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Cephaloridine-induced lipid peroxidation initiated by reactive oxygen species as a possible mechanism of cephaloridine nephrotoxicity.

Rat kidney microsomes reduced cephaloridine when incubated anaerobically with NADPH. Superoxide anion was generated in a concentration- and time-dependent manner when cephaloridine was incubated with rat kidney microsomes. Cephaloridine increased the in vitro peroxidation of rat kidney microsomal lipids in a concentration- and time-dependent manner. Cephaloridine-induced lipid peroxidation was inhibited by a combination of superoxide dismutase and catalase, by the hydroxyl radical scavengers, mannitol, (+)-cyanidanol-3 and by the singlet oxygen scavenger histidine in a concentration-dependent manner. It is proposed that cephaloridine nephrotoxicity may occur through the transfer of an electron from reduced cephaloridine to oxygen and subsequent formation of the superoxide anion, hydrogen peroxide, the hydroxyl radical and singlet oxygen. These activated oxygen species then are very likely to react with membrane lipids to induce lipid peroxidation and nephrotoxicity.

Anaerobiosis

The mechanisms of synergistic effect of antibiotics. A mechanism of synergism, cephaloridine with gentamicin on cephaloridine resistant gram negative bacilli.

Twelve strains out of 75 Gram negative rods, which were isolated at the clinical laboratory in the hospital, were highly resistant to cephaloridine (CER) and relatively sensitive to gentamicin (GM). Nine strains out of the 12 strains revealed synergistic effect when small doses of GM were used together with CER. A mechanism of synergistic effect on Enterobacter cloacae, 1 strain of the 9 strains, was studied through change of beta-lactamase activities. The levels of viable cell count decreased when small doses of GM were added compared with the ones obtained without the addition of GM. Similarly the levels of protein concentration and beta-lactamase activities in the sonicated component of sediment decreased, so did the level of beta-lactamase activities per cell. On the contrary, however, the beta-lactamase activities in the supernatant fluid showed no difference irrespective of the GM. Based upon the above mentioned findings, it is suggested that synergistic effect of CER and GM might be due to inhibition of protein synthesis as well as due to subsequent inhibition of beta-lactamase synthesis. This is compared with the author's previous study, in which the mechanism of synergistic effect of CER and chloramphenicol (CP) was partly due to inhibition of protein synthesis, but mostly due to inhibition of beta-lactamase synthesis.

Bacteria

Cephaloridine nephrotoxicity is potentiated by selenium deficiency but not copper deficiency in rats.

Lipid peroxidation may contribute to the nephrotoxicity of cephaloridine, a beta-lactam antibiotic. Copper and Se may protect against free radical damage, and dietary Se deficiency potentiates cephaloridine nephrotoxicity. The objectives of this study were to further investigate potentiation of cephaloridine toxicity by Se deficiency and to determine whether Cu deficiency increases cephaloridine-induced injury. Weanling male Sprague-Dawley rats were fed adequate, Cu-deficient, Se-deficient, and Se and Cu-deficient diets for 4 wk and subsequently injected i.p. with cephaloridine (1200 mg/kg body wt) or saline. Nephrotoxic response to cephaloridine occurred, with increased plasma urea, kidney weight, excretion of urinary enzymes, and kidney lesions. Cephaloridine also increased plasma sorbitol dehydrogenase activity. Selenium deficiency depressed kidney glutathione peroxidase activity (78%) and potentiated cephaloridine nephrotoxicity. Copper deficiency did not increase cephaloridine nephrotoxicity; the small depression (13%) in kidney Cu,Zn-superoxide dismutase activity may not have been sufficient to impair antioxidant status. However, the marked depression in kidney glutathione peroxidase activity during Se deficiency may have impaired antioxidant status and enhanced cephaloridine-induced injury. In contrast to results in the kidney, neither Se deficiency nor Cu deficiency potentiated cephaloridine hepatotoxicity, as assessed by plasma SDH activity.

Animals

Inactivation of cephalothin and cephaloridine by Staphylococcus aureus.

