Measurement of clofibric acid (CPIB) metabolites in plasma of patients on clofibrate therapy

Carboxylic Acid Drug-Induced DNA Nicking in HEK293 Cells Expressing Human UDP-Glucuronosyltransferases: Role of Acyl Glucuronide Metabolites and Glycation Pathways

Glucuronidation of carboxylic-acid-containing drugs can yield reactive acyl (ester-linked) glucuronide metabolites that are able to modify endogenous macromolecules. Previous research has shown that several carboxylic acid drugs are genotoxic in isolated mouse hepatocytes, and that DNA damage is prevented by the glucuronidation inhibitor, borneol. Whether these species induce comparable genetic damage in human cells is unknown. In this study, we investigated the mechanisms of clofibric acid-induced genotoxicity in HEK293 cells expressing the human UDP-glucuronosyltransferases UGT1A3, UGT1A9, or UGT2B7, and screened three other carboxylic acid drugs for UGT-dependent genotoxicity. DNA damage was detected using the alkaline version of the comet assay. HEK293 cells were incubated for 18 h with vehicle (2.5 mM NaOH), 0.1-2.5 mM clofibric acid or 0.1-1.0 mM benoxaprofen, bezafibrate, or probenecid. To identify mechanisms underlying any observed genotoxicity, we treated UGT2B7 transfectants with 10 mM aminoguanidine, 1 mM borneol, or 2 mM desferrioxamine mesylate prior to co-incubation with 1 mM clofibric acid for 18 h. Compared to vehicle, clofibric acid, benoxaprofen, and probenecid produced significant DNA damage in all three UGT-transfected HEK293 cell lines, detectable from the lowest concentration tested. Bezafibrate caused DNA damage only at higher concentrations (1.0 mM) in UGT2B7- and UGT1A9-, but not UGT1A3-transfected cells. No drug-induced DNA damage was detected in untransfected cells, consistent with the limited glucuronidation capacity of these cells. The glycation/glycoxidation inhibitor aminoguanidine and the glucuronidation inhibitor borneol significantly decreased clofibric-acid-mediated DNA damage in UGT2B7 transfected cells by 73.5 and 94.8%, respectively. The inhibitor of transition-metal-catalyzed oxidation, desferrioxamine mesylate, had no significant effect on DNA damage. This study demonstrates the substrate-dependent role of human UGTs in the bioactivation of carboxylic acid drugs to genotoxic acyl glucuronide metabolites that are able to damage nuclear DNA via glycation and/or glycoxidation mechanisms.

Chromatographic fractionation and analysis by mass spectrometry of conjugated metabolites of bis(2-ethylhexyl)phthalate in urine

Mono(2-ethylhexyl)phthalate (MEHP), the primary metabolite of the plasticizer bis(2-ethylhexyl)phthalate (DEHP), was given to guinea pigs and mice and the methods for the isolation, separation and analysis of its metabolites in urine were developed. Following solid-phase extraction with octadecylsilane-bonded silica, individual metabolites were purified and separated using a combination of ion-exchange chromatography on lipophilic gels and reversed-phase high-performance liquid chromatography. Analysis of intact conjugates, as well as nonconjugated metabolites, was performed by fast atom bombardment mass spectrometry (FAB-MS) and, after derivatization, by gas chromatography-mass spectrometry. Enzymatic methods were used for further characterization. The study confirms glucuronidation as the major conjugation pathway for MEHP in the investigated species. Although less important quantitatively, glucosidation is shown to be an alternative conjugation pathway in mice. The methods developed were applied to a sample of urine from a hyperbilirubinemic newborn infant subjected to DEHP-exposure in conjunction with an exchange transfusion. It was demonstrated that metabolites of DEHP were excreted in amounts which could be analyzed by FAB-MS.

Clinical pharmacokinetic considerations in the elderly. An update

There are numerous studies of drug handling in the elderly, but it is difficult to assess the significance of changes seen in vitro, or after single-dose administration, because they are often compensated by other mechanisms at steady-state. However, a knowledge of these studies is important as the results alert the investigator to possible treatment problems. The high incidence of adverse drug reaction in the elderly population leaves no doubt that improvements in therapy are needed. Research has been directed at seeking patterns of abnormality in the elderly on which to base recommendations for alterations in dosage regimens. The major shortcoming of this approach has been the failure to distinguish between the effect of chronological age on drug pharmacokinetics, and drug kinetics in elderly people with multiple pathology. The latter concern appreciates the variety of factors involved and the importance of treating each patient as an individual: presentation of mean data is confusing and misleading. The objective of drug treatment in any age group, but particularly in the elderly, is to administer the smallest possible dose which gives adequate therapeutic benefit throughout the entire dosage interval with the minimum of side effects. For most drugs the safe starting dose in the elderly is one-third to half that recommended in the young. Vigilance for potential side effects with plasma concentration monitoring, if available, should help keep toxicity to a minimum. When other medications are added or changed, the possibility of interaction should be anticipated. Methods for individualisation of dosage regimens and the use of sustained-release formulations in the elderly are discussed. Dosage alteration in the elderly in terms of reduced dose frequency, rather than dose size, may help improve compliance. A knowledge of the pharmacokinetics of a drug helps determine which approach will be most beneficial.