Recent developments in fluoroquinolone phototoxicity

Lack of phototoxicity potential with delafloxacin in healthy male and female subjects: comparison to lomefloxacin

AIMS

Delafloxacin is a fluoroquinolone antibiotic recently approved by the FDA for treatment of acute bacterial skin and skin structure infections (ABSSSI). Delafloxacin was assessed for phototoxicity potential compared with a known phototoxic fluoroquinolone.

METHODS

A Phase 1, investigator-blind, placebo/active-controlled, randomized, parallel-group study was conducted in 52 healthy male and female volunteers who received 200 or 400 mg of oral delafloxacin, 400 mg oral lomefloxacin or placebo once daily for 6 days. This study evaluated the photosensitizing potential and possible wavelength dependency of delafloxacin by comparing the response of the skin to ultraviolet A (UVA), ultraviolet B (UVB) and visible radiation prior to and during administration of delafloxacin, lomefloxacin as a positive control, or placebo. Adverse events were monitored throughout the study.

RESULTS

Forty-seven subjects completed six days of dosing, and no evidence of phototoxicity was seen with delafloxacin. Delafloxacin at 200 and 400 mg day-1 and placebo did not demonstrate differences in percent change from baseline in minimal erythema dose at all tested wavelengths (295-430 nm) by monochromator and solar simulator. Lomefloxacin, the positive control, had statistically significant differences (p < 0.05) at UVA wavelengths of 335 and 365 ± 30 nm 24 hours after radiation exposure (maximum response). The phototoxic index results were significantly higher for lomefloxacin at 335 nm and 365 nm compared to placebo and delafloxacin.

CONCLUSIONS

200 and 400 mg of delafloxacin administered for 6 days were well tolerated in healthy adult volunteers. Delafloxacin and placebo failed to demonstrate a phototoxic effect but lomefloxacin, the positive control, demonstrated moderate phototoxicity.

Photochemical properties and phototoxicity of Pazufloxacin: a stable and transient study

Photochemical properties and phototoxicity of Pazufloxacin (PAX) were systematically investigated in aqueous solutions using UV-Vis, fluorescence, laser flash photolysis, pulse radiolysis and SDS-PAGE gel electrophoresis techniques. PAX triplet-state ((3)PAX(*)) absorption spectra (λ(max)=570 nm) was determined. (3)PAX(*) was quenched by PAX and O(2), with rate constants of 6.9×10(8) and 3.2×10(8) dm(3) mol(-1) s(-1), respectively. The pK(a) values (5.7 and 8.6) for the protonation equilibrium were determined by UV-Vis and fluorescence techniques. The PAX triplet energy (E(T)=260.3 kJ/mol) was obtained using energy transfer method. The reaction of electron transfer from tryptophan (TrpH) and dGMP to (3)PAX(*) was found with rate constants of 8.8×10(7) and 8.7×10(6) dm(3) mol(-1) s(-1), respectively. The rate constants for reactions of ()OH, SO(4)(-) and hydrated electron with PAX were found to be 5.8×10(8), 2.1×10(9) and 9×10(9)d m(3) mol(-1) s(-1), respectively. Based on the results obtained, a rational scheme for dGMP, TrpH and lysozyme photodamage induced by PAX was proposed.

Role of Excited State Intramolecular Charge Transfer in the Photophysical Properties of Norfloxacin and Its Derivatives

The photophysical properties of 1-ethyl-6-fluoro-7-(1-piperazinyl)-1,4-dihydro-4-oxoquinoline-3-carboxylic acid (norfloxacin, NFX) and some of its derivatives have been studied to evaluate the role of the free carboxylic acid and the nonprotonated piperazinyl group in the behavior of the 1,4-dihydro-4-oxoquinoline ring. Steady state and time-resolved fluorescence measurements at different pHs provide clear evidence in favor of singlet excited-state deactivation of NFX and its N(4')-methyl derivative pefloxacin (PFX) via intramolecular electron transfer from the N(4') atom of the piperazinyl ring to the fluoroquinolone (FQ) main system. This is a very efficient, energy-wasting pathway, which becomes dramatically enhanced in basic media. Acetylation at N(4') (as in ANFX) decreases the availability of the lone pair, making observable its fluorescence and the transient absorption spectrum of its triplet excited state even at high pH. It also reveals that the geometry of FQs changes from an almost sp3 hybridization of the N(1') of the piperazinyl substituent in the ground state to nearly sp2 in the singlet excited state (rehybridization accompanied by intramolecular charge transfer, RICT); accordingly, the singlet energy of ANFX is significantly lower than that of NFX and PFX. The fluorescence measurements using acetonitrile as a polar nonprotic organic solvent further support deactivation of the singlet excited state of nonacetylated NFX derivatives via intramolecular electron transfer from the N(4') atom.

Determination of action spectrum for sparfloxacin-photosensitized single-strand breaks in plasmid pBR322 DNA

BACKGROUND

Various drugs have been reported to induce photosensitivity as a side effect. Sparfloxacin (SPFX) is well known to trigger dermatological phototoxicity upon solar radiation exposure.