Benner, Ernest J. (University of Washington School of Medicine, Seattle), John V. Bennett, Jean L. Brodie, and William M. M. Kirby. Inactivation of cephalothin and cephaloridine by Staphylococcus aureus. J. Bacteriol. 90:1599-1604. 1965.-Marked differences were observed in the susceptibility of penicillinase-producing staphylococci to cephalothin and cephaloridine. All of 100 strains of penicillin G-resistant Staphylococcus aureus, with the use of a large inoculum, were found to be susceptible to 2 mug/ml of cephalothin, whereas only 50% were susceptible to this concentration of cephaloridine, and 15% required 15 mug/ml or more for inhibition. In contrast, penicillin G-sensitive strains were more susceptible to cephaloridine and did not show the marked inoculum effect observed with the cephaloridine-resistant strains. These differences were due to a much greater destruction of cephaloridine than of cephalothin by staphylococcal penicillinase. Cephaloridine-resistant staphyloccoci were stronger penicillinase producers than were susceptible strains, and the resistant strains were found to inactivate cephaloridine by hydrolysis of the beta-lactam ring. In population studies, cephaloridine-resistant cells differed from methicillin-resistant cells in that they decreased in numbers as the drug concentration was increased, and the survivors in higher drug concentrations were no more resistant than was the parent strain. Treatment with acriflavine eliminated resistance of the cells to both penicillin G and cephaloridine. It was concluded that cephaloridine resistance was due to hydrolysis by penicillinase, and that this was related to the pyridine ring substitution in the cephalosporanic acid nucleus.

Anti-Bacterial Agents

Biochemical mechanisms of cephaloridine nephrotoxicity.

Large doses of the cephalosporin antibiotic, cephaloridine, produce acute proximal tubular necrosis in humans and in laboratory animals. Cephaloridine is actively transported into the proximal tubular cell by an organic anion transport system while transport across the lumenal membrane into tubular fluid appears restricted. High intracellular concentrations of cephaloridine are attained in the proximal tubular cell which are critical to the development of nephrotoxicity. There is substantial evidence indicating that oxidative stress plays a major role in cephaloridine nephrotoxicity. Cephaloridine depletes reduced glutathione, increases oxidized glutathione and induces lipid peroxidation in renal cortical tissue. The molecular mechanisms mediating cephaloridine-induced oxidative stress are not well understood. Inhibition in gluconeogenesis is a relatively early biochemical effect of cephaloridine and is independent of lipid peroxidation. Furthermore, cephaloridine inhibits gluconeogenesis in both target (kidney) and non-target (liver) organs of cephaloridine toxicity. Since glucose is not a major fuel of proximal tubular cells, it is unlikely that cephaloridine-induced tubular necrosis is mediated by the effects of this drug on glucose synthesis.

Animals

Lipid peroxidation: a possible mechanism of cephaloridine-induced nephrotoxicity.

Cephaloridine produces renal cortical injury, but the precise mechanism responsible for this nephrotoxicity remains unclear. Recently cephaloridine has been shown to deplete reduced glutathione (GSH) concentration selectively in renal cortex. Cephaloridine nephrotoxicity can be potentiated by diethyl maleate (a GSH depletor), but no glutathione conjugate can be detected. Thus, it was of interest to investigate further the mechanism of depletion of renal cortical GSH by cephaloridine. In the present study, cephaloridine markedly decreased GSH in rat and rabbit renal cortex while concomitantly increasing oxidized glutathione (GSSG). Furthermore, cephaloridine increased lipid peroxidation specifically in renal cortical cells. Conjugated diene formation (an index of lipid peroxidation) was increased in renal cortex but not in the liver shortly following administration of cephaloridine. Removal of selenium and/or vitamin E from the diet, which should enhance lipid peroxidation, potentiated cephaloridine nephrotoxicity and enhanced cephaloridine-induced morphological damage in the kidney. These findings are consistent with a major role of lipid peroxidation in the etiology of cephaloridine nephrotoxicity.

Animals

Effect of verapamil on cephaloridine nephrotoxicity in the rabbit.

Cephaloridine produces proximal tubular necrosis in the rabbit kidney. Calcium channel blockers have ameliorated tissue injury due to toxic and ischemic insults. To determine whether renal damage caused by cephaloridine could be modified by pretreatment with verapamil, groups of rabbits were given cephaloridine, 100 mg/kg sc, 90 min after administration of verapamil, 200 micrograms/kg iv. Histologic scoring of the extent of proximal tubular necrosis 48 h later demonstrated increased necrosis in the group receiving verapamil plus cephaloridine. Verapamil pretreatment increased the concentration of cephaloridine in the renal cortex at 0.5 hr, but did not alter the peak concentration (2 hr after the dose) or cortical concentrations at 1 or 3 hr. Assay of total calcium content in cortical mitochondria 2 hr after cephaloridine showed that verapamil pretreatment abolished the increased accumulation following cephaloridine administration. We conclude that verapamil does not protect renal proximal tubular cells from the toxic effect of cephaloridine, and that verapamil prevents the cephaloridine-induced uptake of calcium by cortical mitochondria.

Animals

Cephaloridine nephrotoxicity in streptozotocin induced diabetic Fischer 344 (F344) rats.

