Turton John A, Fagg Rajni, Sones William R, Williams Thomas C, Andrews C Michael
Centre for Toxicology, Department of Pharmacology, The School of Pharmacy, University of London, London, UK.
Int J Exp Pathol. 2006 Apr;87(2):101-12. doi: 10.1111/j.0959-9673.2006.00460.x.
Chloramphenicol (CAP) is haemotoxic in man, inducing two types of toxicity. First, a dose-related, reversible anaemia with reticulocytopenia, sometimes seen in conjunction with leucopenia and thrombocytopenia; this form of toxicity develops during drug treatment. The second haemotoxicity is aplastic anaemia (AA) which is evident in the blood as severe pancytopenia. AA development is not dose-related and occurs weeks or months after treatment. We wish, in the longer term, to investigate CAP-induced AA in the busulphan-pretreated mouse. However, as a prelude to that study, we wanted to characterize in detail the reversible haemotoxicity of CAP succinate (CAPS), administered at high dose levels in the mouse, and follow the recovery of the bone marrow in the post-dosing period. Female B6C3F1 mice were gavaged with CAPS at 0, 2500 and 3500 mg/kg, daily, for 5 days and sampled (n = 5) at 1, 7, 14 and 21 days post-dosing. Blood, bone marrow and spleen samples were analysed and clonogenic assays carried out. At day 1 post-dosing, at both CAPS dose levels, decreases were seen in erythrocytes and erythrocyte precursors; marrow erythroid cells were reduced. Reductions were also evident in splenic nucleated cell counts, blood high fluorescence ratio (HFR) reticulocyte counts and total reticulocyte counts; burst-forming units-erythroid and colony-forming units-erythroid showed decreases. At day 7 post-dosing (2500 mg/kg CAPS), there was regeneration of erythrocyte production, with marked splenic erythropoietic activity, and raised blood HFR reticulocytes. At day 7, at 3500 mg/kg CAPS, erythrocyte and reticulocyte parameters remained depressed. At 14 days post-dosing (2500 mg/kg CAPS), many erythrocyte parameters had returned to normal; at 3500 mg/kg CAPS, there was erythroid regeneration. By 21 days post-dosing, at both CAPS dose levels, most erythrocytic parameters were equivalent to control values. For leucocyte parameters, there was some depression at day 1 post-dosing (at both CAPS dose levels) and signs of recovery at day 7. At days 14 and 21 post-dosing, most leucocyte parameters were close to control values. Marrow smears at day 1 post-dosing (at both CAPS dose levels) showed vacuolation of early normoblasts, of myeloid and of monocytic precursors. We conclude that the administration of CAPS at 2500 and 3500 mg/kg for 5 days induced significant myelotoxicity in female B6C3F1 mice, with cessation of erythropoiesis at day 1 post-dosing; recovery was seen over the following 7/14 days. The blood HFR reticulocyte count was a precise indicator of CAPS-induced depressive effects and subsequent recovery. It is concluded that the administration of five daily doses of CAPS at 2500 and 3500 mg/kg to the female B6C3F1 mouse induces an anaemia with reticulocytopenia, in conjunction with leucopenia, in the immediate post-dosing period; no evidence was seen at 21 days post-dosing of peripheral blood pancytopenia or a hypocellular/acellular bone marrow, which are both characteristic features of AA in man.
氯霉素(CAP)对人类具有血液毒性,可引发两种类型的毒性反应。其一,是与剂量相关的可逆性贫血,伴有网织红细胞减少,有时还会合并白细胞减少和血小板减少;这种毒性反应在药物治疗期间出现。其二,是再生障碍性贫血(AA),在血液中表现为严重的全血细胞减少。AA的发生与剂量无关,且在治疗数周或数月后出现。我们希望从长远来看,研究在白消安预处理的小鼠中CAP诱导的AA。然而,作为该研究的前奏,我们想要详细表征在小鼠中高剂量给予琥珀氯霉素(CAPS)后的可逆性血液毒性,并跟踪给药后骨髓的恢复情况。将雌性B6C3F1小鼠每日灌胃给予0、2500和3500 mg/kg的CAPS,持续5天,并在给药后1、7、14和21天进行采样(n = 5)。对血液、骨髓和脾脏样本进行分析,并进行集落形成试验。在给药后第1天,在两个CAPS剂量水平下,红细胞和红细胞前体数量均减少;骨髓红系细胞减少。脾有核细胞计数、血液高荧光率(HFR)网织红细胞计数和总网织红细胞计数也明显减少;红系爆式集落形成单位和红系集落形成单位减少。在给药后第7天(2500 mg/kg CAPS),红细胞生成开始恢复,脾脏出现明显的红细胞生成活性,血液HFR网织红细胞升高。在给药后第7天,3500 mg/kg CAPS组的红细胞和网织红细胞参数仍处于抑制状态。在给药后第14天(2500 mg/kg CAPS),许多红细胞参数已恢复正常;在3500 mg/kg CAPS组,出现红系再生。到给药后第21天,在两个CAPS剂量水平下,大多数红细胞参数均与对照值相当。对于白细胞参数,在给药后第1天(两个CAPS剂量水平下)有一定程度的降低,在第7天有恢复迹象。在给药后第14天和21天,大多数白细胞参数接近对照值。给药后第1天(两个CAPS剂量水平下)的骨髓涂片显示早幼红细胞、髓系和单核细胞前体有空泡形成。我们得出结论,以2500和3500 mg/kg的剂量给予CAPS 5天可在雌性B6C3F1小鼠中诱导显著的骨髓毒性,给药后第1天红细胞生成停止;在接下来的7/14天内可见恢复。血液HFR网织红细胞计数是CAPS诱导的抑制作用及随后恢复的精确指标。得出的结论是,对雌性B6C3F1小鼠每日给予5次剂量为2500和3500 mg/kg的CAPS会在给药后即刻诱导伴有网织红细胞减少的贫血,并伴有白细胞减少;在给药后21天未发现外周血全血细胞减少或骨髓细胞减少/无细胞的证据,而这两者都是人类AA的特征性表现。