Allopurinol: alteration in pyrimidine metabolism in man

Management of neurological symptoms in Lesch-Nyhan disease: A systematic review

Lesch-Nyhan Disease (LND) is an X-linked recessive genetic disorder arising from hypoxanthine phosphoribosyltransferase 1 gene mutations, leading to a complete deficiency. LND presents a complex neurological profile characterized by generalized dystonia, motor dysfunctions and self-injurious behavior, which management is challenging. We conducted a systematic review of studies assessing the efficacy of pharmacological and non-pharmacological interventions in management of neurological symptoms in LND (PROSPERO registration number:CRD42023446513). Among 34 reviewed full-text papers; 22 studies were rated as having a high risk of bias. Considerable heterogeneity was found in studies regarding the timing of treatment implementation, adjunctive treatments and outcome assessment. Single-patient studies and clinical trials often showed contradictory results, while therapeutic failures were underreported. S-Adenosylmethionine and Deep Brain Stimulation were the most studied treatment methods and require further research to address inconsistencies. The evidence from levodopa studies underlines that optimal timing of treatment implementation should be thoroughly investigated. Standardized study design and reducing publication bias are crucial to overcome current limitations of assessing intervention efficacy in LND.

The Association between High-Dose Allopurinol and Erythropoietin Hyporesponsiveness in Advanced Chronic Kidney Disease: JOINT-KD Study

INTRODUCTION

The aim of the study was to explore the association between urate-lowering agents and reduced response to erythropoietin-stimulating agents in patients suffering from chronic kidney disease G5.

METHODS

We conducted a cross-sectional, multicenter study in Japan between April and June 2013, enrolling patients aged 20 years or older with an estimated glomerular filtration rate of ≤15 mL/min/1.73 m2. Exclusion criteria encompassed patients with a history of hemodialysis, peritoneal dialysis, or organ transplantation. The patients were categorized into four groups based on the use of urate-lowering drugs: high-dose allopurinol (>50 mg/day), low-dose allopurinol (≤50 mg/day), febuxostat, and no-treatment groups. We used a multivariable logistic regression model, adjusted for covariates, to determine the odds ratio (OR) for erythropoietin hyporesponsiveness, defined by an erythropoietin resistance index (ERI) of ≥10, associated with urate-lowering drugs.

RESULTS

A total of 542 patients were included in the analysis, with 105, 36, 165, and 236 patients in the high-dose allopurinol, low-dose allopurinol, febuxostat, and no-treatment groups, respectively. The median and quartiles of ERIs were 6.3 (0, 12.2), 3.8 (0, 11.2), 3.4 (0, 9.8), and 4.8 (0, 11.2) in the high-dose allopurinol, low-dose allopurinol, febuxostat, and no-treatment groups, respectively. The multivariate regression model showed a statistically significant association between the high-dose allopurinol group and erythropoietin hyporesponsiveness, compared to the no-treatment group (OR = 1.98, 95% confidence interval: 1.10-3.57).

CONCLUSIONS

Our study suggests that the use of high-dose allopurinol exceeding the optimal dose may lead to hyporesponsiveness to erythropoiesis-stimulating agents.

Small-Molecule Inhibitors of Reactive Oxygen Species Production

Reactive oxygen species (ROS) are involved in physiological cellular processes including differentiation, proliferation, and apoptosis by acting as signaling molecules or regulators of transcription factors. The maintenance of appropriate cellular ROS levels is termed redox homeostasis, a balance between their production and neutralization. High concentrations of ROS may contribute to severe pathological events including cancer, neurodegenerative, and cardiovascular diseases. In recent years, approaches to target the sources of ROS production directly in order to develop tool compounds or potential therapeutics have been explored. Herein, we briefly outline the major sources of cellular ROS production and comprehensively review the targeting of these by small-molecule inhibitors. We critically assess the value of ROS inhibitors with different mechanisms-of-action, including their potency, mode-of-action, known off-target effects, and clinical or preclinical status, while suggesting future avenues of research in the field.

Physiologic Medium Rewires Cellular Metabolism and Reveals Uric Acid as an Endogenous Inhibitor of UMP Synthase

A complex interplay of environmental factors impacts the metabolism of human cells, but neither traditional culture media nor mouse plasma mimic the metabolite composition of human plasma. Here, we developed a culture medium with polar metabolite concentrations comparable to those of human plasma (human plasma-like medium [HPLM]). Culture in HPLM, relative to that in traditional media, had widespread effects on cellular metabolism, including on the metabolome, redox state, and glucose utilization. Among the most prominent was an inhibition of de novo pyrimidine synthesis-an effect traced to uric acid, which is 10-fold higher in the blood of humans than of mice and other non-primates. We find that uric acid directly inhibits uridine monophosphate synthase (UMPS) and consequently reduces the sensitivity of cancer cells to the chemotherapeutic agent 5-fluorouracil. Thus, media that better recapitulates the composition of human plasma reveals unforeseen metabolic wiring and regulation, suggesting that HPLM should be of broad utility.

Pyrazolopyrimidine metabolism in parasitic protozoa

The pyrazolopyrimidines are purine analogs that are cytotoxic toward and metabolized by several genera of parasitic protozoa, including the Leishmania and the Trypanosoma. Examples of pyrazolopyrimidines that are selectively metabolized by these parasites include allopurinol, allopurinol riboside, 4-thiopurinol, 4-thiopurinol riboside, and formycin B. These pathogenic protozoa are capable of efficient conversion of the pyrazolopyrimidines to the nucleotide level. The pyrazolopyrimidine metabolites which are isomers of inosine monophosphate are subsequently aminated and incorporated as the adenylate analog into RNA. Mammalian cells are incapable of these metabolic transformations. The sulfur containing pyrazolopyrimidines, however, are neither aminated nor incorporated into nucleic acid. The selective metabolism of the pyrazolopyrimidines by the intracellular metabolic machinery of the parasites of the Trypanosomatidae family offers a rational approach to the chemotherapy of the diseases caused by these pathogenic hemoflagellates.

