Involvement of CYP2D6 activity in the N-oxidation of procainamide in man

Occurrence of a lupus-like syndrome in a significant number of patients treated with procainamide has limited the clinical use of this antiarrhythmic drug. In-vitro studies conducted in our laboratory have demonstrated that CYP2D6 is the major cytochrome P450 isozyme involved in the formation of N-hydroxyprocainamide, a metabolite potentially involved in the drug-induced lupus erythematosus syndrome observed with procainamide. In the current study, we evaluated the role of CYP2D6 activity in the in-vivo oxidation of procainamide in man. Nineteen healthy individuals, 13 with high (extensive metabolizers) and six with low (poor metabolizers) CYP2D6 activity, received a single 500 mg oral dose of procainamide hydrochloride on two occasions, once alone (period 1) and once during the concomitant administration of the selective inhibitor quinidine (50 mg four times daily; period 2). Blood and urine samples were collected over 36 h after drug administration of procainamide and analysed for procainamide and its major metabolites (N-acetylprocainamide, desethylprocainamide, N-acetyl-desethylprocainamide, p-aminobenzoic acid and its N-acetylated derivative, and nitroprocainamide). No differences were observed in the oral and renal clearances of procainamide between extensive metabolizers and poor metabolizers during either study period. However, partial metabolic clearance of procainamide to desethylprocainamide was significantly greater in extensive metabolizers than in poor metabolizers during both periods. Most importantly, the urinary excretion of nitroprocainamide during period 1 was measurable in 7/13 extensive metabolizers but in none of the poor metabolizers. During the concomitant administration of quinidine, nitroprocainamide could not be detected in the urine of any individuals tested. Therefore, our results suggest that CYP2D6 is involved in the in-vivo aliphatic amine deethylation and N-oxidation of procainamide at its arylamine function in man. Further studies are needed to demonstrate whether a low CYP2D6 activity, either genetically determined or pharmacologically modulated, could prevent drug-induced lupus erythematosus syndrome observed during chronic therapy with procainamide.

Effect of hypoxia alone or combined with inflammation and 3-methylcholanthrene on hepatic cytochrome P450 in conscious rabbits

1 To investigate the effect of moderate hypoxia alone or combined with an inflammatory reaction or after 3-methylcholanthrene (3MC) pre-treatment on cytochrome P450 (P450), conscious rabbits were exposed for 24 h to a fractional concentration of inspired O2 of 10% (mean PaO2 of 34 mmHg). Hypoxia decreased theophylline metabolic clearance (ClM) from 1.73+/-0.43 to 1.48+/-0.13 ml min-1 kg-1 (P<0. 05), and reduced (P<0.05) the formation clearance of theophylline metabolites, 3-methylxanthine (3MX), 1-methyluric acid (1MU) and 1,3-dimethyluric acid (1,3DMU). Hypoxia reduced the amount of CYP1A1 and 1A2 but increased CYP3A6 proteins. 2 Turpentine-induced inflammatory reaction reduced (P<0.05) the formation clearance of 3MX, 1MU, and 1,3DMU, and diminished the amount of CYP1A1, 1A2 and 3A6 proteins. However, when combined with hypoxia, inflammation partially prevented the decrease in ClM, especially by impeding the reduction of 1,3DMU. The amount of CYP1A1 and 1A2 remained reduced but the amount of CYP3A6 protein returned to normal values. 3 Pre-treatment with 3MC augmented the ClM by 114% (P<0.05) due to the increase in the formation clearance of 3MX, 1MU and 1,3DMU. 3MC treatment increased the amount of CYP1A1 and 1A2 proteins. Pre-treatment with 3MC prevented the hypoxia-induced decrease in amount and activity of the P450. 4 It is concluded that acute moderate hypoxia and an inflammatory reaction individually reduce the amount and activity of selected apoproteins of the P450. However, the combination of hypoxia and the inflammatory reaction restores P450 activity to near normal values. On the other hand, pre-treatment with 3MC prevents the hypoxia-induced depression of the P450.

Improved high-performance liquid chromatographic assay for the determination of procainamide and its N-acetylated metabolite in plasma: application to a single-dose pharmacokinetic study

An improved high-performance liquid chromatographic assay for the determination of procainamide and N-acetylprocainamide (NAPA) at concentrations observed up to 32 h after a single oral dose administration of procainamide to human subjects is reported. Following liquid-liquid extraction of plasma samples, procainamide, NAPA, and the internal standard (N-propionylprocainamide) are separated on a reversed-phase C8 column with retention times of 4.0, 6.7, and 13.2 min, respectively. The ultraviolet detection limit (wavelength, 280 nm) of procainamide and NAPA is 2 ng/mL (signal-to-noise ratio, 3:1), and the quantitation limit is 4 ng/mL (signal-to-noise ratio, 5:1). Intra- and interday coefficients of variation are less than 8% in the range of 20-500 ng/mL.

