Adverse drug reaction of the month--a new series.
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Adverse Drug Reaction Reporting Systems↗
Biomedical subjects
R Coulson
Publications and source records attributed to R Coulson.
Upregulated renal adenosine A1 receptors augment PKC and glucose transport but inhibit proliferation.
Adenosine A1 receptor densities were increased in cultured LLC-PK1 and OK cells by chronic treatment with the adenosine receptor antagonists 1,3,7-trimethylxanthine (caffeine, 1 mM) and 1,3-dimethyl-8-cyclopentylxanthine [cyclopentyltheophylline (CPT), < or = 0.4 mM], respectively. The A1 receptor number per cell was increased twofold by 10-day treatments with 1 mM caffeine or 0.1 mM CPT, and the sodium-coupled glucose uptake was augmented twofold by 1 mM caffeine and sevenfold by 0.1 microM CPT (higher doses of CPT were progressively less stimulatory). Glucose uptake was blocked by acute (2-h) treatment with CPT, adenosine deaminase, or calphostin C. Caffeine (1 mM) or CPT (> or = 0.1 mM) inhibited cell proliferation for the first 10 days, then cell growth assumed a normal proliferative rate despite continued presence of antagonist. Cytosolic protein kinase C (PKC) beta-isoform immunoactivity and PKC-beta II mRNA were elevated at least twofold during 10 days of 0.1 mM CPT or 1 mM caffeine treatment. The sustained elevation in sodium-glucose symport and PKC activity observed with adenosine receptor antagonists was similar to acute (2-h) effects of the adenosine A1 agonist R(-)-N6-phenylisopropyladenosine (R-PIA, 0.1-1 microM). Moreover, cell proliferation was increased by adenosine (0.1 microM R-PIA), whereas Na-K-adenosinetriphosphatase activity was unaltered with chronic antagonist or acute adenosine treatments. Caffeine treatment may have some non-adenosine A1 receptor-mediated actions, because it slightly (30%) augmented protein kinase A activity. It is concluded that chronic exposure of proximal tubule cells to caffeine or CPT augments PKC and sodium-glucose transport but retards cell proliferation mainly via adenosine A1 receptor-mediated mechanisms.
Adenosine Deaminase↗
Transepithelial phosphate transport in rabbit proximal tubular cells adapted to phosphate deprivation.
Both renal and nonrenal cells in culture adapt to deprivation of Pi by increasing Na-dependent Pi uptake. We studied whether this change in uptake is reflected in an increased renal transepithelial Pi transport. We grew primary cultures of rabbit renal cortical cells in plastic flasks and subcultured them onto Millicell-HA filters. This produced cell monolayers, which structurally and functionally resembled proximal tubule. These cells performed Na-dependent net transepithelial transport of 32Pi in the apical-to-basolateral direction that was inhibited by phosphonoformic acid in the apical fluid or by ouabain in the basolateral fluid or by preincubation with parathyroid hormone. Overnight incubation at low Pi concentrations led to a progressive increase in 5-min Na-dependent Pi uptake into cell monolayers. Na-dependent Pi uptake was threefold higher following overnight incubation at 25 microM Pi, compared with 3 mM Pi, and the increase was one-half maximal with incubation at an extracellular Pi concentration ([Pi]) of 300 microM. This was associated with a decrease in Na-dependent transepithelial Pi flux to the basolateral fluid by the same cells, which fell dramatically following incubation at < or = 300 microM Pi. There was no change in Na-dependent uptake or transepithelial transport of L-glutamine. This adaptation to Pi deprivation in vitro appears to serve to restore depleted cell stores of Pi rather than to regulate transepithelial Pi transport.
Adaptation, Physiological↗
Electromyographic evidence of a multiple motor system: implications for apraxia.
Geschwind (1975) postulated that a multiple motor system accounts for a discrepancy in apraxias in response to commands for truncal and limb movements. Kuypers (1968) provided experimental evidence of a multiple motor system in primates. We present evidence of this multiple motor system in the form of Fourier-transformed electromyographic data in humans of the predominantly short duration motor units for discrete control in hand musculature and the predominantly longer duration motor units in the truncal musculature. Furthermore, the right and left erector spinae muscles had different Fourier-transformed electromyographic data which, in our opinion, represent the medial motor system used by apraxias.
