Hydroxyurea transport across the blood-brain and blood-cerebrospinal fluid barriers of the guinea-pig

Hydroxyurea is used in the treatment of HIV infection in combination with nucleoside analogues, 2'3'-didehydro-3' deoxythymidine (D4T), 2'3'-dideoxyinosine or abacavir. It is distributed into human CSF and is transported from the CSF to sub-ependymal brain sites, but its movement into the brain directly from the blood has not been studied. This study addressed this by a brain perfusion technique in anaesthetized guinea-pigs. The carotid arteries were perfused with an artificial plasma containing [C-14] hydroxyurea (1.6 muM) and a vascular marker, [H-3] mannitol (4.6 nM). Brain uptake of [C-14] hydroxyurea (8.0 +/- 0.9%) was greater than [H-3] mannitol (2.4 +/- 0.2%; 20-min perfusion, n = 8). CSF uptake of [C-14] hydroxyurea (5.6 +/- 1.5%) was also greater than [H-3] mannitol (0.9 +/- 0.3%; n = 4). Brain uptake of [C-14] hydroxyurea was increased by 200 muM hydroxyurea, 90 muM D4T, 350 muM probenecid, 25 muM digoxin, but not by 120 muM hydroxyurea, 16.5 - 50 muM D4T, 90 muM 2'3'-dideoxyinosine or 90 muM abacavir. [C-14] Hydroxyurea distribution to the CSF, choroid plexus and pituitary gland remained unaffected by all these drugs. The metabolic half-life of hydroxyurea was > 15 h in brain and plasma. Results indicate that intact hydroxyurea can cross the brain barriers, but is removed from the brain by probenecid- and digoxin-sensitive transport mechanisms at the blood - brain barrier, which are also affected by D4T. These sensitivities implicate an organic anion transporter ( probably organic anion transporting polypeptide 2) and possibly p-glycoprotein in the brain distribution of hydroxyurea and D4T.