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Renal tubular chloride transport and the mode of action of some diuretics.

The renal diluting segment (thick ascending limb of Henle's loop) reabsorbs sodium chloride in excess of water and is responsible for dilution of the urine as well as reabsorption of a large fraction of the salt present in the glomerular ultrafiltrate. There is active reabsorption of chloride, which causes the voltage to be positive in the tubule lumen. Most, if not all, of the sodium transport is passive, driven by the voltage. Three major diuretics (mersalyl, furosemide, and ethacrynic acid) act in the lumen of the diluting segment to inhibit active chloride transport, not sodium transport as previously believed. This specific action on chloride transport may explain how these drugs are able to inhibit salt transport in the kidney while having so little effect on the transport processes elsewhere in the body.

Adenosine Triphosphatases↗

Potassium activity and plasma membrane potentials in epithelial cells of toad bladder.

Intracellular potassium activity (aki), mucosal and serosal membrane potential (mEm, sEm), short-circuit current (Isc), and transepithelial potential difference in the epithelium of the toad bladder were measured with a potassium-sensitive liquid ion exchanger and an ordinary microelectrode. Under basal conditions, aki was 41.2 +/- 0.5 mM, corresponding to 54.4 mM in free potassium concentration, so half or more of the intracellular potassium may be of bound form or sequestrated within subcellular organelles. The sEm cannot be explained by only the potassium equilibrium potential (Eeq), because the sEm was markedly lower than the Eeq and no relation was found between them. Ouabain and rotenone decreased the aki, but ethacrynic acid, which also inhibited the Isc and the membrane potentials, did not show any effect on aki. Vasopressin decreased aki with an elevation in mEm, whereas prostaglandin E1 increased the aki with elevation in the sEm. These characteristic changes may afford an insight into the mechanisms by which transcellular electrolyte transport occurs.

Animals↗

Characterization of antibody and selection of alternative drug therapy in hydrochlorothiazide-induced immune hemolytic anemia.

The authors report the clinical and laboratory findings of a patient who had severe immune hemolytic anemia due to hydrochlorothiazide (HCTZ). In this case, the HCTZ antibody reacted not only with other thiazide and thiazide-like drugs, but also with a chemically unrelated diuretic, ethacrynic acid. These results indicate that HCTZ antibody activity is not restricted solely to the thiazides and imply that therapy with any of the reactive drugs would be contraindicated for this patient. The serologic screening for drug reactivity may be useful for selecting alternative therapy for patients with drug-induced immune hemolytic anemia.

Anemia, Hemolytic, Autoimmune↗

Physiological melatonin inhibition of human breast cancer cell growth in vitro: evidence for a glutathione-mediated pathway.

Melatonin, the chief hormone secreted by the pineal gland, has been previously shown to inhibit human breast cancer cell growth at the physiological concentration of 1 nM in vitro. In this study, using the estrogen receptor (ER)-positive human breast tumor cell line MCF-7, we have shown that 10 microM L-buthionine-[S,R]-sulfoximine (L-BSO), an inhibitor of gamma-glutamylcysteine synthetase (the rate-limiting enzyme in glutathione synthesis), blocks the oncostatic action of 1 nM melatonin over a 5-day incubation, indicating that glutathione is required for melatonin action. The result was repeated with ZR75-1 cells, suggesting that the glutathione requirement is a general phenomenon among ER+ breast cancer cells. Addition of exogenous glutathione (1 microM) to L-BSO-treated groups restored the melatonin response in both cell lines. Further demonstration of the importance of glutathione was shown using the ER- breast tumor cell line HS578T, which is normally unresponsive to melatonin. Growth in this cell line was inhibited in the presence of 1 microM ethacrynic acid (an inhibitor of glutathione S-transferase) plus 1 nM melatonin, and this effect was blocked with 10 microM L-BSO. We also observed a steady decrease of intracellular glutathione in MCF-7 cells over a 5-day incubation, suggesting that these cells metabolize glutathione differently than do normal cells.

Antimetabolites, Antineoplastic↗

Inhibition of renal PGE2-9-ketoreductase by diuretics.

The metabolism of PGE2 by extracts of renal cortex is species dependent. In the rat PGE2-15-hydroxydehydrogenase initiates metabolism whereas in the rabbit PGE2-9-ketoreductase predominates. In man both mechanisms may operate. Each of the metabolic enzymes, which limits the vasodilator-diuretic actions of PGE2, was inhibited by ethacrynic acid, furosemide and indomethacin. Some inhibition of PGE2-9-ketoreductase was also observed with chlorthalidone, hydralazine and phentolamine but the thiazide diuretics and a number of other cardiovascular-active agents were without significant effect. We conclude that the inhibition of PGE2-9-ketoreductase and PGE2-15-hydroxydehydrogeanse could contribute to the mechanism of action of the non-thiaxide diuretics in man.

