Effect of phenytoin on antibody production: use of a murine model

The psychomotor effects of carbamazepine in epileptic patients and healthy volunteers

The effect of straight release carbamazepine monotherapy was studied in 12 well-controlled epileptic patients using adaptive tracking, smooth pursuit and saccadic eye movements, body sway, Digit Symbol Substitution Test (DSST) and Visual Analogue Scales. Patients were matched to healthy controls for age and gender. After patients had received their usual morning dose of carbamazepine, patient-control pairs were studied for 7 h. Compared to controls, the average DSST scores of patients were significant lower. No relationships were shown between DSST performance and plasma concentrations of carbamazepine and carbamazepine-epoxide. No significant differences were found for any of the other effect parameters. Variations in plasma concentrations were limited, contributing to the absence of systematic fluctuations in test results. Of the used tests, DSST is most clearly related to cognitive function. It is concluded that the difference in DSST performance appears to reflect a long-term small neurocognitive difference between subjects with and without epilepsy.

Phenytoin promotes Th2 type immune response in mice

The effects of chronic administration of phenytoin, a common anticonvulsive drug, on immune responses were studied in mice. Anti-keyhole limpet haemocyanin (KLH) IgE antibody response after KLH-immunization was enhanced in phenytoin-treated mice. Proliferative responses of spleen cells induced with KLH, concanavalin A (ConA), lipopolysaccharide and anti-CD3 antibody were reduced in phenytoin-treated mice. Accessory function of spleen adherent cells on ConA-induced T cell proliferative response was reduced in phenytoin-treated mice. KLH-induced IL-4 production of spleen cells was enhanced, while IFN-gamma production was reduced in phenytoin-treated mice. In addition, production of IL-1 alpha, but not IL-6 and IL-12 by spleen adherent cells from phenytoin-treated mice was reduced. Natural killer cell activity was reduced in phenytoin-treated mice. These results suggest that phenytoin treatment preferentially induces a Th2 type response. We also observed that plasma ACTH and corticosterone levels were increased in phenytoin-treated mice, and speculated that phenytoin might act directly and indirectly, through HPA axis activation, on the immune system to modulate Th1/Th2 balance.

Long-term treatment with 5,5-diphenylhydantoin reduces lymphadenopathy and anti-ssDNA autoantibodies in C57BL/6-lpr/lpr mice

To further the insight in the immunomodulating properties of the anticonvulsant 5,5-diphenylhydantoin (DPH), C57BL/6 (B6), C57BL/6-lpr/lpr (B6-lpr/lpr) and MRL/MpJ- +/+ (MRL) mice received DPH orally for six months to determine weekly urinary biopterin levels, a potential T-cell activation marker, by high performance liquid chromatography. At the end of the experiment serum antibody levels were measured by ELISA and relative lymphoid organ weights determined. DPH treatment resulted in reduced body weight in all strains, reduced spleen weights in B6 and MRL mice, profoundly reduced popliteal lymph node weights in B6-lpr/lpr mice and increased thymus weights in MRL mice. DPH treatment decreased serum IgM, IgG and IgA as well as IgM and IgG anti-ssDNA levels in B6-lpr/lpr mice, but did not affect these parameters in other strains. Effects of DPH on IgM rheumatoid factor levels in B6-lpr/lpr mice were inconsistent. Urinary biopterin levels of untreated B6 and B6-lpr/lpr mice were about equal and lower than those of MRL mice. During the first three months of DPH treatment, persistently elevated biopterin levels were observed in B6 and to a lesser degree in MRL mice, and alternately elevated and control levels in B6-lpr/lpr mice. Thereafter, the effects faded in all strains. Results show that long-term DPH treatment causes only minor lymphoid organ weight changes in B6 and MRL mice, but causes a clear reduction of the lymphadenopathy and (auto)antibody formation in B6-lpr/lpr mice. Observed changes could not be related to altered biopterin excretion indicating that the latter is an inappropriate marker of murine autoimmune disease.

Effects of phenytoin administration on murine immune function

The results obtained in these series of experiments indicate that oral administration of phenytoin (100, 50, or 25 mg/kg) to mice significantly depressed both humoral and cellular immune responses, evaluated by the techniques of enumeration of direct and indirect spleen plaque-forming cells (PFC) and the delayed-type hypersensitivity reaction (DTH) against sheep red blood cells (SR BC), when compared with those observed in normal control animals. Furthermore, spleen cells, purified splenic T lymphocytes or Ly 2 + T cells obtained from 100 mg/kg phenytoin-treated donor mice were capable of diminishing both PFC and DTH responses of normal cells transferred into lethally irradiated mice. The immunodepressor effect of phenytoin was observed despite the fact that administration of this drug induced a rise in spleen cellularity.

