Journal of Hepatology, 1992; 14: 335-341 @ 1992 Elsevier Science Publishers B.V. All rights reserved. 0168-8278/92/$05.00


HEPAT 00990

Axe1 Holstege, Heide-

aria Gengenbacher, Linda ehle and Wolfgang


Department of Internal Medicine, Universityof Freiburg, Freiburg, Federal Republic of Germany

(Received 22 March1991)

A new approach in the treatment of gastrointestinal tumors with 5-tluorouracil involves the infusion of high doses of uridine to improve the chemotherapeutic efficiency of the former. High amounts of uracil formed from uridine can interfere with the hepatic catabolism of 5fluorouracil and thus increase its bioavailability and toxicity. In our study, we analysed the metabolite pattern of uridine in the effluent of isolated perfused rat livers in relation to portal uridine levels. The livers were pelfused hemoglobin-free without recirculation at a constant flow. In the perfusate, uridine was changed from 0.5 to 100 PmoYl. The Icomplete degradation of [2-14C]uridine and [2-‘4C]uracil was monitored via the r&lease of labeled CO*. Radioactive catabolites of uridine including uracil and the sum of dihydrouracil andp-ureidopropionate were separated by high-performance liquid chromatography and counted using a radioactivity flow monitor. Portal uridine concentrations ‘were increased from 0.5 to 1OOymoYl and were accompanied by a rise in the relative amount of non-metabolized uridine in the effluent from 13 to 78%. At uridine concentrations above 50fimol/l, there was a constant release of uracil into the effluent, indicating saturation of uridine phosphorolysis or transport. The amount of 14C02 formed by the liver reflecting complete uridine breakdown was higher than any other uridine metabolite when uridine concentration varied from 0.5 to 15 pmol/l. Saturation of 14C02 formation was achieved at a uridine concentration of 25 pmol/l. Higher peak values of 14C02 release were observed after direct infusion of equivalent amounts of uracil into the portal vein. Extraction of uridine was most efficient at lower nucleoside concentrations indicating dose dependency of clearance by the liver. The dose of uridine in treatment regimens including 5fluorouracil should surpass the capacity of uracil catabolism by the liver counteracting 5fluorouracil degradation and toxicity.

Uridine is a physiological constituent of biood plasma (l-6)) which is used for pyrimidine nucleotide synthesis via the salvage pathway in many tissues (1,7). The pyrimidine nucleotide requirements of cells can be satisfied by the circulating uridine in blood plasma (7). The accumulating intracellular uridine Y&phosphate (UTP) which is formed leads to feedback inhibition of pyrimidine de novo synthesis (7) and antagonizes the effects of pyrimidine antimetabolites which should interfere with this pathway in cancer chemotherapy (1). Recently, the infusion of high doses of &dine have been shown to reverse the DNAand RNA-directed actions of 5-fluoropyrimidines (reviewed in Ref. 8). Uridine rescue resulted in a considerable improvement of antitumor activity and allowed

higher doses of Wluorouracil to be administered (9-11). In order to have this beneficial effect, uridine must first be converted into nucleotides to counteract the cytotoxic effects of both 5-fluoro-2’-deoxyuridine and 5-fluorouridine triphosphates (8). Finally, uridine and uracil can also interfere with the catabolism of 5-fluorouracil(12,13) which can lead to an enhanced bioavailability of the drug (14). In addition to their metabolic effects, uridine and uracil have been shown to possess different pharmacological properties. The administration of uridine favours the restoration of cardiac glycogen (15) and may increase blood pressure in anaesthetized rats (16) presumably by binding itself to a distinct class of pyridiminoreceptors (17) before or after its conversion to uridine S-monophosphate

Correspondence: Dr. Axe1 Holstege, Medizinische Winik I der Universitlt Regenstmrg. Franz-Josef-Strauss Allee, W-8400 Regensburg,