Adult↗
External cephalic version at term. A randomized controlled trial using tocolysis.
OBJECTIVE: To assess the role of external cephalic version (ECV) at term, using tocolysis. DESIGN: A randomized controlled trial over a 12 month period. SETTING: Harare Maternity Hospital, Harare, Zimbabwe. SUBJECTS: 208 women with breech presentation at term were recruited after satisfying eligibility criteria. There were 103 women in the study group and 105 in the control group. At the end of the study a further 104 women were recruited for ECV. INTERVENTION: ECV attempted after intravenous injection of 10 micrograms of hexaprenaline, using either forward or backward somersault over a maximum period of 5 min. MAIN OUTCOME MEASURES: Success rate in terms of presentation during labour, need for caesarean section, and various variables related to fetal outcome. RESULTS: ECV reduced the frequency of breech presentation during labour from 83% to 17% and that of caesarean section from 33% to 13%. There were no troublesome complications from the procedure. CONCLUSION: In carefully selected women with breech presentation, ECV at term using tocolysis, safely reduced the rate of breech presentation in labour and also the caesarean section rate. Further research is needed to determine the role of ECV in early labour.
Adolescent↗
Adenosine stimulates phosphate and glucose transport in opossum kidney epithelial cells.
We have examined the effects of adenosine on sodium-coupled phosphate and glucose transport in cultured opossum kidney (OK) cells, a continuous cell line that resembles proximal tubule. Adenosine analogues R-(-)-N6-phenylisopropyladenosine (PIA) and 2',5'-dideoxy-adenosine (DDA) were employed as adenosine A1 receptor and P site-selective agonists, respectively. Sodium-dependent phosphate uptake activity (Na-Pi symport) increased by approximately 25% above both basal and parathyroid hormone (PTH)-inhibited levels in cells treated with PIA (0.1, 1 microM) but not in cells treated with DDA (100 microM). Adenosine (PIA) also stimulated sodium-coupled 3-O-methylglucose transport by approximately 40%. Intracellular adenosine 3',5'-cyclic monophosphate (cAMP) content was inversely related to Na-Pi symport activity in cells treated with PIA and PTH. However, changes in Na-Pi symport activity did not consistently relate to changes in intracellular cAMP. Protein kinase C was activated 15 s after treatment of OK cells with 1 microM PIA. Preincubation of cells with 3 microM staurosporine attenuated the effect of 1 microM PIA on phosphate uptake. These data suggest that Na-Pi and Na-glucose symport activities are stimulated by adenosine acting at a receptor coupled to more than one intracellular signal. It is likely that both protein kinases A and C are involved in these actions of adenosine.
Adenosine↗
Breech delivery of infants weighing more than 2000 grams: a case controlled retrospective analysis of 751 patients.
This is a case controlled study of 385 women with breech presentation and 357 with cephalic presentation. Unlike many recent studies, vaginal breech delivery was associated with a significantly worse outcome for the infant. The reasons for these are discussed particularly in relation to developing countries and a protocol for management of these women is suggested to attempt to reduce the unacceptably poor outcome. Selective external cephalic version is advocated.
Adolescent↗
Cyclosporin A and vehicle toxicity in primary cultures of rabbit renal proximal tubule cells.
The capability of cyclosporin to produce direct injury to primary proximal tubular renal cells was studied. These cells, when grown on Millicell inserts, retain the functional polarity of the proximal tubule, i.e., generate a transepithelial pH gradient (apical compartment acidic) that is reversibly blocked by amiloride addition only if it is added to the apical compartment. Administration of ouabain to the basal compartment also blocks the generation of the transepithelial pH gradient. Additionally, the cells were more responsive to parathyroid hormone (PTH), a proximal tubule characteristic, than to arginine vasopressin (AVP), a distal tubule characteristic. The following substances were tested for their effect on the capacity of these cells to generate a pH gradient: Sandimmune, the commercial form of cyclosporin A; the free form of the drug; Cremophor EL, the vehicle used in the commercial preparation; and ethanol, the vehicle used to dissolve the free form. Sandimmune, at 25-50 microM, inhibited the generation of the pH gradient within 24 h. Surprisingly, Cremophor also blocked the development of a pH gradient, although somewhat less effectively. In contrast, 10 microM cyclosporin, regardless of the form tested, had no effect for up to 96 h. These findings show that cyclosporin, in the form of Sandimmune, has a direct toxic effect on these cells; they also suggest that the vehicle, Cremophor, may contribute to the well-established nephrotoxicity of cyclosporin A.
