Perfusion-limited effects of plasma drug binding on hepatic drug extraction

The hepatic elimination of phenytoin has been studied in the isolated rat liver perfused at constant flow with Krebs solution alone and in the presence of albumin. At an albumin concentration of 0.5 g/dl, 46.6% of the phenytoin was bound in the perfusate and the comparable value at 5.0 g/dl was 87.4%. The increase in binding resulted in a reduction in the hepatic extraction ratio from 0.67 in Krebs to 0.54 and 0.28 at the two albumin concentrations, respectively. Analysis of this data together with that from the literature on propranolol and warfarin indicated that they were consistent with the perfusion-limited model of hepatic clearance. Accordingly, the general relationship between the extraction ratio and the free fraction of drug in the blood is hyperbolic with the precise shape being determined by the ratio of the clearance of the drug from liver water to the hepatic blood flow rate.     

Steady-state clearance rates of warfarin and its enantiomers in therapeutically dosed patients

Previous studies to identify the pharmacokinetics of R- and S-warfarin have not used steady-state area under the curve (AUC) data during therapeutic doses of racemic warfarin. Instead they have used high single doses of either racemic warfarin or a single enantiomer in volunteers or have taken a single blood sample from anticoagulated patients and assumed full compliance and a steady-state status. In this study, a series of steady-state racemic warfarin, R-warfarin, and S-warfarin serum concentrations, during a 24 h dosage interval, was measured in 10 compliant patients (5 females and 5 males) taking racemic warfarin. The anticoagulation status of all 10 patients according to the International Normalised Ratio (INR) was stable. Their mean (SD) age and weight were 67.0 (9.9) yr and 63.9 (15.4) kg. The mean (SD) clearances derived from steady-state AUC values, following therapeutic dosing, for racemic warfarin, R-warfarin, and S-warfarin were 2.40 (0.82), 2.30 (0.65), and 2.80 (1.17) ml/h/kg, respectively. The mean (SD) ratio of S-:R-warfarin clearance was 1.24 (0.40). Comparison of the clearance measured from the AUC, of these patients, to one point determinations assuming steady state for the samples drawn at either 6, 15, or 20 h after dosage (during the dosing interval) showed some statistical differences. Most single point determinations of warfarin clearance assume that a sample 12 h postdose is equivalent to that of the steady-state concentration, but in this study the steady-state concentration of only 6 patients occurred between 6 and 15 h postdose. This could explain why these studies demonstrate differences in the clearance of R- and S-warfarin compared to the values we have derived from steady-state AUC data using patients with proven compliance and therapeutic doses. Chirality 9:13–16, 1997. © 1997 Wiley-Liss, Inc.     

Influence of free fatty acid anion on the binding of warfarin to cytoplasmic proteins from rat liver

In vitro binding studies have shown that warfarin binds strongly to both ligandins (Y) and Z protein obtained from rat liver cytosol with dissociation constants of 11.7 and 10.1 μM respectively. Increasing concentrations of oleate ion significantly increased the dissociation constant of warfarin with either protein, whereas laurate ion showed the same behavior only with Z protein. On the other hand, the binding of warfarin to liver cytoplasmic proteins in vivo was decreased in 72-h-pre-fasted rats, although such fasting failed to produce any increase in the in vivo levels of the cytoplasmic free fatty acids (FFA). However, based on the results of the in vitro binding study, it is suggested that changes in the composition of hepatic cytoplasmic free fatty acids as a result of fasting could reduce the in vivo binding of warfarin to Y and Z proteins and hence could lead to an increase of unbound warfarin in liver cytosol.     

Clinical and genetic determinants of warfarin pharmacokinetics and pharmacodynamics during treatment initiation

Variable warfarin response during treatment initiation poses a significant challenge to providing optimal anticoagulation therapy. We investigated the determinants of initial warfarin response in a cohort of 167 patients. During the first nine days of treatment with pharmacogenetics-guided dosing, S-warfarin plasma levels and international normalized ratio were obtained to serve as inputs to a pharmacokinetic-pharmacodynamic (PK-PD) model. Individual PK (S-warfarin clearance) and PD (I(max)) parameter values were estimated. Regression analysis demonstrated that CYP2C9 genotype, kidney function, and gender were independent determinants of S-warfarin clearance. The values for I(max) were dependent on VKORC1 and CYP4F2 genotypes, vitamin K status (as measured by plasma concentrations of proteins induced by vitamin K absence, PIVKA-II) and weight. Importantly, indication for warfarin was a major independent determinant of I(max) during initiation, where PD sensitivity was greater in atrial fibrillation than venous thromboembolism. To demonstrate the utility of the global PK-PD model, we compared the predicted initial anticoagulation responses with previously established warfarin dosing algorithms. These insights and modeling approaches have application to personalized warfarin therapy.     

