Excretion, of foreign compounds

The importance of the physicochemical characteristics of compounds has already been alluded to in the previous two chapters. Thus, lipophilicity is a factor of major importance for the absorption, distribution, metabolism, and excretion of foreign compounds. Lipophilic compounds are more readily absorbed, metabolized, and distributed, but more poorly excreted, than hydrophilic compounds. 

Levine WG, Millburn P, Smith RL, et al. The role of the hepatic endoplasmic reticulum in the biliary excretion of foreign compounds by the rat. The effect of phenobarbitone and SKF 525-A diethylaminoethyl diphenylpropylacetate Biochem Pharmac 1970 19 235-244. 

Yang KH, Croft WA, Peterson RE. 1977. Effects of 2,3,7,8-tetrachlorodibenzo-p-dioxin on plasma disappearance and biliary excretion of foreign compounds in rats. Toxicol Appl Pharmacol 40 485-496. 

The kidney is an important organ for the excretion of toxic materials and their metaboHtes, and measurement of these substances in urine may provide a convenient basis for monitoring the exposure of an individual to the parent compound in his or her immediate environment. The Hver has as one of its functions the metaboHsm of foreign compounds some pathways result in detoxification and others in metaboHc activation. Also, the Hver may serve as a route of elimination of toxic materials by excretion in bile. In addition to the Hver (bile) and kidney (urine) as routes of excretion, the lung may act as a route of elimination for volatile compounds. The excretion of materials in sweat, hair, and nails is usually insignificant. 

The metabolism of foreign compounds (xenobiotics) often takes place in two consecutive reactions, classically referred to as phases one and two. Phase I is a functionalization of the lipophilic compound that can be used to attach a conjugate in Phase II. The conjugated product is usually sufficiently water-soluble to be excretable into the urine. The most important biotransformations of Phase I are aromatic and aliphatic hydroxylations catalyzed by cytochromes P450. Other Phase I enzymes are for example epoxide hydrolases or carboxylesterases. Typical Phase II enzymes are UDP-glucuronosyltrans-ferases, sulfotransferases, N-acetyltransferases and methyltransferases e.g. thiopurin S-methyltransferase. 

Renal elimination of foreign compounds may change dramatically with increasing age by factors such as reduced renal blood flow, reduced glomerular filtration rate, reduced tubular secretory activity, and a reduction in the number of functional nephrons. It has been estimated that in humans, beginning at age 20 years, renal function declines by about 10% for each decade of life. This decline in renal excretion is particularly important for drugs such as penicillin and digoxin, which are eliminated primarily by the kidney. 

The rates of movement of foreign compound into and out of the central compartment are characterized by rate constants kab and kei (Fig. 3.23). When a compound is administered intravenously, the absorption is effectively instantaneous and is not a factor. The situation after a single, intravenous dose, with distribution into one compartment, is the most simple to analyze kinetically, as only distribution and elimination are involved. With a rapidly distributed compound then, this may be simplified further to a consideration of just elimination. When the plasma (blood) concentration is plotted against time, the profile normally encountered is an exponential decline (Fig. 3.24). This is because the rate of removal is proportional to the concentration remaining it is a first-order process, and so a constant fraction of the compound is excreted at any given time. When the plasma concentration is plotted on a logio scale, the profile will be a straight line for this simple, one compartment model (Fig. 3.25). The equation for this line is... 

Many toxic substances and other foreign compounds are removed from the blood as it passes through the kidneys. The kidneys receive around 25% of the cardiac output of blood, and so they are exposed to and filter out a significant proportion of foreign compounds. However, excretion into the urine from the bloodstream applies to relatively small, water-soluble molecules large molecules such as proteins do not normally pass out through the intact glomerulus, and lipid-soluble molecules such as bilirubin are reabsorbed from the kidney tubules (Fig. 3.31). 

Excretion into breast milk can be a very important route for certain types of foreign compounds, especially lipid-soluble substances, because of the high lipid content in milk. Clearly, newborn animals will be specifically at risk from toxic compounds excreted into milk. For example, nursing mothers exposed to DDT secrete it into their milk, and the infant may receive a greater dose, on a body-weight basis, than the mother. Also, because the pH of milk (6.5) is lower than the plasma, basic compounds may be concentrated in the fluid. 

In the biotransformation of foreign compounds, the body attempts to convert such lipophilic substances into more polar, and consequently, more readily excreted metabolites. 

Distribution. The distribution of foreign compounds may vary between species because of differences in a number of factors such as proportion and distribution of body fat, rates of metabolism and excretion and hence elimination, and the presence of specific uptake systems in organs. For instance, differences in localization of methylglyoxal-bis-guanyl hydrazone (Fig. 5.6) in the liver account for its greater hepa to toxicity in rats than in mice. The hepatic concentration in mice is only 0.3% to 0.5% of the dose after 48 hours, compared with 2% to 8% in the rat. 

Once absorbed, foreign compounds may react with plasma proteins and distribute into various body compartments. In both neonates and elderly human subjects, both total plasma-protein and plasma-albumin levels are decreased. In the neonate, the plasma proteins may also show certain differences, which decrease the binding of foreign compounds, as will the reduced level of protein. For example, the drug lidocaine is only 20% bound to plasma proteins in the newborn compared with 70% in adult humans. The reduced plasma pH seen in neonates will also affect protein binding of some compounds as well as the distribution and excretion. Distribution of compounds into particular compartments may vary with age, resulting in differences in toxicity. For example, morphine is between 3 and 10 times more toxic to newborn rats than adults because of increased permeability of the brain in the newborn. Similarly, this difference in the blood-brain barrier underlies the increased neurotoxicity of lead in newborn rats. 

The general strategy of xenobiotic metabolism (the metabolism of foreign compounds) is to convert lipophilic compounds into more readily excreted polar products. The rate of this metabolism is an important determinant of the duration and intensity of the pharmacological action of drugs. Drug metabolism can result in either toxication or detoxication. While both do occur, the major metabolites of most drugs are detoxication products. 

Metabolic epoxidation of carbon-carbon double bonds in alkenes and arenes is a fundamentally important biotransformation of foreign compounds. The primary epoxide (oxirane) metabolites formed generally undergo further biotransformation to more polar and readily excreted metabolites via conjugation with glutathione or epoxide-hydrolase-mediated hydrolysis to diols. Thus, epoxidation can be considered the first step in a metabolic detoxification scheme. On the other hand, epoxidation is also a... 

The kinetics described so far have been based on first-order processes, yet often in toxicology, the situation after large doses are administered has to be considered when such processes do not apply. This situation may arise when excretion or metabolism is saturated and hence the rate of elimination decreases. This is known as Michaelis-Menten or saturation kinetics. Excretion by active transport (see below) and enzyme-mediated metabolism are saturable processes. In some cases cofactors are required and their concentration may be limiting (see Chapter 7, salicylate poisoning). When the concentration of foreign compound in the relevant tissue is lower than the km then linear, first-order... 

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