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Young AM, Strobel RJ, Rotar EP, Kleiman A, McNeil JS, Teman NR, Hawkins RB, Raphael J, Mehaffey JH. Perioperative acetaminophen is associated with reduced acute kidney injury after cardiac surgery. J Thorac Cardiovasc Surg 2024; 167:1372-1380. [PMID: 36207161 DOI: 10.1016/j.jtcvs.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 08/19/2022] [Accepted: 09/03/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Cardiac surgery-associated acute kidney injury (AKI) is associated with increased postoperative morbidity and mortality. Evidence suggests an association between perioperative acetaminophen administration and decreased incidence of postoperative AKI in pediatric cardiac surgery patients; however, an effect in adults is unknown. METHODS All patients (n = 6192) undergoing coronary and/or valve surgery with a recorded Society of Thoracic Surgeons (STS) risk score at our institution between 2010 and 2018 were stratified by acetaminophen exposure on the day of surgery using institutional pharmacy records. AKI was determined using the Kidney Disease: Improving Global Outcomes (KDIGO) staging criteria. Logistic regression was used to analyze the association between perioperative acetaminophen and postoperative kidney injury or STS major morbidity. A sensitivity analysis using propensity score matching on the STS predicted risk of renal failure and cardiopulmonary bypass time was performed to account for time bias. RESULTS Perioperative acetaminophen exposure was associated with lower odds of stage 1 to 3 acute kidney injury (odds ratio [OR], 0.68; 95% CI, 0.56-0.83; P < .001) and decreased prolonged postoperative ventilation (OR, 0.53; 95% CI, 0.37-0.76; P < .001). A sensitivity analysis provided well-balanced (standard mean difference <0.10) groups of 401 pairs, in which acetaminophen was associated with a decreased incidence of postoperative AKI (OR, 0.7; 95% CI, 0.52-0.94; P = .016). CONCLUSIONS Exposure to acetaminophen on the day of surgery was associated with a decreased incidence of AKI in our patients undergoing cardiac surgery. These data serve as a measure of effect size to further explore the therapeutic potential of acetaminophen to reduce postoperative AKI after cardiac surgery and to elucidate the mechanisms involved.
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Affiliation(s)
- Andrew M Young
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| | - Raymond J Strobel
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| | - Evan P Rotar
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| | - Amanda Kleiman
- Department of Anesthesiology, University of Virginia, Charlottesville, Va
| | - John S McNeil
- Department of Anesthesiology, University of Virginia, Charlottesville, Va
| | - Nicholas R Teman
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| | - Robert B Hawkins
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Jacob Raphael
- Department of Anesthesiology, University of Virginia, Charlottesville, Va
| | - J Hunter Mehaffey
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa.
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Domizi R, Damiani E, Carsetti A, Graciotti L, Procopio AD, Scorcella C, Casarotta E, Giaccaglia P, Donati A, Adrario E. Potential of acetaminophen on the sublingual microcirculation and peripheral tissue perfusion of febrile septic patients: prospective observational study. Ann Intensive Care 2024; 14:23. [PMID: 38340203 DOI: 10.1186/s13613-024-01251-z] [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: 11/10/2023] [Accepted: 01/15/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Acetaminophen (ACT) has been studied in septic patients with detectable plasmatic levels of cell-free hemoglobin (Hb), where it demonstrated to inhibit the hemoprotein-mediated lipid peroxidation and oxidative injury, with a potential of beneficial effect on the endothelium. On the basis of this background, the aim of this study was to evaluate the sublingual microcirculation and the peripheral tissue perfusion before-and-after administration of ACT on clinical judgment in a cohort of febrile septic and septic shock patients. METHODS Prospective observational study. 50 adult septic and septic shocks treated with ACT for pyrexia, where the sublingual microcirculation and the peripheral tissue perfusion with Near Infrared Spectroscopy (NIRS) and vascular occlusion test (VOT) were evaluated before ACT (t0), after 30 min (t1) and after 2 h (t2). Cell-free Hb and the markers of oxidative stress and endothelial damage were measured at t0 and t2. RESULTS The study showed a significant increase of the density of the perfused small and total vessels of the sublingual microcirculation 30 min after the infusion of ACT; it also showed an increase of the Microvascular Flow Index (MFI) and a decrease in the heterogeneity of the flow. At a peripheral muscular level, we found an acceleration in the reperfusion curve after VOT at t1, expression of a higher reactivity of the microvasculature. CONCLUSIONS ACT infusion did not show a clear correlation with cell-free Hb; however, it exhibited protective effect toward the microcirculation that was evident in particular in septic patients. This correlation merits further exploration.
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Affiliation(s)
- R Domizi
- Anesthesia and Intensive Care Unit, Azienda Ospedaliera Universitaria Delle Marche, Via Conca 71, 60126, Ancona, Italy
- Department of Biomedical Sciences and Public Health, Università Politecnica Delle Marche, Via Tronto 10/a, 60020, Ancona, Italy
| | - E Damiani
- Anesthesia and Intensive Care Unit, Azienda Ospedaliera Universitaria Delle Marche, Via Conca 71, 60126, Ancona, Italy
- Department of Biomedical Sciences and Public Health, Università Politecnica Delle Marche, Via Tronto 10/a, 60020, Ancona, Italy
| | - A Carsetti
- Anesthesia and Intensive Care Unit, Azienda Ospedaliera Universitaria Delle Marche, Via Conca 71, 60126, Ancona, Italy
- Department of Biomedical Sciences and Public Health, Università Politecnica Delle Marche, Via Tronto 10/a, 60020, Ancona, Italy
| | - L Graciotti
- Department of Biomedical Sciences and Public Health, Università Politecnica Delle Marche, Via Tronto 10/a, 60020, Ancona, Italy
| | - A D Procopio
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy
- Clinic of Laboratory and Precision Medicine, IRCCS INRCA, Ancona, Italy
| | - C Scorcella
- Anesthesia and Intensive Care Unit, Azienda Ospedaliera Universitaria Delle Marche, Via Conca 71, 60126, Ancona, Italy
| | - E Casarotta
- Anesthesia and Intensive Care Unit, Azienda Ospedaliera Universitaria Delle Marche, Via Conca 71, 60126, Ancona, Italy
- Department of Biomedical Sciences and Public Health, Università Politecnica Delle Marche, Via Tronto 10/a, 60020, Ancona, Italy
| | - P Giaccaglia
- Department of Biomedical Sciences and Public Health, Università Politecnica Delle Marche, Via Tronto 10/a, 60020, Ancona, Italy
| | - A Donati
- Anesthesia and Intensive Care Unit, Azienda Ospedaliera Universitaria Delle Marche, Via Conca 71, 60126, Ancona, Italy.
- Department of Biomedical Sciences and Public Health, Università Politecnica Delle Marche, Via Tronto 10/a, 60020, Ancona, Italy.
| | - E Adrario
- Anesthesia and Intensive Care Unit, Azienda Ospedaliera Universitaria Delle Marche, Via Conca 71, 60126, Ancona, Italy
- Department of Biomedical Sciences and Public Health, Università Politecnica Delle Marche, Via Tronto 10/a, 60020, Ancona, Italy
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3
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Sun S, Liu H, Liang Q, Yang Y, Cao X, Zheng B. Association between acetaminophen administration and clinical outcomes in patients with sepsis admitted to the ICU: a retrospective cohort study. Front Med (Lausanne) 2024; 11:1346855. [PMID: 38357644 PMCID: PMC10864567 DOI: 10.3389/fmed.2024.1346855] [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: 11/30/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
Background Sepsis, affecting over 30 million people worldwide each year, is a key mortality risk factor in critically ill patients. There are significant regional discrepancies in its impact. Acetaminophen, a common over-the-counter drug, is often administered to control fever in suspected infection cases in intensive care units (ICUs). It is considered generally safe when used at therapeutic levels. Despite its widespread use, there's inconsistent research regarding its efficacy in sepsis management, which creates uncertainties for ICU doctors about its possible advantages or harm. To address this, we undertook a retrospective cohort study utilizing the MIMIC-IV database to examine the correlation between acetaminophen use and clinical outcomes in septic patients admitted to the ICU. Methods We gathered pertinent data on sepsis patients from the MIMIC-IV database. We used propensity score matching (PSM) to pair acetaminophen-treated patients with those who were not treated. We then used Cox Proportional Hazards models to examine the relationships between acetaminophen use and factors such as in-hospital mortality, 30-day mortality, hospital stay duration, and ICU stay length. Results The data analysis involved 22,633 sepsis patients. Post PSM, a total of 15,843 patients were matched; each patient not receiving acetaminophen treatment was paired with two patients who received it. There was a correlation between acetaminophen and a lower in-hospital mortality rate (HR 0.443; 95% CI 0.371-0.530; p < 0.001) along with 30-day mortality rate (HR 0.497; 95% CI 0.424-0.583; p < 0.001). Additionally, it correlated with a decrease in the duration of hospitalization [8.4 (5.0, 14.8) vs. 9.0 (5.1, 16.0), p < 0.001] and a shorter ICU stay [2.8 (1.5, 6.0) vs. 3.1 (1.7, 6.5); p < 0.05]. Conclusion The use of acetaminophen may lower short-term mortality in critically ill patients with sepsis. To confirm this correlation, future research should involve multicenter randomized controlled trials.
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Affiliation(s)
- Shilin Sun
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Han Liu
- Institute for Global Health, University College London, London, United Kingdom
| | - Qun Liang
- The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Yang Yang
- The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xuedan Cao
- The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Boyang Zheng
- Heilongjiang University of Chinese Medicine, Harbin, China
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Turones LC, Machado LS, Vaz BG, de Almeida R Oliveira G, da Silva Moreira LK, Almeida DDS, Martins AN, Fajemiroye JO, Martins JLR, Ghedini PC, Campos HM, Dos Santos FCA, da Silva CRB, Lião LM, Gil EDS, Costa EA, Menegatti R. Anti-inflammatory and antinociceptive effects, and safety toxicological profile of a new paracetamol analog, LQFM291. Inflammopharmacology 2023; 31:2451-2465. [PMID: 37667090 DOI: 10.1007/s10787-023-01324-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/03/2023] [Indexed: 09/06/2023]
Abstract
In the scope of a research program with the goal of developing treatments for inflammatory diseases, the pharmacological evaluation of LQFM291, designed by molecular hybridization from butylated hydroxytoluene and paracetamol, was described. The antioxidant profile of LQFM291 was evaluated by electrochemical measurement. Also, acute or repeated treatments with equimolar doses to paracetamol were used to evaluate the antinociceptive and/or anti-inflammatory activities of LQFM291 in animal models. The toxicologic potential of LQFM291 was also evaluated and compared to paracetamol through biochemical and histopathological analysis after the repeated treatment schedule. As a result of the acute treatment, paracetamol showed a similar antinociceptive effect in formalin test compared to LQFM291. Whereas, after the repeated treatment, when carrageenan-induced hyperalgesia and edema tests were performed, paracetamol showed a delayed antinociceptive and anti-inflammatory effect compared to LQFM291. Furthermore, as other advantages the LQFM291 showed a high redox capacity, a gastroprotective activity and a safety pharmacological profile without any liver or kidney damage. These effects can be related to the prevention of oxidative stress by reduction of protein and lipid peroxidation in gastric tissue, maintenance of glutathione levels in hepatic homogenate, and a systemic reduction of pro-inflammatory cytokine levels, which may characterize the LQFM291 as a more viable and effective alternative to relief pain and inflammatory signs in patients with chronic disorders.
