title: A combination of hydroxyurea and isobutyramide to induce fetal hemoglobin in transgenic mice is more hematotoxic than the individual agents.
abstract: Pharmacologic agents such as hydroxyurea (HU), N, 3-4 trihydroxybenzamide (didox), and isobutyramide (ISB) can elevate gamma-globin as a potential treatment for the beta-hemoglobinopathies. In these experiments, transgenic mice with 5'HS2 from the human beta-globin locus control region, the fetal (A gamma), and adult (beta s) globin genes were used. Mice were treated with HU, didox, or ISB individually, or with combinations of HU or didox with ISB. The aim was to determine whether these drugs have synergistic effects on the induction of fetal hemoglobin (HbF) and whether the combination regimens are more hematotoxic. In the combination regimens, injections of HU or didox for five weeks were concomitant with ISB treatment every other day for the final three weeks of treatment. The combination of HU + ISB was more hematotoxic than the individual drugs based on significantly increased percentages of reticulocytes and reduced hemoglobin, indicating that caution should be taken in treatments involving combinations of these types of drugs. The didox + ISB combination was not more hematotoxic than the individual drugs. HbF was not induced in the groups treated with the combinations of HU or didox with ISB compared to the individual agents. There was a negligible effect on the percentage of HbF and an unexpected negative effect on the percentage of F cells. The results also have implications for future testing of HbF-inducing drugs in mouse models. In control mice that were phlebotomized but not treated with any drugs, increased percentages of F cells were observed, indicating that blood sampling can cause this effect. In addition, increases in the percentage of F cells did not correlate with increases in the percentage of HbF, indicating that monitoring F cells alone is not a sufficient measure of HbF induction.
authors.affiliation: Department of Human Genetics, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298-0033, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Buller
authors.forename: H L
authors.initials: HL
authors.lastname: Elford
authors.forename: C C
authors.initials: CC
authors.lastname: DuBois
authors.forename: J
authors.initials: J
authors.lastname: Meyer
authors.forename: J A
authors.initials: JA
authors.lastname: Lloyd
mesh_terms: D000577:Amides / Q000627:therapeutic use* / Q000633:toxicity*; D000818:Animals; D004195:Disease Models, Animal; D004359:Drug Therapy, Combination; D005319:Fetal Hemoglobin / Q000032:analysis / Q000096:biosynthesis / Q000187:drug effects / Q000378:metabolism*; D006453:Hemoglobinopathies / Q000188:drug therapy; D006801:Humans; D006918:Hydroxyurea / Q000627:therapeutic use* / Q000633:toxicity*; D051379:Mice; D008822:Mice, Transgenic; D012333:RNA, Messenger / Q000032:analysis; D012156:Reticulocytes / Q000737:chemistry / Q000378:metabolism; D005719:gamma-Globulins / Q000187:drug effects / Q000235:genetics
chemical_list: D000577:Amides; D012333:RNA, Messenger; D005719:gamma-Globulins; C030197:isobutyramide; D005319:Fetal Hemoglobin; D006918:Hydroxyurea