PURPOSE

To prevent SPFX-induced phototoxicity, we determined the wavelength range responsible for SPFX phototoxicity.

METHODS

The action spectrum for SPFX photosensitization was assessed by the formation of single-strand breaks in plasmid pBR322 DNA.

RESULTS

The wavelengths of light leading to the formation of single-strand breaks were in the ultraviolet A (UVA) and visible ranges. In comparison with the absorption spectrum, we found that SPFX absorption primarily contributed to the action spectrum of single-strand break formation, but it even expanded to the visible range (between 320 and 480 nm) beyond the absorption wavelengths.

CONCLUSION

The findings suggest that protection of skin from short wavelengths of visible light beyond the absorption wavelengths as well as UVA light is of primary importance in prevention against induction of SPFX phototoxicity.

Evaluation of phototoxic and photoallergic potentials of 13 compounds by different in vitro and in vivo methods

Phototoxic side effects of pharmaceutical and cosmetic products are of increasing concern for patients, dermatologists and the chemical industry. Moreover, the need of new chemicals and drugs puts pressure on pre-clinical test methods for side effects, especially interactive adverse-effects with UV-light. So, the predictive potential of different established test methods, which are used regularly in our departments in order to detect the phototoxic potential of chemicals, were analyzed. Namely the fibroblast 3T3 test, the photo hen's egg test, a guinea pig test for measuring acute photoreactions, and a modified Local Lymph Node Assay, the Integrated Model for the Differentiation of Skin Reactions. Various agents with different photoreactive potential were tested: quinolones like Bay y 3118, ciprofloxacin, enoxacin, lomefloxacin, moxifloxacin, ofloxacin, sparfloxacin, as well as promethazine, chlorpromazine, 8-methoxypsoralen and olaquindox serving as control. Special emphasis was taken to evaluate the capability of the employed test procedures to predict phototoxic side effects in patients. Following our results, both in vitro assays were useful tools to detect photoirritancy while the photoallergic potentials of tested compounds were exclusively detected by an in vivo assay. As long as no in vitro model for photoallergy is available, the UV-IMDS should be considered to evaluate photoallergic properties of a supposed photoreactive agent.

Fluoroquinolones as chemical tools to define a strategy for photogenotoxicity in vitro assessment

Today's lifestyle is often associated with frequent exposure to sunlight, but some xenobiotics used in drugs, cosmetics or food chemicals can produce adverse biological effects when irradiated. In particular, they can increase the risk of photogenotoxicity already due to UV radiation itself. There is thus a need to design appropriate approaches in order to obtain relevant data at the molecular and cellular level in this field. For ethical and practical reasons, in vitro models can be very convenient at least for first evaluation tests. Here, we propose a strategy based on complementary experiments to study the photogenotoxic potential of a compound. The fluoroquinolones BAYy3118 and lomefloxacin were used as standards to demonstrate the performance of each test: photoinduced interaction with supercoiled circular DNA, photomutagenicity in the yeast Saccharomyces cerevisae, induction of DNA photodamage in cultured human skin cells as revealed by comet assay, and finally induction of specific phototoxic stress responses such as p53 activation or melanogenesis stimulation. Such a strategy should help to ensure the safety of products likely to undergo environmental sunlight exposure.

Comparison of an in vitro cellular phototoxicity model against controlled clinical trials of fluoroquinolone skin phototoxicity

Many therapeutic drugs induce phototoxic skin responses following exposure to solar or artificial ultraviolet radiation sources. Several in vitro model systems have been developed to predict drug phototoxicity but none have been conducted in parallel with controlled clinical phototoxicity studies on systemically administered pharmaceuticals. The in vitro phototoxicity of eight fluoroquinolone (FQ) antibiotics (ciprofloxacin, grepafloxacin, lomefloxacin, norfloxacin, ofloxacin, trovafloxacin, BAYy3118, moxifloxacin) was determined by exposing Chinese hamster fibroblasts to UVA radiation. Cell damage was quantified with standard MTT or neutral red assays and an in vitro phototoxic index calculated (PI(vit)=% cell viability with UVA alone /% cell viability with UVA+FQ) for each endpoint. Clinical photosensitizing ability of the eight systemically administered FQ was investigated using double-blind, placebo and positive controlled, clinical skin phototesting of normal subjects. Minimal erythema doses at 365+/-30nm were determined before and after 6-7 days of FQ ingestion and PI(clin) (minimal erythema dose without FQ/minimal erythema dose with FQ) calculated. Linear regression analysis of PI(vit) vs PI(clin) gave correlations of up to 0.893. Principal components analysis of PI(vit), daily dose, plasma levels and photophysical (absorption) properties of the eight FQ showed that phototoxic (arbitrarily defined as PI(clin)> or =2) and non-phototoxic (PI(clin)<2) FQ could be completely discriminated using these parameters, and that the in vitro models were able to rank the relative phototoxic potential of the eight FQ.