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PubMed1977

[Diagnosis and therapy of megaloblastic anemias].

In most cases megaloblastic anaemias are the sequel of a deficiency of vitamin B12, more infrequently of a deficiency of folic acid of different etiology. Oriented to frequency and anamnesis the diagnostics follows the leading symptoms of pernicious anaemia (straw colour, glossitis, achlorhydria) and on the basis of special findings in the peripheral blood (hyperchromacia, megalocytosis, much decreased number of reticulocytes, increased iron and bilirubin level) it leads to the proved suspicion of a megaloblastic anaemia. This suspicion is ascertained by the investigation of the bone-marrow, with the help of aimed investigations the anaemia is further clarified differential-diagnostically. An unclear anaemia should not be treated ex juvantibus with vitamin B12 and/or folic acid. The therapy, always taking into consideration a possible basic disease, is carried out by parenteral application of vitamin B12, possibly in form of hydroxocobalamine or by folic acid. In persisting disturbance of the resorption of vitamin B12 on account of the threatening complication of a funicular spinal disease the long-term therapy must never be interrupted, unless in normal haematological findings.

Anemia, Macrocytic↗

PubMed1982

Internal transport and metabolism of cobalamin in Spirometra mansonoides (Cestoda) spargana.

The anterior 2 mm of the sparganum of Spirometra mansonoides contained 35 to 48% of the total endogenous cobalamin (Cbl) with only 2 to 4% in the terminal 1 cm. [57Co]cobalamin taken up in the posterior region of spargana was transported directionally to the anterior region and concentrated there resulting in a uniform depletion of [57Co]Cbl along the remaining body length. The anterior 2 mm contained 24% of the sparganum's holo-MMCoAM activity with only 5% in the terminal 1 cm. When head and body preparations were chromatographed on Sephadex G-150 columns eluates from both regions exhibited single peaks of MMCoAM activity at an approximate molecular weight of 150,000 and two peaks of endogenous Cbl. The first Cbl peak cochromatographed with MMCoAM activity and the second Cbl peak eluted at the position of free Cbl. Spargana rapidly converted CN-[57Co]Cbl to hydroxocobalamin (OH-Cbl) and adenosylcobalamin (Ado-Cbl) in vitro. In the head region significant amounts of Ado-Cbl were present (25%) although OH-Cbl was the predominant form of Cbl (45%) after 264 hr in a Cbl-free medium. In the body Ado-Cbl was the predominant form of Cbl (44%) although significant amounts of OH-Cbl were present (27%) after 264 hr in a Cbl-free medium. No methylcobalamin (Me-Cbl) was detected, but an unidentified cobalamin-containing entity (Fraction 4) was present. Based on these results we propose that the sparganum takes up cobalamin, concentrates it in the anterior, "head" region, sequentially metabolizes it to the hydroxyl then the adenosyl forms, and that the adenosylated form is used in this region of high, anaerobic metabolism as an obligatory coenzyme for MMCoAM, in coordination with the differentiation of the sparganum to the adult cestode.

Animals↗

PubMed1982

The effect of folate analogues and vitamin B12 on provision of thymine nucleotides for DNA synthesis in megaloblastic anemia.

The role of vitamin B12 in the folate dependent biosynthesis of thymidine nucleotides is controversial. In an attempt to clarify this, three methods have been used to assess the relative efficacy of vitamin B12 (hydroxocobalamin) and various folate analogues in titrated concentrations at correcting 'de novo' thymidylate synthesis by megaloblastic human marrow cells: (1) The deoxyuridine (dU) suppression test which analyses the reduction in (3H)-thymidine labeling of DNA by unlabeled dU. Marrow cells were also labeled with (6-3H)-dU with assessment of (2) its incorporation into DNA and (3) the accumulation of (6-3H)-deoxyuridine monophosphate (3H-dUMP). The three methods gave similar results. In both, N6-formyl tetrahydrofolate (formyl-FH4) was the most effective agent at correcting thymidylate synthesis in megaloblastic anemia due to vitamin B12 or folate deficiency. Vitamin B12 corrected the lesion in vitamin B12 deficiency but not in folate deficiency. Tetrahydrofolate (FH4) and folic acid were effective in deficiency of vitamin B12 or folate, although in both deficiencies they were less effective than formyl-FH4. Methyl-FH4 was effective in folate deficiency but not in vitamin B12 deficiency. These results confirm the failure of methyl-FH4 utilisation in vitamin B12 deficiency. They suggest that if vitamin B12 is needed in the formylation of FH4, this is a minor role in provision of the correct coenzyme for thymidylate synthesis compared with its major role of provision of FH4 from methyl-FH4.

