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Antimicrobial Agents and Chemotherapy, March 2005, p. 1160-1168, Vol. 49, No. 3
0066-4804/05/$08.00+0 doi:10.1128/AAC.49.3.1160-1168.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.
Departamento de Biología Celular,1 Departamento de Patología Experimental, Centro de Investigación y de Estudios Avanzados del IPN,2 Laboratorio de Investigación en Microbiología, Hospital Juárez de México, Mexico City,3 Laboratorio de Química Medicinal, Unidad de Postgrado Campo 1, FES Cuautitlán, UNAM, Cuautitlán Izcalli, Estado de México, Mexico4
Received 27 May 2004/ Returned for modification 5 August 2004/ Accepted 26 October 2004
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Antiamoebic drugs have been classified as luminal if their site of action is in the large intestine and extraluminal if their site of action is in other organs, mainly the liver (11). Although most antiamoebic drugs have been shown to be relatively efficient for the treatment of clinical cases, the long-term use of medications produces undesirable side effects in patients. The chemical products used to eradicate E. histolytica, such as nitroimidazoles, have been shown to have several important problems; for example, they might be mutagenic and toxic for the host when they are used at high doses, amoeba strains are able to develop resistance to these drugs, and insufficient information is available about the drug levels at the tissue sites of infection in vivo (4, 5, 7, 12, 13, 27, 28). On the basis of these considerations, it is important to search for new alternative antiamoebic drugs from either biological or chemical sources that can eliminate the parasite without generating complications or secondary reactions in the host.
In this work we report on a new carbamate derivative drug, ethyl 4-chlorophenylcarbamate (C4), as an antiamoebic agent. The drug showed good activity against axenic E. histolytica cultures and significantly reduced the development of ALAs in hamsters. C4 was neither mutagenic for bacterial cells nor toxic to rat hepatocytes.
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TABLE 1. Carbamic acid derivatives examined in this work
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Care of animals. For the C4 toxicity studies and induction of hepatic amoebiasis, all animals were handled according to the International Norms for Care and Use of Laboratory Animals (NOM 062-200-1999). All procedures were done at the Animal Care Unit of Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN; Mexico City, Mexico).
In vitro detection of carbamate antiamoebic activities. E. histolytica cultures of 48 h were adjusted to 104 cells/ml. Ten carbamates (Table 1) were dissolved in 0.2% (vol/vol) dimethyl sulfoxide (DMSO; Sigma), and each carbamate was tested by addition of the carbamate to cultures at concentrations ranging from 0.025 to 250 µg/ml and incubation at 37°C. Metronidazole (5 µg/ml) was the positive control for growth inhibition. The number of amoebas was measured at 3, 6, 9, 12, 24, 48, 72, and 96 h after cooling and centrifugation of the cultures at 500 x g for 5 min at 4°C. The pellets were suspended in phosphate-buffered saline, and the amoebas were counted in a hemocytometer chamber. Viability was determined by trypan blue stain exclusion (8).
Mutagenicity of C4 in bacteria. Studies of the mutagenicity of C4 were performed as described by Maron and Ames (16) by using both the incorporation and the preincubation methods. These assays were performed with 0.5 ml of saline solution (SS) or 0.5 ml of the S9 fraction of rat liver (S9 mixture), bacteria, and different concentrations of C4. The S9 mixture was obtained from male Wistar rat liver induced with Aroclor 1254 (New England Nuclear, North Haven, Conn.) (16).
Plate incorporation test. Salmonella enterica serovar Typhimurium strains TA97, TA98, TA100, and TA102 were cultured for 16 h at 37°C on a shaking water bath at 90 rpm. In a sterile tube containing 2 ml of soft agar (at 45°C), the bacterial cultures (0.1 ml) were exposed to C4 at different final concentrations ranging from 3.12 to 400 µg/ml or to SS as a control. Afterwards, 2 ml of soft agar was added to each tube, the tube was vortexed for 3 s at low speed, and the tube contents were poured onto plates with Vogel-Bonner agar medium. The cultures were incubated at 37°C for 48 h.
