THE USE OF ANTIPYRINE IN THE MEASUREMENT OF TOTAL BODY WATER IN MAN

Evaluating Lean Liver Volume as a Potential Scaler for In Vitro-In Vivo Extrapolation of Drug Clearance in Obesity Using the Model Drug Antipyrine

BACKGROUND

In vitro-in vivo extrapolation (IVIVE) of hepatic drug clearance (CL) involves the scaling of hepatic intrinsic clearance (CL_int,uH) by functional liver size, which is approximated by total liver volume (LV) as per the convention. However, in most overweight and obese patients, LV includes abnormal liver fat, which is not thought to contribute to drug elimination, thus overestimating drug CL. Therefore, lean liver volume (LLV) might be a more appropriate scaler of CL_int,uH.

OBJECTIVE

The objective of this work was to assess the application of LLV in CL extrapolation in overweight and obese patients (BMI >25 kg/m2) using a model drug antipyrine.

METHODS

Recently, a model to predict LLV from patient sex, weight, and height was developed and evaluated. In order to assess the LLV model's use in IVIVE, a correlation-based analysis was conducted using antipyrine as an example drug.

RESULTS

In the overweight group (BMI >25 kg/m2), LLV could describe 36% of the variation in antipyrine CL (R² = 0.36), which was >2-fold higher than that was explained by LV (R² = 0.17). In the normal-weight group (BMI ≤25 kg/m2), the coefficients of determination were 58% (R² = 0.58) and 43% (R²= 0.43) for LLV and LV, respectively.

CONCLUSION

The analysis indicates that LLV is potentially a more appropriate descriptor of functional liver size than LV, particularly in overweight individuals. Therefore, LLV has a potential application in IVIVE of CL in obesity.

Distribution of antipyrine in the rat liver

The rate and extent of hepatic distribution of antipyrine was examined in the rat isolated perfused liver. Tritiated water and [14C]antipyrine were injected simultaneously into the portal vein as a bolus using either Krebs-Ringer bicarbonate or rat plasma as the perfusate. The effluent profiles of each compound using the two perfusates were superimposable, a finding expected for water and consistent for antipyrine, which was negligibly bound in rat plasma. Although full recovery (97%) of administered material was achieved with both compounds, the fractional output profile for antipyrine peaked at a lower value (0·10 mL−1) and at a later time (24 s) than water (0·14 mL−1, 17·5 s), due to antipyrine having a larger volume of distribution (water 0·61 mL (g liver)−1); antipyrine 0·81 mL (g liver)−1). This observation is explained by antipyrine binding to, or partitioning into cellular components. Nonetheless, like water, distribution of antipyrine into hepatic cells is perfusion rate limited as evidenced by the superimposition of the dimensionless plots of fractional output vs time normalized to mean residence time.

Antipyrine clearance in comparison to conventional liver function tests in hepatitis C virus patients

In this study, 15 healthy volunteers and 96 patients with hepatitis C virus, classified according to Child-Pugh into 36 Child-A, 31 Child-B and 29 Child-C, were examined. All subjects ingested 600 mg antipyrine in the form of hard gelatinous capsules after overnight fasting. One milliliter of saliva was collected at 4 and 24 h after ingestion of antipyrine and analyzed using high-performance liquid chromatography. Blood samples were collected from all subjects for examination, using conventional liver function tests. The pharmacokinetic variables for antipyrine were determined using the two concentration time points selected. A cut-off value of 0.34 ml/min/kg was used to distinguish between cirrhotic and non-cirrhotic patients. Alanine aminotransferase, aspartate aminotransferase and gamma-glutamyl transferase values were significantly higher with significantly lower antipyrine clearance in Child-A, B, and C patients than in normal volunteers. The total protein concentration was significantly lower in Child-B and C patients. Moreover, AST was significantly higher in Child-C patients and antipyrine clearance was lower in Child-B and C patients than in Child-A patients. Antipyrine clearance showed a significant negative correlation with Child-Pugh scores, total protein, the international normalization ratio of prothrombin time and globulin, and a positive correlation with albumin and albumin-to-globulin ratio. Unlike most of the conventional liver function tests, antipyrine clearance, which represents the intrinsic clearance capacity of the liver, measured using saliva, proved to be a sensitive marker of liver function. It was significantly impaired in the Child-Pugh group A patients with the least hepatic impairment. The international normalization ratio of prothrombin time was just as informative as antipyrine clearance in identifying minimal hepatic impairment.