Anemia, Macrocytic↗

PubMed1982

Abnormal deoxyuridine suppression test in congenital methylmalonic aciduria-homocystinuria without megaloblastic anemia: divergent biochemical and morphological bone marrow manifestations of disordered cobalamin metabolism in man.

We studied two brothers (J.R. and M.R.) with the cobalamin D variant of congenital methylmalonic aciduria-homocystinuria, whose previously reported lack of megaloblastic anemia conflicted with current concepts of cobalamin's role in DNA synthesis and the "methyltetrahydrofolate (MTHF) trap" hypothesis. Both subjects were indeed hematologically normal, although J.R. had a mean corpuscular volume of 96 fl. However, both demonstrated abnormalities in the deoxyuridine suppression test. J.R. had an abnormal suppression value of 21.0% (normal less than 10%) that was correctable by adding hydroxocobalamin or folic acid in vitro but not MTHF. M.R. had normal suppression (8.9%), but demonstrated worsening (18.6%) when MTHF was added. J.R.'s classical deoxyuridine suppression pattern of cobalamin deficiency thus supports the trap hypothesis. However, his lack of comparable morphological changes suggests that impaired de novo thymidylate synthesis and the trap hypothesis, though valid, may not fully account for the megaloblastic maturation accompanying cobalamin deficiency. Equally noteworthy was the deleterious effect of MTHF on M.R.'s marrow, suggesting its potential usefulness as an in vitro "stress test" for latent cobalamin abnormality.

Adolescent↗

PubMedDate not supplied

The nitrergic transmitter of the anococcygeus--NO or not?

Nonadrenergic noncholinergic (NANC) relaxations of the anococcygeus muscle are reduced by inhibitors of nitric oxide synthase (NOS). Since NOS can be detected within 6-hydroxydodpamine-resistant nerve tracts running through the muscle, it seems clear that these NANC relaxations result from activation of the L-arginine/NO pathway within the prejunctional nerve terminal, an example of so-called "nitrergic" transmission. However, a number of substances (hydroquinone, superoxide anions, hydroxocobalamin) profoundly reduce relaxations to exogenous NO but do not affect those to nitrergic field stimulation; such observations have raised questions over the nature of the substance actually released from the nitrergic nerves. Several possible explanations are discussed: (1) NO is released attached to a carrier molecule, perhaps in the form of a nitrosothiol; (2) NO is released in a modified redox form; (3) NO is released as a free radical, but is protected within the neuroeffector junction by other substances which preferentially interact with scavenger molecules; and (4) NO is released as a free radical and, because of a rapid and unhindered rate of diffusion over short distances (100-200 microM), it is less susceptible than exogenous NO to scavenger molecules. As yet, there is insufficient experimental evidence to decide which, if any, of these explanations is correct.

Amino Acid Oxidoreductases↗

PubMed1995

Inhibition of productive human immunodeficiency virus-1 infection by cobalamins.

Various cobalamins act as important enzyme cofactors and modulate cellular function. We investigated cobalamins for their abilities to modify productive human immunodeficiency virus-1 (HIV-1) infection of hematopoietic cells in vitro. We show that hydroxocobalamin (OH-Cbl), methylcobalamin (Me-Cbl), and adenosylcobalamin Ado-Cbl (Ado-Cbl) inhibit HIV-1 infection of normal human blood monocytes and lymphocytes. The inhibitory effects were noted when analyzing the monocytotropic strains HIV-1-BaL and HIV-1-ADA as well as the lymphocytotropic strain HIV-1-LAI. Cobalamins did not modify binding of gp120 to CD4 or block early steps in viral life cycle, inhibit reverse transcriptase, inhibit induction of HIV-1 expression from cells with established or latent infection, or modify monocyte interferon-alpha production. Because of the ability to achieve high blood and tissue levels of cobalamins in vivo and the general lack of toxicity, cobalamins should be considered as potentially useful agents for the treatment of HIV-1 infection.