Preincubation test. The preincubation test consisted of exposure of 0.1 ml of cultures (16 h) of S. enterica serovar Typhimurium strains TA97, TA98, TA100, and TA102 to C4 at different final concentrations ranging from 3.12 to 400 µg/ml or to SS. The cultures were incubated for 1 h with the C4 dilutions at 37°C on a shaking water bath at 90 rpm. Afterwards, 2 ml of soft agar was added to each tube, and the tube contents were poured onto plates with Vogel-Bonner agar medium. The cultures were incubated at 37°C for 48 h.
For both tests, the Salmonella histidine revertant (His+) number was assessed with a Fisher colony counter. Positive controls of mutagenesis used for each strain (2AA, CP, ENNG, MC, and PA) were those recommended previously (16).
Cytotoxicity of C4. Hepatocytes were isolated from male Fischer 344 rats (weight, 180 to 200 g) by the collagenase perfusion method (19). Cells were cultured in Dulbecco-Vogt-modified Eagle's minimal essential medium (DMEM; Gibco, Grand Island, N.Y.) supplemented with 1.5 U of insulin and 7% (vol/vol) bovine serum (Equitech-Bio, Inc., Ingram, Tex.). Cell viability was measured by the trypan blue exclusion method, 800,000 cells were placed on each culture dish, and the culture dishes were incubated at 37°C for 1 h in a 9% CO2 atmosphere to allow cell adherence. Afterwards, the medium was removed, C4 was added at different final concentrations ranging from 1.96 to 250 µg/ml in fresh medium, and the mixture was incubated for 4 h. The cells were then washed with DMEM and further incubated for 1 h with 0.4 mg of tetrazolium salt per ml in DMEM. Finally, the medium was removed and DMSO was added to dissolve the intracellular formazan that had formed. This supernatant was diluted in DMSO, and the optical density at 545 nm was read (21).
In vivo model of ALA. Hamsters (M. auratus; age, 2 months; average weight, 100 g) were used for the in vivo model of ALA. They were caged individually and starved for 24 h before surgery. The animals were anesthetized with intraperitoneal sodium pentobarbital (Anestesal; Smith Kline, Mexico City, Mexico). ALA was induced by intrahepatic inoculation of 106 trophozoites in 0.2 ml of medium (n = 6 animals). The production of lesions at approximately 1.5 g per liver was standardized previously. Six groups of six animals each were used to test C4 as an amoebicide. The first two groups were treated with SS and DMSO, respectively, as negative controls; the third group was treated with metronidazole (5 mg/100 g of body weight) as a positive control for healing; and the other three groups were treated with C4 at 50, 75, and 100 mg/100 g of body weight, respectively. Treatments started 4 days after inoculation of the amoebas. Each hamster received 10 intraperitoneal injections of C4 as 1 injection every 3 days (72 h). The six groups were monitored daily for clinical signs, and at the end of the treatment all hamsters were killed. Sera from three random animals were analyzed for their liver enzymatic profiles. The characteristics of the hepatic lesions were recorded, and the livers were dissected and weighed. Representative injured fragments were collected and fixed with 10% paraformaldehyde in phosphate-buffered saline, and the sections were stained with hematoxylin-eosin (10, 14, 17, 30).
Liver enzymatic activities. A Beckman Synchron CX4 instrument was used to measure the levels of aspartate and alanine aminotransferases; amylase; total, direct, and indirect bilirubins; and total proteins in hamster sera.
Transmission electron microscopy. Amoebas (106 cells) treated with 125 or 250 µg of C4 per ml or with metronidazole (5 µg/ml) for 2 h at 37°C were fixed with 2.5% glutaraldehyde in 0.1 M sodium cacodylate buffer (pH 7.4) for 2 h with slow agitation. The samples were then centrifuged, embedded in Epoxy resin, and cut into 1-mm-thick sections. Semithin sections (thickness, 1 µm) were stained with toluidine blue. Thin sections (thickness, 60 to 90 nm) were stained with uranyl acetate and then lead citrate and examined with a JEOL910 transmission electron microscope (15).