Alcohol Oxidoreductases↗

Tubular chloride transport and the mode of action of some diuretics.

The renal diluting segment (thick ascending limb of Henle's loop) reabsorbs sodium chloride in excess of water and is responsible for dilution of the urine as well as reabsorption of a large fraction of the salt present in the glomerular ultrafiltrate. In this segment, there is active reabsorption of chloride which causes the voltage to be positive in the tubule lumen. Most, if not all, of the sodium transport is passive, driven by the voltage. Three major diuretic drugs (mersalyl, furosemide and ethacrynic acid) act in the lumen of the diluting segment to inhibit active chloride transport, not sodium transport as previously believed. This specific action on chloride transport may explain how these drugs are able to inhibit salt transport in the kidney while having so little effect on the electrolyte transport processes elsewhere in the body.

Animals↗

Analysis of myogenic mechanisms in renal autoregulation.

To examine whether local myogenic mechanisms account for autoregulation of renal blood flow, a theoretical analysis was undertaken on a model of the pre-glomerular vascular tree consisting of a main and a short, narrow juxtaglomerular segment. At atmospheric extravascular pressure in vitro data are consistent with a relationship r=r0(1 + k - pk) between radius (r) and transmural pressure (p) at p > 60 mmHg, where k can be estimated from in vitro data and r=r0 at complete autoregulatory vasodilation. After introducing r=r(0)(1 + k - pk), Poiseuille's formula was integrated along the main segment, Deltax long, between arterial pressure P(1) and P(2) at the end of the main segment. At the lowest autoregulatory pressure P(1)=65 mmHg pre-glomerular blood flow is F=5Kr(0)(4)/Deltax. At P(1)=140 mmHg a pressure drop of only 17 mmHg to P2=123 mmHg is sufficient to fulfil the criterion for complete autoregulation: F=5Kr(0)(4)/Deltax. Thus, 80% of the total pre-glomerular vascular resistance is localized to the juxtaglomerular segment. Loop diuretics may abolish juxtaglomerular contractility. Calculated flow/pressure relationships after eliminating juxtaglomerular contractility are similar to those obtained after administering ethacrynic acid. If a constant tension hypothesis (r=60r(0)/p) rather than the transmural pressure hypothesis [r=r(0)(1 + k - pk)] applies, complete autoregulation is maintained to P(2)=89 mmHg, but the effect of loop diuretics is not mimicked. In conclusion, high juxtaglomerular contractility may be attributed to a myogenic mechanism only if extravascular pressure in the juxtaglomerular segment is subatmospheric.

Animals↗

Diabetogenic effect of oral diuretics in asymptomatic diabetes.

Ten patients with asymptomatic diabetes were given 40 mg furosemide, or 50 mg dihydrochlorothiazide, or 50 mg ethacrynic acid alternatively each for a week. Glucose tolerance tests were performed weekly. There was no significant change in the G.T.T. values during the test period. The result support the view that the "diabetogenic" effect of thiazides can not consitute a contraindication to the use of these compounds, as diuretics and the drugs under review probably do not differ significantly in this respect.

Adult↗

Inhibition of sulfation of phenols in vivo by 2,6-dichloro-4-nitrophenol: selectivity of its action in relation to other conjugations in the rat in vivo.

The effect of 2,6-dichloro-4-nitrophenol, an inhibitor of the sulfation of the phenolic compound harmol in vivo, on the sulfation of other phenolic substances and on various conjugation reactions has been studied in the rat in vivo. Compounds chemically related to 2,6-dichloro-4-nitrophenol were also tested as sulfation inhibitors. 2,6-Dichloro-4-nitrophenol inhibited the sulfation of phenol while it had no effect on biliary excretion of dibromosulphthalein, glucuronidation of phenolphthalein, acetylation of procainamide ethobromide or glutathione conjugation of ethacrynic acid. It is concluded that of these conjugation reactions sulfation is inhibited selectively at the dose level used. Some phenols with chloro- or nitro-substituents effectively inhibited the sulfation of harmol but to a lesser extent than 2,6-dichloro-4-nitrophenol. Many other phenols did not affect the conjugation of harmol, which is both glucuronidated and sulfated.

Animals↗

Decreased susceptibility of differentiated PC12 cells to oxidative challenge: relationship to cellular redox and expression of apoptotic protease activator factor-1.