Flavonoid glycosides isolated from unique legume plant extracts as novel inhibitors of xanthine oxidase

Legumes and the polyphenolic compounds present in them have gained a lot of interest due to their beneficial health implications. Dietary polyphenolic compounds, especially flavonoids, exert antioxidant properties and are potent inhibitors of xanthine oxidase (XO) activity. XO is the main contributor of free radicals during exercise but it is also involved in pathogenesis of several diseases such as vascular disorders, cancer and gout. In order to discover new natural, dietary XO inhibitors, some polyphenolic fractions and pure compounds isolated from two legume plant extracts were tested for their effects on XO activity. The fractions isolated from both Vicia faba and Lotus edulis plant extracts were potent inhibitors of XO with IC(50) values range from 40-135 µg/mL and 55-260 µg/mL, respectively. All the pure polyphenolic compounds inhibited XO and their K(i) values ranged from 13-767 µM. Ten of the compounds followed the non competitive inhibitory model whereas one of them was a competitive inhibitor. These findings indicate that flavonoid isolates from legume plant extracts are novel, natural XO inhibitors. Their mode of action is under investigation in order to examine their potential in drug design for diseases related to overwhelming XO action.

Pharmacologically active metabolites of currently marketed drugs: potential resources for new drug discovery and development

Biotransformation is the major clearance mechanism of therapeutic agents from the body. Biotransformation is known not only to facilitate the elimination of drugs by changing the molecular structure to more hydrophilic, but also lead to pharmacological inactivation of therapeutic compounds. However, in some cases, the biotransformation of drugs can lead to the generation of pharmacologically active metabolites, responsible for the pharmacological actions. This review provides an update of the kinds of pharmacologically active metabolites and some of their individual pharmacological and pharmacokinetic aspects, and describes their importance as resources for drug discovery and development.

Differential effects of xanthine oxidase inhibition and exercise on albumin concentration in rat tissues

Albumin is a protein present in almost all kinds of mammalian cells. It has binding sites for several molecules, and possesses antioxidant and other important properties. The aim of this study was to examine the effects of 2 different oxidative stress stimuli — exercise and allopurinol administration — and their combination on albumin concentration in several rat tissues. Samples of soleus, extensor digitorum longus (EDL), and gastrocnemius muscles, and the liver and heart were collected before, immediately after, and 5 h after exercise, and collected at the respective time points after allopurinol administration. Albumin dimmers, markers of oxidative stress, were also assessed in EDL muscle. Albumin concentration increased in the skeletal muscles examined, whereas it decreased in the heart and remained unaffected in the liver after exercise. Allopurinol alone did not affect albumin concentration in any of the tissues. Albumin concentration increased in soleus and EDL muscles, decreased in gastrocnemius muscle and the liver, and remained unaffected in the heart after exercise and allopurinol combination. Albumin dimmers also increased postexercise in EDL muscle. Our findings suggest that the increase in albumin concentration in skeletal muscles may be an antioxidant mechanism response, but may depend on the type of oxidative stress and be stimulation- and tissue-specific.

Blood reflects tissue oxidative stress depending on biomarker and tissue studied

This study investigated whether selected oxidative stress markers measured in blood adequately reflect redox status in skeletal muscle, heart, and liver. Several markers were determined after implementing two treatments known to affect redox status, namely exercise and allopurinol administration. Xanthine oxidase, thiobarbituric acid-reactive substances (TBARS), protein carbonyls (PC), reduced glutathione (GSH), oxidized glutathione (GSSG), catalase, and total antioxidant capacity were determined in blood, skeletal muscle, heart, and liver. Correlation between blood and tissues in each marker was performed through the Spearman rank correlation coefficient. GSSG in erythrocytes was correlated with all tissues, ranging in the five experimental groups as follows: skeletal muscle r(s)=0.656-0.874, heart r(s)=0.742-0.981, liver r(s)=0.646-0.855. Xanthine oxidase and TBARS measured in blood satisfactorily described the redox status of the heart (0.753-0.964 and 0.705-1.000, respectively) and liver (0.755-0.902 and 0.656-1.000, respectively). Skeletal muscle and heart redox status can be adequately described by PC (0.652-1.000 and 0.656-0.964, respectively), GSH (0.693-1.000 and 0.656-1.000, respectively), and catalase (0.745-1.000 and 0.656-1.000, respectively) measured in blood. In conclusion, this study suggests that a combination of markers measured in blood provides a reliable indication about the redox status in skeletal muscle, heart, and liver.

Effects of xanthine oxidase inhibition on oxidative stress and swimming performance in rats

The aim of this study was to examine the effect of allopurinol, a xanthine oxidase inhibitor, on oxidative stress and physical performance after swimming until exhaustion in rats. Blood and gastrocnemius muscle samples were collected before, immediately after, and 5 h after exercise and the respective timepoints after allopurinol administration. Xanthine oxidase and total antioxidant capacity (TAC) were determined in plasma and muscle, whereas catalase activity and reduced (GSH) and oxidized (GSSG) glutathione were measured in erythrocytes and muscle. Thiobarbituric acid–reactive substances (TBARS) and protein carbonyls (PC) were determined in plasma, erythrocytes, and muscle. As expected, allopurinol inhibited xanthine oxidase activity. Compared with their nonallopurinol-treated counterparts, rats treated with allopurinol showed a 35% decrease in physical performance, as indicated by the shorter swimming time to exhaustion. Exercise alone increased PC and TBARS concentration in plasma, erythrocytes, and gastrocnemius muscle. Similarly, allopurinol alone increased PC and TBARS concentration in erythrocytes and gastrocnemius muscle, decreased TAC in plasma and gastrocnemius muscle, and decreased the GSH:GSSG ratio in erythrocytes. Our data illustrate that, in general, exercise and allopurinol alone increased the levels of most of the oxidative stress markers measured in plasma, erythrocytes, and gastrocnemius muscle. Xanthine oxidase inhibition provoked a marked reduction in physical performance.

