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Pascual-Figal D, Núñez Villota J, Pérez-Martínez MT, González-Juanatey JR, Taibo-Urquía M, Llàcer Iborra P, González-Martín J, Villar S, Soler M, Mirabet S, Aimo A, Riquelme-Pérez A, Anguita Sánchez M, Martínez-Sellés M, Sánchez PL, Ibáñez B, Bayés-Genís A. Colchicine in acute heart failure: Rationale and design of a randomized double-blind placebo-controlled trial (COLICA). Eur J Heart Fail 2024. [PMID: 38837516 DOI: 10.1002/ejhf.3300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/13/2024] [Accepted: 05/06/2024] [Indexed: 06/07/2024] Open
Abstract
AIMS Heart failure (HF) elicits a pro-inflammatory state, which is associated with impaired clinical outcomes, but no anti-inflammatory therapies have demonstrated a clinical benefit yet. Inflammatory pathways related with the interleukin-1 axis are overactivated during episodes of acute HF. Colchicine, an anti-inflammatory drug with proven benefits in acute pericarditis and ischaemic heart disease, may target this inflammatory response. This study aims to assess the efficacy of colchicine in acute HF patients. METHODS COLICA is a multicentre, randomized, double-blind, placebo-controlled trial enrolling 278 patients across 12 sites. Patients presenting with acute HF, clinical evidence of congestion requiring ≥40 mg of intravenous furosemide and N-terminal pro-B-type natriuretic peptide (NT-proBNP) >900 pg/ml, are eligible for participation. Patients are enrolled irrespective of left ventricular ejection fraction, HF type (new-onset or not) and setting (hospital or outpatient clinic). Patients are randomized 1:1 within the first 24 h of presentation to either placebo or colchicine, with an initial loading dose of 2 mg followed by 0.5 mg every 12 h for 8 weeks (reduced dose if <70 kg, >75 years old, or glomerular filtration rate <50 ml/min/1.73 m2). The primary efficacy endpoint is the time-averaged proportional change in NT-proBNP concentrations from baseline to week 8. Key secondary and exploratory outcomes include symptoms, diuretic use, worsening HF episodes, related biomarkers of cardiac stress and inflammation, total and cardiovascular readmissions, mortality and safety events. CONCLUSION COLICA will be the first randomized trial testing the efficacy and safety of colchicine for acute HF.
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Affiliation(s)
- Domingo Pascual-Figal
- Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Pascual Parrilla, Universidad de Murcia, Murcia, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- CIBER cardiovascular, Madrid, Spain
| | - Julio Núñez Villota
- CIBER cardiovascular, Madrid, Spain
- Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Maria Teresa Pérez-Martínez
- Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Pascual Parrilla, Universidad de Murcia, Murcia, Spain
| | | | - Mikel Taibo-Urquía
- CIBER cardiovascular, Madrid, Spain
- IIS-Hospital Fundación Jiménez Diaz, Madrid, Spain
| | | | | | - Sandra Villar
- CIBER cardiovascular, Madrid, Spain
- Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Meritxel Soler
- CIBER cardiovascular, Madrid, Spain
- Hospital Germans-Trial i Pujol, Barcelona, Spain
| | - Sonia Mirabet
- CIBER cardiovascular, Madrid, Spain
- Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Alberto Aimo
- Fondazione Toscana Gabriele Monasterio, Health Sciences Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Alejandro Riquelme-Pérez
- Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Pascual Parrilla, Universidad de Murcia, Murcia, Spain
| | | | - Manuel Martínez-Sellés
- CIBER cardiovascular, Madrid, Spain
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Pedro L Sánchez
- CIBER cardiovascular, Madrid, Spain
- Hospital Universitario de Salamanca, IBSAL, Salamanca, Spain
| | - Borja Ibáñez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- CIBER cardiovascular, Madrid, Spain
- IIS-Hospital Fundación Jiménez Diaz, Madrid, Spain
| | - Antoni Bayés-Genís
- CIBER cardiovascular, Madrid, Spain
- Hospital Germans-Trial i Pujol, Barcelona, Spain
