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Previous investigations have indicated the possibility to circumvent multidrug resistance (MDR) by incorporation of an anthracycline into liposomes. We examined the in vitro cytotoxicity and cellular drug accumulation of the anthracyclines daunorubicin and doxorubicin compared with the commercially available liposomal formulations DaunoXome and Caelyx in human myelogenous leukemia K562 cells. The drug-sensitive parental K562/K line was compared with the P-glykoprotein (P-gp)-expressing cell lines K562/Dnr and K562/Vcr. Two cell lines with reduced levels of topoisomerase II (K562/Nov and K562/Ida) were also included. The cytotoxicity was determined by fluorometric microculture cytotoxicity assay and the cellular drug levels were determined by high performance liquid chromatograghy. There was a strong inverse correlation between P-gp levels and cellular drug accumulation (rho = -0.83, p = 0.04) and cytotoxicity (rho = -0.95, p = 0.01) of daunorubicin. Also the cytotoxicity of DaunoXome and doxorubicin was related to P-gp levels (rho = -0.96, p = 0.01 and rho = -0.90, p = 0.07, respectively). Caelyx did not show any cytotoxic effect due to impaired cellular uptake of the pegylated liposome. Regardless of the P-gp levels of the treated cells, DaunoXome showed the same cytotoxic effect despite lower intracellular accumulation (range 22-47%), compared with conventional daunorubicin.

The plasma pharmacokinetics of a second generation anthracycline derivative, idarubicin (Ida), have been studied in 17 patients with acute myelocytic leukemia (AML) and high risk features. The drug (10 mg/m2) was given in a randomized cross-over design as 3 min and 2 h infusions for three consecutive days. Cytosine arabinoside (Ara-C, 1 g/m2) was given on days 1-4. The plasma concentration time course of Ida was most properly described by the three-compartment pharmacokinetic model, independent of administration time. The maximum plasma concentration (Cmax) of Ida was reduced by a factor of 3 by increasing the infusion time from 3 min to 2 h. The pharmacokinetic pattern of the active metabolite idarubicinol (IdaOH) was only to a minor extent affected by the longer infusion time. The time course of IdaOH following each dose of Ida was accurately described by the one-compartment model with a first-order formation phase. The are under the plasma concentration versus time curves (AUC) of Ida and IdaOH were not affected by the administration time. Following Ida in combination with Ara-C, the medial duration of leukopenia (< 1.0 x 10(9)/l) was 14 days (range 5-56) and of thrombocytopenia (< 50 x 10(9)/l) was 22 days (range 7-120). The large majority of patients developed infectious complications. Two patients with MDS-AML showed a good response. The results of the present study give no evidence of reduced hematologic toxicity by increasing the administration time of Ida from 3 min to 2 h. However, minimizing Cmax, by administration of Ida as prolonged infusion during a 3 day course, might be clinically important in order to reduce cardiotoxicity and hopefully to increase anti-tumor efficacy through an increased accumulation of Ida and IdaOH in leukemic cells.

Cytotoxic mechanisms of the antitumor agents daunorubicin and doxorubicin were elucidated in isolated cardiomyocytes from adult rats. Incubation with daunorubicin resulted in a concentration-dependent loss of cell viability and changes of the cell structure. Only the highest concentration of doxorubicin (1 mM) caused similar effects. Doxorubicin was found to stimulate oxygen consumption by cardiomyocytes (about 20%), while the opposite effect was observed after daunorubicin treatment. A rapid decrease of the mitochondrial ATP content (more than 40%) and elevation of the cytosolic ADP level (doxorubicin 2-fold and daunorubicin 6-fold) was followed by increased release of adenosine and inosine to the surrounding medium. When myocytes were exposed to an anthracycline concentration lower than plasma levels measured clinically (0.15 microM), doxorubicin and daunorubicin significantly decreased the intracellular ADP and NAD levels. Isolated cardiomyocytes were found to be able to form daunorubicinol from daunorubicin. In contrast, no conversion of doxorubicin was detected in our experiments. In conclusion, our data demonstrate that decreased ATP production and increased nucleoside formation are major events in the toxicity induced by daunorubicin and doxorubicin in isolated cardiomyocytes. The results also suggest that the toxic effects may be caused by separate mechanisms.

The tissue distribution of daunorubicin (D) and daunorubicin-DNA complex (D-DNA) was studied in mice by means of whole-body autoradiography (WBA) and high-performance liquid chromatography (HPLC). A higher accumulation of radioactivity in the blood after 1 min and a lower initial accumulation in the cardiac muscle were found after administration of 3H-D-DNA than after the infection of free drug. Comparative studies of plasma levels of daunorubicin and daunorubicinol (DOH) in D- and D-DNA-treated animals by HPLC showed that the initial differences were negligible from 2 h onward. A rapid accumulation of D in bone marrow occurred in both D- and D-DNA-treated mice. D reached its maximum level after 1 h and was almost constant for 12 h. A new WBA finding was a rapid and specific accumulation of radioactivity in the pituitary gland, in the thyroid, and in the pancreatic islets, which might be of some interest in consideration of possible late endocrine side effects of anthraquinone glycoside therapy.

