1
|
Doki K, Hashimoto N, Yoshida K, Homma M. Implications of Incorporating Plasma Lipoprotein Binding into a Physiologically-Based Pharmacokinetic Model: A Simulation Study with Amiodarone. Clin Pharmacol Ther 2024; 115:1015-1024. [PMID: 38093601 DOI: 10.1002/cpt.3149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/07/2023] [Indexed: 12/28/2023]
Abstract
Although various lipophilic drugs are bound to lipoproteins, lipoprotein binding in plasma is not usually considered in current physiologically-based pharmacokinetic (PBPK) models. Amiodarone is extensively bound to serum triglyceride-rich lipoproteins. Total plasma amiodarone concentration, which is the sum of both unbound and bound concentrations, increases with increasing serum triglyceride levels. We investigated the impact of lipoprotein binding on amiodarone pharmacokinetics using PBPK modeling and simulations. An amiodarone PBPK model that incorporates plasma lipoprotein binding (LPP model) was developed based on the correlation between serum triglyceride levels and lipoprotein-bound amiodarone. The predicted unbound fraction of amiodarone in plasma and systemic clearance in the LPP and base models (with albumin binding only) were similar, but the coefficients of variation for the LPP model were greater than those for the base model and were closer to the observed data. The total plasma amiodarone concentration predicted using the LPP model increased with higher levels of plasma lipoprotein binding and serum albumin. In contrast, changes in plasma lipoprotein binding and serum albumin levels did not influence the predicted unbound plasma amiodarone concentration at steady-state. This study demonstrates that incorporating plasma lipoprotein binding into a PBPK model improves the accuracy of predicting interindividual variabilities in amiodarone clearance by more reliably predicting the interindividual variability in the plasma unbound fraction of amiodarone. Plasma lipoprotein binding should be considered in PBPK modeling and simulations for lipoprotein-associated drugs if there is available information on the relationship between plasma lipoprotein binding and hyperlipidemia.
Collapse
Affiliation(s)
- Kosuke Doki
- Department of Pharmaceutical Sciences, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Department of Pharmacy, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Naoaki Hashimoto
- Department of Pharmacy, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Keigo Yoshida
- Department of Pharmacy, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Masato Homma
- Department of Pharmaceutical Sciences, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Department of Pharmacy, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| |
Collapse
|
2
|
Kaur P, Kaur A, Sinha A, Khaliq W, Dumic I, Singh A. Amiodarone-Induced Nystagmus and Ataxia: Case Report and Systematic Review of Case Reports. J Clin Pharmacol 2023; 63:1324-1329. [PMID: 37571970 DOI: 10.1002/jcph.2330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/17/2023] [Indexed: 08/13/2023]
Abstract
Amiodarone is an antiarrhythmic drug with a significant adverse effect profile, including neurotoxicity. While ataxia, neuropathy, and tremors are more commonly seen forms of amiodarone neurotoxicity, very few cases of nystagmus are reported. We report the case of an 86-year-old man who presented with abrupt-onset ataxia, dizziness, and inability to ambulate, 10 days after initiating amiodarone for atrial fibrillation. His examination revealed gaze-evoked nystagmus along with features of cerebellar dysfunction. After excluding other etiologies, amiodarone was stopped. His nystagmus resolved, and his ataxia improved within 48 h of stopping amiodarone. Due to the rarity of this drug-induced adverse effect, we performed a systematic review of available case reports in the literature (PubMed and Scopus) using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and presented our findings. Nystagmus is a rarely reported adverse effect of amiodarone, which can occur within days to months of starting the medication. Treatment includes stopping the drug and monitoring for resolution of nystagmus.
Collapse
Affiliation(s)
| | - Ashampreet Kaur
- Sri Guru Ramdas Institute of Medical Sciences & Research, Amritsar, India
| | | | - Waseem Khaliq
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Igor Dumic
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Mayo Clinic Health System, Eau Claire, WI, USA
| | - Amteshwar Singh
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| |
Collapse
|
3
|
Simonen P, Lommi J, Lemström K, Tolva J, Sinisalo J, Gylling H. Amiodarone accumulates two cholesterol precursors in myocardium: A controlled clinical study. J Intern Med 2023; 294:506-514. [PMID: 37400980 DOI: 10.1111/joim.13693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
BACKGROUND Amiodarone is an effective antiarrhythmic drug, which interferes with cholesterol synthesis. In the human body, it inhibits two enzymes in the cholesterol-synthesis pathway, followed by increases especially in serum desmosterol and zymostenol concentrations and a decrease in that of serum lathosterol. OBJECTIVES We explored whether desmosterol and zymostenol accumulate also in myocardial tissue during amiodarone treatment. METHODS Thirty-three patients admitted for cardiac transplantation volunteered for the study. Ten patients were on amiodarone treatment (AD group) and 23 were not (control group). The groups were matched as regards demographic and clinical variables. Myocardial samples were obtained from the removed hearts from 31 patients. Cholesterol, non-cholesterol sterols and squalene were quantified by means of gas-liquid chromatography. RESULTS In serum and myocardium, desmosterol was 19- and 18-fold higher and zymostenol 4- and 2-fold higher in the AD group versus the control group (p < 0.001 for all). In contrast, myocardial cholesterol, squalene and lathosterol levels were lower in the AD group than in the control group (p < 0.05 for all). Levels of phytosterols and cholestanol were similar in the serum and myocardium in the two groups. Levels of myocardial and serum desmosterol, zymostenol, lathosterol and phytosterols correlated with each other in both groups (p < 0.05 for all). CONCLUSION Amiodarone treatment caused the accumulation of desmosterol and zymostenol in myocardium. In particular, myocardial desmosterol concentrations were substantially elevated, which may play a part in some of the therapeutic and adverse effects of amiodarone treatment.
Collapse
Affiliation(s)
- Piia Simonen
- Heart and Lung Center, Cardiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jyri Lommi
- Heart and Lung Center, Cardiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Karl Lemström
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Johanna Tolva
- Transplantation Laboratory, Department of Pathology, University of Helsinki, Helsinki, Finland
| | - Juha Sinisalo
- Heart and Lung Center, Cardiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Helena Gylling
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
4
|
Kim AL, Musin EV, Oripova MJ, Oshchepkova YI, Salikhov SI, Tikhonenko SA. Polyelectrolyte Microcapsules-A Promising Target Delivery System of Amiodarone with the Possibility of Prolonged Release. Int J Mol Sci 2023; 24:ijms24043348. [PMID: 36834760 PMCID: PMC9966882 DOI: 10.3390/ijms24043348] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/01/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023] Open
Abstract
Atrial fibrillation is one of the most common cardiac arrhythmias. Pharmacological preparations are used for treatment to control heart rate and rhythm. Amiodarone is one of these highly effective preparations, but, at the same time, it has significant toxicity and nonspecific accumulation in tissues. The drug delivery system based on polyelectrolyte microcapsules is one of the solutions. For this purpose, we compared different encapsulation methods of amiodaron: monoammonium salt of glycyrrhizic acid (Am:MASGA) complex (molar ratio 1:8). The concentration of amiodarone was determined by spectrophotometric methods at 251 nm. It has been shown that the co-precipitation method allows capturing 8% of Am:MASGA by CaCO3 microspherulites, which is not sufficient for the long-acting drug. The adsorption method allows encapsulating more than 30% of Am:MASGA into CaCO3 microspherulites and polyelectrolyte microcapsules CaCO3(PAH/PSS)3, but, at the same time, an insignificant amount of substance is released into the incubation medium. The development of delivery and long-acting drug system based on such methods are not inexpedient. The most appropriate encapsulation method of Am:MASGA is the adsorption method into polyelectrolyte microcapsules with complex interpolyelectrolyte structure (PAH/PSS)3. Such a type of PMC adsorbed about 50% of the initial amount of the substance and 25-30% of Am:MASGA was released into the medium after 115 h of incubation. The adsorption of Am:MASGA by polyelectrolyte microcapsules has electrostatic nature as evidenced by the acceleration of the release by 1.8 times as ionic strength increases.
Collapse
Affiliation(s)
- Aleksandr L. Kim
- Institute of Theoretical and Experimental Biophysics Russian Academy of Science, Institutskaya St., 3, 142290 Puschino, Moscow Region, Russia
| | - Egor V. Musin
- Institute of Theoretical and Experimental Biophysics Russian Academy of Science, Institutskaya St., 3, 142290 Puschino, Moscow Region, Russia
| | - Munojat J. Oripova
- Institute of Bioorganic Chemistry named after O.Sodikov Academy of Sciences of the Republic of Uzbekistan, M. Ulugbek Str., 83, Tashkent 100125, Uzbekistan
| | - Yulia I. Oshchepkova
- Institute of Bioorganic Chemistry named after O.Sodikov Academy of Sciences of the Republic of Uzbekistan, M. Ulugbek Str., 83, Tashkent 100125, Uzbekistan
| | - Shavkat I. Salikhov
- Institute of Bioorganic Chemistry named after O.Sodikov Academy of Sciences of the Republic of Uzbekistan, M. Ulugbek Str., 83, Tashkent 100125, Uzbekistan
| | - Sergey A. Tikhonenko
- Institute of Theoretical and Experimental Biophysics Russian Academy of Science, Institutskaya St., 3, 142290 Puschino, Moscow Region, Russia
- Correspondence:
| |
Collapse
|
5
|
Fairman K, Choi MK, Gonnabathula P, Lumen A, Worth A, Paini A, Li M. An Overview of Physiologically-Based Pharmacokinetic Models for Forensic Science. TOXICS 2023; 11:126. [PMID: 36851001 PMCID: PMC9964742 DOI: 10.3390/toxics11020126] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/16/2022] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
A physiologically-based pharmacokinetic (PBPK) model represents the structural components of the body with physiologically relevant compartments connected via blood flow rates described by mathematical equations to determine drug disposition. PBPK models are used in the pharmaceutical sector for drug development, precision medicine, and the chemical industry to predict safe levels of exposure during the registration of chemical substances. However, one area of application where PBPK models have been scarcely used is forensic science. In this review, we give an overview of PBPK models successfully developed for several illicit drugs and environmental chemicals that could be applied for forensic interpretation, highlighting the gaps, uncertainties, and limitations.