Dietary feedback regulation of purine and pyrimidine biosynthesis in man

Ten days after a healthy person has consumed a purine-free isoenergetic diet, the excretion of (endogenous) uric acid reaches a minimum and remains constant thereafter. Purines are absorbed in different degrees from various biochemical sources added to such a diet--little from DNA, nearly all from ribomononucleotides--presumably owing to different rates of hydrolysis. There is always a linear relationship between dietary purine content and uric acid excretion, independent of the source of purine. The findings suggest that dietary purines play a minor role (if any) in the regulation of purine synthesis, contrary to the conclusions of other workers. The demonstration that oral administration of uridine diminishes the oroticaciduria in patients with hereditary oroticaciduria suggested dietary feedback regulation of pyrimidine biosynthesis by pyrimidine nucleosides in the diet. The reduction of allopurinol-induced oroticaciduria by dietary RNA pointed in the same direction. Closer analysis with RNA hydrolysate and isolated purine as well as pyrimidine nucleotides, however, revealed that not only pyrimidine derivatives but also purine mononucleotides diminish oroticaciduria. The nucleotides had no influence on the change in the activity of orotidine-5'-phosphate decarboxylase (EC 4.1.1.23), induced by allopurinol; this makes an effect on the decarboxylase unlikely. The feedback regulation is assumed to act by inhibition of an earlier step.

Febuxostat, a novel nonpurine selective inhibitor of xanthine oxidase: a twenty-eight-day, multicenter, phase II, randomized, double-blind, placebo-controlled, dose-response clinical trial examining safety and efficacy in patients with gout

OBJECTIVE

Gout affects approximately 1-2% of the American population. Current options for treating hyperuricemia in chronic gout are limited. The purpose of this study was to assess the safety and efficacy of febuxostat, a nonpurine selective inhibitor of xanthine oxidase, in establishing normal serum urate (sUA) concentrations in gout patients with hyperuricemia (>or=8.0 mg/dl).

METHODS

We conducted a phase II, randomized, double-blind, placebo-controlled trial in 153 patients (ages 23-80 years). Subjects received febuxostat (40 mg, 80 mg, 120 mg) or placebo once daily for 28 days and colchicine prophylaxis for 14 days prior to and 14 days after randomization. The primary end point was the proportion of subjects with sUA levels <6.0 mg/dl on day 28.

RESULTS

Greater proportions of febuxostat-treated patients than placebo-treated patients achieved an sUA level <6.0 mg/dl at each visit (P < 0.001 for each comparison). The targeted sUA level was attained on day 28 in 0% of those taking placebo and in 56% of those taking 40 mg, 76% taking 80 mg, and 94% taking 120 mg of febuxostat. The mean sUA reduction from baseline to day 28 was 2% in the placebo group and 37% in the 40-mg, 44% in the 80-mg, and 59% in the 120-mg febuxostat groups. Gout flares occurred with similar frequency in the placebo (37%) and 40-mg febuxostat (35%) groups and with increased frequency in the higher dosage febuxostat groups (43% taking 80 mg; 55% taking 120 mg). During colchicine prophylaxis, gout flares occurred less frequently (8-13%). Incidences of treatment-related adverse events were similar in the febuxostat and placebo groups.

CONCLUSION

Treatment with febuxostat resulted in a significant reduction of sUA levels at all dosages. Febuxostat therapy was safe and well tolerated.

Selectivity of febuxostat, a novel non-purine inhibitor of xanthine oxidase/xanthine dehydrogenase

The purine analogue, allopurinol, has been in clinical use for more than 30 years as an inhibitor of xanthine oxidase (XO) in the treatment of hyperuricemia and gout. As consequences of structural similarities to purine compounds, however, allopurinol, its major active product, oxypurinol, and their respective metabolites inhibit other enzymes involved in purine and pyrimidine metabolism. Febuxostat (TEI-6720, TMX-67) is a potent, non-purine inhibitor of XO, currently under clinical evaluation for the treatment of hyperuricemia and gout. In this study, we investigated the effects of febuxostat on several enzymes in purine and pyrimidine metabolism and characterized the mechanism of febuxostat inhibition of XO activity. Febuxostat displayed potent mixed-type inhibition of the activity of purified bovine milk XO, with Ki and Ki' values of 0.6 and 3.1 nM respectively, indicating inhibition of both the oxidized and reduced forms of XO. In contrast, at concentrations up to 100 muM, febuxostat had no significant effects on the activities of the following enzymes of purine and pyrimidine metabolism: guanine deaminase, hypoxanthine-guanine phosphoribosyltransferase, purine nucleoside phosphorylase, orotate phosphoribosyltransferase and orotidine-5'-monophosphate decarboxylase. These results demonstrate that febuxostat is a potent non-purine, selective inhibitor of XO, and could be useful for the treatment of hyperuricemia and gout.

Growth inhibition and induction of apoptosis in MCF-7 breast cancer cells by fermented soy milk

The effect of a fermented soy milk product (FSP) on various human breast carcinoma cell lines was investigated, and it was shown to have a growth-inhibitory effect, especially on MCF-7 cells. Thus the MCF-7 cell line was used to study the mechanism of action. In female severe combined immune deficiency mice implanted with MCF-7 cells, pretreatment with FSP significantly inhibited tumor growth. The inhibitory effect of FSP on MCF-7 cells seemed to be caused by the additive effects of a wide variety of constituents. The active components of FSP are mainly in the water phase, and the lipid-soluble fraction, which includes the soy isoflavones such as genistein and daidzein, is relatively ineffective. A variety of methods were used to demonstrate that FSP caused apoptotic cell death in MCF-7 cells. FSP induced generation of reactive oxygen species (ROS). Growth inhibition and ROS generation induced by FSP could be inhibited by catalase and deferoxamine, indicating that the ROS production probably was the cause of this apoptotic cell death. This study suggests that FSP retards tumor growth in vivo and can trigger apoptosis in vitro. It may, therefore, be a potential nutritional supplement in chemotherapy.