Cells, Cultured↗

PubMedDate not supplied

Bioassay and pharmacological characterization of the nitrergic neurotransmitter.

Based on organ bath experiments illustrating nitric oxide (NO) or an NO-releasing substance as mediator of the nonadrenergic noncholinergic (NANC) nerve-induced relaxations in the canine ileocolonic junction and rat gastric fundus, a bioassay superfusion technique was developed to detect and characterize the inhibitory NANC neurotransmitter. Evidence is provided that NANC nerve stimulation results in the release of a vasorelaxant factor with pharmacological properties similar to NO: its release is blocked by inhibition of the NO biosynthesis and tetrodotoxin, but enhanced by L-arginine. Its half-life is comparable to that of NO, and its biological activity is enhanced by superoxide dismutase, but abolished by hemoglobin. In addition, the nitrergic transferable factor is similarly affected as authentic NO by pyrogallol, hydroquione, hydroxocobalamin and L-cysteine. Nitrosothiols, like S-nitroso-L-cysteine, S-nitrosoglutathione and S-nitroso-N-acetyl-D,L- penicillamine, on the other hand, have a different pharmacological profile compared to NO and the nitrergic factor, indicating that NO, and not a nitrosothiol, is released from inhibitory NANC nerves in the canine ileocolonic junction. This nerve-induced release is Ca(2+)-dependent and prejunctionally regulated by K+ channels and alpha 2-adrenoceptors: blockade of K+ channels enhances the release, whereas alpha 2-adrenoceptor activation reduces the release of the nitrergic factor, possibly by activating K+ channels.

Animals↗

PubMed1994

[Shock caused by poisoning. Use of cardiotropic agents].

At toxic doses, cardiotropic drugs may compromise cardiac output leading to circulatory shock. Specific treatment varies depending on the nature and the dose of the drugs ingested as well as causal mechanism including vasopegia, hypovolaemia, cardiogenic effects and sepsis. Progress in our understanding of the pharmacodynamic aspects of intoxication and the development of specific antidotes has led to reduced morbidity and mortality. In addition to the classical inotropes, mainly catecholamines and phosphodiesterase inhibitors, other therapeutic agents may have specific inotrope effects in such ad hoc situations. These include hypertonic alkaline saline solution, calcium, glucagon, hydroxocobalamine and other cobalt salts, oxygen and immunotoxicotherapy. Together with volum replacement, dobutamine at the dose of 7 to 20 micrograms/kg/min can usually restore cardiac performance in cases of carbamate-induced circulatory shock. In case of tricyclic antidepressant overdose, treatment should include respiratory assistance and infusion of alkaline sodium solutions to both reverse the extracellular acidosis and correct sodium balance. Catecholamines may be necessary in cases with severe hypotension. Major vasoplegia and impaired intraventricular conduction may be induced by overdoses of chloroquine and class I antiarrhythmic drugs. Signs of gravity are: ingested dose above 4 g, QRS > or = 0.12 s or systolic arterial pressure < or = 80 mmHg. Treatment with epinephrine, respiratory assistance and diazepam has been proven effective during the acute phase, but right catheterism is often required due to major haemodynamic instability during the first 72 first hours. Beta-blockers have both a bronchoconstrictor and respiratory depressor effects favouring cardiovascular failure by hypoemia. Symptoms occur in 30-40% of the cases of overdose. Shock results from the reduction in blood pressure and cardiac inotropism. Glucagon, isoprenaline and epinephrine, prescribed in that order, can considerably reduce mortality to less than 4%. Despite the development of specific molecules, the risk of mortality due to toxic shock caused by antiarrhythmics, chloroquine, colchicine, calcium inhibitors and paraquat remains high.