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Affiliation(s)
- Larissa Córdova Turones
- Laboratory of Pharmacology of Natural and Synthetic Products, Institute of Biological Sciences, Federal University of Goiás, Room 209, Esperança Avenue, Campus Samambaia, Goiania, 74690-900, Brazil.
| | - Lucas S Machado
- Laboratory of Chromatography and Mass Spectrometry, Chemistry Institute, Federal University of Goiás, Campus Colemar Natal e Silva, Goiânia, Brazil
| | - Boniek G Vaz
- Laboratory of Chromatography and Mass Spectrometry, Chemistry Institute, Federal University of Goiás, Campus Colemar Natal e Silva, Goiânia, Brazil
| | | | - Lorrane Kelle da Silva Moreira
- Laboratory of Pharmacology of Natural and Synthetic Products, Institute of Biological Sciences, Federal University of Goiás, Room 209, Esperança Avenue, Campus Samambaia, Goiania, 74690-900, Brazil
| | - Dionys de Souza Almeida
- Laboratory of Pharmacology of Natural and Synthetic Products, Institute of Biological Sciences, Federal University of Goiás, Room 209, Esperança Avenue, Campus Samambaia, Goiania, 74690-900, Brazil
| | - Aline Nazareth Martins
- Laboratory of Pharmacology of Natural and Synthetic Products, Institute of Biological Sciences, Federal University of Goiás, Room 209, Esperança Avenue, Campus Samambaia, Goiania, 74690-900, Brazil
| | - James Oluwagbamigbe Fajemiroye
- Laboratory of Pharmacology of Natural and Synthetic Products, Institute of Biological Sciences, Federal University of Goiás, Room 209, Esperança Avenue, Campus Samambaia, Goiania, 74690-900, Brazil
| | - José Luís R Martins
- Laboratory of Pharmacology of Natural and Synthetic Products, Institute of Biological Sciences, Federal University of Goiás, Room 209, Esperança Avenue, Campus Samambaia, Goiania, 74690-900, Brazil
| | - Paulo César Ghedini
- Laboratory of Molecular and Biochemical Pharmacology, Institute of Biological Sciences, Federal University of Goiás, Campus Samambaia, Goiânia, Brazil
| | - Hericles Mesquita Campos
- Laboratory of Molecular and Biochemical Pharmacology, Institute of Biological Sciences, Federal University of Goiás, Campus Samambaia, Goiânia, Brazil
| | - Fernanda Cristina A Dos Santos
- Laboratory of Microscopy Applied to Reproduction, Institute of Biological Sciences, Federal University of Goiás, Campus Samambaia, Goiânia, Brazil
| | - Cinthia Rio Branco da Silva
- Laboratory of Microscopy Applied to Reproduction, Institute of Biological Sciences, Federal University of Goiás, Campus Samambaia, Goiânia, Brazil
| | - Luciano M Lião
- Chemistry Institute, Federal University of Goiás, Campus Samambaia, Goiânia, Brazil
| | - Eric de Souza Gil
- Chemistry Institute, Federal University of Goiás, Campus Samambaia, Goiânia, Brazil
| | - Elson Alves Costa
- Laboratory of Pharmacology of Natural and Synthetic Products, Institute of Biological Sciences, Federal University of Goiás, Room 209, Esperança Avenue, Campus Samambaia, Goiania, 74690-900, Brazil
| | - Ricardo Menegatti
- Laboratory of Medicinal Pharmaceutical Chemistry, Faculty of Pharmacy, Federal University of Goiás, Goiânia, Brazil
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Gelotte CK, Vakil AM, Zimmerman BA, Zannikos P, Mishra R, Eichenbaum G, Kuffner EK, Flores CM. JNJ-10450232 (NTM-006), A novel non-opioid with structural similarities to acetaminophen, produces relatively long-lasting analgesia after a single dose in patients undergoing 3rd molar extraction. Regul Toxicol Pharmacol 2023:105480. [PMID: 37625518 DOI: 10.1016/j.yrtph.2023.105480] [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: 07/05/2022] [Revised: 07/30/2023] [Accepted: 08/22/2023] [Indexed: 08/27/2023]
Abstract
JNJ-10450232 (NTM-006) is a non-opioid, non-NSAID analgesic and antipyretic compound with structural similarity to acetaminophen. Preclinical models show comparable analgesia relative to acetaminophen and no evidence of hepatotoxicity associated with overdose. Moreover, it was safe and generally well tolerated in a First-in-Human Study. This single-dose, single-center, inpatient, randomized, double-blind study in moderate-to-severe acute pain following third molar extraction compared efficacy and safety of 250 mg and 1000 mg JNJ-10450232 (NTM-006), 1000 mg acetaminophen, and placebo during the 24 h following administration. While onset of action of 1000 mg JNJ-10450232 (NTM-006) was relatively slower compared with acetaminophen, its duration of action was sustained up to 24 h being superior beginning 7 h after administration. No clinically important differences among treatment groups in nature or severity of adverse events were observed and no serious adverse events were reported. Increased bilirubin, potentially due to UGT1A1 inhibition and ingestion of blood from oral surgery, was the most commonly reported adverse event and the only event reported by ≥ 5% of subjects across treatment groups. These data support further evaluation of JNJ-10450232 (NTM-006) for the treatment of moderate-to-severe pain. CLINICALTRIALS.GOV ID: NCT02209181.
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Affiliation(s)
| | - Amy M Vakil
- Johnson & Johnson Consumer, Inc., Fort Washington, PA, USA
| | | | | | - Rajesh Mishra
- Johnson & Johnson Consumer, Inc., Fort Washington, PA, USA
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Cunico D, Rossi A, Verdesca M, Principi N, Esposito S. Pain Management in Children Admitted to the Emergency Room: A Narrative Review. Pharmaceuticals (Basel) 2023; 16:1178. [PMID: 37631093 PMCID: PMC10459115 DOI: 10.3390/ph16081178] [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: 06/30/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Pain is a biopsychosocial experience characterized by sensory, physiological, cognitive, affective, and behavioral components. Both acute and chronic pain can have short and long-term negative effects. Unfortunately, pain treatment is often inadequate. Guidelines and recommendations for a rational approach to pediatric pain frequently differ, and this may be one of the most important reasons for the poor attention frequently paid to pain treatment in children. This narrative review discusses the present knowledge in this regard. A literature review conducted on papers produced over the last 8 years showed that although in recent years, compared to the past, much progress has been made in the treatment of pain in the context of the pediatric emergency room, there is still a lot to do. There is a need to create guidelines that outline standardized and easy-to-follow pathways for pain recognition and management, which are also flexible enough to take into account differences in different contexts both in terms of drug availability and education of staff as well as of the different complexities of patients. It is essential to guarantee an approach to pain that is as uniform as possible among the pediatric population that limits, as much as possible, the inequalities related to ethnicity and language barriers.
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Affiliation(s)
- Daniela Cunico
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (D.C.); (A.R.); (M.V.)
| | - Arianna Rossi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (D.C.); (A.R.); (M.V.)
| | - Matteo Verdesca
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (D.C.); (A.R.); (M.V.)
| | | | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (D.C.); (A.R.); (M.V.)
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Mallet C, Desmeules J, Pegahi R, Eschalier A. An Updated Review on the Metabolite (AM404)-Mediated Central Mechanism of Action of Paracetamol (Acetaminophen): Experimental Evidence and Potential Clinical Impact. J Pain Res 2023; 16:1081-1094. [PMID: 37016715 PMCID: PMC10066900 DOI: 10.2147/jpr.s393809] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
Paracetamol remains the recommended first-line option for mild-to-moderate acute pain in general population and particularly in vulnerable populations. Despite its wide use, debate exists regarding the analgesic mechanism of action (MoA) of paracetamol. A growing body of evidence challenged the notion that paracetamol exerts its analgesic effect through cyclooxygenase (COX)-dependent inhibitory effect. It is now more evident that paracetamol analgesia has multiple pathways and is mediated by the formation of the bioactive AM404 metabolite in the central nervous system (CNS). AM404 is a potent activator of TRPV1, a major contributor to neuronal response to pain in the brain and dorsal horn. In the periaqueductal grey, the bioactive metabolite AM404 activated the TRPV1 channel-mGlu5 receptor-PLC-DAGL-CB1 receptor signaling cascade. The present article provides a comprehensive literature review of the centrally located, COX-independent, analgesic MoA of paracetamol and relates how the current experimental evidence can be translated into clinical practice. The evidence discussed in this review established paracetamol as a central, COX-independent, antinociceptive medication that has a distinct MoA from non-steroidal anti-inflammatory drugs (NSAIDs) and a more tolerable safety profile. With the establishment of the central MoA of paracetamol, we believe that paracetamol remains the preferred first-line option for mild-to-moderate acute pain for healthy adults, children, and patients with health concerns. However, safety concerns remain with the high dose of paracetamol due to the NAPQI-mediated liver necrosis. Centrally acting paracetamol/p-aminophenol derivatives could potentiate the analgesic effect of paracetamol without increasing the risk of hepatoxicity. Moreover, the specific central MoA of paracetamol allows its combination with other analgesics, including NSAIDs, with a different MoA. Future experiments to better explain the central actions of paracetamol could pave the way for discovering new central analgesics with a better benefit-to-risk ratio.
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Affiliation(s)
- Christophe Mallet
- Université Clermont Auvergne, INSERM, NEURO-DOL Basics & Clinical Pharmacology of Pain, Clermont-Ferrand, France
| | - Jules Desmeules
- Faculty of Medicine and The School of Pharmaceutical Sciences, Faculty of Sciences, Geneva University, Geneva, Switzerland
| | | | - Alain Eschalier
- Université Clermont Auvergne, INSERM, NEURO-DOL Basics & Clinical Pharmacology of Pain, Clermont-Ferrand, France
- Correspondence: Alain Eschalier, Faculté de Médecine, UMR Neuro-Dol, 49 Bd François Mitterrand, Clermont-Ferrand, 63000, France, Email
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Blomqvist A. Prostaglandin E 2 Production by Brain Endothelial Cells and the Generation of Fever. DNA Cell Biol 2023; 42:107-112. [PMID: 36720071 PMCID: PMC10024267 DOI: 10.1089/dna.2022.0662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
We recently demonstrated that prostaglandin production in brain endothelial cells is both necessary and sufficient for the generation of fever during systemic immune challenge. I here discuss this finding in light of the previous literature and point to some unresolved issues.
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Affiliation(s)
- Anders Blomqvist
- Division of Neurobiology, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
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9
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Bello AM, Dye C. Current perceptions and use of paracetamol in dogs among veterinary surgeons working in the United Kingdom. Vet Med Sci 2023; 9:679-686. [PMID: 36798030 PMCID: PMC10029871 DOI: 10.1002/vms3.1058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Paracetamol (acetaminophen) is recommended as a first-line drug in the management of pain and pyrexia in humans due to its minor gastrointestinal, renal and vascular side effects. OBJECTIVES To explore the perceptions and use of paracetamol in dogs by UK veterinarians. METHODS Veterinarians were invited to complete an online survey. Questions addressed career history, previous use, and personal perceptions of the use of paracetamol in dogs. RESULTS A total of 450 veterinarians were included in the survey; 96% (n = 431) of whom worked in small animal practice only. The majority reported a frequency of use of 1-3 times a week (n = 197), with oral dosing being the most common route of administration (n = 440). Only 8 had never prescribed paracetamol. Paracetamol was more commonly used to provide analgesia (n = 431) than for the treatment of pyrexia (n = 292) and was predominantly used as an alternative to NSAIDs (n = 408) or as part of multimodal analgesia (n = 406). Hepatotoxic (n = 311) and gastrointestinal (n = 120) side effects were a common concern, although the majority perceived a low risk of side effects and felt they were likely to be mild if they did occur (n = 279). Only 5% (n = 24) of respondents reported having experienced side effects, with gastrointestinal signs (n = 14) and hepatotoxicity (n = 6) being the most common. CONCLUSIONS Paracetamol is widely used by veterinarians working in the UK. Most veterinarians have changed their perception on the use of paracetamol over the last decade and consider it to be associated with fewer side effects and with more effective analgesic and antipyretic effects than they had previously believed.
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Affiliation(s)
- Alba M Bello
- Department of Small Animal Medicine, Pride Veterinary Centre, IVC Evidensia, Derby, UK
| | - Charlotte Dye
- Department of Small Animal Medicine, Pride Veterinary Centre, IVC Evidensia, Derby, UK
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Lecante LL, Leverrier-Penna S, Gicquel T, Giton F, Costet N, Desdoits-Lethimonier C, Lesné L, Fromenty B, Lavoué V, Rolland AD, Mazaud-Guittot S. Acetaminophen (APAP, Paracetamol) Interferes With the First Trimester Human Fetal Ovary Development in an Ex Vivo Model. J Clin Endocrinol Metab 2022; 107:1647-1661. [PMID: 35147701 PMCID: PMC9113793 DOI: 10.1210/clinem/dgac080] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Indexed: 11/23/2022]
Abstract
CONTEXT Acetaminophen (APAP, paracetamol) is widely used by pregnant women. Although long considered safe, growing evidence indicates that APAP is an endocrine disruptor since in utero exposure may be associated with a higher risk of male genital tract abnormalities. In rodents, fetal exposure has long-term effects on the reproductive function of female offspring. Human studies have also suggested harmful APAP exposure effects. OBJECTIVE Given that disruption of fetal ovarian development may impact women's reproductive health, we investigated the effects of APAP on fetal human ovaries in culture. DESIGN AND SETTING Human ovarian fragments from 284 fetuses aged 7 to 12 developmental weeks (DW) were cultivated ex vivo for 7 days in the presence of human-relevant concentrations of APAP (10-8 to 10-3 M) or vehicle control. MAIN OUTCOME MEASURES Outcomes included examination of postculture tissue morphology, cell viability, apoptosis, and quantification of hormones, APAP, and APAP metabolites in conditioned culture media. RESULTS APAP reduced the total cell number specifically in 10- to 12-DW ovaries, induced cell death, and decreased KI67-positive cell density independently of fetal age. APAP targeted subpopulations of germ cells and disrupted human fetal ovarian steroidogenesis, without affecting prostaglandin or inhibin B production. Human fetal ovaries were able to metabolize APAP. CONCLUSIONS Our data indicate that APAP can impact first trimester human fetal ovarian development, especially during a 10- to 12-DW window of heightened sensitivity. Overall, APAP behaves as an endocrine disruptor in the fetal human ovary.
