Objective-Dexrazoxane is an antioxidant prodrug that on hydrolysis is converted into an intracellular iron chelator. We hypothesized that the antioxidant effects of dexrazoxane would prevent homocysteine-induced endothelial dysfunction in the brachial artery of normal human subjects. Methods and Results-Ten healthy volunteers completed a randomized, double-blind, crossover study. Plasma homocysteine levels and brachial artery endothelium-dependent (flow-mediated dilation [FMD]) and endothelium-independent (sublingual nitroglycerin) responses were measured before and 4 hours after ingestion of L-methionine (100 mg/kg), preceded by intravenous administration of dexrazoxane (500 mg/m 2 ) or placebo over 30 minutes. After placebo, oral methionine increased plasma homocysteine (from 5.1Ϯ0.4 mol/L at baseline to 14.2Ϯ1.3 mol/L at 4 hours, PϽ0.001) and decreased FMD (from 3.8Ϯ0.7% at baseline to 1.2Ϯ0.5% at 4 hours, Pϭ0.02). Dexrazoxane did not change homocysteine concentrations after methionine administration (14.9Ϯ1.1 mol/L at 4 hours, Pϭ0.29 versus placebo) but did completely abrogate the homocysteine-induced reduction in FMD (from 3.5Ϯ0.5% at baseline to 5.9Ϯ1.1% at 4 hours, PϽ0.01 versus placebo). Endothelium-independent responses to sublingual nitroglycerin did not differ after the administration of placebo and dexrazoxane. Key Words: methionine Ⅲ vascular endothelium Ⅲ oxidative stress Ⅲ chelation Ⅲ iron L ow molecular weight ferrous iron (LMW-Fe 2ϩ ) catalyzes the production of hydroxyl radicals from hydrogen peroxide in the Fenton reaction. 1 The hydroxyl radical is a highly reactive species that leads to lipid peroxidation, oxidative damage of DNA, cell dysfunction, and death. 2 Dexrazoxane (ICFR-187), a cyclic derivative of the chelating agent EDTA, is approved by the Federal Drug Administration for the prevention of anthracycline cardiotoxicity in humans. In contrast to EDTA and deferoxamine, dexrazoxane is membrane permeable and chelates LMW-Fe 2ϩ in the intracellular space, where hydrolysis of 2 imide bonds activates its binding sites. 3 The cardioprotective action of dexrazoxane is due to its high-affinity binding of intracellular LMW-Fe 2ϩ , which reduces the formation of anthracycline-iron complexes and the consequent generation of hydroxyl radical and other toxic reactive oxygen species. 4,5 Hyperhomocysteinemia induced by oral methionine ingestion in normal subjects is associated with increased oxidant stress and transient vascular endothelial dysfunction. 6 -8 The present study was undertaken to test the hypothesis that the antioxidant effects of dexrazoxane would prevent vascular endothelial dysfunction induced by homocysteine in the brachial artery of normal human subjects in a double-blind, placebo-controlled, crossover study.
Methods
Study PopulationEight men and 2 women were studied. All subjects were normotensive nonsmokers with no history of chronic illness or chronic medication use. Criteria for exclusion were LDL Ͼ160 mg/dL, fasting blood sugar Ͼ110 mg/dL, plasma homocysteine Ͼ10 mol/L, an...