1
|
Ning C, Su S, Li J, Kong D, Cai H, Qin Z, Xing H, Chen X, He J. Evaluation of a Clinically Relevant Drug-Drug Interaction Between Rosuvastatin and Clopidogrel and the Risk of Hepatotoxicity. Front Pharmacol 2021; 12:715577. [PMID: 34646133 PMCID: PMC8504577 DOI: 10.3389/fphar.2021.715577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/06/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose: The combination therapy of rosuvastatin (RSV) and the platelet inhibitor clopidogrel (CP) is widely accepted in the management of cardiovascular diseases. The objective of the present study was to identify the mechanism of RSV–CP DDI and evaluate the risk of hepatotoxicity associated with the concomitant use of CP. Methods: We first studied the effect of CP and its major circulating metabolite, carboxylic acid metabolite (CPC), on RSV transport by overexpressing cells and membrane vesicles. Second, we investigated whether a rat model could replicate this DDI and then be used to conduct mechanistic studies and assess the risk of hepatotoxicity. Then, cytotoxicity assay in hepatocytes, biochemical examination, and histopathology were performed to measure the magnitude of liver injury in the presence and absence of DDI. Results: CP inhibited OATP1B1-mediated transport of RSV with an IC50 value of 27.39 μM. CP and CPC inhibited BCRP-mediated RSV transport with IC50 values of <0.001 and 5.96 μM, respectively. The CP cocktail (0.001 μM CP plus 2 μM CPC) significantly inhibited BCRP-mediated transport of RSV by 26.28%. Multiple p.o. doses of CP significantly increased intravenous RSV plasma AUC0-infinity by 76.29% and decreased intravenous RSV CL by 42.62%. Similarly, multiple p.o. doses of CP significantly increased p.o. RSV plasma AUC0-infinity by 87.48% and decreased p.o. RSV CL by 43.27%. CP had no effect on cell viability, while RSV exhibited dose-dependent cytotoxicity after 96 h incubation. Co-incubation of 100 μM CP and RSV for 96 h significantly increased intracellular concentrations and cell-to-medium concentration ratios of RSV and reduced hepatocyte viability. Histological evaluation of liver specimens showed patterns of drug-induced liver injury. Cholestasis was found in rats in the presence of DDI. Conclusion: CP is not a clinically relevant inhibitor for OATP1B1 and OATP1B3. The primary mechanism of RSV–CP DDI can be attributed to the inhibition of intestinal BCRP by CP combined with the inhibition of hepatic BCRP by CPC. The latter is likely to be more clinically relevant and be a contributing factor for increased hepatotoxicity in the presence of DDI.
Collapse
Affiliation(s)
- Chen Ning
- Department of Pharmacy, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Clinical Pharmacokinetics Laboratory, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Shengdi Su
- Clinical Pharmacokinetics Laboratory, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Jiaming Li
- Clinical Pharmacokinetics Laboratory, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Dexuan Kong
- Clinical Pharmacokinetics Laboratory, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Hui Cai
- Clinical Pharmacokinetics Laboratory, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Zhiying Qin
- Clinical Pharmacokinetics Laboratory, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Han Xing
- Clinical Pharmacokinetics Laboratory, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Xijing Chen
- Clinical Pharmacokinetics Laboratory, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Jiake He
- Department of Pharmacy, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Clinical Pharmacokinetics Laboratory, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China.,Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| |
Collapse
|
2
|
Zhou X, Fu L, Wang P, Yang L, Zhu X, Li CG. Drug-herb interactions between Scutellaria baicalensis and pharmaceutical drugs: Insights from experimental studies, mechanistic actions to clinical applications. Biomed Pharmacother 2021; 138:111445. [PMID: 33711551 DOI: 10.1016/j.biopha.2021.111445] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 02/07/2023] Open
Abstract
Whilst the popular use of herbal medicine globally, it poses challenges in managing potential drug-herb interaction. There are two folds of the drug-herb interaction, a beneficial interaction that may improve therapeutic outcome and minimise the toxicity of drug desirably; by contrast, negative interaction may evoke unwanted clinical consequences, especially with drugs of narrow therapeutic index. Scutellaria baicalensis Georgi is one of the most popular medicinal plants used in Asian countries. It has been widely used for treating various diseases and conditions such as cancer, diabetes, inflammation, and oxidative stress. Studies on its extract and bioactive compounds have shown pharmacodynamic and pharmacokinetic interactions with a wide range of pharmaceutical drugs as evidenced by plenty of in vitro, in vivo and clinical studies. Notably, S. baicalensis and its bioactives including baicalein, baicalin and wogonin exhibited synergistic interactions with many pharmaceutical drugs to enhance their efficacy, reduce toxicity or overcome drug resistance to combat complex diseases such as cancer, diabetes and infectious diseases. On the other hand, S. baicalensis and its bioactives also affected the pharmacokinetic profile of many drugs in absorption, distribution, metabolism and elimination via the regulatory actions of the efflux pumps and cytochrome P450 enzymes. This review provides comprehensive references of the observed pharmacodynamic and pharmacokinetic drug interactions of Scutellaria baicalensis and its bioactives. We have elucidated the interaction with detailed mechanistic actions, identified the knowledge gaps for future research and potential clinical implications. Such knowledge is important for the practice of both conventional and complementary medicines, and it is essential to ensure the safe use of related herbal medicines. The review may be of great interest to practitioners, consumers, clinicians who require comprehensive information on the possible drug interactions with S. baicalensis and its bioactives.