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Affiliation(s)
- Laetitia L Lecante
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), Rennes, France
| | - Sabrina Leverrier-Penna
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), Rennes, France
| | - Thomas Gicquel
- Inserm, Inrae, Univ Rennes, Institut NuMeCan (Nutrition Metabolism and Cancer), Rennes, France
- Clinical and forensic Toxicology Laboratory Rennes University Hospital, Rennes, France
| | - Frank Giton
- AP-HP, Pôle Biologie-Pathologie Henri Mondor, Créteil, France
- Inserm IMRB, Faculté de Santé, Créteil, France
| | - Nathalie Costet
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), Rennes, France
| | | | - Laurianne Lesné
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), Rennes, France
| | - Bernard Fromenty
- Inserm, Inrae, Univ Rennes, Institut NuMeCan (Nutrition Metabolism and Cancer), Rennes, France
| | - Vincent Lavoué
- CHU Rennes, Service Gynécologie et Obstétrique, Rennes, France
| | - Antoine D Rolland
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), Rennes, France
| | - Séverine Mazaud-Guittot
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), Rennes, France
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11
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Tran-Guzman A, Culty M. Eicosanoid Biosynthesis in Male Reproductive Development: Effects of Perinatal Exposure to NSAIDs and Analgesic Drugs. FRONTIERS IN TOXICOLOGY 2022; 4:842565. [PMID: 35295224 PMCID: PMC8915844 DOI: 10.3389/ftox.2022.842565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
Increasing rates of infertility associated with declining sperm counts and quality, as well as increasing rates of testicular cancer are contemporary issues in the United States and abroad. These conditions are part of the Testicular Dysgenesis Syndrome, which includes a variety of male reproductive disorders hypothesized to share a common origin based on disrupted testicular development during fetal and neonatal stages of life. Male reproductive development is a highly regulated and complex process that relies on an intricate coordination between germ, Leydig, and Sertoli cells as well as other supporting cell types, to ensure proper spermatogenesis, testicular immune privilege, and endocrine function. The eicosanoid system has been reported to be involved in the regulation of fetal and neonatal germ cell development as well as overall testicular homeostasis. Moreover, non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics with abilities to block eicosanoid synthesis by targeting either or both isoforms of cyclooxygenase enzymes, have been found to adversely affect male reproductive development. This review will explore the current body of knowledge on the involvement of the eicosanoid system in male reproductive development, as well as discuss adverse effects of NSAIDs and analgesic drugs administered perinatally, focusing on toxicities reported in the testis and on major testicular cell types. Rodent and epidemiological studies will be corroborated by findings in invertebrate models for a comprehensive report of the state of the field, and to add to our understanding of the potential long-term effects of NSAID and analgesic drug administration in infants.
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Hurwitz LM, Shadyab AH, Tabung FK, Anderson GL, Saquib N, Wallace RB, Wild RA, Pfeiffer RM, Xu X, Trabert B. Analgesic Use and Circulating Estrogens, Androgens, and Their Metabolites in the Women's Health Initiative Observational Study. Cancer Prev Res (Phila) 2022; 15:173-183. [PMID: 34893532 PMCID: PMC8898279 DOI: 10.1158/1940-6207.capr-21-0264] [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: 06/30/2021] [Revised: 09/27/2021] [Accepted: 11/29/2021] [Indexed: 11/16/2022]
Abstract
Though studies have observed inverse associations between use of analgesics (aspirin, NSAIDs, and acetaminophen) and the risk of several cancers, the potential biological mechanisms underlying these associations are unclear. We investigated the relationship between analgesic use and serum concentrations of estrogens, androgens, and their metabolites among postmenopausal women to provide insights on whether analgesic use might influence endogenous hormone levels, which could in turn influence hormone-related cancer risk. The study included 1,860 postmenopausal women from two case-control studies nested within the Women's Health Initiative Observational Study. Analgesic use was reported at study baseline. Fifteen estrogens and estrogen metabolites and 12 androgens and androgen metabolites were quantified in baseline serum by LC/MS-MS. Linear regression with inverse probability weighting, stratified by menopausal hormone therapy (MHT) use, was used to estimate adjusted geometric mean concentrations of each hormone by analgesic use. Among women not currently using MHT (n = 951), low-dose aspirin (<100 mg) use was associated with a higher serum concentration of estrone, estradiol, and 2, 4, and 16 hydroxylated metabolites. Use of regular-dose aspirin (≥100 mg), non-aspirin NSAIDs, and acetaminophen was not associated with serum concentrations of estrogens, androgens, or their metabolites. This study highlights the importance of examining aspirin use by dose and suggests that low-dose aspirin may influence endogenous estrogen concentrations. PREVENTION RELEVANCE This study explores a potential pathway by which analgesic medications such as aspirin may prevent hormone-related cancers. The findings support a positive association between low-dose aspirin use and endogenous estrogens, indicating that further elucidation of the interplay between low-dose aspirin, estrogen concentrations, and cancer risk is needed.
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Affiliation(s)
- Lauren M. Hurwitz
- Division of Cancer Epidemiology and Genetics, National Cancer Institute
| | - Aladdin H. Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA
| | - Fred K. Tabung
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine and Comprehensive Cancer Center
| | | | - Nazmus Saquib
- Research Unit, College of Medicine, Sulaiman AlRajhi University
| | - Robert B. Wallace
- Department of Epidemiology, University of Iowa College of Public Health
| | - Robert A. Wild
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine
| | - Ruth M. Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute
| | - Xia Xu
- Cancer Research Technology Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research
| | - Britton Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute
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Israr F, Javed MT, Ahmed MH, Tariq A, Zarnab S, Kausar R, Tahir MH, Hina I, Ali MZ. Effect of different doses of acetaminophen through drinking water on body organs and serum biochemical parameters in broilers. TOXIN REV 2021. [DOI: 10.1080/15569543.2021.1974043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Faryal Israr
- Department of Pathology, Faculty of Veterinary Science, University of Agriculture, Faisalabad, Pakistan
| | - Muhammad Tariq Javed
- Department of Pathology, Faculty of Veterinary Science, University of Agriculture, Faisalabad, Pakistan
| | - Muhammad Hunain Ahmed
- Department of Pathology, Faculty of Veterinary Science, University of Agriculture, Faisalabad, Pakistan
| | - Aira Tariq
- Department of Clinical Medicine and Surgery, Faculty of Veterinary Science, University of Agriculture, Faisalabad, Pakistan
| | - Shaza Zarnab
- Department of Pathology, Faculty of Veterinary Science, University of Agriculture, Faisalabad, Pakistan
| | - Razia Kausar
- Department of Anatomy, University of Agriculture, Faisalabad, Pakistan
| | - Muhammad Hassan Tahir
- Department of Pathology, Faculty of Veterinary Science, University of Agriculture, Faisalabad, Pakistan
| | - Iram Hina
- Department of Pathology, Faculty of Veterinary Science, University of Agriculture, Faisalabad, Pakistan
| | - Md Zulfekar Ali
- Animal Health Research Division, Bangladesh Livestock Research Institute, Savar, Dhaka-1341, Bangladesh
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15
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Angelis D, Jagarapu J, Wan-Huen P, Savani RC, Jaleel M. Part II. Acetaminophen and closure of ductus arteriosus in the newborns: Mechanisms of action, clinical studies, safety and efficacy. Early Hum Dev 2021; 159:105407. [PMID: 34147306 DOI: 10.1016/j.earlhumdev.2021.105407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Dimitrios Angelis
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Jawahar Jagarapu
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Phyllis Wan-Huen
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rashmin C Savani
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mambarambath Jaleel
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, USA
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Ayoub SS. Paracetamol (acetaminophen): A familiar drug with an unexplained mechanism of action. Temperature (Austin) 2021; 8:351-371. [PMID: 34901318 PMCID: PMC8654482 DOI: 10.1080/23328940.2021.1886392] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 02/02/2023] Open
Abstract
Paracetamol (acetaminophen) is undoubtedly one of the most widely used drugs worldwide. As an over-the-counter medication, paracetamol is the standard and first-line treatment for fever and acute pain and is believed to remain so for many years to come. Despite being in clinical use for over a century, the precise mechanism of action of this familiar drug remains a mystery. The oldest and most prevailing theory on the mechanism of analgesic and antipyretic actions of paracetamol relates to the inhibition of CNS cyclooxygenase (COX) enzyme activities, with conflicting views on the COX isoenzyme/variant targeted by paracetamol and on the nature of the molecular interactions with these enzymes. Paracetamol has been proposed to selectively inhibit COX-2 by working as a reducing agent, despite the fact that in vitro screens demonstrate low potency on the inhibition of COX-1 and COX-2. In vivo data from COX-1 transgenic mice suggest that paracetamol works through inhibition of a COX-1 variant enzyme to mediate its analgesic and particularly thermoregulatory actions (antipyresis and hypothermia). A separate line of research provides evidence on potentiation of the descending inhibitory serotonergic pathway to mediate the analgesic action of paracetamol, but with no evidence of binding to serotonergic molecules. AM404 as a metabolite for paracetamol has been proposed to activate the endocannabinoid and the transient receptor potential vanilloid-1 (TRPV1) systems. The current review gives an update and in some cases challenges the different theories on the pharmacology of paracetamol and raises questions on some of the inadequately explored actions of paracetamol. List of Abbreviations: AM404, N-(4-hydroxyphenyl)-arachidonamide; CB1R, Cannabinoid receptor-1; Cmax, Maximum concentration; CNS, Central nervous system; COX, Cyclooxygenase; CSF, Cerebrospinal fluid; ED50, 50% of maximal effective dose; FAAH, Fatty acid amidohydrolase; IC50, 50% of the maximal inhibitor concentration; LPS, Lipopolysaccharide; NSAIDs, Non-steroidal anti-inflammatory drugs; PGE2, Prostaglandin E2; TRPV1, Transient receptor potential vanilloid-1.
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Affiliation(s)
- Samir S Ayoub
- School of Health, Sport and Bioscience, Medicines Research Group, University of East London, London, UK
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17
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Dai G, Li B, Xu Y, Li Z, Mo F, Wei C. Synergistic interaction between matrine and paracetamol in the acetic acid writhing test in mice. Eur J Pharmacol 2021; 895:173869. [PMID: 33454375 DOI: 10.1016/j.ejphar.2021.173869] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 12/21/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
The purpose of this study was to investigate the analgesic interaction between matrine and paracetamol in an acetic acid-induced writhing model in mice. Fifty percent effective dose (ED50) values of the individual drugs were determined, and the different proportions of matrine and paracetamol were assayed using the isobolographic method. Our study demonstrated that both of matrine and paracetamol dose-dependently inhibited the writhing response evoked by acetic acid, and the ED50 values and their 95% confidence intervals against these tonic pain were 21.10 (17.86-24.92) mg/kg and 61.30 (50.71-74.10) mg/kg for matrine and paracetamol, respectively. At the fixed ratios of 1:1, 1:3 and 3:1, the experimental ED50 values of matrine and paracetamol combinations and their 95% confidence intervals were 10.52 (5.14-21.55) mg/kg, 9.13 (4.46-18.70) mg/kg and 4.98 (4.17-5.95) mg/kg, respectively, their theoretical ED50 values and 95% confidence intervals were 41.20 (36.31-46.74) mg/kg, 51.25 (44.19-59.44) mg/kg and 31.15 (27.25-35.60) mg/kg, and the experimental ED50 values of matrine and paracetamol combination were significantly lower than their calculated theoretical ED50 values (all P < 0.01), as revealed by isobolographic analysis. Furthermore, the experimental regression line was also significantly different from the calculated additive equal-effect line over the range of the tested doses (all P < 0.01). Our results suggest that the combination of matrine with paracetamol exerts analgesic synergistic interactions in a mouse acetic acid-induced writhing model, thereby offering a possible therapeutic alternative for the clinical management of inflammatory pain.
