Troglitazone has no effect on red cell mass or other erythropoietic parameters.

OBJECTIVE: Troglitazone is a new anti-diabetic agent for the treatment of type 2 diabetes. In placebo-controlled trials troglitazone improves glycaemic control, reduces hyperinsulinaemia and has beneficial effects on blood lipids. However, minor, reversible reductions in erythrocyte count, haemoglobin and haematocrit with no associated clinical symptoms have been observed in some troglitazone-treated patients. The primary objective of the present study was to determine if these changes could be explained by a decrease in red cell mass or change in plasma volume. METHODS: Twenty-four healthy males were randomized in a double-blind manner to troglitazone (200 or 600 mg per day) or placebo for 6 weeks. Blood samples for the measurement of red cell mass and plasma volume were obtained in the 2 weeks prior to treatment and after 6 weeks of treatment. Reticulocyte and erythrocyte counts, haemoglobin and haematocrit were also measured. RESULTS: At the end of the treatment period there were no statistically significant changes in red cell mass. Similarly there were no changes in reticulocyte count, erythropoietin or soluble transferrin receptors. These data indicate that troglitazone does not affect erythropoiesis. In addition, troglitazone was not associated with increased red blood cell destruction or haemolysis. There was a trend towards increased plasma volume in the troglitazone groups: increases of 2.5 ml x kg(-1) (5.7% increase) in the troglitazone 200 mg group and 3.4 ml x kg(-1) (7.8% increase) in the troglitazone 600 mg group were observed compared with placebo. CONCLUSION: These data suggest that dilutional effects related to a modest increase in plasma volume may explain the haematological changes seen in other clinical trials with high doses of troglitazone, although this study has shown that the changes in plasma volume are not statistically significant.

A study comparing biopharmaceutic characteristics of four once daily controlled release diltiazem preparations.

In the present study we have compared the steady state biopharmaceutic characteristics of four diltiazem once daily controlled release capsules: Mono-Tildiem LP 300 (300 mg), Adizem XL (300 mg), Cardizem (300 mg) and Dilacor (240 mg). Sixteen healthy male volunteers (aged 22.9 +/- 3.3 years, range 19-31 years) completed an open label, multiple oral dose, randomized, four-period crossover study without a washout period in between. The volunteers received each diltiazem formulation once daily for four days. Trough diltiazem and metabolites plasma concentrations were determined on days 3 and 4. The 24-h plasma concentration-time profiles were assessed after the dose on day 4 of each period. The following steady state pharmacokinetic parameters for diltiazem were calculated: the minimum plasma concentration (cmin), the maximum plasma concentration (cmax), the time to reach that concentration (tmax), the time interval during which the plasma concentration exceeds 50% of cmax (t50), the area under the plasma concentration-time curve (AUC72-96) and the peak-to-trough fluctuation (PTF). For the metabolites of diltiazem, N-mono-desmethyl-diltiazem (NDM) and desacetyldiltiazem (DAD), AUC72-96 (AUCNDM and AUCDAD) and the ratio metabolite/parent compound were calculated. Steady state was achieved on day 3. Except one, all controlled release formulations have satisfactory controlled release properties allowing once daily administration. However, significant (P < 0.05) differences were found between the pharmacokinetic characteristics which do not allow exchange of the various formulations. Concentrations well below 50 ng.mL-1 in the morning hours were observed for Dilacor (240 mg) and Adizem XL (300 mg), which could be a disadvantage of these formulations as it is well-known that ischaemic events occur at a higher rate during that part of the day. The plasma concentration profiles NDM and DAD, the major circulating metabolites, parallel the plasma concentration profiles for the parent compound. From a clinical point of view, all treatments were well tolerated.

Effect of Felbamate on The Pharmacokinetics of Clonazepam.

To assess the possible interaction between clonazepam and felbamate, a double-blind, randomized, placebo-controlled, two-way crossover study was conducted in 18 healthy male volunteers. Volunteers were administered clonazepam (1 mg q12h) and felbamate (1200 mg q12h) or matching placebo for 10 days during each period of the crossover. Following morning dosing on day 10, blood samples were obtained over 12 h for the determination of clonazepam and the metabolites 7-amino-clonazepam and 7-acetamido-clonazepam. Felbamate increased clonazepam's C(max) and AUC(0--12 h) by 17% and 14%, respectively (p < 0.01). The 90% confidence intervals following log-transformation for each of these pharmacokinetic parameters were within the generally accepted interval (80--125%) for bioequivalence. Felbamate had no significant effect on the pharmacokinetics of 7-amino-clonazepam, whereas 7-acetamido-clonazepam concentrations were below the limit of quantification in all but one subject. Adverse events were mainly central nervous system in nature, with a greater incidence reported during coadministration with felbamate compared with placebo. Overall, felbamate appears to have no clinically relevant effects on the pharmacokinetics of clonazepam.

