Loss of homotypic epithelial cell adhesion by selective N-cadherin displacement in bismuth nephrotoxicity.

The nephrotoxicity of single high doses of bismuth (Bi)-containing therapeutic drugs is characterized morphologically by detachment of proximal tubular epithelial cells (PTECs) from each other, followed by cell death. We investigated whether Bi nephrotoxicity is mediated by changes in the distribution of proteins involved in intercellular adhesion. A nephrotoxic dose of colloidal bismuth subcitrate (CBS; 3.0 mmol Bi/kg) was orally administrated to 10 female Wistar rats. After 1 h, N-cadherin had disappeared from the adherence junctions of vital PTECs, whereas ZO-1, a tight junction marker, remained present at the cell-cell border until cell death occurred after 3 h. E-Cadherin, absent in PTECs, remained absent. Exposure of the renal epithelial cell lines NRK-52E and LLC-PK1 to 400 microM Bi(3+) also resulted in the disappearance of N-cadherin expression after 1 h, whereas ZO-1, E-cadherin, and Desmoplakin expression did not resolve before cell death at 24 h, thus confirming in vivo results. Our results are the first to indicate that Bi-induced death of PTECs is preceded by redistribution of N-cadherin and the disruption of homotypic cell adhesion.

Bismuth overdosing-induced reversible nephropathy in rats.

Overdosing of colloidal bismuth subcitrate (CBS), used to treat peptic ulcers and Helicobacter pylori infections, has been reported to result in serious, though reversible, nephrotoxicity in humans. However, little is known about the nature of the renal damage induced by bismuth (Bi), and no well-described experimental model exists. Single large oral CBS doses (0.75, 1.5, and 3.0 mmol Bi/kg) were administered to three groups of 20 female Wistar rats. A control group (n = 20) received only the vehicle. Standard kidney function parameters, urinary excretion of N-acetyl-beta-D-glucosaminidase (NAG) and the Bi content were monitored in blood, urine, liver, and kidneys for 14 days. A dose of 3.0 mmol Bi/kg, 100 times the daily therapeutic dose, caused kidney damage within 6 h as detected by proteinuria, glucosuria, and elevated plasma urea and plasma creatinine levels. The kidneys of all animals, except two that died, recovered functionally within 10 days. At a dose of 1.5 mmol Bi/kg, clinical parameters changed less and normalized within 48 h, whereas a dose of 0.75 mmol Bi/kg induced no changes. Histological evaluation revealed that the S3 tubular segment necrotized first with additional necrotization of the S1/S2 segment when more Bi was absorbed. The lesions were accompanied by interstitial infiltrates of CD45+ leukocytes. In summary, we developed a rat model for Bi-induced reversible nephropathy. A large single oral overdose of CBS administered to Wistar rats led to damage to the proximal tubule, especially in the last segment.

Bismuth biokinetics and kidney histopathology after bismuth overdose in rats.

Bismuth induced nephrotoxicity has been reported to occur after acute overdoses of Bi-containing therapeutic drugs. We studied the development of bismuth induced nephropathy and bismuth biokinetics in rats. Bismuth nephropathy was induced in 33 young adult female Wistar rats weighing ca. 175 g by feeding them a single overdose of colloidal bismuth subcitrate containing 3.0 mmol Bi/kg at (t = 0). Control animals (n = 7) were fed the vehicle only. The animals were sacrificed after 1-48 h. Plasma creatinine increased from 51 +/- 6 micromol/l at t = 0 to 550 +/- 250 micromol/l after 48 h in the experimental group. The S3 segment of the proximal tubule showed epithelial cell vacuolation after 1 h and necrosis after 3 h. Cells of the S1/S2 segment demonstrated vacuolation after 6 h and necrosis after 12 h. Biokinetics of bismuth in blood could best be described with a one-compartment model characterized by an absorption half-life of 0.32 h and an elimination halflife of 16 h. The peak concentration of about 7.0 mg Bi/l was reached after 2 h. In conclusion, cells of the S3 segment of the proximal tubule necrotized first after an oral colloidal bismuth subcitrate overdose and biokinetics of Bi in blood was best described by a one-compartment model.