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Affiliation(s)
- Guidong Dai
- Key Laboratory for Modernization of Qiandongnan Miao & Dong Medicine, Qiandongnan Traditional Medicine Research & Development Center, Kaili University, 3 Kaiyuan Road, Kaili, Guizhou, 556011, People's Republic of China.
| | - Benpeng Li
- Key Laboratory for Modernization of Qiandongnan Miao & Dong Medicine, Qiandongnan Traditional Medicine Research & Development Center, Kaili University, 3 Kaiyuan Road, Kaili, Guizhou, 556011, People's Republic of China
| | - Yuping Xu
- Qiandongnan Engineering and Technology Research Centre for Comprehensive Utilization of National Medicine, Qiandongnan Traditional Medicine Research & Development Center, Kaili University, 3 Kaiyuan Road, Kaili, Guizhou, 556011, People's Republic of China
| | - Zhiji Li
- School of Life and Health Science, Kaili University, 3 Kaiyuan Road, Kaili, Guizhou, 556011, People's Republic of China
| | - Fuchun Mo
- School of Life and Health Science, Kaili University, 3 Kaiyuan Road, Kaili, Guizhou, 556011, People's Republic of China
| | - Chaoqian Wei
- School of Life and Health Science, Kaili University, 3 Kaiyuan Road, Kaili, Guizhou, 556011, People's Republic of China
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18
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Przybyła GW, Szychowski KA, Gmiński J. Paracetamol - An old drug with new mechanisms of action. Clin Exp Pharmacol Physiol 2021; 48:3-19. [PMID: 32767405 DOI: 10.1111/1440-1681.13392] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/09/2020] [Accepted: 08/02/2020] [Indexed: 12/26/2022]
Abstract
Paracetamol (acetaminophen) is the most commonly used over-the-counter (OTC) drug in the world. Despite its popularity and use for many years, the safety of its application and its mechanism of action are still unclear. Currently, it is believed that paracetamol is a multidirectional drug and at least several metabolic pathways are involved in its analgesic and antipyretic action. The mechanism of paracetamol action consists in inhibition of cyclooxygenases (COX-1, COX-2, and COX-3) and involvement in the endocannabinoid system and serotonergic pathways. Additionally, paracetamol influences transient receptor potential (TRP) channels and voltage-gated Kv7 potassium channels and inhibits T-type Cav3.2 calcium channels. It also exerts an impact on L-arginine in the nitric oxide (NO) synthesis pathway. However, not all of these effects have been clearly confirmed. Therefore, the aim of our paper was to summarize the current state of knowledge of the mechanism of paracetamol action with special attention to its safety concerns.
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Affiliation(s)
| | - Konrad A Szychowski
- Department of Lifestyle Disorders and Regenerative Medicine, University of Information Technology and Management in Rzeszow, Rzeszow, Poland
| | - Jan Gmiński
- Department of Lifestyle Disorders and Regenerative Medicine, University of Information Technology and Management in Rzeszow, Rzeszow, Poland
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19
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Current etiological comprehension and therapeutic targets of acetaminophen-induced hepatotoxicity. Pharmacol Res 2020; 161:105102. [DOI: 10.1016/j.phrs.2020.105102] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/03/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023]
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Almutairi A, Zaman F, Day-Lewis M, Tsitsikov E, Reiter A, Xue K, Geha RS, Chou J, Yee CSK. Acetaminophen Inhibits the Neutrophil Oxidative Burst: Implications for Diagnostic Testing. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:3543-3548. [PMID: 32707237 DOI: 10.1016/j.jaip.2020.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Chronic granulomatous disease is a primary immunodeficiency characterized by recurrent bacterial and fungal infections, granuloma formation, and inflammatory disease. Impaired neutrophil oxidative function is an essential diagnostic criterion. In vitro exposure of neutrophils to acetaminophen, a commonly used over-the-counter medication, has been associated with reduced neutrophil oxidative function. The clinical implications of acetaminophen intake for dihydrorhodamine (DHR) testing remain unknown. OBJECTIVE To evaluate the effect of in vivo administration of therapeutic doses of acetaminophen on DHR diagnostic testing. METHODS We performed DHR testing in 15 healthy adults before and after administering a single dose of acetaminophen. We retrospectively reviewed 195 DHR test results from hospitalized patients who had received acetaminophen, nonsteroidal anti-inflammatory drug, or corticosteroid before testing. RESULTS DHR testing result was abnormal in 100% (n = 15) of healthy adults 2 hours after acetaminophen intake. We identified 195 instances of DHR testing less than or equal to 72 hours after acetaminophen ingestion in hospitalized patients who did not have chronic granulomatous disease. DHR results were abnormal in 43 of 195 cases (22.1%). Frequency of false-positive testing was increased in patients who received acetaminophen within 24 hours of testing, and in patients who received more than 1 dose of acetaminophen. Nonsteroidal anti-inflammatory drug and corticosteroid intakes were not associated with abnormal DHR result. CONCLUSIONS Patients treated with acetaminophen have decreased neutrophil oxidative burst as measured by DHR testing. To avoid falsely abnormal testing for chronic granulomatous disease, patients should be advised to avoid acetaminophen for at least 24 hours before DHR testing.
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Affiliation(s)
| | - Fatima Zaman
- Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | | | | | | | - Kanyun Xue
- Boston Children's Hospital, Boston, Mass
| | - Raif S Geha
- Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Janet Chou
- Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Christina S K Yee
- Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
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21
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Microbial Communities Associated with Acetaminophen Biodegradation from Mangrove Sediment. SUSTAINABILITY 2020. [DOI: 10.3390/su12135410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Acetaminophen (ACE) is a widely used medicine. Currently, concerns regarding its potential adverse effects on the environments are raised. The aim of this study was to evaluate ACE biodegradation in mangrove sediments under aerobic and anaerobic conditions. Three ACE biodegradation strategies in mangrove sediments were tested. The degradation half-lives (t1/2) of ACE in the sediments with spent mushroom compost under aerobic conditions ranged from 3.24 ± 0.16 to 6.25 ± 0.31 d. The degradation half-lives (t1/2) of ACE in sediments with isolated bacterial strains ranged from 2.54 ± 0.13 to 3.30 ± 0.17 d and from 2.62 ± 0.13 to 3.52 ± 0.17 d under aerobic and anaerobic conditions, respectively. The degradation half-lives (t1/2) of ACE in sediments amended with NaNO3, Na2SO4 and NaHCO3 under anaerobic conditions ranged from 1.16 ± 0.06 to 3.05 ± 0.15 d, 2.39 ± 0.12 to 3.84 ± 0.19 d and 2.79 ± 0.14 to 10.75 ± 0.53 d, respectively. The addition of the three electron acceptors enhanced ACE degradation in mangrove sediments, where NaNO3 yielded the best effects. Sixteen microbial genera were identified as the major members of microbial communities associated in anaerobic ACE degradation in mangrove sediments with addition of NaNO3 and Na2SO4. Three (Arthrobacter, Enterobacter and Bacillus) of the sixteen microbial genera were identified in the isolated ACE-degrading bacterial strains.
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Stasiulewicz A, Znajdek K, Grudzień M, Pawiński T, Sulkowska JI. A Guide to Targeting the Endocannabinoid System in Drug Design. Int J Mol Sci 2020; 21:ijms21082778. [PMID: 32316328 PMCID: PMC7216112 DOI: 10.3390/ijms21082778] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/07/2020] [Accepted: 04/14/2020] [Indexed: 12/11/2022] Open
Abstract
The endocannabinoid system (ECS) is one of the most crucial systems in the human organism, exhibiting multi-purpose regulatory character. It is engaged in a vast array of physiological processes, including nociception, mood regulation, cognitive functions, neurogenesis and neuroprotection, appetite, lipid metabolism, as well as cell growth and proliferation. Thus, ECS proteins, including cannabinoid receptors and their endogenous ligands’ synthesizing and degrading enzymes, are promising therapeutic targets. Their modulation has been employed in or extensively studied as a treatment of multiple diseases. However, due to a complex nature of ECS and its crosstalk with other biological systems, the development of novel drugs turned out to be a challenging task. In this review, we summarize potential therapeutic applications for ECS-targeting drugs, especially focusing on promising synthetic compounds and preclinical studies. We put emphasis on modulation of specific proteins of ECS in different pathophysiological areas. In addition, we stress possible difficulties and risks and highlight proposed solutions. By presenting this review, we point out information pivotal in the spotlight of ECS-targeting drug design, as well as provide an overview of the current state of knowledge on ECS-related pharmacodynamics and show possible directions for needed research.
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Affiliation(s)
- Adam Stasiulewicz
- Department of Drug Chemistry, Faculty of Pharmacy, Medical University of Warsaw, Banacha 1, 02-097 Warsaw, Poland; (M.G.); (T.P.)
- Interdisciplinary Laboratory of Biological Systems Modelling, Centre of New Technologies, University of Warsaw, Banacha 2c, 02-097 Warsaw, Poland;
- Correspondence: (A.S.); (J.I.S.)
| | - Katarzyna Znajdek
- Interdisciplinary Laboratory of Biological Systems Modelling, Centre of New Technologies, University of Warsaw, Banacha 2c, 02-097 Warsaw, Poland;
- Faculty of Pharmacy, Medical University of Warsaw, Banacha 1, 02-097 Warsaw, Poland
| | - Monika Grudzień
- Department of Drug Chemistry, Faculty of Pharmacy, Medical University of Warsaw, Banacha 1, 02-097 Warsaw, Poland; (M.G.); (T.P.)
| | - Tomasz Pawiński
- Department of Drug Chemistry, Faculty of Pharmacy, Medical University of Warsaw, Banacha 1, 02-097 Warsaw, Poland; (M.G.); (T.P.)
| | - Joanna I. Sulkowska
- Interdisciplinary Laboratory of Biological Systems Modelling, Centre of New Technologies, University of Warsaw, Banacha 2c, 02-097 Warsaw, Poland;
- Faculty of Chemistry, University of Warsaw, Pasteura 1, 02-093 Warsaw, Poland
- Materials and Process Simulation Center, California Institute of Technology, Pasadena, CA 91125, USA
- Correspondence: (A.S.); (J.I.S.)
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Clinical evaluation of postoperative analgesia, cardiorespiratory parameters and changes in liver and renal function tests of paracetamol compared to meloxicam and carprofen in dogs undergoing ovariohysterectomy. PLoS One 2020; 15:e0223697. [PMID: 32059002 PMCID: PMC7021320 DOI: 10.1371/journal.pone.0223697] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/21/2020] [Indexed: 12/23/2022] Open
Abstract
Background In veterinary medicine, the administration of nonsteroidal anti-inflammatory analgesics (NSAIDs) for the control of postsurgical pain in dogs and cats is common given the anti-inflammatory, analgesic, and antipyretic effects of these drugs. This study compared the serum biochemical changes and postoperative analgesic effects of paracetamol, meloxicam, and carprofen in bitches submitted to an ovariohysterectomy using the Dynamic Interactive Visual Analog Scale (DIVAS) and Pain Scale of the University of Melbourne (UMPS) scoring systems. Methods Thirty bitches of different breeds underwent elective ovariohysterectomies and were randomly assigned to one of three treatment groups: a paracetamol group [15 mg kg-1 intravenous (IV)], a carprofen group (4 mg kg-1 IV), and a meloxicam group (0.2 mg kg-1 IV). All treatments were administered 30 minutes prior to surgery. Paracetamol was administered every 8 hours postoperatively for 48 hours total, while carprofen and meloxicam were intravenously administered every 24 hours. An evaluation of post-surgical pain was done with the DIVAS and the UMPS. The first post-surgical pain measurement was performed 1 hour after surgery and then 2, 4, 6, 8, 12, 16, 20, 24, 36, and 48 hours after surgery. Results All groups exhibited a gradual reduction in pain throughout the postoperative period in both scales; however, neither scale significantly differed between the three treatment groups (P > 0.05) during the 48 postoperative hours. Conclusions Paracetamol was as effective as meloxicam and carprofen for post-surgical analgesia in bitches subjected to elective ovariohysterectomy. The present study demonstrates that paracetamol may be considered a tool for the effective treatment of acute perioperative pain in dogs. Furthermore, this drug led to no adverse reactions or changes in the parameters assessed in the present study, indicating its safety.
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N, N'-Diacetyl- p-phenylenediamine restores microglial phagocytosis and improves cognitive defects in Alzheimer's disease transgenic mice. Proc Natl Acad Sci U S A 2019; 116:23426-23436. [PMID: 31685616 DOI: 10.1073/pnas.1916318116] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
As a central feature of neuroinflammation, microglial dysfunction has been increasingly considered a causative factor of neurodegeneration implicating an intertwined pathology with amyloidogenic proteins. Herein, we report the smallest synthetic molecule (N,N'-diacetyl-p-phenylenediamine [DAPPD]), simply composed of a benzene ring with 2 acetamide groups at the para position, known to date as a chemical reagent that is able to promote the phagocytic aptitude of microglia and subsequently ameliorate cognitive defects. Based on our mechanistic investigations in vitro and in vivo, 1) the capability of DAPPD to restore microglial phagocytosis is responsible for diminishing the accumulation of amyloid-β (Aβ) species and significantly improving cognitive function in the brains of 2 types of Alzheimer's disease (AD) transgenic mice, and 2) the rectification of microglial function by DAPPD is a result of its ability to suppress the expression of NLRP3 inflammasome-associated proteins through its impact on the NF-κB pathway. Overall, our in vitro and in vivo investigations on efficacies and molecular-level mechanisms demonstrate the ability of DAPPD to regulate microglial function, suppress neuroinflammation, foster cerebral Aβ clearance, and attenuate cognitive deficits in AD transgenic mouse models. Discovery of such antineuroinflammatory compounds signifies the potential in discovering effective therapeutic molecules against AD-associated neurodegeneration.