Sodium and potassium clearance rhythmicity in diabetic rats with insulin treatment

The effect of insulin treatment on the daily distribution of the urinary volume and urinary sodium and potassium excreted, as well as their clearance rhythms in rats with streptozotocin (STZ)-induced diabetes was investigated. Normal(C), uncontrolled (D) and controlled insulin diabetic rats (DI), were studied during a light-dark (12 h:12 h) cycle and given food and water ad libitum. The DI rats showed a significant reduction in the urinary sodium and potassium excreted during 24 h with respect to the D rats, though these values were significantly higher than the C ones. A loss of the normal circadian rhythmicity of diuresis and both sodium and potassium clearance was observed in the D rats, together with higher values of M (MESOR) than in the C rats. These rhythms could be reestablished with continuous insulin infusion, their orthophases occurring near the C ones. However the M values of sodium and potassium clearance in DI rats are greater than C, showing higher values than this group during the rest phase. These results in DI rats may suggest that the constant rate infusion of insulin can be responsible for the high values of clearance of both ions at the rest phase and so for the incomplete renal rhythms restoration.     

Propranolol metabolism by isolated hepatocytes from normal and cirrhotic rat livers: the effect of albumin

Several recent reports have shown that the hepatic uptake and subsequent elimination of some substrates is faster in the presence of albumin than in its absence, as if some of the substrate bound to albumin was also available for uptake. In the present study, we examined the effect of albumin on the clearance of propranolol by isolated rat hepatocyte suspensions. The clearance of total drug decreased progressively as albumin concentration increased. There was also a progressive decrease in the free fraction of propranolol and the net result was an increase in the clearance of unbound drug (+50% at 40 g/L albumin). This increase was not due to an oncotic pressure effect of albumin, nor to the presence of fatty acids bound to albumin. The clearance of propranolol by isolated hepatocytes from cirrhotic rats was decreased compared with controls (-50%), and albumin also increased propranolol free clearance, albeit to a lesser extent than in control animals. Our results indicate that albumin facilitates the elimination of propranolol by hepatocytes, possibly because of surface-mediated catalysis of the albumin-propranolol complexes.     

Purification and some properties of cytosolic cobalamin-binding protein in Euglena gracilis.

Naturally prepared radiolabelled pulmonary surfactant can be rapidly cleared from the alveolar surface to the lung tissue after intratracheal instillation into experimental rats. This clearance is both time- and dose-dependent, a large dose (10 mg/animal) becoming associated with lung tissue more rapidly than a smaller more physiological dose (0.75 mg/animal). The data indicate that extracellular dipalmitoyl-phosphatidylcholine, the major component of pulmonary surfactant, is not catabolized at the alveolar surface. Alveolar free cells (mainly macrophages) appear to play a minor role in surfactant clearance. Quartz-induced phospholipidosis does not lead to an alteration in the rate of bulk surfactant clearance from the alveolar surface, although the initial distribution of the removed phospholipid complex may change in relation to the enlarged heterogenous free cell population.     

Effect of copper deficiency on the composition of three high-density lipoprotein subclasses as separated by heparin-affinity chromatography

