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A rapid method has been developed which combines immunofluorescence and autoradiography and permits the double labeling of DNA. P388 murine leukemic cells were incubated with bromodeoxyuridine and tritiated thymidine simultaneously. After fixation, the sample was first processed with a monoclonal antibody to bromodeoxyuridine (RPMB I) so that any cell in S-phase was brightly fluorescent (RPMB technique). Next, tritiated thymidine grains were developed by autoradiography, and the result demonstrated fluorescence as well as black grains in each S-phase cell. P388 cells sensitive (P388S) and resistant (P388R) to 1-beta-D-arabinofuranosylcytosine (ara-C) were incubated with bromodeoxyuridine and [3H]ara-C simultaneously. Processing by autoradiography and RPMB techniques revealed that all S-phase cells in the P388S sample demonstrated vivid "double labeling," whereas P388R cells only revealed bright green fluorescence in S-phase cells, but no grains, confirming a lack of ara-C incorporation into the DNA by this line. Finally, a computerized digital analysis system attached to a microphotometer was used to quantitate fluorescence and grains per cell, and the data demonstrated that the number of [3H]ara-C grains in each P388S cell was inversely proportional to the degree of fluorescence in that cell, indicating that DNA synthesis was inhibited by ara-C. In conclusion, a simple, easy-to-use double-labeling method has been introduced which will be useful to a wide variety of researchers, because this technique together with the digital analysis system offers the possibility of measuring drug sensitivities in individual cells.

In this study, the ability of deoxythymidine (dThd) to enhance selectively the metabolism of 1-beta-D-arabinofuranosylcytosine (ara-C) in rats bearing transplantable colon carcinoma was investigated. A steady-state plasma level of 375 microM dThd was achieved within 3 h after initiation of a 24-h infusion of dThd (7 g/kg/day) with a concomitant 80% reduction in circulating 2'-deoxycytidine levels. Complete recovery to control values occurred within 6 to 8 h after termination of the infusion. Under the conditions of dThd infusion, the intracellular levels of 2'-deoxycytidine 5'-triphosphate rose from 0.15 to 60 pmol/mg tumor tissue, from 2.5 to 15 pmol/mg intestinal tissue, and from 0.07 to 0.25 pmol/10(6) bone marrow cells. During the steady-state plasma concentration of dThd, the intracellular concentration of 2'-deoxycytidine 5'-triphosphate in tumor tissue was reduced by 50% at 6 h after the initiation of dThd treatment with a complete recovery 9 h thereafter. Differences in the capacity of tumor and host normal tissues to recover from the effects of dThd pretreatment were evaluated by measuring decreasing 1-beta-D-arabinofuranosylcytosine 5'-triphosphate formation with time following dThd infusion. The ability to accumulate 1-beta-D-arabinofuranosylcytosine 5'-triphosphate was reduced by 60 to 80% in normal tissues by 3 h after cessation of the dThd infusion but was decreased by only 15% in the tumor. These results suggested that delaying ara-C administration following dThd might result in less host toxicity while maintaining the antitumor effect. Sequential infusion of dThd (7 g/kg/day) for 24 h followed 3 h later by a 48-h infusion of ara-C (175 mg/kg/day), was as effective in reducing tumor mass as was dThd infusion immediately prior to ara-C and resulted in reduced host toxicity (less weight loss). The best schedule for the dThd-ara-C combination was two courses of alternating 24-h sequential infusions of dThd and ara-C with a 3-h delay in ara-C administration following dThd. These data show that under the conditions used, reductions in intracellular 2'-deoxythymidine 5'-triphosphate pools by dThd in vivo do not appear to correlate with the antitumor activity of the dThd-ara-C combination. Intracellular 1-beta-D-arabinofuranosylcytosine 5'-triphosphate accumulation, however, was prolonged in rat colon tumor compared to normal tissues, and selectivity of the dThd-ara-C combination in favor of the tumor could be achieved by schedule modification.

A method for the detection and quantitation of 1-beta-D-arabinofuranosylcytosine 5'-triphosphate (ara-CTP), the active metabolite cells and leukemic cells of the peripheral blood from patients receiving ara-C therapy is described. ara-CTP is separated from normal cellular nucleotides by high-pressure liquid chromatography and is quantitated by its absorbance of ultraviolet light at 280 nm with a lower limit of sensitivity of 25 pmol/2 x 10(7) cell equivalents. During separate courses of continuous infusion of different therapeutic doses of ara-C, ara-CTP accumulated in the leukemic bone marrow cells of a patient with acute myelogenous leukemia in proportion to the dose of ara-C. Continuous infusion of ara-C (90 mg/sq m/day) resulted in plateau levels of ara-CPT in peripheral blast cells after 24 hr (115 pmol/1 x 10(7) cell equivalents). A priming dose of ara-C(125 to 250 mg/sq m) followed by a 1-hr infusion of an equal dose of ara-C to patients with acute myelogenous leukemia facilitated the determination of ara-CTP retention in bone marrow and peripheral blood leukemic cells in vivo. This procedure should be useful for extended studies of the biochemical pharmacology of ara-CTP in vivo.

In order to clarify the pharmacological characteristics of N4-behenoyl-1-beta-d-arabinofuranosylcytosine (BHAC) and 1-beta-D-arabinofuranosylcytosine (AraC) with regard to their distribution in vivo, 14C-labeled BHAC and 13C-labeled AraC were injected intravenously into mice. Their in vivo distribution was determined by whole-body macroautoradiography and by an oxidation method. The disappearance rates of BHAC[cytosine-2-14C] and BHAC[behenoyl-l-14C] from the blood were slower than that of AraC[cytosine-2-14C], and the elimination rates of BHAC[cytosine-2-14C] and BHAC[behenoyl-14C] into the urine and feces were also slower than that of AraC[cytosine-2-14C]. The total amounts of BHAC[cytosine-2-14C] and BHAC[behenoyl-1-14C] eliminated within 48 hr after the injection were small. AraC[cytosine-2-14C] was equally distributed in each organ, while large amounts of BHAC[cytosine-2-14C] were found in and the placentae. The BHAC[behenoyl-1-14C]level in the thymus was lower than that of BHAC[cytosine-2-14C]. A very low level of radioactivity was found in most of the organs 6 hr after the injection of Arac[cytosine-2-14C], but BHAC[cytosine-2-14C] was observed even 24 hr after the injection. Radioactivity was still found in the liver, spleen, kidneys and adrenal glands of mice injected with BHAC[behenoyl-1-14C] even after 72 hr. In pregnant mice, AraC]cytosine-2-14C] was transmitted to the fetuses, but only a very small amount of 14C-BHAC was transmitted to the fetuses.