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Loss of hypothermic and anti-pyretic action of paracetamol in cyclooxygenase-1 knockout mice is indicative of inhibition of cyclooxygenase-1 variant enzymes. Eur J Pharmacol 2019; 861:172609. [DOI: 10.1016/j.ejphar.2019.172609] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 08/09/2019] [Accepted: 08/14/2019] [Indexed: 02/02/2023]
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26
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Marconi E, Bettiol A, Ambrosio G, Perduca V, Vannacci A, Troiani S, Dani C, Mugelli A, Lucenteforte E. Efficacy and safety of pharmacological treatments for patent ductus arteriosus closure: A systematic review and network meta-analysis of clinical trials and observational studies. Pharmacol Res 2019; 148:104418. [PMID: 31479749 DOI: 10.1016/j.phrs.2019.104418] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/27/2019] [Accepted: 08/27/2019] [Indexed: 12/14/2022]
Abstract
Efficacy and safety profiles of different pharmacological interventions used to treat patent ductus arteriosus (PDA) are relatively unexplored. Integrating the findings of randomized clinical trials (RCTs) with those from observational studies may provide key evidence on this important issue. We aimed at estimating the relative likelihood of failure to close the PDA, need for surgical closure, and occurrence of adverse events among preterm and full-term infants treated with indomethacin, ibuprofen, or acetaminophen, placebo, or no treatment including both RCTs and observational studies. We searched PubMed, Embase, and the Register of Controlled Trials from inception to October 30, 2018. We first estimated proportions of subjects with failure to close the PDA, subjects in whom surgical closure was performed after pharmacological treatment, death, and subjects with selected adverse events (AEs). These estimates were obtained using frequentist random-effect meta-analysis of arm-specific proportions. We then compared active drugs with each other and with control (either placebo or no treatment) by summarizing results at the end of treatment reported in the papers, regardless of number of administration(s), dose, route and type of administration, and study design and quality. We also summarized primary outcome results separately at first, second and third cycles of treatment. These estimates were obtained using Bayesian random-effects network meta-analysis for mixed comparisons, and frequentist random-effect pairwise meta-analysis for direct comparisons. We included 64 RCTs and 24 observational studies including 14,568 subjects (5339 in RCTs and 9229 in observational studies, 8292 subjects received indomethacin, 4761 ibuprofen, 574 acetaminophen, and 941 control (including placebo or no intervention).The proportion of subjects with failure to close the PDA was 0.24 (95% Confidence Interval, CI: 0.20, 0.29) for indomethacin, 0.18 (0.14, 0.22) for ibuprofen, 0.19 (0.09, 0.30) for acetaminophen, and 0.59 (0.48, 0.69) for control. At end of treatment, compared to control, we found inverse associations between all active drugs and failure to close PDA (for indomethacin Odds Ratio, OR, was 0.17 [95% Credible Interval, CrI: 0.11-0.24], ibuprofen 0.19 [0.12-0.28], and acetaminophen 0.15 [0.09-0.26]), without differences among active drugs. We showed inverse associations between effective drugs and need for surgical closure, as compared to control (for indomethacin OR was 0.28 [0.15-0.50], ibuprofen 0.30 [0.16-0.54], and acetaminophen 0.19 [0.07-0.46]), without differences among drugs. Indomethacin was directly associated with intraventricular hemorrhage (IVH) (1.27; 1.00, 1.62) compared to ibuprofen, and to oliguria as compared to ibuprofen (3.92; 1.69, 9.82) or acetaminophen (10.8; 1.86, 93.1). In conclusion, active pharmacological treatment, with indomethacin, ibuprofen, or acetaminophen, is inversely associated with failure to close the PDA compared to non-treatment. Ibuprofen should be preferred to indomethacin to avoid occurrence of IVH or oliguria, acetaminophen should be preferred to indomethacin to avoid oliguria.
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Affiliation(s)
- Ettore Marconi
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, 50139, Florence, Italy
| | - Alessandra Bettiol
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, 50139, Florence, Italy
| | | | - Vittorio Perduca
- Laboratoire de Mathématiques Appliquées - MAP5 (UMR CNRS 8145), Université Paris Descartes, Paris, France
| | - Alfredo Vannacci
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, 50139, Florence, Italy
| | | | - Carlo Dani
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, 50139, Florence, Italy; Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Alessandro Mugelli
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, 50139, Florence, Italy
| | - Ersilia Lucenteforte
- Department of Clinical and Experimental Medicine University of Pisa, Pisa, Italy.
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Kose D, Cadirci E, Halici Z, Sirin B, Dincer B. The investigation of possible roles of central 5-HT 7 receptors in antipyretic effect mechanism of paracetamol in LPS-induced hyperthermia model of mice. Inflammopharmacology 2019; 27:1169-1178. [PMID: 31309486 DOI: 10.1007/s10787-019-00617-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 06/21/2019] [Indexed: 01/01/2023]
Abstract
AIM This study aimed to investigate the role of the 5-HT7 receptor in fever mechanisms and its possible effect on the antipyretic mechanism of paracetamol. MATERIALS AND METHODS The study consisted of eight experimental groups and one control group. Group I: healthy, II: LPS, III: LPS + PARA, IV: LPS + AGO, V: LPS + ANTA, VI: LPS + AGO + ANTA, VII: LPS + AGO + PARA, VIII: LPS + ANTA + PARA, and IX: LPS + AGO + ANTA + PARA. Rectal temperatures were measured with a rectal thermometer. At the end of the experiment, tissues were examined molecularly. Real-time PCR mRNA expression analyses were performed for the 5-HT7 receptor, IL-6, and TNF-α in hypothalamus tissue. RESULTS The mean differences in rectal temperature increased in the LPS, LPS + ANTA, and LPS + AGO + ANTA groups when compared to the healthy group and decreased in the LPS + PARA, LPS + AGO, LPS + AGO + PARA, and LPS + AGO + ANTA + PARA groups when compared to the healthy group. The IL-6 and TNF-α mRNA expression increased in the LPS, LPS + ANTA, and LPS + AGO + ANTA groups when compared to the healthy group in the 2nd and 4th hours. The IL-6 and TNF-α expression decreased in the LPS + PARA, LPS + AGO, LPS + AGO + PARA, and LPS + AGO + ANTA + PARA groups when compared to the LPS group in the 2nd and 4th hours. The 5-HT7 receptor mRNA expression increased in the LPS group when compared to the healthy group in the 2nd hour. The 5-HT7 receptor mRNA expression decreased in the LPS + AGO and LPS + AGO + PARA groups when compared to the LPS group in the 2nd hour. The 5-HT7 receptor mRNA expression increased the in LPS + ANTA and LPS + ANTA + PARA groups when compared to the LPS group in the 2nd hour. CONCLUSION The 5-HT7 receptor is a potential defense mechanism in stopping fever and the antipyretic property of paracetamol is not due to the 5-HT7 receptor.
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Affiliation(s)
- Duygu Kose
- Department of Pharmacology, Faculty of Medicine, Ataturk University, 25240, Erzurum, Turkey
| | - Elif Cadirci
- Department of Pharmacology, Faculty of Medicine, Ataturk University, 25240, Erzurum, Turkey
| | - Zekai Halici
- Department of Pharmacology, Faculty of Medicine, Ataturk University, 25240, Erzurum, Turkey.
| | - Busra Sirin
- Department of Pharmacology, Faculty of Medicine, Ataturk University, 25240, Erzurum, Turkey
| | - Busra Dincer
- Department of Pharmacology, Faculty of Pharmacy, Binali Yıldırım University, 24100, Erzincan, Turkey
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28
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Jaswal SM, Granados Samayoa JA, Kam JWY, Randles D, Heine SJ, Handy TC. The Influence of Acetaminophen on Task Related Attention. Front Neurosci 2019; 13:444. [PMID: 31130842 PMCID: PMC6509963 DOI: 10.3389/fnins.2019.00444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 04/17/2019] [Indexed: 11/19/2022] Open
Abstract
Our study was designed to examine whether the pain reliever acetaminophen impacts the normal ebb-and-flow of off-task attentional states, such as captured by the phenomenon of mind wandering. In a placebo-controlled between-groups design, participants performed a sustained attention to response task while event-related potentials (ERPs) to target events were recorded. Participants were queried at random intervals for their attentional reports – either “on-task” or “off-task.” The frequency of these reports and the ERPs generated by the preceding target events were assessed. Behaviorally, the frequency of off-task attentional reports was comparable between groups. Electrophysiologically, two findings emerged: first, the amplitude of the P300 ERP component elicited by target events was significantly attenuated during off-task vs. on-task attentional states in both the acetaminophen and placebo groups. Second, the amplitude of the LPP ERP component elicited by target events showed a significant decrease during off-task attentional states that was specific to the acetaminophen group. Taken together, our findings support the conclusion that acetaminophen doesn’t impact our relative propensity to drift into off-task attentional states, but it does affect the depth of neurocognitive disengagement during off-task attentional states, and in particular, at the level of post-categorization stimulus evaluations indexed by the LPP.
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Affiliation(s)
- Sumeet Mutti Jaswal
- Department of Psychology, The University of British Columbia, Vancouver, BC, Canada
| | | | - Julia W Y Kam
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Daniel Randles
- Department of Psychology, University of Toronto Scarborough, Toronto, ON, Canada
| | - Steven J Heine
- Department of Psychology, The University of British Columbia, Vancouver, BC, Canada
| | - Todd C Handy
- Department of Psychology, The University of British Columbia, Vancouver, BC, Canada
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29
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Addo KA, Bulka C, Dhingra R, Santos HP, Smeester L, O’Shea TM, Fry RC. Acetaminophen use during pregnancy and DNA methylation in the placenta of the extremely low gestational age newborn (ELGAN) cohort. ENVIRONMENTAL EPIGENETICS 2019; 5:dvz010. [PMID: 31404209 PMCID: PMC6682751 DOI: 10.1093/eep/dvz010] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/07/2019] [Accepted: 06/10/2019] [Indexed: 05/09/2023]
Abstract
Acetaminophen is considered the safest antipyretic and analgesic medication for pregnant women. However, studies have reported that acetaminophen has endocrine disrupting properties and prenatal exposure has been associated with early life epigenetic changes and later life health outcomes. As the placenta is the central mediator of maternal and fetal interactions, exposure to acetaminophen during pregnancy could manifest as perturbations in the placenta epigenome. Here, we evaluated epigenome-wide cytosine-guanine dinucleotide (CpG) methylation in placental tissue in relation to maternal acetaminophen use during pregnancy in a cohort of 286 newborns born prior to 28 weeks gestation. According to maternal self-report, more than half (166 of 286) of the newborns were exposed to acetaminophen in utero. After adjustment for potential confounders, a total of 42 CpGs were identified to be differentially methylated at a false discovery rate < 0.05, with most displaying increased methylation as it relates to acetaminophen exposure. A notable gene that was significantly associated with acetaminophen is the prostaglandin receptor (PTGDR) which plays an essential role in mediating placental blood flow and fetal growth. Moreover, for 6 of the 42 CpGs, associations of acetaminophen use with methylation were significantly different between male and female placentas; 3 CpG sites were associated with acetaminophen use in the male placenta and 3 different sites were associated with acetaminophen use in the female placenta (P interaction < 0.2). These findings highlight a relationship between maternal acetaminophen use during pregnancy and the placental epigenome and suggest that the responses for some CpG sites are sex dependent.
