Biomedical subjects
Publications and source records attributed to K O Haustein.
16-Acetyl-gitoxin, the cardioactive metabolite of pengitoxin, was estimated by the 86Rb uptake technique. In 70 consecutive patients taking an oral maintenance dose of pengitoxin 0.4 mg (Pentagit), the mean plasma concentration was 20.8 +/- 6.7 ng/ml. Toxic signs were not observed up to plasma levels of 40 ng per ml.
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After oral administration of 3H-penta-acetyl-gitoxin (Pengitoxin W.H.O., Pentagit) 1.5 mg to four volunteers, serum radioactivity diclines with a half-life of 62 +/- 10 hours. After an oral maintenance dose of 0.4 mg pengitoxin in five digitalized patients, four of them with a cannulated bile duct, serum radioactivity declines with half-life of 56 +/- 8 hours. In volunteers within 4 days 50.7% of the administered radioactivity is excreted in urine; in the patients 52.3% in urine and 28.0% in bile. By thin-layer chromatographic studies, 16-acetyl-gitoxin was charactrized as the main metabolite in serum, bile and urine. Furthermore, in the first 8 hours after administration, two additional metabolites occur in urine.
Pharmacokinetic studies were carried out with 3H-phenprocoumon (3H-PPC) during long-term treatment with phenprocoumon (PPC, Falithrom) in 10 female and male patients with thromboembolic diseases. Additionally, 12 mg 3H-PPC were administered per os to 6 male volunteers. Half-life and pattern of urine metabolites were measured and compared with those in patients. The radioactivity decreased independently of the total PPC plasma concentration, which was estimated fluorometrically. An exponential regression with a high coefficient of determination was found between the mean maintenance dose (PPC) and the area under plasma concentration curve of radioactivity. This procedure is considered to be a method to improve long-term treatment with PPC.
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The inotropic and arrhythmogenic effects of 16-acetyl-gitoxin and digoxin were studied in isolated cardiac preparations and in anaesthetized dogs. ECG alteration-producing and lethal doses of both glycosides were determined in anaesthetized cats. In the isolated guinea-pig atrium, the properties of 16-acetyl-gitoxin are identical with those of ouabain, and in the isolated guinea-pig heart they are equal to those of digoxin, while gitoxin and penta-acetyl-gitoxin produce equieffective reactions at higher glycoside concentrations. In the cat, 75% of lethal doses of 16-acetyl-gitoxin and digoxin provoke ECG changes (qrs complex prolongation). The ratio of the lethal doses amounts to 1:2.8 and 1:3.5 (digoxin:16-acetyl-gitoxin). In case of equal contractile increment, the ratio of glycoside doses in dogs amounts to 1:1.3, while the percentages of rhythm disturbances following both glycosides are identical. Apart from slight deviations of the doses used, the cardiac properties of 16-acetyl-gitoxin are equal to those of digoxin.
3H-16-acetyl-16alpha-gitoxin or 3H-penta-acetyl-16alpha-gitoxin were injected iv or administered po to 15 volunteers and 3 patients. The elimination half-life and excretion in urine within 4 days were estimated as a percentage of the administered radioactivity, and metabolic studies on the fate of the administered glycosides were performed. In volunteers the following results were obtained: 3H-16-acetyl-16alpha-gitoxin 1 mg iv.: 50 +/- 11 h, 28.3 +/- 4.1%; 3H-16-acetyl-16alpha-gitoxin 1mg po: 48 +/- 8 h, 25.4 +/- 2.8%; 3H-penta-acetyl-16alpha-gitoxin 2 mg po: 51 +/- 12 h, 20.7 +/- 3.2%, respectively. In 3 patients with a cannulated bile duct 9.9% (mean) of the administered 3H-16-acetyl-16alpha-gitoxin was excreted. By comparison of the radioactivity excreted in urine following the 2 routes of 16-acetate administration, the percentage absorption was calculated to be 88.5%. In serum and urine 16-acetyl-16alpha-gitoxin and 16alpha-gitoxin were found as possible metabolites of both glycosides, in the ratio of 75-85:15-25, and both metabolites were also found in bile. Within 16 h after penta-acetate administration, two additional metabolites (bis-acetyl-derivatives of 16alpha-gitoxin) were detected in serum and urine within 16 h after administration of penta-acetate.
