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van Asseldonk DP, Crouwel F, Seinen ML, Scheffer PG, Veldkamp AI, de Boer NK, Lissenberg-Witte B, Peters GJ, van Bodegraven AA. Exploring the role of oxidative stress and the effect of N-acetylcysteine in thiopurine-induced liver injury in inflammatory bowel disease: A randomized crossover pilot study. Basic Clin Pharmacol Toxicol 2024; 134:507-518. [PMID: 38284479 DOI: 10.1111/bcpt.13978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 12/29/2023] [Accepted: 01/01/2024] [Indexed: 01/30/2024]
Abstract
Thiopurine treatment is regularly complicated by drug-induced liver injury. It has been suggested that oxidative stress may play a synergistic role. To assess whether thiopurine-induced liver injury coincides with increased oxidative stress and whether co-administration with N-acetylcysteine is protective, we performed a randomized open label crossover pilot study in inflammatory bowel disease patients with thiopurine-induced increased serum liver tests. The study comprised four stages of 4 weeks. Patients received no additional therapy followed by N-acetylcysteine 1200 mg twice a day, or the other way around, alongside ongoing thiopurine treatment. The third and fourth stages comprised a washout period and thiopurine reintroduction period. Nine patients completed the study, and the addition of N-acetylcysteine decreased myeloperoxidase concentrations (33.6-24.5 pmol/L, p = 0.038). The other biomarkers remained unchanged, including thiopurine metabolites, xanthine oxidase activity, thiopurine S-methyltransferase activity and serum liver enzyme activity tests. Reintroduction of thiopurines led to an increase of F2-isoprostanes (101-157 ng/mmol, p = 0.038), but not of serum liver enzyme activity tests. Results suggests that thiopurines may increase oxidative stress and although the addition of N-acetylcysteine led to a decrease in plasma myeloperoxidase concentrations, it does not protect from thiopurine-induced increase of serum liver tests.
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Affiliation(s)
- Dirk P van Asseldonk
- Department of Gastroenterology and Hepatology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam University Medical Centers, Location VUMC, Amsterdam, The Netherlands
| | - Femke Crouwel
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam University Medical Centers, Location VUMC, Amsterdam, The Netherlands
| | - Margien L Seinen
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam University Medical Centers, Location VUMC, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Peter G Scheffer
- Metabolic Laboratory, Department of Clinical Chemistry, Amsterdam University Medical Centers, Location VUMC, Amsterdam, The Netherlands
| | - Agnes I Veldkamp
- Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Centers, Location VUMC, Amsterdam, The Netherlands
| | - Nanne K de Boer
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam University Medical Centers, Location VUMC, Amsterdam, The Netherlands
| | - Birgit Lissenberg-Witte
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Location VUMC, Amsterdam, The Netherlands
| | - Godefridus J Peters
- Department of Medical Oncology, Amsterdam University Medical Centers, Location VUMC, Amsterdam, The Netherlands
- Department of Biochemistry, Medical University of Gdansk, Gdansk, Poland
| | - Adriaan A van Bodegraven
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam University Medical Centers, Location VUMC, Amsterdam, The Netherlands
- Department of Gastroenterology, Geriatrics, Internal and Intensive Care Medicine (CO-MIK), Zuyderland Medical Centre, Heerlen-Sittard-Geleen, The Netherlands
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2
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Heidari M, Khalili M, Balouchi F, Roozbeh J, Shamsaefar AR, Malek Hosseini SA, Karimi MH. Investigation of the Association Between ITPA Gene 94C>A Sequence Variant and Kidney Transplant Rejection in Iranian Kidney Transplant Recipients. EXP CLIN TRANSPLANT 2023; 21:652-656. [PMID: 37698399 DOI: 10.6002/ect.2023.0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
OBJECTIVES Thiopurine prodrugs are commonly used in kidney transplant recipients. Inosine triphosphate pyrophosphatase is an enzyme encoded by the ITPA gene. Alteration of ITPA gene is one of the pharmacogenetic sequence variants possibly involved in thiopurine metabolism. The ITPA 94C>A sequence variant (C-to-A substitution at nucleotide 94) is associated with an increased risk of adverse drug reactions in patients treated with the thiopurine drug. The aim of the present study was to investigate the effect of the ITPA 94C>A gene sequence variant in kidney transplant recipients. MATERIALS AND METHODS The genotyping of the ITPA rs1127354 variant was performed by the polymerase chain reaction restriction fragment length polymorphism method in 140 kidney transplant recipients and in 100 control participants. Data were analyzed with SPSS statistical software. RESULTS The results revealed a significant difference between control and nonrejection groups regarding the rs1127354 genotype and allele frequency. No significant difference was found between the rejection and nonrejection groups regarding the rs1127354 genotype and allele frequency. Also, a significant association was observed between the ageofthe control group and age of the rejection group. No significant differences between sex and underlying disease in patients with or without rejection were observed. CONCLUSIONS We observed no significant differences between rejection and nonrejection transplant. Further studies are recommended, in a larger population and with different ethnicities.
