In vitro interactions of the aromatic retinoids Ro 10-9359 (etretinate) and Ro 10-1670 (acitretin), its main metabolite, with human serum lipoproteins and albumin

Serum lipoproteins are good carriers for the aromatic retinoid Ro 10-9359 (etretinate) and to a lesser extent for its main metabolite in human Ro 10-1670 (acitretin). Up to about 200 and 130 etretinate molecules and 200 and 70 acitretin molecules can bind to one LDL and one HDL, respectively. In contrast human serum albumin only binds about 10 etretinate or 30 acitretin molecules. In whole human serum loaded with the retinoids, lipoproteins carry approx. 67% of total etretinate or approx. 37% of total acitretin. In the particular case of etretinate, low density lipoproteins account for about 30% of the lipoprotein-carried etretinate.     

Uptake of the aromatic retinoids Ro 10-9359 (etretinate) and Ro 10-1670 (acitretin), its main metabolite, delivered to cultured human fibroblasts by serum proteins. Lack of evidence for perturbation of LDL catabolism

Etretinate or acitretin are efficiently delivered to cultured human fibroblasts in the presence of low density lipoproteins, high density lipoproteins or human serum albumin. In contrast to acitretin, delivery of etretinate to fibroblasts is more efficiently achieved with human serum albumin than with lipoproteins. The uptake of etretinate and acitretin via low density lipoproteins delivery, does not take place via the low density lipoprotein-receptor endocytotic pathway but mostly through a passive exchange with the plasma membrane. However, in contrast to acitretin, the exchange of etretinate seems to occur alter binding of etretinate-loaded low density lipoproteins to the apolipoprotein B receptors. No differences are observed in binding, internalization and degradation of native, etretinate-loaded low density lipoproteins and acitretin-loaded low density lipoproteins, suggesting that the presence of these retinoids in low density lipoproteins does not alter their processing by the cells. Furthermore, the presence of these retinoids in the cells does not notably affect, under our experimental conditions, the catabolism of native low density lipoproteins.     

Mechanistic studies on the ethyl-esterification of acitretin by human liver preparations in vitro

Studies have been performed with human liver microsome preparations in vitro, to investigate the reaction mechanisms involved in the conversion of acitretin to the corresponding ethyl ester, etretinate. The results indicate that:Three fresh samples of human liver, which had been stored in liquid nitrogen for up to 8 months, all produced traces of etretinate (5.8 ± 0.8 >ng/ml) in the presence of ethanol but not when the acitretin was added in acetone, or when the sample was denatured by preheating.Studies with pooled human liver microsomes, to identify the cellular location of the enzymes and the co-factors involved in this esterification, indicate a primary requirement for both ethanol and CoA + ATP with a secondary potentiation in the presence of an NADPH regenerating system.A possible explanation for these finding is that the microsomal ligase enzymes form an intermediate ester between CoA and acitretin, which is then trans-esterified by the ethanol. The low formation with CoA + ATP may indicate that second stage of this process occurs spontaneously, with the NADPH potentiation suggesting that it could also be mediated enzymically.     

ABCDXXX: The obscenity of postmarketing surveillance for teratogenic effects

Our current system of postmarketing surveillance, which is based on voluntary reporting of suspected teratogenic effects, is a failure. Postmarketing surveillance should, at a minimum, provide reassurance that every approved drug treatment does not produce a teratogenic effect as great as thalidomide embryopathy or fetal alcohol syndrome. This means that postmarketing surveillance should be able to detect a twofold or greater increase in the frequency of major congenital anomalies, a fivefold or greater increase in the frequency of intellectual disability, or a characteristic pattern of minor anomalies and functional abnormalities that occurs with a frequency of at least 10% among the children of women who were treated with the drug during pregnancy. Effective surveillance for teratogenic effects could be accomplished through a complementary set of mechanisms that includes pregnancy exposure registries or cohorts as well as direct examination of a small subset of infants whose mothers received the treatment during various periods of pregnancy. If this routine surveillance reveals a "signal" (i.e., an indication suggesting a possible teratogenic effect), further study would be needed to establish whether the observed effect is real and causal. Once a signal of possible teratogenicity in humans has been recognized, validating or refuting it would become an urgent matter. Birth Defects Research (Part A) 94:670-676, 2012. ? 2012 Wiley Periodicals, Inc.     