We previously showed that tert-butyl hydroperoxide (TBH) induced apoptosis in naïve rat pheochromocytoma (nPC12) cells that correlated with cellular redox imbalance and mitochondrial apoptotic signaling. In this study, we tested the hypothesis that differentiation of nPC12 cells results in altered susceptibility to TBH utilizing a model of differentiated PC12 (dPC12) cells induced by nerve growth factor. TBH (100 microM) induced dPC12 apoptosis (12% at 24 h) at levels lower than naïve cells (35%). This resistance was associated with elevated GSH, NADPH (reduced nicotinamide adenine dinucleotide phosphate), TBH metabolism, redox enzyme activities, reduced cellular GSH/GSSG (glutathione disulfide) status and preservation of mitochondrial membrane potential. Altering cellular GSH with ethacrynic acid or N-acetylcysteine, respectively, exacerbated or protected against dPC12 apoptosis. dPC12 apoptosis was mediated by caspase-9 and -3 activation and apoptosis protease activator protein-1 (Apaf-1) expression. These results show that nPC12 transition to dPC12 cells afforded protection against oxidative challenge due to maintenance of reduced GSH/GSSG and decreased Apaf-1 expression.

Acetylcysteine↗

The effect of loop diuretics on the excretion of Na+, Ca2+, Mg2+, and Cl-.

Bumetanide, ethacrynic acid, and furosemide were administered in two equipotent doses to the same five dogs in three separate studies. Intravascular volume was maintained by the replacement of urinary losses. Fractional chloride excretion was used as a marker of diuretic effect. Comparison of absolute and fractional excretion of Na+, Cl-, Ca2+, and Mg2+ did not demonstrate a significant difference among the three diuretics.

Animals↗

[Pharmacological blockade of the nephrotoxicity of cisplatin in rats].

Cisplatin injection (0.5 mg/100 g body weight) induced 5 days later an increase in serum urea concentration from 3.31 +/- 0.67 to 47.1 +/- 8.68 mg/ml and diuresis decrease following water loading test. Ethacrynic acid, furosemide, paraaminohippurate pre-injections prevented cisplatin nephrotoxicity. The decrease in cisplatin nephrotoxicity took place when furosemide was administered before or 3 h after cisplatin injection; 6 h after cisplatin injection furosemide was not effective. The results suggest that pharmacological blockade of cisplatin nephrotoxicity depends on the drug penetration into secreting cells of proximal tubules.

Animals↗

Ultrasonic electrocochleography in guinea pig.

In order to obtain information about how ultrasonic stimuli are perceived (USP) in man, guinea pig cochleae were stimulated by bone conduction with frequencies (98.8 and 143.5 kHz) above the normal auditory field of this animal. The cochlear potentials recorded consisted of CM, SP and AP originating from the basal turn of the cochlea, and were found to be influenced by asphyxia, administration of ethacrynic acid, hypothermia and change of interstimulus interval. In addition, in kanamycin-treated animals the mean AP amplitude decreased to about one fourth of the normal value, and the mean AP latency increased significantly. These findings suggest that there is no special sense organ for the detection of USP but that such sounds activate hair cells in the basal turn of the cochlea.

Animals↗

Detection of drug-induced apoptosis and necrosis in human cervical carcinoma cells using 1H NMR spectroscopy.

Apoptosis and necrosis need to be differentiated in order to distinguish drug-induced cell death from spontaneous cell death due to hypoxia. The ability to differentiate between these two modes of cell death, especially at an early stage in the process, could have a significant impact on accessing the outcome of anticancer drug therapy in the clinic. Nuclear magnetic resonance spectroscopy was used to distinguish apoptosis from necrosis in human cervical carcinoma (HeLa) cells. Apoptosis was induced by treatment with the topoisomerase II inhibitor etoposide, whereas necrosis was induced by the use of ethacrynic acid or cytochalasin B. We found that the intensity of the methylene resonance increases significantly as early as 6 h after the onset of apoptosis, but that no such changes occur during necrosis. The spectral intensity ratio of the methylene to methyl resonances also shows a high correlation with the percentage of apoptotic cells in the sample (r2=0.965, P<0.003).

Apoptosis↗

GABAA-responses of CA3 neurones: contribution of bicarbonate and of Cl(-)-extrusion mechanisms.

Postsynaptic GABAA-responses of cortical neurones may be composed of an early 'somatic' hyperpolarization (h-GABAA) and a 'dendritic' depolarization (d-GABAA). In order to study underlying anion-fluxes the gradient of bicarbonate across the membrane of CA3-neurones in hippocampal slices (guinea-pig) was reduced by several manoeuvres (NH4-prepulse-technique, CO2/bicarbonate-withdrawal-technique, acetazolamide, DIDS). Each manoeuvre resulted in an attenuation of d-GABAA. The inhibition of a Cl-/bicarbonate-exchanger with DIDS could also weaken h-GABAA which was selectively impaired by ethacrynic acid--known to block an ATP-driven somatic Cl(-)-extrusion mechanism. In conclusion, bicarbonate-fluxes contribute to d-GABAA rather than to h-GABAA which is mainly driven by Cl(-)-fluxes. An uneven distribution of Cl(-)-extrusion mechanisms along the adult CA3-neurones is likely to build up the anion-gradients necessary to generate biphasic GABAA-responses.

