Comparative Veterinary Pharmacology, Toxicology and Therapy

Comparative Veterinary
Pharmacology,
Toxicology and Therapy
Comparative Veterinary
Pharmacology,
Toxicology and Therapy
Proceedings of the 3rd Congress of the European Association for Veterinary
Pharmacology and Toxicology, August 25-29 1985, Ghent, Belgium
Parr II, Invited Lectures
Edited by
A.S.J.P.A.M. Van Miert
M.G. Bogaert and M. Oebackere
~ MTP PRESS LIMITED ~.

~ a member of the KLUWER ACADEMIC PUBLISHERS GROUP "
LANCASTER / BOSTON / THE HAGUE / DORDRECHT
Published in the UK and Europe by
MTP Press Limited
Falcon House
Lancaster, England
British Library Cataloguing in Publication Data

European Association for Veterinary Pharmacology and
Toxicology. Congress (3rd: 1985: Ghent)
Comparative veterinary pharmacology, toxicology and
therapy: proceedings of the Third EAVPT Congress,
Ghent, Belgium, August 25-29, 1985.
Part 2: Invited lectures
1. Veterinary pharmacology-Europe 2. Veterinary
toxicology-Europe
I. Title II. Miert, A.S.J.PAM. van
III. Bogaert, M.G. IV. Debackere. M.
636.089'5'094 SF915
ISBN-13: 978-94-010-8343-0 e-ISBN-13: 978-94-009-4153-3
001: 10.1007/978-94-009-4153-3
Published in the USA by

MTP Press
A division of Kluwer Academic Publishers
101 Philip Drive
Norwell, MA 02061, USA
Library of Congress Cataloging-in-Publication Data

European Association Veterinary Pharmacology and
Toxicology. Congress (3rd: 1985: Ghent, Belgium)
Comparative veterinary pharmacology, toxicology, and
therapy.
Includes bibliographies.
Contents: -pt. 2. Invited lectures.
1.Veterinary pharmacology-Congresses. 2. Veterinary
toxicology-Congresses. 3. Animals-Diseases-
Chemotherapy-Congresses. I. Van Miert,
A. S. J. P. A. M. II. Bogaert, M. G., 1937-
III. Debackere, M., 1930- IV. Title.
SF915.E87 1985 636.089'51 86-19134
ISBN- I 3: 978-94-010-8343-0
Copyright © 1986
Softcover reprint ofthe hardcover 1st edition 1986
All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system, or transmitted in any form or by any
means, electronic, mechanical, photocopying, recording or otherwise,
without prior permission from the publishers.
Contents
Preface xi
Contributors xiii
Welcome address
M. Debackere xxvii
Inaugural lecture:
Comparative pharmacology and toxicology
P. A. Janssen xxxi
ANAESTHESIA, NEUROLEPTANALGESIA AND SEDATION
Influence of halothane anaesthesia, after xylazine premedication,

on serum calcium concentration in the horse
F. Gasthuys, A. De Moor and C. Van Den Hende 3
2 Pharmacological properties of benzodiazepines in animals
W. F. Rehm and U. Schatzmann 13
3 Effects of halogenated inhalational anaesthetics on respiration in dogs

L. W. Hall 25
4 Analgesic activity of butorphanol in horses:
dosage titration and clinical studies
D. A. Gingerich. J. E. Rourke, P. W. Strom, L. L. Gordon
and M. Kalpravidh 33
v
vi COMPARATIVE VETERINARY PHARMACOLOGY, TOXICOLOGY AND THERAPY
TEACHING VETERINARY PHARMACOLOGY
5 Postgraduate training in the veterinary pharmacology

D. Droumev 47
6 The teaching of veterinary pharmacology and toxicology
J. D. Baggot 57
DRUG DELIVERY SYSTEMS AND BIOAVAILABILITY
7 Design and evaluation of studies on drug delivery systems

A. Van Peer and J. Heykants 69
8 Potential of new drug delivery systems in veterinary medicine
D. D. Breimer 75
9 Influence of injection site on the depot effect of procaine penicillin

in dogs
E. G. Flartman 85
10 Influence of food on absorption of antimicrobial drugs
A. D. J. Watson 93
SMOOTH MUSCLE PHARMACOLOGY
11 Pharmacology of the (fore}-stomach smooth muscles

L. A .A. Ooms, A. Weyns, A. Degryse and Y. Ruckebusch 107
12 Smooth muscle pharmacology of the large intestine

Y. Ruckebusch, T. Bardon, C. Cherbut, M. Pairet and J. P. Ferre 123
13 Recent advances in the pharmacological control of the intestinal
and colonic motor profiles
J. Fioramonti, L. Bueno and M. J. Fargeas 133
14 Cholinergic-like effect of the H2-receptor antagonist ranitidine
on the rabbit small intestine
G. Kounenis, M. Koutsoviti-Papadopou/ou and V. E/ezog/ou 143
COMPARATIVE PHARMACOKINETIC STUDIES
15 Comparative pharmacokinetics: introductory remarks

M. G. Bogaert 155
16 Comparative neonatal pharmacokinetics

P. DeBacker 161
17 Comparative pharmacokinetic studies of sulphonamides

T. B. Vree, J. F. M. Nouws and Y. A. Hekster 173
18 Species differences in protein binding
F. Be/paire 187
CONTENTS vii
DRUG RESIDUE TOXICOLOGY
19 The target animal species in drug toxicity studies:

an evaluation of its usefulness and limitations
T. A. J. M. de Roij 199
20 The use of pharmacokinetics in chronic toxicity testing

H. G. Verschuuren and R. H. Reitz 209
21 The Food Animal Residue Avoidance Databank (FARAD):
a computer databank of the pharmacokinetics of drugs. pesticides
and environmental chemicals in food animals
A. L. Craigmill. S. F. Sundlof and J. E. Riviere 225
INFLAMMATION AND ANTI-INFLAMMATORY DRUGS

IMMUNOMODULATION
22 Modulation of autonomic receptor function by Haemophilus

influenzae in the respiratory system
F. P. Nijkamp. F. Engels and G. Folkerts 235
23 Impairment of pulmonary homeostatic and antimicrobial
defence mechanisms by infectious bovine rhinotrache itis
and parainfluenza-3 virus infections
P. 0. Ogunbiyi. P. D.Conlon and P. Eyre 245
24 The potential of biological response modifiers in the
treatment of malignancies in animals and man
E. J . Ruitenberg. W. H . de Jong. P. A. Steerenberg.
W. R. Klein and V. P. M. G. Rutten 253
25 Immunological defence mechanisms as a target for antibiotics
J. L. Grandel and W. B. Van Muiswinkel263
DRUG BIOTRANSFORMATION
26 Comparative aspects of drug conjugation in laboratory animals.

exotic species and man
J. Caldwell 285
27 Hepatic microsomes as models for comparative metabolism in vivo
C. H. Walker 295
28 Pharmacokinetics. hydroxylation and acetylation of sulphadimidine
in mammals. birds. fish. reptiles and molluscs
J. F. M. Nouws. T. B. Vree. H.J. Breukink. A. S. J. P. A. M. van Miert
and J. Grondel 301
29 Disposition and metabolism of 14C-mebendazole in sheep and poultry

P. Benard. v.Burgat-Sacaze. F. Massat and A. G. Rico 319
viii COMPARATIVE VETERINARY PHARMACOLOGY, TOXICOLOGY AND THERAPY
DIARRHOEA
30 Modulation of intestinal ion absorption and secretion by

enterotoxins, hormones and neurotransmitters
H. R. de Jonge and A. B. Vaandrager 331
31 Species and age-dependent factors governing the clinical
severity of diarrhoea
R. A. Argenzio 345
32 Antidiarrhoeal therapy
L. A. A. Ooms and A. -D. Degryse 351
33 The effects of veterinary drugs based on humic acids in the
treatment of enteritis in young animals
S. Golbs, M. Kuehnert and V. Fuchs 365
CLINICAL TOXICOLOGY
34 Drug reactions leading to toxicity

A. DeRick 373
35 Clinical toxicology of an antibiotic ionoohore (monensin) in ponies
and horses; diagnostic markers and therapeutic considerations
J. F. Amend, R. L. Nichelson, L. R. Freeland, R. S. King,
F. M. Mallon and W. W. Stroup 381
36 Mycotpxins and mycotoxicoses in Europe
J. Leibetseder 391
PATHOPHYSIOLOGICAL MODELS IN PHARMACOLOGY,

MISCELLANEOUS
37 Role of animal disease models in evaluating the efficacy of

antimicrobial agents
T. E. Powers, K. J. Varma and J. D. Powers 401
38 Effects of disease states on drug binding to serum proteins
A. L. Aronson, S. A. Bai, J. E. Riviere and D. P. Aucoin 407
39 Tickborne fever: efficacy and effects on pharmacokinetics of

some chemotherapeutic agents in the goat
S. M. Anika, J. F. M. Nouws, T. B. Vree, C. T. M. Van Duin,
J. Nieuwenhuijs and A. S. J. P. A. M. van Miert 415
40 Statistical methods for evaluation of drug efficacy in animal models
J. D. Powers and T. E. Powers 427
41 Pharmacology of carbadox in the pig
L. P. Jager, E. J. van der Molen, G. J. de Graaf,
T. H. J. Spierenburg, M. J. A. Nabuurs and A. J. Baars 435
CONTENTS ix
OPIATES, OPIOIDS AND NEUROPEPTIDES
42 Opioid peptides and their receptors

R. A. Lefebvre 447
43 Endorphin systems, pain and addiction

J. M. vanRee 455
44 Opioid effects on gastrointestinal motor and secretory functions

Y. Ruckebusch and G. Soldani 467
45 Central nervous system control of feeding behaviour by some

neuropeptides in sheep
L. Bueno, C. Honde, A. Duranton and J. Fioramonti 477
DRUG USE AND REGULATION
46 The use in animals of drugs licensed for human use only

A. S. J. P. A. M. van Miert 489
47 The use in small animal medicine of drugs licensed for

human purposes
A. R. M. Kidd 501
48 The use in animals of drugs licensed for human use:

the situation in Sweden
K. Bingefors 513
49 Regulation of drug usage in veterinary medicine:

the situation in Germany
J. Fink 521
50 Do residues of antimicrobial drugs constitute a microbiological

risk for the consumer?
B. van Klingeren 527
Preface
The third congress ofthe European Association for Veterinary Pharmacology and Toxicol-
ogy (EAVPT) was held in Ghent, Belgium, from 25 to 29 August 1985. Part I of the
Proceedings of this congress contains the abstracts of all invited lectures, oral communi-
cations and poster communications, presented at the congress. The invited lectures are
now published (this volume) in extenso as Part II of the Proceedings.
The editors wish to thank all invited speakers for their active contribution to the
success of the third congress of EAVPT. They are very grateful to Dr. P. De Backer for
compiling all manuscripts, Dr. P. Lees for scientific amendments, Miss B. Vermeesch
and Dr. R. Lefebvre for preparing the camera ready copy and MTP Press for literary
advice and publishing.
A. S. J. P. A. M. van Miert
M. G. Bogaert
M. Debackere
xi
Contributors
AMEND J.F.
Department of Anatomy and Physiology, Atlantic Veterinary
College. University of Prince Edward Island. Charlotte-
town. P.E.I. CIA 4P3. Canada.
ANIKA S.M.
Department of Veterinary Physiology and Pharmacology.
University of Nigeria, Nsukka. Nigeria.
ARGENZIO R.A.
Department of Anatomy, Physiological Sciences. and Radio-
logy, School of Veterinary Medicine. North Carolina State
University. Raleigh, NC 27606. USA.
ARONSON A.L.
Clinical Pharmacology Unit. School of Veterinary Medicine.
North Carolina State University, Raleigh. North Carolina
27606. USA.
AUCOIN D.P.
The Animal Medical Center. 510 E 62nd Street. New York.
New York 10021. USA.
xiii
xiv COMPARATIVE VETERINARY PHARMACOLOGY, TOXICOLOGY AND THERAPY
BAARS A.J.
Central Veterinary Institute. P.O. Box 65, 8200 AB Lely-
stadt The Netherlands.
BAGGOT J.D.
Department of Veterinary Pharmacology and Toxicology, Uni-
versity of California. Davis, California 95616. USA.
BAI S.A.
Clinical Pharmacology Unit. School of Veterinary Medicine,
North Carolina State University. Raleigh, North Carolina
27606. USA.
BARDON T.
Department of Physiology, Ecole Nationale Veterinaire, 23,
chemin des Capelles. 31076 Toulouse Cedex, France.
BELPAIRE F.
J.F. and C. Heymans Institute of Pharmacology, University
of Ghent. Medical School, De Pintelaan 185, B-9000 Gent,
Belgium.
BENARD P.
Ecole National~ Veterinaire. Laboratoire de radioelements
et d'etudes metaboliques (I.N.R.A.), 23. chemin des Ca-
pelles. F-31076 Toulouse Cedex. France.
BINGEFORS K.
Department of Social PharmacY, Uppsala University Biome-
dical Center. PO Box 586, S-751 23 Uppsala, Sweden.
BOGAERT M.G.
J.F. and C. Heymans Institute of Pharmacology, University
of Ghent, Medical SChool, De Pintelaan 185, B-9000 Ghent,
Belgium.
CONTRIBUTORS xv
BREIMER D.O.
Center for Bio-Pharmaceutical Sciences. Division of Phar-
macology, University of Leiden, P.O. Box 9503. 2300 RA
Leiden. The Netherlands.
BREUKINK H.J.
Large Animal Clinic of Internal Diseases. Faculty of
Veterinary Medicine. University of Utrecht. The Nether-
lands.
BUENO L.
Station de Pharmacologie-Toxicologie, INRA, 180. chemin de
Tournefeuille, 31300 Toulouse. France.
BURGAT-SACAZE V.
Ecole Nationale Veterinaire. Laboratoire de radioelements
et d'etudes metaboliques (I.N.R.A.). 23, chemin des Ca-
pelles. F-31076 Toulouse Cedex. France.
CALDWELL J.
Department of Pharmacology, St. Mary's Hospital Medical
School. London W2 IPG. England.
CHERBUT C.
Department of Physiology, Ecole Nationale Veterinaire. 23.
chemin des Capelles. 31076 Toulouse Cedex. France.
CONLON P.O.
Department of Biomedical Sciences. Ontario Veterinary
College. University of Guelph, Guelph. Ontario NIG 2Wl,
Canada.
CRAIGMILL A.L.
Veterinary Extension, University of California, Davis. CA
95616, USA.
xvi COMPARATIVE VETERINARY PHARMACOLOGY, TOXICOLOGY AND THERAPY
DE BACKER P.
Department of Veterinary Pharmacology and Toxicology.
Faculty of Veterinary Medicine. University of Ghent.
Casinoplein 24. B-9000 Ghent. Belgium.
DEBACKERE M.
Department of Veterinary Pharmacology and Toxicology.
Faculty of Veterinary Medicine. University of Ghent.
Casinoplein 24. B-9000 Ghent. Belgium.
DE GRAAF G.J.
Central Veterinary Institute. P.O. Box 65. 8200 AB Lely-
stad. The Netherlands.
DEGRYSE A.-D.
Department of Veterinary Research. Janssen Pharmaceutica,
B-2340 Beerse. Belgium.
DE JONG W.H.
National Institute of Public Health and Environmental
Hygiene (RIVM). Laboratory for Pathology, P.O. Box 1. 3720
BA Bilthoven. The Netherlands.
DE JONGE H.R.
Department of Biochemistry I. Medical Faculty, Erasmus
University. P.O. Box 1738. 3000 DR Rotterdam. The Nether-
lands.
DE MOOR A.
Large Animal Surgical Clinic. Faculty of Veterinary Medi-
cine. University of Ghent. Casinoplein 24. B-9000 Ghent.
Belgium.
DE RICK A.
Department of Small Animal Medicine. Faculty of Veterinary
Medicine, University of Ghent. Casinoplein 24. B-9000
Ghent. Belgium.
CONTRIBUTORS xvii
DE ROIJ T.A.J.M.
Animal Health Division. Duphar 8.V., C.J. van Houtenlaan
36. 1381 CP Weesp. The Netherlands.
DROUMEV D.
Department of Pharmacology. Faculty of Veterinary Medici-
ne. Higher Institute of Zootechnics and Veterinary Medi-
cine. D. 8lagoev str. 62. 6000 Stara Zagora. Bulgaria.
DURANTON A.
Station de Pharmacologie-Toxicologie. INRA. 180. chemin de
Tournefeuille. 31300 Toulouse. France.
ELEZOGLOU V.
Department of Pharmacology. Veterinary Faculty, Aristote-
lian University of Thessaloniki. 54006 Thessaloniki.
Greece.
ENGELS F.
Institute of Veterinary Pharmacology, Pharmacy and Toxico-
logy. Faculty of Veterinary Sciences. University of
Utrecht. P.O. Box 80.176. 3508 TO Utrecht. The Nether-
lands.
EYRE P.
College. University of Guelph, Guelph. Ontario N1G 2Wl,
Canada.
FARGEAS M.J.
Station de Pharmacologie-Toxicologie, INRA. 180. chemin de
FERRE J.P.
Department of Physiology. Ecole Nationale Veterinaire. 23.
xviii COMPARATIVE VETERINARY PHARMACOLOGY, TOXICOLOGY AND THERAPY
FINK J.
Institute for Pharmacology. Toxicology and Pharmacy. Tier-
arztliche Hochschule Hannover. FRG.
F IORAMONTI J.
Station de Pharmacologie-Toxicologie. INRA. 180. chemin de
Tournefeuille. 31300 Toulouse, France.
FOLKERTS G.
logy. Faculty of Veterinary Sciences, University of
Utrecht, P.O. Box 80.176, 3508 TO Utrecht, The Nether-
lands.
FREELAND L.R.
town. P.E.I. C1A 4P3. Canada.
FUCHS V.
Department of Veterinary Pharmacology, Pharmacy and
Toxicology. Karl-Marx-University of Leipzig, Zwickauer
Strasse 55. 7010 Leipzig. GDR.
GASTHUYS F.
Large Animal Surgical Clinic, Faculty of Veterinary Medi-
cine, University of Ghent. Casinoplein 24. B-9000 Ghent,
Belgium.
GINGERICH D.A.
Veterinary Research Department, Bristol-Myers Company.
Syracuse. New York. USA.
GOLBS S.
Department of Veterinary Pharmacology. Pharmacy and
Toxicology. Karl-Marx-University of Leipzig. Zwickauer
Strasse 55. 7010 Leipzig, GDR.
CONTRIBUTORS xix
GORDON L.L.
VeterinarY Research Department. Bristol-Myers CompanY,
GRONDEL J.L.
Section Cell Biology, Department of Experimental Animal
Morphology and Cell Biology. Agricultural University, P.O.
Box 338. 6700 AH Wageningen. The Netherlands.
HALL loW.
Department of Clinical Veterinary Medicine. University of
Cambridge, Madingley Road. Cambridge CB3 OES. England.
HARTMAN E.G.
Department of Veterinary Bacteriology. Utrecht University,
P.O. Box 80 171, 3508 TO Utrecht. The Netherlands.
HEKSTER Y.A.
Department of Clinical Pharmacy, Sint Radboud Hospital,
University of NiJmegen. Nijmegen, The Netherlands.
HEYKANTS J.
Department of Drug Metabolism and Pharmacokinetics, Jans-
sen Pharmaceutica, B-2340 Beerse. Belgium.
HONDE C.
Station de Pharmacologie-Toxicologie. INRA. 180, chemin de
JAGER L.P.
JANSSEN P.A.J.
Janssen Pharmaceutica, B-2340 Beerse, Belgium.
xx COMPARATIVE VETERINARY PHARMACOLOGY, TOXICOLOGY AND THERAPY
KALPRAVIDH M.
Veterinary Research Department, Bristol-Myers Company,
Syracuse. New York, USA.
Ministry of Agriculture Fisheries and Food, Central

Veterinary LaboratorY, New Haw, Weybridge, Surrey KT15
3NB, United Kingdom.
KING R.S.
College, University of Prince Edward Island, Charlotte-
town. P.E.I. C1A 4P3, Canada.
KLEIN W.R.
Institute for Veterinary Surgery, Faculty of Veterinary
Medicine, State University Utrecht, The Netherlands.
KOUNENIS G.
Department of Pharmacology, Veterinary Faculty, Aristote-
lian University of Thessaloniki, 54006 Thessaloniki,
Greece.
KOUTSOVITI-PAPADOPOULOU M.
Department of Pharmacology, Veterinary Faculty, Aristote-
lian University of Thessaloniki, 54006 Thessaloniki,
Greece.
KUEHNERT M.
Department of Veterinary Pharmacology, Pharmacy and
Toxicology, Karl-Marx-University of Leipzig, Zwickauer
Strasse 55. 7010 Leipzig, GDR.
LEFEBVRE R.A.
1.F. and C. Heymans Institute of Pharmacology, University
of Ghent, Medical School, De Pintelaan 185, B-9000 Ghent,
Belgium.
CONTRIBUTORS xxi
LEIBETSEOER J.
Institute of Nutrition, University of Veterinary Medicine.
Linke Bahngasse 11. A-l030 Vienna. Austria.
MALLON F.M.
Department of Anatomy and PhYsiology, Atlantic Veterinary
town. P.E.I. C1A 4P3, Canada.
MASSAT F.
Ecole Nationale Veterinaire, Laboratoire de radioelements
et d'etudes metaboliques (I.N.R.A.). 23. chemin des Ca-
pelles, F-31076 Toulouse Cedex, France.
NABUURS M.J.A.
stad, The Netherlands.
NICHELSON R.L.
NIEUWENHUIJS J.
Institute of Veterinary Pharmacology. Pharmacy and Toxico-
logy, Faculty of Veterinary Medicine. University of
Utrecht, P.O. Box 80.176. 3508 TO Utrecht. The Nether-
lands.
NIJKAMP F.P.
logy. Faculty of Veterinary Sciences. University of
Utrecht. P.O. Box 80.176, 3508 TO Utrecht. The Nether-
lands.
NOUWS J.F.M.
Meat Inspection Service. R.V.V.-Oistrict 6. P.O. Box
40010. Nijmegen, The Netherlands.
xxii COMPARATIVE VETERINARY PHARMACOLOGY, TOXICOLOGY AND THERAPY
OGUNBIYI P.O.
College. University of Guelph. Guelph. Ontario NIG 2Wl.
Canada.
OOMS L.A.A.
Department of Veterinary Research. Janssen Pharmaceutica.
B-2340 Beerse. Belgium.
PAIRET M.
POWERS J.D.
Department of Veterinary Physiology and Pharmacology,
College of Veterinary Medicine. The Ohio State University.
1900 Coffey Road. Columbus, OH 43210, USA.
POWERS T.E.
Department of Veterinary Physiology and Pharmacology.
College of Veterinary Medicine, The Ohio State University,
1900 Coffey Road, Columbus, OH 43210, USA.
REHM W.F.
F. Hoffmann-La Roche ~ Co. Ltd., 4002 Basle/Switzerland.
REITZ R.H.
Mammalian and Environmental Toxicology Research Laborato-
ry. Dow Chemical. Midland. Michigan. USA.
RICO A.G.
Ecole Nationale Veterinaire. Laboratoire de radioelements
et d'etudes metaboliques (I.N.R.A.>, 23, chemin des Ca-
pelles, F-31076 Toulouse Cedex, France.
RIVIERE J.E.
College of Veterinary Medicine. North Carolina State
University, Raleigh, NC 27650. USA.
CONTRIBUTORS xxiii
ROURKE J.E.
Veterinary Research Department. Bristol-Myers Company.
RUCKEBUSCH Y.
RUITENBERG E.J.
Hygiene (RIVM). Laboratory for Pathology. P.O. Box 1.3720
RUTTEN V.P.M.G.
Department of Immunology. Faculty of Veterinary Medicine.
State University Utrecht. The Netherlands.
SCHATZMANN U.
Klinik fur Nutztiere und Pferde der Universitat Bern. 3012
Bern. Switzerland.
SOLDANI G.
Farmacologia e Farmacodinamia Veterinaria. Universita de-
gli Studi di Pisa. Via delle Piagge 2. 56100 Pisa, Italy.
SPIERENBURG T.H.J.
Central Veterinary Institute. P.O. Box 65. 8200 AB Lely-
STEERENBERG P.A.
Hygiene (RIVM). Laboratory for Pathology. P.O. Box 1. 3720
STROM P.W.
Veterinary Research Department. Bristol-Myers Company,
xxiv COMPARATIVE VETERINARY PHARMACOLOGY, TOXICOLOGY AND THERAPY
STROUP W.W.
College, University of Prince Edward Island. Charlotte-
SUNDLOF S.F.
College of Veterinary Medicine, University of Florida.
Gainesville. FL 32611. USA.
VAANDRAGER A.B.
Department of Biochemistry I. Medical Faculty, Erasmus
University, P.O. Box 1738. 3000 DR Rotterdam, The Nether-
lands.
VAN DEN HENDE C.

Large Animal Surgical Cl inic. Faculty of Veterinary
Medicine. University of Ghent. Casinoplein 24. B-9000
Ghent. Belgium.
VAN DER MOLEN E.J.

Central Veterinary Institute. P.O. Box 65. AB Lely-
VAN DUIN C.T.M.

logy. Faculty of Veterinary Medicine. University of
lands.
VAN KLINGEREN B.
National Institute of Public Health and Environmental Hy-
giene. P.O. Box 1. 3720 BA Bilthoven. The Netherlands.
VAN MIERT A.S.J.P.A.M.

logy. Faculty of Veterinary Medicine. University of
lands.
CONTRIBUTORS xxv
VAN MUISWINKEL W.B.

Section Cell Biology, Department of Experimental Animal
Morphology and Cell Biology, Agricultural University, P.O.
Box 338. 6700 AH Wageningen. The Netherlands.
VAN PEER A.
Department of Drug Metabolism and Pharmacokinetics. Jans-
sen Pharmaceutica. B-2340 Beerse, Belgium.
VAN REE J.M.

Rudolf Magnus Institute for Pharmacology, Medical Faculty,
University of Utrecht, Vondellaan 6, 3521 GO Utrecht. The
Netherlands.
VARMA K.J.
Department of Veterinary Physiology and Pharmacology,
College of Veterinary Medicine, The Ohio State University,
1900 Coffey Road, Columbus. OH 43210. USA.
VERSCHUUREN H.G.
Department of Toxicology, Dow Chemical Europe, Horgen,
Switzerland.
VREE T.B.
Department of Clinical Pharmacy, Sint Radboud Hospital,
University of Nijmegen, Nijmegen. The Netherlands.
WALKER C.H.
Department of PhYsiology and Biochemistry, University of
Reading. P.O. Box 228, Whiteknights. Reading RG6 2AJ, U.K.
WATSON A.D.J.
Department of Veterinary Clinical Studies, The University
of SydneY, New South Wales, 2006, Australia.
WEYNS A.
Department of Veterinary Anatomy and Embryology, Faculty
of Veterinary Medicine, RUCA Antwerpen, Belgium.
Welcome address
M.DEBACKERE
Chairman Organizing Committee
Mr. Rector and members of the Honorary Committee, dear

ladies, dear colleagues, dear friends,
It is a privilege and a pleasure for me, as Chairman, to

welcome you, on behalf of the organizing committee, to
this 3rd Congress of our European Association for
Veterinary Pharmacology and Toxicology. Although this
Association is relatively young, being founded only seven
years ago, this third congress demonstrates that the EAVPT
has taken an honoured place as an international scientific
association specifically devoted to pharmacology and
toxicology. As in other branches of veterinary medicine,
major advances in pharmacology, including the demonstra-
tion of species differences in pharmacokinetics and drug
biotransformation. have been made. This development
created the need to disseminate newly acquired scientific
information and ideas. To meet this need the European
Association for Veterinary Pharmacology and Toxicology was
formed in 1978 and shortly afterwards a few eminent
scientists organized the first congress in 1979 in
Utrecht. About 200 participants attended this first
congress and they came mainly from European countries.
Three years later, in 1982, the second congress was held
in Toulouse and it was primarily devoted to papers on
xxvii.
xxviii COMPARATIVE VETERINARY PHARMACOLOGY, TOXICOLOGY AND THERAPY
ruminant pharmacology. Today. 3 years later. we meet

again in Ghent. one of the oldest of Flemish and western
European cities. for our third congress with the theme
"Comparative Veterinary Pharmacology. Toxicology and
Therapy".
The main purpose of this Congress is to consider
comparative aspects of pharmacology and toxicology in the
common animal species belonging to the companion group of
animals as well as to the production group of animals.
Our aim is to further our understanding and thus to
increase the success of veterinary therapy. However. our
objectives at this Congress are even broader. The
comparative considerations will not be restricted to
differences between these animal species. for an attempt
has also been made to compare some aspects of human and
veterinary pharmacology. In this venture we are pleased
to acknowledge the collaboration of the staff members of
the Heymans Institute of Pharmacology in the organization
of the congress. In addition. some eminent human pharma-
cologists have been invited to present full papers.
The organizing committee has worked tirelessly to
produce a scientific programme which will. I am sure.
satisfy even the most critical participant. More than 20
leading scientists have agreed to present. as invited
speakers. an up-to-date account of one of the 15 topics
which will be incorporated in 22 separate sessions. More
than 180 scientific contributions have been accepted for
presentation in the form of invited papers. free communi-
cations or posters. Speakers and participants
representing more than 25 countries are attending the
Congress. Most are from Europe. but there are also many
delegates from non-European countries. We hope that the
exchange of scientific knowledge through the scientific
programme as well as through personal contacts will enable
YOU to return to your homes enriched with much new
information. We realize that it is not simply the number
of participants that makes a congress great. This is
important. but I believe that EAVPT congresses have
WELCOME ADDRESS xxix
something even more special. They have always been

characterized by the spirit of true friendship,
constructive criticism and friendly debate. This
open-minded approach is certainly necessary for the
spontaneous exchange of scientific information. I hope
that every participant, and in particular the younger
scientists and colleagues amongst us, will make good use
of this open-mindedness which characterizes all that we do
here in Ghent. I also sincerely hope that everyone of us
will return to his or her institute and laboratory with a
fund of new knowledge and ideas to motivate and to
stimulate our own researches.
It is, I believe. true to say that research has always
been and will always remain as the pillar on which
progress is built. It is of course a continuing process,
and this is what progress is all about. I therefore hope
that those responsible for funding our research can be
made aware that research is the only good investment for
the future. Researchers for their part have to realize
that only research of the highest quality can expect to be
funded in the present economic climate. Sharing progress
in the field of pharmacology and toxicology is the purpose
of our being here together this week in Ghent. It gives
me a particular pleasure to realize that so many
scientists. both veterinarians and non-veterinarians.
working in the field of pharmacology and toxicology and
coming from so many countries will present the results of
their research funded from many differing sources. They
will moreover communicate their findings and views in a
spirit of solidarity. If all this is achieved for the
benefit of mankind and the welfare of the animals
themselves. then I am sure that organizing this 3rd EAVPT
Congress in Ghent will have been worthwhile. We hope that
this exchange of knowledge may contribute to the prestige
of the EAVPT, to the advancement of veterinary
pharmacology and toxicology and to the improvement of
clinical veterinary practice.
At the same time. we hope that this Congress will be
xxx COMPARATIVE VETERINARY PHARMACOLOGY, TOXICOLOGY AND THERAPY
the ideal forum for meeting colleagues. renewing old

friendships and making new acquaintances. Finally. your
stay in our marvellous medieval city of Ghent and the
surrounding provinces of Flanders will enable yOU to enjoy
the famous hospitality and the high creativity of the
Flemish people in the arts and sciences. and in our archi-
tecture.
We must not forget that the organization of this
Congress has been made possible by the generous
hospitality of the University of Ghent. for which we
express our sincere thanks to the Rector of this
University. Our thanks are also due for the much
appreciated financial support of the Congress sponsors
listed on the cover of your programme book.
As Chairman of the organizing committee. I would like
to express my personal thanks to all the members of both
organizing and scientific committees and all those who
have contributed to the organization of this Congress.
Their hard work has guaranteed that we shall have an
enjoYable and successful Congress.
Thank you for your participation in this Congress.
Your presence here in Ghent is much appreciated by the
organizers. I know yoU will help to make this Congress an
unforgettable event in the story of the EAVPT.
Inaugural lecture
Comparative pharmacology and toxicology
P. A. JANSSEN
I can think of two, and only two, reasons, why anybody in

his right mind would be really interested in pharmacolo-
gical and toxicological research.
(1) There are those who are fascinated by the purely aca-
demic questions about the interaction between non-
living and living matter or, more precisely, between
inorganic and organic chemical molecules on the one
hand and biological systems (enzymes, receptors, cell
membranes and organelles, cell cultures, micro-
organisms, isolated tissues or a variety of living
creatures) on the other.
(2) Then there are those who are fascinated by the idea of
trying to find better drugs than those available for
the prevention or treatment of the innumerable
diseases that afflict man, animals and plants; those
who are dreaming of the ideal drugs of the future :
immediately and 100% effective, completely free of
unwanted side-effects, easy to use and as cost-effec-
tive as possible.
As I have stated on previous occasions : drug research is

essentially an interdisciplinary endeavour. It is like an
xxxi
xxxii COMPARATIVE VETERINARY PHARMACOLOGY, TOXICOLOGY AND THERAPY
orchestra with chemists, pharmacologists, toxicologists.

clinicians and many others plaYing their instruments.
Their various disciplines are like the fingers of a hand:
of the same origin. but no longer in contact. To make
them work in harmony is not an easy task. It requires
perception, deep understanding of the problems to be
solved together. enthusiasm and. above all. motivation.
To those of you who have heard these words before I can
only repeat what Bernard Shaw once said: "When a man has
anything to tell in this world, the difficulty is not to
make him tell it. but to prevent him from telling it too
often". But then. as Wi 11 iam Shakespeare wrote: "It is
not enough to speak. but to speak true".
Let us therefore keep in mind that the human mind is
like a parachute, that it works best when it is open, and
also this old and wise Chinese proverb:
I hear and I forget.

I see and I remember,
I do and I understand.
Indeed, all we know about pharmacology and toxicology is

directly derived from well-conducted and reproducible
experiments providing us with the famous "hard data", the
experimental facts. Those of you who have been wrestling
with pharmacological and particularly toxicological prob-
lems long enough know all too well how difficult it is to
distinguish fact from fancY, how easy it is for
interpretative theories or opinions to come and go, and
how sterile and frustrating emotional discussions on these
subjects tend to be.
As I said before: the relevant facts constituting the
basis of pharmacological and toxicological knowledge have
to do with:
(1) chemical molecules.
(2) biological systems, and
(3) their interactions.
The chemical structure of almost 10.000.000 inorganic
INAUGU RAL LECTU RE: COMPARATIVE PHARMACOLOGY AND TOXICOLOGY xxxiii
and organic molecules can be found in the literature, and

something of the order of 1,000,000 new structures are
being determined every year. The majority of these new
molecules are made by synthetic chemists, the others being
purified naturally occurring substances or products made
by modern biotechnological methods.
The spectacular advances in the chemical field over the
last decades allow us not only to make new organic
molecules more efficiently, but also to determine their
precise chemical structure with much greater ease as well
as to detect impurities, quantitatively and qualitatively,
that were undetectable only a few years ago. Information
on the three dimensional structure of small and even very
large molecules is being published at an ever-increasing
rate. The highly complex natural laws determining the
correlation between chemical structure and physical
properties are being explored by more and more physical
chemists as well as the nature and strength of the various
types of intermolecular and intramolecular forces.
The colossal amount of chemical data thus generated
made it mandatory to invent a new communication system for
chemists. Modern and highly efficient computer-aided
techniques are now available in an increasing number of
chemical centres for online retrieval of structural
information of over 6.000.000 stored structures. A "brave
new world" is being created in the field of chemical
communication.
Before any of these old or new chemical substances can
be tested pharmacologically or toxicologically, however.
another seemingly trivial but in fact crucial and
sometimes very difficult pharmaceutical problem must be
solved - that is, how to prepare a stable solution or any
other suitable pharmaceutical form that can be added to
the biological system. Many discrepancies in the phar-
macological literature are the direct result of the
deplorable fact that the importance of this pharmaceutical
problem has all too often been underestimated.
The simplest biological systems of interest to
xxxiv COMPARATIVE VETERINARY PHARMACOLOGY, TOXICOLOGY AND THERAPY
"molecular pharmacologists" are biochemically relevant and

relatively large molecules such as enzymes or other
proteins. haemoproteins. glycoproteins. constituents of
cell membranes such as phospholipids. receptors for the
classical neurotransmitters or neuromodu1ators. for many
hormones and growth factors. DNA. RNA. etc.
It is to be expected that within the next decades the
mode of interaction between organic molecules and their
target macromolecules will be better and better
understood. Looking into the future this new body of
knowledge should then enable the skilled medicinal chemist
to design and make so-called "tailor-made" new molecules
fitting optimally with their desirable target
macromolecules and. in ideal conditions, with no other
biochemically relevant structures.
The question is not "whether" this great dream
wi 11 ever become a real ity, but rather "when". And this
will quite obviously depend on how well medicinal.
analytical. physical chemists and biochemists as well as
pharmacologists and toxicologists will learn to work
together in harmony.
One often reads and hears these days about SAR-struc-
ture activity-relationship, making slow but steady
progress. In 1985 even the best rules of this game are
understandably almost entirely empirical. but nevertheless
increasingly useful in practical terms to the medicinal
chemist trying to predict the pharmacological properties
of newly designed but not yet synthesized molecules. The
more empirical knowledge the chemist accumulates in a
given SAR-fie1d. the more likely it becomes that his
predictions will turn out to be correct.
Rather than waste your time to enumerate or classify
the innumerable number of more complex biological systems,
ranging from single cells to whole healthy or sick
animals. that are of interest to pharmacologists and
toxicologists. 1 have chosen to elaborate on the problem
of the interactions between chemical molecules and these
biological systems.
xxxvi COMPARATIVE VETERINARY PHARMACOLOGY, TOXICOLOGY AND THERAPY
(4)
Inadequate bioavailability;
(5)
Drug resistance;
(6)
Drug interactions:
(7)
Deficient nutritional or immunological status;
(8)
Genetic polymorphism of oxidative metabolism in
humans. as well as other host factors causing large
differences in rates of drug metabolism. for
example. genetic constitution. age. dietary habits.
hepatic. renal. cardiovascular. gastrointestinal
and endocrine function. exposure to other drugs and
chemicals. etc.
Common and typical dose-related side-effects are
detectable in well-controlled clinical trials and many of
them. but not all. are predictable from acute and chronic
toxicological experiments.
One should of course keep in mind the fact that there
are major species differences in pharmacology as well as
in toxicology. To simply extrapolate from one species to
another is scientifically unacceptable.
One of the major problems with which we are confronted
these days is the detection of extremely rare but serious
side-effects in human patients. When their incidence is
less than in 1000 only carefully conducted
post-marketing surveillance studies involving millions of
treated patients can tell us whether a certain unwanted
effect is drug-induced or not.
To assess the relative safety of drugs is of course
much easier in animals than in man.
Those of yOU who are professionally confronted with the
benefit versus risk assessment problems are of course
aware of the fact that absolute safety is an utopian
dream and that it is much easier to destroY than to build.
As Bernard Shaw once said: "The reasonable man adapts
himself to the world; the unreasonable one persists in
trying to adapt the world to himself. Therefore all
progress depends on the unreasonable man". A few years
1ater he wrote "He who can. does. He who cannot.
teaches".
INAUGURAL LECTURE: COMPARATIVE PHARMACOLOGY AND TOXICOLOGY xxxvii
Maurice Tubiana in his marvellous book. Le refus du

Reel. analvses the psvchological reasons whv so many
inhabitants of technologically advanced countries seem to
be more attracted bv mvths than by facts. While the
worldwide consumption of tobacco is increasing. an almost
mvthical importance is attached to minimal or suspected
risks. In spite of the irrational society in which we are
living. pharmacologists and toxicologists must be able to
convince the world that real progress will not be achieved
bv paving lip service to uncontrollable theories. but bv a
better understanding of the real world.
Anaesthesia,
Neuroleptanalgesia
and Sedation
1
Influence of halothane anaesthesia, after xylazine
premedication, on serum calcium concentration
in the horse
F. GASTHUYS, A. DE MOOR AND C. VAN DEN HENDE
ABSTRACT
In 20 horses breathing spontaneously, xylazine premedi-
cation followed by 1.5 h of halothane anaesthesia caused a
significant decrease of the total serum cal cium
concentration. The ionized and complexed calcium fraction
showed a non-significant increase. A significant decrease
in total serum calcium also occurred in another group of
ten horses during halothane anaesthesia with automatic
artificial ventilation. The ionized and complexed calcium
fraction remained at a constant level in these animals. A
possible explanation for, and several consequences of,
this calcium decrease are discussed. Determination of the
serum calcium concentration might be indicated in some
horses during halothane anaesthesia.
INTRODUCTION
Inhalation anaesthesia in the adult horse, especially in
animals with a relative high body weight, can cause
problems when relatively prolonged anaesthesia is
undertaken or when certain predisposing factors are
present. The main problems are cardiovascular depression
and postanaesthetic myopathy or myonecrosis,,3. In some
problem cases, we have been able to achieve a better
recovery by giving a calcium solution intravenously.
3
4 COMPARATIVE VETERINARY PHARMACOLOGY, TOXICOLOGY AND THERAPY
It therefore seemed relevant to examine the influence

of halothane anaesthesia on the serum calcium concentra-
tion. Halothane causes a pronounced cardiovascular
depression and this might be intensified in cases of
hypocalcaemia.
MATERIALS AND METHODS

Group 1
In 20 horses the concentrations of total (Ca 2 +t) and of
ionized plus complexed (Ca 2 +i) calcium in the serum were
measured during 1.5 h of halothane inhalation anaesthesia.
The 20 horses (one thoroughbred, 15 standardbreds and
four halfbreds, included ten mares, two stallions and
eight geldings) were surgically treated by bilateral
neurectomy of the nervi digitali palmaris lateralis and
medialis because of podotrochleosis. The average age of
the horses was 9.2 years (range 4-14 years) and the
average weight was 520 kg (range 420-550 kg). Preopera-
tively, the horses were in good clinical health. Water was
withheld for 12 h, and no access to food was allowed for
24 h, before inducing anaesthesia. The horses received
atropine (1 mg/l00 kg of body weight intravenously), fol-
lowed by xylazine (40 mg/l00 kg of body weight intrave-
venously). After intravenous injection of 10% guaifenesin
(glycerol guaiacol ate) at a dosage of 8-10 g/100 kg of
body weight, the horses were intubated with a cuffed
endotracheal tube and connected to a semiclosed anaesthe-
thetic circle system, already primed with 10-15 litres of
oxygen. Oxygen and nitrous oxide (% of nitrous oxide:
beginning 66.6%, after 5 min 50%, after 10 min completely
cut off) were the carrier gases for halothane, which was
vaporized from a high precision out-of-circuit vaporizer.
After partial denitrogenation, produced by three
compressions of the reservoir bag, we attempted to obtain
a completely closed system using the inspiratory oxygen
concentration as a lead (minimum of 50% Fi0 2 ) . In some
horses, arterial blood samples were taken for blood gas
analysis after 0.5 h of anaesthesia. The depth of
INFLUENCE OF HALOTHANE ANAESTHESIA, ON SERUM CA CONCENTRATION 5
anaesthesia was regulated using both clinical signs

(disappearance of nystagmus, eyelid-reflex slightly
positive) and the recorded capnogram. All horses breathed
spontaneously. The average duration of anaesthesia was 1
h 39 min. All animals had an uneventful anaesthesia and
recovery.
Heparinized venous blood samples were collected and
either analysed directly or stored at 4 °C and analysed
within 24 h. After centrifugation of the heparinized
blood, total serum calcium was measured by atomic spect ro-
.
photometry. After centrifugation of the serum through
Centriflo Membrane Cones (Type CF 25. Amicon cut off
25.000 molecular weight), the ionized and complexed
ca I cium fraction was measured in the fi I trate using the
same procedure.
Group 2
Another group of ten horses (one halfbred. nine
standardbreds including three mares, one stallion and six
geldings) was s~bmitted to surgery for different reasons.
The horses were also in good clinical condition. The same
anaesthetic protocol as in group 1 was followed. However,
the horses were ventilated automatically to achieve a
normal arterial pC0 2 level (5.44-6.80 kPa), which was
determined by blood gas analysis. The average age of the
horses was 6.2 years (range 2-12 years) and the average
weight was 510 kg (range 400-620 kg). Total calcium and
ionized plus complexed calcium were determined in the
serum as described above.
Statistical analysis of the data was undertaken using
the Student t test and the LSD (least significant diffe-
rence) test.
RESULTS
Group 1
The mean serum concentrations of Ca 2 +t and Ca 2 +i in 20
spontaneously breathing horses are shown in Figure 1.1.
Mean values of 2.86 mmol/l and 1.52 mmol/l for Ca 2 +t and
Ca 2 ' j
mmol/I
1.70
1.60
2.80
1.50
2.70
1.40
2.60
1 II III 1\/ \/
I
\/1
r
Figure 1.1 Total (Ca 2 +t, - ) and ionized plus complexed
(Ca 2 +i, ..... -.) calcium concentration (mmol/l) in 20 horses
before, during and after a halothane anaesthesia of 1.5 h
duration (spontaneous respiration, group 1). Mean values
plus mean standard error; I : before premedication; II
before induction; III: after 0.5 h of anaesthesia; IV
after 1 h of anaesthesia; V : after 1.5 h of anaesthesia;
VI 0.5 h after disconnection (recovery); xx : signifi-
cant, P < 0.01, Student t test.
Ca 2 +i, respectively, were found before premedication.

Normal range for Ca 2 +t is from 2.8 to 3.3 mmol/l with
about 50% of Ca 2 +t in the ionized and complexed form.
The Student t test showed that Ca 2 +t concentrations
during anaesthesia were significantly lower (P < 0.01)
than the Ca 2 +t concentrations before and after anaesthe-
sia.
The Ca 2 +i concentration did not change significantly;
only a slight non-significant increase of the Ca 2 +i
concentration was found at the lowest level of Ca 2 +t.
INFLU ENCE OF HALOTHAN E ANAESTHESIA. ON SERUM CA CONCENTRATION 7
1.70
.....····1
••.• •• ••••••••1.
1.60
······l....... ~
xx
1.50
1.40
T II III IV v VI
r
Figure 1.2 Total (Ca 2 +t. - ) and ionized plus complexed
(Ca 2 +i . . .---1) calcium concentration (mmol/l> in ten horses
before. during and after a halothane anaesthesia of 1.5 h
duration (automatic artificial ventilation. group 2). Mean
values plus standard error; I : before premedication; II :
before induction; III : after 0.5 h of anaesthesia; IV
after 1 h of anaesthesia; V : after 1.5 h of anaesthesia;
VI 0.5 h after disconnection (recovery); xx
significant. P < 0.01. Student t test.
Group 2
Figure 1.2 gives the mean serum concentrations of Ca 2 +t
and Ca 2 +i (mmol/l> during automatic artificial ventilation
in ten horses. The Student t test showed that in these
horses the Ca 2 +t concentrations during anaesthesia were
significantly lower (P < 0.01) than the Ca 2 +t concentra-
tions before anaesthesia. The Ca 2 +i concentrations de-
creased slightly but not significantly.
DISCUSSION
Calcium in the blood consists of a protein-bound and a
non-protein-bound fraction. The latter is composed of
ionized (free) calcium and calicum complexed with other
8 COMPARATIVE VETERINARY PHARMACOLOGY. TOXICOLOGYANDTHERAPY
ions (such as phosphate, citrate). The free calcium has

the highest biological activity. The different fractions
remain in equilibrium 7 •
During clinical halothane anaesthesia with the horses
breathing spontaneously or ventilated automatically, a
significant decrease of Ca 2 +t in the serum without
significant changes in the Ca +i fraction, was obtained.
2
As the latter fraction is the most active biologically,

the body attempts to keep this fraction at a constant
I eve I •
We noted a difference between the spontaneously
breathing and the automatically ventilated horses in the
non-protein-bound calcium fraction; in the spontaneously
breathing horses a slight non-significant increase in
Ca 2 +i occurred. Acidosis is known to have an influence on
the protein-bound fraction a lower pH decreases this
fraction and increases the non-protein-bound calcium.
Alkalosis caused the opposite effects. In the first
group, the horses were breathing spontaneously with an
accumulation of CO 2 in the blood and a respiratory
acidosis that was partly metabolically compensated. This
might explain the constant and even increased level of
Ca 2 +i in spite of a Ca 2 +t decrease. In the second group,
all horses were automatically ventilated. The arterial
pC0 2 level was maintained between 5.44 and 6.80 kPa (40
and 50 mmHg) , in order to avoid a respiratory acidosis.
The non-protein-bound fraction showed a very slight
tendency to decrease in this group, but decrease in the
serum Ca 2 +t cannot be caused by acidosis.
In both groups, total serum calcium concentration
decreased while the Ca 2 +i concentration did not change
significantly. Therefore, the protein-bound fraction,
which is the difference between Ca 2 +t and Ca 2 +i, must have
decreased. Some hypotheses can be proposed to explain the
decrease in this protein-bound fraction. During halothane
anaesthesia in the horse, no losses of proteins from the
intravascular space occur'. It is therefore very unlikely
that proteins together with calcium leave the
INFLUENCE OF HALOTHANE ANAESTHESIA ON SERUM CACONCENTRATION 9
intravascular space. Another unlikely possibility is

haemodilution occurring during anaesthesia. If haemo-
dilution was the cause of the decrease in serum calcium.
both fractions would have decreased equally. This did not
happen; indeed in the spontaneously breathing horses Ca 2 +i
even increased slightly. An explanation for the reduction
in protein-bound calcium in the serum during halothane
anaesthesia could be "entrapment" of cell membranes by an
unknown mechanism. This possibility. however. is entirely
speculative.
A loss of the non-protein-bound fraction could also be
explained by an increased transport of this calcium into
cells. or through an increased excretion (through urine.
skin. etc.). The only way to obtain a constant level of
the non-protein-bound fraction in this circumstance would
be by dissociation of the protein-bound calcium.
Several factors (such as halothane. hormonal imbalance
and premedication) could be responsible for the decrease
of the total serum calcium during anaesthesia. Halothane
has an important influence on homeostasis in horses.
Johnson et al. 2 found an elevation of inorganic phosphate
and potassium. with a decrease of the total calcium level.
These changes were even more pronounced by provoked stress
situations before or during anaesthesia. Steffey et al. 10
reported elevated muscle and liver enzymes which persisted
for 4 days after anaesthesia. and a small degree of renal
depression for. at most. 1 day after anaesthesia. The
calcium level did not change after 1 h of anaesthesia.
In vitro experiments have revealed a relationship
between halothane and calcium. Price· noted that calcium
reverses the halothane-induced depressed contractility of
the isolated myocardial muscle of cats. Merin 4 described
a dose-dependent effect of halothane on cardiac muscle
with a diminished uptake of calcium by the sarcoplasmic
reticulum caused by a lowered ATPase activity. The
effects of halothane in the malignant hyperthermia
syndrome have been studied intensively in the pig.
Although there is much discussion about the exact
mechanism. it seems that only the cell membrane regulation

plays a major role in the uncontrolled influx of calcium
into the cells t t • We do not know. however, whether all
these processes occur in the horse.
Another possible explanation for the Ca 2 +t decrease
might be a failure of regulation of the hormonal balance
during halothane anaesthesia. causing a subsequent
hypocalcaemia. After anaesthesia. the rapid normalization
of the disturbed hormonal regulation might explain the
restoration of serum calcium levels within a short period
of time.
Muscle damage (anaesthetic and postanaesthetic myo-
pathy) might also cause a decrease of the serum calcium in
the horse t • t 2 •
Another factor which cannot be discounted is
premedication of the horses with atropine and xylazine.
Xylazine, a commonly used sedative in horses. has a strong
diuretic effect. The actual effect of this agent on serum
calcium concentration remains to be determined. however.
Six horses in this study had low total serum calcium
levels (2.13-2.78 mmol/l) even before premedication. This
might be explained by the preoperative starvation period.
which lasted for 24 h'. These horses also showed a fur-
ther decrease in the total calcium during anaesthesia
without clinical symptoms. but they must still be consid-
ered at risk. In both normal and "low calcium" horses. a
rapid postanaesthetic normalization of serum ca 1 ci um
concentration occurred.
Halothane anaesthesia causes in horses marked cardio-
vascular depression. with a pronounced decrease in cardiac
output t t • In our study. we found a constant hypocalcaemia
during halothane anaesthesia but only the total serum
calcium was reduced. The animal apparently tried to keep
the ionized and complexed calcium concentration at a
constant level. We are convinced that in critical
patients and possibly in some clinically healthy horses.
the low calcium level in the blood must be normalized.
before inducing anaesthesia.
INFLUENCE OF HALOTHANE ANAESTHESIA, ON SERUM CACONCENTRATION 11
CONCLUSIONS
In 20 horses a significant decrease in total calcium
concentration in the serum occurred during halothane
inhalation anaesthesia (spontaneous ventilation). The
same decrease was found in another group of ten horses
which were automatically ventilated. Ionized and
complexed calcium in both groups showed no significant
changes. Although we did not observe clinical symptoms as
a result of this hypocalcaemia, complications might occur
in critical patients during long-lasting halothane
anaesthesia. Preoperative or peroperative determination
of the serum calcium concentration might therefore be
indicated.
References
1. Friend, S.C.E. (1981). Case report: postanesthetic
myonecrosis in horses. Can. Vet. J. 22:367-371.
2. Johnson, B.D., Heath, R.B., Bowman, B., Philips, R.W.,
Rich, L.D. and Voss, J.L. (1978). Serum chemistry
changes in horses during anesthesia: a pilot study
investigation of the possible causes of postanesthetic
myositis in horses. J. Eq. Med. Surg. 2:109-123.
3. Klein. L. (1979). Post-operative myopathy in the
horse-intrinsic and management factors affecting risk.
In : Proceedings of the 24th Annual Convention of the
American Association of Equine Practice, pp.89-94.
4. Merin, R.G. (1973). Inhalation anesthetics and myo-
cardial metabolism. Anesthesiology 39:216-255.
5. Nayler, J.M. (1977). The nutrition of the sick horse.
J. Eq. Med. Surg. 1:64-70.
6. Price. H.L. (1974). Calcium reverses myocardial de-
pression caused by halothane. Anesthesiology
41 :576-579.
7. Simesen, M.G. (1980). Calcium, phosphorus and magne-
sium metabolism. In Clinical Biochemistry of
Domestic Animals, 3rd ed., pp.576-635. New York
Academic Press.
8. Stanec, A., Spiro, A.J. and Lent, R.W. (1978). Malig-
nant hyperthermia associated with hypocalcaemia. In :
Proceedings of the 2nd International Symposium on
Malignant Hyperthermia, pp.437-499.
9. Steffey, E.P. and Howlang, D. (1978). Cardiovascular
effects of halothane in the horse. Am. J. Vet. Res.
39:611-615.
10. Steffey, E.P., Farver, To, linkl, J., Wheat, J.D.,
Meagher, D.M. and Brown, M.P. (1980). Alternations in
horse blood cell count and biochemical values after
halothane anesthesia. Am. J. Vet. Res. 41:934-939.
11. Van Den Hende, C., Muylle, E., Vlaminck, K. and
OYaert, W. (1980). Halothaan gelnduceerde maligne
hyperthermie (MH) bij het Be19ische Landvarken : enke-

le gegevens in verband met de rol van subcellulaire
fracties. Tijdschr. Oiergeneesk. 105:1054-1059.
12. White, K.K. and Short, C.E. (1979). Anesthetic surgi-
cal stress-induced myopathy trial. Part II : A post-
anaesthetic myopathy trial. In: Proceedings of the
24th Annual Convention of the American Association of
Equine Practice, pp.l07-115.
2
Pharmacological properties of benzodiazepines
in animals
W. F. REHM AND U. SCHATZMANN
ABSTRACT
Benzodiazepines are used in veterinary medicine because of
their taming. sedative and skeletal muscle-relaxant ef-
fects. The pharmacological properties of benzodiazepines
in animals are very species-specific. particularly the
reaction of the animal and the duration of action. The
effects in ruminants. pigs. dogs and cats are discussed.
INTRODUCTION
In veterinary medicine benzodiazepines are used mainly as
drugs for taming aggressive animals. as sedatives and for
muscle relaxation. They belong to a large group of
psychopharmacologically active compounds which suppress
many physiological functions of the animal and reduce both
motor activity and aggressiveness. In general. they have
no anaesthetic effect. Figure 2.1 lists the most
important benzodiazepines relevant for veterinary medi-
ci ne.
THE MECHANISM OF ACTION OF BENZODIAZEPINES

It is currently believed that the mechanism of action of
* This paper is dedicated to Professor Dr. K. Ammann on

the occasion of his 80th birthday.
13
Brotizolam
.'~"'{I:1 1
N
:;0" I 1
:,..,
7-("U
~
I)
Climazolam CI N
CI
71
:,..,
Chlordiazepoxide
CI~~I.~"-
:;0" 1 0
:,..,
Diazepam
Elfazepam
Flunitrazepam
o
N II
t~c-o~
~
N
:,..,1
Ro 1';-1786 • N
o \
o
()r~-O~
Ro )';-3';1)<;
~) CI 0 \
Figure 2.1 Formulae of benzodiazepines used in animals.

PHARMACOLOGICAL PROPERTIES OF BENZODIAZEPINES 15
benzodiazepines is the specific enhancement of GABAergic

transmission in the eNS. Benzodiazepines modulate. via
specific receptors. the coupling mechanism between GABA
receptors and their associated chloride channels 3 . ' . 9 •
l4.l~.20.2l; Figure 2 . 2). GABA stimulates the chloride
conductance in target neurones. The highest densities of
the benzodiazepine receptors occur in the glomerular and
external plexiform layers of the olfactory bulb. in the
cerebral cortex. islets of Calleja. ventral pallidum.
hippocampus. dentate gyrus. superior and inferior
colliculi. and cerebellum. The lowest densities are in
the corpus callosum. parts of the thalamus. pons and
medulla (Figure 2.3). Peripheral binding sites also exist
for benzodiazepines. Binding to these sites does not seem
to be relevant to the sedative action of these compounds.
Unlike benzodiazepines. barbiturates may possibly have a
direct effect on the chloride channel. This difference in
the mechanism of action may explain why benzodiazepines do
not produce (over a wide range of doses) the same
intensity of CNS depression as do other sedatives. such as
hypnotics and general anaesthetics. The differences in the
mechanism of action become evident especially when the
dosage is increased. Barbiturates produce surgical
anaesthesia and. with "high doses". apnoea and cardiac
arrest. Benzodiazepines. on the other hand. are unable to
produce complete anaesthesia in animals·· " •
Benzodiazepines with sedative and anxiolytic properties
can be antagonized by compounds which block or displace
such benzodiazepine agonists from the receptor. These
antagonists were first synthesized by Hunkeler et al. 'o
and belong to the imidazobenzodiazepinones. They do not
have anxiolytic or sedative properties. Currently. a
third group of benzodiazepines that contains compounds
which are partly anxiolytic and partly antagonistic
(partial agonists) is under development.
Neurone
GABA-R.
Effector-Neurone
Figure 2.2 Scheme of GABAergic synapse. (From referen-

eel'. with permission).
SOME PHARMACOLOGICAL PROPERTIES OF BENZODIAZEPINES

RELEVANT TO THEIR USE IN VETERINARY MEDICINE
Most properties are very species-specific. This particu-
larly pertains to the reaction of the animal and the
duration of action. In addition to this. some chemical
properties such as the solubility of the benzodiazepines
are of importance for their use in animals. The benzo-
diazepine actions of principal interest for veterinary
usage are the taming effect in aggressive animals. the
effect of muscle relaxation and sedation. A further
property is the influence of benzodiazepines on the intake
of feed.
TAMING EFFECT
This psychopharmacological effect is important in the
prevention of range fighting during the grouping of
Figure 2.3 Autoradiogram of total binding of [3H]c10naze-

pam in a sagittal rat brain section in vitro. Note the
uneven distribution of receptors: highest densities occur
in the glomerular and external plexiform layers of the
olfactory bulb (01), in the cerebral cortex (ctx), islets
of Calleja (IC), ventral pa11idum (VP), hippocampus (hU,
dentate gyrus (dg), superior and inferior co11icu1i (sc,
ic), and cerebellum (cb), and lowest densities in the
corpus callosum (cc), parts of the thalamus (t), pons (p)
and medulla (M). (From reference 2t , with permission).
animals, such as before fattening or during transport of

pigs. A benzodiazepine used optimally as a fear-dispel-
ling agent results in the animal appearing to behave
normally without any reaction of fear. The taming effect
of benzodiazepines is also important for use in zoo
animals and pigs. The use of benzodiazepines in zoo
animals is the subject of a recently published review 7 •
The use of benzodiazepines in pigs is referred to in
several recent papers. Our own investi~ijtions with
c1imazo1am have shown that doses between 0.05 and 0.1
mg/kg body weight suppress the range fighting of pigs
during grouping and transport. The animals were not
afraid and were able to walk.
18 COMPARATIVE VETERINARY PHARMACOLOGY, TOXICOLOGYANDTHERAPY
MUSCLE RELAXATION AND SEDATION

Whether the sedative or the muscle-relaxant effect of a
benzodiazepine appears first depends on the species. In
some species a strong muscle-relaxant effect is evident
before the onset of sedation; thus. in large animals. such
as horses. undesirable reactions may occur. For this
reason. chlordiazepoxide. diazepam and climazolam should
not be used as single. intravenous injections because of
the defence reactions of the horse during casting. and
especially because of the risk of marked ataxia. An
intramuscular premedication of 0.2 mg/kg diazepam or
flunitrazepam 10-20 min before the administration of a
xylazine and ketamine combination successfully suppresses
ketamine convulsions and allows an induction of
anaesthesia free from excitement or other problems. After
the intravenous administration of combinations of diaze-
pam. flunitrazepam or climazolam with other anaesthetic
agents (xylazine/methadone. ketamine or chloral hydrate)
by way of simultaneous injections. or admixed in one
syringe. good relaxation and analgesia can be obtained 1 , 4 ,
6,12,13,16,17 Our preliminary trials have shown that
climazolam in combination with xylazine/methadone or
propionylpromazine can be used in the standing. sedated
horse to achieve lateral recumb ency l I .
USE OF BENZODIAZEPINES IN DIFFERENT SPECIES

Ruminants
In ruminants. optimum sedation can be achieved after
intravenous injection of diazepam (0.5 mg/kg body weight)
or climazolam (up to 2-4 mg/kg body weight). The cows lie
down within 2 min without any complications. Within the
first 10 min after high doses there were signs of shallow
breathing and a protrusion of the tip of the tongue. The
breathing later became quiet and the cow passed into a
calm sleep. Approximately 4 h following the injection the
animals stood UP without difficulty. started to eat and
drink and were apparently normal. Intramuscular injec-
tions cannot be recommended because of the unpredictable
effecp·11.18. Problems were encountered with ataxia in

the last phase of action and with the large injection
volume of the intravenous injection of diazepam. This
problem has been solved with a 10~ climazolam injection.
Pigs
In pigs. the administration of benzodiazepines for
sedation and muscle relaxation has been described for
diazepam and climazolam. Diazepam is reported to be
useful as a premedicant (0.25 mg/kg diazepam + 0.4 mg/kg
azaperone) in the technique of neuroleptanalgesia and to
facilitate intubation for nitrous oxide and oxygen
anaesthesia. but this method includes a risk of hyperther-
mia'·19. In our trials in pig surgery a good quality of
anaesthesia and muscle relaxation could be achieved with a
combination of climazolam and metomidate Hel. For group-
ing before fattening. we found that climazolam alone in
dosages between 0.25-0.5 mg/kg body weight should be used;
5 min after administration the animals were unconscious
for approximately 15 min and were afterwards sedated for
1-2 h.
Dogs
Dogs alone react to benzodiazepines in a similar way to
horses. After intramuscular and intravenous injection of
diazepam or climazolam in doses of 1 mg/kg body weight.
they show predominantly muscle relaxation with ataxia
mainly in the back legs. The sedation is insufficient to
keep the animals quiet; on the contrary. they look
nervous and sometimes howl. From our experiences with
diazepam and climazolam. we were able to use the muscle-
relaxant effect of climazolam in combination with
methadone and ketamine. The anticonvulsant effect of
benzodiazepines suppresses the well-known ketamine convul-
sions. We recommend that it is preferable to use a
combination of 1.5 mg/kg body weight climazolam + 1.0
mg/kg body weight methadone intravenously. This combina-
tion can easily be antagonized with a mixture of a benzo-
diazepine antagonist and an opiate antagonist. for example

0.15 mg Ro 15-1788 + 0.15 mg levallorphan/kg body weight.
Cats
It should be noted that this species should not be excited
before the administration of the drug. In excited cats,
treatment with either diazepam or climazolam alone may
increase the excitation so that useful sedation cannot be
achieved. For anaesthesia. diazepam as well as climazolam
in doses of 1 mg/kg body weight produce good relaxation in
combination with 10-20 mg/kg body weight ketamine.
INFLUENCE OF FEED INTAKE

Benzodiazepines have an appetite-enhancing effect. It is
possible for stimulation of appetite to dominate the
taming or sedative effect. The mechanism of action of
this effect is not fully understood. A direct influence
of benzodiazepines on the process of feeding. in
particular on hypothalamic GABAergic intrinsic neurones,
cannot be totally excluded. On the other hand. it may be
that benzodiazepines enhance feed or fluid intake by
reducing the inhibitory effect of stimuli of satiation 20 •
We assume that benzodiazepines could possibly work as
antagonists of CCK (cholecystokinin).
Our investigations t9 showed that the stimulating
influence of diazepam. climazolam and certain other
benzodiazepines on feed intake is only transient, which
does not justify the use of these compounds as so-called
growth promoters in animal feed.
ANTAGONISM OF BENZODIAZEPINES
In all our trials, independent of the combination with
narcotics or sedatives. it was possible to antagonize the
action of benzodiazepine agonists with specific benzodia-
zepine antagonists. After intravenous injection of the
antagonists, the animals in lateral recumbency stood up
within 1 min, and sometimes less. without any difficulty.
The specificity of the action of the benzodiazepine
antagonists could be demonstrated when climazolam was

administered in combination with ketamine. When the acti-
vity of the benzodiazepine was antagonized during ketamine
anaesthesia, the ketamine convulsions reappeared l • •
On the basis of our investigations with climazolam we
recommend a relationship to the antagonist Ro 15-1788 of
10 to 1. If climazolam is injected in combination with
methadone, levallorphan should be used as an opiate
antagonist in a ratio of 7.5 parts methadone to one part
levallorphan.
CONCLUSIONS
Very few of the large group of benzodiazepines have been
developed for use in veterinary medicine.
The most acceptable hypothesis of the mechanism of
action of benzodiazepines is the specific enhancement of
GABAergic transmission and the indirect action on the
chloride channel, via specific receptors. The main
pharmacological properties of benzodiazepines are very
species-specific; this applies not only to the reaction of
the animal but also to the duration of action. For the
veterinarian the taming effect, skeletal muscle relaxation
and sedation are the principal actions.
The benzodiazepines with sedative and anxiolytic
properties can be antagonized by compounds which block or
displace the agonists from the receptor. The ability of
the specific benzodiazepine antagonists to neutralize the
benzodiazepine effect within a very short time makes the
use of the muscle-relaxant activity of the benzodiazepines
much easier and the well-known long-lasting ataxia
resulting from overdosage of benzodiazepines much less
dangerous.
Acknowledgements
We thank Dr J.G. Richards for reviewing the manuscript,
and Pergamon Press for granting permission to reprint
Figure 2.3 from Neuropharmacology.
References
1. Ammann, K., Osman, M.A.R. and Rehm, W.F. (1965).
Versuche zur Verwendung des Benzodiazepinderivates Ro
5-2807 als Tranquillizer und Mittel zum medikamentosen
Niederlegen der Pferde. Schweiz. Arch. Tierheildkd.
107:59-72.
2. Beglinger, R., Hamza, B., Heizmann, P., Kyburz, E. and
Rehm, W.F. (1977). Untersuchungen zur Anwendung und
Antagonisierung von Benzodiazepinen beim Rind. Dtsch.
Tierarztl. Wochenschr. 89:137-142.
3. Bonetti. E.P., Pieri, L •• Cumin, R., Schaffner, R••
Pieri. M., Gamzu, E.R., Muller, R.K.M. and Haefely. W.
(1982). Benzodiazepine antagonist Ro 15-1788 : Neuro-
logical and behavioral effects. Psychopharmacology
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4. Butera. T.S .• Moore, J.M., Garner, H.E., Amend, J.F.,
Clarke. L.L. and Hatfield. D.G. (1978). Diazepam/
xylazine/ketamine combination for short-term anesthe-
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5. Conzen. M.• Sollmann, H. and Lindner. R. (1984). Er-
fahrungen mit der Neuroleptanalgesie unter Intubation
mit einem Lachgas/Sauerstoff-Gemisch fur grosse
neurochirurgische Eingriffe am Hausschwein (Sus
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der Praxis Kurznarkose beim Pferd mit Diazepam -
Xylazin - Ketamin. Tierarztl. Umsch. 35:393-394.
7. Gutzwiller, A•• Vol 1m, J. and Hamza, B. (1984). Ein-
satz des Benzodiazepins Climazolam bei Zoo- und Wild-
tieren. Kleintierpraxis 29:319-332.
8. Haefely. W•• Kulczar, A., Mohler. H•• Pieri. L •• Pole,
P. and Schaffner. R. (1975). Possible involvement of
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9. Haefely, W., Pole, P" Pieri, L., Schaffner, R. and
Laurent, J.-P. (1983). Neuropharmacology of benzodia-
pines Synaptic mechanisms and neural basis of
action. In : Costa, E. (ed.). The benzodiazepines,
pp.21-67. New York: Raven Press.
10. Hunkeler. W•• Mohler. H. Pieri, L., Pole, P., Bonetti,
E.P •• Schaffner, R. and Haefely, W. (1981). Selective
antagonists of benzodiazepines. Nature 290:514-516.
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Rindes mit dem Benzodiazepin-Derivat Ro 5-2807 (Hoff-
man-La Roche). Giessen: Vet. Diss.
12. Marolt. J. (1966). Weitere Erfahrungen mit dem Benzo-
diazepinderivat Ro 5-2807 bei Haustieren in Kliniek
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(1982). Nova associacao anestesica para cirurgias de
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3
Effects of halogenated inhalational anaesthetics on
respiration in dogs
L. w. HALL
ABSTRACT
The methods used to assess the respiratory depressant
effects of inhalation anaesthetics are illustrated by
reference to observations made during halothane and
enflurane anaesthesia in dogs. The timing of events of
the respiratory cycle, determination of the functional
residual capacity with the maximum pressure generated in
the occluded airway, ventilation, and the response of
these variables to increases in PaC0 2 need to be combined
to give a complete profile of an agent's effects.
INTRODUCTION
The methods used to study the respiratory effects produced
by anaesthetic agents have become more refined with the
passage of time. Early observers noted that breathing
became more shallow as the depth of central nervous (CNS)
depression increased and that it ceased before
circulatory arrest occurred. From these observations the
characteristics of the breathing pattern came to be used
in assessing the depth of anaesthesia and Guedel's
classical description of the signs and stages of diethyl
ether anaesthesia is characterized by extensive reference
to them, but it soon became apparent that respiratory
signs must always be related to a particular agent. For
25
example, under halothane anaesthesia respiration may

become severely depressed before reaction to painful
stimulation is abolished, whereas during ether anaesthesia
it is well maintained long after reaction to stimulation
disappears. These simple observations suggest that
halothane is much more of a selective respiratory
depressant than ether but how much greater cannot be
deduced.
The introduction of the concept of MAC <minimal
alveolar concentration)', made direct comparison of the
effects of different inhalation anaesthetics much easier
and the arrival of simple methods for the determination of
blood gases enabled the clinician to determine the
influence of anaesthetics and analgesics on oxygenation of
the blood and/or the removal of carbon dioxide from the
body. Clearly, determination of the blood gases at
equivalent levels of CNS depression allows assessment of
the respiratory effects of the agents in question, but it
gives no indication of how any observed respiratory
depression arises.
Other methods of assessing the respiratory effects of
drugs centre on the measurement of ventilatory responses
to changes in arterial or end-tidal carbon dioxide levels
during anaesthesia or after the administration of single
doses of analgesics such as the opiates. Many variations
of the basic technique have been described in the
literature but they all involve measurements of pulmonary
ventilation, either as end-tidal carbon dioxide tension is
increased or during steady state conditions at different
carbon dioxide tensions. The various techniques yield
carbon dioxide response curves and there can be little
doubt that the determination of these at equivalent levels
of anaesthesia has proved to be a useful tool in the
comparison of the respiratory effects of the inhalation
anaesthetics. The response curve undoubtedly defines the
way in which depression of the central chemoreceptor is
translated into gaseous exchange, but again, it gives no
indication of the mechanism involved.
EFFECTS OF HALOGENATED ANAESTHETICS ON RESPIRATION IN DOGS 27
More recently, a method of studying the activity of the

respiratory muscles themselves, which gives a much greater
insight into the processes involved in respiration, has
been introduced 3 • It involves occlusion of the airway and
determination of the pressure decrease within it during
the occluded inspiration. If the inspiratory effort
begins at the same lung volume on each occasion, then the
pressure decrease correlates well with the neural
activation of these musc1es • 2 There are now numerous
published accounts of the use of this technique but it
does not appear to have been reported in the veterinary
1 iterature.
Valuable clues to the mechanisms involved in the
production of respiratory depression can be obtained when
all the various techniques are taken into account. as may
be illustrated by consideration of studies of the
respiratory effects of two halogenated anaesthetics,
halothane and enf1urane.

The studies to be described here simulated the conditions
prevailing during clinical anaesthesia using a mixture of
nitrous oxide and oxygen to volatilize the agents and a
non-rebreathing circuit for their delivery (Figure 3.1).
All the animals involved were racing greyhounds free from
evidence of cardiopulmonary disease. Unconsciousness was
always produced with the same short-acting intravenous
drugs (a1fentani1 and methohexitone) before the induction
of anaesthesia was completed by administration of the
inhalation agent through a face-mask until endotracheal
intubation could be performed. Anaesthesia was maintained
with 1% halothane or 2% enf1urane in the inspired gases,
and the body temperature was maintained constant between
37 °C and 38 °C. No observations were made until the dog
had been in a stable state of anaesthesia with a constant
arterial carbon dioxide tension (PaC02) for at least 30
min. Differences were considered to be statistically
significant when the t-test showed p < 0.05.
Chart recorder
Pneumotachograph -
bottle system
Figure 3.1 Modification of the Magill non-rebreathing

circuit used.
RESULTS AND DISCUSSION

During anaesthesia the mean values for arterial blood
pressure and heart rate did not differ significant 1 y
between halothane and enflurane. while arterial oxygen
tension (Pa02 ) was always over 26 kPa so there was no
hypoxic or hypotensive respiratory drive to complicate the
interpretation of results. Mean PaC0 2 was always lower
under halothane (Table 3.1) but the difference was not
significant and thus. by this criterion. the two agents
were equally depressant to breathing. The mean slopes of
the C02 responses. however. differed (Figure 3.2) and
consideration of the tidal and minute volume responses
show that when end-tidal PaC0 2 is increased under
halothane the rate is affected more than the tidal volume.
Minute volume (V) was significantly greater under
halothane (p = 0.04) but there was no statistical diffe-
rence (p = 0.15) between the tidal vol umes (VI)' The du-
ration of inspiration (T 1 ) under enflurane was signi-
Table 3.1 Arterial carbon dioxide tension (PaC02 ;KPa),

inspiratory <T,), expiratory <T.) and total <T l o l ) cycle
times (seconds). maximum pressure in occluded airway
(P ••• ;cmH20), occluded inspiration time <T,o;seconds) and
tidal volume (VI :ml/kg) in racing greyhounds under
halothane (dog 1-7) or enflurane (dog 8-14) anaesthesia.
Animal PaC0 2 TI T. TI 0 I P•••
Halothane
4.93 0.65 2.29 2.94 22.4 1.42 16.8
2 7.33 0.69 5.80 6.49 24.4 1.01 11.0
3 6.67 0.67 2.83 3.50 20.0 1.27 9.3
4 7.73 0.74 4.45 5.19 60.0 0.87 7.6
5 7.07 0.45 3.18 3.63 32.5 0.70 13.0
6 5.47 0.98 2.43 4.14 16.4 0.70 16.4
7 5.47 0.57 3.24 3.80 26.7 0.74 11.9
Enflurane
8 6.00 0.60 9.40 10.00 29.5 0.60 13.2
9 7.07 1.45 5.64 7.09 19.9 2.18 17.6
10 8.67 1.74 15.60 17.00 17.0 1.74 15.0
11 6.93 1.24 5.54 6.78 29.3 1.42 9.0
12 6.53 1.73 5.15 6.88 11.7 1.48 11.0
13 5.60 0.80 8.19 8.99 31.9 1.01 19.0
14 7.33 1.28 7.19 8.47 30.2 1.86 12.0
ficantly longer than under halothane (p = 0.006), and this

may permit much better distribution of inspired gas within
the lungs thus making gas exchange more efficient at the
lower breathing rate associated with enflurane.
Under both anaesthetics section of the vagus nerves
increased inspiratory time (TI) indicating that vagal
feedback was involved in the termination of inspiration,
but it also increased the inspiratory time of occluded
breaths <T,o) so that the shorter TI during halothane
cannot be explained solely on the basis of differences of
Tidal
volume
a
30
20 Halothane Cn = 7)
ml/kg
'0
SEM ~
Jf-T----r---r---""'---,TIO- paco2
kPa
Minute
volume
50
b
Halothane
40 (n: 7l
300
ml/kG
200
'00
SEM ~
(
;
kPa
Figure 3.2 CO 2 responses (a) tidal . and (b) minute vo-

lumes.
activity in the vagus nerves.

Although the difference was not statistically
significant. the maximum pressure generated in the
occl uded airway (P ••• ) was greater under enflurane.
possibly indicating the retention of more power in the
respiratory muscles than during halothane anaesthesia.
__._7 ENFLUItANE
o
!
2
Seconds
HALOTHANE
Figure 3.3 Shape of occlusion pressure curves under halo-

thane and enf1urane anaesthesia.
However. under enf1urane the shape of the occlusion

pressure curve was markedly different (Figure 3.3) in that
the initial rate of decrease in pressure was obviously
less than under halothane but after this initial period
the rates of decrease were not dissimilar. The cause of
this difference is not readily apparent; it may have been
due to weakness of the intercostal muscles or it may
indicate asynchronous activation of the intercostal
muscles and diaphragm during enf1urane anaesthesia.
The effective e1astance [P ••• /VI] was virtually
identical under the two anaesthetics and although not
statistically apparent (probably due to the small number
of animals involved) the effective impedance [(P ••• /I I ) /
(VI/T I ) ] was higher under enf1urane. indicating greater
bronchomotor tone and an increase in the work of breathing
under this anaesthetic.
The results support the suggestion that halothane and
enf1urane produce respiratory depression in dogs through
different effects on the bu1bopontine pacemaker
me chan i sm 4 • but all the observat ions report ed here were
made in the absence of surgical stimulation. and it is
known that measurements made with or without such
stimulation will lead to different conclusions being drawn
about the respiratory depressant effects of an agent such
32 COMPARATIVE VETERINARY PHARMACOLOGY. TOXICOLOGY AND THERAPY
as isoflurane l • Nor were end-tidal concentrations of the

anaesthetics monitored. although inspired concentrations
of 1% halothane and 2% enflurane administered from a
non-rebreathing circuit should produce equivalent levels
of depression of the CNS. Also assumed was that the
respiratory muscles acted from the same initial fibre
length under different anaesthetics. but this would not be
the case if the functional residual capacity was not the
same and there is some evidence to suggest that under
anaesthesia lung volumes depend on the agent used 4 •
CONC~USIONS
It is clear that for the complete assessment of

respiratory depressant effects it is necessary to use more
than one technique. The timing of events of the
respiratory cycle. determination of the funct i ona I
residual capacity with the maximum pressure generated in
the occluded airway. ventilation. and the response of
these variables to increases in inspired PC0 2 need to be
combined to give a complete profile of an agent's effects.
References
1. Eger. E.I. II (1981). Isoflurane: a review. Anesthe-
siology 55:559-576.
2. Eldridge. F.L. (1975). Relationship between respira-
tory nerve and muscle activity and muscle force output.
J. Appl. Physiol. 39:567-574.
3. Grunstein. M.M •• Younes. M. and Milic-Emili. J. (1973).
Control of tidal volume and respiratory frequency in
anaesthetized cats. J. Appl. Physiol. 35:463-476.
4. Marsh. H.M •• Rehder. K. and Hyatt. R.E. (1981). Respi-
ratorY timing and depth of breathing in dogs anaesthe-
tized with halothane or enflurane. J. Appl. Physiol.
Respirat. Environ. Exercise Physiol. 51:19-25.
5. Merkel. G. and Eger II. E.I. (1963). A comparative
studY of halothane and halopropane anaesthesia.
Anesthesiology 24:346-357.
4
Analgesic activity of butorphanol in horses:
dosage titration and clinical studies
D. A. GINGERICH, J. E. ROURKE, P. W. STROM, L. L. GORDON
AND M. KALPRA VIDH
ABSTRACT
Butorphanol is a synthetic opiate of the cyclorphan series
which possesses both narcotic agonist and antagonist
properties. The drug has been characterized pharmacologi-
cally and clinically in humans as an analgesic and as a
component of balanced anaesthesia. and in dogs it has been
used as an antitussive agent.
In order to determine the clinical utility of
butorphanol as an analgesic in horses. a clinical and
pharmacological evaluation of the agent was undertaken in
horses. Analgesic activity was demonstrable in a dose-
dependent manner in horses. the intravenous administration
of 0.1 mg/kg providing a justifiable clinical dosage. In
double-blind clinical studies in horses presenting with
acute abdominal pain. the analgesic effectiveness of
butorphanol at a dosage of 0.1 mg/kg was confirmed.
INTRODUCTION
In 1680 Sydenham wrote "Among the remedies which it has
pleased Almighty God to give to man to relieve his
sufferings. none is so universal and so efficaceous as
opium'" • An ext ract of the opium poppy Papaver
somniferum. opium is now known to be a mixture of
alkaloids. the most important of which is morphine.
33
34 COMPARATIVEVETERINARYPHARMACOLOGY, TOXICOLOGY AND THERAPY
Although morphine is clinically very effective as an anal-

gesic. respiratory depression. gastrointestinal side-
effects. and. most importantly. addiction liability are
dangerous attributes of morphine that severely limit its
clinical acceptability.
Major scientific developments in this century have led
to the synthesis and testing of newer and safer drugs of
the opiate type. The observation that N-allyl
substitution on the codeine molecule abolished respiratory
depression produced by morphine or heroin. gave rise to
the concept of narcotic antagonists and structure-activity
relationships. The development of opiate receptor theory
followed. along with the discovery of endogenous opioids
in the brain.
In the search for a safer. more potent analgesic as a
replacement for morphine. the narcotic agonist-antagonist
class of drugs offered hope. Noting that drugs such as
cyclazocine and cyclorphan provided potent analgesia with
minimal euphoria. and that drugs containing the 14-hydro-
xyl group. such as naloxone. showed distinct antagonist
properties. scientists at Bristol Laboratories undertook a
synthetic programme to pursue the 14-hydroxy cyclorphan
series. The 14-hydroxymorphinans had never before been
produced through total synthesis and unique chemical
procedures had to be devised.
Of the analogues produced. butorphanol proved to be the
most promising.
PHARMACOLOGY OF BUTORPHANOL
Chemistry
The chemical structure of butorphanol in comparison with
related agents is presented in Figure 4.1. Butorphanol is
similar in structure to dextromethorphan but it possesses
a N-methylcyclobutyl substitution as well as a 14-hydro-
xyl group. By comparison. naloxone. which acts as a pure
antagonist. is similar in structure to morphine but
features an N-allyl substitution and a 14-hydroxyl group.
ANALGESIC ACTIVITY OF BUTORPHANOL IN HORSES 35
BUTORPHANOL CODEINE DEXTROMETHORPHAN
NALOXONE MORPHINE PENTAZOCINE
Figure 4.1 Chemical structures of butorphanol and related

agents.
Pharmacokinetics
Butorphanol is rapidly and completely absorbed following
intramuscular or subcutaneous administration. In dogs,
peak concentrations of butorphanol are detected at 0.7 h
after injection 7 • The apparent plasma elimination half-
life (t 1/2) is 1.5-2 h. In horses, intravenous injection
of butorphanol results in a biphasic plasma elimination
curve with a terminal half-life averaging about 2 h as
illustrated in Figure 4.2.
Absorption after oral administration of butorphanol to
dogs is essentially complete. However, oral bioavailabi-
lity is limited (about 16% in dogs) due to extensive
first-pass metabolism in the liver, primarily to hydroxy-
butorphanol, which is subsequently excreted mainly in
urine'. Some biliary excretion, amounting to 11-14% of a
parenteral dosage, also occurs.
Butorphanol readily crosses the placental barrier as
evidenced by studies in both pregnant ewes 6 and women'.
Butorphanol is measurable in fetal circulation of lambs
within 1 min of parenteral administration to the ewe and
rapidly reaches equilibrium with maternal circulation. In
women, parenterally administered butorphanol crosses the
E
-....
en
c
-0
c
d
.c
c.
L..
o
+-'
:J
.0
E
:J
L..
<ll
(f)
Time after administration (h)
Figure 4.2 Butorphanol serum concentration versus time

curve for serum butorphanol in horses (n = 6) following
intravenous dosage of 0.1 mg/kg.
placental barrier and is found in neonatal cord serum at

concentrations comparable to those in maternal plasma.
Butorphanol is also detectable in the milk of lactating
women following oral and intramuscular administration.
with milk-to-serum ratios ranging from 1.9 (oral) to 0.7
(i nt ramuscu 1ar) •
Analgesic and antagonist activity

The analgesic activity of butorphanol is demonstrable in
rodents using the phenyl quinone writing test and the
arthritic vocalization test, in which butorphanol has
approximately ten and 50 times the subcutaneous potency of
morphine and pentazocine, respectivelyt. Naloxone was
shown to reverse the analgesic activity of butorphanol in
mice. but only at dosages 50 times higher than those
required to antagonize morphine.
The antagonist activity of butorphanol is demonstrable
by precipitation of abstinence in non-withdrawn, morphine-
dependent mice and by reversal of morphine analgesia. As

an antagonist, naloxone was found to be 15 times more
potent than butorphanol. The analgesic component of
butorphano1 is approximately ten times more potent than
its antagonistic component.
Antitussive activity
The antitussive activity of butorphano1 was demonstrated
in guinea-pigs and dogs, utilizing an electrically
stimulated cough modeP. In the dog, butorphano1 given
subcutaneously was ten and four times more potent than
pentazocine and morphine, respectively. Orally, butorpha-
no1 was about 15-20 times more potent than codeine as an
antitussive.
In clinical studies, butorphano1 given subcutaneously
at a dosage of 0.055 mg/kg had a rapid onset of
antitussive action in dogs with chronic cough due to
tracheobronchitis, tonsillitis, pharyngitis, or bronchi-
tis J • Follow-up treatment with butorphano1 oral tablets
at a dosage of 0.55 mg/kg provided antitussive control in
dogs for 7-12 h 4 •
In horses, amplitude and frequency of experimentally
induced cough were markedly suppressed by intravenous
butorphano1 dosages of 0.1 and 0.01 mg/kg, but less so by
dosages of 0.001 mg/kg (Caudle, A.B., personal communica-
tion, 1985).
Cardiopulmonary effects
Butorphano1 has considerably less potential to produce
respiratory depression when compared to morphine. as
reflected by comparison of changes in arterial blood pC02
and pH in rats and dogs 1 • Cl inical dosages of butorphanol
cause minimal cardiovascular effects as demonstrated in
humans. dogs. and horses 1o • Unlike morphine, butorphanol
has no significant effect on venous plasma histamine
concentration 11 •
Effect on intestinal moti 1 ity

In contrast to morphine, which decreased intestinal
motility, increased duodenal smooth muscle activity, and
decreased bile duct flow, butorphanol given at equianalge-
sic doses had little or no effect on bile duct flow and
one-tenth the effect on intestinal motility and smooth
muscle activityt. In horses, butorphanol given
intravenously at dosages of 0.5 mg/kg every 4 h for 48 h
had no clinical effect on intestinal motility. In ponies,
migrating myoelectrical complex frequencies and spike
burst frequencies measured in the distal jejunum and left
dorsal colon were not diminished following intravenous
administration of butorphanol at the clinical dosage of
0.1 mg/kg (Adams. 5.8 •• personal communication. 1982).
8utorphanol in anaesthesia
As a pre-anaesthetic agent in dogs, butorphanol given
intramuscularly at dosages of 0.055. 0.11 or 0.22 mg/kg
reduced the dosage of thiamylal sodium required for
induction of anaesthesia in a dose-dependent fashion.
Ponies premedicated with butorphanol at intramuscular
dosages of 0.11 mg/kg. induced with xylazine and ketamine
(1.1 and 2.2 mg/kg. respectively), and maintained on
halothane. achieved a deeper plane of anaesthesia at
comparable halothane flow rates than non-premedicated
controls (Short. C.E., personal communication. 1985).
8utorphanol has been used in horses at dosages of 0.05
to 0.1 mg/kg in conjunction with xylazine (1.1 mg/kg) to
provide analgesia (particularly in the rear Quarters) for
minor surgical procedures that do not require recumbency.
Under these conditions. transient ataxia is the
side-effect most frequently observed.
ANALGESIA IN EQUINE COLIC

Materials and methods
Dosage titration studies
Six healthy adult horses of both sexes and of various
breeds were instrumented for measurement of pain threshold
500
(~~
400
•.iii
0
Q)
C7I 300
"0
c:
0
Q)
•
.~
200
e
Q)
a.
E
0
100
- IOO"\-_ _-~-~-~-~-~-~~
o 30 60 90 120 150 180 210 240
Time post-treatment (min)
Figure 4.3 Analgesic effects af butarphanol given at

various dosages in horses with visceral pain (* = mean
change in response time, in sec, to visceral pain stimulus
relative to placebo, n = 6).
according to methods described by Pippi and Lumb ' • The

experiments were conducted using a 6 x 6 Latin square de-
sign wherein each horse was evaluated with each of the
following six intravenous treatments butorphanol at
0.05, 0.1, 0.2 and 0.4 mg/kg, pentazocine at 2.2 mg/kg
(positive control) and saline. A washout period of at
least 3 days was allowed between successive treatments.
Pain threshold, defined as the elapsed time between
painful stimulus (balloon inflated in caecum [visceral] or
quartz lamp focused on blackened skin [superficial]) and
purposeful avoidance movement, was measured before drug
treatment, 15 to 30 min after treatment and every 30 min
thereafter for a total of 4 h. The resulting data were
analysed statistically by analysis of variance and linear
regression.
Double-blind clinical studies

The analgesic effects of butorphanol (Torbugesic-Bristol
Laboratories) at an intravenous dosage of 0.1 mg/kg were
compared with those of pentazocine at its approved dosage
of 0.33 mg/kg in horses presenting with acute abdominal
pain (colic). Pain intensity was determined before
treatment and at 15 min intervals after treatment by : (a)
a clinical scoring system for individual signs of colic
(sweating, kicking, pawing and head and body movement), on
a 0-4 scale, a being normal and 4 signifying severe signs;
(b) monitoring pulse and respiratory rates; and (c) stan-
dardized behavioural observations. The attending
veterinarians also rated the overall clinical analgesic
effect on a poor, fair, good, or excellent basis.
Analgesia scores were calculated for each parameter by
subtracting the post-treatment pain score from the
pretreatment pain score at each observation time, and
compared statistically between treatment groups by
Student's t test. Overall clinical effects were compared
using the chi square test.
Results
Effect on visceral pain threshold
Measurable increases in response time to vi scera 1 pai n
stimuli were detected within 15 min at all butorphanol
dosages. Analgesia persisted throughout the 4 h as
illustrated in Figure 4.3. The apparent biphasic shape
of the analgesic response curves was an artifact produced
by slight increases in placebo response times at 90 and
120 min. No evidence of enterohepatic shunting of
butorphanol was encountered (see Figure 4.2). A statis-
tically significant (p less than 0.01) linear relationship
was detected between the mean change in response time and
the log of the butorphanol dosage (Table 4.1).
Butorphanol at dosages of 0.1, 0.2 and 0.4 mg/kg, but
not 0.05 mg/kg, had an effect significantly (p less than
0.05) greater than placebo. The effect of pentazocine, at
the exaggerated dosage of 2.2 mg/kg, was also significant-
Table 4.1 Change in response time induced by butorphanol
Butorphanol Mean change in response time

dosage (mg/kg) (sec) relative to placebo
0.05 100
0.1 152
0.2 158
0.4 284
Superficial pain
U
••
III
Vl
•-0
o
.e.
Vl
...
III
l-
.e.
.£:
o
a... 0.05 0.1 0.2 0.4
Butorphanol dosage (mg/ kg)
Figure 4.4 Dose-response relationship of butorphanol in

horses with superficial pain (* = mean change in response
time. in sec. to superficial pain stimulus relative to
placebo at 15 min after intravenous injection. n = 6; **
significantly different from placebo. p less than 0.001).
ly greater than placebo. its activity falling between that

of butorphanol at 0.2 and 0.4 mg/kg.
Effect on superficial pain threshold

Repeated measures analysis of variance across post-treat-
ment times resulted in significant (p less than 0.05)
interaction between treatments and times. such that it was
necessary to compare treatments at each of the nine
post-treatment times. All four dosages of butorphanol and
ANALGESIC SCORE
7r----------------------------------------,
* BUTORPHANOL
4 PENT AZOCINE
o 15 30 45 60
POST-TREATMENT TIME (MIN)
* p<0.05
Figure 4.5 Comparison of analgesic effectiveness of in-
travenous butorphanol (0.1 mg/kg) and pentazocine (0.33
mg/kg) in horses presenting with acute abdominal pain;
analgesia score refers to pretreatment pain score minus
pain score at indicated post-treatment times (* pless
than 0.05).
also pentazocine were significantly (p less than 0.01)

more effective than placebo at 15 min post-treatment. A
dose-response relationship was detected numerically but
not statistically (Figure 4.4). No significant diffe-
rences between any treatments and placebo were detected
beyond 30 min post-treatment.
Butorphanol was occasionally associated with side-
effects consisting of restlessness. ataxia. or sedation
while pentazocine (given at an elevated dosage) caused
restlessness. ataxia. and shivering in all cases.
Analgesia in clinical colic

Case reports on a total of 69 horses with acute abdominal
pain associated with intestinal obstruction. excessive gas
or hypermotility were received. of which 34 were treated
with butorphanol (0.1 mg/kg) and 35 with pentazocine (0.33
mg/kg). Marked improvement in the clinical signs of colic
was detected within 15 min following injection of

butorphanol or pentazocine. Based on calculated mean
analgesic scores, horses of the butorphanol group showed
greater improvement in all parameters at all post-treat-
ment times than did the pentazocine group (Figure 4.5).
Those differences were found to be statistically
significant (p less than 0.05) with regard to sweating,
pawing. total score, and reduction in respiratory rate
(toward normal). An overall satisfactory clinical rating
was given in 88% of the butorphanol cases compared with
59% of the pentazocine-treated horses, a statistically
significant difference (p less than 0.05). Side-effects in
these studies were limited to slight, transient ataxia and
sedation. observed occasionally in both groups.
CONCLUSIONS
The results of these studies indicate that butorphanol is
effective as an analgesic in alleviating abdominal pain
associated with colic in the horse. Analgesic activity
was measurable pharmacologically, a dose-response rela-
tionship was detected and analgesia was confirmed in
double-blind clinical studies conducted under conditions
of veterinary practice.
References
1. Caruso, F.S •• Pircio. A.W., Madissoo. H•• Smyth. R.D.
and Pachter. I.J. (1977). Butorphanol. In: Gold-
berg. M.E. (ed.). Pharmacological and Biochemical
Properties of Drug Substances. Washington DC: Ame-
rican Pharmaceutical Association Academy of Pharma-
ceutical Sciences. pp.19-57.
2. Cavanagh. R.L., Glylys. J.A. and Bierwagen. M.E.
(1976). Antitussive properties of butorphanol. Arch.
Int. Pharmacodyn. Ther. 220:258-268.
3. Christie. G.J •• Strom. P.W. and Rourke. J.E. (1980).
Butorphanol tartrate: a new antitussive agent for use
in dogs. Vet. Med. Small. An. Clin. 75:1559-1562.
4. Gingerich. D.A •• Rourke. J.E. and Strom. P.W. (1983).
Controlling canine cough clinical efficacy of
butorphanol injectable and tablets. Vet. Med. Small
An. Clin. 78:179-182.
5. Jaffe. J.H. and Martin. W.R. (1975). Narcotic analge-
sics and antagonists. In: Goodman. L.S. and Gilman.
A. (eds). The Pharmacological Basis of Therapeutics.
5th ed •• pp.245-283. New York: Macmillan Publishing
Company.
6. Maduska. A.L •• Pittman. K.A •• Ahokas. R.A •• Anderson.
G.D •• Lipshitz. J •• Morrison. J.C. and Smyth. R.D.
(1980). Placental transfer and other physiologic
studies with intravenous butorphanol in the
anesthetized pregnant ewe. Res. Commun. Pathol.
Pharmacol.29:229-241.
7. Pfeffer. M•• Smyth. R.D •• Pittman. K.A. and Nardella.
P.A. (1980). Pharmacokinetics of subcutaneous and
intramuscular butorphanol in dogs. J. Pharmacol. Sci.
69:801-803.
8. Pippi. N.L. and Lumb. W.V. (1979). Objective tests of
analgesic drugs in ponies. Am. J. Vet. Res.
40:1082-1086.
9. Pittman. K.A •• Smyth. R.D •• Losada. M., Zichelboim,
I •• Maduska. A.L. and Sunshine. A. (1980). Human
perinatal distribution of butorphanol. Am. J. Obstet.
Gynecol. 138:797-800.
10. Robertson. J.T •• Muir. W.W. and Sams. R. (1981). Car-
diopulmonary effects of butorphanol tartrate in
horses. Am. J. Vet. Res. 42:41-44.
11. Schurig. J.E •• Cavanagh. R.L. and Buyniski. J.P.
(1978). Effect of butorphanol and morphine on
pulmonary mechanics. arte~ial blood pressure and
venous plasma histamine in the anesthetized dog.
Arch. Int. Pharmacodyn. 233:296-304.
Teaching Veterinary
Pharmacology
5
Postgraduate training in the veterinary
pharmacology
D.DROUMEV
ABSTRACT
The system of postgraduate training in veterinary pharma-
cology adopted in European countries varies in some
countries it is connected predominantly with intensive
research work and with conferring of scientific degrees
(PhD. oSc): in others it involves attending special cour-
ses with formal examinations. optional research work and
receiving certificates (diplomas): in most countries short
postgraduate refresher courses are organized for qualified
veterinarians and pharmacologists. But there are no spe-
cial postgraduate training courses for pharmacologists in
the pharmaceutical industry.
Proposals are presented for postgraduate training in
veterinary pharmacology within the framework of the EAVPT
a unified system of courses (both long-term and
short-term) for specialization and training of young
graduates leading to the awarding of scientific degrees.
Some courses. including international ones. for furthering
qualifications and knowledge are proposed for those
working in veterinary pharmacology; there are also courses
organized with the help of eminent guest scientists
invited to particular countries and mutual visits in
institutes and laboratories. A preliminary 2 year basic
academic course for training of candidates is advisable in
47
the pharmaceutical industrY, followed by special training

in research laboratories of the pharmaceutical firms. It
is preferable that for all courses not only classical
education methods such as frontal lectures and practical
exercises are used. but also films, videotapes, computer
techniques, etc. A permanent committee of the EAVPT
should be set UP to organize and coordinate the post-
graduate training courses in veterinary pharmacology, and
also be concerned with preparing methodology instructions.
dispatching visual and audiovisual materials, videotapes,
printed materials and editing a periodical bulletin.
INTRODUCT ION
Postgraduate and specialist training in veterinary pharma-
cology is both a national. and an international problem.
Each European country strives to educate veterinary
pharmacologists for both research and teaching work in
universities. research institutes and academies, and also
for research work in the pharmaceutical and ecological
laboratories. etc. 3 • The system of specialist training in
this respect is generally different in the various coun-
tries: they need to be unified within the framework of
EAVPT. to improve and possibly lead to more effective and
speedier education of pharmacologists.
SYSTEMS OF POSTGRADUATE TRAINING IN VETERINARY PHARMACO-

