Effect of platelet activating factor antagonist treatment on gentamicin nephrotoxicity

Ascorbic acid reduces gentamicin-induced nephrotoxicity in rats through the control of reactive oxygen species

BACKGROUND & AIM

Oxidative stress has been implicated in the pathophysiology of many forms of acute renal failure. The aim was examine the effect of vitamin C on oxidative stress and its relationship with nitric oxide on gentamicin-induced nephrotoxicity in rats.

METHODS

We utilized 32 Wistar rats allocated in four groups of eight animals each: control (CTL), vitamin C (VIT C), gentamicin (GENTA), and GENTA + VIT C; all groups were treated during seven days.

RESULTS

Serum urea and creatinine, serum and renal tissue malondialdehyde, blood superoxide anion and hydrogen peroxide in GENTA were increased vs CTL and vs VIT C, and decreased in GENTA + VIT C vs GENTA (all P < 0.05). Serum nitric oxide increased in GENTA vs CTL and vs VIT C, and reduced in GENTA + VIT C vs GENTA (P < 0.001). Urinary nitric oxide was reduced in GENTA vs CTL and vs VIT C and increased in GENTA + VIT C vs GENTA (P < 0.001). Severe degeneration of proximal tubules was present in GENTA, but only mild lesions were observed in GENTA + VIT C.

CONCLUSION

This study suggests that VIT C is a valuable tool to protect against GENTA-induced nephrotoxicity, by reducing reactive oxygen species and increasing the nitric oxide.

Attenuation of amiodarone induced lung fibrosis and phospholipidosis in hamsters, by treatment with the platelet activating factor receptor antagonist, WEB 2086

Therapeutic use of amiodarone (AMD), a Class III antiarrhythmic drug is complicated by the development of lung fibrosis (LF) and phospholipidosis (PL). In the present study, the effectiveness of a PAF antagonist, WEB 2086, against AMD induced LF and PL has been tested in hamsters. The animals were randomly divided into four groups: (1) saline + H₂O; (2) WEB + H₂O; (3) saline + AMD; and (4) WEB + AMD. Saline or WEB (10 mg/kg i.p.) was given 2 days prior to intratracheal instillation of water or AMD (1.5 μmol/0.25 ml/100 g BW) and thereafter daily throughout the study. Twenty-eight days after intratracheal instillation, the animals were killed and the lungs processed for various assays. The amount of lung hydroxyproline, an index of LF, in saline + H₂O, WEB + H₂O, saline + AMD, and WEB + AMD groups were 959 ± 46, 1035 ± 51, 1605 ± 85 and 1374 ± 69 μg/lung, respectively. Total lung PL, an index of phospholipidosis, in the corresponding groups were 8.4 ± 0.4, 8.3 ± 0.3, 11.7 ± 0.3 and 9.9 μg/lung. Lung malondialdehyde, an index of lipid peroxidation and superoxide dismutase activity in saline + H₂O WEB + H₂O, saline + AMD, and WEB + AMD were 93.0 ± 4.3, 93.0 ± 2.7, 138.9 ± 6.0 and 109.0 ± 3.8 nmol/lung and 359.7 ± 13.9, 394.0 ± 22.8, 497.5 ± 19.7 and 425.5 ± 4.9 units/lung, respectively. Administration of AMD alone caused significant increases in all the above indexes of lung toxicity, and treatment with WEB 2086 minimized the AMD induced toxicity as reflected by significant decreases in these indexes. Histopathological studies revealed a marked reduction in the extent and severity of lung lesions in the WEB + AMD group compared with the saline + AMD group. Treatment with WEB 2086 also reduced the acute mortality from 35% in saline + AMD group to 22% in WEB + AMD group. It was concluded that PAF is involved in the AMD induced lung fibrosis and phospholipidosis and that the PAF receptor antagonist may, therefore, be potentially useful in reducing AMD induced lung toxicity.

New insights into the mechanism of aminoglycoside nephrotoxicity: an integrative point of view

Nephrotoxicity is one of the most important side effects and therapeutical limitations of aminoglycoside antibiotics, especially gentamicin. Despite rigorous patient monitoring, nephrotoxicity appears in 10-25% of therapeutic courses. Traditionally, aminoglycoside nephrotoxicity has been considered to result mainly from tubular damage. Both lethal and sub-lethal alterations in tubular cells handicap reabsorption and, in severe cases, may lead to a significant tubular obstruction. However, a reduced glomerular filtration is necessary to explain the symptoms of the disease. Reduced filtration is not solely the result of tubular obstruction and tubular malfunction, resulting in tubuloglomerular feedback activation; renal vasoconstriction and mesangial contraction are also crucial to fully explain aminoglycoside nephrotoxicity. This review critically presents an integrative view on the interactions of tubular, glomerular, and vascular effects of gentamicin, in the context of the most recent information available. Moreover, it discusses therapeutic perspectives for prevention of aminoglycoside nephrotoxicity derived from the pathophysiological knowledge.