Induction of β-retinoic acid receptor mRNA by teratogenic doses of retinoids in murine fetuses

Retinoic acid is required for normal growth and development, however excessive doses are teratogenic. Recently several nuclear retinoic acid receptors (RAR) have been identified and postulated to mediate the response of retinoic acid at the gene level. We wished to determine if alpha-RAR mRNA or beta-RAR mRNA levels are modulated by teratogenic doses of retinoic acid in vivo. We have found that beta-RAR mRNA levels in 9-day-gestation mouse conceptuses are increased as early as 3 h after administration of a completely teratogenic dose of retinoic acid (100 mg/kg body weight; b.w.) and reach a maximum of approximately sixfold after 6 h of treatment. Maternal liver and maternal kidney demonstrated a similar pattern of increase in beta-RAR mRNA, however this was only approximately threefold. Retinoic acid dose-response experiments demonstrated a reduced increase of beta-RAR mRNA levels with 10 mg/kg b.w. (minimally teratogenic dose), and no increase with a more-physiological dose of 1 mg/kg b.w. in the conceptuses. beta-RAR mRNA levels were elevated in 18-day-gestation fetuses to a similar extent to that observed in the 9-day-gestation conceptuses. Therefore, the twofold difference in the extent to which beta-RAR mRNA levels increase does not occur because the fetuses are at a developmental stage that is sensitive to the teratogenic effects of retinoic acid. Finally, treatment with another teratogenic retinoid, etretinate, and a nonteratogenic retinoid, retinoyl beta-glucuronide, both resulted in increase in the level of beta-RAR mRNA in the conceptuses and the maternal tissues. Therefore, an increase in beta-RAR mRNA levels caused by treatment with retinoids does not necessarily commit a fetus to undergo an abnormal pattern of development characteristic of teratogenic retinoids.     

Retinoid-induced inhibition of eosinophil LTC4 production

Naturally occurring and synthetic retinoids demonstrate a marked antiinflammatory effect when employed in such disorders as acne and psoriasis. This effect may result in part from their inhibition of release of potent mediators (e.g. eicosanoids) by inflammatory cells. In this study, we examined the effect of eight retinoids (tretinoin, isotretinoin, retinol, retinal, acitretin, retinyl palmitate, etretinate, Ro 15-0778) on the release of leukotriene (LT)C4, an important lipid mediator generated by eosinophils. Tretinoin, isotretinoin, retinol, retinal, and acitretin at 10(-5) M or 10(-4) M concentrations inhibited LTC4 release by A23187-stimulated horse eosinophils in vitro; 10(-4) M retinyl palmitate was also inhibitory. However, 10(-5) M etretinate augmented A23187-induced LTC4 release, and the arotinoid Ro 15-0778 had no effect on LTC4 production. These data suggest that selected retinoids may have potential use in the reduction of LTC4 generation by eosinophils. This inhibition could be beneficial in the therapy of such diseases as bronchial asthma in which release of LTC4 may be involved in the inflammatory process.     

Reduction of all-trans-retinoic acid-induced teratogenesis in the rat by glycine administration

BACKGROUND: Prenatal rat embryo exposure to retinoids induces severe malformations in various organs; the most active and teratogenic metabolite is all-trans-retinoic acid (atRA). The mechanisms of this embryopathy are only partly known. In the present study, the influence of glycine on the teratogenicity of atRA was investigated. METHODS: Embryos from 5 groups of white rats were studied: Group 1 remained untreated; Group 2 received glycine 2% in drinking water ad libitum from the first gestational day (GD 1); Group 3 was administered vehicle (corn oil); Group 4 was treated with atRA (50 mg/kg of body weight) injected (IP); and Group 5 was treated with atRA (50 mg/kg of body weight IP) plus glycine 2% in drinking water ad libitum from GD 1. atRA was administrated daily from GD 8-10. Dams were killed on the 21st day of pregnancy, and their fetuses were examined to detect external, visceral, and skeletal malformations. RESULTS: The results show that the atRA-administered dose is not toxic for the dams, and that although fetal death was not observed, it produced abnormalities in the fetuses. Glycine reduced atRA-induced teratogenic effects (external and skeletal defects). CONCLUSIONS: The results indicate that glycine effectively reduces the teratogenic effects of atRA. Thus, glycine might be useful for the prevention of vitamin A teratogenicity.     