Invited Review: Methods to Determine Body Fat Reserves in the Dairy Cow with Special Regard to Ultrasonographic Measurement of Backfat Thickness

As the dairy cow uses body energy reserves in early lactation, body condition scoring has become an integral part of dairy herd management. Several methods based on visual and tactile evaluation have been developed. Problems caused by the subjectivity of these techniques have been reported. Alternative approaches to predict energy reserves or energy balance in dairy cattle include metabolic profiling and measurement of live weight, heart girth, or skinfold thickness. A less common method to assess fat reserves in body tissues is measuring backfat thickness (BFT) by using ultrasound. An ultrasound technique has been established to predict carcass quality in beef cattle. A new aspect is the application of ultrasound as a monitoring tool in dairy herd management where another location has to be evaluated. This technique has been validated by relating BFT to total body fat (TBF) content and carcass BFT. Backfat thickness also has been related to other methods of body condition scoring. Target values for the development of BFT throughout lactation are available. The relationship between BFT and TBF content is highly significant although biased by multiple factors. A change in BFT of 1 mm equates to approximately 5 kg of TBF content. Measuring BFT by ultrasound is of added value compared with other body condition scoring systems because it is objective and precise. Changes in body condition can be detected and evaluated properly.

Beta-adrenergic blockade affects initial drug distribution due to decreased cardiac output and altered blood flow distribution

Beta-adrenergic receptor blockers decrease intravenous anesthetic dose requirements. The present study determined the effect of propranolol on indocyanine green and antipyrine disposition from the moment of rapid intravenous injection. Anti-pyrine is a physiological marker that distributes to a volume as large as total body water in a blood flow-dependent manner and is a pharmacokinetic surrogate for many lipophilic drugs, including intravenous anesthetics. Antipyrine and indocyanine green disposition were determined twice in five healthy adult males in this Institutional Review Board-approved study, once during propranolol infusion. After rapid indocyanine green and antipyrine injection, arterial blood samples were collected frequently for 2 min and less frequently thereafter. Plasma indocyanine green and antipyrine concentrations were measured by high-performance liquid chromatography. Indocyanine green and antipyrine disposition were characterized, using SAAM II, by a recirculatory pharmacokinetic model that describes drug disposition from the moment of injection. Parameters were compared using the paired t test. The disposition of indocyanine green demonstrated that propranolol decreased cardiac output at the expense of the fast peripheral (nonsplanchnic) intravascular circuit. The area under the antipyrine concentration versus time relationship was doubled for at least the first 3 min after injection due to both decreased cardiac output and maintenance of nondistributive blood flow at the expense of a two-thirds reduction of blood flow (intercompartmental clearance) to the rapidly equilibrating (fast, splanchnic) tissue volume. The increase in antipyrine area under the curve due to propranolol-induced alteration of initial antipyrine disposition could explain decreased intravenous anesthetic dose requirements in the presence of beta-adrenergic receptor blockade.

Effect of erythrocytes on the hepatic distribution kinetics of antipyrine

The role of erythrocyte on the hepatic distribution kinetics of antipyrine was investigated in the in situ isolated perfused rat liver. Perfusion experiments were conducted using Krebs-bicarbonate buffer delivered via the portal vein in a single pass mode at a total flow rate of 15 ml/min. A bolus dose of antipyrine was administered in the presence and absence of erythrocytes. Almost identical moment analysis results (without erythrocytes mean transit time, MTT: 23 s; volume of distribution, VH: 0.57 ml/g liver and with erythrocytes, MTT: 24 s; VH: 0.60 ml/g liver) and superimposable unimodal effluent curves were obtained in the presence and absence of erythrocytes indicates that distribution kinetics of antipyrine within the liver is not affected by erythrocytes.

The concordance of early antipyrine and thiopental distribution kinetics

Studies of factors affecting the initial disposition of drugs with a rapid onset of effect following i.v. administration have used antipyrine as a surrogate for lipophilic drugs because it lacks cardiovascular effects. The present study tested the assumption that antipyrine is a useful surrogate for the flow-dependent tissue distribution of the lipophilic drug thiopental by comparing the recirculatory pharmacokinetic models of antipyrine and thiopental disposition after concomitant administration to five dogs anesthetized with 1.5% halothane. The pharmacokinetics of indocyanine green, a marker of the intravascular behavior of antipyrine and thiopental, and antipyrine in these dogs was nearly identical to that described previously in dogs anesthetized with 1.5% halothane but not given thiopental. The total volume of distribution of the highly lipophilic drug thiopental was more than 60% larger than that of antipyrine, 53 versus 33 liters, respectively. Nonetheless, the initial distribution kinetics of the two drugs, including the pulmonary tissue volume and the volume of the nondistributive pathway as well as the clearance to it, were nearly identical. As a result, the fraction of cardiac output involved in distribution of the two drugs to peripheral tissues was similarly identical, although the distribution of cardiac output between clearance to the rapidly equilibrating tissues and clearance to the slowly equilibrating tissues differed slightly. This study validates the assumption that antipyrine is a useful surrogate for lipophilic drugs in pharmacokinetic studies in which physiologic stability is desirable to meet the assumption of system stationarity.