Cardiotonic Agents↗

PubMed1995

Spectrophotometric determination of plasma thiocyanate by formation of an ion-pair with methylene blue.

We describe a sensitive method for measuring thiocyanate in 500 microliters plasma samples. This technique, although slower than the standard method, improves sensitivity. It requires the extraction in chloroform of an ion-pair formed between thiocyanate ions and methylene blue in acidic medium. Within-day precision had a coefficient of variation of 2.5% and between-day precision a CV of 4.75%. The results were well-correlated (r = 0.997). For 30 non-smokers, the mean thiocyanate level was < 55 mumol/l, and for 30 smokers 90 mumol/l (SD = 20). The method was successfully applied to seven fire smoke victims treated with hydroxocobalamin.

Humans↗

PubMed1976

Sodium nitroprusside: pharmacology, toxicology and therapeutics.

Sodium nitroprusside is a potent, effective, and readily reversible direct vasodilating agent. It is broken down by hemoglobin into cyanide, which is in part detoxified by liver and kidney to thiocyanate. Some cyanide, especially in nitroprusside- "resistant" individuals who need large amounts of the drug, appears to remain free to cause cyanide poisoning. Patients requiring inordinate amounts probably should not continue to receive the drug, although maximum dosage limits for long-term therapy are not established. Blood thiocyanate levels do not indicate the extent to which free cyanide is limiting oxygen utilization in essential tissue, nor do blood cyanide levels. Metabolic acidosis, elevated lactate levels, elevated lactate/pyruvate ratios, and elevated mixed venous blood oxygen content are at present the best indications of the presence of cyanide poisoning during nitroprusside administration. Nitroprusside appears useful for induction of hypotension during surgery, and for treatment of hypertensive emergencies from all causes, although continuance for more than a few days is probably unwise. The reductions of cardiac afterload and ventricular filling pressure by nitroprusside appear useful in treatment of severe myocardial failure or infarction, but studies of myocardial cyanide toxicity are needed before complete acceptance of this therapy is warranted. Initial dose rates between 0.5 and 1.5 mug/kg/min are recommended only as starting points for very careful titration. Total projected intra-operative dosage should be calculated as quickly as possible and should not exceed 3-3.5 mg/kg. It is hoped that future studies will reveal the maximum dose of nitroprusside that can safely be metabolized in a 24-hour period, and may indicate that cofactors of rhodanase such as thiosulfate, or cobalamins such as hydroxocobalamin, can be administered with nitroprusside to prevent cyanide poisoning.

Anesthesia, General↗

PubMed1976

Synthesis of cobalamin coenzymes by human lymphocytes in vitro and the effect of folates and metabolic inhibitors.

The uptake of 57Co-cyanocobalamin (CN-Cbl) and its conversion to 5-deoxyadenosylcobalamin (Ado-Cbl), methylcobalamin (Me-Cbl), and hydroxocobalamin (OH-Cbl) has been studied in phytohemagglutinin (PHA)-transformed lymphocytes from normal subjects and patients with patients with pernicious anemia. Uptake and conversion were much greater by PHA-stimulated lymphocytes than by mature non-transformed lymphocytes. In normal cells, uptake of 57Co-CN-Cbl and synthesis of the cobalamin coenzymes were approximately linear between 3 and 48 hr incubation. Ado-Cbl was the major cobalamin formed, and after 72 hr the cells contained about twice as much Ado-Cbl as Me-Cbl. Uptake by lymphocytes from patients with untreated pernicious anemia (PA) was greater than that by normal lymphocytes, but the proportions of Ado-Cbl and Me-Cbl synthesized by each were similar. Folic acid and methyltetrahydrofolate enhanced synthesis of Me-Cbl both in normal and in PA cells, while methotrexate and 5-fluorouracil depressed it. This depression was overcome by 5-formyltetrahydrofolate, suggesting that an uninterrupted folate cycle may play an important role in Me-Cbl synthesis.

Antimetabolites↗

PubMed1965