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Khiali S, Taban-Sadeghi M, Sarbakhsh P, Khezerlouy-Aghdam N, Entezari-Maleki T. Empagliflozin and colchicine in patients with reduced left ventricular ejection fraction following ST-elevation myocardial infarction: a randomized, double-blinded, three-arm parallel-group, controlled trial. Eur J Clin Pharmacol 2024; 80:93-104. [PMID: 37897527 DOI: 10.1007/s00228-023-03582-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/15/2023] [Indexed: 10/30/2023]
Abstract
PURPOSE There is accumulating evidence regarding the potential benefits of empagliflozin in individuals with acute myocardial infarction (MI). Based on the literature, colchicine could also reduce the risk of MI and death in individuals with cardiovascular disease (CVD). However, trials investigating the effects of the combination of empagliflozin with colchicine and high-dose empagliflozin monotherapy in this setting are lacking. METHODS In this trial, 106 non-diabetic participants with reduced left ventricular ejection fraction (LVEF) following recent ST-elevation MI were randomly assigned to empagliflozin 10 mg/day, empagliflozin 10 mg/day plus colchicine 0.5 mg twice daily, or empagliflozin 25 mg/day groups within 72 h after primary percutaneous coronary intervention (PCI). The study's primary outcomes were the changes in New York Heart Association (NYHA) functional class and high-sensitivity C-reactive protein (hs-CRP) over 12 weeks. RESULTS The baseline characteristics of individuals were statistically similar between the study groups. Changes in NYHA functional class over 12 weeks were not significantly different between the study groups. hs-CRP was significantly reduced in all groups (all P < 0.001); however, there was no significant change between the groups over the study period. Changes in tumor necrosis factor-alpha (TNF-α), LVEF, and left ventricular end-diastolic dimension (LVEDD) during the research period did not differ significantly between groups. CONCLUSION This study showed that neither the combination treatment of empagliflozin 10 mg/day with colchicine nor the monotherapy of empagliflozin 25 mg/day was superior to empagliflozin 10 mg/day in terms of changes in clinical, inflammatory, and echocardiographic outcome parameters in patients with recent MI with reduced LVEF over 3 months. Further studies are warranted to confirm the findings. TRIAL REGISTRATION Clinical trial ID: IRCT20111206008307N39. Registration date: 27 October 2022. https://www.irct.ir/trial/66216.
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Affiliation(s)
- Sajad Khiali
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Parvin Sarbakhsh
- Department of Statistics and Epidemiology, Faculty of Public Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Taher Entezari-Maleki
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Garofalo M, Corso R, Tomasoni D, Adamo M, Lombardi CM, Inciardi RM, Gussago C, Di Mario C, Metra M, Pagnesi M. Inflammation in acute heart failure. Front Cardiovasc Med 2023; 10:1235178. [PMID: 38045909 PMCID: PMC10690826 DOI: 10.3389/fcvm.2023.1235178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/30/2023] [Indexed: 12/05/2023] Open
Abstract
Acute heart failure (AHF) represents a common clinical scenario that requires prompt evaluation and therapy and that is characterized by a high risk of mortality or subsequent rehospitalizations. The pathophysiology leading to AHF decompensation is still not fully understood. Significant activation of inflammatory pathways has been identified in patients with AHF, particularly in its most severe forms, and it has been hypothesized that systemic inflammation has a role in AHF pathogenesis. Several inflammatory mediators and cytokines, such as high sensitivity C-reactive protein, tumor necrosis factor-α, interleukin-6, interleukin-1, soluble suppression of tumorigenicity 2 and galectin-3, have been shown to play a role in the pathogenesis, development and worsening of this condition with an independent prediction of adverse outcomes. This manuscript reviews the prevalence and prognostic value of systemic inflammation in AHF, as well as the potential role of anti-inflammatory therapies, focusing on available evidence from clinical trials and ongoing studies.
