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Functional expression of P-glycoprotein and multidrug resistance-associated protein (Mrp1) in primary cultures of rat astrocytes.

Although it has been well established that the drug efflux pump P-glycoprotein (P-gp) protects the brain against the entry of cytotoxic drugs, its real in situ localization, i.e., at brain capillary endothelial cells or on astrocyte foot processes, is still controversial. The aim of this study was to compare the expression of P-gp and of multidrug resistance-associated protein (Mrp1), another drug efflux pump, in cultured neonatal rat brain astrocytes and in cultured brain capillary endothelial cells. Reverse transcriptase-polymerase chain reaction (RT-PCR) analysis showed that the mdr1b gene was preferentially expressed in astrocytes, whereas both mdr1a and mdr1b mRNA were detected in endothelial cells. Moreover, the mrp1 gene encoding Mrp1 was expressed in both cell types. Western blotting analysis revealed higher expression of P-gp in endothelial cells as compared with astrocytes, but higher expression of Mrp1 in astrocytes. Moreover, P-gp and Mrp1 expression was not modified in more differentiated astrocytes obtained when cultured with db-cAMP for 48 hr. Our functional analysis of P-gp showed a modest effect of P-gp modulators (CsA, verapamil, PSC 833) on the uptake of colchicine (a substrate of P-gp) by astrocytes, whereas they increased by about 50% the uptake of vincristine (a common substrate of P-gp and MRP) by astrocytes. MRP modulators (genistein, probenecid, and sulfinpyrazone) did not modify the uptake of colchicine but increased that of vincristine with a major effect found for sulfinpyrazone. Moreover, indomethacin, probenecid, and sulfinpyrazone increased the uptake of fluorescein (a substrate of MRP but not of P-gp). Taken together, our results provide the first biochemical and functional evidence supporting the expression of P-gp and Mrp1 in rat cultured astrocytes.

ATP Binding Cassette Transporter, Subfamily B, Mem↗

Use of platelet inhibitor drugs in peripheral and cerebral vascular disorders.

A review is given on the clinical studies performed with aspirin in patients with chronic vascular occlusions of the limbs and on studies in cerebral ischemia using aspirin and sulfinpyrazone. Aspirin reduces the risk of reocclusions in patients after vascular surgery and also reduces the risk of peripheral vascular occlusions in diabetic patients. In doses of 1.2-1.5 g/day it also reduces the frequency of transient ischemic attacks. Conclusive results of similar studies with sulfinpyrazone and dipyridamole can be expected of the ongoing studies. Aspirin has no effect on the course of glomerulonephritis in children. Warfarin plus dipyridamole seem to have some effect in patients renal allografts. Sulfinpyrazone and ASA reduced the incidence of shunt thromboses in hemodialyzed patients. Several case reports in patients with thrombocytemia or Raynaud's syndrome made it likely that treatment with antiplatelet drug reduces the incidence of vascular occlusions.

Arterial Occlusive Diseases↗

Selection and results of antiplatelet therapy in the prevention of stroke and myocardial infarction.

Four antiplatelet drugs have been evaluated in cerebrovascular disease and in coronary heart disease--dipyridamole, clofibrate, sulfinpyrazone, and aspirin. There is no evidence that dipyridamole or clofibrate is beneficial in patients with stroke or myocardial infarction. Aspirin is effective in reducing stroke and death in patients with transient cerebral ischemia. Although aspirin has not been reported to significantly (statistically) reduce mortality or frequency of ischemic events in patients with acute myocardial infarction, five of six randomized trials showed a similar favorable trend. Sulfinpyrazone seems to be ineffective in the treatment of transient cerebral ischemia, but there is evidence that it decreases the incidence of sudden death in patients with myocardial infarction. In patients with prosthetic heart valves, the combined use of aspirin or dipyridamole with an oral anticoagulant is more effective in preventing systemic embolism than an oral anticoagulant alone.

Adult↗

The role of platelets in transient ischemic attacks and cerebral vascular accidents.

In a 5 1/2-year study in 585 patients, aspirin, 1200 mg/day, reduced 50% the risk of stroke or death in men who had experienced at least one episode of neurological disability in carotid or vertebral-basilar territory. Adding sulfinpyrazone to aspirin did not improve the results, and sulfinpyrazone alone was no better than placebo. Women did not experience the same benefit; aspirin did not reduce their risk of stroke or death.

Aspirin↗

Role of platelet inhibitor therapy in myocardial infarction.

