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Montealegre-Pomar A, Charpak N, Lince-Rivera C. Theophylline impact on weaning in oxygen-dependent infants followed in an outpatient Kangaroo Program. Front Pediatr 2024; 12:1344291. [PMID: 39228440 PMCID: PMC11368859 DOI: 10.3389/fped.2024.1344291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 07/31/2024] [Indexed: 09/05/2024] Open
Abstract
Background Theophylline was an orally administered xanthine used for treatment of apnea of prematurity and Bronchopulmonary Dysplasia in ambulatory follow-up of Low-Birth-Weight infants (LBWI) with oxygen-dependency in the outpatient Kangaroo Mother Care Program (KMCP). Theophylline's main metabolic product is caffeine; therefore, it was an alternative due to the frequent lack of ambulatory oral caffeine in low and middle-income countries. Objective To assess the effectiveness of oral theophylline in decreasing days with oxygen and to describe frequency of adverse related events. Methods Quasi-experiment before and after withdrawal of theophylline given systematically to LBWI with ambulatory oxygen in two KMCPs. Results 729 patients were recruited; period 1: 319 infants when theophylline was given routinely and period 2: 410 infants when theophylline was no longer used. The theophylline cohort had less gestational age, less weight at birth, more days in Neonatal Intensive Care Unit, more days of oxygen-dependency at KMCP admission, and more frequencies of Intrauterine Growth Restriction and apneas. After adjusting with propensity score matching, multiple linear regression showed that nutrition was associated with days of oxygen-dependency, but theophylline treatment not. No differences were found in frequencies of readmissions up to 40 weeks, intraventricular hemorrhage or neurodevelopmental problems. Participants in period 2 had more tachycardia episodes. Conclusions We did not find association between oral theophylline treatment and the reduction of days with ambulatory oxygen. For the current management of oxygen-dependency in LBW infants, the importance of nutrition based on exclusive breast feeding whenever possible, is the challenge.
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Affiliation(s)
- Adriana Montealegre-Pomar
- Research and Projects Department, Kangaroo Foundation, Bogotá, Colombia
- Pediatrics Department, Pontifical Javeriana University, Bogotá, Colombia
- Pediatrics Department, San Ignacio University Hospital, Bogotá, Colombia
| | - Nathalie Charpak
- Research and Projects Department, Kangaroo Foundation, Bogotá, Colombia
| | - Catalina Lince-Rivera
- Research and Projects Department, Kangaroo Foundation, Bogotá, Colombia
- Pediatrics Department, San Ignacio University Hospital, Bogotá, Colombia
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Balde A, Ramya CS, Nazeer RA. A review on current advancement in zebrafish models to study chronic inflammatory diseases and their therapeutic targets. Heliyon 2024; 10:e31862. [PMID: 38867970 PMCID: PMC11167310 DOI: 10.1016/j.heliyon.2024.e31862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 04/02/2024] [Accepted: 05/22/2024] [Indexed: 06/14/2024] Open
Abstract
Chronic inflammatory diseases are caused due to prolonged inflammation at a specific site of the body. Among other inflammatory diseases, bacterial meningitis, chronic obstructive pulmonary disease (COPD), atherosclerosis and inflammatory bowel diseases (IBD) are primarily focused on because of their adverse effects and fatality rates around the globe in recent times. In order to come up with novel strategies to eradicate these diseases, a clear understanding of the mechanisms of the diseases is needed. Similarly, detailed insight into the mechanisms of commercially available drugs and potent lead compounds from natural sources are also important to establish efficient therapeutic effects. Zebrafish is widely accepted as a model to study drug toxicity and the pharmacokinetic effects of the drug. Moreover, researchers use various inducers to trigger inflammatory cascades and stimulate physiological changes in zebrafish. The effect of these inducers contrasts with the type of zebrafish used in the investigation. Hence, a thorough analysis is required to study the current advancements in the zebrafish model for chronic inflammatory disease suppression. This review presents the most common inflammatory diseases, commercially available drugs, novel therapeutics, and their mechanisms of action for disease suppression. The review also provides a detailed description of various zebrafish models for these diseases. Finally, the future prospects and challenges for the same are described, which can help the researchers understand the potency of the zebrafish model and its further exploration for disease attenuation.
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Affiliation(s)
- Akshad Balde
- Biopharmaceuticals Lab, Department of Biotechnology, School of Bioengineering, SRM Institute of Science and Technology, Kattankulathur, 603203, Tamil Nadu, India
| | - Cunnathur Saravanan Ramya
- Biopharmaceuticals Lab, Department of Biotechnology, School of Bioengineering, SRM Institute of Science and Technology, Kattankulathur, 603203, Tamil Nadu, India
| | - Rasool Abdul Nazeer
- Biopharmaceuticals Lab, Department of Biotechnology, School of Bioengineering, SRM Institute of Science and Technology, Kattankulathur, 603203, Tamil Nadu, India
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Park HJ, Lee JU, Jeon S, Lee HS, Kim BY, Chae YJ, Kim GO, Park JW, Lee JH. Prescription patterns and effectiveness of medications for chronic obstructive pulmonary disease: A retrospective study of real-world settings. PLoS One 2024; 19:e0304362. [PMID: 38857214 PMCID: PMC11164367 DOI: 10.1371/journal.pone.0304362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 05/11/2024] [Indexed: 06/12/2024] Open
Abstract
This study aimed to define real-world prescription patterns in Korea and compare the effectiveness of chronic obstructive pulmonary disease (COPD) medications. We used national claims data provided by the Health Insurance Review and Assessment Service in Korea and examined patients who were first diagnosed with COPD and started treatment between May 1, 2017, and April 30, 2018, with no change in drug regimen. Among 30,784 patients with COPD, long-acting β2 agonist (LABA) combined with long-acting muscarinic antagonist (LAMA) (32.7%), inhaled corticosteroid-LABA (ICS-LABA) (25.6%), LAMA (18.3%), ICS (5.8%), or LABA (4.6%) were prescribed as the first-choice inhalers. The use of LABA-LAMA (hazard ratio [HR], 0.248-0.584), LAMA (HR, 0.320-0.641), ICS-LABA (HR, 0.325-0.643), and xanthine (HR, 0.563-0.828) significantly reduced the total and severe exacerbation rates compared with no use of each medication. However, the use of ICS or LABA individually did not yield such effects. The continued use of LABA-LAMA, LAMA, and ICS-LABA showed a significant effect on exacerbation rate, whereas the long-term use of ICS, LABA, and xanthine did not. Moreover, some high doses of ICS-LABA did not show significant effects. This real-world study revealed that LAMA and/or LABA could be the first choice of therapy, as recommended by recent guidelines. However, ICS, xanthine, and high-dose ICS-LABA are still being prescribed frequently as first-line drugs in Korea.