Role of CYP2D6 in the N-hydroxylation of procainamide

Sequential oxidations at the arylamine moiety of the procainamide molecule leading to the formation of N-hydroxyprocainamide and its nitroso derivative may be responsible for lupus erythematosus observed in patients treated with the drug. The objective of the present study was to characterize major cytochrome P450 isozyme(s) involved in the N-hydroxylation of procainamide. Firstly, incubations were performed with microsomes from either lymphoblastoid cells or yeast transfected with cDNA encoding for specific human cytochrome P450 isozymes. Experiments performed with these enzyme expression systems indicated that the highest formation rate of N-hydroxyprocainamide was observed in the presence of CYP2D6 enriched microsomes. Additional experiments demonstrated that the formation rate of N-hydroxyprocainamide by CYP2D6 enriched microsomes was decreased from 45 +/- 4% to 93 +/- 1% by quinidine at concentrations ranging from 30 nM to 100 microM (all p < 0.05 vs control) and by approximately 75% by antibodies directed against CYP2D6. Secondly, incubations were performed with microsomes prepared from 15 human liver samples. Using this approach, an excellent correlation was observed between the formation rate of N-hydroxyprocainamide and dextromethorphan O-demethylase activity (CYP2D6; r = 0.9305; p < 0.0001). In contrast, no correlation could be established between N-hydroxyprocainamide formation rate and caffeine N3-demethylase (CYP1A2), coumarin 7-hydroxylase (CYP2A6), S-mephenytoin N-demethylase (CYP2B6), tolbutamide methlhydroxylase (CYP2C9), S-mephenytoin 4'-hydroxylase (CYP2C19), chlorzoxazone 6-hydroxylase (CYP2E1), dextromethorphan N-demethylase (CYP3A4), testosterone 6 beta-hydroxylase (CYP3A4/5) or lauric acid 12-hydroxylase (CYP4A11) activities. Furthermore, formation rate of N-hydroxyprocainamide was decreased in a concentration-dependent manner by quinidine (300 nM to 100 microM) and by antibodies directed against CYP2D6 but not by furafylline 20 microM (CYP1A2), ketoconazole 1 microM (CYP3A4), sulfaphenazole 10 microM (CYP2C9) or antibodies directed against CYP1A1/1A2, CYP2C, CYP2A6, CYP2E1 or CYP3A4/3A5. In conclusion, the results obtained in the present study demonstrate that CYP2D6 is the major human cytochrome P450 isozyme involved in the formation of the reactive metabolite of procainamide, namely N-hydroxyprocainamide.

The disposition of fluoxetine but not sertraline is altered in poor metabolizers of debrisoquin

BACKGROUND

Substrates and inhibitors of the cytochrome P450 isozyme CYP2D6 have overlapping structural characteristics. Two prototype serotonin uptake inhibitors, sertraline and fluoxetine, share these structural criteria and have been identified as potent inhibitors of CYP2D6 in vitro. The current study was undertaken to investigate whether genetically determined CYP2D6 activity alters the disposition of sertraline or fluoxetine or both.

METHODS

Single doses of sertraline (50 mg) and fluoxetine (20 mg) were administered successively to 20 young men with high (extensive metabolizers; n = 10) and low (poor metabolizers; n = 10) CYP2D6 activity. Blood and urine samples were collected for 5 to 7 half-lives and sertraline, desmethylsertraline, fluoxetine, and norfluoxetine were determined by GC and HPLC techniques.

RESULTS

Poor metabolizers had significantly greater fluoxetine peak plasma concentrations (Cmax; increases 57%), area under the concentration versus time curve (AUCzero-->infinity; increases 290%), and terminal elimination half-life (increases 216%) compared with extensive metabolizers. The total amount of fluoxetine excreted in the urine during 8 days was almost three times higher in poor metabolizers than in extensive metabolizers (719 versus 225 micrograms; p < 0.05), whereas the total amount of norfluoxetine excreted in urine of poor metabolizers was about half of that of extensive metabolizers (524 versus 1047 micrograms; p < 0.05). Norfluoxetine Cmax and AUCzero-->t were significantly smaller in poor metabolizers (decreases 55% and decreases 53%, respectively), and the partial metabolic clearance of fluoxetine into norfluoxetine was 10 times smaller in this group (4.3 +/- 1.9 versus 0.4 +/- 0.1 L/hr; p < 0.05). No significant differences between extensive and poor metabolizers were found for sertraline and desmethylsertraline pharmacokinetics.

CONCLUSION

These data indicate that poor metabolizers accumulate fluoxetine but not sertraline and that CYP2D6 plays an important role in the demethylation of fluoxetine but not of sertraline.

[Circadian rhythms in hepatic biotransformation of drugs]

The temporal variations in hepatic drug biotransformation are reviewed. Important diurnal variations in the activity of different cytochrome P-450 isoenzymes and in enzyme systems involved in conjugation to glucuronide, sulfate and acetate are described. A circadian rhythm in the hepatic concentration of glutathione is also described. These temporal variations explain the chronopharmacokinetic and chronohepatotoxicity of some drugs or toxic agents.

Role of polymorphic debrisoquin 4-hydroxylase activity in the stereoselective disposition of mexiletine in humans

It was reported previously that mexiletine undergoes stereoselective disposition in humans and that formation of three of its major metabolites co-segregates with polymorphic debrisoquin 4-hydroxylase (CYP2D6) activity. In this study, the hypothesis was tested that the CYP2D6-mediated oxidation pathways of mexiletine are responsible for the stereoselective disposition of the racemate in humans. Fourteen healthy subjects (10 extensive metabolizers [EMs] and 4 poor metabolizers [PMs]) participated in this study. They received a single 200-mg oral dose of racemic mexiletine hydrochloride on two occasions: once alone and once during administration of low-dose quinidine (50 mg four times a day). Blood and urine samples were obtained over 48 hr after the administration of mexiletine and analyzed by a stereoselective high-performance liquid chromatography assay. As reported previously, RS-mexiletine disposition was altered by a genetically determined (PM) or drug-induced (quinidine) decrease in CYP2D6 activity. In contrast, R/S ratio of the apparent total and nonrenal clearances of mexiletine and the R/S ratio of the urinary recovery of both enantiomers were similar in EMs and PMs. Moreover, these ratios were unaltered by quinidine administration. Partial metabolic clearance of N-hydroxymexiletine glucuronide, a non-CYP2D6 dependent metabolite, was highly stereoselective; the R/S ratio was 11.3 +/- 3.4. This ratio was similar in subjects with either an EM or a PM phenotype and was not altered by quinidine administration. Thus, the results obtained in this study suggest that non-CYP2D6-dependent metabolic pathways are responsible for the stereoselective disposition of mexiletine in humans.

