Abstract
Ifosfamide (IF) and cyclophosphamide (CP) are highly effective alkylating cytostatic drugs. IF and CP have to be activated through a metabolic step in vivo; numerous metabolites are known. While both IF and its structural isomer CP have severe urotoxic side effects, only IF is also a nephrotoxic drug, causing tubular damage resulting in Fanconi syndrome in some cases. Little information is available regarding the pathogenic mechanism of tubular damage by IF. We used the renal epithelial cell line LLC-PK1, which has many properties of the proximal tubule, in order to investigate the toxicity of IF and CP and of their reactive metabolites 4-hydroxy-IF (4-OH-IF), 4-hydroxy-CP (4-OH-CP), acrolein and chloracetaldehyde (CAA). Protein content of monolayers, DNA and RNA synthesis were determined by standard techniques (thymidine and uridine incorporation). IF and CP had the lowest toxicities of all compounds tested. Both drugs inhibited thymidine incorporation by about 30% at a concentration of 300 μmol/l after 1 h incubation. 4-OH-IF and 4-OH-CP were significantly more toxic than the parent drugs. Thymidine incorporation, the most sensitive parameter, was reduced by about 70% by 300 μmol/l of either compound. In addition, 4-OH-CP reduced the total protein content of monolayers. 4-OH-IF did not effect protein content and RNA synthesis. Acrolein, the most toxic metabolite tested, reduced all three parameters significantly at concentrations of 50–75 μmol/l after 1 h. Incubation of cells with 100 μmol/l of acrolein showed an effect after only 1 min. CAA significantly damaged monolayers with a reduction of total protein at a concentration of 50–100 μmol/l. Thymidine incorporation was decreased only moderately by CAA, while uridine incorporation was stimulated, which may be interpreted to reflect a mechanism of repair. We conclude that both CP and IF and their metabolites are toxic in renal tubular cells in culture. CAA may play a larger role in the development of renal tubular damage after therapy with IF than was previously recognized.
Similar content being viewed by others
References
Brock N (1989) Oxazaphosphorine cytostatics: past — present — future. Cancer Res 49: 1–7
Arnold H, Bourseaux F, Brock N (1958) Chemotherapeutic action of a cyclic nitrogen mustard phosphamide ester (B 518-Asta). Nature 181: 931
Dechant KL, Brogden RN, Pilkington T, Faulds D (1991) Ifosfamide/Mesna. A review of its antineoplastic activity, pharmacokinetic properties and therapeutic efficacy in cancer. Drugs 42: 428–467
Bielicki L, Voelcker G, Hohorst HJ (1984) Activated cyclophosphamide: an enzyme mechanism-based suicide inactivator of DNA polymerase/3′–5′ exonuclease. J Cancer Res Clin Oncol 107: 195–918
Hohorst HJ, Bielicki L, Voeleker G (1986) The enzymatic basis of cyclophosphamide specificity. Adv Enzyme Regul 25: 99–122
Clarke L, Waxman DJ (1989) Oxidative metabolism of cyclophosphamide: identification of the hepatic monooxygenase catalysts of drug activation. Cancer Res 49: 2344–2350
Low JE, Borch RF, Sladek NE (1983) Further studies on the conversion of 4-hydroxyoxazaphosphorines to reactive mustards and acrolein in inorganic buffers. Cancer Res 43: 5815–5820
Norpoth K, Müller G, Raidt H (1976) Isolierung und Charakterisierung zweier Hauptmetabolite von Ifosfamid aus Patientenurin. Arzneimittelforschung 26: 1376–1377
Brade WP, Herdrich K, Varini M (1985) Ifosfamide — pharmacology, safety and therapeutic potential. Cancer Treat Rev 12: 1–47
