Pharmacokinetic and pharmacodynamic studies of the effect of ketoconazole on reproductive function in male rats

Detection of Effects on Male Reproduction—A Literature Survey

The 1CH (International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use) Guideline for Detection of Toxicity to Reproduction for Medicinal Products, adopted at the Second ICH Conference in Orlando, FL, U.S.A., emphasized the need for research into the suitability of various methods for the detection of effects on fertility in males. The current project was undertaken to compare the efficiency of methods by evaluating reports in the open literature. The results of the examination of 117 substances or substance classes support the view that histopathology and organ weight analysis provide the best general-purpose means of detecting substances with the potential to affect male fertility. Examinations at up to 4 weeks of treatment appear to be as effective as examinations conducted at later times. Mating with females for detection of effects unrelated to interference with sperm production appears to provide an optimal combination because adding other methodologies does not materially improve the detection rate. As to the timing of the mating trial, a 2-week premating period is as efficient as mating at 4 weeks and apparently more efficient than mating after prolonged premating treatment.

Defining targets for investigating the pharmacogenomics of adverse drug reactions to antifungal agents

Adverse drug reactions (ADRs) associated with antifungal therapy are major problems in patients with invasive fungal infections. Whether by clinical history or patterns of genetic variation, the identification of patients at risk for ADRs should result in improved outcomes while minimizing deleterious side effects. A major contributing factor to ADRs with antifungal agents relates to drug distribution, metabolism and excretion. Genetic variation in key genes can alter the structure and expression of genes and gene products (e.g., proteins). Thus far, the effort has focused on identifying polymorphisms with either empirical or predicted in silico functional consequences; the best candidate genes encode phase I and II drug-metabolizing enzymes (e.g., CYP2C19 and N-acetyltransferase), plasma proteins (albumin and lipoproteins) and drug transporters (P-glycoprotein and multidrug resistance proteins), which can affect the disposition of antifungal agents, eventually leading to dose-dependent (type A) toxicity. Less is known regarding the key genes that interact with antifungal agents, resulting in idiosyncratic (type B) ADRs. The possible role of certain gene products and genetic polymorphisms in the toxicities of antifungal agents are discussed in this review. The preliminary data address the following: low-density lipoproteins and cholesteryl ester transfer protein in amphotericin B renal toxicity; toll-like receptor 1 and 2 in amphotericin B infusion-related ADRs; phosphodiesterase 6 in voriconazole visual adverse events; flavin-containing monooxygenase, glutathione transferases and multidrug resistance proteins 1 and 2 in ketoconazole and terbinafine hepatotoxicity; CYP enzymes and P-glycoprotein in drug interactions between azoles and coadministered medications; multidrug resistance proteins 8 and 9 on 5-flucytosine bone marrow toxicity; and mast cell activation in caspofungin histamine release. This will focus on high-priority candidate genes, which could provide a starting point for molecular studies to elucidate the potential mechanisms for understanding toxicity associated with antifungal drugs as well as identifying candidate genes for large population prospective genetic association studies.

Expression pattern of sulfated glycoprotein-2 (SGP-2) mRNA in rat testes exposed to endocrine disruptors

Sulfated glycoprotein-2 (SGP-2) is secreted in Sertoli cells and epididymal epithelial cells and plays important roles in the regulation of spermatogenesis and sperm maturation. To investigate whether endocrine disruptors affect spermatogenesis through an SGP-2-dependent mechanism, daily oral doses of testosterone (50, 200 and 1,000 microg/kg), flutamide (1, 5 and 25 mg/kg), ketoconazole (0.2, 1, 5 and 25 mg/kg), diethylhexylphthalate (10, 50 and 250 mg/kg), nonylphenol (10, 50, 100 and 250 mg/kg), octylphenol (10, 50 and 250 mg/kg), diethylstilbesterol (10, 20 and 40 microg/kg) or corn oil (control) were administered to 5 week-old, male Sprague-Dawley rats for 3 weeks. Following treatment with these endocrine disruptors, testicular expression of SGP-2 mRNA was analyzed using reverse transcription-polymerase chain reaction. Compared with the control, the lowest dose of testosterone (50 microg/kg/day) significantly increased expression of SGP-2 mRNA, whereas 200 and 1,000 microg/kg/day testosterone significantly decreased the expression (P<0.05). Flutamide, ketoconazole, diethylhexylphthalate, nonylphenol, octylphenol and diethylstilbesterol significantly decreased SGP-2 mRNA expression in testes at all doses studied, with the exception of 1 mg/kg/day flutamide (P<0.05). These results suggest that endocrine disruptors might decrease spermatogenesis in testes by decreasing expression of SGP-2 mRNA.

Enhancement of nifedipine-induced gingival overgrowth by concomitant ketoconazole in rats

Nifedipine (NIF), a calcium channel blocker, is well known to induce gingival overgrowth (GO) as an adverse effect, and ketoconazole (KTZ), an azole antifungal agent, has been implicated in various drug interactions. We here examined the effects of concomitant KTZ on NIF-induced GO in a rat model. Fifteen-day-old male Fischer rats were fed chow with NIF, KTZ, or both. After 41 days, gingival conditions were evaluated and the concentration of NIF in serum was measured. Rats fed with NIF alone had induced GO and suppressed growth, while those given KTZ alone did not. Compared to the administration of NIF alone, concomitant KTZ significantly increased the severity of GO and the concentration of NIF in serum. These results suggest that concomitant KTZ increases the serum concentration of NIF and enhances the severity of GO.