Vol.1, No.3, 121-127 (201
opyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/OJAS/
1) Op en Journal of Anim al Sciences
Potential benefits of quinoxaline 1, 4-dioxides in
aldosterone dysmetabolism disease
A medical hypothesis
Da-Jiang Zou1, Qiao-Feng Zheng1, Xian-Ju Huang1,*, Xu Wang2, Awais Ihsan2
1College of Pharmacy, South-Central University for Nationalities, Wuhan, China; *Corresponding Author:
2National Reference Laboratory of Veterinary Drug Residues and MOA Key Laboratory of Food Safety Evaluation, Huazhong Agri-
culture University, Wuhan, China.
Received 13 June 2011; revised 20 July 2011; accepted 22 August 2011.
Quinoxaline 1, 4-dioxides (QdNOs) are quinoxa-
line derivatives which have been used as an-
timicrobial agents and growth promoters in
animals widely. They are also assumed to cure
human disease such as anticancer, antituber-
cular and inhibiting parasite. QdNOs such as
carbadox and their major metabolites induced a
special decline of aldosterone production from
the swine adrenal in vivo and in vitro, and thus
cause hypovolemia, hyponatremia and hyper-
kalemia. This can also be expected to be the
case for human. As a mainly physiological
hormone and a novel steroid w ith potent miner-
alocorticoid activity, aldosterone plays an im-
portant role in the pathophysiological process
of brain, renal and heart disease progression
and may be a renal and vascular risk factor.
Here, we provide evidence to support the hy-
pothesis that QdNOs may lead potential benefit s
in aldosterone dysmetabolism disease via the
synthesis deficiency of aldosterone in adrenal
and/or the cardiovascular tissues. If the hy-
pothesis is true, it may provide a new option
into the therapy for aldosterone dysmetabolism
disease, especially in cardiovascular system,
and thus assume a broader application of
Keywords: Quinoxaline 1; 4-Dioxides; Aldosterone;
Adrenal Gland; Dysmetabolism; Cardiovascular
Since 1940s, Quinoxaline-di-N-oxides (QdNOs) (Fig-
ure 1) are known as potent antibacterial agents which act
on several gram-positive and -negative species [1-4]. For
this reason they have been used as growth promoters in
agricultural stock farming to promote growth of pigs,
cattle, fish and poultry when added to the feed during
rearing in dosages 25 - 100 mg/kg [5-8].
Recently, extensive study has been carried out on
QdNOs which indicates that they can be also applied for
treatment of human diseases. For example, QdNOs have
shown a selective cytotoxicity against hypoxic cells pre-
sented in solid tumors [9-11]. It was [12] demonstrated a
dose-dependent inhibition of the proliferation of T-84
human colon cancer cells by QdNOs. Other studies have
put in evidence that QdNOs are endowed with antitu-
bercular activities in vitro. They have inhibitor activity
of clinical isolates of Mycobacterium tuberculosis [13]
or Mycobacterium tuberculosis H37Rv [14-15]. Fur-
thermore, QdNOs presented good in vitro inhibitor ac-
tivity of Trypanosoma cruzi, the causative agent of Cha-
gas’ disease affects around 20 million people in Central
and South America [16].
The endocrinological effects of these compounds have
long been recognized. Besides their influence on meta-
bolic hormones and epidermal growth factor in swine
[17] QdNOs such as carbadox and its major metabolites
induced a special decline of aldosterone production from
the adrenal in vivo and in vitro, and thus cause hypo-
volemia, hyponatremia and hyperkalemia [18-21] Al-
dosterone is a steroid hormone and the most important
mineralocorticoid in the human body. Clinically, excess
aldosterone is associated with increased stroke risk [22];
progressive renal disease [23], higher morbidity and
mortality in cardiovascular diseases such as myocardial
infarction (MI) and heart failure (HF) [24-25]. Here, we
provide evidence to support the hypothesis that QdNOs
can lead potential benefits in cardiovascular or other
diseases caused by metabolism dysfunction of aldoster-
on via the synthesis deficiency of aldosterone. e
D.-J. Zou et al. / Open Journal of Animal Sciences 1 (2011) 121-127
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/OJAS/
Figure 1. Chemical structures of some quinoxaline 1, 4-oxides.