Collapse
Affiliation(s)
- Kiara Fairman
- Division of Biochemical Toxicology, National Center for Toxicological Research, United States Food and Drug Administration, Jefferson, AR 72079, USA
| | - Me-Kyoung Choi
- Division of Biochemical Toxicology, National Center for Toxicological Research, United States Food and Drug Administration, Jefferson, AR 72079, USA
| | - Pavani Gonnabathula
- Division of Biochemical Toxicology, National Center for Toxicological Research, United States Food and Drug Administration, Jefferson, AR 72079, USA
| | - Annie Lumen
- Division of Biochemical Toxicology, National Center for Toxicological Research, United States Food and Drug Administration, Jefferson, AR 72079, USA
| | - Andrew Worth
- European Commission, Joint Research Centre (JRC), 21027 Ispra, Italy
| | | | - Miao Li
- Division of Biochemical Toxicology, National Center for Toxicological Research, United States Food and Drug Administration, Jefferson, AR 72079, USA
| |
Collapse
|
6
|
Clinical and Mechanistic Review of Amiodarone-Associated Optic Neuropathy. Biomolecules 2022; 12:biom12091298. [PMID: 36139137 PMCID: PMC9496374 DOI: 10.3390/biom12091298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/26/2022] [Accepted: 08/31/2022] [Indexed: 11/26/2022] Open
Abstract
Amiodarone-associated optic neuropathy (AAON) is a complex clinical diagnosis, requiring distinction from non-arteritic ischemic optic neuropathy (NAION) due to a shared at-risk patient population. Diagnosis of AAON is complicated by a varied clinical presentation and incomplete pathophysiologic mechanisms. This article reviews pertinent literature for describing and clinically delineating AAON from NAION, as well as newly reported protective mechanisms of insulin-like growth factor 1 (IGF-1) and PI3K/Akt against amiodarone-induced oxidative and apoptotic injury in retinal ganglion and pigment epithelial cells. These studies offer a basis for exploring mechanisms of amiodarone toxicity in the optic nerve.
Collapse
|
7
|
Mihajlovic M, Vinken M. Mitochondria as the Target of Hepatotoxicity and Drug-Induced Liver Injury: Molecular Mechanisms and Detection Methods. Int J Mol Sci 2022; 23:ijms23063315. [PMID: 35328737 PMCID: PMC8951158 DOI: 10.3390/ijms23063315] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 12/12/2022] Open
Abstract
One of the major mechanisms of drug-induced liver injury includes mitochondrial perturbation and dysfunction. This is not a surprise, given that mitochondria are essential organelles in most cells, which are responsible for energy homeostasis and the regulation of cellular metabolism. Drug-induced mitochondrial dysfunction can be influenced by various factors and conditions, such as genetic predisposition, the presence of metabolic disorders and obesity, viral infections, as well as drugs. Despite the fact that many methods have been developed for studying mitochondrial function, there is still a need for advanced and integrative models and approaches more closely resembling liver physiology, which would take into account predisposing factors. This could reduce the costs of drug development by the early prediction of potential mitochondrial toxicity during pre-clinical tests and, especially, prevent serious complications observed in clinical settings.
Collapse
|
8
|
Kohajda Z, Virág L, Hornyik T, Husti Z, Sztojkov-Ivanov A, Nagy N, Horváth A, Varga R, Prorok J, Szlovák J, Tóth N, Gazdag P, Topal L, Naveed M, Árpádffy-Lovas T, Pászti B, Magyar T, Koncz I, Déri S, Demeter-Haludka V, Aigner Z, Ördög B, Patfalusi M, Tálosi L, Tiszlavicz L, Földesi I, Jost N, Baczkó I, Varró A. In vivo and cellular antiarrhythmic and cardiac electrophysiological effects of desethylamiodarone in dog cardiac preparations. Br J Pharmacol 2022; 179:3382-3402. [PMID: 35106755 DOI: 10.1111/bph.15812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE The aim of the present study was to study the antiarrhythmic effects and cellular mechanisms of desethylamiodarone (DEA), the main metabolite of amiodarone (AMIO), following acute and chronic 4-week oral treatments (25-50 mg·kg-1 ·day-1 ). EXPERIMENTAL APPROACH The antiarrhythmic effects of acute iv. (10 mg·kg-1 ) and chronic oral (4 weeks, 25 mg·kg-1 ·day-1 ) administration of DEA were assessed in carbachol and tachypacing-induced dog atrial fibrillation models. Action potentials were recorded from atrial and right ventricular tissue following acute (10 μM) and chronic (p.o. 4 weeks, 50 mg·kg-1 ·day-1 ) DEA application using the conventional microelectrode technique. Ionic currents were measured by the whole cell configuration of the patch clamp technique in isolated left ventricular myocytes. Pharmacokinetic studies were performed following a single intravenous dose (25 mg·kg-1 ) of AMIO and DEA intravenously and orally. In chronic (91-day) toxicological investigations, DEA and AMIO were administered in the oral dose of 25 mg·kg-1 ·day-1 ). KEY RESULTS DEA exerted marked antiarrhythmic effects in both canine atrial fibrillation models. Both acute and chronic DEA administration prolonged action potential duration in atrial and ventricular muscle without any changes detected in Purkinje fibres. DEA decreased the amplitude of several outward potassium currents such as IKr , IKs , IK1 , Ito , and IKACh , while the ICaL and late INa inward currents were also significantly depressed. Better drug bioavailability and higher volume of distribution for DEA were observed compared to AMIO. No neutropenia and less severe pulmonary fibrosis was found following DEA compared to that of AMIO administration. CONCLUSION AND IMPLICATIONS Chronic DEA treatment in animal experiments has marked antiarrhythmic and electrophysiological effects with better pharmacokinetics and lower toxicity than its parent compound. These results suggest that the active metabolite, DEA, should be considered for clinical trials as a possible new, more favourable option for the treatment of cardiac arrhythmias including atrial fibrillation.
Collapse
Affiliation(s)
- Zsófia Kohajda
- ELKH-SZTE Research Group for Cardiovascular Pharmacology, Eötvös Loránd Research Network, Szeged, Hungary
| | - László Virág
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary.,Department of Pharmacology and Pharmacotherapy, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
| | - Tibor Hornyik
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Zoltán Husti
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Anita Sztojkov-Ivanov
- Department of Pharmacodynamics and Biopharmacy, University of Szeged, Szeged, Hungary
| | - Norbert Nagy
- ELKH-SZTE Research Group for Cardiovascular Pharmacology, Eötvös Loránd Research Network, Szeged, Hungary.,Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - András Horváth
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Richárd Varga
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - János Prorok
- ELKH-SZTE Research Group for Cardiovascular Pharmacology, Eötvös Loránd Research Network, Szeged, Hungary.,Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Jozefina Szlovák
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Noémi Tóth
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Péter Gazdag
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Leila Topal
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Muhammad Naveed
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Tamás Árpádffy-Lovas
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Bence Pászti
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Tibor Magyar
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - István Koncz
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Szilvia Déri
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | | | - Zoltán Aigner
- Institute of Pharmaceutical Technology and Regulatory Affairs, University of Szeged, Szeged, Hungary
| | - Balázs Ördög
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Márta Patfalusi
- Department of Toxicology, ATRC Aurigon Toxicological Research Center Ltd., Dunakeszi, Hungary
| | - László Tálosi
- Department of Pharmacognosy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - László Tiszlavicz
- Department of Pathology, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Imre Földesi
- Department of Laboratory Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Norbert Jost
- ELKH-SZTE Research Group for Cardiovascular Pharmacology, Eötvös Loránd Research Network, Szeged, Hungary.,Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary.,Department of Pharmacology and Pharmacotherapy, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
| | - István Baczkó
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary.,Department of Pharmacology and Pharmacotherapy, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
| | - András Varró
- ELKH-SZTE Research Group for Cardiovascular Pharmacology, Eötvös Loránd Research Network, Szeged, Hungary.,Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary.,Department of Pharmacology and Pharmacotherapy, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
| |
Collapse
|
9
|
Hashimoto N, Doki K, Kawano S, Aonuma K, Ieda M, Homma M. Increased serum amiodarone concentration in hypertriglyceridemic patients: Effects of drug distribution to serum lipoproteins. Clin Transl Sci 2021; 15:771-781. [PMID: 34786846 PMCID: PMC8932714 DOI: 10.1111/cts.13199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 11/29/2022] Open
Abstract
Amiodarone and its main metabolite, desethylamiodarone (DEA), are highly distributed to serum lipoproteins such as very‐low‐density lipoprotein (VLDL) and low‐density lipoprotein (LDL), which are the carriers of triglyceride and cholesterol. This study aimed to investigate the association of serum concentrations of amiodarone and DEA with the levels of serum lipids in terms of drug distribution to lipoprotein fractions in patients with hyperlipidemia. Total serum concentrations of amiodarone and DEA were examined in 116 patients receiving amiodarone for tachyarrhythmias. The concentration‐to‐dose (C/D) ratio of amiodarone positively correlated with the level of serum triglyceride (rs = 0.541, p < 0.001) and was higher in the hypertriglyceridemic state than in normotriglyceridemic state (479 ± 211 vs. 320 ± 161, p < 0.001). No correlation was found between the C/D ratio of DEA and serum triglyceride levels (rs = 0.272), although higher values were observed in the hypertriglyceridemic state (322 ± 125 vs. 285 ± 143, p < 0.001). In the hypertriglyceridemic state, the distribution of amiodarone increased in LDL/VLDL fraction and decreased in high‐density lipoprotein and albumin fractions. The ratio of serum amiodarone to serum DEA, a metabolic ratio of amiodarone, positively correlated with serum triglyceride levels (rs = 0.572, p < 0.001) and was higher in the hypertriglyceridemic state, suggesting that amiodarone metabolism decreased in hyperlipidemia. The results of this study reveal that serum concentrations of amiodarone increase in the hypertriglyceridemic state through the increased lipoprotein‐binding and decreased metabolism of amiodarone.
Collapse
Affiliation(s)
- Naoaki Hashimoto
- Department of Pharmacy, University of Tsukuba Hospital, Tsukuba, Japan.,Department of Pharmaceutical Sciences, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kosuke Doki
- Department of Pharmacy, University of Tsukuba Hospital, Tsukuba, Japan.,Department of Pharmaceutical Sciences, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Satoru Kawano
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazutaka Aonuma
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masaki Ieda
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masato Homma
- Department of Pharmacy, University of Tsukuba Hospital, Tsukuba, Japan.,Department of Pharmaceutical Sciences, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| |
Collapse
|
10
|
Cell-Permeable Succinate Rescues Mitochondrial Respiration in Cellular Models of Amiodarone Toxicity. Int J Mol Sci 2021; 22:ijms222111786. [PMID: 34769217 PMCID: PMC8583998 DOI: 10.3390/ijms222111786] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 12/15/2022] Open
Abstract
Amiodarone is a potent antiarrhythmic drug and displays substantial liver toxicity in humans. It has previously been demonstrated that amiodarone and its metabolite (desethylamiodarone, DEA) can inhibit mitochondrial function, particularly complexes I (CI) and II (CII) of the electron transport system in various animal tissues and cell types. The present study, performed in human peripheral blood cells, and one liver-derived human cell line, is primarily aimed at assessing the concentration-dependent effects of these drugs on mitochondrial function (respiration and cellular ATP levels). Furthermore, we explore the efficacy of a novel cell-permeable succinate prodrug in alleviating the drug-induced acute mitochondrial dysfunction. Amiodarone and DEA elicit a concentration-dependent impairment of mitochondrial respiration in both intact and permeabilized platelets via the inhibition of both CI- and CII-supported respiration. The inhibitory effect seen in human platelets is also confirmed in mononuclear cells (PBMCs) and HepG2 cells. Additionally, amiodarone elicits a severe concentration-dependent ATP depletion in PBMCs, which cannot be explained solely by mitochondrial inhibition. The succinate prodrug NV118 alleviates the respiratory deficit in platelets and HepG2 cells acutely exposed to amiodarone. In conclusion, amiodarone severely inhibits metabolism in primary human mitochondria, which can be counteracted by increasing mitochondrial function using intracellular delivery of succinate.