LOGY WITHIN THE FRAMEWORK OF EAVPT
Almost every European country has a system of postgraduate
training of veterinary pharmacologists. In most cases it
is allied to the need for teachers in pharmacology in the
universities and colleges. The training is usually car-
ried out individually in the institutes and laboratories.
and is a matter of personal interest, of diligence and
persistence in the candidate. but it also concerns the
respective institutions.
POSTGRADUATE TRAINING IN VETERINARY PHARMACOLOGY 49
POSTGRADUATE TRAINING IN VETERINARY PHARMACOLOGY LEADING

TO SCIENTIFIC DEGREES
This is used in most of the European countries and is the
main system for creating academic staff - veterinary phar-
macologists in the veterinary universities, in colleges.
in agricultural and veterinary academies - but also in
some research institutes. and in many cases in the
pharmaceutical industry. It is based on intensive
research work in the field of pharmacology, and is linked
with scientific theses, dissertations. doctorates and with
awarding of scientific degrees. The training terms vary
depending on the profile of the speciality. on the requi-
rements for depth of knowledge, on mastering of research
methods. on the scientific achievements and the scientific
titles.
For scientific degree Doctor of Philosophy (PhD), 1ic.
med. vet. (licentiate degree. CSc) it is necessary first
of all to take educational courses to study investigation
methods. and conduct practical exercises by undergraduate
students in some universities, take examinations. then do
research work and write theses (dissertations) or articles
in scientific publications. The duration of this post-
graduate training is 2-3 Years. The named system (with
some variants) has been introduced in the ~nited Kingdom.
West Germany (a comparable degree is DVM after defence of
the inaugural dissertation). the Netherlands. Denmark
(lic. med. vet.). USSR. East GermanY, Czechoslovakia.
Poland. Bulgaria (CSc). Yugoslavia and other countries 2 •
The scientific degree Doctor of Science (DSc. DVSc. Dr

med. vet.) is higher than PhD. For preparing the thesis
intensive research work over a 4-5 year period (without
attending training courses and without a supervisor) is
mandatory. The conferring of the DSc degree is linked to
a great extent with the originality of the scientific
contribution. with the discovery of new regularities of
fundamental character and/or of scientific-practical
app1icatian. The DSc degree is usually conferred after a
successful public defence. but in some countries it is

possible to gain a degree instead by contribution to
scientific publications. The DSc postgraduate system is
used in the United Kingdom. Norway and Denmark (Dr med.
vet.). France (after the doctorate - Doctor of Biology in
Pharmacology). USSR. West Germany. Czechoslovakia. Poland.
Bulgaria (DSc). Yugoslavia among others 2 • 6 • 7 • a •••
For the scientific degree Master of Science (MSc) the
candidate must attend a postgraduate course in veterinary
pharmacology. Then he works on a (mainly optional) re-
search project and presents a lecture connected with the
major subject. The greater part of the practical training
programme and the research project is taken by an
appointed supervisor. The courses at Master's level in
Denmark. for example. are foreseen for postgraduate
students in the developing countries. and the degree MSc,
is then conferred by the home universit y2.a. The same
level degree in Norway is named Dr scient. The postgra-
duate student must present a thesis in the form of mono-
graph or articles in scientific journals. which must
satisfy the standards of the reputed journals. In France
the comparable scientific degree is Master in Pharmaco-
I Ogy7 •
POSTGRADUATE TRAINING IN VETERINARY PHARMACOLOGY LEADING

TO CERTIFICATES (DIPLOMAS)
This exists only in a few countries in the form of special
courses lasting 2 years: for example in West Germany (Han-
over) the course is "Basic Biological Disciplines"
together with theoretical and practical phYsiology.
biochemistry and toxicology; in Israel the course lasts
one semester. and is mostly theoretical: in Bulgaria the
course lasts 30 days. and is mostly theoretical clinical
pharmacology. Postgraduate students in West Germany in
addition have to produce a research study. and in all the
above-mentioned countries an examination must be passed at
the end of the course before a certificate is recei-
ved a • iD •
POSTGRADUATE TRAINING IN VETERINARY PHARMACOLOGY FOR

FURTHER QUALIFICATIONS AND REFRESHER COURSES FOR WORKING
VETERINARY PHARMACOLOGISTS
This training lasts 3-6 months and should be renewed for
all those qualified every 5 Years. It acquaints practi-
sing veterinary pharmacologists with new investigation
methods. new apparatus and enables them to take part in a
research programme 3 , 4 , l O . It is possible for specialists
to attend lectures and discussions on review materials in
the various fields of pharmacology (in the USSR it is in
the Faculty of Postgraduate Training of Veterinary
specialists of the Moscow Veterinary Academy). This kind
of training is also organized individually in certain
pharmacological institutes with an individual work-plan 4 •
COMPARING POSTGRADUATE TRAINING

The above types of postgraduate training in veterinary
pharmacology are not practised equally in the various
countries. Almost all European countries link postgradu-
ate training with scientific degrees. And usually each
European country has its own postgraduate basic training.
only rarely sending graduates to foreign countries for
training.
Postgraduate training leading to certificates (diplo-
mas) can be considered very valuable because of the rela-
tivelY rapid possibility of specialization. but regretta-
bly it is used to only a limited extent in the different
countries of the EAVPT. Postgraduate training for further
qualification. with refresher courses for veterinary
pharmacologists. is very good. but it is not systemati-
cally introduced in all European countries. The above-men-
tioned postgraduate courses are mainly to create veteri-
nary pharmacologists for research and education.
There is still no specialized way of educating
pharmacologists and toxicologists for the pharmaceutical
industry linked to the specificity of polyvalent knowledge
and to respective research profiles. The need for this
kind of specialist is considerable at present because the
ratio between chemists and pharmacologists in pharmaceu-

tical research laboratories is 1 :27.
There is no unified postgraduate training system for
veterinary pharmacologists within the framework of the
EAVPT which provides planned postgraduate education of
equa l standards. So at the First Congress in Zeist (1979)
the EAVPT was forced to direct its attention to teaching
students and specialists in veterinary pharmacology. The
problem was discussed at the International Conference on
Veterinary Pharmacology, Toxicology and Therapeutics in
Cambridge (1980). The Board of the EAVPT considered it
expedient to set a unified standard for qualification in
veterinary pharmacology and establish compatible education
and postgraduate training standards. Some institutes for
training of young pharmacologists (with scholarships for
3-6 months) were specified at the Second Congress of the
EAVPT in Toulouse (1982). The problem of both postgra-
duate and undergraduate training in veterinary pharmaco-
logy was discussed at the Third Congress of the EAVPT in
Ghent (1985).
PROPOSALS FOR POSTGRADUATE TRAINING IN VETERINARY PHARMA-

COLOGY
Unified systems
It is advisable for a committee to prepare a unified
system for postgraduate training of specialists in
veterinary pharmacology and toxicology to increase the
postgraduate training level in those countries within the
framework of the EAVPT. It is important for training
profiles to be specified with the view of creating small
personnel units for research institutions and academies,
for universities and colleges. for the pharmaceutical
industry, for ecological institutions. and those concerned
with basic pharmacology, clinical pharmacology. toxicology
and biopharmacy, etc.
Scientific degrees
Training courses can ensure the comparatively rapid
education of veterinary pharmacologists. Long-term and

medium-term courses for each countrY, with a common basis
within the framework of the EAVPT should be organized for
studying new achievements in the field of pharmacology.
for mastering investigation methods and for doing limited
research work. culminating in a certificate (diploma) for
particular specialties, and optionally (if the scientific
contributions are of greater importance) a scientific
degree. The long-lasting courses (8-12 months or more)
are convenient for young veterinary graduates to specia-
lize. The medium-term courses (3 months to occasionally. 6
months) are suitable for specialists who need new
knowledge and experience in the research work in
particular areas of pharmacology or a neighbouring
discip1 ine 1 •
It is expedient for international specialists to be
invited to supervise training and to demonstrate new
investigation methods. Both classical and modern training
methods should be used: frontal lectures with not only
slides and transparencies. but also films. videotapes.
television techniques and computer techniques. showing
simulation of drug influences on the biological systems.
simulation techniques for teaching pharmacokinetics.
investigation of pharmacokinetics on healthy and sick
animals. specifying optimal doses and the intervals of
drug app1itation. determination of withdrawal times.
including the minimum to use without killing the animals.
mu1tip)e choice examination system. etc J d " l " 2 .
The pharmaceut ica1 industry

The postgraduate training of veterinary pharmacologists
for the pharmaceutical industry needs a more complicated
system 7 • Preliminary training of young graduates with an
academic basis (lasting approximately 2 years. and leading
to a scientific degree). or a long-term postgraduate
course leading to a certificate (diploma) (relatively sel-
dom) should be organized. followed by specialist training
in research laboratories of pharmaceutical firms. An
ongoing postgraduate education system reflects favourably

upon the activity of the pharmacologists in industry. It
is advisable for them to be able to work every few years
for UP to 6 months in the university laboratories.
Short-term courses
For the higher qualifications and refresher courses for
working veterinary pharmacologists. short-term training
courses for 1-3 months. both national and international.
are suitable : these include lectures and demonstrations
on new research methods. review material about new achie-
vements in various areas of veterinary pharmacology, and
discussions. Other training systems can be used - such as
short-term courses organized with guest scientists who
have considerable scientific and practical experience. or
mutual visits to institutes and laboratories can be
arranged for young pharmacologists to acquaint them with
the achievements of the respective staffs there. Video-
tapes can be exchanged for the same purpose.
Creating a permanent committee

For organizing the systems of postgraduate training in
veterinary pharmacology mentioned above the creating of a
permanent committee may be the answer. The EAVPT Board
can utilize a training base. coordinate postgraduate
training activities. and deal with the education problems.
give regu l ar periodic information to all member countries
of the EAVPT. prepare methodology instructions. visual and
audiovisual materials. videotapes. and printed material
(booklets. technical bulletins. guidelines. monographs.
specialist books). It is also advisable to produce a
review-type periodical bulletin. presenting up-to-date
scientific and research news.
CONCLUSIONS
Three types of postgraduate training in veterinary
pharmacology are used. but are not equal in the various
European countries mentioned above. mostly those courses
leading to scientific degrees. Proposals are presented

for introducing an unified system within the framework of
EAVPT countries postgraduate training courses (both
long-term and medium-term). leading to scientific degrees.
higher qualifications and refreshment courses, including
those with invited guest scientists. For postgraduate
training in the pharmaceutical industry, academic-based
training in long-term courses followed by work in pharma-
ceutical firms. is preferable, using modern methods of
education. Creation of a permanent committee connected to
the EAVPT Board for organizing and coordinating postgra-
duate activity is advisable.
References
1. Brien. J.F. and Racz. W.J. (1984). A methodology
course for graduate students in pharmacology. Trends
in Pharmacol. Sci. 5:171-173.
2. Bruhn. K. and Rasmussen. F. (1983). The Royal Veteri-
nary and Agricultural University, Copenhagen : an
institute for higher education and its relationship to
developing countries. Member CRE Inform. 63:153-161.
3. Brune. K•• Ganten. O. and Habermann. E. (1984).
Teaching of pharmacology, toxicology and clinical
pharmacology. Trends in Pharmacol. Sci. 5:127-131.
4. Evdokimov. P.O. (1984). Tasks of clinical veterinary
pharmacology. Veterinaria (USSR) 9:67-68.
5. Hughes. 1. (1983). Computer club: computers in phar-
macology teaching. Trends in Pharmacol. Sci. 4:
251-252.
6. Knifton. A. (1983). Teaching of veterinary pharmaco-
logy in the United Kingdom. Vet. Res. Comm. 7: 1-4.
7. Pekkarinen. A. (ed.) (1976). Contemporary trends in
the training of pharmacologists. Helsinki: IUPHAR.
8. The Royal Veterinary and Agricultural University In-
formation. Copenhagen (1984). 13.
9. The Royal Veterinary College. University of London.
Postgraduate Prospectus (1984). 10.14.
10. Sanford. J. (1980). Aims and objectives of teaching
clinical pharmacology and toxicology. In: van Miert,
A.S.J.P.A.M •• Frens. J. and van der Kreek (eds).
Trends in Veterinary Pharmacology and Toxicology,
pp.156-161. Amsterdam: Elsevier.
11. Walaczek. E.J. and Ooull. J. (1984). Using computers
for teaching of pharmacology. toxicology and therapy.
London IUPHAR 9th International Congress of
Pharmacology. Abstracts:E5. London: Macmillan press.
12. Welpton. R. (1984). Simulation technique in training
pharmacology. London: IUPHAR 9th International Con-
gress of Pharmacology, Abstracts:E6. London: Macmil-
lan press.
6
The teaching of veterinary pharmacology
and toxicology
J.D.BAGGOT
ABSTRACT
In the teaching of veterinary pharmacology and toxicology
it is important that the courses be placed at stages in
the curriculum when the students have acquired adequate
background in allied disciplines and are enthusiastic
about the material presented. The expertise of the
faculty and the involvement of its members in basic
aspects of clinical veterinary research can greatly
influence the attitude of students towards the discipline.
Postgraduate training in pharmacology and toxicology is
best provided through organized graduate programmes which
have a critical mass of faculty specialists in the
discipl ine.
RECENT HISTORICAL DEVELOPMENTS

It is now almost 30 years ago since veterinary
pharmacology underwent the major change from materia
medica to systemic pharmacology wi t h a bias towards
physiology. This change in emphasis took place rather
abruptly and. in becoming a basic science. the discipline
unintentionally restricted its scope by virtually ignoring
its application in clinical veterinary medicine. I cannot
but feel that the separation from therapeutics which
followed this change must have been a source of
57
disappointment to Professor L. Meyer Jones. It was hi s

textbook of Veterinary Pharmacology and Therapeutics. the
first edition of which was written solely by him and
published in 1954. that was largely responsible for
introducing veterinary pharmacology as it is tod ay 5 . In
An Introduction to Veterinary Pharmacology. first
published in 1960. Professor Frank Alexander emphasized
the principles of veterinary pharmacology and their
application in selected therapeutic situations l • Prior
to these decisive texts. which changed the content and
direction of veterinary pharmacology. Wallis Hoare's
Veterinary Materia Medica and Therapeutics (first edition.
1895) with the various revisions edited by Professors J.
Russell Greig and G.F. Boddie had been the standard
textbook for over 50 years·. Through his studies on the
passage of antimicrobial agents from the systemic
circulation into milk. Professor Fo1ke Rasmussen
stimulated research on the distribution and elimination of
drugs in food-producing anima1s 6 • 7 • His paper. published
in 19586 • was the first in a series of research papers
that linked basic principles to clinical application.
It was through the combined efforts of Professor
Charles R. Short and the late Dr. Andrew T. Yoxa11 that
the Journal of Veterinary Pharmacology and Therapeutics
was created in 1978. The introduction of this
international journal marked a significant development in
the discipline. as it provides a means not only for
disseminating recent information to veterinary
pharmacologists throughout the world. but also for
consolidating the discipline by providing it with an
identity. I should like to think that the monograph
Principles of Drug Disposition in Domestic Animals 2 has
contributed to the development of veterinary pharmacology.
particularly in the area of clinical pharmacokinetics.
Veterinary toxicology has developed in quite a
different way from the pattern of development in
veterinary pharmacology. This can be largely attributed
to the diversity of backgrounds of veterinary
THE TEACHING OF VETERINARY PHARMACOLOGY AND TOXICOLOGY 59
toxicologists, many of whom have appointments in other

major disciplines, such as clinical veterinary medicine or
veterinary pathology. For at least the last 25 years the
principles of toxicology have been incorporated in
pharmacology while applied toxicology is taught much
later in the veterinary curriculum. Veterinary Toxicology
(originally published as Lander's Veterinary Toxicology)
re-written by Professor E.G.C. Clarke and M.L. Clarke
(first edition, 1975) has been the standard textbook over
the yearsJ. In the preface to the first edition (1975)
the authors state that since the book was first published
in 1912, toxicology has changed out of all recognition. A
section entitled Veterinary Toxicology was added to the
fourth edition (1977) of Veterinary Pharmacology and
Therapeutics.
Since analytical techniques have now been mastered in
most diagnostic toxicology laboratories, I feel confident
that at least some of these laboratories will in the
future participate more fully in research activities.
Their sophisticated equipment could be used to advantage
in determining the distribution pattern and elimination
kinetics of toxic substances in the body, and for projects
that would elucidate the biochemical mechanisms of
toxicity. Another area of research that is begging the
attention of veterinary toxicologists is to outline the
pathophysiology of chemical-induced disease conditions and
to determine how these physiological alterations affect
the dispositon and dosage of drugs that might be used in
their presence and/or treatment. I am optimistic that
veterinary toxicology is rapidly approaching a threshold,
beyond which significant scientific advances will follow
in rapid succession.
COURSES IN VETERINARY PHARMACOLOGY AND TOXICOLOGY

There are three features of most courses in the veterinary
medical curriculum, including those in veterinary
pharmacology and toxicology, that deserve particular
attention. The first is the content or syllabus which
most delicately blends the basic and applied aspects of

the discipline; the second is the stage in the curriculum
at which the course is offered. and the third feature is
the manner in which the factual material is presented.
The integrated curriculum. in which pharmacology was
presented in a fragmented manner and economy of time was
an underlying objective. was introduced in some US schools
and colleges of veterinary medicine in 1969. Although
this curriculum was found to be unsatisfactory and was
largely abandoned within a decade. it resulted in a
shorter time being assigned to pharmacology than the
traditional course had enjoyed. Not only was the number
of lectures reduced by about 25%. but the laboratory
classes in which students traditionally participated were
largely replaced by demonstrations and video tapes. The
beneficial outcome from the demise of the integrated
curriculum was that an independent course in veterinary
pharmacology was re-established. The situation was
somewhat different for veterinary toxicology in that it
was spared from the humiliation of fragmentation in the
integrated curriculum and the subsequent drastic reduction
in the time assigned to the course.
CURRICULUM
The curriculum in veterinary pharmacology and toxicology
that is presently offered at the University of California.
Davis is outlined in Table 6.1.
OBJECTIVES
The objectives of the course in veterinary pharmacology
are to introduce the basic principles and general concepts
of pharmacology and toxicology and to apply them in a
veterinarY context. The molecular mechanisms of action
and effects of drugs on body systems are presented wi th
attention given to species variations in response. This
course provides factual information on the classes of
drugs that are of importance in clinical veterinary
medicine.
Table 6.1 Professional courses in veterinary pharmaco-

logy and toxicology
Veterinary pharmacology I; First year-spring

Principles of pharmacology and toxicology <includes
kinetics. fate processes and mechanisms of drug action)
Eight lectures and one laboratory demonstration
Systemic pharmacology (drugs acting on autonomic and
central nervous system. including anaesthetic agents
and neuromuscular blocking drugs)
17 lectures and two laboratory demonstrations
Total: 25 lectures and three laboratory classes
Veterinary pharmacology II; Second year-autumn

Systemic pharmacology (diuretics. cardiovascular drugs.
autocoids. hormones and hormone antagonists. non-
steroidal anti-inflammatory agents (NSAIDS»
Ten lectures and one laboratory demonstration
Chemotherapy (antimicrobial agents and antineoplastic
drugs)
Eight lectures and one laboratory demonstration
Principles of therapeutics
Two lectures
Total : 20 lectures and two laboratory classes
Clinical pharmacology (elective course); Third year-winter

Principles of antimicrobial therapy and approach to
treatment of selected infectious disease conditions (9);
treatment of gastrointestinal diseases in dogs and cats
(1); management of congestive heart failure in dogs (2);
selection and use of antiarrhythmic agents in horses (1);
analgesic and non-steroidal anti-inflammatory agents in
the horse (2); drug therapy of respiratory disorders (1);
treatment of skin conditions in small animals (1);
pharmacological basis of drug interactions (1); adverse
reactions to drugs (1); considerations governing the use
of drugs in neonatal animals (1).
Total: 20 lectures
Veterinary Toxicology; Third year-spring

The prevalence of toxic agents in the environment and
exposure of animals to them; the incidence. pathology,
pathogenesis. diagnosis and treatment of diseases of
animals caused by chemical poisons, organic and inorganic.
Total : 28 1ectures
The overall objective of the course in clinical

pharmacology is to apply the factors involved in the
selection of particular drug preparations for the
treatment of infectious diseases and the therapy of
disorders of body systems. The message presented is that
diagnosis. at least tentative, of the disease and the
physiological condition of the animal patient must first
be determined and this information be used in the
selection of a drug preparation and its dosage regimen.
This course encourages students to think about the use of
drugs in animals. the limitations imposed by the dosage
forms (including veterinary preparations) that are
available in relation to the functional and behavioural
differences among the animal species with which we are
concerned. and the procedures for the clinical evaluation
of drugs.
Veterinary toxicology, which is essentially an applied
course, has the overall objective of providing factual
information on the incidence, pathogenesis, diagnosis, and
treatment of diseases in animals caused by poisonous
substances.
VETERINARY PHARMACOLOGY
All veterinary students have completed a bachelor's and
some a master's degree in science before entering the
4-year DVM degree programme in the School of Veterinary
Medicine. With their background in mathematics.
chemistry and mammalian physiology, the veterinary
students are well prepared to understand the basic
concepts of pharmacology and the mechanisms of action of
drugs at the molecular level. It is only because of the

strong background of the students and the fact that
comprehensive printed lecture notes are provided that the
time assigned for the two-part core course in veterinary
pharmacology, which consists of a total of 45 lectures and
five laboratory classes, is marginally adequate. The
assignment of more time to the pharmacology course would
enable us to elaborate on and discuss the material
presented more fully. It would also enable us to present
lectures on topics that are omitted. such as the
pharmacology of anthelmintic drugs. In the student
evaluations of the course, two comments consistently made
are that more lectures should be assigned to the
pharmacology course to cater for the amount of material
presented, and that the use of video tapes in laboratory
classes is not entirely satisfactory. The content and
management of the laboratory classes are of particular
concern, since they provide the opportunity for students
to participate and to gain a "feel" for the discipline.
It is an unfortunate fact that no lectures are presented
in the pharmacology course on anthelmintic drugs.
CLINICAL PHARMACOLOGY
Clinical pharmacology is an elective course in which an
emphasis is placed on drug therapy of diseases in the
companion animal species (such as horses. dogs, and cats).
This course is offered in the winter quarter of the third
year of the veterinary curriculum. Clinical specialists
in microbiology and various aspects of internal medicine,
and the hospital pharmacist make valuable contributions to
this course, and it is largely their input that stimulates
constructive discussion regarding the basis for selection
and effective dosage of drug preparations in the treatment
of disease conditions.
VETERINARY TOXICOLOGY
Veterinary toxicology, which is offered in the spring
quarter of the third year, is a component of the core
Table 6.2 Required coursework for MS and PhD degrees
Courses Quarter units
Core course block

Principles of Pharmacology and Toxicology
I. Concepts. fate processes.
kinetics-dynamics 5
II. Effects of drugs and toxicants on
body systems and organs (1); prin-
ciples of chemotherapy and drug design 5
III. Effects of drugs and toxicants on
body systems and organs (2); develop-
ment and regulation of drugs and
chemicals 5
Pharmacology-Toxicology seminar 1
Elective_course blocks
Experimental statistics 2
Mol e c u 1 a r. ph y s i 0 log i cal • and/or morpho log i cal
sciences 5
Advanced graduate courses in pharmacology and/or
toxicology 8
Non-block elective courses
Proficiency in one foreign language (French. German. Spa-

nish. or Russian) is a requirement for the PhD degree
Research project for MS/PhD thesis
curriculum. This course is largely of an applied nature,

since knowledge of the basic principles of toxicology is
assumed and were presented in veterinary pharmacology.
Since the students are involved in clinical activities at
this stage of the curriculum. there is much less need for
providing laboratory classes in toxicology compared with
their requirement in basic pharmacology. A single 4 h

session is provided for small groups of students in the
Diagnostic and Clinical Toxicology Laboratory. The
purpose of this session is to familiarize the students
with the range of service offered by the laboratory, the
types of specimens that should be submitted for chemical
analysis, and by reviewing selected cases the scope of
toxicology will be seen in perspective.
PHARMACOLOGY-TOXICOLOGY GRADUATE PROGRAMME

At UC Davis we have an integrated pharmacology-toxicology
graduate programme in which there are 40 faculty members
and 45 graduate students. The majority of the graduate
faculty is based in one of the three member departments
of the programme. These departments are Human Pharmaco-
logy (School of Medicine), Environmental Toxicology
(College of Agricultural and Environmental Sciences), and
Veterinary Pharmacology and Toxicology (School of
Veterinary Medicine).
In the autumn quarter of this year (September 1985) a
new core curriculum will be introduced into the graduate
programme (Table 6.2).
The Principles of Pharmacology and Toxicology is a
three-quarter sequence of courses. In each quarter there
will be 30 lectures, ten discussion periods. and ten
laboratory exercises/demonstrations, which make up five
units.
This structured graduate programme provides advanced
coursework in both pharmacology and toxicology and the
opportunity to conduct research in a variety of
specialized areas. including veterinary pharmacology and
toxicology.
References
1. Alexander. F. (1960). An Introduction to VeterinarY
Pharmacology. Edinburgh: E. & S. Livingstone. Presently
in 3rd edition (1976). Edinburgh: Churchill living-
stone.
2. Baggot. J.D. (1977). Principles of Drug Disposition in
Domestic Animals The Basis of Veterinary Clinical
Pha~macology.Philadelphia: W.B. Saunde~s Co.

3. Cla~ke. E.G.C.and Cla~ke. M.L. (1975). Vete~ina~y
Toxicology. London: Baillie~e Tindall. P~esently in 2nd
edition (1981). Cla~ke. M.L •• Ha~vey. O.G. and Hum-
ph~eys. O.J. (eds). London: Baillie~e Tindall.
4. Hoa~e. W. (1895). Vete~ina~y Mate~ia Medica and The~a
peutics. Sixth edition (1942). edited and ~evised by
J. Russell G~eig and G.F. Boddie. London: Baillie~e.
Tindall and Cox.
5. Jones. L. Meye~ (1954). Vete~ina~y Pha~macology and
The~apeutics. Ames. Iowa: The Iowa State Unive~sity
P~ess. P~esently in 5th edition (1982). Booth. N.H. and
McDonald. L.E. (eds). Ames. Iowa: The Iowa State
Unive~sity P~ess.
6. Rasmussen. F. (1958). Mamma~y exc~etion of sulphon-
amides. Acta Pha~macol. Toxicol. 15:139-148.
7. Rasmussen. F. (1966). Studies on the Mamma~y Exc~etion
and Abso~ption of O~ugs. Copenhagen: Ca~l F~. Mo~ten
sen.
Drug Delivery Systems
and Bioavailability
7
Design and evaluation of studies on drug
delivery systems
A. VAN PEER AND J. HEYKANTS
ABSTRACT
The definition of bioavailability and acceptable
procedures to determine bioavailability of drug delivery
systems are considered in this chapter. Pharmacokinetic
methods to estimate the rate and extent of absorption by
drug concentration measurements in plasma and urine are
discussed. Principles relevant to the design, statistical
analysis and clinical interpretation of bioavailability
studies are reviewed.
INTRODUCT ION
In the 1970's it was recognized that bioavailability could
present practical problems both in safety and
effectiveness of drug usage. As a consequence, guidelines
and requirements for the design and execution of studies
on drug delivery systems were issued by regulatory
authorities. first for drugs intended for use in humans t
and later for drugs to be used in veterinary medicine 2 •
DEF INI nONS

The American Food and Drug Administration (FDA) defines
bioavailability as "the rate and extent to which the
active drug ingredient or therapeutic moiety is absorbed
from a drug product and becomes available at the site of
69
action" 1 • Various types of bioavailability experiments

exist. such as absolute and relative bioavailability and
bioequivalence studies. Common to all studies is the
comparative component that is the evaluation of test
product(s) versus a reference preparation. The reference
in an absolute bioavailability study is intravenous
administration of the drug(s) in solution whereas it may
be a solution or an approved drug product in a relative
bioavailability study. The latter is used to determine
the bioequivalence between products. The objective then
is to demonstrate that the bioavailability of. for
example. a solid dosage form and a solution does not
differ significantly, or does not differ more than a
certain degree, usually 20%.
PHARMACOKINETIC APPROACH
In practice. all bioavailability studies are based on
plasma concentration or urinary excretion-time profiles.
Most studies on drug delivery systems involve a
single-dose comparison of the test product(s) and the
reference, although multiple-dose steady-state studies may
be considered when plasma or urine concentrations are too
low for accurate measurement. Other reasons for a study
at steady-state are : comparison of a sustained-release
formulation to a conventional-release product, or to
overcome excessive variability in absorption by dosing
drugs admixed with food.
RATE OF ABSORPTION
Methods of estimating absorption rates have serious
limitations and depend on the size and choice of
sufficient sampling points in the absorption phase. This
is why urinary excretion profiles do not allow efficient
estimation of this parameter. The easiest approach is the
determination of the time to reach the maximal plasma
concentration <T ••• ) and the peak concentration (C ••• ) by
visual inspection of the plasma concentration-time curve.
Other methods are tedious. often complicated and require
DESIGN AND EVALUATION OF STUDIES ON DRUG DELIVERY SYSTEMS 71
time-consuming curve-fitting. Examples are the

deconvolution methods of Wagner and Nelson and Loo and
Riegelman and direct curve-fitting to well-established
pharmacokinetic models 4 • Moment analysis is a new
approach to absorption. and is simply based on
calculations of the area under the plasma concentration
t ime-curve 7 •
EXTENT OF ABSORPTION
The extent of absorption (F) is expressed as the ratio of
the total area under the plasma concentration-time curve
(AUC) of the test product to that of the reference
product. or as the ratio of the total amount of parent
drug excreted in urine (U) • corrected for dose. To
calculate total AUC and U in single-dose studies, plasma
concentrations and urinary excretion should be determined
for at least three to four times the terminal elimination
half-life (tt/2)' In multiple-dose studies. pre-dose
plasma concentrations on three or more consecutive days
are measured first to establish steady-state. then
comparison of the AUC in a dosing interval gives the
bioavailability of test to the reference product. The
cumulative amount excreted in urine during a dosing
interval at steady-state may also be used.
DESIGN OF BIOAVAILABILITY STUDIES

Crossover design is. in general. preferred because each
animal is subjected to all formulations or drug products
(treatments) and serves as its own control l • The simplest
design is the two-way crossover with two treatments (test
and reference product), two periods and two equal groups
of a sufficient number of animals. Assignment of three or
more treatments can occur according to a series of Latin
squares.
Another type of crossover design is the balanced
incomplete block. where each animal receives a fraction of
the treatments rather than all. When it is impossible to
retain any crossover. a parallel design can be chosen
where each animal receives a single treatment. either test

or reference. The latter types of study are considered as
valid alternatives when there are extended washout periods
in the crossover design, or when frequent sampling of
blood or urine is impossible in the target animal species.
In whatever design. a proper number of animals should
be studied in order to detect a significant difference of
20% between products at an alpha = 0.05 and power = 0.80
(Power test).
STATISTICAL ANALYSIS
Analysis of variance (ANOVA) on bioavailability data has
advantages above simple paired tests. ANOVA enables the
exclusion of important sources of variability such as
individual differences and effects of periods. groups.
sex, etc. from the residual error. However, ANOVA merely
indicates whether there are or are not significant
differences among treatment averages. Therefore multiple
range tests, such as Fisher'S least significant difference
test, are used to compare a posteriori any pair of
treatments for statistical difference. Bioavailability
decisions by ANOVA are based on accepting or rejecting the
null hypothesis of equivalence between test and reference
product. This may result in demonstrating inequivalence
of treatments. whereas clinically the difference is small
and acceptable (for example, 5%). To overcome these
problems, alternative approaches were developed. such as
BaYesian met hods', and paramet ric and nonparamet ric
confidence intervals '.6
CONCLUSIONS
The objective of a bioavailability study is to compare the
rate and extent of absorption of an active drug given by
different routes or products. and to ensure clinical
effectiveness. An appropriate design and reliable
pharmacokinetic parameters and statistics are needed to
demonstrate bioequivalence of products in the target
animal species. However, it is obvious that decisions
DESIGN AND EVALUATION OF STUDIES ON DRUG DELIVERY SYSTEMS 73
cannot be based solely on selected pharmacokinetic

parameters and pure statistics. The bioavailability
approach does not necessarily establish a comparable
depletion profile in residues. and there are also economic
aspects in product selection. such as costlbenefi t
considerations and use of convenient drug delivery
systems.
References
1. American Food and Drug Administration (1977). Bio-
availability and bioequivalence requirements. Fed.
Reg. 42:1624-1653.
2. American Food and Drug Administration (1982). Bio-
equivalence study guideline. Bureau of Veterinary
Medicine.
3. Cochran. W.G. and Cox, G.M. (1957), Experimental
Designs. 2nd ed. New York: Wiley.
4. Gibaldi. M. and Perrier. D. (1982). Pharmacokinetics.
2nd ed. New York: Marcel Dekker.
5. Metzler. C.M. and Huang. D.C. (1983). Statistical
methods for bioavailability and bioequivalence. Clin.
Res. Pract. Drug Reg. Affairs 1:109-132.
6. Steinijans. V.W. and Diletti, E. (1983). Statistical
analysis of bioavailability studies: parametric and
nonparametric confidence intervals. Eur. J. Clin.
7. Yamaoka. K., Nakagawa. T. and Uno. T. (1978). Statis-
tical moments in pharmacokinetics. J. Pharmacokin.
Biopharm. 6:547-558.
8
Potential of new drug delivery systems in
veterinary medicine
D. D. BREIMER
ABSTRACT
New drug delivery systems are characterized by
rate-controlled drug release in vivo. which is predictable
on the basis of the in vitro release profile. They are
capable of producing relatively constant drug
concentrations in the body for long periods of time and
this may be desirable for many drugs. This is discussed
in terms of pharmacokinetic/pharmacodynamic relationships.
The potential advantages of rate-controlled drug delivery
systems are reviewed. and their use as research tools in
pharmacology and toxicology (for example osmotic pumps) is
described. The extent of application in animal health
care is very much dependent on economic benefit; some
examples are given of rumen delivery systems and
injectable or implantable systems. The major areas of
application include therapy with antibiotic and parasitic
agents. the long-term delivery of anthelmintic and/or
antibacterial agents for growth promotion. the delivery of
hormones to achieve accelerated growth or oestrus
synchronization and the long-term administration of trace
nutrients.
INTRODUCTION
New drug delivery systems as used in the terminology of
75
this chapter are defined and characterized by

rate-controlled drug release in vivo. which is predictable
on the basis of the release profile in vitro. There are
four principal elements that such systems consist of: a
drug reservoir. a rate-controlled device. an energy source
that makes the drug leave the system. and a delivery
portal or exit. They are often capable of producing
relatively constant drug concentrations in plasma or at
other sites in the body for long periods of time. whereas
conventional dosage forms give rise to far greater
fluctuations (peak and valley) in concentration-time
profiles. Such new systems have recently been introduced
into human clinical practice. for example infusion pumps
(portable or implantable). transdermal devices with
nitroglycerine. scopolamine. clonidine or oestradiol.
osmotic pump systems for oral therapy with beta-blocking
agents. ocular systems for local therapy with pilocarpine.
intrauterine systems containing progesterone. etc. 7 • 12 •
Most of these systems have been designed on the premise
that constant rate delivery is the desirable
rate-programme. and that the longest duration consistent
with reproducible (constant) bioavailability-rate is best
to achieve optimal therapy. In this chapter some
pharmacokinetic/pharmacodynamic principles underlying this
concept will be given, although it should be realized that
this will not be valid for all drugs or hormones.
Subsequently, the potential advantages of rate-controlled
drug delivery systems will be discussed as related to both
therapeutic practice and research and finally their
potential use in veterinary medicine will be outlined.
THEORETICAL CONSIDERATIONS
Rational therapeutic management of disease, both in
animals and in man. usually requires that drugs are given
for a certain period of time. during which the therapeutic
effect is achieved and maintained in the absence of
undesirable side-effects. Similar considerations apply in
drug prevention of disease. For many drugs the intensity
POTENTIAL OF NEW DRUG DELIVERY SYSTEMS 77
of the pharmacological effect is related to their

concentration at the site of action (in the biophase near
the receptor) and in the plasma under steady-state
conditions. The therapeutic concentration range
(therapeutic window) is defined as the range above which
unacceptable or undesirable side-effects are encountered
(maximal safe concentration, MSC) and below which the
desired effect is generally not achieved (minimal
effective concentration, MEC). The ratio of these
concentrations is often defined as the therapeutic
concentration ratio or therapeutic index. During therapy
drug concentration should be continuously between MEC and
MSC. It has been shown that the various effects of a drug
(desirable and undesirable) may indeed be dissociated at
different serum concentrations l t . If this therapeutic
range is small, then a high degree of control over the
plasma concentration must be exerted to maintain the
concentration within this range. When a drug's
elimination half-life is long, this may be possible with
conventional dosage forms at dosage intervals of, for
instance, 1 day. In theory the following relationship
exists between the maximal dosage interval (Llt ••• ), el i-
mination half-life 01/2.'; first-order kinetics) and
the therapeutic concentration ratio (the fluctuation in
plasma concentrations should not be larger than this
rati 0)
Llt ••• = 1.44 x t I/2 ., x In MSC

MEC
When the elimination half-life is short, as is the case

for most drugs in many animal species, it is often
impossible or impractical to maintain relatively constant
plasma concentrations without the need of frequent
re-dosing. The latter is often very impractical or even
impossible in veterinary medicine. In such cases it is
desirable to apply rate-controlled input of the drug into
the plasma to compensate for rapid elimination. The
frequency of dosing by systems with such characteristics

is. in principle. independent of the kinetics of the
drugs. but will depend on factors like transit through the
gastrointestinal tract (oral systems), capacity of the
system, lifetime of the system, etc. Thereby the duration
of action of the drug becomes a design property of the
rate-controlled dosage form.
POTENTIAL ADVANTAGES OF RATE-CONTROLLED DRUG DELIVERY

SYSTEMS
The advantages of new drug delivery systems with a defined
rate of release may be summarized as follows 21
(1) Release of drug in vivo is predictable from in

vitro test methods and is theoretically independent
of the conditions applied in vitro. which in
general is not possible with conventional dosage
forms or "sustained release" dosage forms. Also
the release in vivo is in principle independent of
physiological conditions. such as pH. enzymatic
environment. food. etc.
(2) The plasma and biophase concentrations of a drug
are maintained constant and within the
therapeutically desirable range with little
fluctuation. Since there exists large variability
in the rate of drug elimination between different
animal species. it will be necessary to use
different release rates in different species.
(3) The selectivity of drug action is optimized. that
is. the number of undesirable side-effects in
severity and incidence is minimized. The latter
may. for instance, be associated particularly with
peak levels of conventional dosage forms or a rapid
change of plasma concentration.
(4) Predictable and extended duration of drug action is
provided.
(5) The inconvenience of repetitive dosing is avoided.
(6) In a single delivery system, the combination of
drugs that have complementary therapeutic actions

but are pharmacokinetically dissimilar. are
rationalized by releasing each drug at its
respective optimum rate for the same period of
time.
(7) The drug systems may be used as research tools in
pharmacology and toxicology: to studY in vivo
dose (concentration> response relationships!9: in
drug toxicity testing!5: to studY certain
time-dependent pharmacodynamic or pharmacokinetic
phenomena. like the development of tolerance or
adaptation. drug-drug i nt eract ions. circadian
variation. etc. •
3
The most widely applied drug delivery systems in such

studies are based upon the osmotic pump principle. which
was described almost 10 years ago by Theeuwes and Yum 2D •
The systems consist of a flexible drug reservoir which is
surrounded by a sealed osmotic agent with an outer
semipermeable membrane. The osmotic agent imbibes water
and generates a hydrostatic pressure on the flexible
membrane of the reservoir. thereby displacing the drug
solution or suspension through the orifice at zero-order
rate. These systems. which are developed by ALZA (Palo
Alto. California>. are available with 0.2 and 2.0 ml
reservoirs and total delivery times between 8 hand 2
weeks. They are widely used as implanted drug delivery
devices in laboratory animals and have thereby opened
novel and previously impractical methods. protocols and
models in drug and hormone research 22 • Also for human
drug research the systems are suitable and may be applied
orally (0.2 ml systems) or rectally (2.0 ml systems)4,tD.
APPLICATIONS OF NEW DRUG DELIVERY SYSTEMS IN VETERINARY

MEDICINE
Recently the potential uses and opportunities of new drug
delivery systems in veterinary medicine have been reviewed
and it was emphasized that there are numerous potential
applications in the entire field of animal health care 6 •

Relative to the development of devices (systems) for human
use. several differences exist for veterinary application.
These include the direct testing and use in the target
animal species. the lack of concern relative to cosmetic
considerations. the latitude in device design and the fact
that the devices need not necessarily biodegrade or be
removed upon complete release of drug. Furthermore. many
situations exist in which controlled release drug delivery
for longer periods of time may be the only rational method
to give a drug. for example. in grazing animals. In
principle. the same theoretical considerations apply for
the use of and the potentials of new drug delivery systems
in animals as compared to man. However. economic
considerations also play a very important role in the
field of animal health care. Therefore the range of
therapeutic applications of new systems is likely to be
limited to those diseases which lead to an economic loss
for the grower and/or to an application in which a
cost-effective accelerated growth of the animal is
achieved. These include the therapeutic delivery of
antibiotic and parasitic drugs, the long-term delivery of
anthelmintic and antibacterial drugs for growth promotion,
the delivery of hormones to achieve accelerated growth and
the long-term delivery of trace nutrients (copper. zinc,
cobalt. selenium. vitamins. aminoacids)6. In most cases,
systems exhibiting a very long duration of drug delivery
are required. which limits their use to relatively potent
drugs. Some examples of systems which either have reached
the market place or are still in the research phase are
reviewed briefly.
Rumen delivery systems

The rumen of cattle has proved to be a suitable place to
keep drug delivery devices for longer periods of time.
provided that a suitable method is found to prevent the
device from either being regurgitated or from moving
through the remainder of the gastrointestinal tract. This
can be accomplished via either weight or geometry. It has

been suggested that a density of about 1.8 is required for
retention in the rumen, whereas with a density greater
than 2.2 the devices are retained in the reticulum 17 •
Similar information on the geometry effects on retention
is not available but it seems likely that if the system
opens to a diameter which is much greater than that of the
oesophagus. then regurgitation should not be a problem.
An example of a slowly eroding device with high density
has been used by Byford. River and Hair' for the long-term
delivery of oxytetracycline. This consists of drug.
carnuba wax. barium sulphate. polyethylene glycol (PEG)
and iron powder and produces a relatively constant release
rate for about 50 days. A second example is exemplified
by morantel tartrate as administered in a metal
cylinder •13 The ends of the cylinder are capped with two
microporous sintered polyethylene discs impregnated with a
hydr'ogel to achieve overall r'ate control. The device is
to be administered at the beginning of the growing season
to young cattle upon their first eXPosur'e to the field.
Depending on the degr'ee of contamination of the field.
treated animals may gain about 50 kg or more weight during
their' fir'st year of gr'owth as compared to contr'01s2,1b,
In the patent literatur'e information is available on a
number' of devices which wer'e designed to utilize geometr'Y
as the r'etention mechanism. One consists of a cylinder
which contains the drug in an erodible core matrix;
r'etention is accomplished via two polyethylene "wings"
which fold against the device during inser'tion. but open
upon passage from the oesophagus 18 •
Another' example of a delivery system of this category
is r'epresented by soluble glass containing tr'ace elements
(copper. cobalt. and selenium)1, Systems can be pr'oduced
which have an effective lifetime of 1 year and ar'e capable
of pr'eventing trace element deficiencies in cattle and
sheep.
82 COMPARATIVE VETERINARY PHARMACOLOGY, TOXICOLOGY AND TH ERAPY
Injectable or implantable systems

A number of products containing steroidal hormones to
achieve growth promotion in cattle are currently used as
implants <oestradiol. progesterone. testosterone and/or
their esters. either alone or in combination)'4. Detailed
information on the system design is generally not
available. but dispersion of drugs into a polymer matrix
and the use of coatings to achieve further rate control
seem to be a common design property.
Implants are also used for the synchronization of
oestrus. The burden of oestrus detection would be greatly
relieved and the rate of conception substantially
increased if an effective oestrus synchronization
treatment could be developed which produces a sexual
response so precise that artificial insemination can be
carried out at a predetermined time schedule. without the
need for oestrus detection in every animal. An example of
a system successfully developed for this purpose has been
described by Chien!. which contains norgestomet in a
suspension of solid particles in a hydrogel/water polymer.
The same group also uses a flurogestone acetate-impregna-
ted vaginal pessary to achieve oestrus synchronization in
sh eep 9 .
CONCLUSIONS
There is considerable potential for new drug delivery
systems in the entire field of animal health care. in
particular when economic benefit of the treatment regimen
can clearly be established. Therefore the major areas of
application of such systems include therapy with
antibiotic and parasitic agents. the long-term delivery of
anthelmintic and/or antibacterial agents for growth
promotion. the delivery of hormones to achieve accelerated
growth or oestrus synchronization and the long-term
administration of trace nutrients h •
References
1. Algar. 8 •• Irlam. P •• Knott. P •• Telfer. S. and
Zervas. G. (1985). The use of soluble glasses to
provide a controlled supply of trace elements to

ruminant animals. In: Peppas. N.A. and Ha Ius ka. R• J •
(eds). Proceedings of the 12th International
Symposium on Controlled Release of Bioactive
Materials. pp.190-191. Lincolnshire: The Controlled
Release Society Inc.
2. Borgsteed. F.H.M. (1983). The effects of morantel
sustained release bolus system on calves grazing a
highly contaminated pasture in The Netherlands. Vet.
Parasitol. 12:251-260.
3. Breimer. D.O •• De Leede. L.G.J. and De Boer. A.G.
(1984). New drug delivery systems as tools in
clinical pharmacology. In: Lemberger. L. and
Reidenberg, M.M. (eds). Proceedings of the 2nd World
Conference on Clinical Pharmacology and Therapeutics.
pp.431-443. Washington: American Society for
Pharmacology and Experimental Therapeutics.
4. Breimer, D.O •• De Leede. L.G.J. and De Boer. A.G.
(1985). Rate-controlled rectal drug delivery. In:
Prescott. L.F. and Nimmo. W.S. (eds). Rate Control in
Drug Therapy. pp.54-64. Edinburgh: Churchill
Li vi ngst one.
5. Byford. R.L •• River. J.L. and Hair. J.A. (1981). A
sustained release oxytetracycline bolus for ruminants.
Bovine fracto 15:91-94.
6. Cardinal, J. (1985). Controlled drug delivery:
veterinary applications. J. Controlled Release
2:393-403.
7. Chien. Y.W. (1982). Novel Drug Delivery Systems. New
York: Marcel Dekker.
8. Chien. Y.W. (1985). Implants and depot formulations:
subcutaneous controlled oestrus synchronization. In:
Prescott. L.F. and Nimmo. W.S. (eds). Rate Control in
Drug Therapy, pp.90-102. Edinburgh: Churchill
Livingstone.
9. Chien. Y.W. and Kabadi, M.B. (1985). Intravaginal
controlled oestrus synchronisation. (II) Intravaginal
delivery of flurogestone acetate, in vitro - in vivo
correlation and clinical efficacy. In: Peppas, N.A.
and Haluska. R.J. (eds). Proceedings of the 12th
International Symposium on Controlled Release of
Bioactive Materials. pp.353-354. Lincolnshire: The
Controlled Release Society Inc.
10. Davis. S.S •• Hardy. J.G., Taylor. M.J •• Stockwell, A.,
Whalley, D.R. and Wilson, C.G. (1984). The in vivo
evaluation of an osmotic device (OSMET) using gamma
scintigraphy. J. Pharm. Pharmacol. 16:740-742.
11. Goldman, P. (1982). Rate-controlled drug delivery.
New Engl. J. Med. 307:286-290.
12. Heilman. K. (1982). Therapeutische Systeme. Konzept
und Realisation programmierter Arzneiverabreichung.
2nd edt Stuttgart: Enke Verlag.
13. Jones, R.M. (1983). Therapeutic and prophylactic
efficacy of morantel when administered directly into
the rumen of cattle on a continuous basis. Vet.
14. Lambert. S.B. and Davis. G.V. (1983). The effects of

Compudose. Ralgro and Synovex-S implants on
performance of finishing yearling steers. J . Animal
Sci. 57 (Supp]. 1>,399.
15. Nau. H. (1983). The role of delivery systems in
toxicology and drug development. Pharm. Intern.
4:228-231.
16. Prost. H•• Supperer. R•• Jones, R.M •• Lockwood, P.W.
and Bliss. D.H . (1983). Morantel sustained release
bolus a new approach for the control of
Trichostrongylosis in Austrian cattle. Vet.
17. River, J.L •• Byford, R.L., Stratton, L.G. and Hair.
J.A. (1982). Influence of density and location on
degradation of sustained release bo l uses given to
cattle. Am. J. Vet. Res. 43:2023-2030.
18. Simpson. B.E. (1983). Sustained release capsule for
ruminants. U.S. Patent 4.416.659.
19. Struyker Boudier, H.A.J. (1982). Rate-controlled drug
delivery: pharmacological, therapeutic and industrial
perspective. Trends Pharmacol. Sci. 3:162-164.
20. Theeuwes, F. and Yum, S.I. (1976). Principles of the
design and operation of generic osmotic pumps for the
delivery of semisolid or liquid formulations. Ann.
Biomed. Eng. 4:343-353.
21. Urquhart. J. (1981). Performance requirement for
controlled-release dosage forms therapeutic and
pharmacological perspective. In: Urquhart, J. (ed.).
Controlled-Release Pharmaceuticals, pp.1-48.
Washington: American Pharmaceutical Association.
22. Urquhart, J., Fara. J. and Willis, K.L. (1984).
Rate-controlled delivery systems in drug and hormone
research. Ann. Rev. Pharmacol. Toxicol. 24:199-236.
9
Influence of injection site on the depot effect of
procaine penicillin in dogs
E. G. HARTMAN
ABSTRACT
The influence of the site and route of injection on the
depot effect of procaine penicillin in dogs was investi-
gated. The drug was administered either intramuscularly
(M. longissimus dorsi. M. semitendineus/M. gracilis. M.
gluteus medius) or subcutaneously (lateral thorax and
neck). The depot effect () 0.1 lU/ml of serum at 24 h)
was found in a higher percentage of cases following
injection into the M. longissimus dorsi (77%). than
following injection into the other intramuscular sites
(33% and 20%. respectively). The probability of a depot
effect was highest following subcutaneous injection in the
lateral thorax region. whereas subcutaneous injection in
the neck resulted in a depot effect in 60% of the cases.
INTRODUCTION
Recent studies both in man and animals have indicated
that. in many instances. differences in a~sorption rates
from various intramuscular and subcutaneous tissue sites
may be significant 2 , 3 , 5 - 7 , In canine practice penicillin
is administered most commonly either intramuscularly in
the thigh or subcutaneously in the lateral thorax or neck.
Pharmacokinetic properties of new formulations of
antimicrobial drugs for dogs need to be tested in the same
85
animal species before being licensed. However. no

directions are provided with respect to the route and site
of administration.
The aim of the present study was to investigate the
possible influence of the site and route of parenteral
administration on the absorption rate. and the depot
effect achieved with procaine penicillin.

Adult beagles of either sex weighing 15-20 kg were
injected with a suspension of procaine benzylpenicillin
(Depoci11in. Gist-Brocades. The Netherlands) at a dose
rate of 1 m1 per 10 kg body weight. which is equivalent to
30.000 IU proc~ine penicillin per kg body weight.
The sites used were either intramuscular (M.
longissimus dorsi. M. graci1is/M. semitendineus. M.
gluteus medius) or subcutaneous (lateral thorax and the
neck region). The subcutaneous injection sites were
chosen as these are commonly used in veterinary practice.
as is intramuscular injection into the thigh region (M.
semitendineus/M. gracilis). Intramuscular injection into
the M. gluteus medius was chosen as an alternative to
injection into the thigh region. as the latter might
result in an intermuscular injection. Injection into the
M. longissimus dorsi was expected to be intramuscular as
this muscle consists of a solid. easily accessible. muscle
mass. Injection into the M. gluteus medius was chosen
because this site is often used in humans. Blood samples
were drawn from the cephalic vein at 2. 4. 6. 8. 12 and
24 h. Blood was allowed to clot and the serum removed by
centrifugation. Serum was analysed for penicillin by an
agar diffusion technique using plate count agar (Oxoid)
and Bacillus stearothermophi1us var. ca1ido1actis as assay
organism' • The course of the serum penici 11 in
concentration in each individual animal was classified
tentatively in one of four groups as follows:
INFLUENCE OF INJECTION SITE ON PROCAINE PENICILLIN 87
Level <IU) at . 12 h 24 h group

> 0.5 > 0.5 lA
> 0.5 > 0.1 18
> 0.5 < 0.1 2A
< 0.5 < 0.1 28
RESULTS
Four different patterns of mean serum penicillin curves
following intramuscular and subcutaneous injection are
depicted in Figure 9.1. These curves are the mean of
the individual serum penicillin curves classified as
described above. Intramuscular and subcutaneous admini-
stration of procaine penicillin resulted in similar types
of mean serum penicillin curves.
In Table 9.1 the classification of the course of the
serum penicillin concentration is presented according to
!lg/ml Ilg/ ml
10 10
1A
1A
0.5 - --- - 0.5
1B
0 .1 0.1
2A
2A
0.01 0.01
O.OO~........_-.---._ _ _ _-.-_.:.:.h_ O.00't-..................----._---........-.:.:.h-

2 4 6 8 12 24 2 4 6 8 12 24
Figure 9.1 Patterns of mean serum penicillin curves fol-

lowing intramuscular (left panel) and subcutaneous (right
panel) administration.
Table 9.1 Classification of the course of the serum

penicillin concentration according to the site of
injection
Injection site Classification group

lA 18 2A 28
M. longissimus dorsi 3 7 2 1
M. gracilis/M. semitendineus 5 6 4
M. gluteus medius 1 2 2
Lateral thorax 9 1
Neck 2 4 3
Table 9.2 Depot effect (> 0.1 IU at 24 h) of procaine

penicillin. expressed as the probability in percentages.
depending on the site and route of injection
Route Site Percentage 00
Intramuscular M. longissimus dorsi 77

M. gracilis/M. semi- 33
tendineus
M. gluteus medius 20
Subcutaneous Lateral thorax 91
Neck 60
the site of injection and the corresponding number of

animals.
The probability of a high serum concentration (above
0.1 IU/ml) at 24 h following administration was
determined by comparing group 1A plus 18 with group 2A
plus 28. The results according to the different injection
sites and routes are given in Table 9.2.
As procaine penicillin preparations are expected to
produce a depot effect. the best sites of injection are
either subcutaneous in the lateral thorax region or
INFLUENCE OF INJECTION SITE ON PROCAINE PENICILLIN 89
~g/ml
10
0.5+--- ---1;- ..--:~~~----
0.1-1----~.,_+-~---
0.0
\
0.00 ~_ _ _~------::_:_-h:.!.--
24 68 12 24
Figure 9.2 Variation of individual curves following sub-

cutaneous injection at the same injection site (neck).
intramuscularly into the M. longissimus dorsi.
DISCUSSION
Procaine penicillin is a poorly water-soluble salt of
penicillin and is for this reason used in depot
preparations with the purpose of obtaining higher serum
levels for an extended period of time. Absorption from
the injection site will depend not only on the solubility
of the compound in water but also on factors such as the
structure of the tissue at the site of injection, blood
flow and spreading of the injected mass which wil l affect
surface area presented for absorption, as was demonstrated
in several mammalian species including man 4 • The results
obtained in this study indicate that the release of active
substance from the injection depot into the blood stream
may vary considerably.
The M. longissimus dorsi was chosen to enhance the
probability that the injection would be correctly
intramuscular. The other intramuscular sites were

expected to give a greater chance of an intermuscular
injection. Indeed a depot effect was found in a higher
percentage of cases after an injection into the M.
longissimus dorsi. thus supporting the conclusion of
Palmer"·. that there will be a difference in absorption
rate following intramuscular and intermuscular injection.
The rapid absorption of penicillin from the thigh and
the M. gluteus medius. however. might also be attributable
to the contraction of these muscles during exercise. The
more pronounced depot effect following injection into the
M. longissimus dorsi could be the result of the different
activity of this muscle. which is almost restricted to a
variation in tension rather than the large contractions
seen with limb muscles.
The difference between the neck and the lateral thorax
might also be the result of exercise. as the subcutaneous
region of the neck will be massaged more intensively
during exercise than the lateral thorax at which site
movement is almost restricted to excursions of the
thoracic wall resulting from breathing. However. the
cause of the variation of the individual curves following
subcutaneous injection in the neck (Figure 9.2) remains
to be established.
CONCLUSION
This study emphasizes that more attention should be paid
to the actual sites of injection of drugs. If. as
described here. a depot effect is desired the best site
for intramuscular injection of procaine penicillin is the
M. longissimus dorsi. and for subcutaneous application the
lateral thorax site is preferred.
Acknowledgements
The author wishes to express his gratitude to Dr R.
Beukers for technical advice and assistance in preparing
this paper. Mrs E.C. Bakker-de Koff and Mrs. H.G. van
Laar are gratefully acknowledged for their excellent
INFLUENCE OF INJECllON SITE ON PROCAINE PENICILLIN 91
technical assistance.
References
1. Ga1es100t, T. and Hassing, F. (1962). A rapid and sen-
sitive paper disc method for the detection of peni-
c i 11 in in mil k. Ne t h. Mil k Da i r y J. 16: 93-95.
2. Groothuis. D.G. and Van Miert, A.S.J.P.A.M. (1979).
Diergeneesmidde1en en extravascu1aire injecties.
Tijdschr. Diergeneesk. 104:886-887.
3. Groothuis, D.G., Werd1er, M.E.B., Van Miert. A.S.J.P.A.
M. and Van Duin. C.T.M. (1980). Factors affecting the
absorption of ampicillin administered intramuscularly
in dwarf goats. Res. Vet. Sci. 29:116-117.
4. MacDiarmid, S.C. (1983). The absorption of drugs from
subcutaneous and intramuscular injection sites. Vet.
Bull. 53:9-21.
5. Marshall, A.B. and Palmer, G.H. <1980>. Injection
sites and drug bioavai1abi1ity. In: Van Miert, A.S.J.
P.A.M. et a1. (eds). Trends in Veterinary Pharmaco-
logy and Toxicology, pp.54-60. Amsterdam: Elsevier.
6. Palmer, G.H. (1980). Effect of injection site on bio-
availability of aminopenici11ins in calves. In: Van
Miert. A.S.J.P.A.M. et a1. (eds). Trends in Veteri-
nary Pharmacology and Toxicology, pp.337-338. Amster-
dam: Elsevier.
7. Rutgers, L.J.E., Van Miert, A.S.J.P.A.M., Nouws, J.F.M.
and Van Ginneken. C.A.M. (1980). Effect of the injec-
tion site on the bioavai1abi1ity of amoxycillin tri-
hydrate in dairy cows. J. Vet. Pharmacol. Ther.
3:125-132.
10
Influence of food on absorption of
antimicrobial drugs
A. D. J. WATSON
ABSTRACT
Interactions between food and drugs affect i ng drug
absorption are widely recognized in human medicine but
have received little attention in the veterinary sphere.
The most common outcome of these interactions is reduced
or delayed absorption of the drug, although in some
instances absorption can be increased or unaffected. The
mechanisms responsible are complex and involve both food-
induced changes in gut physiology and direct interactions
between food components and drugs. The clinical
significance of interactions affecting antimicrobial drugs
is uncertain. However, impaired absorption is more likely
to hinder antimicrobial efficacy than to help it.
Accordingly, it seems prudent to fast patients for 2 hours
before and 2 hours after administration of those agents
whose absorption can be impaired substantially by food,
namely most penicillins and tetracyclines, some cephalo-
sporins and certain erythromycin products. A few anti-
microbial drugs may not require food restriction (chlor-
amphenicol, erythromycin estolate, hetacillin) and some
could be given with food to improve absorption (erythromy-
cin esters, griseofulvin, nitrofurantoin) or reduce
gastric irritation associated with dosage (doxycycline.
metronidazole. nitrofurantoin).
93
INTRODUCTION
There is now extensive evidence that the presence of food
in the gastrointestinal tract, and particularly in the
stomach, can have a profound effect on the absorption of
drugs administered by mouth. These effects can result
from Physiological changes in the gut and from direct
Physical or chemical interactions between drugs and
ingesta. In many cases the mechanism by which food
affects the availability of a particular drug is not known
precisely, as the various changes induced by food can
interact in complex ways.
The interplay of possible effects in man was reviewed
by Welling and Tse t2 in the following way. Large fluid
volumes tend to increase gastric emptying rate, but solid
food has the opposite effect. As most drugs are absorbed
mainly in the small intestine, delayed gastric emptying
may reduce the rate of drug absorption, and also reduce
the efficiency of absorption of drugs which are unstable
at low pH. Conversely, prolonged retention in the stomach
may enhance the percentage of drug in solution when it
eventually passes into the small intestine, thereby
enhancing absorption efficiency. For drugs which are
absorbed by active and saturable processes, slow stomach
emptying may increase the efficiency of absorption due to
non-saturation of carrier mechanisms. Large fluid volumes
and meals with high fluid content tend to increase the
rate and efficiency of drug absorption, apparently related
to increased dissolution and faster stomach emptying. The
increase in intestinal motility induced by ingesta may aid
drug absorption because of faster dissolution and greater
exposure of drug to the intestinal epithelium, but it
could also reduce absorption because of a quicker transit
time. Theoretically, an increase in splanchnic blood flow
associated with eating could also influence drug
absorption.
Furthermore, the ingestion of food causes increases in
gastrointestinal secretions, SUCh as hydrochloric acid,
bile and digestive enzymes, which could also influence
INFLUENCE OF FOOD ON ABSORPTION OF ANTIMICROBIAL DRUGS 95
drug absorption l2 • Gastric acid tends to accelerate

dissolution and absorption of basic drugs but causes
degradation of acid-labile compounds. Bile secretion may
aid dissolution of compounds having poor aqueous
solubility and enhance dissolution of waxy drug
matrices and lipoidal coatings, causing faster drug
absorption. However, bile salts may reduce availability
of drugs such as kanamycin and polymyxin through
complexation. Proteolytic enzymes will degrade peptide
molecules. while est erases of the intestinal lumen and
epithelial lining are capable of hydrolysing esterified
drug forms.
In addition. direct interactions between drugs and food
components can also occur l2 • Food can act as a physical
barrier which limits drug access to the absorptive surface
of the mucosa. Also. complexing of drugs with certain
polyvalent cations or protein can reduce absorption.
The form in which the drug is given can also have an
effect on the outcome of a particular food-drug
interaction •
l2 In general, solutions and suspensions
might be less susceptible than solid dosage forms to the
effects of ingesta because they are mobile in the gut and
pass with relative ease from stomach to intestine.
Enteric-coated tablets could be particularly susceptible
to food interactions because the presence of food may
cause them to remain intact in the stomach for prolonged
periods.
HUMAN FINDINGS
Studies in man have shown that the effect of food on drug
absorption is dependent upon the type and size of the
meal. the chemical and physical form of the drug, the
dosage form. and the time relation between eating and drug
administration l2 • The outcome of any such interaction is
difficult to predict, and, considering the variety of
possible effects involved, it is not surprising that
simple rules governing food-drug interactions have not
been found.
Three possible outcomes of interaction between food and

orally administered drugs have been identified: drug
absorption may be increased. not affected. or
decreasedll • 1 2 . The "decreased" category can be subdivi-
ded into those interactions where drug absorption
is reduced and those in which absorption is delayed.
With antimicrobial drugs. interactions with food most
commonly produce reduced or delayed absorption <Tab 1e
10.1), Reduced absorption occurs with most of the
penicillins and tetracyclines. although other types of
interaction are also seen sometimes with certain
penicillins. Most oral formulations of cephalosporins and
sulphonamides generally exhibit delayed absorption. in
which the rate of absorption is slowed but the overall
absorption efficiency is unaffected. as assessed by the
area under the curve of plasma drug concentration plotted
against time or from urinary excretion data.
By contrast. few food-drug interactions have been
reported to increase the systemic availability of
antimicrobial drugs or to have no appreciable effect
(Table 10.2). Note that amoxycillin availability has been
reported variously to be reduced. delayed and unaffected
by food (Tables 10.1 and 10.2). This illustrates the
complexity of the problem and the undesirability of making
general recommendations on the basis of a single study.
Erythromycin is considered separately (Table 10.3)
because of the variety of food-drug interactions reported
with different erythromycin formulations. As erythromycin
base is unstable at low pH. various oral formulations have
been developed to improve stability and increase
absorption. This has involved formulation of erythromycin
base or its salts in tablets with acid-resistant coatings.
and the development of relatively acid-stable forms such
as the estolate and ethyl succinate esters of erythromycin.
The general picture with erythromycin products is that the
coated formulations of erythromycin base are affected to
only a small extent by food. the absorption of erythro-
mycine stearate is reduced in most cases (but may increase
when given before meals) and the availability of

erythromycin esters tends to be improved by concomitant
food intake 12 •
Table 10.1 Antimicrobial agents whose systemic availabi-

lity may be reduced or delayed by food after oral admini-
stration in man·+
Reduced Delayed
Amoxycillin cap. susp Amoxycillin ns

Ampicillin cap Cefaclor tab. susp
Cephalexin cap. susp Cephalexin cap
Demethylchlortetracycline cap Cephadrine cap
Doxycycline cap·· Metronidazole tab
Ketoconazole tab Sulphadiazine susp
Lincomycin cap Sulphadiazine (Na) sol
Methacycline cap Sulphadimethoxine ns
Nafcillin tab Sulphafurazole ns
Oxytetracycline cap Sulphanilamide susp
Penicillin G tab. susp Sulphamethoxypyridazine ns
Penicillin V (acid) tab Sulphasymazine ns
Penicillin V (Ca) tab
Penici 11 in V (K) tab. cap. susp
Phenet.hicillin tab. cap
Pivampicillin cap
Rifampicin ns
Tetracycline cap
·Modified from references 1 1 . 1 2 and 1 3 . which should be

consulted for original sources. Erythromycin data is
presented separately in Table 10.3.
+Dosage forms as follows: cap = capsules. tab = tablets.
susp = suspension. sol = solution. ns = not stated.
··Slightly reduced.
SOME VETERINARY DATA

Interactions with food affecting drug absorption are not
Table 10.2 Antimicrobial agents whose systemic availabi-

lity may be not affected or increased by food after oral
administration in man"·
Not affected Increased
Amoxyci 11 in cap Griseofulvin ns

Ampicillin susp Hetaci 11 in cap""
Penicillin V (acid) tab Nitrofurantoin tab, cap
Pivampici11in cap Pivampici11in cap
Spiramycin tab Su1phamethoxydiazine tab
Su1phaisodimidine tab
"Modified from referencesl I • I 2 and I 3

which
should be consulted for original sources. Erythromycin
data is presented separately in Table 10.3.
·Dosage forms as follows: cap = capsules, tab = tablets,
susp = suspension, ns = not stated.
··Slight1y increased.
confined to human therapy, but they have not been

investigated thoroughly in species of veterinary interest.
Although several authors have suggested guidelines for
timing drug dosage in relation to food intake in animal
patients 2 • 6 • 7 their proposals have been based. of
necessity. largely on human data.
Chloramphenicol is one drug for which there is
veterinary information without corresponding human data.
Chloramphenicol absorption appeared to be faster when the
drug was given in capsules to greyhounds fed ad libitum
but consumption of canned food immediately before dosing
did not affect plasma drug concentrations 3 • 4 • In cats.
the availability of chloramphenicol from tablets was not
affected by feeding ad libitum. or by administering water
with the tablet'. With chloramphenicol palmitate
suspension. however. drug availability was poorer in
fasted cats than in the same cats when fed ad libitum.
Thus these findings suggest that food does not impede (and
Table 10.3 Influence of food on systemic availability of

eryt hromyci n*
Compound Dosage form Effect
Erythromycin base Capsules Reduced

Tablets Reduced
Coated tablets Delayed or
unaffected+
Erythromycin stearate Coated tablets Reduced· •
Erythromycin esto1ate Capsules Increased

Suspension Unaffected
ErythromYcin ethy1- Suspension Unaffected

carbonate
ErythromYcin ethy1- Coated tablets Increased

succinate Film tablets Delayed
Suspension Increased or
unaffected
·Modified from reference t2 • which should be consulted

for original sources.
+Different effects reported by various workers. also re-
duced absorption in one report.
··Reduced absorption when administered after food. one
report of improved bioavai1abi1ity when given immedia-
tely before food.
may even enhance) the systemic availability of chloramphe-

nicol from solid dosage forms. and that reduced
bioavai1abi1ity might occur with administration of"ch10r-
amphenico1 palmitate suspensions in fasting animals. at
least in cats.
Data concerning interactions between food and
amoxyci11in are conflicting in dogs as in man. In
Table 10.4 Provisional suggestions on feeding and oral

administration of antimicrobial drugs in small animals
Administer on an empty Cephalosporins

stomach' Erythromycin stearate
Lincomycin
Penicillins (except hetacillin)
Sulphonamides (except sulpha-
isodimidine. sulphamethoxy-
diazine)
Tetracyclines (except doxycy-
cl ine)
Food restriction not Chloramphenicol

necessary Erythromycin coated formulations
Hetaci 11 in
Spiramycin
Sulphaisodimidine
Sulphamethoxydiazine
Possibly administer Doxycycline+

with food Erythromycin esters
Griseofulvin
Metronidazol e+
Ni t rofurant oi n+
"Administer at least 2 hours before or 2 hours after

food.
+Drugs which are often irritant when taken on an empty
stomach and whose absorption is not inhibited signifi-
cantly by food. so should be given after food.
greyhounds. amoxycillin absorption seemed to be little

affected by food. whether given as dry food ad libitum or
as a single meal immediately before drug administration 1o •
In recent experiments with dogs of various breeds.
however. the absorption of amoxycillin was reduced and
delayed when food was eaten just before drug dosage. The
decrease in bioavailability was evident with both tablet

and suspension formulations of amoxycillin and was of
similar magnitude to that seen with ampicillin tablets 9 •
Food-drug interactions causing reduced absorption of
penicillin V. phenethicillin and cloxacillin were also
demonstrated in this study.
THE TIME FACTOR

The effect of the time interval between food consumption
and drug dosage has not been studied extensively. Welling
and Tse '2 recommend giving those drugs whose absorption is
reduced by food at least 1 hour before food whenever
possible. On the other hand Welling '2 states that "if a
drug is taken shortly before a meal. its absorption is
likely to be either increased or unaffected". With
post-prandial administration. the extent to which drug
absorption is affect ed is said to be inversely
proportional to the elapsed time between eati ng and
dosing. being maximal when the drug is taken immedia-
tely after food and negligible when the drug is adminis-
tered 2 hours after eating'J.
Experiments with penicillin V in children' and dogs·
support the suggestion that a fasting period of 1-2 hours
before, and 1-2 hours after. drug administration may be
advisable for drugs at risk. In dogs, the systemic
availability of penicillin V was reduced when food was
given immediately before drug dosage. and there was a
clear trend for availability to improve as the fasting
period before and after dosing was increased. The optimum
fasting period might depend on the animal, the drug. type
of food and other factors; however. fasting for 2 hours
before and 2 hours after drug administration seems a
reasonable starting point and should be possible in most
patients.
CLINICAL RELEVANCE
It is difficult to assess the clinical importance of
food-drug interactions as studies comparing the clinical
efficacy of antimicrobial therapy under fasting and non-

fasting conditions have not been reported. This may be an
area where veterinary and human clinical pharmacologists
could cooperate usefully. as studies of this type could be
difficult to perform in human patients.
Of main concern are interactions which reduce or delay
drug absorption. When circulating drug concentrations are
close to the minimum inhibitory concentration for the
offending pathogen. then reduced absorption may well be
clinically significant. Thus the risk of therapeutic
failure may be high in these circumstances with drugs
whose absorption is reduced markedly by food. such as most
penicillins and tetracyclines. some cephalosporins. and
some erythromycin products 12 • On the other hand. there
might be little risk if the same drugs are given well in
excess of requirements against susceptible microbes.
Absorption which is delayed but not reduced adversely
affects tissue penetration by the drug and might be
deleterious whenever immediate antimicrobial activity is
required. In a few instances. however. delayed absorption
might be advantageous. by permitting drug concentrations
to be maintained in vivo more effectively between doses.
The enhancement of drug absorption by food. as seen
with griseofulvin. nitrofurantoin and erythromycin esters.
could conceivably improve the clinical efficacy of
antimicrobial therapy. but this has yet to be proven.
CONCLUSIONS
It is apparent that food-drug interactions occur in
domestic animals and that veterinarians need to consider
them when prescribing antimicrobial agents for enteral
administration in their patients. At the present time
recommendations must be based mainly on human data.
Although this might be satisfactory for species whose
physiology and feeding do not differ greatly from those of
man. such as dogs and cats. it could prove unsuitable for
other species.
As the most common outcome of food-drug interactions
seems to be decreased (that is, reduced or delayed) ab-

sorption. administration on an empty stomach should be the
general rule: exception can be made for a few drugs which
cause gastric irritation, and those whose absorption is
known to be not affected adversely by food. Provisional
suggestions are made in Table 10.4: these may need to be
modified as additional information on food-drug
interactions in domestic animals becomes available.
References
1. Finkel, V•• Bo1me, P. and Eriksson, M. (1981>. The
effect of food on the oral absorption of penicillin V
preparations in children. Acta Pharmaco1. Toxico1.
49:301-304.
2. Green, C.E., O'Neal. K.G. and Barsanti, J.A. (1984).
Antimicrobial chemotherapy. In: Green. C.D. (ed.).
Clinical Microbiology and Infectious Diseases of the
Dog and Cat. pp.144-188. Philadelphia: W.B. Saunders.
3. Watson, A.D.J. (1974). Chloramphenicol in the dog:
observations of plasma levels following oral
administration. Res. Vet. Sci. 16:147-151.
4. Watson. A.D.J. (1977). Effect of concurrent drug
therapy and of feeding on plasma chloramphenicol
levels after oral administration of chloramphenicol in
dogs. Res. Vet. Sci. 22:68-71.
5. Watson, A.D.J. (1979). Effect of ingesta on systemic
availability of chloramphenicol from two oral
preparations in cats. J. Vet. Pharmacol. Ther.
2:117-121.
6. Watson. A.D.J. (1979). Some factors affecting bioavai-
lability of antimicrobial drugs given by mouth in small
animals. In: Grunse11. C.S.G. and Hill. F.W.G. (eds).
Veterinary Annual. 19th issue. pp. 217-222. Bristol:
Scientechnica.
7. Watson. A.D.J. (1983). Effects of food on absorption
of antibacterial drugs. In: Grunse11. C.S.G. and
Hi 11. F .W.G. (eds). Veterinary Annual. 23rd issue.
pp.241- 243. Bristol : Scientechnica.
8. Watson. A.D.J. (1985). Effect of time between feeding
and dosing on systemic availability of penicillin V in
dogs (abstract). Proceedings. Voorjaarsdagen 1985.
Post Academisch Onderwijs. pub1ikatie no 85-6:24-25.
9. Watson. A.D.J. (1985). Food impairs systemic availa-
bility of penicillins administered orally in
dogs. In: Van Miert. A.S.J.P.A.M., Bogaert. M.G. and
Debackere. M. (eds). Comparative Veterinary
Pharmacology, Toxicology and Therapy. Proc. 3rd EAVPT
Congress. Part I. Abstracts. p.53. Utrecht: EAVPT.
10. Watson. A.D.J. and Egerton. J.R. (1977). Effect of
feeding on plasma antibiotic concentrations in
greyhounds given ampicillin and amoxyci11in by mouth.
J. Small An. Pract. 18:779-786.
11. Welling. P.G. (1984). Interactions affecting drug

absorption. Clin. Pharmacokin. 9:404-434.
12. Welling. P.G. and Tse. F.L.S. (1982). The influence
of food on the absorption of antimicrobial agents. J.
Antimicrob. Chemother. 9:7-27.
13. Welling. P.G. and Tse. F.L.S. (1984). Factors contri-
buting to variability in drug pharmacokinetics.
1. Absorption. J. Clin. Hosp. Pharm. 9:163-179.
Smooth Muscle
Pharmacology
11
Pharmacology of the (fore )-stomach
smooth muscles
L. A .A. OOMS, A. WEYNS, A. DEGRYSE AND Y. RUCKEBUSCH
ABSTRACT
A short review is presented on the pharmacology of the
(fore)-stomach smooth muscles. Detailed information is
given on the smooth muscle pharmacology of the lower oeso-
phageal sphincter, the oesophageal groove, the reticulum,
the rumen, the omasum, the abomasum and the pylorus.
CONTRACTION OF SMOOTH MUSCLES

Smooth muscle membrane permeability changes usually affect
membrane potential by allowing one or more ions to pass
through the membrane more freely. Since none of the ions
in smooth muscle cells is in equilibrium at a membrane
potential of -50 to -60 mV, there will be a net flow of
ions into and out of the cells, tending to move the mem-
brane potential closer to equilibrium. Membrane depolari-
zation usually results in a contraction, although a change
in potential is not a prerequisite for induction of con-
traction in all smooth muscle ce11s 9 • Contraction of
smooth muscles can be initiated by changes in membrane
permeability either after binding of agonists to their
receptors or after exposure to high K+ concentrations"·'.
In either instance, electrical or chemical cell membrane
signals indirectly activate contractile elements by relea-
sing membrane-bound Ca 2 + , or increasing Ca 2 + influx, or
107
both. Three sources of Ca can be distinguished: the free

Ca in the extracellular fluid. the Ca bound to the surface
membrane and the intracellular Ca in endoplasmic reticulum
and mitochondria. Ca influx during receptor activation
seems to be different from Ca influx induced by membrane
depolarization·'. Two pathways of transmembrane flux of
Ca 2 + exist: a voltage-dependent Ca 2 + channel. activated
by changes in membrane potential. and a receptor-linked
channel. activated by binding of agonists to their recep-
tors. The plasma membrane of vascular. intestinal and
myometrial smooth muscle seems to be equipped with the ex-
change system to regulate intracellular Ca 2 + concentra-
tion'·. A (Ca 2 +-M g2+)-ATPase was demonstrated in pig sto-
mach muscle. which could be purified on a calmodulin affi-
nity column and is calmodulin-dependent'3,'4. This pro-
tein is able. when incorporated into lipid vesicles. to
transport Ca l + in an uphi 11 fashion i f ATP is present in
the medium n •
Receptor agonists also induce contraction without chan-
ging membrane potential in smooth muscles that do not ge-
nerate action potentials. or in depolarized smooth mus-
cles 45 • All eukaryotic cells contain inositol lipids.
Phospholipase C catalyses the breakdown of phosphatidyl-
inositol 4.5-biphosphate. a multiple-charged anion that
has a very high affinity for Ca 2 + (greater than that of
EOTA) and exhibits a rapid turnover in vivo. Its hydro-
philic/hydrophobic solubility partition coefficient is
markedly altered when Ca 2 + replaces monovalent phosphate
counterions"··. The receptor-mediated breakdown of phos-
pholipids is not mediated by an increase in cytosol Ca 2 +
but is closely coupled to receptor occupation. Inositol
triphosphate (IP3 ) and also the lipid-soluble product of
phoshatidylinositol 4.5-biphosphate breakdown. 1.2 diacyl-
glycerol (OAG). act as second messengers in the cells 2 ' .
The phosphoryl groups. covalently attached to IP. turn
over extremely rapidly. The rise in IP3 may be the means
whereby the intracellular (non-mitochondrial) pools of
calcium are mobilized u • The less Ca 2 + bound to inositol
PHARMACOLOGY OF TH E (FOR E)-STOMACH SMOOTH MUSCLES 109
1.4.5-triphosphate, the stronger the attraction of Ca 2 +.

Diacylglycerol acts in its own right and activates a spe-
cific, calcium-activated. phospholipid-dependent protein
kinase. C-kinase. which catalyses the phosphorylation of a
specific group of protein substrates. Diacylglycerol is
one of the sources of arachidonic acid (liberated by phos-
pholipase A2) which serves as the substrate for prosta-
glandin. leukotriene and/or thromboxane synthesis 3D . 47 •
A group of organic Ca 2 + antagonists or Ca 2 + channel
blockers (including verapamil, methoxyverapamil [0600].
nifedipine. diltiazem and flunarizine) are specific inhi-
bitors of Ca 2 + influx through voltage-dependent Ca 2 + chan-
nels'D.".,6. Nitrocompounds, especially sodium nitro-
prusside. are selective inhibitors of the receptor-linked
Ca 2 + channe]23. Tetraethyl-ammonium (TEA) increases spike
activity of many spike generating smooth muscles and indu-
ces spike potentials in spontaneouslY inactive guinea-pig
fundic muscles 22 • 32 • No effect was observed on the spon-
taneously inactive ruminal preparations by micromolar TEA.
Acetylcholine (10- 6 g/ml> applied to TEA (3 x 10- 3 to
10-2M) pretreated ruminal preparations produced no spike-
free tonic contraction but spike activity and phasic con-
tractions 29 •
Unphosphorylated and dephosphorylated myosin cannot be
activated by actin. but the phosphorylated and rephospho-
rYlated myosin can be activated by actin. The same rela-
tionship between phosphorylation and enzymatic activity
was found for a chymotryptic peptide of myosin, smooth
muscle heavy meromyosin i ,
Many hormones and neurotransmitters (for example.
glucagon. adrenaline [acting through beta-adrenoceptors])
trigger the activation of adenylate cyclase (AC). Stimu-
lation of AC results in an elevation of the intracellular
concentration of cAMP. which transmits the hormonal signal
by activating cyclic AMP dependent protein kinase (PK).
This enzyme phosphorylates a number of intracellular pro-
teins and thereby regulates their activities. for example,
serine (and occasionallY threonine) residues C-terminal to
pairs of adjacent basic amino acids Arg-Arg-X-Ser and

Lys-Arg-X-Y-Ser IO • Some hormones inhibit adenYlate cy-
clase (including enkephalins and adrenaline [acting
through the alpha-2-adrenoceptorJ) and activate the GTPase
activity of a guanine nucleotide binding protein conver-
ting it from a GTP-liganded form (Gs-GTP) that stimulates
adenYlate cyclase to an inactive GDP-liganded form
(Gs-GDP). Hormones that activate adenylate cyclase exert
their effect by promoting the conversion of Gs-GDP to
Gs-GTpa. Indeed. adenylate cyclase consists of a recog-
nition component (a stimulatory receptor unit and an inhi-
bitory receptor unit) and a catalytic unit; Mg2+ stimula-
tes activity to levels approaching that observed with hor-
mones. Ca 2 + at physiological concentrations can stimula-
te as well as inhibit smooth muscle adenylate cyclase ac-
tivity. The stimulation of adenylate cyclase activity is
mediated by calmodulin. The level of calmodulin associa-
ted with smooth muscle adenylate cyclase may modulate the
response (both stimulatory and inhibitory) of the enzyme
to Ca 2 +33 • Forskolin. a steroid-like compound. stimulates
the act i v i t y 0 f all ani ma 1 c ell c y cIa s e s y s t ems. but act s
on a component distinct from the 45.000 or 55.000 dalton
unit through which GTP acts 44 • Sodium nitroprusside,
nitroglycerine and related smooth muscle relaxants were
reported to increase smooth muscle levels of cGMP 4 1 .
Nitroprusside is unstable in aqueous solutions and relea-
ses nitric oxide. Nitric oxide is a potent activator of
guanylate cyclase. cGMP stimulates the activity of the
sarcolemmal Ca + extrusion ATPase in a concentration de-
2
pendent manner. Through this mechanism cGMP seems to be

involved in the relaxing effect of AC stimulation.
In particular, the smooth muscles of the sphincter
regions and also of the stomach (reservoir function) are
equipped with both voltage-linked and receptor-linked
channels. The first regulates the phasic contractions
while the second is involved in the tonic contractions.
In some muscles overlapping between the different systems
is observed. The same is true for the different channel
PHARMACOLOGY OF THE (FORE)-STOMACH SMOOTH MUSCLES 111
blockers in these muscles.
LOWER OESOPHAGEAL SPHINCTER (LES)

Muscles of the LES show both phasic and tonic contrac-
tions. Circular muscle strips from the LES develop a
spontaneous active tension, much higher compared to circu-
lar muscle from the body of the oesophagus. LES spike ac-
tivity was not correlated with basal sphincter pressure.
A decreased muscle tone in muscle strips was observed in
the sphincter region of the opossum oesophagus when it was
exposed to calcium-free solution t9 • 2t • Intravenous injec-
tion of CaC1 2 partially restores the LES pressure depres-
sed by verapami1. Sodium nitroprusside causes marked lo-
wering of the resting LES pressure t3 •
Innervation of the LES is mediated by both inhibitory
and excitatory autonomic nerves. Alpha-adrenergic
agonists increase LES pressure while alpha-adrenergic
blockers decrease it. Also cholinergic mechanisms appear
to maintain some of the resting LES pressure because
atropine and other anticho1inergics have been shown to
lower the pressure. Gastrin receptor activation causes
LES excitation. Moti1in, bombesin and substance Pare
known to cause contraction of the smooth muscle of the
LES. Morphine significantly reduces while naloxone
increases LES pressure 20 • Studying the identification and
localization of opioid receptors in the opossum LES, it
was shown that mu, kappa, sigma and delta opioid receptors
were present. Mu and kappa inhibitory receptors are
present on the sphincter muscle 34 • Direct inhibition of
the LES muscle was observed by vasoactive intestinal
polypeptide (VIP), gastric inhibitory polypeptide (GIP)
and secretin 4 • t4 • 3 ! 1 . 3 9 .
Indirect evidence for the involvement of serotonin in
the development of bloat resulted from the observation
that pretreatment with a serotonin-2 blocker resulted in
an increased volume of gas eructated 39 • In vitro
experiments on circular muscle of the LES of cattle
demonstrated that serotonin (lO-4M) increased muscle tone
and also the phasic contractions. if present. Ritanserin

and sodium nitroprusside (10-6M) reduced muscle tone (Ooms
et al •• unpublished observations). Sodium nitroprusside
induced a short-lasting inhibition of all types of activi-
ty. Acetylcholine induced a contraction followed by an
increased muscle tone.
In vivo. the phasic contractions of the reticulum are
under vagal contro]3l. The number of phasic reticular
contractions were increased in milk-fed calves when ritan-
serino cisapride or both substances were added to the milk
(0.2 mg.kg- t b.i.d.; Ooms et al.. unpublished observa-
tions). Increasing the release of acetylcholine is impor-
tant for induction of phasic contractions. but substances
acting directly on the muscles (to decrease tone) also
seem to be useful. for increasing the number of phasic
contractions. In vitro. the majority of the muscle con-
tractions are of the phasic type. Acetylcholine (10-6M)
only induces phasic contractions. Serotonin (10-4M) in-
creases phasic contractions but also muscle tone of the
circular muscle (Ooms et al •• unpublished observations).
SP had no direct effect on the muscles. suggesting in vivo
action on the local cholinergic neurones.
OESOPHAGEAL GROOVE
In young and adult animals. oesophageal groove closure can
be evoked by oral application of bicarbonate solutions.
but especially with copper. On smooth muscles of the
oesophageal groove of calves and cattle. both phasic and
tonic contractions were observed in vitro. Sodium
nitroprusside (10-6M) and PGE 2 (l0-6M). but not verapami 1
(10- 5 M). i n h i bit e d all t y p e 0 f a c ti v it yin the 0 e sop hag e a 1
groove of cattle in vitro (Ooms et al •• unpublished obser-
vations).
RETICULUM
Xylazine. an alpha-2-agonist. reduced the frequency of re-
ticular contractions. Reticular contractions were resto-
red with tolazoline. an alpha 2-blocker 49 • Histamine inhi-
bits reticular contractions. This effect is inhibited by

HI-antagonists. while the H2-antagonist oxmetidine had no
protective action J1 •
RUMEN
On the ruminal smooth muscles. phasic and tonic types of
activity were observed both in vitro and in vivo. The
tone was completely eliminated in Ca 2 +-free solutions and
also by sodium nitroprusside 29 (also Ooms et al •• unpu-
blished observations). Verapamil and 0600 did not essen-
tially influence the spontaneous tone 29 • In vivo. the mo-
tor events occur in cycles (starting on the reticulum to
the dorsal and ventral sac of the rumen) lasting about 1
min. and in about 40-60% of the cycles they are followed
by a retrograde contraction (Maas. Van Ouin and Van Miert.
unpublished observations). Substances such as dopamine
(20 ug/kg/min for lS min) and apomorphine (2 ug/kg/min for
10 min) cause inhibition of extrinsic ruminal contrac-
tions. Domperidone (O.S mg/kg). but not naltrexone (0.1
mg/kg). prevented these effects. Naltrexone itself induced
a rapid increase in the frequency of extrinsic ruminal
contractions. Ruminal strips all reacted with an increase
in muscle tone after exposure to apomorphine (2.S and S.
10- 6 M). This rise in tone could be blocked by domperi-
done (S.10- 1 M). but not by naltrexone (S.10- 6 M)16. Mor-
phine depressed both frequency and amplitude of ruminal
contractions. while naltrexone and naloxone significantly
increased the frequency of ruminal contractions. Expulsion
of acidic abomasal contents back into the preabomasal com-
partment was the cause of acidification of the rumen after
apomorph i ne i n,j ect i on J •
The fetal bovine rumen is highly sensitive to S-hydro-
xytrvptamine (S-HT) and sensitivity to S-HT increases un-
til S month fetuses. when the magnitude stabilizes 48 •
The effect on bovine rumen is not mediated by autonomic
nervous structures. but is a direct one on the muscle.
Also presynaptic stimulation of cholinergic neurones is
observed after addition of serotonin 48 • Intravenous ad-
ministration of serotonin (6 ~g/kg expressed as the base)

in sheep resulted in a short-lived contraction followed by
a sustained and long-lasting increase in muscle tone and a
concomitant inhibition of the extrinsic reticulorumen con-
tractions. The short-lived contraction was probably due
to neural stimulation (blocked after morphine and atropi-
ne) and the long-lasting increase of muscle tone seemed to
be due to a direct smooth muscle action (blocked by the
5-HT antagonists, R 50970 and methysergide)36. In sheep,
a specific serotonin-2-antagonist (ketanserin; 0.05 mg/kg)
significantly increased the volume of eructated gas, when
the intraruminal pressure was maintained at 2 mmHg, and
increased the frequency of primary and secondary contrac-
tions of the rumen by 41.5 and 24.3%, respectively. At an
intraruminal pressure of 4 mmHg, ketanserin at a dose le-
vel of 0.1 mg/kg, significantly increased the volume of
eructated gas and also the frequency of both primary
(23.6%) and secondary contractions (23.7%). From these
results it seems that specific serotonin-2-antagonists
offer the ability to treat bloat in ruminants ta • In
another study, ritanserin (S2-antagonist) not only pre-
vented bloat during the ruminal stasis induced by hypocal-
caemia in sheep and continuous insufflation in cattle, but
increased the eructated volume 39 •
OMASUM
In the omasum. a significant uptake of fluid and electro-
lytes occurs. The mucosal area is increased by the fold
present in the omasum. For efficient absorption, the mu-
cosa needs time. Rapid transport from reticulum to aboma-
sum seems possible by the omasal groove (limited by parti-
cle size). The main activity, as observed in vitro. was
of the tonic type <Ooms et al., unpubl ished observat ions).
ABOMASUM AND STOMACH OF MONOGASTRIC ANIMALS