The treatment of K562 human myeloblastic leukemia cells and YAC-1 murine lymphoma cells with cadeguomycin at concentrations over 0.6 microM significantly enhanced the cytotoxicity of 1-beta-D-arabinofuranosylcytosine (ara-C). The degree of potentiation depended upon the antibiotic concentration. The treatment with 75 microM cadeguomycin for 18 h increased cellular uptake of [3H]ara-C into K562 cells and formation of ara-C nucleotides, as well as incorporation into nucleic acids. The level of the diphosphate of ara-C plus the triphosphate of ara-C was approximately 10 times higher in the cadeguomycin-treated cells than in the untreated cells by 30 min of incubation with [3H]ara-C. The extracts of 15 microM cadeguomycin-treated K562 cells showed increased activity of formation of ara-C nucleotides, resulting in 4- to 5-fold higher formation of the di- and triphosphates of ara-C than the control cell extracts. Cadeguomycin did not significantly change the level of ribonucleotide and deoxyribonucleotide pool in K562 cells. The mechanism of potentiation of ara-C by cadeguomycin was discussed.

A phase I study of N4-behenoyl-1-beta-D-arabinofuranosylcytosine (BHAC) was conducted in 66 patients, 41 with solid tumors and 25 with hematological malignancies. The patients received either a 2-h single intravenous (i.v.) drip infusion (Schedule 1) or consecutive daily 2-h i.v. infusions (Schedule 2). In Schedule 1 the daily dose was initiated with 1.5 mg kg-1 which was escalated up to 7 mg kg-1. Side-effects were mild, and included nausea, vomiting, epilation, and hot flushes. Because of the presence of the solvent vehicle, HCO-60 and in consideration of the mechanism of action of BHAC, the dose escalation was stopped at 7 mg kg-1. In Schedule 2, the daily dose was started with 1.5 mg kg-1 which was escalated up to 8 mg kg-1 and given for 2-16 days. Myelosuppression was found to be dose-limiting toxicity. The maximum tolerated dose (MTD) in patients with non-hematological solid tumors was assumed to be 5 mg kg-1 daily X 5 days. The plasma disappearance curve of BHAC looked biphasic, and when 4 mg kg-1 of BHAC were administered the half-lives of the initial phase (t1/2 alpha) and the second phase (t1/2 beta) were calculated as 0.798 and 5.76 h respectively. In Schedule 2 complete remission was observed in 5 out of 21 patients with acute leukemia, one partial remission in Hodgkin's disease, and one 1-B response (Karnofsky) in thyroid papillary adenocarcinoma.

Plasma level Ara-C and Ara-U in vivo and intracellular Ara-CTP pools in vivo and in vitro were measured using high-performance liquid chromatography and radioimmunoassay. Plasma Ara-C during High Dose therapy was found in two phases; one, a peak at t1/2 of approximately 5-8 minutes, the other approaching that of Continuous Infusion with a t1/2 of about 6 to 8 hours. There appears to be no relationship between peak levels of plasma Ara-C and intracellular Ara-CTP formed during High Dose therapy. Intracellular Ara-CTP pools were found to be higher in peripheral blood than in bone marrow during High Dose treatment and were also higher in bone marrow of patients treated with High Dose rather than conventional dose Ara-C. In vitro experiments with various concentrations of Ara-C on patient cells prior to treatment suggest that patients may benefit from High Dose therapy when an increase in intracellular Ara-CTP occurred with higher extracellular concentrations of Ara-C. In patients with metabolically sensitive cells containing the necessary enzymes to activate Ara-C to Ara-CTP, where resistance is due to limited drug transport, High Dose therapy may prove beneficial. Conversely, in patients with no increase in Ara-CTP pools in vitro due to a depletion of activating enzymes, High Dose treatment may not be warranted. Therefore, it may be possible to determine patients most likely to benefit from High Dose chemotherapy by measuring pre-treatment in vitro intracellular Ara-CTP.

Tetrahydrodeoxyuridine (dTHU) inhibits deoxycytidine deaminase and, after intracellular phosphorylation to the active 5'-monophosphate, also inhibits deoxycytidylate deaminase (dCMPD). Because in vitro studies have shown that dCMPD may regulate pyrimidine deoxynucleotide metabolism, the objective of this study was to investigate the effects of dTHU on deoxynucleotide metabolism in whole cells. Nearly complete inhibition of dCMPD, measured in intact CCRF-CEM cells by incorporation of [14C]dCyd into dTTP, occurred after a 45-min incubation with 100 microM dTHU. This was accompanied by an 8-fold dCTP pool expansion, although dATP, dTTP, dGTP, and ribonucleoside triphosphate pools were unaffected. Tetrahydrouridine, which inhibits deoxycytidine deaminase exclusively, had no effect on nucleotide pools. The dCTP pool expansion was directly proportional to the dTHU concentration (3-100 microM) and reached a maximum after 2 hr. Inhibition of ribonucleotide reductase by hydroxyurea completely prevented the dTHU-induced dCTP pool expansion, indicating that the substrate of dCMPD was derived from the ribonucleotide pool and that CDP was the predominant precursor of dCTP. dTHU-mediated inhibition of dCMPD appeared reversible. Exposure of cells to 100 microM dTHU followed by washing into fresh medium resulted in a linear decrease of the dCTP pool and an increase in the dTTP pool. The increased dCTP concentration after preincubation with dTHU was associated with an inhibition of deoxycytidine kinase, as indicated by a reduced capacity of cells to phosphorylate ara-C. dTHU is a useful new tool for investigating the role of dCMPD in the regulation of deoxynucleotide metabolism in whole cells.