Lymphocyte migration through monolayers of endothelial cell lines involves VCAM-1 signaling via endothelial cell NADPH oxidase

Lymphocytes migrate from the blood across endothelial cells to reach foreign substances sequestered in peripheral lymphoid organs and inflammatory sites. To study intracellular signaling in endothelial cells during lymphocyte migration, we used murine endothelial cell lines that promote lymphocyte migration and constitutively express VCAM-1. The maximum rate of resting splenic lymphocyte migration across monolayers of the endothelial cells occurred at 0-24 h. This migration was inhibited by anti-VCAM-1 or anti-alpha4 integrin, suggesting that VCAM-1 adhesion was required for migration. To determine whether signals within the endothelial cells were required for migration, irreversible inhibitors of signal transduction molecules were used to pretreat the endothelial cell lines. Inhibitors of NADPH oxidase activity (diphenyleneiodonium and apocynin) blocked migration >65% without affecting adhesion. Because NADPH oxidase catalyzes the production of reactive oxygen species (ROS), we examined whether ROS were required for migration. Scavengers of ROS inhibited migration without affecting adhesion. Furthermore, VCAM-1 ligand binding stimulated NADPH oxidase-dependent production of ROS by the endothelial cells lines and primary endothelial cell cultures. Finally, VCAM-1 ligand binding induced an apocynin-inhibitable actin restructuring in the endothelial cell lines at the location of the lymphocyte or anti-VCAM-1-coated bead, suggesting that an NADPH oxidase-dependent endothelial cell shape change was required for lymphocyte migration. In summary, VCAM-1 signaled the activation of endothelial cell NADPH oxidase, which was required for lymphocyte migration. This suggests that endothelial cells are not only a scaffold for lymphocyte adhesion, but play an active role in promoting lymphocyte migration.

Allopurinol induces renal toxicity by impairing pyrimidine metabolism in mice

We investigated the relationship between the toxic effect of allopurinol and pyrimidine metabolism in mice. Allopurinol-induced increases in plasma transaminase levels in dinitrofluorobenzene (DNFB)-sensitized mice were not affected by uridine. In contrast, plasma creatinine and BUN tended to decrease 18 hr after the last injection of uridine. Both plasma and urinary orotidine (OD) were detected in DNFB-sensitized mice after administration of a single dose of allopurinol. In contrast, TEI-6720, a newly synthesized xanthine oxidase/xanthine dehydrogenase inhibitor, caused neither pyrimidine metabolism abnormality nor renal impairment in DNFB-sensitized mice. Also, normal mice administered high doses of allopurinol showed abnormal pyrimidine metabolism together with renal toxicity which could be ameliorated by uridine, indicating that allopurinol essentially causes pyrimidine metabolism abnormality leading to renal impairment. In DNFB-sensitized mice, allopurinol increased urinary OD excretion to an extent similar to that in normal mice administered the same dose of allopurinol. However, renal impairment by allopurinol was more striking in DNFB-sensitized mice than in normal mice. Histopathological observations showed that allopurinol induced calculus formation in the collecting tubules and papillary duct. Calculus formation was increased by DNFB and decreased by uridine. These observations indicate that the enhancement of the renal toxicity of allopurinol by DNFB-sensitization may be due to some biological interactions between DNFB and allopurinol. In humans, it is possible that there are some biological interactions which serve to enhance the toxicity of allopurinol, resulting in the development of allopurinol hypersensitivity syndrome (AHS). In contrast, TEI-6720, had no effect on pyrimidine metabolism and showed no toxic effect.

The influence of allopurinol on kidney haemodynamic and excretory responses to renal ischaemia in anaesthetized rats

1. This study examined the impact of allopurinol on the renal functional responses to a 30 min period of ischaemia in anaesthetized rats. 2. Immediately on reperfusion, blood pressure rose transiently, while renal blood flow remained stable throughout at control values. Glomerular filtration rate was decreased by some 90% over the first and 80% over the sixth hour (P<0.001). 3. Allopurinol, 50 or 100 mg kg-1, had no effect on the blood pressure or renal blood flow responses over the 6 h reperfusion period but glomerular filtration decreased by 60% initially, and to less than 30% of basal at 6 h. 4. Urine flow and absolute sodium excretion increased 2 - 3 fold in the first 2 h but decreased thereafter. Fractional sodium excretion was 30 times higher for the first 2 h but decreased reaching some 10 fold higher at 6 h. In the presence of allopurinol, urine flow and absolute sodium excretion increased by 5 - 6 fold in the first 2 h, and fell by half by 6 h which was greater than in the vehicle group (P<0.01). Fractional sodium excretion increased 20 fold in the allopurinol animals in the first 2 h period, but fell at a faster rate (P<0.01) than in untreated rats. 5. Potassium excretion decreased (P<0.05) by one half for the 6 h reperfusion period but in the allopurinol animals it was minimally altered. 6. Allopurinol largely ameliorated the decrease in kidney haemodynamic and excretory function following an ischeamic period for the initial few hours of reperfusion.

Effect of allopurinol and benzbromarone on the concentration of uridine in plasma

To investigate whether allopurinol and benzbromarone affect the concentration of uridine in plasma, allopurinol or benzbromarone were administered to patients with gout for 3 to 6 months. Allopurinol decreased the concentrations of uridine and uric acid in plasma and the urinary excretion of uric acid, but increased the plasma concentration and urinary excretion of oxypurines and orotidine. Benzbromarone decreased the concentration of uric acid in plasma and increased the excretion of uric acid in urine. However, it did not affect the plasma concentration of uridine or oxypurines or the urinary excretion of oxypurines or orotidine. These results suggest that orotidilytic decarboxylase was inhibited by allopurinol and oxypurinol ribonucleotides and/or that phosphoribosyl pyrophosphate (PRPP) was consumed by conversion from hypoxanthine, allopurinol, and oxypurinol to the respective ribonucleotides, resulting in a decrease in the de novo synthesis of pyrimidine leading to the decreased concentration of uridine in plasma. Furthermore, it was suggested that benzbromarone did not affect the de novo synthesis of pyrimidine or purine.