Protective effect of trans-resveratrol on gentamicin-induced nephrotoxicity

Reactive oxygen species (ROS) have been involved in glomerular filtration rate (GFR) reduction observed after gentamicin treatment. trans-Resveratrol (TR), a natural hydroxystilbene, has been identified to be a potent inhibitor of ROS production. The aim of this work has been to study whether TR has a protective effect on gentamicin-induced nephrotoxicity in vivo and the effect of TR on lipid peroxidation and the oxidative stress induced by gentamicin. Animals that received a daily intraperitoneal injection of gentamicin (100 mg/kg body weight) showed lower GFR and renal blood flow (RBF) and higher urinary excretion of N-acetyl-beta-D-glucosaminidase (NAG) than control rats. Rats receiving TR together with gentamicin showed higher GFR and RBF and lower NAG urinary excretion than rats receiving gentamicin alone. Moreover, renal lipid peroxidation increased in rats receiving gentamicin alone, and this increase was prevented by the administration of TR. The concentration in plasma of antioxidants was higher in the group that received TR with gentamicin than in the gentamicin and control groups. The activities of lactate dehydrogenase and alkaline phosphatase were higher in rats treated with gentamicin than in control rats and were reduced by the treatment with TR. This study demonstrates an improvement in renal function in response to the administration of TR in gentamicin-induced nephrotoxicity. At least a part of this effect of TR could be based on its antioxidant activity.

Effect of N-acetylcysteine on gentamicin-mediated nephropathy in rats

Studies were performed on the mechanisms of the protective effects of free-radical scavengers against gentamicin-mediated nephropathy. Administration of gentamicin, 100 mg/kg s.c., for 5 days to rats induced marked renal failure, characterised by a significantly decreased creatinine clearance and increased blood creatinine levels, fractional excretion of sodium Na(+), lithium Li(+), urine gamma glutamyl transferase and daily urine volume. A significant increase in kidney myeloperoxidase activity and lipid peroxidation was observed in gentamicin-treated rats. Immunohistochemical localisation demonstrated nitrotyrosine formation and poly(ADP-ribose)synthase activation in the proximal tubule from gentamicin-treated rats. Renal histology examination confirmed the tubular necrosis. N-acetylcysteine (10 mg/kg i.p. for 5 days) caused normalisation of the above biochemical parameters. In addition, N-acetylcysteine treatment significantly prevents the gentamicin-induced tubular necrosis. These results suggest that (1) N-acetylcysteine has protective effects on gentamicin-mediated nephropathy, and (2) the mechanisms of the protective effects can be, at least in part, related to interference with peroxynitrite-related pathways.

Potential role of platelet activating factor in acute renal failure

The clinical condition of acute renal failure (ARF) can be caused by a diverse number of renal injuries, but it is generally characterized by a sharp reduction in the glomerular filtration rate (GFR). A lipid mediator, platelet activating factor (PAF), may be one of the entities responsible for causing the hemodynamic changes in the ARF kidney because it can act as a vasodilator or vasoconstrictor, depending upon its concentration. This review examines the action and mechanisms of PAF in experimental animal models of ischemia and nephrotoxicity, as well as renal failure associated with extrarenal disease. While further research is necessary before extrapolating our current knowledge of PAF into the prevention of renal failure of therapeutic intervention using PAF antagonists in human ARF, there is reasonable evidence to support its role as a mediator of the decrease in GFR characteristic of ARF.