Measurement of total RBC volume relative to lean body mass for diagnosis of polycythemia

An elevated total RBC volume (TRCV) in milliliters per kilogram of body weight has been an essential criterion for determining whether a person is polycythemic. This may be misleading in obese subjects as the TRCV per kilogram of fat is only one-tenth that of the TRCV of the lean body mass (LBM). Various formulas based on surface area have been used to account for this difference, but they are not always reliable. Direct measurement of TRCV per kilogram of lean body mass was obtained originally in studies in which body composition was determined by the combined body density and total body water measurement method. This is impractical as a routine procedure, but simple-to-use instruments are now available for direct measurement of a person's body composition and percentage of fat by impedance technology. Thus, the TRCV can be obtained by a direct measurement that discounts the effects of fat, and a graph has been designed to normalize the TRCV to milliliters per kilogram of LBM. The TRCV for men and women has been established as 36 mL/kg LBM; when it is more than 43 mL/kg LBM, a diagnosis of polychthemia can be made with confidence.

Effects of beta-blockade on hepatic conversion of amino acid nitrogen and on urea synthesis in cirrhosis

beta-Blockers are widely used to prevent gastrointestinal hemorrhage in cirrhosis. The metabolic effects of treatment are scarcely studied: hepatic function reportedly does not change significantly, but beta-adrenoceptors have been reported to regulate protein and amino acid metabolism. We studied hepatic nitrogen metabolism in response to constant alanine infusion in seven patients with cirrhosis before and 7 to 10 days after treatment with oral propranolol (60 to 100 mg/d). Beta-blockade was effective: it decreased heart rate by 25%, abolished orthostatic tachycardia, and reduced portal blood flow by 20%. Alanine-stimulated urea nitrogen synthesis rate (UNSR) was higher in patients with propranolol treatment, without any difference in aminonitrogen concentration. The kinetics of hepatic conversion of amino acid nitrogen into urea--ie, functional hepatic nitrogen clearance (FHNC)--increased by 30%, from (mean +/- SD) 17.0 +/- 4.1 to 22.0 +/- 6.6 L/h (P < .01). Increased urea production during alanine infusion resulted in negative nitrogen exchange even at the peak of alpha-aminonitrogen concentration. Basal insulin level was only slightly reduced during propranolol treatment, whereas the insulin response to alanine was significantly blunted. No differences in glucagon and cortisol were demonstrated. Epinephrine and norepinephrine levels were high-normal and did not vary after treatment. Increased urea production and stimulation of hepatic nitrogen clearance during beta-blockade may be mediated by relative hypoinsulinemia or by direct involvement of beta-adrenoceptors in the control of nitrogen metabolism, possibly by regulation of amino acid uptake and release in peripheral tissues.

Hepatic conversion of amino-nitrogen to urea in thyroid diseases. II. A study in hyperthyroid patients

Conflicting data have been reported on the influence of thyroid hormones on hepatic nitrogen metabolism and on liver metabolic activity. We studied the urea-nitrogen synthesis rate (UNSR) and the kinetics of the process of hepatic amino-nitrogen to urea-nitrogen conversion in response to constant alanine infusion (ie, the functional hepatic nitrogen clearance [FHNC]) in five hyperthyroid female patients before and after the achievement of a stable euthyroid status. In the same patients, galactose elimination capacity and antipyrine clearance were also measured as quantitative indices of hepatic function. The basal urea synthesis rate was nearly doubled in hyperthyroid patients (35.6 +/- 8.5 mmol.h-1 v 17.6 +/- 7.7 in euthyroid patients, P < .05) and increased linearly with increasing alpha-amino-nitrogen (alpha-AN) concentrations in both conditions. The urea synthesis rate during alanine infusion was still higher by approximately 30 mmol.h-1 in hyperthyroid subjects. The FHNC, calculated as the slope of the linear relation between the UNSR in each time interval and the corresponding average alpha-AN concentration, was not different (hyperthyroidism, 30.6 +/- 7.2 L.h-1; euthyroidism, 28.5 +/- 4.4; normal values > 25). The hepatic microsomal and cytosolic activities (antipyrine clearance and galactose elimination) were normal in hyperthyroid patients and did not change significantly after therapy. Our data show that the hepatic nitrogen metabolism of hyperthyroid patients is characterized by an upregulation of amino-nitrogen catabolism and loss of the sparing mechanism at low plasma amino acid levels, without any change in different metabolic activities.

