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Immunoaffinity screening with capillary electrochromatography.

Highly efficient capillary electrochromatographic separations of cardiac glycosides and other steroids are presented. Employing butyl-derivatized silica particles as stationary phase resulted in a nearly three times faster electroosmotic flow (EOF) compared to capillary electrochromatography (CEC) with octadecyl silica particles. On-column focusing with a preconcentration factor of 180 was performed and separation efficiencies of up to 240,000 plates per meter were obtained. Using label-free standard UV absorbance, detection limits of 10-80 nM were reached for all steroids tested. For screening of cardiac glycosides, e.g., digoxin and digitoxin in mixtures of steroids, CEC was combined with immunoaffinity extraction using immobilized polyclonal anti-digoxigenin antibodies and F(ab) fragments. Simply adding small amounts of antibody carrying particles to the samples and comparing chromatograms before and after antibody addition allowed screening for high affinity antigens in mixtures with moderate numbers of compounds. Under conditions of competing antigens, affinity fingerprints of immobilized anti-digoxigenin and anti-digitoxin antibodies were obtained, reflecting the cross-reactivity of eleven steroids. The method provides high selectivity due to the combination of bioaffinity interaction with highly efficient CEC separation and UV detection at several wavelengths in parallel. This selectivity was exploited for the detection of four cardiac glycosides in submicromolar concentrations in an untreated urine sample.

Antibodies↗

Conal contribution to the electrocardiogram of chick embryo hearts.

Contraction of the conus arterisus (conus) is visibly delayed in the tubular heart of the chick embryo, and since the electromechanical coupling interval of isolated conal segment is similar to other areas of the embryonic heart, the delayed contraction of the conus indicated an impedance in the spread of the depolarization wave across the ventriculo-conal (VC) junction. A surface electrode placed on the conus of hearts obtained from the 72-hour chick embryo records a deflection, termed the C wave, appearing between the QRS complex and the T wave. To establish that the C wave arose from below the atrioventricular sulcus, atria were removed from a series of hearts from 96-hour embryos and the electrogram revealed a C wave without a P wave. The VC junction responds to digitoxin just as the atrioventricular tissue. Digitoxin prolongs the interval between the QRS and the C wave prior to a complete block in a manner analogous to the PR interval increase prior to the development of the Wenckeback phenomenon or complete atrioventricular block. As the embryonic heart developed after 96 hours, the C wave was no longer identifiable in the ECG.

Action Potentials↗

Photoaffinity labeling of the ouabain binding site in Na, K-ATPase in developing brine shrimp.

Analysis of purified Na,K-ATPase from brine shrimp nauplii by sodium dodecyl sulfate-polyacrylamide gel electrophoresis reveals two large (alpha) subunits [G.L. Peterson, R.D. Ewing, S.R. Hootman, and F.P. Conte (1978) J. Biol. Chem. 253:4762]. The band with lower mobility in a neutral or alkaline gel is designated alpha 1 and the band with higher mobility alpha 2. Ouabain prevents dephosphorylation of both alpha 1 and alpha 2 as documented by gel analysis, but a higher concentration of ouabain is required to prevent dephosphorylation of alpha 2. The photoaffinity label, [3H]4'(2-ethyldiazomalonyl) digitoxigenin monodigitoxiside, specifically labels alpha in a ouabain-protectable manner without labeling other contaminating proteins in the preparation. Greater than 93% of the total ouabain-protectable labeling of the alpha subunits is associated with alpha 1. The photoaffinity label, [3H]4"' (2-ethyldiazomalonyl) digitoxin, specifically labels alpha 1 and beta in a ouabain-protectable manner without labeling other contaminating proteins. These data show that in the brine shrimp the third digitoxose residue of digitoxin binds in a region in which the alpha 1 and beta chains are in close proximity. Less than 5% of the specific ouabain-protectable labeling of total alpha is associated with alpha 2. These studies indicate that cardioactive steroids have higher affinity for the alpha 1 subunit.

Affinity Labels↗

Binding of 16alpha-gitoxin and its 16-acetate to human serum albumin.

The binding of semi-synthetic (16alpha-gitoxin and its 16-acetate) and naturally occurring cardioactive glycosides (digitoxin, ouabain) to human serum albumin was studied using equilibrium dialysis, ultracentrifugation and gel filtration. 16alpha-gitoxin was 75% bound and its 16-acetate 95%. The percentage binding of digitoxin and ouabain was in good agreement with values reported in literature.