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Affiliation(s)
- Hye Jung Park
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Uk Lee
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soyoung Jeon
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bo Yeon Kim
- Healthcare Insurance Review & Assessment Service, Wonju, Republic of Korea
| | - Yu Jin Chae
- Healthcare Insurance Review & Assessment Service, Wonju, Republic of Korea
| | - Gui Ok Kim
- Healthcare Insurance Review & Assessment Service, Wonju, Republic of Korea
| | - Jung-Won Park
- Division of Allergy and Immunology, Department of Internal Medicine, Republic of Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Hyun Lee
- Division of Allergy and Immunology, Department of Internal Medicine, Republic of Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Republic of Korea
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4
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Evans S, Avdic E, Pessano S, Fiander M, Soll R, Bruschettini M. Doxapram for the prevention and treatment of apnea in preterm infants. Cochrane Database Syst Rev 2023; 10:CD014145. [PMID: 37877431 PMCID: PMC10598592 DOI: 10.1002/14651858.cd014145.pub2] [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] [Indexed: 10/26/2023]
Abstract
BACKGROUND Apnea of prematurity is a common problem in preterm infants that may have significant consequences on their development. Methylxanthines (aminophylline, theophylline, and caffeine) are effective in the treatment of apnea of prematurity. Doxapram is used as a respiratory stimulant in cases refractory to the methylxanthine treatment. OBJECTIVES To evaluate the benefits and harms of doxapram administration on the incidence of apnea and other short-term and longer-term clinical outcomes in preterm infants. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was March 2023. SELECTION CRITERIA We included randomized controlled trials (RCTs) assessing the role of doxapram in prevention and treatment of apnea of prematurity and prevention of reintubation in preterm infants (less than 37 weeks' gestation). We included studies comparing doxapram with either placebo or methylxanthines as a control group, or when doxapram was used as an adjunct to methylxanthines and compared to methylxanthines alone as a control group. We included studies of doxapram at any dose and route. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were clinical apnea, need for positive pressure ventilation after initiation of treatment, failed apnea reduction after two to seven days, and failed extubation (defined as unable to wean from invasive intermittent positive pressure ventilation [IPPV] and extubate or reintubation for IPPV within one week). We used GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS We included eight RCTs enrolling 248 infants. Seven studies (214 participants) provided data for meta-analysis. Five studied doxapram for treatment of apnea in preterm infants. Three studied doxapram to prevent reintubation in preterm infants. None studied doxapram in preventing apnea in preterm infants. All studies administered doxapram intravenously as continuous infusions. Two studies used doxapram as an adjunct to aminophylline compared to aminophylline alone and one study as an adjunct to caffeine compared to caffeine alone. When used to treat apnea, compared to no treatment, doxapram may result in a slight reduction in failed apnea reduction (risk ratio [RR] 0.45, 95% confidence interval [CI] 0.20 to 1.05; 1 study, 21 participants; low-certainty evidence). The evidence is very uncertain about the effect of doxapram on need for positive pressure ventilation after initiation of treatment (RR 0.31, 95% CI 0.01 to 6.74; 1 study, 21 participants; very low-certainty evidence). Doxapram may result in little to no difference in side effects causing cessation of therapy (0 events in both groups; risk difference [RD] 0.00, 95% CI -0.17 to 0.17; 1 study, 21 participants; low-certainty evidence). Compared to alternative treatment, the evidence is very uncertain about the effect of doxapram on failed apnea reduction (RR 1.35, 95% CI 0.53 to 3.45; 4 studies, 84 participants; very low-certainty evidence). The evidence is very uncertain about the effect of doxapram on need for positive pressure ventilation after initiation of treatment (RR 2.40, 95% CI 0.11 to 51.32; 2 studies, 37 participants; very-low certainty evidence; note 1 study recorded 0 events in both groups. Thus, the RR and CIs were calculated from 1 study rather than 2). Doxapram may result in little to no difference in side effects causing cessation of therapy (0 events in all groups; RD 0.00, 95% CI -0.15 to 0.15; 37 participants; 2 studies; low-certainty evidence). As adjunct therapy to methylxanthine, the evidence is very uncertain about the effect of doxapram on failed apnea reduction after two to seven days (RR 0.08, 95% CI 0.01 to 1.17; 1 study, 10 participants; very low-certainty evidence). No studies reported on clinical apnea, chronic lung disease at 36 weeks' postmenstrual age (PMA), death at any time during initial hospitalization, long-term neurodevelopmental outcomes in the three comparisons, and need for positive pressure ventilation and side effects when used as adjunct therapy to methylxanthine. In studies to prevent reintubation, when compared to alternative treatment, the evidence is very uncertain about the effect of doxapram on failed extubation (RR 0.43, 95% CI 0.10 to 1.83; 1 study, 25 participants; very low-certainty evidence). As adjunct therapy to methylxanthine, doxapram may result in a slight reduction in 'clinical apnea' after initiation of treatment (RR 0.36, 95% CI 0.13 to 0.98; 1 study, 56 participants; low-certainty evidence). Doxapram may result in little to no difference in failed extubation (RR 0.92, 95% CI 0.52 to 1.62; 1 study, 56 participants; low-certainty evidence). The evidence is very uncertain about the effect of doxapram on side effects causing cessation of therapy (RR 6.42, 95% CI 0.80 to 51.26; 2 studies, 85 participants; very low-certainty evidence). No studies reported need for positive pressure ventilation, chronic lung disease at 36 weeks' PMA, long-term neurodevelopmental outcomes in the three comparisons; failed extubation when compared to no treatment; and clinical apnea, death at any time during initial hospitalization, and side effects when compared to no treatment or alternative treatment. We identified two ongoing studies, one conducted in Germany and one in multiple centers in the Netherlands and Belgium. AUTHORS' CONCLUSIONS In treating apnea of prematurity, doxapram may slightly reduce failure in apnea reduction when compared to no treatment and there may be little to no difference in side effects against both no treatment and alternative treatment. The evidence is very uncertain about the need for positive pressure ventilation when compared to no treatment or alternative treatment and about failed apnea reduction when used as alternative or adjunct therapy to methylxanthine. For use to prevent reintubation, doxapram may reduce apnea episodes when administered in adjunct to methylxanthine, but with little to no difference in failed extubation. The evidence is very uncertain about doxapram's effect on death when used as adjunct therapy to methylxanthine and about failed extubation when used as alternative or adjunct therapy to methylxanthine. There is a knowledge gap about the use of doxapram as a therapy to prevent apnea. More studies are needed to clarify the role of doxapram in the treatment of apnea of prematurity, addressing concerns about long-term outcomes. The ongoing studies may provide useful data.
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Affiliation(s)
- Shannon Evans
- Neonatal-Perinatal Medicine, Norton Children's Neonatology, affiliated with the University of Louisville School of Medicine, Louisville, Kentucky, USA
| | | | - Sara Pessano
- Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Roger Soll
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Matteo Bruschettini
- Paediatrics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
- Cochrane Sweden, Department of Research and Education, Lund University, Skåne University Hospital, Lund, Sweden
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5
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Kubacka M, Mogilski S, Bednarski M, Pociecha K, Świerczek A, Nicosia N, Schabikowski J, Załuski M, Chłoń-Rzepa G, Hockemeyer J, Müller CE, Kieć-Kononowicz K, Kotańska M. Antiplatelet Effects of Selected Xanthine-Based Adenosine A 2A and A 2B Receptor Antagonists Determined in Rat Blood. Int J Mol Sci 2023; 24:13378. [PMID: 37686188 PMCID: PMC10487961 DOI: 10.3390/ijms241713378] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/19/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
The platelet aggregation inhibitory activity of selected xanthine-based adenosine A2A and A2B receptor antagonists was investigated, and attempts were made to explain the observed effects. The selective A2B receptor antagonist PSB-603 and the A2A receptor antagonist TB-42 inhibited platelet aggregation induced by collagen or ADP. In addition to adenosine receptor blockade, the compounds were found to act as moderately potent non-selective inhibitors of phosphodiesterases (PDEs). TB-42 showed the highest inhibitory activity against PDE3A along with moderate activity against PDE2A and PDE5A. The antiplatelet activity of PSB-603 and TB-42 may be due to inhibition of PDEs, which induces an increase in cAMP and/or cGMP concentrations in platelets. The xanthine-based adenosine receptor antagonists were found to be non-cytotoxic for platelets. Some of the compounds showed anti-oxidative properties reducing lipid peroxidation. These results may provide a basis for the future development of multi-target xanthine derivatives for the treatment of inflammation and atherosclerosis and the prevention of heart infarction and stroke.
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Affiliation(s)
- Monika Kubacka
- Department of Pharmacodynamics, Jagiellonian University Medical College, 9 Medyczna Street, 30-688 Krakow, Poland; (M.K.); (S.M.)
| | - Szczepan Mogilski
- Department of Pharmacodynamics, Jagiellonian University Medical College, 9 Medyczna Street, 30-688 Krakow, Poland; (M.K.); (S.M.)
| | - Marek Bednarski
- Department of Pharmacological Screening, Jagiellonian University Medical College, 9 Medyczna Street, 30-688 Krakow, Poland; (M.B.); (N.N.)
| | - Krzysztof Pociecha
- Department of Pharmacokinetics and Physical Pharmacy, Jagiellonian University Medical College, 9 Medyczna Street, 30-688 Krakow, Poland; (K.P.); (A.Ś.)
| | - Artur Świerczek
- Department of Pharmacokinetics and Physical Pharmacy, Jagiellonian University Medical College, 9 Medyczna Street, 30-688 Krakow, Poland; (K.P.); (A.Ś.)
| | - Noemi Nicosia
- Department of Pharmacological Screening, Jagiellonian University Medical College, 9 Medyczna Street, 30-688 Krakow, Poland; (M.B.); (N.N.)