In vitro uptake and retention of 3H-cytosine arabinoside (ara-C) was studied in 68 acute myelogenous leukemia (AML) patients (ten were studied twice) treated with a regimen containing conventional (54 patients) or high doses (24) of ara-C. Drug uptake and retention after four hours were measured following 30 minutes exposure to 1 and 50 micrograms/mL of ara-C. A good correlation was observed between high uptake in the acid soluble (AS) fraction (P less than .01), or high retention in the acid insoluble (Al) fraction (P less than .03) of 1 microgram, but not 50 micrograms, of the drug and obtainment of complete remission (CR) in patients treated with conventional doses of ara-C. Patients with a high percentage of ara-C retained in the AS fraction (greater than 26%) have a significantly longer CR duration than patients with a lower level of retention (P less than .02). In 17 patients who achieved a CR in spite of a low tritiated ara-C uptake, the clonogenic leukemic (CFU-L) cells were especially sensitive to drugs (15 of 17 v three of 11 among resisting patients).

Enzymatic hydrolysis of acylamide of N4-acyl-1-beta-D-arabinofuranosylcytosine was studied. The highest enzyme activity among various homogenates from mouse tissues, as expressed by specific activity, was found in liver homogenate. More than 50% of the activity in the liver was found in the microsomal fraction. The hydrolysis products of N4-palmitoyl-1-beta-D-arabinofuranosylcytosine by microsomal enzyme were identified stoichiometrically as 1-beta-D-arabinofuranosylcytosine and palmitic acid. The microsomal enzyme showed an optimum pH at 9.0 in Tris-HCl buffer. Michaelis constant for N4-palmitoyl-1-beta-D-arabinofuranosylcytosine was 2.5 X 10(-5) M. The enzyme did not require divalent cations for the reaction. Mn2+ and Co2+ at 1 mM strongly inhibited the reaction. The relative rates of hydrolysis of N4-palmitoyl-, N4-stearoyl-, N4-lauroyl-, N4-butyryl-, and N4-behenoyl-1-beta-D-arabinofuranosylcytosine were 100, 47.6, 31.3, 15.9, and 9.1, respectively. The enzyme might play an important role in the formation of 1-beta-D-arabinofuranosylcytosine from N4-acyl derivatives of 1-beta-D-arabinofuranosylcytosine.

Complement modulated the metabolic conversion of cytosine arabinoside into its nucleotide and nucleic acid derivatives in L cells by augmenting the biphasic effect (inhibitory/stimulatory) of anti-L cell antibody. Antibody in the absence of complement affected both the total cellular pool of cytosine arabinoside (containing the nucleotide and nucleic (DNA) acid derivatives) and the acid-insoluble pool (containing the DNA derivative). Addition of complement in high concentrations inhibited and, in low concentrations, stimulated the incorporation of cytosine arabinoside into DNA of antibody stimulated L cells. At the point of maximum stimulation of cytosine arabinoside incorporation into DNA, there was a pronounced decrease in the size of the total cellular pool with the result that 75% of the total pool of cytosine arabinoside was due to its incorporation into DNA. Simultaneous measurements upon cytosine arabinoside and thymidine or deoxycytidine metabolism were made; the effects of antibody and complement appeared to be quite similar with all three nucleosides, with the exception that all thymidine and deoxycytidine taken up into the cells was incorporated into DNA. Addition of exogenous thymidine (up to 100 microM produced the same enhanced incorporation of [3H]Ara-C and [14H]dCyd into control cells that was observed in antibody and complement stimulated cells. Measurement of deoxycytidine kinase activity in cell-free extracts of cell cultures stimulated by antibody, however, did not reveal enhanced enzymatic activity due to stimulated enzyme synthesis, but, rather indicated that antibody and complement altered the intracellular concentrations of nucleotides which affected the interaction of cytosine arabinoside with deoxycytidine kinase in intact cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Twenty-one patients with chronic myelogenous leukemia (CML) in blastic transformation underwent 22 remission induction attempts with high-dose cytosine arabinoside (ara-C), administered as a two-hour infusion of 3 g/m2 for six to 12 doses. Ara-C doses were administered every 12 hours in 15 patients and every six to ten hours in six patients. Median patient age was 35 years (range, 20 to 62). The median duration of benign phase was 25 months (range, 0 to 167). Morphology of blast crisis blast cells was myeloid in 15 patients and lymphoid in six. Five patients achieved complete remission (CR), three had partial remission (PR), and one had hematologic improvement, for an overall response rate of 41%. Median remission duration was 2.5 months (range, 0.5 to 6 months). Survival duration was 6 months for responding patients and 1.5 months for those with resistant disease. The response rate was similar for patients with myeloid and lymphoid blast crisis (31% v 50%, respectively). The response rate was significantly higher for patients whose benign phase was less than 1 year (75% v 21%, P = .05) and who had prolonged marrow aplasia after ara-C (86% v 27%, P = .05). Myelosuppression was the major dose-limiting toxicity, and cerebellar toxicity occurred in two patients. Intracellular ara-C 5'-triphosphate (ara-CTP) levels were similar in blood and bone marrow leukemic cells and were slightly greater in the cells of responding patients compared to those with resistant disease. We conclude that high-dose ara-C is an effective regimen for CML blast crisis, resulting in a substantial response rate but modest remission duration. Its combination with other agents may further improve the prognosis of patients with this resistant disease.

A rapid and reliable radioimmunoassay method for 1-beta-D-arabinofuranosylcytosine (ara-C) has been developed using antibody induced in rabbits, [3H]ara-C, and a Millipore filtration technique. The sensitivity of this assay was such that ara-C, 0.02 mug/ml, in plasma could be detected, and the assay was practically free from interference by deoxycytidine, cytidine, 1-beta-D-arabinofuranosyluracil, and other nucleosides, as well as from various antibiotics. Blood levels of ara-C in C57BL X DBA/2F1 mice were determined after injection of 1-(3-O-octanoyl-beta-D-arabinofuranosyl) cytosine. Relatively high ara-C levels could be maintained for a fairly long period. Plasmas of mouse, rat, and rabbit contained high esterase activity which hydrolyzed the 3'-octanoyl group in 1-(3-O-octanoyl-beta-D-arabinofuranosyl)cytosine, whereas this activity was relatively low in dog and human plasmas.

