The most common, and sometimes life-threatening, side-effects associated with the human use of the analgesic, nonsteroidal antiinflammatory drugs (NSAIDs) are gastrointestinal. These include gastritis, ulceration, and severe bleeding. The aryl propionic acid class of NSAIDs are among the most widely used of these drugs in the world, including rac-ibuprofen, rac-flurbiprofen, and rac-ketoprofen. Marketed as racemates, it was assumed that the "inactive" (R)-enantiomers, having no cyclooxygenase inhibiting effect, also had no toxic effect. In a 30-day dose response study of (S)-, (R)-, and rac-flurbiprofen given daily over a range of doses the (R)-isomer alone proved to be without apparent gastrointestinal (GI) toxicity. On the other hand the racemate proved to be 2 to 4 times as ulcerogenic in enantiomerically equivalent doses as the (S)-enantiomer. These results have significant clinical implications.

In our search for endogenous natriuretic factors from human uremic urine, we have previously identified a new metabolite of the drug diltiazem (Murray et al. Life Sci. 1995, 57, 2145-2161). The structure of this metabolite, (+)-(2S,3S)-3-hydroxy-5-(2-hydroxyethyl)-2,3-dihydro-2-(4-methoxyphenyl) -1,5-benzothiazepin-4(5H)-one (LLU-beta1; 2), was proved by unequivocal synthesis from a diltiazem synthon. The synthetic material also proved to be natriuretic as had the urinary isolate. Given the acetylation at C-3 in diltiazem, the 3-monoacetate (8) and diacetate (3) derivatives of 2 were prepared. The 4-nor-keto (6) derivative of 2 was also synthesized. Only the parent 2 induced natriuresis over a range of doses without accompanying kaliuretic activity at some doses.

This review summarizes the interesting and significant papers reported at the International Conference on Natriuretic and Digitalis-like Factors held at the ASH meeting in San Francisco, June 1–2, 1997. This area of investigation has been rejuvenated as of late with near structural determination of two ouabain-like isolates from human plasma (OLF) and bovine hypothalamus (HIF) which are apparently the same compound and the isolation and structural elucidation of a natriuretic metabolite of γ-tocopherol. Spectroscopic information has also been obtained for two other compounds, an ouabain-like factor from bovine adrenals and HHIF from the hypothalamus. An explanation was offered for how low concentrations of digitalis-like factors can regulate vascular reactivity when the predominant isoform of the sodium pump has a low affinity for these compounds. Various groups are examining possible in vivo synthetic pathways that could lead to the production digitalis-like factors. The natriuretic metabolite of γ-tocopherol, LLU-α, fits deWardener’s postulates for a natriuretic hormone and is being examined for its involvement in ECF control. Once the structures for some of these ouabain-like compounds are determined and they are synthesized, these compounds will also be able to be studied employing classical pharmacologic methods.

No abstract