Improved high-performance liquid chromatographic assay for the stereoselective determination of mexiletine in plasma

A simple and sensitive high-performance liquid chromatographic procedure for resolution of mexiletine enantiomers has been developed. Proteins from plasma samples containing RS-mexiletine were precipitated with a mixture of barium hydroxide and zinc sulphate before extraction under alkaline conditions with diethyl ether. Organic extracts were evaporated to dryness, and the residues reconstituted with 0.03 M hydrochloric acid (20 microliters). Derivatization with o-phthalaldehyde N-acetyl-L-cysteine reagent was performed after alkalinization with 0.1 M sodium borate. An aliquot of the resulting solution was injected onto a reversed-phase C18 column and resolution of mexiletine diastereoisomeric derivatives was achieved with a mobile phase consisting of methanol-50 mM sodium acetate (65:35), at a flow-rate of 1 ml/min. The retention times of S-(+)- and R-(-)-mexiletine diastereoisomeric peaks were 14 and 15 min, respectively. Product elution was monitored by fluorescence detection using excitation and emission wavelengths fixed at 350 and 445 nm, respectively. Calibration curves were linear over the concentration range 2.5-500 ng/ml for each enantiomer (r greater than 0.99). The assay is shown to be suitable for pharmacokinetic studies after administration of a single oral dose of 200 mg of RS-mexiletine hydrochloride to healthy volunteers.

Isolation and structural characterization by spectroscopic methods of two glucuronide metabolites of mexiletine after N-oxidation and deamination

Urine samples from control and mexiletine-treated human subjects or rabbits (test group) were collected and passed through an ion exchange resin to isolate polar compounds. Methanolic eluates from control and test urines were analyzed by TLC. Exposure to p-dimethylaminocinnamaldehyde gave an additional intense pink band at Rt 0.40-0.45 in TLC analysis of test urine eluate when compared to control urine eluate. Non-exposed silica at this Rt was scraped and metabolites were extracted with methanol. Hydrolysis of this methanolic extract at 100 degrees C with hydrochloric acid released mexiletine. GC/MS and fast atom bombardment mass spectrometry analyses of nonhydrolyzed methanolic extracts evidenced the presence of two conjugated metabolites of mexiletine, namely, N-hydroxymexiletine glucuronide and mexiletine alcohol glucuronide. Synthetic compounds corresponding to these metabolites were obtained and spectra compared with those of isolated metabolites from urine. Definite structure assignment of N-hydroxymexiletine glucuronide was obtained from NMR spectrometry which confirmed the structure to be a hydoxylamine glucuronide (N-O-C link) and showed that the glycoside moiety was in the beta configuration. Thus, it is proposed that N-hydroxymexiletine glucuronide corresponds to mexiletine acid-labile conjugate and represents a major metabolic pathway in the disposition of mexiletine.

Effect of inflammation on the rabbit hepatic cytochrome P-450 isoenzymes: alterations in the kinetics and dynamics of tolbutamide

In order to determine the effect of inflammation on the kinetics and dynamics of tolbutamide, two groups of seven and nine New Zealand rabbits received 50 mg/kg tolbutamide before and 48 hr after the production of an inflammatory reaction generated by the s.c. administration of turpentine in both hind legs. Tolbutamide in plasma and its two major metabolites (hydroxytolbutamide) and carboxytolbutamide in urine were assayed by high-performance liquid chromatography. The influence of inflammation on hepatic cytochrome P-450 was assessed by 1) determining the hepatic concentration in cytochrome P-450 and b5, 2) characterizing the activity of tolbutamide hydroxylase, 3) isolating hepatic microsomal protein bands by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and 4) measuring the concentrations of hepatic cytochrome P-450 isozymes LM-2 and LM-3c. The inflammatory reaction induced a marked decrease in tolbutamide total body clearance, secondary to a reduction in its metabolic clearance. Concerning the metabolites, hydroxytolbutamide metabolic rate constant and the fraction of the dose recovered in urine as carboxytolbutamide were diminished. Tolbutamide hypoglycemic response was not significantly affected by the inflammatory process. The Vmax of tolbutamide hydroxylase was reduced from 14.6 +/- 2.3 to 5.6 +/- 1.4 nmol/mg/60 min (P less than .05), and the Km remained unchanged. The concentration of hepatic cytochrome P-450 was reduced in turpentine-treated rabbits, whereas the cytochrome b5 concentration remained the same in both groups. The systemic inflammation also reduced the content in the 48, 52, 54 and 60 kDa protein bands from hepatic microsomes and the concentration of the LM-3c form.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of debrisoquine phenotype and of quinidine on mexiletine disposition in man