The pharmacokinetics of 3H-16-epi-gitoxin have been investigated after oral administration: The peak serum level occurred after 30-60 min, and its subsequent decline was in two phases with half-lives of 3.5 and 19.5 h, respectively. Within 3 days 66-70% of the administered radioactivity were eliminated by renal excretion. In the first 16 h 15% of excreted activity was in metabolites, but thereafter the glycoside was excreted in unchanged form. The metabolites were characterized by thin-layer chromatography and radio-scanning; it is assumed that they correspond to the bis- and monodigitoxosides as well as to the genin of 16-epi-gitoxin. The unusual pharmacokinetics of the glycoside are discussed in relation to its special kinetics at the molecular level, i.e. the rapid dissociation rate of the glycoside-(Na+ + K+)-ATPase-complex.
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.
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The contractility and arrhythmogenic effects of 16-epi-gitoxin and ouabain were studied in dogs. ECG alteration-producing and lethal doses of both glycosides were determined in cats. 16-Epi-gitoxin was found to be a glycoside with rapid onset and short duration of action. In case of equal contractile increment ouabain caused a higher percentage of rhythm disturbances in dogs than 16-epi-gitoxin. This finding corresponds to that in cats, in which ECG changes (QRS complex prolongation) occurred after ouabain at a lower percentage of the lethal dose than after 16-epi-gitoxin. Apart from its slight arrhythmogenic effects, 16-epi-gitoxin may be compared with acetylstrophanthidin.
Action potentials of isolated Purkinje fibres and ventricular muscle fibres of canine hearts treated with ouabain and 16-epi-gitoxin were recorded by microelectrodes. Under the influence of both glycosides, Purkinje system fibres became inexcitable earlier than ventricular muscle fibres. Being exposed to 0.125 muM ouabain and 2.5 muM 16-epi-gitoxin, both Purkinje and ventricular muscle fibres became poisoned in the same time as ventricular muscle fibres exposed to 0.1 muM ouabain and 1.5 muM 16-epi-gitoxin. At the lower 16-epi-gitoxin concentration Purkinje fibres had 2.5 times the survival time of that exposed to the lower ouabain concentration. Compared to 16-epi-gitoxin the inexcitability of Purkinje fibres after ouabain remained irreversible. The semisynthetic glycoside 16-epi-gitoxin exerts a weaker effect on the specialized conducting system.
In the present paper, the naturally occurring glycosides digitoxin, gitoxin, 16-acetyl-gitoxin, digoxin, cymarol, ouabain, and proscillaridin, and the semi-synthetic 16-epi-gitoxin and 16-acetyl-16-epi-gitoxin are investigated as to their inotropic action and their effects on rhythmicity at isolated spontaneously beating atria of the guinea-pig heart in dependence on the variation of the potassium concentration of the nutritive fluid ([K+]0: 1.34, 2.68, and 5.36 mM resp.). The major results are as follows. 1. Effects of raising [K+]0 from 1.34 to 2.68 mM: The range of the inotropically effective concentrations as well as the size of the maximum inotropic action are more or less strongly improved with all glycosides. The glycoside concentrations required to get inotropic maximum had to be increased to a high degree with proscillaridin and digoxin. The mean arrhythmia percentage occurring at the inotropic maximum is either decreased (gitoxin, 16-epi-gitoxin, digoxin, proscillaridin), unchanged (digitoxin, 16-acetyl-16-epi-gitoxin) or even increased (16-acetyl-gitoxin, cymarol, ouabain). The inotropic value is improved to a high extent with gitoxin only. 2. Effect of raising [K+]0 from 2.68 to 5.36 mM: The range of the inotropically effective concentrations is extended (digitoxin and cymarol) or diminished (proscillaridin), but remains essentially unchanged with most glycosides. The size of the maximum inotropic effect is increased with digoxin, ouabain and 16-epi-gitoxin, but decreased significantly with digitoxin and proscillaridin. The glycoside concentrations required to produce the inotropic maximum are essentially unchanged with the exception of 16-epi-gitoxin, 16-acetyl-gitoxin and ouabain. The mean arrhythmia percentage at the maximum inotropic effect is dramatically reduced with digoxin, cymarol and proscillaridin. The inotropic value is improved with all glycosides except digitoxin. 3. Evaluation of the various glycosides: When judged on the basis of the range of inotropically effective concentrations, the maximum inotropic effect, the mean arrhythmia percentage at the inotropic maximum and the inotropic value, the best first three glycosides include 16-epi-gitoxin and digoxin. 16-Epi-gitoxin and its 16-acetate show that most favourable relationship between the effect on contractility and rhythmicity. The cause of the differential actions of the structurally-different glycosides on contractility and rhythmicity is hypothesized to be due to divergences in structure and/or conformation of the receptor areas of (Na+ + K+)-ATPase of contractile and excitable cells.
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