The primary control of motility of the stomach of monogas-
tric animals and the abomasum of ruminants is of myogenic
origin. Receptors (mechanoreceptors, chemoreceptors and
PHARMACOLOGY OFTHE (FOR E)-STOMACH SMOOTH MUSCLES 115
osmoreceptors). neurones and also hormones influence sto-

mach motility by a direct action on the muscles or by in-
fluence on the release of neurotransmitters and hormones.
The proximal part <stomach fundus) has a receptive func-
tion while the distal part <stomach antrum> functions as a
cyclic pump.
Dopamine has an inhibitory effect on the stomach fundus
and also reduces the contractile amplitude. The dopamine
inhibitory effect on the rat stomach fundus can be explai-
ned by interaction with post junctional beta-receptors on
the smooth muscle cells and prejunctional alpha-receptors
on the intramural cholinergic neurones. No evidence for
the existence of specific dopamine receptors was found.
The inhibition by dopamine is largely indirect. through
uptake in sympathetic nerve endings and liberation of en-
dogenous noradrenaline. The findings with alpha-agonists
and antagonists suggest that the alpha-receptors on the
intramural cholinergic neurones combine the characteri-
stics of both subtypes of alpha-receptors. or that the
receptor population consists of a mixture of alpha-l and
alpha-2-receptors 26 • The alpha-adrenergic mechanisms
through which dopamine and noradrenaline are able to relax
an~ contract the circular smooth muscle from the body re-
gion of guinea-pig stomach are of the alpha-l and alpha-2
types. respectively4o.
Specific desensitization of ganglionic receptors for
5-HT reduced the vagal relaxation. The vagal inhibitory
effect was completely abolished only when competitive
block of acetylcholine receptors was combined with desen-
sitization of 5-HT receptors. The fact that 5-HT is con-
tained within preganglionic nerve fibres in the myenteric
plexus is consistent with the hypothesis that 5-HT. with
acetylcholine. may be a neurotransmitter in the vagal in-
hibitory innervation of the stomach J1 • While acetylcho-
line appears to be the sole preganglionic and postganglio-
nic transmitter in the excitatory portion. both 5-HT and
acetylcholine appear to participate as preganglionic
transmitters in the inhibitory portion of the vagal path-
way. 5-HT produces a long-lasting stimulation of inhibi-

tory responses, so strong as to suppress the excitatory
component of the vagal effect. It should therefore be
possible to reduce inhibitory vagal responses by 5-HT
antagonists without reducing responses to nicotinic com-
pounds, just as the non-depolarizing antagonists of ace-
tylcholine reduce vagal responses without affecting res-
ponses to 5-HT.
The electrical activity of the pyloric antrum is cha-
racterized by slow waves (SW), usually followed by spike
potentials. In cattle, about 80% of the antral SW are
superimposed with spike bursts and half of them pass abo-
rally to the duodenum. The percentage of contractions
running from the antrum to the duodenum seems to depend on
the intensity of the spike bursts (contraction) on the an-
trum 7 • The peripheral dopamine antagonists domperidone
and metoclopramide improve coordination of antroduodenal
motility both in vivo and in vitr042. Metoclopramide also
increases the release of the cholinergic neurotransmit-
ter 24 • In dogs, it was shown that domperidone and cisa-
pride, and to a lesser extent metoclopramide. but not
betanechol. effectively improved antroduodenal coordina-
tion indicating that both dopaminergic and cholinergic
pathways modulate antroduodenal coordination 4l •
Antroduodenal coordination is important for the control
of gastric emptying. Morphine significantly inhibited
gastric emptying of both solids and liquids while naloxone
results in a non-significant acceleration of solid food
emptYing t7 • Intramural cholinergic neurones are activated
by substance Pl'. Substance P is a neurotransmitter
involved in the gastric excitatory motor responses elici-
ted by antidromic activation of thin afferent fibres in
the vagal and splanchnic nerves t2 • The antidromic activa-
tion mechanism was present only in the stomach. not in the
pylorus 28 • The contractile effects of substance P were
sensitive to atropine or local infusion of a substance P
analogue (D-Pr0 2 • D-T rp 7 • , ) -substance P. Acetylcholine
induces phasic contraction with each slow wave. Betanechol
also increases the contractile activity of the antrum and

duodenum. However. the coordination is not enhanced. Ni-
cotine agonists and also hexamethonium inhibit antroduode-
na1 coordination by reducing the amplitude of antral and
duodenal contractions. Cholecystokinin. secretin and glu-
cagon decrease the antral contractions. This antroduodena1
coordination is reduced by moti1in and also by neuroten-
sin.
PYLORUS
The pylorus sphincter is build up on circular muscles
(majority) and longitudinal muscles connecting the antrum
with the duodenum. In most animal species. the underlying
mucosa is not closely attached to the muscular layers. In
physiological conditions. the pylorus contracts after ap-
plication of duodenal stimuli and relaxes during strong
peristaltic contractions of the antrum running to the duo-
denum. Vagal nerve stimulation causes a release (through
beta-adrenergic receptor activation) of 5-HT from entero-
chromaffin cells to the portal circulation and to the gut
1umen 2 • The contractile pyloric responses to 5-HT were
antagonized by peripheral blockade of 5-HT 2 receptors.
Such blockade did not influence the motor responses to ex-
trinsic nerve stimulation. suggesting that 5-HT is not es-
sential for the mediation of these responses. In vitro.
on antral and pyloric strips from the rat. the responses
to substance P and 5-HT were antagonized by antagonist
substance P analogue or substance P tachyphylaxis and
peripheral blockade of 5-HT 2 receptors. respectively. The
responses were not reduced by tetrodotoxin. indicating
principally activation of muscular receptors. However.
the contractile responses were reduced by atropine or
hexamethonium. except the substance P-induced pyloric
contraction. which was atropine-sensitive but hexametho-
nium-resistant. Blockade of 5-HT 2 receptors reduced the
substance P-induced motor responses. indicating an inter-
action between substance P and 5-HT 2 receptors at the mus-
cular level. This may be important since substance P and
5-HT seem to coexist in gut neurones 27 • Substance P may

mediate part of the vagally induced pyloric and gastric
contraction. the latter probably by axon col laterals on
fine cholinergic neurones.
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12
Smooth muscle pharmacology of the large intestine
Y. RUCKEBUSCH, T. BARDON, C. CHERBUT, M. PAlRET AND J. P. FERRE
ABSTRACT
The distinction between tonic and phasic activity
occurring in the isolated colon corresponds to the
localized versus propagated colonic activity recorded in
the conscious dog. The myogenic activity of the circular
muscular layer, unaltered by atropine and adrenergic
antagonists in vitro, seems equivalent to the localized
spike burst (LSB) activity enhanced by prostaglandin
synthetase inhibitors in vivo. The phasic activity of the
longitudinal muscular layer, coupled to that of the
circular layer via myenteric cholinergic neurones, is
similar to the propagated spike bursts (PSB) either
isolated or in series (MSB) under the control of a
permanent inhibitory sympathetic innervation.
The ubiquitous secretory effects of prostanoids and the
prostaglandin-mediated motor effects of several peptides
indicate a possible interspecific therapeutic value of
anti-inflammatory drugs in several cases of motor or
secretory disturbances of the colon.
INTRODUCTION
In carnivores, the colon is a simple tube with a proximal
segment where digesta are similar in consistency to the
ileum and the antiperistaltic motor activity (that is,
123
retrograde versus antegrade propagated spike bursts - PSB)

is predominant. In the middle segment. the contents
become firm enough to be solid due to movements of the
circular muscle layer. also identified as localized spike
bursts (LSB). The contents are moved aborally by PSB in
series termed herein migrating spike bursts (MSB) and
these are only inhibited by stimulation of the lumbar
colonic (sympathetic) nerves. The canine colonic electri-
cal act ivi tv consists of two components one f'l"om the
longitudinal muscle layer occurring as periods of 13-35
osci llations. and the other arising from the circular
muscle layer as an omnipresent myogenic slow-wave activity
unaltered by atropine or adrenergic antagonists.
Superimposed spikes are associated with contractions which
are enhanced by indomethacin (10M); this suggests
inhibition of the circular muscle layer via the release of
prostanoids and by tetrodotoxin (TTX). indicating a
permissive effect against a permanent neural inhibitory
input. and a facilitation of the cholinergic prepotential
activity at the longitudinal muscle layer.
The patterns of contractions of the "simple" colon
involve
(1) in vivo sphincteric relaxation by non-adrenergic inhi-

bitory nerves in response to rectal distension. its
absence leading to a diagnosis of aganglionosis;
(2) colocolonic reflexes consisting at the ganglionic le-
vel of sympathetic inhibition at one end of the colon
in response to mechanoreceptor excitation at the other
end' 0 ;
(3) the colonic response to eating.
This response in dogs is more pronounced on the

proximal colon. including the ileocolonic junction (IeJ).
than on the distal colon. is in part mimicked by neuro-
tensin and is decreased after prostaglandin synthetase
inhibitor pretreatment 2 •
In fact. species variability in colonic structure and
SMOOTH MUSCLE PHARMACOLOGY OF THE LARGE INTESTINE 125
development. especially the enlargement of the large bowel

in the horse t3 • and caecotrophy in the rabbitt2. may be at
the origin of species-specific effects of drugs. The
formation of pellets in sheep and in rats·. the increased
transit rate in response to bulk contents in carnivores or
omnivores·. despite a reduced motility index. are other
aspects of species variations. Four aspects are empha-
sized in this chapter :
(1) the importance of spinal sympathetic inhibition of co-

lonic motility;
(2) the role of the cholinergic nerves in relation to the
effects of stimulation of the pelvic nerves;
(3) the effects on colonic motor and secretory functions
of opiate agonists;
(4) the physiological significance of colonic motility
stimul ati on by prostaglandins (PGs) and serotonin
(5-HT) •
SPINAL SYMPATHETIC INHIBITION

Following removal of the spinal cord between T9 and L5.
the frequency of contractions of the transverse colon was
increased by 30% (1.8 versus 1.4/min) without disappea-
rance of the colonic motor cycles. The motility of the
transverse colon was likewise stimulated by intrathecal
administration of propranolol (10 JJg.kg- t ) and to a lesser
extent by domperidone (5 JJg.kg- t ) and indomethacin (25
ug.kg- t ). The cycles of more intense activity lasting 20
min and 40 min on the proximal and distal colon.
respectively. only disappeared during the increased
propulsive activity evoked by laxatives·.
The role of supraspinal and spinal outflow on colonic
motility is still unclear 7 • Tolazoline. an alpha2-adre-
nergic blocking agent (10 JJg.kg- t intrathecally) is a
potent stimulant of colonic motility. The mechanism of
this excitatory effect is a blockade of the
alpha2-adrenergic receptors acting presynaptically on
Auerbach's plexus to inhibit acetylcholine release.
Tolazoline and vohimbine can prevent the gastrointestinal

propulsive activitv reduced in mice by xvlazine or
ami t raz' • The use of ami t raz in t he horse as an
insecticide/ascaricide has an adverse effect it causes
impaction of the colon. Tolazoline (0.5 mg.kg intrave-
nouslv) is able to antagonize the effects of amitraz. just
as it is able to prevent the effect of xvlazine in the
ponvt'. suggesting a similar mediation bv alpha2-adrener-
gic receptors.
CHOLINERGIC STIMULATION
Cooling the cervical vagi to less than 4 °C has been shown
to cause a marked reduction of colonic activity'. A
direct vagal effect is shown by persistence of the
inhibition induced bv cooling after spinal section. A
large number of enkephalin-immunoreactive nerve fibres has
been observed in the circular smooth muscle laver. the
mventeric plexus and the submucous laver of the feline
colon. The enkephalins hvperpolarize mventeric neurones
and inhibit action potentials bv a reduced release of
acetvlcholine from mventeric neurones. In addition.
enkephalins have a direct contractile effect on smooth
muscle devoid of all neural elements. The action is thus
unchanged in the presence of tetrodotoxin and blocked bv
naioxone. A postganglionic enkephalinergic neurone
mediates the non-cholinergic contraction of the colon.
since naloxone in a dose that blocked the effects of
exogenouslv applied enkephalins also blocked the
non-cholinergic activitv due to pelvic nerve stimulation
under atropine to •
Among anticholinergics. atropine has long been thought
to affect colonic motility. However. clinical experience
does not suggest much response to doses of these drugs
that are used in practice. The inhibition is. at best.
transient and incomplete in carnivores. In the horse. the
spiking activitv (PSB) at the pelvic flexure level ceases
for 30 min after injection of atropine (0.1 mg/kg) with a
concomitant increase in the baseline (mechanical activitv
SMOOTH MUSCLE PHARMACOLOGY OF THE LARGE INTESTINE 127
tracing), suggesting either an increase of smooth muscle

tone and/or the absence of any propulsion.
ROLE OF OPIATES
A colonic origin for the constipating effects of morphine
is likely, since the retention time of digesta, even in
the canine colon, represents more than two-thirds of the
total transit time. That these effects result more from
the stimulation of colonic LSB than from an increased
electrolyte and fluid absorption is questionable.
Motor effects
Mu and delta opiate agonists, administered intratheca1ly,
show a tendency to modulate the activity of the whole
colon in a similar way - that is, stimulation followed by
inhibition 3 • In contrast to the inhibitory and delayed
effects on the small intestine of O-Ala2-0-Leu,-enkepha1in
administered intracerebroventricular1y in rats 14 • the
effects on the colon are excitatory and not delayed 6 • In
both dogs and ponies, the stimulatory component lasted a
few minutes and disappeared at the expense of inhibitory
effects for 1 or 2 h.
Three opiate agonists: meperidine (Oemerol), but or-
phano1 (Stado1) and pentazocine (Ta1win) have only trivial
motor effects on the equine pelvic flexure 1 • In fact,
opiate-agonists stimulate the tonic (LSB) rather than the
phasic (PSB) component of the motility, indicating that
the constipating effects of opiate agonists on the colon
could not be interpreted in terms of motility. In
addition, a decrease in the motility index has been found
to be associated with a higher propulsive activity when
the bulk content of the colon was increased 4 •
We recently found that the injection of naloxone in the
pony consistently increases the MSB patterns of motility
(Figure 12.1). The effects also obtained with methylna10-
xone, suggest that a local opioid system may be operative
to slow the propulsion of contents at the equine colonic
leve1 13 • In the pig, the intraluminal administration of
Jejunum . ".. ~v""

i~I\IjIl*' .III •• "~ 1111111 ~I\I ~""I"I\I.~I"~MIjt\IIM!t*"",1 11\1" Ililll' II" ""I I111111\11111 ~I.' 11~~IIW~IIII1~ij\IIMI' tll.. lljlllhKI~~1i 11I1~ II~M iii MlluJ
+ Im 11
I\II4I!il.I~~MII~I~I_'IIIIII~'"II~IIIII.I~I'~~I.~U~~11II11I1111~111'1'11I'IIIIIIIIIIIIIIII'i,,~I'~~IIIIIIIIIIIIIIIIIIHIIIIIIII\IIII1\111111111111111111111111111111111111)
-]
Pelvic flexure
~1r---_6oe~mfH-I~~I~'IH+HH-II -1lIIIf!H~~.It""'~
••t+-1 'f--j~"-'-'.-~I.lffitll~'.IIt'~'¥'I-.ttl!
_IDem '.(a) (b) \ Ii. (e) '\. • AI. lil ]

~11~".-,~j~II'~'I~I~'.~~~
· 'II~I~~1'~"I~"I~I~~j~"~"~'~~'~·ft~.I~.~~.HW~I~.~.~~~~~----~'.'~I,H~lw~,--
I. +'oem~ "II~IO ~11'Mj'j I~"~,~I j~ ~I~ ,_ 'I~I~' ~ I U~I~*_I~'~]
min
Figure 12.1 Enhancement by naloxone of the electrical ac-

tivity (direct record) of the jejunum and the colon in the
pony; note the high velocity of propagation of spike
bursts (a) and of migrating complexes (b, c) recurring at
3 to 5 min intervals.
10peramide, a locally acting opiate agonist, enhances the

frequency of cycles on the small and large intestine
(Figure 12.2). ACTH (1-24) is able to antagonize such
cyclic activity and immunoreactivity since both ACTH and
endorphin-related peptides are present in the colon,
suggesting the physiological role of a me1anocortin-opioid
homeostatic system in gut cycling activity.
Effects on fluid transport

The antidiarrhoea1 effect of opiates is related to an
enhanced absorption of water and electrolytes by the
mucosa. Enkepha1in and morphine were also shown to block
the PGE 2 but not the VIP-stimulated adeny1ate cyclase
activity, hence their efficacy in the prevention of
diarrhoea induced by PGs and cho1eratoxin. Where there is
acute diarrhoea and severe depletion of body water, the
colon responds homeostatica11y by a state of secondary
hyperaldosteronism, assisting the organism in the Na+
conservation. The two known factors which increase
SMOOTH MUSCLE PHARMACOLOGY OFTHE LARGE INTESTINE 129
DUODENUM
HELICOIDAL COLON
1,111 j HI j)IHlltd~ hJuj JH.H Ii

· · · · ... t··· ....... · .... ... . .. · ·
LOPER AMI DE 0.5 mg I kg intraluminal
I I I I I
h
Figure 12.2 Long-lasting enhancement by locally admini-

stered loperamide of the cyclical myoelectrical events
(integrated records) of the duodenum and of the helicoidal
colon in the pig.
aldosterone secretion. angiotensin II and dopamine

antagonists like metoclopramide (0.5 mg/kg twice daily for
2 weeks in the rabbit) stimulate the motility of the
intestine. The marked inhibitory effects of dopamine on
the distal colon in vitro are better prevented by beta-
adrenergic antagonists like propranolol or sotalo1 8 than
by dopamine antagonists. suggesting a major role for
dopamine in fluid transport rather than in motility.
PROSTAGLANDINS VERSUS SEROTONIN STIMULATION

The first biological effect of prostaglandins to be
described was their ability to induce intestinal smooth
muscle contractiont7. Defaecation. without emesis. can be
induced selectively in the dog by PGF 2 • at the dose level
of 0.15 mg/kg intramuscularly. the response occurring a
few minutes after the injection and the effects persis-
Proximal colon
Distal colon
CISAPRIDE 0.1 mg· kg-I Lv.

h
Figure 12.3 Increased propulsive colonic motility (strain

gauges) following the intravenous administration of
cisapride in the dog.
ting long enough to empty the rectum. The only signifi-

cant side-effect observed is the increase in respiratory
rate. related to the potent bronchoconstrictor effects of
PGF 2 • •
A role for endogenous prostaglandins in colonic soft
faeces formation by the rabbit has been demonstrated t2 •
The inhibition of the proximal colon and the stimulation
of the spiking activity of the distal colon during the
formation of soft faeces is mimicked by the infusion of
both PGE 2 and PGF 2 • • After indomethacin the soft:hard
faeces ratio of 1.45 is reduced to 0.92. suggesting a role
for prostaglandins. The effects of several neuropeptides.
for example. inhibition of gastric acid secretion by
somatostatin. drinking behaviour elicited by angiotensin.
increased colonic activity or stimulation of borborygmi
and defaecation by neurotensin are prostag l andin-mediated.
Accordingly. stimulation by neurotensin of the proximal
colon in dogs was reduced by aspirin or ketoprofen
pretreatment 2 • In horses. the large number of peptides
SMOOTH MUSCLE PHARMACOLOGY OFTHE LARGE INTESTINE 131
which may be involved in colonic motor changes supports

the therapeutic value of antiprostaglandins in addition to
their anti-inflammatory effects. for example. in ulcera-
tive colitis.
The role of 5-HT and the related peptide. sUbstance P.
in large intestinal motor patterns has not yet been
elucidatedt~. except for substances like cisapride. which
has been reported to enhance gastrointestinal transit and
motility via an interaction with 5-HT on myenteric
neurones tt rather than by a release of acetylcholine.
Figure 12.3 shows that its stimulatory effects on the
canine colon involve primarily enhanced cyclical activity.
References
1. Adams. S.B., Lamar, C.H. and Masty. J. (1984). Moti-
lity of the distal portion of the jejunum and pelvic
flexure in ponies: effects of six drugs. Am. J. Vet.
Res. 45:795-812.
2. Bardon. T. and Ruckebusch. Y. (1985). Neurotensin-
induced colonic motor responses in dogs: a mediation
by prostaglandins. Regul. Peptides 10:107-114.
3. Bardon. T. and Ruckebusch. Y. (1985). Comparative ef-
fects of opiate agonists on proximal and distal colo-
nic motility in dogs. Eur. J. Pharmacol. 110:329-334.
4. Cherbut. C. and Ruckebusch. Y. (1985). The effect of
indigestible particles on digestive transit time and
colonic motility in dogs and pigs. Br. J. Nutr.
53:549-557.
5. Collman. P.I •• Grundy. D. and Scratcherd. T. (1984).
Vagal influences on large intestinal motility in the
anaesthetized ferret. J. Physiol. 348:35-42.
6. Ferre. J.P. and Ruckebusch. Y. (1985). Myoelectrical
activity and propulsion in the large intestine of fed
and fasted rats. J. PhYsiol. 362:93-106.
7. Glick. M.L. Meshkinpour. H•• Haldeman. 5 •• Hoehler.
F •• Downey, N. and Bradley. W.E. (1984), Colonic
dYsfunction in patients with thoracic spinal cord
injury. Gastroenterology 86:287-294.
8. Grivegnee. A.R •• Fontaine. J. and Reuse. J. (1984).
Effect of dopamine on dog distal colon in vitro. J.
Pharm. Pharmacol. 36:454-457.
9. Hsu. W.H. and Lu. Z.X. (1984). Amitraz-induced delay
of gastrointestinal transit in mice mediated by
alpha2-adrenergic receptors. Drug Devel. Res. 4:
655-660.
10. King. B.F. and Szurszewski. J.H. (1964). Mechanore-
ceptor pathway from the distal colon to the autonomic
nervous system in the guinea-pig. J. Physiol.
350 : 93-107 •
11. Nemeth. P.R., Ort, C.A •• Zafirov. D.H. and Wood. J.D.
(1985). Interactions between serotonin and cisapride

on myenteric neurons. Eur. J. Pharmacol. 108:77-83.
12. Pairet. M•• Bouyssou. To and Ruckebusch. Y. (1986).
Colonic formation of soft feces in rabbits: a role
for endogenous prostaglandins. Am. J. Physiol. (in
press).
13. Roger. T •• Bardon. T. and Ruckebusch. Y. (1985). Colo-
nic motor responses in the pony: relevance of colonic
stimulation by opiate antagonists. Am. J. Vet. Res.
46:31-35.
14. Ruckebusch. Y•• Ferre. J.P. and Ou. C. (1984). In
vivo modulation of intestinal motility and sites of
opioid effects in the rat. Regul. Peptides 9:109-117.
15. Sellers. A•• Lowe. J.E. and Cummings. J.F. (1985).
Trials of serotonin. substance P and alpha2-adrenergic
receptor effects on the equine large colon. Cornell
Vet. 75:319-323.
16. Sjoqvist. A•• Hellstrom. P.M •• Jodal. M. and Lundgren.
O. (1984). Neurotransmitters involved in the colonic
contraction and vasodilatation elicited by activation
of the pelvic nerves in the cat. Gastroenterology
86:1481-1487.
17. Thor. P •• Konturek. J.W •• Konturek. S.J. and Anderson.
J.H. (1985). Role of prostaglandins in control of
intestinal motility. Am. J. Physio]' 248:G353-G359.
13
Recent advances in the pharmacological control of
the intestinal and colonic motor profiles
J. FIORAMONTI, 1. BUENO AND M. J. FARGEAS
ABSTRACT
Recent studies of the intestinal and colonic motor
profiles led to a new approach of digestive pharmacology,
based on long-term changes in the pattern of gastro-
intestinal contractions. Basically the pattern of the
small intestine is cyclic and is disrupted for several
hours after a meal, while that of the colon consists of
phases of contractile activity with a frequency modified
by meal ingestion. Opiate drugs are among the most active
in modifying this pattern but each drug is characterized
by its own effect and involves peripheral and/or central
pathways. Endogenous opioid peptides playa role in the
control of the motor profile at the level of the central
nervous system, since they are able to block the
postprandial disruption of the cyclic intestinal pattern
and enhance the colonic motor response to feeding. Other
peptides are involved in the central control of intestinal
motility, but each of them involves its own mechanisms.
Several adrenergic, serotoninergic and dopaminergic ago-
nists and/or antagonists are able to modify the occurrence
of the cyclic phases of small intestinal activity. These
data indicate new effects of classical compounds and the
development of new drugs for long-lasting and specific
modifications of digestive motility has now commenced.
133
Most of the Pharmacological data on digestive smooth

muscle have been obtained under in vitro conditions or in
vivo over Short time periods. These studies investigated
the effects of drugs in terms of increases or decreases in
basal or stimulated intestinal motilitv. Other data have
been obtained bv determining drug action on intestinal
transit time but in view of the complex relationships
between digestive motilitv and the propulsion of digesta
no conclusions about the effects of drugs on intestinal
contractions can be drawn from these studies. During the
last decade the motor profile at various levels of the
diQestive tract has been established over relativelv long
periods. ConseQuentlv. a new approaCh to digestive
pharmacoloQv. based on the long-term Changes in patterns
of intestinal motilitv. has been developed.
SMALL INTESTINAL AND COLONIC MOTOR PROFILES

The use of electrodes or strain gauQe transducers
chronically fixed to the serosa permitted investigation of
the patterns of intestinal and colonic motilitv. The
fundamental pattern of small intestinal contractions is
cvclic and was initiallv described in dOQS bv Szurszewski
in 1969 22 • It consists of a period of Quiescence (Phase
1) followed bv a period of irregular activitv <IA or Phase
2) and bv a period of reQular activitv (RA or Phase 3).

These cvclic Phases of activity are first seen on the
duodenum and are then propagated along the jejunum and the
ileum. as a "migrating mvoelectric (or motor) complex"
CMMC) which occurs everv 90 min in dogs and is disrupted
for several hours after a meal in manv species (Figure
13.1).
A fundamental pattern. analogous to that observed for
the small intestine. has not been found for the large
bowel. However. in the dog a clearly defined colonic
motor profile has been described 11 • It consists of Phases
of contractile activitv. 5-10 min in duration and
occurring cvclicallv at 20-30 min intervals. Ingestion of
a dailv meal induces three consecutive changes in colonic
PHARMACOLOGICAL CONTROL OF INTESTINAL MOTOR PROFILES 135
'~ '1"~#"tt"".t'U'" a":..'+"J..C

C~lON '~ll !,om L.(Uu~iiuU uHUlJJ.iulUUJ).llill
t Meal
jJ j 4.lWJC
3 .;
_ _ _ _ _ _ _ pm _ _ _ _ _ _ _ _ _ _ _ __
9 10 II 12 I 5 6 7 a
TI ME (Hours)
Figure 13.1 Typical intestinal and colonic motor profiles

in the conscious dog. The 22 h strain gauge recording of
the ileum and the proximal colon shows intestinal MMCs
disrupted for several hours after a meal and a triphasic
colonic motor response to a meal (1, short lived stimu-
lation; 2, inhibition: 3. long-lasting stimulation). ICJ :
ileocolonic Junction; IA : irregular activity; RA : regu-
lar activity; MMC : migrating motor complex (From refe-
rencel I ) •
motility a shortlived stimulation comprising a supple-

mentary phase of contractile activity, inhibition lasting
1-2 h and a long-lasting (8-10 h) increase in the
frequency of the cyclic activity phases (see Figure 13.1).
OPIATES
Opiate-like drugs are particularly potent in their effects
on digestive motility. However, the existence of multiple
opiate receptors, the possible action of opiates on both
central and peripheral receptors and differences between
the motor profiles at different levels of the digestive
tract lead to very heterogeneous responses after opiate
administration.
The action of morphine itself on digestive motility
involves multiple pathways. It inhibits small intestinal
propulsion in rats through central and peripheral path-
waysl7. On intestinal motility, intravenous admini-
stration of morphine induces a supplementary phase of
regular activity (phase 3). This effect was first
described in sheep· and then confirmed in dogs 20 •
Intracerebroventricular administration of morphine to dogs

induces disruption of the cyclic MMC pattern for 5-6 h
instead of an additional phase 3 13 •
At the colonic level. a stimulatory effect of morphine
has been known for a long t ime l but t he effect s on the
cyclic pattern of colonic contractions in dogs were only
recently described·. They last 3-4 h for a dose of 0.1
mg/kg intravenously and they comprise an increase in the
motility index associated with an increase in the
frequency of the phases of contractions and the occurrence
of periods of continuous contractile activity. These
effects of intravenously administered morphine involve
both central and peripheral opiate receptors. since they
are abolished by a previous intravenous or intracerebro-
ventricular administration of naloxone or of methylleval-
lorphan. a quaternary compound which does not cross the
blood-brain barrier (unpublished results). Moreover. a
central serotoninergic mechanism is probably involved in
the stimulatory effects of intravenous morphine on colonic
motility. since they are blocked by a previous
intracerebroventricular administration of methysergide 6 •
However. the central component of the action of intra-
venous morphine on colonic motility is not reproduced by
intracerebroventricular administration of morphine. which
induces an unusual pattern of short and frequent phases of
contractions. an effect which is probably mediated through
non-opiate receptors (unpublished results).
Not all opiates have the same effects on the digestive
motor profile. Comparison of the effects of the prototype
mu agonist morphine to those of cyclazocine. a supposed mu
antagonist and mixed kappa and sigma agonist was the first
example given l3 • Cyclazocine when given intravenously.
induces disruption and inhibition of the jejunal cyclic
activity instead of a supplementary phase 3 as observed
after morphine. However. cyclazocine and nalorphine.
another mu antagonist and a kappa and sigma agonist.
induce similar stimulatory effects as morphine on colonic
motility··ll. Another typical example of the specific
action of an opiate compound is provided by the effect of

loperamide. Orally administered at a dose rate of 0.1
mg/kg, loperamide stimulates the motility of the entire
digestive tract for a 5-6 h period and induces an unusual
pattern of activity never described for any other opiate
compound. The cyclic activity of the stomach was
replaced by patterns of continuous contractions appearing
at about 2 min intervals. The cyclic jejunal MMCs are
replaced by continuous irregular activity and the
frequency of the phases of colonic contraction is
increased. These effects are mediated peripherally since
they are not modified by the previous intracerebroventri-
lar administration of a quaternary narcotic antagonist.
However, they are probably not local actions since they
can be reproduced by subcutaneous administration at the
same dosage (unpublished results).
Opiates also modify the pattern of intestinal and
colonic contractions in the postprandial state. Morphine
given intravenously after a meal consistently induces a
phase 3 contraction propagated along the small intestine 20
but the most important effect is probably a control of the
small intestinal and colonic patterns of motility by
endogenous opiate pept ides at the central level. A synthe-
tic analogue of metenkephalin, (O-Ala 2 -Met')enkephalin-
amide, when administered intracerebroventricularly just
after a meal strongly reduces the duration of the
postprandial disruption of the Jejunal motor profile and
induces cyclic MMCs instead of a continuous irregular
activi ty7. Central administration before a meal of the
enkephalinase inhibitor, tiorphan, enhances the colonic
motor response to feeding, the postprandial colonic
motility being increased almost three-fold by comparison
to a meal given alone 12 •
Finally, the effects of opiates on the digestive motor
profile are not unequivocal, and endogenous opiates may
playa role in the intestinal and colonic motor response
to feeding. However. the data presented here concern the
jejunum and the proximal colon of the dog. Another
peculiarity of opiates. first described in 1982!'.

concerns species differences and the colonic segment
considered. For example. morphine stimulates colonic
motility in dogs but inhibits it in horses. the effects
being more intense on the proximal than on the distal
colon.
ADRENERGIC. SEROTONINERGIC. DOPAMINERGIC DRUGS

Alpha-adrenergic agonists are known for their inhibitory
effects on intestinal motility. For example. clonidine.
an alpha2-agonist inhibits small intestinal propulsion
through a central pathway!6. In contrast. adrenergic
antagonists such as phentolamine and dihydroergotamine
strongly increase the frequency of MMCs 2 • Beta-adrenergic
agonists such as isoprenaline have been found to initiate
a phase 3 contraction in both fasted and fed states.
through the release of somatostatin 2 !.
In dogs. serotonin infusion during a period of
quiescence. induced an irregular pattern of activity. The
serotonin antagonist. methysergide. stimulates jejunal
motility and disrupts the cyclic MMC pattern!'. However.
an atypical effect of methysergide has been described in
sheep. In this species. contrary to the response in dogs.
methysergide increases the frequency of the phase 3
cont ract ions! 9 •
Dopamine given intravenously induces a premature phase
3 in fasted dogs and sheep. and in fed dogs it restores a
fasted pattern of intestinal motility when given intra-
cerebroventricularly!4. Dopamine administered by intra-
venous infusion in dogs inhibits the proximal colon and
stimulates the distal colon. the inhibitory effect being
partially mediated through alpha!-adrenoceptors. the
stimulation of the distal colon being mediated through
specific dopamine receptors 3 • In contrast. bromo-
criptine. a potent dopamine agonist. stimulates both
proximal and distal colon. these effects being blocked by
dopaminergic. but not adrenergic. antagonists.
PEPTIDES
Biologically active peptides comprise a new sphere of
interest in pharmacology and some neuropeptides of the
brain-gut axis have been found to modify digestive
motility through their central actions. In 1982'
it was shown for the first time that two peptides
centrally administered in fasted rats were able to modify
the cyclical pattern of intestinal motility CCK
octapeptide decreased the frequency of MMCs and at higher
doses it disrupted the cyclic pattern, while somatostatin
increased the frequency of MMCs.
In dogs. two groups of peptides, effective on small
intestinal motor activity through a central pathway, have
been identified. The first category includes calcitonin.
neurotensin. metenkephalin and growth hormone releasing
factor (GRF), which induce a cyclic pattern during the
postprandial state. It has been shown, initially in
rats tD and then in dogs 4 , that the effects of calcitonin
are mediated through the release of prostaglandins since
they are abolished by indomethacin and reproduced by
central administration of PGE2' However, despite the
similarities of the final effects, there is no common
mechanism in the action of these peptides. The effects of
calcitonin and neurotensin are mediated through a release
of prostaglandins. while those of GRF involve central
dopaminergic receptors. None of these compounds seem to
act through opiate receptors since naloxone does not block
the action of these four peptides. even that of metenke-
phalin. Other peptides such as corticotropin releasing
factor. oxytocin and vasopressin disrupt the cyclic motor
profile when administered intracerebroventricularly to
fasted animals.
Finally, studies of the central actions of some
peptides indicate that the digestive influences which
induce a postprandial pattern of intestinal motility
involve a central pathway which can be inhibited by
several peptides.
PERSPECTIVES AND CONCLUSIONS

Knowledge of the patterns of small intestinal and colonic
motility permits the development of new compounds.
selected for their specific modifications of the digestive
motor profile. This is exemplified by cisapride. a non-
antidopaminergic and non-cholinergic compound which
stimulates the irregular (propulsive) activity of the
small intestine and the phasic activity of the colon.
According to the relationships between the pattern of
digestive motility with the transit of digesta. the
absorption of nutrients and the control of the intestinal
flora. the therapeutic value of compounds active on this
pattern seems promising. However. an accurate diagnosis
of digestive motor disturbances is not easy and can limit
the use of such future therapy.
References
1. Adler. H.F. and Ivy. C.A. (1940). Morphine-atropine
antagonism on colon motility in the dog. J. Pharma-
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2. Altaparmakov. I. and Wienbeck. M. (1983). Alpha-adre-
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Bortolotti. M. (eds). Gastrointestinal Motility.
pp.3-7. Verona: Cortina International.
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M.P. (1985). Central control of intestinal motility
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88: 1888-1894.
5. Bueno. L. and Ferre. J.P. (1982). Central regulation
of intestinal motility by somatostatin and chole-
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6. Bueno. L. and Fioramonti. J. (1982). A possible cen-
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7. Bueno. L •• Fioramonti. J •• Honde. C•• Fargeas. M.J.
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88:549-556.
8. Bueno. L •• Fioramonti. J. and Ruckebusch. M. (1981).
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9. Bueno. L., Ruckebusch, Y. (1978). Origine de l'action

excito-motrice de l'intestin par la morphine. C.R.
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10. Fargeas, M.J., Fioramonti, J. and Bueno, L. (1984).
Prostaglandin E2 a neuromodulator in the central
control of gastrointestinal motility and feeding
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(1984). Effects of central and peripheral
administration of dopamine on pattern of intestinal
motility in dogs. Dig. Dis. Sci. 29:1023-1027.
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(1983). Diarrhoea and antidiarrhoeal drugs. In
Ruckebusch Y., Toutain P.L. and Koritz, G.D. (eds).
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Lancaster : MTP Press L.
16. Galligan, J.J. and Burks. T.F. (1983). Effects of
centrally and peripherally administered clonidine on
small intestinal transit in the rat. Proc. West.
Pharmacol. Soc. 26:387-391.
17. Manara. L. and Bianchetti. A. (1985). The central and
peripheral influences of opioids on gastrointestinal
propulsion. Ann. Rev. Pharmacol. Toxicol. 25:249-273.
18. Ormsbee. H.S., Silber, D.A. and Hardy, F.E. (1984).
Serotonin regulation of the canine migrating motor
complex. J. Pharmacol. Exp. Ther. 231:436-440.
19. Ruckebusch. Y. and Bardon, T. (1984). Involvement of
serotonergic mechanisms in initiation of small
intestine cyclic motor events. Dig. Dis. Sci.
29:520-527.
20. Sarna, S., Northcott, P. and Belbeck, L. (1982).
Mechanism of cycling of migrating myoelectric com-
plexes : effect of morphine. Am. J. Physiol. 242:
G588-G595.
21. Summers, R.W., Flatt, A., Yanda, R.J. and Yamada. T.
(1984). Isoproterenol induces activity fronts in fed
dogs through somatostatin release. Gastroenterology
87:999-1003.
22. Szurszewski, J.H. (1969). A migrating electric com-
plex of the canine small intestine. Am. J. Physiol.
217:1757-1763.
14
Cholinergic-like effect of the H2 -receptor
antagonist ranitidine on the rabbit small intestine
G. KOUNENIS, M. KOUTSOVITI-PAPADOPOULOU AND V. ELEZOGLOU
ABSTRACT
The histamine H2 -receptor antagonist ranitidine was tested
for its effect on the rabbit small intestine. Prepara-
tions of isolated segments of duodenum, jejunum and ileum
of adult animals were used. Ranitidine possessed a
significant stimulant action on these preparations. the
action being strongest on the duodenum and weakest on the
ileum. The maximum response to ranitidine was about 62%
of the maximum response to acetylcholine. Ranitidine
produced a dose-dependent potentiation of acetylcholine-
induced contractions and the stimulant action of
ranitidine was prevented by atropine. These findings
suggest that ranitidine's stimulant action is associated
with the cholinergic system and it occurs in descending
degree of intensity from the duodenum to the ileum.
INTRODUCT ION
Histamine H2 -receptor antagonists are usually devoid of
both cholinergic and anticholinergic properties. although
it was reported that under experimental conditions some of
them (metiamide, cimetidine and oxmetidine) may inhibit
the contractions induced by cholinergic agents on isolated
smooth muscle preparations 2 , 7 . t o . It was also reported
that the H2 -receptor antagonist ranitidine has no
143
anticholinergic activity'''·9, but that it exerts a

stimulant effect on the isolated muscular strips of the
lower oesophageal sphincter, the gastric fundus and the
colon of the rat, as well as on isolated muscle strips of
the pylorus of the guinea-pig 4 • 6 • On the other hand,
comparable stimulant effects of ranitidine on isolated
heart preparations of the guinea-pig 3 were never observed.
On the basis of these findings we decided to investi-
gate the action of ranitidine on the rabbit small intes-
tine (duodenum. jejunum and ileum) and its possible
interactions with acetylcholine and atropine. The
findings obtained provide evidence for a cholinergic-like
effect of ranitidine on the rabbit small intestine.
MATERIAL AND METHODS

Rabbits of both sexes. weighing approximately 1500 g. were
killed by a blow on the back of the neck and exsanguina-
ted. The abdomen was opened and sections of duodenum.
jejunum and ileum were removed and placed in beakers
containing warm (37 °C) Tyrode solution (millimolar: NaCl
136.80, KCl 2.68, CaC1 2 1.08. MgC1 2 0.49, NaHC0 3 11.90 and
glucose 5.56). A segment of 10-15 cm ileum. closest to
the caecum. was discarded. After expelling the contents
by gently passing Tyrode solution at 37 °C through the
lumen. the tissue was placed in clean Tyrode solution and
cut in to 1 cm long segments. which were set up in
isolated organ baths at 37 °C and bubbled with 95% oxygen
and 5% carbon dioxide. The isotonic muscle contractions of
the preparations were recorded via a Physiograph (desk
model, type DMP-4A. Narco Co •• U.S.A.). A resting tension
of 2 g was applied to the preparations and they were
allowed to stabilize for a period of 30 min.
The following compounds were used ranitidine
hydrochloride (G1axo. England), acetylcholine chloride (E.
Merck, Darmstadt) and atropine sulfate (Chropee, Greece).
Drug solutions were added in a cumulative manner at time
intervals of 1 min to give molar concentrations from 3.2 x
10- 6 t 0 10- 3 M for ran it i din e and 10- a t 0 10- 5 M for
CHOLINERGIC-LIKE EFFECT OF RANITIDINE ON THE RABBIT SMALL INTESTINE 145
.
ACh Ran
10-' 3.2xlO- 6 1O-5 10- 3 M
I I i I
1min
Figure 14.1 Responses to acetylcholine (ACh) and raniti-

dine (Ran) on the isolated rabbit jejunum. drug doses are
expressed as final molar (M) bath concentrations.
8
..... 7
E
E 6
c 5 ~__ l
0
","'-_'"
..... 4
u
Cd
3 ,12
~", , 2' +
L
..... I
c ',
u
0 2
,'5" +
=A~:' f" "

"
10-8 10- 7 10- 6 10- 5 10- 4 10- 3 M
Figure 14.2 Dose-response curves to acetylcholine (solid

lines) and ranitidine (broken lines) on the isolated rab-
bit duodenum (A). jejunum (.) and ileum (0). Each point
represents the mean value (n = 10-15) and the vertical
lines indicate the SEM. Asterisks and crosses indicate
the significance of the values (* = Duodenum compared with
ieJunum. p < 0.02 - p < 0.05. + = duodenum compared with
ileum. p < 0.01 - p < 0.02).
acetylchol ine. After the maximum concentrations of each

compound had been achieved the preparations were washed
and rested for 10 min. Then acetylcholine was added to
the organ bath fluid 2 min after the treatment with either
•
Ran ACh
10- 4 10-8 10- 6 M
I I
1min
Figure 14.3 The potentiation of the acetylcholine (Ach)-

induced contractions by ranitidine (Ran) on the isolated
rabbit jejunum.
,.... 7 O,J,l j
E
E
6 Q/'x..,{,1'
/'r
Q/2" fl/v
5 I I
c
0
+'
4
u I I
C1l 3
L.
+'
c 2 T,'
I/ll
,
u
0
~ ,t./
g'
10-8 10- 7 10- 6 10- 5 M

line) on the isolated rabbit jejunum and the potentiation
of the acetylcholine-induced contractions by ranitidine
(broken lines) at the concentrations of 3.2 x 10- 5 (0),
10- 4 (A) and 3.2 x 1O- 4 M (~). Each point represents the
mean value (n = 5-15) and the vertical lines indicate the
SEM (all potentiated values were significant, p < 0.001
p < 0.05).
CHOLINERGIC-LIKE EFFECT OF RANITIDINE ON THE RABBIT SMALL INTESTINE 147
Table 14.1 Effect of ranitidine (Ran) and atropine (Atr)

on acetylcholine <Ach)-induced contractions (mm) on iso-
lated rabbit jejunum
ACh ACh
Plus Ran Plus Ran Plus Ran Plus Atr

ACh 3 .2x10- 5 M 10- 4 M 3. 2x 10- 4 M 10-· M
3.2x10- 9 M
0.88.:to.22 1.67.:t0.28 3.66.:t0.43
10-· M
1.43.:t0.27 2. 16.:t0.49 4. 14.:t0.44
3 .2x10- a M
0.81.:t0.11 2. 60.:t0. 28 3. 73.:t0.34 5. 38.:t0.41
10- 7 M
2. 45.:t0. 23 4.50.:t0.39 5.51.:t0.59 6. 58.:t0.49 0.11.:t0.06
3.2xl0- 7 M
3. 79.:!:.0.37 5. 46.:t0.47 6.37.:t0.61 7.01.:t0.62 0.41.:t0.19
10- 6 M
4.81.:t0.35 6.33.:t0.55 6.88.:t0.51 1.29.:!:.0.33
3.2xlO- 6 M
5.87.:t0.36 6.67.:t0.65 3.61.:t0.42
10-' M
6.55.:!:.0.47 4. 66.:t0.62
Values are means .:t SEM; n = 5-15.

ranitidine or atropine; ranitidine was also added 2 min
after the treatment with atropine.
Statistical evaluation of the data was performed using
the Student's t-test for paired or unpaired data.
RESULTS
Ranitidine exerted a significant stimulant effect on the
isolated rabbit duodenum and jejunum at concentrations of
10-' to 10-3M and on the ileum from 3.2 x 10-' to 10-3M.
This stimulant effect was stronger on the duodenum and
Atr ACh Atr Ran

.
10-' 10-' 10-5 M 10-' 3.2xlO- 6 10- 5 10- 3 M
i , I I
i " 1min
Figure 14.5 The prevention of the acetylcholine (ACh) and

ranitidine (Ran)-induced contractions by atropine (Atr) on
the isolated rabbit jejunum.
E 6
E 5
c 4
o
+'
U
nI
3
L
+'
C
2
o
U

line •• ) and ranitidine (broken line •• ) on the isolated
rabbit jejunum and the prevention of the acetylcholine and
ranitidine-induced contractions by atropine at the concen-
tration of 10- a M (.). Each point represents the mean
value (n = 5-15) and the vertical lines indicate the SEM.
Asterisks indicate the significance of the values (p <
0.001 - p < 0.05).
weaker on the ileum. Similar effects were obtained with

acetylcholine at concentrations ranging from 3.2 x 10- a to
10- 5 M. The average maximum contractions (mean ± SEM)
caused by ranitidine were found to be 5.09 ± 0.62 mm for
the duodenum. 4.09 ± 0.37 mm for the jejunum. and 3.49 ±
0.32 mm for the ileum. The above mean values were
CHOLINERGIC-LIKE EFFECTOF RANITIDINE ONTHE RABBIT SMALL INTESTINE 149
Table 14.2 Effect of atropine (Atr) on ranitidine (Ran)-

induced contractions (mm) on isolated rabbit Jejunum
Ran
plus Atr
Ran 10- I M
10- 5 M
0.25 .± 0.08
3. 2x 10-' M
0.69 .± 0.14
10- 4 M
1.57.± 0.28 0.14 .± 0.07
3. 2x 10- 4 M
3.76.± 0.41 1.21 .± 0.20
10- 3 M
4.09 .± 0.37 2.26 .± 0.26
Values are means .± SEM; n = 5-15.

obtained from 10 to 15 separate preparations and were
about 62% of the maximum activity of acetylcholine (8.01 .±
0.45 mm. 6.55 .± 0.47 mm and 5.77 .± 0.72 mm respectively)
(Figures 14.1 and 14.2). Ranitidine potentiated the
acetylcholine-induced contractions on the isolated rabbit
jejunum significantly (Figures 14.3 and 14.4). The mean
results obtained in 5-15 separate preparations are
summarized in Table 14.1. The potentiation of the
acetylcholine-induced contractions depended on the
ranitidine concentration (3.2 x 10-' to 3.2 x 10- 4 M). The
stimulant effects of ranitine and of acetylcholine on the
isolated rabbit jejunum. at concentrations of 10-' to
10- 3 M for ranitidine. and 3.2 x 10- 1 to 10-'M for acetyl-
choline. were significantly inhibited by atropine 10- I M
(Figures 14.5 and 14.6). The mean values obtained in 5-15
separate preparations are represented in Tables 14.1 and
14.2.
DISCUSSION
The histamine H2 -receptor antagonist ranitidine exerted a
strong stimulant effect on rabbit isolated small intestine
(duodenum. jejunum and ileum). This stimulant effect
became progressively weaker from the duodenum to the
ileum. The maximum activity of ranitidine was about 62% of
the maximum activity of acetylcholine. In addition
ranitidine causes a stimulant effect on isolated muscle
strips of the lower oesophageal sphincter. the gastric
fundus and the colon of the rat. as well as on isolated
muscle strips of the pylorus of the guinea-pig 4 • • • On the
other hand. no stimulant action of ranitidine could be
demonstrated on isolated heart preparations of the
9uinea-pig • These data suggest that the stimulant effect
3
of ranitidine is limited to some animals and to some

tissues. Also. ranitidine produced a dose-dependent
potentiation of acetylcholine-induced contractions on the
isolated rabbit jejunum and the stimulant effect of
ranitidine was prevented by atropine. The ranitidine
stimu1an1 effects are therefore associated with the
cholinergic system. The cholinergic effects of ranitidine
on the small intestine may modify intestinal motility.
They may also explain the diarrhoea and constipation that
have been reported in a very small percentage of patients
treated with ranitidine 5 •
CONCLUSION
Ranitldine exerted a stimulant effect on the isolated
rabbit small intestine in descending degree of intensity
from the duodenum to the ileum. This stimulant effect was
prevented by atropine. Ranitidine potentiated the
stimulant effect of acetylcholine. These findings lead us
to the conclusion that the ranitidine stimulant effect
appears to be associated with the cholinergic system.
References
1. Bertaccini. G. and Dobri11a. G. (1980>. Histamine H2 -
receptor antagonists: old and new generation. Pharma-
cology and clinical use. Ital. J. Gastroenterol.
CHOLINERGIC-LIKE EFFECTOF RANITIDINE ON THE RABBIT SMALL INTESTINE 151
12:309-314.
2. Bertaccini. G. and Coruzzi. G. (1981). Azione dei
b10ccanti dei recettori istaminici H2 sullo sfintere
esofageo inferiore (LES) iso1ato di ratto. 11 Farmaco
36:129-134.
3. BertacciBi. G. and Coruzzi. G. (1981). Effect of some
new histamine H2-receptor antagonists on the guinea-
pig papillary muscle. Naunyn-Schmiedeberg's Arch.
Pharmaco1. 317:225-227.
4. Bertaccini. G. and Coruzzi, G. (1982). Cho1inergic-
like effects of the new histamine H2-receptor
antagonist ranitidine. Agents Actions 12:168-171.
5. Bertaccini. G. and Coruzzi. G. (1984). H2-receptor
antagonists: side effects and adverse effects. Ital.
J. Gastroentero1. 16:119-125.
6. Bedaccini. G•• Po1i. E., Adami. M. and Coruzzi. G.
(1983). Effect of some new H2-receptor antagonists on
gastrointestinal motility. Agents Actions 13:157-162.
7. Black. J.W. and Spencer. K.E.V. (1983). Metiamide in
systematic screening tests. In Wood. C.J. and
Simkins. M.A. (eds). International Symposium on
Histamine H2-Receptor Antagonists. pp.23-26. London:
De1takos.
8. Bradshaw. J •• Brittain, J.w •• C1itherow, M.J •• Daly,
M.J., Jack. D •• Price. B.J. and Stables, R. (1979),
Ranitidine (AH 19065) a new potent, selective
histamine H2-receptor antagonist. Sr. J. Pharmaco1.
66:464.
9. Daly, M.J., Humphray. J.M. and Stables, R. (1981).
Some "in vitro" and "in vivo" actions of the new
histamine H2-receptor antagonist, ranitidine. Br. J.
Pharmaco1. 72:49-54.
10. Voutsas. D., Koko1is. N•• Kounenis, G. and E1ezog10u,
V. (1982). Effect of cimetidine (Tagamet) on rabbit
jejunum "in vitro" and antagonistic action of it with
acetylcholine, arecoline and pilocarpine. Proceedings
of the 6th Greek Gastroenterology Congress (1981), pp.
480-488. Thessaloniki: University Studio Press.
Comparative
Pharmacokinetic
Studies
15
Comparative pharmacokinetics:
introductory remarks
M. G. BOGAERT
ABSTRACT
When comparing the pharmacokinetics of a drug in different
species. conclusions can only be drawn from carefully con-
ducted studies and the basic principles of pharmacokine-
tics should be taken into account. Such comparisons are
for example only meaningful if presence of linear kinetics
has been ascertained; absorption in different species can
only be compared if intravenous plasma concentration data
are also available. In these introductory remarks. atten-
tion is drawn to a number of possible problems in that re-
gard. as a guide for the systematic discussions of compa-
rative pharmacokinetics which will follow.
INTRODUCTION
Pharmacokinetics is the study of the time course of drug
concentrations in the organism. these concentrations de-
pending upon absorption. distribution and elimination.
Measurable concentrations in the organism are attained
only after absorption unless the drug is given by the in-
travenous route. Distribution through the body is influ-
enced by factors such as protein binding in the plasma.
and tissue binding. Elimination takes place as excretion
in unchanged form. mainly in the urine but also in the
bile. or as biotransformation to one or more metabolites.
155
PRELIMINARY CONSIDERATIONS
There is considerable interest in interspecies differences
in absorption. distribution and elimination. In order to
compare pharmacokinetics in different species. it is ne-
cessary to be aware of a number of possible variables.i.e.
1. intraspecies variability;
2. influence of disease states;
3. interactions between drugs;
4. biopharmaceutical factors;
5. presence of non-linear kinetics.
Intraspecies variability
The most important factor is intraspecies variability.
Indeed. interspecies differences can only be evaluated in
the light of intraspecies differences. because of conside-
rable animal-to-animal variations. Hence. to make valid
comparisons between species. large numbers of animals of
each species must be used.
Disease states and drug interactions

The possible presence of disease states should be conside-
red. Pharmacokinetic studies are often carried out in un-
healthy animals. This may lead to misleading and incor-
rect pharmacokinetic data. This also applies to drug fn-
teractions : drugs given concomitantly can alter the kine-
tics of the agent being studied.
Kinetics
Formulation may also significantly affect drug kinetics.
Comparative studies can only be made if the kinetics are
linear. Linearity of the kinetics means that there is
proportionality between the dose given and the plasma
concentrations obtained: if one doubles the dose given.
the concentrations at any given time will also be double.
Linearity is only obtained if absorption. distribution and
elimination follow first order-kinetics. In recent years
it has become apparent that for a number of drugs this
COMPARATIVE PHARMACOKINETICS: INTRODUCTORY REMARKS 157
proportionality does not occur. pa~ticularly when high

doses are given. This can be due. for example. to protein
binding with saturation at higher concentrations. or to
capacity-limited biotransformation. When the dose is in-
creased. for example by a factor 2. in case of non-linea-
rity within a certain dose-range. the concentrations will
increase by much more than that.
ABSORPTION STUDIES
Absorption after oral administration in different species
is often compared. Absorption after oral administration
involves transfer of the drug from within the gastrointes-
tinal tract into the plasma of the portal vein; from the
portal vein the drug reaches the systemic circulation
after passing through the liver (so-called first-pass).
Every drug given by the oral route and absorbed from the
stomach or intestine undergoes the hepatic first-pass ef-
fect; some drugs are extracted considerably at that time.
By just looking at plasma concentrations. one cannot
distinguish between absorption in the strict sense and
first-pass effects.
What can be learned from plasma concentration-time
relationship after oral administration of a drug? Peak
plasma concentration. the time at which this is obtained.
and the area under the plasma concentration-time curve can
be estimated. It is important to realize that comparing
the oral curve in one species with that in another can be
very misleading unless the plasma concentrations after
intravenous administration in both species are known. In-
deed. the shape of the plasma concentration-time curve af-
ter oral administration is not only determined by absorp-
tion characteristics. but also by distribution and elimi-
nation of the drug. If the latter show interspecies dif-
ferences. the oral absorption curves will also show diffe-
rences. even if the absorption pattern is similar. Even
the time at which the peak concentration is obtained is
influenced to a large degree by the speed of elimination.
DISTRIBUTION AND ELIMINATION

After absorption the drug is distributed throughout the
body. Distribution is influenced by factors such as bin-
ding of the drug in the plasma. and tissue binding. Dif-
ficulties in comparing serum binding in different species
are extensively dealt with in chapter 18.
A drug may be eliminated in unchanged form. i.e. excre-
ted (for example. renal excretion) or biotransformed to
one or more metabolites. Biotransformation is of particu-
lar interest in comparative studies because variability of
biotransformation is often the main determinant of the
variability of the pharmacokinetics of a drug.
From the plasma concentration-time curve after intra-
venous administration. the volume of distribution and the
elimination parameters can be calculated. It is only
after distribution has taken place. that the elimination
phase can be studied; in many studies it is not easy to
distinguish between distribution and elimination phases.
The elimination half-life is the time necessary for the
plasma concentrations to fall by 50%. Often, data are
expressed as "el iminat ion constant" (k.,) which bears a
very simple relationship to half-life (t I12 ) - in other
words. k., = 0.693.
t I 12
Clearance is the amount of plasma cleared per unit of
time. Some drugs are only cleared by the kidney; others
are completely cleared by the liver that is. by bio-
transformation - and no unchanged drug leaves the orga-
nism. In many instances. however, the drug is cleared
both by renal excretion and by biotransformation in the
liver. and sometimes by other organs and routes as well.
In this case. the "total body cl earance" (Cl c ' ) is the sum
of the plasma clearances by different organs. "Total body
clearance" is also called "plasma clearance". and it can
be calculated from the intravenous plasma concentration
time-curve by obtaining the volume of distribution and the
half-life. where Cl., = kLLO.693.
Vd
COMPARATIVE PHARMACOKINETICS: INTRODUCTORY REMARKS 159
Clearance reflects how well the clearing organs are

performing, while half-life is not only dependent upon
clearance, but also on the volume of distribution. This
distinction is important. When a human patient receives
digoxin and gentamicin, both are cleared mainly by the
kidney, and the plasma clearance of both compounds is
rather similar. However, the half-life of digoxin is
more than 1 day, whereas the half-life of gentamicin is
approximately 2 h. This is because digoxin has a very
large volume of distribution, while for gentamicin it is
very small.
Evaluation of elimination in two species, involves
therefore consideration not only of the half-life but also
of the clearance. so that one is not misled by differences
in half-life which could be due to differences in volume
of distribution.
Species differences in plasma clearance of a substance
can be due to several factors. The clearance of a drug by
either kidney or liver. depends on three main factors
the intrinsic capacity of the clearing organ. the plasma
or blood flow to the organ. and the degree of binding of
the drug in plasma.
The intrinsic ability of the liver to metabolize drugs
can differ widely from species to species. both in terms
of the overall rate and metabolic pathways involved. The
way the kidney handles the drug. for example. reabsorption
and active secretion in the tubuli, shows interspecies
differences. Blood flow to liver and kidney and the
extent of binding of the drug in plasma can also differ
from one species to another.
It is important to know that the effect on clearance.
of changes in the intrinsic abilities of the clearing
organs. in flow and in plasma binding. depends upon the
drug studied. The hepatic clearance of most drugs will be
influenced by changes in the intrinsic state. for example.
enzymatic induction; for these same drugs. the hepatic
clearance is restricted to drugs which are free in plasma.
and changes in flow have only a minor influence: this is
the so-called "restrictive. non-flow dependent" hepatic

clearance. For some drugs however. such as lidocaine and
propranolol. the hepatic clearance depends mainly on flow
to the organ and is not restricted to the free fraction.
It is less influenced by changes in enzymatic activity;
this is the so-called "non-restrictive. flow dependent"
clearance.
CONCLUSION
Studies of interspecies differences in pharmacokinetics
should be performed in a systematical fashion. Conclu-
sions from occasional observations or from studies made in
different circumstances should be viewed with caution; the
plasma concentrations should be interpreted on the basis
of a correct understanding of pharmacokinetic principles.
16
Comparative neonatal pharmacokinetics
P.DEBACKER
ABSTRACT
Postnatal development can affect the disposition and
pharmacokinetics of drugs in man and animals. Factors
such as gastric pH. gastrointestinal motility, mucosal
absorbing area, microbial population and milk feeding are
major determinants in the absorption process of drugs in
the neonate. Postnatal evolution in body composition can
lead to important alterations in distribution pattern of
drugs in newborns. Differences in maturity at birth and
in the rate of postnatal development of the renal and
hepatic functions are present in the various species.
Therefore, important variations in pharmacokinetics and
pharmacodynamics between mammalian newborns can be expec-
ted for the same drug.
INTRODUCTION
Age is one of the factors which modify the disposition and
the actions of a drug. Therefore in the last decade there
has been a growing interest in the actions and fate of
drugs in neonatal man and animals.
In all species. neonates undergo continuous anatomical
and functional changes. Differences between animal
species in both the degree of maturity at the time of
birth and the rate of postnatal development have been
161
reported. Differences in the disposition of a foreign

compound and in its pharmacodynamics between young animals
of different species can. therefore. be expected.
The present study deals with the influence of postnatal
growth on absorption. distribution and elimination of
drugs in animals and man in the neonatal period. These
factors will be discussed in the light of anatomical.
physiological and biochemical developments.
ABSORPTION
Absorption of drugs from the gastrointestinal tract of the
newborn is determined by a variety of continually changing
factors'. Some of these factors are listed in Table 16.1.
Gastric pH
In the human neonate. gastric pH is between 6.5 and 8.0 at
birth. and it fluctuates considerably thereafter and takes
several months to reach adult levels". In newborn
calves. the abomasal pH is 7.5. but it drops in a few
hours to 4.0; on changing to solid food in the following
weeks. the average pH of the abomasum is 3.6'2. A
diminished breakdown of. for example. penicillins. with a
higher bioavailability can therefore be expected. and has
been found in very young humans and calves,o.24.
Gastrointestinal motility
Another major determinant in the drug absorption process
is the development of gastrointestinal motility. It is
generally accepted that. in the newborn. a lack of
propulsive activity affects the transfer of orally
administered drugs and leads to delayed absorption. In
neonates. it takes 6-8 months before the gastric emptying
time approximates to adult values". In dogs also. a
foetal pattern of propulsive activity in the intestine is
present in the first weeks of postnatal life. Adult
patterns of motor activity were registered in the small
bowe 1 of t he newborn 1amb 2 0; the deve 1 opment of funct i ona 1
reticuloruminal activity however only starts after birth
COMPARATIVE NEONATAL PHARMACOKINETICS 163
Table 16.1 Drug absorption affecting characteristics of

the gastrointestinal tract in the neonate
Gastric acid secretion low

Gastrointestinal motility immature
Gastrointestinal anatomy not fully developed
Microbial population low
Intestinal enzymatic activity low
Mucosal absorbing area small
Blood perfusion variable
and several weeks are needed to achieve a fully developed

forestomach function in this species tJ • The postnatal
anatomical development of the forestomachs can have an
important influence on the absorption process of certain
drugs in the young ruminant. In the case of sulphon-
amides. a delayed absorption was noticed in developing
lambs and kids to16 •
Microbial population
The establishment of a ruminal microbial population in the
forestomachs of young ruminants can interfere with the
absorption of drugs. This can lead to a decreased bio-
availability with age as reported for chloramphenico1 6 and
trimethoprim t7 in developing ruminants.
Mucosal area and blood perfusion

In general. at birth the intestinal mucosal absorbing
area is limited while the postnatal development of the
regional blood perfusion in the different parts of the
gastrointestinal tract is variable. Both factors are
capable of substantially modifying the absorption of
drugs.
Milk feeding and absorption

Finally. it should be added that the feeding of milk. an
important food component in the first period of life. also
affects the absorption of drugs. In calves. a lower

bioavailability was found for tetracyclines. penicillin.
chloramphenicol and trimethoprim after a meal containing
milk components to •
First pass extraction

In addition to absorption. first pass extraction can also
affect the bioavailability of certain drugs. To our
knowledge, however. no studies dealing with the evolution
of the first pass Phenomenon in neonates have been
conducted.
DISTRIBUTION
Extracellular and intracellular water
From the plasma. drug is distributed to the tissues.
Binding in serum and in tissues can occur and affect the
distribution of a foreign compound. The continuous
changes in body composition which occur in newborn mammals
can alter the distribution pattern of a drug. The most
important changes in body composition in the very young
animal are listed in Table 16.2. In most mammals. total
bodY water content is initially elevated but decreases
during foetal growth and continues to diminish
postnatally. although at a slower rate. Concomitantly,
extracellular water volume decreases. while intracellular
water tends to increase. Therefore a higher volume of
distribution at birth can be expected for polar drugs such
as penicillin. antipyrine. salicylates. sulphonamides and
aminoglycosides.
Adipose tissue and skeletal mass

The changes in adipose tissue and skeletal mass can also
lead to a different distribution pattern of a drug during
postnatal growth. Experimental data on this subject are
limited however.
Blood-brain barrier permeability

The changes in blood-brain barrier permeability in the
Table 16.2 Neonatal bodY composition. differences in

comparison with the adult
Total bodY water higher

Adipose tissue lower
Skeletal mass lower
Cardiac output lower
Blood-brain barrier permeability higher
Plasma protein concentration (albumin) lower
neonate are of particular interest. A number of events

take place during brain maturation. These include. for
instance. modification in the lipid content. a changing
rate of production of cerebrospinal fluid. a change in the
permeability of the brain capillaries and a tightening of
the junction between the choroid plexus epithelial cells
and the endothelial cells l • As a result. it is possible
that antibiotics such as penicillin which normally
penetrate this barrier poorly. have an enhanced
effectiveness in the brain of young animals 23 • On the
other hand. elevated concentrations of anaesthetics and
anticonsulvants in the CNS of neonatal animals could lead
to toxic effects.
Serum protein binding

An important factor in the distribution of drugs is serum
protein binding. In general. serum protein concentrations
in the newborn are low. mainly the albumin fraction. A
low serum binding of usually highly bound drugs such as
salicylates and sulphonamides has been reported in the
newborn goat. sheep. cow. dog. pig and human 23 • A high
volume of distribution was reported for these drugs in the
first period of life. In the case of sulphamerazine a
positive linear correlation was found between plasma
binding and albumin concentration in developing lambs and
calves' • A plasma protein binding of 45% was seen for
trimethoprim in newborn piglets during the first week of
life. as compared to 75% in adult pigs. notwithstanding a

similar plasma protein concentration 41 •
Apart from concentrations of binding proteins such as
albumin. other factors are also able to influence the
binding of drugs in the newborn. such as the presence of
foetal albumin. substances of maternal origin. high
concentration of free fatty acids and bilirubin. Data
describing the influence of these factors on binding are,
however. mostly restricted to humans 15 •
RENAL EXCRETION
In mammalian species. drugs or their metabolites are
excreted by glomerular filtration or by a combination of
glomerular filtration and active tubular secretion. while
passive tubular reabsorption can also occur. Renal
function of newborn mammals is not fully developed at
birth. This can result in a reduced excretion of drugs.
Species differences in the maturity of renal function at
birth have been reported. Newborn ruminants. for example.
possess a much more mature renal function than other
mammals!. One should also keep in mind that the rate of
postnatal development of renal function can vary
considerably from one species to another.
Glomerular filtration
From Table 16.3. it is clear that the development of
glomerular filtration takes only a few days in newborn
ruminants and in man and pig as well this development
takes place in the first week of life. A somewhat slower
postnatal development of glomerular filtration occurs in
dogs and rodents. As a result. one can expect that the
clearance of drugs which are mainly eliminated by
glomerular filtration, are already high in the early
stages of life in most mammalian species. For gentamicin,
an antibiotic almost entirely eliminated by glomerular
filtration. a high clearance value was found in newborn
ca1ves 4 and man 1 •
Table 16.3 Rate of postnatal development of renal func-

tion in different species: time required to reach adult
values
Glomerular filtration Tubular secretion
Catt 1 e very fast ( 1-3 days) very fast (1-3 days)

Goat very fast ( 1-3 days) fast (1-2 weeks)
Sheep very fast ( 1-3 days) fast (1-2 weeks)
Dog intermediate (2-3 weeks) slow (4-8 weeks)
Rodent intermediate (2-3 weeks) slow (4-8 weeks)
Pig fast (1-2 weeks) slow (4-8 weeks)
Man fast (1-2 weeks) very slow <> 20 weeks)
----------------------------------------------------------
Tubular function
Maturational changes in tubular function can also
influence the elimination of some drugs. From Table 16.3.
it is obvious that the species differences in postnatal
development of tubular function are more pronounced than
those of glomerular filtration. In the newborn calf renal
tubular function is already fully developed a few days
after birth. A somewhat slower development was found in
goats and sheep. In the dog. rodent and pig, several
weeks are required before tubular secretion reaches full
maturity. In human neonates. tubular secretion develops
very slowly, over months. These important species
differences in development of tubular secretion can lead
to large variations between different species in the
clearance of drugs excreted by tUbular secretion in the
newborn. It has. for example. been shown that the
evolution in the elimination of benzylpenicillin. a drug
almost entirely excreted by tubular secretion, is faster
in the calf than in the pig 2t •
BIOTRANSFORMATION
In neonates. drug metabolizing activity is in general low.
Intraspecies differences in maturity at birth and in the
Table 16.4 Postnatal development of biotransformation

time required to reach adult values.
Horse 1-2 weeks

Rodent 1-3 weeks
Ruminant 3-5 weeks
Dog 3-5 weeks
Pig 4-6 weeks
Humans 4-12 weeks
rate of postnatal development have been reported. A sim-

plified representation of the development of drug metabo-
lising capacity in man and other mammals is given in Table
16.4. In the human neonate and in piglets. several weeks
are needed for development of the enzyme system.
associated with drug biotransformation l , . 2 2 . From the few
studies dealing with the pharmacokinetics of antibiotics
in equine species. it can be inferred that the major
metabolic pathways develop very rapidly after birth in
foals 3 •
Postnatal development of drug metabolism is. however.
more complex as indicated in Table 16.4. The rate at
which biotransformation achieves adult levels of activity
varies considerably according to the drug and the
metabolic pathway studied. In general. at the moment of
birth. the cytochrome P.,o-dependent mixed function
oxidase system and the glucuronide conjugating system are
deficient in mammals. Other metabolizing steps such as
acetylation. sulphate and glycine conjugation have been
reported to be already well developed in neonates 2 • The
postnatal development of the sulphonamide biotrans-
formation in different domestic animal species reflects
these findings. Low hydroxylation and low glucuronidation
have been demonstrated during the first days of life for
sulphadimidine 2 ' and sulphadiazine 9 in pigs. for sulpha-
dimidine in calves ls . 19 • for sulphadoxine in goatsl7 and
for sulphamerazine in sheep (unpublished results);
acetylation of sulphonamides is not deficient in these

animal species. For some pathways. such as dealkylation.
it has been reported that the activity can exceed several
times the adult value at some stages of the evolution of
t he young mamma lsi 4 •
CONCLUSIONS
At the time of birth large intraspecies variations in
maturity exist. and the rates of postnatal development are
likewise different from species to species. Therefore.
important differences in the pharmacokinetics of a foreign
compound can be expected between neonates of different
species. although only few studies in this field have been
performed.
References
1. Assael. B.M. (1982). Pharmacokinetics and drug dis-
tribution during postnatal development. Pharmacol.
Ther.18:159-197.
2. Baggot. J.D. (1977). Principles of Drug Disposition
in Domestic Animals. Philadelphia: W.B. Saunders.
3. Baggot. J.D. and Short. C.R. (1984). Drug disposition
in the n eon a t a I ani ma I. wit h par tic u I a r ref ere n c e to
the foal. Equine Vet. J. 16(4) :364-367.
4. Clarke. C.R •• Short. C.R •• Hsu. R. and Baggot. J.D.
(1985). Pharmacokinetics of gentamicin in the calf:
developmental changes. Am. J. Vet. Res. 46:2461-2466.
5. De Backer. P. and Bogaert. M.G. (1983). Drug bio-
availability in the developing ruminant. In: Rucke-
bush. Y., Toutain. P.L. and Koritz. G.D. (eds). Vete-
rinary Pharmacology and Toxicology, pp.133-140.
Lancaster: MTP Press L.
6. De Backer. P., Debackere, M., De Corte-Baeten. K.
(1978). Plasma levels of chloramphenicol after oral
administration in calves during the first weeks of
life. J. Vet. Pharmacol. Ther. 1:135-140.
7. De Backer. P., Belpaire. F.M •• Bogaert. M.G. and
Debackere. M. (1982). Pharmacokinetics of sulfamera-
zine and antipyrine in neonatal and young lambs. Am.
J. Vet. Res. 43:1744-1751.
8. Friis. C. (1983), Postnatal development of renal
function in goats. In: Ruckebush, Y•• Toutain. P.L.
and Koritz. G.D. (eds). Veterinary Pharmacology and
Toxicology, pp.57-62. Lancaster: MTP Press L.
9. Friis. C•• Gyrd-Hansen, N., Nielsen. P., Olsen. C.E.
and Rasmussen. F. (1984). Pharmacokinetics and
metabolism of sulphadiazine in neonatal and young
pigs. Acta Pharmacol. Toxicol. 54:821-826.
10. Groothuis. D.G. (1983). De farmacokinetiek bij vlees-
kalveren en de activiteit van antibacteriele middelen

met betrekking tot salmonella dublin infecties.
Doctoraal proefschrift. Utrecht.
11. GYrd-Hansen. H•• Fr i is. C•• Ni e I sen. P. and Rasmussen.
F. (1984). Metabol ism of trimethoprim in neonatal and
young pigs: comparative in vivo and in vitro studies.
Acta Pharmacol. Toxicol. 55:402-409.
12. Hill. K.J. (1968). Abomasal function. In: Handbook
of PhYsiology. Alimentary Canal. vol. V. pp.2747-2759.
Baltimore: Williams and Wilkins.
13. Leat. W.M.F. (1970). Carbohydrate and lipid metabo-
lism in the ruminant during postnatal development.
In: Phillipson. A.T. (ed.). Physiology of Digestion
and Metabolism in the Ruminant. pp.211-222.
Newcastle-upon-TYne: Oriel Press.
14. Mannering, G.J. (1985). Drug metabolism in the new-
born. Fed. Proc. 44:2302-2308.
15. Morsell i. P.L •• Franco-Morsel 1 i. R. and Bossi. L.
(1980). Clinical pharmacokinetics in newborn and
infants. Age related differences and therapeutic
implications. Clint Pharmacokinet. 5:485-527.
16. Nielsen. P. and Rasmussen. F. (1976). Influence of
age on trimethoprim and sulfadoxone in goats. Acta
Pharmacol. Toxicol. 38:113-119.
17. Nielsen. P., Romvary. A. and Rasmussen. F. (1978).
Sulfadoxine and trimethoprim in goats and cows
absorption fraction. half-lives and the degrading
effect of the rumi na I f lora. J. Vet. Pharmaco I. Ther.
1: 37-46.
18. Nouws. J.F.M .• Vree. T.B .• Baakman. M. and Tijhuis. M.
(1983). Effect of age on the acetylation and
deacetylation reactions of sulphadimidine and
N4 -acetYlsulphadimidine in calves. J. Vet. Pharmacol.
Ther. 6:13-22.
19. Nouws. J.F.M •• Vree. T.B •• Baakman. M.• Driessens. F ••
Breukink. H.J. and Meviu. D. (1986). Age and dosage
dependency in the plasma disposition and the renal
clearance of sulfadimidine and its N.-acetyl and
hydroxy metabolites in calves and cows. Am. J. Vet.
Res. 47:642-649.
20. Ruckebush. Y. (1983). Perinatal pharmacology in rumi-
nant models. In: Ruckebush. Y •• Toutain. P.L. and
Koritz. G.D. (eds). Veterinary Pharmacology and
Toxicology. pp.3-22. Lancaster: MTP Press L.
21. Short. C.R. (1983). Developmental patterns of peni-
cillin G excretion. In: Ruckebush. Y•• Toutain. P.L.
and Koritz. G.D. (eds). Veterinary Pharmacology and
Toxicology. pp.63-72. Lancaster: MTP Press L.
22. Short. C.R. (1984). Drug disposition in neonatal
animals. J. Am. Vet. Med. Assoc. 184:1161-1162.
23. Short. C.R. and Clarke. C.R. (1984). Calculation of
dosage regimens of antimicrobial drugs for the neo-
natal patient. J. Am. Vet. Med. Assoc. 185(10):
1088-1093.
24. Silverio. J. and Poole. J.W. (1973). Serum concen-
trations of ampicillin in newborn infants after oral
COM PARATIVE NEONATAL PHARMACOKINETICS 171
administration. Pediatrics 51:578-580.

25. Svendsen. O. (1976). Pharmacokinetics of hexabarbi-
tal. sulphadimidine and chloramphenicol in neonatal
and young pigs. Acta Vet. Scand. 17:1-14.
17
Comparative pharmacokinetic studies of
sulphonamides
T. B. VREE, J. F. M. NOUWS AND Y. A. HEKSTER
ABSTRACT
In species-dependent pharmacokinetics there are three main
variables: the structure of the drug, the mechanism and
route of metabolism. and renal excretion. When the drug
is administered orally. the structure and characteristics
of the gastrointestinal tract are an additional factor
which may dominate the overall pharmacokinetic behaviour.
Sulphona·mides are metabol ized by acetylation-deacetylation
reactions and by hydroxylation. Hydroxylation is possible
at different positions in the Nt-substituent group. The
ratio between acetylation and hydroxylation depends on the
structure of the sulphonamide and the species. Renal
function. as expressed by inulin or creatinine clearance.
is almost independent of the species and related to the
bodY weight. The renal excretion mechanisms of
sulphonamides and their metabolites are governed by the
molecular structure and kidney architecture. but not by
ani ma 1 s p e c i e s •
There are three main variables governing the

pharmacokinetics of sulphonamides in animals. These are
(1) the molecular structure of the sulphonamide: (2) the
variation in metabolic pathways and variations in the
enzyme concentration in each species: and (3) renal
173
174 COM PARATIVE VETERINARY PHARMACOLOGY, TOXICOLOGY AND TH ERAPY
excretion. By selecting one sulphonamide for a

comparative study it is possible to studY both
species-dependent metabolism and renal clearance.
METABOLISM
Acetylation
Acetylation as a metabolic pathway for su1phonamides is
well known and most studied in man. Acetylation is
carried out by N-acety1ases and acetyl coenzYme-A. There
exists a "fast-slow" acetylation phenotype. Fast
acety1ators have an additional enzyme available. which is
missing in slow acety1ators. The N-acety1ase composition
differs in each species. Fast-slow acetylation has been
demonstrated in man. monkeys and rabbits. and seems to be
absent in ruminants. The structure of the sulphonamide
also has an influence on "fast-slow" acetylation. A clear
phenotype in man is established only for the
2-su1phani1amide-pyridine and -pyrimidine derivatives as
exemplified by su1phadimidine (Figure 17.1). There are
three phenotypes in man characterized by homozygotic and
heterozvgotic fast acetylation and heterozygotic slow
acetv1ation. The homozygotic slow acetylation must also
exist but has not as vet been demonstrated. This
acetylation probably exists in ruminants.
Acetv1ation is part of an acety1ation-deacety1ation
equilibrium. the position of which depends on the
molecular structure of the sulphonamide and the
species t4 . t5 . Dogs (and dog-related species) show an
extremely high rate of deacety1ation. so that no
acetylation appears to take p1ace tJ .t5. Pigeon and sheep
show equal rates of deacety1ation and acetylation.
Acetv1ation is one of the basal conjugation reactions
in life: it is present in old species such as turtles and
snai 1 s' t, t 2 and is present at the time of birth5,7.
Hydroxv1ation
The hvdroxv1ation pathwav of su1phonamides. known since
1944 8 • has been investigated less than the acetylation
COMPARATIVE PHARMACOKINETIC STUDIES OF SULPHONAMIDES 175
A B
plasma cone ug /m l - - - - - - - , plasma c one ug / ml - -----,
,oo{\. \"
RR
fast . "\"
Rr
fast
,
Japan Korea Caucasian
\
\,
....
.....
'.\ ....
\ ,, \"
,, 10 ....
'.\ \ ...... .
,,
\
\ '"
\
s
\44
20 40h 20 40h
c o
pla sma cone ug /rnl - -- plasma cone ug / ml - - - - - - - ,
100 rR '00 rr
slow
Man ? Cow
Goal
10
r··\·········. ..
i \···. . N4 S
20 40 h 20 40h
Figure 17.1 Plasma concentration-time curves of sulpha-

dimidine in four different acetylator phenotypes. Three
phenotypes - A. B. and C - have been detected in man; pos-
sibility 0 occurs only in animals.
pathwaY. The reasons for not studying this pathway are,

firstly, that the Bratton and Marshall reaction cannot
discriminate between parent drug and N.-hydroxy-
metabolites: and secondly, that the synthesis of these
hydroxYmetabolites presents difficulties. The synthesis
of 5-hydroxysulphapyridine is reported by Scudi and
Childress'. Hydroxylation of sulphonamides in man is
reported for sulphapyridine J • to • and recently in man for
su1phamethoxazo1e. su1phadiazine. su1phatroxazo1e and

4
su1 phadimidine . t 4. t 6. In the veterinary literature the
metabolites are identified in urine extracts by thin layer
chromatography and mass spectrometry. Biosynthesis of
NI -hydroxysu1phonamides is possible. using the dog as the
hydroxy1ating animal due to its lack of acetylation
activity. No metabolites that interfere in the isolation
and identification procedures are produced by this
species tJ . t4 • Synthesis of these hydroxymetabo1ites in
the dog is species-dependent. The hydroxymetabo1ites can
be excreted by active tubular secretion. or they can be
first glucuronidated before they are excreted.
Rena 1 excret ion

Su1phonamides are excreted by means of both passive and
active processes depending on their molecular structure t6 •
Active proximal tubular secretion is the excretion
mechanism for su1phamethiazo1e. su1phathiazo1e and
su1phisomidine. while all other su1phonamides are excreted
by passive processes. All N4 -acet y 1 su 1 phonami des and
hydroxyg1ucuronide metabolites are also excreted by active
tubular secretion. Passive excretion comprises glomerular
filtration and passive tubular reabsorption. characterized
by the variables urine flow and urine pH. Man shows
variations in urine pH. between pH 5 and 7. while
ruminants have a highly alkaline pH (8-9) and in the dog
pH ranges from 6 to 9. Urine flow rate is species-
dependent and varies between individual animals. In man
there is an average flow of 1 m1/min. while cows have a
flow of 10-30 m1/min. goats 0.5 m1/min and snails 0.01
m1/min. A high urine 11 ow and alkaline urine pH minimize
the passive tubular reabsorption of su1phonamides. The
glomerular filtration rate. as monitored by creatinine
clearance. depends on th3 species and is related to body
weight. It varies from 2 m1/min in the mouse. to 120
m1/min in man and to 500-700 m1/min in cows.
Edwards 2 has shown that the renal glomerular function.
as indicated by inulin clearance." seems to be independent
of the species. It is related to bodY weight and basal

metabolic rate: it removes the waste products of food
(energy) constituents. the quantity of the dailY food
intake and waste produced being related to the bodY size.
Once excreted by the kidney glomerulus and tubule. the
drug can be reabsorbed according to its pKa value and
lipid solubility from both the renal tubule and the
bladder •
17 A high rate of urine flow and frequent
micturition decrease the rate of reabsorption and increase
the overall renal clearance. With the selection of a
specific sulphonamide as test substrate. two kinetic
variables. structure and renal clearance. are constant for
most species. Species-related differences in pharmaco-
kinetics of the sulphonamide can therefore be ascribed to
differences in metabolism (pathways and rates).
The percentage of the dose excreted in the urine as
each metabolite reflects the yield of the metabolic
pathways for each species when the renal clearance of the
metabolite is considered species-independent. When the
latter assumption is correct. then the plasma
concentration of parent drug and metabolites will in
addition reveal the relative importance of each metabolic
pathwaY.

Drugs
Sulphonamides were obtained from De Onderlinge Pharma-
ceutische Groothandel OPG (Utrecht. the Netherlands).
N.-acetylsulphonamides (N.). and hydroxysulphonamides
(SOH) were synthetized and isolated according to Vree et
Animals
Animals were obtained from the Central Animal Laboratory.
University of Nijmegen. Dotulabs (Nijmegen) and the
Institute of Veterinary Pharmacology (University of
Utrecht. the Netherlands).
HPLC analYsis
Deglucuronidation, sample preparation and HPLC analysis
were performed as described elsewhere'·1.
RESULTS
Sulphamethoxazole
Sulphamethoxazole is predominantly acetylated in man and
animals such as the pigeon. penguin, cat, and sheep.
There is a small percentage of hydroxylation (10-20% of
the dose). Deacetvlation is substantial in cat and sheep,
minimal in man and maximal in the dog t5 • Cats are slow
acetvlators due to a substantial rate of deacetvlation as
illustrated in Figures 17.2 and 17.3. Fish and water
turtles acetvlate about 5% of the dose of sulphametho-
xazole.
Sulphatroxazole
Sulphatroxazole, a 4-methvl substituted analogue of
sulphamethoxazole. is predominantly eliminated by hydroxv-
lation in man and the dog (70%). but it is mainly
acetvlated in cows. Sulphamethoxazole and sulphatroxazole
are both hvdroxvlated at the 5-methvl group. The
hvdroxvmetabolite of sulphatroxazole is excreted renallv
bv active tubular secretion in man and is not
glucuronidated. Although in man hydroxylation is the main
metabolic pathway (70%), it is a relatively slow process,
resulting in a half-life of 25 ht4. Hydroxylation of
sulphatroxazole is species-dependent and in calves
acetYlation dominates the metabolic process. which is
opposite to the finding in man.
Sulphapvridine
Sulphapvridine is hvdroxvlated and acetvlated to a great
ext en tin rna n • That hydroxylation is a major process is
indicated bv the fact that 70% of the dose of the
metabolite N4-acetvlsulphapyridine is hydroxylated. It is
not certain whether 5-hvdroxysulphapyridine becomes
acetvlated. Sulphapyridine shows a clear "fast-slow"
plasma cone. ug/ml - - - - - - - - - - - - - - - ,
i:::-~ S Ty,10h
e---'-e_
10
i······,· ....·!
~· .... ·t
~.5%
i ............. !.! ....... ,
I h ........ , L~:..~.?. 3 %
"_.&.~. .--..-~7 -"'--·-~·-

¢...~.... r..................·•
..
f r-----···---······r·······
·----····----··1
0.1 L.___________........:
i
urine flo";";;:;r7min
........__ .....__________________. .........1
o h
Figure 17.2 Plasma concentration-time curves and renal

excretion rate-time profiles of sulphapyridine (5) and its
metabolite N.-acetvlsulphapyridine (N.) in a cat after a
rapid intravenous infusion of 78 mg of sulphapyridine.
acetylation phenotype. which is reflected in the

half-lives of e 1 imi nati on of the two groups. This
behaviour indicates that acetylation governs the overall
metabolic elimination in man. The hydroxylation of
N.-acetvlsulphapvridine in man is an unusual phenomenon,
because a drug conjugate is further metabolized (Figure
17.4). Dogs, goats and cats are unable to hydroxylate the
N.-acetvlsulphapyridine; they deacetylate this compound
first and then hydroxylate it.
5ulphamerazine
5ulphamerazine is predominantly acetylated in man by a
plasma conc. ug/ml - - - - - - - - - - - - - - ,

renal excr. rate ug/min
c-_·. . .--
100 N4 57.2 0/0
.........
• ·_N4 T\<,2.5h
10
.~
~-••••• ~ ••• -0
S 0 ......... _0•••••••••• 0 .......... ---•
. .!').~···$···:.~·.i;;::;::::::;:··:··:.··········l 1~···~~Z~·
i- j ............. , !
1 i i.u .......... ~
......................
a 4 h

excretion rate-time profiles of N.-acetylsulphamethoxazole
(N.) and its metabolite sulphamethoxazole (8) in a cat
after an intravenous dose of 79 mg of N.-acetyl-
sulphamethoxazole.
"fast-slow" acetylation-deacetylation phenotype. Deacety-

lation is measurable in man. Hydroxylation in man
accounts for maximally 10-20% of the administered dose.
The dog hYdroxylates sulphamerazine predominantly at the
4-position. while the sheep. goat. and cow hydroxylate
ma i n 1 y the 6-me thy 1 g r 0 u pl. I 3 • I 4 •
8ulphadimidine
Sulphadimidine is acetvlated according to the "fast-slow"
acetylation phenotype in man. while the percentage of
hydroxylation in the two groups remains low and
constant (10%) • In ruminants. hydroxylation is the
plasma conc. ug/ml

renal exer. rate ug/min
'slow'
. . . .n
: ,.....,
8.2 %
·z•••1 ~U
"··1.............
I~"" :
I :,',:.\. ""\'"
•~,
•: ""
\'-, i
L •• , 19.9 %
"
:'' r !..... ~ ! ni
i • .i
: • T~4.5h"" •••••• ,i •••••••••• : ..... !
S 50%
!
: \ "
\ 't!l
i
l.J······
!..~..."0
0'Cf;
• " - - - -...- - --""-- --
•••••• (v......... .~1iJ- N~OHglu, ___
f! .............. <;{
• .~----- __ _Iil
=: .....@ •• ) ~ ..................... ...
: su bJ T.BV T],-21~·h·.(OJ ••••••• ?·~

•••••••••••••••1;)••••
o 20 40 60 h

excretion rate-time profiles of N4-acetv1su1phapvridine
(N4) and its hvdroxvmetabo1 ites in man after an oral dose
of 593 mg of N4-acetv1su1phapvridine. Here a conjugate is
hvdroxv1ated into N4-acetvl-5-hvdroxvsu1phapvridine
(glucuronide) (N 4 OH) . The parent drug is also
deacetv1ated into su1phapvridine (S) and subsequent1v
hvdroxy1ated into 5-hvdroxvsu1phapyridine (glucuronide)
(SOH). The hvdroxv1ation of the N4-acetv1 derivative does
not occur in dog. cat or goat.
predominant metabolic pathway. Hvdroxv1ation at the

6-methv1 position is dominant over the hydroxylation at
the 5 position in the cow. sheep, and goat. while in the
horse the position is reversed. At a dose of 100-200
mg/kg. the 6-methv1 hydroxyl derivative is capacitv-
-@-
20 5
-pyrid ine
OH + N40H
=iN
---\Q{
CH3
-diazine
OH
-<g}-OH
~ 60
OH
5
-isomidine
4
3
CH3
~H3 ~H20H
~~ OH
--<0 N
Ni'
-merazine
N~H20H 2
:d,0CH3
-40 -<~
~
~
OH
N 4 5 4
CH3 CH 3 OH OCH3
-dimidine -dimethoxine
Figure 17.5 Structural formulae of the hvdroxymetabolites

of sulpha-2-(6)-pyrimidines.
limited in the cow. but not in the horse. 6-Hydroxyme-

thvlsulphadimidine is excreted renally by passive
processes only. while 5-hydroxvsulphadimidine is rapidly
glucuronidated and excreted by active secretory processes.
For this reason the plasma concentration of 5-hydroxysul-
phadimidine in cows is much lower than that of 6-hvdroxy-
methvlsulphadimidine. Pigs are unable to hydroxylate
sulphadimidine. Fish. turtles and snails acetylate and
hydroxylate sulphadimidine very slowly. Birds must possess
additional metabolic pathways as so much of the dose
remains unaccounted for.
Half-life of elimination
There are striking differences between man and other
mammals in the elimination half-life of sulphonamides. In
man the half-life ranges from 1 h for sulphamethiazole to
100 h for sulphadoxine. while in other animals the range
is much smaller (2-10 h). This variation is obtained with

high doses of 100-200 mg/kg, resulting in capacity-limited
elimination and wide variation in reported half-life. The
short half-life of sulphonamides in animals is predomi-
nantly caused by the high rate of hydroxylation and not by
acetylation. In man acetylation (never hydroxylation) is
the rate-governing step in the elimination half-life.
DISCUSSION
Metabolism is not equivalent to elimination from the body.
The parent drug is removed but another compound, which may
or may not be pharmacodynamically active replaces it.
Metabolism converts the parent drug into a suitable form
so that it can be conjugated and activelY excreted. If
the parent drug or a metabolite is excreted by active
tubular secretion. then clearly no conjugation is needed
nor does it occur. All hydroxymetabolites and N4-acetyl-
metabolites formed from sulphonamides show plasma
concentration-time curves running parallel to that of the
parent drug. This means that the intrinsic elimination of
the metabolites is higher than that of the parent drug.
The hydroxymetabolites are eliminated by glucuronidation
and renal excretion, the glucuronides and N4-acetyl
conjugates by active renal excretion.
When renal function and the mechanism of excretion are
constant for a sulphonamide in each species, then the
different yields in metabolites in the urine or blood
reflect the different metabolic rates and pathways. In
this series of mammals, the number of metabolic pathwaYs
is constant: there are two hydroxylation reactions and one
acetylation-deacetylation equilibrium. The rate constants
of each metabolic pathway differ among the species: they
are species/gene/enzYme related. Figure 17.5 summarizes
the hydroxYmetabolites of some sulphapyrimidines.
References
1. De Backer, P. (1986). Comparative neonatal pharmaco-
kinetics. In: Van Miert. A.S.].P.A.M., Bogaert, M.G.
and Debackere. M. (eds). Comparative Veterinary
Pharmacology. Toxicology and Therapv. Proc. 3rd EAVPT

Congress. Part II. Invited Lectures. Lancaster
MTP Press.
2. Edwards. N.A. (1975). Scaling of renal functions in
mammals. Compo Biochem. Physiol. 52A:63-66.
3. Hansson. K.-A. and Sandberg. M. (1973). Determination
of sulphapvridine and its metabolites in biological
materials after administration of salicylsulphapyri-
dine. Acta Pharm. Suecica 10:87-92.
4. Hekster. V.A. and Vree. LB. (1982), Clinical
pharmacokinetics of sulphonamides and their N.-acetyl
derivatives. Antibiot. Chemother. 31:22-118.
5. Nouws. J.F.M •• Vree. T.B •• TiJhuis. M.W. and Baakman,
M. (1983). Effect of age on the acetylation and
deacetvlation reactions of sulfadimidine and
N.-acetvlsulfadimidine in calves. J. Vet. Pharmacol.
Her. 6: 13-22.
6. Nouws. J.F.M •• Vree. T.B •• Breukink. H.J .• Baakman.
M.,Driessens. F. and Smulders. A. (1985). Dose
dependent disposition of sulfadimidine. its
N.-acetvl-. and its hydroxy metabolites in plasma and
milk of dairy cows. Vet. Q. 7:177-186.
7. Nouws. J.F.M •• Vree. T.B •• Baakman. M•• Driessens. F ••
Breukink. H.J. and Mevius. D. (1986). Age and dosage
clearance of sulfadimidine and its N.-acetyl and
Res. 47:642-649.
8. Scudi. J.V. (1944). Excretion of metabolic products
of sulfapyridine in the dog. Proc. Soc. Exp. BioI.
Med. 55:197-199.
9. Scudi. J.V. and Childress. S.J. (1956). Constitution
of the hvdroxysulfapvridine isolated from dog urine.
J. BioI. Chem. 218:587-593.
10. Schroder. H. and Schroder. B. (1973). Isolation and
excretion of a hvdroxvlated metabolite of
sulphapyridine from human urine. Acta Pharm. Suecica
10:263-268.
11. Vree. LB. and Vree. J.B. (1983). Acetylation of
sulphamethoxazole bv fresh water turtles Pseudemvs
scripta elegans. J. Vet. Pharmacol. Ther. 6:237-240.
12. Vree. LB. and Vree. M.L. (1984). Acetvlation of
sulphamethoxazole by the snail Cepaea hortensis. J.
Vet. Pharmacol. Ther. 7:239-241.
13. Vree. LB •• Tijhuis. M.W •• Nouws. J.F.M. and Hekster.
V.A. (1984). Isolation and identification of
4-hvdroxvsulfamerazine and preliminary studies on its
pharmacokinetics in dogs. Pharm. Weekbl. Sci. Ed.
6:80-87.
14. Vree. T.B •• Hekster. V.A. and Tijhuis. M.W. (1985).
Metabolism of sulfonamides. Antibiot. Chemother.
34:5-65.
15. Vree. LB •• Hekster. V.A •• Nouws. J.F.M. and Dorre-
steijn. 8.M. (1985). Pharmacokinetics of sulfonamides
in animals. Antibiot. Chemother. 34:130-170.
16. Vree. LB. and Hekster. V.A. (1985). Renal excretion
of sulfonamides. Antibiot. Chemother. 34:66-121.

17. Wood. J.H. and Leonard. T.W. (1983). Kinetic implica-
tions of drug resorption from the bladder. Drug Metab.
Rev. 14:407-423.
18
Species differences in protein binding
F. BELPAIRE
ABSTRACT
Protein binding influences the disposition of a drug. and
knowledge of the protein binding in different species can
sometimes help to explain differences in pharmacokinetics
and pharmacodynamics which occur. Comparison of protein
binding of drugs in different species is only of value if
a systematic and careful comparison of binding in
different animal species has been performed since
percentage binding depends on a number of factors such as
methodology used. the concentration of drug tested and
intra-individual and interindividual differences in
binding. Species variations in the degree of binding of
those drugs mainly bound to albumin have been noted. They
are in general more extensively bound in humans than in
other mammalian species. For most drugs the extent of
binding is usually within a range which permits a
classification of high. moderate and low. whatever the
species. For other drugs such as salicylates and
valproate. pronounced interspecies differences in binding
were found. Species differences in binding of drugs
mainly bound to alphat-acid glycoprotein are more
pronounced than for drugs mainly bound to albumin. These
differences are mainly due to differences in affinity and
capacity. This is illustrated for oxprenolol. propranolol
187
and disopyramide.
INTRODUCT ION
Many drugs are to some degree bound to blood constituents
such as albumin. alphal-acid glycoprotein (alphal-AGP).
lipoproteins and erythrocytes. While most drugs are
mainly bound to plasma albumin. many basic drugs such as
beta-adrenoceptor blockers. antiarrhythmics or tricyclic
antidepressants are primarily bound to alphal-AGP. an
acute phase reactant.
Protein binding influences the disposition of a drug.
and knowledge of the protein binding in different species
can sometimes help in explaining the differences in
pharmacokinetics occurring between these species. Protein
binding also affects the intensity of the pharmacological
effect: free. unbound drug is pharmacologically active.
whereas bound drug is inactive. serving as a depot from
which the concentration of free drug in body water is
maintained.
A systematic comparison of protein binding in several
animal species has been performed for relatively few
drugs. In most cases however. interspecies differences
can be inferred from data obtained by different investi-
gators. However. conclusions which are not based on a
systematic study can be misleading. Indeed. the per-
centage binding obtained in a study depends on a number
of factors.
FACTORS INFLUENCING BINDING

Methodology
Several methods have been developed to measure protein
binding of drugs in plasma or serum. Most commonly.
equilibrium dialysis and ultrafiltration are used. each
having both advantages and disadvantages. Rarely are the
various methods systematically compared and in the few
instances when this has been done. different values were
often obtained. Even when the same method. such as
equilibrium dialysis. is used. there can be interlabo-
SPECIES DIFFERENCES IN PROTEIN BINDING 189
ratory variations due to differences in buffer compo-

sition, pH, temperature (25 °C or 37 °C) and other fac-
tors. These problems must be considered when comparing
protein binding data from different laboratories.
Drug concentration
For many drugs, percentage binding is constant within the
therapeutic range, because these concentrations are
usually much lower than those required for saturation of
the binding sites. However, for drugs such as the
sulphonamides, salicylates and phenylbutazone, the
therapeutic levels approach saturation concentrations, and
the percentage binding decreases with increasing drug
concentration. Saturation of the protein binding sites
and concentration-dependency within the therapeutic range
will occur at lower concentration for drugs which bind to
alphal-AGP than for drugs which bind to albumin, because
of the lower alphal-AGP levels in plasma. Comparison of
binding percentage between species is useful only when the
concentration at which binding is measured is known.
Interindividual and intra-individual differences

Considerable intersubject variability frequently exists in
serum binding of a particular ligand; in terms of free
fraction a 4 to 5-fold range is not uncommon even in
healthy animals or humans. Intersubject variation seems
to be more important for drugs mainly bound to alphal-AGP
than for drugs bound to albumin, as illustrated in Figure
18.1. The intersubject variation in serum binding of
three drugs mainly bound to alphal-AGP (lidocaine,
oxprenolol and propranolol), and of three drugs mainly
bound to albumin (digitoxin, phenytoin and diazepam), was
measured by equilibrium dialysis in 21 healthy dogs 4 • The
percentage free lidocaine, propranolol and oxprenolol
varies considerably, whereas the percentage free
digitoxin, phenytoin and diazepam varies to a much lesser
extent. The causes of such variations are many, but are
clearly related to variations in protein concentration and
in binding affinity.
Age. sex. pregnancy and disease states (renal failure.
liver disease. inflammatory diseases) also influence the
variability. This is also illustrated in Figure 18.1. In
21 dogs with inflammatory diseases. the free percentages
of lidocaine. oxprenolol and propranolol are lower than in
control dogs. but interindividual variation is also
important. For digitoxin. the percentage free drug is
higher than in control dogs; for phenytoin there is no
difference. and for diazepam the mean percentage free drug
is higher. Interindividual variations in binding of
digitoxin. phenytoin and diazepam are more important in
inflammatory disease than in healthy dogs. These results
demonstrate that there is a large interindividual
variation in binding of drugs which are mainly bound to
alphal-AGP. whereas this variation is much lower for drugs
mainly bound to albumin. Inflammation increases binding
of drugs bound to alphal-AGP. but does not change much
binding of drugs mainly bound to albumin.
Finally. genetic factors are probably also important.
but this is largely an unexplored area.
SPECIES DIFFERENCES IN BINDING OF DRUGS MAINLY BOUND TO

ALBUMIN
Species variations in the degree of binding to serum
proteins have been found for digitoxin. furosemide.
sulphonamides. phenylbutazone J • Drugs which are mainly
bound to albumin are in general more extensively bound in
human beings than in other mammalian species.
Nevertheless. the extent of binding of most drugs is
usually within a range which permits the binding of drugs
to be classified as high. moderate or low. regardless of
species J
In one study digitoxin binding was high. whereas for
digoxin it was low in several mammalian species. but
interspecies differences were present for each drug. The
fraction of digitoxin bound ranged from 92~ in man to 81%
in the pony. and for digoxin values between 17 and 40% in
LIDOCAINE OXPRENOLOL ~ROPRANOLOL DIGITOXIN PHENYTOIN DIAZEPAM

23 ~g/ml 1.25 ~g/ml 50ng/ml 20ng/ml 10 ~g/ml 250ng/ml
'1. free '1. '/. '/. '/. '/.

