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Increased intraocular pressure in the immediate postoperative period commonly occurs after cataract extraction. We administered acetazolamide (Diamox) to 24 of 49 eyes with increased IOP in 49 patients. All pressures returned to normal within six to eight days. No difference was found between treated and untreated eyes.
In order to establish whether or not chloride ions behave as freely moving particles in "passive", i.e. ouabain- and acetazolamide-treated, frog skin, tracer fluxes of 36Cl-have been measured while a voltage (generally +40 mV, serosal side positive) across the skin was applied. Ussing's flux ratio equation has been used as a criterion for this type of transport. One group of skin samples exhibited significant exchange diffusion phenomena. Most samples in a second group either behaved according to the flux ratio equation of showed significant and extreme exchange diffusion. From flux ratios obtained at two different voltages across various skin samples, showing extreme exchange diffusion, it appeared that the simple form of Kedem and Essig's law derived from irreversible thermodynamics, which is valid for homogeneous systems, does not apply to the type of exchange diffusion found. The system can, however, be described by a 1:1 exchange mechanism working in parallel with a diffusional pathway. The ratio exchange flux/observed efflux must then have a constant value (0.83) at the voltages appled, which implies that the exchange flux is voltage dependent. By comparison with iodide flux experiments as carried out by Ussing, it is shown that iodide exhibits the same type of exchange diffusion. A carrier, possibly responsible for the observed behaviour, is described.
The effect of acetazolamide (AZ) on renal gamma-glutamyl transpeptidase (EC 2.3.2.2) activity (gamma-GT) was studied with the purified enzyme, subcellular fractions, and in the isolated functioning kidney. Activity of gamma-GT was assessed using either one of two gamma-glutamyl donors, gamma-glutamyl-p-nitroanilide (gamma GpNA) or glutamine, and either the gamma-glutamyl acceptor glycylglycine (Gly-Gly) or methionine (Met). With the microsomal enzyme and beta-GpNA, AZ was shown to inhibit p-nitroaniline (p-NA) formation; however, gamma-GpNA Km remained unchanged (1.8 mM), while the Vmax was reduced significantly, 333 vs 200 mumoles . min-1 . mg-1. Adding Gly-Gly removed AZ inhibition, while AZ elevated the apparent Km from Gly-Gly from 16 to 48; AZ inhibition of gamma-GT activity resulted in a decrease in gamma-glutamyl-Gly-Gly formation consistent with interaction at the gamma-glutamyl acceptor site. With glutamine as the beta-glutamyl donor, AZ reduced NH3 and apparent gamma-glutamylmethionine formation in the purified enzyme in agreement with inhibition at the acceptor site. In the functioning kidney, perfused with 10(-3)M L- or D-glutamine, AZ (10(-3)M) markedly reduced NH3 formation and increased glutamine excretion, results consistent with AZ inhibition of the in situ gamma-GT.
Examination of cranial nerves shows that the sensory infraorbital branch of the trigeminal nerve contains many carbonic anhydrase-reactive axons whereas axons of the motor facial nerve are non-reactive. This motor/sensory axon staining difference holds for both cranial and spinal nerves. Chronic treatment with acetazolamide produced no apparent changes in carbonic anhydrase histochemical activity or the structure of peripheral nerve fibers.