Effects of allopurinol on in vivo suppression of arthritis in mice and ex vivo modulation of phagocytic production of oxygen radicals in whole human blood

Recently, we demonstrated elevated levels of xanthine oxidase in serum of patients with various inflammatory and autoimmune rheumatic diseases. The present study reports the antiarthritic efficacy of the xanthine oxidase inhibitor and immunosuppressant allopurinol in DBA/1xB10A(4r) mice suffering from peroxochromate-induced arthritis. A profound dose-dependent suppression of arthritis was noted (P < 0.001). The ED50 was 80 +/- 14 mumol/kg/day. The arthritis index correlated positively to the phagocytic production of oxygen radicals (r2 > 0.672) and negatively to the concentrations of allopurinol (r2 = 0.915). Ex vivo, allopurinol and various conventional antirheumatic drugs were screened for the inhibition of 12-O-tetradecanoylphorbol-13-acetate-stimulated whole human blood chemiluminescence. The concentrations of antirheumatic drugs required to inhibit the chemiluminescence by 50% were compared to the therapeutic doses administered to rheumatic patients. While D-penicillamine and cis-platinum(II) increased the phagocytic generation of superoxide, nonsteroidal antiinflammatory drugs (NSAIDs), steroids, and slow-acting antirheumatic drugs (SAARDs) inhibited the whole blood chemiluminescence in a dose-dependent manner. Therapeutic doses of NSAIDs, SAARDs, or steroids inhibited the phagocytic generation of reactive oxygen species by 10-50%. In addition to well-known mechanisms of action of NSAIDs and SAARDs, our results support the hypothesis that most common anti-rheumatic drugs act also by modulating the levels of reactive oxygen species, which serve important mediator and signal transduction functions in inflammatory and autoimmune diseases. Pharmacologically safe antioxidants like allopurinol, which simultaneously modify the oxidative burst of phagocytes, inhibit xanthine oxidase, and display immunosuppressive effects may well be suited to control the consequences of chronic phagocytic hyperreactivity in rheumatic patients.

Inhibition by gomisin C (a lignan from Schizandra chinensis) of the respiratory burst of rat neutrophils

1. The possible mechanisms of action of the inhibitory effect of gomisin C on the respiratory burst of rat neutrophils in vitro was investigated. 2. The peptide formyl-Met-Leu-Phe (FMLP) induced superoxide anion (O2-) formation and O2 consumption, which was inhibited by gomisin C in a concentration-dependent manner (IC50 21.5 +/- 4.2 micrograms ml-1 for O2- formation). Gomisin C also suppressed O2- formation and consumption at low concentrations of phorbol myristate acetate (PMA) with an IC50 value of 26.9 +/- 2.1 micrograms ml-1 for O2- formation. However, gomisin C did not affect the responses induced by a high concentration of PMA. 3. Gomisin C had no effect on O2- generation and uric acid formation in the xanthine-xanthine oxidase system, and failed to alter O2- generation during dihydroxyfumaric acid (DHF) autoxidation, indicating that it does not scavenge superoxide. 4. Like trifluoperazine (TFP), gomisin C attenuated the activity of PMA-activated neutrophil particulate NADPH oxidase in a concentration-dependent manner. 5. Gomisin C reduced the elevations of cytosolic free Ca2+ in neutrophils stimulated by FMLP in the presence or absence of EDTA. Cyclopiazonic acid (CPA) induced the release of Ca2+ from intracellular stores and this was also reduced by gomisin C. However, the Ca2+ influx pathway activated by CPA was not affected by gomisin C. 6. The cellular cyclic AMP level was markedly increased by forskolin, but not by gomisin C. Moreover, the inositol phosphate levels in FMLP-activated neutrophils were not affected by gomisin C. 7. These results show that the inhibitory action of gomisin C on the respiratory burst is not mediated by changes in cellular cyclic AMP or in inositol phosphates, or by scavenging O2- released from neutrophils, but may be mediated partly by the suppression of NADPH oxidase and partly by the decrease of cytosolic Ca2+ released from an agonist-sensitive intracellular store.

Effect of sodium tanshinone IIA sulfonate in the rabbit myocardium and on human cardiomyocytes and vascular endothelial cells

Sodium tanshinone IIA sulfonate (STS) is a derivative of tanshinone IIA. The latter is a pharmacologically active component isolated from the rhizome of the Chinese herb Salvia miltiorrhiza. Liquid chromatographically pure STS was found to reduce myocardial infarct size by 53.14 +/- 22.79% relative to that in the saline control in a rabbit 1 hr-ischemia and 3 hr-reperfusion model. This effect was comparable to that of Trolox (a better characterized antioxidant serving as a reference cytoprotector), which salvaged the myocardium in the same infarct model by 62.13 +/- 18.91%. Also, like Trolox, STS did not inhibit oxygen uptake by xanthine oxidase (XO), a key enzyme in free radical generation. However, in contrast to Trolox, STS significantly prolonged the survival of cultured human saphenous vein endothelial cells but not human ventricular myocytes in vitro when these cells were separately exposed to XO-generated oxyradicals. Note that the endothelium is recognized to be a key site of oxidant generation and attack. Our findings in vitro and in vivo support the interpretation that STS is a cardioprotective substance, and that it may exert a beneficial effect on the clinically important vascular endothelium.

Inhibition of orotidylate decarboxylase by 4(5H)-oxo-1-beta-D-ribofuranosylpyrazolo[3,4-d] pyrimidine-3-thiocarboxamide (APR-TC) in B lymphoblasts. Activation by adenosine kinase

The nucleoside allopurinol riboside-3-thiocarboxamide (APR-TC; 4-(5H)oxo-1-beta-D-ribofuranosylpyrazolo[3,4,d]pyrimidine-3-thioca rboxamide) demonstrates potent in vitro antiviral activity against various DNA and RNA viruses and cytostatic activity against a variety of cell lines in culture. The IC50 for APR-TC in the splenic derived B lymphoblast cell line, WI-L2, was 0.3 microM. Adenosine kinase-deficient WI-L2 cells were resistant to growth inhibition by APR-TC, indicating that adenosine kinase (EC 2.7.1.20) is responsible for phosphorylation of APR-TC to form the monophosphate derivative (APR-TC-5'P). A 4-hr incubation of cells with 50 microM APR-TC resulted in severe depletion of intracellular pyrimidine nucleotide pools and the accumulation of 3 microM APR-TC-5'P. The cytotoxicity of APR-TC was reversed by uridine, indicating that the active form of this compound inhibits the de novo pyrimidine biosynthetic pathway. Further, APR-TC-treated cells could not utilize the pyrimidine nucleotide precursor [6-14C]orotic acid, suggesting that the UMP synthase complex is the major cellular site of inhibition. In studies utilizing cell-free lysates of WI-L2, chemically prepared APR-TC-5'P provided potent inhibition of the orotidylate decarboxylase activity (ODCase, EC 4.1.1.23) of the UMP synthase complex. APR-TC-5'P was competitive with OMP, and a Ki value of 0.35 nM was determined.