Collapse
Affiliation(s)
- Xian Zhou
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - Ling Fu
- Chinese Medicine Centre, School of Health Sciences, Western Sydney University, Penrith, NSW 2751, Australia; The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, People's Republic of China; The Second Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Second Chinese Medicine Hospital), Nanjing, Jiangsu 210017, People's Republic of China
| | - Pengli Wang
- Chinese Medicine Centre, School of Health Sciences, Western Sydney University, Penrith, NSW 2751, Australia; School of Chinese Medicine, School of Integrated Chinese & Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, People's Republic of China
| | - Lan Yang
- Chinese Medicine Centre, School of Health Sciences, Western Sydney University, Penrith, NSW 2751, Australia; School of Chinese Medicine, School of Integrated Chinese & Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, People's Republic of China
| | - Xiaoshu Zhu
- Chinese Medicine Centre, School of Health Sciences, Western Sydney University, Penrith, NSW 2751, Australia
| | - Chun Guang Li
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia.
| |
Collapse
|
3
|
Wang S, Li W, Yang J, Yang Z, Yang C, Jin H. Research Progress of Herbal Medicines on Drug Metabolizing Enzymes: Consideration Based on Toxicology. Curr Drug Metab 2020; 21:913-927. [PMID: 32819254 DOI: 10.2174/1389200221999200819144204] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 11/22/2022]
Abstract
The clinical application of herbal medicines is increasing, but there is still a lack of comprehensive safety data and in-depth research into mechanisms of action. The composition of herbal medicines is complex, with each herb containing a variety of chemical components. Each of these components may affect the activity of metabolizing enzymes, which may lead to herb-drug interactions. It has been reported that the combined use of herbs and drugs can produce some unexpected interactions. Therefore, this study reviews the progress of research on safety issues caused by the effects of herbs on metabolizing enzymes with reference to six categories of drugs, including antithrombotic drugs, non-steroidal anti-inflammatory drugs, anti-diabetic drugs, statins lipid-lowering drugs, immunosuppressants, and antineoplastic drugs. Understanding the effects of herbs on the activity of metabolizing enzymes could help avoid the toxicity and adverse drug reactions resulting from the co-administration of herbs and drugs, and help doctors to reduce the risk of prescription incompatibility.
Collapse
Affiliation(s)
- Shuting Wang
- New Drug Safety Evaluation Center, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100050, China
| | - Wanfang Li
- New Drug Safety Evaluation Center, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100050, China
| | - Jianbo Yang
- Institute for Control of Chinese Traditional Medicine and Ethnic Medicine, National Institutes for Food and Drug Control, Beijing 100050, China
| | - Zengyan Yang
- Guangxi International Zhuang Medicine Hospital, Nanning, 530001, China
| | - Cuiping Yang
- New Drug Safety Evaluation Center, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100050, China
| | - Hongtao Jin
- New Drug Safety Evaluation Center, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100050, China
| |
Collapse
|
4
|
Abstract
The use of traditional Chinese medicine (TCM) has obtained more and more acceptance all over the world due to its multi-target and multi-level function characteristics. Clopidogrel is a major therapeutic option to reduce atherothrombotic events in patients with acute coronary syndrome, recent myocardial infarction, recent stroke or established peripheral arterial disease. These patients probably take TCM. Are there any interactions between clopidogrel and TCM? Whether TCM will affect the efficacy of clopidogrel or increase the adverse reactions of bleeding? Clarifying this information will help physicians make better use of TCM. A literature search was carried out using Web of Science, PubMed and the Cochrane Library to analyze the pharmacokinetic or pharmacodynamic interactions of clopidogrel and TCM. Some herbs can increase the AUC or Cmax of clopidogrel, such as Scutellarin, Danggui, Gegen, Sauchinone and Dengzhan Shengmai capsules. Whereas others can decrease clopidogrel, for example, Ginkgo and Danshen. Furthermore, some herbs can increase the AUC or Cmax of clopidogrel active metabolite, including Ginkgo and Xuesaitong tablet. And others can decrease the clopidogrel active metabolite, such as Scutellarin, Danshen, Fufang Danshen Dripping Pill and Dengzhan Shengmai capsules. Additionally, Schisandra chinensis, Danggui, Gegen and Fufang Danshen Dripping Pill can decrease the AUC or Cmax of the clopidogrel inactive metabolite, while Curcumin on the contrary. The pharmacodynamics of Panax notoginseng, Notoginsenoside Ft1, Hypericum perforatum, Shexiang baoxin pills, Naoxintong capsule increased the antiplatelet activity compared with clopidogrel alone, while Danshen decreased the platelet inhibition. In adverse reactions, Danggui can enhance the adverse effects of clopidogrel on the bleeding time. With more awareness and understanding on potential drug-herb interactions of clopidogrel and TCM, it may be possible to combine clopidogrel with TCM herbs to yield a better therapeutic outcome.