Development of a simple incubation system for metabolism studies with precision-cut liver slices.

The use of precision-cut liver slices for toxicity and drug metabolism studies becomes more and more popular. So far, most of these studies are conducted using the dynamic organ culture system as incubation system. However, this system has some disadvantages, especially for the study of drug metabolism. Therefore, the aim of this study was to develop a simple incubation system for precision-cut liver slices. Rat liver slices were incubated individually in 12-well culture plates filled with 1.5 ml Krebs-Henseleit buffer, pH 7.4. Instead of glucose, fructose was used as carbohydrate source. The plates were put on a gyratory shaker (90 rpm) in a temperature controlled incubator (37 degrees C) under an atmosphere of 95% air/5% CO2. Under these conditions slices could be kept viable for at least 11 hr, which seems to be long enough for metabolism studies. Slice thickness was a critical factor in both studies on optimal incubation conditions and metabolism studies. A correlation was found between slice thickness (i.e. slice weight) and metabolite production (amount formed/mg slice) as demonstrated with tolbutamide and diazepam as test substances. It is demonstrated that a variation in slice thickness does not alter the number of cells involved in drug metabolism (i.e. the absolute amount of metabolite formed per slice does not alter). In conclusion, the way liver slices are incubated as well as the thickness of slices highly determines the results of studies on incubation conditions and metabolism studies with precision-cut liver slices.

A species comparison of tolbutamide metabolism in precision-cut liver slices from rats and dogs. Qualitative and quantitative sex differences.

Precision-cut liver slices from rats and dogs were used to investigate in vitro the metabolism of tolbutamide. Tolbutamide (100 microM) was incubated with liver slices in 12-well plates (rat: 1 slice/well; dog: 4 slices/well) for up to 9 hr. In rats, qualitative sex differences were found in tolbutamide metabolism, whereas in dogs quantitative sex differences were found. In male and female rats, the major metabolite was hydroxytolbutamide, with minor amounts of carboxytolbutamide. In both sexes, the formation rates of these metabolites were the same. In male rats, also the "dog-specific" metabolites, p-tolylsulfonylurea and p-tolylsulfonamide, were found. No direct toxicity of tolbutamide and its metabolites was observed. In male and female dogs, the major metabolite was p-tolylsulfonylurea, with smaller amounts of hydroxy- and carboxytolbutamide. Formation rates of the various tolbutamide metabolites in male dogs were approximately 3 times higher than in female dogs. The "dog-specific" metabolite p-tolylsulfonamide could not be detected. These results show that precision-cut liver slices are capable of detecting hitherto unknown species and sex differences in the metabolism of tolbutamide. Liver slices are a promising in vitro method for the study of comparative drug metabolism.

Differential effects of extracellular calcium on lipid peroxidation dependent (ethacrynic acid and allyl alcohol) and lipid peroxidation independent (disulfiram)-induced cytotoxicity in normal and vitamin E-deficient rat hepatocytes.

Hepatocytes have been isolated from normal and vitamin E-deficient rats in which the hepatic vitamin E level was less than 6% that of controls. The hypothesis was tested that extracellular calcium ameliorates chemical-induced cell killing because it decreases the extent of vitamin E loss induced by oxidative stress: such a retarding effect of calcium on cytotoxicity should be lost in hepatocytes from vitamin E-deficient rats. In normal hepatocytes, allyl alcohol and ethacrynic acid induced oxidative stress as indicated by GSH depletion, lipid peroxidation and cell death. Extracellular calcium retarded the induction of lipid peroxidation and cell death without affecting the GSH depletion. In vitamin E-deficient cells, extracellular calcium had lost its protective effect on ethacrynic acid- and allyl-alcohol induced cytotoxicity; it did not affect the GSH depletion and subsequent induction of lipid peroxidation and cell death by ethacrynic acid. However, in vitamin E-deficient hepatocytes, extracellular calcium even potentiated the cytotoxicity of allyl alcohol; under those conditions it also increased GSH loss. Neither in normal, nor in vitamin E-deficient hepatocytes, extracellular calcium had an effect on disulfiram-induced cytotoxicity, i.e. cell death in the absence of lipid peroxidation. These results support the hypothesis that the protecting effect of extracellular calcium on cytotoxicity, associated with lipid peroxidation in normal hepatocytes, is mediated by its protection against intracellular vitamin E loss.