The cytotoxic effect of cytosine arabinoside (ara-C) depends on the capacity of cells to form and retain intracellularly the phosphorylated metabolite cytosine arabinoside triphosphate (ara-CTP). In this study accumulation and cellular retention of ara-CTP have been measured in vitro in the bone marrow cells of 69 patients with acute leukemia. Cells were incubated with 3H-ara-C and the amount of ara-CTP formed was determined after separation of the nucleotides by thin-layer chromatography. Phosphorylation of ara-C to ara-CTP appeared to be a saturable process. The Km-equivalents varied between 1.1 and 16.2 microM ara-C. Maximal ara-CTP formation ranged from 12 to 125 pmol ara-CTP/10(6) cells in 30 min. The phosphorylation activity did not correlate with the percentage of S-phase cells. The intracellular half-life time of ara-CTP measured in vitro ranged from 53 to 210 min. Phosphorylation of ara-C was comparable in patients with acute myeloid leukemia (n = 51) and in patients with acute lymphoblastic leukemia (n = 18). Ara-CTP elimination appeared slower in lymphoblasts than in myeloblasts. The average intracellular ara-CTP level in relapsed patients (n = 34) appeared higher than in previously untreated patients (n = 52). The less favourable outcome of second remission induction therapy with conventional doses of ara-C compared to the first remission induction treatment is not explained by an alteration in the intracellular metabolism of ara-C.

Cytosine nucleoside deaminase (EC 3.5.4.5) from Salmonella typhimurium LT2 catalyses the deamination of ribo-, deoxyribo- and arabinosyl nucleosides of cytosine alkylated at the C-5, but not at the N3 or exocyclic N4, of the pyrimidine ring. The enzyme was inert towards analogues etherified at the 3'-OH and 5'-OH of the sugar ring; it was active against the 2'-O-methyl derivative of cytidine, but not arabinosycytosine. The N4-and 5'-O-alkyl non-substrate analogues competitively inhibited deamination of deoxycytidine and arabinosylcytosine, the most inhibitory being 5'-O-methylarabinosylcytosine. The alpha anomer of 5'-ethyldeoxycytidine, the 2,2'-anhydro derivative of cytidine, and the 3'-O-alkyl derivatives were neither substrates nor inhibitors. The presence of cytidine deaminase was demonstrated in both granulocytes and lymphocytes from human peripheral blood. The specificity of this enzyme differed significantly from that of the bacterial enzyme, a finding of some relevance in relation to the frequently encountered intracellular deamination of therapeutically active arabinosylcytosine to the inactive arabinosyluracil.

Although the mechanism of action responsible for the effects of low-dose ara-C remains unclear, certain insights are available concerning the interaction of this agent with DNA. Ara-C incorporates into DNA, and the extent of (ara-C)DNA formation correlates significantly with loss of clonogenic survival. The inhibition of DNA replication by ara-C also results in DNA fragmentation and terminal differentiation of leukemic cells. Other studies have demonstrated that inhibition of DNA replication by ara-C results in an aberrant form of DNA synthesis with certain segments of DNA being replicated more than once within a single cell cycle. The additional copies of certain segments of DNA could lead to the accumulation of DNA fragments and alterations in gene expression. It is of interest that other inhibitors of S-phase DNA replication such as aphidicolin and hydroxyurea can also induce similar phenotypic changes in HL-60 and K562 leukemia cells. Although the in vitro data support the concept that ara-C is capable of inducing leukemic cell differentiation, there is no evidence to suggest that this agent induces differentiation of human leukemic cells in vivo. Drug levels achieved by administration of low-dose ara-C (42-64 nmol/L) result in the incorporation of ara-C into bone marrow mononuclear preparations from patients with preleukemia syndromes. This concentration of ara-C (5 X 10(-8) mol/L) slows DNA replication of human leukemic cells in vitro. Thus, the clinical use of low doses of ara-C that achieve plasma concentrations of 10(-8) to 10(-7) mol/L could theoretically induce maturational effects by partially inhibiting DNA synthesis. At the present time we have no available data to support this contention. On the basis of chromosomal analyses, low-dose ara-C apparently maintains sufficient drug levels to suppress more "malignant" clones, but even "clonal" selection may represent elimination of leukemic cells by either cytotoxicity or induction of terminal differentiation. Further studies will be necessary to define the mechanism of action of low-dose ara-C in preleukemia.

Cytosine arabinoside (araC), a potent inhibitor of DNA replication in mammalian cells, was found to be completely ineffective in Saccharomyces cerevisiae. The 5' monophosphate derivative, araCMP, is toxic and effectively inhibits both nuclear and mitochondrial DNA synthesis in this organism. Although wild-type strains can be inhibited by araCMP, dTMP permeable (tup-) strains were found to be much more sensitive to the analogue. In vivo labelling experiments indicate that araC enters yeast cells; however, it is extensively catabolized by deamination and breakage of the glycosidic bond. In addition, the analogue is not efficiently phosphorylated in S. cerevisiae owing to an apparent lack of deoxynucleoside kinase activity. These results provide further evidence that deoxyribonucleotides can be synthesized only through de novo pathways in this organism. Finally, araCMP was found to be recombinagenic in S. cerevisiae which suggests, together with other previous studies, that, in general, inhibition of DNA synthesis in yeast promotes mitotic recombination events.

[14C]-tetrahydrouridine (THU), a strong inhibitor of cytidine (CR) deaminase, was, after iv administration, rapidly and quantitatively cleared from the blood with a plasma half-life of about 1 hour. The main pathway of excretion was through the kidneys: most of a dose of 50 mg/kg was excreted within 12 hours and excretion was essentially complete within 48 hours. Oral administration of the same dose revealed absorption of about 10% from the gastrointestinal tract. THU at 10, 25, and 50 mg/kg given 15 minutes before [3H]-cytosine arabinoside (ara-C) at a dose of 0.003 mg/kg produced about a two fold increase in ara-C blood levels at all times measured from 5 minutes to 4 hours, with only slight increases in the half-life of ara-C. A dose-related effect of THU upon the deamination of ara-C was obvious only during the time from 15 minutes to 1 hour after the injection of 3H-ara-C. The inhibitory effect of THU upon CR deaminase was also reflected in a considerably increased ratio of ara-C/uracil arabinoside in the urine.