60 60 60 60 60
SO SO SO SO SO
-
\0 40 40 40 40
...L..
-,-~ ..
30 30 30 30 30
:
.. -+
-
'='
....
• *
20
• :
20 20 20
t
~
20 .2 :-
, " "l'
10
a 10 -i-
....
10
t ." 10 10
1t
~
c
~
c " c c c c
Figure 18.1 Percentage free lidocaine. oxprenol 01. pro-

pranolol. digitoxin. phenytoin and diazepam in the serum
of 21 healthy dogs (C) and of 21 dogs with inflammatory
disease (I) • The initial concentrations used for the in
vitro equilibrium dialysis are mentioned for each drug.
the different species were report edt •

The binding of morphine. studied in 13 mammalian
species. was low and ranged from 11% in swine to 24% in
cattle 2 •
The binding of furosemide was high in all species and
varied from 95% in man to 83% in the cat to • For
digitoxin. digoxin. morphine and furosemide species
differences were relatively small.
For salicylates. more pronounced interspecies
differences in binding were found by Sturman and Smithtt
who reported that species could be separated into two
groups. In baboons. horses. dogs. rats. mice. turkeys and
toads. there was a low protein binding capacity for
salicylate (less than 15% bound at a salicylate
concentration of 5 lJg/m 1) • In the second group (rhesus
monkey. rabbit. guinea-pig and man) there was a much
larger affinity (more than 70% bound at a salicylate
concentration of 5 lJg/ml).
More recently. Loscher' demonstrated for valproate. a
drug mainly bound to albumin. striking differences in the

degree of binding between man (95%). dog (79%). rat (63%)
and mouse (12%).
The differences in the extent of binding among species
may reflect different affinities for binding to albumin.
as well as differences in albumin concentration.
Variation in the chemical structure of albumin from
different species probably accounts for both quant i tati ve
and qualitative differences in binding of a given
compound7 , 12.
SPECIES DIFFERENCES IN BINDING OF DRUGS MAINLY BOUND TO

ALPHA1-AGP
For drugs mainly bound to alphal-AGP. such as oxprenolol.
propranolol and disopyramide. the differences in extent of
binding between species are more pronounced than for drugs
mainly bound to albumin. Data in the literature are
sparse. Figure 18.2 shows the binding of oxprenolol (1.25
ug/ml) and propranolol (10 ng/ml) to serum and to albumin
(4 g%) in man. dog. rat and rabbit. and to human alphal-
AGP (70 mg%)'. In the four species. albumin binding is
lower than serum binding and is quite similar in all
species. indicating that in each species except the
rabbit. other binding proteins are involved. probably
alphal-AGP. Indeed. as shown for man. binding to
alphal-AGP was more pronounced than to albumin. The
importance of alphal-AGP binding for the species
differences is also suggested by the fact that serum
binding in the rabbit. which is low and little higher than
the binding to albumin. increases markedly after induction
of arthritis. Inflammatory diseases enhance the concen-
tration of alphal-AGP in man. dog and rat. In healthy
rabbits the concentration of alphal-AGP is probably very
low or the protein has a low affinity for the drugs
studied. Species differences in capacity constant were
demonstrated for both drugs; species differences in
affinity constant were present only for propranolol.
These results suggest that in man. dogs and rats but
_ Serum
E:m Albumin
0/0 bound oxprenolol o o<,-AGP
'00 (51
(61
(51
80 (61
60
(31
40
•
(61
I
(61
20
0
HUMANS DOG RABBIT RAT
0/0 bound propranolol
100 (51 (61 (61
80
(61
(61
60
(61
40
Iii
20
0
HUMANS DOG RABBIT RAT
Figure 18.2 Percentage binding of oxprenolol (1.25 ug/ml)

and propranolol (10 ng/ml) to serum and to albumin (4 g%)
of different species and to human alphal-AGP (70 mg%).
Means (+SEM) are given: the number of experiments is given
between brackets. *Serum of arthritic rabbits. (From refe-
rence'. with permission).
much less in rabbits. oxprenolol and propranolol bind to

alpha.-AGP and that species differences in binding are due
to differences in concentration of alpha.-AGP and affinity
constants.
Similar results were found for disopyramide. another
drug mainly bound to alpha.-AGP in mana. Interspecies
variations in binding of disopyramide to serum in most

animal species (rabbit 5%, man 85%, horse 90%) were due to
differences in affinity for binding to alphal-AGP. There
was no relationship between disopyramide binding and the
capacity constants.
CONCLUSIONS
Protein binding markedly influences the disposition of
drugs, and some of the differences in the pharmacokinetics
among species can partly be explained by differences in
protein binding. This is illustrated for diazepam.
Klotz 6 found a significant correlation between the free
fraction of diazepam and the slow disposition constant n,
which characterizes elimination processes. This might
indicate that plasma protein binding determines the
hepatic elimination of this drug.
References
1. Baggot. J.D. and Davis, L.E. (1973). Plasma protein
binding of digitoxin and digoxin in several mammalian
species. Res. Vet. Sci. 15:81-87.
2. Baggot. J.D. and Davis, L.E. (1973). Species diffe-
rences in plasma protein binding of morphine and
codeine. Am. J. Vet. Res. 34:511-514.
3. Baggot. J.D. (1977). Principles of drug disposition
in domestic animals. Philadelphia: W.B. Saunders.
4. Belpaire, F.M •• Bogaert. M.G. and De Rick. A. (1984).
Variability of serum binding of drugs in healthy dogs
and in dogs with inflammatory disease. London: IUPHAR
9th International Congress of Pharmacology. Abstracts:
88P. London: Macmillan press.
5. Belpaire. F.M., Braeckman. R.A. and Bogaert, M.G.
(1984). Binding of oxprenolol and propranolol to
serum. albumin and alphal-acid glycoprotein in man and
other species. Biochem. Pharmacol. 33:2065-2069.
6. Klotz. U•• Antonin. K.H. and Bieck. R. (1976). Pharma-
kinetics and plasma binding of diazepam in man. dog.
rabbit. guinea pig and rat. J. Pharmacol. Exp. Ther.
199:67-73.
7. Kragh-Hansen. U. (1981). Molecular aspects of ligand
binding to serum albumin. Pharmacol. Rev. 33:17-53.
8. Lima. J.J. and Haughey. D.B. (1981). Disopyramide
binding to serum protein in man and animals. Drug
Metab. Dispos. 9:582-583.
9. Loscher. W. (1979). A comparative studY of the pro-
tein binding of anticonvulsant drugs in serum of dog
and man. J. Pharmacol. Exp. Ther. 208:429-435.
10. Neff-Davis. C.A. and Davis. L.E. (1982). Serum pro-
tein binding of furosemide in several species. J.

11. Sturman. J.A. and Smith. M.J.H. (1967). The binding
of salicylate to plasma proteins in different species.
J. Pharm. Pharmacol. 19:621-623.
12. Thorp. J.M. (1972). Inter- and intra-species diffe-
rences in the binding of anionic compounds to albumin.
In: De C. Baker. S.B. and Neuhaus. G.A. (eds). Toxi-
cological problems of drug combinations. Proc. of the
Meeting of the Eur. Society for the Study of Drug
Toxicity. Berl in 1971, vol. 13. pp.98-109. Den Haag:
De By.
Drug Residue Toxicology
19
The target animal species in drug toxicity studies:
an evaluation of its usefulness and limitations
T. A. J. M. DE ROIJ
ABSTRACT
In the safety evaluation of animal drugs both the target
animal species and man have to be considered. In the case
of feed additives the environment is a third factor. The
value of the target animal species in safety evaluation
can be increased considerably if more advantage is taken
of information obtained either directly or indirectly from
target animal studies. In particular. this applies to
studies of drug pharmacokinetics and metabolism and to
toxic effects in the target animal. The ultimate goals
have to be to obtain more relevant data for a
well-balanced risk assessment and concomitantly aim at a
reduction of the total testing programme.
INTRODUCTION
Drug development has evolved from a somewhat "haphazard"
activity. having many aspects in common with medieval
alchemy. to an enterprise requiring a multidiscipli-
nary approach in a well-structured and equipped setting.
Use is made of the ever-increasing insight into the pa-
thogenesis of diseases. knowledge of chemical struc-
ture-activity relations and new technological methodo-
logies.
The expansion of the scientific and technological
199
possibilities for developing better and safer drugs has

been accompanied by and is to some extent interrelated
with a considerable increase in the regulatory
requirements that have to be fulfilled before the use of
a drug is approved. Consequently. development time and
cost for a completely new drug are long and high,
respectively. A recent survey conducted by the US Animal
Health Institute Market Research Committee showed that to
develop a new anthelmintic for use in cattle takes
approximately 8 years and costs $16 million.
A substantial part of that sum is spent on safety
testing. The cost of a full battery of toxicity tests for
a pharmaceutical product is estimated to be approximately
$4 million. In the case of drugs for animal usage, the
cost of residue-related safety studies has to be added.
This means that between 30 and 40% of the development cost
of a new animal drug is spent on safety testing.
The wording "full battery of toxicity tests"
implies that testing is usually carried out following
rigidly fixed protocols. Animal species used, number of
animals per group. dosing regimen, parameters studied etc.
are standardized as much as possible to ensure that the
test results are acceptable to regulatory authorities.
This situation is unsatisfactory.
Both the academic world and industry put much effort in
the design and development of testing methods that are an
alternative to presently used methods. To be a useful
alternative. new testing methods should enable a more
reliable prediction to be given of the health hazards of a
drug to man. by providing information on the basic
mechanisms underlying the toxic effects t • tO ; they should
minimize the number of animals used and they should be
less expensive and time-consuming. Furthermore, the
availability of a series of tests from which a choice can
be made depending on the requirements in a particular
case, leads to more flexible testing procedures. Finally,
they should not be additional to presently used testing
programmes. but replace parts of it.
THE TARGET ANIMAL SPECIES IN DRUG TOXICITY STUDIES 201
In this chapter an overview is presented on how the

target animal species can be used more efficiently in the
safety evaluation of animal drugs. thus possibly leading
to a reduction of the total testing programme.
TARGET ANIMAL VERSUS LABORATORY ANIMAL

In the safety evaluation of animal drugs both the target
animal species and man have to be considered. In the case
of drugs that are administered repeatedly on a large
scale. the environment is the third entity to be taken
into account. The safety for man relates to the act ua I
contact with drugs during manufacture and handling as well
as to the consumption of edible tissues and products from
drug-treated food-producing animal species.
If a particular drug was initially developed for human
application. the results from a number of toxicity studies
in laboratory animal species are usually already
available. These relate only to the drug itself. not to
metabolites occurring as residues in edible animal
products. However. a separate veterinary drug development
is not uncommon as with growth promoters. coccidiostats.
antibiotic feed additives and anthelmintics.
Data on efficacy. target animal tolerance and drug
residues can only be obtained in studies with the target
species. These studies can by themselves provide a great
part of the information necessary for a risk assessment
relating to man.
PHARMACOKINETICS AND METABOLISM STUDIES

Studies on the pharmacokinetics and metabolism of animal
drugs in the target animal are a first example of how
target animal studies can provide much more information
relevant to safety evaluation and not merely information
on one aspect. namely the occurrence of residues in edible
tissues.
The pharmacokinetics and metabolism of a drug can vary
widely from one species to another. Therefore. studies
pertaining to these aspects with animal drugs have to be
carried out in the target animal species itself. The

methodology used is usually that of administering a
certain quantity of radiolabelled drug at one or more
appropriate sites in the molecule. together with the
non-labelled drug. The radiolabel should preferably be
C14. the appropriate sites are those in which the
radiolabel is not easily lost by metabolic degradation.
Information obtained in these studies relates to
(1) total residue level as a function of withdrawal time:

(2) extraction and concentration procedures;
(3) percentages of extractable and non-extractable
residues.
The extractable residue fraction consists of compounds

(parent drug and metabolites) that are free. that is.
unbound. or relatively easily released from their binding
sites by the extraction procedures used. The non-
extractable fraction is much less easily dealt with. in
view of the analytical difficulties encountered in its
identification. It consists of fragments of the original
drug molecule formed by extensive biodegradation and
incorporated into endogenous tissue structures. residues
that are covalently bound to DNA and other macromolecules
and residues that are not covalently bound. but yet cannot
be extracted with available procedures.
Covalently bound metabolites are a subject of special
concern. since covalent binding of reactive metabolites to
macromolecules such as DNA is considered a first step in
carcinogenesis and teratogenesis. The actual toxico-
logical significance of bound residues for the consumer is
far from clear. however. but this subject will not be
discussed in this chapter.
Aspects that can be investigated in conjunction with
pharmacokinetics and metabolism studies are: the bioavai-
lability of the residues. the mutagenic activity of the
extractable residues and the environmental fate of
excreted residues.
Bioavai labi I ity

The total residue usually is a complex mixture of parent
drug and bound or free metabolites. Consequently, the
bioavailability of the residues is not uniform and is
certainly not identical to that of the parent drug or
known metabolites incorporated as pure chemicals in the
diet. if only because the residues are embedded in the
tissue matrix.
However. if the residue complex contains toxic
components, their effect in man (the consumer) can only be
expressed in terms of bioavailability. An indication on
residue bioavailability is obtained by feeding the target
animal tissues originating from metabolism studies and
containing radiolabelled residue complex to one or more
laboratory animal species (model consumers). By
determining faecal and urinary excretion of radioactivity,
the fraction of the total residue that is absorbed after
oral administration is assessed. Additional analyses may
include level of radioactivity in several tissues of the
model consumers. Further refinements of this procedure
are possible by determining absorption before and after
extraction of the free residue fraction from the target
animal tissues. In this way the bioavailability of the
extractable residue fraction can be distinguished from
that of the non-extractable fraction. (For a more general
overview of this relay bioavailability methodology see 3 ) .
Examples of an application of the above principles
include trenbolone' and ronidazole 8 . , . In the case of
trenbolone no difference was observed between excretory
patterns of radioactivity in rats before and after
extraction of the residue-containing tissues with ethyl
acetate. With ronidazole the residue bioavailability
studies have been of considerable support in confirming
the hypothesis that a substantial fraction of the
persistent residues in swine muscle tissue is due to
endogenous substances (drug-derived fragments incorporated
into endogenous structures).
Mutagenic activity
An important element in the safety assessment of animal
drug residues is the provision of data to establish that
residues are not carcinogenic. whatever the underlying
mechanism of carcinogenicity may be. Before a decision is
taken on the need to commence carcinogenicity testing all
available information on chemical structure of the parent
compound and level and composition of the residue complex
in the edible tissues should be taken into consideration.
In a number of situations the value of this prescreening
assessment can considerably be increased by evaluating the
mutagenicity of the extractable residue complex. In
previous parts of the testing programme extraction and
concentration procedures have been established. These can
be applied to tissues from target animals to which
non-labelled drug has been administered. The concentrated
extract is subsequently su~jected to a limited series of
mutagenicity tests.
An extension of this testing method. which mimics the
processes occurring in the gastrointestinal tract of man.
consists of administering the residue-containing tissue to
laboratory animals and investigating whether the mutagenic
activity of the extractable residues is altered by gastro-
intestinal metabolic processes.
Requirements that have to be fulfilled for the above
procedure to be successful are :
(1) extraction and concentration methods must be suitable

to provide an extract that can be used in several
tests;
(2) the residue components must be sufficiently stable to
withstand extraction and concentration;
(3) the amount of residue must be sufficiently high.
Johnston and Hopke 4 have made an estimate of the

probability of detecting a mutagen with the Ames assay for
any weight of compound assayed. The estimate was based
upon data from 157 chemicals that gave a positive response
in the Ames test. Their results are of great help for the
design and analysis of experiments to detect mutagens.
especially mutagens present in complex. chemically
unidentified mixtures such as food. effluents. drug
residues. drinking water etc.
As far as the present author is aware the literature
gives no example of the application of the above procedure
to drug residue complexes.
Environmental fate
If a drug for use in animals is applied as a feed
additive. which implies large-scale use. an assessment
should be made of its environmental impact. A substantial
portion of the drug is excreted in urine and faeces. which
are subsequently used for soil fertilization. The
residues of the drug present in manure could be persistent
and have an adverse effect on manure degradation and soil
organisms and processes. The fate of the residues in the
environment can be investigated by using the excreta of
target animals. with which metabolism studies were
conducted. De Vries and de Roij have conducted some
experiments (unpublished results) following this procedure
regarding sulphadimidine.
A representative sample of urine and faeces from pigs.
that were administered an oral dose of 14C-sulphadimidine
together with a non-labelled sulphadimidine containing
ration. was applied to soil columns. The columns were
eluted daily during 2 months <equivalent of 9 mm
rain/day). After 2 months the soil columns were dissected
and analysed for extractable sulphadimidine and its major
metabolite N4-acetylsulphadimidine, extractable radio-
activity and non-extractable radioactivity. No radio-
activity could be detected in the leaching water.
From the upper 8 cm of the column. 15% of the applied
sulphadimidine and 40% of the applied N4-acetylsulpha-
dimidine were recovered by extraction. The greatest part
was retained in the upper 4 cm. Approximately 6% of the
total radioactivity applied was extractable from the upper
8 cm, whereas 50~ appeared to be non-extractable. Around

40~ was lost. probably by the formation of volatile
radiolabelled compounds.
From these and other experiments it was concluded that
both sulphadimidine and its major metabolite are rather
strongly adsorbed to soil particles. A substantial part
of these compounds may be transformed to volatile
degradation products.
TOXICITY STUDIES IN THE TARGET ANIMAL

At practical use levels, an animal drug must not be toxic
for the target species. Its safety margin has to be as
wide as possible. Animal drugs can be tested directly in
the target species using doses sufficiently high to
establish a safety margin. Parameters studied include
growth rate. feed and water intake. and also biochemical
and haematological values, histology, immunology and
reproduction. It may seem unnecessary to include the
latter aspects in target animal toxicity tests. However,
it must be realized that studying the toxic effects of
animal drugs in the target animals not only yields
information on the potential toxicity of the parent drug,
but also of the metabolites, to which man can be exposed
by consuming edible animal products. In fact. it is the
best example of the auto-exposure concept that is being
propagated in US drug regulations 2 , 7 . Data on functional.
biochemical and structural changes. resulting from
exposure of the target animal to a drug, can therefore be
very useful for an extrapolation to man.
One limitation might be that, in comparison with the
commonly used laboratory animal species. the target animal
is less uniform from a genetic point of view and that less
baseline data are available on biochemistry. haematology.
histologyetc,6. This will partly be compensated for by
the increasing knowledge of basic mechanisms of toxic
actions of chemicals. Furthermore. an extrapolation from
target species to man will in principle be as good or as
bad as an extrapolation from laboratory species to man.
CONCLUSION
The safety evaluation of new drugs. whether for human or
animal use. has become a long and arduous process. Much
time and money are spent to guarantee as far as possible.
that. under the conditions of use. drugs are safe. or that
the risk of the occurrence of unwanted effects is
acceptable.
For animal drugs. this not only relates to the target
species. but also to man who may be exposed to drug
residues in the edible products of treated animals. In
the last 10-15 years there has been a growing tendency to
put more emphasis on the latter aspect. Although the
wholesomeness of our food is an extremely important issue.
one should strive for a well-balanced approach in this
respect. It is not realistic to try to assess the
carcinogenicity of the last drug-derived molecule in
edible tissues. Moreover. requirements of this nature
will greatly hinder the further development of new drugs.
It has been shown in this chapter that in the process
of safety evaluation there are a number of opportunities
to obtain relevant information that. when used properly.
could result in an increase in testing efficiency and a
decrease in testing requirements.
References
1. Aldridge. W.N. (1981). Mechanism of toxicity. New
concepts are required in toxicology. TIPS 2:228-231.
2. Farber. ToM. (1980). Problems in the safety evalua-
tion of tissue residues. J. Environ. Pathol. Toxicol.
3:73-79.
3. Huber. W.G •• Becker. S.R. and Archer. B.P. (1980).
Bioavailabilitv of residues current status. J.
Environ. Pathol. Toxicol. 3:45-63.
4. Johnston. J .B. and Hopke. P.K. (1980). Estimation of
the weight-dependent probability of detecting a
mutagen with the Ames assay. Environ. Mutag.
2:419-424.
5. Ross. D.B. (1981). Toxicology and residues of trenbo-
lone acetate as a model. In: Jasiorowski. H. (ed.).
Steroids in Animal Production. pp.227-235. Warsaw
ARS Polona-Ruch.
6. Stevenson. D.E. (1979). Current problems in the
choice of animals for toxicity testing. J. Toxicol.
Environ. Hlth 5:9-15.
7. Weber. N.E. (1983). Metabolism and kinetics in the
regulation of animal drugs. J. Anim. Sci. 56:244-251.

8. Wolf. F.J .• Bayliss. F.P •• Smith. G.E .. Rosenblum. C••
Meriwether. H.T .. Alvaro. R.F .• Wolf. D.E •• Koniuszy.
F.R. and Jacob. T.A. (1983). Disposition of
ronidazole in swine. 1. Radiocarbon content of
tissues. J. Agric. Food Chem. 31:559-564.
9. Wolf. F.J •• Alvaro. R•• Steffens. J.J .• Wolf. D.E..
Koniuszy. F.R •• Green. M.L. and Jacob. T.A. (1984).
Tissue residues due to ronidazole : bioavailability of
residues in swine muscle on ingestion by the rat. J.
Agric. Food Chem. 32:711-714.
10. Zbinden. G. (1978). Appl ication of basic concepts to
research in toxicology. Pharmacol. Rev. 30:605-616."
20
The use of pharmacokinetics in chronic
toxicity testing
H. G. VERSCHUUREN AND R. H. REITZ
ABSTRACT
The usefulness of a unified pharmacokinetic model for the
chronic testing of drug residues is described. The model
was very suitable for the disposition and metabolism rate
of methylchloroform (MC) in humans. rats and mice, at
various exposure levels and with two different routes of
administration. The physiological parameters fed into the
model take account of old and young animals. The model
could provide more reliable estimations of health hazards
for the chemicals in our environment.
INTRODUCTION
Chronic toxicity studies are indispensable for the evalua-
tion of risks to humans, resulting from the exposure to
drugs. food additives. residues of pesticides or feed
additives. and to many industrial chemicals. The design
of the studies. including the choice of the dose levels
requires forward projection of available knowledge.
Nevertheless, sometimes results are obtained at high dose
levels. qualitativelY different from those obtained at
intermediate and low dose levels 3 , 7 , 1 4 .
This phenomenon has stimulated research into the fate
of chemicals in the body of animals at different dose
levels. Changes in absorption. distribution and met abo-
209
1ism in a dose-dependent manner have. with hindsight.

provided the key for the explanation of the findings
obtained in many experiments. More scientists are now
prepared to make use of pharmacokinetic data. in setting
dose levels for chronic toxicity and carcinogenicity
studies. The underlying principle is that data obtained
under unusual conditions. such as extremely high dose
levels. cannot be used directly to predict the fate of the
chemical and the effects it will have on the animal at
lower dose levels.
The development of mathematical models has advanced our
ability to predict the events. A unified pharmacokinetic
model was developed. suitable for predicting the
disposition of methv1ch1oroform in young and old animals.
in several species. including man, and by two routes of
administration.
Methy1ch1oroform (1.l,l-trich1oroethane. or Me) had
been investigated in man as well as in anima1s 9 • 12 in
separate experiments. However. a comprehensive unified
model capable of describing the pharmacokinetics of
methy1ch1oroform in several species after administration
by different routes has not been reported before. This
model was developed. based on physiological parameters to
simulate methy1ch1oroform disposition in mice. rats and
humans. following inhalation exposure. The simulation was
compared with actual data generated for these three
species. In addition. by changing the physiological
parameters. the predicted disposition in elderly rats and
mice was compared with data obtained by Schumann et a1 . 1 3 .
Furthermore. the model was used to predict the disposition
of methy1ch1oroform given in drinking water and these
findings were compared with actual data obtained by Reitz
et aLii. Methy1ch1oroform was used to develop this
model. because of the multitude of actual data points
available. The significance of the model for other
chemicals including veterinary drugs is discussed below.
THE USE OF PHARMACOKINETICS IN CHRONIC TOXICITYTESTING 211
METHODS
Four-compartment model
A four-compartment physiological model. similar to that
developed by Ramsey and Andersen 10 was used (Figure 20.1).
PhYsiological parameters
Body weights were as follows: humans: 83 kg; young rats:
215-250 g depending on the average actual weight in a par-
ticular study: elderly rats: 468 g; young mouse: 29 g:
elderly mouse: 37.5 g.
Volumes of individual tissue

The volumes of individual tissue compartments (in litres)
were calculat.ed by multiplying the total bodY weight by
the relative percentage for each tissue. assuming unit
density (1 g/ml> for all tissues. The relative percent-
ages of individual tissue compartments in humans were
taken from Davis and Mapleson'. who obtained much of their
data from the report of the Task Group on reference mana.
and these are summarized in Table 20.1. Relative percent-
ages of the tissue compartments in young rats were taken
from reference 4 • Relative percentages of the tissue
compartments in elderly rats were assumed to be identical
to those of young rats. except that the relative fat
content was increased to 28.3%. with a corresponding
decrease in the relative percentage of the slowly
perfused compartment from 63.5 to 61.3% (see Table 20.1).
Volumes of the tissue compartments in young mice were
assumed to be identical to those of young rats except that
the percentage of body fat was set at 2% of total bodY
weight. The relative percentages of the tissue
compartments in elderly mice were equal to those of young
mice except that the fat compartment was increased from
2% to 16% of bodY weight (see Table 20.1). The values
used for relative fat content of the older animals were
chosen by the computer to give the best possible
simulation of the experimental data.
CI t... cx
QP
Alveolar air T" QP
•• --~-~ rA
T
CV
Pulmonary blood ~
1
QC
QC
t-_c_v_F_~Cl"l
I Fat I---. CA
QF lL-___C_v_F_=_C__F_/P_F____~~ QF
CVR 1 Rapidly perfused J..-,.. CA
QR
1 CVR= CR/PR ('<" QR
CVS
Slowly perfused )0....,. CA
~
QS
1 CVS=CS/PS
I
QS
CVL Liver CA
QL CVL = CLlPL Y QL
r--------'I
Km/Vmax zero order rate
i' constant
/'-~::r-------'
AM(
Figure 20.1 PhYsiological model used to describe the

pharmacokinetics of methylchloroform in rats. mice and
humans during inhalation and drinking water exposures to
methylchloroform. C = concentration: Cl : concentration
in inhaled air: CX = concentration in expired air; CV =
concentration in venous blood; CA = concentration in
arterial blood: CVF = concentration in venous blood
draining adipose tissue: CR = concentration in rapidly
perfused compartment: CS = concentration in slowly
perfused compartment: CL = concentration in liver; Q =
flow in litre/h: QP = alveolar ventilation rate: QC =
cardiac output: QF = flow through fat compartment: QR =
flow through rapidly perfused compartment; QS = flow
through slowly perfused compartment: QL = flow through
liver compartment: PB = blood/air partition coefficient
(pc): PF = blood/fat partition coefficient: PL = liver/
THE USE OF PHARMACOKINETICS IN CHRONIC TOXICITY TESTING 213
blood partition coefficient; PR = rapidly perfused/blood

partition coefficient; PS = slowly perfused/blood parti-
tion coefficient; Km = Michaelis constant; Vmax = maximum
velocity of metabolism.
Cardiac output and alveolar ventilation

Cardiac output and alveolar ventilation for humans were
taken from Davis and Mapleson'. Cardiac output and
alveolar ventilation for the other species were scaled to
the 0.7 power of body weight, as outlined by Ramsey and
Andersen to • All values are tabulated in Table 20.1.
Flows to individual tissue groups

Flows to the individual tissue groups were calculated by
multiplying the relative percentage of flow to each tissue
by the appropriate cardiac output. It was assumed that
the same percentage of cardiac output would perfuse the
tissue groups in all three species. and the percentages
were taken from Davis and Mapleson'. All values are
tabulated in Table 20.1.
Partition coefficients
Tissue/air partition coefficients were determined for rat
blood. liver. fat and muscle using the vial equilibration
technique of Andersen et al. 2 • Tissue/blood partition
coefficients for rat fat, muscle, and liver were than
calculated by dividing the measured tissue/air partition
coefficient by the blood/air coefficient for rat blood.
To estimate the blood/tissue partition coefficients for
the rapidly and slowly perfused compartments. the parti-
tion coefficients for liver/blood and muscle/blood were
doubled (see Table 20.1). This gave a good fit with
experimental data. and was rationalized by considering
that other components of these heterogeneous compartments
such as brain and skin contain more lipid than liver and
muscle. respectively. Blood/air partition coefficients
for human and mouse blood were determined by the method of
M.L. Gargas and M.E. Andersen (personal communication).
Table 20.1 Parameters used in the physiologically based

pharmacokinetics model for methylchloroform. The abbre-
viations are: Rat 1. young rats (2-4 months); Rat 2. old
rats (18.5 months): Mouse 1. young mice; Mouse 2. elderly
mice. Parameters used for drinking water simulation in
rats are very close to Rat 1 and are not shown.
Human Rat 1 Rat 2 Mouse 1 Mouse 2
Weights in kg
Body weight 83.0 0.215 0.468 0.029 0.038
Li ver* 2.6 4.1 4.1 4.1 4.1
Rapidly perfused* 3.1 6.2 6.2 6.2 6.2
Slowly perfused* 52.4 63.5 61.3 63.5 63.5
Fah 19.5 7.1 28.3 2.0 16.0
Flows in litres/h
Alveolar ventilation 300.0 4.64 7.98 1.14 1.37
Cardiac output 388.8 6.01 10.4 1.48 1.77
Li ver** 24 24 24 24 24
Rapidly perfused** 53 53 53 53 53
Slowly perfused** 18 18 18 18 18
Fat** 5 5 5 5 5
Partition coefficients
Blood/air 2.5 6.2 6.2 10.8 10.8
Liver/air 12.5 12.5 12.5 12.5 12.5
Rapidly perfused/air 25.0 25.0 25.0 25.0 25.0
Slowly perfused/air 14.5 14.5 14.5 14.5 14.5
Fatlai r 280.0 280.0 280.0 280.0 280.0
Metabolic constants
Vmax (mg/h) 3.91 0.0604 0.104 0.0149 0.0178
Km (mg/litre) 3.5 3.5 3.5 3.5 3.5
* Percentage of body weight

** Percentage of cardiac output
Tissue/blood coefficients for human and mouse tissues were

calculated by dividing the measured or estimated
tissue/air partition coefficient for the corresponding rat
tissue by the blood/air coefficient for the other species.
Partition coefficients used in these simulations are
listed in Table 20.1.
Values of Vm and Km
The values of Vm and Km were manually adjusted to fit the
data gathered by Schumann et al. '2 describing the
metabolism of inhaled methylchloroform in young rats. The
value of Vm was then scaled to the 0.7 power of body
weight for the other species (see Table 20.1). Km was
held constant at 3.5 mg/l methylchloroform for all three
species.
Computer programs
Simultaneous differential equations describing the fate of
methylchloroform were formulated as a computer program as
outlined by Ramsey and Andersen 'o • Simulations were
conducted with a software package developed by Agin and
Blau ' and were run on an IBM 3033N computer.
RESULTS
In models such as those shown in Figure 20.1, tissues have
been grouped together according to relative blood flow
rates and tissue/blood partition. In this particular
example, we have five groupings: (1) the lung, where gas
exchange occurs; (2) the fat bed. with relatively high
affinity for methyl chloroform: (3) the rapidly perfused
tissues (such as kidney): (4) the slowly perfused tissues
like muscle: and (5) the metabolizing tissues (which com-
prise the liver in this particular case).
Methylchloroform may enter this system either through
the inhaled air (inhalation exposure) or the gastrointes-
tinal tract. Uptake from the gastrointestinal tract was
assumed to occur rapidly. and was simulated by assuming
input directly into the liver for drinking water
exposures. Metabolism of methylchloroform is assumed to

occur according to saturable Michaelis-Menten kinetics.
Simultaneous differential equations to describe the
movement of methylchloroform in each of these compartments
can be formulated if we know the flows and partition
coefficients associated with each step. The first set of
predictions related to the concentration-time course in
venous blood in rats. Figure 20.2 shows a solid line for
the prediction. open circles for the low (150 ppm) and
triangles for the high exposure level <1500 ppm)12. A
good fit was obtained Quickly without the necessity of
extensive adjustments with model parameters.
In addition to predicting the time course of methyl-
chloroform in venous blood. the physiological model is
capable of describing a variety of other properties which
may be verified experimentally. For each of the
parameters the ratio of the model prediction to the a~tual
data is calculated for exposure to 150 and 1500 ppm. For
concentrations in the blood at the end of the 6 hour
exposure this ratio was 1.66 at 150 ppm and 1.9 at 1500
ppm. EquallY so the ratio for the body burden <total
amount present in the body) at the end of the 6 hour
exposure was 1. 11 and 1.36 respectively: for the amount
metabolized: 1.07 and 0.92: for the concentration in fat
1.95 and 1.69: for the concentration in the liver 1.05 and
1.44. The ratio of predicted to actual data varied
between 0.92 and 1.98. with a mean ratio of 1.51 in rats.
The fitting of five additional parameters. keeping the
ratio within a factor of 2. is really remarkable.
The rat model was then used as a basis for
extrapolation to the 86C3Fl mouse. This entailed scaling
the flows and metabolic rates and incorporating a new (ex-
perimentally determined) partition coefficient.
The time profile of methylchloroform in venous blood is
shown in Figure 20.3 for 150 and 1500 ppm exposures during
6 h. Methylchloroform reached higher peak blood levels in
mice (about 4-fold) but was eliminated five to ten times
more rapidly after termination of exposure. The
THE USE OF PHARMACOKINETICS IN CHRONICTOXICITYTESTING 217
Rats
Venous blood
10+ 1
"80
:0
E
U
::0
'""- 10. 1
10. 2
10. 3
0 8 16 24 32 40 48 56
Time (h)
Figure 20.2 Concentrations of methvlchloroform in venous

blood of rats resulting from a 6 h exposure to 150 or 1500
ppm of methvlchloroform.
phYsiological model accurately predicted both these facts

without any adjustments to model parameters.
In addition to the venous blood levels of methylchloro-
form in mice. the model was used to describe several other
properties of this agent. Again. an excellent agreement
was obtained between the model predictions and the actual
data. The ratio of predicted to actual data for the 150
and 1500 ppm exposure levels was as follows for
concentrations in the blood at the end of the 6 hour
exposure the ratio was 0.93 and 0.78 for 150 and 1500 ppm
respectively; for the body burden after 6 hour exposure
0.69 and 0.77: for the amount metabolized 0.78 and 0.69:
for the concentration in fat 1.29 and 1.07 and for the
concentration in the liver 1.00 and 1.22 respectively.
Mice
Venous blood
1500 PPM
10+1
]
.Q
E l()+o
CJ
::IE
at
'"
10- 1
150 PPM
10-2
0 4 8 12 16 20 24 28
Time (h)
Figure 20.3 Concentrations of methylchloroform in venous

blood of mice resulting from a 6 h exposure to 150 or 1500
ppm of methyl chloroform.
With slight modifications. it proved possible to use

this model to describe the disposition of methylchloroform
in rats after consumption of drinking water containing 4.4
mg/ml of 14C methyl chloroform. Rats were given free
access to treated water for 8 h. resulting in a mean dose
of 143 mg/kg. During and following exposure. the rats
were housed in glass metabolism cages. and the radio-
activity in expired air was collected with activated
charcoal traps. The concentration of methyl chloroform in
expired air predicted by the model as well as the
concentration actually obtained are shown in Figure 20.4.
Methylchloroform elimination was well described for the
first 30 h. After this period. the model predicted less
Rats
Expired air
10+ 0
10-'
...
'ii 10-2
~
'i5,
10.3
•>C
S 10.4
~
21
'"E 10. 5
10.6
10- 7
9 17 25 33 41 49 57
Time (h)
Figure 20.4 Concentrations of methyl chloroform in expired

air collected from rats during and following exposure to
saturated solutions (4.4 mg/ml) of methylchloroform in wa-
ter for 8 h.
radioactivity in expired air than was actually observed.

However. at this point. 99.9% of the administered radio-
activity had been recovered. so the last few radioactive
counts may represent a slowly eliminated volatile metabo-
lite of methylchloroform. such as trichloroethanol. The
model predicted 5.3 umol of methyl chloroform would be
metabolized. and 8.0 umol were actually recovered. giving
a prediction ratio of 0.66.
The ultimate test of any extrapolation procedure is how
well it can predict human data from animal experiments.
In this case. we already had the human data available. but
we proceeded as if we had only animal data to check the
usefulness of this procedure. The model was used.
unchanged. to predict the disposition of methyl chloroform
after either 35 or 350 ppm inhalation exposures in humans.
Data gathered by Nolan et a1. 9 for periods UP to 10 days

post-exposure are shown in Figure 20.5. Blood levels of
methy1ch10roform during exposure were slightly lower than
model predictions, but the degree of agreement was
exce11 ent.
Similarly, the concentrations of methy1ch10roform in
expired air obtained by Nolan et a1. 9 were compared with
the model predictions. The expired air concentrations
during exposure were perfectly predicted. There were
slight discrepancies in the 20-40 h post-exposure period.
The methv1ch10roform metabolites recovered by Nolan were
68% and 62%, respectively, of the values predicted by the
model for 350 and 35 ppm.
Finally, the model was used to describe a hypothetical
human exposure to methy1ch10roform in drinking water. For
this simulation it was assumed that humans consume two
1itres of water/day, and that this water contains 0.31 ppm
methy1ch10roform. This value was chosen as a "worst
case". because this is the highest concentration reported
in drinking water supplies by the United States EPA. For
mathematical convenience, it was assumed that people
consume small amounts of water periodically throughout the
day, therefore the input of methylch10roform was simulated
as a zero order process equal to the average rate of
uptake. The stimulation was then run for periods varying
from 1 to 100 days.
It was apparent from these simulations that steady
state is approached within Just a few days. Furthermore.
the bodY burden of methy1ch10roform after 100 days of
water consumption was only 2.7 times higher than that
present after a single day of drinking such water.
The model also made it possible to calculate the
average bodY burden of methy1ch10roform in humans under
these conditions. We compared this value to the average
bodY burden of methy1ch10roform present in animals at the
"no observed effect level" in chronic studies conducted at
Dow. The "no observed effect levels" we observed were 875
ppm for rats and 1500 ppm for mice. The bodY burdens of
Humans
Venous blood.
10-'
I
~::E
~ 10- 2
10- 3
10-'
0 40 80 120 160 200 240 280
Time (h)
Figure 20.5 Concentrations of methylchloroform in venous

blood collected from humans during and following exposure
to 35 ppm (open triangles) or 350 ppm (open circles) of
methylchloroform for 6 h.
methylchloroform failing to produce toxicity in these

animals were five to six orders of magnitude higher than
those predicted to occur in humans consuming such water.
DISCUSSION
From the results obtained. the conclusion may be drawn
that for methylchloroform a unified pharmacokinetic model
can be successfully applied. The model was fed with the
relevant phYsiological data. and a limited number of
experimental determinations of partition coefficients and
metabolism. and disposition studies.
The same model was able to describe a wide variety of
data in humans. rats and mice over a broad range of
inhalation exposures. This was so even when the exposure
levels were high enough to cause saturation of metabolism.
Another feature of this model was its ability to

describe the disposition of methyl chloroform given to rats
by different routes. inhalation or drinking water.
With all the close fits between actual data and model
predictions. one could confidently move to the next step:
prediction into an area where no confirmatory data are
available. Reitztt used the model for the risk evaluation
relevant to an assumed drinking water contamination with
methylchloroform. The bodY burden for humans is
predicted. to be five to six orders of magnitude below the
"no observed effect level sOl in experimental animal s.
The use of this model could mean a significant step
forward in calculating the potential health hazards of
chemicals in our environment. It is obvious that this
promising model should be further tested with other
chemicals. including veterinary drugs. Those chemicals
with data available on partition coefficients and metabo-
lism/disposition in more species should be selected for
this purpose. The results obtained in the application of
this model should stimulate investigations to obtain the
appropriate pharmacokinetic data available before starting
a long term study. Knowing the fate of the chemical in
the bodY at several dose levels can be an enormous help in
estimating the toxicological impact involved.
References
1. Agin. G.L. and Blau. G.E. (1982). Application of
OACSL (Dow Advanced Continuous Simulation Language) to
the design and application of chemical reactor
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2. Andersen. M.E •• Gargas. M.L. and RamseY, J.C. (1984).
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W.O. (1956). Tissue weights of the rat. I. Normal
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Proc. Soc. Exp. Bio1. Med. 91:122-126.
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6. Gehring. P.J. (1968). Hepatotoxic potency of various
chlorinated hydrocarbon vapors relative to their
narcotic and lethal potencies in mice. Toxico1. Appl.
7. Gehring. P.J. and B1au. G.E. (1977), Mechanisms of
carcinogenesis dose response. J. Env. Path. Toxico1.
1:163-179.
8. International Commission on Radiation Protection
(1975). Report of the task group on reference man.
W.S. Snyder et a1. (eds). ICRP Publ ication 23.
New York : Pergamon Press.
9. Nolan. R.J •• Freshour. N.L., Rick, D.L •• McCarty. loP.
and Saunders. J.H. (1984). Kinetics and metabolism of
inhaled methyl chloroform (1.1.1-trich10roethane) in
male volunteers. Fund. Appl. Toxico1. 4:654-662.
10. Ramsey. J.C. and Andersen. M.E. (1984). A phYsiologi-
callY based description of the inhalation pharmacoki-
netics of stYrene in rats and humans. Toxico1. App1.
11. Reitz. R.H •• Schumann. A.M •• Osborne. D.W. and Nolan.
R.J. Pharmacokinetics of 1.1.1-trich10roethane (MC)
in humans. rats and mice after inhalation or drinking
water administration. The Toxicologist 5:110.
12. Schumann. A.M •• Fox, T.R. and Watanabe. P.G. (1982).
[14CJmethy1 chloroform (1.1.I-trich10roethane)
Pharmacokinetics in rats and mice following inhalation
exposure. Toxicol. Appl. Pharmacol. 62:390-401.
13. Schumann. A.M •• Fox. T.R. and Watanabe. P.G. (1982).
A comparison of the fate of inhaled methyl chloroform
(1.1.1-trichloroethane) following single or repeated
exposure in rats and mice. Fundam. App1. Toxico1.
2:27-32.
14. Watanabe. P.G •• Zemp1e. J.A., Pegg. O.Y. and Gehring.
P.J. (1978). Hepatic macromolecular binding following
exposure to vinyl chloride. Toxicol. Appl. Pharmacol.
44:571-579.
21
The Food Animal Residue Avoidance Databank
(FARAD): a computer databank of the
pharmacokinetics of drugs, pesticides
and environmental chemicals in food animals
A. 1. CRAIGMILL, s. F. SUNDLOF AND J. E. RIVIERE
ABSTRACT
The Food Animal Residue Avoidance Databank (FARAD) is a
computer databank of information on chemicals considered
to be actual or potential residue problems in the United
States. FARAD has been developed under the auspices of
the United States Department of Agriculture Extension
Service. Residue Avoidance Program (RAP). FARAD includes
a listing of all drugs approved by the Food and Drug
Administration for use in food animals. all the tissue.
egg and milk tolerances for 119 chemicals. and information
on the chemical properties of these chemicals. The major
focus of FARAD has been to collect all published
information on the pharmacokinetics of these chemicals in
food and non-food animal species. FARAD currently
contains information on 938 proprietary drug preparations
approved by FDA. 253 residue tolerances. and over 3000
pharmacokinetic entries linked to over 700 bibliographic
citations. After completion of data extraction and entry
into FARAD. this information will be used for making
detailed analYsis of interspecies differences in
pharmacokinetics. to study disease-induced changes in
pharmacokinetics. and to study the relationship of serum
pharmacokinetics to tissue residues.
225
INTRODUCT ION
The Food Animal Residue Avoidance Databank (FARAD) is
being developed as an integral part of the United States
Department of Agriculture Extension Service. Residue
Avoidance Program (RAP). The RAP project was started to
implement educational and field research programs that
would help to decrease the incidence of food animal
residue violations in the United States. The FARAD is a
cooperative pilot project between five states
California. Florida. Idaho. Illinois and North Carolina.
The role of FARAD in the Residue Avoidance Program is the
acquisition. consolidation and dissemination of residue
avoidance information.

FARAD was first developed using a commercially available
relational database management program called dBASE II.
and Osborne I microcomputers with 20 megabyte hard disk
storage systems. The data file structure and dBASE II
program files for FARAD operation were developed at North
Carolina State University. The data files and user
program files have been successfully transferred to IBM
personal computers equipped with hard disk storage devices
and to a DEC 11/730 minicomputer. dBASE III. the dBASE II
upgrade program for the IBM personal computer. is the
software program currently used for data storage and
retrieval.
The FARAD is made up of six separate data files that
are linked on the generic chemical name. The first of
these files is the Tradename file which contains a listing
of all the drugs currently approved by the FDA for use in
food animals. the manufacturer name. the species for which
they are approved. the dosage. route of administration.
indications for use. and withdrawal times. The second
file is the Generic chemical file which contains
information on the chemical formula. pKa. log P (partition
coefficient). solubility and analytical methods for 119
different chemicals. The third file is the Tissue
THE FOOD ANIMAL RESIDUE AVOIDANCE DATABANK (FARAD) 227
Tolerance file which contains the tolerance levels

established for the 119 chemicals in food animal products
and the Federal Register reference for each. The fourth
is the RAP Project Material file which contains a
description of all the educational and research materials
developed by all participants in the RAP program, the type
of material. the source, and the address of a contact
person. The fifth is the Bibliographic Citation file
which contains a complete citation of every article from
which pharmacokinetic data were extracted. The sixth, and
most extensive. file is the Pharmacokinetic file. The
information that may be entered into each pharmacokinetic
record is shown in Table 21.1. Each record is referenced
to a bibliographic citation, and each citation may give
rise to multiple pharmacokinetic records.
Da t a ext r a ct ion
The Food Safety and Inspection Service gave FARAD a list
of 119 chemicals that were considered to have the
potential to cause residues in food animal products. In
this list there were 42 antibiotics. 26 pesticides. 13
environmental contaminants. 11 anthelmintics, 8 hormones
and 14 mycotoxins. This list formed the nucleus of
chemicals included in FARAD. Information on the chemical
properties of these compounds was obtained from Toxicology
Data Bank searches and primary sources. Tissue tolerances
were obtained from the Food and Drug Administration and by
searching the Federal Register. Literature sources of
kinetic information were found by doing computerized
searches using AGRICOLA, TOXLINE and MEDLINE and then by
searching the bibliographies of each relevant paper for
additional citations. Copies of each paper that contained
relevant kinetic or residue information were obtained from
local libraries or from the National Agricultural Library
which provided free document delivery as their
contribution to FARAD. All data extraction is carried out
at both the University of California and the University of
Florida.
Table 21.1 Structure of the pharmacokinetic data file
Field Field name Width Description
9 Citation number (Bibliogra-

phic File)
2 CON_CODE Confidence code
3 GENERIC 61 Generic chemical name
4 DRGCLASS 20 Drug class
5 SPECIES 10 Speci es code
6 HEALTH 45 Health status
7 DOSE 16 Dose (mg/kg)
8 INTERVAL 8 Dosage interval
9 DOSE NUM 11 Number of doses given
10 ROUTE 63 Route of administration
11 EXCR 27 Excretion route(s) and
percentages
12 VD 32 Volumes of distribution
(B. ss. area)
13 CLR 12 Clearance(s)
14 SPB 5 Serum protein binding
15 HLIFE 27 Half-lives (1.2.3)
16 CP 39 Maximum and minimum plasma
levels
17 METABOL 65 Measured metabolites
18 OTH_DAT 130 Other useful data
19 LU_DATE 8 Last update to record
20 MATRIX 10 Matrix (serum. liver.
kidney. etc.)
21 INTERC 27 Intercepts (A.B. C)
22 RATE 12 Glomerular filtration rate
23 NUM_ANIM 4 Number of animals studied
24 SPECIES2 20 Breed. age. weight
Over 2000 articles have been screened for residue or

kinetic data. and over 700 citations have been found that
contain useful data. Most art icl es do not contain all of
the parameters listed in Table 21.1, however any useful

information found is entered. If the authors have done a
pharmacokinetic analysis of the data, their results are
entered into FARAD directly. The only changes made are
conversions to standard units. There are many papers
that contain tissue residue or plasma level data that were
not analysed for pharmacokinetic parameters by the
authors. These data are extracted and sent to North
Carolina State University, which is the site at which data
are analysed and entered into FARAD.
Data analysis and entry into FARAD

Data taken from articles that contain residue or plasma
level information that has not been analysed for kinetics,
are processed through an automated curve stripping program
(CSTRIP) for initial parameter estimates and then are
analysed using a non-linear regression program (SAS-NLIN)
which calculates relevant model-independent curve-fit
parameters (slopes, areas, heights. moments). These
estimates are then passed to a Fortran program which
automatically selects the proper number of exponentials
and weighting schemes using parametric and non-parametric
statistical tests. and calculates the desired
pharmacokinetic parameters. Tissue residue depletion data
are analysed using a first-order log-linear regression
analysis to determine the half-life of the residue in
tissues. These data generated by FARAD are keyed both to
the original citation from which the data were extracted,
and to FARAD. Copies of all the FARAD-generated data are
filed with the original article and data extraction
sheets.
There are currently more than 3000 individual
pharmacokinetic entries in FARAD that have been taken from
over 700 articles. The pharmacokinetic file is projected
to contain at least 10.000 records when complete and thus
is approximately 30% finished. Completion of data entry
is expected by January 1986. New records from recently
published 2rticles will be added as they appear in order
to keep FARAD current. The percentage of articles in

FARAD by species is shown in Table 21.2. The make-up of
the kinetic file mirrors the amount of published research
that has been done on the kinetics of chemicals in each
species. Pharmacokinetic data from non-food animals are
included in FARAD because. in many cases. kinetic studies
have not been done in food animals. Limited human kinetic
data are available in FARAD. but not all human data found
are entered.
Table 21.2 Pharmacokinetic file breakdown by species
Speci es Per cent
Rodent 22.55
Bovine 20.73
Human 8.86
Canine 8.43
Avian 8.23
Ovine 3.64
Equine 3.45
Porci ne 3.02
Caprine 0.91
Feline 0.38
Other 19.82
Data dissemination
The dissemination of residue avoidance information is a
major aspect of FARAD and is carried out at three sites.
the Universities of California. Illinois and Florida.
FARAD is not available "online". but is currently an
expert mediated system. Each call for information is
screened by a toxicologist and the appropriate data are
delivered to the caller. Information contained in any
file except the pharmacokinetic file can be sent without
review by the toxicologist. Due to the complexity of the
pharmacokinetic data. the expert is essential for the
appropriate application of kinetic information to residue

problems.
CONCLUSIONS
The FARAD is a multifaceted computer databank of residue
avoidance information. One of its most important elements
is a data file of pharmacokinetic information on the fate
of chemicals in food animals. FARAD contains heretofore
unpublished information generated from the analYsis of
data taken from published articles that did not perform
kinetic analysis. It is a valuable resource for examining
interspecies differences in kinetics. disease-induced
differences in kinetics. and the relationship of serum
kinetics to tissue kinetics.
Acknowledgements
This project was funded by the United States Department of
Agriculture Extension Service with pass-through funding
from the Food Safety and Inspection Service. Postdoctoral
fellow support was provided for in part by NIEHS training
grant ES07046. This support is gratefully acknowledged.
Inflammation and
Anti-Inflammatory Drugs
Immunomodulation
22
Modulation of autonomic receptor function by
Haemophilus influenzae in the respiratory system
F. P. NI]KAMP, F. ENGELS AND G. FOLKERTS
ABSTRACT
Pretreatment of guinea-pigs with the respiratory pathogen
Haemophilus influenzae induces a deterioration of the
pulmonary beta-adrenergic receptor system and
hyperreactivity of the pulmonary cholinergic receptor
system in vitro. This dYsfunction of the autonomic
nervous system is accompanied by a bronchial
hyperreactivity to histamine in vivo. mediated by direct
and reflex effects of histamine in the larger airways.
Guinea-pig pulmonary macrophages stimulated with serum
from H. influenzae pretreated animals mimic the
deteriorating influence on the beta-adrenergic system in
the larger airways in vitro. A role for oxygen-centred
radicals is suggested.
INTRODUCTION
Increased bronchial irritability, or hyperreactivity, to a
wide variety of different phYsical and chemical stimuli is
a characteristic feature of patients with chronic
obstructive lung disease. Airway hyper responsiveness has
often been associated with bronchial i nfl ammat i on 3 • In
healthy subjects respiratory airway infection results in
an increased bronchospasm to inhaled methacholine and
histamine. The mechanisms responsible for bronchial
235
hyperreactivity are largely unknown. but the experimental

evidence suggests that the disorder may stem from
disturbances in mechanisms regulating airway smooth muscle
tone rather than abnormality in the muscle itself (for
reviews see b ,1). In particular. an imbalance between
the bronchoconstrictor parasympathetic cholinergic
receptor system and the bronchodilator sympathetic
beta-adrenergic system of the autonomic nervous system may
predispose to bronchoconstriction 6 • 7 • Release of
acetylcholine at the parasympathetic nerve endings leads
to stimulation of cholinergic receptors with a resulting
excessive bronchoconstriction response. oedema due to
leakage from small vessels and increased mucus secretion.
In contrast. stimulation of the beta-adrenoceptors of the
sympathetic system by the endogenous hormone adrenaline or
the neurotransmitter noradrenaline has opposite effects.
that is. dilatation of the airways. vasodilatation. a
decrease in the oedema. increased clearance of mucus and
furthermore prevention of asthmatic mediator release.
The autonomic receptor system is dynamic and constantly
changing. Stimulation decreases the number of receptors.
while the absence of stimulation due to decreased
concentrations of the specific hormones increases the
number of receptors specific for that hormone. An altered
function of the beta-adrenoceptors of the effector organs
in asthma has been postulated by Szentivanyi t4 • He
regards partial beta-adrenergic blockade as the
fundamental factor of atopic abnormalities in general and
bronchial asthma in particular. This hYPothesis was based
on an analogy of the symptoms of patients with bronchial
asthma to those which could be induced by vaccination with
Bordetella pertussis. such as hypersensitivity to
pharmacological mediators. immunological reaction to
antigen. and a decreased response to beta-sympatho-
mimetics. However. B. pertussis lacks an obvious
relationship with infections in asthmatic bronchitis.
while the taxonomically closely related bacterium
Haemophilus influenzae. usually found in the upper
MODULATION OF AUTONOMIC RECEPTOR FUNCTION BY H. INFLUENZAE 237
respiratory airways. often can be isolated from the deeper

airways of patients with asthmatic bronchitis.
Previously we showed that H. influenzae induces a
deterioration of the pulmonary beta-adrenergic system and
a hyperreactivity of the cholinergic system in
experimental animals (for review see ) . The number of
I2
radioligand detectable beta-adrenoceptor binding sites in

peripheral lung tissue was significantly reduced 4 days
following administration of H. influenzae lo • Furthermore
the tracheal spirals from treated animals showed
significantly less relaxation to the beta-sympathomimetic
isoprenaline. regardless of whether the trachea was
maximally contracted with carbachol or studied with normal
intrinsic tone'.
8esides H. influenzae. other bacterial suspensions also
induced significant decreases in the beta-adrenoceptor
number. that is. Streptococcus pneumoniae. 80rdetella
pertussis and Escherichia coli 01 11 8 •• S. pneumoniae has
entirely different structural components in its cell wall
and is not taxonomically related to H. influenzae.
suggesting a rather aspecific effect. On the other hand.
Staphylococcus aureus. an influenza A virus and
Escherichia coli J~ did not have similar properties.
Because both of the other effective species were
gram-negative. we tested whether the lipopolYsaccharide
(LPS) in the cell outer membrane was the responsible
structure. The LPS of the effective (0111 8.) and
ineffective (J~) E. coli strains were isolated by
phenol-water extraction and tested in our experimental
model. These LPS preparations showed similar properties
to the killed suspensions of complete bacteria. The E.
coli 01118.-LPS induced a decrease in beta-adrenoceptor
number of approximately 20%. 4 days following vaccination.
while the E. coli J~-LPS was not effective l l •
There is an extensive cross-reaction between
polysaccharides of pneumococci and H. influenzae. The
difference between E. coli 011t8. and its UDP-gal-epi-
merase-deficient mutant J, (with lipopolysaccharide that
contains only core glYcolipid) is mainly located in the

repetitive sugar components of the O-antigenic side-chain
of the LPS. Thus. probably the common factor of the
gram-negative bacilli and the gram-positive cocci (S.
pneumoniae) is situated in this immunogenic polysaccharide
part of the LPS. Since all previous reports were obtained
using isolated bronchial tissue we investigated. in the
present experiment. the influence of H. influenzae on in
vivo lung function parameters and additionally analysed
the role of pulmonary macrophages.
EFFECTS ON LUNG FUNCTION PARAMETERS IN VIVO

The animals used were male guinea-pigs weighing 350-400 g
( CPB-TNO. leist. The Netherlands). Treatment with H.
influenzae was performed 4 days prior to the experiments.
The animals were injected intraperitoneally (i.p.) with 5
x lOa killed cells (colony forming units)/100 g bodY
weight. Guinea-pigs were anaesthetized with urethane (2
g/kg i.p.) and allowed to breathe spontaneously. The
right Jugular vein was cannulated for the injection of
histamine hydrochloride and atropine sulphate.
Pulmonary resistance and dynamic lung compliance were
determined breath by breath by a modified method of Amdur
and Mead! using a computerized respiratory analyser. In
each animal. two dose response curves were performed. one
before and one after the administration of atropine. which
was administered 15 min before the start of the second
dose-response curve. Histamine injections were given
with time intervals of at least 10 min. Histamine
CO.5-8.0 ug/100 g bodY weight i.v.). administered as a
bolus injection (0.1 ml) caused a dose-dependent increase
in pulmonary resistance and a dose-dependent decrease in
dynamic lung compliance. Basal values for saline and H.
influenzae-treated guinea-pigs for pulmonary resistance
were. respectively. 0.080 ± 0.025 and 0.073 + 0.013
cmH 2 0/ml.s- 1 and for dynamic lung compliance 0.431 ± 0.031
and 0.539 ± 0.055 ml/cmH 2 0. respectively.
In H. influenzae-pretreated animals the increase in
MODULATION OF AUTONOMIC RECEPTOR FUNCTION BY H.INFLUENZAE 239
pulmonary resistance was significantly potentiated by

1.0-8.0 ~g histamine/lOa g body weight i.v. Decreases in
dynamic compliance did not differ. Maximal potentiation
of the histamine response was observed at 1.0 and 8.0 Wg
histamine/lOa g body weight. Data for increases in
pulmonary resistance after histamine expressed as maximal
value/basal value were 4.9 ± 0.9 for controls and 16.5 ±
3.8 (p < 0.01) for H. influenzae at 1.0 ~g histamine and
19.0 ± 3.9 and 51.8 ± 10.6 (p < 0.01), respectively, at
8.0 ~g histamine. The parasympathetic blocking drug
atropine (100 ~g/kg body weight i.v.), administered 15 min
before the second dose-response curve of histamine.
antagonized the potentiating effect at low doses of
histamine (1.0-2.0 ~g/100 g body weight i.v.) but not at
high doses (4.0-8.0 ug/l00 g body weight i.v.). At 1 ~g
histamine data for controls and treated animals were 5.6 ±
2.2 and 7.7 ± 2.0 and at 8 ~g 19.0 ± 5.5 and 47.3 ± 9.7 (p
< 0.01). respectively.
The results show that following pretreatment with
H. influenzae there is an increased reactivity to
histamine as measured by the potentiated increase in
pulmonary resistance. Since the decreases in dynamic lung
compliance were not different between the two groups,
these data point to hyperreactivity of the larger
respiratorY airways. Histamine induces airway
constriction in guinea-pigs mainly by activation of
H.-receptors. Besides direct stimulation of H.-receptors
of respiratorY smooth muscle. bronchoconstriction by
histamine in vivo is caused by stimulation of sensory
"irritant" receptors which are localized in the major
conducting airways. This reflex-bronchoconstriction is
mediated through afferent and efferent pathwaYs in the
vagus nerve. Since in H. influenzae-treated guinea-pigs
atropine antagonizes the potentiating effect at low doses
of histamine. hyperreactivity is at least partly mediated
by this reflex-arc.
At higher doses of histamine the hyperreactivity is
probablY due to direct stimulation of histamine receptors
on the smooth muscles because atropine does not influence

this increased sensitivity. The hyperreactivity at low
doses of histamine may be due to increased sensitivity of
the muscarinic receptor system since it was shown in in
vitro experiments that carbachol induces in H. inf1uenzae
pretreated animals an increased contractile response of
isolated guinea-pig tracheal spira1s 9 • Douglas et a1. 5
showed by experiments with beta-adrenergic blocking drugs
that an increased histamine sensitivity may also be a
function of a beta-adrenergic hYPoresponsiveness. In
previous work we showed that vaccination with H.
inf1uenzae results in impaired beta-adrenergic functioning
accompanied by loss in radio1igand detectable number of
beta-adrenoceptor binding sites in guinea-pig respiratory
air wa y s 9 • 1 0 • A r e a son a b 1 e s u g g est ion for the
hyperreactivity at low and high doses histamine in vivo
therefore may also be a beta-adrenoceptor hyporesponsive-
ness. which needs to be further substantiated.
ROLE OF PULMONARY MACROPHAGES

Pulmonary macrophages constitute the major cellular
defence in the lung against bacterial invasion. In order
to investigate the possible involvement of pulmonary
macrophages in H. inf1uenzae-induced deterioration of lung
beta-adrenergic function. we additionally studied the
influence of specificallY stimulated pulmonary macrophages
on the relaxation of isolated guinea-pig tracheal spirals
to the beta-adrenoceptor stimulant isoprenaline. Killed.
non-capsulated H. inf1uenzae bacteria (lOa colony-forming
units/IOO g bodY weight) were administered by intra-
peritoneal injection 4 days prior to the experiment.
Pulmonary macrophages were isolated from non-treated
animals by lung lavage via a tracheal cannula with 4 x 20
ml saline washes. containing 2.6 mM EDTA. The lavage
fluid was centrifuged CIO min. 800 g) and the cells were
resuspended in warm Krebs-bicarbonate solution. More than
90% of the cells collected were macrophages. the remaining
cells being lYmphocytes. From a non-treated guinea-pig
MODULATION OF AUTONOMIC RECEPTOR FUNCTION BY H.INFLUENZAE 241
the trachea was isolated and cut in a spiral fashion 9 •

The tracheal preparation was incubated in 2 ml warm
Krebs-bicarbonate solution. continually gassed with 95%
0 2 /5% C02. together with the cells obtained in the lung
lavage <10 cellslml. 60 min at 37°C). This resulted in
6
adherence of about 80% of the added macrophages to the

tracheal preparation. Subsequently, the tracheal
preparation was suspended in an organ bath, containing
warm Krebs-bicarbonate solution. and connected to an
isotonic smooth muscle transducer (Harvard Bioscience).
Specific stimulation of the macrophages was carried out by
a h incubation of the tracheal preparation with serum
(2% v/v) from an animal pretreated with H. influenzae.
Beta-adrenoceptor function of the isolated tracheal
spirals was determined by initial contraction with 10- 6 M
of the cholinergic agonist carbachol, after which a
cumulative dose-response curve to isoprenaline was
constructed. Maximal isoprenaline-induced relaxation was
calculated relative to the precontract ion to 10- 6 M
carbachol.
Adherence of the macrophages per se did not influence
beta-adrenergic function in the trachea. Maximal
isoprenaline-induced relaxation was 104 ± 9%. as compared
to tracheal spiral relaxation in the absence of
macrophages. Stimulation of the pulmonary macrophages
with serum from an animal that had been pretreated witb H.
influenzae. resulted in a highly significant reduction of
isoprenaline-induced relaxation (69 ± 5% as compared to
non-stimulated pulmonary macrophages). Addition of
control serum also led to a decrease of tracheal
relaxation. but this effect was not significant. The
contractile responses to carbachol did not differ between
these experimental groups.
Our data indicate that in guinea-pigs intraperitoneal
administration of H. influenzae results in the
accumulation of a factor in the serum. which can alter
pulmonary macrophage activity. Thus activated. these
macrophages may be responsible for the negative effects
of H. influenzae on pulmonary beta-adrenergic receptor

function and the induction of bronchial hyperreactivity in
viv0 9 , t O , t 1 0 1 2 . The as yet unidentified serum activity
may very well represent an important factor in the
induction of immune activity in the lungs. and maybe
elsewhere.
In an attempt to reveal the mechanism whereby pulmonary
macrophages influence tracheal beta-adrenergic receptor
function. we studied the role of reactive oxygen species
therein. The microbicidal and Cytotoxic capabilities of
macrophages are determined by their ability to release
various lysosomal enzymes and reactive oxygen species like
superoxide anion. hydrogen peroxide. and hydroxyl
radicals. subsequent to phagocytosis 2 • At the scene of
bacterial killing. these oxygen metabolites inevitablY
leak into the surrounding tissue and may inflict
considerable damage.
To assess whether this phenomenon is also responsible
for the changes in tracheal beta-adrenergic function. we
studied the influence of several enzymes and inhibitors.
which interfere with the formation and activity of oxygen
metabolites. on the effects of pulmonary macrophages on
tracheal spiral relaxation. Carbachol-induced
precontract ion of the tracheal spirals was not
significantly different between the various experimental
groups. Addition of thiourea (25 mM) 30 min prior to
stimulation of the pulmonary macrophages with serum from a
H. influenzae-treated animal. resulted in complete
inhibition of macrophage-induced reduction of tracheal
relaxation (111 ± 21% as compared to non-stimulated
pulmonary macrophages). Since thiourea is a potent
scavenger of the highly reactive hydroxyl radical this
points to this oxygen species being responsible for the
deterioration of tracheal beta-adrenoceptor function.
Catalase (5000 U/ml). an enzyme which catalyses the
reduction of hydrogen peroxide to water. was equally
effective (102 ± 9%). The latter may be explained by a
diminished availability of hydrogen peroxide for the
MODULATION OFAUTONOMIC RECEPTOR FUNCTION BY H.INFLUENZAE 243
formation of hydroxyl radicals. Superoxide anion does not

seem to be directly involved in the effects of pulmonary
macrophages on tracheal relaxation. since superoxide
dismutase (300 U/ml). catalysing the conversion of
superoxide to hydrogen peroxide. did not affect the
decrease in tracheal relaxation (71 ± 4%).
From the present results we conclude that pulmonary
macrophages may be responsible for the ~egative effects of
H. influenzae on tracheal beta-adrenergic receptor
function through the release of oxygen radical species, in
particular the highly reactive hydroxyl radicals. It has
been shown that oxygen radicals can directly damage
endothelial cells s . t 3 . It is conceivable that low
concentrations of radical species could specificall y
affect the beta-adrenergic receptor moiety. In situations
where the integrity of the pulmonary lining material has
been affected. such as in chronic obstructive lung
diseases (COLD), the negative effects on beta-adreno-
ceptors could be even more significant, because of the
diminished protective capacity which the lining material
normally displays towards radical species 4 • A disturbance
of the pulmonary beta-adrenergic system may result in a
relative preponderance of the bronchoconstrictive
mechanisms and. as a result. may contribute to the
reduction of the airflow as is observed in chronic
obstructive lung diseases. Therefore. the above-mentioned
mechanisms may also apply for patients with chronic
asthmatic bronchitis. in other words. they might
contribute to exacerbations of bronchial asthma. and to
bronchial hyperreactivity in general.
Acknowledgements
This work was subsidized by the Dutch Asthma Foundation.
References
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ration in unanaesthetized guinea pigs. Am. J.
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3. Boushev, H.A., Holzman, M.J., Sheller, J.R. and Nadel,
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6. Nijkamp. F.P. and Schreurs. A.J.M. (1984). Infection
and fi-adrenoceptor function. In: Morlev, J. (ed.).
Perspectives in Asthma. 1: Beta-adrenoceptors in
Asthma. pp.129-139. London: Academic Press.
7. Nijkamp, F.P. (1985). Hyperreactivitv, inflammation
and the fi-adrenoceptor. In: Bonta. I.L •• Brav, M.A.
and Parnham. M.J. (eds). Handbook of Inflammation. pp.
335-354. Amsterdam: Elsevier Science Publishers BV.
8. Sacks. To, Moldow, C.F •• Craddock. P.R. and Bowers.
T.K. (1978). Oxygen radicals mediate endothelial cell
damage by complement-stimulated granulocytes. J.
Clint Invest. 61:1161-1167.
9. Schreurs. A.J.M •• Terpstra, G.K., Raaijmakers. J.A.M.
and Nijkamp. F.P. (1980). Effects of vaccination with
Haemophilus influenzae on adrenoceptor function of
tracheal and parenchymal strips. J. Pharmacol. Exp.
Ther. 215:691-696.
10. Schreurs. A.J.M. and Nijkamp. F.P. (1982). Haemophilus
influenzae-induced loss of lung beta-adrenoceptor
binding sites and modulation bv changes in peripheral
catecholaminergic input. Eur. J. Pharmacol.
77:95-102.
11. Schreurs. A.J.M •• Verhoef. J. and Nijkamp. F.P.
(1983). Bacterial cell-wall components decrease the
number of guinea pig lung beta-adrenoceptors. Eur. J.
Pharmacal. 87:127-132.
12. Schreurs. A.J.M. and Nijkamp. F.P. (1984). Haemophilus
influenzae and the beta-adrenergic system: a review.
Vet. Res. Commun, 8:1-14.
13. Shasby. D.M •• VanbenthuYsen. K.M •• Tate. R.M •• Shasby.
S.S •• McMurtrY. I. and Repine. J.E. (1982).
Granulocvtes mediate acute edematous lung injury in
rabbits and in isolated rabbit lungs perfused with
phorbol myristate acetate: role of oxygen radicals.
Am. Rev. Resp. Dis. 125:443-447.
14. Szentivanyi. A. (1968). The beta-adrenergic theory of
the atopic abnormalitv in bronchial asthma. J.
Allergy 42:203-232.
23
Impairment of pulmonary homeostatic and
antimicrobial defence mechanisms by infectious
bovine rhinotracheitis and parainfluenza-3 virus
infections
P. O. OGUNBIYI, P. D. CONLON AND P. EYRE
ABSTRACT
In calves. infectious bovine rhinotracheitis and para-
influenza-3 viruses caused significant inhibition of the
macrophage chemiluminescence reaction. Simi lar effects
were observed due to parainfluenza-3 virus in guinea-pigs.
Beta-adrenergic receptors in both macrophages and airway
smooth muscle were disrupted by virus infection. The vi-
ruses caused marked hyperreactivity in airway smooth mus-
cle and in mast cell histamine release. Hyperreactivity
may be a factor in bovine virus infection and may predis-
pose to opportunistic secondary bacterial colonization.
Levamisole and verapamil prevent some of the virus - induced
responses. These drugs may be useful in the management of
secondary bacteria pneumonia.
INTRODUCTION
Respiratory tract infections. particularly influenza
virus. rhinovirus and Haemophilus influenzae in man. are
known to induce or exacerbate obstructive pulmonary
disease and to increase airway reactivity to bronchocon-
strictors (such as histamine. acetylcholine). Szentivanyi
and others have proposed that impaired beta-adrenoceptor
activity might predispose to bronchoconstriction in
asthma"o,a, Busse l reported a decreased granulocyte
245
response to isoprenaline in asthma during respiratory

virus infection.
The bovine "shipping fever" complex (bovine pasteu-
rellosis) is an economically important disease of poorly
understood multiple aetiologies. Infectious bovine rhi-
notracheitis (IBR) virus and parainfluenza-3 virus (PI-3)
have been implicated as predisposing to pulmonary pasteu-
rellosis 1o • Viral impairment of pulmonary homeostasis may
contribute to secondary bacterial infection.

Experiments were conducted in calves and guinea-pigs.
Jersey (male) calves were purchased locally at birth.
They ranged from 2 to 5 months of age at the time of
experiment. All animals were examined clinically every
day. Immediately prior to virus infection. nasopharyngeal
swabs/cultures were carried out for common viral and
bacterial pathogens. Also. standard immunological tests
for virus antibodies were conducted. Calves were divided
randomly into treatment groups. One group acted as
controls to provide uninfected tissue samples. A second
group of calves was infected with IBR virus and a third
group was infected with PI-3 virus. The second group
received a field isolate of IBR virus at a dose of 2.5 x
10' TCID 50 in sal ine. aerosol ized for 10 min. The third
group was aerosolized for 15 min with a field strain of
PI - 3 vir usa t the rat e 0 f 5 x 106 TC1050 i n s a lin e • AI I
groups underwent bronchoalveolar lavage (BAL) after 4 days
and were euthanized on day 6 post-infection. Lavage fluid
was centrifuged and the cell suspension differentially
counted. Viability of more than 95% was determined by
trypan blue exclusion. Alveolar macrophages (AM) were
challenged with opsonized zymosan and release of super-
oxide radicals and H2 0 2 was measured as chemiluminescence
following reaction with luminol. The effects of virus
infection on luminescence were estimated as well as the
effects of added drugs. Following euthanasia a bronchus
(3 mm diameter) was taken from each calf. cut spirally and
IMPAIRMENT OF PULMONARY DEFENCE MECHANISMS 247
mounted in 02-Krebs-Henseleit solution at 37°C at a

resting tension of 2 g. Cumulative dose-response curves
to bronchoconstrictor and bronchodilator drugs J were
established in both control and virus-infected animals.
In one group of calves. lung mast cell histamine was re-
leased using the calcium ionophore : A23187. Histamine
concentration was measured spectrophotofluorimetrically
before and after PI-3 virus infection.
In a further experiment. adult guinea-pigs were aero-
solized with PI-3 virus (1 x 10' TCID,o/15 min). Alveolar
macrophages were harvested at day 4 and animals were
euthanized at day 6 for mast cell histamine release and
airway smooth muscle studies.
Two groups of guinea-pigs were treated daily. for 3
days. with verapamil. 5 mg/kg. intramuscularly. or levami-
sole. 2.2 mg/kg. subcutaneously. during PI-3 virus infec-
tion. Bronchoalveolar lavage (BAL) was performed 4 days
post-viral exposure (PVE) and the animals were sacrificed
on day 6 PVE. Alveolar macrophage activity. pulmonary
smooth muscle responses and mast cell mediator release
were then examined.
RESULTS
In control calves. isoprenaline and dobutamine signifi-
cantly inhibited alveolar macrophage chemiluminescence.
dose-dependently. and their effects were blocked by
propranolol (a non-selective beta-antagonist) and atenolol
(betal-antagonist). respectively. Salbutamol and terbu-
taline (beta2-selective agonists) were of low potency and
inconsistent in effect. PGE2 also modulated alveolar
macrophage function. Both IBR and PI-3 virus infections
significantly inhibited the alveolar macrophage chemilumi-
nescence in calves. and the same observation was made
following PI-3 virus infection in guinea-pigs. Betas-
adrenoceptor agonist effect was negated by PI-3 and IBR
viruses in calves and PI-3 virus in guinea-pigs. The
virus effect on beta2-adrenoceptor activity was incon-
sistent (Figure 23.1). The modulating action of PGE2 was
80
•
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o 0
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_ .....
j'S' l! S'S'
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II) ... II) -
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, TERS.'
ISOP. DOS. TEAS. ISOP. DOS.
CONTROl CAllIES PI-3V CALVES
Figure 23.1 Inhibition of the chemiluminescence of alveo-

lar macrophages by different concentrations of isoprena-
line (ISOP), dobutamine (OOB) and terbutaline (TERB) in
control and parainfluenza-3 virus-infected calves; n = 5.
Vertical bars are SEM.
not affected by PI-3 virus. IBR virus was not tested in

this case.
Pulmonary virus infection induced significant impair-
ment of bronchodilator responses and tracheal relaxation
to beta2-sympathomimetics, histamine H2-agonists, adeno-
sine diphosphate (AOP) and adenosine triphosphate (ATP)
(purinergic agonists) in calves and guinea-pigs, respecti-
vely (Figure 23.2). At the same time, the potency and ef-
ficacy of carbachol and histamine Ht-agonists, as broncho-
constrictors, was enhanced.
0
-"'Q.., TRACHEA
20 \\ ,
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II)
Z
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II: 60
,
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ISOPRENAlINE CONCENTRATION (M)
Figure 23.2 Log concentration-response curves for isopre-

naline in the trachea (upper panel) and bronchus (lower
panel) of control <___.) and infectious bovine rinotra-
cheitis CIBR) virus-infected (o--~) calves: n = 5. Drug
doses are final molar bath concentrations. Values are
means ± SEM.
Infection with PI-3 virus in calves and guinea-pigs re-

sulted in a lO-fold increase in calcium ionophore A23187-
induced histamine release by the pulmonary mast cells. IBR
virus was not examined in this case. The spontaneous
histamine release from the mast cell was also significant-
ly increased in the infected animals.
Both verapamil and levamisole significantly reversed or
o ----,. --- .
\ - Control
0- . -0 PI-3 virus
'\. .. - . PI-3 virus + levamisole

w
(II
z
~50
(II
w
a: ~
l00~---_~8~---_~7~--~~---_*5-----_4~'--_~5X
o
D- - -<J PI-3 virus + verapamM
~
z
~50
w
a:
100~----_8~1-----_:7-----_~6~----=-----_~4---_~5~
ISOPRENALINE CONCENTRATION (M)
Figure 23.3 Log concentration-response curves for isopre-

naline in the trachea of control and parainfluenza-3
(PI-3) virus-infected guinea-pigs and of (PI-3) virus-
infected guinea-pigs pretreated with levamisole (upper
panel) and verapamil (lower panel); n = 9. Drug doses are
final molar bath concentrations. Values are means ± SEM.
prevented smooth muscle hyperreactivity induced by the

virus (Figure 23.3). These drugs also reversed the
virus-induced suppression of the alveolar macrophage
activity and the beta-adrenoceptor effects on alveolar
macrophages were partly restored. Levamisole was more
effective than verapamil at the dosages studied. and
neither drug had any effect in uninfected animals. In the
mast cell. 1evamiso1e did not influence Ca 2 + A23187-indu-

ced mediator release. whereas verapami1 attenuated the
enhanced histamine release.
DISCUSSION
The present results indicate a virus-induced airway smooth
muscle hyperreactivity. which is presumably due. partly,
to blunting of the pharmacological inhibitory mechanisms.
Also occurring are lung mast cell hyperreactivity and
alveolar macrophage hyporeactivity. The mechanisms by
which a variety of stimuli induce smooth muscle
hyperreactivity are poorly understood although a number of
factors have been suggested? There are indications that
alveolar macrophages may contribute to the observed im-
pairment in pulmonary beta-adrenoceptor-mediated effects 2 •
These studies demonstrated the presence of beta-adre-
nergic receptors on the alveolar macrophages. Catecho1a-
mines are known to modulate the functions of immunocom-
petent cells and this may also be applicable to alveolar
macrophages. The expression of immunological receptors on
macrophages are altered during inflammatory responses in
the lung'. It is. therefore. highly probable that
alveolar macrophage pharmacological receptors are similar-
ly altered. Since alveolar macrophages are the first
line of defence against pulmonary insults, such altera-
tions may be important in the pathogenesis and pathophy-
siology of pulmonary diseases.
We propose that the down-regulation of the pulmonary
inhibitory homeostatic system and the enhanced excitatory
mechanisms (for examp1 e. the "1 eaky" mast cell phenomenon)
with the resulting homeostatic disturbances, will lead to
increased tissue damage. All of these changes, together
with virus-induced tissue damage, increased mucus
production and alveolar exudate will create a favourable
microenvironment for opportunistic bacterial infection.
Levamiso1e and verapami1 reversed the virus-induced
responses in macrophages and smooth muscle. The mecha-
nisms involved in these actions are not known. However.
the Ca 2 + antagonizing action of verapamil and the effect

of levamisole on intracellular cyclic nucleotides· may be
involved. These drugs are worthy of clinical evaluation
in pulmonary disease, although we recognize the limitation
imposed by the cardiovascular actions of calcium antago-
nists.
References
1. Busse, W.W. (1977). Decreased granulocyte response to
isoproterenol in asthma during upper respiratory
infections. Am. Rev. Resp. Dis. 115:783-790.
2. Engels, F., Oosting, R.S. and Nijkamp, F.P. (1985).
Pulmonary macrophages induce deterioration of guinea-
pig tracheal beta-adrenergic function through release
of oxygen radicals. Eur. J. Pharmacol. 111:143-144.
3. Eyre, P. (1971). Pharmacology of bovine pulmonary
vein anaphylaxis in vitro. Br. J. Pharmacol. 43:
302-311.
4. Mikul ikova, D. and Trnavsky, K. (1980>. Effect of
levamisole on lysosomal enzyme release from polymor-
phonuclear leukocytes and intracellular levels of cAMP
and cGMP after phagocytosis of monosodium urate
crystals. Agents Actions 10:374-377.
5. Nijkamp, F.P. and Schreurs, A.J.M. (1984). Infection
and fi-adrenoceptor funct i on. In: Morley, J. (ed.).
Beta Adrenoceptor in Asthma, pp.129-146. London: Aca-
demic Press.
6. Norris, A.A. and Eyre, P. (1982). Pharmacological
abnormality in bronchial asthma and the role of
respiratory pathogens. Med. Hypotheses 8:199-205.
7. Stempel, O. and Boucher, R.C. (1981>. Respiratory
infection and airway reactivity. Med. Clin. N. Am.
65 : 1045-1053 •
8. Szentivanyi, A. (1968). The beta-adrenergic theory of
the atopic abnormality in bronchial asthma. J.
Allergy 42:203-232.
9. Warr, G.A., Jakab, G.J. and Hearst, J.E. (1979). Al-
terations in lung macrophage immune receptor(s) acti-
vity associated with viral pneumonia. J. Reticulo-
endothel. Soc. 26:357-366.
10. Yates, W.D.G. (1982). A review of infectious bovine
rhinotracheitis, shipping fever pneumonia and viral-
bacterial synergism in respiratory disease of cattle.
Can. J. Compo Med. 46:225-263.
24
The potential of biological response modifiers in
the treatment of malignancies in animals and man
E. J. RUITENBERG, W. H. DE JONG, P. A. STEERENBERG, W. R. KLEIN AND
V. P. M. G. RUTTEN
ABSTRACT
Baci 11 us Calmette-Guerin (BCG) was able to induce
regression of established tumours in an experimental
guinea-pig tumour system, and in two spontaneously
occurring tumours of farm animals. In the guinea-pig
tumour system a tumour line-specific immunity remained,
indicating that antigen presentation occurred during
BCG-induced tumour regression. In bovine ocular squamous
cell carcinoma (BOSCC) and sarcoid tumours of the skin in
the horse a substantial number of animals showed tumour
regression (approximately 70%). Local BCG immunotherapy
seems promising especially for equine sarcoid tumours of
the skin. These findings are discussed in relation to the
results obtained with BCG immunotherapy in clinical trials
in man.
INTRODUCTION
Immunotherapy for cancer has been intensively studied 2 • 9 •
The results in clinical trials have generally been
disappointing, and it is now clear that immunotherapy is
not a panacea for cancer treatment. However, the interest
in cancer immunotherapy has intensified studies of the
immune reactions of the host against its tumour. More
knowledge on tumour immunology is therefore now available
253
than in the early days of cancer immunotherapy. It has

now become apparent that there are many agents and
products that can interact with the immune system. These
agents have recently been designated biological response
modifiers (BRMs)1 t • Interpreted most widel y these BRMs
modify or change the relationship between tumour and host
with resultant therapeutic effects, and BRMs include the
classical immunostimulants like Bacillus Calmette-Guerin
(BCG) and Corynebacterium parvum. BCG is the most widely
studied immunostimulating agent and some tumours in man,
such as squamous cell carcinomas of the head and neck
region 3 and bladder carcinomas l4 , respond favourably to
local BCG immunotherapy. Based on results in an experi-
mental guinea-pig tumour system (the line ten hepato-
cellular carcinoma), experiments were performed in sponta-
neously occurring tumours of farm animals (bovine ocular
squamous cell carcinoma [BOSCC] and equine sarcoid tumours
of the skin).

Line ten tumour system
The line ten hepatocellular carcinoma was originally
induced by orally feeding diethylnitrosamine to strain 2
guinea-pigs. The tumour has been converted to ascites
form and is maintained by intraperitoneal passages. One x
lOb viable line ten tumour cells were inoculated on the
flank. BCG (one x 107 culturable particles) was admini-
stered intralesionally. Tumour growth was measured twice
weekly with vernier callipers. This line ten tumour is
non-immunogenic; after conventional immunization proce-
dures with irradiated tumour cells or amputation of a
growi ng tumour, no tumour immun it y is i nduced l 7 • Aft er
BCG administration (either admixed with tumour cells or
intratumorally) the surviving animals are immune against
the line ten tumour. For immunological studies, spleen
cells of line ten immune animals were obtained and used in
both in vitro and in vivo experiments.
BIOLOGICAL RESPONSE MODIFIERS IN THE TREATMENT OF MALIGNANCIES 255
Spontaneously occurring tumours

In addition to the guinea-pig tumour system local
(intralesional) immunotherapy with BeG was performed on
two spontaneously occurring tumours of farm animals -
bovine ocular squamous cell carcinoma and fibroepithelial
sarcoid tumours of the skin of horses. For both tumours a
randomized clinical trial was performed using extensive
surgery as treatment for the control group.
RESULTS
Line ten tumour system
Intralesional treatment of an established intradermally
growing line ten tumour resulted. within 4-5 weeks. in
complete tumour regression (Figure 24.1). The BeG-induced
inflammation resulted in a granulomatous reaction in which
cells of the macrophage lineage were predominantly
present. The animals became immune against the line ten
tumour. as a second tumour cell challenge of these
BeG-cured animals was rejected (Figure 24.1). The line
ten tumour is by itself non-immunogenic • the resulting
'7
tumour immunity remaining after addition of BeG to a line
ten tumour challenge or after intralesional BeG treatment.
It is therefore concluded that. during the BeG-induced
tumour rejection. antigen presentation must have occurred
resulting ultimately in specific immune T cells.
Some aspects of this immunity were further investigated
using spleen cells from line ten immune guinea-pigs (data
not shown). Line ten immune guinea-pigs were obtained
after a primary immunization with a mixture of BeG and
line ten tumour cells. The results of these
investigations""" can be summarized as follows: the
tumour immunity. induced after BeG treatment (either
intratumorally or BeG admixed with line ten tumour cells),
could be transferred to naive non-immune strain 2
guinea-pigs using spleen cells of line ten immune animals.
These line ten immune spleen cells showed a specific
tumour rejection capacity; the line ten tumour was
rejected and an antigenically distinct line one tumour was
E 20 0---0 control (n:5)

E
- - - BeG (n=4)
.!: /fT"'-'''''''"'''O
'0~" 15
E /d'
BeG
~
~
c
c
10 1
"
E second challenge with
5 1 x 10 6 tumour cells
0 +-....,1;';4--2;!;1-----::28;;----::3'::-5-"-~42:""'"
63
1 7'0 77 84 91
days after inoculation of 1 x 106 tumour cells
Figure 24.1 Effect of BCG-RIVM (1 x 107 culturable parti-

cles intralesionally) at day 7 after tumour cell inocula-
tion) on growth of the line ten hepatocellular carcinoma
in strain 2 guinea-pigs.
not. The transferred immunity was long-lasting; at 160

days after adoptive transfer tumour cells were still
rejected. For this rejection in vivo proliferation seemed
necessary. In vitro the line ten immune spleen cells
showed a non-specific Cytotoxic activity, whereas in a
lymphocyte stimulation assay line ten tumour antigen was
specifically recognized. In addition, these immune spleen
cells showed in vivo a specific migration to the line ten
challenge site.
In this non-immunogenic tumour system it is concluded
that BCG treatment resulted in the induction of a
tumour-specific, long-lasting solid immunity against the
line ten tumour. This immunity is carried by cells with a
helper and/or amplifier function.
Spontaneously occurring tumours

In bovine ocular squamous cell carcinoma (BOSCC),
intralesional BCG treatment (either as live BCG or a
non-l iving BCG cell wall preparation) resulted in almost
complete tumour regression in 60-70% of the treated
animals. In approximately 50% of these BCG-cured animals
tumour recurrence occurred (Table 24.1). No serious
side-effects of the BCG treatment were observed. In
Table 24.1 Intralesional BCG treatment of bovine ocular

squamous cell carcinoma (BOSCC)- : I = Regression of pri-
mary tumour; II = Local recurrence; III = Intercurrently
killed; IV = Metastases at necropsy'
Treatment I II III IV
No treatment 10 2/10" 012 7/10 5/10

Surgeryd 10 0110 1110 1/10
BCG lot 048 10 5/10 0/5 4/10 3/10
BCG lot 060 10 7/10 417 1110 2/10
BCG eel I wa I I s 10 7/10 417 5/10 3/10
-BOSCC tumour size ranging from 1 x 1 to 4 x 4 em.

'Regional lymph node (lymphonodulus subparotidealis) andl
or lung.
"Number of animals with regression versus number of ani-
mals treated.
dSurgery : total block resection including primary tumour.
eye. lymphonodulus subparotidealis. lymphonodulus retro-
pharyngealis, parotid salivary gland and part of the
mandibular salivary gland.
sarcoid skin tumours of the horse. 70-90% of the

BCG-treated tumours showed complete and long-lasting
regression (Table 24.2). Some animals now have a
follow-up period of more than 2-3 years. No recurrences
were observed.
In BOSCC no evidence for the induction of tumour
immunity was found. the appearance of recurrences
generally at the same localization of the regressed
primary tumour suggesting that the cured animals were not
immune. The BOSCC-bearing cows could be divided into
three groups : animals not responding to therapy (~33%);
animals showing long-lasting regression (~33%); and ani-
mals showing regression followed by recurrences (~33%).
Whether this also reflects a difference in immune
reactivity remains to be established. In comparison with
Table 24.2 Intralesional BCG treatment of fibroepithelial

(sarcoid) tumours of the skin in horses: I = Complete
regression; II = Partial regression; III = No regression
Treatment Mean II III

area
(cm 2 )
CryosurgeryC 26(10) 8.0 26(100%)

BCG d 29(10) 10.8 24( 83%) 5<17%)
BCG cell walls" 16(10) 11.0 11( 69%) 4(25%) 1( 6%)
·Number of tumours with number of animals in brackets.

~Number of tumours with percentage in brackets.
<Intensive cryosurgery existing of several freeze-thaw

cycles (mean number of treatments 3.0).
dMean number of BCG treatments 3.6.
"Mean number of BCG cell wall treatments 3.4.
the guinea-pig studies. the group with long-lasting

regression is particularly interesting. For sarcoid
tumours of the skin of the horse. BCG immunotherapy seems
to be indicated; in a prognostically unfavourable group of
animals (treated outside the randomized clinical study)
complete cure was obtained in eight of eleven animals
(data not shown). These animals were not included in the
clinical trial because the localization of the tumours
(preventing surgery) made them unsuitable for rando-
mization.
DISCUSSION
Bacillus Calmette-Guerin is one of the oldest and
best-known biological response modifiers (BRMs). From the
late 1960s onwards attempts were made to use BCG for
cancer therapy and to date several hundred clinical trials
have been performed in man. most of them with
disappointing results. What then is the reason that BeG
is still used for cancer immunotherapy? It is well known
BIOLOGICAL RESPONSE MODIFIERS IN THE TREATMENTOF MALIGNANCIES 259
that BCG has a profound effect on the immune system and

both activation and suppression may occur. Whether the
final result of BCG administration is activation (the
desired effect) or not. depends on many factors. including
the dose of BCG. the route of administration. the immuno-
assay in which BCG is studied. the genetic background of
the host animal and the BCG vaccine itself (strain of BCG.
amount of dead material present. and additives in the
vaccine). Only recently has more detailed knowledge
become available on the relation between the immune system
and cancer. and there remains much still to be learned.
Part of the therapeutic failure of BCG in many trials may
be attributable to the fact that the agent was used
without an understanding of the relationships between the
immune system and cancer and its influence on this
relation.
In experimental animal tumours such as the line ten
hepatocellular carcinoma. and in spontaneously occurring
tumours such as BOSCC and equine sarcoid tumours of the
skin. the authors and others'·tD have clearly demonstrated
that BCG has the ability to inhibit tumour growth and to
induce tumour regression. In the line ten tumour system
the tumour size seems a limiting factor for BCG
immunotherapy; only tumours of 10 mm diameter or less
<which is relatively large in a species as small as the
guinea-pig) can be cured. whereas larger tumours (more
than 12 mm) cannot te • In the study with BOSCC no
indications were found that the tumour size was related to
the cl inical outcome'. However. the tumour size in this
study was limited. as it ranged from 10 x 10 to maximally
40 x 40 mm. For sarcoid tumours of the skin the total tu-
mour mass was correlated with the clinical result. larger
tumours showing less regression (unpublished data from
this laboratory). Although BCG has been administered by
most routes. there seems to be a general consensus that
the best responses are obtained with local application.
although the intraJesional administration of BCG may have
the disadvantage of associated toxicit yt3.t6. Those
clinical trials in man with BCG which resulted in a

beneficial effect are mainly those in which the agent was
administered 10callyJ,6,t4. The benefits of local appli-
cation of BCG in recurrent bladder carcinoma. in particu-
lar. are now well establ ished '4 •
In experimental animal tumour systems in syngeneic
inbred animals BCG immunotherapy induced immunity against
the tumour in several tumour systems (present data
and , ,'2.'8). In the line ten tumour system this is a
remarkable change as the tumour by itself is non-
immunogenic • '7 Why BCG causes this change from non-
immunogenic into an immunogenic tumour is still unknown.
However. that immunotherapy may result in tumour immunity
is an important phenomenon as it implies that residual
minimal (metastatic) disease and/or recurrences may be
cured. In contrast. the data obtained in our study with
BOSCC (see Table 24.1) do not indicate that the tumour
regression was followed by tumor immunit y8 .
In the various animal tumour systems. as in man.
differing results were obtained with BCG immunotherapy.
Hence, the result of cancer immunotherapy seems to be at
least partially dependent on the tumour system itself. At
present BCG immunotherapy seems only indicated for
'4
transitional bladder carcinoma • For other tumours like
carcinoma of the head and neck region. some leukaemia and
lymphoma subgroups and gastric cancer. promising prelimi-
nary results have been obtained. although there is still
doubt whether BCG immunotherapy is indeed effective for
these cancers. The use of BCG as adjuvant in autologous
tumour cell vaccines may introduce a new area for the
clinical use of BCG. sinee colon cancer patients were
recently found to show an immune reaction against their
own tumour after vaccination with a mixture of BCG and
autologous tumour cells 7 •
Acknowledgements
The financial support of the Koningin Wilhelmina Fonds
(Netherlands Cancer Foundation) for W.H. de Jong is grate-
fully acknowledged.
References
1. Baldwin, R.W. and Pimm, M.V. (1973). BCG immunothera-
py of a rat sarcoma. Br. J. Cancer 28:281-287.
2. Baldwin, R.W. and Pimm, M.V. (1978). BCG in tumor
immunotherapy. Adv. Cancer Res. 28:91-147.
3. Bier, J., Rapp, H.J., Borsos, T., Zbar, B., Klein-
schuster, S., Wagner, H. and Rollinghof, M. (1981).
Randomized clinical study on intratumoral BCG cell
wall preparation (CWP) therapy in patients with
squamous cell carcinoma in the head and neck region.
Cancer Immunol. Immunother. 12:71-79.
4. De Jong, W.H., Van de Plas, M.M.T., Steerenberg, P.A.,
Kruizinga, W. and Ruitenberg, E.J. (1985). Selective
localization of tumor immune spleen cells at the tumor
challenge site after adoptive transfer of line 10
tumor immunity in strain 2 guinea pigs. J. Immunol.
134:2032-2040.
5. De Jong, W.H., Steerenberg, P.A., Van de Plas, M.M.T.,
Kruizinga, W. and Ruitenberg, E.J. (1985). T-cell
involvement in adoptive transfer of line 10 tumor
immunity in strain 2 guinea pigs. J. Natl. Cancer
Inst. 75:483-489.
6. Goodnight, J.E. and Morton, D.L. (1978). Immuno-
therapy for malignant disease. Ann. Rev. Med.
29:231-283.
7. Hoover, H.C., Surdijke, M., Dangel, R.B., Peters, loC.
and Hanna. M.G. (1984). Delayed cutaneous hyper-
sensitivity to autologous tumor cells in colorectal
cancer patients immunized with an autologous tumor
cell : bacillus Calmette-Guerin vaccine. Cancer Res.
44:1671-1676.
8. Klein. W.R., Ruitenberg, EoJ., Steerenberg, P.A., De
Jong, W.H., Kruizinga, W., Misdorp, W., Bier, J.,
Tiesjema, R.H., Kreeftenberg, J.G., Teppema, J.S. and
Rapp, H.J. (1982). Immunotherapy by intralesional
injection of BCG cell walls or live BCG in bovine
ocular squamous cell carcinoma: a preliminary study.
J. Natl. Cancer Inst. 69:1095-1103.
9. Mitchell, M.S. and Murahata, R.I. (1979). Modulation
of immunity by bacillus Calmette-Guerin (BCG).
Pharmacol. Ther. 4:329-353.
10. Murphy, J.M., Severin, G.A., Lavach, J.D., Hepler,
0.1., Lueker, D.C. (1979). Immunotherapy in ocular
equine sarcoid. J. Am. Vet. Med. Assoc. 174:269-272.
11. Oldham, R.K. (1983). Biological response modifiers.
J. Natl. Cancer Inst. 70:789-796.
12. Salomon, J.C. and Lynch, N. (1976). Intralesional
injection of immunostimulants in rat and mouse tumors.
Cancer Immunol. Immunother. 1:145-151.
13. Schwarzenberg, L., Simmler, M.C. and Pico, J.L.
(1976). Human toxicology of BCG applied in cancer
immunotherapy. Cancer Immunol. Immunother. 1:69-76.
14. Shapiro, A., Kadmon, D., Catalona, W.J. and Ratliff,
T.L. (1982), Immunotherapy of superficial bladder
cancer. J. Urol. 128:891-894.

