The disposition of sulindac.

The disposition of sulindac, a new nonsteroid anti-inflammatory drug, has been studied in normal volunteers in five separate clinical studies. Based upon material balance considerations, a minimum of approximately 88% of an oral dose is absorbed. The major biotransformations involve irreversible oxidation of the sulfinyl group of sulindac to sulfone and reduction to the corresponding sulfide. The latter, which all available evidence indicates to be the pharmacologically active form of sulindac, is not excreted in urine, and has an apparent terminal half-life of 18.2 hr, well suited to twice daily dosage of its pro-drug. Following twice daily dosage of sulindac for 5 days, plasma levels of sulfide approach an apparent steady state with concentrations varying only within a twofold range over each dosage interval. The reversible biotransformation between sulindac and its active sulfide metabolite provides the basis for two therapeutic advantages relating to the gastrointestinal intolerance usually associated with anti-inflammatory drugs: (1) circumvention of initial exposure of gastric and small intestinal mucosa to the active form of the drug and (2) maintenance of systemic levels of active drug by means of enterohepatic recycling, principally of inactive pro-drug.

Bioavailability of oral dexamethasone.

Bioavailabilities of dexamethasone tablets and elixir in man were evaluated by each of 3 model-independent methods of pharmacokinetic analysis employing plasma and urinary values as determined by radioimmune assay. There were no significant differences among the results determined by the 3 methods nor between the respective availabilities of the two formulations; the latter averaged 82.6 +/- 17.7% for the elixir formulation and 78.0 +/- 12.1% for tablets.

Bioavailability of dexamethasone. II. Dexamethasone phosphate.

Plasma levels of dexamethasone phosphate (DP) and dexamethasone free alcohol (DA) were determined by a modification of existing radioimmunoassay methodology following intravenous administration of DP in man. Areas under DA plasma profiles were a linear function of DP dosage over the 40-fold range 0.05 to 2.0 mg/kg, and, by comparison with values obtained after DA was intravenously administered, indicated an overall conversion of DP to DA of 90%. The first-order rate constant for the conversion, 4.03 hr-1, was approximately 25 times that for hydrolysis in whole blood incubated in vitro. This relationship as well as disposition kinetics suggested that the major component of DP hydrolysis occurs within highly perfused organ(s) comprising the central kinetic compartment. Eighteen subjects were studied in a crossover experiment, and no significant differences were observed in best-fit parameters for the 4 mg/ml parenteral solution of DP in current use and an experimental high potency preparation of 24 mg/ml.

Enterohepatic circulation of sulindac and metabolites.

Four subjects were studied by continuous intraduodenal sampling to establish the existence and determine the extent of enterohepatic recirculation of sulindac and its sulfide and sulfone metabolites. Sulindac, 200 mg by mouth, was given every 12 hr for 7 days. After the last dose was given intraduodenally, constant duodenal infusion of a nutrient mixture and sampling of duodenal contents were performed through a triple-lumen intraduodenal tube for 12 hr. Calculation of nonabsorbed drug in the samples and quantitation of drug and metabolite levels in the biliary secretions were made possible by nonabsorbable markers in the drug solution and in the infusate. Interindividual variations in the absolute values for each of the chemical species were over a 200% range, but for each subject relative clearances were in a remarkably constant ratio, averaging 1:12:12 for sulfide:sulindac:sulfone. Total biliary excretions of the prodrug (sulindac) and active pharmacophore (sulfide) calculated from these biliary clearances and historic mean plasma AUCs were 136% and 22% of dose. Thus, there is a correlation between data in man and those in five other species and the data established that, after sulindac, the contribution of enterohepatic circulation to conservation of the active pharmacophore is achieved predominantly at the level of inactive prodrug.

3,5-disubstituted 1,2,3,4-triazoles, 1 new class of xanthine oxidase inhibitor.

3,5-Bis(4-pyridyl)-1,2,4-triazole (PPT), 3-(4-pyrimidinyl)-5-(4-pyridyl)-1,2,4-triazole (PMPT), and 3-(4-pyridazinyl)-5-(4-pyridyl)-1,2,4-triazole (PZPT) are among the most active competitive inhibitors of xanthine oxidase among a series of 3,5-disubstituted triazoles synthesized for this purpose, inhibition constants being less than 1 times 10(-7) M for each. ED50 values in squirrel monkeys derived from first-order rate constants for the first and rate-limiting step of the sequence, xanthine leads to uric acid leads to allantoin plus CO2, range from 0.04 to 0.08 mg kg-1 orally, with unusually long durations of action attributable to asymmetric distribution of inhibitor within liver and gut as a consequence of enterohepatic recirculation. Sensitivity of rats, dogs, and anthropoid species to these, as to other xanthine oxidase inhibitors, is markedly less than that of the squirrel monkey, but the triazoles are at least an order of magnitude more active than the representative purine analogs tested.