Copper deficiency in rats produces a hypercholesterolemia with a marked increase in HDL fraction. This study investigated changes in the plasma distribution and composition of HDL subclasses as affected by copper deficiency. Plasma HDL were separated into the following three subclasses by heparin-affinity chromatography: HDL containing no apo E but high in apo A-I (HDL-E0); HDL with an intermediate level of apo E (HDL-E1); and HDL highly enriched in apo E but low in apo A-I (HDL-E2). The compositional analysis showed that the hypercholesterolemia observed in copper-deficient rats was due specifically to an increase in plasma cholesterol carried by HDL-E0. Copper deficiency did not alter the percent distribution of apo A-I in HDL-E0, but lowered the apo A-I content in HDL-E1 and HDL-E2, with an increase in apo E in these subclasses. The total plasma concentration of apo A-I was, however, significantly elevated in Cu-deficient rats, which was attributable to an increase in the total number of circulating HDL particles. No difference was noted between Cu-deficient and control groups in the distribution of free cholesterol or the ratio of free cholesterol to esterified cholesterol in any of the HDL subclasses. The present results and earlier observations suggest that copper deficiency may produce a defect in the plasma clearance or tissue uptake of the HDL subclass high in apo A-I but devoid of apo E (HDL-E0), which may be mediated by the specific apo A-I receptor or non-endocytotic transfer of HDL-E0 cholesterol to the liver. Such metabolic defects may partly explain the simultaneous increases in both plasma HDL cholesterol and apo A-I and altered cholesterol homeostasis observed in copper deficiency.     

The submicrosomal site for the conversion of prothrombin precursor to biologically active prothrombin in rat liver

The submicrosomal site for the conversion of prothrombin precursor to prothrombin in rat lever has been investigated by subcellular fractionation techniques.Prothrombin precursor activity could be detected in the luminal as well as the membrane fraction of the rough microsomes. The corresponding fractions from smooth microsomes did not exhibit any activity. After warfarin treatment of the rats, the concentration of prothrombin precursor in rough microsomes increased rapidly from approx. 2 to 6–8 h, when a plateau was reached. In smooth microsomes, prothrombin precursor activity appeared 1 h after injection of warfarin, and increased to a plateau reached after about 4 h. The total activity of prothrombin precursor at the plateau obtained after warfarin treatment was 4–5 times higher in the rough luminal fraction than in the corresponding smooth fraction.The vitamin K-dependent carboxylase activity was localized to the rough microsomes. The enzyme system was associated with the membrane, mainly at the luminal side, whereas the substrate appeared to be localized in both the luminal and membrane fraction.The results indicate that the conversion of prothrombin precursor to biologically active prothrombin occurs at a late stage in the rough endoplasmic reticulum or at a transition between rough and smooth endoplasmic reticulum.     

Involvement of multidrug resistance-associated protein 2 (ABCC2/Mrp2) in biliary excretion of micafungin in rats

The drug transporter, multidrug resistance-associated protein 2 (ABCC2/Mrp2), is known to play important roles in excretion of various drugs. In the present study, we investigated whether Mrp2 is involved in the transport of micafungin, a newly developed antifungal agent. When Sprague-Dawley rats received an intravenous injection of micafungin (1 mg/kg) in combination with cyclosporine, the cyclosporine significantly delayed the disappearance of micafungin from plasma and decreased the systemic clearance and volume of distribution at steady-state of micafungin to 54% and 65% of the corresponding control values, respectively. When Sprague-Dawley rats received a constant-rate infusion of micafungin, cyclosporine significantly decreased the steady-state biliary clearance of micafungin (~80%). A significant decrease in the biliary clearance of micafungin (~60%) was observed in Eisai hyperbilirubinemic rats, which have a hereditary deficiency in Mrp2. The present findings at least suggest that Mrp2 is involved mainly in the hepatobiliary excretion of micafungin in rats.     

Effects of fasting on the myocardial subcellular distribution and lipid distribution of terminal p-iodophenyl-substituted fatty acids in rats

The myocardial lipid pool distribution and subcellular distribution of radiolabeled methyl-branched fatty acids in rats was evaluated under conditions of fasting (24 h) and feeding. With the unbranched iodophenyl fatty acid, fasting resulted in increased myocardial extraction and clearance time with a decrease in the incorporation into triglycerides and greater radioactivity in the mitochondrial fraction. With the monomethyl-branched analogue, the effects of fasting on lipid and subcellular distribution were minor except for a decrease in triglyceride incorporation. Like the unbranched analogue, the dimethyl-branched iodophenyl fatty acid showed increased myocardial extraction with fasting, however, this structurally-modified fatty acid showed increased rather than decreased incorporation into triglycerides.     