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Affiliation(s)
- Kezia A Addo
- Curriculum in Toxicology and Environmental Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Department of Environmental Sciences and Engineering, Gilling School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Catherine Bulka
- Department of Environmental Sciences and Engineering, Gilling School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Radhika Dhingra
- Department of Environmental Sciences and Engineering, Gilling School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Institute for Environmental Health Solutions, Gilling School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Hudson P Santos
- Institute for Environmental Health Solutions, Gilling School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- School of Nursing, University of North Carolina, Chapel Hill, NC, USA
| | - Lisa Smeester
- Department of Environmental Sciences and Engineering, Gilling School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Institute for Environmental Health Solutions, Gilling School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - T Michael O’Shea
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Rebecca C Fry
- Curriculum in Toxicology and Environmental Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Department of Environmental Sciences and Engineering, Gilling School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Institute for Environmental Health Solutions, Gilling School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Correspondence address. Curriculum in Toxicology and Environmental Medicine, School of Medicine, University of North Carolina, Rosenau Hall, Rm 166, Campus Box 7431, 135 Dauer Drive, Chapel Hill, NC 27599, USA. Tel: +1-919-966-1171; Fax: +1-919-966-7911; E-mail:
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30
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Van Driest SL, Jooste EH, Shi Y, Choi L, Darghosian L, Hill KD, Smith AH, Kannankeril PJ, Roden DM, Ware LB. Association Between Early Postoperative Acetaminophen Exposure and Acute Kidney Injury in Pediatric Patients Undergoing Cardiac Surgery. JAMA Pediatr 2018; 172:655-663. [PMID: 29799947 PMCID: PMC6110290 DOI: 10.1001/jamapediatrics.2018.0614] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE Acute kidney injury (AKI) is a common and serious complication for pediatric cardiac surgery patients associated with increased morbidity, mortality, and length of stay. Current strategies focus on risk reduction and early identification because there are no known preventive or therapeutic agents. Cardiac surgery and cardiopulmonary bypass lyse erythrocytes, releasing free hemoglobin and contributing to oxidative injury. Acetaminophen may prevent AKI by reducing the oxidation state of free hemoglobin. OBJECTIVE To test the hypothesis that early postoperative acetaminophen exposure is associated with reduced risk of AKI in pediatric patients undergoing cardiac surgery. DESIGN, SETTING, AND PARTICIPANTS In this retrospective cohort study, the setting was 2 tertiary referral children's hospitals. The primary and validation cohorts included children older than 28 days admitted for cardiac surgery between July 1, 2008, and June 1, 2016. Exclusion criteria were postoperative extracorporeal membrane oxygenation and inadequate serum creatinine measurements to determine AKI status. EXPOSURES Acetaminophen exposure in the first 48 postoperative hours. MAIN OUTCOMES AND MEASURES Acute kidney injury based on Kidney Disease: Improving Global Outcomes serum creatinine criteria (increase by ≥0.3 mg/dL from baseline or at least 1.5-fold more than the baseline [to convert to micromoles per liter, multiply by 88.4]) in the first postoperative week. RESULTS The primary cohort (n = 666) had a median age of 6.5 (interquartile range [IQR], 3.9-44.7) months, and 341 (51.2%) had AKI. In unadjusted analyses, those with AKI had lower median acetaminophen doses than those without AKI (47 [IQR, 16-88] vs 78 [IQR, 43-104] mg/kg, P < .001). In logistic regression analysis adjusting for age, cardiopulmonary bypass time, red blood cell distribution width, postoperative hypotension, nephrotoxin exposure, and Risk Adjustment for Congenital Heart Surgery score, acetaminophen exposure was protective against postoperative AKI (odds ratio, 0.86 [95% CI, 0.82-0.90] per each additional 10 mg/kg). Findings were replicated in the validation cohort (n = 333), who had a median age of 14.1 (IQR, 3.9-158.2) months, and 162 (48.6%) had AKI. Acetaminophen doses were 60 (95% CI, 40-87) mg/kg in those with AKI vs 70 (95% CI, 45-94) mg/kg in those without AKI (P = .03), with an adjusted odds ratio of 0.91 (95% CI, 0.84-0.99) for each additional 10 mg/kg. CONCLUSIONS AND RELEVANCE These results indicate that early postoperative acetaminophen exposure may be associated with a lower rate of AKI in pediatric patients who undergo cardiac surgery. Further analysis to validate these findings, potentially through a prospective, randomized trial, may establish acetaminophen as a preventive agent for AKI.
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Affiliation(s)
- Sara L. Van Driest
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee,Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Edmund H. Jooste
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Yaping Shi
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Leena Choi
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Leon Darghosian
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee,Cardiovascular Perfusion Technology Program, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kevin D. Hill
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Andrew H. Smith
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Prince J. Kannankeril
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Dan M. Roden
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee,Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee,Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Lorraine B. Ware
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee,Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee
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31
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Mirrasekhian E, Nilsson JLÅ, Shionoya K, Blomgren A, Zygmunt PM, Engblom D, Högestätt ED, Blomqvist A. The antipyretic effect of paracetamol occurs independent of transient receptor potential ankyrin 1-mediated hypothermia and is associated with prostaglandin inhibition in the brain. FASEB J 2018; 32:5751-5759. [PMID: 29738273 DOI: 10.1096/fj.201800272r] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The mode of action of paracetamol (acetaminophen), which is widely used for treating pain and fever, has remained obscure, but may involve several distinct mechanisms, including cyclooxygenase inhibition and transient receptor potential ankyrin 1 (TRPA1) channel activation, the latter being recently associated with paracetamol's propensity to elicit hypothermia at higher doses. Here, we examined whether the antipyretic effect of paracetamol was due to TRPA1 activation or cyclooxygenase inhibition. Treatment of wild-type and TRPA1 knockout mice rendered febrile by immune challenge with LPS with a dose of paracetamol that did not produce hypothermia (150 mg/kg) but is known to be analgetic, abolished fever in both genotypes. Paracetamol completely suppressed the LPS-induced elevation of prostaglandin E2 in the brain and also reduced the levels of several other prostanoids. The hypothermia induced by paracetamol was abolished in mice treated with the electrophile-scavenger N-acetyl cysteine. We conclude that paracetamol's antipyretic effect in mice is dependent on inhibition of cyclooxygenase activity, including the formation of pyrogenic prostaglandin E2, whereas paracetamol-induced hypothermia likely is mediated by the activation of TRPA1 by electrophilic metabolites of paracetamol, similar to its analgesic effect in some experimental paradigms.-Mirrasekhian, E., Nilsson, J. L. Å., Shionoya, K., Blomgren, A., Zygmunt, P. M., Engblom, D., Högestätt, E. D., Blomqvist, A. The antipyretic effect of paracetamol occurs independent of transient receptor potential ankyrin 1-mediated hypothermia and is associated with prostaglandin inhibition in the brain.
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Affiliation(s)
- Elahe Mirrasekhian
- Division of Neurobiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; and
| | - Johan L Å Nilsson
- Division of Clinical Chemistry and Pharmacology, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Kiseko Shionoya
- Division of Neurobiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; and
| | - Anders Blomgren
- Division of Clinical Chemistry and Pharmacology, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Peter M Zygmunt
- Division of Clinical Chemistry and Pharmacology, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - David Engblom
- Division of Neurobiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; and
| | - Edward D Högestätt
- Division of Clinical Chemistry and Pharmacology, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Anders Blomqvist
- Division of Neurobiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; and
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32
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Cooper DJ, Plewes K, Grigg MJ, Rajahram GS, Piera KA, William T, Chatfield MD, Yeo TW, Dondorp AM, Anstey NM, Barber BE. The effect of regularly dosed paracetamol versus no paracetamol on renal function in Plasmodium knowlesi malaria (PACKNOW): study protocol for a randomised controlled trial. Trials 2018; 19:250. [PMID: 29690924 PMCID: PMC5926539 DOI: 10.1186/s13063-018-2600-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/19/2018] [Indexed: 11/27/2022] Open
Abstract
Background Plasmodium knowlesi is the most common cause of human malaria in Malaysia. Acute kidney injury (AKI) is a frequent complication. AKI of any cause can have long-term consequences, including increased risk of chronic kidney disease, adverse cardiovascular events and increased mortality. Additional management strategies are therefore needed to reduce the frequency and severity of AKI in malaria. In falciparum malaria, cell-free haemoglobin (CFHb)-mediated oxidative damage contributes to AKI. The inexpensive and widely available drug paracetamol inhibits CFHb-induced lipid peroxidation via reduction of ferryl haem to the less toxic Fe3+ state, and has been shown to reduce oxidative damage and improve renal function in patients with sepsis complicated by haemolysis as well as in falciparum malaria. This study aims to assess the ability of regularly dosed paracetamol to reduce the incidence and severity of AKI in knowlesi malaria by attenuating haemolysis-induced oxidative damage. Methods PACKNOW is a two-arm, open-label randomised controlled trial of adjunctive paracetamol versus no paracetamol in patients aged ≥ 5 years with knowlesi malaria, conducted over a 2-year period at four hospital sites in Sabah, Malaysia. The primary endpoint of change in creatinine from enrolment to 72 h will be evaluated by analysis of covariance (ANCOVA) using enrolment creatinine as a covariate. Secondary endpoints include longitudinal changes in markers of oxidative stress (plasma F2-isoprostanes and isofurans) and markers of endothelial activation/Weibel–Palade body release (angiopoietin-2, von Willebrand Factor, P-selectin, osteoprotegerin) over 72 h, as well as blood and urine biomarkers of AKI. This study will be powered to detect a difference between the two treatment arms in a clinically relevant population including adults and children with knowlesi malaria of any severity. Discussion Paracetamol is widely available and has an excellent safety profile; if a renoprotective effect is demonstrated, this trial will support the administration of regularly dosed paracetamol to all patients with knowlesi malaria. The secondary outcomes in this study will provide further insights into the pathophysiology of haemolysis-induced oxidative damage and acute kidney injury in knowlesi malaria and other haemolytic diseases. Trial registration Clinicaltrials.gov, NCT03056391. Registered on 12 October 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2600-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel J Cooper
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia. .,Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia.
| | - Katherine Plewes
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Division of Infectious Diseases, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Matthew J Grigg
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia.,Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Giri S Rajahram
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia.,Infectious Diseases Unit, Clinical Research Centre, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia.,Sabah Department of Health, Kota Kinabalu, Sabah, Malaysia
| | - Kim A Piera
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
| | - Timothy William
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia.,Jesselton Medical Centre, Kota Kinabalu, Sabah, Malaysia
| | - Mark D Chatfield
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia.,Queensland Institute of Medical Research, Brisbane, Australia
| | - Tsin Wen Yeo
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia.,Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Arjen M Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nicholas M Anstey
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia.,Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Bridget E Barber
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia.,Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia.,Queensland Institute of Medical Research, Brisbane, Australia
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33
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Shaver CM, Wickersham N, McNeil JB, Nagata H, Miller A, Landstreet SR, Kuck JL, Diamond JM, Lederer DJ, Kawut SM, Palmer SM, Wille KM, Weinacker A, Lama VN, Crespo MM, Orens JB, Shah PD, Hage CA, Cantu E, Porteous MK, Dhillon G, McDyer J, Bastarache JA, Christie JD, Ware LB. Cell-free hemoglobin promotes primary graft dysfunction through oxidative lung endothelial injury. JCI Insight 2018; 3:98546. [PMID: 29367464 DOI: 10.1172/jci.insight.98546] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 12/19/2017] [Indexed: 12/31/2022] Open
Abstract
Primary graft dysfunction (PGD) is acute lung injury within 72 hours of lung transplantation. We hypothesized that cell-free hemoglobin (CFH) contributes to PGD by increasing lung microvascular permeability and tested this in patients, ex vivo human lungs, and cultured human lung microvascular endothelial cells. In a nested case control study of 40 patients with severe PGD at 72 hours and 80 matched controls without PGD, elevated preoperative CFH was independently associated with increased PGD risk (odds ratio [OR] 2.75, 95%CI, 1.23-6.16, P = 0.014). The effect of CFH on PGD was magnified by reperfusion fraction of inspired oxygen (FiO2) ≥ 0.40 (OR 3.41, P = 0.031). Isolated perfused human lungs exposed to intravascular CFH (100 mg/dl) developed increased vascular permeability as measured by lung weight (CFH 14.4% vs. control 0.65%, P = 0.047) and extravasation of Evans blue-labeled albumin dye (EBD) into the airspace (P = 0.027). CFH (1 mg/dl) also increased paracellular permeability of human pulmonary microvascular endothelial cell monolayers (hPMVECs). Hyperoxia (FiO2 = 0.95) increased human lung and hPMVEC permeability compared with normoxia (FiO2 = 0.21). Treatment with acetaminophen (15 μg/ml), a specific hemoprotein reductant, prevented CFH-dependent permeability in human lungs (P = 0.046) and hPMVECs (P = 0.037). In summary, CFH may mediate PGD through oxidative effects on microvascular permeability, which are augmented by hyperoxia and abrogated by acetaminophen.
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Affiliation(s)
- Ciara M Shaver
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nancy Wickersham
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - J Brennan McNeil
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hiromasa Nagata
- Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan
| | - Adam Miller
- Tennessee Donor Services, Nashville, Tennessee, USA
| | - Stuart R Landstreet
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jamie L Kuck
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joshua M Diamond
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David J Lederer
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University School of Medicine, New York, New York, USA
| | - Steven M Kawut
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Scott M Palmer
- Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Keith M Wille
- Division of Pulmonary and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ann Weinacker
- Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, Palo Alto, California, USA
| | - Vibha N Lama
- Division of Pulmonary and Critical Care Medicine, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Maria M Crespo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jonathan B Orens
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University Medical Center, Baltimore, Maryland, USA
| | - Pali D Shah
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University Medical Center, Baltimore, Maryland, USA
| | - Chadi A Hage
- Division of Pulmonary, Allergy, Critical Care, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Edward Cantu
- Division of Cardiovascular Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mary K Porteous
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gundeep Dhillon
- Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, Palo Alto, California, USA
| | - John McDyer
- Division of Pulmonary, Allergy, and Critical Care, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Julie A Bastarache
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jason D Christie
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lorraine B Ware
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Abstract
Fever depends on a complex physiologic response to infectious agents and other conditions. To alleviate fever, many medicinal agents have been developed over a century of trying to improve upon aspirin, which was determined to work by inhibiting prostaglandin synthesis. We present the process of fever induction through prostaglandin synthesis and discuss the development of pharmaceuticals that target enzymes and receptors involved in prostaglandin-mediated signal transduction, including prostaglandin H2 synthase (also known as cyclooxygenase), phospholipase A2, microsomal prostaglandin E2 synthase-1, EP receptors, and transient potential cation channel subfamily V member 1. Clinical use of established antipyretics will be discussed as well as medicinal agents under clinical trials and future research.