Effects of carbamazepine on murine humoral and cellular immune responses

Oral administration of carbamazepine (CBZ) (15, 10, or 5 mg/kg) to mice significantly decreased both humoral and cellular immune responses evaluated by enumeration of direct and indirect plaque-forming spleen cells (PFC) and delayed-type hypersensitivity reaction (DTH) against sheep red blood cells (SRBC) as compared with those observed in normal control animals. Moreover, spleen T cells obtained from CBZ-treated donor mice were capable of decreasing both PFC and DTH responses of normal spleen cells transferred into lethally irradiated recipient animals. The immunodepressor effect of CBZ was observed even though administration of CBZ induced augmentation of spleen cellularity.

Effect of antiepileptic drugs on growth of murine lymphoid tumor cells in single-cell culture

The effect of three commonly used antiepileptic drugs (AEDs), phenytoin (PHT), carbamazepine (CBZ), and valproate (VPA), on the growth of lymphoid tumor cells was assessed in vitro. A single-cell culture method was used to determine growth rates by direct visualization. The amount of free drug was determined by ultrafiltration to ascertain its correlation to therapeutic drug levels. VPA slowed the growth of B-myeloma (FO) and T-lymphoma (AKR-1) cells significantly within the range of therapeutic drug levels. CBZ and PHT likewise inhibited cell growth in both lineages but at two to four times the therapeutic level of free drug. CBZ was shown to have long-term effects on FO and AKR-1 cells, demonstrated by the reduced growth rates of cloned lines for 2-3 months after drug removal. Cloned sublines of myeloma cells secreting lambda light chain (J558L) treated with CBZ or PHT had a higher frequency of lambda light chain secretion loss mutations than the nontreated parent line.

Segregation of the growth slowing effects of valproic acid from phenytoin and carbamazepine on lymphoid tumor cells

One human and six murine tumor cell lines of lymphoid origin were assessed for growth in the presence of three commonly used antiepileptic drugs (AEDs). All seven lines were sensitive to the growth slowing effects of phenytoin (PHT) and carbamazepine (CBZ). Six lines showed a similar effect when exposed to valproic acid (VPA), while one murine B cell line was resistant to inhibition of growth by VPA.

Toxic effects of antiepileptic drugs on immunoglobulin gene expression

Murine myeloma cells were exposed to toxic, growth-retarding levels of two antiepileptic drugs (AEDs2), phenytoin (PHT) and carbamazepine (CBZ). J558L cells were treated for 12 days, washed free of drug and, upon recovery of growth, cloned to determine the frequency of lambda light chain secreting lines. Our results indicate that short-term exposure to high, toxic levels (5-10 times the therapeutic dose) of PHT and CBZ reduces or eliminates lambda light chain secretion at a high frequency. Furthermore, although most cloned lines tested positive for cytoplasmic lambda light chain, some lines had no detectable cytoplasmic immunoglobulin (Ig). The data are consistent with the hypothesis that long-term changes in fully differentiated B cell function may occur after toxic level AED exposure.

Urinary biopterin levels in mice during graft-versus-host reactions and during exposure to 5,5-diphenylhydantoin

Based on evidence that urinary neopterin levels are useful markers of disordered cellular immunity in man, we investigated murine urinary biopterin excretion during acute and chronic graft-versus-host (GvH)-reactions as well as after oral exposure to drugs with documented immune disregulating potential in man. Biopterin levels were determined in urine spot samples by reversed-phase high performance liquid chromatography and expressed in relation to the urinary creatinine content. Similarly increased and decreased biopterin levels were observed during acute and chronic GvH-disease in (C57BL/6J x DBA/2J)F1 (B6D2F1) mice. Increased and/or decreased levels of urinary biopterin were observed during treatment with 5,5-diphenylhydantoin (DPH), methimazole, propylthiouracil and nitrofurantoin, but no consistent pattern could be distinguished. The DPH-induced alterations were similar in B6 and B6D2F1 mice, were dose-dependent, reversible and independent of mature T-cells, as judged by the pronounced biopterin excretion of B6-nu/nu mice in comparison with their T-cell competent litter mates. The results indicate that monitoring of urinary biopterin excretion in mice does not represent a useful biochemical marker for T-cell activation.

Physiologic and metabolic aspects of anticonvulsants

A great number of anticonvulsants are available for treating these different types of epilepsy. Therapeutic drug monitoring has been favored as the method for controlling drug concentrations in the plasma and preventing untoward effects. When these anticonvulsants are prescribed to treat epilepsy in children, careful monitoring is most important because drug metabolism varies depending on maturation and development of body functions. Molecular approaches are also important to elucidate the effectiveness of the drugs for treatment of different seizure disorders and should contribute to a better understanding of body functions.