Amiloride↗
L-histidine augments the response to 1-deamino-8-D-arginine vasopressin in Brattleboro homozygous (di/di) rats.
Studies in vitro have shown that L-histidine increases the hydroosmotic response to vasopressin. We examined whether this phenomenon occurs also in vivo. Homozygous Brattleboro rats (di/di) were fed a regular diet (0.5% histidine) or a diet enriched with histidine and received 1 ng of 1-deamino-8-D-arginine vasopressin (dDAVP) daily. Addition of histidine (1% by weight) increased post-dDAVP urine osmolality to a level higher than that of control (502 +/- 62 vs. 316 +/- 36 mosmol/kg, P less than 0.05). Similar results were seen with 3.0% and 5.5% dietary histidine. There were significant increases in free-water reabsorption and in the ratio of free-water reabsorption to osmolar clearance, but no difference in osmolal clearance. No significant effect was found with supplemental histidine of 0.5% or less. The cause for these findings appears not to be the metabolism of histidine, since the nonmetabolizable D-histidine had a significant, albeit smaller, effect, and the isonitrogenous addition of albumin, alanine, arginine, or glutamine was ineffective. In part, histidine may operate by increasing cAMP since the renal cAMP content in response to vasopressin is increased in histidine-fed rats (13.1 +/- 0.9 vs. 9.8 +/- 0.8 nmol/g dry weight, P less than 0.01). The role of prostaglandins appears less clear. Histidine greatly decreased urinary PGE2 during baseline (1.5 +/- 0.3 vs. 7.0 +/- 2.3 micrograms/mg creatinine, P less than 0.001), but it profoundly augmented urinary prostaglandin excretion after dDAVP stimulation (40.0 +/- 4.2 vs. 7.0 +/- 2.0 micrograms/mg creatinine, P less than 0.001).
Animals↗
Xanthine effects on renal proximal tubular function and cyclic AMP metabolism.
We evaluated the renal effects of xanthines using two in vitro models: the isolated perfused rat kidney (IPRK) and cultured opossum kidney (OK) cells, a continuous cell line that resembles proximal tubule and responds to parathyroid hormone (PTH). 1,3-Diethyl-8-phenylxanthine (DPX) a potent adenosine receptor antagonist, increased urine volume, glomerular filtration rate, vascular resistance and the fractional excretions of Na, K, Ca and Pi in the IPRK. DPX lowered the Na-dependent uptake of Pi by OK cells. By comparison enprofylline, 3-propylxanthine (ENP), a weak adenosine receptor antagonist, produced a slight elevation in glomerular filtration rate but no changes in electrolyte excretion by IPRK or Pi uptake by OK cells. Both DPX and ENP produced negligible elevations in basal IPRK cAMP. A 1-nM bolus of PTH elevated urinary and perfusate cAMP 50- and 10-fold, respectively. PTH-elevated urinary and perfusate cAMP were augmented further 4- to 7-fold with DPX and 3- to 4-fold with ENP (All IPRK experiments used 50 microM xanthine). OK cells produced a 2-fold cAMP response to 10 nM PTH alone. OK cells treated with 50 microM DPX exhibited no increase in basal but a 13-fold increase in PTH-stimulated cell cAMP. The rank order of potency at 50 microM to augment OK cell cAMP with 10 nM PTH was DPX greater than 1,3-dipropyl-8-cyclopentylxanthine (DPC) greater than 1-methyl-3-isobutylxanthine greater than theobromine greater than theophylline greater than caffeine greater than ENP = no effect.(ABSTRACT TRUNCATED AT 250 WORDS)
Adenosine↗
Outcome of term breech presentation.