The extraction of daunorubicin and doxorubicin and their hydroxyl metabolites daunorubicinol and doxorubicinol was studied using chloroform-1-pentanol (9:1) as the organic phase. Because of differences in acid dissociation constants, the pH for optimum extraction varied from 8.0 to 8.6 for the different compounds. Self-association in the aqueous phase significantly influenced the distribution ratio. Constants for the formation of dimers and tetramers in aqueous solutions were about 10(4.5) and 10(12), respectively.

Adriamycin and daunorubicin and their metabolites adriamycinol and daunorubicinol were separated by reversed-phase liquid chromatography using LiChrosorb RP-2, RP-8 and RP-18 as supports and acetone, acetonitrile and alcohols as organic modifiers in the mobile phase. The highest separation selectivity was obtained using a mobile phase containing low concentrations (less than 20%) of acetonitrile. The length of the hydrocarbon chains of the surface-modified silica supports had no significant influence on the selectivity. The lowest capacity factor was obtained with 40-60% of organic solvent in the mobile phase. Increasing the length of the hydrocarbon chains of the supports increased the retention of the solutes.

A method is given for the determination of daunorubicin and its main metabolite, daunorubicinol, in plasma from leukemic patients after administration of daunorubicin as the free drug or as a complex with DNA. Daunorubicin and daunorubicinol are extracted from 2 ml of plasma (pH 8.1) using a mixture of chloroform and 1-heptanol (9:1). After re-extraction into phosphoric acid (0.1 M), the separation is performed as reversed phase liquid chromatography on a LiChrosorb RP-2 (5 micrometer) column with a mobile phase of acetonitrile-water, acidified with phosphoric acid. The precision, by quantitation with a photometric detector, was better than 2% within the range 20 ng/ml to 200 ng/ml. Some determinations of plasma levels of daunorubicin and daunorubicinol are presented.

A method is given for the determination of idarubicin and its main metabolite, idarubicinol, in plasma from cancer patients. Idarubicin and idarubicinol are extracted from 2-ml samples of buffered plasma (pH 8.1) using chloroform-1-heptanol (9:1). After reextraction into phosphoric acid (0.1 M), separation is performed by reversed-phase liquid chromatography on a LiChrosorb RP-2 column (5 microns) with a mobile phase of acetonitrile-water, acidified with phosphoric acid. The absolute recovery in the range 5-100 ng/ml was greater than 83% with a precision better than 8% (relative standard deviation), using photometric detection at 484 nm. Proper handling of whole blood samples containing idarubidin is essential to avoid metabolic conversion into idarubicinol. Prolonged storage of the drug and its main metabolite under alkaline conditions should be avoided to prevent chemical degradation.

Fifteen patients with acute nonlymphocytic leukemia have been randomized for treatment with daunorubicin (1.0--1.5 mg/kg) either as the free drug (for 45 min or 4 h) or as the drug bound to a DNA carrier (for 5--6 h). The correlation between plasma kinetics of daunorubicin and its main metabolite daunorubicinol and the different administration schedules of daunorubicin has been studied by reversed-phase liquid chromatography. Plasma concentration kinetics of daunorubicin as well as the daunorubicin-DNA complex was biphasic in character. Maximum plasma level of daunorubicin was found during the infusion period. Its concentration decreased rapidly when the infusion stopped and was below the detection limit of the analytical method 2--4 h later. The data suggests a slower disposition of the duanorubicin-DNA complex compared with the free drug.

An earlier whole-body autoradiographic study in mice revealed large differences between the tissue distribution of daunorubicin (D) after administration as free drug as as DNA-linked D. Therefore, the pharmacokinetics of D administered as free drug or linked to DNA was studied in 15 adult patients with acute non-lymphoblastic leukemia. The data obtained following infusion of free drug over either 45 or 240 min could be fitted to a two-compartment open-body model. With the D-DNA infusion considerably higher plasma concentrations were achieved, with a slower distribution and elimination from plasma than seen after the administration of free drug. this confirmed earlier animal data indicating a different pharmacokinetic behavior of D when it was administered linked to DNA. Furthermore, different pharmacokinetic parameters were obtained for D during infusion and in the post-infusion phase after administration of DNA-linked D (P less than 0.005). This finding strongly indicates that the D-DNA acts as a slow-release preparation in humans, which might modify tissue distribution and toxic side-effects of the drug.