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Extended abstract of a paper presented at Microscopy and Microanalysis 2006 in Chicago, Illinois, USA, July 30 – August 3, 2005

Many nonsteroidal anti-inflammatory drugs act by inhibiting the cyclooxygenase activity of prostaglandin H2 synthase (PGHS), a key enzyme in the biosynthesis of prostaglandins. Gastric toxicity remains a serious problem with the current drugs, however. Recent advances in the understanding of PGHS now suggest two possible approaches to producing drugs with fewer side effects.

The gastric toxic effects of aspirin (ASA) and NCX-4016, a nitric oxide (NO)-releasing ASA, were compared in normal, cirrhotic, and arthritic rats. Oral administration of ASA (100 mg/kg) produced hemorrhagic lesions on the gastric mucosa in normal rats. The gastric ulcerogenic response to ASA was significantly worsened in both cirrhotic rats induced by N-nitrosodiethylamine and in arthritic rats induced by Freund's complete adjuvant. By contrast, NCX-4016 at 190 mg/kg (a dose equimolar to 100 mg/kg of ASA) did not induce damage in normal rat stomachs but caused slight lesions in the gastric mucosa of both cirrhotic and arthritic rats. Plasma salicylate levels following administration of ASA or NCX-4016 were not different between normal, cirrhotic, and arthritic rats, although the latter drug gave significantly lower values in any group of rats as compared to the former. Acid secretion was significantly increased in both cirrhotic and arthritic rats. ASA with 150 mM HCl caused severe gastric lesions in normal rats, the degree of damage being significantly greater than that induced by ASA alone. Coadministration of NOR-3, a NO donor, significantly prevented the development of gastric lesions induced by ASA, irrespective of whether or not ASA was given together with HCl. Gastric mucosal application of ASA (100 mg/kg) for 30 min caused a marked reduction of transmucosal potential difference (PD) with a minimal effect on gastric mucosal blood flow in both normal and cirrhotic rats, while that of NCX-4016 did not cause a PD reduction and produced a marked increase in the mucosal blood flow in both groups of rats. These results suggest that gastric mucosal susceptibility to ASA-induced damage is increased in both cirrhotic and arthritic rats (the process being partly accounted for by acid hypersecretion in these animals), NCX-4016 has even less gastric toxicity in both cirrhotic and arthritic rats, and the gastric-sparing effect of NCX-4016 is due, at least partly, to an increase of gastric mucosal blood flow, mediated by NO released from this drug.

1. The comparative gastric toxicology and pharmacokinetics of two phenoxyisobutyrate derivatives have been evaluated in the Fischer rat. 2. After oral administration of single daily doses for 7 days, the plasma elimination half-life for bezafibrate was rapid (t1/2 of 4-5 h) in comparison to ciprofibrate (t1/2 of 76 h). 3. The area under the plasma drug concentration versus time curve (AUC) 0-24 (micrograms.h/ml +/- SD) for bezafibrate (dose 125 mg/kg per day) was 1553 +/- 334, which was less than half the value of 3748 +/- 358 achieved by ciprofibrate (10 mg/kg per day) after 7 days. 4. Oral administration of ciprofibrate at 10 mg/kg every 48 h produced similar sustained plasma concentrations to those achieved by bezafibrate 125 mg/kg dosed every 12 h. The AUC 0-48 values (micrograms.h/ml +/- SD) achieved were 5124 +/- 450 for bezafibrate compared to 4207 +/- 240 for ciprofibrate. 5. In chronic oral multidose studies with ciprofibrate and bezafibrate, similar gastric toxicity (neuroendocrine cell hyperplasia) occurred in the rat when dose regimens were adjusted to compensate for the pharmacokinetic differences between these two drugs.

In recent studies we have shown that polyene phosphatidyicholine (PPC, Phospholipon 100), a non-toxic phospholipid containing a high proportion of polyunsaturated fatty acids, reduces the gastric toxicity of NSAIDs in rats1,2. These results are summarized here together with new data on the mechanism of action of PPC.

Rats receiving 14 daily gavage doses of 100 or 200 mg/kg ethyl acrylate (EtAc) and killed at varying times following the end of dosing exhibited dose-dependent lesions and recovery from lesions in the forestomach. The glandular stomach which was previously shown to be affected by acute exposure to EtAc appeared to have adapted to resist EtAc toxicity with repeat exposure and appeared normal in all animals. Adaptation of the forestomach was characterized by increased papillomatous thickening with dose. Lesions observed in acute exposure to EtAc were still present with repeat dosing and were more pronounced at the high dose. Forestomachs of rats which received 100 mg/kg EtAc for 14 days were recovered to normal within 2 weeks following the last dose. Forestomachs of rats receiving 200 mg/kg EtAc still exhibited numerous lesions 2 weeks following the last dose, and mucosal hyperplasia was present in the forestomachs at 4 weeks postexposure. Two lesions, submucosal fibrosis and foreign body reaction, became more prevalent in high-dose animals with time. Foreign body reaction, which was present in all animals 4 weeks postexposure, appeared to have resulted from entrapment of hair and/or feed particles in forestomach lesions in the course of healing. It is speculated that the increased cell proliferation and the induced foreign body reactions may contribute to the previously demonstrated carcinogenic effect of EtAc on the rat forestomach.

Comparative oral toxicity studies with ciprofibrate have been undertaken in the mouse, rat, and marmoset for up to 26 weeks. Chronic administration of ciprofibrate (20 mg/kg/day) produced a prolonged, modest, but statistically significant hypergastrinemia in the rat. Morphological changes in the rat stomach included increased eosinophilia and hypertrophy of oxyntic cells after 2 or more weeks treatment and hyperplasia of the neuroendocrine (NE) cells after 8 weeks treatment. In contrast, only a transient hypergastrinemia was induced, but not sustained in the mouse at the same dose level over an 8-week time period. No morphological changes were detected in the stomach of this species. In the marmoset treatment, up to 80 mg/kg/day for 26 weeks failed to induce hypergastrinemia and no significant alterations in gastric NE cells were detected.

A pro-drug of aspirin (ASA), 2(1-decanoylpropyl)o-acetyl salicylate (IDT-36), was synthesized with the aim of reducing the acute toxic effects of ASA. The comparison of toxic effects on rats was carried out using ASA as the reference drug. It was found that gastric bleeding caused by a 500 mg/kg oral dose of IDT-36 was not significantly different from control values (P

s. Internal diseases.F.L.Samsonov. A rare case of toxic gastritis with a discharge of the stomach mucous membrane. Doctor. 1901, 36.Patient M.V., 39 years old, was admitted to the hospital "Savich" with typical attacks of toxic gastritis after about 2 tablespoons of crude hydrochloric acid.