Collapse
|
11
|
Cahill JF, Kertesz V. Quantitation of amiodarone and N-desethylamiodarone in single HepG2 cells by single-cell printing-liquid vortex capture-mass spectrometry. Anal Bioanal Chem 2021; 413:6917-6927. [PMID: 34595558 DOI: 10.1007/s00216-021-03652-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 10/20/2022]
Abstract
Quantitative measure of a drug and its associated metabolite(s) with single-cell resolution is often limited by sampling throughput or other compromises that limit broad use. Here, we demonstrate the use of single-cell printing-liquid vortex capture-mass spectrometry (SCP-LVC-MS) to quantitatively measure the intracellular concentrations of amiodarone (AMIO) and its metabolite, N-desethylamiodarone (NDEA), from thousands of single cells across several AMIO incubation concentrations ranging from 0 to 10 μM. Concentrations obtained by SCP-LVC-MS were validated through comparison with average assays and traditional measurement of cells in bulk. Average of SCP-LVC-MS measurements and aggregate vial collection assay the concentrations differed by < 5%. Both AMIO and NDEA had clear log-normal distributions with similar standard deviation of concentrations in the cell population. The mean of both AMIO and NDEA intracellular concentrations were positively correlated with AMIO incubation concentration, increasing from 0.026 to 0.520 and 0.0055 to 0.048 mM for AMIO and NDEA, respectively. The standard deviation of AMIO and NDEA log-normal distribution fits were relatively similar in value across incubation concentrations, 0.15-0.19 log10 (mM), and exhibited a linear trend with respect to each other. The single cell-resolved conversion ratio of AMIO to NDEA increased with decreasing incubation concentration, 7 ± 2%, 18 ± 3%, and 20 ± 7% for 10.0, 1.0, and 0.1 μM AMIO incubation concentrations, respectively. Association with simultaneously measured lipids had several ions with statistically significant difference in intensity but no clear correlations with AMIO intracellular content was observed.
Collapse
Affiliation(s)
- John F Cahill
- Bioanalytical Mass Spectrometry Group, Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, 37831-6131, USA.
| | - Vilmos Kertesz
- Bioanalytical Mass Spectrometry Group, Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, 37831-6131, USA
| |
Collapse
|
12
|
Hubel E, Fishman S, Holopainen M, Käkelä R, Shaffer O, Houri I, Zvibel I, Shibolet O. Repetitive amiodarone administration causes liver damage via adipose tissue ER stress-dependent lipolysis, leading to hepatotoxic free fatty acid accumulation. Am J Physiol Gastrointest Liver Physiol 2021; 321:G298-G307. [PMID: 34259586 DOI: 10.1152/ajpgi.00458.2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Drug-induced liver injury is an emerging form of acute and chronic liver disease that may manifest as fatty liver. Amiodarone (AMD), a widely used antiarrhythmic drug, can cause hepatic injury and steatosis by a variety of mechanisms, not all completely understood. We hypothesized that repetitive AMD administration may induce hepatic lipotoxicity not only via effects on the liver but also via effects on adipose tissue. Indeed, repetitive AMD administration induced endoplasmic reticulum (ER) stress in both liver and adipose tissue. In adipose tissue, AMD reduced lipogenesis and increased lipolysis. Moreover, AMD treatment induced ER stress and ER stress-dependent lipolysis in 3T3L1 adipocytes in vitro. In the liver, AMD caused increased expression of genes encoding proteins involved in fatty acid (FA) uptake and transfer (Cd36, Fabp1, and Fabp4), and resulted in increased hepatic accumulation of free FAs, but not of triacylglycerols. In line with this, there was increased expression of hepatic de novo FA synthesis genes. However, AMD significantly reduced the expression of the desaturase Scd1 and elongase Elovl6, detected at mRNA and protein levels. Accordingly, the FA profile of hepatic total lipids revealed increased accumulation of palmitate, an SCD1 and ELOVL6 substrate, and reduced levels of palmitoleate and cis-vaccenate, products of the enzymes. In addition, AMD-treated mice displayed increased hepatic apoptosis. The studies show that repetitive AMD induces ER stress and aggravates lipolysis in adipose tissue while inducing a lipotoxic hepatic lipid environment, suggesting that AMD-induced liver damage is due to compound insult to liver and adipose tissue.NEW & NOTEWORTHY AMD chronic administration induces hepatic lipid accumulation by several mechanisms, including induction of hepatic ER stress, impairment of β-oxidation, and inhibition of triacylglycerol secretion. Our study shows that repetitive AMD treatment induces not only hepatic ER stress but also adipose tissue ER stress and lipolysis and hepatic accumulation of free fatty acids and enrichment of palmitate in the total lipids. Understanding the toxicity mechanisms of AMD would help devise ways to limit liver damage.
Collapse
Affiliation(s)
- Einav Hubel
- The Research Center for Digestive Tract and Liver Diseases, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sigal Fishman
- The Research Center for Digestive Tract and Liver Diseases, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Gastroenterology and Hepatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Minna Holopainen
- Helsinki University Lipidomics Unit, Helsinki Institute for Life Science and Biocenter Finland, Helsinki, Finland.,Molecular and Integrative Biosciences Research Programme, Faculty of Biological and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | - Reijo Käkelä
- Helsinki University Lipidomics Unit, Helsinki Institute for Life Science and Biocenter Finland, Helsinki, Finland.,Molecular and Integrative Biosciences Research Programme, Faculty of Biological and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | - Ortal Shaffer
- Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Inbal Houri
- The Research Center for Digestive Tract and Liver Diseases, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Gastroenterology and Hepatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Isabel Zvibel
- The Research Center for Digestive Tract and Liver Diseases, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oren Shibolet
- The Research Center for Digestive Tract and Liver Diseases, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Gastroenterology and Hepatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| |
Collapse
|
13
|
Wiener PC, Babapoor-Farrokhran S, Reinaker T, Mainigi SK. Unforeseen consequences: Class III antiarrhythmic amiodarone stimulated increase in prostate-specific antigen. HeartRhythm Case Rep 2021; 7:267-269. [PMID: 34026512 PMCID: PMC8134753 DOI: 10.1016/j.hrcr.2021.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Philip C Wiener
- Division of Cardiology, Heart and Vascular Institute, Einstein Medical Center, Philadelphia, Pennsylvania
| | | | - Travis Reinaker
- Department of Pharmacy, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Sumeet K Mainigi
- Division of Cardiology, Heart and Vascular Institute, Einstein Medical Center, Philadelphia, Pennsylvania
| |
Collapse
|
14
|
Pedro L, Rudewicz PJ. Analysis of Live Single Cells by Confocal Microscopy and High-Resolution Mass Spectrometry to Study Drug Uptake, Metabolism, and Drug-Induced Phospholipidosis. Anal Chem 2020; 92:16005-16015. [PMID: 33280372 DOI: 10.1021/acs.analchem.0c03534] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The analysis of large numbers of cells from a population results in information that does not reflect differences in cell phenotypes. Individual variations in cellular drug uptake, metabolism, and response to drug treatment may have profound effects on cellular survival and lead to the development of certain disease states, drug persistence, and resistance. Herein, we present a method that combines live cell confocal microscopy imaging with high-resolution mass spectrometry to achieve absolute cell quantification of the drug amiodarone (AMIO) and its major metabolite, N-desethylamiodarone (NDEA), in single liver cells (HepG2 and HepaRG cells). The method uses a prototype system that integrates a confocal microscope with an XYZ stage robot to image and automatically sample selected cells from a sample compartment, which is kept under growth conditions, with nanospray tips. Besides obtaining the distributions of AMIO and NDEA cell concentrations across a population of individual cells, as well as variabilities in drug metabolism, the effect of these on phospholipidosis and cell morphology was studied. The method was suited to identify subpopulations of cells that metabolized less drug and to correlate cell drug concentrations with cell phospholipid content, cell volume, sphericity, and other cell phenotypic features. Using principal component analysis (PCA), the treated cells could be clearly distinguished from vehicle control cells (0 μM AMIO) and HepaRG cells from HepG2 cells. The potential of using multidimensional and multimodal information collected from single cells to build predictive models for cell classification is demonstrated.
Collapse
Affiliation(s)
- Liliana Pedro
- Novartis Institutes for BioMedical Research, Emeryville, California 94608, United States
| | - Patrick J Rudewicz
- Novartis Institutes for BioMedical Research, Emeryville, California 94608, United States
| |
Collapse
|
15
|
Gunesch AP, Zapatero-Belinchón FJ, Pinkert L, Steinmann E, Manns MP, Schneider G, Pietschmann T, Brönstrup M, von Hahn T. Filovirus Antiviral Activity of Cationic Amphiphilic Drugs Is Associated with Lipophilicity and Ability To Induce Phospholipidosis. Antimicrob Agents Chemother 2020; 64:e00143-20. [PMID: 32513799 PMCID: PMC7526846 DOI: 10.1128/aac.00143-20] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/04/2020] [Indexed: 02/07/2023] Open
Abstract
Several cationic amphiphilic drugs (CADs) have been found to inhibit cell entry of filoviruses and other enveloped viruses. Structurally unrelated CADs may have antiviral activity, yet the underlying common mechanism and structure-activity relationship are incompletely understood. We aimed to understand how widespread antiviral activity is among CADs and which structural and physico-chemical properties are linked to entry inhibition. We measured inhibition of Marburg virus pseudoparticle (MARVpp) cell entry by 45 heterogeneous and mostly FDA-approved CADs and cytotoxicity in EA.hy926 cells. We analyzed correlation of antiviral activity with four chemical properties: pKa, hydrophobicity (octanol/water partitioning coefficient; ClogP), molecular weight, and distance between the basic group and hydrophobic ring structures. Additionally, we quantified drug-induced phospholipidosis (DIPL) of a CAD subset by flow cytometry. Structurally similar compounds (derivatives) and those with similar chemical properties but unrelated structures (analogues) to those of strong inhibitors were obtained by two in silico similarity search approaches and tested for antiviral activity. Overall, 11 out of 45 (24%) CADs inhibited MARVpp by 40% or more. The strongest antiviral compounds were dronedarone, triparanol, and quinacrine. Structure-activity relationship studies revealed highly significant correlations between antiviral activity, hydrophobicity (ClogP > 4), and DIPL. Moreover, pKa and intramolecular distance between hydrophobic and hydrophilic moieties correlated with antiviral activity but to a lesser extent. We also showed that in contrast to analogues, derivatives had antiviral activity similar to that of the seed compound dronedarone. Overall, one-quarter of CADs inhibit MARVpp entry in vitro, and antiviral activity of CADs mostly relies on their hydrophobicity yet is promoted by the individual structure.
