RESEARCH FOR VITAMIN P. (Department of Internal Medicine, Dairen Hospital.) (Received for publication, December 25, 1938)

Transcription

1 The Jourual'of Biochemistry, Vol. 29, No. 3. RESEARCH FOR VITAMIN P. By SHIRO MORII. (Department of Internal Medicine, Dairen Hospital.) (Received for publication, December 25, 1938) There is no doubt of the fact that crystallized ascorbic acid has curative effects on hemorrhagic diseases, but we have frequently heard that it is not always effective in the treatment of all hemorr hages of the skin. Moreover, notwithstanding the fact that dis position to hemorrhage is often improved by the application of paprica or lemon, there are cases in. which pure ascorbic acid alone has no effects. This suggests that besides ascorbic acid, lemon and paprica contain other substances which have effective results on hemorrhagic disposition. Szent Gyorgyi and co-workers identi fied of the these effective substances as belonging to the flavon group, and named it "Vitamin P", which is probably so called because it has an effect on capillary permeability. Together with ascorbic acid, Vitamin P has great significance in the plane oxidization system. It is especially important in the peroxydase system. Szen t-gyorgyi and co-workers extracted from 200 kilograms or 70 litres of citrous juice, 2 grams of crystallized flavon, which they named citrin. This substance is slightly yellow in color and is insoluble in water and alcohol, but dissolves in alkaline solvents. Analytically, it has the following composition. C 28H36-38O17. Its melting point is 205 Experiments conducted later by S z e n t-gyorgyi and co workers revealed that citrin is not a single substance, but is made up of a large amount of hesperidin and a small amount of glykosid of eriodictyol. (See Table I). The agricon of hesperidin, which is the greater part of citrin, is a flavanon called hesperetin, the chemical structure of which has already been established by 487

2 488 Shiro Morii : Professor A s a h i n a. It has been synthesized by Dr. Shinoda. Dr. Zilva of the Lister Institute, London, produced a very small quantity of citrin from a large amount of lemon juice. The citrin obtained was re-crystallized and it was found to have, the same melting point and composition as pure hesperidin. At first Szent Gyorgyi and co-workers made a clinical research for Vitamin P, and as a result of experiments with vascular purpura, pleurisy, endocarditis and myxoedema, they discovered that capillary resistance had markedly increased, while capillary permeability had noticeably decreased. Following this discovery, they made animal experiments in an effort to confirm the above fact, and are said to have noted that animals suffering from scurvy, when treated with a small amount of Vitamin P, survived longer and the degree of their hemorrhage was less in comparison with untreated animals. The results of their experiments were, how ever, contradicted by Moll of the Merk Company's Laboratory, and by Dr. Zilva. The original announcement made by fungarian workers on the Vitamin P problem lies in the clinical research in this vitamin, and experiments on animals are of secondary importance. In con sequence, clinical research is considered the most rational way to discuss the efficacy of Vitamin P. Even to this day, however, we have not heard of any systematic experiments being conducted to test the results obtained by Szent-Gyorgyi and co-workers. Such being the case, I made a series of experiments to ascertain whether Vitamin P is really as effective as Szent-Gyorgyi claims it to be. Dr. Makinoof the Dairen Hospital received one gram of citrin from Szent Gyorgyi, the discoverer of Vitamin P, but before experimenting with this substance, I conducted experiments with hesperidin. Since hesperidin, in the belief of Szent-Gyorgyi forms the greater part of, and is the chief active principle in Vitamin P, it seemed to me that I would be able to ascertain the action of Vitamin P if I conducted experiments with it. Employing the method written of by Tiemann, I was able to produce from orange peel, which had been dried and converted into coarse powder, a comparatively large amount of hesperidin.