- Division of Neuroscience, Vita Salute San Raffaele University, 20132 Milan, Italy
| | - Jakub Schabikowski
- Department of Technology and Biotechnology of Drugs, Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna Street, 30-688 Krakow, Poland; (J.S.); (M.Z.); (K.K.-K.)
| | - Michał Załuski
- Department of Technology and Biotechnology of Drugs, Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna Street, 30-688 Krakow, Poland; (J.S.); (M.Z.); (K.K.-K.)
| | - Grażyna Chłoń-Rzepa
- Department of Medicinal Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna Street, 30-688 Kraków, Poland;
| | - Jörg Hockemeyer
- PharmaCenter Bonn, Pharmaceutical Institute, Pharmaceutical & Medicinal Chemistry, An der Immenburg 4, D-53121 Bonn, Germany; (J.H.); (C.E.M.)
| | - Christa E. Müller
- PharmaCenter Bonn, Pharmaceutical Institute, Pharmaceutical & Medicinal Chemistry, An der Immenburg 4, D-53121 Bonn, Germany; (J.H.); (C.E.M.)
| | - Katarzyna Kieć-Kononowicz
- Department of Technology and Biotechnology of Drugs, Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna Street, 30-688 Krakow, Poland; (J.S.); (M.Z.); (K.K.-K.)
| | - Magdalena Kotańska
- Department of Pharmacological Screening, Jagiellonian University Medical College, 9 Medyczna Street, 30-688 Krakow, Poland; (M.B.); (N.N.)
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6
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Shah BK, Singh B, Wang Y, Xie S, Wang C. Mucus Hypersecretion in Chronic Obstructive Pulmonary Disease and Its Treatment. Mediators Inflamm 2023; 2023:8840594. [PMID: 37457746 PMCID: PMC10344637 DOI: 10.1155/2023/8840594] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/29/2023] [Accepted: 06/23/2023] [Indexed: 07/18/2023] Open
Abstract
Most patients diagnosed with chronic obstructive pulmonary disease (COPD) present with hallmark features of airway mucus hypersecretion, including cough and expectoration. Airway mucus function as a native immune system of the lung that severs to trap particulate matter and pathogens and allows them to clear from the lung via cough and ciliary transport. Chronic mucus hypersecretion (CMH) is the main factor contributing to the increased risk of morbidity and mortality in specific subsets of COPD patients. It is, therefore, primarily important to develop medications that suppress mucus hypersecretions in these patients. Although there have been some advances in COPD treatment, more work remains to be done to better understand the mechanism underlying airway mucus hypersecretion and seek more effective treatments. This review article discusses the structure and significance of mucus in the lungs focusing on gel-forming mucins and the impacts of CMH in the lungs. Furthermore, we summarize the article with pharmacological and nonpharmacological treatments as well as novel and interventional procedures to control CMH in COPD patients.
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Affiliation(s)
- Binay Kumar Shah
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
- Tongji University School of Medicine, Shanghai 200092, China
| | - Bivek Singh
- Tongji University School of Medicine, Shanghai 200092, China
| | - Yukun Wang
- Tongji University School of Medicine, Shanghai 200092, China
| | - Shuanshuan Xie
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Changhui Wang
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
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7
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Calzetta L, Chetta A, Aiello M, Pistocchini E, Rogliani P. The Impact of Corticosteroids on Human Airway Smooth Muscle Contractility and Airway Hyperresponsiveness: A Systematic Review. Int J Mol Sci 2022; 23:ijms232315285. [PMID: 36499612 PMCID: PMC9738299 DOI: 10.3390/ijms232315285] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/08/2022] Open
Abstract
Classically, the effects elicited by corticosteroids (CS) are mediated by the binding and activation of cytosolic glucocorticoid receptors (GR). However, several of the non-genomic effects of CS seem to be mediated by putative non-classic membrane receptors characterized by pharmacological properties that are different from those of classic cytosolic GR. Since pre-clinical findings suggest that inhaled CS (ICS) may also regulate the bronchial contractile tone via putative CS membrane-associate receptors, the aim of this review was to systematically report and discuss the impact of CS on human airway smooth muscle (ASM) contractility and airway hyperresponsiveness (AHR). Current evidence indicates that CS have significant genomic/non-genomic beneficial effects on human ASM contractility and AHR, regardless of their anti-inflammatory effects. CS are effective in reducing either the expression, synthesis or activity of α-actin, CD38, inositol phosphate, myosin light chain kinase, and ras homolog family member A in response to several pro-contractile stimuli; overall these effects are mediated by the genomic action of CS. Moreover, CS elicited a strong bronchorelaxant effect via the rapid activation of the Gsα-cyclic-adenosine-monophosphate-protein-kinase-A pathway in hyperresponsive airways. The possibility of modulating the dose of the ICS in a triple ICS/long-acting β2-adrenoceptor agonist/long-acting muscarinic antagonist fixed-dose combination supports the use of a Triple MAintenance and Reliever Therapy (TriMART) in those asthmatic patients at Step 3-5 who may benefit from a sustained bronchodilation and have been suffering from an increased parasympathetic tone.
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Affiliation(s)
- Luigino Calzetta
- Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Correspondence:
| | - Alfredo Chetta
- Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Marina Aiello
- Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Elena Pistocchini
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
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8
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Bondarev AD, Attwood MM, Jonsson J, Chubarev VN, Tarasov VV, Liu W, Schiöth HB. Recent developments of phosphodiesterase inhibitors: Clinical trials, emerging indications and novel molecules. Front Pharmacol 2022; 13:1057083. [PMID: 36506513 PMCID: PMC9731127 DOI: 10.3389/fphar.2022.1057083] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/04/2022] [Indexed: 11/25/2022] Open
Abstract
The phosphodiesterase (PDE) enzymes, key regulator of the cyclic nucleotide signal transduction system, are long-established as attractive therapeutic targets. During investigation of trends within clinical trials, we have identified a particularly high number of clinical trials involving PDE inhibitors, prompting us to further evaluate the current status of this class of therapeutic agents. In total, we have identified 87 agents with PDE-inhibiting capacity, of which 85 interact with PDE enzymes as primary target. We provide an overview of the clinical drug development with focus on the current clinical uses, novel molecules and indications, highlighting relevant clinical studies. We found that the bulk of current clinical uses for this class of therapeutic agents are chronic obstructive pulmonary disease (COPD), vascular and cardiovascular disorders and inflammatory skin conditions. In COPD, particularly, PDE inhibitors are characterised by the compliance-limiting adverse reactions. We discuss efforts directed to appropriately adjusting the dose regimens and conducting structure-activity relationship studies to determine the effect of structural features on safety profile. The ongoing development predominantly concentrates on central nervous system diseases, such as schizophrenia, Alzheimer's disease, Parkinson's disease and fragile X syndrome; notable advancements are being also made in mycobacterial infections, HIV and Duchenne muscular dystrophy. Our analysis predicts the diversification of PDE inhibitors' will continue to grow thanks to the molecules in preclinical development and the ongoing research involving drugs in clinical development.
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Affiliation(s)
- Andrey D. Bondarev
- Department of Surgical Sciences, Functional Pharmacology and Neuroscience, Uppsala University, Uppsala, Sweden
| | - Misty M. Attwood
- Department of Surgical Sciences, Functional Pharmacology and Neuroscience, Uppsala University, Uppsala, Sweden
| | - Jörgen Jonsson
- Department of Surgical Sciences, Functional Pharmacology and Neuroscience, Uppsala University, Uppsala, Sweden
| | | | | | - Wen Liu
- Department of Surgical Sciences, Functional Pharmacology and Neuroscience, Uppsala University, Uppsala, Sweden
| | - Helgi B. Schiöth
- Department of Surgical Sciences, Functional Pharmacology and Neuroscience, Uppsala University, Uppsala, Sweden,*Correspondence: Helgi B. Schiöth,
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9
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Aprile S, Colombo G, Serafini M, Di Paola R, Pisati F, Bhela IP, Cuzzocrea S, Grosa G, Pirali T. An Unexpected Deuterium-Induced Metabolic Switch in Doxophylline. ACS Med Chem Lett 2022; 13:1278-1285. [PMID: 35978700 PMCID: PMC9377007 DOI: 10.1021/acsmedchemlett.2c00166] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/11/2022] [Indexed: 01/03/2023] Open
Abstract
Precision deuteration has become part of the medicinal chemist's toolbox, but its usefulness can be undermined by unpredictable metabolic switch effects. Herein we report the deuteration of doxophylline, a drug used in the treatment of asthma and COPD that undergoes extensive oxidative metabolism. Labeling of the main metabolic soft spots triggered an unexpected multidirectional metabolic switch that, while not improving the pharmacokinetic parameters, changed the metabolic scenario and, in turn, the pharmacodynamic features in two murine models of lung injury.