Mexiletine is a low clearance drug which undergoes extensive metabolism in man. In vitro studies with human liver microsomes have suggested that major oxidation pathways of mexiletine are predominantly catalyzed by the genetically determined debrisoquine 4-hydroxylase (cytochrome P450IID6) activity. In this study, we investigated the role of debrisoquine polymorphism and the effects of low dose quinidine, a selective inhibitor of cytochrome P450IID6, on the disposition of mexiletine. Fourteen healthy volunteers, 10 with the extensive metabolizer (EM) and 4 with the poor metabolizer (PM) phenotype, received a single 200-mg dose of mexiletine hydrochloride orally on two occasions (1 week apart), once alone and once under steady-state conditions for quinidine (50 mg QID). During the phase mexiletine alone, total clearance, nonrenal clearance and partial metabolic clearance of mexiletine to hydroxymethylmexiletine, to m-hydroxymexiletine and to p-hydroxymexiletine were decreased in PM compared to EM (all P less than .05). In EM, quinidine decreased mexiletine total clearance from 621 +/- 298 to 471 +/- 214 ml/min (mean +/- S.D.; P less than .05) and mexiletine nonrenal clearance from 583 +/- 292 to 404 +/- 188 ml/min (P less than .05). Moreover, quinidine increased mexiletine elimination half-life in EM from 9 +/- 1 to 11 +/- 2 h (P less than .05). In these subjects, partial metabolic clearance to hydroxymethylmexiletine, m-hydroxymexiletine and p-hydroxymexiletine were decreased by quinidine coadministration 5-, 4- and 7-fold, respectively, whereas partial metabolic clearance to N-hydroxymexiletine was unaffected. Changes induced by quinidine in EM were correlated to their debrisoquine metabolic ratio. Thus, genetically determined or pharmacologically induced modulation of cytochrome P450IID6 activity represents a major determinant of mexiletine disposition.

Biological rhythms in the absorption, distribution, metabolism and excretion of drugs

Studies carried out in the last 20 years indicated that biological rhythms can be detected in the pharmacokinetics of most classes of drugs. These time-dependent variations could be due to parallel changes in the physiological functions and variables involved in the absorption, distribution, metabolism and excretion of drugs. A review of the data available suggests that the peak and trough values of these functions and variables do not occur at the same hour of the day in every factor involved in drug disposition. This information could be used to predict the time-dependent changes in the pharmacokinetics. The presence of circadian variations in the kinetics of drugs raise the rather old question: "When to administer drug?"

Resolution and electrophysiological effects of mexiletine enantiomers

Resolution of mexiletine enantiomers from the racemic mixture has been achieved by fractional crystallization through the formation of diastereoisomeric p-toluoyl tartrate salts. Following three crystallization steps in methanol, R-(-)- and S-(+)-mexiletine were resolved with an optical purity greater than 98% (yield approximately 30%) and their hydrochloride salts formed. Incremental doses of mexiletine enantiomers were administered to dogs with experimentally-induced arrhythmias to investigate the stereoselective antiarrhythmic and electrophysiological effects of these compounds. Using up to three extrastimuli, programmed electrical stimulation was performed in conscious animals 7-30 days after coronary ligation. R-(-)-Mexiletine prevented ventricular tachycardia in 3/6 dogs (2 after 0.5 mg kg-1, 1 after 8 mg kg-1); two animals died after 1 and 8 mg kg-1, respectively; one remained unchanged even at the highest dosage (16 mg kg-1). S-(+)-Mexiletine prevented ventricular tachycardia in only one dog (after 1 mg kg-1); two died after 4 and 8 mg kg-1, respectively; 2/5 remained unchanged even after the administration of 16 mg kg-1. No significant changes in any electrocardiographic intervals (PR, QRS, QTc) or refractory periods were induced by mexiletine enantiomers at any doses used (0.5-16.0 mg kg-1). These results suggest that R-(-)-mexiletine possesses greater antiarrhythmic properties than the opposite enantiomer.

Metabolism, sister chromatid exchanges, and DNA single-strand breaks induced by 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone and their modulation by vitamin A in vitro

The nicotine-derived N-nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1- butanone (NNK) is abundant in smokeless tobacco and tobacco smoke and is hepatocarcinogenic in F344 rats. We have investigated how vitamin A modulates sister chromatid exchanges and DNA single-strand breaks induced by NNK. In V79 cells, vitamin A at concentrations ranging from 34.9 to 139.6 microM inhibited sister chromatid exchange frequencies induced by 20 mM NNK activated by primary rat hepatocytes. Sister chromatid exchanges were inhibited by 24, 44, and 55% when cells were cotreated with 34.9, 69.8, and 139.6 microM vitamin A, respectively. DNA single-strand breaks induced by NNK in rat hepatocytes were also inhibited by vitamin A. After 9 h of elution, DNA single-strand breaks induced by 1, 5, and 10 mM NNK were inhibited by 13, 5, and 3.5% in the presence of 69.8 microM vitamin A, respectively. This protective effect by vitamin A was associated with a reduction of alpha-carbon hydroxylation, an activation pathway of NNK. This pathway was inhibited by 50% when cells were cotreated with 3.49 microM vitamin A. The reduction in the hepatic microsomal aminopyrine N-demethylase, aniline hydroxylase, and N,N-dimethyl aniline N-demethylase in the presence of vitamin A (0.035 to 0.35 microM) suggests that vitamin A could reduce NNK genotoxicity by inhibiting the enzymes involved in the activation process.