A study of dose-response relationships of allopurinol in the presence of low or high purine turnover

Effects of allopurinol (125-500 mg/m2 body surface) were studied in normal subjects during periods of 18 days both during a purine-free, isoenergetic liquid formula diet and additional intake of ribonucleic acid, 4 g/day. Plasma uric acid and renal excretion of uric acid, oxypurines (hypoxanthine plus xanthine) and orotic acid were measured and total purine excretion calculated. Effects of allopurinol were evaluated by comparison of the results obtained in the steady state during diet alone (average of days 7-10) with those during allopurinol administration (days 16-18). During the purine-free diet, plasma uric acid was lowered more than urinary uric acid by allopurinol on doses of 250-500 mg/m2 (44%-54% of control values on 500 mg/m2), demonstrating an increase in renal clearance. At the same dose, the uric acid lowering effect of allopurinol was more pronounced with than without purine loads (plasma 41%, urine 32% of control on 500 mg/m2 during purine intake), while renal uric acid clearance was decreased. The more pronounced reduction of uric acid excretion during purine administration was balanced to the greater part by a more pronounced increase in oxypurine excretion. Total purine excretion was reduced by about 20% during the purine-free diet irrespective of dose. The size of this purine deficit was doubled, but was also independent of dose during addition of purines. Orotic acid excretion increased with dose during allopurinol treatment and was reduced by addition of purines.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of glycine on the induction of orotic aciduria and urinary bladder tumorigenesis in the rat

The mechanism by which amino acids increase the cellular levels of orotic acid (OA) was investigated. Administration of glycine (2.5 mmoles/100 g) to rats resulted in a 100-fold increase in urinary OA excretion, which was inhibited by pretreatment with cycloheximide or actinomycin D. The induction of OA synthesis from NH4Cl but not from carbamoylaspartate (CA) was inhibited by cycloheximide, indicating that the cycloheximide sensitive step was after the formation of ammonia and before the formation of CA. The glycine-stimulated OA synthesis was not inhibited by acivicin, a potent inhibitor of the cytosolic carbamoylphosphate (CP) synthetase, implicating the mitochondrial CP synthetase in supplying the CP for OA synthesis. Preliminary results indicated that cycloheximide did not inhibit glycine-induced urea synthesis to any significant extent. The results thus suggest that (i) the increased OA synthesis induced by glycine requires a transcription-translation dependent step and (ii) the regulatory step may be the transport of mitochondrial CP to cytosol and/or the synthesis of cytosolic CA. Attempts to determine whether increased exposure of urinary bladder to high concentrations of OA will influence bladder tumorigenesis revealed that chronic administration of glycine (2.5 mmoles/100 g, ip, daily, 5 days a week for 20 weeks) resulted in a 44% increased incidence of hyperplastic, preneoplastic, and neoplastic lesions. Some of these rats also exhibited stones in urinary bladders. The mechanism by which glycine induces tumorigenesis in the urinary bladder is currently being explored.

Purine seizure disorders

Developing antiepileptic agents that are specifically tailored to a patient's individual biochemistry has long been a goal of neurology. Three patients who had hyperuricosuria combined with a seizure disorder that failed to respond to traditional anticonvulsants are described. The patients had the best control of their seizure disorder when a specific metabolic drug, allopurinol, was used as an anticonvulsant. All three patients had onset of the seizure disorder at 22 months of age, a finding possibly related to maturation of purine enzymes. Because elevated uric acid levels in the immediate postictal period may occur in seizure patients, the presence of an elevated uric acid clearance in seizure-free periods is needed to consider the diagnosis of an allopurinol-responsive seizure problem in any individual patient. In the two patients past the onset of puberty, lowering (one case) and cessation (other case) of the dose of allopurinol has been possible.

Orotic acid, arginine, and hepatotoxicity

This communication presents evidence from the literature and recent experiments that describe circumstances wherein arginine may be a conditional dietary essential. Previous work has established that the synthesis of orotic acid (OA), the first pyrimidine formed in the de novo pathway of nucleic acid synthesis, becomes elevated whenever the ammonia load exceeds the capacity of the urea cycle. Under these circumstances, the common intermediate, carbamyl phosphate, leaks from the mitochondria and induces OA synthesis in the cytoplasm. This leads to increased OA excretion in the urine as pyrimidine synthesis escapes feedback control. A deficiency of urea cycle substrates such as arginine, and administration of certain drugs, ammonium salts, urease, or excess amino acids raises orotic acid excretion. Our recent experiments in rats show that OA excretion is also elevated after partial hepatectomy following galactosamine administration, exposure to carbon tetrachloride, or feeding 36% of calories as ethanol. The elevation in OA excretion was suppressed by dietary supplementation with arginine, implying that arginine is conditionally essential. Adult human male alcoholics showed elevated urinary orotic acid-to-creatinine ratios early after drinking episodes, which declined with time following abstinence. Such evidence shows that well studied hepatotoxins and surgical liver injury affect pathways of ammonia metabolism and suggests that urinary orotic acid can be an indicator of hepatotoxicity and increased needs for arginine. Arginine-deficient diets and alcohol feeding both enhance fatty deposition in the liver, which can be worsened by high fat intakes in rats. Alcoholism, various other diseases, and fasting and realimentation change orotic acid excretion. Such responses will have to be taken into account in establishing "normal values" for OA excretion.

Metabolic studies of high doses of allopurinol in humans

In animals and in humans given high doses of allopurinol, the oxidation of allopurinol to oxipurinol is inhibited, resulting in a higher proportion of unchanged allopurinol and of allopurinol riboside in plasma and urine than is seen at low doses. The dose which produces this inhibition of allopurinol oxidation is higher in rodents than in man or in the dog. Urinary orotate and orotidine increased in proportion to the dose of allopurinol. These increased levels of orotate would be expected to compete more effectively with 5-fluorouracil for conversion to a nucleotide by orotate phosphoribosyltransferase. Since allopurinol and allopurinol riboside are active against leishmaniae in vitro, it may be possible to attain therapeutic levels of allopurinol and allopurinol riboside in vivo by using high doses of allopurinol.