Jürgens H, Exner U, Kühl J, Ritter J, Treuner J (1989) High-dose ifosfamide with mesna uroprotection in Ewing's sarcoma. Cancer Chemother Pharmacol 24: 40–44
Magrath I, Sandlund J, Raynor A, Rosenberg S, Arasi V (1986) A phase II study of ifosfamide in the treatment of recurrent sarcomas in young people. Cancer Chemother Pharmacol 18: 25–28
Pinkerton CR, Pritchard J (1989) A phase II study of ifosfamide in pediatric solid tumors. Cancer Chemother Pharmacol 24: 13–15
Brock N, Stekar J, Pohl J, Niemeyer U, Scheffler G (1979) Acrolein, the causative factor of urotoxic side effects of cyclophosphamide, ifosfamide, trofosfamide and sufosfamide. Drug Res 29: 659–661
Holoye PY, Glisson BS, Lee JS, Dhingra HM, Murphy WK (1990) Ifosfamide with mesna uroprotection in the management of lung cancer. Am J Clin Oncol 13: 148–155
Meanwell CA, Blake AE, Kelly KA, Honigsberger L, Blackledge G (1986) Prediction of ifosfamide/Mesna associated encephalopathy. Eur J Cancer Clin Oncol 22: 815–819
Pratt CB, Goren MP, Meyer WH, Singh B, Dodge RK (1990) Ifosfamide neurotoxicity is related to previous cisplatin treatment for pediatric solid tumors. J Clin Oncol 8: 1399–1401
Shaw IC, Graham MI (1987) Mesna — a short review. Cancer Treat Rev 14: 67–86
Burk CD, Restaino I, Kaplan BS, Meadows AT (1990) Ifosfamide-induced renal tubular dysfunction and rickets in children with Wilms tumor. J Pediatr 117: 331–335
Goren MP, Wright RK, Horowitz ME, Pratt CB (1987) Ifosfamide-induced subclinical tubular nephrotoxicity despite mesna. Cancer Treat Rep 71: 127–130
Skinner R, Pearson ADJ, Price L, Cunningham K, Craft AW (1989) Hypophosphataemic rickets after ifosfamide treatment in children. BMJ 298: 1560–1561
Skinner R, Pearson ADJ, Price L, Coulthard MG, Craft AW (1990) Nephrotoxicity after ifosfamide. Arch Dis Child 65: 732–738
Suarez A, McDowell H, Niaudet P, Comoy E, Flamant F (1991) Long-term follow-up of ifosfamide renal toxicity in children treated for malignant mesenchymal tumors: an international society of pediatric oncology report. J Clin Oncol 9: 2177–2182
Mohrmann M, Pauli A, Ritzer M, Schönfeld B, Seifert B, Brandis M (1992) Inhibition of sodium-dependent transport systems in LLC-PK1 cells by metabolites of ifosfamide. Renal Physiol Biochem 15: 289–301
Mohrmann M, Pauli A, Schönfeld B, Walkenhorst H, Brandis M (1993) Effect of ifosfamide metabolites on sodium dependent phosphate transport in a model of proximal tubular cells (LLC-PK1) in culture. Renal Physiol Biochem 16: 285–298
Hull RN, Cherry WR, Weaver GW (1976) The origin and characteristics of a pig kidney cell strain, LLC-PK1. In Vitro 12: 670–677
Biber J, Brown CDA, Murer H (1983) Sodium-dependent transport of phosphate in LLC-PK1 cells. Biochim Biophys Acta 735: 325–330
Rabito CA, Karish MV (1983) Polarized amino acid transport by an epithelial cell line of renal origin (LLC-PK1). The apical systems. J Biol Chem 258: 2543–2547
Rabito CA, Karish MV (1982) Polarized amino acid transport by an epithelial cell line of renal origin (LLC-PK1). The basolateral systems. J Biol Chem 257: 6802–6808
Amsler K, Cook JS (1982) Development of Na+-dependent hexose transport in a cultured line of porcine kidney cells. Am J Physiol 242 (Cell Physiol 11): C94-C101
Mullin JM, McGinn MT, Snock KV, Kofeldt LM (1989) Na+-independent sugartransport by cultured renal (LLC-PK1) epithelial cells. Am J Physiol 257 (Renal Fluid Electrolyte Physiol 26): F11-F17
Cantiello HF, Scott JA, Rabito CA (1986) Polarized distribution of the Na/H exchangesystem in a renal cell line (LLC-PK1) with characteristics of proximal tubular cells. J Biol Chem 261: 3252–3258