Cardiotoxicity of vasodilators and positive inotropic/vasodilating drugs in dogs: an overview.

Standard toxicological studies in dogs using high doses of vasodilators and positive inotropic/vasodilating agents give rise to a species-specific cardiotoxicity. The reason may be the extreme sensitivity of the dog to the pharmacological effects of these drugs; exaggerated pharmacodynamic effects and prolonged disturbance of homeostasis mechanisms often are responsible for the observed organ lesions. An assessment of the toxicological relevance and the risk for patients taking the drugs at therapeutic doses cannot be made without taking into account their pathomechanisms and the pathophysiological basis of the exceptional reaction patterns occurring in dogs. A large series of vasodilating and positive inotropic agents are presented, their pharmacological properties are described, and toxicological effects in dogs are compared. In view of the poor correlation between the distinct cardiac lesions induced in dogs and a lack of comparable toxicity in humans, it appears desirable to reassess the adequacy of the standard toxicological approaches for these substances.

Role of microtubuli in secretion of very-low-density lipoprotein in isolated rat hepatocytes: early effects of thiol reagents.

The secretion of very-low-density lipoprotein from hepatocytes proceeds through the microtubules. In this study, the role of glutathione in the maintenance of intact microtubules and the secretion of very-low-density lipoprotein has been investigated. When rat hepatocytes were incubated with reagents that deplete glutathione (e.g., diethylmaleate, alpha-bromoisovalerylurea or allyl alcohol) or reacted directly with protein thiols (disulfiram), the secretion of very-low-density lipoprotein by the cells was inhibited and the microtubules were severely damaged as visualized by immunofluorescence staining. Both events occurred within 30 min; long before, an effect on the energy status of the cells became evident. The observed inhibition of the secretion therefore seems due to an effect of the toxicants on the microtubules. For alpha-bromoisovalerylurea, diethylmaleic acid and allyl alcohol, it may be related to glutathione depletion; preincubation of the hepatocytes with N-acetyl-L-cysteine reduced the decrease of glutathione by alpha-bromoisovalerylurea and allyl alcohol (but not of diethylmaleic acid) and almost completely prevented the inhibition of very-low-density lipoprotein secretion and microtubule damage. Depletion of glutathione may result in modification of a small group of essential free protein thiols. Disulfiram did not deplete glutathione, and N-acetyl-L-cysteine could not prevent the effects of disulfiram on microtubules. The binding to protein thiols of radiolabeled disulfiram, which binds to microtubules in vitro, was determined. At 0.2 mmol/L disulfiram, only 3% of total cellular protein thiols were conjugated, but secretion of very-low-density lipoprotein was already inhibited by 25%, and microtubules were severely affected. We propose that modification of a small fraction of cellular protein thiols results in the loss of microtubular ultrastructure and thereby leads to inhibition of very-low-density lipoprotein secretion.

Lipid peroxidation and protein thiol depletion are not involved in the cytotoxicity of N-hydroxy-2-acetylaminofluorene in isolated rat hepatocytes.

Freshly isolated rat hepatocytes were used to study the mechanism of cell death induced by N-hydroxy-2-acetylaminofluorene (N-OH-AAF). Exposure to 1.0 mM N-OH-AAF resulted in more than 90% cell death (as measured by LDH leakage) of hepatocytes isolated from male rats within 6 hr. Only 36% of the hepatocytes isolated from female rats died within this period. When inorganic sulfate was omitted from the incubation medium, a 6 hr exposure to 1.0 mM N-OH-AAF resulted in only 40% cell death of male hepatocytes. These findings are in accordance with the sex difference and sulfation dependence of N-OH-AAF hepatotoxicity observed in the rat in vivo. N-OH-AAF decreased glutathione (GSH) in male hepatocytes in a concentration-dependent manner. This GSH consumption was only partly dependent on the presence of inorganic sulfate. No lipid peroxidation was observed during N-OH-AAF exposure; N-OH-AAF even prevented endogenous and diethyl maleate (DEM)-induced lipid peroxidation. No reduction of free protein thiol groups was found after exposure to N-OH-AAF, even after 75% cell death had occurred. A reduction of protein thiols after N-OH-AAF exposure was observed in GSH depleted hepatocytes (obtained by DEM plus vitamin E pretreatment). Under these conditions N-OH-AAF-induced cell death occurred earlier. Therefore, GSH protects against protein thiol depletion by N-OH-AAF in control cells. N-OH-AAF-induced cell death was preceded by a loss of intracellular ATP. It is concluded, therefore, that neither lipid peroxidation nor depletion of protein thiols, but possibly loss of intracellular ATP, is involved in the sulfation-dependent cytotoxic mechanism of N-OH-AAF in isolated rat hepatocytes.

