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Evidence for intestinal secretion as an additional clearance pathway of talinolol enantiomers: concentration- and dose-dependent absorption in vitro and in vivo.

PURPOSE: To evaluate carrier-mediated intestinal secretion of talinolol enantiomers in vivo and in vitro. METHODS: In clinical studies with i.v. and p.o. dosage of rac-talinolol (30 mg and 100 mg, resp.) performed in a small number of cholecystectomized patients total and partial clearances were determined on the basis of plasma, bile and urine concentrations. The dose-dependence of AUC was investigated in 12 healthy volunteers (25, 50, 100, and 400 mg rac-talinolol as single p.o. doses). Concentration-dependence of the permeability across Caco-2 cell monolayers included concentrations from 0.1 to 2.0 mM, inhibition by verapamil was tested at 0.5 mM. RESULTS: The total clearance as well as the apparent oral clearance (CL/F) were slightly higher for S-(-)- than for R-(+)-talinolol. Calculation of the partial clearances showed that also the residual clearance was higher for the S- than for the R-enantiomer. In the healthy volunteers, CL/F increased with increasing doses, while the S/R ratio decreased approaching unity for the highest dose. Also the results from Caco-2 cell permeation studies yielded a clear concentration-dependence with decreasing stereoselectivity for the higher concentration range. Permeability of both enantiomers was considerably higher for b-->a than a-->b transport, however, this difference disappeared when verapamil was added. CONCLUSIONS: Although not very expressed, the detected stereoselectivities indicate a preferential absorption of R-(+)-talinolol in a lower concentration and dose range, which is most probably due to a moderate stereoselectivity at the carrier system involved in intestinal secretion.

Administration, Oral↗

Oral bioavailability and intestinal secretion of amitriptyline: Role of P-glycoprotein?

The aim of the study was to evaluate the influence of quinidine, a P-glycoprotein inhibitor, on oral bioavailability and on intestinal secretion of amitriptyline, a tricyclic antidepressant. Amitriptyline was administrated intravenously (5 mg/kg) and orally (50 mg/kg) to rabbits, with and without quinidine. Jejunal segments of rats were mounted on diffusions chambers and the permeation of amitriptyline was measured across the tissue in luminal-serosal (LS) and serosal-luminal (SL) directions, with and without quinidine. Finally, an in situ recirculating intestinal perfusion model was performed in rabbits to study amitriptyline permeation in LS direction with and without quinidine. Absolute oral bioavailability (F) of amitriptyline was significantly increased more than three-fold in presence of quinidine (F = 0.6+/-0.4% versus 1.9+/-1.1%). The apparent permeability coefficients in SL direction were significantly higher than in LS direction (P(app (SL))=6.01+/-2.42 versus P(app (LS)) = 4.90+/-2.73 x 10(-4) cm min(-1)). In presence of quinidine, the intestinal absorption was increased (P(app (LS)) = 4.02+/-2.91 versus P(app (LS)) = 5.99+/-2.43 x 10(-4) cm min(-1)) and the intestinal secretion was decreased (P(app (SL)) = 4.58+/-0.54 versus P(app (LS)) = 3.63+/-1.46 x 10(-4) cm min(-1)) but not significantly. In conclusion, P-glycoprotein appears to be involved in oral amitriptyline absorption but other intestinal uptake and efflux transporters maybe implicated.

ATP Binding Cassette Transporter, Subfamily B, Mem↗

Modulation of the P-glycoprotein-mediated intestinal secretion of ivermectin: in vitro and in vivo assessments.

The everted gut sac method was used to assess the role of the P-glycoprotein (P-gp) on the intestinal secretion of ivermectin (IVM), an antiparasitic widely used in human and veterinary medicine. The work included the evaluation of two different P-gp modulators [itraconazole (ITZ) and valspodar (PSC833)] used at equimolar doses in the rat. Furthermore, the influence of both P-gp modulator agents on the disposition kinetics of IVM in plasma, liver, and gastrointestinal tissues was characterized. For the in vitro experiments, ileal sacs were incubated with IVM (3 microM) in the presence or absence of either ITZ (10 microM) or PSC833 (10 microM). In the in vivo experiments, male Wistar rats were randomly allocated to three groups (n=18) and subcutaneously treated with IVM (200 microg/kg-1), alone and coadministered with ITZ (5 mg, two doses) or PSC833 (8.6 mg, two doses). Animals were sacrificed between 6 and 96 h. Blood, liver, and gastrointestinal samples were collected. IVM concentrations were determined by high performance liquid chromatography. The rate of IVM accumulation in the intestinal wall of everted sacs was significantly higher after its incubation with ITZ (0.115 nmol/g/min) and PSC833 (0.238 nmol/g/min) than that obtained after the incubation without the P-gp modulators (0.016 nmol/g/min). In agreement with the in vitro experiment, the presence of ITZ and PSC833 induced an enhancement in the concentrations of IVM in plasma and gastrointestinal tissues. The results obtained in the current work, both under in vivo and in vitro conditions, confirm the relevance of P-gp-mediated transport to the intestinal secretion of IVM.