Atherosclerotic plaque disruption is the predominant pathogenetic mechanism underlying the acute coronary syndromes. Plaque rupture leads to the exposure of collagen and vessel media, resulting in platelet and clotting activation, and occlusive thrombus formation. While drugs that interfere with platelet activation and function have been available for years, more powerful agents with novel mechanisms of action are being developed. Of the available platelet inhibitor drugs, only aspirin, sulfinpyrazone, and dipyridamole have undergone extensive clinical testing in patients with cardiovascular disease. More recently ticlopidine, a new and potent platelet inhibitor, has been successfully tested in patients with coronary and vascular disease. In acute myocardial infarction, aspirin significantly reduces cardiovascular mortality and reinfarction. Furthermore, the combination of aspirin and a thrombolytic agent produces maximal benefit. A role for heparin in the prevention of early mortality and reinfarction is emerging. This drug is effective for the prevention of left ventricular thrombosis in patients with anterior myocardial infarction. In the secondary prevention of reinfarction and cardiovascular mortality, available data support the use of a platelet inhibitor. Trials have shown that aspirin is as effective alone as in combination with dipyridamole, and is probably more effective than sulfinpyrazone. Long-term anticoagulant therapy also appears to be beneficial, but is associated with a high cost, need for extensive monitoring, and potential for hemorrhagic side effects. The role of aspirin in primary prevention is controversial. It may be indicated for patients at high risk for coronary disease in whom the benefit of therapy may outweigh the potential risk of cerebral bleeding. Coronary atherosclerotic plaque rupture, associated with thrombus formation, is fundamental to the development of acute myocardial infarction. Based on this concept, the role of antithrombotic therapy for the prevention or treatment of ischemic events in patients with coronary artery disease has stimulated enormous interest among clinicians and basic investigators. In this review we will examine: a) the pathogenesis of coronary thrombosis, b) the pharmacology of platelet-inhibitor agents, and c) their role in the management of patients with acute myocardial infarction and in primary and secondary prevention of cardiovascular disease. Platelets interact with both the coagulation and fibrinolytic systems in the pathogenesis of thrombosis.(ABSTRACT TRUNCATED AT 400 WORDS)

Aspirin↗

Modulation of arachidonic acid metabolites and vulnerability to ventricular fibrillation during myocardial ischemia in the cat.

To determine the relative importance of arachidonic acid pathway products on vulnerability to ventricular fibrillation (VF), we examined the effects of synthesis inhibitors and a receptor blocker acting in the cyclooxygenase (C) and lipoxygenase (L) pathways on VF thresholds in a feline model of coronary occlusion. Thresholds for the induction of VF wer measured before and after a 5-minute coronary occlusion in drug-treated animals and control subjects. Animals were treated with BW755c, a dual L and C inhibitor, CGS-8515, and L inhibitor, FPL-55712, a leukotriene receptor blocker, or sulfinpyrazone, a C inhibitor. BW755c, CGS-8515, and FPL-55712 all prevented an otherwise significant fall in VF threshold during coronary occlusion (p less than 0.01) independent of an effect on effective refractory period, heart rate, or blood pressure. In contrast, sulfinpyrazone, the only compound devoid of an effect on the L pathway, did not protect against an occlusion-related fall in VF threshold. BW755c and CGS-8515 inhibited the synthesis of L and C metabolites coincident with their protection against VF (p less than 0.01). We conclude that agents that antagonize the effects of L products protect against enhanced ventricular vulnerability during acute ischemia, whereas C inhibition alone may not afford this protection.

4,5-Dihydro-1-(3-(trifluoromethyl)phenyl)-1H-pyraz↗

Indium-111 platelet imaging for detection of platelet deposition in abdominal aneurysms and prosthetic arterial grafts.

Thirty-four platelet imaging studies were performed in 23 patients to determine whether platelet deposition could be detected in patients with vascular aneurysms (18 patients) or in patients in whom Dacron prosthetic grafts had been place (5 patients). In patients in whom abnormal platelet deposition was detected, the effect of administration of platelet-active drugs on platelet deposition was examined. Of the 18 patients with an aneurysm, 12 had positive studies on initial imaging and 2 had equivocally positive images. Of five patients with Dacron arterial grafts in place, four had diffuse platelet deposition in the grafts; the fifth patient had platelet deposition only in a pseudoaneurysm. Eight patients with an abdominal aneurysm and positive or equivocally positive baseline images were restudied during platelet-active drug therapy either with aspirin plus dipyridamole (seven patients) or with sulfinpyrazone (four patients). No patient studied during treatment with aspirin plus dipyridamole had detectably decreased platelet deposition compared with baseline determinations. In contrast, two of four patients studied while receiving sulfinpyrazone showed decreased platelet deposition. Thus, platelet imaging may be of value for studying platelet physiology in vivo and for assessing platelet-active drugs and the thrombogenicity of prosthetic graft materials in human beings.