Lipoprotein composition as a component in the lipoprotein clearance defect in experimental diabetes

The hypertriglyceridemia associated with streptozotocin-induced diabetes in rats is largely reflected in the plasma lipoproteins of density less than 1.006 g/ml. Analysis of the plasma apolipoproteins of these rats indicated marked alterations in both the total levels and in the lipoprotein distribution of the major apolipoproteins. In whole plasma, diabetes was associated with significant increases in apolipoprotein (apo)-AIV, apo-AI, and apo-B (mainly in the intestinally derived apo-B240) and a marked decrease in apo-E. In the d less than 1.006 g/ml lipoprotein fraction (very-low-density lipoproteins (VLDL], there were significant increases in apo-B240, apo-AI, and apo-AIV and decreased levels of apo-E and the C apolipoproteins. The decrease in apo-C was primarily due to lower levels of apo-CII, and the ratio of the lipoprotein lipase inhibitor, apo-CIII, to the lipoprotein lipase activator, apo CII, was significantly increased over that in controls. The comparative clearance of triglycerides of VLDL particles from control and diabetic rat plasma was tested in recirculating heart perfusion in vitro. During 45-min perfusions of hearts from control donor rats, lipolysis of triglycerides of VLDL from diabetic rats was only 63-64% of that using plasma VLDL from control rats. Perfusion of hearts from diabetic rats with VLDL from control rats gave lipolysis values of only 53% of that obtained with normal hearts. Where both the VLDL and hearts were obtained from diabetic rats, lipolysis was 23% of that observed when both the lipoprotein and the organ were from control rats. The data suggest that in addition to depressed lipoprotein lipase activity in the tissue from diabetic rats, there are also major compositional changes in circulating lipoproteins which may contribute to defective triglyceride clearance from the circulation.     

Epimerization of moxalactam by albumin and simulation of in vivo epimerization by a physiologically based pharmacokinetic model

We investigated the mechanism of epimerization (R to S or S to R) of moxalactam in serum of rats, dogs, and humans. The epimerization of moxalactam occurred in the serum of these animals, but not in the serum filtrate. The albumin fraction of human serum purified by gel filtration catalysed the epimerization of moxalactam at an identical rate to serum, but other fractions (i.e., lipoproteins and globulins) showed slower epimerization. alpha 1-acid glycoprotein, which was eluted in the same fraction with albumin by G-200 gel filtration, did not epimerize moxalactam. The presence of 2 mM warfarin decreased the binding of R- and S-moxalactam and decreased the epimerization of moxalactam in human serum. These results demonstrate moxalactam was epimerized on the warfarin binding site on albumin in serum. Additionally, a physiologically based pharmacokinetic model shows that the epimerization of moxalactam after administration in dogs is simulated by the epimerization in serum.     

The influence of aging on the stereoselective pharmacokinetics of propranolol in the rat.

The influence of aging on the pharmacokinetics and the tissue distribution of (R)- and of (S)-propranolol was studied in 3-, 12-, and 24-month-old rats. After both iv and oral administration of rac-propranolol, the plasma concentrations were higher for the (R)- than for the (S)-enantiomer. For the tissue concentrations, the reverse was true. The free fraction of (S)-propranolol in plasma was about 4 times larger than that of (R)-propranolol, and this is the main factor responsible for the differences in kinetics between the two enantiomers. There was a suggestion for a difference in tissue binding between the two enantiomers. With aging, the plasma and tissue concentrations of both enantiomers increase, probably due to a decrease in blood clearance. Tissue binding did not change much with aging. Notwithstanding the marked differences between the kinetics of the propranolol enantiomers, the changes which occur with aging affect both enantiomers to the same degree.     

High salt intake-induced changes in atrial natriuretic factor kinetics are mediated by clearance receptors.