Chromatography, Gel↗

On the pharmacokinetics of 16-acetyl-gitoxin and its bioavailability from pengitoxin-containing tablet formulations.

In six volunteers the pharmacokinetics of 16-acetyl-gitoxin (16AG, 0.5 mg) administered intravenously (A1) and as an oral solution (A2) and of pengitoxin (PAG, 0.6 mg) administered intravenously (A3) was evaluated. In six volunteers the bioavailability of 16AG from two PAG tablet formulations (1.2 mg) (B2, B3) was measured by comparison with the absorption after administration of a pengitoxin solution (1.2 mg) (B1). In both studies the test was performed using a crossover design. After a single i.v. injection of equimolar doses, 16AG and PAG showed similar mean kinetic parameters: t1/2 = 51.6 hr (16AG) and 60.8 hr (PAG), CL = 11.7 ml min-1 (16AG) and 12.7 ml min-1 (PAG), CLR = 4.1 ml min-1 (16AG) and 4.2 ml min-1 (PAG). The 16AG was absorbed from solution with a mean half-life of 0.2 hr to an extent of 98.6%. The mean urinary excretion/Ae (0,4)/of 16AG amounted to 24.6% (A1), 20.8% (A2) and 28.1% (A3). On the basis of AUC values, the mean bioavailability of PAG from either tablet formulation amounted to 79.6% (B2) and 89.6% (B3). The pharmacokinetic parameters of 16AG (PAG) are closer to those of digitoxin than those of digoxin. In general, 16AG is characterized as a digitoxin with a digoxin-like elimination half-life.

Acetyldigoxins↗

On the ocular distribution of cardiac glycosides in guinea pigs following acute administration.

Tritiated ouabain, digitoxin, and digoxin were given IV to anesthetized guinea pigs. The tritium content of the ocular tissues (cornea, iris, lens, vitreous body, retina, choroid, sclera, and optic nerve) was measured after 1 and 3 h and compared with the amount of tritium found in the brain and some peripheral organs. High levels of digitoxin were found in the brain and retina. Digoxin was detected in large quantities in the retina, but only small levels were found in brain tissue. Ouabain was nearly absent in the retina and cerebrum, whereas in most other ocular and peripheral tissues the three cardiac glycosides were present in comparable quantities. The IP injection of tritiated digoxin resulted in lower absolute tissue levels, but a pattern of distribution similar to that observed in anesthetized guinea pigs was found in conscious animals.

Animals↗

Nonocclusive mesenteric ischemia induced by digitalis.

BACKGROUND: Nonocclusive mesenteric ischemia is a rare but serious disorder with a high mortality rate; causal factors include cardiac glycosides, digoxin, and digitoxin in addition to severe hypotension, decompensated heart failure, and septic shock. CASE PRESENTATION: We present a patient with digitoxin intoxication who died from autopsy-confirmed ischemic gangrenous colitis. CONCLUSION: Despite the frequent occurrence of intoxication with cardiac glycosides nonocclusive mesenteric ischemia is a rare event. However, it should always be included as a differential diagnosis of diffuse abdominal pain in patients treated with cardiac glycosides.

Aged↗

Purification of a rat liver cytosolic sulfotransferase responsible for the conjugation of digitoxigenin.

Previous investigations on the digitoxin metabolism hardly considered the role of the sulfate ester conjugation. Therefore, this study examined whether digitoxin (dt-3) or one of its cleavage products might be sulfated in vitro. It was proven that digitoxigenin (dt-0) is by far the best substrate for the cytosolic sulfotransferases (ST). Digitoxigenin-monodigitoxoside (dt-1) and digitoxigenin-bisdigitoxoside (dt-2) are sulfated in trace amounts whereas dt-3 is not sulfated at all. The purification of the responsible enzyme was performed by liquid chromatography on Q-Sepharose and hydroxyapatite. During the purification procedure this enzymatic activity corresponded exactly to that towards dehydroepiandrosterone (DHEA). The 134-fold purified and gel electrophoretically homogeneous enzyme protein (Mr 33,000) showed a Vmax of 12.5 nmoles dt-0 sulfate/min mg protein and a KM of 37 mumol/L. The purified enzyme conjugated dt-1 and dt-2 in trace amounts only and was inhibited competitively by DHEA. It can be concluded that in the rat a 3 beta-hydroxy-steroid sulfotransferase is responsible for the sulfation of dt-0. The purified enzyme reacts with dt-1, dt-2 and digoxigenin (dg-0) in traces only, a sulfation of dt-3 is not detectable.