2.1. Metabolic Pathway of Aldosterone
Induction of aldosterone biosynthesis can be divided
into two temporal phases: an acute phase resulting from
accelerated cholesterol translocation and a chronic phase
involving synthesis of mRNA and enzymes [26]. There
are four enzymes involved, i.e. Cholesterol desmolase
(CYP11A), 21-hydroxylase (CYP21), 3β-Hydroxysteroid
dehydrogenase (3β-HSD) and aldosterone synthase
(CYP11B2). CYP11A, CYP21 and CYP11B2 are cyto-
chromes P450 (CYP), membrane-bound heme-containing
enzymes that accept electrons from NADPH via acces-
sory proteins and utilize molecular oxygen to perform
hydroxylations or other oxidative conversions. 3β-HSD
is a member of the short-chain dehydrogenase family
[27-28]. Biosynthetic reactions of aldosterone happened
not only in adrenal but also in other tissues. CYP11B2 is
expressed both in the zona glomerulosa and ex-
tra-adrenal tissues. Such synthesis has also been detected
in brain [29-30], heart [31-32] and vascular smooth
muscle [33-34]. Perfusion of angiotensin II increased
local aldosterone production, suggesting that aldosterone
is formed within the isolated tissue from a locally pre-
sent substrate [35]. Even though the function of
CYP11B2 in most of the tissue is not fully understood,
aldosterone synthesized in these tissues can elicit impor-
tant biological responses in an autocrine or paracrine
Disorder of aldosterone biosynthesis can lead to ster-
oid hormone-related diseases such as hypoaldosteronism
and hyperaldosteronism. Defective aldosterone biosyn-
thesis may be caused by congenital adrenal hyperplasia
due to CYP21 deficiency, in which case cortisol biosyn-
thesis is also affected, or as an isolated defect termed
CYP11B2 deficiency [27]. Primary hyperaldosteronism
is a state characterized by long-standing aldosterone
excess and suppressed plasma renin activity, resulting in
hypertension and hypokalemia. It is the most common
endocrine cause of hypertension and affects 5% - 13% of
all patients and is commonly caused by aldosterone-pro-
ducing adenoma (APA) or bilateral idiopathic hyperal-
dosteronism [36-37] (IHA).
2.2. Deleterious Effects of High Levels of
As a mainly physiological hormone and a novel ster-
oid with potent mineral corticoid activity, aldosterone
controls electrolyte balance, plasma volume, and vascu-
lar functions. With a low salt intake plasma aldosterone
concentration may increase to high levels without any
negative effects on the organism. However, growing
body of evidence suggests that high plasma aldosterone
levels have been shown to correlate with hypertension
[38], left ventricular hypertrophy [39-41], stroke [22]
and renal dysfunction [23]. Genetic and experimental
models of hypertension have demonstrated that excess
aldosterone induces severe injury in the heart, brain and
kidneys [23]. Aldosterone synthesis in the cardiovascular
system is up regulated during both acute MI and the as-
sociated remodeling of the myocardium [42], an effect
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Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/OJAS/
that is believed to be due to local angiotensin II produc-
tion [43], suggesting that tissue-specific effects of al-
dosterone contribute to pathophysiological changes.
The neurohormonal actions of aldosterone influence
the prognosis of patients with HF and ischemic heart
disease through two main electrolyte homeostatic actions.
Firstly, overproduction of aldosterone leads to inappro-
priate levels of sodium and water retention, which sets
up a vicious cycle whereby the kidney attempts to com-
pensate for impaired cardiac output by releasing angio-
tensin II, leading to further rises in aldosterone and
volume overload. Secondly, aldosterone increases the
urinary excretion of magnesium and potassium leading
to electrolyte imbalance, increasing the risks of ven-
tricular arrhythmias—which in the presence of myocar-
dial remodelling following MI or secondary to HF, in-
creases risk of sudden death [44]. In several pathological
conditions aldosterone promotes vascular damage by
formation of reactive oxygen species [45]. Moreover,
clinical and experimental data indicate that aldosterone
and its receptor are implicated in various non-renal loca-
tions [41], in particular the heart [35], brain tissue [46],
and within the vasculature [47], suggesting that aldos-
terone also exerts local effects in tissue levels.