Collapse
Affiliation(s)
- Yunzhen Hu
- Department of Pharmacy, The First Affiliated Hosptial, College of Medicine, Zhejiang University, Hangzhou, China.
| | - Jing Wang
- Department of Pharmacy, The First Affiliated Hosptial, College of Medicine, Zhejiang University, Hangzhou, China
| |
Collapse
|
5
|
Pharmacokinetics and pharmacodynamics analysis of XQ-1H and its combination therapy with clopidogrel on cerebral ischemic reperfusion injury in rats. J Pharm Biomed Anal 2020; 179:112975. [PMID: 31735472 DOI: 10.1016/j.jpba.2019.112975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/11/2019] [Accepted: 11/04/2019] [Indexed: 11/21/2022]
Abstract
Ischemic stroke is the main cause of disability and mortality worldwide. 10-O-(N N-dimethylaminoethyl)-ginkgolide B methane-sulfonate (XQ-1 H) is a novel drug based on the remedial approach for ischemic stroke. Clopidogrel, a widely used anti-platelet drug, is often co-prescribed in the clinic. In this study, we established an UPLC-MS/MS spectrometry method for the determination of XQ-1H and investigated the pharmacokinetic effect of clopidogrel on XQ-1H in rats subjected to middle cerebral artery occlusion (MCAO). Meanwhile, the anti-apoptotic and neuroprotective effects of XQ-1H and its combination with clopidogrel were also studied. The results revealed that XQ-1H and its combination with clopidogrel abridged brain infarct volume, cerebral edema and alleviated neurological dysfunction caused by cerebral ischemic reperfusion injury. Further study demonstrated that XQ-1H combined with clopidogrel lessened TUNEL positive cells, up-regulated bcl-2 expression notably and down-regulated bax expression as compared to both XQ-1H and clopidogrel individually. In addition, a rapid, sensitive UPLC-MS/MS method was developed to quantify the concentration of XQ-1H in MCAO/R rats. Our pharmacokinetic results showed that clopidogrel significantly increased the exposure of XQ-1H, increased the peak plasma concentration (Cmax), area under the curve (AUC) and slowed elimination of XQ-1H in the co-administered group. Besides, for further exploring which CYP450 isoforms are involved in the XQ-1H metabolism, XQ-1H was incubated in human liver microsomes (HLMs) system with or without P450 isoform-selective inhibitors. Our results revealed that clopidogrel altered pharmacokinetics of XQ-1H potentially and subsequently enhanced the pharmacological effect of XQ-1H. Moreover, XQ-1H could be applied as an efficacious neuroprotective agent for ischemic stroke because of its considerable effect on averting neuronal apoptosis.
Collapse
|
6
|
Lopez JJ, El Haouari M, Jardin I, Alonso N, Regodon S, Diez-Bello R, Redondo PC, Rosado JA. Flavonoids and Platelet-Derived Thrombotic Disorders. Curr Med Chem 2019; 26:7035-7047. [DOI: 10.2174/0929867325666180417170218] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 12/14/2017] [Accepted: 12/14/2017] [Indexed: 01/12/2023]
Abstract
:
Thrombotic disorders are characterized by an increase in the probability of the
formation of unnecessary thrombi that might be due to the activation of the coagulation cascade
or the circulating platelets. Platelets or thrombocytes play an essential role in hemostasis
but abnormal platelet function leads to the development of a number of cardiovascular
complications, including thrombotic disorders. Under pathological conditions, platelets are
associated with the development of different thrombotic disorders, including atherosclerosis,
arterial thrombosis and stroke, deep venous thrombosis and pulmonary embolism; therefore,
platelets are the target of a number of anti-thrombotic strategies. Flavonoids, a large group
of polyphenols ubiquitously expressed in fruits and vegetables that have attracted considerable
attention because of their benefits in human health, including the reduction of the risk
of cardiovascular disease. Flavonoids have been reported to reduce platelet activity by attenuating
agonist-induced GPIIb/IIIa receptor activation, mobilization of intracellular free
Ca2+, granule exocytosis, as well as activation of different signaling molecules such as mitogen-
activated protein kinases or phospholipases. This review summarizes the current studies
concerning the modulation of platelet activation by flavonoids, giving especial attention to
those events associated to thrombotic disorders.