4-Trifluoromethylimidazoles and 5-(4-pyridyl)-1,2,4-triazoles, new classes of xanthine oxidase inhibitors.

The syntheses of a number of 2-substituted 4-trifluoromethylimidazoles and 3-substituted 5-(4-pyridyl)-1,2,4-triazoles are described. The trifluoromethylimidazoles were prepared from 3,3-dibromo-1,1,1-trifluoroacetone after hydrolysis with aqueous sodium acetate solution and condensation with an aldehyde in the presence of ammonia. Basic hydrolysis of the trifluoromethyl group was found to provide a facile method for the synthesis of imidazole-4-carboxylic acids. In the imidazole series a 2-aryl substituent and a free imino group were required for xanthine oxidase inhibitory activity. The triazoles were obtained through the reaction of an aroylhydrazine and an imino ether followed by thermal ring closure of the intermediate acylamidrazone. As in the imidazole series, a free imino group is an absolute requirement for in vitro activity. Additional structure-activity relationships of these compounds are presented.

2-pyridylimidazoles as inhibitors of xanthine oxidase.

A series of 28 4-substituted and 4,5-disubstituted 2-pyridylimidazoles was synthesized and evaluated in vitro for inhibition of xanthine oxidase. Included within this group are examples of 2-pyridylimidazopyridines and halo-substituted 2-pyridylbenzimidazoles. Five compounds exhibited inhibitory activity in the same range as the standards, 4-hydroxypyrazolo[3,4-d]pyrimidine and 2-(4-pyridyl)-4-trifluoromethylimidazole (22). Two examples, 2-(4-pyridyl)-4,5-dicyanoimidazole (16) and 2-(4-pyridyl)-4-nitroimidazole (3), were at least an order of magnitude more active than the standards and therefore rank among the most potent known inhibitors of the enzyme.

Inhibitors of glycolic acid oxidase. 4-Substituted 3-hydroxy-1H-pyrrole-2,5-dione derivatives.

An extensive series of novel 4-substituted 3-hydroxy-1H-pyrrole-2,5-dione derivatives has been prepared and studied as inhibitors of glycolic acid oxidase (GAO). Compounds possessing large lipophilic 4-substituents are, in general, potent, competitive inhibitors of porcine liver GAO in vitro. Methylation of the nitrogen or the 3-hydroxy substituent reduced potency dramatically, indicating the requirement for the two acidic functions on the 1H-pyrrole-2,5-dione nucleus. In rat liver perfusion studies, with three representative compounds, concentration-dependent inhibition of the conversion of [1-14C]glycolate to [14C]oxalate was observed. Chronic oral administration to ethylene glycol fed rats of the 4-(4'-bromo[1,1'-biphenyl]-4-yl) derivative (83) was shown to effect a significant reduction in urinary oxalate levels over a 58-day period.

Protein binding as a primary determinant of the clinical pharmacokinetic properties of non-steroidal anti-inflammatory drugs.

The ability of a wide variety of anionic, cationic, and neutral drugs to bind in a reversible manner to plasma proteins has long been recognised. Non-steroidal anti-inflammatory drugs (NSAIDs) are distinguished as a class by the high degree to which they bind to plasma protein. Plasma protein binding properties are primary determinants of the pharmacokinetic properties of the NSAIDs. Theoretical relationships are reviewed in order to define quantitatively the impact of plasma protein binding on clearance, half-life, apparent volume of distribution, and the duration and intensity of pharmacological effect. The quantitative relationships governing competitive displacement binding interactions are also presented. Experimental methods for in vitro and in vivo determination of the degree of plasma protein binding are discussed. The more common in vitro methods are equilibrium dialysis and ultrafiltration. Methods for characterising the degree of plasma protein binding in vivo consist of either measuring the concentration of drug at equilibrium in an implanted semipermeable vessel or measuring the relative drug concentrations in two body spaces with different protein content. Emphasis is given to the comparative advantages and disadvantages of experimental application of the various in vitro and in vivo methods. Plasma protein binding is discussed as a determinant of the trans-synovial transport of NSAIDs. Trans-synovial transport of NSAIDs appears to be a diffusional process. Limited data in humans receiving ibuprofen, indomethacin, aspirin, carprofen, alclofenac, or diclofenac suggest that clearance of each of these NSAIDs from the synovium is slower than clearance from plasma. The clinical data relevant to the relationship between plasma NSAID concentration and various measures of anti-inflammatory effect are reviewed. A positive correlation between plasma NSAID concentration and anti-inflammatory effect has been observed in only one study on naproxen and one study on piroxicam. In several other studies, the lack of concentration-response correlations is generally attributed to the relatively subjective, quantitatively inexact methods used to assess anti-inflammatory effect and analgesia in arthritic patients, as well as the substantial interpatient variabilities in the fraction of unbound NSAID and the unbound plasma NSAID concentration. In view of the generally poor correlation between concentration and therapeutic response, routine therapeutic monitoring of total plasma NSAID concentration is not recommended as a means of titrating individual dosages to the desired effect in each patient.(ABSTRACT TRUNCATED AT 400 WORDS)