15. Shu, S., Steerenberg, P.A., Hunter, J.T., Evans, C.H.
and Rapp, H.J. (1981). Adoptive immunity to the
guinea pig line 10 hepatoma and the nature of in vitro
I ymphoid tumor cell interact ions. Cancer Res.
41 :3499-3506.
16. Sparks, F.C. (1976). Hazards and complications of BCG
immunotherapy. Med. Clin. N. Am. 60:499-509.
17. Zbar, B., Bernstein, 1.0. and Rapp, H.J. (1971).
Suppression of tumor growth at the site of infection
with living bacillus Calmette-Guerin. J. Natl. Cancer
Inst. 46:831-839.
18. Zbar, B., Bernstein, 1.0., Bartlett, G.L., Hanna, M.G.
and Rapp, H.J. (1972). Immunotherapy of cancer:
regression of intradermal tumors and prevention of
growth of lymph node metastases after intralesional
injection of living Mycobacterium bovis. J. Natl.
Cancer Inst. 49:119-130.
25
Immunological defence mechanisms as a target
for antibiotics
J. 1. GRONDEL AND W. B. VAN MUISWINKEL
ABSTRACT
When the immunological defence mechanisms fail to prevent
the establishment of infections within the host. the
consequence is disease. Particularly under these circum-
stances. antibiotics have proved to be of remarkable value
for therapeutic treatment of bacterial infections. The
antibiotic generally interferes with the metabolism of the
pathogen. allowing the immune system to eliminate it. In
this way. the antibiotic cooperates with the immune
system. However. the effect of antibiotics on immuno-
logical processes is rarely taken into consideration.
In this paper. we selectively review antimicrribial
agents used in veterinary and human medicine with regard
to their effects on non-specific and specific defense
mechanisms.
INTRODUCTION
The barriers. which bacteria have to overcome when
invading a host. are either non-specific or specific. In
both types of resistance. humoral factors and specialized
cells play pivotal roles. forming an elaborate network of
physical. chemical and cellular defence mechanisms.
including the immune system.
The skin with its low pH and bactericidal fatty acids.
263
and mucous epithelial surfaces containing growth-

decreasing factors or phagocytizing cells. are examples of
non-specific. external defence. In addition to this
barrier. internal non-specific defence is mediated by
serum factors (such as transferrin and alternative
complement route) and phagocytizing cells (macrophages and
granulocytes). Specific defensive responses against
invading microorganisms are effected by the immune system.
An immune response is a rather complex interaction
between distinct leucocyte populations and humoral
factors. and can be characterized by two phenomena:
amplification and regulation. Foreign materials (anti-
Qens) are processed by macrophages and presented to
antiQen-sensitive lymphocytes in the correct physical
configuration. The lymphocytes are required for antibody
formation and cellular immune responses. These cells and
their products contribute to the rapid elimination of
antigen.
When defence mechanisms fail to prevent the
establishment of an infective agent in the host. the
consequence will be disease. Under these circumstances.
antibiotics have proved to be of remarkable value for the
therapy of bacterial infections. The antibiotic generally
inhibits growth of the pathogen. allowing the immune
system to eliminate it. In this way. the antibiotic
cooperates with the immune system. However. the effect on
the immune status of animal or man is rarely taken into
consideration when choosing an antibiotic for therapeutic
use.
The importance of antimicrobial agents for the
maintenance of animal health is generally accepted in
animal husbandry. Besides being used for prevention and
control of bacterial diseases. antibiotics are sometimes
used because of their growth-promoting effects. However.
it is also known that some of these drugs can lead to
adverse immunotoxic effects. and that prolonged use will
increase the risk for raising drug-resistant bacterial
strains.
IMMUNOLOGICAL DEFENCE MECHANISMSASA TARGET FOR ANTIBIOTICS 265
Several studies have been performed on the interaction

between antibiotics and the immune system in mammals,
birds and fish. Impairment of the immune system may have
serious implications for the outcome of therapy.
especially when a relatively long recovery period is
required.
Many reports have described either positive, negative
or no effect at allan the defence system. However. the
picture is based on effects of different antibiotics
studied in many animal species. Only a limited number of
studies are available concerning the effects of
antibiotics upon specific immunological processes such as
antigen processing, proliferation and maturation of
lymphocytes and the production of immunoregulatory
factors.
The effects of a wide range of antimicrobial agents on
the mammalian immune response in vivo as well as in vitro
have been reviewed by Finch 13 and Hauser and Remington 24 •
In this chapter. we selectively review antimicrobial
agents used in veterinary and human medicine with regard
to their effects on non-specific and specific defence
mechanisms.
NON-SPECIFIC DEFENCE MECHANISMS

Chemotaxis and phagocytosis
Chemotaxis and subsequent phagocytosis, important neutro-
phil and macrophage functions in defence against bacterial
infections. are suppressed by several antibiotics in vitro
and in vivo. In particular. tetracyclines have been shown
to interfere with these leucocyte processes. 80th sponta-
neous and induced migration of human leucocytes in vitro
were severely depressed by lymecycline 7 • doxycycline 7 and
tetracycline I4 - 16 • On the other hand. the chemotactic
response of bovine polymorphonuclear leucocytes (PMN) was
not inhibited in the presence of tetracyclines, strepto-
mycin or penicillin at concentrations normally achieved in
blood during systematic treatment. In local therapy, as
with intramammary injections and topical applications.
higher concentrations will be achieved.

Ziv et aLB and Dulin et al. 12 examined intramammary
injected antibiotic products and corresponding vegetable
based vehicles for their effect on phagocytosis by bovine
neutrophils. The concentrations used in the phagocytosis
assay were similar to those found in milk immediately. and
6 and 12 h after injection. The results indicated that
some antibiotics. including penicillins alone or in
combinations. chloramphenicol. cephalosporin. tetra-
cycline. erythromycin. gentamicin and nitrofurantoin as
well as the vehicles in which they are suspended cause a
reduction in phagocytic capability of bovine milk PMN.
Phagocytosis and humoral factors

In the initial phase of phagocytosis a phagocyte has to
recognize and attach firmly to the foreign particle.
These processes are facilitated by a subcomponent of the
complement system (C3b) and immunoglobin after binding at
the particle surface (opsonization). The phagocytic cells
expose receptors for C3b and the Fc portion of certain
immunoglobulins at their cell surface.
Athl in et al. 3 showed that doxycycl ine at therapeutic
concentrations (5 ~g/ml) did not affect the adherence of
yeast cells to human blood monocytes in vitro. However.
the median value of engulfed yeast cells by doxycycline-
treated monocytes was 30% lower than in control cultures.
though statisticallY not significant.
Augmentation of the effects of cephalosporins on host
defences were reported by Lam and co-workers 26 • In their
studies. microdiffusion chambers containing either E. coli
alone or E. coli plus PMN were implanted intraperitoneally
in mice receiving a single dose (3 mg/kg) of cefotaxime.
moxalactam or the new product CPW 86-363. It was
demonstrated that moxalactam and CPW 86-363 led to a
significant reduction in viability of the microorganisms
in the chambers containing both leucocytes and bacteria.
Milatovic 28 has shown that pretreatment of Pseudomonas
aeruginosa with a third of the minimum inhibitory concen-
IMMUNOLOGICAL DEFENCE MECHANISMS AS A TARGET FOR ANTIBIOTICS 267
tration (MIC) of azlocillin. carbenicillin. cefoperazone

or piperacillin changed the opsonic requirements of these
bacteria. P. aeruginosa exposed to the beta-lactam
antibiotics were opsonized and engulfed by human PMN
without participation of the complement system. It was
suggested that the filament formation induced by these
antibiotics is accompanied by changes of bacterial surface
characteristics. Antibiotic-mediated bacterial killing by
serum factors has been reported by Lam et al. 26 • The
survival of a previously serum resistant E. coli strain
was evaluated in media containing fresh human serum and a
low concentration (MIC/4) of the cephalosporins
moxalactam. cefotaxime or CPW 86-363. Cefotaxime and CPW
86-363 improved the bactericidal activity of serum.
Tetracycline. oxytetracycline. lymecycline and doxy-
cycline have been found to suppress the bactericidal
effect of serum on E. colil4. This effect can be reversed
by the addition of Mg2+ ions. Lochmann et a].27 reported
a significant deficiency in the values of C3. the key-
molecule in the complement system. in rabbits immunized
with staphylococcal haemolysin and simultaneously given
antibiotics (chloramphenicol or oxytetracycline). Inter-
ference with the complement system by sulphonamides and
penici 11 ins has been reported by Von Zabern et al. 43 •
Human PMN showed enhanced intracellular killing of
untreated Pseudomonas aeruginosa after pretreatment (and
subsequently washing) of the leucocytes in vitro with
nocardin A. a monocyclic beta-lactam antibiotic. These
augmenting effects occurred at much lower concentrations
than those which exert antibacterial effects without PMN~.
Studies by Hawkey et al. 25 with three antipseudomonal
antibiotics. gentamicin. azlocillin and carbenicillin. did
not reveal significant effects on the phagocytic function
of human PMN in vitro.
Cannon et al.· investigated the in vitro effect of
several antibacterial drugs including sulphonamides and
trimethoprim on neutrophil function. Human PMN were
pretreated with 10 vg/ml of each drug at 37°C for 60 min.
Sulphamethoxazole. sulphanilamide. trimethoprim. brodimo-

prim and cotrimoxazole significantly increased neutrophil
activity. whereas sulphamerizine. sulphadiazine and
ceftriazone did not change the phagocytic process. Wolff
and Stankova 44 investigated whether sulphamethoxazole and
trimethoprim (1:5) improved alveolar mononuclear phagocyte
oxygen metabolism and intracellular killing of Staphylo-
coccus aureus. Rats were given sulphamethoxazole/trime-
thoprim 10/50 mglday for 6 weeks. It was shown that
neither the hexose-phosphate shunt activity, nor the
oxygen metabolism or the intracellular killing properties
were affect ed.
Clindamycin is a well-established drug in the treatment
of serious anaerobic infections. Subinhibitory concen-
trations of clindamycin interfered with the adhesion of E.
coli to buccal epithelial cells and also promoted
phagocytosis and killing by human PMN°. Obviously. the
adherence to phagocytes was not affected. Here too. it
was suggested that alteration of the bacterial cell wall
may inhibit adherence to epithelial cells. necessary for
initiation/establishment of infection. and render the
organism more susceptible to phagocytosis.
SPECIFIC DEFENCE MECHANISMS

Antibody-mediated immune response
When antigen enters the body. it must be processed by
macrophages and presented to T and 8 lymphocytes capable
of a specific response. Depending on the nature of the
antigen. the B cell receives appropriate s~imuli from T
helper cells and macrophages. and it will start to divide.
While the antigen specific 8 cells expand. some of these
cells will start to differentiate into plasma cells. which
specialize in immunoglobulin synthesis and secretion.
One of the protective effects of antibodies is mediated
by the constant region (Fc) of the antibody molecule.
After combining with antigen. antibody acquires the
ability to activate the complement cascade. to bind to
phagocytes or to provoke degranulation of mast cells and
basophils. Thong and Ferrante J1 investigated the effect

of doxycycline on antibody responses to sheep red blood
cells (SRBC) in mice. According to these authors a daily
dose of 100 mq/kg intraperitoneally for 5 days was the
usual therapeutic regime in mice. Under these experimen-
tal conditions. the anti-SRBC response of the antibiotic-
treated animals was not significantly affected. In a
detailed study in rats by Van den Bogert and Kroon J9 ,
oxytetracycline was administered by continuous,
intravenous infusion (20 mg/kg/day). It was shown that
the primary response to SRBC was severely impaired when
the drug was given for more than 48 h after priming. The
kinetics of the IgM response (for example peak day) were
not changed, but the amount of antibodies produced was
much lower. The anamnestic response to SRBC was
completely depressed when oxytetracycline was given during
the first 48 h of the primary response. There was
concluded from these experiments that oxytetracycline
interferes with T cell proliferation and memory cell
formation.
Gillissen ll and Gillissen and Pusztai-Markosl 9 examined
several cephalosporins and cephamycins in respect of their
effect on humoral immunity. The response was evaluated
with the direct plaque-forming cell assay (lgM-producing
spleen cells). Mice were injected intravenously only once
with antibiotics on the same day as being immunized with
SRBC. The results showed that three (cefotetan 30 mq/kg,
cefmenoxime 30 mg/kg, and cefoxitin 20 mg/kg) out of six
antibiotics reduced the antibody response. On the other
hand. the remaining antibacterial agents (cefotaxime,
cefsulodin and cefoperazone) had an enhancing effect. A
totally different picture emerged when the effects of 7
day's therapy on the primary humoral reaction to SRBC was
investigated in mice JJ • Cefotaxime, amikacin, mezlocillin
and piperacillin inhibited the IgM response by 88, 55, 100
and 56%, respectively. Clindamycin did not interfere with
the response. The mezlocillin-induced suppression was
long-lasting, being still present 20 days after completion
of the treatment.
It is known that multiple injections of the same drug
result in different pharmacokinetics compared to a single
dose. This may explain the contradictory results presen-
ted by Gillissen and Pusztai-Markost 9 and Roszkowski et
Adverse effects of antibiotics on the development of

gut-associated lymphoid tissue (GALT) and serum immuno-
globulin levels in chickens and turkeys were investigated
by Naqi et al. 29 and Cook et al. tt , respectively. The
treatment started by dipping eggs in a gentamicin solution
(500 mg/l) for 15 min before incubation. The newly
hatched birds were each injected with 0.2 mg (chickens) or
1 mg (turkeYs) of gentamicin subcutaneously and fed a
commercial diet containing chlortetracycline 200 mg/kg for
the duration of the study (turkeys: 21 days: chickens:
28 days). In the antibiotic-treated chickens a lowered
Ig6 level was observed at 21 days. By day 28, all serum
Ig fractions (lgM. IgG, IgA) were below control values.
Also the number of IgM. IgG and IgA-bearing lymphocytes in
caecal tonsils and large intestine were reduced as
compared to controls. Furthermore, the growth-rate of the
bursa of Fabricius was lower than normal.
Feeding antibiotic-containing diets, as well as appli-
cation of antimicrobial agents with drinking water. may
change the enteric microflora. Consequently. the anti-
genic load and/or composition will be altered.
Oxytetracycline. administered in therapeutic doses for
6 days starting 1 day before immunization, affected the
primarY and the secondary response to SRBC in chickens
(unpublished data). The primary plaque forming spleen
cell response was delayed or suppressed in animals which
received the antibiotic by intramuscular injection or by
oral application (drinking water). Surprisingly, however.
the haemagglutination titre was enhanced. The secondary
direct plaque-forming cell response was not significantly
changed by oxytetracycline. when it was administered
orally during the development of the primary response.
However. the peak response of the indirect plaque forming

cells was delayed for day. 80th the total and
2-mercaptoethanol-resistant haemagglutination titres were
enhanced.
Despite the fact that oxytetracycline affected the
development of the antibody forming cells in the spleen,
the anti-SR8C-titres increased. This indicates that other
lymphoid tissues such as bone marrow may also be important
sites for antibody synthesis.
It has been shown in fish that oxytetracycline
administered as a food additive or by intraperitoneal
injection severely reduced the in vivo immune response. It
was observed that the plaque-forming cell response against
SR8C was depressed by 80-95% after treatment of carp3t.32.
Furthermore. it was demonstrated that oxytetracycline
caused a delay in the peak response rather than
suppression (unpublished data). Clear immunosuppression
was shown in rainbow trout after feeding with pellets
containing oxytetracycl ine t • 4 0 ,
Mitogenic stimulation
Mitogens can stimulate cell division. Certain mitogens
have the ability to activate T or 8 cells specifically.
The plant lectins phytohaemagglutinin (PHA) and concanava-
lin A (con A) provoke T cells to proliferate. whereas
lipopolysaccharide (LPS). derived from Gram-negative
bacteria. can function as 8 cell mitogen. Lymphocyte
mitogenesis can be measured by adding tritiated thymidine
to the culture medium. The amount of radioactivity
incorporated into newly synthesized DNA is regarded as an
estimate of cell proliferation.
The effect of a wide range of antibiotics on human T
and 8 lymphocytes was studied in vitro by 8anck and
Forsgren 4 • In their studY 14 antibiotics (aminobenzyl-
penicillin. benzylpenicillin. carbenicillin. cefazolin.
cephalothin. chloramphenicol. 5-fluorocytosine. genta-
micin. kanamycin. lymecycline. nalidixic acid. sulphame-
thoxazole. tetracycline chloride and trimethoprim) did not
inhibit or stimulate the PHA response when 50 Wg of each

drug/ml was added for 3 days. Inhibitory effects on both
T and B cell mitogenic responses were detected for
erythromycin. clindamycin and rifampicin at relatively
high concentrations. However. doxycycline. nitrofurantoin
and fusidic acid significantly depressed both mitogenic
responses at low concentrations. These antibiotics had to
be present in culture from day 1 or 2 onwards to exhibit a
strong suppressive effect. No significant effect was
observed after addition of the drugs for the last 24 h
combined with tritiated thymidine.
lymecycline and tetracycline chloride (25 wg/ml) did
not influence the thymidine incorporation into PHA-activa-
ted cells. whereas minocycline inhibited this process
significant ly.
Anderson et a 1 .2 investigated the effect of
erythromycin on mitogenic stimulation of human peripheral
blood leucocytes. Erythromycin base at concentrations of
1 x 10- 6 M - 1 x 10-~M did not affect the PHA-induced
proliferation. Only at higher concentrations was a dose-
dependent suppression observed. Ingestion of a single
dose of 500 mg erythromycin stearate by normal volunteers
was not associated with a significant change in mitogenic
responsiveness to PHA or con A. measured 90 min and 4 days
after drug intake. The authors observed consistently a
slight. but statistically insignificant. increase in
thymidine incorporation into con A-activated leucocytes.
Sulphonamides and trimethoprim did not modify the
mitogenic response of human PBl'. However. a highly
significant increase in lymphocyte transformation was
produced by co-trimoxazole.
In mice. the immunodepressive effect of antibacterial
agents was tested in a detailed study by Voiculescu et
al. 41 • It was demonstrated that erythromycin. col istin
and chloramphenicol strongly inhibited the antigen-depen-
dent B cell blastogenesis in vitro. related to in vivo
antibiotic treatment. A T helper-cell deficiency in the
colistin- and chloramphenicol-treated animals was sugges-
ted by the authors, because the B cell response could be

restored by supplementation with autologous T helper-
cells.
These careful studies indicate clearly that certain
antibiotics selectively interfere with the immune system.
Roszkowski et al. 33 and Borowski et al.- showed that
the cephalosporin cefotaxime affected the mitogen-induced
proliferation of mouse spleen cells in vitro only at high
concentrations. Cephradine was inhibitory at therapeutic
levels. Furthermore, Borowski demonstrated that mezlocil-
lin and piperacillin severely reduced the mitogenic res-
ponse to con A and lipopolysaccharide. Amikacin and clin-
damycin did not influence the proliferation. When the
animals were injected with different concentrations of
antibiotics (cefotaxime, amikacin, mezlocillin, pipera-
cillin or clindamycin) twice a day for 7 consecutive daYs,
only clindamycin did not affect the lymphocyte stimulation
induced by con A or lipopolysaccharide. Cefotaxime and
amikacin were effective only in the highest doses tested:
1.2 mg/day and 0.3 mg/day, respectively.
To investigate whether fish leucocytes, obtained from
different lymphoid organs, were sensitive to antibiotic
treatment in vitro, both phytohaemagglutinin and lipopoly-
saccharide mitogenic responses were evaluated in the
presence of various concentrations of oxytetracycline in
carp2D. It was demonstrated that this drug significantly
inhibited thymidine incorporation. The 50% inhibition
level was reached at a concentration of 4-6 wg/ml.
Furthermore, oxytetracycline caused a dose-dependent delay
in the leucocyte response rather than a true suppressive
effect22. Obviously, the impairment of cellular functions
like DNA synthesis was not due to cytotoxicity as was
suggested in previous investigations.
Sulphatroxazole/trimethoprim (5:1), sulphadimethoxine,
sulphadimidine, lincomycin/spectinomycin (1:2) and ampi-
cillin did not suppress the mitogenic response. On the
contrary, at low concentrations an increased thymidine
uptake was observed. Gentamicin and furaltadone showed a
dose-dependent inhibition. Chloramphenicol was stimulato-

ry at concentrations below 5 ~g/m1. whereas higher quanti-
ties became suppressive.
Immunoregu1atory factors
Immune responses. both cell-mediated and antibody-media-
ted. are under strict control. mediated by a number of
different mechanisms. Today. many soluble factors
produced by immunocompetent cells are known to exert a
regulatory effect. In this section we will describe the
effect of several antimicrobial agents on immunoregu-
1ation.
In 1974 Serrou 36 published a report on the suppressive
influence of rifampicin on migration inhibition factor
(MIF) secretion by human lymphocytes. Inhibition of
protein and 1ymphokine synthesis was also observed when
tetracycline was present in human leucocyte cu1tures!7.
The effects of erythromycin on the release of
prostaglandin E2 (PGE2) by mitogen-stimulated mononuclear
1eucocytes were investigated by Anderson et a1. 2 • This
drug caused significant inhibition of PGE2 release by
resting and mitogen-activated cells at relatively low
concentrations. According to the literature PGE2 exerts
immunosuppressive activities. Therefore. Anderson et a1. 2
concluded that the observed increase in leucocyte
transformation following erythromycin ingestion. can be
explained by reduced PGE2 production.
The above-mentioned modification of the phytohaemagglu-
tinin response of mouse T cells by erythromycin. colistin
and chloramphenicol. was also observed in experiments with
T helper or T suppressor soluble factors 42 • These data
confirmed the T helper-cell deficiency in antibiotic-
treated animals as well as the T suppressor-cell enhance-
ment in chloramphenicol-treated mice. Furthermore. a sig-
nificant immunosuppressive activity has been demonstrated
using the migration inhibition assay. following in vivo
treatment with the same antibiotics. On the other hand.
benzylpenicillin. streptomycin. kanamycin and tetracyc1in
did not affect the inhibition of macrophage migration.

A T cell-dependent immune response is amplified by the
action of both interleukin (IL-l) and interleukin 2
(IL-2). Both factors are proliferation and/or differen-
tiation signals for T and B lymphocytes during the res-
ponse JD , J 7 . The amplification process is dependent upon
both the level of interleukin synthesis and induction of
interleukin receptors. Interleukins have been isolated
and characterized in many mammalian species. The existen-
ce of interleukin-like factors has also been demonstrated
in birds J4 , J ' and fish lD • 2l , emphasizing the phylogenetic
importance of amplifying/regulatory factors for a standard
immune reaction.
In chickens. the early stages of the mitogen-induced T
cell proliferation can be inhibited by oxytetracyclin 2J •
In this study, supernatants of con A-induced spleen cell
cultures were harvested at different time intervals and
tested for their growth-promoting activity on T cell
blasts. in order to determine the IL-2 production in the
presence or absence of oxytetracycline. The antibacterial
agent did not seem to have any effect on IL-2 production,
whereas the uptake of tritium-labelled thymidine by
growth-factor-dependent T cell blasts was severely redu-
ced.
The delaYed-type hypersensitivity (DTH) reaction is
based upon the interaction between antigen and primed T
cells. Several lymphokines are released which account for
the typical events during the DTH response. DTH is
characterized by the appearance of an induration and
erythematous reaction which reaches a maximum at 24-48 h.
During this process, macrophages and lymphocytes infil-
trate and accumulate at the inflammation site.
Thong and Ferrante J I have shown that mice treated in
vivo with different tetracycline analogues have a reduced
capacity to mount DTH responses to SRBC. A significant
reduction (30-45%) was observed in experimental groups
treated once with doxycycline. rolitetracycline and
tetracycline. Oxytetracycline did not evoke a significant
effect. The suppressive effect of doxycycline was more

pronounced when the drug was administered on the day of
challenge than 2 days prior to priming. This suggests an
interference with macrophages and/or lymphocytes.
A severely depressed DTH response was observed in rats
when oxytetracycline (20 mg/kg/day) was administered con-
tinuously. starting just before the moment of priming 39 •
Furthermore. it was shown that oxytetracycline. only
suppressed the response when the drug was present between
18 and 72 h after priming. According to these authors,
this implies that during this particular period the number
of T cell divisions is large enough to reduce the
mitochondrial ATP-generating capacity in the presence of
the drug. Consequently, inhibition of cell proliferation
will occur.
In contrast to tetracyclines, several cephalosporins
and cephamycins significantly enhanced the DTH response in
mice " • The antibiotics were given once (30 mg/kg) on the
day of immunization or 3, 2 and 1 days before. Pretreat-
ment of the animals with drugs (cefotaxime. cefoxitin.
cefsulodin, cefoperazone. cefotetan and cefmenoxime)
resulted in a more pronounced effect. However. 7 days of
chemotherapy with cefotaxime suppressed the DTH
response •
33
CONCLUSIONS
It is clear that some of the commonly used antimicrobial
agents can interfere with non-specific and/or specific
defence systems. Antibiotics may exert suppressing as
well as enhancing immunological side-effects. depending on
test models and animal species. Therefore, it is impossi-
ble to draw general conclusions on the effects of anti-
biotics on the immune system as such. We also cannot
define the clinical relevance of antibiotic-mediated
immunomodulation at the present time. Yet. it is very
important to exclude any immunosuppression by certain
drugs in either animals or man. This is obvious. because
the defence mechanisms have to eliminate the pathogens
IMMUNOLOGICAL DEFENCE MECHANISMSASATARGETFORANTIBIOTICS 277
final I y.
To day. many in vitro and in vivo immunological assays
are available and provide us with sensitive tools for
monitoring drug effects. However. it is essential to
standardize these assays and to incorporate carefully
designed studies. which reflect the disease status.
There exists a general relation between the specific
growth-rate of bacteria and the nutrient concentration
available. In addition. temperature is also an important
environmental factor. which determines the rate of all
biochemical reactions. For instance. fish pathogens are
psychrophilic. which means that their optimal growth-rate
is far below 37°C, in contrast to thermophilic organisms.
The immune system of ectothermic animals has to be adapted
in such a way that it can mount an adequate response at
relatively low temperatures. This biochemical adaptation
(for example metabolic rate and membrane lipid composi-
tion) may have implications for the pharmacokinetics of
the drugs and for the susceptibility of the immunological
process to toxic damage. It is clear that antibiotics
have been used over a wide range of species. For some
species pharmacokinetic data are scarce or even absent.
Kinetic data on tissue distribution, plasma disposition
and biological half-life time can differ markedly between
mammalian species. Moreover. extreme differences may be
expected with respect to the pharmacokinetic behaviour of
the drug in birds and fish.
The immunoenhancing effects of antibiotics, caused by
interference with the bacterial physiology and/or by
stimulation of the host immune system are promising. The
combined action of immune system and drug will increase
the defensive potential. The ultimate goal of
antibacterial therapy is to achieve the best action
against pathogens with minimal adverse side~effect5. It
can be seen in Figure 25.1 that many factors determine the
clinical efficacy of a selected antibiotic. One of these
factors is the binding to plasma proteins. because only
free material will pass to the tissues. Another factor is
Figure 25.1 Diagram showing the various factors which can

influence the outcome of antibiotic therapy.
the amount of unbound drug at the site infection and the

degree of interference with local and systemic defence
systems.
It is emphasized that a multidisciplinary approach, as
is visualized in the diagram, is necessary to tackle the
problems efficiently. Immunological, pharmacological and
microbiological research has to be extended over a wide
range of animal species to support an effective management
in animal husbandry and an optimal veterinary practice.
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Drug Biotransformation
26
Comparative aspects of drug conjugation in
laboratory animals, exotic species and man
].CALDWELL
ABSTRACT
The great majority of xenobiotics entering the animal body
undergo enzymic metabolism in a biphasic sequence of
reactions. involving first a reaction of oxidation.
reduction or hydrolysis. followed by conjugation of the
product with an endogenous moiety. Six major conjugation
reactions may be discerned. involving glucuronic acid.
sulfate. methyl or acetyl groups. glutathione or one of a
number of amino acids. In addition. a number of novel
conjugations are known. Although the fundamental pattern
of metabolism is common to all species. there occur within
the pattern substantial phylogenetic differences. both
qua I itati ve and quanti tati ve. These are especially
evident with the major conjugation reactions. certain of
which exhibit "species defects". for example glucuronida-
tion in the cat and N-acetylation in the dog. while other
reactions are restricted in their occurrence to particular
groups of species: this is noteworthy with respect to
primate species. An understanding of the characteristics
of xenobiotic metabolism in particular species may have
taxonomic value. It is increasingly appreciated that the
conjugation reactions are of considerable pharmacological
and toxicological significance. generally by favouring
detoxication and excretion. There do exist. however.
285
circumstances where conjugation results in metabolic

activation. In either situation. the occurrence of
substantial species differences in conjugative metabolism
frequently underlies interspecies differences in
biological activity of xenobiotics.
When exogenous chemicals. drugs. agricultural

chemicals. etc. enter the animal body. they undergo one of
four distinct fates. They may (a) be eliminated
unchanged; (b) undergo enzymic metabolism; (c) undergo
spontaneous chemical transformation; or (d) accumulate
unchanged. Although examples of all of these
possibilities can be cited. by far the greatest majority
of drugs entering the body undergo enzymic metabolism.
This is typically a biphasic process (see Figure 26.1). in
which the compound undergoes initially a phase I. or
functionalization reaction of oxidation. reduction or
hydrolysis. which serves to introduce within the substrate
a suitable functional group to act as the site for the
phase II. or conjugation. reactions.
Phase I Phase II
reaction reaction
Drug ---------<.- Metabol i te ------~.~ Conjugate
(oxidation.
reduct ion. (conjugation)
hydrolysis)
Figure 26.1 The biphasic sequence of drug metabolism
In some cases. a compound may be eliminated as a phase

I metabolite. while other drugs may undergo conjugation
directly. The elimination products of drugs will thus
comprise some or all of phase I metabolites. phase II
metabolites. products of the biphasic sequence and. to a
greater or lesser extent. the unchanged compound. It is
the purpose of this chapter to review the major
conjugation reactions of drug metabolism and their
DRUG CONJUGATION IN LABORATORY ANIMALS. EXOTIC SPECIES AND MAN 287
zoological distribution and to comment upon their

significance in pharmacology and toxicology.
The conjugation reactions may be defined as "a group of
biosynthetic reactions in which a drug or a metabolite
thereof is covalently linked with an endogenous moiety to
give a characteristic product known as a conjugate"3. The
endogenous groupings involved in metabolic conjugation all
have well-defined roles in intermediary biochemistry
and/or biosynthesis. and these reactions may be viewed as
interfaces between drug metabolism and intermediary
biochemistry. It is appropriate to consider the
conjugation reactions as falling into two groups, a small
number of "pr i nc i pa 1" react ions. whose spec i es
distribution. substrate versatility and enzymic mechanism
are (reasonably) well understood. and a much larger number
of "novel" reactions. which are at present viewed. through
the paucity of our knowledge. as restricted in their
occurrence to particular combinations of animal species
and substrate 3 • 4 • These novel reactions are outside the
scope of the present coverage. but are reviewed at length
el sewhere 3 • 9 .
There are six principal metabolic conjugations divided
mechanistically into two types t : (a) those deriving the
required energy from an activated endogenous conjugating
agent. generally a nucleotide: and (b) those where the
xenobiotic undergoes metabolic activation prior to
conjugation. These reactions are shown in Table 26.1.
During the course of evolution, living organisms have
developed an immense diversity. The mammalia alone
comprise over 4000 species. It is remarkable to note that
the biphasic pattern of drug metabolism is found to occur
in all mammals (and most other organisms) : however. there
occur widespread qualitative and quantitative variations
within this fundamental pattern. and these are documented
at 1 ength in the drug metabol ism 1 i terature 8 • t 4 . Qual i-
tative differences between species may arise in one of two
ways (a) a species may be (relatively) defective in a
reaction of otherwise widespread occurrence: or (b)
Table 26.1 Mechanistic classification of the major con-

jugation reactions
(A) Reactions involving activated conjugating agents

Glucuronidation (UDPGA)
Sulphation (PAPS)
Methylation (S-adenosylmethionine)
Acetylation (acetyl CoAl
(8) Reactions involving activated xenobiotics
Glutathione conjugation (epoxides. alkyl and aryl
halides and nitro com-
pounds. etc.)
Amino acid conjugation (xenobiotic acyl CoAs)
reactions being restricted in their occurrence to

particular species or groups of species. Quantitative
species differences arise from variations in the relative
activities of two or more alternative metabolic options
which a given compound may undergo. It is this last case
which is encountered most frequently.
A number of so-called "species defects" of metabolic
conjugation have been documented. and a list is presented
in Table 26.2 2 , 1 1 .
The best-known of these examples are the defects of
glucuronidation in the cat and related feline species 7 and
of N-acetylation in the dog 5 • It is important to
appreciate that these defects are not absolute. but must
be qualified with reference to the substrate(s) in
question. Thus. the cat is unable to glucuronidate
simple. relatively water-soluble phenols and carboxylic
acids. However. the glucuronidation of more complex.
lipid-soluble substrates proceeds in the cat to the same
extent as in other species. Similarly, dogs are unable to
N-acetylate aromatic amino groups and hydrazides. but do
acetylate the S-substituted cysteines which are the
penultimate intermediates in the conversion of glutathione
conjugates to mercapturic acids. Guinea-pigs. on the
Table 26.2 Some species defects in metabolic conjugation

reactions
Reacti on Affect ed speci es
Glucuronidation Cat and related species

N-Acetylation of Dog and related species
aromatic amines
N-Acetylation of Guinea-pig
S-substituted cysteines
Sul phation Pig
Glutamine conjugation Non-primates
of arylacetic acids
Glycine conjugation of Horse
salicylate (but not
benzoate)
other hand. apparently cannot N-acetylate these

substituted cysteines. but do acetylate a variety of other
amines. The failure of the guinea-pig to excrete
mercapturic acids thus arises not from a defect in
conjugation with glutathione. but rather from one in the
catabolism of the products of this reaction 2 •
For many years. there has been much interest in the
possibility that certain metabolic reactions have been
restricted by evolutionary pressures to specific groups of
species. In particular. the close similarities between
man and primate species has led to numerous comparative
metabolic studies which have thus far revealed the
existence of five conjugation reactions which only occur
in these species7.'~. These are:
(1) the glutamine conjugation of arylacetic and aryloxy-

alkyl acids (found in man. apes and old and new world
monkeys);
(2) the O-methylation of 4-hydroxy-3.5-diiodobenzoic acid
(man. old and new world monkeys);
(3) the N'-glucuronidation of certain methoxysulphonamides

(a 1 1 p rima t e s) ;
(4) the quaternary N-glucuronidation of tertiary aliphatic
amines (man and apes only);
(5) the C-glucuronidation of pyrazolone rings (man and
apes only).
Another example of a metabolic reaction being largely

restricted in its occurrence to a group of species is that
of taurine conjugation, which occurs at low levels in many
species but is particularly well-developed only in
carnivores.
Quantitative speci es differences in the relative
extents of competing metabolic options can be seen in the
cases of phenols, which may undergo either sulphation or
glucuronidation, and carboxylic acids, which are
conjugated with amino acids or glucuronic acid. Table
26.3 illustrates this in the case of phenol itself2.
In other cases, it is found that the physicochemical
properties of the drug as well as the animal species in
question determine the pattern of conjugation of a parti-
cular phenol'2 or carboxylic acid b •
There are many reasons for the detailed studY of
Table 26.3 Species variations due to competing reactions:

the conjugation of phenol
Speci es Percentage dose

conjugated with
sulphate glucuronide Rati 0 S/G
Man and old world

monkeys 80 12 7
New world monkeys 25 50 0.5
Rat and mouse 45 40 1
Cat 93 1 93
Pig 2 95 <0.1
species differences in drug metabolism. in particular the

usefulness of such studies in explaining interspecies
variations in pharmacological and toxic effects. Another.
less widely appreciated reason is the use of comparative
metabolic data in the classification of animals. for which
the term "pharmacotaxonomy" has been coined 2 • This is
very well illustrated by data from a variety of carnivores
examining the species distribution of the glucuronidation
defect of the felines and the N-acetylation defect of
canines. The data listed in Table 26.4 show that the
feline species (cat. lion. lynx. civet) were metabolically
completely distinct from the canines (dog and hyena).
Although classical taxonomy usually classes the hyena as a
feline species rather than a canine. this data suggest
that a revision of this view is indicated.
The metabolic conjugation reactions are of great
importance for the pharmacological and toxic actions and
interactions of drugs and other chemicals. and reasons for
this are presented in Table 26.5. By causing substantial
changes in the chemical structure and physicochemical
properties (the majority of conjugates are more polar and
have greater water solubility than their parent compounds)
of drugs. the conjugation reactions generally result in
the inactivation and facile elimination of drugs from the
Table 26.4 Comparative glucuronidation and acetylation of

various substrates amongst carnivores
Glucuronidation of N-Acetylation of
1-naphthyl-acetic acid sulphadimethoxine
Cat 0 18
Lion 0 48
Lynx 0
Civet 0 66
Hyena 40 0
Dog 20 0
body. In a small number of cases, however, conjugation

may result in metabolic activation. and thus contribute to
the actions of drugs tJ •
Species variations in metabolic conjugation have great
significance as determinants of species differences in
biological response. Thus, cats are far more susceptible
to the toxic effects of various glucuronidogenic
substrates than are rats, rabbits and other species in
which this reaction is extanF. Simi larlv, aromatic
amines produce methaemoglobinaemia far more readily in the
dog than in other species which are able to N-acetylate
these amines. The absence of this conjugation in the dog
allows metabolic activation, by N-oxidation, to occur far
more extensivelyJ. Many aromatic amines are carcinogenic,
and the acetylation defect in the dog has a site-directing
influence upon their tumorigenicityJ. Such amines are
potent bladder carcinogens in the dog, with little or no
effect on other organs, while in the mouse, rat and other
species they produce tumours in a variety of tissues but
have no effect on the urinary bladder. The relationships
between the oxidation. acetylation. sulphation and glucu-
ronidation of aromatic amines and their carcinogenicity
are complex 'o • but the N-acetylation defect in the dog has
a major role in targetting their carcinogenicity to the
urinary bladder.
The capacity of the principal metabolic conjugations
depends upon the affinities of the transferase enzymes
involved both for the xenobiotic substrate and the
endogenous conjugating agent, and upon the availability of
the conjugating agent. Since these latter have important
roles in intermediary metabolism. their availability for
the conjugation of xenobiotics may be limited. This.
together with the widespread distribution of conjugation
activity amongst the tissues of the body (notablY in the
absorptive and excretory organs) leads to a number of
pharmacokinetic consequences of conjugation which are
listed in Table 26.5. Space does not permit more than the
briefest mention of these, but full descriptions are to be
DRUG CONJUGATION IN LABORATORY ANIMALS, EXOTIC SPECIES AND MAN 293
Table 26.5 Biological significance of the conjugation

reactions
Conjugation reactions result in :

(1) Readily excreted end-products of xenobiotic metabolism
(2) Metabolic activation, in certain cases
(3) Detoxication , which may however be defective, due to
(a) species defects
(b) saturation (capacity limitations)
(4) Pharmacokinetic implications, including
ta) capacity limitations
(b) enterohepatic recirculation
(c) presystemic elimination
(d) determination of route-of-elimination
(e) drug-drug interactions
found e I sewhere t .4 •
In summary. therefore. it will be clear from the above
that the conjugation reactions are of great importance in
the metabolic disposition of drugs and other chemicals in
the animal body, and consequently of pharmacological and
toxicological significance. In the futu r e. our awareness
of metabolic conjugation will develop further in various
ways (a) with enhanced knowledge of both the "principal"
and novel conjugation reactions; (b) the discovery of more
novel conjugations; (c) further recognition of the
biological consequences of conjugation; and (d) by viewing
the conjugations as interfaces between xenobiotic
metabolism and the biochemistry of endogenous compounds,
with possible pathological sequelae.
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tics. In: Matern, S., Bock, K.W. and Gerok, W.
(eds). Advances in Glucuronide Conjugation, pp.5-18.
Lancaster : MTP Press.
8. Caldwell, J. and Paulson, G.D. (1984). Foreign Com-
ound Metabolism. London: Taylor and Francis.
9. Eadsforth. C.V. and Hutson. D.H. (1984). Formation of
carbohYdrate. sulphate and other xenobiotic conJu-
gates. In Caldwell. J. and Paulson. G.D. (eds).
Foreign Compound Metabolism, pp.171-184. London
Taylor and Francis.
10. Flammang. T.J. and Kadlubar. F.F. (1985). Acetyl CoA-
dependent. cytosol-catalysed binding of carcinogenic
N-hydroxy-arylamines to DNA. In Boobis, A.R.,
Caldwell. J., De Matteis, F. and Elcombe. C.R. (eds).
Microsomes and Drug Oxidations. pp.190-197. London
Taylor and Francis.
11. Marsh, M.V •• Caldwell. J •• Smith. R.L •• Horner. M.W ••
Houghton. E. and Moss. M.S. <1981>. The metabol ic
conjugation of some carboxylic acids in the horse.
Xenobiotica 11:655-663.
12. Mulder. G.J. (1982). Conjugation of phenols. In:
JakobY. W.B •• Bend. J.R. and Caldwell. J. (eds). Meta-
bolic Basis of Detoxication. pp.247-269. New York
Academic Press.
13. Mulder. G.J. (1984). The role of sulfation and glucu-
ronidation in toxification of xenobiotics. In: Cald-
well. J. and Paulson. G.D. (eds). Foreign Compound
Metabolism. pp.235-244. London: Taylor and Francis.
14. Parke. D.V. and Smith. R.L. <1977>. Drug Metabol ism
from Microbe to Man. London: Taylor and Francis.
15. Smith. R.L. and Caldwell. J. (1977). Drug metabolism
in sub-human primates. In: Parke. D.V. and Smith.
R.L. (eds). Drug Metabolism from Microbe to Man.
pp.331-356. London: Taylor and Francis.
27
Hepatic microsomes as models for comparative
metabolism in vivo
C.H. WALKER
ABSTRACT
Hepatic microsomal systems have been used to studY the
metabolism of lipophilic xenobiotics. Sometimes these
systems give reasonable qualitative and quantitative
predict ions of metabolism in vivo. In vi t ro systems such
as these can be used to study a much wider range of spe-
cies than is possible in vivo.
Comparative studies have shown considerable species
differences in hepatic microsomal mono-oxygenase activi-
ties. which show the general trend mamma1s>birds>fish.
With mammals there is a negative correlation between
average mono-oxy-genase activity and log body weight.
With lipophilic xenobiotics particular attention is
given to cases where microsomal metabolism is so slow that
it may influence rates of excretion and biological
half-1 ives. Here. species differences in enzyme activity
may result in corresponding differences in bioaccumu-
1ation.
INTRODUCTION
Liposoluble xenobiotics are metabolized by vertebrates.
especially in the liver. Although metabolism is usually a
detoxifying process. there are important exceptions. where
metabolism causes activation (for example, of certain
295
polycyclic aromatic carcinogens and organophosphorous

insecticides). Thus. a knowledge of metabolism is an
important part of the safety evaluation of drugs.
pesticides and other man-made chemicals.
Data are sought on metabolism in vivo in man and in
beneficial organisms. but this aim can only be realized to
a limited extent. For reasons of cost and because of
practical and ethical considerations. only a very limited
number of vertebrate species can be studied. This is a
serious limitation in the fields of veterinary toxicology
and ecotoxico1ogy because there is much evidence of marked
species differences in response to toxic agents. For
these reasons there is a growing interest in the use of in
vitro techniques to predict in vivo metabolism. In vitro
techniques are relatively cheap and easy to perform. and
can be used to investigate a much wider range of species
than is possible by in vivo studies alone.
Many lipophilic xenobiotics undergo their initial
biotransformation in the hepatic endoplasmic reticulum.
This paper will discuss the use of hepatic microsomes to
study metabolism in vitro by different species. and the
possibility of using this system to make qualitative and
quantitative predictions of metabolism in vivo.
QUALITATIVE COMPARISONS BETWEEN IN VITRO AND IN VIVO

METABOLISM
The biodegradable dieldrin analogue HCE (1.2.3.4.9.9-hexa-
ch1oro-l.4.4a.5.6.7.8.8a-octahydro-exo-7.8-epoxy-l.4-metha
nonaphtha1ene) was used as substrate in a comparison
between in vivo and in vitro metabolism by the rat. rab-
bit. pigeon (Columba 1ivia) and Japanese quail (Coturnix
coturnix japonica)3. In all species hepat ic microsomal
metabolism was predominantly by mono-oxygenase attack.
with one primary metabolite undergoing further oxidation
to two other metabolites as the substrate concentration
fell with time. The same metabolic pattern was found in
all cases in vivo. Thus. the major in vivo metabolites
were correctly predicted by the microsomal model in four
HEPATIC MICROSOMESAS MODELS FOR COMPARATIVE METABOLISM 297
contrasting species. In other studies with the rat.

hepatic microsomes again provided a good prediction of the
major metabolites of phenytoin. griseofulvin. and HE OM
(1.2.3.4.9.9-hexachloro-l.4.4a.5.6.7.8.8a-octahydro-6.7-ep
oxy-l.4-methanonaphthalene; dieldrin analogue)3.
QUANTITATIVE COMPARISONS BETWEEN IN VITRO AND IN VIVO

METABOLISM
Using dieldrin. HCE and HEOM. hepatic microsomal
metabolism was compared with in vivo metabolism (biliary
excretion) in the male rat. Both microsomal metabolism
and biliary excretion were much slower for dieldrin than
for the other two compounds 3 •
Induction with phenobarbitone caused a 17-fold increase
in microsomal mono-oxygenase activity towards HCE in
vitro. but there was no significant increase in the rate
of biliary excretion of HCE metabolites in vivo. With
dieldrin. on the other hand. phenobarbitone induction
caused a significant three-fold increase in the maximum
rate of excretion. clearly indicating that the enzymic
activity was limiting the rate of excretion of metabolites
for this compound but not for HCE. A Lineweaver-Burke
plot of HCE metabolism by rat microsomes successfully
predicted the rate of excretion into bile.
Other workers have successfully used microsomal
metabolic data in pharmacokinetic models to predict the
rate of loss of lipophilic xenobiotics such as phenytoin.
and polychlorinated biphenyl (PCB) isomers 3 •
A survey was conducted on the relative mono-oxygenase
activities of liver microsomes of different species
reported in the literature 2 • Data were collected for 65
vertebrate species. and covered a wide range of assay
procedures using different substrates (results are
included for ten different substrates). To facilitate
comparison between species. activities were calculated
relative to those of the male rat. With mammals. there
was a good negative correlation between relative activity
and body weight (correlation coefficient -0.808). In
all cases fish showed lower activities than mammals of the

same body size. while most birds had intermediate
activities. Cattle. sheep. pigs. cats and dogs fitted
into this general pattern. all showing lower relative
activities than rats. in keeping with their relatively
high body weights\,2. The values for dogs. sheep and pigs
were close to the regression line. The value for cats
fell below the line; the value for cattle was above the
line. but the significance of this is uncertain since it
was based on only two assay procedures.
DISCUSSION
From the foregoing account. it is clear that microsomal
systems can give reasonable qualitative and/or
quantitative predictions of the in vivo metabolism of
certain lipophilic xenobiotics. However. the examples
quoted were for compounds which are metabolized in a
relatively simple fashion and which undergo most of their
primary biotransformation in the hepatic endoplasmic
reticulum. This model would not be appropriate for
compounds which are. for example. broken down primarily by
blood esterases. or by gut microf10ra. Anticipation of
the likely mechanism and location of biotransformation are
needed in the selection of appropriate model systems for
in vitro studies. Future progress in this field will
depend upon the development. and the successful integra-
tion. of a variety of in vitro techniques including the
use of perfused organs. cell suspensions and cultures.
subcellular fractions and purified enzymes.
Microsomal systems (including induced preparations) may
give forewarning of the very slow biotransformation of
certain xenobiotics by certain species. with the attendant
risk of bioaccumu1ation. The possibility of using kinetic
data to predict bioaccumu1ation risks was discussed in a
recent paper 4 • Where biotransformation rates are very
slow. substantial species differences in enzyme activity
may be accompanied by corresponding differences in
biological half-lives and in susceptibilities to toxic
HEPATIC MICROSOMESAS MODELS FOR COMPARATIVE METABOLISM 299
agents.
References
1. Smith. G.S •• Watkins. J.B •• Thompson. T.N. Rozman. K.
and Klaassen. C.D. (1984). Oxidative and conjugative
metabolism of xenobiotics by livers of cattle. sheep.
swine and rats. J. Animal Sci. 58:386-395.
2. Walker. C.H. (1980). Species variations in some hepa-
tic microsomal enzymes. Prog. Drug Metab. 5:113-164.
3. Walker. C.H. (1981). The correlation between in vivo
and in vitro metabolism of pesticides in vertebrates.
Prog. Pesticide Biochem. 1:247-285.
4. Walker. C.H. (1985). Bioaccumulation in marine food
chains - a kinetic approach. Marine Env. Res. 17:297-
300.
28
Pharmacokinetics, hydroxylation and acetylation
of sulphadimidine in mammals, birds, fish,
reptiles and molluscs
J. F. M. NOUWS, T. B. VREE, H. J. BREUKINK, A.S.J.P.A.M. VAN MIERT
AND J. GRONDEL
ABSTRACT
Plasma disposition, plasma protein binding, recovery in
urine and renal clearance of sulphadimidine (SOM), its
N. -acet Y1 (N. -SOM) , its 6-hydroxYmet hy 1 (SCH 2 OH). its 5-
hydroxy (SOH) and its glucuronide (SOH-gluc) metabolites
were studied in man, ruminants. horses. pigs. laying-hens
and the carp. The elimination half-life depended mainly
on the extent of metabolism and the renal excretion rate
of the metabolites. N.-SOM, SCH 2 0H and SOH metabolites
exhibited higher renal clearance values than SOM. Hydroxy-
lation of SOM predominated over acetylation in horses, ru-
minants. poultry, turtles and snails. The main metabolite
in horses was SOH: in cows. calves. goats. turtles and
snails it was SCH 2 0H. In ruminants a capacity-limited
hydroxylation of SOM to SCH 2 0H was observed at dosages of
100-200 mg/kg. Also in laying-hens a capacity-limited
elimination-like pattern was obtained following an intra-
venous SOM dosage of 100 mg/kg. In man and pigs the ace-
tylation pathwaY was predominant and the elimination half-
life in the latter species depended on the position of the
acetYlation-deacetylation equilibrium. Fish are able to
hYdroxylate and acetylate SOM.
301
INTRODUCTION
Sulphadimidine (SDM) is the most widely used sulphonamide
for prophylactic and therapeutic purposes in a wide range
of species. Between-species differences in elimination
half-lives for SDM as well as for other sulphonamides have
been reported. and these have been recently reviewed 1 •
Most reported pharmacokinetic data have been based on
assays performed by the Bratton and Marshall method, which
does not distinguish SDM from its hydroxy metabolites 2 . , .
1 1 ) •
Sulphadimidine can be metabolized by hydroxylation at

the 5 or 6 position of the pyrimidine ring, and by the
acetylation-deacetylation pathwayll-lJ. After hydroxy-
lation the metabolites may become glucuronidated (Figure
28.1). The hydroxy metabolites are microbiologically
active and they may be potentiated by trimethoprim 6 •
Because of its widespread therapeutic use and from the
residue point of view, SDM was selected for comparative
study of its metabolism, pharmacokinetics and renal
clearance of both the parent drug and its metabolites.

Drugs
Sodium sulphadimidine (33.3%) was obtained from AUV (Cuyk,
the Netherlands); N.-acetylsulphadimidine (N.-SDM), 6-hy-
droxymethylsulphadimidine (SCH 2 0H) and 5-hydroxysulpha-
dimidine (SOH) were synthesized and isolated according to
Vree et al. 11 • 12 ,
Experiments
The experiments were performed at different institutes in
the Netherlands. SDM was administered intravenously to
horses, ruminants, pigs and laying-hens, orally to human
volunteers, pigs, turtles and snails, and intraperitone-
ally to carp. N.-SOM was administered intramuscularly to
carp. From man, horses, ruminants, pigs, laying-hens, and
carp heparinized blood samples were taken at regular time
intervals. centrifuged, and the plasma was stored at
PHARMACOKINETICS, HYDROXYLATION AND ACETYLATION OF SULPHADIMIDINE 303
-20°C pending HPLC analysis. Urine was collected by

either spontaneous voiding. or catheterization. or with
special urine collection facilities in man. horses.
ruminants and pigs. With respect to carp. turtles. and
snails. aquatic water samples were taken at 4-12 h inter-
vals and in the case of carp sampling was followed by
refreshment of water.
HPLC analysis
Oeglucuronidation. sample preparation and HPLC analysis
were performed as described elsewhere 7 • a • SOM. its N4 -SDM
and two hydroxy metabolites were determined simultaneously
in the samples.
RESULTS
Table 28.1 summarizes the percentages of sulphadimidine
and its metabolites in plasma of different species; Table
28.2 presents their plasma protein binding data. Table
28.3 shows the urinary recovery data; and in Table 28.4
the renal clearance values of creatinine and unbound
sulphadimidine and its metabolites are summarized.
Man
The main metabolic pathway in man is the acetyl-deacetyl-
ation pathway. Hydroxylation only accounts for 10% of the
dose. The renal clearance of N4 -SDM is four to five times
higher than the creatinine clearance. being lower than in
ruminants. but similar to that obtained in pigs. horses
and goats. In man. acetylation dominates deacetylation in
the acetylation-deacetylation equilibrium. which causes
the short elimination half-life. "Slow" and "fast" (Figure
28.2) acetylator phenotypes are distinguishable. exhi-
biting elimination half-lives ranging between 8.7 and 2 h.
respectively <Tables 28.3 and 28.4)11.
Horses
In the horse. hydroxylation is more important than
acetylation. with hydroxylation of the 5 position being
______ ..blucuron 1dat lon- - - - - --I
illI
: I
I"".:,',", I' f
I StOOH 11 N4-SCOOH? I
i
Other I SCH20H 1 N4-SCH20H-o_:
21
pathways ~ I6 -met
\ hy1 Co
~
-desOOllnat I on hydroxylation 0-
-glycoside ? 1 1
-ornithine? 80M 2 N14-SDM I
-glycine ? !5-h YdrOX Y- ! :
-sulphation? lation?
/ I
I ,,(-
SOH 1 N SOH I
Acetylation
Deacetylatlon i
Glucuronidat IOn- - - - - ---'
Figure 28.1 Metabolic pathways of sulphadimidine.
dominant over hydroxylation of the 6-methyl group. The

elimination half-life of sulphadimidine varies between 5
and 14 h. independent of the dosage. The main metabolite
in urine is the SOH and its glucuronide. accounting for
50% of the drugs present (Table 28.3).
Cows and calves

SDM is extensively converted to hydroxy derivatives and to
a lesser extent it is acetylated. Hydroxylation of the
6-methyl group to form 6-hydroxymethylsulphadimidine
dominates (1.5 times) hydroxylation of the 5 position. At
high dose levels (100 mg/kg). a biphasic elimination SOM
plasma concentration-time curve was observed with a steady
state plasma concentration of SCH20H (6-15 ~g/ml) during a
period when the SDM plasma concentration exceeded 20
ug/ml. At high dosage a capacity-limited hydroxylation of
SDM into SCH2 0H was obtained (Figure 28.3). The main
metabolite in the urine was SCH20H accounting for 23-55%
of the administered dose. An unknown metabolite (X) and
Table 28.1 Mean percentages· of sulphadimidine and its

metabolites in plasma of different species
Man b Calf Cow

(S) (F)
Dose mg/kg 12 12 10 100 10 100

SOMe 57.6 23.5 62.6 79.7 70.5 85.4
N4 -SOMe 32.7 67.3 5.7 11.0 2.1 2.3
SCH2 0He 30.9 8.6 22.4 9.7
SO He 1.4 0.7 3.9 1.0
X(+gluc>e 3.4 2.2
----------------------------------------------
Goat Horse Pig Poultry Fish
(Carp)
Dose mg/kg 100 20-200 20 100 560

SOMe 77.6 95.0 90.0 87.8 96.8
N4 -SOMe 1 .5 0.7 10.0 7.5 2.8
SCH 2 OW 7.2 0.5 4.5 0.4
SOW 5.4 3.8 1.2 0.05
X(+gluc>e 8.5
a Percentage of AUC versus total AUC (= AUC parent + meta-

bolites).
b S = Slow acetylator. F = Fast acetylator phenotype.
c Percent.
its glucuronide were detected in plasma (Figure 28.3)

and/or in urine of cows. goats and horses (Tables 28.1 and
28.3). The unknown metabolite (X) may be the further oxi-
dation product of the 6-hydroxymethyl metabolite (Figure
28.2) being tentatively identified as the compound 6-car-
boxysulphadimidine and its glucuronide. The renal clea-
rance of SOM was urine-flow correlated. and was half the
creatinine clearance (Table 28.4).
Table 28.2 Protein binding of sulphadimidine and its me-

tabolites in different species
Calf Cow Pig Goat

----------------------------------------------
SOM- IJg/ml <50 <50 >50 <100 <50
SOM 81.1 79.0 50.8 64.9 75.4
N4-SOM 86.0 86.2 59.3 63.9 77.9
SCH 2 0H 49.9 48.4 22.2 50.2
SOH 53.0 64.0 39.3 53.7
SOHgluc 67.4
X x x 89 94
Xgluc x x 22 91
Horse Fish Man Poultry
SOM- IJg/ml <50 >50 >100 <50 >50

SOM 65.0 51.0 41.2 88.6 49.9
N4-S0M 55.4 46.0 14.7 92.5 45.1
SCH 2 0H 15.1 33.8 60.8 51.2
SOH 59.2 38.3 29.0
SOHgluc
X x
Xgluc x 73
----------------------------------------------------------
a Plasma concentration; - Not present; x Not determined.
Goats
Goats eliminate sulphadimidine very rapidly and predomi-
nantly by hydroxylation. The elimination half-life of the
parent drug and metabolites in the dwarf goat is appro-
ximately 3 h. Recently it has been shown that hydroxyla-
tor phenotypes exist between goat breeds. Acetylation-
deacetylation is a minor pathway. The unknown metabolite
(X) and its glucuronide were detected in plasma and urine
in considerable amounts (Table 28.1 and 28.3). Hydroxy-
lation at the 5 position followed by glucuronidation is a
minor pathway (Figure 28.4). In castrated male goats the
PHARMACOKINETICS. HYDROXYLATION AND ACETYLATION OF SULPHADIMIDINE 307
Table 28.3 Plasma elimination half-life. and urinary re-

covery of sulphadimidine and its metabolites expressed as
percentages of the dose administered (mean values) in dif-
ferent species
Calf Cow Pig Goat
Dose mg/kg 10 100 10 100 20 100

TI / 2 el h 3.5 15+5' 3.5 12+6.5 b 9-11 2.7-3.8
Time period h 0-72 0-120 0-72 0-72 0-72 0-20
Total recovery· 84 88 86 72 52 98
80M· 7 22 9.7 26 10.1 15.1
N4 -80M· 13 34 7.2 9 41.7 4.5
8CH20H· 50 26 50.5 26 28.2
80H· 14 6 18.0 8 30.9
X· 0.2 1.4
Xg I u c· 4.8 2.3 18.2
Horse Fish Man d Poultry

(Carp) (S) (F)
Dose mg/kg 200 560 12 12 100

Tlnel h 9.5 17.5 7.7 1.6+5 b 10+3.5 b
Time period h 0-27 0-48 0-60 0-60 0-60
Total recovery· 25 64.4 88 87 42
80M· 10. 1 (40. 5) C 62.2 12.9 3.6 13.9
N4 -SOM· 1.4(5.6)C 1.8 62.5 74.1 12.1
SCH2OH· 0.25<1.0)C 0.23 6.3 7.0 10.2
SOH· 12.7(51)c 0.18 3.5 0.75 5.8
X· 0.4<1.4)C 2.8 1.56
X9 I u c·
----------------------------------------------------------
- Not detected.
a Urinary recovery as percentage of the dose.
b BiPhasic elimination-time curve (both elimination half-
lives given).
c Relative percentage of the total recovered drug in 27 h.
d S = Slow acetylator. F = Fast acetylator Phenotype.
Table 28.4 Renal clearance values of creatinine, unbound

sulphadimidine and its unbound metabolites in different
species
Calf Cow Pig

----------------------------------------
Urine flow ml/min 5 5 15 15 0.45
pH urine 7.5 7.5 8 8 7.5
Dose mg/kg 10 100 10 100 20
Creatinine· 0.83 0.62 1.45 1.55 3.25
SOM· 0.37 b 0.34 b 0.89 b 0.28 b 0.40 b
SCH 2 OH· 2.45 1.59 3.57 3.38
SOH· 8.6 6.8 12.8 4.9
SOHg 1uc· 17.4
X·
Xgluc· 7.4 10.4
N4 -SOM· 17.3 6.1 25.4 7.4 10.0
----------------------------------------
Goat Horse Fish Mane Poultry
(S) (F)
----------------------------------------
Urine flow ml/min 2.6 1.27 x 1 .3 1.5 x
pH urine 8 8.5 x 6.4 6.6 x
Dose mg/kg 100 200 560 12 12 100
Creatinine· 2.5 0.68 x 1.9 1.9 x
SOM· 0.75 0.20 0.29 1.21 0.64 0.27
SCH 2 OH· 7.7 1.9 0.22 x x 4.8
SOH· 10.9 1.2 x x x 10.9
SOHg 1uc· 8.7 x x x x
X· 0.34 2.6 x x x x
Xgluc· 37.1 x x x X
N4 -SOMa 15.2 2.9 0.39 11.6 8.5 3.5
a Renal clearance expressed as ml/kg per min.

b Urine flow related.
c S = Slow acetYlator. F = Fast acetylator phenotype.
x Not determined.
Concentration.
,AJg/ml plasma
100
SULPHADIMIDINE ORAL
(man)
Dose 14 mg/kg
10
"Fast acetylator"
\ \ \'.
\ \.~
1
,..................
., ' ~! 4.2 H,
......
0.1
•
•
J
Sub]. J,N,
•
O.Ol'!f-_--.-_--r_ _or--_..,....._.....-_-,-_-......
o 20 40 60 H
Figure 28.2 Plasma concentration-time curves of sulphadi-

midine (SOM). its N.-acetyl (Nd. unknown (X) metabolite
and the N.-acetyl derivative and its glucuronide of 6-
hydroxYmethylsulphadimidine in a human volunteer after an
oral dose of 14 mg/kg ("fast acetylator" phenotype).
percentage of the hydroxy metabolites in plasma was signi-

ficantly higher than in female goats. Disease states like
tickborne fever slow down the rate and yield of hydroxy-
lation products and increases the half-life to 5 hi.
Pigs
In pigs SOM is metabolized by acetylation into N.-SOM; no
hydroxy metabolites could be detected in plasma. tissues
and urine (Table 28.3 and referenceS), The elimination
Concentration~
I1Jg/ml plasma - - - - - - - - - - - - - - - ,
500
SULPHADIr1IDINE I. V.
Dose 200 mg/kg
Cow F
100
PLASMA
10
o 20 60 H

midine (SDM). and its 6-methylhydroxy (CH 2 0H), 5-hydroxy
(SOH) and its gl ucuronide (SOH. 1 u c ) , N4 -acetyl (Nd and
unknown (X) metabolites in a cow after an intravenous dose
of 200 mg/kg.
half-life ranged from 9 to 11 h, because the acetylation-

deacetylation equilibrium favours the deacetylation, in
contrast to man.
Dogs
Because of the absence of the acetylation pathway, hydro-
xylation of sulphadimidine in dogs is the dominant pathway
Concentration,
Alg/ml plasma
1000
SOD SULPHADIMIDINE r.v.
Goat Appie
Dose 100 mg/kg
100 ..II!..
50 .•
..........
a 10 20 H

midine (SDM), and its metabolites N.-acetyl (Nd. 5-
hydroxy (SOH), 6-hydroxymethyl (SCH20H). and unknown meta-
bolite (X) with its glucuronide (Xgluc) following intra-
venous administration of 100 mg/kg to a castrated male
dwarf goat.
(mainly CH20H). but 50% of the administered dose is still

unaccounted for. Other metabolic pathways may be assumed
to occur, for example. oxidation of the 6-hydroxymethyl
metabolite and glucuronidation 11 •
Pl.ASI1A CONC., UG/ML

500
SULPHADIMIDINE (,V.
Dose: 100 mg/kg
10
CHICKEN
....."',., •..,
" ..................
---~\
0.1
\Y~N4
SO~ \.
O.O.......,t--_ _._--,----....;.-.-r--_._--,
~ CH20H .J
20 40 60 H
o

midine (SDM). its metabolites N4-acetylsulphadimidine
(N4). 6-hydroxymethylsulphadimidine (CH 2 0H) and 5-hy-
droxysulphadimidine(SOH) after an intravenous dose of 100
mg/kg sulphadimidine.
Poultry
Both hydroxylation and acetYlation are relatively impor-
tant pathways for metabolism of sulphadimidine. but appro-
ximately 57% of the administered dose is unaccounted for
Concentration,
IUg/ml plasma
100
N4-ACETYLSULPHADIMIDINE I.M.
Dose 70 mg/kg
Flsh(carp)
10
0.1
O.Ol-;r-_T"""_-r-_-,._.....,_ _~_T"""_..,...._-,
40 80 120 160 H
Figure 28.6 Plasma concentration-time curves of N.-ace-

tylsulphadimidine (N.-SOM) and its metabolite sulphadi-
midine (SOM) following intramuscular administration of 70
mg/kg N.-acetylsulphadimidine.
(Table 28.3). No glucuronides are formed and excreted in

the faeces. A capacity-limited-like elimination pattern
was noticed after intravenous dosage of 100 mg/kg (Figure
28.5). The renal clearance values for N.-SOM and the
hydroxy metabolites are ten to 50 times greater than that
of SOM (Table 28.4).
314 COM PARATIVE VETERI NARY PHARMACOLOGY, TOXICOLOGY AND THERAPY
Concentration,
,AJ9/ml water
1000
SULPHADIMIDINE 54.7 mg
20 snails in water
60%
SDM
100
12%
l I l _ l l l - IiiI - IiiI- III - 1ii
~.-.-- SCH20H
10 /111
III/III 2.1%
(j)/ ..........................................
................ N4-SDM
i
/ .•...• 0.6%
".~.A'. ,-D---crcr'~--~
1(' ,P/AS N4-SCH:10~
.1 /
I /6
0,1 -f:;....-r---,.---L.,.--~-""T'"-"""T"---,.-.....,-
24 48 72 96 H
Figure 28.7 Concentration-time curves of sulphadimidine

(SOM) and cumulative concentration-time curves of its me-
tabolites 6-hydroxymethyl (SCH20H), N.-acetylsulphadimi-
dine and its N.-acetyl metabolite of SCH20H (N.-SCH20H) in
20 snails (C. hortensis) with an environmental dose of
54.7 mg sulphadimidine.
Fish (carp)
In the carp SOM is hydroxylated and acetylated to a small
extent. The clearance values of SOM, N.-SOM and hydroxy
metabolites were equivalent and the elimination was predo-
minantly by a passive diffusion process· (Table 28.4). An
acetylation-deacetylation equilibrium also exists in the
carp, as shown in Figure 28.6.
PHARMACOKINETICS, HYDROXYLATION AND ACETYLATION OFSULPHADIMIDINE 315
Turtles
The turtle (Cuora amboniensis) is able to acetylate and to
hYdroxylate sulphadimidine at the 6 position (SCH 2 0H).
Molluscs
In snails 6-methyl group hydroxylation predominates over
acetYlation: within 4 days 12% of the administered SoM
dose was converted into SCH 2 0H and 2.1% into N.-SoM. The
hydroxylated metabolite was also acetylated (Figure 28.7).
DISCUSSION
Various metabolic pathways of sulphadimidine are found in
different species. as illustrated in Figure 28.1. In
mammals and poultry. all N.-acetyl metabolites formed at
low and high dosages. and hydroxy metabolites formed at
low dosages. show plasma concentration-time curves running
parallel with that of the parent compound. SOM. This
observation indicates that the intrinsic elimination of
metabolites is higher than that of the parent drug as
shown in Table 28.4. The hydroxy metabolites are elimina-
ted partly by glomerular filtration with some tubular
reabsorption. and partly by tubular secretion. producing a
net excretion of 50 times higher renal clearance than for
the parent sulphadimidine. The N.-acetyl and glucuronides
are eliminated predominantly by tubular secretion (Table
28.4). In fish (carp) the plasma clearance of SOM and its
metabolites occurs to a similar extent. presumably due to
a passive diffusion process (glomerular filtration and
presumably diffusion across the gills: Table 28.4). For
turtles and molluscs no data are available. For mammals
and birds the biotransformation of sulphadimidine yields
metabolites which are excreted faster than the parent drug
(Table 28.4). Thus hydroxylation and the subsequent glu-
curonidation as well as acetYlation. speeds up the elimi-
nation of SoM (Figure 28.1).
In horses hydroxylation of the 5 position (SOH)
predominates over that of the 6-methyl group (SCH 2 0H). In
goats. cows and calves. and poultrY hydroxylation of the
316 COM PARATIVE VETERI NARY PHARMACOLOGY. TOXICOLOGY AND TH ERAPY
6-methyl group (SCH 2 0H) predominates over that of the 5

position (SOH). For the goat it was shown that the yield
of hydroxylation products was higher in castrated dwarf
males than in females. In dwarf goats the hydroxylation
rate is greater than in cows; in the latter a capacity-
limited hydroxylation of SOM into SCH 2 0H was observed at a
dosage of 100-200 mg/kg. A similar capacity-limited
elimination of SOM was reported by Van Gogh 3 for goats
(mixed breed) at a dosage of 200 mg/kg, for sulphadiazine
in rabbits by Souich et al. tO and for sulphamonomethoxine
in pigs by Shimode et al.". A capacity-limited elimina-
tion pattern was also noticed in laying-hens (Figure
28.5); this may be attributable to either capacity-limited
metabolism or extensive reabsorption from the cloaca. In
the latter, the urinary faecal flow may become the limi-
ting factor in the elimination rate (especially at night)
resulting in a "pseudo" capacity-limited elimination of
SOM and its metabolites; this has been called chronophar-
macokinetics. In poultry both hydroxylation and acetyla-
tion are relatively important, but even so 57% is unde-
tected at high dosage. This was also noticed in pi-
geons t t , so, birds must possess additional metabol ic
pathways. Our data show clearly (Tables 28.3 and 28.4)
that the rate and extent of hydroxylation as well as the
overall renal clearance values of the hydroxy metabolites
determine the elimination half-life whenever hydroxyla-
tion is predominant over acetylation (for example, in
cows, calves, goats, horses).
When hydroxylation is absent or negligible, and SOM is
acetylated, the position of the acetylation-deacetylation
equilibrium 2 is important, as shown for man and pigs. The
renal clearance values of N4-SOM in the latter two species
are the same (approximately 10 ml/kg per min; Table 28.4),
but in man the equilibrium favours acetylation t t , while
for pigs deacetylation predominates·. Hence, the amount of
N4-S0M formed and excreted per min (renal excretion rate)
is higher in man than in pigs producing a shorter elimina-
tion half-life in the former (2-8.7 h, versus 9-11 h for
pigs). The acetylation-deacetylation equilibrium is not

affected by dosage; the same plasma concentration ratios
of Nc-SDM to SDM in the equilibrium state were measured in
cows at 10 and 200 mg/kg dose level (Table 28.1), even
though the renal clearance of Nc-SDM was diminished at
the high dosage of 100-200 mg/kg (Table 28.4). This is
also observed for Nc-acetylsulphamonomethoxine in pigs'.
and Nc-acetylsulphamethoxazole in man i i • It may be
explained by precipitation of sulphonamides (crystalluria)
or competitive inhibition between the tubular secretion of
Nc-SDM and hydroxy metabolites 7 , ' - i i . At high SDM
dosage. acetylation becomes relatively more important in
the elimination process of SDM (Table 28.3).
Differences in elimination half-lives between species
could not be related to differences in plasma protein
binding (Tables 28.2 and 28.3).
In conclusion, differences in SDM elimination half-
lives between specie~ depend mainly on : (a) the extent
and rate of hydroxylation, conjugation, and acetylation
versus deacetylation (thus amount and composition of enzy-
mes available). which differ between species, and is pre-
sumably related to the sulphonamide structure iO ; (b) the
renal clearance values of the metabolites, which are usu-
ally constant between species: (c) the position of the
acetylation-deacetylation equilibrium; (d) in ruminants,
the dosage: (e) in birds. a faecal/urinary flow rate; (f)
other factors affecting absorption and elimination of SDM
including age. gender (affecting hydroxylation) of the
animal. disease state of the animal, season, mode of
application. and product formulation.
References
1. Anika. S.M •• Nouws. J.F.M •• Van Duin. C.T.M. and Van
Miert. A.S.J.P.A.M. (1986). Tick-borne fever model
effects on pharmacokinetics of chemotherapeutic agents
in the goat. In: Van Miert, A.S.J.P.A.M., Bogaert.
M.G. and Debackere. M. (eds). Comparative Veterinary
Pharmacology. Toxicology and Therapy, Proc. 3rd EAVPT
2. Bevill. R.F., Dittert. L.W. and Bourne. D.W.A. (1977),
Disposition of sulfonamides in food-producing animals.
IV. Pharmacokinetics of sulfamezathine in cattle fol-

lowing administration of an intravenous dose and three
oral dosage forms. J. Pharmacol. Sci. 66:619-622.
3. Gogh. H. van (1980). Pharmacokinetics of nine sulfon-
amides in goats. J. Vet. Pharmacol. Ther. 3:69-81.
4. Haenen. O.L.M., Grondel, J.L. and Nouws. J.F.M.
(1986). Pharmacokinetics of oxytetracycline, trime-
thoprim. sulphatroxazole and sulphadimidine in the
carp. In: Van Miert. A.S.J.P.A.M., Bogaert, M.G. and
Debackere. M. (eds). Comparative Veterinary, Pharma-
cology. Toxicology and Therapy, Proc. 3rd EAVPT
5. Nielsen. P. (1973). The metabolism of four sulfona-
mides in cows. Biochem. J. 136:1039-1045.
6. Nouws. J.F.M •• Vree. T.B. and Hekster, V. (1985). In
vitro antimicrobial activity of hydroxy and N.-acetyl
sulfonamide metabolites. Vet. Q. 7:70-72.
7. Nouws. J.F.M •• Vree. T.B., Baakman. M., Driessens, F ••
Breukink. H.J. and Mevius, D. (1986). Age and dosage
clearance of sulfamethazine and its N.-acetyl and
Res. 47:642-649.
8. Nouws o J.F.M., Vree. T.B., Baakman. M., Driessens. F.,
Vellenga. L. and Mevius. D. (1986). Pharmacokinetics.
renal clearance. tissue distribution and residue as-
pects of sulphadimidine and its N.-acetyl metabolite
in pigs. Vet. Q. (in press).
9. Shimode. M., Shimizu. T., Kokue. E. and Hayama, T.
(1984). Possibility of saturation in renal excretion
after high dose of intravenous sulfamonomethoxine in
pigs. Jap. J. Vet. Sci. 46:331-337.
10. Souich. P. duo McLean, A.J •• Lalka. D•• Vicuna, N••
Chauhuri. E. and McNay, J.L. (1978). Sulfadiazine
handling in the rabbit. II. Mechanisms of nonlinear
kinetics of elimination. J. Pharmacol. Exp. Ther.
207:228-235.
11. Vree. T.B. and Hekster. V.A. (1985). Pharmacokinetics
of sulfonamides revisited. Antibiot. Chemother. 34:
1-208.
12. Vree. T.B •• Ti.jhuis. M., Baakman. M. and Hekster. V.A.
(1983). Analysis of N.-trideuteroacetylsulphamera-
zine and its metabolites sulphamerazine and N.-
acetylsulphamerazine in man by means of high-perfor-
mance liquid chromatography and mass spectrometry.
Biomed. Mass SpectrometrY 10:114-119.
13. Vree. T.B •• Tijhuis, M., Nouws. J.F.M. and Hekster.
V.A. (1984). Identification. isolation. chromatogra-
phy. and preliminarY pharmacokinetics of 4-hydroxysul-
famerazine in dogs. Pharmacol. Weekbl., Sci. Ed. 6:
80-87.
29
Disposition and metabolism of 14C-mebendazole
in sheep and poultry
P. BENARD, V. BURGAT-SACAZE, F. MASSAT ANDA. G. RICO
ABSTRACT
In sheep, guinea-fowl chicks and laying hen-pheasants,
dosed orally with 14C-mebendazole, radioactivity was
distributed in several compartments. The terminal
half-life was between 189.6 and 304.8 h in sheep and
between 132.5 and 150.6 h in birds. Radioactivity was
detected in all the tissues examined and rather high
residual concentrations were present in the melanin-
containing tissues and in the liver, 15 days (guinea-fowl
chicks and hen-pheasants) and 30 days (sheep) after
administration. In sheep liver a concentration of 1.23 ug
unchanged mebendazole per g of wet tissue was measured 30
days after dosing.
INTRODUCTION
Mebendazole (MBDZ) is the generic name for methyl(5-
benzoyl-1H-benzimidazol-2-yl)carbamate. It is an anthel-
mintic drug with a broad spectrum of activity. It affects
numerous species of nematodes and cestodes, so it is wide-
ly used both in human medicine and veterinary practice.
In order to define the withdrawal time for different
species, it was necessary to obtain metabolic data. The
aim of this paper is to describe results obtained in three
animal species : sheep, guinea-fowl chicks and hen-phea-
319
sants.

Labelled compound
14C-mebendazole was prepared by Janssen Pharmaceutica
Research Centre. It was labelled in the 2-position of the
benzimidazole ring. The specific activity was 3
mCLmmol- • l The radiochemical purity was checked by
thin-layer chromatography. It was found to be higher than
96%. 14C-mebendazole was dispersed in an aqueous solution
of Tween 80 with unlabelled mebendazole so that the final
concentration was 5.15 mg.ml- I and the volume activity 50
uCi.ml- l • The radiochemical purity of the suspension was
controlled before every administration.
Animals
The experiment was performed on sheep, guinea-fowl chicks
and hen-pheasants. Ten sheep were housed in metabolic
cages in order to collect separately faeces and urine
every day. All the animals were dosed orally with 20
mg.kg- I body weight labelled mebendazole. Blood samples
were obtained from the jugular vein at regular times. The
animals were killed 24 and 48 hand 4, 6, 10. 15 and 30
days after administration of the drug. Four lactating
ewes were caged separately and milked twice a day; 16
guinea-fowl chicks and three hen-pheasants were also used
in this study. They were fed orally and all animals were
maintained under the same conditions. Blood samples were
obtained from the jugular vein. The animals were killed
24 and 48 hand 3. 8, 10 and 15 days (guinea-fowl chicks)
and 8. 10 and 15 days (hen-pheasants) after dosing.
Techniques
Whole-body autoradiography (WBA) was performed on sheep
and birds according to Ullberg's technique 4 • In sheep.
the technique was carried out to establish the
distribution of radioactivity on two lambs killed 24 and
48 h after dosage and on the main organs of sheep
DISPOSITION AND METABOLISM OF 14C-MEBENDAZOLE 321
slaughtered later. In sheep, WBA was performed on one

animal each time.
Liquid scintillation counting was carried out on
whole-blood. plasma. blood cells. urine, faeces, milk and
most of the organs collected after slaughter. All the
samples were prepared with an Oxidizer 306 Packard as
described previouslyl. The results were expressed as ~g
of unchanged mebendazole per g of wet tissue. Separation
of urinary radioactivity fractions was performed by thin-
layer chromatography and radioactivity was detected either
by autoradiography or by scanning (Berthold II).
RESULTS
Sheep
As illustrated in Figure 29.1. most of the detected
radioactivity was present in the lumen of the digestive
tract. Rather low activity was detected in all other
organs except the melanin-containing tissues and the liver
which concentrated high radioactivity.
The highest plasma concentration (approximately 2
ug.ml- I of unchanged mebendazole) was observed between 24
and 30 h after administration. From a pharmacokinetic
point of view. radioactivity was distributed in three
compartments. The terminal half-life was 304.8 and 189.6
h on two animals (Figure 29.2). In the body, concentra-
tions rapidly decreased except in the melanin-containing
tissues and the liver. In bile. radioactivity was still
detectable 10 days after dosing. In the liver. a concen-
tration of 1.23 ~g of unchanged mebendazole was still
measurable (Figure 29.3) at 30 days.
Most of the radioactivity was excreted in faeces (73.1
± 7.2%) and to a lesser extent in urine (10.8 ± 1.4%). In
milk. very low concentrations « 0.1 ppm) were present for
4 days. In urine. 13 metabolites were separated by
thin-layer chromatography. Very low concentrations of
parent compound were present. The main metabolite
isolated was the methyl[5-(~-hydroxy-~-phenylmethyl)-lH
benzimidazol-2-yIJcarbamate which results from the
A
2
7
B
Figure 29.1 Whole body autoradiogram of lambs dosed with
t4C-mebendazole and killed 24 h (A) and 48 h (8) later.
1 = spinal cord: 2 = aorta; 3 = chord; 4 = spleen; 5 =
adrenal gland; 6 = liver; 7 = heart; 8 = kidney; 9 = uri-
nary bladder: 10 = intestines; 11 = lungs.
reduction of the ketone grouping. Minor metabolites were

also present in urine: they resulted from carbamate
hYdrolysis.
Guinea-fowl chicks
Whole-body autoradiography clearly indicated that
radioactivity was distributed throughout the body 24 h
after dosing (Figure 29.4). On the animal killed after 15
days. radioactivity was still detectable in the skin. the
uveal tract and the liver. Autoradiograms also
demonstrated the presence of radioactivity i~ bile in all
animals.
From a kinetic point of view. the plasma concentration
".-1-'
• 0.'
o ow •
• 0 ....
6 0""
o 0 ....
• 0.'
I.,
" " " " "
Figure 29.2 Plasma kinetics of radioactivity in sheep

dosed with t·C-mebendazole. Concentrations are expressed
as Ug mebendazole per ml of plasma.
-' .
$
.
N
o
.~
o
..
co
z
1:
o
Z
~
Figure 29.3 Residual concentrations of unchanged mebenda-

zole in organs of sheep dosed with t·C-mebendazole. Con-
centrations are expressed as Ug parent drug per g of wet
ti ssue.
1
8
3
2
5
9
Figure 29.4 Whole body autoradiogram of a guinea-fowl

chick sacrificed 24 h after feeding with l·C-mebendazole.
1 = uveal tract; 2 = crop; 3 = blood; 4 = liver; 5 = gall
bladder; 6 = kidney: 7 = lungs; 8 = caecum: 9 = muscles.
Figure 29.5 Autoradiogram of an egg collected 3 days

after administration of l·C-mebendazole to a laying hen-
pheasant.
curve demonstrated that the highest concentrations

occurred around the 24th h. The peak concentration was
between 3.5 and 5.5 ~g.ml-l . Radioactivity was
distributed in at least two compartments; the half-life of
the slowest elimination phase was 150.6 h.
By liquid scintillation counting, evaluation of the
residual levels in different organs confirmed that the
liver. the skin and the uveal tract concentrate the
Figure 29.6 Whole bodv autoradiogram of the head of a

lamb killed 24 h after feeding with labelled mebendazole.
A B
~
Figure 29.7 Enlargement of autoradiograms. Note the high

radioactive content in melanin-containing tissues
(arrows); (A) autoradiogram of the eve of a sheep killed
15 days after the administration of 14C-mebendazole; (8)
autoradiogram of the head of a guinea-fowl chick killed 2
days after feeding with labelled mebendazole.
highest activities. In the liver. the residual

concentration was 0.66 ~g of unchanged mebendazole per g
of wet tissue (15 days).
Hen-pheasants
In this species. the highest plasma concentration was
obtained between the 24th and the 48th h (2.01 to 2.23 ug
of unchanged mebendazo1e.m1- t ) . In tissues. the highest
concentrations were present in the liver and in me1anin-
containing tissues. 15 days after dosing. residual
activities were still measurable in the liver (0.45 ppm)
and kidneys (0.21 ppm).
In eggs obtained from laying hen-pheasants. the
presence of radioactivity was demonstrated in the albumin
24 h after dosing and it was still detectable in the yolk
and to a lesser extent in the albumin of the egg collected
3 days after drug administration (Figure 29.5).
DISCUSSION
From the results obtained using whole-body autoradiography
and liquid scintillation counting. it appears that the
absorption of mebendazo1e is rather slow. This is
demonstrated by the plasma kinetic curves. The curves
clearly indicate that radioactivity is distributed within
at least three compartments in sheep and two compartments
in birds. The slow absorption is also indicated by the
fact that the highest plasma concentrations were obtained
24 h or later after the administration of the labelled
preparation to animals. Moreover. it is clear from the
autoradiograms that the highest hepatic concentrations are
obtained after 24 h. All of these observations are very
consistent with a slow absorption pattern.
In the body, our results clearly show that in the first
day after administration. radioactivity is present in all
organs including the central nervous system (Figure 29.6).
However, several tissues are able to concentrate
mebendazo1e or its main metabolites; we have found in the
three animal species studied that radioactivity persists
for as long as month in melanin-containing tissues
(Figure 29.7) and in the liver of sheep. Persistence of
residues in the liver is the consequence of prolonged
biliary excretion which lasts 10 days in sheep and 15 days
in guinea-fowl chicks. Such a long biliary excretion can

be explained by an enterohepatic cycle. The long
persistence of residues in the liver can also be explained
by the presence of conjugated and covalently bound
metabolites as demonstrated previous1 y2 . 3 . In the liver.
the residual concentrations 15 days after administration
are: 1.27 ppm in sheep. 0.70 ppm in guinea-fowl chicks
and 0.50 ppm in hen-pheasants.
CONCLUSION
From a safety point of view. hepatic residues of
mebendazo1e and its metabolites are most important since
they are the most persistent. In order to define
tolerance limits for this drug. one must consider
toxicological data and the toxicological significance of
these hepatic residues. Such an approach would seem to
provide a rational basis for estimating the relative
hazard of the residues compared to the parent drug.
References
1. Benard. P •• Rico. A.G •• Braun, J.P., Burgat. V•• Bon-
naud. B. and Cousse. H. (1981). Pi cafi brat e. Not e II
Absorption. distribution et elimination chez 1e rat
apres marquage au carbone-14. Boll. Chim. Farm.
120:114-123.
2. Benard. P •• Burgat. V•• Massat. F. and Rico. A.G.
(1984). Metabolism of C-14-mebendazo1e in sheep. 9th
European Congress on Drug Metabolism Workshop. Pont a
Mousson. Abstract. P4.
3. Burgat-Sacaze. V. and Rico. A.G. (1984). Bioactivation
and bound residues. Food Additives and Contaminants
2:121-129.
4. U11berg. S. (1954). Studies on the distribution and
fate of S-35-1abe11ed benzylpenicillin in the bodY.
Acta Radiol.. Suppl.1l8:1-110.
Diarrhoea
30
Modulation of intestinal ion absorption and
secretion by enterotoxins, hormones and
neurotransmitters
H. R. DE JONGE AND A. B. V AANDRAGER
ABSTRACT
The absorption of electrolytes and water by mammalian
small intestine and proximal colon is primarily controlled
by an electroneutral entry mechanism for Na+ and Cl- in
the brush-border membrane of the enterocytes, consisting
of parallel Na+/H+ and Cl-/HC03 - exchangers coupled by
circular proton movements. Enterotoxins produced by
non-invasive micro-organisms (such as choleratoxin,
heat-stable and heat-labile Escherichia coli toxin) and
neurohumoral factors (such as acetylcholine, vasoactive
intestinal peptide [VIP], prostaglandins, bradykinin) pro-
mote salt and water secretion by a dual action involving
(1) blockade of the antiporters in the villus compartment
and (2) Cl- channel opening in the apical membrane of
intestinal crypt cells, allowing Cl- exit down an
electrochemical gradient created by a basolateral Na-K-C1 2
entry process. During Cl- secretion, the accumulation of
Na+ and K+ in the enterocyte is prevented by Na+ exit
through the Na+/K+-pump and K+ exit through secreta-
gogue-sensitive K+ channels in the basolateral membrane.
Secretagogues act through at least three different
mechanisms :
331
(1) a reversible activation of adenylate cyclase coupled

to hormone receptors (VIP. PGE 2 ) in the basolateral
membrane or a permanent activation of this enzyme through
AOP-ribosylation of the coupling factor Ns (CT. LT). both
leading to cyclic AMP accumulation;
(2) activation of guanylate cyclase in the brush-border
membrane presumably by thiol-disulphide exchange (ST A ) and
raising intramicrovillous cyclic GMP levels;
(3) receptor-mediated activation of a phosphatidylinositol
specific phospholipase C in the basolateral membrane (such
as acetylcholine) generating two products: inositoltri-
phosphate <IP 3 ) . initiating Ca 2 + mobilization from
internal stores; and diacylglycerol (OAG). an activator of
Ca 2 +/phospholipid-dependent protein kinase (C-kinase).
The recent recognition of high-affinity receptors for
cyclic nucleotides. OAG and Ca 2 + in the intestinal
brush-border as regulatory components of protein kinases
suggest a causal relationship between protein phosphoryl-
ation and modulation of ion transport systems in the
apical membrane. Calcium may additionally inhibit Na+/Cl-
entry in a more direct manner through binding to the Ca 2 +
receptor protein calmodulin.
New aspects of stimulus-secretion coupling discussed in

this review include:
(1) the role of a 25.000 molecular weight proteolipid in

the brush-border membrane as a key regulator of ion trans-
port across the apical membrane. its phosphorylation by
both cyclic GMP-dependent and cyclic AMP-dependent protein
kinases and a possible link between its phosphorylation
state and phosphatidylinositol metabolism ("PI-cycle") in
intestinal microvilli;
(2) the identification of potential targets for pharmaco-
logical intervention along the molecular pathways leading
to secretion. potentially enabling the rational design of
new antidiarrhoeal drugs.
MODULATION OF INTESTINAL ION ABSORPTION AND SECRETION 333
INTRODUCTION
Diarrhoeal diseases constitute a major cause of morbidity
and mortality on a global scale t9 • Plasmid-encoded heat-
labile (LT) and heat-stable (ST) enterotoxigenic proteins
secreted by Escherichia coli are the most frequent cause
of non-inflammatory infectious diarrhoea in man and of
neonatal diarrhoea in calves. lambs and piglets. Both
toxins evoke excessive water and electrolyte secretion by
triggering a physiological mechanism of stimulus-secretion
coupling in the intestinal epithelium. In this chapter.
the mode of action of each of these toxins is briefly
discussed and its similarity to the action of neurohumoral
regulators of intestinal secretion is emphasized.
Moreover, recent insights into the mechanisms by which
intracellular signals (cyclic nucleotides, Ca 2 +) could
modulate ion transport processes in the intestinal
brush-border membrane are recapitulated.
HEAT-LABILE ESCHERICHIA COLI TOXINS

The heat-labile toxins. analogous to choleratoxin, are
composed of five binding (B) subunits and one active (A)
subunit. Following binding of B to surface receptors on
the intestinal microvilli (ganglioside. and perhaps glyco-
protein), the A subunit is injected into the cytoplasm and
split by disulphide bond reduction into fragments At and
A2 • The At peptide migrates towards the basolateral
membrane and activates adenylate cyclase in an essentially
irreversible manner by catalysing transfer of the ADP-
ribosyl moiety of NAD+ (nicotinamide adenine dinucleo-
tide) to an arginine residue in the alphas subunit of the
coupling protein Ns (references 4,t8 for recent reviews).
Sustained activation of the cyclase leads to excessive
production of cyclic AMP, an intracellular signal leading
to electrolyte secretion. The spontaneous recovery from
heat-labile and choleratoxin-provoked diarrhoea may there-
fore only occur by turnover of cells or regulatory pro-
teins. In contrast. some endogenous secretagogues, such
as vasoactive intestinal peptide (VIP) and eicosanoids
(PGE z ) induce a less permanent activation of adenylate

cyclase through binding to basolateral hormone receptors.
Neurohumoral cascade mechanisms may potentiate toxin-evo-
ked secretion. For example. heat-labile (and possibly
heat-stable toxins also) could mobilize serotonin from
enterochromaffin cells. initiating a neural reflex through
a nicotinic ganglion to liberate a secretagogue (possibly
VIP or acetylcholine) that acts on the enterocytel,lJ.
HEAT-STABLE ESCHERICHIA COLI TOXINS

Heat-stable enterotoxins are low-molecular weight peptides
(18-72 amino acids) lacking a subunit structure. One
cysteine-rich subclass (STA) binds to a protein receptor
in the intestinal microvilli and triggers a rapid and
reversible activation of a unique isoenzyme of guanylate
cyclase (GC) embedded in the apical membrane~·16; Figure
30.1). Membrane-bound forms of guanylate cyclase in
non-intestinal tissues seem to be insensitive to the
toxin2~. Both the structure and mechanism of action of
STA show a striking resemblance to a recently discovered
family of peptide hormones. the atrial natriuretic factors
(ANF) 2 I • Re c e n t e vi den c e s u 9 9 est s t hat a r e v e r sib 1 e
activation of particulate guanylate cyclase in non-intes-
tinal tissues (smooth muscle. kidney. adrenal cells) forms
the basis of their antihypertensive action z9 • Activation
of guanylate cyclase by STA or ANF is reproducible in
isolated membranes in the absence of soluble proteins or
co-factors. such as NAD+. excluding a choleratoxin-like
mechanism. Studies in our laborat ory 7. and elsewhere l2 •
have also ruled out a cascade mechanism analogous to
hormone-induced phospholipid turnover. but instead suggest
a direct interaction between ST A and its receptor or
guanylate cyclase itself presumably involving mixed
disulphide formation. Our recent finding that bivalent
metal ions (Cu z +. Cd 2 +. Znz+) and hemin were able to mimic
STA-activation of the brush-border cyclase. whereas the
action of all three compounds. but not basal guanylate
cyclase activity. was inhibited by thiol-blocking and
(CRYPT) (VILLUS)
CI Na +-C(
~ ~
./ -- - - - - - - - -/ - - - -
~ -,-
/
- - al
-- - _ _______ .§'l_~
I f <ii,,
DPI TPI ,
,.
"
BlM
Figure 30.1 Model of stimulus-secretion coupling in in-

testinal epithelium. Details of the various secretory
mechanisms are explained in the text. STA, heat-stable
Escherichia coli toxin; CT, choleratoxin; PGE2, prosta-
glandin E2; VIP, vasoactive intestinal peptide; PI. phos -
phatidylinositol; DPI, phosphatidylinositol-4-phosphate:
TPI. phosphatidylinositol-4.5-biphosphate ; DAG. diacyl-
glycerol; PL-C. phospholipase C; IP J • inositol 1.4,5,-
triphosphate; BLM, basolateral membrane; ER. endoplasmic
reticulum: +, stimulation; -. inhibition.
disulphide-reducing agents, further indicates the role of

critical SH-groups in the activation mechanism. Inte-
restingly, ANF was unable to mimic the action of STA on
guanylate cyclase and ion transport in rat intestine (H.R.
de Jonge, unpublished observation) but it reproduced
perfectly the blockade of NaCl entry by cyclic GMP in
teleost intestine (S.M. O'Grady and M. Field. personal
communication).
The other major subclass of heat-stable toxins. ST B •

initiates intestinal secretion exclusively in weaned
piglets by a presently unknown mechanism distinct from
adenylate or guanylate cyclase activation 3o •
PHYSIOLOGICAL SECRETAGOGUES ACTING THROUGH CALCIUM

A number of endogenous secretagogues. such as acetylcho-
line. serotonin. neurotensin and bradykinin. do not
directly change intestinal cyclic nucleotide levels but
act primarily by a receptor-mediated activation of
phospholipase C in the basolateral membrane of the
enterocyte. leading to the rapid breakdown of polyphos-
phoinositides. a specific class of phospholipids 9 ; see
Figure 30.1. One of the products. inositol triphosphate
(IP3 ). analogous to its role in other tissues. is likely
to release Ca 2 + from endoplasmic reticulum through an as
yet unknown mechanism. By direct measurements of
intracellular free Ca 2 + levels in the colon carcinoma
cell line HT-29 loaded with the fluorescent Ca 2 + probe
quin-2. we have recently obtained direct evidence for the
triggering of internal Ca 2 + mobilization by acetylcholine.
neurotensin. adrenaline (acting through alphal-receptors)
and bradykinin (see Figure 30.1). In contrast to recent
observations in chicken enterocytes 2 • no changes in
intracellular Ca 2 + levels were observed in response to
PGE 2 • VIP. cyclic AMP and cyclic GMP indicating that. at
least in this secretory cell type. Ca 2 + did not function
as a third messenger.
The other product of phospholipid breakdown, diacylgly-
cerol (DAG) stimulates a Ca 2 +/phospholipid-dependent
protein kinase (C-kinase) recently discovered in the
cytosol and brush-border membranes of villous and crypt
epithelium 9 • Direct activation of the enzyme in intact
epithelium by phorbolesters and membrane-permeable diacyl-
glycerols partially mimicked the secretory action of
acetylcholine in rabbit ileum and colon 3 . lo • underscoring
its importance in signal transduction.
Mucosal and submucosal prostaglandins, presumably gene-
rated from arachidonic acid released by Ca 2 +-activation of

phospholipase A2 • do not playa role in the acute phase of
the secretory response to acetylcholine (0-2 min) but
appeared to be responsible for the maintenance of the
response during the next 5-10 min. This conclusion is
based on our recent electrophysiological measurements in
rat intestinal mucosa mounted in Ussing chambers and
exposed to carbachol in the presence or absence of indo-
methacin (10- 5 M). a specific blocker of prostaglandin
synthesis. In this model system. prostaglandins were
apparently not involved in the secretory response to VIP.
cyclic nucleotides. substance P and bradykinin (H.R. de
Jonge and J.A. Groot. manuscript in preparation).
A third mechanism contributing to acetylcholine-evoked
secretion is the influx of extracellular Ca 2 + through
hormone-responsive and verapamil-sensitive Ca 2 +-channels
in the basolateral membrane. However. our recent measure-
ments of Ca 2 + transients in the HT-29 cell 1 ine have shown
that. in comparison with other cell lines. such as fibro-
blasts. the hormone-induced Ca 2 + signals in the
colonocytes were remarkedly resistant to extracellular
Ca 2 +-depletion. The secretory response to cyclic
nucleotides in rabbit ileum was also found to be
insensitive to Ca 2 + depletion at the serosal side of the
epithel ium 1 1 .
PHYSIOLOGICAL ANTISECRETAGOGUES
Noradrenaline. the principal sympathetic neurotransmitter
producing absorption. is able to counteract the secretory
response to acetylcholine. VIP. choleratoxin and heat-
labile toxins (but not to cyclic nucleotides; H.R. de
Jonge. unpublished observations) through binding to
alpha2-receptors on the enterocytes followed by blockade
of adenylate cyclase through the inhibitory factor
N,7.t5.t8; (Figure 30.1). At least part of its antagonism
of acetylcholine action may be explained by the
involvement of prostaglandins in the secretory response to
acetylcholine.
338 COMPARATIVE VETERI NARY PHARMACOLOGY, TOXICOLOGY AND THERAPY
Other important antisecretory hormones and neurotrans-

mitters include:
(1) angiotensin, presumably acting through noradrenaline

release 23 ;
(2) dopamine, acting through dopaminergic receptors diffe-
rent from peripheral DA,- or DA2-receptors 28 ;
(3) enkephalins, increasing basal absorption rates but not
blocking secretagogue actions, probably mediated through
delta-receptors in the submucous plexus 24 •
Somatostatin and neuropeptides may also promote basal

absorption rates through as yet unknown mechanisms.
COUPLING MECHANISMS BETWEEN SECOND MESSENGERS AND ION

TRANSPORT SYSTEMS IN THE INTESTINAL BRUSH-BORDER
The major Ca 2 +-, diacylglycerol (DAG)- and cyclic nucleo-
tide-sensitive electrolyte transport systems in the
enterocyte have been localized at the mucosal border and
include:
(1) an electroneutral Na-Cl co-transport process in the

villus cell, presumably composed of separate Na+/H+ and
Cl-/CH03- exchangers coupled by circular proton movements.
The blockade of one or both exchangers by Ca 2 +, DAG or
cyclic nucleotide signals may lead to a reduced absorption
rate of NaCl and water in the villus compartment;
(2) an electrogenic Cl- channel, presumably enriched in
intestinal crypt cells. The triggering of Cl- channel
opening by cyclic AMP or Ca 2 + constitutes the basis of
hormone-induced salt secretion in a number of other secre-
tory epithelia'7; however, a similar role for cyclic GMP
is unique for intestinal epithel ium 9 •
The molecular mechanism involved in stimulus-secretion

coupling at the level of the brush-border membrane
constitutes a major area of research in our laboratory.
High-affinity receptors for intracellular signals identi-
fied in the apical membrane include:
(1) a unique isoenzyme of cyclic GMP-dependent protein ki-

nase (G-kinase) structurally and immunologically diffe-
rent from soluble and particulate G-kinases in other
(2) the type II isoenzyme of cyclic AMP-dependent protein

kinase (A-kinase s • 9 ) ;
(3) Ca 2 +/phospholipid-dependent protein kinase (C-kina-
se' ) ;
(4) Ca 2 +/calmodulin-dependent protein kinase s ;
(5) calmodulin, presumably forming a complex with the Na-
Cl cotransport system l4 (Figure 30.1);
(6) phospholipase C, triggered by micromolar amounts of
Ca 2 + (Figure 30.1).
Most protein kinases were found capable of phosphorylating

a specific set of apical membrane proteins. The precise
role of each of these phosphoproteins in stimulus-
secretion coupling has still to be elucidated. However,
only the G-kinase showed an extremely limited substrate
specificity apart from catalysing phosphate incorpora-
tion into its own structure (autophosphorylation; Figure
30.1), it was found capable of phosphorylating only one
other brush-border protein possessing a molecular weight
of 25,000 1 - ' . The same protein also served as one of the
major substrates for A-kinase in the brush-border re-
gion. and might therefore playa crucial role in cyclic
nucleotide-provoked ion secretion.
STRUCTURE AND FUNCTION OF THE 25K PROTEIN COMPONENT OF THE

INTESTINAL BRUSH-BORDER
The 25K protein is a minor component of the brush-border
membrane, but also one of the major phosphoproteins
extractable by chloroform-methanol in the presence of HCI
(but not in its absenceS), and should therefore by
classified as an acidic proteolipid. Mapping of its
phosphorylation sites by tryptic fingerprinting has
recently demonstrated that the same serine residues

(possibly two) are recognized by both G- and A-kinase but
not by endogenous Ca 2 +/calmodulin-kinase and C-kinase 7 •
In this respect, the protein clearly differs from
phospholamban, a 25K proteolipid regulating Ca 2 +-pump
activity in heart membranes, which is phosphorylated on
different sites by A-, C- and Ca 2 +/calmodulin kinases 22 •
Analogous to phospholamban, the 25K protein might function
as a regulatory subunit of an ion transport system or even
be identical to the ion channel or carrier itself.
Preliminary results from phosphorylation studies with
isolated brush-borders in our laboratory, however, suggest
that cyclic GMP-dependent protein phosphorylation, presu-
mably of the 25K proteolipid, triggers the phosphorylation
of a phospholipid component of the apical membrane in
other words, it converts phosphatidylinositol (PI) into
OPI (Figure 30.1). Similarly to OPI-modulation of a Ca 2 +-
pump in skeletal muscle 27 , the formation of OPI in the
vicinity of the transporter might directly regulate its
function. Alternatively, phosphorylation of PI may start
a cascade of other phospholipid transitions ("PI-cycle")
very similar to hormone-induced PI turnover at the baso-
lateral membrane (Figure 30.1). Enzymes involved in such
lipid transition (such as PI-kinase and OPI-kinase; phos-
pholipase C) were found to be integral components of the
brush-border membrane (A.B. Vaandrager-manuscript in pre-
paration). As shown in Figure 30.1, the main products of
PI metabolism, that is, IP 3 and OAG, may promote Ca 2 +-
mobilization and C-kinase activation at the brush-border
region, analogous to the action of acetylcholine at the
basolateral membrane. This concept, although still rather
speculative. may elegantly explain several recent
observations
(1) the occurrence of a highly active polyphosphoinositide

turnover in the apical membrane despite the apparent lack
of hormone receptors at this subcellular region; the model
in fact suggests that the action of first messengers at
the baso1atera1 membrane is mimicked by second messengers

at the brush-border membrane;
(2) the reversal of cyclic nucleotide-provoked inhibition
of the Na-C1 entry pathway by calmodulin antagonists
(chlorpromazine, trifl uoperazine t t . t 4);
(3) the cyclic AMP-induced internal Ca 2 +-mobi1ization mea-
sured in chicken villous cells by the quin-2 method 2 •
Future research on PI metabolism in the brush-border and

analysis of the properties of the 25K proteolipid is
needed to further substantiate this model.
TARGETS FOR PHARMACOLOGICAL INTERVENTION IN SECRETORY

DIARRHOEA
A better knowledge of the molecular pathways leading to
excessive electrolyte and water secretion could potenti-
ally lead to the rational design of new antidiarrhoea1
drugs. Unfortunately, most regulatory components of the
absorptive and secretory pathways in the enterocyte are
not unique to the intestinal epithelium (compare a1pha2-,
de1ta- and dopamine receptors; adenyl ate and guanylate
cyc1ases; A-, G- and C-kinase; phospholipase A2 and C;
cyc10-oxygenase). Moreover, transport systems involved in
secretion (Na-K-C1 2 co-transport; C1--channe1s and
Ca 2 +-sensitive channels) are also operating in other
epithelial tissues, such as kidney and trachea. Therefore.
the ideal antidiarrhoea1 drug should be effective upon
oral administration and should be prevented of reaching
the circulation, for example, by rapid inactivation in the
liver or by entrapment in the intestinal lumen or epithe-
lial cell layer. Compounds interacting from the luminal
site with secretory components of the brush-border mem-
brane are potentially important candidates. With refe-
rence to the model shown in Figure 30.1, such compounds
may include: (1) C1- channel blockers; (2) antica1modu1in
drugs (such as trifluoperazine; ca1midazo1ium); (3) inhi-
bitors of PI metabolism in the brush-border membrane (such
as chlorpromazine); and (4) inhibitors of A-, G- and
342 COMPARATIVEVETERINARYPHARMACOLOGY, TOXICOLOGYANDTHERAPY
C-kinase. CYclic nucleotide receptor antagonists (such as

Rp-cAMPS; compare reference 26 ) , and a novel class of
potent and selective protein kinase inhibitors, the iso-
quinoline sulphonamides 2o are presently being screened in
our laboratory for antidiarrhoeal activity.
References
1. Cassuto. J., Siewert. A., Jodal, M. and Lundgren. O.
(1982). The involvement of intramural nerves in
choleratoxin-induced intestinal secretion. Acta
PhYsiol. Scand. 117:195-202.
2. Chang, E.B. and Semrad, C.E. (1985). Calcium-mediated
cyclic AMP inhibition of Na/H exchange in chicken
small intestine. Gastroenterology 88:1345.
3. Chang, E.B., Wang, N.S. and Rao, M.C. (1985). Role of
protein C-kinase in intestinal anion secretion.
Gastroenterology 88:1345.
4. Coulson. C.J., Nassau, P.M. and TaiL R.M. (1984).
The ADP-ribosyltransferase activity of choleratoxin
and Escherichia coli heat-labile toxin. Biochem. Soc.
Trans. 12:184-187.
5. De Jonge, H.R. (1975). The localization of guanylate
cyclase in rat small intestinal epithelium. FEBS
Lett. 53:237-242.
6. De Jonge, H.R. (1981). Cyclic GMP-dependent protein
kinase in intestinal brush-borders. Adv. Cyclic
Nucleotide Res. 14:315-333.
7. De Jonge. H.R. (1984). The mechanism of action of
Escherichia coli heat-stable toxin. Biochem. Soc.
Trans. 12:180-184.
8. De Jonge, H.R. (1984). Cyclic nucleotide-dependent
protein phosphorylation in intestinal epithelium.
Kroc Foundation Ser. 17:263-286.
9. De Jonge, H.R. and Lohmann. S.M. (1985). Mechanisms
by which cyclic nucleotides and other intracellular
mediators regulate secretion. Ciba Foundation Symp.
112:116-138.
10. Donowitz, M., Cheng, N. and Sharp. G.W.G. (1985).
Role of protein kinase C in regulation of rat colonic
active NaCl transport. Gastroenterology 88:1367.
11. Donowitz. M., Wicks. J., Madara, J.L. and Sharp, G.W.
G. (1985). Studies on role of calmodulin in Ca 2 +
regulation of rabbit ileal Na and Cl transport. Am.
J. Physiol. 248:G726-G740.
12. Dreyfus, L.A., Jaso-Friedmann, L. and Robertson, D.C.
(1984). Characterization of the mechanism of action
of Escherichia coli heat-stable enterotoxin. Infect.
Immunol. 44:493-501.
13. Eklund. S., Jodal, M. and Lundgren, O. (1985). The
enteric nervous system participates in the secretory
response to the heat-stable enterotoxin of Escherichia
coli in rats and cats. Neuroscience 14:673-681.
14. Fan, C.C. and Powell, D.W. (1983). Cal cium/calmodul in
inhibition of coupled NaCl transport in membrane
vesicles from rabbit ileal brush-border. Proc. Nat1.