Collapse
Affiliation(s)
- Jose J. Lopez
- Department of Physiology (Cell Physiology Research Group), University of Extremadura, 10003-Cáceres, Spain
| | - Mohammed El Haouari
- Faculté Polydisciplinaire de Taza, Laboratoire des Matériaux, Substances Naturelles, Environnement et Modélisation (LMSNEM), Université Sidi Mohamed Ben Abdellah, B.P. 1223, Taza Gare, Morocco
| | - Isaac Jardin
- Department of Physiology (Cell Physiology Research Group), University of Extremadura, 10003-Cáceres, Spain
| | - Nieves Alonso
- Department of Hematology, Hospital Infanta Cristina, 06006 Badajoz, Spain
| | - Sergio Regodon
- Department of Animal Medicine, University of Extremadura, 10003-Cáceres, Spain
| | - Raquel Diez-Bello
- Department of Physiology (Cell Physiology Research Group), University of Extremadura, 10003-Cáceres, Spain
| | - Pedro C. Redondo
- Department of Physiology (Cell Physiology Research Group), University of Extremadura, 10003-Cáceres, Spain
| | - Juan A. Rosado
- Department of Physiology (Cell Physiology Research Group), University of Extremadura, 10003-Cáceres, Spain
| |
Collapse
|
7
|
Deng W, Han W, Fan T, Wang X, Cheng Z, Wan B, Chen J. Scutellarin inhibits human renal cancer cell proliferation and migration via upregulation of PTEN. Biomed Pharmacother 2018; 107:1505-1513. [PMID: 30257368 DOI: 10.1016/j.biopha.2018.08.127] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/18/2018] [Accepted: 08/24/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Scutellarin is a naturally flavone glycoside that has been shown to exhibit anti-proliferative and anti-apoptotic activities among various human malignancies. However, the anti-cancer effect of Scutellarin in Renal cell carcinoma (RCC) and the underlying mechanism remains unclear. METHODS AND MATERIALS RCC cell lines ACHN and 786-O were treated with different concentrations (0-210 μM) of Scutellarin in vitro. Cell viability and proliferation were investigated by MTT and colony formation assays. Cell invasion and migration were detected by Transwell assays. Cell apoptosis and cell cycle distribution was measured by flow cytometry. Western blot was used to investigate the expression levels of crucial proteins. Xenograft tumor model was established to evaluate tumor growth in vivo. RESULTS Scutellarin significantly inhibited RCC cell proliferation in a dose- and time- dependent manner. Treatment of RCC cells with Scutellarin (30, 60, and 90 μM) markedly induced apoptosis and cell cycle arrested at G0/G1 phase in a concentration-dependent characteristic. Cell invasion and migration capacities of RCC cells were also dose-dependently suppressed by Scutellarin treatment. Western blot assays revealed that the crucial proteins including cyclin D1, CDK2, Bcl2, MMP-2, and MMP-9 were significantly reduced while Bax, cleaved caspase 3 and p21 were increased by Scutellarin in RCC cells. In vivo assay indicated that Scutellarin possessed anti-cancer effect on xenograft without triggering toxic effect. Mechanically, Scutellarin dramatically increased the protein level of phosphatase and tensin homologue (PTEN) and inhibited the activity of P13K/AKT/mTOR signaling. Ectopic expression of PTEN enhanced the inhibitory effect of Scutellarin on RCC proliferation while knockdown of PTEN abrogated it through regulating its downstream P13K/AKT/mTOR signaling pathway. CONCLUSION Scutellarin inhibited RCC cell proliferation and invasion partially by enhancing the expression of PTEN through inhibition of P13K/AKT/mTOR pathway, suggesting that Scutellarin might serve as a potential therapeutic agent in RCC treatment.
Collapse
Affiliation(s)
- Wenting Deng
- College of Pharmacy, Xi'an Medical University, No. 1 Xinwang Road of Weiyang District, 710021, Xi'an, Shaanxi, China.
| | - Wei Han
- Department of Medical Equipment, Shaanxi Provincial People's Hospital, No. 256 Youyi West Road, 710068, Xi'an, Shaanxi, China
| | - Tao Fan
- College of Pharmacy, Xi'an Medical University, No. 1 Xinwang Road of Weiyang District, 710021, Xi'an, Shaanxi, China
| | - Xiaoku Wang
- College of Pharmacy, Xi'an Medical University, No. 1 Xinwang Road of Weiyang District, 710021, Xi'an, Shaanxi, China
| | - Zhao Cheng
- College of Pharmacy, Xi'an Medical University, No. 1 Xinwang Road of Weiyang District, 710021, Xi'an, Shaanxi, China
| | - Bo Wan
- College of Pharmacy, Xi'an Medical University, No. 1 Xinwang Road of Weiyang District, 710021, Xi'an, Shaanxi, China
| | - Jinlian Chen
- College of Pharmacy, Xi'an Medical University, No. 1 Xinwang Road of Weiyang District, 710021, Xi'an, Shaanxi, China
| |
Collapse
|
8
|
Qian C, Luo X, Yang M, Jin J, Zuo Z. Impaired liver cytochrome P450 2C11 activity after dual antiplatelet therapy with aspirin and clopidogrel in rats. Xenobiotica 2018; 48:911-919. [PMID: 29052493 DOI: 10.1080/00498254.2017.1380242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/11/2017] [Accepted: 09/12/2017] [Indexed: 06/07/2023]
Abstract
1. Aspirin (ASA) and clopidogrel (CLP) are used in combination as dual antiplatelet therapy (DAPT) for acute coronary syndrome based on their complementary mechanisms for platelet aggregation inhibition. However, the pharmacokinetics of such drug combination usage has not been thoroughly investigated. 2. In the current study, an LC-MS/MS method was developed to simultaneously determine the plasma concentrations of ASA and its metabolite salicylic acid (SA) with CLP and its metabolites, clopidogrel carboxylic acid (CLPM) and clopidogrel active metabolite derivative (CAMD). The pharmacokinetics of ASA, SA, CLP, CLPM and CAMD in rats receiving two-week DAPT with ASA and CLP were then determined. 3. After two-week DAPT with ASA and CLP in rats, the activities of aspirin esterase and rCyp2c11, enzymes mediating rat metabolism of ASA and CLP, respectively, in prepared rat liver microsomes were measured followed by further determination of rCyp2c11 mRNA expressions. The results demonstrated that DAPT led to minimal impact on aspirin esterase activity but significant decrease in rCyp2c11 activity and mRNA expression. 4. In conclusion, our findings on impairment in rCyp2C11 activity and mRNA expression by DAPT in rats could provide guidance on its safe clinical use with other CYP 2C19 substrates.