Mohrmann M, Cantiello HF, Ausiello DA (1987) Renal epithelial cell growth can occur in absence of Na+−H+ exchanger activity. Am J Physiol 253: C633-C638
Mohrmann I, Mohrmann M, Biber J, Murer H (1986) Sodium-dependent transport of Pi by an established intestinal epithelial cell line (CaCo-2). Am J Physiol 250: G323-G330
Mohrmann I, Mohrmann M, Biber J, Murer H (1986) Stimulation of Na/phosphate cotransport in LLC-PK1 cells by 12-O-tetradecanoylphorbol 13-acetate (TPA). Biochim Biophys Acta 860: 35–43
Moran A, Handler JS, Hagan M (1986) Role of cell replication in regulation of Na-coupled hexose transport in LLC-PK1 epithelial cells. Am J Physiol 250: C314-C318
Smith PK, Krohn RI, Hermanson GT, Mallia AK, Gartner FH, Provenzano MD, Fujimoto EK, Goeke NM, Olson BJ, Klenk DC (1985) Measurement of protein using bicinchoninic acid. Anal Biochem 150: 76–85
Pearcey R, Calvert R, Mehta A (1988) Disposition of ifosfamide in patients receiving ifosfamide infusion therapy for the treatment of cervical carcinoma. Cancer Chemother Pharmacol 22: 353–355
Low JE, Borch RF, Sladek NE (1982) Conversion of 4-hydroperoxycyclophosphamide and 4-hydroxycyclophosphamide to phosphoramide mustard and acrolein mediated by bifunctional catalysts. Cancer Res 42: 830–837
Wagner T, Heydrich D, Jork T, Voelcker G, Hohorst HJ (1981) Comparative study on human pharmacokinetics of activated ifosfamide and cyclophosphamide by a modified fluorometric test. J Cancer Res Clin Oncol 100: 95–104
Pohl J, Stekar J, Hilgard P (1989) Chloroacetaldehyde and its contribution to urotoxicity during treatment with cyclophosphamide or ifosfamide. Drug Res 39: 704–705
Goren MP, Wright RK, Pratt CB, Pell FE (1986) Dechlorethylation of ifosfamide and neurotoxicity. Lancet II: 1219–1220
Winckler K, Obe G, Madle S, Kocher-Becker U, Kocher W, Nau H (1987) Cyclophosphamide: interstrain differences in the production of mutagenic metabolites by S9-fractions from liver and kidney in different mutagenicity test systems in vitro and in the teratogenic response in vivo between CBA and C57 BL mice. Teratogenesis Carcinog Mutagen 7: 399–409
Brock N, Hilgard P, Peukert M, Pohl J, Sindermann H (1988) Basis and new developments in the field of oxazaphosphorines. Cancer Invest 6: 513–532
Ohno Y, Ormstad K, Ross D, Orrenius S (1985) Mechanism of allyl alcohol toxicity and protective effects of low molecular weight thiols studied with isolated rat hepatocytes. Toxicol Appl Pharmacol 78: 169–179
Grafstrom RC, Dypbukt JM, Willey JC, Sundqvist K, Edman C, Atzori L, Harris CC (1988) Pathobiological effects of acrolein in cultured human bronchial epithelial cells. Cancer Res 48: 1717–1721
Kimes BW, Morris DR (1971) Inhibition of nucleic acid and protein synthesis inE. coli by oxidized polyamines and acrolein. Biochim Biophys Acta 228: 235–244
Marano F, Puiseux-Dao S (1982) Acrolein and cell cycle. Toxicol Lett 14: 143–149
Marano F, Demestere M (1976) Ultrastructural autoradiographic study of the intracellular fixation of3H acrolein. Experientia 32: 501–502
Sarosy G (1989) Ifosfamide — pharmacologic overview. Semin Oncol 16: 2–8
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Mohrmann, M., Ansorge, S., Schmich, U. et al. Toxicity of ifosfamide, cyclophosphamide and their metabolites in renal tubular cells in culture. Pediatr Nephrol 8, 157–163 (1994). https://doi.org/10.1007/BF00865466
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00865466