Effect of nitric oxide synthesis modification on renal function in gentamicin-induced nephrotoxicity

We evaluated the effect of acute or chronic nitric oxide (NO) synthesis activation or inhibition in rats with gentamicin-induced acute renal failure. Rats received gentamicin 100 mg/kg per day for 6 days, or isotonic saline. Some animals of each group also received N(G)-monomethyl-l-arginine (l-NAME, 4 mg/kg per day) or l-arginine (1%) in the drinking water for 6 days (chronic NO synthesis modification). In another experimental set, animals were treated with gentamicin or saline for 6 days and glomerular filtration rate (GFR) and renal plasma flow (RPF) were measured before and after the infusion of l-NAME (50 mg/h per kg) or l-arginine (60 mg/h per kg) (acute NO synthesis modification). Acute l-NAME administration induced a decrease in GFR and RPF both in control and gentamicin treated animals. Chronic l-NAME treatment induced an impairment in GFR only in gentamicin-treated animals. Acute l-arginine administration did not modify renal function in any experimental group whereas chronic l-arginine administration improved renal function only in gentamicin-treated animals. Urinary excretion of N-acetyl-β-d-glucosaminidase and alkaline phosphatase was increased by chronic treatment with l-NAME in both groups, whereas l-arginine had no effect. In conclusion, NO synthesis inhibition aggravates gentamicin-induced renal damage. However, chronic NO synthesis stimulation partially prevents against gentamicin nephrotoxicity, thus suggesting that increased renal NO synthesis during gentamicin-induced nephrotoxicity plays a protector role on renal function.

Increased severity of gentamicin nephrotoxicity in aging rats is mediated by a reduced glomerular nitric oxide production

The present experiments have been performed to assess whether the increased severity of gentamicin-induced nephrotoxicity in old animals could be mediated by a decreased production of nitric oxide. Aging rats (12 months) treated with gentamicin showed higher plasma creatinine and a higher reduction in creatinine clearance. After gentamicin treatment, glomerular nitrite production was higher in young than in old animals, whereas no differences in cortical gentamicin concentration were observed between young and aging animals. The increased severity of gentamicin-induced acute renal failure in old animals could be based on a decreased glomerular NO production after gentamicin treatment.

Gentamicin nephrotoxicity in humans and animals: some recent research

It would appear from the literature cited in this article, that interest in gentamicin nephrotoxicity is still thriving. Despite extensive studies, the mechanism(s) of the nephrotoxicity is uncertain. Several clinical and experimental strategies have been employed in order to ameliorate or abolish the signs of gentamicin nephrotoxicity. Most of these were unsuccessful, impractical or unsafe. Therefore there is still a need for further studies to elucidate the mechanism(s) of action of the drugs nephrotoxicity, and to discover safe, practical and effective agents to ameliorate the nephrotoxicity in patients at risk.

Glomerular angiotensin II receptors in gentamicin-induced renal failure in the rat

We evaluated the properties of glomerular angiotensin II receptors in renal glomeruli isolated from control rats and from rats with gentamicin-induced renal failure. There were no differences in the affinity of angiotensin II for its receptor between glomeruli from control and those from rats treated with gentamicin. Angiotensin II receptor density was lower in glomeruli from rats with renal failure than in those from control rats (985 +/- 71 in gentamicin treated rats vs. 1602 +/- 213 fmol/mg prot in controls). No significant differences were observed in renin activity in the supernatant from glomeruli isolated from control rats (3.74 +/- 0.29 ng angiotensin l/mL h) and those isolated from rats with gentamicin-induced renal failure (2.99 +/- 0.29 ng angiotensin l/mL h, p > 0.1). These findings do not support the contention of a role of angiotensin II in the development and maintenance of gentamicin-induced ARF.

Gentamicin activates rat mesangial cells. A role for platelet activating factor

Gentamicin-induced decreases in glomerular filtration rate have been associated with a marked decline in the glomerular capillary ultrafiltration coefficient which could be mediated by mesangial cell contraction or release of vasoactive hormones. We studied the effect of gentamicin on mesangial cells proliferation, contraction and Ca2+ mobilization. Moreover, we attempted to assess a possible role of platelet activating factor (PAF) as a mediator of the observed effects of gentamicin on mesangial cells. Gentamicin induced a reduction of planar surface area of cultured rat mesangial cells that was blunted by the PAF-antagonist, BN-52021. Gentamicin induced an increase in [Ca2+]i that was inhibited by BN-52021. Gentamicin also stimulated [3H]thymidine incorporation into DNA, an effect that was also reduced by BN-52021, and by other two structurally different PAF receptor antagonists: alprazolam and BB-823. Gentamicin induced c-fos mRNA expression in quiescent mesangial cells. Gentamicin stimulated the synthesis and release of PAF in cultured rat mesangial cells. The present studies demonstrate that gentamicin activates mesangial cell function. These actions seem to be mediated, at least in part, by PAF synthesis and release.