A study has been made to determine if the cytotoxicity observed when cells in culture were exposed to liposome-entrapped cytotoxic drugs was liposome mediated or resulted from leakage of drug from the liposomes with subsequent uptake of free drugs by the cells. In preliminary experiments with the EMT6 cell line in monolayer culture, the cytotoxicity observed when the cells were exposed to a range of concentrations of liposome-entrapped methotrexate, actinomycin D and cytosine arabinoside for a variety of liposome compositions was somewhat less than that observed when the cells were exposed to similar concentrations of free drug. We suspected that the cytotoxicity was mediated via uptake of free drug leaked from liposomes. This was confirmed in experiments involving the EMT6 and S49 cell lines in monolayer or suspension culture, respectively, in the absence and presence of the nucleoside transport inhibitor, 6-(4-nitrobenzyl)thio)-9-beta-D-ribofuranosylpurine. Additional experiments were performed in a transport-deficient mutant of the S49 cell line, the AE1 cell line. No evidence for liposome-mediated cell death could be found in these cell lines when tubercidin 5'-monophosphate was entrapped in either large or small unilamellar liposomes composed of egg phosphatidylcholine/cholesterol (2 : 1), bovine brain phosphatidylserine/egg phosphatidylcholine/cholesterol (8 : 2 : 5) or egg phosphatidylcholine/stearylamine/cholesterol (10 : 1 : 5). Considerable toxicity due to empty liposomes of a variety of compositions was observed in the S49 cell line at high lipid concentrations.

We recently demonstrated a highly significant relationship between the incorporation of 1-beta-D-arabinofuranosylcytosine (ara-C) into L1210 DNA and the loss of clonogenic survival. These studies have now been extended to the human promyeloblast (HL-60) cell line and myeloblasts from a patient with acute myelogenous leukemia. Our results demonstrate: (i) the specific internucleotide incorporation of ara-C into human myeloblast DNA; (ii) the lability of [3H]ara-C-labeled DNA to alkali which necessitates the use of nondegrading assay conditions; and (iii) a highly significant relationship (P less than 0.0001) between the loss of clonogenicity of these cells and the extent of ara-C incorporation. These findings suggest that the incorporation of ara-C into DNA is one of the initial events leading to cell lethality. This method is applicable to clinical samples of bone marrow and peripheral blood as an in vitro assay for studying the sensitivity of cell populations to this drug.

A deoxycytidine kinase-deficient variant of a human promyelocytic leukemic cell line (HL-60/ara-C) has been isolated and characterized. These cells are capable of proliferating in the presence of 10(-6) M 1-beta-D-arabinofuranosylcytosine (ara-C), a level achieved in the plasma of leukemic patients undergoing conventional-dose ara-C therapy. The cells share numerous biological and biochemical features with the parent line, including: morphology; rate of growth; cloning characteristics; karyotype; rates of DNA, RNA, and protein synthesis; and ability to undergo terminal differentiation in the presence of agents such as 12-O-tetradecanoylphorbol acetate and dimethyl sulfoxide. In contrast, these cells display a great reduction in the total intracellular accumulation of ara-C following a 4-hr exposure to 10(-6) M ara-C (2.4 versus 99.0 pmol ara-C/10(6) cells). Resistant cells exposed to 10(-6) M ara-C for 1 hr also exhibited a reduction in the generation [1.2 versus 31.9 pmol 1-beta-D-arabinofuranosylcytosine 5'-triphosphate (ara-CTP)/10(6) cells] and the 4-hr retention (0.30 versus 3.87 pmol ara-CTP/10(6) cells) of ara-CTP, the lethal ara-C metabolite, in comparison to parent cells. Incorporation of ara-C into resistant HL-60 cell DNA was also profoundly decreased. These biochemical alterations were associated with a 1000-fold decrease in the sensitivity of clonogenic cells to continuously administered ara-C (ara-C 50% inhibitory concentration: 1.8 X 10(-6) M for HL-60/ara-C; 3.0 X 10(-9) M for HL-60). A variety of antagonists of de novo pyrimidine synthesis inhibited the growth of ara-C-sensitive and -resistant cells to a similar extent. When HL-60 cells were exposed to a lethal concentration of thymidine (5 X 10(-3) M), coadministration of 5 X 10(-6) M deoxycytidine restored 90 +/- 4% (S.D.) of colony-forming capacity. Normal human bone marrow progenitor cells were protected to a similar degree by 3 X 10(-3) M deoxycytidine. In contrast, deoxycytidine concentrations as high as 5 X 10(-3) M were unable to confer any protection to HL-60/ara-C cells under identical conditions. These studies suggest that an enzymatic perturbation rendering human leukemic cells highly resistant to ara-C may be exploited to achieve a selective in vitro chemotherapeutic effect.

The present study was undertaken to determine whether cytotoxicity by 1-beta-D-arabinofuranosylcytosine (ara-C) in LoVo colon carcinoma cells, which are resistant to high concentrations of ara-C, would be enhanced by concurrent exposure to hydroxyurea (HU). Since mechanisms underlying the effects of HU on ara-C induced cytotoxicity are unclear, we also evaluated the effect of HU on the incorporation of ara-C into DNA, as well as potential consequences of misincorporation. Our results demonstrate that HU synergistically enhances cytotoxicity by ara-C in these cells. This effect was not present when HU was combined with aphidicolin, an agent that resembles ara-C in competing with dCTP for binding to polymerase alpha but that is not incorporated into DNA. Further, cells exposed to HU and ara-C incorporated up to 5-fold as much ara-C into DNA as cells solely treated with ara-C. While the extent of inhibition of DNA synthesis was comparable with cells exposed to HU and aphidicolin as those treated with HU and ara-C, recovery of DNA synthesis was delayed more significantly by the latter combination. These findings suggest that HU synergistically potentiates ara-C induced cytotoxicity by enhancing incorporation of ara-C in LoVo cell DNA.

Sc administration of cytarabine entrapped in multivesicular liposomes to BDF1 mice resulted in slow first-order release from skin, with a half-life of 4 days. The half-life was 10 minutes for unencapsulated free drug. A single-dose sc treatment of BDF1 mice, inoculated iv with 10(5) L1210 leukemia cells 24 hours previously, resulted in long-term survivors over a wide dose range. This study demonstrates that encapsulation of cytarabine in multivesicular liposomes results in slow release from skin and that a single sc dose is often curative for mice with systemic leukemia.