Collapse
Affiliation(s)
- Chenyu Qian
- a School of Pharmacy, Faculty of Medicine , The Chinese University of Hong Kong , Shatin , Hong Kong SAR and
| | - Xi Luo
- a School of Pharmacy, Faculty of Medicine , The Chinese University of Hong Kong , Shatin , Hong Kong SAR and
| | - Mengbi Yang
- a School of Pharmacy, Faculty of Medicine , The Chinese University of Hong Kong , Shatin , Hong Kong SAR and
| | - Jing Jin
- b School of Pharmaceutical Science , Sun Yat-sen University , Guangzhou , P.R. China
| | - Zhong Zuo
- a School of Pharmacy, Faculty of Medicine , The Chinese University of Hong Kong , Shatin , Hong Kong SAR and
| |
Collapse
|
9
|
Gong EC, Chea S, Balupuri A, Kang NS, Chin YW, Choi YH. Enzyme Kinetics and Molecular Docking Studies on Cytochrome 2B6, 2C19, 2E1, and 3A4 Activities by Sauchinone. Molecules 2018; 23:molecules23030555. [PMID: 29498658 PMCID: PMC6017976 DOI: 10.3390/molecules23030555] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 02/26/2018] [Accepted: 02/28/2018] [Indexed: 02/06/2023] Open
Abstract
Sauchinone, an active lignan isolated from the aerial parts of Saururus chinensis (Saururaceae), exhibits anti-inflammatory, anti-obesity, anti-hyperglycemic, and anti-hepatic steatosis effects. As herb–drug interaction (HDI) through cytochrome P450s (CYPs)-mediated metabolism limits clinical application of herbs and drugs in combination, this study sought to explore the enzyme kinetics of sauchinone towards CYP inhibition in in vitro human liver microsomes (HLMs) and in vivo mice studies and computational molecular docking analysis. In in vitro HLMs, sauchinone reversibly inhibited CYP2B6, 2C19, 2E1, and 3A4 activities in non-competitive modes, showing inhibition constant (Ki) values of 14.3, 16.8, 41.7, and 6.84 μM, respectively. Also, sauchinone time-dependently inhibited CYP2B6, 2E1 and 3A4 activities in vitro HLMs. Molecular docking study showed that sauchinone could be bound to a few key amino acid residues in the active site of CYP2B6, 2C19, 2E1, and 3A4. When sibutramine, clopidogrel, or chlorzoxazone was co-administered with sauchinone to mice, the systemic exposure of each drug was increased compared to that without sauchinone, because sauchinone reduced the metabolic clearance of each drug. In conclusion, when sauchinone was co-treated with drugs metabolized via CYP2B6, 2C19, 2E1, or 3A4, sauchinone–drug interactions occurred because sauchinone inhibited the CYP-mediated metabolic activities.
Collapse
Affiliation(s)
- Eun Chae Gong
- College of Pharmacy and Intergrated Research Institute for Drug Development, Dongguk University-Seoul, 32 Dongguk-lo, Ilsandong-gu, Goyang, Gyeonggi-do 10326, Korea; (E.C.G.); (S.C.); (Y.-W.C.)
| | - Satya Chea
- College of Pharmacy and Intergrated Research Institute for Drug Development, Dongguk University-Seoul, 32 Dongguk-lo, Ilsandong-gu, Goyang, Gyeonggi-do 10326, Korea; (E.C.G.); (S.C.); (Y.-W.C.)
| | - Anand Balupuri
- Graduate School of New Drug Discovery and Development, Chungnam National University, Daejeon 305-764, Korea; (A.B.); (N.S.K)
| | - Nam Sook Kang
- Graduate School of New Drug Discovery and Development, Chungnam National University, Daejeon 305-764, Korea; (A.B.); (N.S.K)
| | - Young-Won Chin
- College of Pharmacy and Intergrated Research Institute for Drug Development, Dongguk University-Seoul, 32 Dongguk-lo, Ilsandong-gu, Goyang, Gyeonggi-do 10326, Korea; (E.C.G.); (S.C.); (Y.-W.C.)
| | - Young Hee Choi
- College of Pharmacy and Intergrated Research Institute for Drug Development, Dongguk University-Seoul, 32 Dongguk-lo, Ilsandong-gu, Goyang, Gyeonggi-do 10326, Korea; (E.C.G.); (S.C.); (Y.-W.C.)
