Thiamphenicol during the first trimester of human pregnancy: Placental transfer in vivo, placental uptake in vitro, and inhibition of mitochondrial function☆

Abstract Thiamphenicol (TAP) was administered as a single oral dose of 500 mg (8–9 mg/kg) to pregnant women about to undergo therapeutic abortions. The length of gestations varied from 7 to 12 weeks. The concentrations of TAP were determined by electron capture gas chromatography in maternal serum, placenta, amniotic fluid, and various embryonal/fetal tissues when abortion occurred 1.5 to 20 hr after drug administration. TAP was rapidly transferred across the placental membranes and was fairly evenly distributed in the tissues of the embryonal/fetal compartment. The placental concentrations of TAP were usually higher than the corresponding maternal serum levels (1.1 to 7-fold), suggesting some active role of the placenta in TAP uptake. This was confirmed by in vitro studies with immature and term placenta tissue. From a bathing medium containing 10 μg/ml (comparable to therapeutic blood levels) TAP was accumulated in the intracellular compartment to concentrations about 2.6 times those in the medium. This process was time and temperature dependent. Inspite of the low content of mitochondrial particles in human fetal liver the relatively few mitochondria present exhibited high protein synthesis in vitro which decreased with increasing gestational age. Mitochondrial protein synthesis was inhibited by TAP, and a 50% reduction of amino acid incorporation was observed at 10–15 μg TAP/ml. Such levels of the drug are required for successful chemotherapy. To ascertain such therapeutic drug levels, TAP is usually given at 3 g daily (divided, e.g., into three doses 1 g each). The data obtained for a single application of 0.5 g TAP suggest inhibition of mitochondrial protein synthesis during therapy. While the pharmacokinetic characteristics of TAP suggested that this compound might be well suited to treat intrauterine bacterial infections sensitive to TAP, the drug concentrations reached in human embryonal tissues in vivo are known to produce embryolethality in pregnant rats at comparable developmental stages. The findings reported here raise serious concerns about the suitability of TAP for repeated administration to pregnant women during the first trimester of gestation.