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Affiliation(s)
- Mozhdeh Heidari
- >From the Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Sikorski PM, Kusner LL, Kaminski HJ. Myasthenia Gravis. Clin Immunol 2023. [DOI: 10.1016/b978-0-7020-8165-1.00065-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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Genova E, Lucafò M, Pelin M, Di Paolo V, Quintieri L, Decorti G, Stocco G. Insights into the cellular pharmacokinetics and pharmacodynamics of thiopurine antimetabolites in a model of human intestinal cells. Chem Biol Interact 2021; 347:109624. [PMID: 34416244 DOI: 10.1016/j.cbi.2021.109624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/04/2021] [Accepted: 08/16/2021] [Indexed: 02/07/2023]
Abstract
Thiopurines, immunomodulating drugs used in the management of different chronic autoimmune conditions and as anti-leukemic agents, may exert in some cases gastrointestinal toxicity. Moreover, since these agents are administered orally, they are absorbed across the gastrointestinal tract epithelium. On these premises, cellular and molecular events occurring in intestinal cells may be important to understand thiopurine effects. However, quantitative information on the biotransformation of thiopurines in intestinal tissues is still limited. To shed light on biotransformation processes specific of the intestinal tissue, in this study thiopurine metabolites concentrations were analyzed by an in vitro model of human healthy colon, the HCEC cell line, upon exposure to cytotoxic concentrations of azathioprine or mercaptopurine; the investigation was carried out using an innovative mass spectrometry method, that allowed the simultaneous quantification of 11 mono-, di-, and triphosphate thionucleotides. Among the 11 metabolites evaluated, TIMP, TGMP, TGDP, TGTP, MeTIMP, MeTIDP and MeTITP were detectable in HCEC cells treated with azathioprine or mercaptopurine, considering two different incubation times before the addition of the drugs (4 and 48 h). Different associations between metabolites concentrations and cytotoxicity were detected. In particular, the cytotoxicity was dependent on the TGMP, TGDP, TGTP and MeTITP concentrations after the 4 h incubation before the addition of thiopurines. This may be an indication that, to study the association between thiopurine metabolite concentrations and the cytotoxicity activity in vitro, short growth times before treatment should be used. Moreover, for the first time our findings highlight the strong correlation between cytotoxicity and thiopurine pharmacokinetics in HCEC intestinal cells in vitro suggesting that these cells could be a suitable in vitro model for studying thiopurine intestinal cytotoxicity.