A newly discovered xenobiotic metabolic pathway: ethyl ester formation.

Formation of etretinate, ethyl ester of acitretin, can be confirmed in vitro and in vivo using acitretin as the substrate. Etretinate was identified by LC/MS. The in vitro incubation was performed using rat and human liver 12,000 g supernatant, and the in vivo experiment was conducted in rats after oral dosing of acitretin. The ethyl ester formation was greatly enhanced by addition of or dosing with ethanol.     

Prenatal exposure to fluconazole: an identifiable dysmorphic phenotype

BACKGROUND: Fluconazole is a triazole antifungal used to treat mycotic infections. Fluconazole is reported to act as a teratogen when used continuously at a dosage of 400-800 mg daily. Fluconazole embryopathy was previously reported in 4 cases. The common features that were also seen in the current case include multiple synostosis (including craniosynostosis and digital synostosis), congenital heart defects, skeletal anomalies, and recognizable dysmorphic facial features. CASE: We report the case of a 9-month-old male born to a 30-year-old woman following a 37-week pregnancy. The pregnancy was complicated by maternal human immunodeficiency virus (HIV) infection and multiple drug exposures, including fluconazole (400 mg/day) until the fifth month and then from 6 months to term, efavirenz, nevirapine, methadone, dapsone, pentamidine, and trimethoprim-sulfamethoxazole. At birth the infant had seizures related to neonatal abstinence syndrome and was noted to have multiple congenital anomalies. On examination at age 9 months, he had craniosynostosis secondary to coronal and lambdoidal suture closures, shallow orbital region, hypoplastic supraorbital ridges, hypertelorism, and mild ptosis. He had radioulnar synostosis and metacarpophalangeal-proximal interphalangeal symphalangism of D2-D5 bilaterally. CONCLUSIONS: The findings of cranial synostosis, multiple symphalangism, and long-bone abnormalities in our case are typical of other reported cases of fluconazole embryopathy. Our patient showed no evidence of embryopathy due to efavirenz, and he did not have the features of Antley-Bixler or other craniosynostosis syndromes. We review the literature regarding the teratogenic effects of prenatal exposure to fluconazole and provide additional evidence that prenatal fluconazole exposure has a clearly identifiable phenotype.     

Involvement of c-Jun N-terminal kinases activation in diabetic embryopathy

The mechanisms for diabetic embryopathy are not well understood. JNK1/2 activation is increased in diabetic embryopathy, and antioxidants abolish JNK activation, and thus, ameliorate diabetic embryopathy. Phosphorylated SEK1 were significantly elevated in malformed embryos from diabetic mouse. In a dose-dependent manner, JNK inhibitor (SP600125) significantly reduced hyperglycemia-induced embryopathy. Malformation rates in embryos from the diabetic WT group were 15.6-fold higher than that in the non-diabetic WT control group. Jnk2 null mutant (JNKKO mice) was associated with a 71% reduction in the malformation rate of embryos under maternal diabetic conditions. Embryos cultured in 0.5mM sorbitol (JNK activator) had a malformation rate that was significantly higher than that of the control group. Pharmacological and genetic evidence from the present studies strongly support JNK activation being an indispensable mediator of diabetic embryopathy. JNK activation itself is sufficient to induce embryonic anomalies, and thus mimics the teratogenic effect of hyperglycemia.     

Klippel-Feil syndrome in a boy exposed inadvertently to cyclophosphamide during pregnancy: a case report

BACKGROUND: Cyclophosphamide (CPA) is an alkylating agent widely used as an immunosuppressive agent in the treatment of several autoimmune diseases, including systemic lupus erythematosus. Its teratogenic effect has been well studied in different experimental mammalian and non-mammalian animal models. In humans, 11 cases of CPA teratogenesis have been documented. CASE: We present a case of a patient with Klippel-Feil syndrome inadvertently exposed to CPA and prednisone in utero during the first trimester. CONCLUSIONS This case of possible cyclophosphamide embryopathy provides evidence of teratogenesis as an etiologic agent in developmental field defects such as Klippel-Feil syndrome.     

