The effects of hypoxia on drug-metabolizing enzymes

Human Parathion Poisoning

The mortality rate of suicidal parathion poisoning is particularly high, the onset of fulminant cholinergic signs, and the patients frequently present to the emergency physician with life-threatening symptoms. Despite this uniformity, subsequent clinical course differs significantly among patients, mostly not as a result of different delays in treatment or insufficiency of primary care. Probably, the differences depend on the amount of poison absorbed and/or the disposition of the active poison, paraoxon. We followed the toxicokinetics of parathion and tried to quantify the actual poison load. To this end, we monitored parathion-intoxicated patients (patients requiring artificial ventilation) for plasma levels of parathion and paraoxon along with the activity of erythrocyte acetylcholinesterase and its reactivatability. Plasma obidoxime concentrations were followed as well as the cumulative urinary para-nitrophenol conjugate excretion as a measure of total poison load. All patients received a standard obidoxime scheme of a 250 mg bolus dose intravenously, followed by continuous infusion with 750 mg per 24 hours as long as reactivation could be expected (usually 1 week). All other treatment was instituted as judged by the physician. It was recommended to use atropine at low doses to achieve dry mucous membranes, no bronchoconstriction and no bradycardia. Usually 1-2 mg/h were sufficient. Seven selected cases are presented exemplifying toxicokinetic peculiarities. All patients were severely intoxicated, while the amount of parathion absorbed varied widely (between 0.12 and 4.4 g; lethal dose 0.02-0.1 g) and was generally much lower than anticipated from the reports of relatives. It remains open whether the discrepancies between reports and findings were due to exaggeration or to effective decontamination (including spontaneous vomiting, gastric lavage and activated charcoal). Absorption of parathion from the gastrointestinal tract was sometimes retarded, up to 5 days, resulting in fluctuating plasma profiles. The volume of distribution at steady-state (Vdss) of parathion was around 20 L/kg. Post-mortem analysis in one patient revealed a 66-fold higher parathion concentration in fat tissue compared with plasma, 16 days after ingestion. Biotransformation of parathion varied widely and was severely retarded in one patient receiving fluconazole during worsening of renal function, while phenobarbital (phenobarbitone) sedation (two cases) had apparently no effect. The proportion of plasma parathion to paraoxon varied from 0.3-30, pointing also to varying paraoxon elimination, as illustrated by one case with particularly low paraoxonase-1 activity. Obidoxime was effective at paraoxon concentrations below 0.5 microM, provided aging was not too advanced. This concentration correlated poorly with the paration concentration or the poison load. The data are discussed in light of the pertinent literature.

Role of hypoxia and constitutionally different resistance to hypoxia/stress as the determiners of individual profile of cytochrome P450 isozyme activity

The hepatic cytochromes P450 1A1, 1A2, 2B1, and 2E1 activities have been investigated in the sublines of Wistar rats with principally different (high or low) resistance to hypoxia/stress. Repeated measurements in normoxic conditions showed a significant prevalence of total cytochrome P450 content, CYP 1A1, and CYP 2E1 activities in rats with low-resistance (LR) to hypoxia compared to rats with high-resistance to hypoxia (HR), whereas in HR rats the CYP 1A2 activity was 63% higher (p < 0.001) than in LR rats. In the conditions of acute hypobaric hypoxia these differences were manifested distinctly: in HR rats an enhancement of CYP 1A2 activity by 49% of aerobic value (p < 0.01) was observed, in LR rats the total P450 content, CYP 1A1 and 2E1 activities (p < 0.05-0.001) were increased. The 30-min total liver ischemia formed an individual response of the drug-metabolizing system: in HR rats CYP 1A2 and 2B1 activities were decreased in the early postischemic period and were not restored by the 21st day, whereas in LR rats CYP 1A2 activity was not affected and was induced more than 2-fold of aerobic value in the late post-ischemic period. The CYP 2B1 activity was induced almost 1.5-fold during the whole postischemic period. These data suggest that acute hypoxia and individual resistance to hypoxia/stress, one of the cardinal constitutional features, provide an individual reaction of drug-metabolizing system and enzymes of P450, in particular. The individual constitutional resistance to hypoxia/stress may be a serious criterion for an individual approach in pharmacotherapy of hypoxic states, diseases, as well as for prognosis and prevention of early and distant complications of irrational pharmacotherapy.

Pesticides and Parkinson's disease

Epidemiological studies and case reports provide evidence for an association between Parkinson's disease and past exposure to pesticides. Susceptibility to the effects of pesticides and other putative neurotoxins depends on variability in xenobiotic metabolism possibly generated by genetic polymorphisms, aging and variation in exposure to environmental agents including pesticides. The simplest mechanistic hypothesis for the association of pesticides with Parkinson's disease is that pesticides or their metabolites are directly toxic to mitochondria, although modulation of xenobiotic metabolism by pesticides provides an adjunct or alternative hypothesis.

Binding of 3H-metronidazole in olfactory, respiratory and alimentary epithelia in rats

Whole-body autoradiography of 3H-metronidazole in rats showed retention of bound metabolites in the epithelia lining the olfactory part of the nose, the tongue, the gingiva, the palate, the pharynx, the oesophagus and the forestomach. In vitro microautoradiography in O2- and N2-atmosphere with some of these tissues indicated reductive formation of bound metabolites in specific cells of the epithelia. Studies with subcellular fractions of the nasal olfactory mucosa showed formation of DNA- and protein-bound metronidazole metabolites. A lower bioactivating capacity was found in experiments with the liver. The bioactivation was dependent on N2-atmosphere, and presence of the P450-inhibitor metyrapone or GSH in the incubation media depressed the protein-binding of metronidazole both in the nasal olfactory mucosa and the liver. These data indicate that the bioactivation is partly P450-dependent and GSH may play an important role in scavaging the bioactivated drug. The epithelial cells with a capacity to bioactivate metronidazole may be potential targets for negative effects of the drug. Whole-body autoradiography also showed a strong binding of radioactivity in the contents of caecum and colon. This can be considered to be due to reductive bioactivation of metronidazole by the intestinal microorganisms and reflects the principal site of action of the drug.