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Affiliation(s)
- Jonathan J Lee
- Biochemistry Department, Brigham Young University, Provo, UT, United States
| | - Daniel L Simmons
- Biochemistry Department, Brigham Young University, Provo, UT, United States.
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Affiliation(s)
- Rebecca Y Klinger
- Department of Anesthesiology, Duke University, Durham, NC 27710, United States
| | - Ashraf S Habib
- Department of Anesthesiology, Duke University, Durham, NC 27710, United States.
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Hadzi-Petrushev N, Mitrov D, Kostovski V, Mladenov M. The impact of vitamin C on the relationship among inflammation, lipid peroxidation and platelet activation during analgesic nephropathy in rats. J Basic Clin Physiol Pharmacol 2017; 28:473-481. [PMID: 28771433 DOI: 10.1515/jbcpp-2016-0150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 06/05/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Oxidative stress and inflammation are involved in the pathogenesis of paracetamol-induced renal damage. This study examines the relationship between 8-iso-prostaglandin F2α (8-iso-PGF2α) and platelet activation as well as the relative contribution of the pro-inflammatory markers interleukin (IL)-1β and tumor necrosis factor-α (TNF-α) in enhanced 8-iso-PGF2α biosynthesis, as a complementary onset during analgesic nephropathy induced by chronic treatment with paracetamol. The protective effects of vitamin C on the aforementioned settings are also investigated. METHODS Analgesic nephropathy was induced in Wistar rats. Renal function markers and the activity of antioxidant enzymes were determined spectrophotometrically. Immunoassays were used to measure the pro-inflammatory markers and the markers of lipid peroxidation and platelet activation. RESULTS The chronic treatment with paracetamol led to renal dysfunction, represented by the elevation of plasma urea and creatinine and the decline in the enzymatic antioxidant status, but did not cause a significant increase in TNF-α and IL-1β. The paracetamol-induced lipid peroxidation and enhanced production of 8-iso-PGF2α was not sufficient to cause changes in platelet activation represented by the level of 11-dehydro thromboxane B2. CONCLUSIONS Our results suggest that oxidative stress cannot circumvent the need of stimulation by circulatory cytokines in order to induce inflammatory response and changes in platelet activation during analgesic nephropathy. Vitamin C proved to be beneficial in restoring the renal function markers to normal, increasing the renal enzymatic antioxidant potential, inhibiting lipid peroxidation, and lowering cytokine production and 11-dehydro thromboxane B2 excretion. The observed effects of vitamin C offer support for its potential use as protective treatment in cases of chronic paracetamol overdose.
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Schwartz JI, Musser BJ, Tanaka WK, Taggart WV, Mehta A, Gottesdiener KM, Greenberg HE. Inhibition of prostacyclin and thromboxane biosynthesis in healthy volunteers by single and multiple doses of acetaminophen and indomethacin. Clin Pharmacol Drug Dev 2016; 4:337-45. [PMID: 27137142 DOI: 10.1002/cpdd.194] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 04/10/2015] [Indexed: 11/07/2022]
Abstract
This double-blind, randomized crossover study assessed the effect of acetaminophen (1000 mg every 8 hours) versus indomethacin (50 mg every 8 hours) versus placebo on cyclooxygenase enzymes (COX-1 and COX-2). Urinary excretion of 2,3-dinor-6-keto-PGF1α, (prostacyclin metabolite, PGI-M; COX-2 inhibition) and 11-dehydro thromboxane B2 (thromboxane metabolite, Tx-M; COX-1 inhibition) were measured after 1 dose and 5 days of dosing. Peak inhibition of urinary metabolite excretion across 8 hours following dosing was the primary end point. Mean PGI-M excretion was 33.7%, 55.9%, and 64.6% on day 1 and 49.4%, 65.1%, and 80.3% on day 5 (placebo, acetaminophen, and indomethacin, respectively). Acetaminophen and indomethacin inhibited PGI-M excretion following single and multiple doses (P = .004 vs placebo). PGI-M excretion inhibition after 1 dose was similar for indomethacin and acetaminophen, but significantly greater with indomethacin after multiple doses (P = .006). Mean Tx-M excretion was 16.2%, 45.2%, and 86.6% on day 1 and 46.2%, 58.4%, and 92.6% on day 5 (placebo, acetaminophen, and indomethacin, respectively). Tx-M excretion inhibition following 1 dose was reduced by acetaminophen (P ≤ .003). Indomethacin reduced Tx-M excretion significantly more than acetaminophen and placebo after single and multiple doses (P ≤ .001). Acetaminophen and indomethacin inhibited COX-1 and COX-2 following a single dose, but acetaminophen was a less potent COX-1 inhibitor than indomethacin.
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Affiliation(s)
| | | | | | | | - Anish Mehta
- Merck & Co., Inc., Whitehouse Station, NJ, USA
| | | | - Howard E Greenberg
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
- Janssen Research and Development, LLC, Titusville, NJ, USA
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Polzin A, Hohlfeld T, Kelm M, Zeus T. Impairment of aspirin antiplatelet effects by non-opioid analgesic medication. World J Cardiol 2015; 7:383-391. [PMID: 26225198 PMCID: PMC4513489 DOI: 10.4330/wjc.v7.i7.383] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 05/28/2015] [Accepted: 06/16/2015] [Indexed: 02/06/2023] Open
Abstract
Aspirin is the mainstay in prophylaxis of cardiovascular diseases. Impaired aspirin antiplatelet effects are associated with enhanced incidence of cardiovascular events. Comedication with non-opioid analgesic drugs has been described to interfere with aspirin, resulting in impaired aspirin antiplatelet effects. Additionally, non-opioid analgesic medication has been shown to enhance the risk of cardiovascular events and death. Pain is very frequent and many patients rely on analgesic drugs to control pain. Therefore effective analgesic options without increased risk of cardiovascular events are desirable. This review focuses on commonly used non-opioid analgesics, interactions with aspirin medication and impact on cardiovascular risk.
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Janz DR, Ware LB. The role of red blood cells and cell-free hemoglobin in the pathogenesis of ARDS. J Intensive Care 2015; 3:20. [PMID: 26933497 PMCID: PMC4772369 DOI: 10.1186/s40560-015-0086-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 04/12/2015] [Indexed: 12/15/2022] Open
Abstract
The primary focus of research into the pathophysiology of the acute respiratory distress syndrome (ARDS) has been on the interaction between the lung, underlying causes of ARDS, and the role of white blood cells and platelets in contributing to lung injury. Given a lack of specific therapies for this common complication of critical illness, further insight into the pathophysiology of this syndrome is greatly needed to develop targeted interventions. The red blood cell (RBC) has been reported to undergo deleterious changes in critical illness and be present in the alveoli of patients with ARDS. Release of RBC contents is known to be injurious in other conditions but has only recently been studied in critical illness and ARDS. The contribution of the RBC to ARDS represents a new avenue of research that may produce new, targeted therapies for this deadly syndrome.
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Affiliation(s)
- David R Janz
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, Louisiana State University School of Medicine, New Orleans, LA USA
| | - Lorraine B Ware
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, T-1218 MCN, 1161 21st Avenue South, Nashville, TN 37232-2650 USA ; Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, T-1218 MCN, 1161 21st Avenue South, Nashville, TN 37232-2650 USA
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40
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Janz DR, Bastarache JA, Rice TW, Bernard GR, Warren MA, Wickersham N, Sills G, Oates JA, Roberts LJ, Ware LB. Randomized, placebo-controlled trial of acetaminophen for the reduction of oxidative injury in severe sepsis: the Acetaminophen for the Reduction of Oxidative Injury in Severe Sepsis trial. Crit Care Med 2015; 43:534-41. [PMID: 25474535 DOI: 10.1097/ccm.0000000000000718] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This trial evaluated the efficacy of acetaminophen in reducing oxidative injury, as measured by plasma F2-isoprostanes, in adult patients with severe sepsis and detectable plasma cell-free hemoglobin. DESIGN Single-center, randomized, double-blind, placebo-controlled phase II trial. SETTING Medical ICU in a tertiary, academic medical center. PATIENTS Critically ill patients 18 years old or older with severe sepsis and detectable plasma cell-free hemoglobin. INTERVENTIONS Patients were randomized 1:1 to enteral acetaminophen 1 g every 6 hours for 3 days (n = 18) or placebo (n = 22) with the same dosing schedule and duration. MEASUREMENTS AND MAIN RESULTS F2-Isoprostanes on study day 3, the primary outcome, did not differ between acetaminophen (30 pg/mL; interquartile range, 24-41) and placebo (36 pg/mL; interquartile range, 25-80; p = 0.35). However, F2-isoprostanes were significantly reduced on study day 2 in the acetaminophen group (24 pg/mL; interquartile range, 19-36) when compared with placebo (36 pg/mL; interquartile range, 23-55; p = 0.047). Creatinine on study day 3, a secondary outcome, was significantly lower in the acetaminophen group (1.0 mg/dL; interquartile range, 0.6-1.4) when compared with that in the placebo (1.3 mg/dL; interquartile range, 0.83-2.0; p = 0.039). There was no statistically significant difference in hospital mortality (acetaminophen 5.6% vs placebo 18.2%; p = 0.355) or adverse events (aspartate aminotransferase or alanine aminotransferase > 400; acetaminophen 9.5% vs placebo 4.3%; p = 0.599). CONCLUSIONS In adults with severe sepsis and detectable plasma cell-free hemoglobin, treatment with acetaminophen within 24 hours of ICU admission may reduce oxidative injury and improve renal function. Additional study is needed to confirm these findings and determine the effect of acetaminophen on patient-centered outcomes.
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Affiliation(s)
- David R Janz
- 1Section of Pulmonary and Critical Care Medicine, Department of Medicine, Louisiana State University School of Medicine, New Orleans, LA. 2Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. 3Division of Clinical Pharmacology, Department of Internal Medicine, Vanderbilt University School of Medicine, Nashville, TN. 4Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN
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Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions: translating clinical research to dental practice. J Am Dent Assoc 2015; 144:898-908. [PMID: 23904576 DOI: 10.14219/jada.archive.2013.0207] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Effective and safe drug therapy for the management of acute postoperative pain has relied on orally administered analgesics such as ibuprofen, naproxen and acetaminophen, or N-acetyl-p-aminophenol (APAP), as well as combination formulations containing opioids such as hydrocodone with APAP. The combination of ibuprofen and APAP has been advocated in the last few years as an alternative therapy for postoperative pain management. The authors conducted a critical analysis to evaluate the scientific evidence for using the ibuprofen-APAP combination and propose clinical treatment recommendations for its use in managing acute postoperative pain in dentistry. TYPES OF STUDIES REVIEWED The authors used quantitative evidence-based reviews published by the Cochrane Collaboration to determine the relative analgesic efficacy and safety of combining ibuprofen and APAP. They found additional articles by searching the Ovid MEDLINE, PubMed and ClinicalTrials.gov databases. CONCLUSIONS The results of the quantitative systematic reviews indicated that the ibuprofen-APAP combination may be a more effective analgesic, with fewer untoward effects, than are many of the currently available opioid-containing formulations. In addition, the authors found several randomized controlled trials that also indicated that the ibuprofen-APAP combination provided greater pain relief than did ibuprofen or APAP alone after third-molar extractions. The adverse effects associated with the combination were similar to those of the individual component drugs. Practical Implications. Combining ibuprofen with APAP provides dentists with an additional therapeutic strategy for managing acute postoperative dental pain. This combination has been reported to provide greater analgesia without significantly increasing the adverse effects that often are associated with opioid-containing analgesic combinations. When making stepwise recommendations for the management of acute postoperative dental pain, dentists should consider including ibuprofen-APAP combination therapy.
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Petejova N, Martinek A. Acute kidney injury due to rhabdomyolysis and renal replacement therapy: a critical review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:224. [PMID: 25043142 PMCID: PMC4056317 DOI: 10.1186/cc13897] [Citation(s) in RCA: 225] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Rhabdomyolysis, a clinical syndrome caused by damage to skeletal muscle and release of its breakdown products into the circulation, can be followed by acute kidney injury (AKI) as a severe complication. The belief that the AKI is triggered by myoglobin as the toxin responsible appears to be oversimplified. Better knowledge of the pathophysiology of rhabdomyolysis and following AKI could widen treatment options, leading to preservation of the kidney: the decision to initiate renal replacement therapy in clinical practice should not be made on the basis of the myoglobin or creatine phosphokinase serum concentrations.