Collapse
Affiliation(s)
- Antonia P Gunesch
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
- German Center for Infection Research, Hannover-Braunschweig Site, Braunschweig, Germany
- Institute of Experimental Virology, TWINCORE, Center for Experimental and Clinical Infection Research Hannover, Hannover, Germany
| | - Francisco J Zapatero-Belinchón
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
- German Center for Infection Research, Hannover-Braunschweig Site, Braunschweig, Germany
- Institute of Experimental Virology, TWINCORE, Center for Experimental and Clinical Infection Research Hannover, Hannover, Germany
| | - Lukas Pinkert
- Department of Chemical Biology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Eike Steinmann
- Department for Molecular and Medical Virology, Ruhr Universität Bochum, Bochum, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
- German Center for Infection Research, Hannover-Braunschweig Site, Braunschweig, Germany
| | - Gisbert Schneider
- Department of Chemistry and Applied Biosciences, Institute of Pharmaceutical Sciences, Eidgenössische Technische Hochschule, Zurich, Switzerland
| | - Thomas Pietschmann
- German Center for Infection Research, Hannover-Braunschweig Site, Braunschweig, Germany
- Institute of Experimental Virology, TWINCORE, Center for Experimental and Clinical Infection Research Hannover, Hannover, Germany
| | - Mark Brönstrup
- German Center for Infection Research, Hannover-Braunschweig Site, Braunschweig, Germany
- Department of Chemical Biology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Thomas von Hahn
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
- German Center for Infection Research, Hannover-Braunschweig Site, Braunschweig, Germany
- Institute of Experimental Virology, TWINCORE, Center for Experimental and Clinical Infection Research Hannover, Hannover, Germany
- Department of Gastroenterology and Interventional Endoscopy, Asklepios Hospital Barmbek, Semmelweis University, Hamburg, Germany
| |
Collapse
|
16
|
Garcia JR, Campbell PF, Kumar G, Langberg JJ, Cesar L, Deppen JN, Shin EY, Bhatia NK, Wang L, Xu K, Schneider F, Robinson B, García AJ, Levit RD. Minimally Invasive Delivery of Hydrogel-Encapsulated Amiodarone to the Epicardium Reduces Atrial Fibrillation. Circ Arrhythm Electrophysiol 2019; 11:e006408. [PMID: 29748197 DOI: 10.1161/circep.118.006408] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/09/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common cardiac arrhythmia. Although treatment options for AF exist, many patients cannot be maintained in normal sinus rhythm. Amiodarone is an effective medication for AF but has limited clinical utility because of off-target tissue toxicity. METHODS Here, we use a pig model of AF to test the efficacy of an amiodarone-containing polyethylene glycol-based hydrogel. The gel is placed directly on the atrial epicardium through the pericardial space in a minimally invasive procedure using a specially designed catheter. RESULTS Implantation of amiodarone-containing gel significantly reduced the duration of sustained AF at 21 and 28 days; inducibility of AF was reduced 14 and 21 days post-delivery. Off-target organ drug levels in the liver, lungs, thyroid, and fat were significantly reduced in animals treated with epicardial amiodarone gel compared with systemic controls in small-animal distribution studies. CONCLUSIONS The pericardium is an underutilized therapeutic site and may be a new treatment strategy for AF and other cardiovascular diseases.
Collapse
Affiliation(s)
- Jose R Garcia
- Woodruff School of Mechanical Engineering, Petit Institute for Bioengineering and Bioscience (J.R.G., A.J.G.)
| | - Peter F Campbell
- Georgia Institute of Technology, Atlanta. InnovatiëLifeSciences, Santa Clara, CA (P.F.C.)
| | - Gautam Kumar
- Division of Cardiology, Department of Medicine (G.K., J.J.L., J.N.D., E.Y.S., N.K.B., L.W., K.X., R.D.L.).,Emory University School of Medicine, Atlanta, GA. Division of Cardiology, Atlanta VA Medical Center, Decatur, GA (G.K.)
| | - Jonathan J Langberg
- Division of Cardiology, Department of Medicine (G.K., J.J.L., J.N.D., E.Y.S., N.K.B., L.W., K.X., R.D.L.)
| | - Liliana Cesar
- South Atlanta Veterinary Emergency Specialists, Fayetteville, GA (L.C.)
| | - Juline N Deppen
- and Walter H. Coulter Department of Biomedical Engineering (J.N.D.).,Division of Cardiology, Department of Medicine (G.K., J.J.L., J.N.D., E.Y.S., N.K.B., L.W., K.X., R.D.L.)
| | - Eric Y Shin
- Division of Cardiology, Department of Medicine (G.K., J.J.L., J.N.D., E.Y.S., N.K.B., L.W., K.X., R.D.L.)
| | - Neal K Bhatia
- Division of Cardiology, Department of Medicine (G.K., J.J.L., J.N.D., E.Y.S., N.K.B., L.W., K.X., R.D.L.)
| | - Lanfang Wang
- Division of Cardiology, Department of Medicine (G.K., J.J.L., J.N.D., E.Y.S., N.K.B., L.W., K.X., R.D.L.)
| | - Kai Xu
- Division of Cardiology, Department of Medicine (G.K., J.J.L., J.N.D., E.Y.S., N.K.B., L.W., K.X., R.D.L.)
| | - Frank Schneider
- Division of Cardiology, Department of Medicine (G.K., J.J.L., J.N.D., E.Y.S., N.K.B., L.W., K.X., R.D.L.).,and Department of Pathology and Laboratory Medicine (F.S., B.R.)
| | - Brian Robinson
- and Department of Pathology and Laboratory Medicine (F.S., B.R.)
| | - Andrés J García
- Woodruff School of Mechanical Engineering, Petit Institute for Bioengineering and Bioscience (J.R.G., A.J.G.)
| | - Rebecca D Levit
- Division of Cardiology, Department of Medicine (G.K., J.J.L., J.N.D., E.Y.S., N.K.B., L.W., K.X., R.D.L.)
| |
Collapse
|
17
|
Patel A, Hoffman E, Ball D, Klapwijk J, Steven RT, Dexter A, Bunch J, Baker D, Murnane D, Hutter V, Page C, Dailey LA, Forbes B. Comparison of Oral, Intranasal and Aerosol Administration of Amiodarone in Rats as a Model of Pulmonary Phospholipidosis. Pharmaceutics 2019; 11:pharmaceutics11070345. [PMID: 31319538 PMCID: PMC6680908 DOI: 10.3390/pharmaceutics11070345] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 12/31/2022] Open
Abstract
‘Foamy’ alveolar macrophages (FAM) observed in nonclinical toxicology studies during inhaled drug development may indicate drug-induced phospholipidosis, but can also derive from adaptive non-adverse mechanisms. Orally administered amiodarone is currently used as a model of pulmonary phospholipidosis and it was hypothesized that aerosol administration would produce phospholipidosis-induced FAM that could be characterized and used in comparative inhalation toxicology. Han-Wistar rats were given amiodarone via (1) intranasal administration (6.25 mg/kg) on two days, (2) aerosol administration (3 mg/kg) on two days, (3) aerosol administration (10 mg/kg) followed by three days of 30 mg/kg or (4) oral administration (100 mg/kg) for 7 days. Alveolar macrophages in bronchoalveolar lavage were evaluated by differential cell counting and high content fluorescence imaging. Histopathology and mass-spectrometry imaging (MSI) were performed on lung slices. The higher dose aerosolised amiodarone caused transient pulmonary inflammation (p < 0.05), but only oral amiodarone resulted in FAM (p < 0.001). MSI of the lungs of orally treated rats revealed a homogenous distribution of amiodarone and a putative phospholipidosis marker, di-22:6 bis-monoacylglycerol, throughout lung tissue whereas aerosol administration resulted in localization of both compounds around the airway lumen. Thus, unlike oral administration, aerosolised amiodarone failed to produce the expected FAM responses.
Collapse
Affiliation(s)
- Aateka Patel
- Sackler Institute of Pulmonary Pharmacology, Faculty of Life Sciences & Medicine, Franklin-Wilkins Building, King's College London, 150 Stamford Street, London SE1 9NH, UK
- Institute of Pharmaceutical Science, King's College London, Franklin-Wilkins Building, King's College London, 150 Stamford Street, London SE1 9NH, UK
| | - Ewelina Hoffman
- Centre for Topical Drug Delivery and Toxicology, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Herts AL10 9AB, UK
- Department of Pharmaceutical Biochemistry and Molecular Diagnostics, Pharmacy Faculty, Medical University of Lodz, 90-151 Lodz, Poland
| | - Doug Ball
- Allergic Inflammation Discovery Performance Unit, GlaxoSmithKline, Gunnelswood Road, Stevenage, Herts SG1 2NY, UK
| | - Jan Klapwijk
- Translational Medicine and Comparative Pathobiology, GlaxoSmithKline, Park Road, Ware, Hertfordshire SG12 0DP, UK
| | - Rory T Steven
- National Physical Laboratory, Teddington, London TW11 0LW, UK
| | - Alex Dexter
- National Physical Laboratory, Teddington, London TW11 0LW, UK
| | - Josephine Bunch
- National Physical Laboratory, Teddington, London TW11 0LW, UK
| | - Daniel Baker
- Centre for Topical Drug Delivery and Toxicology, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Herts AL10 9AB, UK
| | - Darragh Murnane
- Centre for Topical Drug Delivery and Toxicology, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Herts AL10 9AB, UK
| | - Victoria Hutter
- Centre for Topical Drug Delivery and Toxicology, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Herts AL10 9AB, UK
| | - Clive Page
- Sackler Institute of Pulmonary Pharmacology, Faculty of Life Sciences & Medicine, Franklin-Wilkins Building, King's College London, 150 Stamford Street, London SE1 9NH, UK
| | - Lea Ann Dailey
- Institute of Pharmaceutical Technology and Biopharmacy, Martin Luther University Halle-Wittenberg, Wolfgang-Langenbeck-Str. 4, 06108 Halle (Saale), Germany.
| | - Ben Forbes
- Institute of Pharmaceutical Science, King's College London, Franklin-Wilkins Building, King's College London, 150 Stamford Street, London SE1 9NH, UK
| |
Collapse
|
18
|
Van den Bruel A, Delanote J, Braeckman A, De Vroe C, Pyfferoen L, Ghekiere J, Duytschaever M, Tavernier R. "White Thyroid" on Unenhanced Computed Tomography in Amiodarone-Induced Thyrotoxicosis Type 2. Thyroid 2018; 28:769-772. [PMID: 29631498 DOI: 10.1089/thy.2017.0651] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Amiodarone-induced thyrotoxicosis is a common complication of long-term amiodarone treatment. In a patient with amiodarone-induced lung toxicity and amiodarone-induced thyrotoxicosis type 2 (AIT2), a "white thyroid" was incidentally observed on an unenhanced chest computed tomography (CT) scan. This "white thyroid" resembled a thyroid image on a contrast-enhanced CT scan. Therefore, the thyroid density was prospectively evaluated on unenhanced CT scans in cases of AIT2, in euthyroid patients on amiodarone (AEuth), and in unexposed controls. The aim was to test the hypothesis of a higher thyroid density in AIT2 compared to AEuth. The thyroid density, as measured in Hounsfield Units on unenhanced CT scans, is higher in AIT2 compared to AEuth and much higher than in controls. The causality of this association and its potential diagnostic use require further study.