Ultrastructural pathologic changes of rat extraembryonic visceral endodermal cells exposed to teratogenic antibodies in vivo

It has been well established that certain heterologous tissue antibodies may induce abnormal embryonic development when injected into pregnant rodents during the organogenetic period. It has been postulated that these antibodies indirectly cause embryopathy by interfering with the normal functions of the yolk-sac placenta. The exact mechanism whereby these antibodies may induce placental pathology is not known. Specific teratogenic antibodies against a homogeneous rat kidney glycoprotein or a visceral yolk-sac glycoprotein antigen were injected intraperitoneally into 9th day pregnant rats. Electron microscopic examinations of the extraembryonic visceral endodermal cells of the egg cylinder were performed at 4, 6, 9, and 24 hours after the administration of the teratogenic antibodies. Control animals were injected with normal rabbit serum proteins. Extraembryonic visceral endodermal cells were similarly processed and examined as the experimental groups. The results seemed to indicate that the teratogenic antibodies induced increased autophagocytosis and morphologic changes associated with the phagolysosomes (secondary lysosomes) within the extraembryonic visceral endodermal cells at 9 hours following antibody administration. After 24 hours there was an apparent reduction or a complete disappearance of the supranuclear phagolysosome-like and lysosome-like structures, and the appearance of many large and small electron lucent vacuoles containing finely granular materials. Similar ultrastructural pathology was not observed in the 4 and 6 hour experimental and all of the control groups of animals. No other obvious intracellular or intercellular changes were observed in all of the experimental groups. Although the exact mechanism whereby the teratogenic antibodies may induce pathologic changes in the extraembryonic visceral endodermal cells remains to be determined, the present ultrastructural study demonstrated, for the first time, that teratogenic antibodies induced abnormal pathology in the extraembryonic visceral endodermal cells during the critical period of organogenesis.     

Retinoid-induced inhibition of bosinophil LTC4 production

Naturally occuring and synthetic retinoids demonstrate a marked antiinflammatory effect when employed in such disorders as acne and psoriastis. This effect may result in part from their inhibition of release of potent mediators (e.g. eicosanoids) by inflammatory cells. In this study, we examined the effect of eight retinoids (tretinoin, isotretinoin, retinol, retinal, acitretin, retinyl palmitate, etretinate, Ro 15–0778) on the release of leukotriene (LT)C₄, an important lipid mediator generated by eosinophils. Tretinoin, isotretinoin, retinol, retinal, and acitretin at 10⁻⁵ M or 10⁻⁴ M concentrations inhibited LTC₄ release by A23187-stimulated horse eonsinophils in vitro; 10⁻⁴ M retinyl palmitate was also inhibitory. However, 10⁻⁵ M etretinate augmented A23187-induced LTC₄ release, and the arotinoid Ro 15–0778 had no effect on LTC₄ production. These data suggest that selected retinoids may have potential use in the reduction of LTC₄ generation by eosinophils. This inhibition could be beneficial in the theraphy of such diseases as bronchial asthma in which release of LTC₄ may be involved in the inflammtory process.     

Anatomy of a duplicated human foot from a limb with fibular dimelia.

At birth, a patient presented with a right lower limb featuring preaxial polydactyly and fibular dimelia with a complete absence of the tibia. Radiographic studies of the patient's foot revealed a duplicated tarsus with eight metatarsals and toes. The three preaxial toes were surgically removed at 1 year of age. A hallux and four normal-appearing postaxial toes remained. The foot was amputated when the patient was 3 years old. Dissection of the amputated foot revealed that the muscles of the dorsum were normal, except that the tendon of the extensor hallucis brevis muscle inserted into both the hallux and toe 2, rather than only into the hallux. The few abnormalities observed among the muscles on the plantar surface of the foot included absence of the insertions of the tibialis posterior and the abductor hallucis muscles. In addition, the two heads of the adductor hallucis muscle inserted abnormally into the medial (tibial) side of metatarsal 1, rather than into the lateral side. These various muscular anomalies, in addition to the mirror duplication of the foot with the presence of only a single metatarsal 1, leads us to propose that this metatarsal probably represents two lateral (fibular) halves that form a laterally duplicated bone. Although the dorsalis pedis artery was present on the dorsal surface of the foot, most of its derivatives were absent. This artery did give rise to a supernumerary medial branch that ended abruptly in the connective tissue (presumably postsurgical scar) at the medial border of the foot. This branch may have represented a duplicated dorsalis pedis artery associated with the duplicated preaxial portion of the foot. The arteries on the plantar surface of the foot were normal. Even though some anomalies in the pattern of the cutaneous innervation were observed, the nerves of the foot were largely normal. The gross and radiographic anatomy of this specimen and the radiographic anatomy of the leg suggest that some teratogenic event occurred when developmental specification reached the level of the future knee. The teratogenic event, which probably occurred early in the fifth week of development, may have caused damage that led to a lateral duplication of both the leg and the foot with the absence of some of the most medial structures. Teratology 60:272-282, 1999.     