Extracellular calcium alleviates cell toxicity due to hepatotoxins that induce lipid peroxidation, but has no effect on toxins that do not cause lipid peroxidation. A study in isolated rat hepatocytes.

The effect of extracellular calcium on cell death, induced by hepatotoxins that induce lipid peroxidation [diethyl maleate (DEM), allyl alcohol (AA) and bromoisovalerylurea (BIU)] and hepatotoxins that do not induce lipid peroxidation [disulfiram (DSF), N-hydroxy-2-acetyl-aminofluorene (N-OH-AAF) and tetrahydroaminoacridine (THA)] was studied in freshly isolated rat hepatocytes. Extracellular calcium strongly delayed the onset of toxicity of DEM, AA and BIU as detected by lipid peroxidation, depletion of free protein thiol groups and cell death. This protective effect of calcium was decreased at higher concentrations of the toxic compounds. In contrast, no effect of calcium was observed on toxicity induced in the absence of lipid peroxidation by DSF, N-OH-AAF and THA. Addition of calcium was also without effect on the protein thiol depletion. These results indicate that calcium only alleviates cytotoxicity which is induced by thiol depletion resulting from lipid peroxidation. Cytotoxicity as a result of protein thiol depletion through disulfide formation is not affected by extracellular calcium.

Prolonged high intracellular free calcium concentrations induced by ATP are not immediately cytotoxic in isolated rat hepatocytes. Changes in biochemical parameters implicated in cell toxicity.

Isolated rat hepatocytes were incubated with ATP to induce high intracellular free Ca2+ concentrations as determined with the Quin-2 method. Immediately after addition of ATP, the intracellular concentration of Ca2+ rose from 200 nM to more than 2.5 microM. It stayed at this value during the first 1/2 h; the rise was absolutely dependent on extracellular Ca2+. After the first 1/2 h the Ca2+ concentration decreased to 1-2 microM (5-10 times the control value). These high intracellular free Ca2+ concentrations did not lead to an immediate loss of cell viability. Only after 2 h of incubation a substantial number of cells lost viability. This was preceded by a decrease in cellular NADH (greater than 40%) and accompanied by a sharp increase in the intracellular Ca2+ concentration. Under these conditions the NADPH concentration was not affected. Cellular GSH was decreased to 30% of the initial value, but no lipid peroxidation or protein-thiol depletion was observed. Intracellular ATP, ADP and AMP were increased in the presence of extracellular ATP. Ca2+-dependent proteases seemed not to be involved in cell death. These observations are consistent with a collapse of mitochondrial functions as a final trigger of cell death.

Lipid peroxidation-dependent and -independent protein thiol modifications in isolated rat hepatocytes: differential effects of vitamin E and disulfiram.

Exposure of isolated rat hepatocytes to allyl alcohol (AA), diethyl maleate (DEM) and bromoisovalerylurea (BIU) induced lipid peroxidation, depletion of free protein thiols to about 50% of the control value and cell death. Vitamin E completely prevented lipid peroxidation, protein thiol depletion and cell death. A low concentration (0.1 mM) of the lipophylic disulfide, disulfiram (DSF), also prevented the induction of lipid peroxidation by the hepatotoxins; however, in the presence of DSF, protein thiol depletion and cell death occurred more rapidly. Incubation of cells with a high concentration (10 mM) of DSF alone led to 100% depletion of protein thiols and cell death, which could not be prevented by vitamin E. The level of free protein thiols in cells, decreased to 50% by exposure to AA, DEM and BIU, could be reversed to 75% of the initial level by dithiothreitol (DTT) treatment, indicating that the protein thiols were partially modified into disulfides and partially into other, stable thiol adducts. The 100% depletion of protein thiols by DSF was completely reversed by DTT treatment. The involvement of lipid peroxidation in protein thiol depletion was studied by measuring the effect of a lipid peroxidation product, 4-hydroxynonenal (4-HNE), on protein thiols in a cell free liver fraction. 4-HNE did not induce lipid peroxidation in this system, but protein thiols were depleted to 30% of the initial value, irrespective of the presence of vitamin E. DTT treatment could reverse this for only 25%. Similar, DSF-induced protein thiol depletion could be reversed completely by DTT. We conclude that (at least) two types of protein thiol modifications can occur after exposure of hepatocytes to toxic compounds: one due to interaction of endogeneously generated lipid peroxidation products with protein thiols, which is not reversible by the action of DTT, and one due to a disulfide interchange between disulfides like DSF and protein thiols, which can be reversed by the action of DTT.