We have previously demonstrated that 1-beta-D-arabinofuranosylcytosine (ara-C) incorporates into leukemic cell DNA and that the extent of this incorporation correlates significantly with loss of clonogenic survival. These studies have now been extended by monitoring the incorporation of ara-C in DNA undergoing repair of UV-induced damage. The present studies have been performed using human foreskin diploid fibroblasts that undergo density-dependent growth arrest. The results demonstrate that ara-C incorporates specifically into DNA undergoing repair of damage by UV light. The extent of ara-C incorporation in AG1522 DNA during UV repair correlates significantly (p less than 0.0006) with cell lethality. These findings confirm that incorporation of ara-C into DNA undergoing either semiconservative or unscheduled DNA synthesis results in lethal cellular events. The present findings may provide the experimental basis for the development of new therapeutic approaches using ara-C in combination with agents that damage DNA.

The dose-response relationship between extracellular concentration of cytosine arabinoside (ara-C) and intracellular formation of the putative active metabolites of ara-C [ara-C incorporation into DNA and intracellular pools of ara-C in triphosphate form (ara-CTP)] was investigated in blast cells obtained from patients with acute nonlymphocytic leukemia (ANLL) by exposing these cells in vitro to 10, 100, or 1,000 nmol/L of ara-C. We studied 23 untreated patients who subsequently achieved complete remission (CR) with a regimen using daunorubicin and conventional doses of ara-C (ara-C-sensitive group), and 30 patients judged to be ara-C-resistant either by failing initial induction therapy (16 patients) or by having relapsed on an ara-C-containing maintenance regimen (14 patients). In both patient groups, ara-C incorporation into DNA and intracellular ara-CTP both displayed statistically significant increases in response to increasing extracellular concentrations of ara-C (P = .0001 in both cases), with the rate of increase of ara-CTP greater than that of ara-C incorporation. Moreover, blast cells from all patients, even those who were most clinically resistant to ara-C, were able to form ara-CTP and to incorporate ara-C into DNA. Each tenfold increment in extracellular ara-C concentration caused an 8.5-fold increase in ara-CTP, but only a 3.6-fold increase in ara-C incorporation into DNA. Thus, the efficiency of incorporation of ara-C into DNA (defined as the ratio of ara-C incorporation to ara-CTP pools) decreased by 58% with each tenfold increment in the extracellular concentration of ara-C (P less than .0001), presumably as a result of the inhibitory effect of ara-CTP on DNA polymerase. Using an analysis of covariance, modest differences were found in the levels of the ara-C metabolite variables in the ara-C-sensitive group as compared with the resistant group. However, because there was considerable overlap in ara-C metabolite formation among the patient groups, it was not possible to predict clinical outcome by these in vitro assessments of ara-C metabolism.

Cytosine arabinoside (ara-C) has been used in the treatment of leukemia, but its exact mechanism of cytotoxicity is not yet known. One of the proposed mechanisms for the effectiveness of this drug in treating leukemias suggests that a metabolite of ara-C, i.e., 2'-deoxycytidine 5'-triphosphate (araCTP), competes with cytosine arabinoside 5'-triphosphate (dCTP) for binding to DNA polymerase. The ratio of the drug metabolite to the endogenous nucleotide (araCTP/dCTP) may, therefore, be important in determining the effectiveness of ara-C therapy. This ratio may also play a role in drug resistance. Previously published methods have focused on either araCTP or dCTP, along with metabolites and analogues of one of these compounds. The methods presented here provide two simple, sensitive ways to measure dCTP and araCTP in the same biological sample.

1. We present a theoretical analysis of the tandem processes of transport and metabolic trapping which together constitute uptake of a substrate by intact cells. 2. Transport is assumed to occur by means of a simple carrier here analysed in its general form. Trapping is assumed to occur by a simple enzymic reaction. 3. We show how to obtain the separate parameters of the steps by analysing uptake data over a range of uptake times and substrate concentrations. 4. We present uptake data for uridine and cytosine-beta-D-arabinoside entering Nil 8 hamster fibroblasts, normal and murine sarcoma virus transformed, in the quiescent condition and after stimulation by added serum. We analyse the data in terms of the theory for tandem processes. 5. Transport is characterised by a system having a high Km and a high V for entry. The data for cytosine-beta-D-arabinoside suggest that the cytosine-beta-D-arabinoside system is not far from a symmetric one. The data for uridine transport do not differ when quiescent and serum-activated cells are compared. Transformed cells transport uridine at half the maximum velocity of normal cells, with or without added serum. 6. Trapping of cytosine-beta-D-arabinoside is insignificant. Trapping of uridine occurs by a system with both V and Km at least an order of magnitude smaller than are these parameters for transport. Trapping of uridine by non-transformed cells activated by serum, has twice the V of such cells in the quiescent state. 7. In the virus-transformed cells, the control of uridine trapping by added serum is lost, along with control of growth by this stimulant.

When incubated with 1-beta-D-arabinofuranosylcytosine (ara-C), RPMI 6410 cells formed a hitherto unrecognized ara-C metabolite, 1-beta-D-arabinofuranosylcytosine diphosphate choline. This compound was characterized by (a) chromatographic behavior, (b) chemical and enzymatic hydrolysis, (c) phosphorus content, and (d) incorporation of [5-3H]ara-C and [methyl-14C]choline. Formation of 1-beta-D-arabinofuranosylcytosine diphosphate choline by RPMI 6410 cells was enhanced in the presence of 3-deazauridine (DU) and was preceded by that of 1-beta-D-arabinofuranosylcytosine triphosphate. The antiproliferative effects of ara-C and DU toward RPMI 6410 cells were potentiated when the agents were present together. The anabolism of ara-C during a 24-hr interval of culture was markedly enhanced by the presence of DU; cellular concentrations of 1-beta-D-arabinofuranosylcytosine triphosphate and 1-beta-D-arabinofuranosylcytosine diphosphate choline were 5- and 15-fold higher than those in the absence of DU. This enhancement appears to be the basis of the potentiation of cytotoxicity resulting from combination of the agents. Pretreatment of RPMI 6410 cells with DU resulted in enhanced rates of cellular uptake of ara-C. ara-C uptake under these circumstances was blocked by the inhibitor of nucleoside transport, nitrobenzylthioinosine.