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Affiliation(s)
- Elena Genova
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Marianna Lucafò
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Marco Pelin
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Veronica Di Paolo
- Laboratory of Drug Metabolism, Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
| | - Luigi Quintieri
- Laboratory of Drug Metabolism, Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
| | - Giuliana Decorti
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy; Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - Gabriele Stocco
- Department of Life Sciences, University of Trieste, Trieste, Italy
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5
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Genova E, Cavion F, Lucafò M, Pelin M, Lanzi G, Masneri S, Ferraro RM, Fazzi EM, Orcesi S, Decorti G, Tommasini A, Giliani S, Stocco G. Biomarkers and Precision Therapy for Primary Immunodeficiencies: An
In Vitro
Study Based on Induced Pluripotent Stem Cells From Patients. Clin Pharmacol Ther 2020; 108:358-367. [DOI: 10.1002/cpt.1837] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/06/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Elena Genova
- PhD Course in Reproductive and Developmental Sciences University of Trieste Trieste Italy
- Department of Life Sciences University of Trieste Trieste Italy
| | - Federica Cavion
- Department of Life Sciences University of Trieste Trieste Italy
| | - Marianna Lucafò
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste Italy
| | - Marco Pelin
- Department of Life Sciences University of Trieste Trieste Italy
| | - Gaetana Lanzi
- ″Angelo Nocivelli” Institute for Molecular Medicine ASST Spedali Civili Brescia Italy
- Department of Molecular and Translational Medicine University of Brescia Brescia Italy
| | - Stefania Masneri
- ″Angelo Nocivelli” Institute for Molecular Medicine ASST Spedali Civili Brescia Italy
- Department of Molecular and Translational Medicine University of Brescia Brescia Italy
| | - Rosalba Monica Ferraro
- ″Angelo Nocivelli” Institute for Molecular Medicine ASST Spedali Civili Brescia Italy
- Department of Molecular and Translational Medicine University of Brescia Brescia Italy
| | - Elisa Maria Fazzi
- Child Neurology and Psychiatry Unit ASST Spedali Civili Brescia Italy
- Department of Clinical and Experimental Sciences University of Brescia Brescia Italy
| | - Simona Orcesi
- Department of Brain and Behavioral Sciences University of Pavia Italy
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation Pavia Italy
| | - Giuliana Decorti
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste Italy
- Department of Medical, Surgical and Health Sciences University of Trieste Trieste Italy
| | - Alberto Tommasini
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste Italy
| | - Silvia Giliani
- ″Angelo Nocivelli” Institute for Molecular Medicine ASST Spedali Civili Brescia Italy
- Department of Molecular and Translational Medicine University of Brescia Brescia Italy
| | - Gabriele Stocco
- Department of Life Sciences University of Trieste Trieste Italy
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Luceri C, Bigagli E, Agostiniani S, Giudici F, Zambonin D, Scaringi S, Ficari F, Lodovici M, Malentacchi C. Analysis of Oxidative Stress-Related Markers in Crohn's Disease Patients at Surgery and Correlations with Clinical Findings. Antioxidants (Basel) 2019; 8:antiox8090378. [PMID: 31489956 PMCID: PMC6771139 DOI: 10.3390/antiox8090378] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 12/13/2022] Open
Abstract
Crohn' disease (CD) patients are at high risk of postoperative recurrence and new tools for the assessment of disease activity are needed to prevent long-term complications. In these patients, the over-production of ROS generated by inflamed bowel tissue and inflammatory cells activates a pathogenic cascade that further exacerbates inflammation and leads to increased oxidative damage to DNA, proteins, and lipids. We measured the products of protein/lipid oxidation and the total antioxidant capacity (ferric reducing ability of plasma, FRAP) in the serum of CD patients with severe disease activity requiring surgery with the aim to characterize their redox status and identify associations between oxidative stress-related markers and their clinical characteristics. At the systemic level, CD was associated with increased levels of protein and lipid oxidation products when compared to healthy volunteers, even though the FRAP values were similar. Advanced oxidation protein product (AOPP) levels showed the highest difference between patients and the controls (11.25, 5.02-15.15, vs. 1.36, 0.75-2.70, median, interquartile range; p < 0.0001) and the analysis of receiver operating characteristic (ROC) curves, indicated for AOPP, the best area under the curve (AUC) value for CD prediction. Advanced glycated end-products (AGEs) were also significantly higher in CD patients (p < 0.01), which is of interest since AOPP and AGEs are both able to activate the membrane receptor for advanced glycation end products (RAGE) involved in inflammatory diseases. Thiobarbituric acid reactive substance (TBARS) levels were significantly higher in CD patients with ileal localization and aggressive disease behavior, in smokers, and in patients suffering from allergies. In conclusion, our data indicate that circulating oxidative stress biomarkers may be attractive candidates as disease predictors as well as for clinical or therapeutic monitoring of CD. Our results also suggest that AOPP/AGEs and RAGE signaling may represent a pathogenic factor and a potential therapeutic target in CD.