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Affiliation(s)
- Silvio Aprile
- Department
of Pharmaceutical Sciences, Università
del Piemonte Orientale, 28100 Novara, Italy
| | - Giorgia Colombo
- Department
of Pharmaceutical Sciences, Università
del Piemonte Orientale, 28100 Novara, Italy
| | - Marta Serafini
- Department
of Pharmaceutical Sciences, Università
del Piemonte Orientale, 28100 Novara, Italy
| | - Rosanna Di Paola
- Department
of Chemical, Biological, Pharmaceutical and Environmental Sciences, Università di Messina, 98166 Messina, Italy
| | - Federica Pisati
- Histopathology
Unit, Cogentech S.C.a.R.L., 20139 Milan, Italy
| | - Irene Preet Bhela
- Department
of Pharmaceutical Sciences, Università
del Piemonte Orientale, 28100 Novara, Italy
| | - Salvatore Cuzzocrea
- Department
of Chemical, Biological, Pharmaceutical and Environmental Sciences, Università di Messina, 98166 Messina, Italy
| | - Giorgio Grosa
- Department
of Pharmaceutical Sciences, Università
del Piemonte Orientale, 28100 Novara, Italy
| | - Tracey Pirali
- Department
of Pharmaceutical Sciences, Università
del Piemonte Orientale, 28100 Novara, Italy
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10
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Patil VB, Malode SJ, Mangasuli SN, Tuwar SM, Mondal K, Shetti NP. An Electrochemical Electrode to Detect Theophylline Based on Copper Oxide Nanoparticles Composited with Graphene Oxide. MICROMACHINES 2022; 13:mi13081166. [PMID: 35893164 PMCID: PMC9394302 DOI: 10.3390/mi13081166] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 02/04/2023]
Abstract
The electrochemical analysis of theophylline (THP) was investigated by fabricating a carbon paste electrode (CPE) modified with graphene oxide (GO) along with copper oxide (CuO) nanoparticles (CuO-GO/CPE). The impact of electro-kinetic parameters such as the heterogeneous rate constant, the scan rate, the accumulation time, the pH, the transfer coefficient, and the number of electrons and protons transferred into the electro-oxidation mechanism of THP has been studied utilizing electrochemical methods such as cyclic voltammetry (CV) and differential pulse voltammetry (DPV). The differential pulse voltammetry technique was employed to investigate THP in pharmaceutical and biological samples, confirming the limit of detection (LOD) and quantification (LOQ) of the THP. X-ray diffraction (XRD) and scanning electron microscopy (SEM) analysis were performed to characterize the CuO nanoparticles. The CuO-GO/CPE was more sensitive in THP detection because its electrocatalytic characteristics displayed an enhanced peak current in the 0.2 M supporting electrolyte of pH 6.0, proving the excellent sensing functioning of the modified electrode.
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Affiliation(s)
- Vinoda B. Patil
- Department of Chemistry, Karnatak Science College, Dharwad 580001, Karnataka, India; (V.B.P.); (S.N.M.)
| | - Shweta J. Malode
- Department of Chemistry, School of Advanced Sciences, KLE Technological University, Vidyanagar, Hubballi 580031, Karnataka, India;
| | - Sumitra N. Mangasuli
- Department of Chemistry, Karnatak Science College, Dharwad 580001, Karnataka, India; (V.B.P.); (S.N.M.)
| | - Suresh M. Tuwar
- Department of Chemistry, Karnatak Science College, Dharwad 580001, Karnataka, India; (V.B.P.); (S.N.M.)
- Correspondence: (S.M.T.); (K.M.); (N.P.S.)
| | - Kunal Mondal
- Idaho National Laboratory, Idaho Falls, ID 83415, USA
- Correspondence: (S.M.T.); (K.M.); (N.P.S.)
| | - Nagaraj P. Shetti
- Department of Chemistry, School of Advanced Sciences, KLE Technological University, Vidyanagar, Hubballi 580031, Karnataka, India;
- Correspondence: (S.M.T.); (K.M.); (N.P.S.)
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11
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Adenosine Receptor Signaling in Diseases with Focus on Cancer. JORJANI BIOMEDICINE JOURNAL 2022. [DOI: 10.52547/jorjanibiomedj.10.1.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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12
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Electrochemical Sensor Based on CuO Nanoparticles Fabricated From Copper Wire Recycling-loaded Carbon Paste Electrode for Excellent Detection of Theophylline in Pharmaceutical Formulations. Electrocatalysis (N Y) 2022. [DOI: 10.1007/s12678-021-00698-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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13
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Kowalski R, Pikul P, Lewandowski K, Sakowicz-Burkiewicz M, Pawełczyk T, Zyśk M. The cAMP Inducers Modify N-Acetylaspartate Metabolism in Wistar Rat Brain. Antioxidants (Basel) 2021; 10:1404. [PMID: 34573036 PMCID: PMC8466109 DOI: 10.3390/antiox10091404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 12/22/2022] Open
Abstract
Neuronal N-acetylaspartate production appears in the presence of aspartate N-acetyltransferase (NAT8L) and binds acetyl groups from acetyl-CoA with aspartic acid. Further N-acetylaspartate pathways are still being elucidated, although they seem to involve neuron-glia crosstalk. Together with N-acetylaspartate, NAT8L takes part in oligoglia and astroglia cell maturation, myelin production, and dopamine-dependent brain signaling. Therefore, understanding N-acetylaspartate metabolism is an emergent task in neurobiology. This project used in in vitro and in vivo approaches in order to establish the impact of maturation factors and glial cells on N-acetylaspartate metabolism. Embryonic rat neural stem cells and primary neurons were maturated with either nerve growth factor, trans-retinoic acid or activators of cAMP-dependent protein kinase A (dibutyryl-cAMP, forskolin, theophylline). For in vivo, adult male Wistar rats were injected with theophylline (20 mg/kg b.w.) daily for two or eight weeks. Our studies showed that the N-acetylaspartate metabolism differs between primary neurons and neural stem cell cultures. The presence of glia cells protected N-acetylaspartate metabolism from dramatic changes within the maturation processes, which was impossible in the case of pure primary neuron cultures. In the case of differentiation processes, our data points to dibutyryl-cAMP as the most prominent regulator of N-acetylaspartate metabolism.
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Affiliation(s)
- Robert Kowalski
- University Clinical Center in Gdansk, 80-952 Gdansk, Poland; (R.K.); (K.L.)
| | - Piotr Pikul
- Laboratory of Molecular and Cellular Nephrology, Mossakowski Medical Research Institute, Polish Academy of Sciences, 80-308 Gdansk, Poland;
| | - Krzysztof Lewandowski
- University Clinical Center in Gdansk, 80-952 Gdansk, Poland; (R.K.); (K.L.)
- Department of Laboratory Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Monika Sakowicz-Burkiewicz
- Department of Molecular Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland; (M.S.-B.); (T.P.)
| | - Tadeusz Pawełczyk
- Department of Molecular Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland; (M.S.-B.); (T.P.)
| | - Marlena Zyśk
- Department of Molecular Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland; (M.S.-B.); (T.P.)