Statistical analysis. All data represent the means of three independent experiments performed in triplicate. The results for the different times of incubation and the different concentrations of C4 in the in vitro studies were analyzed by analysis of variance (ANOVA).
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FIG. 1. Kinetics of growth inhibition of E. histolytica trophozoites treated with different concentrations of C4. Strain HM-1:IMSS (104 cells/ml) was incubated in medium TYI-S-33 at 37°C for 96 h with 100, 125, or 250 µg of C4 per ml dissolved in 0.2% DMSO. Samples were taken out at the indicated times, and the amoebas were counted in a Neubauer chamber. Viability determination was done by exclusion of trypan blue dye. Negative controls were amoebas in DMSO. Positive controls were amoebas treated with 5 µg of metronidazole per ml. The results represent the means and standard deviations of triplicate experiments.
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FIG. 2. Mutagenicity of the C4 carbamic acid derivative for Salmonella serovar Typhimurium His strains. Positive controls (final concentration) were PA (82 µg/ml), 2AA (16 µg/ml), CP (820 µg/ml), ENNG (8.2 µg/ml), and MC (0.04 µg/ml). (A and B) Strains TA97 and TA98, respectively, used for detection of frame-shift mutations; (C) strain TA100, used for determination of base-pair substitutions; (D) strain TA102, used for determination of damage due to free radicals. Average rates of reversion for spontaneous revertants ± standard deviations were as follows: TA97, 251.3 ± 26.0; TA98, 40.0 ± 2.6; TA100, 223.0 ± 18.6; TA102, 335.6 ± 19.8. Data represent the means of three experiments, with each experiment performed in triplicate.
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FIG. 3. Toxicity of the C4 carbamic acid derivative for primary cultures of 344 Fischer rat liver cells. Hepatocytes were exposed to C4 by the collagenase perfusion method. Three replicates of 8 x 105 cells were incubated for 4 h at 37°C in a 9% CO2 atmosphere with C4 at final concentrations of 1.96 to 250 µg/ml in fresh medium and were then incubated with a tetrazolium salt for 1 h at 37°C. Three independent experiments were done. Bars indicate standard deviations. Metronidazole (ME) was used at concentration of 5 µg/ml and was the positive control. DMSO (0.2%) and DMEM were used as negative controls. ANOVA was used to compare the means for the treated and the negative control cultures. *, significantly different (P < 0.001) from the results for the controls.
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FIG. 4. Percentage of damaged liver in hamsters exposed to the carbamate C4. Abscesses were induced by intrahepatic inoculation of 106 trophozoites in 0.2 ml of medium. Treatments started 4 days after infection, when the abscess reached an average of 23% of the total liver weight (A). Intraperitoneal injections of C4 were given every 3 days up to 10 times. Animals were treated with saline solution (B), DMSO (C), 5 mg of metronidazole per 100 g of body weight (D), 50 mg of C4 per 100 g of body weight (E), 75 mg of C4 per 100 g of body weight (F), or 100 mg of C4 per 100 g of body weight (G). (H) Histopathology of hamster liver treated only with 100 mg of C4. Each group represents the average value for six animals, and bars indicate standard deviations. ANOVA was used to compare means between the C4 and the SS or DMSO treatments. *, significantly different (P < 0.001) from the results for the controls.
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Hepatic function tests. Drug metabolism and transport data for the livers of hamsters treated with C4 were expressed as the enzymatic activity profile of the organ. In the control hamsters the levels of all enzymes tested except amylase were similar to the human reference values. Treatment with neither metronidazole nor C4 produced changes in enzyme levels compared with those in the control animals. Also, C4 did not alter the liver function in animals with hepatic abscesses treated with this carbamate (data not shown).
