[Cardenolide glycosides. XVI. Studies on the stability of lanatoside C and of the complex of lanatosides ABC in drug forms].
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The bioavailability of digoxin and lanatoside C from tablets and dragees and from solutions of the two substances has been investigated intraindividually in patients on maintenance therapy. Plasma levels and urinary excretion were analyzed by radioimmunoassay. Both plasma concentrations and urinary excretion were significantly higher after digoxin tablets (1.5+/-0.17 ng/ml; 0.15 mg/24 h) than after lanatoside C dragees (0.98+/-0.15 ng/ml; 0.1 mg/24 h). When equimolar solutions of both drugs, corresponding to 0.5 mg digoxin, were given, plasma concentrations and urinary excretion after digoxin (1.6+/-0.08 ng/ml; 0.14 mg/24 h) were again significantly higher than after lanatoside C (1.18+/-0.09 ng/ml; 0.1 mg/24 h). These results suggest that while the absorption of lanatoside C is lower than that of digoxin, it is better than has been generally assummed. The variability in the absorption of lanatoside C between patients is no greater than with digoxin.
The absorption, metabolism, and excretion of lanatoside C were studied in hospitalized subjects following oral administration of the tritiated drug. Previous reports of an unusual double peak in plasma levels of radioactivity were confirmed. Fifty plasma samples taken from 31 patients showed that an average of 74% of the radioactive material was digoxin and its metabolites. There was little or no lanatoside C in 36 of the 50 samples of plasma. Similar results were obtained for urine radioactivity. The results confirm that lanatoside C is converted to "digoxin" in the gut prior to absorption as previously proposed by us. "Digoxin" refers to digoxin and its breakdown products, namely, digoxigenin and its mono- and didigitoxosides. According to these proposals, the conversion to "digoxin" takes place partly as a result of acid hydrolysis in the gut and partly by the action of bacteria in the intestine. The effects of concurrent administration of antacid therapy, anticholinergic therapy, and food on the fate of oral lanatoside C were separately studied. There were no significant differences between groups with respect to the amount of radioactive material absorbed or excreted, but there were marked qualitative differences in the plasma profiles. There was a statistically significant increase in the time to the first peak in plasma radioactivity in patients concurrently receiving either food or anticholinergic therapy and there was a significant decrease in the relative height of the first peak in patients treated concurrently with antacid.
The effects of intravenous strophanthin K (0.125 and 0.25 MG) and lanatoside C (0.4, 0.8 and 1.6 mg) on systolic time intervals (STI) and impedance plethysmographic (IP)P values were studied in ten patients with compensated coronary heart disease. The heart rate decreased significantly during a two-hour study in the lying position after both glycosides and placebo; the systemic blood pressure remained unchanged. Electromechanical systole (QS2), left ventricular ejection time (LVET) and preejection period (PEP), corrected for heart rate (QS2I, LVETI, PEPI), showed no change after placebo. The glycosides caused no change in LVETI. QS2I was significantly shortened only after lanatoside C 1.6 mg. PEPI and ICT were significantly shortened by both doses of strophanthin K and lanatoside C; the effects were dose-related. Taking into consideration the effects of cardiac glycosides on STI, use of the index ICT/QS1, the quotient of isovolumic contraction time and electro-mechanical delay, is proposed, because it showed quite sensitively the increase in myocardial contractility after digitalis. The effect of strophanthin K could be detected 10 minutes, and that of lanatoside C 30-40 minutes, after injection. The amplitude of the IP curve and the relative pulse volume showed positive and negative changes without any trend after administration of placebo or glycoside. The data suggests that the usual therapeutic doses of these cardiac glycosides do not cause significant changes in the peripheral circulation in patients with compensated coronary heart disease, but their action on STI is quite marked, showing a positive inotropic effect.
Lanatoside C, a digitalis glycoside previously shown to be a polyclonal B-cell activator (PBA), was found to stimulate immature cells residing in fetal liver, bone marrow and spleen but also to activate cells from peripheral lymph nodes and peripheral blood. The proliferative response obtained in spleen cells was not affected by macrophage removal, whereas anti-Ig or anti-Ia antiserum pretreatment partially inhibited the responses. Removal of T cells by a pretreatment with anti-Thy 1.2 antiserum plus complement caused a marked increase in the proliferative response of the remaining cells, suggesting the existence of a naturally occurring suppressor T cell for glycoside-induced mitogenesis. Synergy experiments with 'classical' PBAs and lanatoside C, given simultaneously or subsequently, suggest an overlap between the lanatoside-C-responding cell population and the dextran sulphate (DxS)- and lipopolysaccharide (LPS)-sensitive cells. Since DxS-induced activation of B cells is dependent on macrophages, it is suggested that lanatoside C may be used as a functional marker for direct activation of immature B cells.