Acad. Sci. USA 80:5248-5252.
15. Field, M. and McColl, I. (1973). Ion transport in
rabbit ileal mucosa. III. Effects of catecho1amines.
Am. J. Physio1. 225:852-857.
16. Field. M., Graf, L.H. Jr., Laird, W.S. and Smith, P.L.
(1978). Heat-stable enterotoxin of Escherichia coli:
in vitro effects on guanylate cyclase activity, cyclic
GMP concentration of ion transport in small intestine.
Proc. Natl. Acad. Sci. USA 75:2800-2805.
17. Frizzell, R.A •• Field, M. and Schultz, S.G. (1979).
Sodium-coupled chloride transport by epithelial
tissues. Am. J. Physiol. 236:F1-F8.
18. Gill. O.M. and Woo1kalis, M. (1985). Toxins which
activate adeny1ate cyclase. Ciba Foundation Symp.
112:57-73.
19. Guerrant. R.L. (1985). Microbial toxins and diar-
rhoeal diseases: introduction and overview. Ciba
Foundation Symp. 112:1-13.
20. Hidaka. H•• Inagaki, M., Kawamoto. S. and Sasaki, Y.
(1984). Isoquina1inesu1fonamides. Novel and potent
inhibitors of cyclic nucleotide dependent protein
kinase and protein kinase C. Biochemistry 23:
5036-5041.
21. Kangawa, K•• Fukuda. A. and Matsuo, H. (1985). Struc-
tural identification of /3- and~-human atrial natri-
uretic polypeptides. Nature (London) 313:397-400.
22. Le Peuch. C.J., Haiech. J. and Oemaille. J.G. (1979).
Concerted regulation of cardiac sarcoplasmic reticulum
calcium transport by cAMP-dependent and calcium-
calmodulin-dependent phosphorylation. Biochemistry
18:5150-5157.
23. Levels. N.R. (1985). Control of intestinal absorption
by the renin-angiotensin system. Am. J. Physiol.
249:G3-G15.
24. Miller. R.J •• Brown. O.R •• Chang. E.B. and Friel. D.O.
(1985). The pharmacological modification of secretory
responses. Ciba Foundation Symp. 112:155-174.
25. Rao. M.C •• Guandalini, S •• Smith. P.L. and Field. M.
(1980). Mode of action of heat-stable E. coli
enterotoxin: tissue and subcellular specificities and
role of cyclic GMP. Biochim. Biophys. Acta 632:35-46.
26. Van Haastert. P.J.M., Van Oriel, R•• Jastorff. B.,
Baraniak. J., Stec, W.J. and De Wit. R.J.W. (1984).
Competitive cAMP antagonists for cAMP-receptor
proteins. J. Bio1. Chem. 259:10020-10024.
27. VarsanYi. M•• Toll e, H.G •• Hei lmeyer, L.M.G. Jr., Daw-
son. R.M.C. and Irvine. R.F. (1983). Activation of
sarcoplasmic reticular Ca 2 +-transport ATPase by phos-
phorylation of an associated phosphatidy1inositol.
Embo J. 2:1543-1548.
28. Wahawisan. R., Gagine1la. T.S. and Wallace. L.J.
(1985). Jejunal-ileal difference in dopaminergic but
not ~-adrenergic anti-secretory effects. Am. J.
Physio1. 248:G332-G336.
29. Waldman. S.A •• Rapoport, R.M. and Mucad. F. (1984).
Atrial natriuretic factor selectively activates

particulate guanylate cyclase and elevates cyclic GMP
in rat tissues. J. Biol. Chern. 259:14332-14334.
30. Weikel. C.S. and Guerrant. R.L. (1985), ST B ente-
rotoxin of Escherichia coli: cyclic nucleotide-in-
dependent secretion. Ciba Foundation Symp. 112:
94-115.
31
Species and age-dependent factors governing the
clinical severity of diarrhoea
R. A. ARGENZIO
ABSTRACT
Many of the species and age-dependent factors governing
the severity of a diarrhoea can be explained by the
development of colonic function. Compensatory responses
by the colon for a small bowel diarrhoea are brought about
bv the aldosterone mechanism and by the microbial
fermentation process. These two functions may be of
importance in enterotoxigenic secretory diarrhoea and in
small bowel ma1absorptive disease. Similarly. in species
where colonic function is quantitativelY important. such
as in non-ruminant herbivores. colonic malabsorption or
secretion may result in serious fluid and energy losses.
whereas in carnivores. colonic disease usually results in
mild diarrhoea and weight loss is uncommon. The quantita-
tive importance of the colon in fluid and energy absorp-
tion and in compensating for small bowel fluid losses is
age-dependent and may explain to some degree the age-
dependent resistance in some species to infectious diar-
rhoea.
INTRODUCTION
Loss of bodY fluids. electrolytes. and energy due to a
given enteric infection differs substantially in the neo-
nate and the adult animal. Although these age-dependent
345
differences are in large part due to development of immu-

nological factors and mucosal resistance. a second impor-
tant factor which has been less well appreciated is deve-
lopment of colonic function. In diseases affecting pri-
marily the small bowel. the compensatory response of the
colon may be substantial and is mediated by (a) the aldo-
sterone mechanism. and (b) microbial fermentation of car-
bohydrate. The efficacy of this compensatory response is
dependent on colonic absorptive capacity and the develop-
ment of microbial digestion. both age-dependent factors.
On the other hand. the severity of a diarrhoea in diseases
primarily affecting the colon will be greater in the older
animal. This is because the adult colon. especially in
non-ruminant herbivores and omnivores. normally handles
much more fluid than the neonatal colon and loss of this
fluid is significant.
This chapter describes the response of secretory and
ma1absorptive diarrhoeas affecting either the small or
large bowel and some of the age-dependent factors involved
in the severity of the response.
ENTEROSYSTEMIC CYCLE AND DEVELOPMENT OF COLONIC FUNCTION

Depending on the species and age of the animal. there are
large differences in the amount of endogenous fluids
handled daily by the intestine. In all species. these
digestive secretions increase with age. but the relative
amounts are much greater in herbivores. In adult
non-ruminant herbivores (the pig will be included in this
group). these daily secretions may equal the extracellular
fluid volume. Most of these fluids are reabsorbed by the
distal intestine and col on 6 , t t • The proximal intestine
becomes relatively inefficient in absorption after the
animal is weaned. Prior to weaning. however. the small
bowel may reabsorb up to 90% of these endogenous secre-
tions t • This change in intestinal handling of fluid pa-
rallels the development of microbial fermentation diges-
tion in the large intestine. which requires large amounts
of buffered fluids for its operation. A similar pattern
SPECIES AND AGE-DEPENDENT FACTORS IN DIARRHOEA 347
is not seen in the ruminant and carnivore whose small

intestine remains relatively efficient.
These differences in intestinal function explain to a
degree why the relative dehydration and malnutrition cau-
sed by a small or large bowel diarrhoea differ substanti-
ally depending on the species and age of the animal affec-
ted. For example. small bowel involvement in the dog is
characterized by large volumes of stool and. if chronic.
weight loss is present, while large bowel involvement is
characterized by small stools and weight loss is uncom-
mon 4 • In contrast, large bowel involvement in the pig or
horse may be characterized by a fatal loss of extracellu-
lar fluids. and if a more chronic condition is present,
weight loss can be expected 2 •
M~LABSORPTIVE DIARRHOEA : SMALL INTESTINE

Malabsorptive diarrhoea is commonly caused by enteric
viral infection. These agents cause villous atrophy in
various degrees of severity. resulting in both maldiges-
tion due to loss of surface enzymes and malabsorption due
to the loss of transport mechanisms. In the pig. both
rotavirus and coronavirus result in marked losses of lac-
tase and sucrase enzymes and failure of the intestinal mu-
cosa to absorb glucose,,7,t2.
There is an age-dependent resistance to the severity of
enteric virus infection. Moon et al.' have shown that the
turnover rate of intestinal epithelium increases with age
in the pig, so that in older pigs. regeneration of the
villus could occur more rapidly. They have postulated
that this more rapid restoration of the villus in older
pigs may be responsible for the age-dependent resistance
to transmissible gastroenteritis virus (TGE).
However, an equally important feature in these malab-
sorptive diseases is the degree of compensation by the
colon. In the case of the pig coronavirus (TGE), the
colon is unaffected and could presumably compensate for
the small bowel malabsorption to some degree. It must be
kept in mind. however. that the milk lactose. or any
carbohydrate for that matter. cannot be digested and ab-

sorbed by the colonic epithelium. Rather. these carbo-
hydrates are fermented by microbial action to volatile
fatty acids (VFA). which can then be absorbed by the
colonic mucosa. Thus. the ability to compensate relies on
the development of microbial digestion. In pigs 1 week
old or less. both rotavirus and coronavirus infections
lead to severe diarrhoea with large amounts of lactose in
the stool'·5. However. in 3 weeks old infected pigs which
had been introduced to some solid feed, nearly all of the
unabsorbed lactose was converted to VFA and absorbed as
such. Thus. these older pigs had a very mild diarrhoea
and maintained their body weight, even though the small
bowel was severely affected 1 • These factors again point
out the importance of colonic compensation in older
animals.
MALABSORPTIVE DIARRHOEA : LARGE INTESTINE

An example of a colonic malabsorptive disease is swine
dysentery. This disease exclusively affects the large
bowel and results in malabsorption of ions and water;
hypersecretion is not evident 3 • In older pigs. the
dehydration can be severe, resulting in death in up to 60%
of the cases. Presumably, this reflects the fact that the
colon must reabsorb large amounts of endogenous secretions
to preserve the extracellular fluid volume in these
animals.
Similar. acute diarrhoeas are seen in horses with colo-
nic involvement'; however. in this species. endotoxin ab-
sorption and prostaglandin production may cause hyperse-
cretion by the colon.
In dogs, colonic inflammation usually results in chro-
nic diarrhoea with small amounts of fluid lost. This can
be postulated to be due to two factors. First, cyclic AMP
does not seem to cause colonic secretion in the dog 1o • so
that products of inflammation (such as prostaglandins) may
not be capable of activating colonic secretion in this
species. Secondly, a colonic malabsorption caused by
SPECIES AND AGE-DEPENDENT FACTORS IN DIARRHOEA 349
mucosal damage would not result in serious loss of fluids,

due to the efficiency of small bowel absorption in this
species.
Thus. there appears to be a great deal of species
variation in the response to inflammation. Further study
may provide a critical role for metabolites of arachidonic
acid in these responses.
References
1. Argenzio, R.A., Moon, H.W., Kemeny, L.J. and Whipp, S.
C. (1984). Colonic compensation in transmissible gas-
troenteritis of swine. Gastroenterology 86:1501-1509.
2. Argenzio, R.A. and Whitlock, R.H. (1980). Diseases of
the colon. rectum, and anus in the horse, cow, and
pig. In: Anderson, N.V. (ed.). Veterinary Gastroente-
rology,pp.523-552. Philadelphia: Lea and Febiger.
3. Argenzio, R.A., Whipp, S.C. and Glock, R.D. (1980>.
Pathophysiology of swine dysentery: colonic transport
and permeability studies. J. Infect. Dis. 142:
676-684.
4. Burrows, C.F. (1980). Diseases of the colon, rectum,
and anus in the dog and cat. In: Anderson, N.V.
(ed.). Veterinary Gastroenterology, pp.553-592. Phi-
ladelphia: Lea and Febiger.
5. Graham. D.Y., Sackman, J.W. and Estes, M.K. (1984).
Pathogenesis of rotavirus-induced diarrhoea. Dig.
Dis. Sci. 29:1028-1035.
6. Hamilton, D.L. and Roe, W.E. (1977). Electrolyte le-
vels and net fluid and electrolyte movements in the
gastrointestinal tract of weanling swine. Can. J.
Compo Med. 41:241-250.
7. Kerzner, B., Kelly, M.H., Gall, D.G., Butler, D.G. and
Hamilton. J.R. (1977). Transmissible gastroenteritis:
sodium transport and the intestinal epithelium during
the course of viral enteritis. Gastroenterology
72:457-461.
8. Moon. H.W., Kemeny, L.J., Lambert, G., Stark, S.L. and
Booth. G.D. (1975). Age-dependent resistance to
transmissible gastroenteritis of swine. Vet. Pathol.
12:434-445.
9. Palmer, J.E. (1984). Acute diarrhoeal diseases of the
adult horse. Proc. American College of Veterinary
Internal Medicine. Washington, DC, pp.247-250.
10. Robinson, J.W.L. (1976). Inhibition of transport pro-
cesses in the dog colon. In: Robinson, J.W.L. (ed.).
Intestinal Ion Transport, pp.187-198. Baltimor&;
University Park Press.
11. Schmall, L.M., Argenzio, R.A. and Whipp, S.C. (1982).
Effects of intravenous Escherichia coli endotoxin on
gastrointestinal function in the pony. In: Byars,
ToG., Moore, J.W. and White, N.A. (eds). Proc. Equine
Colic Research SYmposium, Athens, Georgia, pp.157-164.
University of Georgia: College of Veterinary Medi-
cine.
12. Shepperd, R.W., Gall, D.G., Butler, D.G. and Hamilton,
J.R. (1979). Determinants of diarrhoea in viral en-
teritis. Gastroenterology 76:20-24.
32
Antidiarrhoeal therapy
L. A. A. OOMS AND A.-D. DEGRYSE
ABSTRACT
A short review on the pharmacology of current anti-
diarrhoeal therapy is presented. Fluid replacement
therapy and symptomatic therapy are useful in the treat-
ment of diarrhoea of varying origin. The pharmacology of
loperamide. alpha-2-agonists. anti-inflammatory drugs.
chlorpromazine. trifluoperazine. parasympatholytics and
serotonin-2-antagonists is discussed.
INTRODUCTION
Theoretically. diarrhoea can be classified into decreased
intestinal absorption. increased intestinal secretion.
decreased transit time and diarrhoea due to local blood
flow disturbances. The origin of diarrhoea can be located
in the small and/or large intestine. Usually, more than
one factor is involved: exceptionally it is restricted to
only small or large intestine.
FLUID REPLACEMENT THERAPY

Intravenous fluids are effective, but require maintenance
therapy. Oral rehydration in diarrhoea is viewed as a
practical and effective therapy, especially in secretory
diarrhoea. In the developing countries, oral rehydration
of man is established as pivotal by the World Health
351
Organization 4o •
The coupled Na-organic solute (glucose or neutral amino
acids) mechanism is still active in secretory diarrhoea.
These two solutes increase the effective osmotic pressure
in the intercellular spaces. thus creating a driving force
for transepithe1ia1 water absorption. Rice water (the
excess water in which whole rice has been cooked) is
believed to supply amylose and amylopectin as carbohydrate
sources (glucose is released by intraluminal digestion).
In weanling pigs. diarrhoea induced with rotavirus
followed by haemolytic enteropathogenic Escherichia coli,
it was shown that the dietary regimen plays an important
role in the treatment of diarrhoea. In piglets fed one-
third of the nutrient intake either hourly or three times
a day, the diarrhoea was shortened and the colonization of
the E. coli and the shedding of rotavirus was less in
comparison with the full dietary regimen 23 •
SYMPTOMATIC TREATMENT OF DIARRHOEA

The symptomatic treatment of diarrhoeas of different
origin can only be undertaken in animal species with
substances reducing the occurrence in the absence of
side-effects. Antidiarrhoea1 specificity is defined as
the ratio of the lowest dose producing undesirable
effects. to the dose at which protection from diarrhoea
occurs. The larger the ratio. the higher the anti-
diarrhoeal specificity of a test compound. The data for
different substances are summarized in Tables 32.1 and
32.2.
Loperamide
Loperamide (for extensive review. see 30 and 32) has high
antidiarrhoea1 specificity. irrespective of the desired
duration of such effects. Intravenous loperamide is
capable of producing opiate-like CNS activity, although
this activity occurred only at doses that are equal to or
only slightly lower than the lethal dose H • Loperamide is
by far the most specific of all known drugs producing
ANTI DIARRHOEAL THERAPY 353
Table 32.1 Comparative pharmacological data on 20 com-

pounds with antidiarrhoeal properties in rats ED,o
(mg/kg) for antidiarrhoeal activity and side-effects
A B C o E F
Anticholinergics
1. Atropine 1.76 9.30 49.2 98.4
2. Scopolamine 1.03 7.12 28.3 37.3
3. Methylscopol- 3.52 14.1 37.3 74.6
amine
4. Propantheline 65.1 149.0 299.0 320.0
5. Isopropamide 18.6 74.6 113.0 160.0
Narcotic analgesics
6. Phenazocine 6.65 15.3 23.0 40.0 90.0
7. Dextromoramide 1.80 2.83 5.58 8.25 71.8
8. Propoxyphene 25.0 50.1 90.0 101.0 48.2 2 990.0
9. Anileridine 4.42 8.05 17.8 33.0 9.48 2 175.0
10. Pethidine 16.3 30.2 52.5 87.0 54.5 2 760.0
11. Fentany 1 0.19 0.49 0.96 1.60 0.86 2 43.9
12. Methadone 2.19 6.38 12.6 16.9 14.2 2 95.0
13. Codeine 2.85 10.8 28.8 70.0 56.5 2 427.0
14. Morphine 1.52 5.21 30.9 60.7 33.6 2 905.0
Antidiarrhoeals
15. Diphenoxylate 0.15 0.54 1.41 4.77 12.82 221.0
16. Difenoxine 0.04 0.16 0.31 0.91 4.06 2 149.0
17. Nufenoxole 0.83 1.72 3.12 9.41 85.9 2 105.0
18. Loperamide 0.15 0.29 0.61 1 .81 160 2 185.0
19. Clonidine 0.012 0.028 0.043 0.19 0.085 3
20. Li dami dine 0.45 1.67 3.81 9.36 24.9 3 184.0
Antidiarrhoeal activity by the castor oil test: A = lo-

west ED,o: B = EDH 2 h; C = EDH 4 h; 0 = ED,o 8 h.
Side effects: E = lowest ED,o: F = LD,o' The side ef-
fects limiting the antidiarrhoeal use of these drugs are:
'mydriasis: 2 inhibition tail-withdrawal reaction: 3 au to-
nomic side-effects.
- data not available.
Table 32.2 Comparative pharmacological data on 20 com-

pounds with antidiarrhoeal properties in rats: antidiar-
rhoeal specificity. based on the data given in Table 32.1
E/A E/B E/C E/O FlO
Anticholinergics
1. Atropine 0.22 0.042 0.0079 0.0040
2. Scopolamine 0.21 0.031 0.0078 0.0059
3. Methylscopol- 0.76 0.19 0.072 0.036
amine
4. Propantheline 1.00 0.44 0.22 0.20
5. Isopropamide 1.15 0.29 0.19 0.13
Narcotic analgesics
6. Phenazoci ne 1.23 0.53 0.36 0.20 2.25
7. Oextromoramide 1.54 0.98 0.50 0.34 8.70
8. Propoxyphene 1.93 0.96 0.54 0.48 9.80
9. Anileridine 2.14 1.18 0.53 0.29 5.30
10. Pethidine 3.34 1.80 1.04 0.63 8.74
11. Fentanyl 4.53 1.76 0.90 0.54 27.4
12. Methadone 6.48 2.23 1.13 0.84 5.62
13. Codeine 19.9 5.24 1.97 0.81 6.10
14. Morphine 22.1 6.45 1.09 0.55 14.9
Antidiarrhoeals
15. Oiphenoxylate 85.3 23.7 9.08 2.68 46.3
16. Oifenox i ne 102.0 25.4 13.1 4.46 164.0
17. Nufenoxole 103.0 49.9 27.5 9.13 11.2
18. Loperamide 1067.0 552.0 262.0 88.4 102.0
19. Clonidine 7.08 3.04 1.97 0.45
20. Lidamidine 55.3 14.9 6.54 2.66 19.7
Antidiarrhoeal specificity - E/A : at peak effect; E/B :

for a duration of action of 2 h; E/C : for a duration of
action of 4 h; E/D : for a duration of action of 8 h: FlO:
safety margin of antidiarrhoeal activity of 8 h.
antidiarrhoeal effects. irrespective of the desired

duration of such effect s <Tab Ie 32.1). In addition.
loperamide also has a wide safety margin. High doses of

loperamide are well tolerated over long periods of time.
and do not lead to significant side-effects 2 • About 70%
of orally administered 14C-loperamide (1 mg/kg) in rats
was absorbed by the intestine. 30% of which was secreted
back into the intestinal cavity after demethylation while
the remaining 40% was transferred to the liver. metabo-
lized and largely excreted into the bile. In rats. unal-
tered loperamide was eliminated from the plasma with a
half-life of 15 h. Only 1.4% of the dose was excreted in
the urine up to 72 h. Although initial and maximum plasma
levels were higher following intravenous administration
than after oral administration. the elimination pattern
was very similar.
Loperamide significantly inhibited the activity of the
calmodulin-activated enzyme (calmodulin-activated phospho-
diesterase activity) at concentrations as low as 5 umol/l
and reduced activity to levels observed in the absence of
calmodulin between 50 and 100 umol/l. suggesting that
calmodulin had been completely inactivated. Morphine.
diamorphine and dihydrocodeine and the opioid peptide
metenkephalin had no effect. This was further supported
by the inability of naloxone to reverse the inhibition of
calmodulin by loperamide 26 • The order of potency of
binding to calmodulin in the presence of calcium is
loperamide = diphenoxylate. chlorpromazine. promethazine.
amitryptiline in order or decreasing potency. A positive
correlation between calmodulin binding and antidiarrhoeal
activity was demonstrated 43 •
Loperamide reverses cholera (CT)-induced secretion
(ligated colon loops in rats) without affecting adenylate
cyclase and without affecting tissue cAMP levels (in
man)8. Loperamide interferes with the secretory process
at a point beyond the cAMP increase caused by activation
of adenyl ate cyclase. The effect of loperamide on
CT-induced secretion is blocked by naloxone without any
effect on cAMp34. Loperamide prevents theophylline from
inducing net chloride secretion. but does not signifi-
cantly affect the theophylline-dependent increase of Cl-

exchange across the mucosal border l6 • Loperamide may
activate a separate Cl- transport system across the
serosal border of the intestine ("morphine effect"). This
has also been demonstrated in the isolated rabbit colon
and rabbit ileum 28 • This increased Cl- permeability could
reduce intestinal secretion by facilitating the net loss
of electrolytes from the mucosal epithelial cells into the
serosal bathing solution. Naloxone (10- 6 M) prevents the
loperamide-induced increase in Cl- movement across the
serosal border l6 • Also in the colon. loperamide reverses
the stimulated chloride secretion and produces an increase
in the chloride permeability of the serosal border. There
is also evidence of greater Na absorption and this further
enhances the antisecretory effect.
Using a triple lumen perfusion technique. it was shown
that loperamide (4 mg bolus followed by 3 mg/l perfusate)
inhibited PGE 2 (5 x 1O- 4 M) induced secretion of Na. Cl and
water. Loperamide converted secretion to absorption in
three of six subjects and reduced mean water secretion by
91.1 ± 15.2%. In addition. loperamide given after the
PGE 2 reduced secretion l4 • Loperamide effectively antago-
nized prostaglandin (PGE 2 • 5 mg orally) induced diarrhoea
in adult healthy male volunteers; also loperamide admini-
stered 30 min before PGE 2 prevented (4 mg orally) the PGE2
induced diarrhoea. In patients undergoing pregnancy ter-
mination with prostaglandins (PGF2.) three oral doses of
4 mg loperamide at 6 h intervals prevented diarrhoeal ••
Also diarrhoea induced with other prostaglandin derivates
could be prevented by pretreatment with 10peramide 22 •
Loperamide did not reduce the prostaglandin-induced in-
crease in net Cl secretion. although it prevented the in-
hibition of mucosal-to-serosal Na movement. Hence. lope-
ramide does not alter cyclic adenosine 3' .5'-monophosphate
levels induced by prostaglandins by a direct action at the
enterocyte. since in isolated enterocytes. neither basal
nor prostaglandin-stimulated cyclic AMP levels were affec-
ted by the drug ll • Oral administration of 0.1-2 mg/kg
PGE 2 to rats produced a dose-dependent increase in the

volume of intestinal contents. The fluid volume was redu-
ced for 6-8 h and by 60-80% when the animals were pretrea-
ted with 1 mg/kg orally!8. Loperamide also enhances nor-
mal absorption from glucose-electrolyte mixture in steady
state perfusion technique. The mechanism of action is un-
known.
The opposing action on fluid transport (guinea-pig
colonic mucosa) of the laxative 1,8-dihydroxyanthraquinone
by loperamide seems to be due to decreased paracellular
permeabilit yJ 9 . Bisacodyl and other diphenolic laxatives
inhibit the Na+-K+-activated ATP-ase and increase cAMP
content J5 • Bile acid (4 mM deoxycholic acid)-induced
secretion in the rat caecum is associated with mucosal
blunting. degranulation of goblet cells, crypt dilatation,
increased inflammatory cells, submucosal oedema and
vascular congestion. At 0.6 mg/kg, loperamide signifi-
cantly decreased the secretion and also protected against
these histological changes! 0 •
Loperamide inhibits the release of acetylcholine and
prostaglandin produced by distention of the intestine (in
vitro)42. Hence, loperamide inhibits the peristaltic
movement principally by reducing the release of acetyl-
choline and prostaglandin. at least during circumferential
distention of the intestinal wall in vitro. Also the
release of acetylcholine from the intestine without dis-
tention was decreased after loperamide. L~peramide also
blocked the smooth muscle stimulating action of prosta-
glandins. acetylcholine and histamine on gastrointestinal
smooth muscle preparations!8. Loperamide (administered
enterally : 5 ug/kg/min or intravenously 1.5 ug/kg/min)
significantly reduced the slow wave frequency and signi-
ficantly increased the percentage of slow waves initiating
fast wave activity. Naloxone (40 ~g/kg/h) abolished
interdigestive motor activity or reduced mean cycle dura-
tion and the mean motility index.
The mode of action of loperamide may involve a
reduction in the quantity of intracellular free ionized
cal dum available to the stimu1us-re1ease-coup1ing

mechanism (guinea-pig isolated ileum). 4-Aminopyridine.
which enhances calcium influx into the cell. antagonizes
the effect of na10xone 2o • Loperamide (intragastrica11y
4 mg bolus in 2 m1) reversed these effects. In the small
intestine. morphine and loperamide seem to lock the small
intestinal circular muscles of all species studied into a
continuous segmentation pattern of motility (mixing) which
is non-propulsive and constipating. In rats (in vitro) it
was shown that the opiate-induced contractile response is
mediated by stereospecific. naloxone-sensitive. opiate
receptors and that the muscular response involves the
activation of a S-HT (S-Hydroxytryptamine) neurone in the
nerve terminals of the co10n!~.
A1pha-2-agonists
A1pha-2-receptor activation mediates the inhibition of a
number of gastrointestinal functions including gastric and
intestinal secretions. A1pha-2-adrenergic agonists also
enhance absorption. A1pha-2-receptors are present on the
enterocytes. These receptors mediate enterocyte fluid and
electrolyte transport 4 • A1pha-2-receptors are coupled to
inhibition of basal and hormone-stimulated adeny1ate
cyclase activity. A1pha-2-induced decrease in cellular
cAMP levels are mediated at least in part by decreased
cAMP synthesis 24 • In vitro in the rabbit intestine. both
c10nidine and 1idamidine increased sodium and chloride
absorption 7 • Perfusion of the pig jejunum with Escherichia
coli heat-stable enterotoxin reversed net absorption of
water and electrolytes to net secretion. C10nidine.
L-pheny1ephrine and morphine, added to the perfusate.
reduced the secretory response to enterotoxin and
stimulated absorption!. In dog jejunum. 1idamidine
reduced intestinal secretion due to damage by deoxy-
cho1ate!l. The antisecretory activity was related to the
ability of 1idamidine to reduce intestinal villous damage
and enhance permeability changes!2. C10nidine inhibited
the distention-induced peristaltic reflex in the isolated
guinea-pig ileum. For the inhibitory effects of alpha-2-

agonists. the pacemaker neurones of the enteric nervous
system as well as postganglionic neurones innervating
intestinal smooth muscles are involved 4 • Lidamidine
inhibited gastric emptying. but not intestinal transit 27 •
Anti-inflammatory drugs
Prostaglandins are involved in secretion 3 &. Acetylsali-
cylic acid given orally (100 mg/kg) 4 h before inoculation
of Escherichia coli heat-stable enterotoxin (ST) into
ligated loops in the distal part of the jejunum of calves
did not substantially alter the intestinal fluid response
to the toxin. Intravenous sodium salicylate administered
simultaneously with or 1 h after inoculation of ST signi-
ficantly decreased fluid accumulation in loops with ST
dilutions of 1:25 or greater 41 • Quinacrine hydrochloride
and zomepirac sodium decreased secretion caused by Esche-
richia coli heat stable toxin in mice 3 &. Indomethacin
decreased secretion in rabbits 34 • Flunixin meglumine
reduces the quantity of diarrhoeal fluid loss in calves
with colibacillosis 17 • Despite promising results in
selected situations. most anti-inflammatory drugs are
potentially dangerous. especially in dehydrated animals.
Chlorpromazine and trifluoperazine

Both substances act by inhibition of intracellular
calmodulin activit y5 . In piglets. secretion was induced
with Escherichia coli producing both heat-stable and
heat-labile toxins. and chlorpromazine (1-5 mg/kg) decrea-
sed the intestinal fluid losses. A similar effect was
obtained in spontaneous outbreaks of colibacillosis 25 •
ParasYmpatholytics
Secretion induced with ampiphatic drugs (bile salts, fatty
acids) in dogs was reversed by the intravenous injection
of atropine 21 • Atropine also decreases Cl-secretion in
porcine enterocytes induced by Escherichia coli heat-
stabile enterotoxin.
Benzetimide. when combined with antibiotics in newborn

calves and adult cattle cured diarrhoea more quickly than
when antibiotics were given a10ne 37 • In another study
benzetimide again shortened the duration of diarrhoea 9 •
Serotonin-2-antagonists
Both in vitro and in vivo. it was shown that 5-HT
increased the electrical activity of the rat jejunum. The
increased potential difference and short circuit current
resulted from a stimulation of electrogenic chloride
secretion and by reducing NaC1 absorption. Intestinal
secretagogues. including cholinergic agonists and
serotonin from the serosal side do not cause mucosal cAMP
to increase and require extracellular calcium to produce a
full electric response; these substances may act as
calcium ionophores on the epithelial cells. Intravenous
infusion in rabbits of 5-HT (20 ~g/kg/min) resulted in
highly significant net secretion of water and sodium in
both jejunum and ileum. The addition of glucose to the
perfusate completely abolished the serotonin effect. The
effect was achieved without any detectable histological
alterations in small bowel mucosa by light or electron
microscopy'9. In the dog small intestine. Burks 3 provided
evidence that 5-HT excited intraneural cholinergic nerve
elements since the intestinal contracting effect of 5-HT
was blocked by tetrodotoxin. nicotinic depolarization and
atropine. but not by TEA. After oral ingestion of 5-HTP
(30 mg/kg), increased spiking (from 25% [control] to 50%)
activity was observed on dog intestine during the first
hour, A percentage of 90 to 95 is reached for the next 5
hours 33 • Piglets. 10 days old. infected by gastric tube
with an Escherichia coli strain producing heat-stable and
heat-labile enterotoxin and treated with a serotonin-2-
antagonist survived while all controls died. Blind loops
were created in the jejunum of pigs and injected with
cholera toxin. and a significant reduction in secretion
(m1/cm of intestine) was observed after treatment with a
serotonin-2-antagonisP' •
ANTIDIARRHOEAL THERAPY 361
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Effects of loperamide on acetylcholine and prosta-
glandin release from isolated guinea pig ileum. Jap.
J. Pharmacol. 28:873-882.
43. Zavecz. J.H., Jackson, T.E., Limp, G.L. and Yellin,
T.O. (1982). Relationship between anti-diarrheal ac-
tivity and binding to calmodulin. Eur. J. Pharmacol.
78:376-377.
33
The effects of veterinary drugs based on humic
acids in the treatment of enteritis in young animals
S. GOLBS, M. KUEHNERT AND V. FUCHS
ABSTRACT
The breeding of young pigs and cattle presents a number
of difficulties due to an increased occurrence of disea-
ses. especially those of the gastrointestinal tract - for
example. in calves and piglets - in conventional as well
as industrial circumstances.
In the German Democratic Republic humic acids have been
used for more than 15 years as agents for the therapy,
prophylaxis and metaphylaxis of infectious and non-infec-
tious gastrointestinal diseases (particularly in pigs and
ruminants). In these clinical cases the chemical.
biochemical and physicochemical properties. as well as
their broad spectrum of pharmacological effects. are
uti I ized.
Experiments on laboratory animals and clinical tests in
practice showed that humic acids are a valuable supplement
to the present conventional therapeutic methods against
enteritis of calves. pigs and several species of zoo ani-
mals.
INTRODUCTION
Due to the increased gastrointestinal diseases. especially
in calves and pigs. the breeding of young livestock has
problems in conventional as well as industrial cattle
365
breeding farms and zoo animal st.

For more than 15 years humic acids as basic active
substances have been used in the German Democratic Repu-
blic for the treatment of infectious and non-infectious
gastro-intestinal diseases.
Experiments on laboratory animals and clinical tests in
practice have shown that humic acids contained as solitary
active substances in the veterinary medicaments Kalumat
and Sulumin ara a valuable supplement to the present
therapeutic methods against enteric diseases.
In these cases the chemical. biochemical and physico-
chemical properties of humic acids as well as their broad
spectrum of pharmacological effects have been used.

About 70% of the earth's organic bound carbon is found in
fossi I fuel <coal. oi I. peat and natural gases). Up to
8-10% of it belongs to the group of humic substances. but
only 1% is present as cellulose and less than 0.001% is
available as biologically active substances used for
medical purposes - for example. antibiotics and hormones.
Humic acids are polyvalent macromolecules composed of a
large number of basic components. These substances are
three-dimensional molecules with molecular mass between
10.000 and 200.000.
The peripheral zones consist of partially modified
metabolites of organic structures resulting from protein.
fatty acid and carbohydrate metabolism'. Core and peri-
phery are bound mainly by phenolic groups (the substitu-
tion pattern is usually lignin-like. flavonoid-like or
chi no i d-l ike) • Functional groups are found in the peri-
pheral zones (hydroxyl-free. carbonyl-free. carboxyl-free
phenolic as well as amino. and sulphydryl groups).
Humic acids are weak polyvalent organic acids with a
tendency to form complexes (absorption. ion exchange.
mainly concerning cationoid groups. such as metals). For
pharmaceutical use highly concentrated humic acids are
available.
THE EFFECTS OF HUMIC ACIDS IN THE TREATMENT OF ENTERITIS 367
The clinical and pharmacological effects of humic

acids. which can be derived from their chemical properties
and from the wellknown pharmacological and toxicological
effects. may be summarized as follows 3 :
(1) antiphlogistic. astringent and analgesic effects:

(2) adsorption effect as well as resorption-reducing ef-
fect particularly concerning cationic compounds:
(3) antimicrobial effects on the basis of the presence of
phenolic-chinoid groups:
(4) detoxifYing effects with pesticides 4 •

The most favourable use of these pharmacodynamic proper-
ties may be by combination of several products of humic
acids. as found in the veterinary drugs Kalumat and
Sulumin (humic acids in form of an acid depending
primarily on the molecular mass have antimicrobial
properties as well as antiphlogistical effects: on the
other hand. the alkaline salts of the humic acids have
both adsorptive and metabolism-regulating effects).
Kalumat in the treatment of enteritis in calves and zoo

animals
The composition of Kalumat is as follows: humocarb 90%:
highly concentrated humic acids 5%: and aluminium/magne-
sium silicate 5%. Its use is for the prevention and
treatment of infectious and non-infectious enteritis in
calves and zoo animals. Administration is oral.
Various clinical tests showed that Kalumat is more
effective in comparison to the conventional chemotherapy3.
After the oral administration of Kalumat the frequency
of enteritis was reduced by more than 30%. Moreover. the
costs of used drugs were decreased by about 60%. and bodY
weight was increased by nearly 7%.
In summary. therefore Kalumat is highly effect i ve and
extremely well tolerated. when applied orally and can
therefore be used successfully in therapy and prevention
368 COM PARATIVE VETERINARY PHARMACOLOGY, TOXICOLOGY AN D THERAPY
of specific (such as Escherichia coli) infections. and

unspecific (for example. dyspepsia) enteritis in calves
and zoo animals (such as elephants. tigers. horses. and
monkeys).
It is possible to substitute the conventional treatment
with chemotherapy on the basis of humic acids as a
solitary active substance. the drug must be used at an
early stage.
Sulumin in the treatment of diarrhoea in suckling pigs and

young pigs
Worldwide the breeding of pigs is connected with many
types of gastrointestinal diseases. such as virus
diarrhoea. E. coli diseases. colitoxicosis and dYspepsia.
In most cases mortality and morbidity is very high.
especially in virus diarrhoea and E. coli infections.
Some authors have even described rates of morbidity UP to
100%t . 2 •
In the German Democratic Republic Sulumin is the newest
of the veterinary medicaments based on humic acids as a
complex agent. Its composition is as follows highly
concentrated humic acids 70%; Fe 2 + 1.5%: Na-carboxYmethyl-
cellulose 28.5%. Its use is for the prevention and treat-
ment of infectious and non-infectious enteritis especially
E. coli diseases and virus diarrhoea in babY pigs. piglets
and young pigs. Administration is oral.
The scheme of dosage. which showed the optimum results
of treatment in various enteritic diseases of pigs. could
be ascertained on the basis of laboratory tests and
clinical investigations in practice (Tables 33.1 and
33.2) •
In clinical tests on sick animals the efficacy of
Sulumin on morbidity. mortality. frequency of enteritis.
development of bodY weight. effect of iron contained in
the drug. and the possibility of side-effects. was mainly
examined.
Table 33.3 shows that the frequency of enteritis was
reduced in more than 50% of patients. The development of
THE EFFECTS OF HUMIC ACIDS IN THE TREATMENT OF ENTERITIS 369
Table 33.1 Dosage of Sulumin in suckling pigs
Escherichia coli disease 500-750 mg/kg body weight,

twice a day, for 3 days
Virus diarrhoea 350-500 mg/kg bodY weight.

twice a day, for 3 days
<maximum 1000 mg/kg bodY weight)
Chronic TGE 500-750 mg/kg body weight.

for 5-10 days
DYspepsia 500-750 mg/kg body weight,

for 5-10 days
Infectious necrotic 500-750 mg/kg body weight,

enteritis for 5-10 days
Table 33.2 Dosage of Sulumin in piglets and young pigs
Col itoxicosis interval dosage : 500-1000-500

mg/kg bodY weight. for 10 days.
in difficult cases. maximum
2000 mg/kg bodY weight
DYspepsia 500-750 mg/kg body weight. for

5-10 days
bodY weight in the Sulumin group showed better progress

and. furthermore. the rate of mortality in the case of
virus diarrhoea was decreased from 24% to 0.5%.
Results on the influence of Sulumin on the metabolism
of trace elements showed that plasma l evels of iron.
copper and zinc moved in the physiological range. Analo-
gous effects were found in the following haematological
parameters: erythrocytes. haemoglobin and haematocrit.
Table 33.3 Frequency of enteritis and development of body

weight in piglets during preventive oral administration of
Sulumin (400 mg/kg body weight)
Group n Frequency (%) of Development of

enteritis body weight (kg)
start end
Control 53 93 4.80:t0.15 11.62:t3.36
Sulumin 43 44 14.27:t8.77
CONCLUSIONS
In summary. Kalumat is highly effective and extremely well
tolerated. when applied orally. and can therefore be used
successfully in the treatment of specific (E. coli) and
non-specific (dYspepsia) enteritis in calves and several
zoo animals.
Sulumin has similar effects to Kalumat in the treatment
of infectious bacterial diseases (E. coli. Clostridia per-
fringens). virus diarrhoea (coronavirus and rotaviruses)
and dYspepsia in piglets and young pigs.
References
1. Elze. K. (1982). Ober den Einsatz von Huminsauren zur
Profylaxe und Therapie von Durchfallen bei Zootieren.
Internat. Symp. Erkrankungen Zootiere. Veszprem.
Ungarn.
2. Golbs. S. (1983). Experimentelle Untersuchungen zur
pharmakologischen Wirksamkeit und zur PharmakodYnamik
von Huminsauren unter besonderer Berucksichtigung koer-
gistischer Effekte und ihrer therapeutischen und pro-
phylaktischen Nutzung beim Schwein. Prom. B. Leipzig:
Karl-Marx-Universitat.
3. Golbs. S. and Kuehnert. M. (1983). Huminsaurenanwendung
in Therapie, Pro- und Metaphylaxe in der Veterinarmedi-
zin. Z. PhYsiother. 35:151-158.
4. Golbs. S •• Kuehnert, M. and Fuchs. V. (1984). Beein-
flussung der akuten Toxizitat von ausgewahlten Pesti-
ziden durch Huminsauren. Z. Ges. Hyg. 30:720-723.
5. Schnitzer. M. and Khan, S.U. (1972). Humic Substances
in the Environment. New York: Marcel Dekker. Inc.
Clinical Toxicology
34
Drug reactions leading to toxicity
A. DE RICK
ABSTRACT
Clinically relevant drug interactions leading to toxicity
are discussed with emphasis on the mechanism of action and
clinical implications. No attempts are made to cover the
whole field of drug interactions. Instead. the problems
are illustrated by examples of pharmacodynamic and
pharmacokinetic interactions described in the literature
of veterinary and human medicine.
INTRODUCTION
Multiple drug therapy is often used and this may lead to
drug interactions. Drug interactions change the expected
relation between the dose administered and the effect
obtained. This can involve the concentration of the drug
at the site of action (pharmacokinetic interactions) or
the sensitivity of the target organs (pharmacodynamic
i nt eract ions) •
There is extensive information on "potential" drug
interactions. However. well-documented clinically
relevant interactions are less numerous. Several reasons
for this discrepancy can be cited. Drug interactions are
often studied in vitro. A typical illustration is drug
interaction at the level of serum protein binding
concentrations used in vitro are often higher than those
373
occurring in vivo in the clinical situation. Even if

altered serum protein binding occurs in vivo, it may not
have the expected consequences. When, for example, the
free fraction of a drug with a large volume of
distribution is increased, the displaced molecules will
redistribute outside the plasma compartment. As a result,
even a marked increase in free drug fraction will only
lead to a small change of free concentration, and no
alteration of the effect will be seen. An increased
elimination of free drug too tends to counteract the
increase of free concentration. In vivo interactions are
often studied in experimental conditions. Such
experiments are predictive only if they mimic the clinical
situation and if they relate to dosage regimens that are
used in the clinic. Another problem is the difficulty of
differentiating effects of drugs in normal animals from
those with disease in the clinical situation.
Interactions can decrease or increase the efficacy of a
drug so that exaggerated responses and toxicity can occur.
Clinically relevant interactions leading to toxicity will
mainly be seen for drugs with a steep dose-response curve.
In this chapter some of the clinically relevant drug
interactions, leading to toxicity, will be discussed.
PharmacodYnamic as well as pharmacokinetic interactions at
the level of drug distribution and drug metabolism will be
illustrated. No attempt will be made to cover the whole
field as detailed information is available in recent
reviews 4 . , . 7 . 9 . 1 2 .
PHARMACODYNAMIC INTERACTIONS
Diuretics are commonly administered together with digoxin
in the treatment of congestive heart failure. A drug
interaction which causes an emergency seen in human
medical practice is digitalis toxicity precipitated by the
use of potassium-losing diuretics (for example,
furosemide)4. Digitalis glycosides inhibit
Na+-K+-membrane ATPase and this results in a decrease in
intracellular potassium. Diuretic-induced hypokalaemia
DRUG REACTIONS LEADING TO TOXICITY 375
may precipitate digitalis toxicity. It is generally

accepted that hypoka1aemia and potassium loss induced by
diuretics are able to sensitize the myocardium to the
arrhythmogenic effects of digitalis in man tt • Thus.
dosage of concurrently administered cardiac glycosides may
require adjustment in patients treated with
potassium-losing diuretics.
In dogs also it is known that furosemide may induce
digitalis toxicityto. However. in the dog the mechanisms
of interplay between digitalis, hypoka1aemia and potassium
loss are not clear. Binnion 2 showed that neither acutely
nor chronically induced hypoka1aemia sensitized the dog
heart to digitalis-induced arrhythmias. These data were
obtained in anaesthetized dogs. More recently this view
was substantiated in awake dogs and in a more clinical
setting of experiments!. In this latter study, c1 inica1
signs of digitalis toxicosis occurred when furosemide was
added to chronically digitalized dogs but in the absence
of changes in serum potassium concentration. Another
important finding in this study was the increase in the
steady-state serum digoxin concentrations caused by the
furosemide treatment. Thus. in the dog the digoxin-
furosemide interaction seems not to be purely pharmaco-
dynamic. Whatever the underlying mechanisms of this
interaction. the following recommendations can be made for
the veterinary clinician. Chronic mitral valve insuffi-
ciency is the most common cause of heart failure in the
dog. These dogs are often presented as class III patients
and respond well in most cases to diuretic treatment
alone. Therefore it is advisable to commence therapy with
diuretics, without the use of digitalis glycosides. When
digoxin and furosemide are used concomitantly, the
recommended dose of furosemide should not be exceeded
(especially in anorexic dogs) and the effectiveness of
alternate-day administration should be investigated. When
furosemide is given parenterally, the administered dose
should be lower by 30-50% than the oral dose as the
bioavai1abi1ity after oral administration is lower.
The most commonly administered drugs in veterinary

medicine are undoubtedly the antibacterials. Many
i nt eract ions affecting their activity against pathogens
are known (for example. synergistic and antagonistic
combinations of antibiotics). Interactions between
antibiotics or between an antibiotic and other agents can
also decrease their safet y5 . 7 . 1 2 . The aminoglycosides
(streptomYcin, neomycin. kanamycin, gentamycin) have a
potential for ototoxicity, nephrotoxicity and
neuromuscular blockade. These toxic effects can be
additive with combinations of the aminoglycosides. The
combination of aminoglycosides with other neuromuscular
blockers. including anaesthetics, can result in
respiratory failure and reduced cardiac output.
Parenterally administered tetracycline may interact with
the inhalation anaesthetic methoxyflurane to produce
lethal nephrotoxicity.
PHARMACOKINETIC INTERACTIONS
Pharmacokinetic interactions leading to toxicity can take
place at different levels. for example, absorption,
distribution and elimination.
Absorption
Interactions due to effects on drug absorption which can
lead to toxicity are rare in both human and veterinary
medicine. Enhancement of digitalis toxicity has been
recorded in animals treated with stool softeners 9 •
Distribution
Drugs can alter each other's distribution. In the
literature on human research much has been written about
interactions of drugs at the level of the serum albumin
binding. especially for the coumarin-based anticoagulants.
These agents are highly bound to plasma proteins.
Non-stero ida I anti -i nfl ammat ory agent s (NSAIDS) • among
other drugs. can decrease the protein binding of the
coumarin anticoagulant and potentiate its effect. In
veterinary medicine coumarin anticoagulants are less

commonly used therapeutic agents. In horses. however,
they are used in the treatment of navicular disease.
Moreover. poisoning of domestic animals by warfarin does
occur quite frequently. In both cases the effects of
warfarin could be expected to be more severe when plasma
protein binding is decreased by concomitant therapy with
non-steroidal anti-inflammatory agents such as
phenylbutazone.
Recently, much work has been done on the binding of
drugs to another plasma constituent.
glYcoprotein. an acute phase reactant t • Inflammatory
diseases and administration of enzyme-inducing agents can
increase the alphat-acid glycoprotein concentration in
plasma and lead to an enhanced binding of mainly basic
drugs. However. toxic effects due to decreased binding of
drugs on this protein have not been reported.
A clinically relevant interaction where distribution
phenomena are. at least in part, involved is that of
digoxin and quinidine. Although quinidine and digoxin
have been used concomitantly for many years in both human
and veterinary medicine. an interaction between these two
drugs was only detected a few years ago t3 • In human
patients quinidine causes an increase in serum digoxin
concentration in about 90% of cases. The increase may be
accompanied by digitalis intoxication. In dogs the
findings were similar. Serum digoxin concentrations
increase as a consequence of two main factors : (a) a
displacement of digoxin from tissue stores leading to a
reduced volume of distribution (about 30%). and (b) a
reduction in renal and non-renal elimination resulting in
a reduced total clearance of digoxin. The first effect is
responsible for the initial rise in serum digoxin seen in
most studies when quinidine treatment is commenced: and
the second. a fall in clearance, maintains the elevated
level for as long as the two drugs are administered (see
below). Skeletal muscles are quantitatively the most
important binding sites for digoxin. The reduction of the
volume of distribution is mainly due to a displacement of

digoxin from its skeletal muscle binding sites by
quinidine.
Elimination
A number of different drugs can affect each other's
elimination. Interactions leading to toxicity are to be
expected when the elimination of one drug is diminished by
the other. This will be illustrated by the interaction
between chloramphenicol and other agents, and between
digoxin and quinidine.
Chloramphenicol is still widely used in veterinary
medicine and it is well known for its ability to inhibit
mitochondrial protein synthesis. This inhibition results
in a reduced metabolism of several other drugs.
Pentobarbitone sleeping time in chloramphenicol-treated
dogs and cats is markedly prolonged due to reduced
oxidative metabolism of the barbiturate. This effect may
last for 2-3 weeks after the last dose of chloramphenicol.
Another well-known interaction involves chloramphenicol
and the antiepileptic drug phenytoin. Phenytoin
intoxication has been seen in both human and canine
patients receiving chloramphenicol. Intoxication can
occur even after a few days of topical treatment with
chloramphenicol in eye drops. Chloramphenicol inhibits
the metabolism of phenytoin and this results in higher
steady-state concentrations of phenytoin. A reduction of
phenytoin dosage should be considered if phenytoin and
chloramphenicol are given concurrently. The most prudent
recommendation. however, is that concurrent use of these
drugs be avoided. Moreover. phenytoin cannot be
recommended as a suitable anticonvulsant drug in the dog,
for several reasons. The bioavailability after oral
administration is highly variable in the dog (15-75%). It
has a short half-life in the dog (about 4 h). making
multiple dosing necessary. Phenytoin stimulates its own
degradat ion in the dog 6 • a process t hat occurs in humans
only at high dosages. It is also a drug that is
difficult to use without plasma concentration

determinations because of its zero-order kinetics. These
experimental data support the impression of many
clinicians that phenytoin is not the first choice drug for
anticonvulsant therapy in the dog 3 •
Quinidine. as alreadY mentioned. not only decreases the
volume of distribution of digoxin. but also inhibits the
elimination of digoxin. The latter is responsible for the
sustained elevation of the steady-state plasma
concentrations of digoxin when quinidine is added to the
treatment. Indeed. the steady-state concentrations of a
drug are dependent on the dose. the dosing interval. the
bioavailable fraction and the total body clearance.
Quinidine has no important influence on the
bioavailability of digoxin. Thus. the increased
steady-state concentrations are due to a reduction in
total body clearance. The increase in the steady-state
concentrations of digoxin by quinidine can lead to
digitalis toxicity as has been seen in humans and dogs.
For rational therapy with digoxin-quinidine. it is
necessary to understand the mechanisms underlYing the
adverse reactions. The pharmacokinetic data available.
however. are of limited help. A frequent observation is
that the rise in serum digoxin concentration as a result
of quinidine co-administration is unpredictable and that
the rise is largest in those subjects with the highest
concentrations of digoxin and. therefore. in those most at
risk. Regular monitoring of the clinical symptoms, ECG
and serum digoxin concentrations is regarded as mandatory.
Another possibility is not to use digoxin but digitoxin,
as no interaction is seen between quinidine and digitoxin
in the dog. The use of new antiarrhythmic drugs instead
of quinidine can also be considered. However, it should
be borne in mind that these drugs too (for example,
verapamil) can interact with digoxin.
CONCLUSIONS
There is a wide variety of mechanisms responsible for drug
interactions. A number of adverse drug interactions are

of practical importance to veterinary clinicians. Knowing
the principles which underlie the mechanisms of drug
interactions may help to minimize the incidence of adverse
effects. Neverless. these data are not always sufficient
for the clinician to adjust the dosage regimen in
individual cases.
References
1. Belpaire. F.M •• Braeckman. R.A. and Bogaert. M.G.
(1984). Binding of oxprenolol and propranolol to
serum. albumin and alphat-acid glycoprotein in man and
other species. Biochem. Pharmacol. 33:2065-2069.
2. Binnion. P.F. (1975). Hypokalaemia and digoxin-
induced arrhythmias. Lancet i:343.
3. Bunch. S.E. (1983). Anticonvulsant drug therapy in
companion animals. In: Kirk. R.W. (ed.). Current
veterinary therapy VIII. pp.746-754. Philadelphia:
W.B. Saunders Company.
4. D'ArcY. F.P. (1983). Clinically relevant interactions
with important classes of drugs. In: Noack. E ••
Ledwoch. W. and Schrey. A. (eds). Adverse Drug
Interactions. pp.271-285. Munchen Universitats-
druckerei und Verlag. Dr. C. Wolf und Sohn.
5. Davis. L.E. (1979). Important interactions of anti-
biotic drugs. J. Am. Vet. Med. Assoc. 175:729.
6. Frey. H.H. and Lasher. W. (1980). Clinical pharmaco-
kinetics of phenytoin in the dog a reevaluation.
Am. J. Vet. Res. 41:1635-1638.
7. Paul. J.W. (1982). Drug interactions. Mod. Vet.
Pract.63:780-785.
8. Pedersoli. W.M. and Nachreiner. R.F. (1980). Serum
diqoxin concentrations in dogs before and during
concomitant administration of furosemide. J. Vet.
Pharmacol. Ther. 3:1-7.
9. Reilly. P.E.B. and Isaacs. J.P. (1983). Adverse drug
interactions of importance in veterinary practice.
Vet. Rec. 112:29-33.
10. Ross. J.N.Jr. (1983). Heart failure. In: Ettinger,
S.J. (ed.). Textbook of Veterinary Internal Medicine.
Diseases of the Dog and Cat. 2nd ed., pp.901-932.
Philadelphia: W.B. Saunders Company.
11. Steiness. E. and Olesen. K.H. (1976). Cardiac
arrhythmias induced by hypokalaemia and potassium loss
during maintenance digoxin therapy. Br. Heart J.
38: 167-172.
12. Stowe. C.M. (1984). Antimicrobial drug interactions.
J. Am. Vet. Med. Assoc. 185:1137-1141.
13. Woodcock. B.G. and Rietbrock. N. (1982). Digitalis-
quinidine interactions. TIPS 3:118-122.
35
Clinical toxicology of an antibiotic ionophore
(monensin) in ponies and horses; diagnostic
markers and therapeutic considerations
J. F. AMEND, R. L. NICHELSON, L. R. FREELAND, R. S. KING,
F. M. MALLON AND W. W. STROUP
ABSTRACT
Toxicity of the ionophorous antibiotic monensin has been
documented in a number of species. with the horse showing
greatest sensitivity. This study examined haemodynamic.
rena 1. eryt hrocyt i c. and biochemical variables to
determine mechanisms of equine monensin toxicosis. and
potential therapy. Horse and pony mares were fitted with
catheters for blood and urine collection. then given
monensin orally. Other studies were carried out in
anaesthetized ponies. which received an intravenous dose
of monensin. Cardiovascular effects included pressor and
positive inotropic responses. myocardial lesions post-
mortem. and increased pericardial fluid CK and LDH. Renal
disturbances noted were rises in BUN and in clearance of
phosphorus and potassium. decline in urine pH. and
elevated urine N-acetylglucosaminidase. Erythrocytic
responses included a rise in unconjugated serum bilirubin.
increased red cell osmotic fragility, and altered blood
gas variables.
INTRODUCTION
Ionophorous antibiotics of the carboxylic class, of which
monensin is one example, are used in substantial
Quantities in the production of poultry and beef cattle.
381
Their efficacy as poultrY coccidiostats' and promoters of

feed efficiency in beef cattle 3 is well documented. First
approved for use in food animals. monensin has a longer
historY of application and evaluation than related
ionophores. It has. therefore. been more fully described
in terms of its actions. and in certain cases. of its
toxic manifestations· than other members of the group. As
described in reports documenting feed-mixing accidents
involving excessive dosage'. or exposure of inappropriate
species'. monensin. and potentially other carboxylic
ionophores. possess a capacity for toxicity when used
inappropriately. In particular. the horse shows little
tolerance to monensin l • The separate studies reported
here were performed to further define mechanisms of
monensin toxicity in the equine. to determine clinicopa-
thological variables of diagnostic significance. and to
search for therapeutic approaches helpful to clinicians
confronted with ionophorous antibiotic toxicosis in the
horse.

Ten adult horses and 30 adult ponies were experimental
subjects. Each was procured. housed. and handled
according to guidelines established by National Institutes
of Health (USA) and the American Physiological Society.
Horses (mares) were fitted with jugular venous catheters
(Medicut Cannula. Sherwood Medical. St. Louis. Missouri>
and Foley bladder catheters (Bardex. C.R. Bard. Murray
Hill. New Jersey). Each then received 3 mg/kg crystalline
monensin orally. in ethanol vehicle. and was monitored for
48 h. Euthanasia (T-61 Euthanasia solution. American
Hoechst. Somerville. New Jersey) was then performed. Pony
mares were similarly prepared and monitored for 36 h. then
euthanatized. Blood and urine samples were taken every 4
h. with control samples drawn immediately prior to
administration of monensin. A number of ponies and horses
were studied in identical sham protocols using ethanol
vehicle. Certain ponies and horses were prepared with
CLINICAL TOXICOLOGY OF AN ANTIBIOTIC IONOPHORE (MONENSIN) 383
arterial catheters for blood pressure measurement. and

sampling for blood gases. In a few cases. left
ventricular pressure (Mikro-tip catheter pressure
transducer. Millar Instruments Inc •• Houston. Texas) and
dP/dt max (Beckman R611. Beckman Instruments Inc ••
Schiller Park. Illinois) were measured. Venous blood was
examined for red cell osmotic fragility and blood gas
analyses (Model 713 Blood Gas Analyzer. Instrumentation
Laboratories. Lexington. Massachusetts) and serum was
collected for a range of biochemical variables (Sequential
Multiple Analysis Computer [SMAC 20], Technicon Inc ••
Tarrytown. New York). Arterial blood gases and acid-base
values were also measured. Urine samples were used to
determine volume and pH. and urine electrolytes were
measured to allow electrolyte clearance calculations.
Urine N-acetylglucosaminidase (NAG), a renal tubular
lysosomal enzyme, was measured as an index of renal
inj ury 7 .
A second group of ponies was used to study
cardiopulmonary effects of monensin when given by
intravenous infusion. These ponies were anesthetized with
a combination of xylazine (0.5 mg/kg: Rompun. Bayvet
Division, Miles Laboratories. Shawnee. Kansas). ketamine
hydrochloride (2.5 mg/kg: Ketaset. Bristol Laboratories.
Syracuse. New York). and glyceryl guaiacolate (50 mg/kg:
Gecolate, Summit Hill Laboratories, Avalon, New Jersey),
and were maintained in anaesthesia with halothane (USP,
American Hospital Supply Corp.. Scientific Products
Division, Evanston, Illinois), 2-4% as required, vaporized
in 100% O2 , Catheters were placed for venous sampling
(red blood count fragilities and blood gases), and for
intravenous administration of monensin. An arterial
catheter was inserted for blood gas and blood pressure
monitoring. In certain cases a catheter was passed into
the left ventricle for determination of left ventricular
pressure and dP/dt max. A ureter was catheterized for
collection of urine and measurement of volume, pH. and
NAG. A Wright's respirometer (Ohio Medical Products,
EFFECT OF ORAL MONENSIN ON

ERYTHROCYTE FRAGILITY IN PONIES
SOLID BAR = SHAM
Figure 35.1 Erythrocyte osmotic fragility in sham-treated

(solid bars) and monensin-treated (dotted open bars)
ponies. The concentration of saline at which these
measurements of haemolysis were made was 0.50%. Haemolytic
responses of cells from sham-treated ponies ranged from 40
to 58% haemolysis. while cells from monensin-treated
ponies showed progressive increase in haemolysis (peaking
at 85% at 20-24 h).
Atlanta. Georgia) was used to measure minute ventilation

prior to and following administration of monensin. Each
pony received an intravenous dose of 200 ug/kg crystalline
monensin. Sham procedures were performed in which ponies
were given intravenous ethanol vehicle alone. Necropsy,
histopathology, and pericardial fluid enzyme analyses were
performed postmortem.

Horses and ponies responded to oral monensin with
haemodynamic stimulation, including increases in heart
rate. systolic and diastolic arterial pressures, and dP/dt
max. An haemolytic effect of monensin was observed, as
300 EFFECT OF INTRAVENOUS MONENSIN

ON ARTERIAL P02
IN ANESTHETIZED POHIES
270
240
210
180
+. · · · . . ·. . . . ·1..·····..............+. . . . . . . . . . +
150 ·•·......···•···..+··· ......·········.
o 1e . 20 30 40 50
TIME (MINUTES)
Figure 35.2 Intravenous monensin (200 wg/kg) caused a re-

duction in arterial P02 of nearly 100 torr within 5 min;
the control value of 270 torr reflects the fact that halo-
thane anaesthetic was vaporized in 100% O2 , Although some
recovery of P02 occurred, the control level was never res-
tored. in spite of profound hyperventilation.
indicated by rising indirect bilirubin. and increased

plasma haemoglobin. Increases in erythrocyte osmotic
fragility also occurred following monensin (Figure 35.1).
In anaesthetized ponies. osmotic fragility of red cells
rose immediately after injection of monensin. and remained
elevated for the duration of the experiment.
Blood gas changes in anaesthetized ponies comprised
depression of P02, a rise in pC02 and fall in pH. Figure
35.2 illustrates the disturbance in P02 in these anaesthe-
tized animals. Minute ventilation was, paradoxically,
dramatically elevated. but this change in ventilation was
not effective in compensating for the disturbances in
blood gas variables.
Urine volume was transiently increased after monensin,
and this appeared to be related to a rise in arterial
40 EFFECT OF ORAL MONENSIN ON

P CLEARANCE RATIO IN PONIES
36
32
p
28
c 24 SOLID BAR = SHAM
I
20
16
12
8
:::::::::::::::::::::::::: m·
..··
S ~~~~~~ ~ ~ ~ ~ ~~~~~~ ~~~~~~~ El ~ ~~~~~~
a . ····~ . IiiifiiiI.... ·· ........................~..~...........+
4
a 4 8 12 16 20 24 28 32 36 40
TI ME ( HOURS)
Figu~e 35.3 Phospho~us c1ea~ance ~atio was p~ofound1y

elevated (dotted ba~s) by 16 h following 0~a1 monensin.
This ~esponse was maintained th~oughout the ~emainde~ of
the expe~imenta1 pe~iod. A low phospho~us c1ea~ance ~atio
(sham t~eatment: solid ba~s) is no~ma1 fo~ equine animals.
thus the magnitude of phospho~us c1ea~ance ~atio ~esponse
wa s sub s tan t i a 1 •
blood p~essu~e.which may have ~esu1ted in inc~eased ~ena1

fi1t~ation. Se~um potassium was simi1a~ly t~ansient1y
dep~essed. and the~e was a delayed fall in se~um phospho-
~us. C1ea~ance ~atios fo~ potassium and phospho~us we~e
significantly elevated. Of the two. phospho~us c1ea~ance

~atio was most p~ofound1y affected. as shown in Figu~e
35.3. U~ine pH changed f~om alkaline to acid as the
effects of monensin developed. Both conscious and
anaesthetized ponies and ho~ses ~esponded to monensin with
inc~eases in u~ine N-acety1g1ucosaminidase (NAG). The NAG
~esponse is i11ust~ated in Figu~e 35.4.
Postmo~tem g~oss and histopathology demonst~ated
myoca~dia1 lesions typical of those ~epo~ted by othe~s2.

1 EFFECT OF ORAL "ONENSIN

ON URINE NAG IN PONIES
£I
£I 4 8 12 16 28 24 28 32 36 40
TIME (HOURS)
Figure 35.4 Confirmation of proximal renal tubular injury

following monensin was demonstrated by the increase in
urine N-acetylglucosaminidase (dotted bars). Solid bars
show that urine NAG in sham-treated ponies rarely exceeded
1 unit/litre. while the maximum NAG response in monensin-
treated ponies was 8 units/litre at 24 h.
and pericardial fluid CK enzyme levels were grossly

increased (Figure 35.5). This increase resulted from the
MB. or myocardial isoenzyme. fraction. Similarly, peri-
cardial LDH was increased. with LDH\ the predominant
isoenzyme.
CONCLUSIONS
The severe myocardial lesions of equine monensin toxicosis
seem to arise from a combination of increased cardiac
work. electrolyte imbalance secondary to proximal renal
tubular malfunction. and compromise in oxygen transport
secondary to disturbed erythrocyte function. Diagnostic
variables of importance may include elevated indirect
bilirubin. depressed serum potassium and phosphorus (and
38 FFECT OF ORAL "OHEHSIH ON POST-

"ORTE" PERICARDIAL CPK IN HORSES
~ 2S
K
I 28
U
/
L IS
)(
10
§2.....
.......... :..: : : :
..........
o . . . ...!..:r...I.........,.." ...-+-....1.....,....1...-+-.. . .. . ,. . . . . . +
..........
..... H... .......... ..........
.......... ........
.........
.... .... ......... ......... ....... ..
o 12 24 36 48 60 72 84
TI ME ( HOURS)
Figure 35.5 Pericardial CPK. obtained from samples taken

immediately after euthanasia. was profoundly elevated in
horses in which the duration of exposure to monensin was
72 h or more. Smaller increases were observed in peri-
cardial fluid from horses which were euthanized with
briefer exposure periods.
increased clearance of these electrolytes). decreased

urine pH and elevated urine NAG. and at postmortem.
myocardial lesions together with increased pericardial
fluid CK-MB and LDH t concentrations. Therapeutic conside-
rations should include pharmacological means of reducing
cardiac work. fluid and electrolyte replacement with po-
tassium and phosphorus supplementation. and probably
supportive oxygen administration.
Acknowledgements
Supported in part by a grant from Eli Lilly and Co ••
Indianapolis. Indiana. the Agricultural Research Division.
University of Nebraska-Lincoln. Lincoln. Nebraska. US and
the Atlantic Veterinary College. University of Prince
Edward Island. Charlottetown. Canada.
References
1. Matsuoka, T. (1976). Evaluation of monensin toxicity
in the horse. J. Am. Vet. Med. Ass. 169:1098-1100.
2. Mollenhauer, N.N., Rowe, L.O. and Witzel, O.A. <1981>.
Ultrastructural observations in ponies after treatment
with monensin. Am. J. Vet. Res. 42:35-40.
3. Raun, A.P •• Cooley, C.O., Potter. EoL. et a], (1976).
Effect of monensin on feed efficiency of feedlot
cattle. J. Anim. Sci. 43:670-677.
4. Schlafer. M•• Romson. J.L. and Kane. P. (1980), Poten-
tial adverse actions of the ionophore monensin. Fed.
Proc. 39:694.
5. Schweitzer. 0 •• Kimberl ing. C•• Spraker. To et al.
(1984). Accidental monensin sodium intoxication of
feedlot cattle. J. Am. Vet. Med. Ass. 184:1273-1276.
6. Shumard. R.F. and Callender. M.E. (1968). Monensin. a
new biologically active compound. VI. Anticoccidial
Activity. Antimicrob. Agent Chemother.:369.
7. Tucker. S.M., Pierce. R.J. and Price. R.C. <1980>.
Characterization of human N-acetyl-B-O-glucosaminidase
as an indicator of tissue damage in disease. Helv.
Chim. Acta 102:29-40.
8. Whitlock. R.N •• White. N.A •• Rowland. G.N. and Plue. R.
(1979). Monensin toxicosis in horses: Clinical mani-
festations. Proc. 24th Ann. Mtg. A.A.E.P •• pp. 473-
486.
36
Mycotoxins and mycotoxicoses in Europe
J. LEIBETSEDER
ABSTRACT
Because of the moderate climate. fusariotoxins (zeara-
lenone. vomitoxin> and ochratoxin are the most frequently
occurring mycotoxins in Europe. Aflatoxins are detected
almost solely in feed imported from tropical or subtropi-
cal areas. Mycotoxins often cause clinical symptoms in
livestock and tremendous economic losses in animal pro-
duction. The main symptoms of mycotoxicoses are described.
The possibility of diagnosing and preventing intoxication
is considered.
INTRODUCTION
After the identification of toxins occurring in certain
plants and animals and the subsequent provisions for
avoiding intoxication by these substances. the environ-
mental toxins caused by advancing technology are of
greatest importance at present. In addition, it must not
be ignored that even today naturally occurring toxins
create not only major economic losses in the animal
production by disease or decreased performance but also
risks for human health. Since classification of the
etiology of "turkey X disease" 25 years ago the mycotoxins
became very important amongst naturally occurring toxic
substances. Intensive research during the last two
391
decades has shown that about 30-40% of all fungal species

occurring world wide are able to produce toxic secondary
metabolites called mycotoxins under certain conditions. At
present more than 100 toxins are chemically defined but
there exists a much greater number of toxins not yet
identified'. Mycotoxicosis is poisoning by the ingestion
of toxins of fungal origin. The wide variety of the
chemical structure of the toxins complicates their
Quantitative determination. Identical toxins can be
synthesized by different fungal species. and different
toxins can cause similar symptoms in man and animals. The
toxins affect the synthesis of cell membranes. DNA-
synthesis. transcription of the genetic code. and protein
synthesis. Some of them are also carcinogenic or muta-
genic. The mainly affected organs are: gastrointestinal
tract. urinary tract. nervous system. haematopoietic
system. genital tract. skin. and liver. In chronic
intoxication the symptoms are often not very clear. but a
deterioration of performance and reduced feed conversion
can be observed.
NATURAL OCCURRENCE IN EUROPE

Besides the rarely occurring mycotoxicoses like ergotism.
facial eczema in ruminants. slobber syndrome etc. only the
frequently seen mycotoxicoses are discussed: fusario-
toxicosis. ochratoxicosis and aflatoxicosis. Due to the
preconditions of toxin synthesis (type and moisture of the
substrate. temperature. microbiological ecosystem,
insects) fusariotoxins and ochratoxins figure large in all
European countries. whereas aflatoxins are synthesized
only under hot and humid conditions. Aflatoxicosis is
therefore a problem in the mediterranean area and in
countries using contaminated feed imported from tropical
or subtropical areas (Table 36.1).
FUSARIOTOXICOSIS
On the basis of the chemical structure as well as the
toxic effects. two groups of fusariotoxins exist which
MYCOTOXINS AND MYCOTOXICOSES IN EUROPE 393
Table 36.1 2752 feed samples of a survey analysed since

1979 at the Institute of Nutrition. University of
Veterinary Medicine. Vienna (A = number of samples. B. C.
o = percentage of samples containing < 0.1. 0.1-1.0 and>
1 ppm respectively)
Feeds Zearalenone Vomitoxin

A B C o A B c o
Maize 755 22.1 7.3 1.9 661 8.5 40.8 16.9

Barley 134 12.7 3.0 o 86 3.5 18.6 2.3
Oat 268 12.3 4.1 o 196 6.6 23.0 7.6
RYe 16 50.0 o o 12 8.3 25.0 o
Wheat 204 19.1 10.3 1.5 112 10.7 50.9 13.4
Corn silage 183 49.1 13.7 o 157 7.0 44.6 19.1
Mixed feed 214 15.9 5.6 0.9 252 10.7 35.7 12.3
Ot hers 70 17.1 2.9 1.4 64 9.4 9.4 o
Feeds Ochratoxin A Aflatoxins

A B C o A B C o
Maize 26 7.7 3.8 o 15 o o o

Barley 32 15.6 o o 4 o o o
Oat 37 32.4 5.4 o 9 o o o
RYe 10 10.0 o o 9 o o o
Wheat 35 5.7 o o 15 o o o
Corn silage 7 28.6 o o 4 o o o
Peanut meal 48 10.4 18.7 47.9
Mixed feed 23 13.0 o o 75 16.0 8.0 5.3
Others 6 0 o o 58 6.9 5.2 1.7
occur separately or together zearalenone and its

derivatives; and trichothecenes.
Zearalenone
Zearalenone causes an oestrogenic syndrome primarily
involving the genital system. This toxin can be produced
by various Fusarium species commonly infecting maize but

also other cereals. In all European countries
investigated for mycotoxins. zearalenone could be detected
in concentrations ranging from 0.04 to 175 ppm 2 • The
frequency of contaminations varies from 2 to about 50% of
the analysed samples due to the weather conditions in
different Years. The sensitivity of various animal
species differs: oestrogenic effects could be observed in
swine (1 ppm). cows (5 ppm) and other farm and expe-
rimental animals at different concentrations.
The gross changes include tumefaction of the vulva.
enlargement of the mammary glands. hypertrophy of the
nipples and increased size and weight of the uterus.
Microscopic changes include oedema and hyperplasia of the
uterus due to increased thickening of the myometrium.
ductular proliferation of the mammary gland. and squamous
metaplasia of the cervix and vagina. Prepubertal animals
show ovarian hypoplasia and lack Graafian follicular
development. while in adult females cystic degenerations
of ovarian follicles are observed. In male swine reports
indicate atrophic changes in the gross appearance of the
testicles together with oedematous swelling of the prepuce
as well as stimulation of mammary gland development. The
semen quality seems to be affected as well. The
consequence of these changes is a reduced or absent
ferti 1 i tv.
Trichothecenes
Trichothecenes are sesquiterpenoids. Usually they are
divided into four groups (A-D). The main toxins of these
groups are :
group A : T-2 toxin. HT-2 toxin. neosolaniol. diacetoxy-

scirpenol. monoacetoxyscirpenol. T-2 tetraol. scirpen-
triol
group B : nivalenol. fusarenon-X. trichothecin. deoxy-
nivalenol (vomitoxin)
group C : verrucarin A. roridin A
MYCOTOXINSAND MYCOTOXICOSES IN EUROPE 395
group 0 crotocin
At present more than 40 different trichothecenes are

chemically defined. Under natural conditions only T-2.
diacetoxYscirpenol (OAS), nivalenol. T-2 tetraol, neo-
solaniol and deoxynivalenol (vomitoxin) could be
detected in feedstuffs. Trichothecenes are associated
with human and animal intoxications throughout the world
("staggering grains toxicosis". alimentary toxic aleukia.
stachYbotryotoxicosis. "red mould disease". "mouldY corn
toxicosis"). The toxicological characteristics of tricho-
thecenes are lesions in the oral cavity and the
digestive tract characterized by intense inflammation.
haemorrhage and necrosis of the mucous membranes as well
as of the skin. vomiting and feed refusal. diarrhoea.
neural disturbances and abnormal positioning, degeneration
and haemorrhage in many tissues and organs. destruction of
the haematopoietic system with a marked reduction in
erythrocyte counts and a severe depression of leukocyte
and thrombocyte counts leading to a progressive
leukopenia. and immunosuppressive effects. Some of them
(nivalenol and fusarenon-x) are mutagenic. Trichothecenes
can be sYnthesized by the same species of Fusarium
producing zearalenone. Additionally. some others are able
to form trichothecenes. The most frequently contaminated
grain is maize. again in countries where maize is grown.
but all other cereals can be contaminated too. At first
T-2 and DAS were found more frequently but since methods
for determining vomitoxin have become available this toxin
seems to be the most frequently occurring of the
trichothecenes. Acute intoxications by trichothecenes
take place only rarely today but chronic intoxications of
farm animals are numerous and cause tremendous economic
losses in pig and broiler production. Toxicological
studies and field experiences indicate that animals can
take feed containing 0.1 ppm vomitoxin without distinct
risks for health and performance'.
OCHRATOXICOSIS
Ochratoxicosis produced by Penicillium and Aspergillus
spp. became an important mycotoxin because of the
nephrotoxic effects in man and animals. The renal
disorder is structurally characterized by tubular
degeneration accompanied by interstitial fibrosis. whereas
the predominant functional change is impairment of tubular
activity. In kidneys showing pronounced changes the
weight can be increased by 25%. The proximal tubules are
frequently atrophic and the tubular basement membrane is
thickened. Many glomeruli are totally hyalinized and
Cysts are noted in the cortex. Clinical symptoms are
polydipsia and polyuria but also gastroenteritis and
growth retardation. Under natural conditions ochra-
toxicosis is a chronic disease with a very low mortality.
However; an acute syndrome including renal damage
identical to mycotoxic nephropathy has been observed.
mainly in newly weaned pigs. called "perirenal oedema".
In addition to the symptoms already mentioned,
subcutaneous oedema, ataxia, stiff arched back. and
distention of the paralumbar abdominal wall were observed.
The mortality is 40-90% within 1-2 days. Ochratoxin
poisoning is not only recognized in pigs but also in
poultrY. As well as the renal lesions and the changes in
the gastrointestinal tract the liver is severely affected
in poultry. Pathological changes are fatty liver. focal
haemorrhages. necrosis and marked vacuolation of
hepatocytes. The concentration of ochratoxin residues is
much higher in the liver of chicks than in the muscular
tissue and corresponds well with the concentration of the
kidney and the blood concentration. Especially in the
Scandinavian countries. Poland, Yugoslavia and Austria
ochratoxin was detected in foodstuffs and feedstuffs at
concentrations which are able to affect human and animal
health4. Residues in kidneys of pigs might cause a risk
for consumers. so that the determination of ochratoxin in
kidneys is indicated when kidneys show pathological
changes. The tolerance level in the feed is 0.1 ppm.
MYCOTOXINS AND MYCOTOXICOSES IN EUROPE 397
AFLATOXICOSIS
At present knowledge concerning aflatoxin is the greatest
amongst mycotoxins. The great importance of aflatoxin is
Justified by its carcinogenicity. 1We symptoms of
aflatoxicosis range from none to acute or chronic disease
with diagnostic characteristics which vary with the
species. the amount of toxin consumed. and the length of
time over which it was ingested. In acute poisoning a
sudden loss of appetite. nervous symptoms. and a high and
rapid mortality occur. Pathological changes are gastro-
enteritis. haemorrhages in many tissues and organs and
severe lesions in a number of par~nchymal organs
especially in the liver and kidneys and proliferation of
the bile duct.
Liver tumours are probablY induced by chronic aflatoxin
intake. In general. aflatoxin contamination of home-grown
products occurs only in the southern part of Europe.
whereas in middle and northern Europe aflatoxin problems
originate from imported feedstuffs especially from peanut
products. Some European countries have alreadY regulated
the maximum allowance of aflatoxin by law which is in
general 0.05 ppm in single feedstuffs and 0.02 ppm in
concentrates for dairy cows. Dairy cOws are the most
critical species because toxin metabolites are excreted
with the milk and cause a risk for human health.
DIAGNOSIS. TREATMENT AND PREVENTION

Diagnosis of chronic mycotoxicoses is difficult because of
non-specific symptoms. The microbiological status of the
feed is not closely correlated with the mycotoxin
content • Mycotoxicoses can be definitely diagnosed by
J
mycotoxin determination in the feed. Only symptomatic

treatments (increase of protein and vitamins in rations)
are available. Methods for detoxification of feed
applicable in practice are very few and only effective
against aflatoxin. The most effective measures against
mycotoxicosis are the reduction of fungal growth in the
field (growing crop varieties suitable for climate
conditions. crop rotation). careful harvesting. quick and

adequate preservation after harvesting (drying. ensiling).
correct storing. periodic cleaning and disinfection of
feed containers and feeding equipment l •
References
1. Leibetseder. J. (1982). Kenntnisse und Empfehlungen
zur Mvkotoxin-Problematik. In: Akt. Them. Tierernahr.
Veredelungswirtschaft. Zusammenfassung der Vortrage
der wissenschaftlichen Tagung der Lohmann Tierernahrung
GmbH. In Cuxhaven vom 21. und 22. Oktober 1981.
pp. 73-81.
2. MOller. H.-M. (1978). Zearalenon - ein ostrogen wirk-
sames Mvkotoxin. Obers. Tierernahr. 6:265-300.
3. Neuhold. F. (1982). Untersuchungen Ober den Zusammen-
hang zwischen mikrobiologischem Status und
Mvkotoxingehalt von Futtermitteln. Diss. Vet. med.
Univ. Vienna.
4. Schuh. M. and Schweighardt. H. (1981). Ochratoxin A -
ein nephrotoxisch wirkendes Mvkotoxin. Obers. Tier-
ernahr. 9:33-70.
5. Schweighardt. H. and Schuh. M. (1981). Desoxvnivalenol
- ein bedeutendes Trichothecen. Obers. Tierernahr.
9:11-32.
6. Wyllie. T.D. and Morehouse. L.G. (eds). (1977. vol.
I>. (1978. vol. II. III> Mycotoxic fungi. Mycotoxins.
Mvcotoxicoses. New York: Marcel Dekker. Inc.
Pathophysiological
Models in Pharmacology
Miscellaneous
37
Role of animal disease models in evaluating the
efficacy of antimicrobial agents
T. E. POWERS, K. J. VARMA AND J. D. POWERS
ABSTRACT
The advantages of the use of animal infectious disease
models in determining the efficacy of antimicrobial agents
are discussed. They are of particular interest in
veterinary medicine as the antibiotic can be studied in
the same species. where it will be used clinically. A
good infectious disease model should fulfill several
criteria. In our laboratory. we developed Streptococcus
zooepidemicus disease models in beagle dogs and horses.
The results are shortly discussed.
INTRODUCTION
Animal disease models of target animal species are useful
in determining the in vivo pharmacological efficacy and
dosage regimens of antimicrobial agents. These animal
models offer several advantages: (a) preinfection data
can be collected: (b) all animals can be maintained under
similar conditions: (c) one can conduct disposition
studies of drugs in act uc\ 1 disease conditions. thereby
eliminating the need for extrapolation: (d) use of
controls is expedited: (e) they are of particular use in
veterinary medicine since we can use the same species in
which the drug will be used clinically; (f) they serve as
a well-controlled method for dosage titration studies.
401
enabling us to better bridge the gap between in vitro and

clinical studies.
OBJECTIVES OF RESEARCH
Our research in the area of animal disease models over the
last 12 vears has had as its objectives: (a) the deve-
lopment and characterization of several specific infec-
tious animal disease models in dogs and horses: (b) to
studv the efficacv of several antibiotics in the treatment
of the experimental 1 v induced diseases: (c) to studv the
pharmacokinetics of antibiotics in the healthv and disea-
sed states: (d) to correlate if possible the pharmacokine-
tic parameters with the efficacv of the drugs.
Animal disease models mav be classified as
(1) Those that mimic natural disease

a) in local infections:
b) in systemic infections.
(2) Those that show a similar disease state in different
species of animal.
(3) Those that are a challenge to death.
In this chapter tvpe (1) models of svstemic and local

infection are discussed.
The desirable properties of a good disease model to
prove efficacv of antimicrobial agents are that: (1) it
is caused preferablv bv a single pathogen: (2) it should
produce clinicallv observable signs of disease in an acute
and chronic phase: (3) it should run a course of several
davs (10-20): (4) it should be readilv susceptible to
therapv bv the commonlv available antibiotics: (5) it
should be consistentlv reproducible.
LABORATORY MODELS
In our laboratorv we have developed Gram-positive
(Streptococcus zooepidemicus) disease models in beagle
dogs and horses 3 , 4 . 7 . 8 .
ROLE OF ANIMAL DISEASE MODELS IN EVALUATING ANTIMICROBIAL AGENTS 403
Dogs
In a systemic Strep. zooepidemicus model. 6-8 month old
beagle dogs were challenged with the microorganisms by the
intravenous route. Various clinical parameters were moni-
tored during the course of disease in order to characte-
rize it well. These clinical parameters included daily
blood culture tests. haematological examinations. body
temperature and general condition.
The disease signs were scored subjectively by three
clinicians dailyl. This subjective scoring of degree of
illness (health index on a scale of 0-40) was broken down
as follows:
Lameness 0-15
Size of lYmph nodes 0-08
Colour of mucous membranes 0-05
Degree of alertness 0-04
Condition of haircoat 0-04
Degree of dehydration 0-04
To determine the influence of blood level upon the

efficacy. three graded steady-state levels of the antibio-
tics were usually employed which corresponded to two to
four times the minimum inhibitory concentration (MIC).
equal to the MIC. and half to a Quarter of the MIC. For
intermittent level studies we attempted to have the peak
blood levels well exceeding the MIC. equal to the MIC.
and below the MIC.
In another experiment. intermittent intravenous dosing
with potassium penicillin G was studied. Doses that were
studied were 10.000 IU/0.45 kg. 1000 IU/0.45 kg. or 100
IU/0.45 kg. All doses were effective. The very low dose
of 100 IU/0.45 kg was also effective even though blood
levels with the latter doses remained above the MIC for
only 20 min.
Our conclusions from these studies were that:
(1) Streptococcus zooepidemicus is a well-characterized

and consistently reproducible viable model for drug
efficacy studies.
(2) Repeat kinetic studies were not different from
single injection kinetic studies.
(3) The disease process did not change the kinetics of
the drugs studied.
(4) Most antibiotics required blood levels that were
equal to or four times the in vitro MIC.
(5) Gentamicin was not effective in vivo even at four
times the in vitro MIC.
(6) Intermittent therapy with trough levels below the
MIC were effective with penicillin G.
(7) Initiation of therapy as earlY as 12 h before expe-
rimental infection gave no additional benefits.
In a local infection model. sterilized tissue cages.

with perforated holes. were implanted subcutaneously in
beagle dogs'. Fibrous tissue grows around the cage and
through the perforated holes to the inside of the cage so
that the entire wall of the cavity becomes lined with
connective tissue. The fluid inside the cavity does not
come in contact with the cage itself but instead is in a
true tissue space lined on all sides by tissues that are
supplied with a vascular system. After 3 weeks the tissue
fluid which can be withdrawn from these tissue cages is
similar in composition to interstitial fluid. These tis-
sue cages were then infected with Strep. zooepidemicus and
the number of viable pathogens. degree of inflammation.
fever and number of viable leukocytes in tissue cage fluid
were recorded during the course of the disease'.
A constant intravenous infusion of potassium penicillin
G was injected so as to maintain blood levels of once the
MIC and a half the MIC of Strep. zooepidemicus. This
resulted in decreases in the number of pathogens in the
tissue cage fluid after 72 h as compared to the control
animals. In the untreated control only 3.3% of leukocytes
were viable at the end of 44 h. whereas in case of once
ROLE OF ANIMAL DISEASE MODELS IN EVALUATING ANTIMICROBIAL AGENTS 405
the MIC and a half the MIC groups. 96.5 and 47.5% of
leukocytes were viable after 44 h.
Horses
A reproducible experimental disease model in horses using
Strep. zooepidemicus was also developed 4 , 7 , The disease
was characterized by depression. pyrexia. anorexia. abnor-
mal lung sounds. inflammation of joints. moderate to
severe lameness. gradual loss of condition and emaciation.
The disease state had no effect on serum glucose, sodium.
potassium. chloride. urea nitrogen. creatinine. uric acid.
calcium. phosphorus and the enzymes serum glutamic-pyruvic
transaminase (SGPT) and serum glutamic-oxaloacetic trans-
aminase (SGOT). However. alkaline phosphatase showed a
gradual decline. The serum iron levels dropped markedly
and remained low to the last day of observation (post-
infection day 13). The elevation of rectal temperatures
and white blood cell counts related well with clinical
observations. The serum iron levels proved very valuable
in predicting the severity of clinical signs and often
dropped before the onset of clinical signs and pyrexia.
In another disease model in horses. virulent Strep.
equi were inoculated nasopharyngeally2. Animals with
evidence of previous exposure to Strep. equi (positive
dermal response), with one exception, developed minimal or
no sign of disease after inoculation. In contrast Strep.
equi skin test negative horses developed predictable and
severe clinical signs of infection after their inocula-
tion. including shedding of organisms from nasal dischar-
ges and ruptured mandibular lYmph nodes. Results of this
studY indicated that resistance to virulent Strep. equi
infection is correlated with existing immune responses to
streptococcal antigens. In susceptible horses. recovery
from infection was accompanied by the acquisition of a
positive skin test response to Strep. equi antigen.
CONCLUSIONS
Our conclusion is that when well-characterized and
standardized infectious disease models are available. they

should be used as one of the required well-controlled
studies for determining both the pharmacokinetics and the
efficacy of new developing antimicrobial agents.
Acknowledgements
This research was suPPorted in part by FDA contracts
number 223-74-7194 and 223-79-7054.
References
1. Garg. R•• Powers. l. and Powers. J. (1978). Role of
tissue cage models for studYing the disposition of
drugs in tissue. Abstract. Proc. Conf. of Res.
Workers in Anim. Disease. November 1978.
2. Nara. P.L •• Krakowka. S •• Powers. T.E. and Garg. R.C.
(1983). Experimental Streptococcus equi infection in
the horse correlation with in vivo and in vitro
immune responses. Am. J. Vet. Res. 44:529-534.
3. Powers. l.E •• Powers. J.D •• Garg. R.C •• Scialli, V.l.
and HaJJans. G.H. (1980). Trimethoprim and sulfadia-
zine : experimental infection in beagles. Am. J. Vet.
Res. 41:1117-1122.
4. Powers. l.E •• Garg. R.C •• Gabel. A.A. and Kohn. C.W.
(1981). Experimental Streptococcus zooepidemicus
infection model in horses. Proc. Am. Col], Vet.
Intern. Med •• 21.
5. Powers. l.E •• Varma. K.J. and Powers. J.D. (1984).
Selecting therapeutic concentrations: minimum inhibi-
torY concentrations vs. sub- or supra-minimum inhibi-
torY concentrations. J. Am. Vet. Med. Assoc. 185:
1062-1067.
6. Powers. J.D •• Powers. T.E •• Varma. K.J •• Gabel. A.A.
and Spurlock. S.L. (1984). A health index to clini-
cally evaluate a Strep. disease model in the horse.
J. Vet. Pharm. Ther. 7:213-217.
7. Varma. K.J •• Spurlock, S.L. and Powers. T.E . (1984).
Standardization of an experimental disease model of
Streptococcus zooepidemicus in equines. J. Vet.
Pharm. Ther. 7:183-188.
8. Varma. K.J •• Powers. l.E .. Garg. R.C. and Spurlock.
S.L. (1982). Experimental infectious models in
horses. Pharm. Toxicol. Vet. INRA. Publ. Paris. Les
Colloques de l'INRA 8:485-486.
38
Effects of disease states on drug binding
to serum proteins
A. L. ARONSON, S. A. BAI, J. E. RIVIERE AND D. P. AUCOIN
ABSTRACT
The effect of disease on the serum protein binding of
phenytoin and propranolol. model drugs for weak acids and
bases. respectively. was studied in dogs. Our preliminary
investigations showed that. as in humans. the binding of
organic bases is increased in diseases associated with
stress and inflammation. The implication of this finding
is that larger doses of basic drugs. such as propranolol.
quinidine. lidocaine. chlorpromazine and procainamide. may
be required if the patient has a concurrent disease
associated with inflammation.
INTRODUCTION
Drug dosage is usually selected on the basis of the weight
or surface area of a patient. Many factors can influence
the pharmacological/therapeutic response expected from an
intended dosage; some of these factors are illustrated in
Figure 38.1. Patient compliance problems. whether
intentional or non-intentional. and errors in dose affect
the dose that is actually administered to the patient.
Once a dose is given one can encounter bioavailability
problems related to the drug formulation or to
gastrointestinal factors. including content and motility.
if the drug is dosed orally. Individual patient
407
Intended dosage
I
compliance
errors in dose
Administered dosage
bioavailability
distribution
rate of biotransformation
and excretion
Plasma concentration
I
protein binding
displacement by another drug
or endogenous substances
Plasma water concentration
t
Concentration at receptor sites
!
Pharmacological/Therapeutic effect
Figure 40.1 Some factors influencing dose-effect

relationships.
variations in cardiac output. rate of drug

biotransformation. hepatic and renal function. whether due
to age. genetic variation. concurrent administration of
other drugs. or to the presence of disease. can have a
marked effect on the plasma or serum concentration and
pharmacological/therapeutic response produced by a given
dose.
Experience has shown that the pharmacological/therapeu-
tic response correlates much more closely with serum or
plasma concentrations of drug than with the dose of the
drug. Thus monitoring plasma concentrations has been
advocated especially for drugs with a narrow therapeutic
range and narrow margin of safety7. These include
antibiotics <such as aminoglycosides). anticonvulsants
<such as phenobarbitone. phenytoin. primidone).
bronchodilators <such as theophylline) and cardiac drugs
<such as digoxin. digitoxin. lidocaine. procainamide.
EFFECTS OF DISEASE STATES ON DRUG BINDING 409
propranolol and quinidine).

