Formation of complement-activating particles in aqueous solutions of Taxol

Possible role in hypersensitivity reactions

J. Szebeni, Carl R. Alving, Sandor Savay, Yechezkel Barenholz, Aba Priev, Dganit Danino, Yeshayahu Talmon

Research output: Contribution to journalArticle

108 Citations (Scopus)

Abstract

We reported earlier that the anticancer drug paclitaxel (Taxol) activated the complement (C) system in human serum in vitro, raising the possibility that C activation might play a role in the ill-understood hypersensitivity reactions (HSRs) to this drug [J. Natl. Cancer Inst. 90 (1998) 300]. In pursuing the mechanism of C activation by Taxol, the present study provided evidence that dilution of the injection concentrate in aqueous solvents led to the formation of micelles and needle-like structures, both of which caused C activation in vitro. Micelles were formed mainly from Cremophor EL (CrEL), the nonionic emulsifier vehicle of paclitaxel, whose level in Taxol infusion exceeded its critical micelle concentration by at least 400-fold. CrEL micelles were shown by quasi-elastic light scattering and cryo-transmission electron microscopy (cryo-TEM) to be spherical with diameters in the 8-22 nm range; however, de novo formation of 50-300 nm microdroplets following incubation with human plasma suggested further fundamental structural transformation in blood. The needle-like structures extended to the multimicron range and were shown by electron diffraction to be crystalline paclitaxel. Taxol-induced C activation was manifested in varying rises of serum C3a-desarg, iC3b and SC5b-9. The causal role of CrEL micelles in C activation was demonstrated by the fact that filtration of aqueous solutions of Taxol or pure CrEL via 30-kDa cutoff filters eliminated, while the filter retentate restored C activation. C activation by Taxol was also inhibited by 10 mg/ml human immunoglobulin (IVIG). If proven clinically, HSRs to Taxol may represent a hitherto vaguely classified adverse drug reaction recently called C activation-related pseudoallergy (CARPA) [Circulation 99 (1999) 2302].

Original languageEnglish
Pages (from-to)721-735
Number of pages15
JournalInternational Immunopharmacology
Volume1
Issue number4
DOIs
Publication statusPublished - 2001

Fingerprint

Paclitaxel
Hypersensitivity
Micelles
Needles
Complement C3b
Cryoelectron Microscopy
Intravenous Immunoglobulins
Drug-Related Side Effects and Adverse Reactions
Serum
Transmission Electron Microscopy
Pharmaceutical Preparations
Immunoglobulins
Electrons
Injections
cremophor EL

Keywords

  • Cancer chemotherapy
  • Cremophor EL
  • Cryo-TEM
  • Drug allergy
  • Hypersensitivity reactions
  • IVIG
  • Micelles

ASJC Scopus subject areas

  • Immunology
  • Pharmacology

Cite this

Formation of complement-activating particles in aqueous solutions of Taxol : Possible role in hypersensitivity reactions. / Szebeni, J.; Alving, Carl R.; Savay, Sandor; Barenholz, Yechezkel; Priev, Aba; Danino, Dganit; Talmon, Yeshayahu.

In: International Immunopharmacology, Vol. 1, No. 4, 2001, p. 721-735.

Research output: Contribution to journalArticle

Szebeni, J. ; Alving, Carl R. ; Savay, Sandor ; Barenholz, Yechezkel ; Priev, Aba ; Danino, Dganit ; Talmon, Yeshayahu. / Formation of complement-activating particles in aqueous solutions of Taxol : Possible role in hypersensitivity reactions. In: International Immunopharmacology. 2001 ; Vol. 1, No. 4. pp. 721-735.
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