The characteristics of the microsomal hydroxylation of tolbutamide

The in vitro metabolism of tolbutamide to the hydroxymethyl derivative was studied using hepatic microsomal homogenates. The hydroxymethyl metabolite was quantitated by HPLC. The hepatic microsomal hydroxylase was completely inhibited by carbon monoxide and was NADPH dependent. Metyrapone, alpha-naphthoflavone, phenelzine, mercuric chloride, and nitrogen significantly inhibited the reaction indicating the involvement of the cytochrome P-450 monooxygenase. Species variation showed that the order of hepatic microsomal activity was rat greater than rabbit much greater than guinea pig much greater than mouse and hamster. The reaction increased with time up to 40 min and followed Michaelis-Menten kinetics in rat liver microsomes with apparent Km and Vmax values of 224.4 microM and 359.9 pmol.mg-1.min-1, respectively. The reaction was induced by phenobarbital but was depressed after pretreatment with 3-methylcholanthrene and isosafrole. However, expression of the hydroxylase activity per nanomoles of cytochrome P-450 showed that the activity was much higher in liver microsomes of isosafrole pretreated rats. These results indicate the involvement of different isozymes of cytochrome P-450 in the microsomal hydroxylation of tolbutamide.

Meta-hydroxymexiletine, a new metabolite of mexiletine. Isolation, characterization, and species differences in its formation

Meta-hydroxymexiletine [1-(3-hydroxy,2,6-dimethyl)phenoxy-2-amino-propane], a novel metabolite of the antiarrhythmic drug mexiletine, was isolated from urine of rats given mexiletine. The structure of the metabolite was elucidated by 1H-NMR and mass spectrometry and by IR spectrophotometry. The metabolite is produced in vitro by hepatic microsomes of various laboratory animals including rat, guinea-pig, hamster, rabbit, and mouse. In humans, meta-hydroxymexiletine accounts for approximately 2% of the administered dose of mexiletine.

Temporal variations in microsomal lipid peroxidation and in glutathione concentration of rat liver

The temporal variation in the NADPH-dependent lipid peroxidation and glutathione-S-transferase activity and in the concentration of cytosolic and microsomal proteins and in reduced glutathione of rat liver were investigated at 0100, 0500, 0900, 1300, 1700, and 2100 in male Sprague-Dawley rats synchronized to a 12-hr light-dark cycle. Highly significant time-dependent variations were obtained in the microsomal rate of lipid peroxidation, and in the concentration of reduced glutathione and cytosolic and microsomal protein. The maximal mean values for the lipid peroxidation, for the concentration of reduced glutathione, and of cytosolic and microsomal proteins were obtained at 1300, 0900, 0100 and 2100, respectively, whereas the corresponding minimal values were determined at 0100, 1700, 0900, and 1700. There was no temporal variation in the glutathione-S-transferase activity of rat liver. The temporal variation in microsomal peroxidation and in the concentration of reduced glutathione exhibited a characteristic circadian rhythm. There was no reverse relationship between the daily variation in the rate of microsomal lipid peroxidation and the hepatic concentration of reduced glutathione.

Temporal variation in the effects of warfarin on the vitamin K cycle

In this in vivo study, the time-dependent effect of oral sodium warfarin was studied in male rats synchronized under a 12-hr light-dark cycle (light 0600-1800). Groups of 5 animals received an oral dose of 500 micrograms/kg of warfarin or saline at 0600 or 1800 and 1 mg/kg of vitamin K 8 hr later and the rats were sacrificed 240 min after vitamin K administration. The activities of the vitamin K reductase and vitamin K epoxide reductase were measured indirectly by determining the content of vitamin K1 and vitamin K epoxide reductase in the plasma and liver. The data obtained in control rats indicated that vitamin K and vitamin K 2,3 epoxide concentrations in plasma and liver were higher (P less than 0.05) at 1800 than at 0600. Warfarin had a greater (P less than 0.05) inhibitory effect on the vitamin K and vitamin K-epoxide reductases at 0600 compared to 1800; plasma levels of S- and R-warfarin did not vary with time of administration. The findings suggest that the activity of both reductases under control conditions, and the warfarin-induced inhibition of these enzymes varied depending on the time of drug administration.

[Basic mechanisms of chronopharmacology]

Many animal and human studies have demonstrated time-dependent changes in the effects and kinetics of drugs that can be explained in part by parallel changes in their absorption, metabolism and excretion. Although food influences drug absorption, its presence in the stomach does not explain the circadian rhythms in the absorption of xenobiotics. Circadian rhythms in blood flow, biliary secretion and the physico-chemical properties of drugs seem to be very important factors involved in the circadian rhythms of drug absorption. Time-dependent changes have been reported in the activity of hepatic enzyme involved in drug metabolism and they can explain the circadian rhythms in the effect of hexobarbital and in the kinetics of acetaminophen. However, circadian changes in blood flow, biliary secretion and in the binding to plasma proteins must be investigated thoroughly because they could explain many circadian rhythms in drug metabolism. The role of hepatic extraction ratio must also be looked at carefully. Finally, circadian changes in urinary pH, glomerular filtration and in other mechanisms of drug elimination by the kidneys can account for the circadian rhythms in the elimination of drugs such as the salicylates and furosemide. Future research on the molecular mechanisms of the circadian variations in the effects and kinetics of drugs must be carried out to give health professionals a better understanding of the phenomenon. Concepts and findings from investigative chronopharmacology are becoming now indispensable to solve problems of drug optimization.