The raw material of lanatoside C was examined for preparation of the "Lanatoside C Reference Standard". The analytical data obtained were: melting point, 247.4 degree C; optical rotation, [alpha]20(D) = + 34.0 degree, loss on drying, 6.93%; infrared spectrum, the same as that of the Lanatoside C Reference Standard (Control 784); thin-layer chromatography, two impurities detected; high-performance liquid chromatography, several impurities detected and the total amount estimated to be about 1.26%; assay by spectrophotometry, 103.0%. Based on the above results, the candidate material was authorized as the Lanatoside C Reference Standard (Control 981) of the National Institute of Health Sciences.
Serum lanatoside C concentrations were measured by radioimmunoassay in 56 patients on oral maintenance therapy. Seven patients were judged to have digitalis toxicity and the lanatoside C concentration in this group was 6.99+/-2.00 ng/ml (mean +/-1 SD). 49 patients were non-toxic and the mean serum lanatoside C concentration in this group corresponded to 2.32+/-1.08 ng/ml.
Functional ablation of the cerebral cortex by cortical spreading depression (CSD) significantly increased the dose of desacetyl lanatoside C required to induce A-V block and ventricular fibrillation. To examine the role of the posterior hypothalamus in the increased resistance of decorticated rats to arrhythmia induced by toxic doses of desacetyl lanatoside C, four groups of animals were injected with this drug: group 1 rats had a craniotomy; group 2 rats had a craniotomy and functional decortication; group 3 rats had a craniotomy and a hypothalamic lesion; and group 4 rats had a craniotomy, hypothalamic lesion and functional decortication. The dose of drug required to induce A-V block and ventricular fibrillation was significantly less in group 1, than in groups 2,3 and 4, and there was no statistically significant difference between these last three groups. These results are consistent with the hypothesis that the increased resistance to arrhythmia induced by desacetyl lanatoside C in decorticated rats is mediated by the posterior hypothalamus.
In animal experiments arrhythmias induced by cardiac glycosides which prove fatal if untreated can be terminated by administration of glycoside-specific antibodies. Immunotherapy with digoxin-specific antibody fragments had hitherto only been employed on one occasion, namely in a person who had taken a massive overdose of digoxin with suicidal intent and who had failed to respond to symptomatic treatment. The present paper describes the use of F(ab')2 fragments of digoxin-specific antibodies in a female patient with lanatoside C intoxication to treat the associated life-threatening cardiac arrhythmia. The arrhythmia was rapidly terminated and normal sinus rhythm was restored. Treatment with the heterologous antibodies did not cause any side-effects.
Activation of Na+, K+-ATPase has previously been suggested to be the triggering signal in mitogen-induced cell activation. Using a digitalis glycoside known to be a potent polyclonal B-cell activator, this hypothesis could be tested since digitalis activates ATPase at different concentrations in various species, depending on the degree of sensitivity to the toxic effects of glycosides. Lanatoside C was found to stimulate lymphocytes from glycoside resistant species such as rat, mouse and hamster. The possible involvement of Na+, K+-ATPase was made less likely by the similarity in dose--response profile in these cells although they have been reported to display varying degrees of glycoside resistance. Furthermore, using lymphocytes from digitalis-sensitive species such as man, guinea-pig or rabbit, no mitogenicity could be recorded, strongly suggesting a lack of correlation between glycoside-induced effects on Na+, K+-ATPase and cell activation.
Lanatoside 15'-O-acetylesterase (LAE) from in-vitro-cultivated cells of Digitalis lanata Ehrh. was isolated and partially sequenced. The enzyme was extracted with citrate buffer from acetone dry powder. It was purified in a two-step chromatographical procedure including Phenyl Sepharose hydrophobic interaction chromatography followed by CM Sepharose cation-exchange chromatography to more than 330 mumol.s-1.(g protein)-1. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) of the purified protein showed a major band at 39 kDa. The protein was identified by correlation of band intensity on SDS-PAGE and enzyme activity of CM Sepharose column fractions. Size-exclusion chromatography on Sephacryl 200 revealed a single activity peak with an apparent molecular mass of about 85 kDa. Electrophoresis under nondenaturating conditions of purified LAE showed only one band with esterase activity. The intensity of this band was correlated with that of the 39-kDa band after SDS-PAGE. About 30% of the protein, including the N-terminus and several fragments obtained by Lys-C protease digestion, was sequenced. A fragment obtained by Lys-C digestion showed partial homology to other hydrolases and apoplasmic proteins. It included the probable location of an active-site histidine. The activity of LAE was high in non-morphogenic D. lanata cell strains selected for high activities in the chemical transformation of cardenolides, but rather low in the proembryogenic masses of the embryogenic cell strain VIII. It increased during the development of somatic embryos. The LAE activity in leaves of D. lanata plants was in the range 4-24 nmol.s-1.(g protein)-1.
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