[The effect of dietary purines and pyrimidines on human pyrimidine biosynthesis]

Young healthy volunteers received a purine-free, isoenergetic formula diet over a period of 28 to 32 days. After a short time under formula diet alone 400 mg allopurinol were administered daily. After a further 10 days each volunteer received daily, in addition, either 4 g RNA, 4 g RNA-hydrolysate, 1 g guanosine-5-monophosphate (GMP), 1 or 3 g adenosine-5-monophosphate (AMP), uridine-5-monophosphate (UMP), cytidine-5-monophosphate (CMP) or adenosine, guanosine, uridine, cytidine, guanine, hypoxanthine, xanthine, cytosine and uracil. Finally the allopurinol was omitted. The renal excretion of total orotic acid (orotic acid and orotidine), uric acid and creatinine was determined daily; serum uric acid concentrations and the enzyme activities of orotidine-5-phosphate-decarboxylase (ODCase) and hypoxanthine-guanine-phosphoribosyltransferase (HGPRTase) from erythrocytes were determined every other day. The results show that RNA, RNA-hydrolysate, purine- and pyrimidine-nucleotides and -nucleotides as well as hypoxanthine, and to a lesser extent adenine, diminish allopurinol-induced orotaciduria. This is compatible with an influence of dietary purines and pyrimidines on human pyrimidine biosynthesis.

Renal complications of cytotoxic therapy

The expanding use of cytotoxic drugs in cancer therapy has resulted in a confusing and increasingly frequent array of severe renal complications. This article reviews the nephrotoxicity and other renal and urological complications of commonly used drugs and the clinical setting in which they are prescribed. Emphasis is placed on the mechanisms, prevention and treatment of renal damage.

Effect of allopurinol on the toxicity of high-dose 5-fluorouracil administered by intermittent bolus injection

The effect of allopurinol pretreatment on the toxicity of 5-fluorouracil (5-FU) was examined in a clinical trial. Twenty-three patients were given bolus infusions of 5-FU every two weeks in doses that produced mild toxicity (0.8-1.9 g/m2). On alternate courses patients were pretreated with allopurinol either 300 mg two hours prior to and 10 hours after 5-FU, or 300 mg every 8 hours for 4 doses starting 24 hours before 5-FU. Seventeen and 20 pairs of courses were evaluable from the 2- and 24-hour pretreatment groups, respectively. Allopurinol did not produce a significant degree of protection against 5-FU-induced myelosuppression or mucositis on either dose schedule. Neurotoxicity manifesting as both cerebellar and encephalopathic signs and symptoms was the most important toxicity encountered and was dose-limiting for 5-FU on this schedule. Mean oxipurinol serum concentrations at the time of 5-FU administration were 24 microM and 104 microM for the 2- and 24-hour allopurinol pretreatment schedules respectively. Allopurinol increased the T 1/2 of 5-FU by a mean of 67% in three of the four patients studied. Pretreatment with allopurinol did not reduce the toxicity of 5-FU administered as an intravenous bolus.

Stimulation by 6-azauridine of carbamoyl phosphate synthesis for pyrimidine biosynthesis in mouse spleen slices

1. Slices of spleen from anaemic mice were incubated with [14C]bicarbonate in the presence and absence of 6-azauridine and the amounts of 14C that entered the de novo pyrimidine biosynthetic pathway were assessed and compared. Compounds analyzed included carbamoylaspartate, dihydroorotate, orotate plus its derivatives, acid-soluble uracil and cytosine 5'-nucleotides, nucleic acid pyrimidines, free pyrimidine bases and nucleosides. As the intracellular levels of carbamoyl phosphate and acid-soluble deoxyribonucleotides are known to be relatively low, the radioactivities of these compounds were not measured. Degradation of labelled uridine was limited in this tissues, therefore the radioactivity of degradative products of pyrimidines was not considered. 2. When the slices were incubated with 0.5 mM 6-azauridine for 10 min and then with [14C]bicarbonate for an additional 10 min and 30 min, the sum of radioactivity found in the above compounds, which represents the total amount of 14C that entered the pyrimidine pathway, was 2.1 and 2.3 times greater than when the tissue slices were incubated in the absence of the analogue. 3. When the 14C distribution among the carbon atoms of the molecules of labelled carbamoylaspartate and uracil was investigated, we found that more than 90% of the total 14C in these compounds derived directly from carbamoyl phosphate and the remaining portion was from aspartate, either in the presence or absence of 6-azauridine. 4. There was no indication that 6-azauridine altered [14C]bicarbonate permeation through the cell membrane or its intracellular metabolism. 5. These results, along with the pattern of early intermediate accumulation seen in the presence of 6-azauridine, indicate that 6-azauridine stimulates the production of carbamoyl phosphate for the pyrimidine biosynthetic pathway in the mouse spleen. 6. Of the radioactive early intermediates which accumulated, only orotate, its derivatives (orotidine and orotidine 5'-monophosphate) or both appeared in the medium, presumably the result of leakage through the cell membranes. 7. Stimulation of the pyrimidine pathway was not observed in the case of Ehrlich ascites tumour cells incubated under similar conditions with 6-azauridine.

Purine and pyrimidine metabolism

The pathways of purine biosynthesis and degradation have been elucidated during the last 30 years; the regulation of the mechanisms involved is not yet fully understood, particularly with respect to quantitative aspects. Research into inborn errors of purine metabolism has provided valuable insights into purine synthesis and salvage pathways. Nutrition experiments using purine-free formula diets and supplements with defined purine sources permit precise descriptions of the influence of various dietary purines on uric acid formation. Supplements of dietary purines produce dose-proportional increases in plasma uric acid concentrations, uric acid pool size and renal uric acid excretion. The magnitude of these increases depends on the type of purine compound administered, which may limit the value of food tables for human dietetics. Purine content of food must be related not only to weight but also to energy and to protein, particularly if new foodstuffs or a vegetarian diet are ingested. Dietary purines appear to influence the biosynthesis of pyrimidines. In contrast to dietary purines, pyrimidines in the diet, if administered as nucleosides or nucleotides, are utilized in animals for the synthesis of nucleic acids. Much further work is necessary for a better understanding of the inter-relationships of purine and pyrimidine metabolism.