336 (UMP). Jn addition, high doses of uridine interfere with the regulation of body temperature in different species (18-20).One of its breakdown products appears to induce fever in man and rabbits (20). Continuous administration of a diet supplemented with uracil was followed by uracil-induced urolithiasis and the development of a reversible papillomatosis in the urinary bladder of F344 rats (21). Inborn dehydropyrimidine dehydrogenase deficiency led to thymine uraciluria and a non-specific clinical picture of cerebral dysfunction in man (22). These pathological conditions strongly point to the need four ongoing unimpaired pyrimidine degradation. Thi; liver has been shown to be the key site for complete degradation of uridine, uracil and their analogs {14,23-28). Earlier studies showed that the isolated perfused rat liver eliminates uridine in a single pass and releases a constant amount of the nucleoside from hepatic pools of uridine nucleotides (27,28). In our study, we used a non-recirculating perfusion system to further clarify the role of the liver in portal vein &dine degradation end we tested a wide range of natural and non-physiological nucleoside concentrations. High uridine levels can occur under in vivo conditions during combinations of high doses of uridine with Nluorouracil in cancer chemotherapy (18). Furthermore, we analyzed the metabolite pattern of uridine in the liver vein effluent; this indicated efficient extraction with most of the nucleoside completely catabolized at low physiological uridine concentrations. We present evidence for a dose-dependent clearance of uridine.

et al.

Hemoglobin-free liver perfusion

Isolation and perfusion of the liver were performed exactly as previously described (29,30). Rats were anesthetized with sodium pentobarbital (3 mg/lOO g body weight; Ceva, Bad Segeberg, F.R.G.) injected intraperitoneally. Heparin (100 U; Hoffmann-La Roche, Grenzach-Wyhlen, F.R.G) was administered into the femoral vein. The isolated livers were perfused at constant flow in a non-recirculating system using bicarbonate-buffered Krebs-Henseleit saline plus L-lactate (2.1 mmol/l) and pyruvate (0.3 mmoyl) (29,30). The buffer was equilibrated with O&O2 (95:5, v/v) at 37 “C to give a final pH of 7.4. Perfusate flow was 4 mlmin-‘.g liver-“. The perfusate entered the liver via the cannulated portal vein (influent). A cannula fixed in the superior caval vein served to drain the liver (effluent). The hepatic artery was tied off. Portal pressure, oxygen consumption and pH were continuously monitored by using, a pressure transducer, (Sachs Elektronik, Hugstetten, F.R.G.), a Clarke-type electrode (Bachofer, Reutlingen, F.R.G), and a pH electrode (Ingold, Frankfurt, F.R.G.), respectively. Pyrimidines were infused into the influent perfusate using a precision micropump (Braun Melsungen, Melsungen, F.R.G.). Pyrimidine concentrations in influent perfusate were controlled by measurement of their ultraviolet absorbance and using published absorption coefficients (31). After an equilibration period of at least 20 min effluent samples were collected every minute. Half of the samples were used for CO, measurement and the other half for metabolite analysis. Measurement of radioactive CO2

Materials and Methods Animals, chemicals and isotopes

Male Wistar rats (Tierzuchtanstalt Jautz, Hannover, F.R.G.) weighing 150 to 200 g had free access to water and a standard rat diet (Altromin 300 R, Altromin, Lage, F.R.G.). Uridine and its catabolites (uracil, dihydrouracil, /3-ureidopropionate) were from Sigma Chemicals (Deisenhofen, F.R.G.) or from Merck (Darmstadt, F.R.G.). ZPhenylethylamine was obtained from Serva Biochimica (Heidelberg, F.R.G.). Pyruvate and L(+)-lactate were bought from Boehringer Mannheim (Mannheim, F.R.G.) and from Roth (Karlsruhe, F.R.G.), respectively. All other chemicals were from E. Merck of the highest quality available. [2-‘4C]Uridine (52 Ci/mol) and [2-14C]uracil (48 Ciimol) were from Amersham Buchler (Braunschweig, F.R.G.). Purity was more than 98% for each of the isotopes as determined by reversed-phase high-performance liquid chromatography.

