha meE, respectively. Duration of mydriatic effect was also dose-related, although more prolonged with DP alpha meE. This probably reflects differences in rate of inactivation of these compounds. The onset of IOP lowering effect of DP alpha meE was more rapid (35-45 min) when compared with DPE (1.5-2 hr) which may be due to the initial ocular hypertensive response seen with DPE. The initial rise in IOP was prevented by transection of three rectus muscles. DP alpha meE produced initial ocular hypertension only at the highest doses. The decrease of IOP lasted more than 6 hr for both drugs, returning to normal by 24 hr. No pupillary or IOP effects were seen in the contralateral eye. Denervation supersensitivity to both the pupillary and IOP responses to DP alpha meE was seen after superior cervical ganglionectomy. These findings are consistent with the hypothesis that the pupillary and IOP responses to DP alpha meE do not require intact adrenergic innervation to the eye, and that these effects are mediated by activation of postjunctional alpha-adrenoceptors. It is concluded that DP alpha meE is a potent adrenergic ocular hypotensive agent.(ABSTRACT TRUNCATED AT 250 WORDS)

Inhibition of a peripheral sympathetic-cholinergic system by presynaptic alpha 2-adrenoceptors

Intravenous administration of catecholamines produced dose-related inhibition of electrodermal responses (EDRs) evoked by electrical stimulation of the post-ganglionic sciatic nerve in anaesthetized rats, with relative potencies being (-)-adrenaline greater than (+/-)-adrenaline greater than (-)-noradrenaline = (+)-adrenaline. The suppression of EDRs by (+/-)-adrenaline and (-)-noradrenaline was blocked by pretreatment with yohimbine (0.75 mg/kg i.v.) but not by prazosin (0.3 mg/kg i.v.). The selective alpha 2-adrenoceptor agonist B-HT 920 also inhibited neurally evoked skin potential responses. This effect of B-HT 920 was antagonized by the selective alpha 2-adrenoceptor antagonist idazoxan (0.1 mg/kg i.v.) but was insensitive to prazosin. Idazoxan was more potent than yohimbine in blocking (+/-)-adrenaline-induced suppression of EDRs. Methacholine administered into the femoral artery evoked EDRs by an atropine-sensitive mechanism. Methacholine-induced EDRs were not suppressed by intravenous administration of (-)-adrenaline (1 microgram/kg or 3 micrograms/kg) whereas EDRs evoked by the sciatic nerve stimulation on the other hindpaw were inhibited. Increase in the endogenous catecholamines by asphyxia strongly inhibited EDRs by a mechanism which was also sensitive to yohimbine but not to prazosin. These results suggest that peripheral presynaptic alpha 2-adrenergic mechanisms are involved in inhibition of transmitter release in this sympathetic-cholinergic system.

Alpha-2 adrenergic modulation of norepinephrine secretion in the perfused rabbit iris-ciliary body

Clonidine and other selective alpha-2 adrenergic agonists have been found to lower intraocular pressure in the eyes of rabbits and primates, including humans. It has been suggested that the ocular hypotensive response to alpha-2 agonists may be mediated, in part, by prejunctional inhibition of norepinephrine secretion at intraocular synapses. In this study, we have investigated the effects of adrenergic agonists and antagonists on field-stimulated, Ca++-dependent release of 3H-norepinephrine (3H-NE) from isolated, perfused rabbit iris-ciliary bodies and have utilized radioligand binding methods to identify prejunctional adrenoceptors in this tissue. Clonidine (10(-9)-10(-5) M) produced a dosage-dependent inhibition of stimulation-evoked 3H-NE secretion (EC50 approximately equal to 3 X 10(-8) M), but did not alter basal secretion. Other adrenergic agonists capable of activating alpha-2 adrenoceptors (e.g., epinephrine, norepinephrine and xylazine) also significantly depressed 3H-NE secretion, whereas selective alpha-1 adrenergic or beta adrenergic agonists were without effect. Clonidine-mediated inhibition of 3H-NE release was reversed by the selective alpha-2 antagonist yohimbine (10(-7) M), but was unaffected by prazosin or timolol. Yohimbine alone markedly enhanced 3H-NE secretion, indicating tonic activation of prejunctional alpha-2 adrenoceptors by endogenous released norepinephrine. Forskolin or 8-bromo-cAMP, which alone enhanced norepinephrine secretion, failed to attenuate the inhibitory responses to alpha-2 agonists. 3H-rauwolscine binding measurements showed a small decrease in alpha-2 receptor sites in iris-ciliary body membranes following surgical sympathetic denervation. It is concluded that the rabbit iris-ciliary body contains functional, prejunctional alpha-2 adrenoceptors which may play an autoregulatory role in vivo and contribute to the ocular effects of adrenergic drugs.

Intraocular pressure and aqueous humor dynamics in rabbit and primate with d- and 1-adrenergic compounds

The effects of the d- and 1-isomers of epinephrine and norepinephrine have been determined on intraocular pressure (IOP) in conscious rabbits and rhesus monkeys, and on aqueous humor turnover rate (AHTR) in rabbits. Relatively specific beta-adrenergic antagonists (butoxamine and metoprolol) were used to attempt to modify the responses. The effects on IOP in both species are similar to those of racemic mixtures. The d- and 1-isomers of norepinephrine and epinephrine reduced IOP, and reduced AHTR in rabbits. The d- and 1-isomers of norepinephrine had little effect on IOP in monkeys while d- and 1-epinephrine increased IOP. Metoprolol, a beta 1-antagonist was more effective than butoxamine (beta 2-antagonist) at modifying the effect of the norepinephrine isomers in rabbits.