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14
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Martin C, Burgel PR, Roche N. Inhaled Dual Phosphodiesterase 3/4 Inhibitors for the Treatment of Patients with COPD: A Short Review. Int J Chron Obstruct Pulmon Dis 2021; 16:2363-2373. [PMID: 34429594 PMCID: PMC8378910 DOI: 10.2147/copd.s226688] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/19/2021] [Indexed: 11/23/2022] Open
Abstract
Current pharmacological treatments for chronic obstructive pulmonary disease (COPD) are mostly limited to inhaled bronchodilators and corticosteroids. Azithromycin can contribute to exacerbation prevention. Roflumilast, a phosphodiesterase (PDE) 4 inhibitor administered orally, also prevents exacerbations in selected patients with chronic bronchitis, recurrent exacerbations, severe airflow limitation and concomitant therapy with long-acting inhaled bronchodilators. This outcome likely results from anti-inflammatory effects since PDE4 is expressed by all inflammatory cell types involved in COPD. The use of this agent is, however, limited by side-effects, particularly nausea and diarrhea. To address remaining unmet needs and enrich therapeutic options for patients with COPD, inhaled dual PDE3/4 inhibitors have been developed, with the aim of enhancing bronchodilation through PDE3 inhibition and modulating inflammation and mucus production though PDE4 inhibition, thus producing a potentially synergistic effect on airway calibre. Experimental preclinical data confirmed these effects in vitro and in animal models. At present, RPL554/ensifentrine is the only agent of this family in clinical development. It decreases sputum markers of both neutrophilic and eosinophilic inflammation in patients with COPD. Clinical Phase II trials confirmed its bronchodilator effect and demonstrated clinically meaningful symptom relief and quality of life improvements in these patients. The safety profile appears satisfactory, with less effects on heart rate and blood pressure than salbutamol and no other side effect. Altogether, these data suggest that ensifentrine could have a role in COPD management, especially in addition to inhaled long-acting bronchodilators with or without corticosteroids since experimental studies suggest potentiation of ensifentrine effects by these agents. However, results from ongoing and future Phase III studies are needed to confirm both beneficial effects and favourable safety profile on a larger scale and assess other outcomes including exacerbations, lung function decline, comorbidities and mortality.
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Affiliation(s)
- Clémence Martin
- AP-HP Centre, Hôpital Cochin, Service de Pneumologie, Paris, France.,Université de Paris, Institut Cochin, INSERM UMR 1016, Paris, France
| | - Pierre-Régis Burgel
- AP-HP Centre, Hôpital Cochin, Service de Pneumologie, Paris, France.,Université de Paris, Institut Cochin, INSERM UMR 1016, Paris, France
| | - Nicolas Roche
- AP-HP Centre, Hôpital Cochin, Service de Pneumologie, Paris, France.,Université de Paris, Institut Cochin, INSERM UMR 1016, Paris, France
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15
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Abstract
Inhaled therapy remains the cornerstone of chronic obstructive pulmonary disease pharmacologic care, but some systemic treatments can be of help when the burden of the disease remains high. Azithromycin, phosphodiesterase-4 inhibitors, and mucoactive agents can be used in such situations. The major difficulty remains in the identification of the optimal target populations. Another difficulty is to determine how these treatments should be positioned in the global treatment algorithm. For instance, should they be prescribed in addition to other antiinflammatory agents or should they replace them in some cases? Research is ongoing to identify new therapeutic targets.
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Affiliation(s)
- Nicolas Roche
- Respiratory Medicine, Pneumologie et Soins Intensifs Respiratoires, APHP Centre, Cochin Hospital, Université de Paris (Descartes), Institut Cochin (UMR 1016), 27, rue du Fbg St Jacques, Paris 75014, France.
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16
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Mokra D, Mokry J. Phosphodiesterase Inhibitors in Acute Lung Injury: What Are the Perspectives? Int J Mol Sci 2021; 22:1929. [PMID: 33669167 PMCID: PMC7919656 DOI: 10.3390/ijms22041929] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/12/2021] [Accepted: 02/14/2021] [Indexed: 12/14/2022] Open
Abstract
Despite progress in understanding the pathophysiology of acute lung damage, currently approved treatment possibilities are limited to lung-protective ventilation, prone positioning, and supportive interventions. Various pharmacological approaches have also been tested, with neuromuscular blockers and corticosteroids considered as the most promising. However, inhibitors of phosphodiesterases (PDEs) also exert a broad spectrum of favorable effects potentially beneficial in acute lung damage. This article reviews pharmacological action and therapeutical potential of nonselective and selective PDE inhibitors and summarizes the results from available studies focused on the use of PDE inhibitors in animal models and clinical studies, including their adverse effects. The data suggest that xanthines as representatives of nonselective PDE inhibitors may reduce acute lung damage, and decrease mortality and length of hospital stay. Various (selective) PDE3, PDE4, and PDE5 inhibitors have also demonstrated stabilization of the pulmonary epithelial-endothelial barrier and reduction the sepsis- and inflammation-increased microvascular permeability, and suppression of the production of inflammatory mediators, which finally resulted in improved oxygenation and ventilatory parameters. However, the current lack of sufficient clinical evidence limits their recommendation for a broader use. A separate chapter focuses on involvement of cyclic adenosine monophosphate (cAMP) and PDE-related changes in its metabolism in association with coronavirus disease 2019 (COVID-19). The chapter illuminates perspectives of the use of PDE inhibitors as an add-on treatment based on actual experimental and clinical trials with preliminary data suggesting their potential benefit.
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Affiliation(s)
- Daniela Mokra
- Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 03601 Martin, Slovakia
| | - Juraj Mokry
- Department of Pharmacology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 03601 Martin, Slovakia;
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17
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Matera MG, Cazzola M, Page C. Prospects for COPD treatment. Curr Opin Pharmacol 2020; 56:74-84. [PMID: 33333428 DOI: 10.1016/j.coph.2020.11.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/10/2020] [Indexed: 02/09/2023]
Abstract
The management of chronic obstructive pulmonary disease (COPD) is fundamentally still heavily dependent on the use of bronchodilators and corticosteroids. Therefore, there is a need for alternative, more effective and safer therapeutic approaches. In particular, since inflammation in COPD lungs is often poorly responsive to corticosteroid treatment, novel pharmacological anti-inflammatory approaches are needed to optimally treat COPD patients. There have been multiple attempts to develop drugs that inhibit recruitment and activation of inflammatory cells, such as macrophages, neutrophils and T-lymphocytes, in the lungs of patients with COPD or target inflammatory mediators that are important in the recruitment or activation of these inflammatory cells or released by such cells. This review article focuses on novel classes of anti-inflammatory drugs that have already been tested in humans as possible treatments for patients with COPD.
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Affiliation(s)
- Maria Gabriella Matera
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mario Cazzola
- Chair of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy.
| | - Clive Page
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, UK
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18
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Abstract
Inhaled therapy remains the cornerstone of chronic obstructive pulmonary disease pharmacologic care, but some systemic treatments can be of help when the burden of the disease remains high. Azithromycin, phosphodiesterase-4 inhibitors, and mucoactive agents can be used in such situations. The major difficulty remains in the identification of the optimal target populations. Another difficulty is to determine how these treatments should be positioned in the global treatment algorithm. For instance, should they be prescribed in addition to other antiinflammatory agents or should they replace them in some cases? Research is ongoing to identify new therapeutic targets.
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Affiliation(s)
- Nicolas Roche
- Respiratory Medicine, Pneumologie et Soins Intensifs Respiratoires, APHP Centre, Cochin Hospital, Université de Paris (Descartes), Institut Cochin (UMR 1016), 27, rue du Fbg St Jacques, Paris 75014, France.