Collapse
Affiliation(s)
- Annick Van den Bruel
- 1 Department of Internal Medicine, Division of Endocrinology, General Hospital Sint-Jan Brugge-Oostende , Bruges, Belgium
| | - Joost Delanote
- 2 Department of Radiology, General Hospital Sint-Jan Brugge-Oostende , Bruges, Belgium
| | - Arnaud Braeckman
- 2 Department of Radiology, General Hospital Sint-Jan Brugge-Oostende , Bruges, Belgium
- 3 Department of Radiology, Ghent University , Ghent, Belgium
| | - Carine De Vroe
- 4 Department of Pharmacy, General Hospital Sint-Jan Brugge-Oostende , Bruges, Belgium
| | - Lotte Pyfferoen
- 2 Department of Radiology, General Hospital Sint-Jan Brugge-Oostende , Bruges, Belgium
| | - Johan Ghekiere
- 2 Department of Radiology, General Hospital Sint-Jan Brugge-Oostende , Bruges, Belgium
| | - Mattias Duytschaever
- 5 Department of Cardiology, General Hospital Sint-Jan Brugge-Oostende , Bruges, Belgium
- 6 Department of Cardiology, Ghent University , Ghent, Belgium
| | - Rene Tavernier
- 5 Department of Cardiology, General Hospital Sint-Jan Brugge-Oostende , Bruges, Belgium
- 6 Department of Cardiology, Ghent University , Ghent, Belgium
| |
Collapse
|
19
|
Bognar Z, Fekete K, Bognar R, Szabo A, Vass RA, Sumegi B. Amiodarone's major metabolite, desethylamiodarone, induces apoptosis in human cervical cancer cells. Can J Physiol Pharmacol 2018; 96:1004-1011. [PMID: 29847733 DOI: 10.1139/cjpp-2018-0113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Previously, we found that desethylamiodarone (DEA) may have therapeutic potentiality in bladder cancer. In this study, we determined its effects on human cervical cancer cells (HeLa). Cell viability was evaluated by Muse Cell Count & Viability Assay; cell apoptosis was detected by Muse Annexin V & Dead Cell Assay. Cell cycle was flow cytometrically determined by Muse Cell Cycle Kit and the morphological changes of the cells were observed under a fluorescence microscope after Hoechst 33342 staining. The changes in the expression levels of apoptosis-related proteins in the HeLa cells were assessed by immunoblot. Our results showed that DEA significantly inhibited the proliferation and viability of HeLa cells and induced apoptosis in vitro in dose-dependent and also in cell cycle-dependent manner because DEA induced G0/G1 phase arrest in the HeLa cell line. We found that DEA treatment downregulated the expression of phospho-Akt and phospho-Bad. In addition, DEA could downregulate expression of Bcl-2, upregulate Bax, and induce cytochrome c release. Our results indicate that DEA might have significance as an anti-tumor agent against human cervical cancer.
Collapse
Affiliation(s)
- Zita Bognar
- a Department of Biochemistry and Medical Chemistry, University of Pécs Medical School, Pécs, Hungary
| | - Katalin Fekete
- a Department of Biochemistry and Medical Chemistry, University of Pécs Medical School, Pécs, Hungary
| | - Rita Bognar
- a Department of Biochemistry and Medical Chemistry, University of Pécs Medical School, Pécs, Hungary
| | - Aliz Szabo
- a Department of Biochemistry and Medical Chemistry, University of Pécs Medical School, Pécs, Hungary
| | - Reka A Vass
- b Department of Anatomy, University of Pécs Medical School, Pécs, Hungary
| | - Balazs Sumegi
- a Department of Biochemistry and Medical Chemistry, University of Pécs Medical School, Pécs, Hungary.,c Nuclear-Mitochondrial Interactions Research Group, Hungarian Academy of Sciences, Budapest, Hungary.,d Szentagothai Research Center, University of Pécs, Pécs, Hungary
| |
Collapse
|
20
|
Kashimura A, Tanaka K, Sato H, Kaji H, Tanaka M. Imaging mass spectrometry for toxicity assessment: a useful technique to confirm drug distribution in histologically confirmed lesions. J Toxicol Pathol 2018; 31:221-227. [PMID: 30093793 PMCID: PMC6077156 DOI: 10.1293/tox.2018-0006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/06/2018] [Indexed: 11/19/2022] Open
Abstract
To evaluate the usefulness of imaging mass spectrometry (IMS) technology for assessing
drug toxicity, we analyzed animal tissues in an amiodarone (AMD)-induced phospholipidosis
model by IMS and confirmed the relationship between the distribution of AMD, its
metabolites, and representative phospholipids (phosphatidylcholine, PC) and histological
changes. AMD was administered to rats for 7 days at 150 mg/kg/day. The lung, spleen, and
mesenteric lymph node were histologically examined and analyzed using IMS. The detection
intensities of AMD, its metabolites, and typical PCs were higher in regions infiltrated by
foamy macrophages compared with normal areas. This tendency was common in all three organs
analyzed in this study. For the spleen, signals for AMD, its metabolites, and typical PCs
were significantly more intense in the marginal zone, where foamy macrophages and
vacuolated lymphocytes are abundant, than in the other areas. These results indicate that
AMD, its metabolites, and PCs accumulate together in foamy or vacuolated cells, which is
consistent with the mechanism of AMD-induced phospholipidosis. They also indicate that IMS
is a useful technique for evaluating the distribution of drugs and biological components
in the elucidation of toxicity mechanisms.
Collapse
Affiliation(s)
- Akane Kashimura
- Safety Research Laboratories, Sohyaku. Innovative Research Division, Mitsubishi Tanabe Pharma Corporation, 2-2-50 Kawagishi, Toda-shi, Saitama 335-8505, Japan
| | - Kouji Tanaka
- DMPK Research Laboratories, Sohyaku. Innovative Research Division, Mitsubishi Tanabe Pharma Corporation, 2-2-50 Kawagishi, Toda-shi, Saitama 335-8505, Japan
| | - Hiroko Sato
- Safety Research Laboratories, Sohyaku. Innovative Research Division, Mitsubishi Tanabe Pharma Corporation, 2-2-50 Kawagishi, Toda-shi, Saitama 335-8505, Japan
| | - Hidefumi Kaji
- Advanced Medical Business Development Department, Drug Development Service Segment, LSI Medience Corporation, 1-13-4 Uchikanda, Chiyoda-ku, Tokyo 101-8517, Japan
| | - Masaharu Tanaka
- Safety Research Laboratories, Sohyaku. Innovative Research Division, Mitsubishi Tanabe Pharma Corporation, 2-2-50 Kawagishi, Toda-shi, Saitama 335-8505, Japan
| |
Collapse
|
21
|
Desethylamiodarone-A metabolite of amiodarone-Induces apoptosis on T24 human bladder cancer cells via multiple pathways. PLoS One 2017; 12:e0189470. [PMID: 29220397 PMCID: PMC5722307 DOI: 10.1371/journal.pone.0189470] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 11/28/2017] [Indexed: 12/12/2022] Open
Abstract
Bladder cancer (BC) is a common malignancy of the urinary tract that has a higher frequency in men than in women. Cytostatic resistance and metastasis formation are significant risk factors in BC therapy; therefore, there is great interest in overcoming drug resistance and in initiating research for novel chemotherapeutic approaches. Here, we suggest that desethylamiodarone (DEA)–a metabolite of amiodarone—may have cytostatic potential. DEA activates the collapse of mitochondrial membrane potential (detected by JC-1 fluorescence), and induces cell death in T24 human transitional-cell bladder carcinoma cell line at physiologically achievable concentrations. DEA induces cell cycle arrest in the G0/G1 phase, which may contribute to the inhibition of cell proliferation, and shifts the Bax/Bcl-2 ratio to initiate apoptosis, induce AIF nuclear translocation, and activate PARP-1 cleavage and caspase-3 activation. The major cytoprotective kinases—ERK and Akt—are inhibited by DEA, which may contribute to its cell death-inducing effects. DEA also inhibits the expression of B-cell-specific Moloney murine leukemia virus integration site 1 (BMI1) and reduces colony formation of T24 bladder carcinoma cells, indicating its possible inhibitory effect on metastatic potential. These data show that DEA is a novel anti-cancer candidate of multiple cell death-inducing effects and metastatic potential. Our findings recommend further evaluation of its effects in clinical studies.
Collapse
|
22
|
Continuous intravenous antiarrhythmic agents in the intensive care unit: strategies for safe and effective use of amiodarone, lidocaine, and procainamide. Crit Care Nurs Q 2016; 38:329-44. [PMID: 26335213 DOI: 10.1097/cnq.0000000000000082] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The development of cardiac arrhythmias in the intensive care unit is common and associated with poor prognoses and outcomes. Because of the complexity of patients admitted to the intensive care unit, the management of arrhythmias is often difficult and may require multiple therapeutic interventions. In order for clinicians to appropriately manage arrhythmias, a thorough understanding of all available therapies, including intravenous antiarrhythmic agents, is essential. Suitable antiarrhythmic agents for use in the critical care setting include amiodarone, lidocaine, and procainamide. While these agents can be effective in managing cardiac arrhythmias, they also possess significant disadvantages and require additional monitoring during use. Therapy with these agents is often complicated because of the presence of significant associated adverse effects, clinician unfamiliarity, variable dosing strategies, and the potential for drug-drug interactions. The purpose of this review is to discuss indications and strategies for safe and effective use of amiodarone, lidocaine, and procainamide.
Collapse
|
23
|
Wu Q, Ning B, Xuan J, Ren Z, Guo L, Bryant MS. The role of CYP 3A4 and 1A1 in amiodarone-induced hepatocellular toxicity. Toxicol Lett 2016; 253:55-62. [PMID: 27113703 DOI: 10.1016/j.toxlet.2016.04.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/01/2016] [Accepted: 04/20/2016] [Indexed: 12/12/2022]
Abstract
Amiodarone is a widely used potent antiarrhythmic for the treatment of cardiac disease; however, its use is often discontinued due to numerous adverse effects, including hepatotoxicity. To investigate the role of drug metabolism in this liver toxicity, amiodarone and its major metabolite desethylamiodarone were incubated with HepG2 cells overexpressing a series of cytochrome P450 (CYP) isoforms. Significantly higher cytotoxicity of amiodarone was observed in HepG2 cells overexpressing CYP3A4 or CYP1A1, compared with that observed in empty vector transduced control cells. Further, higher levels of the more potent hepatotoxic metabolite desethylamiodarone were detected in CYP3A4 or CYP1A1 expressed cells. The CYP3A4 inhibitor ketoconazole and the CYP1A1 inhibitor α-naphthoflavone drastically inhibited the metabolism of amiodarone to desethylamiodarone. Along with the inhibition of CYP1A1 or CYP3A4, the cytotoxicity of amiodarone was significantly reduced. These data indicate that the metabolism of amiodarone to desethylamiodarone by CYP1A1 or CYP3A4 plays an important role in the hepatocellular toxicity of amiodarone.