Amelioration of bleomycin-induced lung fibrosis by treatment with the platelet activating factor receptor antagonist WEB 2086 in hamsters

Therapeutic use of bleomycin, an antineoplastic drug, is complicated by the development of a dose-dependent lung toxicity leading to fibrosis. This study tested the effectiveness of a platelet activating factor (PAF) receptor antagonist, WEB 2086, against bleomycin (BLEO)-induced lung fibrosis in hamsters. The animals were assigned to four groups: (1) saline (SA) + SA, (2) WEB 2086 (WEB) + SA, (3) SA + BLEO, and (4) WEB + BLEO. Sterile isotonic saline or WEB 2086 (10 mg/kg IP) was administered daily for the duration of the study starting 2 days prior to intratracheal (IT) instillation of saline or bleomycin (2.5, 2.0, and 1.5 units/kg 5 mL-1) in three consecutive doses at weekly intervals. The animals were killed at 21 days after the last IT instillation and their lungs were processed for various studies. The lung hydroxyproline levels in SA + SA, WEB + SA, SA + BLEO, and WEB + BLEO groups were 932 +/- 31, 943 +/- 48, 1302 +/- 72, and 964 +/- 63 micrograms/lung, respectively. The lung myeloperoxidase (MPO) activity and malondialdehyde equivalent, an index of lipid peroxidation, in the corresponding groups were 10 +/- 2, 8 +/- 2, 14 +/- 3, and 5 +/- 1 units/lung and 93 +/- 7, 77 +/- 5, 102 +/- 8, and 75 +/- 6 nmol/lung, respectively. The lung prolyl hydroxylase activity in the WEB + SA, SA + BLEO, and WEB + BLEO groups was 130.1 +/- 7.7, 236.2 +/- 12.8, and 138.1 +/- 7.0% of the SA + SA control group (8.3 x 10(4) dpm/lung 30 min-1), respectively. Daily treatment with WEB 2086 caused significant (p < or = .05) reductions in the BLEO-induced increases in the lung hydroxyproline content, prolyl hydroxylase and MPO activities, lipid peroxidation, and acid phosphatase activity of the BALF supernatant. Although daily treatment with WEB 2086 reduced the bleomycin-induced increases in the BALF total and neutrophil cell counts, BALF supernatant protein, and morphometric estimates of the lesions, these parameters were not significantly different from those of the SA-BLEO group. Histopathologic studies revealed that there were no lesions of alveolar consolidation and fibrosis in the lungs of WEB + BLEO group as compared with the SA + BLEO group. The results suggest that PAF is involved in the BLEO-induced lung fibrosis and that PAF-receptor antagonist may therefore be potentially useful in the attenuation of lung fibrosis caused by bleomycin.

Increased glomerular nitric oxide synthesis in gentamicin-induced renal failure

Renal glomeruli isolated from normal rats and from rats with gentamicin-induced renal failure were incubated with substances that modify nitric oxide (NO) synthesis and the resulting changes in glomerular cyclic GMP (cGMP) levels were measured by radioimmunoassay. Glomeruli from normal and gentamicin-treated rats contained 0.17 +/- 0.04 and 2.02 +/- 0.63 pmol cGMP/mg protein respectively. In normal glomeruli, acetylcholine and bradykinin significantly increased cGMP levels whereas NG-nitro-L-arginine-methyl ester, an inhibitor of NO synthesis, completely blocked this increase. In glomeruli from gentamicin-treated animals, acetylcholine and bradykinin also stimulated cGMP accumulation, while NG-nitro-L-arginine-methyl ester decreased the cGMP content to levels significantly below the basal concentrations. These data suggest an increased glomerular production of NO in rats with gentamicin-induced renal failure.

Gentamicin nephrotoxicity in rats is not modified by verapamil

To assess whether calcium could be involved in the gentamicin-induced nephrotoxicity, we have studied the effect of the calcium channel blocker verapamil on renal function in rats intoxicated by gentamicin. Male Wistar rats were divided in three groups. In group I (n = 7) they were injected with gentamicin 100 mg/kg body wt/day s.c. for 5 days. In group II (n = 6), they received gentamicin and verapamil s.c. 2 mg/rat/day. In group III rats served as control. Plasma creatinine and creatinine clearance were daily measured. Rats treated with gentamicin showed a progressive increase in plasma creatinine and a drop in creatinine clearance. No differences between rats treated with gentamicin and those with gentamicin plus verapamil were observed. The urinary flow decreased after treatment with gentamicin, this decrease being more marked in rats treated with verapamil. No differences in daily urinary sodium and potassium excretion were found between intoxicated rats treated or not with verapamil. The present results show that, in rats, verapamil has no protective effect against the nephrotoxicity of gentamicin.