ATP Binding Cassette Transporter, Subfamily B, Mem↗

Inhibition of cholera-toxin-stimulated intestinal secretion by CGS 9343B in rats: a specific calmodulin inhibitor.

In this study, the effect of CGS 9343B on cholera-toxin-stimulated intestinal secretion in rats was determined using in vivo isolated loops. This recently developed compound is a potent and specific inhibitor of calmodulin, but not of protein kinase C. At a luminal dose of 15 mg/kg, CGS 9343B has little effect on basal intestinal absorption but completely inhibited the secretory effects of cholera toxin. The less specific calmodulin inhibitor, trifluoperazine, has a similar antisecretory effect, but unlike with CGS 9343B, severe toxicity was noted at luminal doses of 7.5 mg/kg. In animals where two intestinal loops were created, one with cholera toxin alone and the other with CGS 9343B and cholera toxin, significant inhibition of secretion was observed in both loops, consistent with a systemic effect of this compound. Finally, both CGS 9343B and trifluoperazine inhibited choleratoxin stimulated increases in mucosal cyclic AMP content, whereas basal levels were unaffected. We conclude that CGS 9343B significantly inhibits choleratoxin-stimulated intestinal secretions, possibly by inhibition of calmodulin-dependent adenylate cyclase activity. Its lack of major toxicity at therapeutic doses makes this compound potentially useful for the treatment of enterotoxigenic diarrheal diseases.

Animals↗

Pharmacokinetic modelling of the effect of activated charcoal on the intestinal secretion of theophylline, using the isolated vascularly perfused rat small intestine.

The effect of activated charcoal administration on the secretion of theophylline from the blood into the intestinal lumen has been examined by use of the rat isolated vascularly perfused small intestine. A closed two compartment model was used to analyse the vascular and luminal concentration-time curves obtained. An equation was derived to calculate the time-dependent intestinal clearance. From control experiments it was concluded that theophylline is secreted by a diffusional transport system through the intestinal wall. The intestinal clearance declined rapidly with time as a result of the concomitant increase in luminal theophylline concentration. After 120 min a steady state between the vascular and luminal perfusate was established. Administration of activated charcoal in the lumen had a profound effect on the kinetics of the drug. The vascular steady state concentration was depressed dramatically. The theophylline clearance remained nearly constant with time, because the blood to lumen concentration gradient was maximized. The maximal value for the intestinal theophylline clearance was estimated to be 0.88 mL min-1 and it equalled the value for the intestinal blood flow at the absorptive site. By use of the concept of absorptive site blood flow, the maximal effect of charcoal on systemic theophylline clearance could be adequately predicted for rats, dogs and man. Activated charcoal administration is only useful to enhance the systemic clearance of drugs or toxicants if that clearance is of the same order of magnitude as the absorptive site blood flow or lower.

Animals↗

Villus and crypt electrolyte and fluid transport during intestinal secretion.

The apical parts of jejunal villi of net-absorbing intestine have been shown to contain sodium chloride concentration gradients which are associated with water absorption (Sjöqvist & Beeuwkes 1989). To determine whether these gradients are different in states of intestinal net secretion, jejunal segments of chloralose-anaesthetized cats were perfused with modified Krebs-Henseleit solutions while secretion was elicited by cholera toxin or vasoactive intestinal polypeptide (VIP). The segments were then rapidly frozen and freeze-dried, and sodium and chloride contents of the lamina propria of single villi were measured by X-ray microanalysis. The apical third of the villus was found to contain a concentration gradient of sodium and chloride when the lumen contained sodium, with no difference between secreting intestine and absorbing control intestine. When the intestine was perfused with hypotonic choline-mannitol solution, no sodium or chloride gradient was found. In this state, treatment of the intestines with secretagogues allowed development of an apical concentration gradient. This demonstrated that the absorptive function of the villus tip was unimpaired during secretion and that secretion from the crypt could supply sufficient electrolyte to allow formation of an apical gradient.

Animals↗

Regulation of intestinal secretion involved in the interaction between neurotransmitters and prostaglandin E2.

