Target-independent prediction of drug synergies using only drug lipophilicity.

Physicochemical properties of compounds have been instrumental in selecting lead compounds with increased drug-likeness. However, the relationship between physicochemical properties of constituent drugs and the tendency to exhibit drug interaction has not been systematically studied. We assembled physicochemical descriptors for a set of antifungal compounds ("drugs") previously examined for interaction. Analyzing the relationship between molecular weight, lipophilicity, H-bond donor, and H-bond acceptor values for drugs and their propensity to show pairwise antifungal drug synergy, we found that combinations of two lipophilic drugs had a greater tendency to show drug synergy. We developed a more refined decision tree model that successfully predicted drug synergy in stringent cross-validation tests based on only lipophilicity of drugs. Our predictions achieved a precision of 63% and allowed successful prediction for 58% of synergistic drug pairs, suggesting that this phenomenon can extend our understanding for a substantial fraction of synergistic drug interactions. We also generated and analyzed a large-scale synergistic human toxicity network, in which we observed that combinations of lipophilic compounds show a tendency for increased toxicity. Thus, lipophilicity, a simple and easily determined molecular descriptor, is a powerful predictor of drug synergy. It is well established that lipophilic compounds (i) are promiscuous, having many targets in the cell, and (ii) often penetrate into the cell via the cellular membrane by passive diffusion. We discuss the positive relationship between drug lipophilicity and drug synergy in the context of potential drug synergy mechanisms.

Preclinical skin sensitization testing of antihistamines: guinea pig and local lymph node assay responses.

Preclinical test methods for allergic contact sensitivity have been widely used for sensitization hazard identification and, with consideration of human exposure conditions, have also been valuable tools for sensitization risk assessment. For many years, the guinea pig has been the test species of choice with a variety of test methods developed to assess the sensitization response. More recently the local lymph node assay (LLNA) in mice has been developed to provide a more objective index of sensitization potential. The standardized methods have proven to be very well suited to most situations in which potential skin sensitization of a chemical needs to be assessed before human exposure. A potential difficulty with all these relatively limited exposure preclinical test methods, however, is in the ability to detect weak contact allergens that prove to be significant clinical allergens due to chronic topical exposure, exposure to compromised skin, and/or highly exaggerated exposure through transdermal delivery. This has been shown with the transdermal drug clonidine and might also be the case for topical antihistamines. The latter are considered significant clinical contact allergens, although predictive preclinical test data are minimal or lacking. A series of guinea pig (modified Buehler) tests with two common antihistamine compounds (triprolidine and diphenhydramine) and LLNA on these and two other compounds (chlorpheniramine and promethazine) was conducted. Positive Buehler test results required use of penetrating vehicle systems and a modified nine-induction patch regimen. Positive LLNA responses were obtained with all four materials (to varying degrees) only if the application site was pre-abraded or a penetrating vehicle (dimethylformamide) was used. These data support the notion that preclinical sensitization test methods can be modified to increase sensitivity. This may be critical for preclinical assessment of topical/transdermal drugs or other materials with chronic or high-concentration exposures in man.

Triprolidine: 104-week feeding study in rats.

The antihistamine triprolidine hydrochloride, was fed at dietary concentrations of 0, 250, 1000, or 2000 ppm (as the free base) to groups of 60 Fischer 344 (F344) rats of each sex for up to 2 years to evaluate its potential carcinogenicity. Up to 12 per sex from each group were killed at 65 weeks, and hematology, clinical chemistry, and histopathology were evaluated. A complete histopathological evaluation was performed on all other animals; survivors were killed at 2 years. Survival was significantly extended in triprolidine-treated males and females, particularly at the high dose. At the close of the study high-dose males and females had gained significantly less body weight than controls. Among rats killed at 65 weeks females in the mid- and high-dose groups weighed significantly less than controls, but weights of control and dosed males were not significantly different. The incidences of numerous lesions tended to decrease with increasing triprolidine dose. In females, clitoral gland adenomas, thyroid c-cell hyperplasia and neoplasia, mammary gland hyperplasia and fibroadenomas, and uterine stromal polyps, and in males, anterior pituitary gland adenomas, preputial gland neoplasia, thyroid c-cell pancreatic islet neoplasia, mononuclear cell leukemia, and the combination of lymphocytic, histiocytic, and undifferentiated cell malignant lymphomas and mononuclear leukemia, all exhibited negative dose trends. Cytoplasmic alterations of the parotid gland and numerous liver lesions tended to be more frequent in treated than in control animals. Liver lesions that exhibited positive dose trends include chronic inflammation and centrilobular fatty change in both sexes, mixed cell foci, and the combination of mixed cell foci and eosinophilic foci in females, and in males, basophilic foci and eosinophilic foci. Triprolidine was not carcinogenic in F344 rats.