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19
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Matera MG, Page CP, Calzetta L, Rogliani P, Cazzola M. Pharmacology and Therapeutics of Bronchodilators Revisited. Pharmacol Rev 2020; 72:218-252. [PMID: 31848208 DOI: 10.1124/pr.119.018150] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Bronchodilators remain the cornerstone of the treatment of airway disorders such as asthma and chronic obstructive pulmonary disease (COPD). There is therefore considerable interest in understanding how to optimize the use of our existing classes of bronchodilator and in identifying novel classes of bronchodilator drugs. However, new classes of bronchodilator have proved challenging to develop because many of these have no better efficacy than existing classes of bronchodilator and often have unacceptable safety profiles. Recent research has shown that optimization of bronchodilation occurs when both arms of the autonomic nervous system are affected through antagonism of muscarinic receptors to reduce the influence of parasympathetic innervation of the lung and through stimulation of β 2-adrenoceptors (β 2-ARs) on airway smooth muscle with β 2-AR-selective agonists to mimic the sympathetic influence on the lung. This is currently achieved by use of fixed-dose combinations of inhaled long-acting β 2-adrenoceptor agonists (LABAs) and long-acting muscarinic acetylcholine receptor antagonists (LAMAs). Due to the distinct mechanisms of action of LAMAs and LABAs, the additive/synergistic effects of using these drug classes together has been extensively investigated. More recently, so-called "triple inhalers" containing fixed-dose combinations of both classes of bronchodilator (dual bronchodilation) and an inhaled corticosteroid in the same inhaler have been developed. Furthermore, a number of so-called "bifunctional drugs" having two different primary pharmacological actions in the same molecule are under development. This review discusses recent advancements in knowledge on bronchodilators and bifunctional drugs for the treatment of asthma and COPD. SIGNIFICANCE STATEMENT: Since our last review in 2012, there has been considerable research to identify novel classes of bronchodilator drugs, to further understand how to optimize the use of the existing classes of bronchodilator, and to better understand the role of bifunctional drugs in the treatment of asthma and chronic obstructive pulmonary disease.
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Affiliation(s)
- M G Matera
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy (M.G.M.); Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom (C.P.P.); and Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy (L.C., P.R., M.C.)
| | - C P Page
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy (M.G.M.); Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom (C.P.P.); and Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy (L.C., P.R., M.C.)
| | - L Calzetta
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy (M.G.M.); Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom (C.P.P.); and Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy (L.C., P.R., M.C.)
| | - P Rogliani
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy (M.G.M.); Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom (C.P.P.); and Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy (L.C., P.R., M.C.)
| | - M Cazzola
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy (M.G.M.); Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom (C.P.P.); and Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy (L.C., P.R., M.C.)
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20
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Phillips JE. Inhaled Phosphodiesterase 4 (PDE4) Inhibitors for Inflammatory Respiratory Diseases. Front Pharmacol 2020; 11:259. [PMID: 32226383 PMCID: PMC7080983 DOI: 10.3389/fphar.2020.00259] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/24/2020] [Indexed: 01/09/2023] Open
Abstract
PDE4 inhibitors can suppress a variety of inflammatory cell functions that contribute to their anti-inflammatory actions in respiratory diseases like chronic obstructive pulmonary disease (COPD) and asthma. The systemically delivered PDE4 inhibitor roflumilast has been approved for use in a subset of patients with severe COPD with chronic bronchitis and a history of exacerbations. Use of systemically delivered PDE4 inhibitors has been limited by systemic side effects. Inhaled PDE4 inhibitors have been considered as a viable alternative to increase tolerability and determine the maximum therapeutic potential of PDE4 inhibition in respiratory diseases.
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Affiliation(s)
- Jonathan E. Phillips
- Department of Inflammation Research, Amgen Research, Thousand Oaks, CA, United States
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21
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Zhao X, Ma H, Pan Q, Wang H, Qian X, Song P, Zou L, Mao M, Xia S, Ge G, Yang L. Theophylline Acetaldehyde as the Initial Product in Doxophylline Metabolism in Human Liver. Drug Metab Dispos 2020; 48:345-352. [PMID: 32086296 DOI: 10.1124/dmd.119.089565] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/30/2020] [Indexed: 11/22/2022] Open
Abstract
Doxophylline (DOXO) and theophylline are widely used as bronchodilators for treating asthma and chronic obstructive pulmonary disease, and DOXO has a better safety profile than theophylline. How DOXO's metabolism and disposition affect its antiasthmatic efficacy and safety remains to be explored. In this study, the metabolites of DOXO were characterized. A total of nine metabolites of DOXO were identified in vitro using liver microsomes from human and four other animal species. Among them, six metabolites were reported for the first time. The top three metabolites were theophylline acetaldehyde (M1), theophylline-7-acetic acid (M2), and etophylline (M4). A comparative analysis of DOXO metabolism in human using liver microsomes, S9 fraction, and plasma samples demonstrated the following: 1) The metabolism of DOXO began with a cytochrome P450 (P450)-mediated, rate-limiting step at the C ring and produced M1, the most abundant metabolite in human liver microsomes. However, in human plasma, the M1 production was rather low. 2) M1 was further converted to M2 and M4, the end products of DOXO metabolism in vivo, by non-P450 dismutase in the cytosol. This dismutation process also relied on the ratio of NADP+/NADPH in the cell. These findings for the first time elucidated the metabolic sites and routes of DOXO metabolism in human. SIGNIFICANCE STATEMENT: We systematically characterized doxophylline metabolism using in vitro and in vivo assays. Our findings evolved the understandings of metabolic sites and pathways for methylxanthine derivatives with the aldehyde functional group.
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Affiliation(s)
- Xiaohua Zhao
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China (X.Z., Q.P., H.W., X.Q., P.S., L.Z., G.G., L.Y.); Center for Systems Pharmacokinetics, Shanghai University of Traditional Chinese Medicine, Shanghai, China (X.Z., Q.P., H.W., X.Q., P.S., L.Z., G.G., L.Y.); College of Basic Medical Sciences, Dalian Medical University, Liaoning, China (H.M.); Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China (H.M.); and Respiratory Medicine Department, Central Hospital Affiliated to Shenyang Medical College, Liaoning, China (M.M., S.X.)
| | - Hong Ma
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China (X.Z., Q.P., H.W., X.Q., P.S., L.Z., G.G., L.Y.); Center for Systems Pharmacokinetics, Shanghai University of Traditional Chinese Medicine, Shanghai, China (X.Z., Q.P., H.W., X.Q., P.S., L.Z., G.G., L.Y.); College of Basic Medical Sciences, Dalian Medical University, Liaoning, China (H.M.); Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China (H.M.); and Respiratory Medicine Department, Central Hospital Affiliated to Shenyang Medical College, Liaoning, China (M.M., S.X.)
| | - Qiusha Pan
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China (X.Z., Q.P., H.W., X.Q., P.S., L.Z., G.G., L.Y.); Center for Systems Pharmacokinetics, Shanghai University of Traditional Chinese Medicine, Shanghai, China (X.Z., Q.P., H.W., X.Q., P.S., L.Z., G.G., L.Y.); College of Basic Medical Sciences, Dalian Medical University, Liaoning, China (H.M.); Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China (H.M.); and Respiratory Medicine Department, Central Hospital Affiliated to Shenyang Medical College, Liaoning, China (M.M., S.X.)
| | - Haiyi Wang
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China (X.Z., Q.P., H.W., X.Q., P.S., L.Z., G.G., L.Y.); Center for Systems Pharmacokinetics, Shanghai University of Traditional Chinese Medicine, Shanghai, China (X.Z., Q.P., H.W., X.Q., P.S., L.Z., G.G., L.Y.); College of Basic Medical Sciences, Dalian Medical University, Liaoning, China (H.M.); Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China (H.M.); and Respiratory Medicine Department, Central Hospital Affiliated to Shenyang Medical College, Liaoning, China (M.M., S.X.)
| | - Xingkai Qian
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China (X.Z., Q.P., H.W., X.Q., P.S., L.Z., G.G., L.Y.); Center for Systems Pharmacokinetics, Shanghai University of Traditional Chinese Medicine, Shanghai, China (X.Z., Q.P., H.W., X.Q., P.S., L.Z., G.G., L.Y.); College of Basic Medical Sciences, Dalian Medical University, Liaoning, China (H.M.); Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China (H.M.); and Respiratory Medicine Department, Central Hospital Affiliated to Shenyang Medical College, Liaoning, China (M.M., S.X.)
| | - Peifang Song
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China (X.Z., Q.P., H.W., X.Q., P.S., L.Z., G.G., L.Y.); Center for Systems Pharmacokinetics, Shanghai University of Traditional Chinese Medicine, Shanghai, China (X.Z., Q.P., H.W., X.Q., P.S., L.Z., G.G., L.Y.); College of Basic Medical Sciences, Dalian Medical University, Liaoning, China (H.M.); Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China (H.M.); and Respiratory Medicine Department, Central Hospital Affiliated to Shenyang Medical College, Liaoning, China (M.M., S.X.)