- Correspondence: ; Tel.: +82-31-961-5212
| |
Collapse
|
10
|
Wang J, Xie Y, Zhao S, Zhang J, Chai Y, Li Y, Liao X. Dengzhanxixin injection for cerebral infarction: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2017; 96:e7674. [PMID: 28796050 PMCID: PMC5556216 DOI: 10.1097/md.0000000000007674] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND No systematic review has been published in English of Dengzhanxixin (DZXX) injection for cerebral infarction. The aim of this systematic review was to assess the effects and safety of DZXX injection for cerebral infarction. METHODS Eight databases were searched from their inception. Randomized controlled trials (RCTs) related to DZXX for cerebral infarction in English or Chinese without restrictions on the publication status were included. Neurological deficit, quality of life, and response rates were analyzed. Adverse events were also investigated. RESULTS Twenty-three randomized controlled trials (RCTs) with 2291 participants were included. Meta-analysis showed that DZXX injection plus routine western therapy was better than routine western therapy alone for reducing neurologic deficit (MD -2.86, 95% CI -3.87 to -1.86), for improving quality of life (MD 9.48, 95% CI 8.34-10.63), and for improving response rates (RR 1.20, 95% CI 1.15-1.25). No serious adverse drug events (ADE) were reported. CONCLUSIONS DZXX injection may have a potential therapeutic effect for cerebral infarction in reducing neurologic deficit, improving life quality and response rates. However, we could not draw any definitive conclusions due to the insufficient evidences. More high-quality trials are needed to provide more strong evidence and to assess the safety of DZXX injection.
Collapse
Affiliation(s)
- Jia Wang
- Institute of Basic Research in Clinical Medicine
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences
| | - Yanming Xie
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences
| | | | - Jiangsong Zhang
- Zhejiang University of Traditional Chinese Medicine, Zhejiang, China
| | - Yan Chai
- Department of Epidemiology, University of California-Los Angeles, CA
| | - Yuanyuan Li
- Institute of Basic Research in Clinical Medicine
| | - Xing Liao
- Institute of Basic Research in Clinical Medicine
| |
Collapse
|
11
|
Zhang K, Song W, Li D, Jin X. Apigenin in the regulation of cholesterol metabolism and protection of blood vessels. Exp Ther Med 2017; 13:1719-1724. [PMID: 28565758 PMCID: PMC5443212 DOI: 10.3892/etm.2017.4165] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 12/13/2016] [Indexed: 01/01/2023] Open
Abstract
Hyperlipidemia is a major independent risk factor for atherosclerosis. Seeking natural compounds in medicinal plants capable of reducing blood fat and studying their mechanisms of action has been the focus of research in recent years. The aim of the present study was to analyze the mechanisms of apigenin in regulating cholesterol metabolism and protecting blood vessels, and to provide a theoretical basis for the clinical application of apigenin. The mouse model of hyperlipidemia was established to verify the efficacy of apigenin in improving hyperlipidemia and to observe the mechanism of action of apigenin in reducing cholesterol content. In vitro cell experiments were conducted to evaluate the role of apigenin in mediating reverse cholesterol transport. Additionally, H2O2-injured human umbilical venous endothelial cells (EA.hy926 cells) were used for further study on the roles of apigenin in resisting oxidization and protecting vascular endothelial cells. Apigenin significantly regulated blood fat, reduced animal weight, and reduced total cholesterol (P=0.024), triglyceride (P=0.031) and low-density lipoprotein cholesterol (P=0.014) in the serum of the high-fat diet mice. Apigenin improved the blood lipid metabolism of the hyper-lipidemia model mice. Body weight and serum cholesterol content increased abnormally (P=0.003) as a consequence of high-fat diet. Apigenin increased the activity of superoxide dismutase in EA.hy926 cells (P=0.043) and increased the amount of nitric oxide secreted by the cells (P=0.038). Apigenin also inhibited the proliferation of vascular smooth muscle cells in a dose-dependent manner (P=0.036). In conclusion, apigenin can regulate cholesterol metabolism in vivo and plays a role in reducing the level of blood fat by promoting cholesterol absorption and conversion, and accelerating reverse cholesterol transport. Apigenin also has a role in resisting oxidization and protecting blood vessels.