Chronic study of triprolidine for oncogenicity in mice.

Triprolidine hydrochloride was fed to groups of 60 B6C3F1 mice per sex at dietary levels of 0, 500, 2000, or 4000 ppm (as the free base) for up to 2 years. Up to 12 mice of each sex and dose group were terminated after 65 weeks for hematology and clinical chemistry. The control and high-dose groups were examined histologically. A complete histopathological examination was performed on the remaining 48 mice from each dose group when removed from study due to moribund condition, early death, or terminal euthanization at 105 weeks. Triprolidine did not significantly alter the survival of either sex. High-dose male and mid- and high-dose female body weights were significantly less than controls at the end of the study. Significant trends toward lower frequency with increasing dose were noted in females for fatty change in the liver and lymphomas (combination of lymphocytic, mixed, and histiocytic lymphomas). Similar negative trends in males were for lymphocytic cellular infiltration in multiple organs and lung alveolar/bronchiolar adenomas or the combination of alveolar/bronchiolar adenomas or carcinomas. Significant trends toward increased frequency with increasing dose were found in female mice for lymphocytic infiltration in multiple organs and cytoplasmic alterations of the acinar cells of the parotid gland. Similar positive trends were found in males for cytoplasmic alterations of the parotid gland and various hepatocellular changes (e.g., hypertrophy and altered foci). While there was a positive dose response trend for hepatocellular adenomas in males the combination of these and hepatocellular carcinomas eliminated the significant trend, and it was concluded that there was no evidence of a carcinogenic response to triprolidine in B6C3F1 mice.(ABSTRACT TRUNCATED AT 250 WORDS)

Terfenadine alters action potentials in isolated canine Purkinje fibers more than acrivastine.

Acrivastine and terfenadine are second-generation antihistamines with similar pharmacologic profiles and comparable clinical efficacies for allergic rhinitis. However, terfenadine therapy has been associated with cardiovascular side effects that include prolonged QT interval, torsades de pointes, and ventricular fibrillation (VF). We examined the adverse effects induced by terfenadine on evoked action potentials (APs) in isolated canine cardiac Purkinje fibers and determined whether acrivastine causes similar disturbances in this preparation. Terfenadine produced a statistically significant decrease in the maximal rate of increase in the AP (dV/dt) at 10(-7) M, which corresponds to the highest plasma concentration observed clinically. The IC50 (mean +/- SEM) value for terfenadine-induced inhibition of dV/dt was 1.3 +/- 0.3 x 10(-6) M. The decrease in dV/dt caused by terfenadine became more pronounced with faster rates of stimulation. Acrivastine at a concentration of 10(-5) M, a value 10 times higher than plasma concentrations observed in clinical studies, caused no significant changes in AP duration (APD) or dV/dt. The IC50 (mean +/- SEM) value for the acrivastine-induced inhibition of dV/dt was estimated to be 8.0 +/- 3.7 x 10(-3) M. Terfenadine blocked the evoked AP at 3 x 10(-6) M, whereas no block was observed with acrivastine at 10(-3) M. The effective serum concentration of acrivastine is approximately 100 times higher than that of terfenadine. Because the IC50 value for inhibition of dV/dt for acrivastine is approximately 6,000 times greater than that for terfenadine, we estimate that acrivastine is approximately 60-fold less likely to cause disturbances in cardiac conduction than terfenadine.

Evaluation of the primary skin irritation and allergic contact sensitization potential of transdermal triprolidine.