Animals↗

(Na+,K+)-ATPase and noradrenergic regulation: effects of cardiac glycoside treatment and noradrenergic manipulations.

We examined effects of treatment with cardiac glycosides, in combination with noradrenergic stimulation or depletion, on (Na+,K+)-ATPase activity in rat cerebral cortex, heart, and kidney. Treatment with digitoxin increased the apparent number of (Na+,K+)-ATPase sites in heart, cerebral cortex, and kidney. Ouabain, which crosses the blood-brain barrier poorly, did not affect enzyme in brain but was otherwise similar. Norepinephrine depletion prevented the increase in heart but not in cerebral cortex. Noradrenergic stimulation increased the number of sites in cerebral cortex and in heart. In rats treated with digitoxin, noradrenergic stimulation increased enzyme activity further in heart but not in cerebral cortex. Examination of effects on noradrenergic receptor binding and on norepinephrine metabolite concentrations suggested that, while in heart cardiac glycosides appeared to increase norepinephrine release, in brain there was no effect on release but there may have been appreciable inhibition of norepinephrine reuptake under stimulated conditions.

Animals↗

In ability of Na+,K+-ATPase inhibitor to cause hypertension in sodium-loaded or deoxycorticosterone-treated one kidney rats.

The role of an endogenous inhibitor of Na+,K+-ATPase in hypertension observed in one-kidney NaCl-loaded rats treated with deoxycorticosterone (DOC) was examined. Ouabain or digitoxin, an exogenous inhibitor of Na+,K+-ATPase, failed to cause hypertension in one-kidney NaCl-loaded rats without DOC treatment or one-kidney DOC-treated rats without NaCl loading. Moreover, neither ouabain nor digitoxin acted additively with a putative endogenous inhibitor of Na+,K+-ATPase to augment hypertension observed in one-kidney NaCl-loaded rats treated with DOC. The results do not support the hypothesis that an endogenous inhibitor of Na+,K+-ATPase plays an important role in the development or maintenance of hypertension in this animal model.

Animals↗

High-performance liquid chromatography-ionspray mass spectrometry for the specific determination of digoxin and some related cardiac glycosides in human plasma.

An original method based upon high-performance liquid chromatography coupled to ionspray mass spectrometry (HPLC-ISP-MS) has been developed for the identification and quantification in plasma of several cardiac glycosides, namely digoxin, digitoxin, lanatoside C and acetyldigitoxin. After single-step liquid-liquid extraction by chloroform-2-propanol (95:5, v/v) at pH 9.5 using oleandrin as an internal standard, solutes are separated on a 4 microm NovaPak C18 (Waters) column (150x2.0 mm, I.D.), using a gradient of acetonitrile-2 mM NH4COOH, pH 3 buffer (flow-rate 200 microl/min, post-column split 1:3). Detection is done by a Perkin-Elmer Sciex API-100 mass analyzer equipped with an ISP interface. In most instances the major ion observed is not [M+H]+ as expected, but [M+NH4]+. The mean retention times (min) are: lanatoside C, 5.74; digoxin, 6.00; digitoxin, 8.08, oleandrin, 8.30, acetyldigitoxin, 8.66 and 9.01 (isomers alpha and beta, respectively). The lower limits of detection in single ion monitoring mode range from 0.15 ng/ml (alpha- and beta-acetyldigitoxin) to 0.60 ng/ml (lanatoside C), making the method less sensitive than radioimmunoassay, whereas it is much more specific.

Acetyldigitoxins↗

Kinetics in interactions between antibodies and haptens.

Association and dissociation kinetics of antibody-hapten interactions of high affinity and specificity have been determined by newly developed techniques using dextran-coated charcoal for rapid separation of free and antibody-bound hapten. Interactions of 12 combinations of four antibody populations (rabbit digoxin-specific antibody, sheep digoxin-specific antibody, rabbit ouabain-specific antibody, and rabbit digitoxin-specific antibody) with three haptens ([3-H]digoxin, [3-H]ouabain, and [3-H]digitoxin) have been studied in terms of both association and dissociation kinetics, and compared in selected instances with association constants determined under equilibrium conditions. Association rate constants determined under both second-order and pseudo-first-order conditions were found to be similar for all antibody-hapten pairs studied (range 0.87-1.7 times 10-7 M-minus 1 sec- minus 1), and were comparable to values previously estimated for antibodies to dye haptens of markedly lower affinity. In contrast, dissociation rate constants varied markedly from 1.9 times 10- minus 4 to 1.7 times 10- minus 2 sec- minus 1. Ratios of association to dissociation rate constants measured by these methods were in satisfactory agreement with average intrinsic association constants measured under equilibrium conditions. These studies support the concept that the major kinetic variable governing antibody-hapten interactions is the rate of dissociation of the complex, and that the strength of antibody-hapten association is determined principally by the activation energy for dissociation.