The purpose of this study was to determine if cephaloridine nephrotoxicity is attenuated in streptozotocin (STZ)-induced diabetic rats. Fischer 344 (F344) rats (205-250 g) were given a single injection (i.p.) of STZ (27-35 mg/kg) or citrate buffer. The nephrotoxicity of (750 mg/kg) cephaloridine (i.p.) was then compared with normoglycemic and 14-day diabetic rats. Increased blood urea nitrogen (BUN) levels as well as diminished renal cortical slice accumulation of tetraethylammonium (TEA) and lactate-stimulated p-aminohippurate (PAH) were measured (P less than 0.05) in normoglycemic rats 48 h after cephaloridine administration. Cephaloridine failed to alter BUN levels and organic ion accumulation in diabetic rats. Diabetes did not totally protect against cephaloridine toxicity since kidney weights were elevated in normoglycemic and diabetic rats 48 h after administration of 750 mg/kg cephaloridine. A series of experiments also measured BUN levels, kidney weight and renal cortical slice uptake of PAH and TEA 24, 48 and 72 h after (1500 mg/kg) cephaloridine administration. Cephaloridine increased (P less than 0.05) kidney wt and decreased PAH and TEA uptake (P less than 0.05) in the normoglycemic group at 24-72 h. No change in kidney wt, PAH or TEA uptake was observed in the diabetic rats. These data indicate diabetes reduces cephaloridine nephrotoxicity.

Animals

Comparative studies of in vitro renal cephaloridine toxicity between normoglycemic and diabetic rats.

This study investigated if the attenuation in cephaloridine toxicity associated with streptozotocin (STZ)-induced diabetes can be attributed to a direct cellular effect. Comparative studies examined the direct toxicity of cephaloridine 14 days after (35 mg kg-1, i.p.) STZ or vehicle injection of male Fischer 344 (F344) rats. In vitro cephaloridine toxicity was assessed by measuring lipid peroxidation, renal gluconeogenesis and organic ion accumulation in renal cortical slices. The in vitro toxicity of cephaloridine was reduced in the diabetic group since lipid peroxidation was not increased following a 120-min exposure to cephaloridine. This was in contrast to a concentration- and time-dependent increase in lipid peroxidation in renal tissue derived from normoglycemic animals pre-incubated with 0-5 mM cephaloridine. Renal gluconeogenesis was inhibited in a concentration-dependent manner in the normoglycemic group following a 15-90-min exposure to 0-5 mM cephaloridine. Pyruvate-stimulated gluconeogenesis was diminished in the diabetic group only after a 90-min preincubation. Renal cortical slice accumulation of p-aminohippurate (PAH) and tetraethylammonium (TEA) was decreased in the normoglycemic group. Accumulation of TEA, but not PAH, was decreased (P less than 0.05) in the diabetic group. These results indicate that in vitro cephaloridine toxicity was attenuated by STZ-induced diabetes.

Animals

Effects of drug-metabolizing enzyme inducers on cephaloridine toxicity in Fischer 344 rats.

High doses of cephaloridine produce necrosis of renal proximal tubular cells and this nephrotoxicity has been shown to be reduced by piperonyl butoxide (a mixed-function oxidase inhibitor) in rats and rabbits, and potentiated by phenobarbital (a mixed-function oxidase inducer) in rabbits but not rats. Phenobarbital is known to increase rabbit but not rat renal mixed-function oxidase activities; however, several other compounds such as polybrominated biphenyls (PBB), trans-stilbene oxide (TSO) and beta-naphthoflavone (BNF) have been shown to induce renal enzyme activities in rats. Thus, it was of interest to determine the effects of PBB, TSO and BNF on cephaloridine toxicity in Fischer 344 rats. Nephrotoxicity was estimated by measuring alterations in the kidney-to-body weight ratio, blood urea nitrogen and accumulation of p-aminohippurate (PAH) and tetraethylammonium by renal cortical slices. Hepatotoxicity was quantified as changes in serum glutamic pyruvic transaminase (SGPT) activity. Cephaloridine produced only minor changes in SGPT activity. Animals fed diet supplemented with 100 ppm of PBB for 10 days became less susceptible to cephaloridine nephrotoxicity. Similarly, pretreatment of animals with TSO (300 mg/kg) or BNF (100 mg/kg) for 4 days decreased cephaloridine toxicity. Thus, these results suggest that induction of renal drug-metabolizing enzyme activities by these 3 inducers may enhance some detoxification pathway(s) which convert cephaloridine to a non-toxic metabolite(s). Alternatively, treatments with these inducers may alter cephaloridine pharmacokinetics and decrease renal cortical accumulation of cephaloridine.

Animals

Inhibition of cephaloridine-induced lipid peroxidation.