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Affiliation(s)
- Cristina Luceri
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), Section of Pharmacology and Toxicology, University of Florence, 50139 Florence, Italy.
| | - Elisabetta Bigagli
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), Section of Pharmacology and Toxicology, University of Florence, 50139 Florence, Italy.
| | - Sara Agostiniani
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), Section of Pharmacology and Toxicology, University of Florence, 50139 Florence, Italy
| | - Francesco Giudici
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Daniela Zambonin
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Stefano Scaringi
- Department of Experimental and Clinical Medicine, Surgery Unit IBD, Careggi-University Hospital (AOUC), 50139 Florence, Italy
| | - Ferdinando Ficari
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Maura Lodovici
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), Section of Pharmacology and Toxicology, University of Florence, 50139 Florence, Italy
| | - Cecilia Malentacchi
- Department of Biomedical Experimental and Clinical Sciences "Mario Serio", University of Florence, 50134 Florence, Italy
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7
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Vestergaard C, Wollenberg A, Barbarot S, Christen-Zaech S, Deleuran M, Spuls P, Flohr C, Trzeciak M, von Kobyletzki L, Seneschal J, Paul C, Bieber T, Werfel T, Fölster-Holst R, Darsow U, Gieler U, Svensson Å, Cork M, Stalder JF, De Raeve L, Kunz B, Simon D, Chernyshov P, Hijnen D, Gelmetti C, Ring J, Taieb A, de Bruin-Weller M, Thyssen JP. European task force on atopic dermatitis position paper: treatment of parental atopic dermatitis during preconception, pregnancy and lactation period. J Eur Acad Dermatol Venereol 2019; 33:1644-1659. [PMID: 31231864 DOI: 10.1111/jdv.15709] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 05/07/2019] [Indexed: 12/14/2022]
Abstract
Atopic dermatitis (AD) is a common inflammatory skin disease that affects both children and adults, including a large number of adults of reproductive age. Several guidelines for the treatment of AD exist, yet specific recommendations for the treatment of pregnant or lactating women and for adults planning to have a child are often lacking. This position paper from the European Task force on Atopic Dermatitis (ETFAD) is based on up-to-date scientific literature on treating pregnant and lactating women as wells as adults with AD planning to have a child. It is based on the expert opinions of members of the ETFAD and on existing safety data on the proposed treatments, many of which are derived from patients with other inflammatory diseases or from transplantation medicine. For treating future parents, as well as pregnant and lactating women with AD, the use of topical treatments including moisturizers, topical corticosteroids, tacrolimus, antiseptics such as chlorhexidine, octenidine, potassium permanganate and sodium hypochlorite (bleach) is deemed to be safe. Ultraviolet (UV) therapy may also be used. Systemic treatment should be prescribed only after careful consideration. According to the opinion of the ETFAD, treatment should be restricted to systemic corticosteroids and cyclosporine A, and, in selected cases, azathioprine.