Collapse
Affiliation(s)
- Kun Zhang
- Department of Vascular Surgery, Qingdao Municipal Hospital, Qingdao, Shandong 266011, P.R. China.,Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Wei Song
- Department of Endocrinology, Qingdao Municipal Hospital, Qingdao, Shandong 266011, P.R. China
| | - Dalin Li
- Department of Vascular Surgery, Qingdao Municipal Hospital, Qingdao, Shandong 266011, P.R. China
| | - Xing Jin
- Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| |
Collapse
|
12
|
Chen X, Zhao Z, Chen Y, Gou X, Zhou Z, Zhong G, Cai Y, Huang M, Jin J. Mechanistic understanding of the effect of Dengzhan Shengmai capsule on the pharmacokinetics of clopidogrel in rats. JOURNAL OF ETHNOPHARMACOLOGY 2016; 192:362-369. [PMID: 27459888 DOI: 10.1016/j.jep.2016.07.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 06/24/2016] [Accepted: 07/23/2016] [Indexed: 06/06/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The Dengzhan Shengmai capsule (DZSM) is known in China for its remarkable curative effect as a treatment of cardiovascular diseases, such as coronary heart disease and ischemic stroke. DZSM is a Chinese herbal compound preparation that consists of four ingredients, including Erigeron breviscapus (Vaniot) Hand.-Mazz., Panax ginseng C.A. Mey, Ophiopogon japonicas (Thunb.) Ker-Gawl. and Schisandra chinensis (Turcz.) Baill., and was indexed in the Chinese Pharmacopoeia 2010. DZSM and clopidogrel are often co-prescribed in the clinic to prevent the recurrence of stroke or other cardiovascular and cerebrovascular diseases. However, the effect of DZSM on the pharmacokinetics of clopidogrel remains unclear. AIM OF THE STUDY The purpose of the study is to explore the pharmacokinetics and potential interaction between DZSM and clopidogrel and the underlying mechanism. MATERIALS AND METHODS Rats were used to investigate the effect of DZSM on the pharmacokinetics of clopidogrel and its active metabolite in vivo. The plasma concentrations were simultaneously determined using LC-MS/MS. The effects of DZSM on the P-gp-mediated efflux transport and CYP450-mediated metabolism of clopidogrel were investigated using MDCKII-MDR1 cells and rat liver microsomes, respectively. RESULTS After pretreatment with DZSM, the Cmax and AUC0-∞ of clopidogrel increased from 0.4±0.1 to 1.7±0.6ng/mL and 0.9±0.4 to 2.0±0.2ng/mLh, respectively. The Cmax and AUC0-∞ of the derivatized active metabolite of clopidogrel decreased from 8.2±1.2 to 2.8±0.5ng/mL and 18.2±5.6 to 6.4±3.7ngh/mL, respectively. In MDCKII-MDR1 cells, the P-gp-mediated efflux transport of clopidogrel was significantly inhibited by the DZSM extract. In rat liver microsomes, DZSM inhibited clopidogrel metabolism with an IC50 of 0.02mg/mL. CONCLUSIONS DZSM significantly affects the pharmacokinetics of clopidogrel and its active metabolite by inhibiting the P-gp-mediated efflux transport and CYP450-mediated metabolism of clopidogrel. Thus, caution is needed when DZSM is co-administered with clopidogrel in the clinic because the interaction of these drugs may result in altered plasma concentrations of clopidogrel and its active metabolite.
Collapse
MESH Headings
- ATP Binding Cassette Transporter, Subfamily B, Member 1/genetics
- ATP Binding Cassette Transporter, Subfamily B, Member 1/metabolism
- Activation, Metabolic
- Administration, Oral
- Animals
- Area Under Curve
- Cardiovascular Agents/administration & dosage
- Cardiovascular Agents/toxicity
- Chromatography, Liquid
- Clopidogrel
- Cytochrome P-450 Enzyme System/metabolism
- Dogs
- Dose-Response Relationship, Drug
- Drugs, Chinese Herbal/administration & dosage
- Drugs, Chinese Herbal/toxicity
- Herb-Drug Interactions
- Madin Darby Canine Kidney Cells
- Male
- Metabolic Clearance Rate
- Microsomes, Liver/metabolism
- Platelet Aggregation Inhibitors/administration & dosage
- Platelet Aggregation Inhibitors/blood
- Platelet Aggregation Inhibitors/pharmacokinetics
- Platelet Aggregation Inhibitors/toxicity
- Rats, Sprague-Dawley
- Risk Assessment
- Tandem Mass Spectrometry
- Ticlopidine/administration & dosage
- Ticlopidine/analogs & derivatives
- Ticlopidine/blood
- Ticlopidine/pharmacokinetics
- Ticlopidine/toxicity
- Transfection
Collapse
Affiliation(s)
- Xinmeng Chen
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, PR China
| | - Zhongxiang Zhao
- School of Chinese Materia Medica, Guangzhou University of Chinese Medicine, Guangzhou 510006, PR China
| | - Yibei Chen
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, PR China
| | - Xiaoli Gou
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, PR China
| | - Ziyi Zhou
- Guangdong Provincial Hospital of Traditional Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111# Dade Road, Guangzhou 510120, PR China
| | - Guoping Zhong
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, PR China
| | - Yefeng Cai
- Guangdong Provincial Hospital of Traditional Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111# Dade Road, Guangzhou 510120, PR China
| | - Min Huang
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, PR China
| | - Jing Jin
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, PR China.