The present study was designed to elucidate whether cephaloridine-induced lipid peroxidation is inhibited by probenecid, cobalt chloride and antioxidants such as alpha-tocopherol and N,N'-diphenyl-p-phenylenediamine (DPPD). Kidney slices obtained from the renal cortex of male Wistar rats were incubated for 1 h in a cephaloridine or cefotaxime (1.25-10 mg/ml) containing medium. In another series of experiments, kidney slices were incubated with cephaloridine or cefotaxime (5 mg/ml) for different periods of time (30-120 min). Lipid peroxidation was monitored by measuring the production of malondialdehyde (MDA). Subsequently, kidney slices were incubated in both series of experiments, in a cephalosporin free medium containing tetraethylammonium (TEA). Accumulation of TEA in renal cortical slices, expressed as slice to medium ratio (S/M), was used to measure changes in the transport capacity of the kidney cells. While cefotaxime had only a slight effect, cephaloridine induced a significant time- and concentration-dependent increase of MDA production and a significant time- and concentration-dependent decrease of TEA accumulation. Inhibition of the renal uptake of cephaloridine by probenecid induced a decrease in MDA production and complete recovery of TEA accumulation. The antioxidants DPPD and alpha-tocopherol inhibited cephaloridine-induced lipid peroxidation in a concentration-dependent manner. Recovery of TEA accumulation accompanied the decrease in lipid peroxidation. DPPD was a more potent inhibitor of lipid peroxidation than alpha-tocopherol. Cobalt chloride, known for its ability to decrease cellular concentration of cytochrome P-450, effectively decreased cephaloridine-induced lipid peroxidation. Thus, these findings support the concept that lipid peroxidation has an important role in the development of cephaloridine-induced nephrotoxicity.

Animals

Cephaloridine nephrotoxicity in aging male Fischer-344 rats.

Age-related differences in susceptibility to cephaloridine nephrotoxicity were evaluated in male Fischer-344 rats. Rats, 2.5, 4, 10-12 and 27-29 months old, were administered a single intraperitoneal dose of cephaloridine and renal function evaluated 24 h later. Susceptibility to cephaloridine-induced nephrotoxicity was age-related. Older rats (10-12 and 27-29 months) were the most susceptible to cephaloridine nephrotoxicity as indicated by a dose-related increase in relative kidney weight, elevation in blood urea nitrogen concentrations and a diminished capacity of renal cortical slices to accumulate the organic anion, p-aminohippurate (PAH) and the organic cation, tetraethylammonium (TEA). Impaired renal function following cephaloridine treatment was not detected in 2.5-month-old, apparent to a slight extent in 4-month-old, and most pronounced in 10-12- and 27-29-month-old rats. Serum and renal cortical concentrations of cephaloridine tended to be greater in older rats compared to that of young adults. Thus, the enhanced susceptibility of older rats to cephaloridine nephrotoxicity may be related in part to the increased renal cortical accumulation of cephaloridine.

Age Factors

Contribution of acetone and osmotic-diuresis by streptozotocin-induced diabetes in attenuation of cephaloridine nephrotoxicity.

Previous studies have indicated that cephaloridine nephrotoxicity was reduced in streptozotocin (STZ)-induced diabetic rats. Experiments were performed to investigate if a shorter duration of diabetes would reduce cephaloridine nephrotoxicity. Studies were also conducted to examine the contribution of osmotic diuresis and ketone accumulation to the mechanism for reduced toxicity. Male Fischer 344 (F344) rats were injected with 30 mg/kg STZ or vehicle. Seven days after STZ or vehicle administration, the animals were treated (i.p.) with 1500 mg/kg cephaloridine. Increased kidney weight, blood urea nitrogen (BUN) level and decreased renal cortical slice accumulation of p-aminohippurate (PAH) and tetraethyl-ammonium (TEA) were measured in the normoglycemic group. No differences in renal function were detected between diabetic groups treated with cephaloridine or vehicle (PFC). Pretreatment of euglycemic rats with 0 or 10% dextrose in the drinking water and by oral gavage failed to prevent the renal damage produced by 1500 mg/kg cephaloridine despite glucosuria and urine output comparable to diabetic animals. However, dextrose-diuresis afforded a slight reduction in toxicity as indicated by changes in kidney weight and renal cortical slice accumulation of PAH and TEA. Pretreatment (oral) with 0 or 1.5 ml/kg acetone had no effect on cephaloridine toxicity (1000 mg/kg, i.p.). These findings suggested that attenuation of cephaloridine toxicity may be independent of the duration of diabetes. These results also indicated that glucose-mediated osmotic diuresis and acetone accumulation cannot account for reduced cephaloridine toxicity in diabetic rats.

Acetone