Inhibition of lipid peroxidation by disulfiram and diethyldithiocarbamate does not prevent hepatotoxin-induced cell death in isolated rat hepatocytes. A study with allyl alcohol, tert-butyl hydroperoxide, diethyl maleate, bromoisovalerylurea and carbon tetrachloride.

The relationship between lipid peroxidation and cell death, induced by a number of hepatotoxins, was studied in isolated rat hepatocytes. Disulfiram (DSF) and diethyldithiocarbamate (DDC) completely prevented lipid peroxidation, induced by allyl alcohol, tert-butyl hydroperoxide (t-BHP), diethyl maleate (DEM), bromoisovalerylurea (BIU) and carbon tetrachloride (CCl4). Lipid peroxidation was measured by the formation of both thiobarbituric acid positive material and conjugated dienes. However, DSF and DDC did not protect against cell death, induced by these hepatotoxins. In the presence of DSF or DDC, cell death occurred even earlier in time. We conclude that cell death can occur in the absence of lipid peroxidation. Therefore, lipid peroxidation is not a requisite for the induction of cell death.

alpha-Bromoisovalerylurea as model substrate for studies on pharmacokinetics of glutathione conjugation in the rat. II. Pharmacokinetics and stereoselectivity of metabolism and excretion in vivo and in the perfused liver.

The hypnotic drug alpha-bromoisovalerylurea (BIU) has been studied in the rat with respect to its potential use as model substrate to investigate the pharmacokinetics of glutathione conjugation in vivo. The major metabolites of racemic BIU are the diastereomeric glutathione conjugates (bile) and mercapturates (urine). BIU was metabolized mainly by glutathione conjugation: after i.v. administration of [14C]BIU to freely moving rats, 89% of the dose was recovered in urine within 24 hr, mostly as mercapturates. The rate-limiting step in the clearance of BIU from blood most likely is glutathione conjugation as it was shown that rate-limitation is not due to flow-limited clearance in the liver (the initial extraction ratio of BIU in the perfused liver preparation was low: hepatic extraction ratio = 0.23), protein binding (60% was unbound in plasma) or enzyme saturation (linear pharmacokinetics in the dose range studied: 22-270 mumol/kg). Water solubility of BIU was sufficient to allow its i.v. administration, whereas the absence of toxic effects enables animal as well as human studies. Thus, BIU is a promising model substrate for studies of glutathione conjugation in vivo. In pentobarbital-anesthetized rats with a bile duct catheter, equal amounts of metabolites were excreted in bile (almost exclusively as the two diastereomeric BIU glutathione conjugates) and urine (mostly as the two diastereomeric mercapturates). Based on similar experiments with bile duct-ligated rats, it was concluded that the appearance of the mercapturates in urine could also occur without biliary excretion and subsequent gut metabolism of the BIU glutathione conjugates. The ability of the liver to metabolize BIU was studied in a hemoglobin-free, recirculating liver perfusion system. Of the recovered radioactivity 40% was excreted in bile within 2 hr, almost exclusively in the form of the two BIU glutathione conjugates. Also, glutathione conjugates were found in the perfusate (16% of the radioactivity present in the perfusate after 2 hr). A distinct stereoselectivity was observed in the metabolite excretion rates. The excretion half-lives of the two diastereomeric glutathione conjugates in bile differed 2- to 3-fold, both in anesthetized rats and in the perfused liver preparation. A similar difference in excretion half-lives was found for the urinary excretion of the diastereomeric mercapturates. Thus, BIU can be used to investigate in vivo the stereoselectivity of glutathione conjugation.