title: Blood thiols following amifostine and mesna infusions, a pediatric oncology group study.
abstract: The Pediatric Oncology Group study for metastatic Ewing's sarcoma used amifostine and mesna with the alkylating agents. To determine the fate of combined drug thiols, we measured thiol levels in plasma, red blood cells (RBC), and peripheral blood mononuclear cells (PBMC) of four patients. We also conducted analogous measurements on two patients who received mesna alone and a volunteer's blood following in vitro treatment. Thiols were labeled with monobromobimane, separated on high-pressure liquid chromatography, and detected by fluorescence. Incubation of a volunteer's blood with mesna, WR-1065, or both revealed that cellular uptake of total reducible drug was approximately 10% of plasma level for mesna but approximately 60% for WR-1065. Cellular drugs were mainly the thiol form, whereas half of the plasma drugs were disulfides. Combined incubation with both thiols did not change the extent or form of uptake. WR-1065 and mesna prevented glutathione depletion by 4-hydroperoxycyclophosphamide. Results from patients were similar. WR-1065 and mesna appeared in the cells by the end of the drug infusions, although WR-1065 uptake was more efficient than mesna. The concentration-time profiles of mesna in RBC paralleled those in plasma. Amifostine administration during mesna infusion caused transient increase in mesna levels. Both agents increased blood cysteine and decreased total reducible cysteine. Mesna alone and mesna plus amifostine prevented cellular glutathione depletion. In conclusion, mesna is imported by RBC and PBMC, but less efficiently than WR-1065. When present at equal levels, these thiols do not influence each other's uptake. Adequate dosing of either drug is necessary for protecting the cells from toxic effects of alkylating agents.
authors.affiliation: Department of Pediatrics, State University of New York, Upstate Medical University, Syracuse, New York, USA. souida@upstate.edu
authors.forename: A K
authors.initials: AK
authors.lastname: Souid
authors.forename: R C
authors.initials: RC
authors.lastname: Fahey
authors.forename: M K
authors.initials: MK
authors.lastname: Aktas
authors.forename: O A
authors.initials: OA
authors.lastname: Sayin
authors.forename: S
authors.initials: S
authors.lastname: Karjoo
authors.forename: G L
authors.initials: GL
authors.lastname: Newton
authors.forename: P D
authors.initials: PD
authors.lastname: Sadowitz
authors.forename: R L
authors.initials: RL
authors.lastname: Dubowy
authors.forename: M L
authors.initials: ML
authors.lastname: Bernstein
mesh_terms: D000293:Adolescent; D000328:Adult; D004999:Amifostine / Q000008:administration & dosage* / Q000378:metabolism / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000097:blood* / Q000627:therapeutic use; D002648:Child; D002851:Chromatography, High Pressure Liquid; D004220:Disulfides / Q000378:metabolism; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007963:Leukocytes, Mononuclear / Q000187:drug effects / Q000378:metabolism; D008297:Male; D008624:Mercaptoethylamines / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use; D015080:Mesna / Q000008:administration & dosage* / Q000097:blood / Q000627:therapeutic use; D020011:Protective Agents / Q000008:administration & dosage* / Q000378:metabolism / Q000627:therapeutic use; D011837:Radiation-Protective Agents / Q000008:administration & dosage* / Q000378:metabolism / Q000627:therapeutic use; D012512:Sarcoma, Ewing / Q000097:blood / Q000188:drug therapy; D013438:Sulfhydryl Compounds / Q000097:blood*
chemical_list: D004220:Disulfides; D008624:Mercaptoethylamines; D020011:Protective Agents; D011837:Radiation-Protective Agents; D013438:Sulfhydryl Compounds; C020174:N-(2-mercaptoethyl)-1,3-diaminopropane; D004999:Amifostine; D015080:Mesna