However. serum concentrations are not perfect indices
of the pharmacological/therapeutic response. It is
well-documented in humans that disease states can
significant I y influence the binding of drugs to serum
proteins 3 • 4 • b • 8 • • • In contrast. there is little
information concerning the effects of disease states on
the binding of drugs to serum proteins in animals. It is
critical to know the degree to which a drug is bound to
serum proteins and to what extent this may be altered by
disease. Information of this kind is essential for
therapeutic drug monitoring (TOM) and pharmacokinetic
consultation. The total (bound + free) concentration of a
drug may provide misleading information. because the
intensity of a drug's action is related to its
concentration in plasma water (also referred to as free or
unbound drug). Thus. any change in the extent of binding
of a drug, especially if it is highly bound to serum
proteins. may have marked effects on the intensity of a
drug's action. In addition, the extent to which a drug is
bound to serum proteins will influence its pharmacokine-
tics by altering its clearance and/or apparent volume of
distribution.
In serum. albumin and alpha-l-acid glycoprotein are the
two major proteins involved in binding the majority of
drugs. In general, albumin is involved in binding drugs
that are weak acids while alpha-l-acid glycoprotein is
involved in binding many drugs that are weak bases. The
concentration of albumin in healthy subjects is high
relative to the therapeutic concentration of most drugs,
thus binding sites generally are not saturated. However.
in hepatic or renal dysfunction. hypoalbuminaemia may
occur and contribute appreciably to a decrease in the
bound fraction of many acidic drugs!. Alpha-l-acid
glycoprotein is known as an acute-phase reactant. The
concentration of this protein (normally about 25 to 50
times less than albumin in serum) has been shown to
increase 2- to 3-fold in humans with acute stresses such
as surgery, trauma, cancer, myocardial infarct and

inflammation 4 • It also has been shown that chronic
administration of phenobarbitone leads to significant
increases of base-binding proteins in the serum of dogs l •
Thus it may be expected that the binding of basic drugs
will increase in conditions associated with increases in
this binding protein.
The purpose of this study was to evaluate the effects
that defined disease states have on the binding of two
model drugs phenytoin as a model for weak acids, and
propranolol as model for weak bases. These drugs have,
respectively, been shown to bind predominantly to albumin
and alpha-l-acid glycoprotein.
Materials and methods

Serum from dogs with defined disease states was divided
into two ml aliquots. Binding to serum proteins in
vitro was determined by equilibrium dialysis l • 2 •
Unlabelled propranolol (Ayerst Laboratories. New York) and
3H-propranolol (Amersham Corporation, Arlington Heights,
Illinois) were added to one aliquot to obtain a final
concentration of 50 ng/ml. Unlabelled phenytoin (Sigma,
St Louis, Missouri) and 14C-phenytoin (Amersham Corpo-
ration, Arlington Heights) were added to the other aliquot
to obtain a final concentration of 10 ~g/ml. Each aliquot
was dialysed against 1 ml phosphate buffer (pH, 7.4; ionic
strenght, 0.111). Dialysis was carried out in Lucite
dialysis chambers (Fisher Scientific Company, Springfield,
New Jersey) that were gently rocked for 18 hours at 37°C.
The percentage of serum-bound drug was calculated from
the amount of radioactivity (DPM) in 50 ~l aliquots of
serum (s) and dialysate (d) :
DPM. - DPM d
% bound = ----------- x 100
DPM.

In this chapter we present preliminary findings. and in
future investigations we intend to study the effect of
disease states on drug binding to serum proteins in
several species. Our studies to date on canine patients
suffering from renal dysfunction and inflammatory diseases
are presented.
Renal dYsfunction patients

One of the most thoroughly studied conditions causing
altered drug binding in humans is that due to renal
diseases·. The binding of virtually all acidic drugs (for
example. phenytoin. salicylates. benzylpenicillin.
dicloxacillin. phenobarbitone. thiopentone. phenyl-
butazone) that are primarily bound to albumin is decreased
in chronic renal disease. often by a factor of two or
three. Factors responsible include loss of protein
through the kidneys resulting in hypoalbuminaemia and the
presence of endogenous inhibitors such as fatty acids in
uraemic plasma. In contrast. out of six basic drugs
studied. only triamterene had decreased protein binding
from patients with poor renal function.
We investigated the binding of propranolol and
phenytoin in vitro to proteins in serum obtained from dogs
with chronic renal disease (CRD) and in dogs partially
(75-80%) nephrectomized experimentally (Table 38.1).
There was little effect on the unbound fraction of either
drug. This may have been expected for propranolol. but
not for phenytoin. The finding may be due to the fact
that all of the dogs had serum albumin concentrations
within the normal range except for one of the chronic
renal disease patients with a value of 1.2 g/dl. Serum
creatinine concentrations were normal in the partially
nephrectomized patients. but ranged up to 10 mg/dl in the
chronic renal disease patients.
Inflammatory disease patients

The binding of basic drugs appears to increase in several
Table 38.1 Effect of chronic renal disease (CRO) and

experimental partial nephrectomy (PN) in dogs on the
binding of propranolol and phenytoin to serum proteins
Percentage of unbound*
Propranolol Phenytoin
Control (n = 12) 21.1 (3.4) 35.4 (3.3)

CRO (n = 4) 17.6 (3.2) 33.3 (4.0)
PN (n = 6) 17.1 (1.6) 38.6 (4.6)
* mean (SO)
disease states associated with inflammation and stress.

for example. myocardial infarction. postsurgical.
ulcerative colitis and Crohn's disease. burns and
t r a uma' . 6 • Ins u c h dis e as est ate sit has bee n f 0 u n d t hat
the concentration of alpha-i-acid glycoprotein is
increased. The binding of basic drugs to this protein is
expected to increase in these conditions. Indeed, this
has been observed for propranolol and quinidine in human
patients with Crohn's disease and rheumatoid arthritis.
The binding correlated with the plasma concentration of
alpha-l-acid-glycoprotein.
We have investigated propranolol and phenytoin binding
in vitro in several canine patients suffering from
inflammatory diseases including meningitis. pleuritis,
pancreatitis and fever of indeterminate origin (Table
38.2). The binding of phenytoin increased slightly in
these patients. but the effect was not significant.
However. the binding of propranolol was significantly
increased in these patients (6.7% unbound) as compared to
control dogs (21.1% unbound). Serum alpha-i-acid
glycoprotein concentrations were not measured. but the
data suggest that. as in humans. the concentration of this
protein was probably increased in patients with
inflammatory disease.
We believe these data strongly suggest that it will be
Table 38.2 Effect of inflammatory disease in dogs on the

binding of propranolol and phenytoin to serum proteins
Percentage of unbound*
Propranolol Phenytoin
Control (n = 12) 21.1 (3.4) 35.4 (3.3)

Inflammatory 6.7 (2.1)** 27.8 (8.9)
disease (n = 6)
* mean (SO)
** p < 0.01
necessary to increase the dose of basic drugs that bind to

a1pha-l-acid glYcoprotein (for example. propranolol.
quinidine. lidocaine. chlorpromazine) in order to achieve
the desired therapeutic effect if the patient also is
suffering concurrently from stress or an inflammatory
condition.
A case of rapidly progressing acute renal failure
illustrates a problem in studying the effects of disease
Table 38.3 Effect of time-course of acute renal failure

in a dog on the binding of propranolol and phenytoin to
serum proteins
Date 12 February 28 February March

1985 1985 1985
Albumin. g/d1 2.5 2.0 1.9

Total protein. g/d1 6.1 4.9 4.5
BUN. mg/d1 60 128 101
Creatinine. mg/dl 4.4 8.9 7.3
Percentage of free 5 32 33
propranolol
Percentage of free 31 43 56
phenytoin
on the binding of drugs to serum proteins (Table 38.3).

Serum albumin and total protein concentrations fell while
BUN and creatinine concentrations rose rapidly over a
period of 2 weeks. The marked increase in the free
fraction of both propranolol and phenytoin may be due to
reduced synthesis or to the loss of their binding proteins
via the kidneys. Obviously. any drug kinetic study
performed at any given time with such rapidly changing
functional parameters would apply only to that time. Daily
therapeutic drug monitoring with determination of unbound
drug may be required to optimize therapy.
References
1. Bai. S.A. and Abramson. F.P. (1982). Interactions of
phenobarbital with propranolol in the dog. 1. Plasma
protein binding. J. Pharmaco1. Exp. Ther. 222:589-594.
2. Ehrnebro. M•• Augre11. S. and Boreus. L.O. (1971>. Age
differences in drug binding by plasma proteins.
Studies on human foetuses, neonates and adults. Eur.
J. C1in. Pharmacol. 3:189-193.
3. Jusko. W.J. (1976). Pharmacokinetics in disease states
changing protein binding. In: Benet. L.E. (ed.). The
Effect of Disease States on Drug Pharmacokinetics,
pp.99-124. Washington, DC American Pharmaceutical
Association.
4. Piafsky. K.M. (1978). Increased plasma protein binding
of propranolol and chlorpromazine mediated by
disease-induced elevations of plasma acid glycoprotein.
New Engl. J. Med. 299:1435-1439.
5. Piafskv, K.M. (1980). Disease-induced changes in the
plasma binding of basic drugs. C1in. Pharmacokinet.
5:246-262.
6. Piafskv, K.M. (1983). Disease-induced changes in the
plasma binding of basic drugs. In: Giba1di. M. and
Prescott, L. (eds). Handbook of Clinical Pharmaco-
kinetics. Section III. pp.70-88. New York ADIS
Health Science Press.
7. Pribor. H.C •• Morrell, G. and Scherr. G.H. (1980>.
Drug Monitoring and Pharmacokinetic Data. p.18. Park
Forest South. Illinois: Pathotox Publishing Inc.
8. Reidenberg. M.M. and Drayer, D.E. (1984). Alteration
of drug-protein binding in renal disease. C1in.
Pharmacokinet. 9 (Supp1. 1):18-26.
9. Ti11ement. J.P., Lhoste. F. and Giudice11i. J.F.
(1983). Diseases and drug protein binding. In:
Giba1di. M. and Prescott, L. (eds). Handbook of
Clinical Pharmacokinetics, Section III. pp.57-69. New
York: ADIS Health Science Press.
39
Tickborne fever: efficacy and effects on
pharmacokinetics of some chemotherapeutic
agents in the goat
S. M. ANIKA, J. F. M. NOUWS, T. B. VREE. C. T. M. VANDUIN.
J. NIEUWENUIJS AND A.S.J.P.A.M. VAN MIERT
ABSTRACT
The tickborne fever model developed in dwarf goats and
used in this study has an acute character : fever.
dullness. anorexia. tachycardia. a moderate inhibition of
rumen contractions. leucopenia and a decreased serum
alkaline phosphatase activity. The model can be of great
value in testing the therapeutic efficacy and pharmaco-
kinetics of chemotherapeutic agents in rickettsial infec-
tions. The dwarf goats receiving oxytetracycline. chlor-
amphenicol or trimethoprim (plus sulphonamides) showed
improvement. whereas ampicillin and spiramycin were
ineffective. Furthermore. marked changes in drug metabo-
lism were observed in tickborne fever-infected goats
treated with chloramphenicol or sulphadimidine; the
elimination half-life values of these drugs and of
oxytetracycline were significantly prolonged. The
pharmacokinetics of ampicillin. spiramycin and sulpha-
methylphenazole did not show marked differences between
healthy and tickborne fever-infected animals.
INTRODUCTION
Tetracyclines are dramatically effective in rickettsial
infect ions l • 3 . incl uding t ickborne fever <TBF) in rumi-
nants l • • These drugs are usually merely rickettsiostatic.
415
whereas less information is available about the

effect i veness of other chemotherapeutic agents. Tickborne
fever is caused by Ehrlichia phagocytophila. which invades
neutrophils and to a lesser degree - monocytes 20 .
Characteristic tickborne fever inclusion bodies can be
found in the peripheral neutrophils during febrile
episodes. In dwarf goats. tickborne fever is characteri-
zed by high fever. dullness. anorexia. tachycardia. a
moderate inhibition of rumen motility. leucopenia. decrea-
sed serum alkaline phosphatase activity (ALP) and a marked
decline in plasma zinc and iron concentrations t6 • The
clinical effects may cause therapeutic problems if fever
alters the absorption. distribution. biotransformation
and/or excretion of drugs being administered to treat this
disease 7 ,t2,t3. In the present study. experimentally
infected dwarf goats were treated with chloramphenicol.
ampicillin. spiramycin. trimethoprim plus sulphadimidine
and sulphamethylphenazole (TSS) and oxytetracycline in
groups of four or five animals each. to studY the pharma-
cokinetics of these drugs and to evaluate the effective-
ness of the doses administered using ALP. white blood cell
count (WBC). parasitaemia and bodY temperature as parame-
ters.
MATERlAL AND METHODS

Animals
Twenty-five healthy dwarf goats. female and castrated
males. were used (mean bodY weight ± SE 37 ± 1.7 kg).
All goats were kept indoors and fed a diet of hay and
pelleted concentrate: water was provided ad libitum.
Drugs
The drugs used were: sodium ampici 11 in (Penbri t in R • 20
mg.kg- t ). chloramphenicol (Amicol R Forte. 50 mg.kg- t ).
spiramycin (Suanovi lR. 20 mg.kg- t ). oxytetracycl ine (Enge-
mycine A • 10 mg.kq-t) and sulphamethylphenazole (Vesulong R •
50 mg.kg- t ) plus sulphadimidine (50 mg.kg- t ) and trime-
thoprim (20 mg.kg- t ) . All drugs were given by injection
TICKBORNE FEVER: EFFICACY OF SOME CHEMOTHERAPEUTIC AGENTS 417
into the jugular vein. Moreover, spiramycin was also stu-

died after intramuscular injection into the thigh.
Experimental procedures
The animals were trained to stand quietly during act ua 1
recording sessions by repeatedly placing them in the
experimental cage for several hours at a time. There-
after, they were allocated into several groups: I = ampi-
cillin (n = 5), II = spiramycin (n = 5), III = chloramphe-
nicol (n = 5), IV = oxytetracyline (n = 5), and V = TTS (n
= 5). Firstly, experiments were performed with single
doses of the drugs given intravenously to goats free from
any infection; experiments with infected animals were
carried out 6 weeks later. The goats were infected by
intravenous inoculation of 2 ml of a stabilate, which was
prepared by a method described earlier 16 • On postinfec-
tion day 4 (PID.) the same dose levels of drugs were admi-
nistered. Of the five goats in group II, III and V, four
were treated. The remaining three infected animals served
as untreated controls (group VI). Blood samples were ob-
tained before infection, immediately before treatment and
at 2, 4, 6, 8, 12, 18, 24 and 48 hours posttreatment (by
caudal puncture of the vena jugularis). White blood cell
counts. parasitaemia and ALP activity were determined
using methods described previously16.21.
Fever
The procedure for recording rectal temperature was the
same as earlier described 1•• A fever index (FIe),
proportional to the area between the response curve and
the baseline temperature - with the response plotted so
that five units on the ordinate represent a change of 1 °c
and so that two units on the abscissa represent 1 hour -
was calculated for a period of 8 h following drug
administration on PID.; ten units of FI are therefore
equivalent to aloe change lasting 1 h.
Drug analysis
Heparinized jugular blood samples were collected at
0.16. 0.33. 0.5. 0.75. 1.0. 1.5. 2. 3. 4. 6. 8. 12. 18.
24. 36 and 48 h after drug administration. Concentrations
in these samples were determined by methods previously
described ... , t o , t t
Pharmacokinetic and statistical analysis.

Results were expressed as mean ± SEM. In values compared
from the same goats between control and later values of
any group. the paired t-test was used. In comparisons
made between two groups. an independent t-test was used.
The "null" hypothesis was rejected at the 5% level.
Pharmacokinetic analysis 2 was performed by standard proce-
dures employing preprogrammed calculators.

The mean rectal temperature in the goats before they were
infected was 38.5 ± 0.2 OCt whereas the mean preinfection
values of ALP activity and wac counts were 377 IU.I- t and
9 • 2 ± O. 6 • 10' • I - t . res p e ct i vel y • The s e val u e sag r e e wit h
those reported earlier t2 • t3 • After infection. the level
of ALP activity showed a progressive fall in all goats
(PID4 50.7 ± 2.7% from baseline values). whereas wac
counts demonstrated a decline in the number of circulating
white blood cells (PID4 : 53.7 ± 6.3 % from baseline).
Similar changes were observed in a previous stud y t 6 .
After a sudden rectal temperature rise on the 3rd day of
infection. a plateau of 40.5-41.5 °c was maintained over a
period of 3-6 days (on PID4 • 0 h : 40.8 ± 0.1 °c. n = 25).
followed by a rapid fall to normal body temperature.
Concurrently. tachycardia and a moderate inhibition of
rumen contractions were observed t6 •
Efficacy studies
Rectal temperature seemed to be the most effective
parameter to check the effectiveness of chemotherapeutic
agents (Table 39.1 and 39.2). TSS. oxytetracycline and
TICKBORNE FEVER : EFFICACY OF SOME CHEMOTHERAPEUTIC AGENTS 419
Table 39.1 Tickborne fever: effects of some chemothera-

peutic agents on fever index, serum ALP activity and WBC
counts in dwarf goats
Ampicillin Spiramycin Chloram-

phenicol
(1) (II ) ( III>
Fever index
(PlO. - 8 h) 163.6:t13.5 170.3:t14.6 107.9:t4.2*
ALP
Mean baseline 128.3 372 302.3
<IU.1- t )
PlO. (% change) 43.2:t2.8 46.9:t6.9 48.8:t3.4

PlO, (% change) 37.6:t2.3 37.4:t9.3 38.9:tl.9
PlO6 (% change) 37.3:t4.6 35.9:t4.2 31.7:t1.4
WBC
Baseline 8.7:t1.9 8.4:tl.0 11.1:t0.3
( 10' • 1- t )
PlO. - 0 h 42.4:t7.5 31.9:t5.4 30.3:t7.4
(% change)
PlO. - 8 h 33.5:t8.4 30.6:t5.6 33.3:t9.6
(% change)
PlO. - 12 h 37.9:t7.1 32.8:t6.3 43.5:t8.3
(% change)
PlO, - 18 h 30.0:t3.8+ 32.7:t4.5 46.1:t8.6*+
(% change)
PlO. - 24 h 33.6:t6.9 31.9:t3.3 43.2:t7.6*
(% change)
--------------------------- - ------------------------------
* p < 0.05, independent t-test
+ p < 0.05. paired t-test
PlO Postinfection day
ch 1 orampheni co 1 showed significant effect s. whereas

neither ampicillin nor spiramycin (intramuscular) were
Table 39.2 Tickborne fever: effects of some chemothera-

peutic agents on fever index, serum ALP activity and WBC
counts in dwarf goats
Oxytetracy- TSS Control

cline
(IV) (V) (VI>
Fever index
( PIO. - 8 h) 92.3:tl0.7* 42. 9:t20. 1* 213.3:t22.5
ALP
Mean baseline
(lU.l- t ) 392 272 172.7
PIO. (% change) 58.7:t8.6 45.5:t2.6 64.3:tll.7
PIO, (% change) 54.8:t4.0 38.9:t2.5 47.7:t8.6
PIO, (% change) 50.3:t3.8 40.3:t2.6 43.8:t12.7
WBC
Baseline
( 10' • 1- t ) 9.1:tl.l 10.8:tl.3 11.5:t2.6
PIO. - 0 h
(% change) 78.3:t1.7 36.8:t3.9 36.0:t5.2
PIO. - 8 h
(% change) 64.4:t7.6+ 35.8:t4.5 30. 2:tl .0
PIO. - 12 h
(% change) 81.4:t5.5 35. 2:tl .2 30.9:t4.8
PIO. - 18 h
(% change) 88. 2:t2. 2+ 32.4:t3.1 30.7:t3.4*
PIO. - 24 h
(% change) 75. 7:t1. 5 30.6:t2.2 27.0:t1.2*+
----------------------------------------------------------
* p < 0.05, independent t-test
+ p < 0.05, paired t-test
PIO Postinfection day
effect i ve. Moreover, in groups I, II and VI goats.

febrile reactions persisted for several days ( PI 0, - PI 07 ) •
Temperature relapses were not observed after

oxytetracycline administration in contrast to the goats
from group III (PIO,-PIO,). The fast temperature effect
of TSS in addition to a shortlived relapse (on PIO, )
suggest that trimethoprim is probably the active compound.
because sulphonamides are not rickettsiostatic'. The
characteristic inclusions of tickborne fever were most
prominent in the neutrophils on the 3rd and 4th day of
infection.
Approximately 8 h after oxytetracycline administration
( PI 04 ). p y c not i c s pot s we reo b s e r v e d wi til i nth e s e i n f e ct e d
cells. whereas the other drugs did not induce this
phenomenon. In most groups. the number of infected cells
varied from 12 to 36% on PIO,. with somewhat lower values
in the oxytetracycline-treated group. Therefore. it was
not surprising that most drugs had no marked effects on
the decline of WBC counts (Table 39.1 and 39.2). The fall
in ALP activity appears to be correlated with the drop in
WBC counts. Likewise. similar changes have been demon-
strated in goats after bacterial toxin administration t5 •
t7.1I. in veal calves with salmonellosis 4 and in febrile
horses due to Streptococcus zooepidemicus infection t9 •
Therefore. the relationship between ALP activity and white
blood cells requires more detailed investigations.
Pharmacokinetic studies
Table 39.3 shows the mean elimination half-life. plasma
protein binding and total body clearance values for the
chemotherapeutic agents tested in healthy dwarf goats. In
the infected groups. treated with chloramphenicol.
sulphadimidine or oxytetracycline half-life values were
significantly (p < 0.05) prolonged. With ampicillin. both
volume of distribution (V d area in l.kg- t ) and the
peripheral compartment (V 2 in l.kg- t ) were significantly
greater during the febrile episode: 0.73 ± 0.05 l.kg- t
and 0.04 ± 0.003 l.kg- t versus 1.04 ± 0.11 l.kg- t and 0.08
+ 0.012 l.kg- t • respectively. Febrile goats treated with
chloramphenicol. showed a greater peripheral compartment
Table 39.3 Tickborne fever in goats: some pharmacokine-

tic data (t1l2 fl. h; protein binding. %; Cl. l.kg- t .h- t )
of chemotherapeutic agents after intravenous administra-
tion into the jugular vein; A : Spiramycin; 8: Oxytetra-
cycline; C: Chloramphenicol; 0 : Ampicillin; E : Sulpha-
methylphenazole; F : Sulphadimidine; G : Trimethoprim
A 8 C
tt/2 fl
6.1±0.S8 1.49±O.16
+ 7.3±0.33* 1.94±O.2S*
Protein binding
NO 66.7±1.3 46.S±1.3
+ NO 69.6±1.4 4S.7±3.0
Cl
0.3±0.02 0.13±O.01 O.40±0.04
+ NO O.10±0.Ol* 0.36±0.OS
o E F G
tt/2 fl
0.92±0.08 33.4±3.7 2.9±0.31 1.9±0.27
+ 1.1±O.OS 37.4±1.6 S.1±0.7* 1.8±0.44
Protein binding
44.1±2.8 98.0±0.3 7S.4±3.4 NO
+ 48.2±1.6 90.S±2. h S9.3±4.0* NO
Cl
0.S6±0.03 0.O6±0.01 O.9S±O.1
0.67±0.07 0. 02±0. 004* 1.46±0.09*
- before infection. + after infection

* p < O.OS
for this agent as well (0.33 ± 0.05 l.kg- t versus 0.19 ±

0.031.kg- t ) . With oxytetracycline the AUC value (h.J,Jg.
ml- t ) increased from 82.4 ± 7.4 to 103.1 ± 6.4 in infec-
ted animals.
The pharmacokinetics of spiramycin (intramuscular) did
not show significant differences between healthy and
tickborne fever-infected goats. Blood concentrations and
the clearance of trimethoprim significantly changed in
tickborne fever-infected goats (Table 39.3); the mean AUC
value was 39.1% less than in the control experiments. In
the infected animals marked changes in drug metabolism
were observed in the groups treated with chloramphenicol
or sulphadimidine. In the control experiments chloramphe-
nicol was rapidly conjugated with glucuronic acid. whereas
during fever this major metabolite could not be detected.
Biotransformation of sulphadimidine involved acetylation.
hydroxylation and glucuronidation. In general. biotrans-
formation processes of drugs speed UP elimination. In
particular the acetylated and glucuronidated metabolites
of sulphadimidine contribute to this acceleration process.
because they are excreted by tubular secretion. The
SCH20H and SOH metabolites are excreted approximately six
times faster than sulphadimidine itself'. This explains
the relatively short elimination half-life of sulphadimi-
~ine in healthy dwarf goats in contrast to other species
such as the horse. the pig and the cow·. In the tickborne
fever-infected dwarf goats. hydroxylation into SCH20H and
SOH metabolites was dramatically reduced (-57.6% and
-63.6% respectively'). Acetylation decreased to a lesser
extent (-22.1%). whereas the glucuronidated SOH metabolite
was hardly detectable. The diminished metabolic capacity
resulted in a decreased total body clearance and in a
prolongation of its half-life (Table 39.3). Sulphamethyl-
phenazole was acetylated. but no significant differences
were found between healthy and febrile episodes (3.1 ±
0.4% versus 2.9 ± 0.2%).
Thus. during fever a complex pattern emerges of
retardation of certain biochemical pathways. At the
present time. sufficient data are not available to permit

clear understanding of how fever affects drug metabolism
and/or excretion in tickborne fever-infected goats. It
was suggested 20 that the parasite only penetrates
polymorphonuclear leucocytes and monocytes; up till now
there is no evidence for tickborne fever-induced lesions
within the liver and/or kidneys. Studies concerning the
effects of tickborne fever-infection on renal clearance
values and the alteration in overall metabolism of drugs
related to liver function tests are in progress.
CONCLUSION
The tickborne fever model used in this study has an acute
character. In dwarf goats the disease is characterized by
fever. dullness. anorexia. tachycardia. a moderate inhi-
bition of rumen contractions. leucopaenia and a decreased
serum alkaline phosphatase activity. This model can be of
great value in testing the therapeutic efficacy and
pharmacokinetics of chemotherapeutic agents in rickettsial
infections. The goats receiving oxytetracycline. chlor-
amphenicol or trimethoprim (plus sulphonamides) showed
improvement. whereas ampicillin and spiramycin were inef-
fective. Furthermore. marked changes in drug metabolism
were observed in tickborne fever-infected goats treated
with chloramphenicol or sulphadimidine; the half-life va-
lues of these drugs and of oxytetracycline were signifi-
cantly prolonged. The pharmacokinetics of spiramycin.
ampicillin and sulphamethylphenazole did not show marked
differences between healthy and tickborne fever-infected
animals.
References
1. Anigstein. L. (1964). Chemotherapy of rickettsial in-
fection. In: Schnitzer. R.J. and Hawking. F. (eds).
Experimental Chemotherapy vol. III. pp.481-525. New
York : Academic Press.
2. 8aggot. J.D. (1977). Principles of Drug Disposition
in Domestic Animals. 1st ed. Philadelphia: W.8.
Saunders Company.
3. 8uhles. W.C •• Huxsoll. D.L. and Ristic. M. (1974).
Tropical canine pancytopaenia cl inical. haemato-
logic and serologic response of dogs to Ehrlichia

canis infections. tetracycline therapy and challenge
inoculations. J. Infect. Dis. 130:357-367.
4. Groothuis. D.G. (1983). Pharmacokinetics of some
antimicrobial drugs in veal calves and their activity
in relation to Salmonella dublin infections. Utrecht
PhD thesis.
5. Hudson. J.R. (1950). The recognition of tick-borne
fever as a disease of cattle. Br. Vet. J. 106:3-17.
6. Nouws. J.F.M. (1984). Irritation. bioavailability.
and residue aspects of 10 oxytetracycline formulations
administered i.m. to pigs. Vet. Q. 6:80-84.
7. Nouws. J.F.M •• Anika. S.M •• Van Miert. A.S.J.P.A.M ••
Vree. T.B •• Baakman. M. and Van Duin. C.T.M. (1986).
Effect of tick-borne fever on the disposition of
sulpnadimidine and its metabolites in plasma of goats.
Res. Vet. Sci.(in press).
8. Nouws. J.F.M •• Van Ginneken. C.A.M •• Hekman. P. and
Ziv. G. (1982). Comparative plasma ampicillin levels
and bioavailability of 5 parenteral ampicillin
formulations in ruminant calves. Vet. Q. 4:62-71.
9. Nouws. J.F.M •• Vree. T.B •• Breukink. H.J •• Van Miert.
A.S.J.P.A.M. and Grondel. J. (1986). Pharmacokine-
tics. hydroxylation and acetYlation of sulphadimidine
in different species of mammals. birds. fish.
reptiles. and molluscs. In: Van Miert. A.S.J.P.A.M ••
Bogaert. M.G. and Debackere. M. (eds). Comparative
Veterinary Pharmacology. Toxicology and Therapy.
Proc. 3rd EAVPT Congress. Part II. Invited lectures.
10. Nouws. J.F.M. and Ziv. G. (1979). Distribution and
residues of macrolide antibiotics in normal dairy
cows. Arch. Lebensmittelhyg. 30:202-208.
11. Van Gogh. H. (1980). Pharmacokinetics of nine sul-
phonamides in goats. J. Vet. Pharmacol. Ther.
3;69-81.
12. Van Miert. A.S.J.P.A.M. (1984). La febbre e le modi-
ficazioni ematologiche. ematochimiche e funzionali
organiche ad essa associate nella capra ed in altre
specie animali. Rassegna Sci. Vet. 3:296-314.
13. Van Miert. A.S.J.P.A.M. (1985). Fever and associated
clinical haematologic and blood biochemical changes in
the goat and other animal species. Vet. Q. 7:200-216.
14. Van Miert. A.S.J.P.A.M •• Van der Wal-Komproe. L.E. and
Van Duin. C.T.M. (1977). Effects of antipyretic
agents on fever and ruminal stasis induced by endoto-
xins in conscious goats. Arch. Int. Pharmacodyn.
Ther. 225:39-50.
15. Van Miert. A.S.J.P.A.M •• Van Duin. C.T.M. and Schot-
man. A.J.H. (1984). Comparative observations of fever
and associated clinical haematological and blood bio-
chemical changes after i.v. administration of staphy-
lococcal enterotoxins Band F (toxic shock syndrome
Toxin-l) in goats. Infect. Immun. 46: 354-360.
16. Van Miert. A.S.J.P.A.M., Van Duin. C.T.M •• Schotman.
A.J.H. and Franssen. F.F. (1984). Clinical. haema-
tological and blood biochemical changes in goats after

experimental infection with tick-borne fever. Vet.
17. Van Miert, A.S.J.P.A.M., Van ouin, C.T.M., Verheijden,
J.H.M. and Schotman, A.J.H. (1982). Endotoxin-induced
fever and associated haematological and blood bioche-
mical changes in the goat. The effect of repeated
administration and the influence of flurbiprofen.
Res. Vet. Sci. 33:248-255.
18. Van Miert. A.S.J.P.A.M., Van ouin, C.T.M •• Verheijden,
J.H.M. and Schotman, A.J.H. (1983). Staphylococcal
enterotoxin Band E. coli endotoxin: comparative
observations in goats on fever and associated clinical
haematologic and blood biochemical changes after i.v.
and intramammary administration. Am. J. Vet. Res.
44:955-963.
19. Varma. K.J., Powers, T.E., Carg, R.C., Spurlock, S.L.
and Powers. J.D. (1983). Efficacy of penicillin
against Streptococcus zooepidemicus infection model in
the horse. In Ruckebusch, Y., Toutain, P.L. and
Koritz. G.o. (eds). Veterinary Pharmacology and
Toxicology. Proc. 2nd EAVPT Congress, pp.429-436.
20. Woldehiwet, Z. (1983). Tick-borne fever: a review.
Vet. Res. Commun. 6:163-175.
21. Woldehiwet, Z. and Scott, G.R. (1982). Immunological
studies on tick-borne fever in sheep. J. Compo
Pathol. 92:457-467.
40
Statistical methods for evaluation of drug
efficacy in animal models
J. D. POWERS AND T. E. POWERS
ABSTRACT
Animal disease models are used to simulate a naturally
occurring disease state and/or to evaluate drug efficacy.
A numerical rating system allows the clinician to express
subtle differences he is observing; a rating system with a
wide range of possible scores can furthermore statistical-
ly be handled as a continuous variable in longitudinal
studies across time. A health index possessing the fol-
lowing properties reproducible rating between clini-
cians. measuring existing differences and easy to use
provides such a rating system. Two health indices. deve-
loped for the Streptococcus zooepidemicus model in the
beagle dog and the horse. respectively. are discussed.
INTRODUCTION
Animal disease models are primarily used to evaluate drug
efficacy and/or to simulate a naturally occurring disease
state. In either case it is necessary to quantitatively
evaluate the results of the investigation. This evalua-
tion occurs at two levels: (a) measuring the response of
the individual subject at any point in time. and (b) mea-
suring efficacy over time in groups of subjects receiving
different treatments.
To restrict this quantification to only a few catego-
427
ries such as improved. no change. or deterioration imposes

several limitations: for example. it increases the number
of subjects needed to detect a difference and forces the
evaluating clinician to report gross impressions only.
Hence a numerical rating system which provides the
clinician with a method of expressing the subtle
differences his experienced eye preceives is preferable
both to him and to the statistician who must evaluate the
results. Furthermore. a rating system which has a broad
range can be statistically handled as a continuous
variable in longitudinal studies across time. This. in
most cases. permits the use of parametric procedures such
as analysis of variance and/or regression.
A health index to evaluate an animal disease model
would provide such a rating system. However. to be of
value. this index must possess the following properties
(1) reproducible ratings between clinicians:

(2) measure differences when they exist;
(3) easy to use.
In our laboratory. two such indices have been develo-

ped. The first was constructed to be used with a Strepto-
coccus zooepidemicus model in the beagle dog' and the
second index evaluates a similar model in the horse 2 •
CONSTRUCTION OF A HEALTH INDEX

The construction of a health index can only be achieved by
the cooperative efforts of the clinician. the pharmacolo-
gist and the statistician. The clinician and pharmacolo-
gist must communicate verbally to the statistician those
characteristics which their trained eyes observe which
result in an ordering of a group of subjects. with respect
to degree of illness. In turn. the statistician must
convert these observations into a numbering system which
has the following properties
(1) Reproducible scores between clinicians i f the sco-

STATISTICAL METHODS FOR EVALUATION OF DRUG EFFICACY 429
Table 40.1 Health index for beta-haemolvtic streptococcal

di sease mode lin t he dog
Cl inical sign Descr i pti on Score given
(1) Lameness (0-1S)

(a) Is unable to get UP and move and has
painful I imb ,joints 13-1S
(b) Can get UP with difficultv, feels pain on
walking. and has inflamed leg joints 10-12
(c) Can get UP easilv. moves with staggering,
leg and ,joints are painful on palpltion 7-9
(d) Shows some lameness and has abnormal gait 4-6
(e) Almost no lameness, no inflammation. and no
pain in joints even on palpation 0-3
(2) Size of IvmPh nodes (0-8)
(a) Size more than double normal size 6-8
(b) Almost double normal size 3-S
(c) Normal to slight enlargement 0-2
(3) Colour of mucous membranes (O-S)
(a) Pale and cyanotic 4-S
(b) Pal e 2-3
(c) Pink or whitish pink 0-1
(4) Degree of alertness (0-4)
(a) No response to surroundings. lving listless
in a prostrate manner 4
(b) Unconcerned to surroundings but has healthier
posture 3
(c) Not getting UP on subjective approach but does
move the tail 2
(d) Active on approach shows playing behaviour.
moves tail. and Shakes head and ears 0-1
(S) Condition of hair coat (0-4)
(a) Looks dull with falling of hair 3-4
(b) Loss of shine. looking rough but no loss of
hair 2
(c) Shinv compact hair coat with no falling off 0-1
(6) Degree of dehydration (0-4)

(a) Skin just adherent with subcutaneous tissue 3-4
(b) Can get a skin fold. stays for some time on
releasing the fold 2
(c) Can get a skin fold which disappears immedia-
te ]y with the release of fold 0-1
ring system is qiven to two or more "equallY compe-

tent" clinicians. with a minimal amount of training.
these clinicians will independentlY rate the same
subject with similar scores. By "equallY competent"
it is meant that the clinician has experience in
evaluating each of the components which comprise the
health index. A clear example of this would be the
small animal clinician attempting to evaluate the
degree of lameness in a horse or b10atedness in a cow.
This clinician's eye is not called upon to rate such
syndromes in his professional activities and hence is
not expected to do so with the same expertise of an
equinine or food animal clinician. respectively.
(2) Measure differences when they exist. This property is
most easily described by considering two "equally"
sick subjects and at 1 east one subject which is "1 ess"
ill and one which is clinically "quite" ill. The
desired property would dictate that the two "equally"
sick subjects would receive similar scores. whereas
the remaining two patients would be assigned scores
different from the first two and different from each
other.
(3) Easy to use indicates that with little or no instruc-
tion a qualified clinician is capable of translating
his professional expertise into a score appropriate
for the condition of the given patient.
STATISTICAL EVALUATION
Traditionally. efficacy studies compare treatment groups
across time. This permits the investigator to compare
Table 40.2 Health index for beta-haemolvtic streptococcal

disease model in the horse
Cl inical sign Score
General appearance
Normal o
Depression slight but discernible (responsive-
ness. head position and involvement. "eve" and
hair coat) 1
Head down. but responds to noise or menace 2
Head down with poor response 3
Verv depressed. stares. little or no response 4
Down most of the time 5
Nasal and ocular exudate

Normal. ocular 0
Ocular serous
Ocular purulent 2
Normal. nasal 0
Nasal serous 1
Nasal purulent (sma 11 ) 2
Nasal purulent (large) 3
Respiratorv examination
Normal o
Harsh tracheal sounds
Hvperpnoea
Slight r~spiratory distress at rest 1
Abnormal lung sounds 2
Cough elicited bv pressure on trachea or larynx 2
Spontaneous cough 3
Moist. coarse rales in a third or more of lung
field 4
Easilv detected respiratory distress at rest and
unable to exercise or walk more than 15 m slowlv 5
Significant area of consolidation or evidence of
pleural effusion 6
Lameness
Normal (no lameness) o
Detectable at trot only 1
Detectable at walk 2
Bears only 50% weight on lame leg. or stiff and
unwi 11 ing to wal k except if urged 3
Drags or jumps to carry lame leg 4
Down all the time except when urged to stand 5
Down and unable to raise head 6
Swo 1 len j 0 i n t s. etc.

One joint swollen (independent of lameness)
Each additional joint swollen or painful 0.1.2.3.
4.5.6.7
Bursa of withers affected
Other abscesses 0.1.2.3
responses across both time and treatment groups. Further.

the interaction between groups and time is usually of
major importance to the pharmacologist. The only effi-
cient statistical equipment which results in these three
evaluations is an analysis of variance (ANOVA). Clearly
broad categories of clinical ratings such as improved. not
improved or no change can not be handled by ANOVA. On the
other hand. a health index which has a wide range of
possible scores. can be used in this type of analysis.
Obviously an index is not a continuous random variable.
but if the range covers. for example 50 points. the
violation of the normality assumption of this test is not
so serious as to negate its use and indeed the robustness
of this test compensates well for this violation. In
addition. when differences are found by ANOVA one of the
appropriate multiple comparison tests can be used.
EXAMPLES OF HEALTH INDICES

Two health indices have been developed at the Ohio State
University. The first was constructed to be used with a
Streptococcus zooepidemicus model in the beagle dog and

the second was for the same pathogenic model in the horse.
Tables 40.1 and 40.2 describe the details of the index for
the dog and horse respectivelv.
Bv comparing the individual components of the two
indices. it is possible to observe the similarities and
differences of the clinical manifestations in the two
species. Moreover. the issue addressed earlier regarding
"eQuallv competent" clinicians is exemplified bv the
lameness and respiratorv scoring in the horse. Each of
these components requires a competent eve and ear
respectivelv.
The health index for the dog model was used to evaluate
the efficacv of a combination product of trimethoprim and
suI phadiazine l •
References
1. Powers. J.D. and Powers. T.E. (1977). A health index
to Quantitate disease states in animal models.
Proceedings of the 10th International Congress of
Chemotherapv.
2. Powers. J.D •• Powers. ToE •• Varma. K.J •• Gabel, A.A.
and Spurlock. S.L. (1984). A health index to clinical-
Iv evaluate Strep disease model in the horse. J. Vet.
Pharm. Ther. 7:213-217.
3. Powers. ToE •• Powers. J.D. et a]. (1980). Trimethoprim
and sulfadiazine experimental infection of beagles.
Am. J. Vet. Res. 41:1117-1122.
41
Pharmacology of carbadox in the pig
1. P. JAGER, E. J. VAN DER MOLEN, G. J. DE GRAAF,
T. H. J. SPIERENBURG, M. J. A. NABUURS AND A. J. BAARS
ABSTRACT
An evaluation has been made of the in vitro minimal
inhibitory concentrations (MIC) of carbadox against
various bacterial species in relation to the carbadox
levels obtained in the gastrointestinal tract and in the
blood after in-feed medication of carbadox. Although a
prophy 1act i c efficacy against orally transmitted
enteropathogenic spirochaetes and anaerobic bacilli seems
warranted. no justification for the therapeutic
application of carbadox was found. In fact. therapeutic
dosages were found to induce hypoaldosteronism in young
pigs. A direct anabolic action of carbadox could not be
reproduced in healthy young pigs fed a standard commercial
feed. The widespread use of carbadox in pig husbandry
constitutes a selection pressure towards Escherichia coli
strains with MIC values above the carbadox levels in the
small intestines. Carbadox R-plasmids in E. coli strains
can be transmitted to other gram-negative bacilli but not
to Treponema hyodysenteriae. Prevention of swine
dYsentery seems now to be the only indication for in-feed
administration of carbadox. A lower dosage and a shorter
treatment period than those currently advised might
provide a marginal safety factor while still being
effective.
435
INTRODUCTION
Most of the pigs raised each year in the Netherlands
(1983 :17 million) receive car bad ox in their feed. either
as a feed additive. as in-feed medication or as feed
contamination. Despite the widespread use of this drug.
relatively little is known about the effects carbadox can
induce in wea'ned pigs. As new data concerning its modes
of action are emerging. further pharmacological evaluation
of carbadox is required to reassess the desirability of
its use in pig husbandry.
In this overview the pig. as a target animal, wi 11
serve as a focal point in a discussion of the pharmacology
of carbadox. Subsequently the "desired" effects of
carbadox. as deduced from the indications for its current
use. and the side-effects. will be discussed and an
attempt will be made to estimate the therapeutic margin of
carbadox in pig husbandry.
PHARMACOLOGICAL CHARACTERISTICS
Antimicrobial activity
The antimicrobial activity of carbadox involves use as a
prophylactic by in-feed medication of pigs at levels of
50-55 mg.kg- t (ppm). whereas a therapeutic effect is
sought with in-feed dosages of 100-150 mg.kg- t (ppm). The
available data concerning in vitro studies of its minimal
inhibitory concentration (MIC) against several pathogens
(Table 41.1) indicate that its antimicrobial activity
under aerobic circumstances is poor. Under anaerobic
circumstances much lower MIC values are reported
especially for enteropathogenic bacilli and Treponema
hyodysenteriae. supposedly the causative agent in swine
dysentery (dYsentery Doyle). In vitro MIC values of about
40 ng.m1- t imply that carbadox might be an effective
drug" •
The pharmacokinetic characteristics of carbadox after
oral administration however. do raise doubts about its
probable efficacyt4. As the infection is transmitted by
the oral route. the amount of carbadox in the contents of
PHARMACOLOGY OF CARBADOX IN THE PIG 437
Table 41.1 In vitro susceptibility of bacteria for carba-

dox
Minimal inhibitory
Species concentration (MIC). References
aerobic anaerobic
ug.ml- t Ug. mJ - t
Escherichia coli 6 0.2 9

(chicken 1976) 0.31.:t0.03 10
(cattle 1976) 0.31.:t0.04 10
(swine 1976) 1 • 45.:t0 • 17 10
(swine 1980) 131.:t18 16 • 13.:t2 • 57 10
6-12 2
(swine 1978-80) 30.:t 2 2
12-25 0.4-1.6 12.13
Klebsiella pneumoniae 25 0.8 10.13
Citrobacter freundii 0.4 10
Shigella flexneri 0.4 10
Shigella sonnei 25 13
Salmonella typhi 0.2 10
Salmonella typhimurium 12-50 0.8-1.6 12.13
Salmonel Ja dubl in 1.6 12
Salmonella chole- 1.6-25 1.6 12.13
raesuis
Salmonella spp. 6-50 0.8-1.6 12.13
Lactobacillus spp. 8. O.:t 1 .3 3
Staphylococcus aureus 25-50 2
Streptococcus faecalis 12-25 2
Treponema hyodysen- <0.01-0.04 12
teriae <0.01 6
<0.05-0.08 16
<0.02-0.04 17
<0.01 18
• Average (m .:t SEM). range or single value of the MICs

reported.
the gastrointestinal tract proximal to the jejunum after

in-feed medication with 50 ppm carbadox seems to be high
enough to kill invading treponemes. Also. carbadox levels
in the stomach and duodenum might be effective against
invading bacilli. assuming anaerobic conditions. The MIC
values reported under aerobic conditions are often well
above the levels present after in-feed medication.
With regard to a therapeutic application of carbadox
the prospects are less promising than for prophylaxis.
In-feed medication of carbadox at therapeutic dosages (100
ppm) yields carbadox levels which. even in the distal half
of the jejunum. are below the anaerobic MIC values. The
pathogenic activity of T. hyodysenteriae includes
penetration of mucosal cells of the colon. but even after
in-feed medication with 100 or 150 ppm carbadox the level
of carbadox in the contents of this part of the
gastrointestinal tract can. by extrapolation. be assumed
to be virtually zero. The blood levels of carbadox after
in-feed medication might just attain the MIC values. but
the concentration gradient across the colonic mucosa makes
it unlikely that significant amounts of carbadox reach the
infected mucosal cells. In outbreaks of dysentery (or
diarrhoea) in-feed medication with carbadox (50 ppm) can
be used to protect the animals not yet infected. but for
the treatment of infected animals other drugs should be
used.
With regard to the development of resistance of
intestinal bacteria carbadox is notable. The widespread
use of this drug as a feed additive constituted an
enormous selection pressure in favour of intestinal
bacilli with low sensitivities • Ohmae et al.
2 tO reported
that in 1980 more than 80% of the E. coli isolates from
pigs had aerobic MIC values above 10 ug.ml- t • and from the
anaerobic MIC values 33% exceeded this value. while a few
years earlier less than 1% of the isolated strains
exceeded this value. It seems safe to assume that. on
farms where carbadox is used as a standard feed additive.
the aerobic sensitivity of all intestinal bacilli present
is such that they will not be affected by the carbadox

concentrations encountered in the gastrointestinal tract.
With the increase of aerobic MIC values an increase of the
anaerobic MIC values was observed. but the difference
between these two values remained on the average 10-fold.
Not surprisingly with this selection for carbadox-
insensitive strains. R-plasmids were found in E. coli
isolates· • Their existence and the reported transfer to
other gram-negative bacilli has consequences for an
assessment of the usefulness of this drug. The already
meagre prospects for prophylactic efficacy against
enteropathogenic bacilli. because of the heavy reliance on
anaerobic conditions in the gut. are now zero. Moreover.
the possibility that multiple resistant gram-negative
bacilli are selected might reduce the efficacy of other
antimicrobial drugs. However. there is evidence indica-
ting that carbadox actually reduces the incidence of
multiple resistant strains of enteric bacteria and thus
increases the efficacy of other antimicrobial agents 4 • The
R-plasmid-eliminating activity of carbadox seems to be
directly related to its inhibition of DNA-synthesis 4 •
Also. the persistence of transposed carbadox resistance is
short in the absence of selection pressure. therefore the
introduction of a carbadox resistant gene might ultimately
facilitate the disappearance of all resistant traits.
encoded in the same plasmid as the carbadox resistance.
So far neither selection pressure nor R-plasmids have
impaired the efficacy of carbadox against T.
hyodYsenteriae1,lo. The difference between the highest
reported MIC-value and the concentrations of carbadox in
the stomach and duodenum after in-feed medication is
100-fold. In order to obtain a safety margin (see below)
a lower dosage for carbadox as a preventive feed additive
seems possible without attenuation of its efficacy.
Growth-promoting activity
The in-feed medication with carbadox UP to 50 ppm has
become popular in pig husbandry mainly because it is a
cheap growth promoter. As with other antimicrobial

agents. growth-promoting activity was found to increase
with infection pressure. Furthermore. a growth-promoting
effect not attributable to the antimicrobial activity of
carbadox or direct anabolic action of carbadox is claimed.
Although there are reports indicating that with SPF pigs a
significant growth-promoting effect was observed'. in two
different experiments we were unable to detect a growth-
promoting activity in MD pigs. In field trials carbadox
is reported to have a growth promoting effect of almost
25% in weight gain which can decrease to 18% in "clean
uninfected university" pigs l3 •
In our experiments we concluded that there was no basis
for a growth-promoting effect of 10% or more by 50 ppm
carbadox. The animals were fed ad libitum to enhance a
growth-promoting effect. Frequent faecal samples
indicated the absence of pathogens to ensure the detection
of a direct anabolic action. The feed conversion of the
control animals was ~ 2 during the treatment. which
reduces the margin for growth promotion to the lower
values reported l3 • The normal commercial pig feed used in
these experiments. however. contained 11%. lysine. well
above the 8%. lysine reported to be the upper limit for an
improvement of the feed conversion by carbadox' • This
might explain our negative findings. but also casts doubts
about the justification for the use of carbadox as the
ever-present growth promoter in pig feed.
From our observations of young pigs fed 0.25 or 50 ppm
carbadox in their rations we concluded that carbadox at
the 50 ppm dosage induced urine-drinking behaviour. It is
tempting to speculate that this behaviour is brought about
by salt-craving. an early symptom of hypoaldosteronism 7 •
Toxic activity
The outstanding characteristic of the toxicology of
carbadox is the seemingly highly selective and specific
effect on the glomerular zone of the adrenal cortex after
a few weeks of carbadox medication in feed at levels of
100 ppm and higher'. This histological observation was

subsequently corroborated by the finding that even after a
short period of carbadox administration aldosteron~
<released from the adrenal zona glomerulosa>, sodium and
potassium ion levels in blood are significantly altered 7 •
It is doubtful whether the adrenal damage induced by
carbadox is reversible. To date, we have not found an
explanation for this specific and selective action of
carbadox on the adrenals. Preliminary experiments did not
confirm a supposed accumulation of carbadox in the
adrenals. That the glomerular zone of the adrenals is a
first site of action for carbadox is indirectly shown by
our observation that within a week of the start of the
administration of 100 ppm carbadox the aldosterone levels
are reduced to 35% of the control values. The sodium and
potassium levels in the blood only start to deviate from
controls after 4 weeks.
Other. longer known aspects of the toxicological
profile of carbadox are its mutagenicity in bacteria l5 ,
and its g e not 0 xi c act ion in mamma I s I I . It is po s sib I e
that the toxic effects of carbadox are related to its
antibacterial activity. The proposed mechanism of this
action of carbadox is that it affects nucleic acid
metabolism. and it was found to bind to DNA in bacteria.
A similar interaction with mammalian DNA cannot be
excluded. In this respect the difference between
bacterial and mammalian cells might not be large for
carbadox. At least in weaned pigs the factor between the
prophylactic. growth-promoting dosage used and the lowest
dosage studied with an undeniable toxic effect is only
two.
CONCLUSION
The conclusion is reached that the current almost
unrestricted use of carbadox as a feed additive for
piglets is hardly justified. The prophylactic medication
with 50 ppm only prevents orally invading T.
hyodYsenteriae. the protection against other
enteropathogens having become negligible. A direct

anabolic effect of carbadox seems doubtful with the high
lysine content of commercial Dutch pig feed. A reliable
protection against swine dysentery with a safety margin
might be provided by in-feed medication with 25 ppm
carbadox. The current therapeutic use of carbadox to
"cure" diarrhoea has a questionable efficacy because it
alters the aldosterone regulation of extracellular fluid
electrolyte concentration. extracellular fluid volume.
blood volume. arterial pressure and renal function; in
short it induces hypoaldosteronism.
References
1. Baumgartner. A•• Meyer. J •• Lebek. G. and Nicolet. J.
(1985). Natur und Verbreitung der Carbadoxresistenz
bei Escherichia coli. isoliert von Mastschwenen.
-Kalbern und GeflUgel. Schweiz. Arch. Tierheilk.
127:339-347.
2. Das. N.K. (1984). In vitro susceptibility of Escheri-
chia coli of swine origin to carbadox and other anti-
microbials. Am. J. Vet. Res. 45:252-254.
3. Dutta. G.N. and Devriese. L.A. (1981). Sensitivity
and resistance to growth promoting agents in animal
lactobacilli. J. Appl. Bact. 51:283-288.
4. Gedek. B. (1979). Bewertung der Leistungsfahigkeit
von Carbadox als Wachstumsforderer nach mikrobio-
logischen Kriterien. Zbl. Vet. Med. B. 26:7-19.
5. Gropp. J. (1976). Der Einfluss von Fortigro bei
Schweinen auf die Nahrstoffverwertung. In: Wissen-
schaftliche Vortragstagung Uber wirtschafliche
Schweineproduktion :Fortigro R (carbadox) zwei Jahre
im Einsatz. pp.67-94. Karlsruhe :Pfizer GmbH.
6. Kitai. K.• Kashiwazaki. M•• Adachi. Y., Kume. T. and
Arakawa. A. (1979). In vitro activity of 39
antimicrobial agents against Treponema hyodysenteriae.
7. Van der Molen. E.J •• de Graaf. G.J. and Baars. A.J.
(1985). Carbadox-induced changes in aldosterone and
ion levels in the blood of weaned pigs. In: Van
Miert. A.S.J.P.A.M •• Bogaert. M.G. and Debackere. M.
(eds). Comparative Veterinary Pharmacology. Toxico-
logy and Therapy. Proc. 3rd EAVPT Congress. Part I.
Abstracts. p.247. Utrecht: EAVPT.
8. Van der Molen. E.J., Nabuurs, M.J.A. and Jager, L.P.
(1985). Clinical and pathological changes related to
toxicity of carbadox in weaned pigs. Zbl. Vet. Med.
B. 32: 540-550.
9. Ohmae. K•• Yonezawa, S. and Terakado. N. (1981).
R-Plasmid with carbadox resistance from Escherichia
coli of porcine origin. Antimicrob. Agents Chemo-
t her. 19: 86-90.
10. Ohmae. K•• Yonezawa. S. and Terakado. N. (1983). Epi-

zootiological studies on R Plasmid with Carbadox
resistance. Jap. J. Vet. Sci. 45:165-170.
11. Oud. J.L •• Reutlinger. A.H.J. and Branger. J. (1979).
An investigation into the cytogenetic damage induced
by the coccidiostatic agents amprolium. carbadox.
dimetridazole and ronidazole. Mut. Res. 68:179-182.
12. Pfizer (1983). Mecadox (carbadox) vs. olaquindox.
Technical information update. no. 8307. New York:
Pfizer International Inc.
13. Pfizer (undated). Mecadox (carbadox) technische hand-
leiding. Rotterdam: Pfizer BV.
14. Spierenburg. Th.J •• De Graaf, G.J. and Jager. L.P.
(1985). Levels of carbadox in porcine blood and
gastrointestinal contents after in-feed administra-
tion. In: Van Miert. A.S.J.P.A.M •• Bogaert. M.G. and
Debackere. M. (eds). Comparative and Veterinary
Pharmacology. Toxicology and Therapy. Proc. 3rd EAVPT
Congress. Part I. Abstracts. p.91. Utrecht :EAVPT.
15. Voogd. C.E •• Van der Stel. J.J. and Jacobs. J.J.J.A.A.
(1980). The mutagenic action of quindoxin. carbadox.
olaquindox and some other N-oxides on bacteria and
yeast. Mut. Res. 78:233-242.
16. Williams. B.J. and Babcock. W.E. (1976). In vitro
susceptibility of Treponema hyodysenteriae to carba-
dox. Virglnlamycin. and tylosin. Vet. Med. Small
Anim. Clint 71:957-959.
17. Williams. B.J. and Shively, J.E. (1978). In vitro
antitreponemal activities of carbadox. virglnlamycin.
olaquindox and tylosin as indices of their
effectiveness for preventing swine dysentery. Vet.
Med. Small Anim. Clint 73:349-351.
18. Williams. B.J. and Babcock. W.E. (1978). In vivo and
in vitro susceptibility of Treponema hyodysenteriae to
carbadox before and after repeated in vitro passage in
sublethal concentrations of drug. Vet. Med. Small
Anim. Clint 73:432-436.
Opiates, Opioids
and
N europeptides
42
Opioid peptides and their receptors
R. A. LEFEBVRE
ABSTRACT
The endogenous opioid peptides belong to three groups:
the endorphins. the enkephalins and the dynorphins. These
three groups are clearly distinct chemical families deri-
ved from three different precursor peptides pro-opio-
melanocortin. proenkephalin and prodynorphin. Endogenous
opioid peptides are present as well in the brain as in the
periphery and interact with opioid receptors. Three
subtypes of opioid receptors are now generally accepted
mu. delta and kappa. Enkephalins are preferentially
active at delta-receptors. beta-endorphin is very potent
at both mu- and delta-receptors. while dynorphins show
kappa-receptor preference.
INTRODUCTION
The effects of opiates have undoubtedly been known for
many centuries. In the 1960s. it became clear that these
effects are due to interaction with specific receptors.
which were called "opiate receptors". In the early
1970s. evidence for the existence of endogenous ligands
for the opiate receptor was obtained and in 1975 the
structures of [Leu]enkephalin and [MetJenkephalin were
elucidated. Since then. many other endogenous ligands
acting on opiate receptors have been discovered.
447
The term "opioids" is now used to indicate directly

acting compounds with effects that are stereospecifically
antagonized by naloxone. The term "opiates" should be
reserved for products derived from the opium POppy and
related synthetic alkaloids. The endogenous ligands are
mainly peptides; they should be called "endogenous opioid
peptides"; as they are the physiological ligands for the
opiate receptors. the latter should be called "opioid
receptors".
CLASSES OF ENDOGENOUS OPIOID PEPTIDES

The endogenous opioid peptides belong to three major
groups the endorphins. the enkephalins and the
dynorphins 2 • 3.!... Some opioid peptides cannot be
classified within these groups; these include the
exorphins. which are present in body fluids (for example.
beta-casomorphin in bovine milk).
The three main groups of endogenous opioid peptides are
clearly distinct chemical families. each group being
derived from another precursor peptide or prohormone.
These prohormones contain from 256 to 265 amino acids and
are genetically coded; after translation of the messenger
RNA into the protein sequence of the prohormone. smaller
fragments of the prohormone are cleaved out. In the
prohormones. the peptides are surrounded by a pair of
basic amino acid residues. which are presumed to be
recognition sites for the cleavage by processing enzymes.
Endorphins
Endorphins are derived from pro-opiomelanocortin (POMC;
Figure 42.1). POMC contains. at its C-terminal side. beta-
lipotropin (a 91 amino acid sequence) beta-endorphin.
the main representative of the endorphin group, is the
terminal 31 amino acid sequence of beta-lipotropin and has
also been called C-fragment . Smaller fragments of beta-
endorphin have also been extracted: beta-endorphin(1-16)
or alpha-endorphin. beta-endorphin(1-17) or gamma-endor-
phin. beta-endorphin(1-26) and beta-endorphin(1-27), which
OPIOID PEPTIDESANDTHEIR RECEPTORS 449
is also known as delta-endorphin or C'-fragment. POMC

further contains adrenocorticotrophic hormone (ACTH) and
three copies (alpha, beta and gamma) of melanocyte-stimu-
lating hormone (MSH).
High concentrations of endorphins are present in the
pituitary. In the anterior lobe. a small number of cells
produces beta-endorphin; in the intermediate lobe. which
is not present in humans. all cells produce
beta-endorphin-related peptides. In the brain. the
distribution of endorphin-containing cell bodies is
limited. A high concentration is found in the
hypothalamus; from this area. fibres project to many areas
of the brain. Endorphins have also been found in
peripheral organs such as the pancreas.
Enkephalins
The enkephalins are derived from the prohormone
proenkephalin (see Figure 42.1). Proenkephalin contains
once the [LeuJenkephalin sequence and 4 times the
[MetJenkephalin sequence. [LeuJenkephalin and [MetJenke-
phalin are both 5 amino acid peptides. From the brain.
two extensions of [MetJenkephalin at its C-terminal end
were extracted: [MetJenkephalinyl-Arg-Phe and [MetJenke-
phalinyl-Arg-Gly-Leu. Both of these peptides are present
once in proenkephalin. Proenkephalin also contains three
longer peptides. which were extracted from the adrenal
medulla. that is. peptide F. peptide I and peptide B.
These three peptides contain one or more of the smaller
sequences. cited previously.
The enkephalins are much more widely distributed in the
brain than the endorphins; the highest concentrations are
found in the striatum and in the hypothalamus. High
concentrations of enkephalins are also present in the
brain stem. in the spinal cord. and in the periphery,
mainly in the nervous plexus of the gastrointestinal tract
and in the adrenal medulla.
PRO-OPIOMElANOCORTIN
~"'"....;n,,--.,;:.LI;:...PO.::...T:.;,;Rc:;.OP:....;I;.;,.N--4
gamma-MSH beta -MSH beta-END
......... alpha~H
1---01-----0
1----------------------------------~leoo
NH2 ....
265
PROENKEPHALIN
.......
MEME
...
ME ME-3
f...o-4
ME LE
~ I-t
ME-2
H
NH2 ....
,----------------------------------~leOOH
263
PEPTIDE F PEPTIDE I PEPTIDE B
1-------1 0------0------0
PRODYNORPHIN
alpha -NEO-END DYN 32

I-i 1-----1
NH2' I eOOH
256
Figure 42.1 Schematic structure of pro-opiomelanocortin.

proenkephalin and prodynorphin. The number of amino acids
present in the prohormone is indicated. beta-END beta-
endorphin; ACTH adrenocorticotrophic hormone; MSH
melanocyte stimulating hormone; LE : [LeuJenkephalin; ME
[MetJenkephalin; ME-2 : [MetJenkephalinyl-Arg-Phe; ME-3
[MetJenkephalinyl-Arg-Gly-Leu ; alpha-NEO-END : alpha-neo-
endorphin; DYN32 : dynorphin 32.
Dynorphins
Dvnorphins all contain the [LeuJenkephalin sequence but
are derived from a different precursor to proenkephalin.
that is, prodvnorphin (see Figure 42.1). Because of the
similarity of this precursor peptide to proenkephalin. it
is also known as proenkephalin B. Prodvnorphin contains
two opioid peptides : dynorphin 32 (32 amino acids) and
alpha-neo-endorphin (10 amino acids). Smaller fragments
of these peptides have also been isolated dynor-
phin(1-8). dynorphin A and dynorphin B. which represent.
OPIOID PEPTIDES AND THEIR RECEPTORS 451
respectively, sequences 1-8, 1-17 and 20-32 of dynorphin

32. and beta-neD-endorphin, which is alpha-neD-endorphin
without the C-terminal lysyl group.
DYnorphins are widely distributed. High concentrations
of peptides of the prodynorphin group are found in the
posterior lobe of the pituitary, the hypothalamus. the
spinal cord and the periphery, for example. in the nervous
plexus of the gastrointestinal tract.
OPIOID RECEPTORS
The opioid receptor is the receptor with which opiates and
opioids interact and which is blocked by naloxone. The
existence of several subtypes of opioid receptor was first
postulated in 1976 by Martin and his co-workers! on the
basis of the pharmacological profile of opioids in
neurophysiological and behavioural tests in the dog.
Three types of opioid receptors were proposed: - mu.
delta and sigma - for which the prototype agonists are
morphine. ketocyclazocine and N-allylnormetazocine (SKF
10047). respectively.
On the basis of pharmacological assays on guinea-pig
ileum and mouse vas deferens and binding assays in
guinea-pig brain. Kosterlitz and his co-workers 7 suggested
in 1977 that two types of opioid receptors are present
both in brain and in peripheral organs the mu-receptor
and the delta-receptor. interacting preferentially with
the enkephalins. The existence of other opioid receptor
types has been proposed: epsilon-receptors - selective
for beta-endorphin - in rat vas deferens 10 and brain l :
iota-receptors in dog and rabbit ileum'; lambda-receptors
- selective for 4.5-epoxymorphinans such as naloxone and
morphine - in rat brain 4 •
There is now firm evidence for the existence of three
different opioid receptors. the delta-. kappa- and
mu-subtypes. This conclusion is based mainly on the
results of binding assays in brain homogenates but is
parallelled by results obtained by in vitro assay systems.
such as the guinea-pig ileum and the mouse and rabbit vas
deferens.
The three main groups of opioid peptides seem to
possess selectivity for these three types of opioid
receptors. The enkephalins show preferential delta-
receptor activity. beta-endorphin is equally potent at
delta- and mu-receptors and the dynorphins interact pre-
ferentially with kappa-receptors 2 • Further studies are
needed to investigate whether there is a relationship
between the anatomical distribution of the three families
of opioid peptides and that of the three types of opioid
receptors. In vitro results suggest that there is a
relationship between the distribution of enkephalins and
delta-receptors. and between the distribution of
dYnorphins and kappa-receptors.
ROLE OF ENDOGENOUS OPIOID PEPTIDES

The pharmacological properties of the endogenous opioid
peptides resemble those of the opiates. They induce
analgesia. respiratory depression. hypothermia. beha-
vioural changes. alterations of endocrine secretions
and gastrointestinal motility: tolerance and dependence
occur with chronic administration. This variety of
effects. the wide distribution and other experimental data
suggest that endogenous opioid peptides could be involved
in the regulation of functions such as nociception.
cardiovascular and respiratory control. behaviour.
temperature regulation. gastrointestinal motility.
appetite and thirst. and several endocrine secretions.
Most work has been undertaken to determine a possible
role of endogenous opioid peptides in pain regulation.
Endogenous opioid peptides are probably involved in pain
regulation at the level of the periaqueductal grey matter
in the midbrain and of the dorsal horn of the spinal cord.
It is thought that the endogenous opioid systems involved
in pain control are relatively dormant under physiological
conditions. In stressful situations. however. endogenous
opioid peptides are released and they could then play a
role in the regulation of pain sensation: opioid peptides
OPIOID PEPTIDESANDTHEIR RECEPTORS 453
released from the anterior pituitary and adrenal medulla

could also be important.
References
1. Akil, H., Hewlett, W.A., Barchas, J.D. and Li, C.H.
(1980). Binding of JH-fi-endorphin to rat brain
membranes: characterization of opiate properties and
interaction with ACTH. Eur. J. Pharmacol. 64:1-8.
2. Akil, H., Watson, S.J., Young, E., Lewis. M.L. Kha-
chaturian, H. and Walker, J.M. (1984). Endogenous
opioids : biology and function. Ann. Rev. Neurosci.
7:233-255.
3. Cox, B.M. (1982). Endogenous opioid peptides : a
guide to structures and terminology. Life Sci.
31: 1645-1658.
4. Grevel, J. and Sadee, W. (1983). An opiate binding
site in the rat brain is highly selective for 4,5-epo-
xymorphinans. Science 221:1198-1201.
5. Hughes, J. (ed.). (1983). Opioid peptides. Br. Med.
Bu 11. 39: 1-100.
6. Kitchen, I. (1985). Endogenous opioid nomenclature:
1 ight at the end of the tunnel. Gen. Pharmaco1.
16:79-84.
7. Lord, J.A.H., Waterfield, A.A., Hughes, J. and Koster-
1itz, H.W. (1977). Endogenous opioid peptides
multiple agonists and receptors. Nature 267:495-499.
8. Martin, W.R., Eades, C.G., Thompson, J.A., Hupp1er,
R.E. and Gilbert, P.E. (1976). The effects of
morphine- and nalorphine-like drugs in the nondepen-
dent and morphine-dependent chronic spinal dog. J.
Pharmaco1. Exp. Ther. 197:517-532.
9. Oka, To (1981). Enkepha1 in (opiate) receptors in the
intestine. TIPS, Oecember:328-340.
10. Schulz. R., Faase, E., WUster, M. and Herz, A. (1979).
Selective receptors for fi-endorphin on the rat vas
deferens. Life Sci. 24:843-850.
43
Endorphin systems, pain and addiction
J.M. VANREE
ABSTRACT
Several endogenous peptides with morphine-like properties
(endorphins) are present in the pituitary, brain and
various peripheral tissues. The presently known
endorphins belong to three major families, arising from
three distinct systems pro-opiomelanocortin.
proenkephalin and prodynorphin. There is some evidence
that the opioid peptides belonging to a certain family can
activate a specific subclass of opioid receptors.
Endorphins may be concerned in motivational processes
implicated in pain sensation, pain tolerance and the
integrated response to pain and less in pain perception.
Multiple endogenous analgesic systems are present in the
body. Both neural and humoral pathwaYs and both opioid
and non-opioid substances play roles in the complex
modulation of pain transmission. These various systems
can be selectively activated by different environmental
manipulations. Endorphins have inherent addictive
properties and they have been implicated in reward
mechanisms in the brain. It is postulated that they may
facilitate "physiological" feelings of euphoria and lead
to a state of ecstasy, which may be an important factor in
addiction to various substances and habits.
455
INTRODUCTION
For many centuries it has been known that opium. derived
from the POppy plant. causes pain relief and euphoria.
This latter property is thought to be an important factor
in the addictive properties of opium'3. After the
discovery of morphine as the most effective analgesic and
addictive component of opium. morphine-related drugs have
been developed in order to separate the desired analgesic
and the undesirable addictive properties. Although these
attempts were not very successful. the structure-activity
relationship studies have revealed that specific opiate
receptors are present in the body. The existence of such
receptors was further supported by the finding showing
specific binding of opiates to brain tissue".
Subsequently. the presence of endogenous substances that
can interact with these receptor systems was postulated.
This suggestion accords well with the idea that animals
and humans have to a certain extent control over pain
sensation. It was found in 1975 that brain tissue
contains two pentapeptides. called enkephalins. that have
morphine-like properties as assessed using isolated tissue
preparat ions in vi t rob. Si nce t hen severa 1 pept i des wi t h
morphine-like action have been isolated from the brain and
other tissues. These substances are called endorphins
(endogenous morphine). Soon after their discovery these
peptides were implicated in pain-related mechanisms. in
chronic pain and various psychopathological disorders such
as psychosis. depression. mania and addiction. The
present survey will mainly focus on pain and addiction.
ENDORPHIN SYSTEMS
The several endorphins presently known belong to three
major families. arising from three distinct systems, each
containing a large precursor molecule of about 240 amino
acids. Enzymatic processing of this molecule can generate
peptide fragments with certain biological functions.
These fragments are. however. also precursor molecules for
smaller peptides with other biological activities. This
ENDORPHIN SYSTEMS, PAIN AND ADDICTION 457
illustrates the neuropeptide concept, that enzymatic

processing of peptide molecules can evoke specific
information enclosed in the molecule 4 • The three endorphin
systems are designated as pro-opiomelanocortin.
proenkephalin and prodynorphin (Table 43.1).
Pro-opiomelanocortin is located predominantly in the
pituitarY. but it is also present in neuronal pathways in
the brains. From the basal hYPothalamus (nucleus
arcuatus) and the brain stem (nucleus tractus solitarius)
these pathwaYs spread to several structures of the limbic
system and the brain stem. In addition. pro-opiomelano-
cortin is present in the gut and in peripheral nerves.
Enzymatic processing can release from pro-opiomelanocortin
the hormones beta-lipotropin (beta-LPH) and adrenocortico-
tropin (ACTH). Beta-LPH is further processed to the
opioid peptide beta-endorphin. which is the precursor
molecule for at least two other opioid peptides. alpha-
and gamma-endorphin. The structure of the N-terminal part
of these opioid peptides is identical to that of
(Met)-enkephalin. but this enkephalin is not derived from
these peptides.
Proenkephalin is located peripherally (for example. in
the adrenal medulla) and in widespread short neuronal
pathwaYs in the brains. Peptides belonging to this system
have been demonstrated. among other sites, in the basal
ganglia, hypothalamus. midbrain and spinal cord. Several
opioid peptides are derived from proenkephalin. These are
the pentapeptides (Met)-enkephalin and (Leu)-enkephalin.
but also larger sequences including (Met)-enkephalin-
Arg-Phe and BAM-22P.
Prodynorphin is also synthesized throughout the brain
ina wi de var i et y of neurona 1 Syst ems s • Ce 11 bodi es
containing this molecule are present in several cerebral
cortical areas. basal ganglia. hippocampus. brain-stem
areas and certain hypothalamic nuclei. including those of
the hypothalamic-hypophYseal neuronal pathwaY. The
N-terminal part of the sequence of the opioid peptides
derived from prodYnorphin. for example. dynorphin and
Table 43.1 Endorphins and opiate receptors
- Endorphins derived from Pro-opiomelanocortin (245 AA)

Alpha-endorphin (16 AA)
Gamma-endorphin (17 AA)
Beta-endorphin (31 AA)
St ruct ure
Tyr-Gly-Gly-Phe-Met
Prototype
Beta-endorphin
Opiate receptor
Mu (delta)
- Endorphins derived from Proenkephalin (239 AA)
(Met)-enkephalin (5 AA)
(Leu)-enkephalin (5 AA)
Heptapeptide (7 AA)
Octapeptide (8 AA)
St ruct ure
Tvr-Glv-Glv-Phe-Met (or Leu) ...
Prototype
Met/Leu-enkephalin
Opiate receptor
Del ta (mu)
- Endorphins derived from Prodynorphin (236 AA)
Dvnorphin (8 AM
Beta-neo-endorphin (9 AA)
Alpha-neo-endorphin (10 AA)
Dvnorphin (17 AA)
"New" big dynorphin (29 AA)
Structure
Tvr-Glv-Glv-Phe-Leu
Prototype
Dvnorphin
Opiate receptor
Kappa
AA = Amino acids
alpha- and beta-neo-endorphin. is identical to that of

(Leu)-enkephalin. In the brain the prodYnorphin and
proenkephalin systems are often anatomically contiguous.
which may suggest that these peptides participate in a
number of related brain functions.
Several subpopulations of opioid receptors have been
proposed. Some information is available that the opioid
peptides belonging to a certain family can activate a
specific subclass (see Table 43.1) beta-endorphin may
activate the mu-receptor. but also the delta-receptor.
enkephalins may activate the delta and to some extent the
mu-receptor. while dYnorphin may activate predominantly
the kappa-receptor'9. However. the exact relationship
between these subclasses of opioid receptors and the
physiological roles of the different opioid peptides have
so far not clearly been elucidated.
When injected into bodY fluids. beta-endorphin is the
most potent peptide in mimicking morphine-like actions.
The other endorphins are also active. but more of these
peptides is needed. presumably because of the more rapid
degradation of the shorter endorphins. Accordingly.
enkephalin analogues such as FK 33-824 which are less
susceptible to enzymatic degradation than (Met)-
enkephalin. are indeed more potent in eliciting
morphine-like actions in vivo. Intracerebroventricularly
injected beta-endorphin induces antinociception.
hypothermia. hormonal changes. excessive grooming. and at
higher dose levels profound immobilization and muscular
rigidity'·. Most. i f not all. of these effects are
mimicked by morphine and related drugs and are blocked by
the specific opiate antagonists naloxone and naltrexone.
Beta-endorphin also shows common actions with
morphine-like drugs after repeated administration. Thus.
tolerance develops to the effect of beta-endorphin on pain
perception following repeated treatment". Chronic
administration of beta-endorphin induces physical
dependence. characterized by opiate withdrawal symptoms' s •
Low doses of beta-endorphin causes self-injecting
behaviour. indicating inherent addictive properties t • •

Most of these effects are. however. elicited by injecting
rather high doses as compared to the amount of
beta-endorphin available in the brain. and can therefore
be considered as pharmacological rather than physiological
actions.
ENDORPHINS AND PAIN

Opioid receptors and various endorphins are present at
different levels of the spinal cord and in brain pathways.
activated by painful stimuli and involved in pain
detection. pain sensation. tolerance to pain and the
response to pain. Different strategies have been followed
to studY the significance of endorphins for pain-related
mechanisms. for example. antagonizing the opiate action of
endorphins by opiate antagonists or by specific antisera
which inactivate the physiologically available endorphins:
the administration of endorphins or the release of
endogenously available endorphins during pain; measurement
of endorphin levels in body fluids in the presence and
absence of pain.
The studies with the opiate antagonists in both animals
and humans do not indicate a major role of endorphins in
pain perception. In general. these substances failed to
affect pain threshold of animals and humans without pain.
However. when pain is present certain effects of naloxone
have been described. which may suggest that pain may
activate endorphin systems. The behavioural changes
elicited by pain stimuli in animals and the pain sensation
of humans are faci 1 i tated by nal oxone 7 • The diurnal
rhythm of the response to pain stimuli is absent after
treatment with opiate antagonist. It has been suggested
that endorphins are implicated in motivation and adaptive
behaviour. Thus. the endorphins may be more concerned in
motivational processes implicated in pain sensation. pain
tolerance and the integrated response to pain than in pain
perception.
As mentioned previously. endorphins. especially
beta-endorphin. produce long-lasting analgesia when

injected into the cerebrospinal fluid. As with morphine.
both the perception of pain and the response to pain are
diminished. Several procedures have be~n applied to
mobilize the endogenously available endorphins. These
procedures include electrical stimulation of certain brain
structures. stress-inducing stimuli (such as
immobilization> and acupuncture and transcutaneous nerve
stimulation. Electrical stimulation of structures in the
brain-stem of animals and patients with chronic pain
results in release of endorphins into the cerebrospinal
fluid and in pain relief without sedation. which can
partly be blocked by opiate antagonists t • Severe
stress-inducing stimuli may be followed by a period of
analgesia. which is abolished by removal of the pituitarY
and can partly be antagonized by opiate antagonists.
There is evidence that acupuncture analgesia. induced by
mechanical manipulation (classical) or electrical
stimulation of the needles (electro-acupuncture). is
accompanied by release of endorphins in body fluids and
may be sensitive to treatment with opiat~ antagonists 5 •
These data suggest a certain relation between the
mobilization of endorphins in the body and pain relief.
Some patients suffering from chronic pain have a lower
level of endorphin-like material in the cerebrospinal
fluid as compared to healthy subJects t2 • This lower level
was particularly apparent in patients with organic pain
syndromes. Subnormal levels have been reported in
patients with headache and with chronic pain. These
findings. together with the increased endorphin levels
after some procedures resulting in pain relief. suggest
that a low level of endorphins may be related to some
pain syndromes. However. the available data do not allow
definite conclusions to be drawn in this respect.
Several procedures exist to treat clinical pain. Most
of them were developed before information about endogenous
systems involved in pain control became available.
Evidence has been presented for multiple endogenous
analgesia systems· 7 • Both neural and hormonal pathwaYs

and both opioid and non-opioid substances play roles in
the complex modulation of pain transmission. These
various systems can be selectively activated by different
environmental manipulations. For example. the
neural-opioid system may be activated by morphine
treatment and the hormonal-opioid system by stress.
classical acupuncture and variants of acupuncture. such as
the twitch procedure in horses. which calms down the
animals and activates pain-decreasing mechanisms 9 •
Electrical brain stimulation may activate both
neural-opioid and neural-non-opioid systems. while
transcutaneous nerve stimulation may enhance activity in
opioid or non-opioid systems. depending on the type of
stimulation.
ENDORPHINS AND ADDICTION

Repeated administration of psYchoactive drugs may lead to
a state of drug dependence characterized by the drug user
exhibiting erratic behaviour leading specifically to
further administration of the drug. Severe degrees of
dependence are commonly labelled as addiction.
particularly in clinical practice. Extensive studies in
animals have revealed that the self-administration
technique. in which drug administration is contingent on
the occurrence of a prior response. is a useful method to
predict the abuse potential of drugs. It establishes the
reinforcing (rewarding) efficacy of drugs and is reliably
applicable to evaluate the variables that interfere with
drug-taking behaviour' 3 • Morphine and related drugs are
abused. self-administered and interfere with brain reward
mechanisms. The presence of endorphins in the pituitary
and brain led to the postulate that these peptides may be
involved in the functioning of phYsiological systems that
are implicated in reward and which are susceptible to
narcotic drugs. Thus. the endorphins may have intrinsic
reinforcing efficacy and may mediate or modulate brain
reward. which can be studied by intracranial electrical
self-stimulation.
Beta-endorphin has been found to support self-admini-
stration when administered intracerebroventricularly16.
The same has been reported for synthetic enkephalin
analogues that are resistant to enzymatic breakdown.
Thus. beta-endorphin and enkephalin analogues can serve as
positive reinforcers. Other data suggest that these
peptides also possess discriminative internal stimulus
properties similar to·those of narcotic drugs. Both the
positive reinforcing and the discriminative stimulus
properties of beta-endorphin indicate that this peptide
may exert powerful control over behaviour. This action of
beta-endorphin may be mimicked by narcotic drugs. and in
this way organisms may become dependent on these drugs.
The involvement of endorphins in reward is suggested by
the decreasing influence of opiate antagonists or brain
electrical self-stimulation. This may suggest that
endorphins are also implicated in dependence with other
than narcotic drugs and in reward mechanisms in general.
It has been shown that blockade of opioid receptor systems
with opiate antagonists decreases the reinforcing effects
of ethanol. In alcoholics. the concentration of
beta-endorphin in the cerebrospinal fluid was markedly
decreased as compared to that of normal individuals. In
addition. other brain endorphins. such as enkephalins.
have been implicated in drug addiction especially with
ethanol consumption in experimental animals 2 • Naloxone
has been reported to reduce the amount of cigarettes
smoked by chronic smokers. Nicotine has been shown to
increase the plasma level of beta-endorphin lD • Thus.
endorphins may be a common factor in drug dependence.
The involvement of endorphins in brain reward and drug
dependence permits questions to be raised as to whether
these entities are involved in the functioning of
phYsiological systems involved in euphoria. a feeling of
wellbeing. Certainly. euphoria can be induced or
facilitated by many addictive drugs, even resulting in a
state of ecstasy or trance. but feelings of wellbeing
(phvsiological euphoria) are also present after a good

performance. delicious meals. sexual behaviour and
enJovable social contacts among others. There is some
evidence that endorphins are indeed implicated in food.
sexual and social behaviour; for example. beta-endorphin
facilitates social contact behaviour of animals. However.
whether this and other endorphins mediate the euphoria of
these behaviours is not vet known.
CONCLUSION
Endorphin svstems are implicated in several mechanisms
controlling pain. which are present in the brain as well
as in the spinal cord. The endorphin svstems can be
activated by procedures such as stress. electrical
stimulation and acupuncture. resulting in relief of pain.
Different endorphin svstems and various types of opioid
receptors are present in the brain, but their distinct
role in processes involved in pain is still under debate.
Developing substances or procedures that can selectively
activate one of the endorphin svstems or one of the
non-opioid analgesic svstems mav lead to a more
goal-directed treatment of the svmptom pain. a frequentlv
occurring symptom and sometimes markedlv resistant to
treatment.
Endorphins mav also be concerned in dependence not onlv
for morphine-related drugs but also for other addictive
drugs. In particular. thev mav be implicated in brain
reward mechanisms and "physiological" feelings of
euphoria. Excess of endorphins mav lead to a state of
ecstasv or trance. which mav be an important factor in
addiction to various substances and habits. In view of
the properties of morphine-related drugs, analgesia and
addiction, which can hardlv be separated. it may be
proposed that a balanced system is operative in the body,
characterized bv the continuum affection(anhedonia)-
dvsphoria(pain)-euphoria-ecstasv, in which endorphins may
plav a profound role. Morphine and endorphins mav move
the continuum to the right, and when this happens
frequently addictive behaviour may occur. This could

suggest that addiction to endogenously available
endorphins would be possible (for example, gambling) and
that (mental or physical) pain and dYsphoria-inducing
situations would facilitate the release of endorphins in
order to restore the balance. Chronic exposure to these
latter situations may result in abundant release of
endorphins and addictive-like behaviour may be elicited.
An example of such a process may be the development of
stereotyped behaviour of tethered sows. induced by the
housing conditions in present use J • This stereotyped
behaviour can be markedly decreased by treatment with
naloxone.
References
1. Basbaum. A.!. and Fields, H.L. (1984). Endogenous
pain control systems : brainstem spinal pathways and
endorphin circuitry. Ann. Rev. Neurosci. 7:309-338.
2. Blum. K. (1984). Psychogenetics of drug seeking
behaviour. In MUller. E.E. and Genazzani. A.R.
(eds). Central and Peripheral Endorphins: Basic and
Clinical Aspects. pp.339-356. New York: Raven Press.
3. Cronin. G.M •• Wiepkema. P.R. and Van Ree. J.M. (1985).
Endogenous opioids are involved in abnormal
stereotyped behaviours of tethered sows.
Neuropeptides 6:527-530.
4. De Wied. D. (1977), Peptides and behavior. Life Sci.
20: 195-204.
5. Han. J ,So and Terenius. L. (1982). Neurochemical
basis of acupuncture analgesia. Ann. Rev. Pharmacal.
Toxicol. 22:193-220.
6. Hughes. J •• Smith. T.W •• Kosterlitz. H.W •• Fothergill.
L.A •• Morgan. B.A. and Morris. H.R. (1975).
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7. Jacob. J.J.C. and Ramabadran. K. (1981). Role of
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Watson. S.J. (1985). Anatomy of the CNS opioid
systems. TINS March:111-119.
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J.M. (1984). The twitch in horses: a variant of
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10. Pomerleau. O.F. and Pomerleau. C.S. (1984). Neuro-
regulators and the reinforcement of smoking: towards
a biobehavioral explanation. Neurosci. Biobehav. Rev.
8:503-513.
11. Teren i us. L. (1973). Charact er i st i cs of the "recep-
tor" for narcotic analgesics in synaptic plasma

membrane fraction from rat brain. Acta Pharmacol.
Toxicol. 33:377-384.
12. Terenius. L. (1978). The implication of endorphins in
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L. (eds). Characteristics and Function of Opioids.
pp.143-158. Amsterdam Elsevier/North Holland
Biomedical Press.
13. Van Ree. J.M. (1979). Reinforcing stimulus properties
of drugs. Neuropharmacology 18:963-969.
14. Van Ree. J.M. and De Wied. D. (1983). Behavioral
effects of endorphins: modulation of opiate reward by
neuropeptides related to pro-opiocortin and
neurohypophyseal hormones. In: Smith. J.E. and Lane.
J.D. (eds). The Neurobiology of Opiate Reward
Processes. pp.109-145. Amsterdam: Elsevier Biomedical
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15. Van Ree. J.M •• De Wied. D•• Bradbury. A.F •• Hulme.
E.C •• Smyth. D.G. and Snell. C.R. (1976). Induction
of tolerance to the analgesic action of lipotropin
C-fragment. Nature 264:792-794.
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C-fragment (n-endorphin) : evidence for its internal
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endogenous opiate and nonopiate pain control systems.
Science 216:1185-1192.
18. Wei. E. and Loh. H. (1976). Physical dependence on
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Neuropharmacology 21:487-497.
44
Opioid effects on gastrointestinal motor and
secretory functions
Y. RUCKEBUSCH AND G. SOLDANI
ABSTRACT
The term "opioid" refers to morphine. simi lar synthetic
drugs (opiates) and exogenous or endogenous opioid
peptides (EOP). and it corresponds to substances which
share. in common, modulation of nociceptive processes and
regulation of gastrointestinal (GI) functions. Opioids
strongly affect gastric and colonic motility in
non-ruminant species, resulting in a delayed gastric
emptying and constipation. The main site of action is
peripheral and involves cholinergic and non-cholinergic
enteric neurones rather than the muscle cells.
Opioids can stimulate gastric secretion via the release
of histamine or gastrin and by increasing mucosal blood
flow rather than by a primary action on the parietal
cells. However, there is also a strong inhibition of acid
secretion by delta and mu opioid agonists which is mainly
centrallY mediated via a reduction in the vagal tone. The
anti-secretory effects of opioids on pancreaticobiliary
and intestinal secretions are also centrally mediated,
possibly through decreased vagal activity and increased
sympathetic activity on the proximal part of the small
intestine.
467
INTRODUCTION
Any coherent picture of the imposing amount of data on
gastrointestinal motility and secretions as affected by
opioids must take into account considerable species
differences. These have long been known in the effect of
morphine and similar drugs on the central nervous system
(CNS). for example, excitation and mydriasis in horse.
cattle and cats versus sedation and myosis in dogs and
rodents as described in 1898 by Guinard·. The use of
inbred strains of mice has confirmed the genetic influence
on the density of opiate receptors and their subtypes 13 •
The mode of action of opioids on gastrointestinal motility
patterns in carnivores and rodents has been recently
reviewed. The effects range from inhibition of propulsive
activity via the release of acetylcholine and substance P
from enteric neurones in the guinea-pig ileum to a
spasmogenic action via increased release of acetylcholine
and/or serotonin (5-hydroxytryptamine. 5-HT) in the ileum
of most species. The abolition of naloxone-induced
withdrawal diarrhoea by indomethacin and 5-HT suggests
that 5-HT and prostaglandins (PG) are involved in the
antidiarrhoea1 activity of EOP2. On the other hand.
suppression of the EOP antisecretory activity by
adrenergic agonist pretreatment indicates participation
of the sympathetic nervous system 4 • either locally or at
the spinal cord 1eve1 17 •
In this chapter, special attent ion wi 11 be given to the
opioid effects on digestive functions of herbivores as
compared to carnivores, the former group including species
with enlargement for plant fibre fermentation of the
foregut (ruminants) or the hindgut (rabbi t. horse). These
will be contrasted with the effects in rats. the species
in which the majority of studies on secretory functions
have been carried out.
MOTOR FUNCTIONS
Oesophagus
The oesophagus smooth muscle is richly supplied with
OPIOID EFFECTS ON GI MOTOR AND SECRETORY FUNCTIONS 469
adrenergic. cholinergic and peptidergic (vasoactive

intestinal polypeptide. VIP)-containing nerves. In cattle
subjected to rumen insufflation. naloxone and methylr
naloxone increase the volume of gas expelled without
changes in ruminal motility. and these drugs alleviate gas
accumulation resulting from the inhibition of reticulo-
ruminal cycles by morphine and loperamide. Furthermore.
the alpha2-adrenoceptor blocker. tolazoline. reduced the
bloating effect in cattle. but not in sheep, of morphine
or loperamide when given systemically, a finding in agree-
ment with the recent claim of involvement of adrenoceptors
in the effect of morphine 25 •
Stomach
Reduction of antral spike electrical activity and, at
higher doses. gastric relaxation, is a common effect of
morphine and fentanyl in dogs. The effects are blocked by
naloxone. Fentanyl. unlike morphine. does not elicit
vomiting in dogs. but like morphine, induces regular
spiking activity (RSA)-like events on the proximal
duodenum followed by a period of quiescence.
Pylorus
Duodenal acidification induces pyloric closure associated
with duodenal contractions which are blocked by naloxone
and atropine. respectively'4. In sheep. both tonic and
phasic contractions of the pylorus are likewise associated
with duodenal activity elicited by an opioid peptide
agonist. dermorphin. or following an enkephalinase inhi-
bitor. thiorphan.
Forestomach
The inhibition of reticulorumen cyclical contractions by
mu opiate agonists given systemically is similar to the
effect of alpha2-adrenoceptor agonists in that it does not
affect the secondary ruminal contractions which depend on
the enteric nervous system (ENS)". thus it indicates a
centrally mediated effect. Evidence for a central opioid
inhibitory system involved in the reticular contractions

associated to a regurgitation and subserved by mu and
delta receptor subtypes has been documented t ' . The
classical competitive antagonism between morphine and
nalorphine of respiratory movements in rabbits has also
been found between fentanyl-ethylketazocine concerning the
frequency of reticular contractions in sheep.
Sma I lin t est i n e

The major effect of several opiate agonists like fentanyl
or D-Ala 2 -D-Leu'-enkephalin (DADLE) administered centrally
is an inhibition of motility corresponding to a
supraspinal inhibition of the intestinal motor
functions 20 • The motor effects of intraluminal opioids
(loperamide) on the small intestine or the release of
endorphin (END) into the systemic circulation consist of
an increased motor activity with for beta-endorphin in
dogs. a regional specificity of enzymatic processing 7 •
These effects are blocked by atropine or tetrodotoxin
pretreatment in dogs. but not in ruminants. in which.
because of the length of the bowel and the large amount of
contents. minimal changes in the motility index are
accompanied (in sheep) by dramatic changes in the net flow
of digesta.
Large intestine
The existence of differential affinity of the proximal
versus distal colon for mu. kappa or delta opiate agonists
with considerable species differences is becoming more
apparent t . • t 2 . As shown in Fi gure 44.1. the d i sta I port ion
of the rabbit colon exhibits an opposite response.
compared to the proximal colon. to the EOP dynorphin.
This stimulatory effect of a kappa agonist on the distal
colon is lacking in the dog where mu opiate agonists have
stimulatory effects instead. In the horse. opioids. after
a shortlived stimulation of the replicated colon have a
dose-related inhibitory effect which resembles that
obtained in other species t • •
r
PROXIMAL COLON
I.e .v . • IOcm .,
Il l~I~ 1 ~I ~ I ~I,I
PROXIMAL COLON
109
16
DISTAL COLON "C

Rectum .IOem
-
DYNORPHIN
2.5 nmoles . k~· I min"
30 min,
t DERMORPHIN
5 nmoles . k,;r'I.V
Figure 44.1 Stimulation of rabbit distal colonic electri-

cal activity (integrated record) by dynorphin and of
canine distal colon (mechanical activity) by dermorphin.
SECRETORY FUNCTIONS
Gastric secretion
Although Riege1 t5 described an excitatory effect of
morphine on gastric acid secretion as early as 1900.
opiates are usually considered inhibitors of gastric
secretion. Using the mu opioid agonists dermorphin and
morphine. we have found a significant increase in acid
secretion in dogs 24 • These stimulatory effects were
prevented by naloxone and also by peripheral opioid
antagonists. However. dermorphin did not modify acid
output stimulated by 2-deoxy-0-g1ucose (20G) from gastric
fistulae. while morphine significantly inhibited it
(Figure 44.2). These results may thus be explained. as for
c10nidine 23. on the basis of simultaneous yet opposite
effects of opioids on interdependent regulatory pathwaYs
in the stomach. This involves inhibition related to im-
pairment of the vagal tone and excitation related to a di-
rect stimulation of peripheral opioid receptors. This. in
turn. increases mucosal blood flow. induces the release of
histamine and gastrin. and inhibits somatostatin release.
GF 7'f
••.
~
E
HP
plriodl 115 mIn I ,,~.iod!lo 11!!1 "",nl
Figure 44.2 Effects of dermorphin or morphine on 2DG-sti-

mulated gastric acid secretion from gastric fistulae (GF)
and Heidenhain pouch (HP) dogs. Note that morphine
possesses two simultaneous yet opposite effects (inhibi-
torY and excitatory) on vagally stimulated secretion
(*P < 0.01>.
Pancreatic secretion
Opiates generally have direct inhibitory effects on both
bicarbonate and enzyme secretion. For example, methadone
inhibits both bicarbonate and protein output induced by
vagal stimulation. whereas the effects of direct
cholinergic stimulation remain unchanged ta • Since the
intracerebroventricular administration of doses of
D-Ala 2 -O-Met'-enkephalin (OAMA) which are inactive by the
systemic route strongly inhibits both basal and
20G-stimulated secretion'. and this effect is not blocked
by methylnaloxone. it seems that the inhibitory effects on
pancreatic secretion resemble those on gastric secretion
and likewise involve a vagal pathway at the central
I eve I' •
Intestinal secretion
Morphine inhibits PG-induced and VIP-induced secretion by
the rat jejunum in vivoto. Similarly, loperamide
increases absorption and inhibits secretion provoked by
prostaglandins and Escherichia coli enterotoxin in
isolated rabbit i leal mucosa'. Such an antisecretory
effect has been also observed for morp~ine in E. coli
enterotoxin-exposed pig jejunum 27 • The fact that the
effects of morphine on short-circuit current are increased
by the presence of low Ca 2 + bathing solution on the
serosal surface indicates that the opiates alter
intestinal transport by Ca 2 + or calmodulin-dependent
mechanisms. Accordingly. loperamide and diphenoxylate
possess a high affinity for calmodulin binding sites, the
potency in binding calmodulin being correlated to their
antidiarrhoea I act i vi t y2b •
DISCUSSION AND CONCLUSIONS

Concepts of an EOP system in the gastrointestinal tract
are closely linked to the roles of neuropeptides
ENK-like peptides located in the ENS and END-like peptides
in the CNS and adrenals. Whether different receptors
subserve different functions in the gastrointestinal tract
remains to be determined. except that the occupation of
opiate receptor sites within the villus core and
intestinal glands leads to profound effects on the
handling of fluid and electrolytes', and the occupation of
receptors within the ENS leads to changes in the motility
patterns. Since the potency of intracerebroventricular
morphine in inhibiting gastrointestinal transit is about
50 times that when given intravenously, and this effect
can be blocked by vagotomy, it has been concluded that
morphine produces most of its motor effects by acting
supraspinally via the vagal nerves. The fact that the
synthetic opiate agonists diphenoxylate and loperamide,
given intraluminally, are selective for peripheral
gastrointestinal opiate receptors suggests that peripheral
effects are also important. The use of opiate receptor
474 COMPARATIVEVETERINARYPHARMACOLOGY, TOXICOLOGYANDTHERAPY
antagonists which do not cross the blood-brain barrier to

a large extenpt , 2 4 . in conjunction with agonists acting
on the eNS. represent interesting means of dissociatirrg
the centrally mediated effects from those corresponding to
local effects via the ENS. Recently. the synthetic
enkephalin analogue (Hoe 825). a mixed mu-delta opiate
agonist. was shown to cause. in dogs. the appearance of a
premature myoelectric migrating complex. These
stimulating effects were of peripheral origin since this
opioid peptide does not penetrate into the CNS. They were
prevented in part (70%) by atropine and fully suppressed
by naloxone 3 • Thus the EOP can stimulate small intestinal
motility by enhancing acetylcholine release and by a
direct action on muscle. and these stimulating effects
might be of therapeutic benefit for treating humans under
conditions where gastrointestinal motility is diminished
or absent.
Prevention of the influx of Ca 2 • in epithelial cells by
opioid agonists such as loperamide results in an
inhibition of the propulsion of fluid through the gut • 22
hence th~ possibility of the existence of a peripheral

mechanism in the inhibition of secretory functions by EOP.
However. the intestina1 4 and pancreatic' antisecretory
activity of opiates administered into the CNS is also
relevant. and furthermore. its adrenergic mediation via
the spinal cord is likely. It is thus tempting to
speculate that the motor functions of the gastrointestinal
tract are modulated by the opiates peripherally and via a
parasympathetic pathwaY at the supraspinal level. while
the modulation of secretory functions by opiates also
involves peripheral receptors but works at the spinal
level via a sympathetic pathway. This indicates that the
EOP can work both centrally and peripherally and that the
major site of action would depend on species-specific
differences in the location and types of receptors. and in
the autonomic nervous system as well.
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45
Central nervous system control of feeding
behaviour by some neuropeptides in sheep
1. BUENO. c. RONDE. A. DURANTON AND J. FIORAMONTI
ABSTRACT
The hypothalamus is a major site responsible for the
control of food intake. Many peptides are able to modify
feeding behaviour when centrally administered in sheep.
They may be classified into two categories: (1) CCKB, CRF
and ~alcitonin which reduce food intake by affecting the
rate of eating (CCKB), the frequency and the duration of
meals (CRF. calcitonin), while the gastrin group of pep-
tides promotes rumination; (2) GRF and CGRP which increa-
se food intake by delaying satiety.
INTRODUCTION
The hypothalamus is a major site responsible for the
integration of information in the regulation of energy
balance. From the pioneering work of Della-Fera and
Baile', showing that centrally administered cholecysto-
kinin-octapeptide (CCKB) exerted anorectic effects in
sheep. much information has been accumulated concerning
the involvement of neuropeptides in the control of food
intake in sheept~ : the CCK family of peptides initiates
satiety and opioid peptides (enkephalins, beta-endorphin
and dynorphin) increase feeding. However. separation into
these two classes is not wholly satisfactory in view of
recent findings. For example. naloxone. an opioid mu and
477
delta receptor antagonist, does not reduce food intake as

expected but, in contrast, can block the anorectic effects
of centrally administered CCK8 and it antagonizes the
inhibitory effect of CCK8 on postprandial ruminoreticular
mot i 1 it y in sheepl.
We report herein the results of experiments performed
to determine the nature of behaviour disturbances respon-
sible for short-term anorexia produced by some peptides
administered centrally to hay-fed animals.
CCK8 AND GASTRIN GROUP PEPTIDES

Mammalian brain extracts contain peptides which cross-
react in gastrin radioimmunoassay, the majority of this
immunoreactivity being due to the presence in such brain
extracts of a peptide mainly corresponding to the C-ter-
minal octapeptide of cholecystokinin.
However. using a sequence-specific radioimmunoassay,
the presence of a smaller molecular form probably corres-
ponding to the C-terminal tetrapeptide common to gastrin
and CCK has been identified in brain extracts of rats 12 •
The comparative influence of these peptides administe-
red centrally was analysed in Lacaune ewes (50-60 kg)
equipped with a stainless steel cannula 29 mm in length
and 1-2 mm in diameter inserted into one of the cerebral
ventricles l •
Figure 45.1 summarizes the influence of these treat-
ments on feeding behaviour and permits the conclusion that
gastrin group peptides (tetragastrin, pentagastrin and
gastrin 17), but not CCK8, administered intracerebroven-
tricularly reduced food intake from 0 to 120 min after
their administration by promoting an early rumination.
This finding suggests that the C-terminal tetrapeptide or
a smaller form is the probable fragment of gastrin 17
responsible for this action.
In contrast. CCK8 affected food intake by reducing the
rate of ingestion over 3 h of feeding without affecting
rumination l • The lack of an immediate anorectic effect
of CCK4. compared to CCK8, reinforces previous results
CNS CONTROL OF FEEDING BEHAVIOUR BY SOME NEUROPEPTIDES IN SHEEP 479
FOOO INTAKE
400 400 1500
300 300
200
100 100
o o oj
RATE OF INGESTION TIME OF RUMINATION o CONTROL (vehicle)
6
200
E3 TETRAGASTRIN
EII] PENTAGASTRIN
4
[J] GASTRIN 17
100 Illl§I CCK 8
ImllI CRF
* P < 005
o o ** P < 001
Figure 45.1 Comparative effects of intracerebroventricu-

lar (ICV) administration of tetragastrin. pentagastrin.
gastrin 17. CCK8 and CRF on feeding behaviour in hay-fed
ewes (mean ± SD: experiments in duplicate in six ewes).
Note that gastrin group peptides induced premature rumina-
tion. while CCK8 and CRF affect food intake by reducing
the rate of ingestion and the time spent eating respecti-
vely.
showing that the satiety properties of CCK8 are associated

with the presence of a sulphydryl bond and that CCK4 in
the brain is more representative of the gastrin peptides
than the cholecystokinin residue.
CORTICOTROPIN-RELEASING FACTOR AND CORTISOL

A peak of plasma corticoids has been found just prior to
feeding". and treatment with glucocorticoids results in
an increased appetite 7 • These observations suggest that
plasma glucocorticoids interact with feeding behaviour.
but the specific nature of the site and mode of action.
whether peripheral or central. remain unknown!'.