Acetazolamide↗

Uneven distribution of intracellular Cl- in rat hippocampal neurons.

Electrophysiological observations of neurons suggest that perikarya and dendrites differ in local intracellular Cl- concentration ([Cl-]i), that has not been demonstrated yet. Regional [Cl-]i in cultured hippocampal neurons was estimated using a Cl(-)-sensitive fluorescent dye. Calibration showed that perikaryonic [Cl-]i was lower than dendritic [Cl-]i. Ethacrynic acid, an inhibitor of the outwardly directed Cl(-)-pump, increased the perikaryonic but not dendritic [Cl-]i. A decrease in [Cl-]i induced by furosemide or bumetanide, inhibitors of Na+/K+/2Cl- cotransporters, was more prominent in dendrites than in perikarya. These findings suggest that uneven distribution of Cl- is generated by the region-specific localization of these transporters.

Animals↗

Thiol ester hydrolysis catalyzed by glutathione S-transferase A1-1.

rGSTA1-1 has been shown to catalyze the hydrolysis of the thiol ester glutathionyl ethacrynate (E-SG). In contrast, neither the retro-Michael addition with the substrate EA-SG, to yield GSH and ethacrynic acid (EA), nor the conjugation reaction between GSH and EA to yield the thiol ester E-SG was catalyzed to any measurable extent under similar conditions. The steady state kcat and KM for hydrolysis of E-SG by wild type rGSTA1-1 were 0.11 +/- 0.009 min-1 and 15.7 +/- 1.6 mM, respectively. The site-directed mutant, Y9F, in which the catalytic Tyr-9 is substituted with Phe, was completely inactive in this reaction. To uncover a mechanistic signature that would distinguish between direct hydrolysis and covalent catalysis involving acylation of Tyr-9, solvent isotope exchange and mass spectrometry experiments were performed. No 18O incorporation into the starting thiol ester was detected with initial velocity solvent isotope exchange experiments. However, covalent adducts corresponding to acylated protein also were not observed by electrospray ionization mass spectrometry, even with an assay that minimized the experimental dead time and which allowed for detection of N-acetyltyrosine acylated with EA in a chemical model system. The kon and koff rate constants for association and dissociation of E-SG were determined, by stopped flow fluorescence, to be 5 x 10(5) s-1 M-1 and 6.7 s-1, respectively. Together with the isotope partitioning results, these rate constants were used to construct partial free energy profiles for the GST-catalyzed hydrolysis of E-SG, assuming that Tyr-9 acts as a general acid-base catalyst. The "one-way flux" of the thiol esterase reaction results directly from the thermodynamic stability of the products after rate-limiting attack of the thiol ester by H2O or Tyr-9, and is sufficient to drive the hydrolysis to completion, in contrast to GST-catalyzed breakdown of other GSH conjugates.

Animals↗

Evidence against a contribution by Na(+)-Cl- cotransport to chloride accumulation in rat arterial smooth muscle.

1. Chloride accumulation into rat saphenous arterial smooth muscle has been examined using chloride-sensitive microelectrodes, to assess the contribution of Na(+)-Cl-cotransport. 2. Bumetanide (10 microM) produced a fall in intracellular chloride ([Cl-]i), and a hyperpolarization of membrane potential (Em). However, [Cl-]i remained above the equilibrium level predicted from the membrane potential, indicating a residual accumulation. 3. Replacement of extracellular sodium with N-methyl-D-glucamine or choline caused a fall in [Cl-]i similar to that observed with bumetanide, but the hyperpolarization of Em was larger. In Na(+)-free media, bumetanide had no effect. [Cl-]i remained significantly above equilibrium. 4. In the presence of bumetanide, chlorothiazide produced a further dose-dependent fall in [Cl-]i, and hyperpolarization of Em. However, although [Cl-]i fell more than with bumetanide alone, it remained significantly above equilibrium. Metolazone was without effect at 100 microM. 5. In the presence of bumetanide, ethacrynic acid and N-ethyl maleimide caused a dose-dependent hyperpolarization of Em and a fall in [Cl-]i to equilibrium. 6. The third inward chloride pump in rat saphenous arterial smooth muscle appears not to be a form of Na(+)-Cl- cotransport. The potency series of thiazide diuretic action (acetazolamide > chlorothiazide > metolazone) differed significantly from that published for Na(+)-Cl- cotransport, and there is no sodium dependence.

Animals↗