Collapse
Affiliation(s)
- Qiangen Wu
- Division of Biochemical Toxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079, USA
| | - Baitang Ning
- Division of System Biology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079, USA
| | - Jiekun Xuan
- Division of Biochemical Toxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079, USA
| | - Zhen Ren
- Division of Biochemical Toxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079, USA
| | - Lei Guo
- Division of Biochemical Toxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079, USA.
| | - Matthew S Bryant
- Division of Biochemical Toxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079, USA.
| |
Collapse
|
24
|
Habbab LM, Chu FV. Intrapericardial Amiodarone for the Prevention of Postoperative Atrial Fibrillation. J Card Surg 2016; 31:253-8. [DOI: 10.1111/jocs.12700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Louay M. Habbab
- Division of Cardiac Surgery; Department of Surgery; Hamilton General Hospital; McMaster University; Hamilton Ontario Canada
| | - F. Victor Chu
- Division of Cardiac Surgery; Department of Surgery; Hamilton General Hospital; McMaster University; Hamilton Ontario Canada
| |
Collapse
|
25
|
Takai S, Oda S, Tsuneyama K, Fukami T, Nakajima M, Yokoi T. Establishment of a mouse model for amiodarone-induced liver injury and analyses of its hepatotoxic mechanism. J Appl Toxicol 2016; 36:35-47. [DOI: 10.1002/jat.3141] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Shohei Takai
- Drug Metabolism and Toxicology, Faculty of Pharmaceutical Sciences; Kanazawa University; Kakuma-machi Kanazawa 920-1192 Japan
| | - Shingo Oda
- Department of Drug Safety Sciences; Nagoya University Graduate School of Medicine; 65 Tsurumai-cho, Showa-ku Nagoya 466-8550 Japan
| | - Koichi Tsuneyama
- Department of Diagnostic Pathology, Graduate School of Medicine and Pharmaceutical Science for Research; University of Toyama; Sugitani Toyama 930-0194 Japan
| | - Tatsuki Fukami
- Drug Metabolism and Toxicology, Faculty of Pharmaceutical Sciences; Kanazawa University; Kakuma-machi Kanazawa 920-1192 Japan
| | - Miki Nakajima
- Drug Metabolism and Toxicology, Faculty of Pharmaceutical Sciences; Kanazawa University; Kakuma-machi Kanazawa 920-1192 Japan
| | - Tsuyoshi Yokoi
- Drug Metabolism and Toxicology, Faculty of Pharmaceutical Sciences; Kanazawa University; Kakuma-machi Kanazawa 920-1192 Japan
- Department of Drug Safety Sciences; Nagoya University Graduate School of Medicine; 65 Tsurumai-cho, Showa-ku Nagoya 466-8550 Japan
| |
Collapse
|
26
|
Pomponio G, Zurich MG, Schultz L, Weiss DG, Romanelli L, Gramowski-Voss A, Di Consiglio E, Testai E. Amiodarone biokinetics, the formation of its major oxidative metabolite and neurotoxicity after acute and repeated exposure of brain cell cultures. Toxicol In Vitro 2015; 30:192-202. [DOI: 10.1016/j.tiv.2015.01.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 01/09/2015] [Accepted: 01/26/2015] [Indexed: 12/23/2022]
|
27
|
Di-22:6-bis(monoacylglycerol)phosphate: A clinical biomarker of drug-induced phospholipidosis for drug development and safety assessment. Toxicol Appl Pharmacol 2014; 279:467-476. [PMID: 24967688 DOI: 10.1016/j.taap.2014.06.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 05/06/2014] [Accepted: 06/17/2014] [Indexed: 11/24/2022]
Abstract
The inability to routinely monitor drug-induced phospholipidosis (DIPL) presents a challenge in pharmaceutical drug development and in the clinic. Several nonclinical studies have shown di-docosahexaenoyl (22:6) bis(monoacylglycerol) phosphate (di-22:6-BMP) to be a reliable biomarker of tissue DIPL that can be monitored in the plasma/serum and urine. The aim of this study was to show the relevance of di-22:6-BMP as a DIPL biomarker for drug development and safety assessment in humans. DIPL shares many similarities with the inherited lysosomal storage disorder Niemann-Pick type C (NPC) disease. DIPL and NPC result in similar changes in lysosomal function and cholesterol status that lead to the accumulation of multi-lamellar bodies (myeloid bodies) in cells and tissues. To validate di-22:6-BMP as a biomarker of DIPL for clinical studies, NPC patients and healthy donors were classified by receiver operator curve analysis based on urinary di-22:6-BMP concentrations. By showing 96.7-specificity and 100-sensitivity to identify NPC disease, di-22:6-BMP can be used to assess DIPL in human studies. The mean concentration of di-22:6-BMP in the urine of NPC patients was 51.4-fold (p ≤ 0.05) above the healthy baseline range. Additionally, baseline levels of di-22:6-BMP were assessed in healthy non-medicated laboratory animals (rats, mice, dogs, and monkeys) and human subjects to define normal reference ranges for nonclinical/clinical studies. The baseline ranges of di-22:6-BMP in the plasma, serum, and urine of humans and laboratory animals were species dependent. The results of this study support the role of di-22:6-BMP as a biomarker of DIPL for pharmaceutical drug development and health care settings.
Collapse
|
28
|
Abstract
A presence of black pigmentation involving the endobronchial tree is not uncommon. It was first described in the literature in association with occupational exposure in the early 1940s. However, in 2003, Packham and Yeow formally used the term black bronchoscopy to describe endobronchial metastasis from a malignant melanoma. Hyperpigmentation of the airway, however, is associated with multiple etiologies such as congenital disease, inborn errors of metabolism, infections, environmental exposures, neoplasm, and iatrogenic causes. Although the majority of these conditions are benign, a proper diagnosis is important for optimal management. In this article, we review the etiology of black bronchoscopy and discuss its presentations and current management guidelines.
Collapse
Affiliation(s)
| | - Tanmay S Panchabhai
- Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Danai Khemasuwan
- Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Atul C Mehta
- Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH.
| |
Collapse
|
29
|
Marcano J, Campos K, Rodriguez V, Handy K, Brewer MA, Cohn WE. Intrapericardial Delivery of Amiodarone Rapidly Achieves Therapeutic Levels in the Atrium. Heart Surg Forum 2013; 16:E279-86. [DOI: 10.1532/hsf98.2013188] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Amiodarone is widely used worldwide as an important drug for managing supraventricular arrhythmias, regardless of its association with potentially severe side effects due to systemic toxicity. Amiodarone reduces the incidence of atrial fibrillation after cardiac surgery, but oral therapy requires a presurgery loading period, lasting from 1 to 4 weeks. In this study, we showed that it is possible to rapidly obtain therapeutic cardiac tissue levels of the drug by infusing aqueous amiodarone intrapericardially, without appreciable systemic exposure. We also examined the long-term histologic safety of intrapericardial infusion.Methods: In this observational study, 9 adult sheep, randomized into 3 groups of 3 animals each, were given low (2.5-mg/h), medium (10-mg/h), or high (50-mg/h) dosages of amiodarone by continuous infusion intrapericardially for 72 hours. An intrapericardial drain prevented tamponade from fluid build-up. Levels of amiodarone and its active metabolite, desethylamiodarone (DEA), were assessed both in plasma and in transmural biopsy specimens taken from the left atrial appendage and left and right ventricular myocardium. Cardiac, hepatic, and renal functions were also assessed. Humane euthanization was performed after 3 months, and cardiac and thoracic tissues were assessed for evidence of epicarditis, severe fibrotic changes, or other adverse effects potentially caused by the local amiodarone administration.Results: Pericardial infusion resulted in rapid uptake and high concentrations of amiodarone and DEA in the myocardial tissues, without an appreciable systemic presence of either drug. The highest and lowest levels of these agents were observed in the left atrium and left ventricle, respectively. Drug concentrations in all cardiac biopsy specimens were similar to, or higher than, those reportedly observed in patients taking long-term oral amiodarone. At 90 days, postmortem microscopic, biochemical, and hematologic evaluation of end-organ tissues from the 8 surviving sheep showed no adverse effects. Excessive inflammation or fibrotic changes were not observed in these 8 sheep. The ninth sheep died prematurely, and its death was deemed not to be related to this study.Conclusions: Short-term intrapericardial delivery of amiodarone is a safe method for rapidly obtaining therapeutic atrial-tissue drug levels. When begun perioperatively, this method may prevent postoperative atrial fibrillation similarly to oral or intravenous amiodarone therapy. However, we have shown that pericardial administration avoids systemic drug distribution and thus may greatly decrease the systemic complications resulting from this drug.
Collapse
|
30
|
Roth FC, Mulder JE, Brien JF, Takahashi T, Massey TE. Cytotoxic interaction between amiodarone and desethylamiodarone in human peripheral lung epithelial cells. Chem Biol Interact 2013; 204:135-9. [DOI: 10.1016/j.cbi.2013.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 04/12/2013] [Accepted: 05/02/2013] [Indexed: 11/24/2022]
|
31
|
Adlan AMA, Lip GYH. Benefit-risk assessment of dronedarone in the treatment of atrial fibrillation. Drug Saf 2013; 36:93-110. [PMID: 23329540 DOI: 10.1007/s40264-012-0012-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Rhythm control in atrial fibrillation (AF) can be achieved using pharmacological therapy. Amiodarone is the most efficacious anti-arrhythmic agent; however, its use is limited due to an unfavourable safety profile, including pro-arrhythmia, thyroid, liver, skin and pulmonary complications. Dronedarone, which is structurally similar to amiodarone, was developed to try and achieve a favourable balance of efficacy and risk. Dronedarone has been evaluated in several large clinical trials, which have shown reduced mortality and hospitalization rates in patients with non-permanent AF. In patients with permanent AF and/or heart failure, dronedarone has been shown to cause increased mortality and morbidity and should not be used in these groups. Compared with amiodarone, dronedarone has fewer toxic effects (thyroid, skin, pulmonary) and, although less efficacious, may be used as first-line therapy for maintenance of sinus rhythm in patients with non-permanent AF. Clinicians must be vigilant in monitoring their patients to ensure they do not develop permanent AF or heart failure.