Transmission electron microscopy of E. histolytica exposed to C4. E. histolytica trophozoites untreated and treated with DMSO showed normal cytoplasmic vacuoles and nuclei with typical chromatin arrangements. Parasites exposed to metronidazole showed structural changes; were of various sizes, mostly spherical, and highly vacuolated; and contained increased amounts of glycogen. The level of membrane damage was approximately 30% in amoebas treated with 125 µg of C4 per ml, and the cells were vacuolated. Most amoebas in cultures treated with 250 µg of C4 per ml were killed by the action of C4; the remainder were round with scarce pseudopodia and displayed atypical irregular nuclei, abundant vacuolization, and changes in the plasma membrane and arrangements of intracellular material as result of cellular damage (data not shown).
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Several procedures can be used to test the antiamoebic activities of drugs in vitro, but none of them is free of criticism. First, in axenic cultures E. histolytica trophozoites exist under growth conditions completely different from those that exist when they invade host tissues; inside the host, immune defense mechanisms, bacteria, and other factors affect multiplication and attack of the target site. Second, there are different opinions about the best container to be used to culture amoeba; microplates, dishes, or glass tubes can be used for culture, but we chose glass tubes, since these provide a better quantitative recovery of amoebas, can be used for long periods of testing, and also produce an adequate proportion of amoeba per amount of medium that does not interfere with the logarithmic growth phase. Third, the drug effect is influenced by the size of the amoeba inoculum, growth phase, and the period of amoeba exposure to the drug (8, 22). For C4, the use of an inoculum of 104 amoebas and the time of amoeba contact with the drug were important, since they allowed us to determine over a short period of time the amoebostatic versus the amoebicidal effect.
By using a wide range of C4 concentrations, we found that it was amoebicidal for in vitro growth at a concentration greater than 100 µg/ml. Another important characteristic was that, at this concentration, C4 did not exhibit mutagenic activity by the Ames test when it was incubated with bacteria, which is in contrast to the data reported for metronidazole, the drug currently used for the treatment of invasive amoebiasis, as well as for other antiparasitic drugs (1, 5, 7, 33).
The use of MTT in rat liver cell cultures is a good indicator of various dehydrogenases and mitochondrial function and, thus, is a good cellular toxicity marker (31). With this tool we demonstrated that a concentration of 125 µg/ml was moderately toxic for Fischer 344 rat liver cells. This variety of rat liver cells was selected because of its high degree of susceptibility to all kinds of carcinogens.
We used an experimental model of ALA in hamsters to determine the possible curative effect of C4 on amoebiasis in vivo. This model provides a hepatic abscess of approximately 20% of the total organ weight after 4 days of intrahepatic inoculation of trophozoites. The results of previous studies of the effect of metronidazole on ALA in hamsters, together with the information obtained in this work about the in vitro effects of metronidazole and C4, were the bases for choosing the dose of C4 to be used in our in vivo studies (10, 14, 17). C4 inhibited growth of the ALA. Furthermore, the functions of several liver enzymes were unaltered during C4 administration.
The results of the present study show that the carbamate derivative C4 is not genotoxic to bacteria and did not alter hepatic enzyme function. This compound was also capable of diminishing ALA development in the hamster model. However, the effectiveness of C4 could be increased and its toxicity could be decreased if it were used in combination with silica beads or divalent cations or if it were administered in liposomal formulations (20, 23, 29). Also, we believe that several exposures of amoebas to C4 (such as during in vivo treatments) could diminish the effective dose of the carbamate required. On the other hand, we have observed synergistic effects between C4 and metronidazole, which should possibly improve the activities of both drugs. Thus, C4 could be considered for evaluation in future pharmacological studies as an antiamoebic candidate that could eventually be used for the treatment of human amoebiasis. We are studying the mechanism of action of C4 against E. histolytica trophozoites.
We thank L. Alemán, E. Arce, D. Carrasco, S. Fattel, D. Godínez, S. Hernández, E. Molina, M. Reyes, and A. Silva for technical assistance and Rafael Leyva Muñoz for care and work with animals in the Animal Care Unit of CINVESTAV-IPN. Lastly, we thank V. Tsutsumi for critical comments on the manuscript.
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