In this short review, it will be described that neurotransmitter-induced secretion in the intestine may be influenced by the tissue level of prostaglandin E2 (PGE2). In the normal condition, vasoactive intestinal polypeptide (VIP) and acetylcholine (ACh) are the predominant neurotransmitters of secretomotor neurones. VIP and ACh activate distinct second messenger systems in epithelial cells, i.e. adenosine 3', 5'-cyclic monophosphate (cAMP) and calcium ion (Ca2+), respectively. An increase in intracellular cAMP induces a small amount of chloride (Cl-) secretion in epithelial cells, while simultaneous increases in intracellular Ca2+ and cAMP greatly enhances the cAMP-induced Cl- secretion. When the concentration of prostaglandins reaches a high level in the intestinal tissue substance P, which is a neurotransmitter of sensory neurones, can also induce a massive Cl- secretion by cross-potentiation of cAMP and Ca2+ in epithelial cells. In conclusion, it is considered that the concentration of tissue PGE2 may indicate tissue alert level, and when this level elevates, PGE2 enhances ACh and SP-induced Cl- secretion, thus mediating massive fluid secretion for host defence.

Animals↗

The action of loperamide in inhibiting prostaglandin-induced intestinal secretion in the rat.

1 The mechanisms by which loperamide inhibits the intestinal secretion induced by prostaglandin E2 were investigated in rat jejunum. 2 In vivo loperamide prevented prostaglandin-induced fluid secretion but did not reduce the associated rise in the transintestinal potential difference. 3 In intestinal sheets the electrical response to prostaglandin E2 was enhanced in the presence of loperamide. 4 The ionic basis of these changes was determined by measuring Na+ and Cl- fluxes across intestinal sheets. Loperamide did not reduce the prostaglandin-induced increase in net Cl- secretion, although it prevented the inhibition of mucosal-to-serosal Na+ movement. 5 Loperamide does not alter cyclic adenosine 3',5'-monophosphate (cyclic AMP) levels by a direct action at the enterocyte, since in isolated enterocytes neither basal nor prostaglandin-stimulated cyclic AMP levels were affected by the drug.

Animals↗

Effect of experimental trichinosis on intestinal secretion and on local antibody formation to cholera toxin.

The life cycle of Trichinella spiralis, a parasitic nematode, has three main stages: intestinal, migration and muscular stage. The present study was initiated to clarify the possible effects of the various stages of the infection on (a) enterotoxin induced intestinal secretion and (b) development of local immunity to cholera toxin. During the intestinal stage of trichinosis in mice challenge of ligated loops with cholera toxin gave rise to significantly greater fluid accumulation than was demonstrated in uninfected animals. In contrast, during migration and early muscular stage the secretory response was markedly reduced whereas in late muscular stage the fluid accumulation was normal. Absorption studies revealed that the intestinal fluid uptake was normal during the migration and muscular stages while it was markedly decreased during the intestinal stage which could probably explain the increased fluid accumulation in response to enterotoxin at this time. The normal absorption during the other stages suggests a true inhibition of the secretory process. To study the antibody response to cholera toxin during the various stages of T. spiralis infection the mice were given repeated peroral immunizations according to a schedule known to induce immunity to experimental cholera in mice. We found that T. spiralis infected mice, in which the immunization started ("priming") during the intestinal stage, had a significantly reduced IgA response in the small intestine. On the other hand T. spiralis infection had much less, if any effect on the IgA response to cholera toxin when immunization started before the infection and only the booster dose was given in the intestinal stage or when both priming and boosting were done after the intestinal stage.

Animals↗

Antibodies in the intestinal secretions of rats. Primary and secondary responses to polymeric flagellin.

The antibody responses in serum and secretions obtained from the mucosal surfaces of the small intestine of rats immunized by a parenteral and intestinal route have been compared. Though no significant differences in the mean serum titres were found, the responses of animals immunized via the latter route to large doses of antigen were far less uniform. Apart from the first few days of the primary response, antibody activity was found in three major immunoglobulin classes (IgG2, IgA and IgM), irrespective of the route of immunization. Significant antibody activity appeared in the intestinal surface secretions only after two injections of antigen. In rats immunized parenterally the activity was found only in the IgG2 component. Whilst activity was found in both IgG2 and IgA fractions of the secretions obtained from intestinally immunized rats, it was predominantly of the IgG2 class. The possible significance of this observation is discussed.

Animals↗

Human IgA- and IgM-secreting intestinal plasma cells carry heavily mutated VH region genes.