Collapse
Affiliation(s)
- Ahmed M A Adlan
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Dudley Road, Birmingham B18 7QH, UK
| | | |
Collapse
|
32
|
Van Cott TE, Yehle KS, DeCrane SK, Thorlton JR. Amiodarone-induced pulmonary toxicity: Case study with syndrome analysis. Heart Lung 2013; 42:262-6. [DOI: 10.1016/j.hrtlng.2013.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 05/10/2013] [Accepted: 05/12/2013] [Indexed: 01/24/2023]
|
33
|
Garg J, Agrawal N, Marballi A, Agrawal S, Rawat N, Sule S, Lehrman SG. Amiodarone induced pulmonary toxicity: An unusual response to steroids. AMERICAN JOURNAL OF CASE REPORTS 2012; 13:62-5. [PMID: 23569490 PMCID: PMC3615935 DOI: 10.12659/ajcr.882757] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 05/09/2012] [Indexed: 11/09/2022]
Abstract
Background: Amiodarone, class III anti-arrhythmic was originally introduced to treat angina pectoris, was later approved by FDA in 1985 for the treatment of ventricular arrhythmias. Despite its anti-arrhythmic properties, amiodarone is associated with side effects such as thyroid dysfunction, corneal deposits, bluish skin discoloration, neuropathy and pulmonary toxicity. Amiodarone induced pulmonary toxicity (AIPT) is one of the most serious side effect thus limiting its use. Case Report: We encountered a 66 year old male with early onset AIPT who presented with dyspnea and chest imaging revealed extensive ground-glass opacities throughout lung parenchyma with rapid resolution of these opacities in a week following treatment with corticosteroids. Conclusions: There have been few case reports of AIPT with complete resolution of ground glass opacities on treatment with corticosteroids, but none demonstrated a rapid response to corticosteroids. Heath care providers should withdraw amiodarone at the earliest suspicion (as illustrated in our case); any delay can potentially be fatal. This case highlights the fact that AIPT is a reversible phenomenon, provided its early recognition and treatment before fibrosis sets in This case also highlights the need to include AIPT in the differential diagnosis in any patient on amiodarone who presents with shortness of breath.
Collapse
Affiliation(s)
- Jalaj Garg
- Department of Internal Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, U.S.A
| | | | | | | | | | | | | |
Collapse
|
34
|
Population Pharmacokinetic Investigation for Optimization of Amiodarone Therapy in Japanese Patients. Ther Drug Monit 2011; 33:750-6. [DOI: 10.1097/ftd.0b013e318239a728] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
35
|
Piccoli E, Nadai M, Caretta CM, Bergonzini V, Del Vecchio C, Ha HR, Bigler L, Dal Zoppo D, Faggin E, Pettenazzo A, Orlando R, Salata C, Calistri A, Palù G, Baritussio A. Amiodarone impairs trafficking through late endosomes inducing a Niemann-Pick C-like phenotype. Biochem Pharmacol 2011; 82:1234-49. [PMID: 21878321 PMCID: PMC7092840 DOI: 10.1016/j.bcp.2011.07.090] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 07/19/2011] [Accepted: 07/20/2011] [Indexed: 02/03/2023]
Abstract
Patients treated with amiodarone accumulate lysobisphosphatidic acid (LBPA), also known as bis(monoacylglycero)phosphate, in airway secretions and develop in different tissues vacuoles and inclusion bodies thought to originate from endosomes. To clarify the origin of these changes, we studied in vitro the effects of amiodarone on endosomal activities like transferrin recycling, Shiga toxin processing, ESCRT-dependent lentivirus budding, fluid phase endocytosis, proteolysis and exosome secretion. Furthermore, since the accumulation of LBPA might point to a broader disturbance in lipid homeostasis, we studied the effect of amiodarone on the distribution of LBPA, unesterified cholesterol, sphingomyelin and glycosphyngolipids. Amiodarone analogues were also studied, including the recently developed derivative dronedarone. We found that amiodarone does not affect early endosomal activities, like transferrin recycling, Shiga toxin processing and lentivirus budding. Amiodarone, instead, interferes with late compartments of the endocytic pathway, blocking the progression of fluid phase endocytosis and causing fusion of organelles, collapse of lumenal structures, accumulation of undegraded substrates and amassing of different types of lipids. Not all late endocytic compartments are affected, since exosome secretion is spared. These changes recall the Niemann-Pick type-C phenotype (NPC), but originate by a different mechanism, since, differently from NPC, they are not alleviated by cholesterol removal. Studies with analogues indicate that basic pKa and high water-solubility at acidic pH are crucial requirements for the interference with late endosomes/lysosomes and that, in this respect, dronedarone is at least as potent as amiodarone. These findings may have relevance in fields unrelated to rhythm control.
Collapse
Affiliation(s)
- Elena Piccoli
- Department of Histology, Microbiology and Medical Biotechnologies, University of Padova, via A. Gabelli 63, 35121, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Pellegatti M, Pagliarusco S. Drug and metabolite concentrations in tissues in relationship to tissue adverse findings: a review. Expert Opin Drug Metab Toxicol 2011; 7:137-46. [DOI: 10.1517/17425255.2011.545053] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
37
|
Golli-Bennour EE, Bouslimi A, Zouaoui O, Nouira S, Achour A, Bacha H. Cytotoxicity effects of amiodarone on cultured cells. ACTA ACUST UNITED AC 2010; 64:425-30. [PMID: 21093234 DOI: 10.1016/j.etp.2010.10.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 10/04/2010] [Accepted: 10/20/2010] [Indexed: 10/18/2022]
Abstract
Amiodarone is a potent anti-arrhythmic drug used for the treatment of cardiac arrhythmias. Although, the effects of amiodarone are well characterized on post-ischemic heart and cardiomyocytes, its toxicity on extra-cardiac tissues is still poorly understood. To this aim, we have monitored the cytotoxicity effects of this drug on three cultured cell lines including hepatocytes (HepG2), epithelial cells (EAhy 926) and renal cells (Vero). We have investigated the effects of amiodarone on (i) cell viabilities, (ii) heat shock protein expressions (Hsp 70) as a parameter of protective and adaptive response and (iii) oxidative damage.Our results clearly showed that amiodarone inhibits cell proliferation, induces an over-expression of Hsp 70 and generates significant amount of reactive oxygen species as measured by lipid peroxidation occurrence. However, toxicity of amiodarone was significantly higher in renal and epithelial cells than in hepatocytes. Vitamin E supplement restores the major part of cell mortalities induced by amiodarone showing that oxidative damage is the predominant toxic effect of the drug.Except its toxicity for the cardiac system, our findings demonstrated that amiodarone can target other tissues. Therefore, kidneys present a high sensibility to this drug which may limit its use with subjects suffering from renal disorders.
Collapse
Affiliation(s)
- Emna El Golli-Bennour
- Laboratory of Research on Biologically Compatible Compounds, Rue Avicenne, 5019 Monastir, Tunisia.
| | | | | | | | | | | |
Collapse
|
38
|
Affiliation(s)
- Spyros A Papiris
- 2nd Pulmonary Department, 'Attikon' University Hospital, National and Kapodistrian University of Athens, Athens Medical School, Haidari, Greece.
| | | | | | | | | |
Collapse
|
39
|
Tengstrand EA, Miwa GT, Hsieh FY. Bis(monoacylglycerol)phosphate as a non-invasive biomarker to monitor the onset and time-course of phospholipidosis with drug-induced toxicities. Expert Opin Drug Metab Toxicol 2010; 6:555-70. [DOI: 10.1517/17425251003601961] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
40
|
Bolderman RW, Bruin P, Hermans JJR, Boerakker MJ, Dias AA, van der Veen FH, Maessen JG. Atrium-targeted drug delivery through an amiodarone-eluting bilayered patch. J Thorac Cardiovasc Surg 2010; 140:904-10. [PMID: 20363485 DOI: 10.1016/j.jtcvs.2010.01.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2009] [Revised: 12/18/2009] [Accepted: 01/10/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Clinical studies have demonstrated the efficacy of oral and intravenous amiodarone therapy to prevent postoperative atrial fibrillation. However, because of significant extracardiac side effects, only high-risk patients are eligible for prophylactic amiodarone therapy. This study addressed the hypothesis that atrium-specific drug delivery through an amiodarone-eluting epicardial patch reduces vulnerability to atrial tachyarrhythmias, whereas ventricular and plasma drug concentrations are minimized. METHODS Right atrial epicardiums of goats were fitted with electrodes and a bilayered patch (poly[ethylene glycol]-based matrix and poly[lactide-co-caprolactone] backing layer) loaded with amiodarone (10 mg per patch, n = 10) or without drug (n = 6). Electrophysiologic parameters (atrial effective refractory period, conduction time, and rapid atrial response to burst pacing) and amiodarone levels in plasma and tissue were measured during 1 month's follow-up. RESULTS Epicardial application of amiodarone-eluting patches produced persistently higher drug concentrations in the right atrium than in the left atrium, ventricles, and extracardiac tissues by 2 to 4 orders of magnitude. Atrial effective refractory period and conduction time increased, whereas rapid atrial response inducibility decreased significantly (P < .05) during the 1-month follow-up compared with that seen in animals treated with drug-free patches. Amiodarone concentrations in plasma remained undetectably low (<10 ng/mL). CONCLUSIONS Atrium-specific drug delivery through an amiodarone-eluting patch produces therapeutic atrial drug concentrations, whereas ventricular and systemic drug levels are minimized. This study demonstrates that sustained targeted drug delivery to a specific heart chamber is feasible and might reduce the risk for ventricular and extracardiac adverse effects. Epicardial application of amiodarone-eluting patches is a promising strategy to prevent postoperative atrial fibrillation.
Collapse
Affiliation(s)
- Robert W Bolderman
- Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
41
|
Abstract
The mechanisms of adverse drug effects have not been adequately classified. Here, we propose a comprehensive mechanistic classification of adverse drug effects that considers five elements: the Extrinsic chemical species (E) that initiates the effect; the Intrinsic chemical species (I) that it affects; the Distribution (D) of these species in the body; the (physiological or pathological) Outcome (O); and the Sequela (S), which is the adverse effect. This classification, which we have called EIDOS, describes the mechanism by which an adverse effect occurs; it complements the DoTS classification of adverse effects (based on clinical pharmacology), which takes into account Dose responsiveness, Time course, and Susceptibility factors. Together, these two classification systems, mechanistic and clinical, comprehensively delineate all the important aspects of adverse drug reactions; they should contribute to areas such as drug development and regulation, pharmacovigilance, monitoring therapy, and the prevention, diagnosis, and treatment of adverse drug effects.
Collapse
Affiliation(s)
- Robin E Ferner
- West Midlands Centre for Adverse Drug Reactions, City Hospital, Birmingham, UK.
| | | |
Collapse
|
42
|
Fukuchi H, Nakashima M, Araki R, Komiya N, Hayano M, Yano K, Sasaki H, Yukawa E. Effect of obesity on serum amiodarone concentration in Japanese patients: population pharmacokinetic investigation by multiple trough screen analysis. J Clin Pharm Ther 2009; 34:329-36. [DOI: 10.1111/j.1365-2710.2008.00987.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
43
|
Seki S, Kobayashi M, Itagaki S, Hirano T, Iseki K. Contribution of organic anion transporting polypeptide OATP2B1 to amiodarone accumulation in lung epithelial cells. BIOCHIMICA ET BIOPHYSICA ACTA-BIOMEMBRANES 2009; 1788:911-7. [PMID: 19285480 DOI: 10.1016/j.bbamem.2009.03.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Revised: 02/27/2009] [Accepted: 03/03/2009] [Indexed: 02/07/2023]
Abstract
The accumulation mechanisms of amiodarone (AMD) involving transporters in lung alveolar epithelial type II cells were studied. The uptake of AMD was examined using human alveolar epithelial-derived cell line A549 as a model. AMD was transported by the carrier-mediated system, and the apparent K(m) and V(max) values were 66.8+/-30.3 muM and 49.7+/-9.7 nmol/mg protein/5 min, respectively. The uptake of AMD by A549 cells was Na(+)-independent and was inhibited by substrates of human organic anion transporting polypeptide (OATP). The inhibition profiles were similar to the inhibitory effects of several compounds on OATP2B1-mediated E-3-S transport, and RT-PCR analysis showed mRNA expression of OATP2B1 and 1B3 in A549 cells. SiRNAs targeted to the OATP2B1 gene decreased the OATP2B1 mRNA expression level in A549 cells up to about 50% and reduced the uptake of AMD up to about 40%. These results indicate that AMD uptake mediated by carriers, including OATP2B1, might lead to accumulation of AMD in the lung and AMD-induced pulmonary toxicity (AIPT).