Inhibition of histamine synthesis in vitro and in vivo by S-alpha-fluoromethylhistidine.

(S)-alpha-Fluoromethylhistidine (alpha-FMH) is a Kcat or "suicide-substrate" inhibitor of partially purified mammalian histidine decarboxylase; i.e. the agent is converted enzymatically to a more active form which effects a time-dependent, irreversible inhibition. Incubation of a alpha-FMH[4-3H] with enzyme and pyridoxal phosphate resulted in an apparently irreversible labeling of protein, with no demonstratable formation of free-amine product, suggesting a very low to non-existent turnover ratio. alpha-FMH was accumulated in isolated mastocytoma cells and effected a time-dependent inhibition of the conversion histidine[3H]----histamine[3H], the latter product having a markedly different distribution between cells and medium than the pre-existing histamine pool. Inhibition of whole-body histidine decarboxylase activity, as specifically measured by alpha-methylhistidine-14COOH----14CO2, was also time dependent. Concomitant reduction in histamine levels was seen only in the rapidly turning-over pools of stomach and brain. However, over the course of 13 weeks of chronic treatment, depletion of the relatively inert mast-cell histamine pool(s) was seen as well.

Radioimmunoassay of indomethacin in biological fluids.

A radioimmunoassay was developed for the determination of indomethacin in biological fluids at concentrations as low as 50 ng/ml. Antibodies were produced in rabbits immunized with a conjugate of bovine serum albumin and indomethacin. This conjugate was prepared by an N-hydroxysuccinimide active ester procedure. Antiserums exhibited minimal cross-reactivity with the O-desmethyl and deschlorobenzoyl metabolites. However, the glucuronide conjugate was about three times as reactive as indomethacin, thus invalidating direct determinations of indomethacin in urine. This difficulty was circumvented by analyzing urine aliquots before and after conjugate hydrolysis. Concentrations of free and conjugated indomethacin were calculated by difference.

Analysis of sulindac and metabolites by combined isotope dilution-radioimmunoassay.

Sulindac, a new anti-inflammatory agent, and its sulfone and sulfide metabolites were conjugated to bovine serum albumin by the N-hydroxysuccinimide active ester procedure. Antiserum from rabbits immunized with each of these haptens exhibited extensive cross-reactivity, precluding differential analyses of the three species by displacement assay without prior separation. Therefore, an analytical method based on a combination of isotope dilution and radioimmunoassay was devised. A known mixture of the three chemical species, each labeled with tritium, was equilibrated with plasma or urine samples, reisolated chromatographically, and quantitated by binding to an appropriate immunoglobulin. The radiolabeled materials thus served as recovery standards as well as labeled antigens for each displacement assay. Sulindac and each of its metabolites in plasma or urine at concentrations as low as 500 ng/sample were differentially determined by this procedure. However, since an extraction is required, several milliliters of plasma can be used for each sample, thus increasing the actual sensitivity of the assay.

Bioanalysis and disposition of alpha-fluoromethylhistidine, a new histidine decarboxylase inhibitor.

A sensitive, selective, and rapid high-performance liquid chromatographic procedure was developed for the determination of alpha-fluoromethylhistidine (alpha-FMH) in human biological samples. The plasma assay required isolation of the drug using a weak cation-exchange resin prior to HPLC analysis with UV detection. The urine assay employed postcolumn derivatization with o-phthalaldehyde (without a thiol) and fluorescence detection. The extent of metabolism of alpha-FMH in humans was studied in four healthy volunteers using tritium-labeled material. No significant differences in the plasma and urine concentrations of radioactivity and unchanged drug were detected. In addition, the radiochromatograms of selected urine samples revealed a single peak with a retention time corresponding to the unchanged drug. The evidence presented suggests negligible biotransformation of alpha-FMH in humans.

Sulindac: therapeutic implications of the prodrug/pharmacophore equilibrium.