Animals↗

Cardiac glycosides inhibit TNF-alpha/NF-kappaB signaling by blocking recruitment of TNF receptor-associated death domain to the TNF receptor.

Digitoxin and structurally related cardiac glycoside drugs potently block activation of the TNF-alpha/NF-kappaB signaling pathway. We have hypothesized that the mechanism might be discovered by searching systematically for selective inhibitory action through the entire pathway. We report that the common action of these drugs is to block the TNF-alpha-dependent binding of TNF receptor 1 to TNF receptor-associated death domain. This drug action can be observed with native cells, such as HeLa, and reconstituted systems prepared in HEK293 cells. All other antiinflammatory effects of digitoxin on NF-kappaB and c-Jun N-terminal kinase pathways appear to follow from the blockade of this initial upstream signaling event.

Blotting, Western↗

Ca2+ dependence of transverse tubule-mediated calcium release in skinned skeletal muscle fibers.

Isometric force and 45Ca efflux from the sarcoplasmic reticulum were measured at 19 degrees C in frog skeletal muscle fibers skinned by microdissection. After Ca2+ loading, application of the ionophores monensin, an Na+(K+)/H+ exchanger, or gramicidin D, an H+ greater than K+ greater than Na+ channel-former, evoked rapid force development and stimulated release of approximately 30% of the accumulated 45Ca within 1 min, whereas CCCP (carbonyl cyanide pyruvate p-trichloromethoxyphenylhydrazone), a protonophore, and valinomycin, a neutral, K+-specific ionophore, did not. When monensin was present in all bathing solutions, i.e., before and during Ca2+ loading, subsequent application failed to elicit force development and to stimulate 45Ca efflux. 5 min pretreatment of the skinned fibers with 50 microM digitoxin, a permeant glycoside that specifically inhibits the Na+,K+ pump, inhibited monensin and gramicidin D stimulation of 45Ca efflux; similar pretreatment with 100 microM ouabain, an impermeant glycoside, was ineffective. Monensin stimulation of 45Ca efflux was abolished by brief pretreatment with 5 mM EGTA, which chelates myofilament-space calcium. These results suggest that: monensin and gramicidin D stimulate Ca2+ release from the sarcoplasmic reticulum that is mediated by depolarization of the transverse tubules, which seal off after sarcolemma removal and form closed compartments; a transverse tubule membrane potential (myofilament space-negative) is maintained and/or established by the operation of the Na+,K+ pump in the transverse tubule membranes and is sensitive to the permeant inhibitor digitoxin; the transverse tubule-mediated stimulation of 45Ca efflux appears to be entirely Ca2+ dependent.

Animals↗

Reduction of beta-adrenoceptor density and evaluation of positive inotropic responses in isolated, diseased human myocardium.

Cardiac beta-adrenoceptors and the positive inotropic effects of adenylate cyclase-dependent (dobutamine, histamine, forskolin) and adenylate cyclase-independent agents (isobutylmethylxanthine (IBMX), dibutyryl-cAMP (db-cAMP), digoxin, digitoxin and calcium were measured in papillary muscle strips from severely failing (NYHA IV), moderately failing (NYHA II-III) and non-failing (NYHA I) human hearts. The density of beta-adrenoceptors in three NYHA I patients were 40.0, 42.0 and 42.9 fmol mg-1 protein. The density of cardiac beta-adrenoceptors was significantly reduced in NYHA II-III to 18.0 +/- 1.1 fmol mg-1 protein (n = 16) and further reduced in NYHA IV to 9.5 +/- 1.6 fmol mg-1 protein (n = 7). The KD values did not differ between the groups. Correspondingly, the positive inotropic effect of dobutamine was significantly reduced in NYHA II-III and almost lost in NYHA IV. The positive inotropic effect of histamine was similar in non-failing and moderately failing myocardium but reduced in preparations from severely failing hearts (NYHA IV). The positive inotropic effect of IBMX was diminished in moderately and severely failing myocardium depending on the functional class of heart failure. In contrast, the effects of forskolin, db-cAMP, digoxin and digitoxin were not impaired in NYHA IV when compared with the maximal positive inotropic effect of calcium. It is concluded that in the failing human heart (a) the number of cardiac beta-adrenoceptors is reduced proportional to the severity of heart failure; (b) the receptor coupling of H2-receptors to adenylate cyclase may be impaired, but only in severe heart failure; (c) the basal cAMP formation may be diminished; and that (d) the catalytic subunit of the adenylate cyclase and the cAMP-dependent protein kinases may be promising targets for drugs to restore force of contraction in human heart failure.