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Affiliation(s)
- C Vestergaard
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - A Wollenberg
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany.,Hautklinik Thalkirchner Straße, Staedtisches Klinikum Muenchen, Muenchen, Germany
| | - S Barbarot
- Department of Dermatology, CHU Nantes, Nantes, France
| | - S Christen-Zaech
- Pediatric Dermatology Unit, Departments of Dermatology and Pediatrics, Lausanne University Hospital, Lausanne, Switzerland
| | - M Deleuran
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - P Spuls
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C Flohr
- St. Johns Institute of Dermatology, Kings College and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Trzeciak
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland
| | | | - J Seneschal
- Department of dermatology, INSERM, University of Bordeaux, Bordeaux, France
| | - C Paul
- Department of Dermatology, Larrey Hospital, Toulouse University, Toulouse, France
| | - T Bieber
- Department of Dermatology and Allergology, and Christine Kühne-Center for Allergy Research and Education, University of Bonn, Bonn, Germany
| | - T Werfel
- Department of Dermatology and Allergology, Hannover Medical School, Hannover, Germany
| | - R Fölster-Holst
- Department of Dermatology, Venerology and Allergology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - U Darsow
- Department of Dermatology and Allergology Biederstein, Technical University of Munich, Munich, Germany
| | - U Gieler
- Department of Dermatology, Justus-Liebig-University, Giessen, Germany
| | - Å Svensson
- Department of Dermatology, Lund University, Malmoe, Sweden
| | - M Cork
- Sheffield Dermatology Research, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - J-F Stalder
- Department of Dermatology, CHU Nantes, Nantes, France
| | - L De Raeve
- Department of Dermatology, UZ Brussel, Free University of Brussels (VUB), Brussels, Belgium
| | - B Kunz
- Dermatologikum, Hamburg, Germany
| | - D Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - P Chernyshov
- Department of Dermatology, National Medical University, Kiev, Ukraine
| | - D Hijnen
- Department of Dermatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - C Gelmetti
- Department of Pediatric Dermatology, Ospedale Maggiore Policlinico, University of Milan, Milano, Italy
| | - J Ring
- Department of Dermatology and Allergology Biederstein, Technical University of Munich, Munich, Germany.,Christiane-Kühne Center for Allergy Research and Education (CK-Care), Davos, Switzerland
| | - A Taieb
- Department of dermatology, INSERM, University of Bordeaux, Bordeaux, France
| | - M de Bruin-Weller
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J P Thyssen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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General Principles of Immunotherapy in Neurological Diseases. CONTEMPORARY CLINICAL NEUROSCIENCE 2019. [DOI: 10.1007/978-3-030-19515-1_12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Wang S, Breskovska I, Gandhy S, Punga AR, Guptill JT, Kaminski HJ. Advances in autoimmune myasthenia gravis management. Expert Rev Neurother 2018; 18:573-588. [PMID: 29932785 PMCID: PMC6289049 DOI: 10.1080/14737175.2018.1491310] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Myasthenia gravis (MG) is an autoimmune neuromuscular disorder with no cure and conventional treatments limited by significant adverse effects and variable benefit. In the last decade, therapeutic development has expanded based on improved understanding of autoimmunity and financial incentives for drug development in rare disease. Clinical subtypes exist based on age, gender, thymic pathology, autoantibody profile, and other poorly defined factors, such as genetics, complicate development of specific therapies. Areas covered: Clinical presentation and pathology vary considerably among patients with some having weakness limited to the ocular muscles and others having profound generalized weakness leading to respiratory insufficiency. MG is an antibody-mediated disorder dependent on autoreactive B cells which require T-cell support. Treatments focus on elimination of circulating autoantibodies or inhibition of effector mechanisms by a broad spectrum of approaches from plasmapheresis to B-cell elimination to complement inhibition. Expert commentary: Standard therapies and those under development are disease modifying and not curative. As a rare disease, clinical trials are challenged in patient recruitment. The great interest in development of treatments specific for MG is welcome, but decisions will need to be made to focus on those that offer significant benefits to patients.