| |
Collapse
|
13
|
Deng Y, Mo YF, Chen XM, Zhang LZ, Liao CF, Song Y, Xu C. Effect of Ginkgo Biloba Extract on the Pharmacokinetics and Metabolism of Clopidogrel in Rats. Phytother Res 2016; 30:1886-1892. [PMID: 27487816 DOI: 10.1002/ptr.5691] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/12/2016] [Accepted: 07/11/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Ying Deng
- Department of Pharmacy; The People's Hospital of Baoan Shenzhen; Guangdong 518101 China
| | - Yu-fei Mo
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine; University of Hong Kong; Hong Kong
| | - Xin-meng Chen
- School of Biomedical Sciences; The Chinese University of Hong Kong; Shatin, N. T. Hong Kong
| | - Lv-zhao Zhang
- Department of Pharmacy; The People's Hospital of Baoan Shenzhen; Guangdong 518101 China
| | - Chao-feng Liao
- Department of Pharmacy; The People's Hospital of Baoan Shenzhen; Guangdong 518101 China
| | - Yu Song
- Department of Pharmacy; The People's Hospital of Baoan Shenzhen; Guangdong 518101 China
| | - Chenshu Xu
- Department of Pharmacy, School of Medicine; Shenzhen University; Shenzhen Guangdong 518060 China
| |
Collapse
|
14
|
Ma BL, Ma YM. Pharmacokinetic herb–drug interactions with traditional Chinese medicine: progress, causes of conflicting results and suggestions for future research. Drug Metab Rev 2016; 48:1-26. [DOI: 10.3109/03602532.2015.1124888] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
15
|
Chen F, Yang Y, Fang C, Zhao J, Han M, Zhu Q, Bai X, Liu M, Yang G. Effect of fluvoxamine on the pharmacokinetics and pharmacodynamics of clopidogrel in rats. Xenobiotica 2015; 45:1122-8. [DOI: 10.3109/00498254.2015.1045570] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
16
|
Wang ZY, Chen M, Zhu LL, Yu LS, Zeng S, Xiang MX, Zhou Q. Pharmacokinetic drug interactions with clopidogrel: updated review and risk management in combination therapy. Ther Clin Risk Manag 2015; 11:449-67. [PMID: 25848291 PMCID: PMC4373598 DOI: 10.2147/tcrm.s80437] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Coprescribing of clopidogrel and other drugs is common. Available reviews have addressed the drug–drug interactions (DDIs) when clopidogrel is as an object drug, or focused on combination use of clopidogrel and a special class of drugs. Clinicians may still be ignorant of those DDIs when clopidogrel is a precipitant drug, the factors determining the degree of DDIs, and corresponding risk management. Methods A literature search was performed using PubMed, MEDLINE, Web of Science, and the Cochrane Library to analyze the pharmacokinetic DDIs of clopidogrel and new P2Y12 receptor inhibitors. Results Clopidogrel affects the pharmacokinetics of cerivastatin, repaglinide, ferulic acid, sibutramine, efavirenz, and omeprazole. Low efficacy of clopidogrel is anticipated in the presence of omeprazole, esomeprazole, morphine, grapefruit juice, scutellarin, fluoxetine, azole antifungals, calcium channel blockers, sulfonylureas, and ritonavir. Augmented antiplatelet effects are anticipated when clopidogrel is coprescribed with aspirin, curcumin, cyclosporin, St John’s wort, rifampicin, and angiotensin-converting enzyme inhibitors. The factors determining the degree of DDIs with clopidogrel include genetic status (eg, cytochrome P540 [CYP]2B6*6, CYP2C19 polymorphism, CYP3A5*3, CYP3A4*1G, and CYP1A2-163C.A), species differences, and dose strength. The DDI risk does not exhibit a class effect, eg, the effects of clopidogrel on cerivastatin versus other statins, the effects of proton pump inhibitors on clopidogrel (omeprazole, esomeprazole versus pantoprazole, rabeprazole), the effects of rifampicin on clopidogrel versus ticagrelor and prasugrel, and the effects of calcium channel blockers on clopidogrel (amlodipine versus P-glycoprotein-inhibiting calcium channel blockers). The mechanism of the DDIs with clopidogrel involves modulating CYP enzymes (eg, CYP2B6, CYP2C8, CYP2C19, and CYP3A4), paraoxonase-1, hepatic carboxylesterase 1, P-glycoprotein, and organic anion transporter family member 1B1. Conclusion Effective and safe clopidogrel combination therapy can be achieved by increasing the awareness of potential changes in efficacy and toxicity, rationally selecting alternatives, tailoring drug therapy based on genotype, checking the appropriateness of physician orders, and performing therapeutic monitoring.
Collapse
Affiliation(s)
- Zhi-Yu Wang
- Department of Pharmacy, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Meng Chen
- Department of Pharmacy, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Ling-Ling Zhu
- VIP Care Ward, Division of Nursing, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Lu-Shan Yu
- Department of Pharmaceutical Analysis and Drug Metabolism, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Su Zeng
- Department of Pharmaceutical Analysis and Drug Metabolism, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Mei-Xiang Xiang
- Department of Cardiology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Quan Zhou
- Department of Pharmacy, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| |
Collapse
|