1-Methyl-3-isobutylxanthine↗

Heat treatment of human serum to inactivate HIV does not alter protein binding of selected drugs.

Human immunodeficiency virus (HIV) may be transmitted via certain biological fluids, particularly blood. To minimize the risk of accidental exposure, the virus may be inactivated by heat treatment of blood, plasma, or serum samples at 54-56 degrees C for 5 h. The objective of this study was to determine whether heat treatment of human serum alters the protein binding of model compounds. Diazepam, phenytoin, and digitoxin were selected for investigation because they bind to three different sites on human serum albumin (HSA); propranolol also was examined since it binds to both HSA and alpha 1-acid glycoprotein. The unbound fraction of selected drugs was measured by ultrafiltration at 37 degrees C after addition of each compound to either untreated or heat-treated serum. The percentage unbound in serum for diazepam, phenytoin, digitoxin, and propranolol was not significantly different between the untreated and heat-treated samples. Therefore, heat treatment of serum does not appear to alter the binding characteristics at these four binding sites and would not be expected to lead to erroneous unbound concentration estimates and inappropriate adjustments in drug therapy.

Anti-Arrhythmia Agents↗

Plasma concentration, uptake by liver, and biliary excretion of tritiated cardiac glycosides in the isolated perfused guinea-pig liver.

1. Investigations were carried out on isolated perfused guinea-pig livers. Different doses of tritiated ouabain, digoxin, and digitoxin were added to the perfusion medium and the subsequent plasma elimination, hepatic uptake, and biliary excretion quantitatively measured. After the perfusion, extracts of liver, bile and plasma were subjected to thin layer chromatography in order to detect the radioactively labelled glycosides and their metabolites.2. The ouabain concentration in the plasma approached the equilibrium stage within 45 minutes. At this time 40% of the administered dose had been taken up by the liver, and no further elimination occurred. The elimination curve for ouabain followed a simple exponential function. After 1 h the tissue medium (T/M) ratio was approximately 3. In bile hardly any radioactivity could be detected. Ouabain was therefore not excreted by the liver.3. Up to 80% of the digitoxin was eliminated from the plasma within 4 hours. The elimination of radioactive material for the dose range studied could be described by a hyperbolic function. The T/M ratio in the liver varied with time. At the beginning it was as high as 10 and after 4 h reduced to approximately 3. After 45-60 min the concentration of radioactive material in the bile was 500 times as high as that in the plasma. Almost 70% of the administered radioactivity was excreted with the bile within 4 hours. At the end of the perfusion almost all the identifiable substances in plasma and bile were polar metabolites, as shown by thin layer radiochromatography.4. Digoxin behaved similarly to digitoxin.5. The findings led to the following hypothesis: uptake of cardiac glycosides into the liver cells occurs by a passive diffusion process and is related to their lipid solubility. On the other hand excretion in the bile occurs in general if polar metabolites are formed in the liver cells.

Animals↗

Digitalis in chronic renal insufficiency.

Cardiac dysfunction is common in patients with terminal renal failure. However, no consensus has been reached with respect to the indications for digitalis therapy. Depression of myocardial contractility may occur as a result of circulating toxic factors, parathyroid hormone, and altered catecholaminergic responsiveness. On the other hand, paradoxical positive inotropic effects have been observed possibly as a result of a circulating natriuretic factor (an endogenous digitalis analogue) which inhibits Na,K-ATP'ase. Pharmacokinetics and pharmacodynamics of digitalis steroids are altered in uremia. Elimination half-lives of strophanthin and digoxin are prolonged, whereas the elimination half-life of digitoxin is unchanged. Altered protein binding and volume of distribution have been noted. Despite its long elimination half-life, most nephrologists favor administration of digitoxin because of its insensitivity to changes in renal function.

Animals↗