3 Research for vitamin P. 489 Compared with the Vitamin P sent by Szen t-gyorgyi, this substance was almost colourless and was a mass of needle-shaped crystals. Its melting point was 252? Its properties were the same as those given by Tiemann. No Vitamin C was found mixed in the substance. In order to demonstrate clinically, the effects of Vitamin P on capillary permeability, Szent-Gyorgyi employed the method used by Borbely to measure capillary resistance, and the Landis' capillary permeability test. However, as a result of recent investi gations on the adaptability of the Landis' test by J e n a Bin g of the Medical-Physiological Institute of Copenhagen University, it was found that if a pressure of 40 mm. Hg. is applied, capillary filtration appears even in normal persons, while on the other hand, there are cases in which practically no filtrate appears in diseases in which permeability is believed to have increased. Thus, even if the data obtained by Landis' test are large, it does not prove further that capillary permeability increases. Moreover, it is im possible to say anything about the action of Vitamin P by this test. I experimented With Landis' test on various occasions, and found not a few clinical errors. It is difficult to obtain accurate results, and on this point I agree with Bing's view. It seems that Szent-Gyorgyi himself chiefly measured capil lary resistance and employed Landis' test merely for comparison. The amount of capillary filtrate which appeared in Szent Gyorgi's experiments was from 2 to 3 c.c. As such an amount of filtrate appears even in normal cases, it may be said that the effects of testing capillary permeability on the basis of Landis' test are not very distinct. Szent-Gyorgyi himself chiefly used Borbely's, suction method, which I think is very resonable since it enables one to measure fairly accurately. As clinical experiments, I selected patients suffering from the following diseases: (1) pleurisy, (2) pleurisy with adhesions, (3) pulmonary tuberculosis, (4) pulmonary tuberculosis with tuberculosis of the peritoneum, (5) tuberculosis of the peritoneum, (6) Basedow's Disease, (7) beri-beri, (8) patients with no serious diseases but whose blood sedimentation rate was accelerated,

4 490 Shiro Morii: TABLE I. and (9) healthy persons who were not given any hesperidin, for the purpose of comparison. Szent Georgyi injected Vitamin P into the veins, but as hesperidin does not readily dissolve in water, I applied orally 30 mg. of crystallized hesperidin once every day early in the morning, when the stomach is empty, for fifteen days, giving 450 mg. in all, and watched the progress of the patients. In the meantime I avoided giving any medicine, the internal application or injection of which might affect capillary permeability and resistance, and also mechanical stimulus. I did not observe any harmful effects on the patients or in the symptoms of the diseases, resulting from the application of hesperidin. In measuring capillary resistance, I used Borbe1y's apparatus and followed his principle. The parts of the body examined were on the voral aspect of the forearm and the part below the clavicle. The examinations were made once every five days before and after hesperidin was given, up to the 25th day. On the 20th day the progress after the final application of hesperidin the test was repeated. (See Table U). 1. In the case of pleurisy, the capillary resistance of the forearm had increased 7.5 cm. Hg., and of the part below the clavicle 2 cm. Hg. compared with the resistance before hesperidin was given. 2. In the case of pleurisy with adhesions, the capillary resistance of the forearm had increased 2.9 cm. Hg., and that of the part below the clavicle 3.4 cm. Hg. 3. In the case of pulmonary tuberculosis, the capillary resist ance of the forearm had increased 11.2 cm. Hg., and that of the

5 TABLE U.

6 492 Shiro Morii: part below the clavicle 5.2 cm. Hg. 4. In the case of pulmonary tuberculosis with tuberculosis of the peritioneum, the capillary resistance of the forearm had in creased 1.0 cm. Hg., and that of the part below the clavicle 15.4 cm. Hg. 5. In the case of tuberculosis of the peritoneum, the capillary resistance of the part below the clavicle was measured specially once every three days. On the 9th day it increased 3.5 cm. Hg., but the patient died on the 11th day. In this ease a dark purplish, speckled hemorrhage, about 5 cm. in diameter, occurred under the skin around both mammae two weeks before hesperidin was given. As treatment 2.0 c.c. of vitacimin (1 c.c. =50 mg. ascorbic acid) in jection was given eight times, but with no effect. However, from the third day after hesperidin was simultaneously given with the vitacimin injection, the hemorrhage began to disappear, and com pletely disappeared on the 7th day. 6. In the case of Basedow's Disease, the capillary resistance of the forearm had increased 3.2 em. Hg., and that of the part below the clavicle 1.3 cm. Hg. 7. In the case of beri-beri, the capillary resistance of the forearm had increased 4.2 cm. Hg., and that of the part below the clavicle 3.0 cm. Hg. 8. In the case of persons who had no serious diseases, but only with accelerated blood sedimentation rate the capillary resist ance of the forearm had increased 2.2 cm. Hg., and that of the part below the clavicle 1.0 cm. Hg. 9. In the case of healthy persons who were not given hesperidin, a difference of over 1.0 cm. Hg. in capillary resistance was not seen in either part. In short, the capillary resistance gradually increased after hesperidin was given, and reached the maximum between 15 and 20 days. It began falling from the 25th day (the 5th day after the application of hesperidin had been stopped), and on the 35th day, in five out of seven cases, the capillary resistance returned to the condition prior to the application of hesperidin. In the two remaining cases, the capillary resistance increased a little. On