Single IgA- or IgM-secreting plasma cells were isolated from histological sections of human jejunum and terminal ileum, and Ig heavy chain variable (VH) region genes were amplified and sequenced. Taken together, 62 of 63 cells analyzed harbored somatically mutated VH region genes, indicating that the vast majority of both IgA- and IgM-secreting intestinal plasma cells derive from germinal center B cells. On average, rearranged VH genes of IgA- and IgM-secreting plasma cells showed a mutation frequency of 9.0 % and 8.5 %, respectively, which exceeds the level of somatic mutation of V region genes carried by human memory B cells. Moreover, we detected deletions or insertions in the complementarity-determining regions of 5 of the 58 functional VH region genes analyzed, suggesting that these alterations may contribute to the diversification of the human antibody repertoire in the course of an immune reaction.

Genes, Immunoglobulin↗

Influence of quinidine on the intestinal secretion of digoxin and digitoxin in guinea pigs.

The secretion of digoxin and digitoxin into in situ perfused jejunal and colonic segments of normal or quinidine treated guinea pigs was studied. Quinidine was administered intravenously by constant rate infusion resulting in a quinidine plasma concentration of about 6 micrograms/ml. After 2 h digoxin or digitoxin was injected i.v. (10 micrograms/kg). The quinidine treatment enhanced the plasma concentration of [3H]digoxin to about 140% as compared to controls, whereas the [3H]digitoxin concentration was not influenced by the quinidine infusion. Both, digoxin and digitoxin were secreted against a concentration gradient into the intestinal lumen. During the experimental period of 180 min controls secreted 0.24% of the administered digoxin dose per cm of jejunal and 0.13% per cm of colonic segment. Quinidine treatment resulted in a decrease of the jejunal digoxin secretion to about 80% of the control values. In both, jejunum and colon the concentration ratio between lumen and plasma (L/P) was diminished by quinidine to 50% as compared with the controls. The amount of [3H]digitoxin secreted into the intestinal segments was decreased by quinidine from 0.19% of the dose/cm to 0.13% in the jejunal and from 0.17% to 0.12% in the colonic segments, respectively. The decrease of the L/P ratio for [3H]digitoxin was more pronounced in the colon (58%) than in the jejunum (77% of the control values). As compared with controls the content of [3H]digoxin in the jejunal as well as colonic tissue was decreased by quinidine to 60% or 73%, respectively. On the other hand quinidine increased the tissue content of [3H]digitoxin in jejunum (+56%) and colon (+88%). In conclusion quinidine inhibits the intestinal secretion of both, digoxin and digitoxin, possibly by different mechanisms.

Animals↗

Inhibition of macrophage migration by normal guinea pig intestinal secretions.

The incubation fluid from 24-hr cultures of normal guinea pig small intestines was found to contain activity capable of inhibiting the migration of normal guinea pig peritoneal macrophages. Each of three different culture fluids showed macrophage inhibitory activity in the 25,000-55,000 mol wt range when subjected to Sephadex G-100 gel filtration. One of these three preparations also contained inhibitory activity in the excluded volume. The low molecular weight activity was nondialyzable and heat stable to 56 degrees for 30 min. It was destroyed by boiling for 1 hr, and its activity was reversed by 10(-4)M epinephrine. Based upon these properties it is suggested that this activity was due to migration inhibitory factor (MIF). The high molecular weight inhibitor was stable to heating and its activity was not reversed by epinephrine. This material was most likely endotoxin. The presence of MIF, which may be associated with T-cell activity in the intestine, suggests that cell-mediated immunity (CMI) could play a role in local protection against gut infections. Furthermore, its presence in normal intestinal secretions suggests that some MIF-producing cells are always being stimulated by normal flora. The question is thus raised whether further specific stimulation of local CMI in the gut could be successful.

Animals↗

Functional characterization of the adenosine receptor mediating inhibition of intestinal secretion.