Abdomen↗

Platelets, carotids, and coronaries. Critique on antithrombotic role of antiplatelet agents, exercise, and certain diets.

"Antiplatelet" drugs and certain life styles seem to have an "antithrombotic" effect that may help protect against stroke and heart attack. This review of the experience with aspirin, dipyridamole, and sulfinpyrazone offers new interpretations of some of the major clinical trials, suggests guidelines for use of antiplatelet drugs, and integrates novel observations on diet and exercise into the "thromboxane-prostacyclin balance" hypothesis. It is argued that the Canadian stroke study showed that aspirin protects men with transient ischemic attacks from coronary death as well as from stroke, that type II errors may have been made in some clinical trials, that aspirin protects women as well as men, that aspirin benefits patients who have had a heart attack, that the effect of aspirin in angina varies with the type of angina, that the dose of aspirin used may not be critical, that guidelines for use of dipyridamole and sulfinpyrazone are still inconclusive, and that exercise and fish oil supplements may be "antithrombotic."

Angina Pectoris↗

Flow cytometric measurement of calcium influx in murine T cell hybrids using Fluo-3 and an organic-anion transport inhibitor.

A method is described to facilitate flow cytometric analysis of calcium mobilization upon stimulation of murine T cell hybrids. In these transformed cell lines, the accuracy of cytometric measurement of free cytoplasmic calcium with Fluo-3 is compromised by the rapid loss of the intracellular dye. We have found that the addition of sulfinpyrazone, a known organic-anion transporter inhibitor in epithelial cells and in macrophages, severely impairs the leakage of the Fluo-3 probe from the cytoplasmic matrix. Under appropriate conditions, sulfinpyrazone has little effect on the cell physiology and permits the detection of calcium influx in a variety of murine T cell hybrids.

Aniline Compounds↗

A sensitive model of venous thrombosis in rats.

Several antithrombotics (heparin, acetylsalicylic acid, sulfinpyrazone and dipyridamole) as well as an antiserotonin ketanserin were tested in a new sensitive model of venous thrombosis in rats. Intravenous injection of hypotonic saline was used for thrombus induction combined with the vena cava ligation. Formation of thrombi was evaluated by their weights. With i.v. heparin, oral sulfinpyrazone and acetylsalicylic acid, i.v. dipyridamole and ketanserin an effective inhibition was obtained, whereas with oral dipyridamole and ketanserin the inhibition remained incomplete.

Animals↗

Antithrombotics in view of thrombosis models.

Two highly sensitive models of arterial and venous thrombosis forming with the test of endothelial stability a complementary system with a maximum stress on the role of vascular lesion were used to test a series of four antithrombotic drugs (heparin, acetylsalicylic acid, dipyridamole, sulfinpyrazone) and four drugs with other indications but with an antithrombotic activity in experiment (prenylamine, troxerutin, ketanserin and pizotifen). All drugs, except heparin, were given orally. Whereas heparin, aspirin and prenylamine had mixed effects on both arterial thrombosis (i.e. mostly on platelet functions) as well as on endothelial stability, ketanserin and pizotifen had a predominant effect on the former while dipyridamole, troxerutin and sulfinpyrazone influenced mostly the latter function.

Animals↗

Human equivalent doses of platelet inhibitors and experimental atherosclerosis.

The effects of aspirin, dipyridamole and sulfinpyrazone on the development of atherosclerotic lesions in the aorta were studied in cholesterol-fed rabbits. Aspirin and sulfinpyrazone prevented the development of atherosclerosis, whereas dipyridamole-treated animals developed advanced atherosclerotic lesions. As all the three drugs inhibit platelet function, some non-platelet effects are probably responsible for the differences in results. It is felt that dipyridamole should be avoided in hypercholesterolemic individuals.

Animals↗

Plasma factor and platelet sensitivity to prostacyclin in patients with peripheral vascular disease before and after treatment with a combination of a cyclooxygenase and a phosphodiesterase inhibitor.