Time-dependent variations in the organ extraction ratios of acetaminophen in rat

The pharmacokinetics of a single 40 mg/kg dose of acetaminophen was investigated at 09h00 and 21h00 in Sprague-Dawley rats synchronized to a 12-h light-dark cycle. Acetaminophen was administered by the intraarterial, intravenous, intraperitoneal, and oral routes in order to determine the contribution of the gastrointestinal tract, liver, and lung to the oral extraction ratio of the drug. A mean oral extraction ratio of 0.46 was obtained at 21h00 as compared to 0.39 at 09h00. The mean extraction ratios of the gastrointestine, liver, and lung were 0.05, 0.41, and 0 at 09h00 and 0.18, 0.24, and 0.13 at 21h00, respectively. These results indicate that the extrahepatic metabolism of acetaminophen is important at 21h00, but is barely detectable at 09h00, whereas the hepatic extraction ratio is higher at 09h00 than at 21h00. Thus, there are temporal variations in the disposition of acetaminophen in the rat.

Pharmacokinetics of a sustained-release product of indomethacin in the elderly

The pharmacokinetics of indomethacin (Indo) was studied in 10 healthy elderly male volunteers (age 67-81 years) following the oral administration of a single 75-mg dose of a sustained release form of Indo. The total and free plasma and erythrocyte concentrations of Indo were determined by a specific high-pressure liquid chromatographic method. A maximum concentration (Cmax) of 4.28 +/- (SE) 0.43 micrograms/ml was reached after 1.85 +/- 0.22 h. The area under the plasma concentration versus time curve (AUC) was 22.83 +/- 2.70 micrograms ml-1 h and the plasma elimination half-life was 4.34 +/- 0.64 h. The maximum concentration of Indo in the red blood cells was 0.123 +/- 0.013 microgram/ml and was obtained at 1.95 +/- 0.14 h after drug administration. The erythrocyte concentrations of Indo represented 2.4% of the total plasma levels of Indo whereas only 1.3% of the drug was unbound to plasma proteins. The Cmax and AUC values determined in the elderly were approximately double the values reported in young adults for the same dose.

Effect of nonsteroidal anti-inflammatory drugs on the microsomal monooxygenase system of rat liver

The effect of acetylsalicylic acid, ibuprofen, indomethacin, ketoprofen, naproxen, phenylbutazone, and salicylic acid on the microsomal oxidative drug metabolism of rat liver was studied. Pretreatment of the rats with pharmacologic doses of acetylsalicylic acid, indomethacin, and ketoprofen decreased both the demethylase and hydroxylase activities of rat liver microsomes. These effects were paralleled by decreases in microsomal cytochrome P-450 content. The rate of the microsomal reactions was increased after pretreatment with ibuprofen and naproxen but only the former increased the concentration of cytochrome P-450. Phenylbutazone and salicylic acid had no in vivo effect on the hepatic monooxygenase. The addition of 1 mM of ibuprofen, indomethacin, ketoprofen, naproxen, and phenylbutazone to rat liver microsomes inhibit both the aminopyrine N-demethylase and p-nitro-anisole O-demethylase activities. The extent of the inhibition varied between 21 and 73% of the control incubation. Indomethacin, naproxen, and phenylbutazone also decreased the aniline hydroxylase activity to roughly 60% of the control value. Acetylsalicylic acid and salicylic acid had no in vitro effect on the microsomal monooxygenase. The nonsteroidal anti-inflammatory drugs produced a reverse type I binding spectrum with oxidized cytochrome P-450; indomethacin and phenylbutazone were the strongest ligands. There is no correlation between the effect of addition of nonsteroidal anti-inflammatory drugs to the hepatic microsomal homogenate and their in vivo effect on the monooxygenase activity.

Monthly variations in the clearance of antipyrine in the rat

The variation in the pharmacokinetics of antipyrine was determined in synchronized rats over a period of 12 consecutive months. The mean values +/- SE (range) for the serum half-life, apparent volume of distribution and total body clearance of antipyrine were: 2.5 +/- 0.6 (1.6-4.9) h, 868.7 +/- 203.9 (590-1275) ml/kg and 269.2 +/- 14.7 (165-516) ml/h/kg respectively. The magnitude of the variation was three fold for the serum half-life and body clearance and two fold for the apparent volume of distribution. A new gas-liquid chromatographic assay for antipyrine is also described.

Chronobiological study of plasma exudation in carrageenan-paw oedema in the rat

The time-courses of exudation of protein-bound Evans' blue and of the formation of oedema following the injection of carrageenan (2 mg) or normal saline in the rat hind paw at 10.00 hours and 21.00 hours were studied. During the first 90 min after the carrageenan injection, the tissue content of the dye and the oedema formed were much greater when the inflammatory agent was administered at 21.00 hours than at 10.00 hours. A second study carried out at every 3 hours of the 24 hour span showed the presence of a circadian rhythm in the exudation of protein in the paw and in the formation of oedema. The paw volume and content of the dye were found to be highest between 19.00 hours and 01.00 hours whereas the minimal values were obtained at 16.00 hours. There is a correlation between the exudation of plasma proteins and the formation of oedema.

Pharmacokinetics of sulfisoxazole in young and elderly subjects

The pharmacokinetics of sulfisoxazole was studied in 6 elderly (age 63-75 years) and 7 young (age 22-37 years) healthy nonsmoking volunteers following the oral administration of 2 g of Gantrisin. The plasma levels of sulfisoxazole obtained in the postabsorption phase were higher in the elderly subjects. There was no significant variation between the two groups of volunteers in the absorption rate constant, Cmax, bioavailability, the fraction of the dose of sulfisoxazole excreted unchanged, the area under the plasma curve of the N4-acetyl conjugate formed, and in the apparent volume of distribution of the drug. The tmax value and plasma half-life of sulfisoxazole were significantly longer, and the total body and renal clearances of the drug decreased in the elderly subjects. Diminished renal function as estimated by the creatinine clearance and urinary flow may explain the slower elimination of sulfisoxazole in the elderly subjects. Therefore, advancing age should be considered as a factor in the adjustment of sulfisoxazole dosage.

