Carbidopa (CD), a competitive inhibitor of aromatic l-amino acid decarboxylase that does not cross the blood-brain barrier, is routinely administered with levodopa (LD) to patients with Parkinson disease (PD) to reduce the peripheral decarboxylation of LD to dopamine. Using a stable isotope-labeled form of LD, the authors examined in 9 PD patients the effects of variable CD absorption on peripheral and central LD metabolism. Subjects were administered orally 50 mg of CD followed in 1 hour by a slow bolus intravenous infusion of 150 mg stable isotope-labeled LD (ring 1′,2′,3′,4′,5′,6′-13C). Eight patients underwent a lumbar puncture 6 hours following the infusion. Blood and cerebrospinal fluid (CSF) samples were analyzed for labeled and unlabeled metabolites using a combination of high-performance liquid chromatography and mass spectrometry. When patients were divided into “slow” and “rapid” CD absorption groups, significantly greater peripheral LD decarboxylation (as measured by area under the curve [AUC]-labeled serum HVA) was noted in the poor absorbers (p = 0.05, Mann-Whitney U test). Elimination half-lives for serum LD did not differ between groups, suggesting a further capacity for decarboxylation inhibition in the “rapid” absorbers. A significant correlation between AUC serum CD and percent-labeled HVA in CSF was found for all patients (R = 0.786, p = 0.02). “Rapid” as compared to “slow” CD absorbers had significantly more percent-labeled CSF HVA (60 vs. 49, p = 0.02, Mann-Whitney U test), indicating greater central-labeled DA production in the better CD absorbers. The data suggest that peripheral aromatic l-amino acid decarboxylase activity is not saturated at CD doses used in current practice. The authors believe that future studies to better examine a dose dependence of CD on peripheral LD decarboxylation and LD brain uptake are warranted.
卡比多巴(CD)是一种竞争性
抑制剂,能够抑制芳香族L-
氨基酸脱羧酶,但不穿越血脑屏障,通常与
左旋多巴(LD)共同给药于帕
金森病(PD)患者,以减少LD在外周转化为
多巴胺。作者使用稳定同位素标记的LD形式,在9名PD患者中研究了CD吸收的变化对外周和中枢LD代谢的影响。受试者口服50毫克CD,1小时后进行150毫克稳定同位素标记的LD(环1′,2′,3′,4′,5′,6′-13C)缓慢静脉输注。8名患者在输注后6小时接受腰椎穿刺。血液和脑脊液(CSF)样本通过高效
液相色谱和质谱的组合分析了标记和未标记代谢产物。当患者分为“慢速”和“快速”CD吸收组时,发现吸收差的患者外周LD脱羧化(通过曲线下面积[AUC]标记的血清HVA测量)显著增加(p = 0.05,Mann-Whitney U检验)。两组血清LD的消除半衰期没有差异,这表明“快速”吸收者仍有进一步的脱羧化抑制能力。对所有患者发现AUC血清CD与CSF中标记HVA百分比之间有显著相关性(R = 0.786,p = 0.02)。“快速”CD吸收者与“慢速”吸收者相比,CSF中标记HVA的百分比显著更高(60 vs. 49,p = 0.02,Mann-Whitney U检验),这表明更好的CD吸收者在中枢产生的
多巴胺更高。数据表明,在当前实践中使用的CD剂量下,外周芳香族L-
氨基酸脱羧酶的活性并未达到饱和。作者相信,未来的研究有必要更好地检查CD对外周LD脱羧化和LD脑摄取的剂量依赖性。