Aldosterone exerts most of its biological effects on
cells by occupying an intracellular receptor, termed the
type I or mineralocorticoid receptor (MR), which then
binds DNA and thereby influences transcription of vari-
ous genes [38-49]. However, not all of the actions of
aldosterone are mediated by the classic genomic path-
way involving transcription and translation. There is
experimental evidence that aldosterone in a number of
circumstances can stimulate an increase in intracellular
calcium concentration and cause vasoconstriction by a
mechanism which involves protein kinase C (PKC), and
which may be independent of the classical MR. Despite
pharmacological antagonism of aldosterone, which is
nowadays part of a commonly applied standard therapy,
could markedly reduce myocardial injury, cerebral hem-
orrhage and renal vascular disease, most of the
non-classical effects are insensitive to inhibitors of the
classical cytosolic mineralocorticoid receptor [50].
Moreover, this type of chemical also has some adverse
effect such as breast tenderness with or without gyneco-
mastia. It occurs more commonly in men but not exclu-
sively. Studies indicate that approximately 10% of men
will complain of breast tenderness with use spironolac-
tone at the 25 mg dose. Other adverse effects that are
associated with spironolactone include sexual dysfunc-
tion and menstrual irregularities [51].
2.3. Evidences of Quinoxaline 1, 4-Dioxides
in Aldosterone Production
Experimental studies in pigs fed with carbadox,
olaquindox, and cyadox had revealed obvious decreases
in aldosterone and sodium concentrations in blood, with
increases in potassium levels at 150 mg/kg or above
[52-53]. As these drugs are given continuously, the bio-
genesis of aldosterone in vivo is likely to be seriously
impaired, even when used in the advised dosages. Pigs
treated with 100 and 200 mg/kg carbadox showed a sig-
nificant decline of aldosterone after five and three weeks,
respectively. With olaquindox a continuous, significant
decline was found from 50 mg/kg and above after five
weeks. In the cyadox groups, a significant decline was
measured after six weeks in the 50, 200 and 400 mg/kg
groups [52]. The animals might compensate with en-
hanced production via the alternative pathway and/or by
enhanced release of other corticosteroids with mineralo-
corticosteroid activity. The rapid shutdown of the mito-
chondrial biogenesis of corticosteroids by QdNOs will
then lead to hypoaldosteronism [51,54]. Moreover, the
aldosterone decline effect was also seen in vitro. Spier-
enburg et al. investigated that the carbadox had the abil-
ity to inhibition of aldosterone production by pig adrenal
slices. A dose dependent decrease in aldosterone produc-
tion was reported at the 1~40 µg/ml [55]. In a study us-
ing a suspension of porcine adrenocortical cells, QdNOs
were found to reduce the output of aldosterone. The car-
badox and their major metabolites induced a slowly de-
veloping but virtually irreversible inhibition of the C18
transformations from corticosterone to aldosterone. But
these compounds hardly affected the alternative pathway
from deoxycortisol [17-18].
Obviously, the information obtained above is rather
insufficient to interpret the mechanisms of QdNOs on
aldosterone production related gene expression and en-
zymes interactions. More detailed investigation is re-
quired to delineate the pathophysiological linkage
among QdNOs exposure, aldosterone synthesis, and
aldosterone dysmetabolism diseases. Recently, our pre-
vious work in vivo [56-57] and in vitro [57] have sug-
gested that high dose of QdNOs could lead to adrnal
gland impaiment and aldosterone down-regulation,
combined with sodium decrease and potassium increase
in rat plasma. It’s demonstrated that a complex crosstalk
between ROS-generating system and aldosterone secre-
tion. The induction of oxidative stress following expo-
sure to mequindox (MEQ) could result in a membrane
damage and dysfunction of adrenal mitochondrion, and
then cause the contents loss of steroid hormone includ-
ing CYP11A1, CYP11B1 and CYP11B2, finally leading
to the deregulation of steroid hormone secretion and
unbalance of ion concentration [55]. Moreover, Higher
doses of MEQ showed similar depressive responsibility
for most of renin-angiotensin-aldosterone system
D.-J. Zou et al. / Open Journal of Animal Sciences 1 (2011) 121-127
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/OJAS/
(RAAS) components in adrenal and kidney, indicating a
down-regulation of both intra- and extra-RAAS, the up-
stream of aldosterone production [58].