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Affiliation(s)
- Manuel Garofalo
- Department of Cardiology, Careggi University Hospital, Florence, Italy
| | - Rossana Corso
- Department of Internal Medicine, ASST Sette Laghi, Varese, Italy
| | - Daniela Tomasoni
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Marianna Adamo
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Carlo M. Lombardi
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Riccardo M. Inciardi
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Cristina Gussago
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Carlo Di Mario
- Department of Cardiology, Careggi University Hospital, Florence, Italy
| | - Marco Metra
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Matteo Pagnesi
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
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Pascual-Figal D, Fuster JJ, Bayes-Genis A. Personalizing anti-inflammatory therapy in heart failure: A new way. Eur J Heart Fail 2023; 25:1933-1935. [PMID: 37792725 DOI: 10.1002/ejhf.3052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/02/2023] [Indexed: 10/06/2023] Open
Affiliation(s)
- Domingo Pascual-Figal
- Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
- Universidad de Murcia, Murcia, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- CIBER en Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Jose Javier Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- CIBER en Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Antoni Bayes-Genis
- CIBER en Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
- Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain
- Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
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Chen T, Liu G, Yu B. A meta-analysis evaluating efficacy and safety of colchicine for prevention of major cardiovascular events in patients with coronary artery disease. Clin Res Cardiol 2023; 112:1487-1505. [PMID: 37505274 DOI: 10.1007/s00392-023-02254-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 06/21/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Inflammatory plays a key role in the development of coronary artery disease (CAD). Colchicine as an anti-inflammatory treatment for CAD has attracted much attention, its efficacy and safety are controversial and deserved further exploration. METHODS AND RESULTS To evaluate the efficacy and safety of colchicine for patients with CAD, relevant randomized controlled trials (RCTs) were identified by searching several databases including PubMed, Web of Science, and EMBASE from January 1992 to May 2022. Fourteen eligible trials of colchicine therapy include populations with chronic coronary syndrome (CCS) (N = 2), acute coronary syndrome (ACS) (N = 5), and percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) (N = 7), and involve a total of 13,235 patients which include 6654 subjects in colchicine group and 6581 subjects in the respective control arms. The outcome was reported as odds ratio (OR) and 95% confidence interval (CI), as the relative measure of association. Overall, the incidences of major adverse cardiovascular events (MACEs) (OR 0.65; 95% CI 0.54-0.77, p < 0.01), new ACS (OR 0.68; 95% CI 0.57-0.81, p < 0.01), coronary revascularization (OR 0.65; 95% CI 0.53-0.78, p < 0.01), and stroke (OR 0.51; 95% CI 0.32-0.82, p < 0.01), were lower in the colchicine group than in the placebo arm. We did not find a significant reduction in the incidence of atrial fibrillation (OR 0.84; 95% CI 0.68-1.04, p = 0.11), all-cause mortality (OR 1.06; 95% CI 0.83-1.35, p = 0.83), cardiovascular mortality (OR 0.77; 95% CI 0.52-1.15, p = 0.21). However, we found that colchicine did increase non-cardiovascular mortality (OR 1.44; 95% CI 1.04-2.01, p = 0.03). Although the incidence of gastrointestinal events in the colchicine treatment group was higher than that in the placebo arms (OR 2.08; 95% CI 1.39-3.12, p < 0.01), the symptoms disappeared rapidly after drug withdrawal and could be tolerated by most patients. Colchicine did not increase the incidence of infections (OR 1.42; 95% CI 0.82-2.46, p = 0.22), pneumonia (OR 1.55; 95% CI 0.58-4.18, p = 0.39), cancers (OR 0.98; 95% CI 0.79-1.22, p = 0.88), bleeding (OR 1.14; 95% CI 0.41-3.14, p = 0.80). CONCLUSIONS Colchicine is an effective, relatively safe drug that could be considered for the treatment of CAD. However, we need to pay attention to the increasing occurrence of non-cardiovascular mortality and infection especially pneumonia possibly caused by colchicine. Efficacy and safety of colchicine for patients with CAD. CAD coronary artery disease; RCTs randomized controlled trials; OR odds ratio; MACEs major adverse cardiovascular events; ACS acute coronary syndrome; NNT number needed to treat; NNH number needed to harm.
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Affiliation(s)
- Tao Chen
- Department of Cardiology, The First Affiliated Hospital of China Medical University, Nanjing North Street No. 155, Heping District, Shenyang, 110001, China
| | - Guihong Liu
- Department of Oncology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bo Yu
- Department of Cardiology, The First Affiliated Hospital of China Medical University, Nanjing North Street No. 155, Heping District, Shenyang, 110001, China.