Three hundred and ninety five cases of breech presentation at Harare Maternity Hospital, Harare revealed that caesarean section either electively or in labour resulted in good fetal outcome. Vaginal breech delivery was associated with a perinatal mortality of 74 per 1,000. Fifty four (25%) out of 216 infants delivered vaginally required admission to the Neonatal Unit and thirteen of these had a five minute Apgar Score of 5 or less. Various reasons for this unacceptably high morbidity and mortality are discussed in order to develop a protocol for management of breech presentation in a developing country. The protocol includes the advocation of external cephalic version.
Breech Presentation↗
Gentamicin-induced increases in cytosolic calcium in pig kidney cells (LLC-PK1).
LLC-PK1 cells, an established epithelial cell line derived from pig kidney, were tested as a model system for assessing the role of calcium in gentamicin-induced nephrotoxicity. Cell viability was evaluated by a vital dye exclusion procedure, and intracellular free calcium [Ca2+]i was measured employing Fura-2 fluorescence. Exposing cell suspensions (10(6)/ml) to concentrations of the drug, which had no apparent effect on viability, produced a rapid and prolonged increase in intracellular [Ca2+]. The perturbation of calcium homeostasis could be blocked by the addition of mepiperphenidol, an inhibitor of the organic cation transport system. We propose that LLC-PK1 cells are an appropriate model to study drug-induced nephrotoxicity. Gentamicin disrupts calcium homeostasis and causes plasma membrane alterations. Since mepiperphenidol blocked the gentamicin-induced Ca2+ increases, the data suggest that aminoglycosides enter the cell via the organic cation transporter.
Animals↗
Effects of papaverine and theophylline on renal adenosine transport.
We have studied the effects of papaverine and theophylline on the transport of adenosine by the isolated perfused rat kidney and by isolated renal luminal (L) and antiluminal (AL) membrane vesicles. In filtering isolated kidneys perfused with 0.1 mM adenosine, 1 mM papaverine inhibited adenosine removal from the perfusate by 40% and elevated the fractional excretion of adenosine from 0.4 +/- 0.1 to 0.7 +/- 0.0. Theophylline (10 mM) inhibited 0.1 mM adenosine removal in the filtering kidney by 18% and decreased the fractional excretion of adenosine to 0.2 +/- 0.1. In nonfiltering isolated kidneys perfused with 0.1 mM adenosine, 1 mM papaverine or 10 mM theophylline inhibited the rate of adenosine removal from the perfusate by 41 or 19%, respectively. Papaverine (50 or 100 microM) was a potent cis inhibitor of the initial (15 sec) rate of 1 microM [3H]adenosine influx into L and AL membrane vesicles. The influx of 1 microM [3H]adenosine was inhibited partially by 50 microM and inhibited completely by 100 microM papaverine. Papaverine at 10 microM trans stimulated the efflux of 50 microM [3H]adenosine preloaded into AL vesicles. However, theophylline (up to 100 microM) had no effect on the influx of 1 microM [3H]adenosine into L and AL vesicles. The data suggest that papaverine is a potent, direct inhibitor of adenosine transport across both L and AL membranes whereas it is likely that theophylline increases net adenosine influx across the L membrane and decreases adenosine influx across the AL membrane by indirect metabolic effects.
Adenosine↗
Failure of exogenous prostaglandin to afford complete protection against acetaminophen-induced hepatotoxicity in the rat.
The protective effect of 16, 16-dimethylprostaglandin E2 (dm-PGE2) against acetaminophen-induced hepatotoxicity was determined in the rat. The dm-PGE2 was administered at two dose levels both before and after acetaminophen administration. The hepatotoxicity was evaluated by a rise in serum transaminases 24 h after acetaminophen administration and by histological examination of liver preparations. The urinary acetaminophen and its metabolites were determined by high-pressure liquid chromatography. The results suggest that exogenous dm-PGE2 administration had a modest protection against acetaminophen-induced hepatotoxicity, in contrast to its well established cytoprotective effect against many noxious agents in the gastrointestinal tract. Prostaglandin treatment had little effect on acetaminophen metabolites excretion in the urine, suggesting that it did not affect the cytochrome P-450-dependent mixed-function oxidase drug-metabolizing enzyme system. The livers from dm-PGE2-acetaminophen-treated rats showed less advanced necrosis compared to those from saline-acetaminophen-treated rats. Whereas only 2 of 13 rats died in the prostaglandin-treated group, 4 of 13 rats died in the saline-treated group.