Cutaneous and immunologic reactions to phenytoin

Phenytoin (diphenylhydantoin; Dilantin) is a highly effective and widely prescribed anticonvulsant and antiarrhythmic agent. Since 1938 it has been invaluable in the treatment of grand mal and psychomotor epilepsy. Hydantoin derivatives have been used medicinally for more than a half-century. In recent years dermatologists have broadened the indications for phenytoin use to include recessive dystrophic epidermolysis bullosa, linear scleroderma, and pachyonychia congenita. In spite of widespread use and popularity, it is interesting that the frequency of complications relating to drug therapy remains low, relatively speaking. Nevertheless, a broad spectrum of cutaneous and immunologic reactions to phenytoin have been reported. These range from tissue proliferative syndromes (side effects), drug hypersensitivity syndromes (allergic effects), and a possible linkage with lymphoma (idiosyncratic effects). Therapeutic and toxic reactions to this commonly prescribed drug are comprehensively reviewed, analyzed, and summarized in this monograph.

Chemical-induced autoimmune reactions and Spanish toxic oil syndrome. Focus on hydantoins and related compounds

Autoimmune diseases comprise a wide spectrum of overlapping, systemic and organ-specific disorders. Although, etiology and pathogenesis of such disorders are largely unknown, endogenous host factors and exogenous agents, such as viruses, bacteria, and small molecular weight chemicals, drugs and food components, are believed to be involved. The toxicological significance of low molecular weight compounds on induction of autoimmune disorders is illustrated by the toxic oil syndrome (TOS), a chemically induced epidemic, observed in Spain since 1981. The causative chemical(s) of TOS is still elusive, but an association between ingestion of refined aniline-adulterated rapeseed oil and the syndrome is well-documented. Epidemiological, clinical and immunopathological symptoms of TOS are briefly reviewed. The striking resemblance with immunological disorders, observed in man upon medication with hydantoins and related compounds, is demonstrated. The likeliness of formation of a hydantoin-related compound in the aniline-adulterated oil is evidenced and its role as possible toxic agent in TOS is proposed. Further, the presence of hydantoins and related compounds in food is briefly reviewed and it is suggested that these chemicals may account for a portion of idiopathic autoimmune diseases observed in man. The need for development of animal models to assess this kind of immunotoxicological effects is stressed.

Structural requirements for hydantoins and 2-thiohydantoins to induce lymphoproliferative popliteal lymph node reactions in the mouse

The ability of a large number of hydantoins and 2-thiohydantoins to induce primary local lymphoproliferative popliteal lymph node (PLN) reactions has been investigated, as judged by PLN weight enlargement, in an attempt to evaluate the discriminating potential of the PLN reaction to low mol. wt chemicals and to establish structure-activity relationships. Among a series of nineteen hydantoins and related compounds only 5,5-diphenylhydantoin (phenytoin), its major metabolite 5-(p-hydroxyphenyl)-5-phenylhydantoin, 5,5-diphenyl-2-thiohydantoin and N-(5-nitro-2-furfurylidene)-1-aminohydantoin (nitro-furantoin) elicited marked PLN reactions in C57BL/6J mice. In DBA/2 mice, PLN responses to the aforementioned compounds were considerably less or virtually absent. A number of hydantoin derivatives and related compounds with one phenyl group and/or other substituents at the 1,3 or 5 position induced only slightly elevated or suppressed PLN responses in C57BL/6J mice. The influence of polar, and lipophilic aliphatic and aromatic substituents at the 5 position were compared among a series of 22 3-methyl-2-thiohydantoin as well as 21 3-phenyl-2-thiohydantoin amino acid derivatives for their ability to elicit primary PLN reactions in C57BL/6J mice. Substitution with only one aromatic group at the 5 position seemed to be necessary to induce PLN enlargements to 2-thiohydantoins already substituted at the 3 position with a methyl group or even more pronounced when substituted with a phenyl group. p-Hydroxylation of 5-benzyl-3-phenyl-2-thiohydantoin significantly diminished the PLN response. In contrast, p-hydroxylation of one of two phenyl groups as in 5-(p-hydroxyphenyl)-5-phenylhydantoin had little effect on lymphoproliferative PLN reactions. The presence of a hydroxyl group in a non-aromatic cyclic substituent as in hexahydro-6-hydroxy-2-methyl-3-thioxo-1H-pyrrolo[1,2-c]imidazol-1- one had no effect on the PLN reaction. A series of aliphatic substituents in the 5 position of 2-thiohydantoins showed that the number of carbon atoms of the substituents as well as the position of side chains in the isomer, rather than the methyl or phenyl group in the 3 position of the 2-thiohydantoin molecule, determined the strength of the PLN enlargement. It is concluded that the PLN weight increase assay appears to be able to discriminate between subtle chemical differences as studied with a large series of hydantoin and 2-thiohydantoin derivatives. The PLN assay may therefore be useful as a preliminary short-term screening method for identification of (classes of) compounds able to induce lymphoproliferative reactions.(ABSTRACT TRUNCATED AT 400 WORDS)