We studied the ability of the purine deoxynucleoside deoxyguanosine (dGuo) to enhance 1-beta-D-arabinofuranosylcytosine (ara-C) incorporation into DNA of HL-60 cultured human leukemia cells. The effects of dGuo on ara-C incorporation into DNA were compared to those of thymidine (dThd), a pyrimidine deoxynucleoside known to augment ara-C effects both in vitro and in vivo. Both deoxynucleosides doubled the cells in the S phase of the cell cycle within the exposure periods (up to 48 hr) and concentrations (10 to 1000 microM) tested. Both deoxynucleosides enhanced ara-C incorporation into DNA equally. However, dThd and dGuo differed in the schedule required to achieve this effect. Simultaneous exposure of cells to ara-C and dThd increased ara-C incorporation into DNA approximately 3.5-fold. Preincubation of cells with dThd for 16 hr prior to the addition of ara-C further enhanced ara-C incorporation into DNA (to approximately 5-fold) in direct proportion to the dThd-induced increase in cells in S phase. Preincubation was essential for dGuo, since 16-hr preincubation of cells with concentrations as low as 30 microM caused augmentation of ara-C incorporation into DNA; but simultaneous exposure of cells to dGuo and ara-C caused no augmentation of ara-C incorporation into DNA. The augmentation of ara-C incorporation into DNA caused by preincubation of the cells with dGuo results from a number of factors, including the cytokinetic effect of increasing the percentage of cells in S phase and the reduction of intracellular dCTP pools. Maximal dGuo enhancement of ara-C incorporation into DNA (approximately 5-fold) required greater than 100 microM dGuo, 16-hr preincubation with dGuo, and final incubation of cells with ara-C after removal of dGuo. We explain this further augmentation of ara-C incorporation into DNA caused by the removal of dGuo prior to adding ara-C by our observed inhibition of ara-C phosphorylation by dGuo concentrations greater than 100 microM.

The uptake of uridine by mammalian cells consists of transport of uridine across the plasma membrane followed by its metabolic conversion, mainly by phosphorylation. S-substituted aromatic derivatives of 6-mercaptopurine ribosides are potent inhibitors of the nucleoside uptake systems in human erythrocytes and in mammalian cells in culture and have been studied extensively. We present here a theoretical analysis which enables one to decide whether transport of metabolites, their metabolic trapping within the cell, or both, are susceptible to inhibition. This analysis was applied in the study of the effect of some inhibitors on uridine and cytosine-beta-D-arabinoside uptake by transformed Nil-8 cells. It was found that in Nil-SV cells, both transport and metabolic conversion are susceptible to inhibition by nitrobenzylmercaptoinosine and by dansylaminoethylmercaptoguanosine. Nitrobenzylmercaptoinosine displays inhibition constants of 20 and 7 nM for transport and phosphorylation, respectively, while for dansylaminoethylmercaptoguanosine the inhibition constants are 1.8 and 0.6 microM, respectively, for the same processes. Cytosine-beta-D-arabinoside is a synthetic nucleoside which is not metabolizable in Nil cells. Its uptake properties are determined by the transport mechanism alone. The transport of this nucleoside into Nil-SV cells in inhibited by nitrobenzylmercaptoinosine and the inhibition constant found is approx. 5 times greater than that for uridine.

After a 3-day exposure to 0.1 microM 1-beta-D-arabinofuranosylcytosine (ara-C) in culture, growth was inhibited to 5.6% in MOLT-4F, 25% in Raji, and 91% in Daudi cells compared with control. Growth inhibition was more profound when exposure time was extended up to 7 days. Inhibition of DNA synthesis varied with sensitivity to ara-C. Plateau levels of intracellular 1-beta-D-arabinofuranosylcytosine 5'-triphosphate (ara-CTP) were 35.5, 13.4, and 3.6 nmol/10(9) cells exposed to 0.1 microM ara-C in MOLT-4F, Raji, and Daudi cells, respectively, corresponding to the sensitivity to ara-C. The nucleotide levels at the plateau, however, did not correspond to the initial levels of the ara-CTP or to the calculated rate of ara-CTP synthesis, which decreased from Raji to MOLT-4F to Daudi cells. ara-C deamination had negligible effect on the differential accumulation of ara-CTP. ara-CTP degradation due to dephosphorylation was marked in Raji and Daudi cells but slight in MOLT-4F cells. The half-life of intracellular ara-CTP was 204, 26.4, 31.1 min in MOLT-4F, Raji, and Daudi cells, respectively. The ara-CTP level was considered to be maintained bimodally by synthesis and degradation of the nucleotide. This conclusion was supported by the fact that, in Raji and Daudi cells exposed to 0.1 microM ara-C in the presence of 1 mM hydroxyurea, the plateau levels of ara-CTP increased 3-fold through inhibition of the nucleotide degradation. Thus, not only ara-C phosphorylation but also subsequent ara-CTP dephosphorylation was important in the accumulation and maintenance of ara-CTP and in the sensitivity to ara-C.

We entrapped the antimetabolite cytarabine hydrochloride in a multivesicular liposome for sustained drug delivery to the eye. The in vitro half-life of cytarabine release from these liposomes was 359 hours. Following subconjunctival administration of 6 mg of cytarabine to 12 rabbits, the tissue half-life of drug at the injection site was 52.5 hours in the six rabbits treated with liposomes compared with 0.2 hours in the six nonliposome controls treated with the same amount of drug in normal saline solution. The aqueous humor drug concentration peaked after 1.5 hours in both the experimental (0.4 mg/L) and control (19 mg/L) groups. In control eyes, the cytarabine level of both the tissue and aqueous humor had decreased to less than 1% of peak value by eight hours. In the liposome-treated eyes, almost 30% of the cytarabine remained in the conjunctiva and episcleral tissue after 72 hours. The difference in cytarabine levels in tissue between the liposome-treated group and controls was highly significant. By controlling the rate of drug release, it may be possible to reduce the ocular toxicity and increase the efficacy of this drug for treating ocular proliferative disorders.