Effluent samples were collected in glass flasks and occluded with a rubber stopper. After addition of 3 ml perchloric acid (3 mol/l) radioactive CO2 was trapped in 1 ml 2-phenylethylamine over 16 to 24 h and counted at an efficiency of 85% in Instant Stint Gel (Packard Instrument, Downers Grove, IL). Metabolite analysis

For high-performance liquid chromatography 10 ml of each sample was lyophilized and resuspended in 1 ml of water. After filtration (0.22 pm Millipore filter units; Eschbom, F.R.G.) 30~1 HClO, (2.5 mol/l) were added to 300 ,ul of the filtrate. The supematant was neutralized with solid KHC03, centrifuged and filtrated using Millex HV 0.45 pm filter units (Millipore). Fifty ~1 of the clear sample wac injected onto two Cts-PBondapak columns connected in series with a Guard-PAK precolumn module containing a C,s-PBondapak insert (Waters, Eschbom, F.R.G.). HPLC and counting of the radioactive peaks was performed as described (30) using an isocratic Waters




HPLC equipment and a radioactivity flow monitor connected in series. The PLC eluent was continuously mixed with liquid scintillator (Rialuma; Baker Chemicals, Deventer, The Netherlands) at a flow rate of 3 ml/min using a 1 ml mixing chamber (Model LB-1 thold, Wildbad, F.R.G.). The sum of dihydrouracil an\dpureidopropionate is given since minor conversions of dihydrouracil into @reidopropionate cannot be excluded. Alkaline treatment of samples at 4 “C, however, did not reduce dihydrouracil contents indicating a higher stability of this compound as compared to its fluorinated analog (14,33). Uridine clearance (C&; ml/min) was calculated from the portal flow (V, ml/min) as well as from the influent (Ci) and effluent (c,) uridine concentration (nmol/ml) according to the following formula: Clu,a = V.Ci-C,JCi.

Changes ofuridine catabolite pattern with increasing portal vein nucleoside concentrations Five different radioactive metabolites were detected in


1 &lease

wi& &rent

of ufiane



urac~ CC& and the sum

uridine Cc&n&ons


uent perfusate of isolated rat livers perfused with increasing concentrations of “4C-labeled uridine including uridine, uracil, dihydrouracil, @reidopropionate and 14C02 (Fig. 1). Total radioactivity in the liver vein effluent was 98.5 + 3.6% (mean f SD.) of the label icfused into the portal vein excluding any significant intracellular trapping of uridine in the form of uracil nucleotides. When the livers were perfused with low concentrations of uridine (0.5 to IO~umoVl), radioactive CO, was the predominant catabolite. Ilt peaked at 55 + 4% of total radioactivity in the hepatic outflow and reflected complete degradation of the nucleosides. Under these conditions, uracil and the sum of dibydrouracil and j&ureidopropionate amounted to 18.5 and 5.3%, respectively (Fig. 2). .4t an infItlent uridine concentration of 3 ymoY1, which is close tc the amount detected in blood plasma under physiological conditions (2-6), 79% of the nucleoside was converted into catabolites by the liver in a single pass. At higher portal m-idine concentrations (215 PmoVI), unchanged uridine became the predominant metabolite in liver vein effluent (Fig. 1): the relative proportion of this nucleoside increased from 31 to 78% at influent uridine




of dihydrouracil and @-ureidopropionate (catabolites) into the effluent of rat livers perfused

@.5 to 100 pmol/l). Isolation and perfusion of rat livers was performed as described under

Materials and M&o&. (2-‘4C]ufidine(15 Ca) and the indicated amount of nonlabeled uridine were included into the influent perfusate. Uridine and its cata-

bolites were quantitated by HPLC and a radioactivity flow monitor. 14C02was trapped in 2-phenylethylamine and counted. Symbols represent the mean +- SD. (vertical bars) least three separate perfusions. The right half of the figure indicates an enhanced view low uridine concentration range.

of at

of the

A. HOLSTEGE et al.

338 I


1 ’


I ‘0












1 T-

‘I 100 (pmol/l)

Fig. 2. Relative amount of uridine and its catabolites in the liver vein effhtent of rat livers perfused with different uridine concentrations. Values were calculated from the data in Fig. 1.

