title: Pharmacokinetics and in vitro studies of l-leucovorin. Comparison with the d and d,l-leucovorin.
abstract: BACKGROUND
  The active isomer of leucovorin (LV), LV-6S was compared with the racemic form, LV-6R,S and the inactive form, LV-6R.
  
  
  METHODS
  Pharmacokinetic studies of LV-6S and 6R,S were performed on normal volunteers and patients. Growth of Pediococcus Cerevisiae (PC), a LV-dependent strain, was measured with the 3 forms of LV. CCRF-CEM, a leukemic human cell line, was used to compare the effect of LV-6S, 6R,S and 6R on the rescue of methotrexate (MTX) and on the cytotoxicity of 5-fluorouracil (5-FU).
  
  
  RESULTS
  LV-6S exhibits pharmacokinetic patterns similar to those obtained with LV-6R,S whatever the route used, oral or intravenous. The growth of PC was similar with the active isomer and the racemic form while the unnatural isomer, LV-6R did not promote any growth. Cells exposed to MTX (10(-7) to 10(-5) M) were rescued from MTX cytotoxicity with LV-6S and LV-6R,S at concentrations 100 and 200 fold higher, whereas LV-6R did not reverse toxic effects of MTX. An enhancement of the cytotoxicity induced by 5-FU (10(-4) M) was obtained after preexposure of cells to LV-6S or LV-6R,S while LV-6R did not exhibit any synergistic effect.
  
  
  CONCLUSIONS
  LV-6S has similar effects to LV-6R,S in vitro and in vivo but at half doses; its clinical use prevents the possible interference of the inactive isomer, especially in patients receiving high doses of LV.
authors.affiliation: Laboratoire Central d'Hématologie-Immunologie, Hopital Henri Mondor, Creteil, France.
authors.forename: J
authors.initials: J
authors.lastname: Zittoun
mesh_terms: D004357:Drug Synergism; D005472:Fluorouracil / Q000494:pharmacology; D006801:Humans; D002955:Leucovorin / Q000737:chemistry / Q000493:pharmacokinetics* / Q000494:pharmacology; D008297:Male; D008727:Methotrexate / Q000633:toxicity; D010376:Pediococcus / Q000187:drug effects / Q000254:growth & development; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000473:pathology; D013237:Stereoisomerism; D014407:Tumor Cells, Cultured / Q000187:drug effects
chemical_list: D002955:Leucovorin; D005472:Fluorouracil; D008727:Methotrexate