Chronobiological studies on the hypotensive effect of prostaglandin E2 and arachidonic acid in the rat

The present study was designed to determine whether biological rhythm variations could be detected in the hypotensive action of prostaglandin E2 (PGE2) and arachidonic acid (AA) in normal rats. Doses of 1.0 microgram kg-1 of PGE2 or 0.5 mg kg-1 of AA were administered to pentobarbital-anesthetized rats at 6 times of the day. Maximal reduction of systolic and diastolic blood pressures was obtained when PGE2 or AA were administered to rats between 0930 and 1200. The lowest falls in blood pressure were found when the same doses of the two substances were injected between 0300 and 0500. Mechanisms to explain these circadian variations are suggested.

Differential properties of the microsomal deamination and hydroxylation reactions

The addition of 1 mM of the metal complexing reagents such as EDTA, alpha, alpha'-dipyridyl, 1,10-phenanthroline and Tiron to the incubation of benzylamine, aminopyrine, p-nitroanisole and aniline, respectively, inhibited selectively the microsomal deamination of benzylamine, whereas the addition of the monoamine oxidase inhibitors tranylcypromine, nialamide and iproniazid specifically decreased the metabolism of aminopyrine, p-nitroanisole and aniline. Pretreatment of rats with 3,4-benzpyrene or phenobarbital increased the liver microsomal concentration of cytochrome P-450 (448) and the rate of aminopyrine and p-nitroanisole demethylation and of aniline hydroxylation whereas pretreatment cytochrome P-450 depressor agents such as cadmium or cobalt lowered the concentration of the hemoprotein and decreased the rate of the demethylation reactions. Phenobarbital and 3,4-benzpyrene pretreatment had either no effect or decreased significantly the rate of the microsomal deamination reaction respectively. The administration of cadmium slightly decreased the rate of benzylamine deamination whilst cobalt produced no significant effect. These results indicate that the microsomal oxidative deamination reaction has different properties than the dealkylation and aromatic hydroxylation reactions, thus suggesting a different enzyme system.

Chronopharmacological studies of phenylbutazone in the rat

Temporal variations in the anti-inflammatory action and in the ulcerogenic and lethal effects of phenylbutazone were studied in rats. The results indicate that small doses of the drug produced a larger reduction of paw edema in the morning than in the evening. At 0900, doses of 10, 30, and 100 mg/kg of phenylbutazone reduced the carrageenan-induced paw edema by 23, 44, and 66%, respectively. At 2000, the same doses of the drug decreased the paw edema by 9, 22, and 62%, respectively. No circadian variation was observed in the ulcerogenic effect of phenylbutazone. The mean lethal dose (LD50) of the drug was larger in the morning than in the evening and the values obtained were 710 +/- 24 (SE) mg/kg at 0900 in comparison to 525 +/- 38 (SE) mg/kg at 2000.

Inhibitory effect of phenelzine on oxidative microsomal enzyme systems of rat liver

The inhibitory effects of phenelzine on the hepatic microsomal demethylation of aminopyrine, N,N-dimethylaniline, and p-nitroanisole on the hydroxylation of aniline and on the pharmacokinetics of antipyrine were investigated in the rat. Phenelzine produced a competitive and noncompetitive inhibition of the demethylation of p-nitroanisole and N,N-dimethylaniline, respectively, but was a mixed-type inhibitor of the aminopyrine N-demethylase and aniline hydroxylase. The inhibition constant, Ki, varied between 0.06 to 0.25 mM depending on the substrate used. Preincubation of phenelzine for 30 min with the microsomal homogenate prior to substrate addition doubled its inhibitory effect. Phenelzine induced a type II spectral change when combined with oxidized cytochrome P-450 with a Ks value of 0.4 mM. The administration of one dose of 50 mg X kg-1 of phenelzine sulfate concomitantly with 50 mg X kg-1 of antipyrine resulted in a significant decrease of the serum elimination of antipyrine. The serum half-life, apparent volume of distribution, and total body clearance of antipyrine were modified to 3.6 h, 294.1 mL X kg-1, and 56.8 mL X h-1 X kg-1, respectively, from 1.5 h, 666.7 mL X kg-1, and 312.5 mL X h-1 X kg-1 when antipyrine was administered alone. It is concluded that the inhibitory effect of phenelzine on the microsomal oxidative reactions of rat liver is related to its interaction with cytochrome P-450.

Circannual variations in carrageenan-induced paw edema and in the anti-inflammatory effect of phenylbutazone in the rat

Circannual variation in the edema produced by intraplantar injection of carrageenan (carr) was examined over a period of 31 months. The anti-inflammatory effect of a dose of 30 mg/kg of phenylbutazone (PHZ) was also determined over a period of 1 year. Carr-induced edema was significantly larger in spring while it was smaller in winter. PHZ induced a pronounced reduction of paw edema throughout the year except in spring when the anti-inflammatory effect of the drug could not be detected. Mechanisms responsible for these circannual variations are discussed.