concentrations of 15 and lOO~moV1,respectively (Fig. 2). This concentration-dependent escape of uridine from hepatocellular degradation was inversely related to a fall in the relative amount of labeled CO*, whereas the percentage of uracil and of the sum of dihydrouracil and /3ureidopropionate remained almost constant. Steady-state concentrations of uracil and CO2 in hepatic vein effluent were reached when the amount of portal uridine was increased above 50 and 20pmoUl, respectivelyDose-dependent cleurance of uridine The clearance of different amounts of uridine by the

isolated perfused rat liver was calculated from the nucleoside concentrations in influent (CJ and effluent (c,) and the perfusate flow. Since perfusate flow was kept constant under our experimental conditions, uridine clearance was directly related to the difference between ci and c, divided by ci. With rising uridine concentrations (ci = 0.5 to 20 pmol/l) there was a rapid decline in the clearance of the nucleoside (Fig. ‘3). A further enhancement of portal uridine levels beyond 20 pmolil was associated with a less pronounced fall in uridine clearance. Accordingly, extraction of portal vein uridine was most efficient at lower extracellular nucleoside concentrations; clearance was

















Fig. 3. Relationship between uridine clearance and increasing influent uracil nucleoside concentrations in the isolated perfused rat liver. Uridine clearance was calculated from the nucleoside concentration in influent and effluent and the perfusate flow. The mean f SD. (vertical bars) of at least three determinations is given.

maximal at the lowest uridine dose tested (0.5 PmoVl) with 24 ml/min representing 86% of total perfusate flow. Uridine clearance dropped by 50% when portal uridine was enhanced to 50pmol/l Catabolismof uracil

Similar to the degradation of uridine, t4COzformation from [2-t4C]uracil increased when higher concentrations of the pyrimidine base were infused into the portal vein (Fig. 4). Plateau values of CO, formation were reached when uracil in the perfusate was enhanced to more than 40 pmol/l. Under these conditions, the rate of uracil degradation peaked at a value of 50 nmol.min-l-g liver-‘. The maximal rate of CO1 formation after uridine infusion only amounted to 62% of the rate of portal uracil catabolism. Direct administration of uracil (50 pmol/l or 240 nmoLmin_t-g liver-‘) was followed by.a release of CO, at a rate of 50 nmol-min-t,g liver-’ (Fig. 4). The apparent rate of uracil formation from uridine (50 pmol/l) was calculated from the rate of uracil, dihydrouracil, /3ureidopropionate, and CO2 formation, the sum of which amounted to 73.2 nmol-min-l-g liver-’ (~18








Fig. 4. Release of radioactive CO, from isolated rat livers after perfusion with [2-‘4C]uracil (15 @i/l; 1 to 2OOpmoUl). Each symbol represents an individual perfusion experiment. The mean of five CO, measurements f. SD. (vertical bars) is given.

pmol/l). If this amount of uracil was included into the perfusate, a similar rate of CO, release would have been measured (30 nmol~min-‘g liver-’ vs. 27.5 nmol.min-‘g liver-’ after 50 pmol/l uridine). Uridine transport and/or phosphorolysis thus appear to limit maximal CO2 formation from sinusoidal uridine.

iseussion The complete recovery of label and the pattern of radioactive uridine metabolites in the effluent of isolated perfused rat livers indicated that in the absence of any significant uridine anabolism, portal vein uridine leaves the sinusoidal space either unchanged or degraded (Fig. 1). Minimal hepatic anabolism has been confirmed by studies in the whole animal (4,14,23,25), m the perfused rat liver (27,28), or in isolated liver cells (34). In contrast to earlier observations (27), the highest percentage of uridine which was completely converted into the endproducts of the catabolic pyrimidine pathway in our study only amounted to 55% at the influent concentration of 3/~mol/l (Fig. 2). However, if incomplete breakdown products of uridine other than labeled COz were also considered, py-