According to a pathogenetic concept originally presented by Moncada in 1977 a therapeutic combination of a low-dose cyclooxygenase inhibitor with a phosphodiesterase inhibitor might help in restoring a disturbed hemostatic balance, as thromboxane synthesis in the platelets should be inhibited to a greater extent than the prostacyclin synthesis of the endothelium. Therefore, we evaluated the influence of a therapeutic combination of cyclooxygenase inhibitors in different dosages (sulfinpyrazone, acetylsalicylic acid) with a phosphodiesterase inhibitor (dipyridamole) on platelet sensitivity and plasma factor in comparison to placebo treatment. We examined 76 males with peripheral vascular disease (PVD) stage IIa according to Fontaine in a double-blind randomized study over a 3 months period. Patients were divided into 4 groups and the different drugs were randomized as follows: I. 75 mg sulfinpyrazone and 75 mg dipyridamole, II. 150 mg ASA and 75 mg dipyridamole, III. 330 mg ASA and 75 mg dipyridamole, IV. placebo. Clinical symptoms as well as the plasma factor and the diminished platelet sensitivity to prostacyclin in patients with PVD remained unchanged throughout the whole observation period. Our findings suggest that no improvement in hemostatic dysregulation can be obtained by this combined treatment.

Aspirin↗

Protection from arrhythmias of cultured heart cells by nonsteroidal antiinflammatory drugs.

The nonsteroidal antiinflammatory drugs: acetylsalicylic acid, salicylic acid, sulfinpyrazone and indomethacin were tested at 10(-10) - 10(-5) M for their effect on arrhythmias of monolayer cultures of neonatal rat heart myocytes. Arrhythmias produced by reoxygenation were prevented or significantly reduced (p less than or equal to 0.05) by either indomethacin or salicylic acid at 10(-9) M. Acetylsalicylic acid and sulfinpyrazone, while not significantly anti-arrhythmic, produced consistent numerical inhibition of arrhythmias at 10(-9) M.

Animals↗

Mutation of Trp1254 in the multispecific organic anion transporter, multidrug resistance protein 2 (MRP2) (ABCC2), alters substrate specificity and results in loss of methotrexate transport activity.

The ATP-binding cassette (ABC) proteins comprise a large superfamily of transmembrane transporters that utilize the energy of ATP hydrolysis to translocate their substrates across biological membranes. Multidrug resistance protein (MRP) 2 (ABCC2) belongs to subfamily C of the ABC superfamily and, when overexpressed in tumor cells, confers resistance to a wide variety of anticancer chemotherapeutic agents. MRP2 is also an active transporter of organic anions such as methotrexate (MTX), estradiol glucuronide (E217betaG), and leukotriene C4 and is located on the apical membrane of polarized cells including hepatocytes where it acts as a biliary transporter. We recently identified a highly conserved tryptophan residue in the related MRP1 that is critical for the substrate specificity of this protein. In the present study, we have examined the effect of replacing the analogous tryptophan residue at position 1254 of MRP2. We found that only nonconservative substitutions (Ala and Cys) of Trp1254 eliminated [3H]E217betaG transport by MRP2, whereas more conservative substitutions (Phe and Tyr) had no effect. In addition, only the most conservatively substituted mutant (W1254Y) transported [3H]leukotriene C4, whereas all other substitutions eliminated transport of this substrate. On the other hand, all substitutions of Trp1254 eliminated transport of [3H]MTX. Finally, we found that sulfinpyrazone stimulated [3H]E217betaG transport by wild-type MRP2 4-fold, whereas transport by the Trp1254 substituted mutants was enhanced 6-10-fold. In contrast, sulfinpyrazone failed to stimulate [3H]MTX transport by either wild-type MRP2 or the MRP2-Trp1254 mutants. Taken together, our results demonstrate that Trp1254 plays an important role in the ability of MRP2 to transport conjugated organic anions and identify this amino acid in the putative last transmembrane segment (TM17) of this ABC protein as being critical for transport of MTX.

Amino Acid Sequence↗

The interaction of 3,5-pyrazolidinedione drugs with receptors for f-Met-Leu-Phe on human neutrophil leukocytes: a study of the structure-activity relationship.