Acetaminophen↗
Effects of (Sp)- and (Rp)-adenosine cyclic 3',5'-phosphorothioates on electrolyte excretion by the isolated perfused rat kidney.
We studied the effects of the (Sp) and (Rp) diastereomers of the phosphorothioate analogue of cyclic AMP (cAMPS) on the excretion of electrolytes in the isolated perfused rat kidney. cAMPS is highly permeant across the peritubular cell membrane and is not metabolized by the rat kidney (Coulson et al., Life Sci. 32: 1489-1498, 1983). Addition of 10 microM cAMPS(Sp) to the perfusate resulted in a significant phosphaturia, bicarbonaturia, magnesuria and natriuresis and no change in renal vascular resistance or glomerular filtration rate. Fractional excretion of calcium was elevated by cAMPS(Sp) but proportionately less than the fractional excretion of sodium so that the ratio of calcium to sodium clearances was significantly lowered. cAMPS(Rp) 10 or 100 microM was without effect on renal electrolyte excretion. The parathyroid hormone-like effects of the (Sp) diastereomer are consistent with its known ability to activate protein kinase.
Animals↗
Abdominal pregnancy associated with extremely elevated serum alpha-fetoprotein. Case report.
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Abnormalities, Multiple↗
Adenosine transport in perfused rat kidney and renal cortical membrane vesicles.
Adenosine is a modulator of renal function but little is known about transport of this compound by renal tubular cells. Transport of exogenous adenosine was studied in isolated perfused rat kidney and in luminal (L) and antiluminal (AL) membrane vesicles isolated from rat renal cortex. Most experiments were performed in the presence of the adenosine deaminase inhibitor erythro-9-(2-hydroxy-3-nonyl)adenine. Kidneys were perfused in a recirculating system with Krebs-Henseleit bicarbonate buffer containing 6 g albumin/dl and adenosine. Net secretion of adenosine occurred at perfusate adenosine concentrations greater than 40 microM, and net reabsorption was seen at concentrations less than 40 microM. N6-(L-2-phenylisopropyl)adenosine (PIA), a nondeaminated adenosine receptor agonist, also showed net reabsorption when unbound PIA concentrations were 10-20 microM. Influx or efflux of [3H]adenosine in vesicles was measured using a rapid filtration technique. Transport into both L and AL vesicles was saturable. L vesicles demonstrated both high Km (43 +/- 4 microM) and low Km (4.4 +/- 0.6 microM) transport systems. Only a low Km (5 +/- 1 microM) system could be demonstrated in AL vesicles. Results indicate that at concentrations in the physiological range (less than 1 microM) adenosine undergoes mediated transport across both L and AL membranes and that net transport across the L membrane is in the direction of reabsorption.
Adenosine↗
Effect of perfusate phosphate concentration on responses to PTH in isolated rat kidney.
We studied the excretion of electrolytes and adenosine 3',5'-cyclic monophosphate (cAMP) by rat kidneys perfused for 2 or 3 h at several concentrations of phosphate (Pi). Fractional phosphate excretion increased with higher perfusate Pi concentrations (up to 4.0 mM Pi) without parathyroid hormone (PTH), but no tubular maximum for phosphate reabsorption was reached. The addition of synthetic bovine 1-34 PTH (bPTH) gave a dose-related phosphaturia that depended on the perfusate Pi level. The urinary cAMP response to doses of bPTH was highly dependent on perfusate Pi concentration: with 20 nM bPTH, urinary cAMP was 211 +/- 94 pmol/ml glomerular filtration rate at 1.2 mM Pi and was 3,998 +/- 711 at 4.0 mM Pi (P less than 0.001). Without bPTH, cAMP excretion did not differ among Pi levels. Calcium-to-sodium clearance ratio rose with time in kidneys perfused without bPTH but fell with the addition of as little as 0.02 nM bPTH, regardless of Pi concentration. Variations in Pi or bPTH did not affect fractional magnesium excretion, which fell by 68% through 3 h of perfusion (P less than 0.001). These data suggest that the effects of Pi concentration on renal electrolyte excretion are consistent with changes in the filtered Pi load but that extracellular Pi concentrations dramatically alter the renal cAMP response to bPTH in the isolated perfused kidney.
Animals↗