rimidine nucleoside extraction proved to be very efficient with up to 87% of the portal uridine being catabolixed. The hepatic clearance of uridine was maximal at the lowest concentration tested and rapidly declined with increasing portal nucleoside levels (Fig. 3). This pointed to a strong dose-dependent elimination of the nucleoside from portal vein blood. When radioactive uracil (Fig. 4) or its deoxytmcleoside analog, 5-fluoro-2’-deoxyuridine (35) were infused into the perfusate, a similar inverse relationship between dose and clearance was apparent. A prerequisite for the occurrence of uridine catabolism is its transport across the cell membrane. Cell entry of nucleosides can be mediated either by symmetrical, nonconcentrative facilitated diffusion or a sodium-dependent concentrative nucleoside transporter (36). Recently, we presented evidence for the existence of a sodium-dependent transport system in rat liver (37) which was saturated at a portal uridine concentration of 20 ,umol/l. The initial rapid decline in uridine clearance (Fig. 3) caused by only minor increases in influent uridine concentrations can be best explained by saturation of this high-affinity low capacity transport system (37,38). At these low substrate levels, uridine phosphorylase rapidly converted most of the sinusoidal uridine into uracil (Fig. 1) and apparently was not rate limiting. In mouse spleen cells the Michaelis constant (40 pmol/l) and maximum velocity of the Na+dependent nucleoside transporter was only l/5 of those of the facilitated nucleoside transporter (38). From similar first-order rate constants for both transport systems, it was concluded that at low uridine concentrations (much lower than the K,,, value), uridine entry into the cells occurred about equally via both routes. However, at higher uridine concentrations, facilitated uridine transport was the primary route of entry in rat liver (37) and in mouse spleen cells (38). At low exogenous nucleoside concentrations, first-order rate constants for the subsequent in situ phosphorylation of uridine in spleen cells was similar to those of the nucleoside transporters (38). This indicates a limiting role of transport for uridine metabolism under these conditions. In the liver, uridine anabolism was almost completely absent and uridine phosphorolysis was the predominant reaction (Fig. 1) (34). Moreover, the specific enzymatic activity of uridine phosphorylase was higher in the liver than in the spleen (40) strongly arguing for a limiting role of transport and not for successive uridine phosphorolysis at low circulating uridine concentrations. Maximal sinusoidal uracil concentrations were obtained when portal uridine levels were higher than 50 pmol/l (Fig. 1). The plateau values of uracil presumably reflect saturation of dihydrouracil dehydrogenase which converts uracil into dihydrouracil and is located exclu-

A. HOLSTEGE et al.


sivelv in the .oarenchymal cells of the liver (34). Additional non-competitive inhibition of dihydrouracil dehydrogenase by uridine (12) may contribute to a higher production rate of 14C02 during uracil administration than with equimolar doses of uridine. In isolated hepatocytes incubated in the presence of 5fluorouracil the fluorinated analog of dihydrouracil accumulated intracellularly indicating dihydropyrimidinase as the rate-limiting enzyme of 5-fluorouracil catabolism (41). In our perfusion experiments, the sum of dihydrouracil and p-ureidopropionate was low. There were gradual increases with higher extracellular uridine concentrations (Fig. 1). The relative amount never exceeded 10% of the total radioactivity in the hepatic vein effluent (Fig. 2). The possibility of an intracellular accumulation of dihydrouracil with limited transport of this catabolite across the cell membrane as has been observed for dihydrofluorouracil cannot be excluded by our experiments. Potentiation of 5-fluorouracil cytotoxicity by uridine can either be a result of interference with 5-fluorouracil catabolism or increased anabolism (8). Uridine-induced

increases in UTP lead to feedback inhibition of de novo pyrimidine synthesis (1) and increased conversion of 5fluorouracil into 5-fluoroUMP by orotate phosphoribosyl transferase. Uridine rescue can result from competition of UTP and dUMP with the respective cytotoxic analogs of 5-fluorouracil(8-10). The results of our study indicate a high extraction of circulating uridine at low, physiological concentrations and a lower clearance at higher, exogenously administered uridine levels. Uridine doses leading to the latter blood plasma concentration range of the nucleoside (220 eel/l) should saturate the catibolic capacity of the liver providing enough unchanged uridine to rescue nonneoplastic tissues from 5-fluorouracil toxicity.


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Acknowledgement This study was supported by a grant from the Deutsche Forschungsgemeinschaft, SFB 154, ‘Klinische und experimentelle Hepatologie’.


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Uridine catabolism by the isolated perfused rat liver.

A new approach in the treatment of gastrointestinal tumors with 5-fluorouracil involves the infusion of high doses of uridine to improve the chemother...
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