Role of Renal Cysteine Conjugate beta‐Lyase in the Mechanism of Compound A Nephrotoxicity in Rats

Background The sevoflurane degradation product compound A is nephrotoxic in rats, in which it undergoes extensive metabolism to glutathione and cysteine S‐conjugates. The mechanism of compound A nephrotoxicity in rats is unknown. Compound A nephrotoxicity has not been observed in humans. The authors tested the hypothesis that renal uptake of compound A S‐conjugates and metabolism by renal cysteine conjugate beta‐lyase mediate compound A nephrotoxicity in rats. Methods Compound A (0–0.3 mmol/kg in initial dose‐response experiments and 0.2 mmol/kg in subsequent inhibitor experiments) was administered to Fischer 344 rats by intraperitoneal injection. Inhibitor experiments consisted of three groups: inhibitor (control), compound A, or inhibitor plus compound A. The inhibitors were probenecid (0.5 mmol/kg, repeated 10 h later), an inhibitor of renal organic anion transport and S‐conjugate uptake; acivicin (10 mg/kg and 5 mg/kg 10 h later), an inhibitor of gamma‐glutamyl transferase, an enzyme that cleaves glutathione conjugates to cysteine conjugates; and aminooxyacetic acid (0.5 mmol/kg and 0.25 mmol/kg 10 h later), an inhibitor of renal cysteine conjugate beta‐lyase. Urine was collected for 24 h and then the animals were killed. Nephrotoxicity was assessed by light microscopic examination and biochemical markers (serum urea nitrogen and creatinine concentration, urine volume and urine excretion of protein, glucose, and alpha‐glutathione‐S‐transferase [alpha GST], a marker of tubular necrosis). Results Compound A caused dose‐related nephrotoxicity, as shown by selective proximal tubular cell necrosis at the corticomedullary junction, diuresis, proteinuria, glucosuria, and increased alpha GST excretion. Probenecid pretreatment significantly (P < 0.05) diminished compound A‐induced increases (mean +/‐ SE) in urine excretion of protein (45.5 +/‐ 3.8 mg/24 h vs. 25.9 +/‐ 1.7 mg/24 h), glucose (28.8 +/‐ 6.2 mg/24 h vs. 10.9 +/‐ 3.2 mg/24 h), and alpha GST (6.3 +/‐ 0.8 micro gram/24 h vs. 1.0 +/‐ 0.2 micro gram/24 h) and completely prevented proximal tubular cell necrosis. Aminooxyacetic acid pretreatment significantly diminished compound A‐induced increases in urine volume (19.7 +/‐ 3.5 ml/24 h vs. 9.8 +/‐ 0.8 ml/24 h), protein excretion (37.2 +/‐ 2.7 mg/24 h vs. 22.2 +/‐ 1.8 mg/24 h), and alpha GST excretion (5.8 +/‐ 1.5 vs. 2.3 micro gram/24 h +/‐ 0.8 micro gram/24 h) but did not significantly alter the histologic pattern of injury. In contrast, acivicin pretreatment increased the compound A‐induced histologic and biochemical markers of injury. Compound A‐related increases in urine fluoride excretion, reflecting compound A metabolism, were not substantially altered by any of the inhibitor treatments. Conclusions Intraperitoneal compound A administration provides a satisfactory model of nephrotoxicity. Aminooxyacetic acid and probenecid significantly diminished histologic and biochemical evidence of compound A nephrotoxicity, whereas acivicin potentiated toxicity. These results suggest that renal uptake of compound A‐glutathione or compound A‐cysteine conjugates and cysteine conjugates metabolism by renal beta‐lyase mediate, in part, compound A nephrotoxicity in rats.