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Wang D, Leng X, Tian Y, Liu J, Zou J, Xie S. Toxic Effects of Koumine on the Early-Life Development Stage of Zebrafish. TOXICS 2023; 11:853. [PMID: 37888703 PMCID: PMC10611223 DOI: 10.3390/toxics11100853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/16/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023]
Abstract
Koumine is one of the most abundant alkaloids found in Gelsemium elegans, and it has a wide range of pharmacological effects including antitumor, anti-inflammatory, analgesic treatment effects, and antianxiety. However, its high toxicity and unclear mechanism of action have greatly limited the medicinal development and use of koumine. We investigated the toxic effects of koumine on the developmental toxicity and behavioral neurotoxicity of zebrafish embryos and larvae. Embryos at 6 h postfertilization (hpf) were exposed to 12.5, 25, 50, 75, and 100 mg/L of koumine until 120 hpf. Koumine affected the hatching and heartbeats of the embryos. The morphological analysis also revealed many abnormalities, such as shortened bodies, yolk sac edemas, tail malformations, and pericardial edemas. To identify the neurotoxicity of koumine, the behavior of the larvae was measured. Koumine at 50 and 100 mg/L affect the escape response. The embryos exhibited uncoordinated muscle contractions along the body axis in response to touch at 36 hpf. More importantly, we found that the neurotoxicity of koumine is mainly caused by influencing the ACh content and the activity of AChE without impairing motor neuron development. A comprehensive analysis shows that a high concentration of koumine has obvious toxic effects on zebrafish, and the safe concentration of koumine for zebrafish should be less than 25 mg/L. These results will be valuable for better understanding the toxicity of koumine and provide new insights into the application of koumine.
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Affiliation(s)
- Dongjie Wang
- College of Marine Sciences, South China Agricultural University, Guangzhou 510642, China;
| | - Xinyi Leng
- College of Life Sciences, Wuhan University, Wuhan 430000, China; (X.L.); (J.L.)
| | - Yao Tian
- Global Health Institute, School of Life Science, École Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland;
| | - Jiangdong Liu
- College of Life Sciences, Wuhan University, Wuhan 430000, China; (X.L.); (J.L.)
| | - Jixing Zou
- College of Marine Sciences, South China Agricultural University, Guangzhou 510642, China;
| | - Shaolin Xie
- College of Marine Sciences, South China Agricultural University, Guangzhou 510642, China;
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Zhang L, Dong Y, Lu Y, Mo R, He Q. Photolysis and cytotoxicity of the potentially toxic composition of daylily flower: colchicine. JOURNAL OF FOOD MEASUREMENT AND CHARACTERIZATION 2023. [PMCID: PMC9909145 DOI: 10.1007/s11694-023-01844-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The photolysis of colchicine under ultraviolet and visible light irradiation was studied by ultraviolet (UV) scanning and HPLC-MS. The photoproduct was proposed and the cytotoxicity change before and after irradiation was investigated. Results showed that both ultraviolet and visible light irradiation could effectively degrade colchicine into deacetamido-lumicolchicine. The process conformed to first-order kinetics, in which a high degradation rate (K = 0.5862 h− 1) was observed when colchicine was dissolved in ethanol and irradiated by UV light. Cell viability and cell cycle studies proved that a photolysis treatment of colchicine could weaken the cytotoxicity effectively. Colchicine inhibited the division of BRL 3 A cells in G2/M phase with an IC50 value of 0.48 µg/mL, while the toxic effect could be reduced significantly with IC50 2.1 µg/mL when colchicine was exposed to UV irradiation. Results are beneficial to the toxicity elimination of colchicine in the processing of daylily flower in food industry, and can also provide photochemistry reference for colchicine-related studies.
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Affiliation(s)
- Lin Zhang
- College of Biomass Science and Engineering, Sichuan University, 610065 Chengdu, P. R. China
| | - Yi Dong
- College of Biomass Science and Engineering, Sichuan University, 610065 Chengdu, P. R. China
| | - Yunhao Lu
- School of Food and Biological Engineering, Chengdu University, 610106 Chengdu, P. R. China
| | - Rui Mo
- College of Biomass Science and Engineering, Sichuan University, 610065 Chengdu, P. R. China
| | - Qiang He
- College of Biomass Science and Engineering, Sichuan University, 610065 Chengdu, P. R. China
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Colchicingabe bei Gicht und Herzinsuffizienz. Dtsch Med Wochenschr 2022. [DOI: 10.1055/a-1797-3403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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