Characterization of digoxin binding and daunorubicin uptake by isolated mature rat cardiac myocytes

Prevention of chronic anthracycline cardiotoxicity in the adult Fischer 344 rat by dexrazoxane and effects on iron metabolism

PURPOSE

Anthracyclines, such as doxorubicin and daunorubicin, continue to be widely used in the treatment of cancer, although they share the adverse effect of chronic, cumulative dose-related cardiotoxicity. The only approved treatment in prevention of anthracycline cardiotoxicity is dexrazoxane, a putative iron chelator. Previous in vitro studies have shown that disorders of iron metabolism, including altered IRP1-IRE binding, may be an important mechanism of anthracycline cardiotoxicity.

METHODS

This study examined the role of IRP1-IRE binding ex vivo in a chronic model of daunorubicin cardiotoxicity in the Fischer 344 rat and whether dexrazoxane could prevent any daunorubicin-induced changes in IRP1 binding. Young adult (5-6 months) Fischer 344 rats received daunorubicin (2.5 mg/kg iv once per week for 6 weeks) with and without pretreatment with dexrazoxane (50 mg/kg ip). Other groups received saline (controls) or dexrazoxane alone. Rats were killed either 4 h or 2 weeks after the last dose of daunorubicin to assess IRP1-IRE binding.

RESULTS

Contractility (dF/dt) of atrial tissue, obtained from rats 2 weeks after the last dose of daunorubicin, was significantly reduced in daunorubicin-treated compared to control rats. Dexrazoxane pretreatment protected against the daunorubicin-induced decrease in atrial dF/dt. However, left ventricular IRP1/IRE binding was not affected by daunorubicin treatment either 4 h or 2 weeks after the last dose of daunorubicin.

CONCLUSIONS

IRP1 binding may not be altered in the rat model of chronic anthracycline cardiotoxicity.

Daunorubicin and daunorubicinol pharmacokinetics in plasma and tissues in the rat

Recent evidence suggests that 13-hydroxy metabolites of anthracyclines may contribute to cardiotoxicity. This study was designed to determine the pharmacokinetics of daunorubicin and the 13-hydroxy metabolite daunorubicinol in plasma and tissues, including the heart. Fisher 344 rats received 5 mg kg-1 daunorubicin i.v. by bolus injection. Rats were killed at selected intervals for up to 1 week after daunorubicin administration for determination of concentrations of daunorubicin and daunorubicinol in the plasma, heart, liver, kidney, lung, and skeletal muscle. Peak concentrations of daunorubicin were higher than those of daunorubicinol in the plasma (133 +/- 7 versus 36 +/- 2 ng ml-1; P < 0.05), heart (15.2 +/- 1.4 versus 3.4 +/- 0.4 micrograms g-1; P < 0.05), and other tissues. However, the apparent elimination half-life of daunorubicinol was longer than that of daunorubicin in most tissues, including the plasma (23.1 versus 14.5 h) and heart (38.5 versus 19.3 h). In addition, areas under the concentration/time curves (AUC infinity) obtained for daunorubicinol exceeded those found for daunorubicin in almost all tissues, with the ratios being 1.9 in plasma and 1.7 in the heart. The ratio of daunorubicinol to daunorubicin concentrations increased dramatically with time from < 1 at up to 1 h to 87 at 168 h in cardiac tissue. Thus, following daunorubicin injection, cumulative exposure (AUC infinity) to daunorubicinol was greater than that to daunorubicin in the plasma and heart. If daunorubicinol has equivalent or greater potency than daunorubicin in causing impairment of myocardial function, it may make an important contribution to the pathogenesis of cardiotoxicity.

The plasma disposition and renal elimination of digoxin-specific Fab fragments and digoxin in the rabbit

Administering digoxin-specific antibody fragments (DSFab, 1.9 mg kg-1, i.v.) to rabbits 1 h after digoxin (15 micrograms kg-1 or 12.5 microCi kg-1, i.v.) produced a redistribution of digoxin associated with a 5-fold elevation in total plasma concentration and 36-86% reductions in elimination half-life, apparent volume of distribution at steady-state and total body clearance (CLT). Renal clearance (CLR) was also reduced (54%), but urinary digoxin excretion was increased by one-third (35% vs 25%). This apparent anomaly is due to the large rise in total plasma digoxin concentration with a consequent increase in the area under the plasma concentration curve (AUC). The AUC, which is the denominator term in calculating CLR (and CLT), was increased to a greater extent than urinary digoxin excretion (numerator term in calculating CLR) so that an overall reduction in CLR occurred. The initial presence of digoxin appeared to alter the distribution of DSFab, since their plasma concentrations were markedly higher when the antibody was given after the hapten. The digoxin also reduced (from 3 to 1%) the amount of detectable DSFab in the urine.

Changes in membrane proteins in chronic mechanical overload of the heart

Several data suggest that in species such as humans, dogs or guinea pigs, sarcomere protein changes do not explain the physiologic modifications that occur in the heart in response to chronic overload. In the guinea pig, e.g., the shortening velocity of an intact papillary muscle negatively correlates with the degree of hypertrophy while the shortening velocity of a skinned hypertrophied fiber does not correlate with heart weight. This review is an attempt to summarize quantitatively data concerning membrane proteins in chronic experimental cardiac overload. With that respect, 2 groups of proteins can be distinguished: (1) the group formed by the calcium-activated adenosine triphosphatase (Ca2(+)-ATPase) of the sarcoplasmic reticulum, the beta 1-adrenergic and muscarinic receptors and the low affinity isoform of the Na+K(+)-ATPase. The synthesis of these proteins is not activated by the process of hypertrophy and consequently their density diminished and their total number per myocyte or per ventricle is unchanged. (2) The second group is formed by the calcium channels and the high affinity isoform of the Na+K(+)-ATPase whose density, in contrast, is unchanged or even increases. Their synthesis is therefore stimulated commensurately with the degree of overload and their total number per myocyte is enhanced. These data suggest that search in the field of inotropes must take into account the fact that the keys that these drugs represent must be modeled as a function of the lock they have to fit into.

Daunomycin inhibits the uptake of adenine, amino acids, and glucose into cardiac myocytes

Daunomycin and adriamycin are widely used antitumor agents which induce dose-dependent cardiotoxicity. The mechanisms by which daunomycin causes cardiotoxicity have been investigated in neonatal rat cardiac myocytes maintained in tissue culture. Daunomycin inhibited the uptake of adenine, amino acids, and deoxyglucose in a dose-dependent fashion. The uptake of both adenine and methionine was inhibited without any delay while the glucose uptake (deoxyglucose) was inhibited after a delay of 2 hr. Since daunomycin affected the uptake of both adenine and amino acids without any delay and since daunomycin did not affect the incorporation of adenine into nucleotide and amino acids into proteins once these were transported into the cell, it is possible the daunomycin exerted these effects by acting directly on the cell membrane. Thus, one of the early toxic manifestations of anthracycline antibiotics may be on the transport of nutrients such as amino acids, glucose, and adenine.