Isolated mouse islets exposed to 3mM glucose released an increased amount of insulin in the presence of acetazolamide (AZM) (10 mM) and diphenylhydantoin (DPH) (0.35 or 3.5 mM), whereas insulin secretion due to 20 mM glucose was decreased in the presence of AZM (10 mM) and DPH (0.35, 0.70 or 3.5 mM). The serum insulin concentration was increased 1 h after AZM injection, but was not significantly altered 1 h after combined administration of AZM and DPH. A moderate transient hyperglycemia was found 1 and 2 h after DPH injection (100 mg/kg b.w.) in fed mice, and a slight, transient hyperglycemic response was observed 24 h after administration of AZM (1.5 g/kg b.w.) to fed mice. A steadily increasing, marked hyperglycemia was seen in both fed and starved mice when AZM was given shortly before or after DPH. All animals subjected to this kind of treatment died within 48 h after the injections. Ketones were found in urine and serum of the hyperglycemic animals, and the hyperglycemia was abolished and the survival of the animals was prolonged by insulin administration, suggesting that ketoacidosis contributed to the death. Light microscopy disclosed degeneration and necrosis of some B-cells, and occasionally insulitis after combined treatment with AZM and DPH. Pretreatment with AZM inhibited the hyperglycemic response to p-hydroxymercuribenzoate in fed mice, but did not affect the hyperglycemic response of fed mice to D-mannoheptulose. The findings indicate that AZM and DPH, when given to mice in combination and in sufficient amount, cause impaired B-cell function with an inhibited glucose-induced insulin release and a severe, fatal hyperglycemia. The B-cell changes are believed to be due to intracellular ionic alterations.
The effects of the vacuolar-type H(+)-ATPase inhibitor bafilomycin A1 (baf.A1) and the carbonic anhydrase II inhibitor acetazolamide (AZ) on bone resorption and procathepsin L secretion of rat osteoclasts were investigated using the bone slice assay method, pit formation test. Baf.A1 completely suppressed osteoclastic bone resorption stimulated by parathyroid hormone (PTH), but did not affect procathepsin L secretion, while AZ suppressed both bone resorption and procathepsin L secretion. These findings suggest that bone resorption by procathepsin L secretion and its processing are regulated by proton production and proton secretion.
1. Acetazolamide (ACET)-resistant and -sensitive carbonic anhydrase (CA) activity was measured in post-mitochondrial supernatants from the soleus (SOL), deep vastus lateralis (DVL) and superficial vastus lateralis (SVL) muscles of rats and rabbits. 2. The relative total CA activity in the three muscles of both species can be summarized as SOL greater than DVL greater than SVL. 3. ACET-resistant CA activity was found in the SOL and DVL muscles of both species whereas a low level of ACET-sensitive CA activity was detected in the SVL muscle. 4. ACET-sensitive CA activity was also found in sarcoplasmic reticulum preparations from rat and rabbit SOL muscles.
Five males in one kindred suffered from intermittent ataxia and one female may have been more mildly affected. The pattern of inheritance strongly suggests X-linkage. Cerebral pathology in one case had some features of Leigh's disease. A defect in pyruvate metabolism was found in two cases. Acetazolamide gave a temporary clinical and biochemical improvement in two cases.
Five members in three generations of a family were affected by an illness that had many clinical features of the hypokalemic form of periodic paralysis (HPP). The serum potassium was either moderately reduced or normal during attacks, and there was no evidence of myotonia or cold-intolerance. All of the patients improved to a variable degree with oral potassium supplements, and 3 responded favorably to triamterene. The usually beneficial drug acetazolamide, however, invariably caused weakness in these patients, an effect previously described in only one other family with HPP. In addition, amphetamine-like sympathomimetic drugs effectively aborted or prevented paralysis in several members. Muscle biopsy in two patients revealed some unusual features, and electromyography showed myopathic potentials. There was no evidence of diabetes. The urine electrolyte concentrations during glucose tolerance tests, however, were different from those previously reported in HPP. This family may represent a variant form of HPP.
Twenty-four chronic schizophrenic patients were treated successfully with the addition of acetazolamide and thiamine (A + T) to their unchanged existing therapies in a double-blind, placebo-controlled crossover study. Therapeutic effects were measured by the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms. Overall, 50% of the patients showed improvement on all assessment scales. No untoward effects occurred in these patients or in patients in previous studies who have been treated continuously with A + T therapy for as long as 3 years.
A 44-year-old man presented with symptoms of periodic ataxia, dysarthria, nausea and excessive sweating during the last twenty years. These symptoms could be provoked by physical or emotional stress and disappeared after bedrest for several hours. No other members of his family were known to have such complaints. Acetazolamide (Diamox) proved effective in preventing these symptoms. A disturbance of tryptophan metabolism is suggested as a cause of this disorder.