2.4. Nucleotide Similarity of Aldosterone
Biosynthesis Enzymes in Human and
Although exposure to QdNOs would lead to deregula-
tion of aldosterone production in pigs, little information
is known regarding their influence on human body. To
evaluate the potential role of QdNOs in human aldos-
terone production, a multiple sequence alignment of the
full length nucleotide sequence of CYP11A (GeneID: Sus
scrofa 403329; Homo sapiens 1583), CYP21 (GeneID:
Sus scrofa 403337; Homo sapiens 1589)and 3β-HSD
(GeneID: Sus scrofa 445539; Homo sapiens 3284) gene
were identified by performing BLASTN searches in
GenBankTM. Sus scrofa and Homo sapiens shared 84%
identity with CYP11A1, 84% identity with CYP21A and
79% identity with 3β-HSD, respectively. The great simi-
larity of aldosterone biosynthesis enzymes between hu-
man and pig confirmed the possibility that QdNOs in-
fluence aldosterone synthesis enzymes in human body.
As QdNOs and their major metabolites induced a special
decline of aldosterone production from the swine adrenal
in vivo and in vitro, this can also be expected to be the
case for human.
Based on above information, there is plenty of evi-
dence to support the notion that aldosterone is an inde-
pendent risk factor for brain, renal and heart disease.
QdNOs may be helpful for the diseases caused by ele-
vated levels of aldosterone. Thus we focus on the hy-
pothesis that QdNOs could also cause aldosterone defi-
ciency in human body and be beneficial for aldosterone
dysmetabolism disease, which may suggest a newly
candidate remedy for cerebrovascular system, renal and
cardiovascular disease.
Although treatment with a mineralocorticoid receptor
antagonist promotes blood pressure (BP) reduction and
regresses target organ damage, they may be useless for
non-genomic aldosterone action in clinical studies par-
ticularly in the cardiovascular system [49]. QdNOs have
an effect independent of MR and perhaps act on the up-
stream cascade of aldosterone production, which is to-
tally different with mineralocorticoid receptor antagonist.
Further research on QdNOs may improve the under-
standing of their participation in the pathogenesis of
aldosterone related diseases and eventually enhance the
options for therapy.
There are at least three proposed mechanisms of
QdNOs mediated in aldosterone deficiency and heart
disease. Firstly, we postulate that the mechanism by
which QdNOs inhibit the production of aldosterone,
mainly by regulating some key enzymes necessary for
aldosterone biosynthesis. To make known whether it is
true, interaction of QdNOs with aldosterone associated
physiological regulators, enzymes and cellular second
messengers should be investigate to further discuss their
mechanisms. Secondly, as most of enzymes involved in
the biogenesis of adrenal steroids are also present in
other steroid hormone producing organs, aldosterone
produced within brain or heart was suggested to be
similarly influenced by QdNOs. A comparable differen-
tial effect of QdNOs on the biogenesis and release of
steroid hormones is to be expected. Lastly and most im-
portantly, the chronic and continuously down regulation
of aldosterone level in plasma and/or heart tissue caused
by QdNOs would lead a directly shutdown of MR affini-
ties, which may be an important direction in the therapy
for heart diseases. Future pre-clinical and clinical studies
associated with the precise mechanisms for QdNOs on
heart diseases are anticipated. These studies should cir-
cumvent (1) appropriate pathological models in vivo and
in vitro, (2) secure evaluation of QdNOs for their toxic-
ity and adverse effects on human or other animals, (3)
comparison between QdNOs and aldosterone antagonists
such as eplerenoneK+-canrenoate or spironolactone, the
agents being currently used clinically [59]. All of the
above hypothesis are testable in lab or in clinical.
Although QdNOs are known to their adrenal or other
toxicities [19,21,60], their adverse effects can be avoided
or decreased by controlling the dose. This aldosterone
inhibition effect of QdNOs occurs in concentrations well
below toxicity concentration found in vivo treatment.
Moreover, some QdNOs such as cyadox is relatively less
toxic and effective member of this family. Cyadox has
been shown to be a very safe drug when used as a feed
additive, and thus should be taken more attention than
It is meaningful to investigate the profitable role of
QdNOs in cardiovascular or other diseases caused by
metabolism dysfunction of aldosterone, which will lead
to a further study in this kind of chemical. If the hy-
pothesis is true, it may provide a new option into the
therapy for aldosterone dysmetabolism disease, espe-
cially in cardiovascular system, and thus assume a
broader application of QdNOs.
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