Sulindac is a prodrug which, following absorption, rapidly attains a metabolic equilibrium with its active pharmacophore, the sulfide metabolite. At the level of the whole body, the reversible interconversion sulindac in equilibrium sulfide, and the differing distributional and excretory properties of each, provide a theoretical basis for the long plasma half-life of active drug and, in animal species, for the favorable gastrointestinal tolerance observed. In all organ cells examined, and in macrophages, enzyme systems mediating each of the opposing biotransformations between prodrug and active sulfide are present: sulindac reductase in the cytoplasm, and the sulfide oxidase activity in microsomes. Estimated metabolic rate constants for intracellular pools are of the order 0.1-0.3 min-1. It is thus proposed that sulfide, which is oxidized to sulindac in the course of scavenging oxidizing radicals generated in inflammatory responses, may be efficiently regenerated in situ.

Novel genotypes among transductants made with bacteriophage P1 lysates from an F14 merogenote strain of Escherichia coli K-12.

Among P1 transductants in Escherichia coli K-12 that were selected for the proximal and distal markers from the large F14 merogenote, a variety of unusual genotypes were found. As earlier workers had found, one class of these could transfer the proximal genes (argH, metB) and distal genes (ilvEDAC) of the F14 during conjugation. These F14 genes could be transferred into RecA recipients, indicating that they were carried on an F-merogenote rather than on an Hfr chromosome. The transduced F-merogenotes could transfer other F14 genes (metE, rha) as well. Transfer kinetic analysis showed that all of the latter transduced F-merogenotes that were examined were indistinguishable from the parental F14 in the order of transfer and the genetic distance between proximal and distal markers. This suggests that the whole F14 had been received somehow by the primary transductional recipients, a remarkable possibility since the F14 is much larger than the largest deoxyribonucleic acid segment normally transduced by P1. The mechanism of this phenomenon is not yet known. Many of the transductants did not transfer any of the F14 markers tested. Some of these transductants segregated certain F14 genes, indicating they were carried on self-replicating genetic elements, but others were not cured of F14 markers, even by acridine orange. Cotransductional analysis of this group was consistent with the hypothesis that the F14 markers in some of these strains had integrated into the chromosome in the expected manner, since in these latter the F14 alleles were linked to the expected chromosomal genes. Other strains among the stable transductants had acquired new linkages in that genes previously separated by several minutes could now be cotransduced. These latter included the novel cotransductional linkages of rbs-ilv-argH, rbs-ilv-argH-metB, and ilvD-argH-purD. Such strains might have been formed as a result of insertion into the chromosome of small circles derived from F14.

Ordering of mutant sites in the isoleucine-valine genes of Escherichia coli by use of merogenotes derived from F 14 : a new procedure for fine-structure mapping.

F-merogenotes derived from F(14) by transductional shortening have previously been found to consist of the sex factor plus one or more of the ilv genes. It is shown here that they carry one or more ilv genes and a variable portion of the adjacent proximal ilv gene. This observation was used to develop a method, analogous to deletion mapping, for ordering mutant sites within the ilv genes. This method requires the use of a series of merogenotes each carrying an increasingly longer segment of the gene being mapped. A simplified method of fine-structure mapping is also described which requires only one or two F' donor strains to map any one gene. This method is based on the large differences observed in recombination frequencies for mutant sites at various distances from the origin of the incomplete merogenote gene. The sequence of 25 mutant sites within three of the ilv genes was determined by use of the simplified procedure.

Kinetics of the tissue distributions of sulindac and metabolites. Relevance to sites and rates of bioactivation.

Sulindac (sulfoxide) is a prodrug in reversible metabolic equilibrium with its pharmacologically active metabolite, the corresponding sulfide. Following simultaneous parenteral injection of sulfoxide-14C and sulfide-3H at equivalent dosage, all labeled species in the plasma of rats and guinea pigs and in representative tissues were determined at various times. Rate constants for sulfoxide in equilibrium or formed from sulfide, calculated from the rates of interchange of the two labels in plasma, are still higher than those approximated from earlier, single-label studies, and indicate turnovers of total body pools every 45 and 8.5 min in rat and guinea pig, respectively. From the time-course of tissue/plasma ratios of endogenous labeled species, it can be concluded that kidney and liver are major sites of bioactivation of the prodrug, with significant sulfoxide leads to sulfide activity present in all tissues examined. At steady state, tissue concentrations of each redox form are determined by the ratio of the metabolic rate constants for the two opposing biotransformations and by unique tissue/plasma distributive constants for each redox form, resulting in all tissues, except lung, and at all times examined, in a sulfide/sulfoxide ratio greater than one.