The effect of acetazolamide (ACZ) on HCO3- and Cl- activities in inner ear fluid was investigated by ion-selective microelectrode methods. The endocochlear potential, at 81.6 +/- 1.5 mV under normal conditions, was reduced by 4.9 +/- 0.9 mV in 30 min following the ACZ injection. The HCO3- concentrations by 11.5 +/- 1.7 mM in 30 min, while the change of Cl- level was not consistent but showed a tendency toward slight increase in average. The calculated PCO2 in endolymph was 39.6 mmHg. ACZ induced a constant elevation of the endolymph PCO2, with an increase in the venous PCO2 during the initial 20 min and thereafter the endolymph PCO2 attained a plateau despite the continuous increase of the venous PCO2. We postulate that the HCO3- secretion into the endolymph is mediated by carbonic anhydrase (CAH) and is decreased by ACZ due to the inhibition of CAH.
Pregnant SWV mice were treated on day 9 of gestation (PC) with 50 mg/kg of caffeine (CAFF), 200 mg/kg (LD) or 1000 mg/kg (HD) of acetazolamide (ACZM), or a combination of both agents, or on day 8 PC with both agents (ACZM + CAFF). Untreated (UNTD) and vehicle-treated (VEH) groups served as controls. The SWV strain is widely reported to be resistant to ACZM; it was resistant to ACZM or CAFF + ACZM when treated on day 9 of gestation, but a significant frequency of malformations, primarily exencephaly, was produced by ACZM + CAFF on day 8 PC. This study provides evidence that ACZM, coupled with a subteratogenic dose of caffeine can produce abnormalities in the "resistant" SWV mice, using the endpoint of exencephaly on day 8 of gestation. The mean number of ossified caudal vertebrae in day-9 treatments and ossified cervical vertebral centra in day-8 treatments were reduced. The frequency of ossification of the first cervical vertebra (C1) was reduced from 93% in UNTD to 39% in HD-ACZM day 9 PC and 69% in HD-ACZM + CAFF day 9 PC groups, and was also significantly reduced in the HD-ACZM + CAFF day-8 treated group.
We describe a patient with tumoral calcinosis, in which acetazolamide (ACZ) was, for the first time, tested for its therapeutic efficacy. The 19-year-old Japanese man had been suffering from multiple recurrent calcific masses with tenderness around the finger, knee, and toe joints since 10 months of age. Radiographs revealed several calcific subcutaneous masses around the finger joints, and calcific myelitis around the right knee joint and in the calvarium. The patient had hyperphosphatemia with elevated maximal threshold of renal phosphate excretion in the presence of normal kidney function and normocalcemia, suggesting a reduced ability to excrete phosphorus in the urine. A delay of disappearance of orally administered phosphate from the blood stream was found. A serum parathyroid hormone (PTH) level was normal, and responses to PTH and ACZ were also normal regarding the induction of phosphaturia. Since the masses tended to recur easily despite repeated surgical resections, we started medical treatment with phosphorus deprivation by oral aluminum hydroxide. However, the drug alone had no effect on hyperphosphatemia or calcific lesions, and ACZ was added in expectation of making the patient's phosphorus balance negative by its phosphaturic effect. Fourteen years of administration of the two drugs apparently improved the patient's symptoms, the biochemical findings, and the calcific lesions on radiographs. Thus, ACZ appeared to be useful for tumoral calcinosis resistant to phosphorus deprivation by aluminum hydroxide alone.