1. Previous studies have shown that the mixed A1/A2 adenosine agonist 5'-N-ethylcarboxamido-adenosine (NECA) inhibits intestinal fluid secretion which is thought to contribute to its antidiarrhoeal effect in the rat. The aim of this study was to characterize the adenosine receptor mediating this antisecretory effect via functional studies using a range of selective agonists and antagonists and by applying the pharmacological criteria of relative agonist and antagonist potencies. 2. Adenosine agonists and antagonists were administered i.v. to anaesthetized rats. Intestinal secretion was then stimulated by i.a. infusion of vasoactive intestinal peptide (VIP, 0.8 microgram min-1) and the net fluid transport across the wall of the jejunum was measured by a recirculation technique. 3. The rank order of agonist potency to reduce the response to VIP was: NECA > N6-cyclopentyladenosine (CPA) > R-N6-(2-phenylisopropyladenosine) (R-PIA) > S-PIA > chloroadenosine (2-CADO) > 2-phenylaminoadenosine (CV-1808). This order best complies with the rank order of agonist potency that represents activation of the recently described A2B receptor: NECA > 2-CADO > R-PIA = CHA > S-PIA > = CV-1808 > = CGS-21680. The most potent agonists (NECA, CPA and RPIA) had ED50 values in the low microgram range. 4. The anitsecretory action of NECA (submaximal dose of 40 micrograms kg-1) was antagonized equally (approximately 50%) by the selective adenosine antagonists 8-cyclopentyl-1,3-dipropylxanthine (DPCPX, 0.1 mg kg-1) and 8-phenyltheophylline (8-PT, 0.1 mg kg-1). This equipotent activity indicates the presence of an A2 and not an A1 receptor. 5. It is suggested that adenosine A2B receptor agonists could be evaluated for potential use as antidiarrhoeal drugs.

Adenosine↗

The role of mdr1a P-glycoprotein in the biliary and intestinal secretion of doxorubicin and vinblastine in mice.

Drug-transporting P-glycoproteins are abundantly present in the liver and the intestinal wall. We have now investigated their role in the biliary and intestinal secretion of the anticancer drugs doxorubicin (unlabeled: 5 mg/kg) and vinblastine ((3)H-labeled: 1 mg/kg) i.v. administered to wild-type and mdr1a P-glycoprotein knockout [mdr1a(-/-)] mice. At 90 min after drug administration, levels of unchanged drug and metabolites in plasma, intestinal contents, and bile were determined by high-performance liquid chromatography and radioactivity by liquid scintillation counting. The bile of both wild-type and mdr1a(-/-) mice contained only minor amounts of unchanged vinblastine, whereas the total biliary secretion of unknown (3)H-labeled breakdown products was about 25 to 30% of the dose. The direct secretion of unchanged vinblastine through the gut wall was 6.7 and 3.3% of the dose in wild-type and mdr1a(-/-) mice, respectively. The biliary secretion of unchanged doxorubicin decreased from 13.3% of the dose to only 2.4% in the absence of mdr1a P-glycoprotein. Approximately 10% of the dose was secreted as unchanged doxorubicin into the intestinal contents of both types of mice. Thus, the absence of mdr1a P-glycoprotein affects the fate of vinblastine chiefly by diminishing secretion into the lumen of the small intestine, whereas it affects the fate of doxorubicin chiefly by diminishing secretion of parent drug into bile.

ATP Binding Cassette Transporter, Subfamily B, Mem↗

Prevention and reversal of cholera enterotoxin-induced intestinal secretion by methylprednisolone induction of Na+-K+-ATPase.

The relationship of the mucosal enzyme systems Na+-K+-activated adenosine triphophatase (Na-K-ATPase) and adenylate cyclase and their associated intestinal transport processes was studied in the rat ileum. Two ileal loops were constructed in each anesthetized rat; one loop was inoculated with saline, the other loop with choleragen. Net transport of water and electrolytes was measured in vivo after which enzyme activity was measured in the mucosa of the perfused loops. All doses of choleragen between 5 and 150 mug decreased water movement as early as 3 1/2 h after inoculation. A linear relationship between the dose of choleragen and the level of net water and electrolyte secretion was observed when choleragen doses between 5 and 150 mug were incubated in ileal loops for 4 h. Adenylate cyclase activity was always increased in secreting intestinal loops, whereas Na-K-ATPase was unaffected by choleragen. In animals pretreated with methylprednisolone acetate, 3 mg/100 g per day for 3 days before loop inoculation, saline loops had enhanced mucosal Na-K-ATPase activity had increased net water and electrolyte absorption; choleragen-exposed loops had increased adenylate cyclase and Na-K-ATPase activities, and net absorption of water and electrolytes 4 h after inoculation. These effects of methylprednisolone acetate were still present 19 1/2 h after inoculation. When a single injection of methylprednisolone acetate was given 3 1/2 h after choleragen inoculation, both adenylate cyclase and Na-K-ATPase were activated, and net intestinal absorption of water and electrolytes was observed 19 1/2 h after inoculation. These results suggest that methylprednisolone can prevent and reverse the secretory effects of choleragen by selectively stimulating a coexisting absorptive process.

Adenosine Triphosphatases↗