Hepatic conversion of amino nitrogen to urea nitrogen in hypothyroid patients and upon L-thyroxine therapy

Conflicting studies have been reported regarding the influence of thyroid hormones on hepatic nitrogen metabolism and liver metabolic activity. We studied urea N synthesis rate (UNSR), functional hepatic N clearance (FHNC), galactose elimination capacity, and antipyrine clearance in six hypothyroid female patients before and after achievement of a stable euthyroid status. In both conditions, UNSR measured at intervals in response to constant alanine infusion was linearly related to the average alpha-amino N concentrations. In the hypothyroid state, peak UNSR was decreased by 31% in comparison with values measured in euthyroidism, which were in the normal range. FHNC (ie, the slope of the linear relation between UNSR and blood alpha-amino N concentration) is a measure of the kinetics of the process of hepatic amino N to urea N conversion; it was 19.8 +/- 4.0 L.h-1 in hypothyroid patients and increased to normal values after L-thyroxine replacement (30.4 +/- 3.3 L.h-1, P < .01; normal values > 25 L.h-1). Hepatic microsomal and cytosolic activities (antipyrine clearance and galactose elimination) were normal in hypothyroid patients and did not change significantly after therapy. Our data show a specific defect in hepatic handling of amino acids in hypothyroid patients, leading to reduced alpha-amino N to urea N conversion, in the absence of any detectable impairment in different hepatic metabolic activities.

Determination of capillary leakage due to recombinant interleukin-2 by means of noninvasive conductivity measurements

One of the most common side effects of treatment with recombinant interleukin-2 (IL-2) is capillary leakage. Its genesis is not completely understood. The aim of the study was to determine whether capillary leakage can be monitored by means of a noninvasive conductivity technique and to study its starting point. Eight patients with advanced renal cell cancer were studied in a medium care section of the Department of Medical Oncology, University Hospital over 4 days during treatment sessions of continuous, intravenously administered IL-2 (mean dose of 15.6 x 10(6) IU.m-2.day-1). The fluid shift from the intravascular to the extra- and intracellular compartments was monitored by means of noninvasive conductivity measurements. Changes in blood volume were calculated from serial erythrocyte counts. The clinical parameters of capillary leakage (oliguria, positive fluid balance, and gain in mass) were recorded. The mean gain in mass was 9% after 4 days of IL-2 treatment. The extracellular fluid volume increased significantly [46 (SD 23.2)%; P < 0.01], whereas the intracellular fluid volume did not change. The increase in blood volume (BV) amounted to 7% (P < 0.05). The decline in albumin concentration was significantly more than the increase in BV [38 (SD 4.3)%; P < 0.01], indicating capillary albumin leakage. The main changes were observed after the 2nd day of treatment. From this study, it is suggested that conductivity measurements are a suitable method to monitor capillary leakage induced by IL-2, and could be used to detect the exact onset and severity of this leakage.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of malaria infection and endotoxin-induced fever on the metabolism of antipyrine and metronidazole in the rat

Antipyrine and metronidazole were administered as a cocktail to young (4 weeks old) male Wistar rats (N = 12 for each treatment) to investigate the effect of malaria infection due to the rodent parasite Plasmodium berghei and Escherichia coli endotoxin-induced fever on the metabolism of the two compounds in vivo. Control rats received normal saline. Antipyrine and metronidazole clearances were estimated from a single saliva sample while the formation clearances of their metabolites (in malaria-infected and control rats) were estimated from the product of clearance of parent drug and the fraction of the administered dose excreted as metabolites in urine in 24 hr. Rats treated with endotoxin produced no urine during this period. Malaria infection had no effect on clearance of antipyrine or on formation clearance of any of its metabolites. However, the clearance of metronidazole was reduced by approximately 20% compared with controls as a result of decreased formation of hydroxymetronidazole. Fever decreased clearance of both antipyrine and metronidazole by approximately 36% and 23%, respectively. These results demonstrate that both malaria infection and fever can influence P450-dependent drug metabolism and the effects seen appear to be isozyme-selective.