Teratogen update: vitamin A congeners.

Despite animal vitamin A congener teratogenicity in animal studies since 1954, striking human findings only arose in 1983 following isotretinoin (ITR) marketing for oral treatment of severe acne. By November 1985, 44 outcomes with central nervous system (CNS), cardioaortic (CV), microtia, facial palsy, micrognathia, cleft palate, and/or thymic aplasia defects, and 33 spontaneous abortions have been reported. The critical period for exposure appears to be two to five weeks postconception, although this is clinically inexact. ITR half life is less than a day, although a teratogenic metabolite, 4-oxo-isoretinoin, has a half life of several days. Seven defect outcomes and one stillbirth have been reported with another congener, etretinate (ETR), used for psoriasis. Three of these had meningomyeloceles. Half life of several months makes levels cumulative. Only one additional defect, which may have occurred by chance, is reported with use stopped before conception (4 months). Other discontinuations 1 to 6 months before conception had 11 normal outcomes and two spontaneous abortions. ITR and ETR dose ranged from 0.5 to 1.5 mg/kg. Normal outcomes are reported both with ITR and ETR, but some of these appear not to have been exposed during the critical period. Less striking defects, abortions, and normal outcomes are less well reported. Because vitamin A analogs are therapeutically important and unplanned outcome not always avoidable, further animal research is needed for better risk/benefits. Megadose vitamin A (retinol) use is widespread, but experience poorly observed. Eighteen suspicious birth defect outcomes have been reported from pregnancies with high dose exposure. Twelve had findings similar to those seen in animals and in human retinoid syndromes, e.g., CNS, CV, microtia, and clefts. Epidemiological controls are lacking to establish human teratogenicity, but based on animal studies and experience with ITR and ETR, avoiding long term megadose Vitamin A use in fertile women is warranted.

Detection of teratogenic compounds using differentiating embryonic cells in culture.

Methods are described for screening for teratogenic compounds using differentiating neural crest and prechondrogenic limb bud mesenchyme cells in culture. Substances to be tested are either added directly to the culture medium or are combined in a dialysis bag with the postmitochondrial fraction from rat liver and certain cofactors. In the latter case, the compound and its metabolites are gradually released into the medium from the dialysis bag. The results obtained with 14 compounds demonstrate a positive relationship between teratogenicity in vivo and alterations in the growth or the differentiation of the cultured cells.

Induction of craniofacial malformations in rhesus monkeys (Macaca mulatta) with cyclophosphamide.

Administration of cyclophosphamide to pregnant rhesus monkeys induces two syndromes of craniofacial malformations characterized by underdevelopment of the face of different pattern depending on the timing of treatment. The first is cleft lip with cleft palate and exophthalmos. The second is a craniofacial dysmorphia with marked underdevelopment of the midfacial bones, highly arched closed palate, and either meningoencephalocele or persistent anterior fontanel. Since cleft lip and palate are among the most common malformations in man, and several human syndromes involving abnormal craniofacial development have features in common with the dysmorphic monkeys, these induced anomalies may prove valuable in investigations on the pathogenesis of such malformations and as surgical models.

Enhancement of chlorcyclizine teratogenicity in the rat by coadministration of calcium chelating agents.

Chlorcyclizine and structurally related drugs induce a high incidence of cleft palate and skeletal malformations in fetal rats. We have shown previously that these teratogens bind tightly and reversibly to chondroitin sulfate of cartilage and compete with calcium for binding. Experiments reported here demonstrate that co-administration of calcium chelating agents with chlorcyclizine significantly increases both the frequency of malformations and retention of [14C] chlorcyclizine by embryos. Retention of radioactive teratogen by embryos is inverse to retention of [45Ca]calcium. These findings suggest that drug binding to embryonic glycosaminoglycans is involved in the pathogenesis of malformations produced by chlorcyclizine.

Chlorcyclizine induction of cleft palate in the rat: degradation of palatal glycosaminoglycans.

Administration of the cleft palate teratogen chlorcyclizine or norchlorcyclizine to pregnant rats causes an alteration in glycosaminoglycans (GAGs) in embryonic palatal shelves. Pulse-chase experiments in vitro indicate that norchlorcyclizine enhances the degradation of hyaluronic acid and chondroitin sulfate but has little or no effect on their synthesis. These changes in GAGs are caused by concentrations of norchlorcyclizine that have no appreciable effect on DNA or protein synthesis. These findings suggest that degradation of palatal GAGs may be the primary biochemical defect responsible for the inhibition of palatal shelf elevation by norchlorcyclizine.