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Affiliation(s)
- Shuhui Wang
- Department of Neurology, George Washington University, Washington DC 20008
| | - Iva Breskovska
- Department of Neurology, George Washington University, Washington DC 20008
| | - Shreya Gandhy
- Department of Neurology, George Washington University, Washington DC 20008
| | - Anna Rostedt Punga
- Department of Neuroscience, Clinical Neurophysiology, Uppsala University, Uppsala, Sweden
| | - Jeffery T. Guptill
- Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Henry J. Kaminski
- Department of Neurology, George Washington University, Washington DC 20008
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Pelin M, Genova E, Fusco L, Marisat M, Hofmann U, Favretto D, Lucafò M, Taddio A, Martelossi S, Ventura A, Stocco G, Schwab M, Decorti G. Pharmacokinetics and pharmacodynamics of thiopurines in an in vitro model of human hepatocytes: Insights from an innovative mass spectrometry assay. Chem Biol Interact 2017; 275:189-195. [PMID: 28811125 DOI: 10.1016/j.cbi.2017.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 07/05/2017] [Accepted: 08/11/2017] [Indexed: 02/07/2023]
Abstract
AIM To apply an innovative LC-MS/MS method to quantify thiopurine metabolites in human hepatocytes and to associate them to cytotoxicity. METHODS Immortalized human hepatocytes (IHH cells) were treated for 48 and 96 h, with 1.4 × 10-4 M azathioprine and 1.1 × 10-3 M mercaptopurine, concentrations corresponding to the IC50 values calculated after 96 h exposure in previous cytotoxicity analysis. After treatments, cells were collected for LC-MS/MS analysis to quantify 11 thiopurine metabolites with different level of phosphorylation and viable cells were counted by trypan blue exclusion assay to determine thiopurines in vitro effect on cell growth and survival. Statistical significance was determined by analysis of variance (ANOVA). RESULTS Azathioprine and mercaptopurine had a significant time-dependent cytotoxic effect (p-value ANOVA = 0.012), with a viable cell count compared to controls of 55.5% and 67.5% respectively after 48 h and 23.7% and 36.1% after 96 h; no significant difference could be observed between the two drugs. Quantification of thiopurine metabolites evidenced that the most abundant metabolite was TIMP, representing 57.1% and 40.3% of total metabolites after 48 and 96 h. Total thiopurine metabolites absolute concentrations decreased over time: total mean content decreased from 469.9 pmol/million cells to 83.6 pmol/million cells (p-value ANOVA = 0.0070). However, considering the relative amount of thiopurine metabolites, TGMP content significantly increased from 11.4% cells to 26.4% (p-value ANOVA = 0.017). A significant association between thiopurine effects and viable cell counts could be detected only for MeTIMP: lower MeTIMP concentrations were associated with lower cell survival (p-value ANOVA = 0.011). Moreover, the ratio between MeTIMP and TGMP metabolites directly correlated with cell survival (p-value ANOVA = 0.037). CONCLUSION Detailed quantification of thiopurine metabolites in a human hepatocytes model provided useful insights on the association between thioguanine and methyl-thioinosine nucleotides with cell viability.
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Affiliation(s)
- Marco Pelin
- Department of Life Sciences, University of Trieste, I-34127 Trieste, Italy
| | - Elena Genova
- PhD School in Reproduction and Developmental Sciences, University of Trieste, I-34127 Trieste, Italy
| | - Laura Fusco
- PhD School in Chemistry, University of Trieste, I-34127 Trieste, Italy
| | - Monzer Marisat
- Department of Medical, Surgical and Health Sciences, University of Trieste, I-34127 Trieste, Italy
| | - Ute Hofmann
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, D-70376 Stuttgart, Germany; University of Tübingen, Tübingen, Germany
| | - Diego Favretto
- Institute for Maternal and Child Health I.R.C.C.S. Burlo Garofolo, I-34137 Trieste, Italy
| | - Marianna Lucafò
- Department of Medical, Surgical and Health Sciences, University of Trieste, I-34127 Trieste, Italy
| | - Andrea Taddio
- Department of Medical, Surgical and Health Sciences, University of Trieste, I-34127 Trieste, Italy; Institute for Maternal and Child Health I.R.C.C.S. Burlo Garofolo, I-34137 Trieste, Italy
| | - Stefano Martelossi
- Institute for Maternal and Child Health I.R.C.C.S. Burlo Garofolo, I-34137 Trieste, Italy
| | - Alessandro Ventura
- Department of Medical, Surgical and Health Sciences, University of Trieste, I-34127 Trieste, Italy; Institute for Maternal and Child Health I.R.C.C.S. Burlo Garofolo, I-34137 Trieste, Italy
| | - Gabriele Stocco
- Department of Life Sciences, University of Trieste, I-34127 Trieste, Italy.