Collapse
Affiliation(s)
- Satoru Seki
- Department of Clinical Pharmaceutics, Graduate School of Pharmaceutical Sciences, Hokkaido University, Kita-12jo, Nishi-6-chome, Kita-ku, Sapporo 060-0812, Japan
| | | | | | | | | |
Collapse
|
44
|
Lafuente-Lafuente C, Alvarez JC, Leenhardt A, Mouly S, Extramiana F, Caulin C, Funck-Brentano C, Bergmann JF. Amiodarone concentrations in plasma and fat tissue during chronic treatment and related toxicity. Br J Clin Pharmacol 2009; 67:511-9. [PMID: 19552745 DOI: 10.1111/j.1365-2125.2009.03381.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIMS To determine if amiodarone, highly lipophilic, accumulates in excess with respect to dose in fat tissue during long-term administration, and study if plasma and fat tissue concentrations are correlated with adverse effects. METHODS Trough concentrations of amiodarone and N-desethyl-amiodarone were measured simultaneously in plasma and fat tissue, in 30 consecutive patients treated with amiodarone for 3 months to 12 years. Subcutaneous adipose tissue was obtained by needle aspiration from lumbar and abdominal areas. Concentrations were measured by liquid chromatography-tandem mass spectrometry. RESULTS Plasma levels of amiodarone and N-desethyl-amiodarone were significantly correlated with daily maintenance doses (R= 0.52, P= 0.003). Amiodarone concentrations in fat tissue were four to 226 times (mean 55) higher than in plasma, and well correlated with plasma levels (R= 0.68, P < 0.001). Concentrations of amiodarone and N-desethyl-amiodarone in adipose tissue did not significantly increase with higher total cumulated doses or longer treatment duration. Nine of 12 patients who had received amiodarone for > or =2 years developed clinically important adverse effects, predominantly hypothyroidism (n= 6), compared with two of 18 patients treated for less time (relative risk 6.75; 95% confidence interval 1.8, 26). The incidence of those adverse effects was not significantly associated with amiodarone concentrations, whether in plasma or in adipose tissue. CONCLUSIONS We found no evidence of excessive or unexpected accumulation of amiodarone in fat tissue on long-term administration. Late amiodarone adverse effects, particularly hypothyroidism, are associated with longer exposure times, but do not seem to be explained by higher concentrations in plasma or in fat tissue.
Collapse
|
45
|
Seki S, Itagaki S, Kobayashi M, Hirano T, Iseki K. Amiodarone increases the accumulation of DEA in a human alveolar epithelium-derived cell line. Biol Pharm Bull 2008; 31:1449-52. [PMID: 18591791 DOI: 10.1248/bpb.31.1449] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Amiodarone (AMD)-induced pulmonary toxicity (AIPT) is the most life-threatening side-effect of AMD treatment. N-Monodesethylamiodarone (DEA), an active metabolite of AMD, also exhibits cytotoxicity and tends to accumulate in the lung more intensively than AMD. In this study, we characterized the mechanism of DEA accumulation using A549 cells as a model of the alveolar epithelium. Typical ATP-depletion compounds caused an approximately 30% increase in the accumulation of DEA in A549 cells, although these effects were less than those in Caco-2 cells. Triiodothyronine (T(3)), which exhibited an inhibitory effect on DEA efflux in Caco-2 cells, did not affect the accumulation of DEA in A549 cells. On the other hand, 100 microM AMD caused an approximately 200% increase in DEA content in A549 cells, although AMD accumulation was not affected by 100 microM DEA. Since the reducing effect of AMD on cellular ATP levels and that of FCCP were similar, the mechanism by which DEA accumulation is increased by AMD might be different from the ATP-dependent DEA efflux mechanism. The decrease in cell viability by DEA in the presence of AMD (IC(50) value of DEA for A549 cell viability: 25.4+/-2.4 microM) was more pronounced than that by DEA alone (IC(50) value: 11.5+/-3.0 microM). This further DEA accumulation by AMD might be a factor responsible for the greater accumulation of DEA than that of AMD in the lung in long-term AMD-treated patients.
Collapse
Affiliation(s)
- Satoru Seki
- Laboratory of Clinical Pharmaceutics & Therapeutics, Division of Pharmasciences, Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan
| | | | | | | | | |
Collapse
|
46
|
Diaz-Guzman E, Mireles-Cabodevila E, Arrossi A, Kanne JP, Budev M. Amiodarone pulmonary toxicity after lung transplantation. J Heart Lung Transplant 2008; 27:1059-63. [PMID: 18765204 DOI: 10.1016/j.healun.2008.05.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Revised: 04/13/2008] [Accepted: 05/21/2008] [Indexed: 12/01/2022] Open
Abstract
Atrial fibrillation occurs frequently after lung transplantation and is commonly treated with amiodarone. Pulmonary toxicity may result from amiodarone exposure and is characterized by non-specific respiratory manifestations. To our knowledge, there are no reports of this complication occurring after lung transplantation. We present a patient who developed radiologic evidence of amiodarone deposition in the lungs after bilateral lung transplantation.
Collapse
Affiliation(s)
- Enrique Diaz-Guzman
- Department of Pulmonary, Allergy and Critical Care Medicine, Cleveland Clinic, Cleveland, Ohio 44119, USA.
| | | | | | | | | |
Collapse
|
47
|
Ghezel-Ahmadi V, Kürschner V, Fisseler-Eckhoff A, Schirren J, Schmitz J, Obenhaus T. Amiodaroninduzierte Pneumonitis. Anaesthesist 2008; 57:982-7. [DOI: 10.1007/s00101-008-1407-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
48
|
SALERNO DAVIDM. Part IV: Class II, Class III, and Class IV Antiarrhythmic Drugs, Comparative Efficacy of Drugs, and Effect of Drugs on Mortality - A Review of Their Pharmaco kinetics, Efficacy, and Toxicity*. J Cardiovasc Electrophysiol 2008. [DOI: 10.1111/j.1540-8167.1991.tb01714.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
49
|
Stadler K, Ha HR, Ciminale V, Spirli C, Saletti G, Schiavon M, Bruttomesso D, Bigler L, Follath F, Pettenazzo A, Baritussio A. Amiodarone alters late endosomes and inhibits SARS coronavirus infection at a post-endosomal level. Am J Respir Cell Mol Biol 2008; 39:142-9. [PMID: 18314540 DOI: 10.1165/rcmb.2007-0217oc] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Amiodarone interferes with the endocytic pathway, inhibits proteolysis, and causes the formation of vacuoles, but uptake and intracellular distribution of the drug, origin of vacuoles, and functional consequences of amiodarone accumulation remain unclear. Our objective was to study amiodarone uptake, clarify the origin of vacuoles, and investigate the effect of amiodarone on the life cycle of the coronavirus responsible for the Severe Acute Respiratory Syndrome (SARS), which, to enter cells, relies on the proteolytic cleavage of a viral spike protein by the endosomal proteinase cathepsin L. Using alveolar macrophages, we studied uptake of (125)I-amiodarone and (125)I-B2, an analog lacking the lateral group diethylamino-beta-ethoxy, and analyzed the effects of amiodarone on the distribution of endosomal markers and on the uptake of an acidotropic dye. Furthermore, using Vero cells, we tested the impact of amiodarone on the in vitro spreading of the SARS coronavirus. We found that (1) amiodarone associates with different cell membranes and accumulates in acidic organelles; (2) the diethylamino-beta-ethoxy group is an important determinant of uptake; (3) vacuoles forming upon exposure to amiodarone are enlarged late endosomes; (4) amiodarone inhibits the spreading in vitro of SARS coronavirus; and (5) trypsin cleavage of the viral spike protein before infection, which permits virus entry through the plasma membrane, does not impair amiodarone antiviral activity. We conclude that amiodarone alters late compartments of the endocytic pathway and inhibits SARS coronavirus infection by acting after the transit of the virus through endosomes.
Collapse
|
50
|
Yamazaki K, Mitsuhashi T, Yamada E, Yamada T, Kosaka S, Takano K, Obara T, Sato K. Amiodarone reversibly decreases sodium-iodide symporter mRNA expression at therapeutic concentrations and induces antioxidant responses at supraphysiological concentrations in cultured human thyroid follicles. Thyroid 2007; 17:1189-200. [PMID: 18020914 DOI: 10.1089/thy.2007.0215] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Amiodarone, a potent antiarrhythmic, iodine-containing agent, is a highly active oxidant exerting cytotoxic effects on thyrocytes at pharmacological concentrations. Patients receiving amiodarone usually remain euthyroid, but occasionally develop thyroid dysfunction. Although there is a general consensus that amiodarone-associated hypothyroidism is iodine induced, the destructive mechanism of thyroid follicles in amiodarone-induced thyrotoxicosis remains unknown. OBJECTIVE To elucidate the mechanism by which amiodarone elicits thyroid dysfunction. DESIGN Human thyroid follicles were cultured with thyroid-stimulating hormone (TSH) and amiodarone at therapeutic (1-2 microM) and pharmacological (10-20 microM) concentrations, and the drug-induced effect on whole human gene expression was analyzed by cDNA microarray. Microarray data were confirmed by real-time PCR and Western blot. MAIN OUTCOMES Amiodarone at 1-2 muM decreased the expression level of the sodium-iodide symporter (NIS) to nearly half, but did not affect genes participating in thyroid hormonogenesis (thyroid peroxidase, thyroglobulin, pendrin, and NADPH oxidase). Higher concentrations (10-20 microM) decreased the expression of all these genes, accompanied by increased expression of antioxidant proteins such as heme oxygenase 1 and ferritin. When thyroid follicles obtained from a patient with Graves' disease who had been treated with amiodarone were cultured in amiodarone-free medium, TSH-induced thyroid function was intact, suggesting that amiodarone at a maintenance dose did not elicit any cytotoxic effect on thyrocytes. The ultrastructural features of cultured thyroid follicles were compatible with these in vitro findings. CONCLUSION These in vitro and ex vivo findings suggest that patients taking maintenance doses of amiodarone usually remain euthyroid, probably due to escape from the Wolff-Chaikoff effect mediated by decreased expression of NIS mRNA. Further, amiodarone is not cytotoxic for thyrocytes at therapeutic concentrations but elicits cytotoxicity through oxidant activity at supraphysiological concentrations. We speculate that when amiodarone-induced prooxidant activity somehow exceeds the endogenous antioxidant capacity, the thyroid follicles will be destroyed and amiodarone-induced destructive thyrotoxicosis may develop.
Collapse
|