Modulation of 5-fluorouracil toxicity by allopurinol in man

Oxipurinol, the major metabolite of allopurinol, decreased the toxicity of 5-fluorouracil (5-FU) to human granulocyte colony-forming units in vitro by a factor of four. The ability of allopurinol to reduce 5-FU toxicity in vivo was studied in 23 advanced cancer patients during 42 courses of treatment. 5-FU was administered by continuous intravenous infusion for five days; allopurinol, 300 mg, po, every 8 hours was started 2 hours before and continued during and for 24 hours after 5-FU infusion. 5-FU was escalated from 1.5 to 2.25 g/m2/day on separate courses; the dose-limiting toxicity was mucositis which occurred at a level of 2.0 g/m2/day. At a 5-FU dose rate of greater than 2.0 g/m2/day 5-FU pharmacokinetics were nonlinear, reflecting saturation of catabolic pathways, and the steady-state 5-FU serum concentration was approximately 4 times that which was tolerable without allopurinol. At these concentrations of 5-FU oxipurinol significantly influenced the clearance of 5-FU. Thus concurrent allopurinol therapy permitted a doubling of the maximum tolerated dose of 5-FU and a four-fold increase in the tolerated concentration x time exposure to 5-FU.

The genes for and regulation of the enzyme activities of two multifunctional proteins required for the de novo pathway for UMP biosynthesis in mammals

UMP biosynthesis requires six enzyme activities. Five of these enzyme centers are clustered into two multienzymatic proteins which are known to, or appear to, sequester the intermediates carbamyl approximately P, carbamyl aspartate and orotidylic acid. The advantages of sequestering these intermediates appear to be a conservation of energy, since two intermediates, carbamyl approximately P and orotidylate, might otherwise be rapidly degraded in mammalian cells. Carbamyl-aspartate appears not to be degraded rapidly in mammalian cells but it can pass into the blood and could possible disrupt brain metabolism by action as an acetylaspartate analog, if it passes the blood-brain barrier. For this, and possible for other reasons, there may be advantages to the fact that these intermediates are not other reasons, there may be advantages to the fact that these intermediates are not readily released from Complex A and U. In addition, these multienzymatic proteins may have other kinetic advantages, some of which have been discussed above. Studies with intact cells illustrate that azauridine, a chemical designed originally as an antineoplastic drug, produces a "ripple" effect when it inhibits the last enzyme of this pathway which leads to a sequential accumulation of pools of the various intermediates or their metabolites. This same agent increases the amount of some of the enzymes of this biosynthetic pathway in cells exposed to this drug. Both of these effects can negate the effectiveness of this potential antineoplastic drug. Sophisticated drug design may depend on whole-cell studies, such as those discussed here, in addition to the classic studies on the inhibition of a single enzyme center to select drugs that may be without significant side effects when they are finally tested in animals.

Elevation of pyrimidine enzyme activities in the RBC of patients with congenital hypoplastic anaemia and their parents

The activities of orotate phosphoribosyl transferase (OPRT) and orotidine monophosphate decarboxylase (ODC) were significantly elevated (P less than 0.001) in erythrocytes (RBC) from five patients with prednisone-responsive congenital hypoplastic anaemia (CHA). (OPRT: patients - 10.1--64.2 nmol/h/10(9) RBC; controls - 2.8 +/- 0.3 (mean +/- SEM, n = 37); ODC: patients = 30--124 nmol/h/10(9) RBC; controls = 10.2 +/- 0.7 (mean SEM, n = 37).) Two patients had a less pronounced, but significant, increase of aspartate transcarbamylase activity and three patients had marginal increases of dihydroorotase activity. Dihydroorotate dehydrogenase activity was not detected in any CHA patient or control. In one patient prior to prednisone therapy, the OPRT and ODT activities were elevated 10-fold and remained elevated 3-fold after 16 months of therapy. An elevated enzyme pattern similar to that of RBC from CHA patients was observed in three parents of three CHA patients, but not in three parents of two other CHA patients. The activities of all five pyrimidine enzymes were normal for one patient with transient erythroblastopenia of childhood. In contrast, the activities of all the pyrimidine biosynthetic enzymes were elevated in blood from patients with a young RBC population: sickle cell anaemia, sickle-beta-thalassaemia, hereditary spherocytosis, and DiGuglielmo syndrome and from the newborn. It is postulated that factors which affect the activities of pyrimidine enzymes in CHA may also result in diminished erythropoiesis.

[Properties of hypoxanthineguanine-phosphoribosyltransferase (HGPRTase) in a gout patient with partial deficiency of this enzyme (author's transl)]

Some physicochemical properties of HGPRTase were studied in hemolysates and fibroblasts of a gout patient with partial deficiency of this enzyme. In comparison to normal HGPRTase the mutant enzyme from erythrocytes was found to have an elevated apparent Km-value for hypoxanthine and guanine and a lower Km-value for PRPP. The patient's enzyme from erythrocytes is more stable at +4 degrees C and +80 degrees C, the enzyme from fibroblasts more labile than that of controls. The inhibition of the mutant enzyme by some purine nucleosides and -nucleotides differed from that found in controls. No evidence was shown for an inhibitor of the patient's HGPRTase from erythrocytes. Ultracentrifugation of hemolysate in a saccharose gradient revealed no difference in the sedimentation coefficient.

The urinary excretion of orotic acid and orotidine, measured by an isotope dilution assay

Unknown concentrations of orotic acid can be measured by competition with a known amount of [carboxyl-14C]orotic acid for reaction with a limiting amount of phosphoribosylpyrophosphate in the presence of orotate phosphoribosyltransferase and orotidine monophosphate decarboxylase. The dilution of the specific radioactivity in the product 14CO2 is a sensitive and accurate measure of the amount of orotic acid present in the sample. Orotidine can also be determined after hydrolytic cleavage to orotic acid. The method was used to measure orotic acid and orotidine in urine samples from newborns, healthy controls and patients with gout or deficiency of hypoxanthine-guanine phosphoribosyltransferase receiving allopurinol. Urinary excretion of orotic acid and orotidine in newborns was similar whether the infants were breast-fed or received milk powder. The excretion of orotidine was increased in all patients receiving allopurinol. After allopurinol administration orotic acid excretion was increased in gouty patients but close to normal values in patients with deficiency of hypoxanthine-guanine phosphoribosyltransferase. The results are discussed in relation to the mechanism by which allopurinol inhibits pyrimidine metabolism.