We have reported a paradoxical plasma atrial natriuretic factor (ANF) decline following prolonged high salt intake that was attributed to an increased tissue uptake of circulating ANF, leading to its augmented distribution volume (Vas) and metabolic clearance rate (MCR) as compared with control rats on a standard diet. To explore this phenomenon further, we evaluated possible chronic salt-loading-induced changes in ANF clearance (C-ANF) receptors, which appear to play a major role in ANF removal from the circulation. We studied changes in plasma [125I]ANF(1-28) and its pharmacokinetics after preoccupation of C-ANF receptors by its specific ligand, C-ANF(4-23), in high-salt-treated rats and their controls. Following C-ANF(4-23) administration, we detected significantly higher circulating [125I]ANF levels throughout the study period (8 min) in high-salt-fed rats compared with the controls (280-470% vs 100-215% increase of basal values, P less than 0.05). C-ANF(4-23) infusion caused a significantly greater decrease of the metabolic clearance rate and distribution volume of [125I]ANF in high-salt-fed rats than in control animals (74 +/- 6% vs 41 +/- 6% and 75 +/- 4% vs 50 +/- 5% of basal values, respectively; P less than 0.05). These data suggest that a prolonged high salt diet may increase the availability of C-ANF receptors and, through this mechanism, may negatively modulate plasma ANF concentrations. C-ANF receptors may thus fulfill a regulatory function on circulating ANF during prolonged salt loading in rats.     

Contribution of amiloride-insensitive pathways to alveolar fluid clearance in adult rats.

The contributions of amiloride-sensitive and -insensitive fractions of alveolar fluid clearance in adult ventilated rats were studied under control conditions and after beta-adrenergic stimulation. Rats were instilled with a 5% albumin solution containing terbutaline (10(-4) M) or dibutyryl-cGMP (DBcGMP; 10(-4) M) with or without the cyclic nucleotide-gated cation channel inhibitor l-cis-diltiazem (10(-3) M) and/or amiloride (10(-3) M). Alveolar fluid clearance over 1 h was 18 +/- 2% in controls. In controls, amiloride inhibited 46 +/- 15% of alveolar fluid clearance, whereas l-cis-diltiazem had no inhibitory effect. Terbutaline and DBcGMP stimulated alveolar fluid clearance by 85 +/- 3 and 36 +/- 5%, respectively. Amiloride and l-cis-diltiazem inhibited nearly equal fractions of terbutaline-stimulated alveolar fluid clearance when given alone. Amiloride and l-cis-diltiazem given together inhibited a significantly larger fraction of alveolar fluid clearance in terbutaline-stimulated rats and in DBcGMP-stimulated rats. Based on these data, terbutaline stimulation recruited both amiloride-sensitive and l-cis-diltiazem-sensitive pathways. In contrast, DBcGMP mainly recruited l-cis-diltiazem-sensitive pathways. Therefore, the amiloride-insensitive fraction of Na+-driven alveolar fluid clearance may be partly mediated through cyclic nucleotide-gated cation channels and activated by an increase in intracellular cGMP.     

Iodoamino acid distribution and weight of the thyroid gland, T4 serum level and T4 metabolism in relation to diet, body fat content and age of rats

Rats were rendered obese by feeding them a fatty diet (HFD, fat: 50% of weight). At the end of the experimental period the animals were divided, also the control rats, which were fed a low-fat diet (LFD, fat: 3% of weight), in light and heavy weight groups. The heavy and obese HFD groups showed, unlike the light LFD-animals, equal absolute but significantly lower relative thyroidal weights. The absolute thyroidal weights of light and heavy animal groups, which received in each case the same diet, were identical, the relative thyroidal weights of the heavy rats on the other hand decreased significantly. The iodoamino acid distribution in the thyroid of rats showed no variation in animals fed various diets and differed in body mass and fat content. The T4 serum levels of the HFD-, in comparison to the LFD-animals increased significantly. Between light and heavy animals in equal diet groups no differences were obtained for the T4 serum values. The serum T3 levels of LFD- and HFD-rats were also equal. The heavy HFD- showed in comparison to the light LFD-animals a significantly lower T4 clearance and in the higher age groups a significantly extended T4 half-life time. The HFD- and LFD-rats with approximately equal body mass and body fat content showed no differences in T4 half-life time and T4 clearance rate depending on diet. A relation between higher body fat content and increased serum T4 levels as a possible adaption to obesity in heavy HFD-rats is discussed. By the comparison of younger and older rats in the most investigated diet and weight groups the older animals showed a decreasing tendency for K and TD/100 g KM and a significant decrease in the clearance rate and in the TD for T4, related to body mass. An influence of diet, body mass or fat content on the decrease of the T4 metabolism of rats with increased age is not evident. The T4 serum levels were not different in dependence on age, but the free T4 serum level was significantly lower in the older rats.     