The 3,5-pyrazolidinedione (3,5-P) drugs, phenylbutazone and sulfinpyrazone, have been reported to bind to receptors for the chemotactic peptide, f-Met-Leu-Phe, and to behave as functional antagonists of f-Met-Leu-Phe in human and rabbit neutrophils. To explore the structure-activity relationship of this family of drugs for f-Met-Leu-Phe receptor binding, 36 drugs with the 3,5-P structure, a structure related to antipyrine, or an unrelated structure were tested as competitors for the binding of f-Met-Leu-Phe-Lys-fluorescein isothiocyanate on human neutrophils by flow cytometric analysis. Only drugs possessing the 3,5-P ring were significant competitors. The five most potent 3,5-Ps behaved as selective antagonists of f-Met-Leu-Phe-induced superoxide anion release by neutrophils. The potency was not correlated to the pKa or to their capacity to inhibit prostaglandin E2 released from culture fibroblasts but instead appeared to be correlated to their apparent octanol-buffer partition coefficients. The most potent f-Met-Leu-Phe antagonist identified, 1,2-diphenyl-4-(3-(1-naphthyl)-propyl)-3,5-pyrazolidinedione (DPN), may also possess an improved pharmacodynamic specificity compared with phenylbutazone and sulfinpyrazone, as it was less potent than phenylbutazone in the inhibition of prostaglandin synthesis and it was not cytotoxic. DPN may be a prototype for a valuable new class of anti-inflammatory drugs.

Binding, Competitive↗

111In-oxine platelet imaging in hemodialysis patients: detection of platelet deposition at vascular access sites.

The value of 111In-oxine platelet imaging to assess abnormal platelet deposition at different vascular access sites was studied in 19 hemodialysis patients. Platelets were labelled immediately following dialysis and imaging was performed 2 and 48 h later; abnormal platelet deposition was defined as a localized increase in activity over time when compared to the opposite, control extremity. 10 patients had bovine grafts, 4 had arteriovenous fistulae, and 5 had Gore-Tex grafts. 111In-oxine platelet imaging demonstrated abnormal platelet deposition in 13 out of 19 patients. Positive images were obtained in some patients with each type of vascular access. Preliminary evaluation showed no clear relationship between image positivity and the history of prior graft occlusion. The imaging method provided in vivo evidence of the efficacy of treatment with the antiplatelet agent sulfinpyrazone in half of the treated patients. Following 1 week of sulfinpyrazone, 200 mg t.i.d., in 6 patients, 3 showed a definite decrease in platelet deposition, 2 showed a probable decrease, and 1 showed no change following therapy. We conclude that platelet imaging may provide organ-specific, in vivo evidence for abnormal platelet deposition in several types of vascular access sites, and may be useful in assessing the thrombogenicity of prosthetic materials and the efficacy of antithrombotic drugs.

Adult↗

Saphenous vein graft patency 1 year after coronary artery bypass surgery and effects of antiplatelet therapy. Results of a Veterans Administration Cooperative Study.

To determine whether antiplatelet therapies improve saphenous vein graft patency after coronary artery bypass grafting, we compared 1) aspirin (325 mg once daily), 2) aspirin (325 mg three times daily), 3) aspirin and dipyridamole (325 mg and 75 mg, respectively, three times daily), 4) sulfinpyrazone (267 mg three times daily), and 5) placebo (three times daily). Therapy with dipyridamole and sulfinpyrazone was started 48 hours before bypass graft surgery, and aspirin treatment was begun 12 hours before surgery as a single 325-mg dose. Postoperative treatment was started 6 hours after surgery and continued for 1 year. Graft patency data were obtained early (median, 9 days) and late (median, 367 days) after surgery. The early graft occlusion rate was decreased with all aspirin treatment regimens compared with that of the placebo regimen. At 1 year, in 406 patients with 1,315 grafts, the graft occlusion rate in all of the aspirin groups combined was 15.8% compared with 22.6% for the placebo group (p = 0.029). The patients taking aspirin once daily had a lower occlusion rate (13.2%) compared with the patients receiving placebo (p = 0.050). At 1 year, in the vein grafts placed to vessels less than or equal to 2.0 mm in diameter (804 distal sites), the graft occlusion rate in all of the aspirin groups was 20.1% compared with 32.3% for the placebo group (p = 0.008). In the vein grafts placed to vessels greater than 2.0 mm in diameter (511 distal sites), there was no difference in the occlusion rates between aspirin and the placebo group at 1 year (8.7% vs. 9.0%, p = 0.918).(ABSTRACT TRUNCATED AT 250 WORDS)

Aspirin↗