7 Research for vitamin P. 493 examining the difference in the increase of capillary resistance before and after hesperidin was given, it was noted that in case of the forearm, the minimum increase was 1.0 cm. Hg., and maxi mum was 11.2 cm. Hg., while in the case of the part below the clavicle, the minimum increase was 1.0 cm. Hg. and the maximum was 15.4 cm. Hg. No decrease in resistance was noted. As to the healthy persons and the persons who had no serious diseases clinically, there was no marked rise in their capillary re sistance. In the case of the patients who had symptoms of inflam mation and whose capillary resistance had noticeably decreased prior to the application of hesperidin, the degree of increase in their capillary resistance was marked. The relatively small in crease in the capillary resistance of the part below the clavicle in comparison with the increase in the capillary resistance of the forearm on the whole, is due to the difference in capillary distribu tion between the parts in question, and to other factors. The Landis tests were made in the following manner before hesperidin was given, and on the 10th and 19th day after the ap plication of hesperidin: The experimental person is placed in a warm room, lying down with the arms horizontal. After half an hour, during which the person lies quite still, the experiment begins: a cuff is placed on one arm and inflated, so that there is a pressure of 40 mm. Hg. After half an hour a blood sample is taken from both arms simultaneously. Then the amount of hemoglobin, the blood sedimentation rate (b.s.r.), the cell volume with a hemato krit, and the protein content in the blood-plasma (by Kjeldahl's method) are measured. The value of the filtration (=F), which is expressed by the number of cm3 of fluid filtered out of 100 cm3 of the blood, is calculated by means of the following formula: Hu and Hg are the percentile cell volume of blood from the unstased and the stased arm respectively. 1. In the case of pleurisy, the amounts of capillary filtrate before and during the application of hesperidin and after the

8 TABLE V-(1). Before the application of hesperidin.

9 TABLE V-(2). 10th day after the application of hesperidin.

10 TALE V-(3). 19th day after the application of hesperidin.

11 Research for vitamin P. 497 application was stopped, were 18.0 c.c., 3.1 c.c. and 3.8 c.c. respec tively. 2. In the case of pleurisy with adhesions, the amounts before, during and after the application were 17.3 c.c., 10.0 c.c. and 13.1 c.c. 3. In the case of pulmonary tuberculosis, the amounts before, during and after the application were 8.5 c.c., 0 c.c. and 0 c.c., also showing a decrease in the process. In the case of other diseases in which there were either no filtrate or only a small amount of filtrate from the beginning, no effects were noted. (See Table III, 1-3, and Figure 1-9). Figure (1-9)

12 498 Shiro Morii :

13 Research for vitamin P. 499

14 500 Shiro Morii The blood sedimentation rate (average for one hour) was measured once every week, but no marked changes were noted either before or after the experiment. (See Table W). TABLE W. The blood sedimentation rate (average for one hour). SUMMARY. It seems mat nespericlm, that is, Vitamin Y, takes part in increasing capillary resistance to some extent, and in decreasing capillary permeability. But Vitamin P and Vitamin C are generally not the only substances which affect capillary hemorrhage or permeability. It is thought that capillary hemorrhage and per-

15 Research for vitamin P. 501 meability are affected greatly also by Vitamin K, Vitamin B and the protein properties contained in food, especially by amino acids. There are various methods for measuring capillary resistance and filtrate, but since these are imperfect, it is almost impossible to conclude without hesitation that various kinds of hemorrhage of the skin are due to one or two factors alone. From a clinical viewpoint, it is often thought that various factors are involved. Although the results of Szent Gyorgy is experiments on animals were totally contradicted, it apparently cannot be denied that there are cases in which some effects can be expected. I realize the necessity of conducting further comprehensive experiments in the future. The gist of the above research was read before the Third Korea Manchuria Medical Meeting held in Hsinking on September 3, Recently I have received a large amount of hesperidin manu factured by the Takeda Company, and am about to conduct experi ments with it. In conclusion, I wish of express my deep gratitude to Dr. Morinaka, the director of the Dairen Hospital, for his interest and encouragement, to Dr. Making for his guidance, and to Mr. Goro Yano for his help in my research. The work was undertaken with the aid of the scholarship from the research fundation of South Manchuria Railway Company.. (Katashi Makino). REFERENCES. Bing, Jens (1938): Act. Med. Stand., 44, 254. Borbely (1930): M. m. Woch., 886. Eppinger, H. (Wien 1935): Die Serose Entzundung. Landis zit. each Eppinger. Moll (1937): Klin. Woch., 16, Szent-Gyorgyi (1936): D. Med. Woch., 62, Tiemann (1881): Bericht d. D. chem. G., 14, 948. Zilva (1937): Biochem. J., 31, 915.