| | - Matthias Schwab
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, D-70376 Stuttgart, Germany; University of Tübingen, Tübingen, Germany; Department of Clinical Pharmacology, University Hospital Tübingen, D-72076 Tübingen, Germany; Department of Pharmacy and Biochemistry, University of Tübingen, D-72076 Tübingen, Germany
| | - Giuliana Decorti
- Department of Medical, Surgical and Health Sciences, University of Trieste, I-34127 Trieste, Italy; Institute for Maternal and Child Health I.R.C.C.S. Burlo Garofolo, I-34137 Trieste, Italy
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Xanthine oxidase inhibitors from Archidendron clypearia (Jack.) I.C. Nielsen: Results from systematic screening of Vietnamese medicinal plants. ASIAN PAC J TROP MED 2017; 10:549-556. [PMID: 28756918 DOI: 10.1016/j.apjtm.2017.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/08/2017] [Accepted: 05/26/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To screen Vietnamese medicinal plants for xanthine oxidase (XO) inhibitory activity and to isolate XO inhibitor(s) from the most active plant. METHODS The plants materials were extracted by methanol. The active plant materials were fractionated using different organic solvents, including n-hexane, ethyl acetate, and n-butanol. Bioassay-guided fractionation and column chromatography were used to isolate compounds. The compounds structures were elucidated by analysis of spectroscopic data, including IR, MS, and NMR. RESULTS Three hundreds and eleven methanol extracts (CME) belonging to 301 Vietnamese herbs were screened for XO inhibitory activity. Among these plants, 57 extracts displayed XO inhibitory activity at 100 μg/mL with inhibition rates of over 50%. The extracts of Archidendron clypearia (A. clypearia), Smilax poilanei, Linociera ramiflora and Passiflora foetida exhibited the greatest potency with IC50 values below 30 μg/mL. Chemical study performed on the extract of A. clypearia resulted in the isolation of six compounds, including 1-octacosanol, docosenoic acid, daucosterol, methyl gallate, quercitrin and (-)-7-O-galloyltricetiflavan. The compound (-)-7-O-galloyltricetiflavan showed the most potent XO inhibitory activity with an IC50 value of 25.5 μmol/L. CONCLUSIONS From this investigation, four Vietnamese medicinal plants were identified to have XO inhibitory effects with IC50 values of the methanol extracts below 30 μg/mL. Compound (-)-7-O- galloyltricetiflavan was identified as an XO inhibitor from A. clypearia with IC50 value of 25.5 μmol/L.
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Combination treatment with 6-mercaptopurine and allopurinol in HepG2 and HEK293 cells - Effects on gene expression levels and thiopurine metabolism. PLoS One 2017; 12:e0173825. [PMID: 28278299 PMCID: PMC5344510 DOI: 10.1371/journal.pone.0173825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 02/26/2017] [Indexed: 12/13/2022] Open
Abstract
Combination treatment with low-dose thiopurine and allopurinol (AP) has successfully been used in patients with inflammatory bowel disease with a so called skewed thiopurine metabolite profile. In red blood cells in vivo, it reduces the concentration of methylated metabolites and increases the concentration of the phosphorylated ones, which is associated with improved therapeutic efficacy. This study aimed to investigate the largely unknown mechanism of AP on thiopurine metabolism in cells with an active thiopurine metabolic pathway using HepG2 and HEK293 cells. Cells were treated with 6-mercaptopurine (6MP) and AP or its metabolite oxypurinol. The expression of genes known to be associated with thiopurine metabolism, and the concentration of thiopurine metabolites were analyzed. Gene expression levels were only affected by AP in the presence of 6MP. The addition of AP to 6MP affected the expression of in total 19 genes in the two cell lines. In both cell lines the expression of the transporter SLC29A2 was reduced by the combined treatment. Six regulated genes in HepG2 cells and 8 regulated genes in HEK293 cells were connected to networks with 18 and 35 genes, respectively, present at known susceptibility loci for inflammatory bowel disease, when analyzed using a protein-protein interaction database. The genes identified as regulated as well as the disease associated interacting genes represent new candidates for further investigation in the context of combination therapy with thiopurines and AP. However, no differences in absolute metabolite concentrations were observed between 6MP+AP or 6MP+oxypurinol vs. 6MP alone in either of the two cell lines. In conclusion; the effect of AP on gene expression levels requires the presence of 6MP, at least in vitro. Previously described AP-effects on metabolite concentrations observed in red blood cells in vivo could not be reproduced in our cell lines in vitro. AP’s effects in relation to thiopurine metabolism are complex. The network-identified susceptibility genes represented biological processes mainly associated with purine nucleotide biosynthetic processes, lymphocyte proliferation, NF-KB activation, JAK-STAT signaling, and apoptotic signaling at oxidative stress.
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