A transdermal patch for the OTC antihistamine, triprolidine (TP), might provide benefits in terms of increased efficacy and reduced sedative side effects. However, concerns over potential irritant or allergic contact sensitization (ACS) skin reactions necessitated through skin toxicity testing before and during initial clinical development. Initial effort was expended on development of a binary vehicle delivery system comprised of TP in 0.5% oleic acid (OA) in propylene glycol (PG). Rabbit skin irritation and Buehler guinea pig skin sensitization testing indicated that this TP/OA/PG formula had both skin irritation and ACS potential. Both tests underestimated, to some degree, the skin toxicities observed in later clinical testing. In clinical tests, skin irritation was due mainly to the OA/PG vehicle, but was enhanced in the presence of high TP concentrations. Of 26 subjects enrolled in a rising dose clinical pharmacokinetics study, one subject exposed twice to TP/OA/PG presented with delayed skin reactions suggestive of ACS. Positive diagnostic patch test results for this subject and four out of five other twice-exposed study subjects suggested that the TP/OA/PG formula had a very high ACS potential. Subsequent predictive clinical patch testing was conducted with a buffered aqueous TP formula which provided in vitro skin penetration of the drug equivalent to the TP/OA/PG formula. These clinical studies demonstrated that TP itself had no significant irritation potential but still induced ACS reactions in a high proportion of test subjects. The incidence of adverse skin reactions to TP was considered to be too high relative to the degree of improved therapeutic benefit of this delivery form. On this basis, all technology development effort was discontinued.

Microbial transformation of the antihistaminic drug triprolidine hydrochloride.

The production of a known mammalian metabolite of the antihistamine triprolidine through fungal metabolic transformation has been demonstrated. The filamentous fungus Cunninghamella elegans ATCC 9245 was grown in Sabouraud dextrose broth containing triprolidine hydrochloride monohydrate. One major metabolite was extracted with methylene chloride, isolated by high-performance liquid chromatography, and identified by its proton-nuclear magnetic resonance and desorption chemical ionization mass spectral properties as hydroxymethyl triprolidine (2-[1-(4-hydroxymethylphenyl)-3-(1-pyrrolidinyl-1-propenyl)] pyridine). After 240 h of incubation, the hydroxymethyl derivative represented approximately 55.0% of the initial dose. Fungal oxidation of hydroxymethyl triprolidine to the corresponding carboxylic acid triprolidine derivative (also a known mammalian triprolidine metabolite) was not observed. No mutagenic activity was observed for triprolidine and hydroxymethyl triprolidine by reversion of Salmonella typhimurium strains TA97, TA98, TA100, and TA104 at concentrations up to 1000 and 200 micrograms/plate, respectively. These results suggest that the fungal metabolism of triprolidine to the hydroxymethyl derivative occurs predominantly through pathways which do not result in mutagenic activation. Incubation of C. elegans with triprolidine under an 18O2 atmosphere and subsequent electron impact mass spectral analysis of the hydroxymethyl triprolidine formed indicate that molecular oxygen was incorporated into the methyl group and suggest a mono-oxygenase catalyzed reaction. This study parallels previous studies on the mammalian metabolism of triprolidine and clearly indicates that the microbial transformation of triprolidine is a useful alternative for the synthesis of potential mammalian metabolites.

The H2-antagonists, cimetidine and ranitidine: studies on performance.

The effects of single oral doses of cimetidine (200 and 400 mg) and ranitidine (150 and 300 mg) were evaluated on visuo-motor coordination, dynamic visual acuity, digit symbol substitution, symbol copying, and critical flicker fusion, and on subjective assessments of mood and well-being in seven healthy female volunteers. The study was double blind and placebo controlled, and triprolidine (10 mg) was used as an active control. With cimetidine and ranitidine there were no adverse changes in performance, central nervous function or subjective assessment of mood. Triprolidine impaired visuo-motor coordination, reduced the number of substitutions on the digit symbol substitution test and the number of symbols copied, lowered the critical flicker fusion threshold and reduced dynamic visual acuity. Cimetidine (200-400 mg) and ranitidine (150-300 mg) are highly unlikely to impair performance, and may be used in individuals involved in skilled activity.