Temporal variations in the elimination of antipyrine in normal and adrenalectomized rats

An oral dose of antipyrine was administered at 08:00 and 20:00 hours to groups of sham operated and adrenalectomized rats standardized in an alternating 12-hour-light-dark cycle for 7 days prior the experiments. Temporal variations in the rate of elimination of antipyrine were obtained in both groups. Adrenalectomy decreased the serum elimination of antipyrine but had no effect on the temporal variations.

Metabolic reduction of 1-nitrosoadamantane by rabbit liver microsomes. Properties of a C-nitroso reductase system

Washed microsomes from rabbit liver reduced 1-nitrosoadamantane to N-hydroxy-1-aminoadamantane in the presence of a cofactor solution under aerobic conditions; no further reduction of the hydroxylamino metabolite to 1-aminoadamantane (amantadine) occurred. Reduced pyridine nucleotide cofactors are needed for the metabolic reduction. The rate of formation of N-hydroxy-1-aminoadamantane depended upon the microsomal protein content, the time of incubation and the concentration of 1-nitrosoadamantane incubated. The metabolic reduction occurred in air as well as under nitrogen or carbon monoxide. Cupric chloride, mercuric chloride, cysteamine, FAD, and FMN decreased significantly the C-nitroso reductase. The properties of the C-nitroso reductase differed from those of other microsomal reductive pathways.

Electron impact induced fragmentation of some 1-substituted trans-2-phenylcyclopropane compounds

The electron impact induced fragmentation of seven derivatives of trans-2-phenylcyclopropane substituted at position one with functional groups like amino (tranylcypromine), trifluoroacetamido, cyano, carboxylic acid, carboxylic acid chloride, carboxamide and carboxylate methyl ester was investigated. Mechanisms are proposed for the formation of the major ions of each compound. The nature of the substituent determined the relative abundances of [M]+., [M-1]+, [M-R]+, UM-RH]+. [M-C6H5]+ and m/z 115 ions. A molecular ion was present in all spectra except that of carboxylic acid chloride substituted compound. In most cases, metastable peaks are involved in the decomposition of the most abundant ions. An interesting elimination mechanism involving the opening of the cyclopropane ring to yield a 4-membered cyclic ion at m/z 56 was obtained in the spectrum of trans-1-amino-2-phenylcyclopropane. All the above compounds gave mass spectra containing diagnostic fragment ions which are of great value for identification purposes.

[Two cases of benign polypes of the ureter (author's transl)]

The polyp of the ureter is a tumour which originates in the connective tissue and is covered by normal urothelium. Radical surgery is justified in some of these urothelial tumours but one should also consider a more conservative attitude when one deals with a benign fibro-epithelial polyp of the ureter especially when they are located in the lower or upper third of the ureter. We present two cases, one which represents the eleventh case of benign fibro-epithelial polyp described in children in the literature.

The metabolism, distribution and elimination of chlorphentermine in man

1 A gas-liquid chromatography procedure for the determination of chlorphentermine (I), N-hydroxychlorphentermine (II) and alpha,alpha-dimethyl-alpha-nitro-beta-(4-chlorophenyl)ethane (IV) in urine has been developed. Also methods are reported to determine conjugated II and the total N-oxidized metabolites of I, i.e. II, conjugated II, alpha,alpha-dimethyl-alpha-nitroso-beta-(4-chlorophenyl)ethane (III) and IV in urine. 2 The synthesis of alpha,alpha-dimethyl-alpha-nitroso-beta-(4-chlorophenyl)ethane (III) and its properties are reported. 3 The kinetics of urinary excretion of I and its metabolic products after the oral administration of I to a human subject on separate occasions have been studied. Under normal conditions of urinary pH, metabolism by N-oxidation was the main elimination route of I; acidifying the urine increased the urinary excretion of unchanged I at the expense of the N-oxidized products. 4 The importance of the N-oxidation metabolic route in the distribution of chlorphentermine (I) in man is discussed.

The microsomal N-oxidation of phentermine

The microsomal N-oxidation of phentermine (Ia) to N-hydroxyphentermine (Ib) and to alpha,alpha-dimethyl-alpha-nitroso-beta-phenylethane (Ic was investigated. Maximum activities were obtained with microsomal (9000 g supernatant and microsomes) fractions of rabbit liver in the presence of an NADPH generating system. Incubation of Ia with hepatic washed microsomes from a phenobarbitone pretreated rabbit increased the formation of Ib and decreased that of Ic but the total amount of N-oxidized metabolites (i.e. Ib + Ic) was not affected. The ratio of the metabolically produced Ic to Ib but not the total amount of N-oxygenated metabolites varied greatly depending of the liver microsomal fractions used in the incubation mixtures of Ia; more Ib was produced from Ia using 9000 g supernatant and conversely, more Ic was formed using the washed microsomes of the same liver. The nitroso compound (Ic) was metabolically reduced to Ib and Ib to Ia by the hepatic 9000 g supernatant and soluble fraction; under the same conditions, washed microsomes had only limited reductive properties towards Ic and Ib. N-Hydroxyphentermine (Ib) was not metabolically oxidized to Ic when incubated with washed microsomes from rabbit liver. The use of known carbon-oxidation inhibitors showed that cytochrome P-450 is not involved in the incorporation of oxygen at the nitrogen centre of Ia. The metabolic characteristics and kinetic behavior of the microsomal N-oxidation of Ia supported a recently proposed mechanism explaining the independent formation of Ib and Ic from a common precursor resulting from metabolic N-oxidation of Ia.