Recently we have shown' in sheep as previously found in
rats!6 that CRF administered intracerebroventricularly
induces rapid anorexia by limiting the time spent eating
(Figure 45.1).
Using a similar methodology to that for comparing the
effects of CCK8 and gastrin group peptides. we have tested
the effects of intracerebroventricular versus intravenous
administration of cortisol injected at 9.00 or 12.00 h.
Furthermore. we have evaluated the nature of the action of
cortisol by measuring the effects of its administration on
CRF-induced anorexia and plasma cortisol levels.
Cortisol administered intracerebroventricularly at a
dose of 40 ng/kg at 9.00 h prior to feeding did not affect
the first hour food intake but increased (P < 0.01) by
29.4% the 3 h (morning) food intake without affecting the
daily consumption or the rate of ingestion. A similar
increase (31.9%) in afternoon food intake was observed
when cortisol was injected intracerebroventricularly at
noon and this also resulted in an increase in daily food
intake. Cortisol (40 ng/kg) administered intracerebro-
ventricularly 5-10 min before CRF (100 ng/kg) partially
reduced the first 30 min period of anorexia induced by
CRF. abolished the 2 h effects and restored to normal
rumination altered by CRF.
These results are in agreement with the observation
that corticoids interact permissively with noradrenaline
injected into paraventricular nuclei (PVN) to elicit fee-
ding!', while CRF suppressed feeding induced by noradre-
naline!·. The existence of steroid-sensitive single neu-
rones in the hypothalamus and midbrain has been demonstra-
ted!7 and corticoid-induced behavioural effects are
observed independently of the feedback effect of plasma
hormonal level on the hypothalamo-pituitary adrenocorti-
coid (HPA) system 2 or spontaneous variations·. The present
results indicate that cortisol interacts in the brain at a
site involved in the control of food intake in sheep
independently of its feedback action on the HPA system.
CALCITONIN AND CALCITONIN GENE-RELATED PEPTIDE (CGRP)

Calcitonin is considered to be one of the major factors
concerned in satiety'-". Calcitonin gene-related peptide
(CGRP), a product of alternative processing of RNA trans-
scripts, to form the calcitonin gene, has been found in
the brain ' and mRNA encoding CGRP is found in several
brain nuclei important in ingestive behaviour. Centrally
administered CGRP inhibits both spontaneous and starva-
tion-induced food intake in rats l4 but only with a 1000
times higher dose rate than calcitonin, and with a low
ratio (1:2) between intracerebroventricular and intrave-
nous administration.
In sheep, intracerebroventricular calcitonin at a dose
level of 2-200 mU/kg, reduced, in a dose-related manner,
the immediate (0-60 min) food intake. The daily food
intake was also significantly (P < 0.05) decreased with
doses up to 20 mU/kg. In contrast, CGRP given intracere-
broventricularly did not affect the first 3 h period of
food intake. while a significant increase (27.8%) in daily
food intake was observed at a dose of 20 ng/kg. Further-
more, CGRP given intracerebroventricularly (100 ng/kg) did
not antagonize the immediate anorectic effects of calc ito-
nin (200 mU/kg), although it delayed commencement of rumi-
nation and partially restored the daily food intake
(Figure 45.2).
The fact that CGRP increases food intake in sheep, at
doses as low as 20 ng/kg intracerebr~ventricularly, con-
trasts with the anorectic action observed in rats , for
intracerebroventricular doses of 1-10 Ug by Krahn et al. 14
emphasizing the species differences in action. The hypo-
thesis that these two peptides affect food intake by ac-
ting selectively on two parts of the hypothalamus is not
in agreement with our observations that CGRP failed to an-
tagonize the early (0-180 min) anorectic effect of calci-
tonin and produced a slight immediate (0-60 min) inhibi-
tion of food intake at the highest intracerebroventricular
dose (100 ng/kg).
Finally, it is tempting to speculate from our results
FOOD INTAKE
O_I80IIIln Totol
O_flOIIII"
600 1200
800
400 400
..
200
o o
RATE OF INGESTION TIME OF RUMINATION
D
7
CONTROL<_l
6
5 I11III CALCITONN(IOO mU/kg ICV)

..
i
....
4
~ CALCITCHII (100 mU/ kg ICV)
~.cGRP (100 ng/ kg ICV)
2
* P <005
Figure 45.2 Influence of intracerebroventricular admi-

nistration of calcitonin with or without previous intra-
cerebroventricular injections of CGRP on feeding behaviour
in Sheep (means ± SO, n = 6).
that CGRP increases food intake When centrally administe-

red at relative low doses by (1) inhibiting the release or
the synthesis of calcitonin and/or its precursors by the
thyroidal "C" cel Is; or (2) affecting the structure of
hypothalamic receptors for calcitonin.
GROWTH HORMONE RELEASING FACTOR AND DOPAMINE

GRF immunoreactivity has been found in rat hypothalamus,
being localized in neurones bordering the ventromedial
hYPothalamic nucleus l9 • It has recently been Shown in rats
that intracerebroventricular administration of hPGRF and
rhGRF stimulates food intake in rats 2D • The increased
milk production observed in cows injected with GRF has
prompted us to investigate the effects of GRF on short-
60-'80 min TOTAL

€OO 600 2000
hay conc
conc.
~400 400 hay conc.

W
~
<
f-
Z !
o 200 200
o
ou.
o o o
DCONTROL ~ hp GRF I _44 (O.l pg/kg ICV)
Figure 45.3 Effect of central intracerebroventricular ad-

ministration of hGRF t - 44 on food intake level and profile
in hay and concentrates-fed ewes (mean ± SO. n = 4).
term satiety in sheep submitted to two different feeding

regimens hay and concentrates. In hay-fed sheep, GRF
administered intracerebroventricularly at a dose of 0.1
~g/kg did not affect (0-60 min) food intake significantly
(P > 0.05) while a 25.5% increase was noticed over the 3 h
post-treatment. This effect mainly corresponded to an
increased number and duration of meals without affecting
the rate of ingestion or the occurrence of rumination. In
concentrate-fed animals only the early (0-60 min) food in-
take was increased while no effect was observed on the to-
tal daily consumption (Figure 45.3). As previously obser-
ved for the gastrointestinal motor effects4, the orectic
action of GRF on hay-fed animals was abolished when admi-
nistered after intravenous administration of metocloprami-
de suggesting a mediation through dopaminergic receptors.
CONCLUSIONS
It is clear that several brain peptides play important
roles within the CNS in the control of feeding behaviour
in sheep. These peptides may be divided into two main

groups
(1) CCK8, CRF and calcitonin seem to act as short-term

satiety factors, acting respectively on the rate of
eating (CCK8), number and duration of meals (CRF,
calcitonin), while gastrin group peptides modulate
rumination.
(2) CGRP and GRF delay satiety without affecting either
immediate feeding behaviour or appetite.
Feed intake is an important component in the regulation

of energy balance and peptides are likely to be involved
at the interface between the energy balance regulator and
controller of feed intake. The use of new behavioural and
anatomical approaches may lead to a better understanding
of peptidergic influences in long-term regulation and to
the development of new ways of increasing the efficiency
of production in ruminants.
References
1. Amara, S.G., Jones, V., Rosenfeld, M.C., Ong, E.S.and
Evans, R.M. (1982). Alternative RNA processing in
calcitonin gene expression generates mRNAs encoding
differ.nt polypeptide products. Nature 298:240-244.
2. Buckingham, J.C. (1982). Corticotrophin releasing
factor. Pharmacol. Rev. 31:253-275.
3. Bu~no, lo, Durant on, A. and Ruckebusch, Y. (1983).
Antagonistic effects of naloxone on CCK-octapeptide
induced satiety and ruminoreticular hypomotility in
sheep. Life Sci. 32:855-863.
4. Bu~no, L., Fioramonti, J. and Primi, M.P. (1985).
Central effects of growth hormone-releasing factor
(GRF) on intestinal motility in dogs: involvements of
dopaminergic receptors. Peptides 6:403-407.
5. Bu~no, lo, Hond~, C., Duranton, A. and Fioramontt, J.
(1985). CNS control of feeding behavior by some
neuropeptides (gastrin, CCK8 and CRF) in sheep. Rep.
Nutr. Dev. 2:456-457.
6. Chestworth, J.M. and Easdon, M.P. (1983). Effect of
diet and se.son on steroid hormones in the ruminant.
J. Steroid Biochem. 19:715-723.
7. Dallman, M.F. (1984). Viewing the ventromedial hypo-
thal.mus from the adrenal gland. Am. J. Physio].
246:R1-R12.
8. Della-Fera, M.A. and B.i 1 e, C.A. (1979). Chol ecysto-
kinin octapeptide continuous picomolar injections into
the cerebral ventricles suppress feeding. Science

206:471-473.
9. Fargeas, M.J., Fioramonti, J. and Bueno, L. (1984).
Prostaglandins E2 a neuromodulator in the central
control of gastrointestinal motility and feeding
behavior by calcitonin. Science 225:1050-1052.
10. Fischer, J.A., Henke, H., Petermann, J. and Ischopp,
F.C. (1984). Calcitonin gene related peptide (CGRP)
and calcitonin (CT) and their binding sites in the
central nervous system. In: Pecile, A. (ed.). In-
ternational Symposium on Calcitonin. Abstract n 0 66.
11. Freed, W.J., Perlow, M.J. and Wyatt, R.J. (1979),
Calcitonin: inhibitory effect on eating in rats.
Science 206:850-852.
12. Halmy, L., Nyakas, C. and Walter, J. (1982). The
C-terminal tetrapeptide of cholecystokinin decreases
hunger in rats. Experientia 38:873-874.
13. Honde, C. and Bueno, L. (1984). Evidence for central
neuropeptidergic control of rumination in sheep.
Peptides 5:81-83.
14. Krahn, D.O., Gosnell, A., Levine, A.S. and Morley,
J.E. (1984). Effects of calcitonin gene-related pep-
tide on food intake. Peptides 5:861-864.
15. Leibowitz, S.F., Roland, O.R., Hor, L. and Squillary,
V. (1984). Noradrenergic feeding elicited via the
paraventricular nucleus is dependent upon circulating
corticosterone. Physiol. Behav. 32:857-864.
16. Levine, A.S., Rogers, B., Kneip, J., Grace, M. and
Morley, J.E. (1983). Effects of centrally administe-
red corticotropin releasing factor (CRF) on multiple
feeding paradigms. Neuropharmacology 22:337-339.
17. Mandelbrod, I., Feldman, S. and Werman, R. (1974).
Inhibition of firing is the primary effect of micro-
electrophoresis of cortisol to units in the rat
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18. Moberg, G.P., Bell inger, L.L. and Mendel, V.E. (1975).
Effect of meal feeding on daily rhythms of plasma
corticosterone and growth hormone in the rat. Neuro-
endocrinology 19:160-169.
19. Smith, R.M., Howe, P.R.C., Oliver, J.C. and Willough-
by, J.O. (1976). Growth hormone releasing factor im-
muno~eactivity in rat hypothalamus. Neuropeptides 4:
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20. Va c car i no, F. J ., B1 00 m, F. E ., Ri vie r, J., Va 1e, W. and
Koob, G.F. (1985). Stimulation of food intake in rats
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Drug Use and Regulation
46
The use in animals of drugs licensed for
human use only
A. S. J. P. A. M. VAN MIERT
ABSTRACT
In relation to the use in animals of drugs licensed for
human use only. extrapolation of dosages based on body
weight is open to objections. Conversion based on the
two-thirds or three-quarters power of the body weight is
regarded as preferable. Some examples are given of
conversion of dosages for one species of animal (including
man) into those suitable for other mammals (including dogs
and cats).
INTRODUCTION
When faced with a patient who needs treatment. the
veterinarian must make a choice among a variety of
possible drugs and devise a dosage regimen that is likely
to produce maximal benefit and minimal toxicity. The
choice of a drug not only depends upon the effect desired.
but is also influenced by the species of animal undergoing
therapy. For instance. lincomycin is contraindicated for
hamsters. guinea-pigs and rabbits. Low doses in these
species cause severe enterocolitis. anorexia. diarrhoea.
and death within 2 days'. On the other hand. the
mechanism of action of a drug is often the same in humans
and other mammalian species. whereas the intensity and
duration of the effects produced can vary widely. This
489
implies that in most cases, species variations in response

produced by a fixed dose of drug can be attributed to
differences in pharmacokinetic processes.
Patients may differ in the rate of absorption of a
drug 22 , in distributing it through body compartments 2 • J ,
in metabol izing iP, or in clearing the drug from the
bodyJ. Any of these pharmacokinetic differences may alter
the concentration of drug that reaches relevant receptors
and thus alter the clinical response. Repeated
measurements of drug concentrations in blood during the
course of treatment are often helpful in dealing with the
variability of clinical response caused by pharmacokinetic
differences due to pathophysiological processes. These
pharmacokinetic differences can be used to guide
quantitative decisions regarding an initial dosing
regimen. For example, the kinetics of chloramphenicol in
veal calves experimentally infected with Salmonella
dublin, showed that the plasma elimination half-life of
the drug rose from a value of 7.5 ± 0.8 h (mean ± SO) in
healthy calves to 13.6 ± 1.5 h in infected animals 8 • On
the basis of a MIC value of 3 ~g.ml-t, Groothuis 8
therefore advises an initial intravenous dose of 40
mg.kg- t followed by an oral maintenance dose every 24 h of
about 35 mg. kg- t •
Because the patient is never an idealized system, the
veterinarian will not have precise information about the
physicochemical nature of the receptors involved, the
number of receptors. or their affinity for drugs.
Nonetheless, in order to make rational therapeutic
decisions. the veterinarian must understand how
drug-receptor interactions underlie the relations between
dose and response in non-ideal patients. the nature and
causes of variation in pharmacological responsiveness, and
the clinical implications of selectivity of drug action.
Experimental studies have documented changes in drug
responsiveness caused by increases or decreases in the
number of receptor sites or by alterations in the
efficiency of coupling of receptors to distal effector
THE USE OF DRUGS LICENSED FOR HUMAN USE ONLY 491
mechanisms. These differences account for much of the

individual variability in response to some drugs.
particularly those that act at receptors for hormones.
biogenic amines. and neurotransmitters. In some cases.
the change in receptor number is caused by bacterial
fragments: for example. Haemophilus influenzae endotoxin
can affect negativelY the funct i on i ng of the
beta-adrenergic system on cells involved in anaphylactic
mediator release and respiratorY smooth muscle.
Secondarily. the cholinergic bronchoconstrictive impulses
are elevated by this bacterial product l ! .
In small animal medicine. a rather high number of drugs
licensed for human use only are used. but may be often
misused because of the lack of specific data in these
species of animal. There are several possible ways to
tackle this problem. Very often. pharmaceutical firms do
have information about the pharmacokinetics and
side-effects of their products in small animal species.
For example. the beagle is often used in pharmacokinetic
and toxicity studies. whereas the cat is a well-known
experimental animal in research projects concerning the
development of new non-steroidal anti-inflammatorY agents
(NSAIDS) •
THE INFLUENCE OF THE SIZE OF AN ANIMAL

There can only be a question of a real difference in
responsiveness for a drug or poison between man and other
mammals if in one way or another the difference in bodY
size is taken into account. Taking full account of the
bodY size is also essential if calculating doses of drugs
based on data obtained from other animal species. and for
instance for extrapolation of toxic doses or no-effect
dosages from laboratory animals to man. Within one single
species the dosage based on bodY weight can as a rule be
a usable starting point provided that the very special
position of very young animals is taken into account.
However. as soon as extrapolation from man to cat is
necessary. a dosage calculated on bodY weight. which can
be correct for an adult human patient, can be ineffective

in a cat.
When one realizes that processes in the pharmacokinetic
phase of the action of drugs which influence the
concentration in the blood are related to the functions of
the liver and the kidneys, it will be clear that special
attention should be paid to the relationship of these
functions with the size of the body. It can be taken for
granted that the capacity of the liver and kidneys are
adapted to the requirements resulting from normal food
intake and digestion, which means with normal metabolism.
For example, excretion of a drug and its metabolites is
promoted by larger kidneys. In rats, the ratio between
the weight of the kidneys and body weight is 0.7%. In
man, goats (40 kg>, and dogs (15 kg), these values are
0.35. 0.46 and 0.61% respectivelytJ.t~.
It is known that basic metabolism of warm-blooded
animals is a function of surface of the body rather than
that of the body weight. Smaller animals have greater
body surface area when related to body weight (Table
46.1). To maintain a steady body temperature, a higher
heat production is required, which is achieved by a higher
level of metabolism. Many investigators have studied the
relationships between doses, body surface area, plasma
levels and elimination half-life values to respon~es in
various species tJ . 2J • They have found that the difficulty
in relating results from one species to another (including
man) may be partly overcome if the dosage is adjusted in
relation to body surface area.
Table 46.1 represents a proposal taken from Mellet tJ
and Spector t9 , to use the Km factor for the modification
of mg.kg- t dosage into mg.m 2 dosage. By dividing one Km
factor by another, we can find the mg.kg- t dose ratio
between two species ( mg. kg -t e qui val en t s) • This
extrapolation is, of course, not sufficient for
calculating a safe drug dose for cat and dog from data
obtained from other animal species (including man). The
area under the serum curve for the various doses tested
THEUSEOFDRUGSUCENSEDFORHUMANUSEON~ 493
Table 46.1 Representative body surface area to body

weight ratios for various species (after Mellett t3 and
Spector t9 , modified)
Species Body Surface Km Dose

weight area factor* equivalent
(kg) (m 2 ) (kg- t )+
Man adult 60 1.6 37.5 1

Man child 20 0.8 25 1.5
Mouse 0.02 0.0066 3 12.5
Rat 0.15 0.025 6 6.3
Cat 3 0.24 12.5 3
Dog 16 0.65 24.5 1.5
Sheep/goat 50 1.1 45.5 0.8
Pig 75 1.5 50 0.75
Cow 150 2.4 62.5 0.6
Cow 500 5.0 100 0.4
Pony 280 4.4 63.5 0.6
Horse 350 4.0 87.5 0.4
Horse 650 5.9 110 0.3
* To express a mg.kg- t dose in any given species as an

equivalent mg.m 2 dose, multiply the dose by the
appropriate Km factor. In the cat. 10 mg.kg- t is
equivalent to 10 mg.kg- t x 12.5 = 125 mg.m 2 •
+ Setting the dose equivalent for man (adult. 60 kg) as 1.
we may obtain the dose equivalent kg- t (in relation to
man) by dividing the Km factor for humans through the Km
factor for any species given in the table.
should bear a linear relationship to the dose in mg.m 2 •

If this relationship holds for various other species. it
is likely to hold for the cat and the dog. If one
observes great variations in the response of various
species that bear no relationship to the size of the
animals. then it is unlikely that any prediction can be
made for the dog and the cat t3 •
Other authors have found that the metabolic activity on

the whole range from mouse to cow can be placed on one
line in a double logarithmic diagram and that it is
approximately proportional to the weight of the body to
the three-quarter power (the computed regression line
corresponds to an exponent 0.756).
In his computation over a large range of warm-blooded
animals. Brody' found the regressions indicated in Table
46.2. in which some additional values for the number of
nephrons and the hippurate clearance t are included. Based
on these data. it is to be expected that it will be
possible to approximate the dosage in relation to the size
of the body by the three-quarters power of body weight.
Extrapolation of dosages using this formula is not a
simple matter; therefore. some ratios are given in Table
46.3 (taken from Van Genderen 2t ) .
CORRELATION BETWEEN DOSE. BASIC METABOLISM AND RESPONSE

It is the quantitative rate of drug disposition that is of
practical importance in determining optimal dosage
schedules. Therefore. some examples were selected based on
the availability of quantitative data in various species
after various doses of drugs. In rabbits procaine
penicillin G (40.000 IU.kg- t intramuscularly for 5 days)
is often the antibiotic of choice to treat pasteurel-
losis'. In vitro. Pasteurella multocida is sensitive to
penicillin G. although sensitivity varies from isolate to
isolate (MIC values: 0.27-5 IU.ml - t ) . Furthermore. there
are penicillin G-resistant strains. The calculated doses
based on metabolic weight (G.O,75) for dogs. cattle. swine
and piglets from rabbit data for procaine penicillin G are
remarkably close to the doses advised by pharmaceutical
firms: dogs 30.000 IU.kg- t • cats 40.000 IU.kg- t • piglets
25.000 IU.kg- t • swine 20.000 IU.kg- t and cows 15.000
IU.kg - t ( 4 , t b l .
The efficacy of this drug can be expected to be related
to levels of penicillin G in the plasma. Penicillin G
concentrations in dog serum after parenteral
Table 46.2 Body weight (G) in relation to various factors

(taken from Van Genderen 2 t )
Basic metabolism (cal) 70.5 xGO. 13

Weight of liver (adult) kg 0.0333xG O • 81
Weight of kidneys (adult) kg 0.0073xG O • 85
Number of nephrons (adult) 2600 xG O • 62
Hippurate (PAH) clearance 5.4 xG O • 80
Blood (kg) 0.0507xG O • 99
administration (thoracic wall) of 30,000 IU.kg- t were more

than 0.5 IU.ml- t at 12 h. whereas at 24 h this was still
the case in nine out of 11 animals to • In pigs (30-68 kg)
the mean concentrations of penicillin G in serum after an
intramuscular injection of 21,000 IU.kg- t (calculated dose
range 19,000-25.000 IU.kg- t ) were 0.25 and 0.05 IU.ml- t at
the 12th and 24th h after treatment, respectivelyt4.
Similar results were obtained in cows after an
t
intramuscular dose of 13,000 IU.kg- (t1), whereas in serum
samples from steers (182-314 kg) given a massive dose of
33.000 IU.kg- t • concentrations were 0.25 and 0.05 IU.ml- t
at the 24th and 36th h after treatment 20 • In these
species. comparison of serum concentrations in relation to
the doses used is somewhat complicated by the fact that
the injection sites were not systematically reported. When
drug suspensions are used. the absorption rate depends on
the injection site, being superior for the cervical area
in comparison with other regions such as the gluteal
muscles '2 • In the study with steers the injection site
was in the gluteal region. Nevertheless. the published
data do suggest a reasonable correlation between dose.
basic metabolism and serum profile.
A second example are the liver-fluke anthelmintics
bromophenophos (Acedist R ) and nitroclofene (Oistoject R ) .
In rats bromophenophos is highly active (95-100%) at an
oral dosage of 60 mg.kg- t (tt). When this value is used
for computing highly effective doses for cattle and sheep
Table 46.3 Proportion scheme of dosages on basis of body

weight : G. O • n <taken from Van Genderen 2 t )
Body weight Dosage given to Dosage given to

man (60 kg) rat (0.2 kg)
= (A)mg.kg- t = (B)mg.kg- t
corresponds
0.2 kg ( rat) to 4.2(A) mg. k g- t or to 1.0(B)mg.kg- t
1 kg to 2.8 mg.kg- t 0.67 mg.kg- t
10 kg to 1.5 mg.kg- t 0.37 mg.kg- t
60 kg (man) to 1.0 mg.kg- t 0.24 mg.kg- t
100 kg to 0.89 mg.kg- t 0.22 mg.kg- t
500 kg to 0.58 mg. k g- t 0.14 mg.kg- t
(see Table 46.3), the following results will be obtained:

sheep 14.4 mg.kg- t and cattle 8.4-10 mg.kg- t • Efficacy
studies have proved that an oral dose of 10 mg.kg- t is
highly effective in cattle; in sheep this is 15
mg. k g- t ( ttl • For practical reasons the advised doses to
be administered to cattle and sheep are 12 and 16 mg.kg- t •
respectively. In the mouse and rat nitroclofene is highly
active against 12-week-old Fasciola hepatica after an
intramuscular injection of 40 and 10 mg.kg- t respecti-
velytt.
The calculated doses based on metabolic weight (Tables
46.1 and 46.3) for cattle and sheep from these data are:
1.6 mg.kg- t and 2.5 mg.kg- t , respectively. These values
are remarkably close to the effective doses against
16-week-old F. hepatica infections in cattle (EDqa 2.6
mg.kg- t ) and sheep (EDu : 2.1 mg.kg- t ). From clinical
efficacy studies based on the permanent reduction of the
excretion of fluke ova as well as on the eradication of
liver flukes. Ladage tt concluded that 3 mg.kg- t
intramuscularly is the dose that may be used for treatment
of cattle suffering from chronic fascioliasis; for sheep
a dosage of 4 mg.kg- t intramuscularly is recommended. The
elimination half-life values in goats. sheep and cattle

for nitroc10fene are 22.5 ± 5.3. 46 ± 4.6 and 62.1 ± 1.1
h. respective1 y t t .
Another example is pro1igestone. which is used to
suppress or to postpone oestrus in the bitch and the
female cat24. In rats pro1igestone delayed the onset of
pregnancy for 4-5 weeks after subcutaneous injection of
50-55 mg.kg- t • The efficacy of pro1igestone can be
expected to be related to levels of active compound in the
plasma. This is essentially the difference between the
amount released from the subcutaneous injection depot and
that inactivated mainly by biotransformation in the liver.
Therefore Van OS24 compared the effectiveness of the
advised doses with doses based on metabolic weight
(G.o. n ).
With the advised doses smaller animals were somewhat
overdosed and larger animals underdosed. A significant
trend (p < 0.01) was found for advised dosages towards a
higher efficacy for smaller dogs. and a lower efficacy for
larger animals. In cats the efficacy was 96% (500
injections). Furthermore. a lower efficacy for correct
doses was found for some breeds only: Siamese and Angora
cats. Alsatians and Great Danes. Van Os concluded that
his results seem to confirm the correctness of dosing
according to metabolic weight calculated according to the
formula G.O. 7 '6(24 ••
LACK OF CORRELATION BETWEEN DOSE. BASIC METABOLISM AND

RESPONSE
The examples just discussed were intended to call
attention to the fact that important quanti tative
differences in rates of drug excretion and metabolism are
to be expected in various species and in the same species
when the subjects differ greatly in size. In general.
excretion and metabolism of drugs does occur more rapidly
in small animal species than in large ones. There are. of
course. exceptions to this generalization. For example
phenylbutazone is more rapidly metabolized in laboratory
4,98 COMPARATIVE VETERINARY PHARMACOLOGY, TOXICOLOGY AND THERAPY
species than in cattle 6 • 7 ; however. the horse 4 also

metabolized this drug at about the rate of the smaller
animal species (phenylbutazone half-life values in hours
in the rabbit. rat. horse. cow and man are 3. 6,
3.5-8.6. 31-82 and 72. respectively). Another example are
the aminoglycosides. which have a limited distribution
volume. are not metabolized and are excreted by passive
glomerular filtration. Therefore. it is not surprising
that the advised dosages in mg.kg- t in various species are
rather uniform for these drugs.
There are a number of other phenomena which may cause
complications : (a) the plasma level of a drug may exceed
protein-binding capacity; (b) distribution may increase at
higher blood levels: (c) an enzyme system metabolizing a
drug may become saturated at higher blood levels; (d) a
drug's metabolism may be stimulated by the drug itself; or
(e) a drug's metabolism may be stimulated or inhibited by
another agent. Nevertheless. for many drugs there exists
a valid relationship between dose. plasma levels. body
size and response. However. if one sees great variations
in response of some animal species that bear no
relationship to the size of the animals. then it is
unlikely that any prediction can be made for other animal
species. The approaches suggested in the foregoing
discussion to the solution of the problem may help to
expand the extrapolation of drug dosages in laboratory
animals. man or large animal species to those effective in
dogs and cats.
References
1. Adolph. E.F. (1949). Quantitative relations in the
phYsiological constitution of mammals. Science
109:579.
2. Anika. S.M •• Nouws. J.F.M •• Van Duin. C.T.M •• Nieuwen-
huiJs. J. and Van Miert. A.S.J.P.A.M. (1986). Tick-
borne fever: efficacy and effects on pharmacokinetics
of some chemotherapeutic agents in the goat. In: Van
Miert. A.S.J.P.A.M •• Bogaert. M.G. and Debackere. M.
(eds). Comparative Veterinary Pharmacology. Toxico-
logy and Therapy. Proc. 3rd EAVPT Congress. Part II.
Invited lectures. Lancaster: MTP Press.
3. Baggot. J.D. (1977). Principles of Drug Disposition
in Domestic Animals. Philadelphia: W.B. Saunders.

4. Bogan. J.A., Lees, P. and Yoxall, A.T. (1983). Phar-
macological Basis of Large Animal Medicine. Oxford:
Blackwell Scientific.
5. Brody. S. (1968). Bioenergetics and Growth. New York:
Hafner Publishing Company.
6. De Backer. P., Braeckman, R., Belpaire. F. and Deback-
kere. M. (1980). Bioavailability and pharmacokinetics
of phenylbutazone in the cow. J. Vet. Pharmacol.
Ther. 3:29-33.
7. Eberhardson. B., Olsson, G., Appelgren, L. and Jacobs-
son, S. (1979). Pharmacokinetic studies of phenyl-
butazone in cattle. J. Vet. Pharmacol. Ther. 2:31-37.
8. Groothuis. D.G. (1983). Pharmacokinetics of some
antimicrobial drugs in veal calves and their activity
in relation to Salmonella dublin infections.
Utrecht: Ph.D thesis.
9. Harkness. J.E. and Wagner, J.E. (1983). The Biology
and Medicine of Rabbits and Rodents, 2nd ed.
Philadelphia: Lea and Febiger.
10. Hartman, E.G. (1985). Influence of the injection site
on the depot-effect of procaine-penicillin G in dogs.
In: Van Miert, A.S.J.P.A.M., Bogaert. M.G. and
Debackere, M. (eds). Comparative Veterinary Pharmaco-
logy, Toxicology and Therapy. Proc. 3rd EAVPT
11. Ladage, C.A. (1979). The development of a new injec-
table anti-liver fluke compound. Utrecht: PhD thesis.
12. MacDiarmid. S.C. (1983). The adsorption of drugs from
subcutaneous and intramuscular injection sites. Vet.
Bu I I. 53: 9-23 •
13. Mellett. L.B. (1969). Comparative drug metabolism.
In: Jucker. E. (ed.). Progress in Drug Research 13,
pp.136-169. Basel: Birkhauser Verlag.
14. Mercer. H.D., Righter. H.F. and Carter, G.G. (1971).
Serum concentrations of penicillin and dihydro-
streptomycin after their parenteral administration in
swine. J. Am. Vet. Med. Assoc. 159:61-65.
15. Neff-Davis, C•• Davis, L.E. and Powers. T.E. (1975).
Comparative body compositions of the dog and goat.
Am. J. Vet. Res. 36:309-311.
16. Rossoff. 1.S. (1974). Handbook of Veterinary Drugs.
New York: Springer.
17. Schipper. I.A., Filipors, D., Ebeltoft, H. and Scher-
meister. L.J. (1970). Blood serum concentrations of
various benzyl penicillins after their intramuscular
administration to cattle. J. Am. Vet. Med. Assoc.
158:494-500.
18. Schreurs. A.J.M. and Nijkamp. F.P. (1984), Haemo-
philus influenzae and the fi-adrenergic system a
review. Vet. Res. Commun. 8:1-14.
19. Spector. W.S. (1961). Handbook of Biological Data.
Philadelphia: W.B. Saunders.
20. Teske. R.H •• Rollins. L.D. and Carter, G.G. (1972).
Penicillin and dihydrostreptomycin serum
concentrations after administration in single and
repeated doses to feeder steers. J. Am. Vet. Med.

Assoc. 160:873-878.
21. Van Genderen. H. (1975). Combined use of drugs and
variations in action in various animals. Tijdschr.
Diergeneesk. 100:25-36.
22. Van Gogh. H•• Van Deurzen. E.J.M •• Van Duin. C.T.M.
and Van Miert. A.S.J.P.A.M. (1984). Effect of
staphylococcal enterotoxin B-induced diarrhoea on the
pharmacokinetics of sulphadimidine in the goat. J.
23. Van Noordwijk. J. (1964). Communication between the
experimental animal and the pharmacologist.
Statistica Neerlandica 18:403.
24. Van Os. J.L. (1982), Oestrus control in the bitch
with proligestone. Utrecht: PhD thesis.
47
The use in small animal medicine of drugs licensed
for human purposes
A. R. M. KIDD
ABSTRACT
Products licensed for human medical purposes in the United
Kingdom may also be legally obtained and used under UK
medicines legislation by qualified veterinarians. Many of
the disease conditions encountered by veterinary surgeons
in small animal medicine require treatment with products
for which there is usually a very limited veterinary
market. As a result it is often necessary to employ
products which have been designed for use in man. This
chapter describes some of the disease conditions
encountered in small animal medicine which can be treated
with products licensed for human use in the United
Kingdom.
Under United Kingdom legislation drug substances are
classified for distribution purposes into one of three
categories. Most of the products considered in the paper
are classified as prescription-only medicines. The
possibility of misuse is considered in relation to the
disciplinary procedures applied by the veterinary
profession to its members and the legal strictures which
apply in the United Kingdom where the veterinary
profession has the freedom to prescribe licensed human
product s.
This chapter also emphasizes the importance of
501
reporting adverse reactions and of applying principles of

clinical pharmacology in pioneering new developments in
veterinary medicine.
INTRODUCTION
The licensing of veterinary medicines in the United
Kingdom is controlled by legislation enacted in 1968 under
the Medicines Act. This Act requires that for any
veterinary product which is sold or supplied, parameters
of safety, quality and efficacy must be fully taken into
account and the product recommended for licensing by an
independent Committee of Experts, the Veterinary Products
Committee. The licensing authority responsible for
issuing the licence is the Ministry of Agriculture,
Fisheries and Food (MAFF).
The same piece of legislation and the same criteria of
safety, quality and efficacy apply in the case of products
intended for use in man. Applications for product
licenses are also considered by an independent expert
committee known as the Committee of Safety of Medicines
and product licenses or clinical trials certificates are
issued by the licensing authority which in the case of
human medicines is the Department of Health and Social
Security.
Licensed veterinary products must also satisfy the
requirements of the Veterinary Medicines Directives (EC
82/851 and EC 82/852) and equally those licensed for use
in man are licensed in accordance with the requirements of
the parallel human directives.
Products which have been fully licensed for medical
purposes in the United Kingdom may normally be legally
obtained or administered by qualified veterinarians for
the treatment or prevention of disease or for other
veterinary purposes (SUCh as anaesthesia) in animals under
their care.
Certain disease conditions, especially some encountered
by veterinarians involved in small animal species, are not
necessarily very common and the volume demand for products
THE USE OF HUMAN DRUGS IN SMALL ANIMAL MEDICINE 503
to treat these conditions may not be high. As a result

there is no great incentive for a commercial company to
develop specific veterinary products for a very limited
market. The veterinarian is therefore often obliged to
seek and use alternative products and turns to those
designed primarily for use in man.
For discussion at this congress the question "which
drugs are essential in small animal medicine" (that is.
human drugs) has been posed. The following examples of
drugs and the uses to which they are put will hopefully
serve to illustrate that. although not always essential, a
considerable number of substances are used on occasion.
In this era of fast-moving advances in our knowledge of
small animal medicine there is clearly a need for such
drugs to improve the welfare of the animals with which we
as veterinarians have to deal.
DISEASES SUITABLE FOR TREATMENT WITH LICENSED MEDICAL

PRODUCTS
For the purpose of this paper examples have been selected
of various types of condition which seem particularly
suitable for treatment with approved and licensed medical
products. Some of the diseases involved are often
unrewarding to treat. irrespective of the drugs available
and the prognosis may frequently be poor.
Skin diseases
Skin diseases of the dog and cat associated with
autoimmune phenomena have been well described in recent
papers. Wilkinson 7 for example refers to three major
types and indicates drugs which may be valuable for
treatment. The feline pemphigus group and feline
ulcerative pododermatitis may be resistant to conventional
immunosuppressive doses of prednisolone but may respond to
aurothiomalate or aurothioglucose. For systemic lupus
erythematosus Wilkinson suggests immunosuppressive drugs
such as melphalan with monitoring for myelosuppression.
BennetP in a review in 1984 alludes to the use of
Cytotoxic drugs to treat pemphigus vulgaris particularly

in cases which do not respond to steroids. He
specifically mentions cyclophosphamide and azathioprine.
Chlorambucil has also been recommended. Combinations of
steroids and Cytotoxic drugs are suggested where the main
advantage lies in being able to employ lower doses of
each.
Cushing's syndrome
Cushing's syndrome is a condition associated with
hyperadrenocortism caused by excessive glucocorticoid
production usually because of increased adrenocortico-
tropin hormone secretion; it is characterized by polyuria,
polydypsia. and polyphagia. There are no products
licensed for use in the United Kingdom for the treatment
of the condition but mitotane (United States Pharmacopoeia
- USP) has been recommended.
Addison's disease
Addison's disease is a condition of hypoadrenocortism
associated with vomiting, diarrhoea, muscular weakness.
dehydration. polyuria. polydypsia. trembling and weight
loss. Some human preparations not licensed for veterinary
use have been used in the United Kingdom. These include
minera10corticoids such as deoxycortisone piva1ate, and
f1udrocortisone acetate.
Lymphosarcoma
LYmphosarcoma is seen in both cats and dogs and it has
been treated with a variety of immunosuppressive
substances such as azathioprine, chlorambucil, vincristine
sulphate as well as L-asparaginase. Close collaboration
between veterinary and human oncologists is clearly very
desirable since tumours exist where the histological
appearance in dogs and cats resembles that seen in man.
In addition to those drugs already mentioned,
methotrexate. cytosine arabinoside, and doxorubicin have
been used. Combination therapy using vincristine.
cytosine arabinoside. cyclophosphamide and prednisolone

give median survival times of 6 months in canine
lymphosarcoma.
Diabetes
Diabetes mellitus is a condition which is not uncommon in
dogs. and as no insulin preparations are licensed for use
in animals. licensed human products have been used in the
United Kingdom for many years. It is generally thought
desirable to use depot insulin for stabilization and
maintenance. It is also worth mentioning that as yet
there is no evidence to suggest that any of the oral
hypoglycaemics have been used with success.
Diarrhoeal conditions
It has been said that colitis and proctitis account for
half of all cases of chronic diarrhoea in the dog.
Similarities with Crohn's disease have been postulated,
especially in the case of histiocytic ulcerative colitis
in boxers and regional enterocolitis in the cocker
spaniel. These are conditions where recourse to human
products has been associated with iatrogenic problems.
Wilson' has reported the successful use of a 5 day regimen
of sulphasalazine and Isogel in cases which were a . sequel
to chronic rectal impaction. Sulphasalazine has been
particularly useful in older dogs, where due to other
disease conditions the use of steroids has been
contraindicated. Because of differences in the metabolism
of sulphonamides in man and the dog the possibility exists
of unusual side-effects. Sansom et al.' reported 13 cases
of iatrogenic and bilateral keratoconjunctivitis sicca
following the use of sulphasalazine for the treatment of
colitis in dogs. The lacrimotoxic effect of
sulphasalazine was permanent in all except one case.
Other drugs used for colitis include metronidazole and
diphenoxylate.
HUMAN PRODUCTS AND CONDITIONS IN SMALL ANIMALS

Reports and recommendations exist for the use of human
products against a variety of other conditions seen in
small animals. Licensed veterinary preparations are
available which can be used for treatment but alternative
human drugs and products exist which veterinarians choose
to use on an occasional basis. For convenience of
presentation these conditions can be divided into five
categories eye conditions. central nervous system and
skeletal conditions. intestinal conditions. cardiac and
respiratory conditions. and a range of miscellaneous
conditions.
Eye conditions
In the case of eye conditions. they include anterior
uveitis. conjunctivitis. corneal oedema. glaucoma.
keratitis. and keratoconjunctivitis sicca. Some of the
drugs used for treatment are atropine. pilocarpine.
proxymetacaine. acetazolamide. demecarium bromide.
dichlorphenamide. idoxuridine and N-acetylcysteine. the
latter in cases of keratoconjunctivitis sicca.
Central nervous system and skeletal conditions

Central nervous and skeletal conditions are clearly varied
in character and severity of symptoms. but nervous
problems such as narcolepsy. Scottie cramp or convulsions
may benefit from treatment with substances such as
amphetamines. imipramine. methylphenidate. phenytoin and
diazepam. Skeletal or arthritic conditions may respond to
treatment with sodium aurothiomalate. aspirin. pethidine
or ibuprofen. bearing in mind that toxicity to some of
these substances in the dog and cat is well recognized.
Intestinal tract disorders

A vast range and diversity of substances is used to treat
disorders of the intestinal tract many of them
antimicrobial and designed to deal with specific
infections. Cimetidine. however. may have a place in
treating gastritis especially where a reduction in acidity

is likely to be beneficial. Medium-chain triglYcerides
are useful in malabsorption syndromes; also of value in
dealing with persistent vomiting and diarrhoea are drugs
such as metoclopramide. prochlorperazine. loperamide and
diphenoxylate, the latter in combination with atropine.
Spironolactone is one substance which is marketed under a
number of different trade names in the United Kingdom and
is considered to be of value in the treatment of chronic
liver disease. or for idiopathic oedema.
Cardiac and respiratory diseases

As with intestinal disease. many drugs in suitable
veterinary formulations are available to treat cardiac and
respiratory diseases. For congestive heart failure and
feline cardiomyopathy, digoxin and digitalis remain high
in popularity. Non-specific cough • . not associated with
known specific disease agents may on occasion be treated
with codeine. acetyl cysteine or carbocisteine.
Miscellaneous conditions
A number of miscellaneous conditions are not readily
classified into any of the above groups. Cat leprosy
associated with infection with Mycobacterium lepramurium
has been treated with dapsone. and cryptococcosis with
amphotericin. Chlorpropamide has been used in cases of
diabetes inaipidus, chlorpheniramine in urticarial
conditions and allopurinol to treat urolithiasis.
IDENTIFYING AND CLASSIFYING SUBSTANCES

Altogether. without attempting to be comprehensive. it has
been possible to identify some 50 different compounds
available in human medicine which are used to treat or
alleviate up to 40 different disease conditions in dogs
and cats. It is important to recognize. however. that
limitations exist. In a recent review on canine glaucoma.
Bedford t emphasizes differences in approach between man
and animals. The use of miotics has little place in the
dog. and suppression of aqueous humour is much more

effectively carried out with carbonic anhydrase
inhibitors. Sympathomimetic agents and beta-blockers are
therefore not much used.
Under United Kingdom legislation drug substances used
in human medicine are classified for distribution purposes
into three categories. Some substances such as aspirin
are classified as suitable for general sale (GSL) but the
vast majority of those mentioned in this paper come within
the prescription-only (PaM) category. The distribution of
some of these is restricted to hospitals only. Those
substances which are not listed in either of these
categories are sold only under the direction of a
pharmacist (category P). The same categories also exist
for veterinary medicines. but an additional category
exists for certain substances considered suitable for sale
from agricultural merchant's premises (category PML).
Examples include sheep dips, as well as many of the
anthelmintics used for treating agricultural livestock.
Substances used in small animal medicine are not normally
considered suitable for this category.
MISUSE OF DRUGS
The misuse of drugs is a matter raised for discussion
within the framework of this congress. The sale and
supply of licensed products is controlled under th~ terms
of the Medicines Act and the sale or supply of unlicensed
products is therefore an offence subject to prosecution.
The practising veterinary surgeon is free to prescribe
licensed products, whether human or veterinary. If he
advocates a product's use in accordance with the data
sheet recommendations (and these reflect the terms of the
licence) responsibility for the product lies with the
product licence holder. While the veterinary surgeon is
free to use the product outside the terms of the data
sheet. he then does so on his own responsibility. The
governing body of the veterinary profession in the United
Kingdom. the Royal College of Veterinary Surgeons. also
THE USE OF HUMAN DRUGS IN SMALLANIMAL MEDICINE 509
exercises control over the profession in general as well

as providing guidance to it on a wide range of issues
including the use of drugs.
ADVERSE REACTIONS TO DRUGS

Licensed products are regarded as safe when used in
accordance with experimentally determined dosage. but the
Medicines Act requires the reporting and collection of
suspected adverse reactions. When a veterinarian
administers to animals products recommended only for use
in man. he should be aware of increased chances of adverse
drug reactions occurring. A recent example has been the
reporting of keratoconjunctivitis sicca in dogs treated
for colitis with su1phasa1azine.
Another recent review by Taylor' dealing with the use
of analgesics in small animal medicine lists a number of
preparations for which no veterinary licensed product is
available as well as referring to some of the older
opiates now no longer so readily obtainable. Non-
steroidal anti-inflammatory drugs (NSAIDS) such as indo-
methacin a-nd ibupr-o fen are - becominqmore commonly used.
but problems of gastric irritation with vomiting and
diarrhoea as well as occasional blood dYscrasias indicate
the potential for adverse reactions.
A review article by Keen and Livingston J on adverse
reactions to drugs published in 1983 referred to several
preparations not licensed in the United Kingdom for use in
the dog. but which though effective gave rise to
unacceptable side - effects. One example quoted was the
prostaglandin dinoprost used in the treatment of pyometra.
which may give rise to bronchoconstriction and
gastrointestinal side-effects. Another drug sometimes
used to treat gastrointestinal disorders is c1ioquino1 and
when used in dogs it can cause a fatal encephalitis. Keen
also emphasized that cats are only poorly able to
metabolize phenolic derivatives and are the r efore
susceptible to toxic side-effects from such compounds. In
the case of sa1icy1ates. cats should therefore receive a
lower dose than the dog. Lees et a1 . 4 drew attention to

the need for great care in prescribing aspirin in the cat
and suggested it should not be used at all in either very
young and very old cats. Keen observed that paracetamo1
is also toxic to the cat. and recent reports of incidents
of paracetamo1 poisoning include one where cats were able
to obtain access to tablets and then exhibited symptoms of
vomiting. diarrhoea. cyanosis. ataxia. and hypothermia.
It therefore seems desirable to ensure that the use of
human drugs in animals. especially in small animals. is
accompanied by a system of reporting and investigating
adverse reactions so that more information can be made
available on the pharmacological effects of such products
in these species.
CONCLUSIONS
This paper has attempted to take account of many types of
situation under which products licensed for human use are
employed in small animal medicine in the United Kingdom.
It is necessary. however. to bear in mind that human
health and safety problems might arise if human products
are used to treat animals destined for human consumption.
and the question of residues is especially important.
The majority of products licensed for human use are not.
however. of suitable pack size to be widely used in
agricultural situations. Thought has nevertheless been
given in the United Kingdom to cater for situations where
human or veterinary products are administered despite no
residue data having been generated. In such circumstances
a standard withdrawal period of 28 days for meat and meat
products. and 7 days for milk has been proposed. As
mentioned earlier there is little incentive for companies
to generate data such as no effect levels and acceptable
daily intakes for products which are old or have a limited
market. In the case of products possessing antimicrobial
properties the possibility. however remote. that residues
may give rise to plasmid-mediated resistance also needs to
be considered. and resolved.
References
1. Bedford. T.G.C. (1985). The treatment of glaucoma i~
the dog. Vet. Annual 25:352-357.
2. Bennett, D. (1984). Skin diseases of the dog and cat
associated with autoimmunity. Vet. Annual 24:198-207.
3. Keen, P. and Livingston, A. (1983). Adverse reactions
to drugs. Practice 5:174-180.
4. Lees. P., Higgins. A.J. and Sedgwick, E.D. (1985).
As p i r i n i n cat s • Ve t. Re c. 116 : 479 .
5. Sansom. J., Barnett, K.C. and Long. R.D. (1985).
Keratoconjunctivitis sicca in the dog associated with
the administration of salicylazosulphapyridine (sulpha-
salazine). Vet. Rec. 116:391-393.
6. Taylor. P. (1985). Analgesia in the dog and cat.
Prae ti c e 7: 5-13 •
7. Wilkinson. G.T. (1985). Autoimmune skin disease in the
cat. Vet. Annual 25:248-253.
8. Wilson. N.D. (1985). Proctocolitis in the dog. Vet.
Rec.116:503.
48
The use in animals of drugs licensed for human use:
the situation in Sweden
K. BINGEFORS
ABSTRACT
Use of human drugs in the treatment of animals was studied
by means of a cross-sectional prescription survey. Human
drugs were primarily prescribed to small animals. Dogs in
particular received a great variety of human drugs. The
most frequent prescribing of human drugs occurred in the
chemotherapeutics group. but drugs from all pharmaco-
logical groups were used in animal treatment. Some human
drugs are more often prescribed for animals than for
people. Availability of substances. more suitable for-
mulations and strengths and manufacturer preference were
considered important factors in choosing human drugs in
the treatment of animals.
INTRODUCTION
In Sweden all drugs. veterinary and human. are distributed
only via the National Corporation of Swedish Pharmacies
(NCSP). The only exception to this monopoly is the
distribution of antibiotic feed additives. As from
January 1986. growth promoting antibiotics will not be
allowed on the market while therapeutic antibiotics will
fall under the same legislation as licensed pharmaceutical
specialities. In contrast to many other countries.
veterinarians may only dispense drugs to a limited extent
513
as part of a consultation within their clinic or in acute

situations in the field.
Veterinarians are qualified to prescribe practically
all drugs on the market as long as they can be shown to be
justified in the treatment of animals. Drugs registered
for veterinary use are licensed for use in one or more
specified species. They may, of course, be prescribed for
use in other species but in this case, as is also true for
human drugs, the responsibility lies with the prescribing
veterinary practitioner. In Sweden very comprehensive drug
utilization statistics are published yearly, mainly based
on wholesale statistics. It is not possible, however, to
study the use of human drugs in veterinary practice via
the official drug utilization data. Human drugs sold for
use in animals are recorded as if they were used in
humans. Also, there are no possibilities for studying the
use of drugs in different species.

The monopolized drug distribution system in Sweden has
made possible a study of the use in animals of drugs
registered for human use. This study was designed as a
cross-sectional prescription surveyl. All veterinary
prescriptions cdffi~ieted throughout the whole country
during 2 weeks in iRe autumn of 1981 were collected and
analysed. The stu81 also included drug requisitions from
surgeries and anima1 hospitals. For each prescription
item the type of drug, quantity dispensed and species were
recorded. A computerized analysis was performed with the
help of central drug registers at the NCSP.
Naturally, there are some limitations in using the
prescription survey method. The main objection is that
the studY tends to be purely descriptive and very few
valid analytical studies can be made on the material
collected. However, further studies of a more explanatory
nature can be made with a descriptiv~ study as a basis.
Another objection is that over-the-counter drugs are
poorly represented even though they are included in the
THE USE OF DRUGS LICENSED FOR HUMANS IN SWEDEN 515
pharmacy monopoly. There are few incentives to actually

prescribe over-the-counter drugs since there are no
economic benefits in buying them with a prescription.
Rather a large proportion of the drugs are delivered to
veterinary surgeries and hospitals. It is not possible to
determine the species for which these drugs are intended.
In spite of these limitations. the results of the present
study ought to be representative of the prescription
pattern for human drugs in veterinary therapy.
In contrast to the situation in many other countries.
all pharmaceutical specialities have to be sold in
unbroken manufacturer's packages. In the absence of a
better measure of the vo1J~e prescribed. we decided to use
the number of packages di~~ensed
,. as our unit of measure in
this study. Furthermore. t~is is the unit used in all
available sales statistics. thus we were able to make
direct comparisons with this.
RESULTS
In 1981 there were about 2500 pharmaceutical specialities
on the market in Sweden. Our survey showed the use of 900
separate entities in animals. two-thi r ds of these being
drugs licensed for human use only. By volume. 20% of the
45.798 packages dispensed during the period of study were
human drugs. Human drugs from all 19 officially
classified pharmacological groups were prescribed for
animal treatment. Since drug use in other than the major
species <such as dogs. cats. horses. cattle and swine) is
negligible. only drug use in major species and in
veterinary clinics will be considered.
As expected. most human drugs were prescribed for small
animals and for use in veterinary surgeries <Table 48.1).
More than half of all human drugs prescribed were intended
for use in dogs. and in this species the most varied drug
prescribing also occurred. Almost a third of all drugs
prescribed for dogs were human drugs <Figure 48.1) while
other species received smaller proportions of their total
drug use as human drugs. A great variety of different
Table 48.1 Human drugs. distribution on major species.

n = 9023
Dogs 57.7%
Cats 9.5%
Horses 4.8%
Cattle 1.6%
Swine 1.5%
Veterinary practice 24.9%
SPECIESr-______________________________ ~
Dogs 29%
Cats
Horses
Cattle
Swine
VET.PRACT.
Figure 48.1 Human drugs as a proportion of the total

prescribing for each species and for use in veterinary
cl inics.
drugs were prescribed for dogs even if most of them were

not frequently used. On the other hand. use of human
drugs in food-producing animals can be considered as
relatively low. For this chapter we have selected some of
the more interesting pharmacological groups for a closer
study.
By far the largest prescribing of human drugs occurs in
the chemotherapeutic drug group. This was almost totally
restricted to use in cats and dogs, more than a third of
the total chemotherapeutics used for these species being
human drugs (Figure 48.2). A large part of the pre-
SPEC IES ,.--_ _ _ _ _ _ _ _ _ _ _ _ _ _-----.l~
Dogs
Cats 39%
Horses
Cattle
Swine
VET.PRACT.
Figure 48.2 Chemotherapeutic agents: human drugs as a

proportion of the total prescribing of chemotherapeutic
agents for each species and for use in veterinary clinics.
SPEC I ES ,.--_ _ _ _ _ _ _ _ _ _ _ _ _ _---"~
Dogs 63%
Horses
Cattle
VET.PRACT.
Figure 48.3 Analgesics: human drugs as a proportion of

the total prescribing of analgesics for each species and
for use in veterinary clinics.
scribing in this group consisted of synonymous prepa-

rations of penicillins and tetracyclines. Sulphonamides.
erythromycin. trimethoprim-sulphamethoxazole. nitrofu-
rantoin and chloramphenicol were commonly used in small
animals. In fact. the relatively high sales figures for
chloramphenicol tablets (licensed for human use) have been
discussed. but according to our data 80% of sales are

actually consumed by dogs. In cats there was a frequent
use of demeclocycline paediatric drops. a drug which is
apparently hardly ever used for children. an amount
corresponding to the total sales of this drug being
prescribed for cats. The proportion of human drugs used
in the analgesics/anaesthetics group was also high in some
species (Figure 48.3). Most of this drug use is
phenylbutazone tablets where veterinarians seem to prefer
the synonyms licensed for human use. Phenylbutazone is
not licensed at all for use in cattle. due to problems
with residues 3 , and yet it was used in cattle to some
extent. The use of drugs from this group in veterinary
clinics was dominated by the use of human anaesthetics.
Dermatological agents had a widespread use in animals.
All species received between a third and a half of their
use in this group as human specialities (Figure 48.4).
Commonly used preparations were corticosteroids in
different combinations.
Respiratory drugs (Figure 48.5) only licensed for
humans, mainly bronchodilators, were used to some extent
in dogs and in horses. Dogs were also treated with
different kinds of cough mixtures.
CONCLUSIONS
The market for animal drugs in Sweden is very small.
Consequently. it is not economically feasible for drug
companies to keep a large variety of drugs licensed for
veterinary use only. Registration and marketing of
veterinary drugs entail fees and costs for maintaining
information that in many cases would exceed the earnings.
Thus there is a definite need to use human drugs.
particularly in small animal practice. Many drugs used
are substances with a fairly good documentation in
veterinary medicine but many "new" drugs are also used.
particularly in species for which the documentation of
effects and kinetics is still not reliable. This is
especially true in drug treatment of dogs.
SPEC I ES r--------------------"~
Dogs
Cats
Horses 49%
Cattle
Swine
VET.PRACT.
Figure 48.4 Dermatological agents: human drugs as a pro-

portion of the total prescribing of dermatological drugs
for each species and for use in veterinary clinics.
SPEC I ES r-------------------'»<..><..<I!
Dogs 89%
Horses
Figure 48.5 Respiratory drugs : human drugs as a propor-

tion of the total prescribing of respiratory drugs for
each species and for use in veterinary clinics.
In some cases, notably penicillins and phenylbutazone.

veterinarians prefer to prescribe human synonyms rather
than their veterinary equivalents. This phenomenon seems
to be partly the result of manufacturer preference; for
example, a manufacturer with a good reputation in the
veterinary market also gets a certain amount of their
human drugs used in animal therapy in spite of the fact

that unlicensed promoting is prohibited. Apart from the
above-mentioned reasons. the most important factors in
choosing human drugs seem to be the more suitable
formulations and strengths for use in small animal
medicine.
In conclusion. there is a widespread use of human drugs
in veterinary practice today. A wide variety of human
drugs are tried in therapy and quite a few are also widely
used.
The results of this studY have been used as a guidance
for analysis of residues in meats and in malfunctioning
fermentation processes 2 • They may also be used by
manufacturers and licensing boards in determining which
drugs should be licensed for use in animals or. in some
cases. regulated due to their use in food-producing
animals.
References
1. Bingefors. K•• Isacson. D. and Hamring. A. (1982),
Veterinar lakemedelsf5rskrivning- en receptstudie.
Copenhagen Proc. of the 14th Nordic VeterinarY
Congress.
2. Hagelberg. M•• Mathiesen. B •• Sandkvist. A. and S5der-
lind. I.-L. (1984). Effekt p~ biogasprocesser av vete-
rinarmedicinska preparat. Stockholm: Royal Institute
of Technology Report Trita-Vat-3843.
3. Martin. K•• Andersson. L •• Stridsberg. M•• Wiese. B.
and Appelgren. L.-E. (1984). Plasma concentration.
mammary excretion and side-effects of phenylbutazone
after repeated oral administration in healthy cows. J.
49
Regulation of drug usage in veterinary medicine:
the situation in Germany
J. FINK
ABSTRACT
The legislative basis of drug usage in veterinary medicine
is discussed following the outline of the German Medical
Act. Different drug formulations and their regulations
are mentioned including the procedure of drug registra-
tions.
The historical right of veterinarians to dispense drugs
and to have their own supplies. as well as the legal
possibility to use drugs from human medicine in veterinary
therapeutics include a high responsibility for the indivi-
dual practitioner. Usage of homeopathic formulations and
administration of "home made" formulations need a clear
legal definition. especially when these formulations are
administered to food producing animals.
The development of drug legislation is determined by

increasing awareness of the risks in drug usage and the
fear of undesirable effect and hazards. This is of
special concern in the regulation of veterinary drug
usage. Considering the specific term "drug", German drug
legislation covers all subjects of both human and veteri-
nary medicine under one Medical Act.
521
THE MEDICAL ACT

The "II. Medical Act" consists of different sections whi<:h
should be interpreted from a veterinary point of view.
Definition of "drug"
In the first section <Table 49.1) the term "drug" is
defined as a compound which is used for the treatment of
diseases and disorders including substitutive and sYmpto-
matic administration. prophylactic therapy and use for
diagnostic purposes. For a precise explanation of margi-
nal "therapeutic" areas. a clear demarcation with other
administrative and legal fields is often used. There is
interaction with other areas of German legislation for
cosmetics. disinfectants and mineral water which are
covered under food regulations. as well as for food
additives that are regulated with the foodstuff law.
Quality and declaration of drugs

The second section of the Medical Act gives detailed
information about the quality and declaration of drugs
including prohibited compounds. This part also contains
an obligation not to supply drugs which are sterilized by
gamma-radiation. Where there is no alternative method
this is only possible with special additional permission
of the Ministry of Internal Affairs.
Commercial production
The third section defines commercial production. Accor-
ding to this section a veterinarian or phYsician has to
prove his participation in special pharmaceutical courses.
which are not included in the regular studies. Thus. prac-
tically only pharmacists have the right to supervise com-
mercial drug manufacturing.
Veterinarians may only produce special formulations for
their clients: quality of these formulations is defined by
the regulations of the national pharmacopoeia and quantity
by the needs <cfr. number of clients) of the veterinarian.
PhYsicians are almost totally excluded from the field of
REGULATION OF DRUG USAGE IN GERMANY 523
Table 49.1 Legislative definition
TREATMENT
SUBSTITUTION and symptomatic THERAPY
PROPHYLAXIS
DIAGNOSIS
formulated preparations (drugs)

~ registration of the formula
Nutritively applied mixtures (antibiotics. vitamins. etc.)

~ registration of the premix
Food additives (growth promoters. coccidiostats)

~ registration by the EEC
HO.l!l.!lil£athic formulations and plant extracts

announcement by the supplier
quality assurance needed
drug product ion.
Registration
The fourth section of the Medical Act deals with registra-
tion requirements. Registration of a veterinary drug
involves four dossiers: (a) the analytical dossier: (b)
the results of pharmacological and toxicological trials:
(c) efficacy and clinical data including species-specific
tolerances and interactions with other drugs; and (d)
pharmacokinetic data. residue levels in edible tissues and
the proposal of a withdrawal time based on the no-effect
I eve I.
PROVIDING DATA FOR THE AUTHORITIES

To provide these data for the authorities. a company can
include its own original investigation or provide general
documentation with data available in the scientific
literature. if these are reviewed by an independent
expert.
In the daily practice of registration. discussions with
the authorities commonly arise about questions of experi-
ence at the time of introduction of a new compound. An-
other crucial point is the definition of safety. including
primarY and secondary toxicity considerations. The deter-
mination of specific side-effects such as neurotoxicity,
endocrinological effects and alterations in the immunolo-
gical status are still the subject of discussion because
of the need for basic research in order to understand and
interpret biochemical mechanisms.
Secondary toxicity summarizes possible hazards for the
consumer in correlation with the incidence and toxicity of
druQ residues. The FDA proposed the use of score-factors
accordinQ to the frequency of drug administration. but
this concept is not generally accepted. Therefore. the
threshold limit is based on a no-effect level established
by experiments in at least two different laboratory animal
species.
PRACTICAL USE OF VETERINARIAN DRUGS

Apart from general scientific questions surrounding legis-
lation. there is still the problem of supervising the
practical usage of veterinary drugs.
For the latter. the company has to provide a precise
description of a simple and reproducible analytical pro-
cedure. The task is to monitor actual drug residue levels
as "routinelY carried out food control" by governmental
health institutes throughout the country. As this
prediction is part of the latest modification of the
Medical Act for public interest. only little experience is
currently available on its success. but the financial
burden. for laboratory equipment and staff to monitor
REGULATION OF DRUG USAGE IN GERMANY 525
experiments. is enormous.
HOMEOPATHIC FORMULATIONS
Official registration is also necessary for homeopathic
formulations. but at a different level. Formulations have
to be manufactured according to the generally accepted
principles of homeopathy. laid down in a special national
pharmacopoeia. Substance specific data including toxicity
and safety evaluations are not generally required. which
seems illogical considering the fact that. for example.
food additives are administered in "homeopathic" dosages.
DELIVERY OF DRUGS
A special section of the Medical Act refers to the delive-
ry of drugs. Distribution of drugs as "pharmacologically
act ive compounds" is controll ed by pharmacists for human
drugs: but veterinarians still have the right to dispense
and prescribe drugs for their clients - that is. all spe-
cies of animal. They also have the right to use their own
supplies. with the sole restriction of only distributing
drugs for specific clients. To sell drugs to a third
person is onlY allowed for companies granted special per-
mission. A directive to the Medical Act gives detailed
information about the practical circumstances of an
individual practitioner's dispensary <Table 49.2).
PRESCRIBING DRUGS FOR ANIMALS

Within the general right to dispense and prescribe drugs.
a veterinarian can also use human medicines. However. the
Medical Act prohibits the use of compounds for food-produ-
cing animals: if they are not registered definitively for
this species. administration of such a compound is limited
to emergency cases. This is at the practitioner's own
risk. the Question of legal responsibility no~ being com-
pletelY clarified. The same legal situation exists for
the practitioner's own formulations prepared in his labo-
ratorY. Although he has the legal right to use his own
formulations. the administration is at his own risk. This
Table 49.2 Usage of human drugs in veterinary medicine
Prescription for gJL_individual animal

At the risk of the veterinarian
For pet animals only???
Withdrawal time? 5 days
Table 49.3 Experiences and problems
"Black market" - price limits

Important Quality of living animals and food
Epidemic diseases and vaccinations
Natural products and endogenous compounds
situation is still unsatisfYing especiallY when one con-

siders the fact that about 15% of practitioners increa-
singlY use their right to dispense. due to the trend
towards alternative methods in veterinary medicine.
"BLACK MARKET" DRUG USE

The tasks of the latest revision of the Medical Act
were to consider the problems of the "black-market" use of
drugs and the increasing pressures and criticisms from the
public on the Question of safe and residue-free foodstuffs
of animal origin <Table 49.3). Strict limitation of drug
distribution and increasing efforts in safety regulations
were the consequence. For a practitioner working. per-
haps. in poultrY production the pathwaY to legal drug
usage is extremely narrow. thus producing criticism about
overregulation and suppression of new developments in
anima 1 product ion.
50
Do residues of antimicrobial drugs constitute a
microbiological risk for the consumer?
B. VAN KLINGEREN
ABSTRACT
In relation to the veterinary use of antibiotics the
question has arisen whether ingestion of residues of these
agents in food of animal origin might result in a build UP
of resistance in the human intestinal flora.
Since direct evidence is lacking the (im)probability of
this presumed effect can be estimated from the intrinsic
activity of a compound and its kinetics. that is its mea-
sured or calculated concentration in the lower intestinal
tract •
The relevant data are reviewed for those antimicrobial
drugs that are extensively used in human and veterinary
medicine. They include the penicillins. tetracyclines.
sulphonamides. trimethoprim. macrolides. aminoglycosides
and chloramphenicol. It is argued that the microbio-
logical risk of residues of these drugs is negligible as
compared to the risk of resistance development as a con-
sequence of their (sub)therapeutic and prophylactic use.
INTRODUCTION
Since it is obvious that resistance to antimicrobial drugs
is a real threat to human health. every use of these drugs
that can induce a rise in the level or incidence of
resistance has to be considered thoroughly.
527
There has been and there is still much debate going on

about the main cauSes of resistance development. There is
a broad consensus now that resistance in human pathogens
is in the first place caused by the therapeutic and
prophylactic use of antibiotics in humans. and resistance
in animal pathogens by the veterinary use. not only in
therapeutic and prophylactic dosages but also by
subtherapeutic low level feeding for growth promo-
tionttot'.
It is widely known that. in particular. the selection
of R-plasmids in Enterobacteriaceae constitutes a major
hazard. although the importance of a veterinary build up
of an R-plasmid reservoir for human health is far from
clear.
Within the framework of our subject we have to confine
ourselves to the question: "Do residues of antimicrobial
drugs in food of animal origin constitute a
microbiological risk for the consumer ?".
Recently this topic has also been discussed during a
joint FAD/WHO Expert Consultation on residues of
veterinary drugs in foods (Rome. 1984). Quoting from the
report of that meetingt2 :
"The principal question is whether the ingestion of

residues of antimicrobial agents via food of animal origin
poses a danger to human health either
(a) by exerting a selective pressure on the intestinal
flora and thus favouring the growth of microorganisms
with natural or acquired resistance; or
(b) by giving rise. directly or indirectly. to the deve-
lopment of acquired resistance in pathogenic enteric
bacteria.
The Consultation was not aware of any relevant studies
which have been performed with food which contained
residues of antimicrobial agents. hence no direct answer
can be given to either question".
Because of this lack of direct information one has to

ANTIMICROBIAL DRUG RESIDUES: RISKTO HUMANS 529
approach the matter indirectly and find arguments to

convince the community that the presumed risk does or does
not exist.
WHERE AND HOW COULD RESIDUES ACT UPON BACTERIA

A basic principle must be that in order to exert a
selective pressure a residue should have at least some
bacterial growth inhibiting effect.
It is obvious that the only candidate for antimicrobial
attack by residues is the human gut flora. Theoretically
one could argue that also the bacterial microflora of the
oral cavity will come in contact with residues but the
short time of exposure makes any selective pressure highly
improbable if not impossible.
Subsequently we have to define how residues of
antimicrobials could possibly influence the intestinal
flora in human beings in a negative way. The following
possibilities can be distinguished:
(1) selective pressure on Enterobacteriaceae. in particu-

lar E. coli;
(2) impairment of the colonization resistance;
(3) promotion of R-plasmid transfer.
IN VITRO ACTIVITY OF RESIDUES

A well-known parameter for quantifying antibacterial
activity is the MIC. defined as the lowest concentration
at which no growth at all is visible in liquid or on agar
media after appropriate incubation. It is widely
recognized. however. that bacterial growth is already
influenced (retarded) by sub-MIC concentrations. For
instance Greenwoods showed that the growth rate of E. coli
under the influence of chloramphenicol gradually decreases
at increasing subinhibitory concentrations; with
gentamicin a sub-MIC concentration-dependent delay of
growth was observed. The lowest concentration at which
any effect could be observed in vitro amounted to 1/16 of
the MIC. Approximately the same value can be found in the
proceedings of a symposium on the effects of subinhibitory

concentrations of antibiotics on bacteria during the 10th
International Congress of Chemotherapy in 19773 • Another
parameter is the so called MAC (minimum antibacterial
concentration) introduced by Lorian lD who studied
subinhibitorv effects in great detail. The MAC is the
lowest concentration of an antibacterial agent that will
affect bacterial structure, the growth rate or both.
For beta-lactam antibiotics and aminoglycosides MIC/MAC
ratios were usually found to be between 10 and 20, in
other words concentrations of 1/10 to 1/20 of the MIC can
be expected to exert a selective pressure in vitro. This
has been confirmed more directly by Lebek and Egger·.
These authors followed the growth of a tetracycline-sus-
ceptible E. coli strain and a clone of the same strain
harbouring a tetracycline-resistant plasmid in a
continuously growing mixed culture in a chemostat in the
presence of varying subinhibitory concentrations of
tetracycline. They found that concentrations as low as
1/10 of the MIC exerted a selective pressure on the
susceptible strain resulting in overgrowth of the
resistant clone. Therefore they suggested replacement of
zero tolerances in food to levels equal to half of the
minimal selection concentrations (MSC).
IN VIVO ACTIVITY OF RESIDUES

The question, of course, is whether this MSC-approach is
relevant in the in vivo situation. It might be an
oversimplification leading to tolerances that, although
more realistic than zero tolerances, are lower than
necessary. In the first place food of animal origin will
be diluted within the total mass of food and water
ingested. In total diet studies carried out in the
Netherlands the mean daily food and water intake was found
to be approximately 2.5 kg (losing 80% at drying).
Assuming that the daily amount of meat and meat products
is approximately 250 g it follows that residues will be
diluted 10-fold in vivo. Moreover, many antimicrobial
ANTIMICROBIAL DRUG RESIDUES: RISKTO HUMANS 531
drugs will undergo chemical or bioinactivation or will be

absorbed during their passage through the intestinal
tract. So presumably the concentration of residues in the
large intestine. where the influence (if any) on the
microflora will take place. will be substantially lower
than the residual level in the food of animal origin.
Other factors decreasing the risk of selective pressure
of antibiotic residues in vivo are the interaction
between the different organisms within the gut's ecosystem
resulting in lower growth rates than under optimal in
vitro circumstances. and the fact that exposure to
residues will be pulsed so that a selective pressure. if
any, will be significantly lower than under continuous in
vitro exposure.
Nevertheless. it is quite understandable that attempts
have been made to study the selective potential of food
containing low levels of antibiotics under in vivo
circumstances. In 1961, Goldberg et al. studied the
4
influence of long-term feeding of oxytetracycline in human

volunteers. Daily dosages of 10 mg were given calculated
to result in 5-10 ppm of their total diet. In half of the
individuals an increase of oxytetracycline-resistant
coliforms was observed. However, the discriminative power
of studies in men is rather poor due to great natural
fluctuations in the human gut flora. Studies by Rollins
et al. t3 with beagle dogs showed a selective pressure of
food containing 10 ppm oxytetracycline but not with food
containing 2 ppm. The latter concentration is approxi-
mately the MIC for susceptible E. coli.
Recently, Corpet 2 has proposed an animal model using
germ-free mice inoculated with a donor intestinal
microflora. for instance human gut flora. As shown by
Hazenberg et al. 7 this microflora wi 11 be stable for weeks
in mice. In this model the selective pressure on Entero-
bacteriaceae. in particular E. coli, can be studied in
mice drinking water ad libitum containing antibiotics in
varying concentrations. In this model, water with 20 ppm
of chlortetracycline was found to promote the prevalence
of tetracycline-resistant E. coli. However. the question

is whether this model is representative for the human in
vivo situation. For instance. metabolism in mice differs
from metabolism in men and the exposure via drinking water
is closer to continuous exposure than to intermittent
exposure.
To quote Cor pet : "Due to species differences other
than the flora. i.e. drug absorption or the enterohepatic
cycle, direct extrapolation to animals or humans should
not be considered".
Earlier the possibility of impairment of colonization
resistance (CR). that is by interfering with the
anaerobic intestinal bacteria which outnumber the coliform
organisms by a factor of 100-1000. was mentioned. From
studies carried out by van der Waay and others l6 it
follows that for such an effect high therapeutic dosages
of particular antibiotics are needed. It is evident that
the local antibiotic concentrations in the lower gut that
will induce CR impairment will never be obtained through
ingestion of residues in food.
A third possibility of negative interference of
antimicrobial residues in the lower intestinal tract might
be the promotion of R-p1asmid transfer. The author is not
aware of published evidence for this. On the contrary. as
early as 1965 Guinee' concluded from experiments with
mice inoculated with multiresistant Salmonellae and fed on
a diet containing tetracycline. streptomycin or chloram-
phenico1: "There is no evidence that the frequency of
resistance transfer itself is influenced by administration
of antibiotics".
ANTIMICROBIAL DRUGS : RESIDUES AND TOLERANCES

It can be argued that primarily, or only, those
antibiotics in veterinary practice that are also widely
used in the treatment or prophylaxis of infectious
diseases in humans will be of importance. However, one
has to face the possibility that other agents might select
for R-p1asmids. encoding for combined resistance to
ANTIMICROBIAL DRUG RESIDUES: RISK TO HUMANS 533
unrelated compounds.
The main compounds in veterinary and human use are
penicillins. tetracyclines. sulphonamides. trimethoprim.
macrolides. aminoglycosides and chloramphenicol. As
recommended by the World Health Organization t7 • low level
feeding of virtually all of these compounds is prohibited
in many European countries. Residue tolerances for most
of the antibiotics have been established by several
countries. Some relevant Dutch and American FDA values
are shown in Table 50.1 together with the usual MIC values
for E. co 1 i •
Penicillins
The tolerance for penicillins is very low on immunological
grounds (allergy). The MICs for Enterobacteriaceae are at
least 50 times higher. Moreover. significant inactivation
or absorpt i on wi 11 take place before resi dua 1 amount s
reach the lower intestine. It is therefore very unlikely
that these levels will do any microbiological harm.
Chloramphenicol
For chloramphenicol a zero tolerance has been established
in many countries since even low doses may induce aplastic
anaemia in susceptible individuals. One might expect that
real tolerances of this drug will be fixed at ppb levels
and thus wi 1 I be weI I bel ow ant i mi c rob i a 1 con c e n t rat ions.
Macrolides
Among the macrolides. tylosin is used extensively in
veterinary practice. either therapeutically or as a growth
promoter. It is not used in human therapy. Macrolides
are not active against Enterobacteriaceae and most other
gram-negative bacteria. Subinhibitory concentrations were
found not to induce resistance in staphylococci and
streptococci. Hence. it is very unlikely and there is no
evidence that the use of tylosin will compromise human
therapy·,t4. The same argument is valid for the related
antibiotic virginiamYcin. which is only used as a feed
Table 50.1 Tolerances of antibiotics in muscle tissue

(J,Jg/g)
Substance Dutch Public FDA MIC (lJg/ml)

Health Council for E. coli
Penicillins 0.005 zero-0.05 2-R

Tetracyclines zero 1 0.5-4
Chloramphenicol zero ? 2-8
Neomyci n 0.25 M 0.25 1-2
Erythromycin 0.03 M 0.1 R
Tylosin 0.03 M 0.2 R
Sulphonamides 1 M 0.1 (2?) 4-16
Trimethoprim 0.025 M ? 0.5-2
----------------------------------------------------------
M = microbiological motives
R = resistant : > 64
additive.
Aminoglycosides
Aminoglycosides such as neomycin, kanamycin and gentamicin
are not, or only poorly, absorbed when given by the oral
route. Parenteral use in food-producing animals should be
restricted on toxicological and immunological grounds.
The present tolerance for neomycin (0.25 Ug/g) is
approximately one-quarter of the MIC for E. coli.
So the discussion about a microbiological risk' of

antimicrobial residues can mainly be reduced to an
evaluation of the risk involved with the use of a very
limited number of drugs widely used in animals as well as
in humans. They are the tetracyclines, the sulphonamides
and trimethoprim.
Tetracvclines
The present tolerance of tetracyclines in several European
countries is zero. In the United States a level of 1 ppm
ANTIMICROBIAL DRUG RESIDUES: RISK TO HUMANS 5.35.
is accepted. It follows from the literature that the

probability of exposure to a residue of tetracyclines
greater than 1 Wg/g in meat is very low. In a USDA
monitoring programme among 5300 animal tissue samples only
23 were found with tetracycline residues between 0.01 and
Ug/g and only five with levels more than 1 Wg/g'5.
Moreover. one has to realize that tetracyclines are
unstable to the temperatures usually obtained in preparing
food. Nevertheless. incidental exposure to food
containing 1 or 2 Ug/g tetracycline (only obtainable with
therapeutic dosages) might occur. As discussed earlier.
it is very unlikely that this will lead to any selective
pressure in the lower gut.
Sulphonamides
The present FDA tolerance of 0.1 ppm is 10-fold lower than
the level permitted in the Netherlands. However. in 1978
the American Food Safety and Inspection Service found more
than 10% of pigs being slaughtered for human consumption
with higher residue levels'. From current toxicological
studies it is anticipated that the tolerance may be
increased to 2 Wg/g. The question is whether regular
ingestion of food with 1 or 2 ppm sulphonamides will exert
a selective pressure upon the intestinal flora. One
should realize that this level is approximately the lower
level of the MIC-range of susceptible E. coli. If present
in the lower intestinal tract this concentration could
possibly promote the growth of less susceptible bacteria.
However. sulphonamides are absorbed in the upper
intestinal tract; this makes. together with the dilution
factor. a build-up of antimicrobial concentrations in the
colon unlikely.
Trimethoprim
Trimethoprim (TMP) is usually given in combination with a
sulphonamide. although monotherapy in humans is becoming
more popular. in particular for the prophylaxis and
treatment of lower urinary tract infections. Information
on residues of TMP is lacking, but from the kinetics of

this compound one can expect that immediately after
treatment muscle tissue levels will not exceed 1 ~g/g.
This level is approximately the MIC for E. coli. However,
in the presence of 1 ~g/ml of a sulphonamide only 0.05
~g/ml TMP is sufficient to inhibit E. coli in vitro. For
this reason a relatively low tolerance (0.025 ~g/g) has
been established by the Dutch Public Health Council. The
most popular TMP/sulphonamide combination in human therapy
is co-trimoxazole (TMP + sulphamethoxazole). It is
frequently used for selective decontamination of immuno-
compromised patients. High therapeutic dosages do not
impair the colonization resistance'·.
CONCLUSION
From an assessment of the available information. the
conclusion seems to be Justified that the microbiological
risk of eating food containing low levels of residues of
antimicrobial substances is negligible as compared to the
risk of resistance development as a consequence of the
(sub)therapeutic and prophylactic use of these drugs.
There is indeed in vitro evidence that concentrations
as low as 1/10 or 1/20 of the MIC might elicit some
selective pressure but the extrapolation to tolerances of
the same level is an unjustified simplification. The
proposed animal model of Corpet 2 to study the influence of
residues in germ-free mice inoculated with human gut flora
is an interesting one from an academic point of view. but
the results are. as with the in vitro information. hard to
extrapolate to the conditions of real life.
As a consequence. establishing tolerances on
microbiological grounds is a rather arbitrary exercise.
One might choose a quarter or even 1/20 of the usual MIC
for E. coli. but there is no evidence that even the daily
ingestion of meat and meat product s containing anti-
microbials at MIC level wi 11 do any harm from a microbio-
logical point of view.
With this in mind. and provided there are no
ANTIMICROBIAL DRUG RESIDUES: RISK TO HUMANS 537
toxicological objections. it should be possible to

establish realistic and safe tolerances that can ,be
measured reliably and cheaply in routine control
laboratories.
References
1. Bevill, R.F. (1984). Sulfonamides. In: CRC Handbook
Series in Zoonoses. Section OJ Antibiotics. Sulfon-
amides. and Public Health. Vol. 1. pp.355-365. Boca
Raton. Florida: CRC Press. Inc.
2. Corpet. D.E. (1984). The effect of bambermycin. car-
badox. chlortetracycline and olaquindox on antibiotic
resistance in intestinal coliforms a new animal
model. Ann. Microbiol. (Inst. Pasteur) 135A:329-339.
3. Effects of subinhibitory concentrations of antibiotics
on bacteria (1978). In: Current Chemotherapy. pp.
72-78. Proc. of the 10th Intern. Congr. Chemother ••
Zuri c h. 1977.
4. Goldberg. H.S •• Goodman. R.N •• Logue. J.T. and Hand-
ler. F.P. (1961). Long-term. low-level antibiotics
and the emergence of antibiotic-resistant bacteria in
human volunteers. Antimicrob. Agents Chemother.:
80-87.
5. Greenwood. D. (1981). In vitro veritas? Antimicro-
bial susceptibility tests and their clinical rele-
vance. J. Inf. Dis. 144:380-385.
6. Guinee. P.A.M. (1965). Transfer of multiple drug
resistance from Escherichia coli to Salmonella
typhimurium in the mouse intestine. Antonie van
Leeuwenhoek 31:314-322.
7. Hazenberg. M.P •• Bakker. M. and Verschoor-Burggraaf.
A.(1981). Effects of the human intestinal flora on
germ-free mice. J. Appl. Bacteriol. 50:95.
8. Knothe. H. (1977). Medical implications of macrolides
resistance and its relationship to the use of tylosin
in animal feeds. Infection 5:137-139.
9. Lebek. G. and Egger. R. (1983). R-selection of sub-
bacteriostatic tetracycline concentrations. Zbl.
Bakt. Hyg. I. Abt. Orig. A. 255:340-345.
10. Lorian. V. (1985). Low concentrations of antibiotics.
J. Antimicrob. Chemother. 15. Suppl. A:15-16.
11. National Academy of Sciences (1980). The effects on
human health of sub-therapeutic use of antimicrobials
in animal feeds. Washington DC: Report of the
National Research Council.
12. Residues of veterinary drugs in food (1984). Report
of a joint FAO/WHO Expert Consultation. Rome 29
October to 5 November 1984.
13. Rollins. R.D •• Gaines. S.A •• Pocurull, D.W. and Mer-
cer. H.D. (1975). Animal model for determining the
no-effect level of an antimicrobial drug on drug
resistance in the lactose fermenting enteric flora.
14. Ten years on from Swann (1981). Proceedings of a sym-
posium organized by the Association of Veterinarians

in Industry: London.
15. Timoney. J.F. The tetracyclines. In: CRC Handbook
Series in Zoonoses. Section 0: Antibiotics. Sulfon-
amides. and Public Health. Vol. 1. pp.267-279. Boca
Raton. Florida: CRC Press. Inc.
16. Van der Waay. D. and Verhoef. J. (ed. 1979). New cri-
teria for antimicrobial therapy: maintenance of
digestive tract colonization resistance. Amsterdam.
Oxford: Excerpta Medica.
17. World Health Organization (1974). The public health
aspects of antibiotics in foodstuffs. Report of a
Working Group. Bremen. 1-5 October 1973. Copenhagen:
WHO Regional Office for Europe.
18. World Health Organization (1981). Antimicrobial resi-
stance. Report of a Scientific Working Group. Geneva.
23-27 November 1981.

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ANAESTHESIA, NEUROLEPTANALGESIA AND SEDATION

Influence of halothane anaesthesia, after xylazine premedication,

3 Effects of halogenated inhalational anaesthetics on respiration in dogs

TEACHING VETERINARY PHARMACOLOGY

5 Postgraduate training in the veterinary pharmacology

DRUG DELIVERY SYSTEMS AND BIOAVAILABILITY

7 Design and evaluation of studies on drug delivery systems

9 Influence of injection site on the depot effect of procaine penicillin

SMOOTH MUSCLE PHARMACOLOGY

11 Pharmacology of the (fore}-stomach smooth muscles

12 Smooth muscle pharmacology of the large intestine

COMPARATIVE PHARMACOKINETIC STUDIES

15 Comparative pharmacokinetics: introductory remarks

16 Comparative neonatal pharmacokinetics

17 Comparative pharmacokinetic studies of sulphonamides

DRUG RESIDUE TOXICOLOGY

19 The target animal species in drug toxicity studies:

20 The use of pharmacokinetics in chronic toxicity testing

INFLAMMATION AND ANTI-INFLAMMATORY DRUGS

22 Modulation of autonomic receptor function by Haemophilus

26 Comparative aspects of drug conjugation in laboratory animals.

29 Disposition and metabolism of 14C-mebendazole in sheep and poultry

30 Modulation of intestinal ion absorption and secretion by

34 Drug reactions leading to toxicity

PATHOPHYSIOLOGICAL MODELS IN PHARMACOLOGY,

37 Role of animal disease models in evaluating the efficacy of

39 Tickborne fever: efficacy and effects on pharmacokinetics of

OPIATES, OPIOIDS AND NEUROPEPTIDES

42 Opioid peptides and their receptors

43 Endorphin systems, pain and addiction

44 Opioid effects on gastrointestinal motor and secretory functions

45 Central nervous system control of feeding behaviour by some

DRUG USE AND REGULATION

46 The use in animals of drugs licensed for human use only

47 The use in small animal medicine of drugs licensed for

48 The use in animals of drugs licensed for human use:

49 Regulation of drug usage in veterinary medicine:

50 Do residues of antimicrobial drugs constitute a microbiological

Ministry of Agriculture Fisheries and Food, Central

VAN DEN HENDE C.

VAN DER MOLEN E.J.

VAN DUIN C.T.M.

VAN MIERT A.S.J.P.A.M.

VAN MUISWINKEL W.B.

VAN REE J.M.

Mr. Rector and members of the Honorary Committee, dear

It is a privilege and a pleasure for me, as Chairman, to

ruminant pharmacology. Today. 3 years later. we meet

something even more special. They have always been

the ideal forum for meeting colleagues. renewing old

I can think of two, and only two, reasons, why anybody in

As I have stated on previous occasions : drug research is

orchestra with chemists, pharmacologists, toxicologists.

I hear and I forget.