| | - Liwei Zou
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China (X.Z., Q.P., H.W., X.Q., P.S., L.Z., G.G., L.Y.); Center for Systems Pharmacokinetics, Shanghai University of Traditional Chinese Medicine, Shanghai, China (X.Z., Q.P., H.W., X.Q., P.S., L.Z., G.G., L.Y.); College of Basic Medical Sciences, Dalian Medical University, Liaoning, China (H.M.); Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China (H.M.); and Respiratory Medicine Department, Central Hospital Affiliated to Shenyang Medical College, Liaoning, China (M.M., S.X.)
| | - Mingqing Mao
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China (X.Z., Q.P., H.W., X.Q., P.S., L.Z., G.G., L.Y.); Center for Systems Pharmacokinetics, Shanghai University of Traditional Chinese Medicine, Shanghai, China (X.Z., Q.P., H.W., X.Q., P.S., L.Z., G.G., L.Y.); College of Basic Medical Sciences, Dalian Medical University, Liaoning, China (H.M.); Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China (H.M.); and Respiratory Medicine Department, Central Hospital Affiliated to Shenyang Medical College, Liaoning, China (M.M., S.X.)
| | - Shuyue Xia
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China (X.Z., Q.P., H.W., X.Q., P.S., L.Z., G.G., L.Y.); Center for Systems Pharmacokinetics, Shanghai University of Traditional Chinese Medicine, Shanghai, China (X.Z., Q.P., H.W., X.Q., P.S., L.Z., G.G., L.Y.); College of Basic Medical Sciences, Dalian Medical University, Liaoning, China (H.M.); Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China (H.M.); and Respiratory Medicine Department, Central Hospital Affiliated to Shenyang Medical College, Liaoning, China (M.M., S.X.)
| | - Guangbo Ge
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China (X.Z., Q.P., H.W., X.Q., P.S., L.Z., G.G., L.Y.); Center for Systems Pharmacokinetics, Shanghai University of Traditional Chinese Medicine, Shanghai, China (X.Z., Q.P., H.W., X.Q., P.S., L.Z., G.G., L.Y.); College of Basic Medical Sciences, Dalian Medical University, Liaoning, China (H.M.); Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China (H.M.); and Respiratory Medicine Department, Central Hospital Affiliated to Shenyang Medical College, Liaoning, China (M.M., S.X.)
| | - Ling Yang
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China (X.Z., Q.P., H.W., X.Q., P.S., L.Z., G.G., L.Y.); Center for Systems Pharmacokinetics, Shanghai University of Traditional Chinese Medicine, Shanghai, China (X.Z., Q.P., H.W., X.Q., P.S., L.Z., G.G., L.Y.); College of Basic Medical Sciences, Dalian Medical University, Liaoning, China (H.M.); Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China (H.M.); and Respiratory Medicine Department, Central Hospital Affiliated to Shenyang Medical College, Liaoning, China (M.M., S.X.)
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Talmon M, Massara E, Brunini C, Fresu LG. Comparison of anti-inflammatory mechanisms between doxofylline and theophylline in human monocytes. Pulm Pharmacol Ther 2019; 59:101851. [PMID: 31563516 DOI: 10.1016/j.pupt.2019.101851] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 09/26/2019] [Accepted: 09/26/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Methylxanthines are important pharmacological agents in the treatment of asthma and of chronic obstructive pulmonary diseases. The present study was designed to compare the ability of doxofylline and theophylline to modulate inflammatory pathways in human monocytes. METHODS Monocytes isolated from healthy anonymous human buffy coats were treated with doxofylline or theophylline in the presence of phorbol 12-myristate 13-acetate (PMA) or lipopolysaccharide (LPS), and their phenotype, the oxidative burst, cytokine expression and release, cAMP production, and protein kinase C (PKC) activity were evaluated. RESULTS Doxofylline and theophylline did not have overlapping effects on human monocytes. While sharing some common characteristics, they differed significantly in their selectivity. Theophylline affected LPS- above PMA-induced cellular responsivity, while doxofylline behaved in the opposite manner. Furthermore, when testing PKC activity, we found an inhibitory effect of doxofylline but not of theophylline, at equimolar doses. CONCLUSIONS In conclusion, our data support the growing hypothesis that doxofylline does not have a superimposable mechanism of action compared to theophylline, and this may both explain some differences in the risk/benefit ratio and may direct studies to tailor therapy for patients.
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Affiliation(s)
- Maria Talmon
- Department of Health Sciences, University of Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy
| | - Erika Massara
- Department of Health Sciences, University of Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy
| | - Chiara Brunini
- Department of Health Sciences, University of Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy
| | - Luigia Grazia Fresu
- Department of Health Sciences, University of Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy.
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Development and validation of a UPLC-MS/MS method for quantification of doxofylline and its metabolites in human plasma. J Pharm Biomed Anal 2019; 174:220-225. [DOI: 10.1016/j.jpba.2019.05.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/18/2019] [Accepted: 05/20/2019] [Indexed: 02/06/2023]
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Cazzola M, Calzetta L, Rogliani P, Matera MG. Ensifentrine (RPL554): an investigational PDE3/4 inhibitor for the treatment of COPD. Expert Opin Investig Drugs 2019; 28:827-833. [PMID: 31474120 DOI: 10.1080/13543784.2019.1661990] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: A compound that simultaneously inhibits PDE3 and PDE4 should increase airway caliber by relaxing the smooth muscle and, simultaneously, suppress airway inflammatory responses. Ensifentrine (RPL554) is considered a PDE3/4 inhibitor, although its affinity for PDE3 is 3,440 times higher than that for PDE4, that is under clinical development for the treatment of asthma and COPD and, potentially, cystic fibrosis. Areas covered: We analyze the development of this molecule from its basic pharmacology to the present clinical Phase II studies. Expert opinion: Ensifentrine is an interesting drug but there is a lack of solid studies that still does not allow us to correctly allocate this molecule in the current COPD and even asthma therapeutic armamentarium. Furthermore, apparently ensifentrine has not yet entered Phase III clinical development and, in any case, there is no reliable evidence of its ability to elicit an anti-inflammatory activity in patients with COPD or asthma. Therefore, the real anti-inflammatory profile of ensifentrine must be clarified with new studies of basic pharmacology and adequate clinical studies specifically designed. However, at present the most intriguing perspective is linked to its possible use in the treatment of cystic fibrosis, also considering the lack of valid therapeutic options for this disease.
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Affiliation(s)
- Mario Cazzola
- Unit of Respiratory Medicine, Dept. Experimental Medicine, University of Rome "Tor Vergata" , Rome , Italy
| | - Luigino Calzetta
- Unit of Respiratory Medicine, Dept. Experimental Medicine, University of Rome "Tor Vergata" , Rome , Italy
| | - Paola Rogliani
- Unit of Respiratory Medicine, Dept. Experimental Medicine, University of Rome "Tor Vergata" , Rome , Italy
| | - Maria Gabriella Matera
- Unit of Pharmacology, Dept. Experimental Medicine, University of Campania "Luigi Vanvitelli" , Naples , Italy
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Rogliani P, Calzetta L, Ora J, Cazzola M, Matera MG. Efficacy and safety profile of doxofylline compared to theophylline in asthma: a meta-analysis. Multidiscip Respir Med 2019; 14:25. [PMID: 31388422 PMCID: PMC6679461 DOI: 10.1186/s40248-019-0189-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 05/29/2019] [Indexed: 01/17/2023] Open
Abstract
Background Oral methylxanthines are effective drugs for the treatment of chronic obstructive respiratory disorders. The novel methylxanthine doxofylline, that has bronchodilator and anti-inflammatory activities, is not affected by the major drawback of theophylline. Nowadays large-scale quantitative synthesis comparing the efficacy and safety profile of doxofylline vs. theophylline in the treatment of asthma is still lacking. Therefore, we performed a quantitative synthesis to compare the efficacy/safety profile of doxofylline and theophylline in asthma. Methods A pairwise and network meta-analyses were performed to assess the impact of doxofylline vs. theophylline and placebo on the change in asthma events, risk of adverse events (AEs), forced expiratory volume in 1 s (FEV1), and salbutamol use. Results Data obtained from 696 asthmatic patients were extracted from 4 randomized controlled trials published between 2015 and 2018. Doxofylline was significantly (P < 0.05) more effective than theophylline in reducing the daily asthma events (mean difference − 0.14, 95%CI -0.27 – 0.00) and risk of AEs (relative risk 0.76, 95%CI 0.59–0.99). Doxofylline was as effective as theophylline in improving FEV1, and a trend of superiority (P = 0.058) was detected for doxofylline over theophylline with respect to the reduction in the use of salbutamol as rescue medication. The rank of effectiveness was doxofylline>theophylline> > placebo, and the rank of safety was placebo>doxofylline> > theophylline. Conclusions Doxofylline is an effective and safe methylxanthine for the treatment of asthma, with an efficacy/safety profile greater than that of theophylline. Trial registration Meta-analysis registration: CRD42019119849.