To test for environmental persistence in order to determine the potential of carbonic anhydrase inhibitors as larvicides, the decomposition and degradation of samples containing methazolamide (MTZ) and acetazolamide (ACZ) in aqueous solution were monitored under different conditions. Additionally, nontarget species impact was assessed in an acute toxicity test using sheepshead minnow (Cyprinodon variegatus). The fish were exposed for 120 h to 10(-3) and 10(-4) M each compound in replicate seawater tanks. In the high-MTZ treatment, all fish died within 48 h, while mortality in the low-MTZ treatment was 27% at 120 h. In the high-ACZ treatment mortality reached 83% at 120 h. We observed no mortality for the lowest dose of ACZ. Tissue samples were collected from the fish to investigate absorption of the compounds. In the gills, MTZ concentrations were around 40 microg g(-1) and ACZ reached concentrations up to 80 microg g(-1). Liver concentrations were low for MTZ probably due to metabolism.
Bolus tracking magnetic resonance imaging (MRI) is a powerful technique for assessing cerebral perfusion, but its capability to measure absolute cerebral blood flow (CBF) and volume (CBV) values is still debated. To validate the MRI technique, absolute CBF and CBV values in healthy humans obtained by echo planar gradient echo MRI were compared to H(2)(15)O and (11)CO positron emission tomography (PET) before and after acetazolamide (ACZ) (n = 8) or saline (n = 4) administration. The repeatability of CBF and CBV measurements was moderate with both methods, and slightly lower with MRI than with PET. At rest, the mean CBF values were similar with both techniques except in the cortex where they were moderately higher with MRI. CBV was higher with MRI than with PET in all areas, which may reflect an underestimation of the arterial input function (AIF). After ACZ, a significant CBF increase was observed in gray matter with both MRI and PET, suggesting that MRI might be used to assess the cerebrovascular reserve. In individual subjects, the correlation between MRI and PET measurements was good for both CBF and CBV (R(2) between 0.70 and 0.84). However, when all results were considered as a group, R(2) was lower (0.40 to 0.65), and the limits of agreement between the two methods (SD of the difference) were large. Our data suggest that physiologic CBF values and systematically overestimated CBV values may be obtained with MRI in healthy humans, but that an individual scale factor should be applied to MRI measurements to improve the agreement with PET.
Assessment of cerebral blood flow velocities (CBFV) can be used as a non-invasive tool to evaluate specific drug effects, like caffeine (CAF), acetazolamide (AA) as well as cognition. Their influences on each others CBFV were evaluated in detail, using a randomized, double-blind, double-dummy, placebo-controlled three-fold cross-over study design in 18 right-handed healthy male volunteers. CBFV (maximal, mean, minimal) and pulsatility index of both middle cerebral arteries were recorded by transcranial Doppler ultrasound simultaneously, during a verbal memory test, oral CAF, intravenous AA or placebo. AA led to increase in CBFV of 25-32%. Caffeine resulted in decreased V(mean) and V(min) of 10-13%. Cognitive stimulation resulted in a slight increase of CBVF of about 4%, but was overruled by effects of AA and CAF. We conclude that pharmacological effects can easily be assessed by TCD during clinical pharmacological studies of vasoactive drugs. However intraindividual variability and effects of neuropsychological stimulation needs to be taken into account.
Acetazolamide (ACZ) administration was compared on ventilation in outbred male ICR Swiss Webster (ICR) and inbred C57BL/6J (C57) mice, used in development of transgenic strains. We hypothesized that in both strains ACZ would affect breathing similarly. Mice received intraperitoneally vehicle and the next week ACZ (40 mg/kg), and were exposed to air for 90 min, followed by 5-min exposure to 10% O(2), air for 15 min, and to 5 min of 5% CO(2) in O(2). Ventilation was evaluated using plethysmography. ACZ stimulated ventilation in both stains exposed to air. C57 mice minimally increased frequency and tidal volume, whereas ICR mice markedly increased frequency. Strain differences in the ventilatory pattern in response to hypoxia and hypercapnia occurred. ACZ-treated ICR mice decreased hypoxic responsiveness to 50% of vehicle values, whereas ACZ had no effect in C57 mice. ACZ decreased hypercapnic ventilatory responsiveness in both strains. Differential effects of ACZ breathing in these two strains suggest that genetic factors modulate its effect on breathing.