Craniofacial and axial skeletal defects induced by the fungicide triadimefon in the mouse

BACKGROUND: Triadimefon is an antifungal derived from triazole. In in vitro whole-rodent embryo cultures, triazole-derivatives showed specific teratogenic effects at the branchial apparatus. The aim of the present work was to test in vivo triadimefon (FON), in order to verify a relationship between triazole exposure, embryonic abnormalities, and/or fetal malformations. METHODS: Pregnant CD-1 mice were treated with 0-300 mg/kg FON by gavage on day 8 post coitum (p.c.) at 10:00 AM, and sacrificed on day 8 p.c. at 1:00 PM, on day 9 p.c. at 10:00 AM, on day 10 p.c. at 10:00 AM, and at term of gestation (day 18 p.c.). At midgestation, the embryos were processed for specific immunostainings to visualize the hindbrain segmentation (day 8 p.c.) and the neural crest cell migration (days 8 and 9 p.c.). Fetuses explanted at term were all processed for skeletal examination after double-staining of osseous and cartilaginous tissues. RESULTS: At midgestation, the immunostaining of rhombomeres 3 and 5 showed a light scattering of the immunostained areas; the neural crest cell migration was unaffected, but their localization at the branchial arch level was abnormal. At term, several severe malformations were observed at the craniofacial and at the axial skeletal level. Ectopic cartilage was observed at the upper jaw. CONCLUSIONS: Triadimefon is teratogenic. The observed craniofacial malformations could be explained by an alteration of the rhombomeric organization and neural crest migration to the branchial arches; the axial abnormalities could be explained by the abnormal segmental identity specification.     

Teratogenicity of the 13-cis and all-trans-isomers of the aromatic retinoid etretin: correlation to transplacental pharmacokinetics in mice during organogenesis after a single oral dose

NMRI mice were treated on day 11 (day 0 = plug day) of gestation with a single oral dose of 100 mg/kg of either all-trans-etretin (acitretin) or 13-cis-etretin. For teratology studies mice were sacrificed on day 18 of gestation, and the fetuses were examined for malformations. For pharmacokinetic studies, groups of 5 mice were sacrificed after 5, 10, and 30 min and 1, 2, 4, and 8 h. The concentrations of retinoids in maternal plasma and in embryos were determined by a newly developed HPLC gradient method. All-trans-etretin induced malformations in 94% of the fetuses, mainly in fore and hind limbs and cleft palate. 13-cis-etretin did not show any teratogenic or embryo-lethal effects at the dose level used. These findings could be explained by a transplacental pharmacokinetic study. The maximum peak level and also the AUC (area under the concentration-time curve) value of all-trans-etretin in the embryos was 7-8 times higher than corresponding values for 13-cis-etretin, probably due to extensive transport of the trans-isomer and limited transport of the cis-isomer from maternal plasma to the embryos. The concentration quotient between embryo and the maternal plasma was between 0.43 and 1.10 for all-trans-etretin, and only 0.16-0.31 for 13-cis-etretin over the time period studied. An in vivo isomerization of the compounds was also observed which was more extensive for 13-cis-etretin than for all-trans-etretin. Our results indicate that the low teratogenic potency of 13-cis-etretin is due to a limited placental transfer of this compound; on the other hand, the potent teratogen all-trans-etretin is rapidly and extensively transferred to the embryo.     