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Zhong H, Lu J, Xia L, Zhu M, Yin H. Formation of electrophilic oxidation products from mitochondrial cardiolipin in vitro and in vivo in the context of apoptosis and atherosclerosis. Redox Biol 2014; 2:878-83. [PMID: 25061570 PMCID: PMC4099507 DOI: 10.1016/j.redox.2014.04.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 04/08/2014] [Accepted: 04/09/2014] [Indexed: 12/04/2022] Open
Abstract
Emerging evidence indicates that mitochondrial cardiolipins (CL) are prone to free radical oxidation and this process appears to be intimately associated with multiple biological functions of mitochondria. Our previous work demonstrated that a significant amount of potent lipid electrophiles including 4-hydroxy-nonenal (4-HNE) was generated from CL oxidation through a novel chemical mechanism. Here we provide further evidence that a characteristic class of CL oxidation products, epoxyalcohol-aldehyde-CL (EAA-CL), is formed through this novel mechanism in isolated mice liver mitochondria when treated with the pro-apoptotic protein t-Bid to induce cyt c release. Generation of these oxidation products are dose-dependently attenuated by a peroxidase inhibitor acetaminophen (ApAP). Using a mouse model of atherosclerosis, we detected significant amount of these CL oxidation products in liver tissue of low density lipoprotein receptor knockout (LDLR −/−) mice after Western diet feeding. Our studies highlight the importance of lipid electrophiles formation from CL oxidation in the settings of apoptosis and atherosclerosis as inhibition of CL oxidation and lipid electrophiles formation may have potential therapeutic value in diseases linked to oxidant stress and mitochondrial dysfunctions. 4-HNE and other electrophilic lipids are formed from mitochondrial cardiolipin. Novel electrophilic oxidation products EAA-CL were identified in vitro and in vivo. Level of EAA-CL in liver tissue of LDLR −/− mice is higher with Western diet feeding. ApAP dose-dependently inhibits EAA-CL formation during t-Bid induced cyt c release. CL electrophilic lipid formation is important in apoptosis and atherosclerosis.
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Key Words
- 4-HNE, 4-hydroxy-nonena
- 4-ONE, 4-oxo-2-nonenal
- 4-hydroxy-2-nonenal (4-HNE)
- ALDH2, aldehyde dehydrogenase-2
- ApAP, acetaminophen
- Apoptosis
- Atherosclerosis
- BHT, butylate hydroxytoluene
- CL, cardiolipin cyt c cytochrome c
- Cardiolipin
- EAA-CL, epoxyalcohol-aldehyde-CL
- ESI, electrospray
- ETC, electron transport chain
- Epoxyalcohol-aldehyde-CL (EAA-CL)
- H2O2, hydrogen peroxide
- HODE, hydroxyoctadienoic acid
- HpODE, hydroperoxyoctadecadienoic acid
- KODE, keto-octadecadienoic acid
- L3OCL, trilinoleoyl oleoyl cardiolipin
- L4CL, tetralinoleoyl cardiolipin
- LA, linoleic acid
- LC–MS, liquid chromatography–mass spectrometry
- LDLR −/−, low density lipoprotein receptor knockout
- Lipid peroxidation
- Liquid chromatography–mass spectrometry (LC–MS)
- M4CL, tetramyristeoyl cardiolipin
- MRM, multiple reaction monitoring
- Mitochondria
- PHGPX, hospholipid hydroperoxide glutathione peroxidase
- PUFAs, Polyunsaturated fatty acids
- Prdx3/Prx3, peroxiredoxin 3
- ROS, reactive oxygen species
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Affiliation(s)
- Huiqin Zhong
- Key Laboratory of Food Safety Research, Institute for Nutritional Sciences (INS), Shanghai Institutes for Biological Sciences (SIBS), Chinese Academy of Sciences (CAS), Shanghai, China
- University of the Chinese Academy of Sciences, CAS, Beijing, China
- Key Laboratory of Food Safety Risk Assessment, Ministry of Health, Beijing, China
| | - Jianhong Lu
- Key Laboratory of Food Safety Research, Institute for Nutritional Sciences (INS), Shanghai Institutes for Biological Sciences (SIBS), Chinese Academy of Sciences (CAS), Shanghai, China
- University of the Chinese Academy of Sciences, CAS, Beijing, China
- Key Laboratory of Food Safety Risk Assessment, Ministry of Health, Beijing, China
| | - Lin Xia
- Key Laboratory of Food Safety Research, Institute for Nutritional Sciences (INS), Shanghai Institutes for Biological Sciences (SIBS), Chinese Academy of Sciences (CAS), Shanghai, China
- Key Laboratory of Food Safety Risk Assessment, Ministry of Health, Beijing, China
| | - Mingjiang Zhu
- Key Laboratory of Food Safety Research, Institute for Nutritional Sciences (INS), Shanghai Institutes for Biological Sciences (SIBS), Chinese Academy of Sciences (CAS), Shanghai, China
- Key Laboratory of Food Safety Risk Assessment, Ministry of Health, Beijing, China
| | - Huiyong Yin
- Key Laboratory of Food Safety Research, Institute for Nutritional Sciences (INS), Shanghai Institutes for Biological Sciences (SIBS), Chinese Academy of Sciences (CAS), Shanghai, China
- University of the Chinese Academy of Sciences, CAS, Beijing, China
- Key Laboratory of Food Safety Risk Assessment, Ministry of Health, Beijing, China
- School of Life Science and Technology, ShanghaiTech University, Shanghai, China
- Correspondence to: Room 1826, New Life Science Building, 320 Yueyang Road, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China.
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The Study of Pyridazine Compounds on Prostanoids: Inhibitors of COX, cAMP Phosphodiesterase, and TXA2Synthase. J CHEM-NY 2014. [DOI: 10.1155/2014/703238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The pyridazine moiety is an important structural feature of various pharmacological active compounds. Synthetic pyridazine compounds have been reported as effective antiprostaglandins (PGs), 5-lipoxygenase (5-LOX), and antiplatelet agents, that is, inhibitors of prostaglandin or cyclooxygenase (COX-I & COX-II) enzyme, platelet cAMP phosphodiesterase, and thromboxane A2 (TXA2) synthase. These compounds are selective and nonselective COX inhibitors and showed analgesic, anti-inflammatory, and antipyretic activity. Pyridazine compounds with antiplatelet agents inhibited TXA2enzyme. Pyridazines also exhibited antirheumatoid activity. These pyridazine compounds hold considerable interest relative to the preparation of organic intermediates and other anticipated biologically active compounds.
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Probert PME, Ebrahimkhani MR, Oakley F, Mann J, Burt AD, Mann DA, Wright MC. A reversible model for periportal fibrosis and a refined alternative to bile duct ligation. Toxicol Res (Camb) 2014. [DOI: 10.1039/c3tx50069a] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Shchepin RV, Liu W, Yin H, Zagol-Ikapitte I, Amin T, Jeong BS, Roberts LJ, Oates JA, Porter NA, Boutaud O. Rational Design of Novel Pyridinol-Fused Ring Acetaminophen Analogues. ACS Med Chem Lett 2013; 4:710-714. [PMID: 24482730 DOI: 10.1021/ml4000904] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Acetaminophen (ApAP) is an electron donor capable of reducing radicals generated by redox cycling of hemeproteins. It acts on the prostaglandin H synthases (cyclooxygenases; COXs) to reduce the protoporphyrin radical cation in the peroxidase site of the enzyme, thus preventing the intra-molecular electron transfer that generates the Tyr385 radical required for abstraction of a hydrogen from arachidonic acid to initiate prostaglandin synthesis. Unrelated to this pharmacological action, metabolism of ApAP by CYPs yields an iminoquinone electrophile that is responsible for the hepatotoxicity, which results from high doses of the drug. We synthesized novel heterocyclic phenols predicted to be electron donors. Two of these inhibited the oxygenation of arachidonic acid by PGHS-1 and myoglobin and also were shown to be more metabolically stable and exhibited less direct cytotoxicity than acetaminophen. They are leading candidates for studies to determine whether they are free of the metabolism-based hepatotoxicity produced by acetaminophen.
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Affiliation(s)
- Roman V. Shchepin
- Department of Chemistry, Vanderbilt University, 7330 Stevenson Center, Station
B 351822, Nashville, Tennessee 37235, United States
| | - Wei Liu
- Department of Chemistry, Vanderbilt University, 7330 Stevenson Center, Station
B 351822, Nashville, Tennessee 37235, United States
| | - Huiyong Yin
- Department of Medicine, Division
of Clinical Pharmacology, Vanderbilt University Medical Center, 536 Robinson Research Building, Nashville, Tennessee
37232-6602, United States
| | - Irene Zagol-Ikapitte
- Department of Medicine, Division
of Clinical Pharmacology, Vanderbilt University Medical Center, 536 Robinson Research Building, Nashville, Tennessee
37232-6602, United States
| | - Taneem Amin
- Department of Medicine, Division
of Clinical Pharmacology, Vanderbilt University Medical Center, 536 Robinson Research Building, Nashville, Tennessee
37232-6602, United States
| | - Byeong-Seon Jeong
- Department of Chemistry, Vanderbilt University, 7330 Stevenson Center, Station
B 351822, Nashville, Tennessee 37235, United States
| | - L. Jackson Roberts
- Department of Medicine, Division
of Clinical Pharmacology, Vanderbilt University Medical Center, 536 Robinson Research Building, Nashville, Tennessee
37232-6602, United States
- Department of Pharmacology, Division
of Clinical Pharmacology, Vanderbilt University Medical Center, 536 Robinson Research Building, Nashville, Tennessee
37232-6602, United States
| | - John A. Oates
- Department of Medicine, Division
of Clinical Pharmacology, Vanderbilt University Medical Center, 536 Robinson Research Building, Nashville, Tennessee
37232-6602, United States
| | - Ned A. Porter
- Department of Chemistry, Vanderbilt University, 7330 Stevenson Center, Station
B 351822, Nashville, Tennessee 37235, United States
| | - Olivier Boutaud
- Department of Pharmacology, Division
of Clinical Pharmacology, Vanderbilt University Medical Center, 536 Robinson Research Building, Nashville, Tennessee
37232-6602, United States
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Engström Ruud L, Wilhelms DB, Eskilsson A, Vasilache AM, Elander L, Engblom D, Blomqvist A. Acetaminophen reduces lipopolysaccharide-induced fever by inhibiting cyclooxygenase-2. Neuropharmacology 2013; 71:124-9. [DOI: 10.1016/j.neuropharm.2013.03.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 03/11/2013] [Accepted: 03/17/2013] [Indexed: 02/02/2023]
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Modular pharmacology: deciphering the interacting structural organization of the targeted networks. Drug Discov Today 2013; 18:560-6. [DOI: 10.1016/j.drudis.2013.01.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Revised: 12/14/2012] [Accepted: 01/16/2013] [Indexed: 12/24/2022]
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Janz DR, Bastarache JA, Peterson JF, Sills G, Wickersham N, May AK, Roberts LJ, Ware LB. Association between cell-free hemoglobin, acetaminophen, and mortality in patients with sepsis: an observational study. Crit Care Med 2013; 41:784-90. [PMID: 23314583 DOI: 10.1097/ccm.0b013e3182741a54] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the association of circulating cell-free hemoglobin with poor clinical outcomes in patients with sepsis and to characterize the potential protective effects of acetaminophen, an inhibitor of hemoprotein-mediated oxidation. DESIGN Retrospective observational study. PATIENTS A total of 391 critically ill patients with sepsis in multiple ICUs in an academic tertiary care hospital. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Nonsurvivors had significantly higher plasma cell-free hemoglobin concentrations (median 20mg/dL, interquartile range 10-40) measured on enrollment compared to survivors (10mg/dL, interquartile range 10-30, p = 0.002). After controlling for potential confounders, patients with higher cell-free hemoglobin concentrations were significantly more likely to die in the hospital (odds ratio 1.078, 95% confidence interval 1.012-1.149, p = 0.02). In addition, receiving acetaminophen in the setting of increased cell-free hemoglobin was independently associated with a protective effect against death (odds ratio 0.48, 95% confidence interval 0.25-0.91, p = 0.026) and lower plasma concentrations of the lipid peroxidation product F2-isoprostanes (18.5 pg/mL, interquartile range 9-22.2) compared to no acetaminophen (42 pg/mL, interquartile range 29.7-86, p = 0.009). CONCLUSIONS In critically ill patients with sepsis, elevated concentrations of circulating cell-free hemoglobin are independently associated with an increased risk of death. Acetaminophen may exert a protective effect by reducing cell-free hemoglobin-induced oxidative injury.
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Affiliation(s)
- David R Janz
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
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