The effect of dipyridamole, an inhibitor of membrane nucleoside transport, on the uptake and toxicity of cytarabine was examined in normal and malignant tissues. Preliminary pharmacokinetic data were obtained in mice and humans to determine appropriate dipyridamole dosage ranges for in vitro testing. At concentrations achievable in man, dipyridamole produced 75% and 94% reductions in cytarabine uptake in freshly harvested normal mouse and human bone marrow cells, respectively. Under the same conditions, greater than 90% reductions in cytarabine uptake were also seen in both L1210 murine leukemia and HL-60 human leukemia cells. In addition, treatment with dipyridamole also reduced the growth inhibitory effects of cytarabine on HL-60 cells in culture and protected mice from toxic doses of this antimetabolite. These results demonstrate the ability of dipyridamole to modulate the activity of cytarabine in both murine and human cells.

Hydroxyurea and pyrimidine analogs have been shown to enhance the chemotherapeutic efficacy and the DNA excision repair-inhibitory capacity of arabinofuranosylcytosine (ara-C). Since various cell types are expected to respond differently to these combination treatments and since little is known about the nature of their antiproliferative effects, we have investigated the metabolism and uptake into acid-soluble pools of deoxycytidine (dCyd) and ara-C in cycling and non-cycling human diploid fibroblasts. A substantial fraction of dCyd is converted through deamination to deoxyuridine and thymidine nucleotides, and this occurs to a greater degree in log phase cultures. ara-C is more resistant to deamination and is metabolized primarily to ara-CTP. Hydroxyurea decreases the proportion of dCyd and ara-C which is deaminated under both growth conditions, leading to higher levels of ara-CTP and dCTP. Trifluorothymidine causes an accumulation of dUMP and decreases the formation of dCTP in log phase and confluent cells. Thymidine inhibits deamination in log phase cells but stimulates this pathway in noncycling cells. Dideoxythymidine did not appreciably alter the spectrum of metabolites of dCyd formed in log or confluent phase cells but was shown to inhibit the transport of dCyd and thymidine across the membrane. These studies provide information regarding the nature of the enhancement of the antiproliferative activity of ara-C by commonly used drugs and indicate that the cycling state of the target cell plays a major role in determining the metabolism of the nucleoside and the efficacy of chemotherapeutic treatments.

The blood clearance, tissue distribution, and tumor uptake of temperature-sensitive liposomes containing the anticancer drug cytosine [3H]-1-beta-D-arabino-furanoside (Ara-C) or [3H]-methotrexate (MTX) were measured. Large unilamellar liposomes composed of a mixture of dipalmitoylphosphatidylcholine and dipalmitoylphosphatidylglycerol (4:1 by weight) were formed by reverse-phase evaporation and sequentially extruded through polycarbonate membranes with pore sizes of 0.4, 0.2, 0.1, 0.08, and 0.05 micron. The liposomes were injected intravenously via the tail vein into B6D2F1 mice containing solid tumors (M5076 ovarian carcinoma) implanted in both hind feet. Drug release, organ distribution, and tumor uptake were studied during and following local hyperthermia treatments (42 degrees C, 60 minutes). Local hyperthermia increased the relative amount of liposome encapsulated drug delivered to a heated solid tumor compared with the unheated control. The clearance studies showed that liposome blood clearance was inversely proportional to liposome size. However, tumor uptake was not significantly affected by reducing liposome size. In addition, for the range of liposome sizes studied, the majority of the liposome encapsulated drug was found in the liver, spleen, and kidney; not in the heated tumor.

The antitumor activity and the pharmacological fate of N4-palmitoyl-1-beta-D-arabinofuranosylcytosine (N4-palmitoyl-ara-C) administered p.o. were examined in mice and were compared with those of the parent compound 1-beta-D-arabinofuranosylcytosine (ara-C). N4-Palmitoyl-ara-C administered p.o. showed chemotherapeutic effects superior to those of ara-C when used against P388 leukemia, L1210 leukemia, mammary adenocarcinoma 755, and colon 38 adenocarcinoma. The derivative also inhibited the spontaneous pulmonary metastasis of s.c.-inoculated Lewis lung carcinoma more efficiently than did ara-C. After a single p.o. injection of a suspension of N4-palmitoyl-[2-14C]ara-C at a therapeutic dose of 350 mu/kg, a high concentration of the drug was found in the liver, lung, and plasma of portal venous blood. The level of the drug in other tissues and peripheral plasma was rather low. The two main metabolites, identified as ara-C and 1-beta-D-arabinofuranosyluracil, were found in plasma and various tissues. Plasma ara-C concentration was maintained for at least 6 hr in the range of 2.3 to 5.1 nmol/ml after p.o. administration of N4-palmitoyl-ara-C (350 mu/kg). On the other hand, when an equimolar amount of ara-C was given, the plasma levels of the drug decreased rapidly; from 2 to 6 hr after administration, the level (1.0 to 4.1 nmol/ml) was less than that obtained with N4-palmitoyl-ara-C. These results suggested that N4-palmitoyl-ara-C administered p.o. is absorbed as an intact form from the gastrointestinal tract and that the absorbed compound is the depot form of ara-C, releasing ara-C over a prolonged period of time.

Human cytomegalovirus-induced DNA polymerase and cellular DNA polymerase alpha were purified by successive chromatography on DEAE-cellulose, phosphocellulose, heparin agarose, and single-stranded DNA agarose columns. The purified virus-induced DNA polymerase was resolved to consist of two polypeptides corresponding to molecular weights of 140,000 and 58,000, as analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Virus-induced DNA polymerase and cellular alpha polymerase were examined for their sensitivities to the triphosphates of 1-(2'-deoxy-2'-fluoro-beta-D-arabinofuranosyl)-5-methyluracil (FMAUTP), -5-iodocytosine (FIACTP), and -5-methylcytosine (FMACTP). The inhibitive effects of these triphosphates on the DNA polymerases were competitive with regard to the natural substrates; thus FMAUTP competes with dTTP, and FIACTP and FMACTP compete with dCTP. The inhibition constants (Ki) for FMAUTP, FIACTP, and FMACTP of virus-induced DNA polymerase are 0.06, 0.30, and 0.47 microM, respectively. Cellular DNA polymerase alpha is much less sensitive to these inhibitors, and its Ki values for FMAUTP, FIACTP, and FMACTP are 0.45, 3.10, and 2.90 microM, respectively. In addition, human cytomegalovirus-induced DNA polymerase, but not cellular DNA polymerase alpha, can utilize these analog triphosphates as alternate substrates for their corresponding natural deoxyribonucleoside triphosphates in in vitro DNA synthesis.