Klippel‐Feil syndrome in a boy exposed inadvertently to cyclophosphamide during pregnancy: A case report

BACKGROUND Cyclophosphamide (CPA) is an alkylating agent widely used as an immunosuppressive agent in the treatment of several autoimmune diseases, including systemic lupus erythematosus. Its teratogenic effect has been well studied in different experimental mammalian and non‐mammalian animal models. In humans, 11 cases of CPA teratogenesis have been documented. CASE We present a case of a patient with Klippel‐Feil syndrome inadvertently exposed to CPA and prednisone in utero during the first trimester. CONCLUSIONS This case of possible cyclophosphamide embryopathy provides evidence of teratogenesis as an etiologic agent in developmental field defects such as Klippel‐Feil syndrome. Birth Defects Research (Part A) 2012. © 2012 Wiley Periodicals, Inc.     

Multiple antigens in the rat visceral yolk sac induce teratogenic antisera

Preparative isoelectric focusing was used to fractionate the supernatant from a homogenate of day 19 rat visceral yolk sac. Three fractions, of pI ranges 3.5-5.0, 5.0-7.0, and 7.0-9.0, were isolated and used to immunize rabbits, by four or six weekly injections, each containing 5 mg protein. The resulting antisera were all teratogenic when injected into rats on day 9 of gestation, but widely differing potencies were observed. The most potent antiserum was that against yolk sac components focusing in the pI 7.0-9.0 range: An optimum teratogenic dose of 50 mg protein per kg body weight was observed, and a dose of 100 mg/kg was shown to cause 100% embryonic resorption. Antiserum against the fraction focusing in the pI 3.5-5.0 range was the least teratogenic: A significant incidence of embryonic malformation and death was seen only at doses of 600 mg/kg and above. The two fractions that yielded the more teratogenic antisera were refocused over narrower pH ranges, yielding four subfractions in the pI 5.0-7.0 range and eight subfractions in the pI 7.0-9.0 range. Antisera against each of these 12 fractions were raised in rabbits; most of these antisera were shown to be teratogenic, although of differing potencies. It is concluded that the yolk sac contains many antigens that can elicit antibodies with teratogenic and yolk sac-localizing properties.     

Teratogenic antibody internalization by rat visceral yolk-sac endoderm in vitro: an ultrastructural colloidal gold tracer study

Previous work from our laboratory has demonstrated that specific rabbit immunoglobulins G (IgG) against a glycoprotein antigen of rat kidney proximal tubule or a cross-reacting visceral yolk-sac endodermal cell antigen will induce abnormal embryonic development when they are injected into pregnant rats during the period of organogenesis. It has been proposed that these antibodies may induce embryopathy by interfering with functions of the visceral yolk-sac placenta, an important organ providing nutrients to the embryo at this stage of development. In order to gain some insight into the underlying pathogenic mechanism(s) in which specific teratogenic IgG may interfere with visceral yolk-sac functions, we examined the uptake of these teratogenic IgG by the visceral yolk-sac endodermal cells at the electron microscopic level. The results demonstrated that teratogenic rabbit IgG specifically localized on the fuzzy coat of the external apical cell membrane of the visceral yolk-sac endoderm at the intermicrovillous region. Within 5 min, the IgG were rapidly internalized via coated pits and micropinocytic vesicles. Within 30 min, an increasing proportion of gold particles appeared within uncoated vesicles or vacuoles of various sizes; most of the gold particles were in close proximity to the inner membranous lining of the vesicles. Similar findings were observed after 1- or 2-hr incubation. After 24- to 48-hr culture, however, the gold particles appeared to have dissociated from the inner surface of the vesicle membrane.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of etretinate on the distribution of elements in rats

We studied in the rat the effects of the drug etretinate (Tigason), given at three doses 3, 10, and 30 mg/kg body wt for 1 mo, on the concentrations of Na, K, Ca, Mg, Fe, S, P, Cu, and Zn in the plasma, brain, thymus, heart, liver, lung, kidney, testicle, muscle, and bone. The elements were simultaneously determined in tissues after nitric acid dissolution by inductively coupled plasma emission spectrometry using a JY 48 instrument. At the dose of 3 mg/kg, etretinate did not induce any statistically significant modifications of the element distribution. At the dose of 10 mg/kg, the main observed modifications were in plasma an increase of copper (+38%) and a decrease of zinc (-25%). At the highest dose of 30 mg/kg, some variations of the concentrations of elements in tissues were observed. But, on no account did retinoids induce an alteration of the mineral composition of bone, despite obvious macroscopic bone alterations.