Immunofluorescent detection of 8-oxoguanine DNA lesions in liver cells from aging OXYS rats, a strain prone to overproduction of free radicals

Production of free radicals in animals is accompanied with a number of pathologic conditions, some of which may be manifested through DNA damage. Studies of mechanisms of oxidative DNA damage by free radicals in vivo are hindered by the lack of good animal models with significant overgeneration of or increased sensitivity to free radicals. An inbred rat strain (OXYS) is characterized by inherited overgeneration of free radicals, lipid peroxidation, protein oxidation, DNA rearrangements, and pathological conditions paralleling several human degenerative diseases. We have used monoclonal antibodies against a common pre-mutagenic base lesion 8-oxoguanine (8-oxoG) in combination with indirect immunofluorescence microscopy and image analysis to follow the relative age-dependent amounts and distribution of 8-oxoG in liver cells from OXYS and Wistar rats. 8-OxoG increased with age in both strains of rats, with OXYS rats always displaying statistically significantly higher levels of oxidative DNA damage than Wistar rats. Statistical analysis indicates that 8-oxoG does not uniformly accumulate in all cells with advancing age or increasing free radical load, but rather concentrates in a minor fraction of cells with a high damage level.     

Studies on the protein-synthesizing activity of the ribosomes of rat liver. The activity of free polysomes

1. The activities of microsome fractions from the liver of adult and 5-day-old rats for the incorporation of [(14)C]phenylalanine into protein were similar in the presence and absence of polyuridylic acid. 2. The activity of a light-microsome fraction from adult liver was greater than that of a heavy-microsome fraction, and the light-microsome fraction was also more markedly stimulated by the presence of polyuridylic acid. 3. The light-microsome fraction, when analysed by density-gradient centrifugation, contained a higher ratio of free ribosomes to bound ribosomes, whereas the reverse was true for the heavy-microsome fraction. Similar results were obtained for liver from adult and 5-day-old rats. 4. When the light-microsome fraction was incubated under conditions in which amino acid was incorporated into protein there was only a small increase in the ratio of free to bound ribosomes. When such a fraction was incubated with [(14)C]leucine and was then subjected to density-gradient centrifugation the fraction with the highest specific activity based on RNA had a density between that of the bound and free ribosomes. Treatment of the incubated fraction with ribonuclease shifted the radioactivity towards the free ribosome peak. These properties are consistent with the presence of active free polysomes. Such a component appeared also to be present when the heavy-microsome fraction was incubated under similar conditions. 5. The effect of the presence of polyuridylic acid on the incorporation of [(14)C]phenylalanine by the light-microsome fractions from liver of adult and 5-day-old rats was greatest in the region of the free ribosomes, but it is probable that some small polysomes containing polyuridylic acid are formed. 6. Polyuridylic acid also stimulated the bound ribosomes to a small extent when the heavy-microsome fraction from the liver of young rats was incubated with [(14)C]phenylalanine. 7. The results are discussed in terms of the various morphological constituents in liver now known to play a role in the synthesis of protein for export and for the internal activity of the cell.     

Antidiuretic reaction of the human and rat kidney to peroral administration of arginine-vasopressin and desmopressin

Water in amount of 5 ml/100 g body weight was administered through a gastric probe into the stomach in alert rats; subjects-volunteers drank 20 ml of water per 1 kg of body weight. This resulted in diuresis at the peak of which the excreted water fraction reached 23% in rats and 12.4% in human subjects, whereas excretion of the osmotically free water amounted to 0.103 +/- 0.018 ml/min/100 g body weight and 10.0 +/- 1.8 ml/min/1.73 m2 of the body surface, respectively. These data indicate a practically complete inhibition of the arginine vasopressin secretion. On intragastric administration of 10 micrograms of arginine vasopressin or 0.2 microgram of desmopressin, with water in rats, a prolonged and quite obvious antidiuretic response occurred, with a marked increase of reabsorption of the osmotically free water in kidneys. A direct correlation has been found between the dose of the intragastrically administered vasopressin in the dose range from 0.1 to 10 micrograms/100 g body weight and a decrease of clearance of the osmotically free water. In subjects volunteers, an antidiuretic reaction to administration of 0.2 mg of desmopressin with water, was found. The data obtained provide a direct proof of intestinal absorption of nanopeptides without loss of their physiological activity. Significance of the data obtained for physiology of digestion and for clinical medicine, is discussed.