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Affiliation(s)
- Paola Rogliani
- 1Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
| | - Luigino Calzetta
- 1Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
| | - Josuel Ora
- 2Division of Respiratory Medicine, University Hospital "Tor Vergata", Rome, Italy
| | - Mario Cazzola
- 1Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
| | - Maria Gabriella Matera
- 3Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
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Ensifentrine (RPL554): an inhaled 'bifunctional' dual PDE3/4 inhibitor for the treatment of asthma and chronic obstructive pulmonary disease. Pharm Pat Anal 2019; 7:249-257. [PMID: 30657422 DOI: 10.4155/ppa-2018-0030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Ensifentrine (RPL554), an inhaled 'bifunctional' dual phosphodiesterase 3/4 inhibitor that exhibits both bronchodilator and anti-inflammatory activities, provides a new option in the treatment of chronic obstructive pulmonary disease (COPD) and other inflammatory airway diseases that are under clinical development. Ensifentrine appears to be initially under development for the treatment of COPD although it is not yet clear whether it should be understood as an add-on therapy in patients for the treatment of acute exacerbations of COPD or for the regular maintenance treatment of patients either alone, or on top of existing drug classes.
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Matera MG, Rinaldi B, Page C, Rogliani P, Cazzola M. Pharmacokinetic considerations concerning the use of bronchodilators in the treatment of chronic obstructive pulmonary disease. Expert Opin Drug Metab Toxicol 2018; 14:1101-1111. [DOI: 10.1080/17425255.2018.1530215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Maria Gabriella Matera
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Barbara Rinaldi
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Clive Page
- Sackler Institute of Pulmonary Pharmacology, King’s College London, London, UK
| | - Paola Rogliani
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Mario Cazzola
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
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Singh N, Shreshtha AK, Thakur M, Patra S. Xanthine scaffold: scope and potential in drug development. Heliyon 2018; 4:e00829. [PMID: 30302410 PMCID: PMC6174542 DOI: 10.1016/j.heliyon.2018.e00829] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/25/2018] [Accepted: 09/25/2018] [Indexed: 02/07/2023] Open
Abstract
Medicinal plants have been the basis for discovery of various important marketed drugs. Xanthine is one such lead molecule. Xanthines in various forms (caffeine, theophylline, theobromine, etc) are abode in tea, coffee, cocoa, chocolate etc. giving them popular recognition. These compounds are best known for their diverse pharmaceutical applications as cyclic nucleotide phosphodiesterase inhibition, antagonization of adenosine receptor, anti-inflammatory, anti-microbial, anti-oxidant and anti-tumor activities. These properties incentivize to use xanthine as scaffold to develop new derivatives. Chemical synthesis contributes greater diversity in xanthine based derivatisation. With highlighting the existing challenges in chemical synthesis, the present review focuses the probable solution to fill existing lacuna. The review summarizes the available knowledge of xanthine based drugs development along with exploring new xanthine led chemical synthesis path for bringing diversification in xanthine based research. The main objective of this review is to explore the immense potential of xanthine as scaffold in drug development.
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Affiliation(s)
- Nivedita Singh
- Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati 781039, India
| | | | - M.S. Thakur
- Fermentation Technology and Bioengineering Department, Central Food Technological Research Institute, Mysore, India
| | - Sanjukta Patra
- Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati 781039, India
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Calzetta L, Hanania NA, Dini FL, Goldstein MF, Fairweather WR, Howard WW, Cazzola M. Impact of doxofylline compared to theophylline in asthma: A pooled analysis of functional and clinical outcomes from two multicentre, double-blind, randomized studies (DOROTHEO 1 and DOROTHEO 2). Pulm Pharmacol Ther 2018; 53:20-26. [PMID: 30219705 DOI: 10.1016/j.pupt.2018.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/10/2018] [Accepted: 09/12/2018] [Indexed: 12/26/2022]
Abstract
This pooled analysis of double-blind, randomized, placebo-controlled trials aimed to investigate the impact of DOxofylline compaRed tO THEOphylline (DOROTHEO 1 and DOROTHEO 2 studies) on functional and clinical outcomes in asthma. Asthmatic patients ≥16 years of age with forced expiratory volume in 1 s (FEV1) ≥50% and <80% and with ≥15% post-bronchodilator increase in FEV1 were randomized in a 1:1:1:1 ratio in DOROTHEO 1 to receive doxofylline 200 mg, doxofylline 400 mg, theophylline 250 mg, or placebo; in DOROTHEO 2 patients were randomized in a 1:1:1 ratio to receive doxofylline 400 mg, theophylline 250 mg, or placebo. All double-blind treatments were taken orally with immediate release formulations and three times daily. Data evaluating the effect of doxofylline 400 mg, theophylline 250 mg and placebo on FEV1, asthma events rate, use of salbutamol as rescue medication and adverse events (AEs) were pooled from both studies. The pooled-analysis of 483 patients demonstrated that both doxofylline 400 mg and theophylline 250 mg significantly increased FEV1, reduced the rate of asthma events and use of salbutamol to relieve asthma symptoms compared to placebo (p < 0.01). No significant differences were detected between doxofylline 400 mg and theophylline 250 mg. Doxofylline 400 mg did not significantly (p > 0.05) increase the risk of AEs compared to placebo, conversely in patients treated with theophylline 250 mg the risk of AEs was significantly (p < 0.05) greater than in those that received placebo. We conclude that doxofylline seems to offer a promising alternative to theophylline with a superior efficacy/safety profile in the management of patients with asthma.
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Affiliation(s)
- Luigino Calzetta
- Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy
| | - Nicola A Hanania
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Frank L Dini
- Cardiopulmonary and Vascular Department, University of Pisa, Pisa, Italy
| | | | | | | | - Mario Cazzola
- Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy.
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Rosenberg HF, Druey KM. Modeling asthma: Pitfalls, promises, and the road ahead. J Leukoc Biol 2018; 104:41-48. [PMID: 29451705 PMCID: PMC6134392 DOI: 10.1002/jlb.3mr1117-436r] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/28/2017] [Accepted: 01/28/2018] [Indexed: 12/19/2022] Open
Abstract
Asthma is a chronic, heterogeneous, and recurring inflammatory disease of the lower airways, with exacerbations that feature airway inflammation and bronchial hyperresponsiveness. Asthma has been modeled extensively via disease induction in both wild-type and genetically manipulated laboratory mice (Mus musculus). Antigen sensitization and challenge strategies have reproduced numerous important features of airway inflammation characteristic of human asthma, notably the critical roles of type 2 T helper cell cytokines. Recent models of disease induction have advanced to include physiologic aeroallergens with prolonged respiratory challenge without systemic sensitization; others incorporate tobacco, respiratory viruses, or bacteria as exacerbants. Nonetheless, differences in lung size, structure, and physiologic responses limit the degree to which airway dynamics measured in mice can be compared to human subjects. Other rodent allergic airways models, including those featuring the guinea pig (Cavia porcellus) might be considered for lung function studies. Finally, domestic cats (Feline catus) and horses (Equus caballus) develop spontaneous obstructive airway disorders with clinical and pathologic features that parallel human asthma. Information on pathogenesis and treatment of these disorders is an important resource.
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Affiliation(s)
- Helene F. Rosenberg
- Inflammation Immunobiology Section Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Kirk M. Druey
- Molecular Signal Transduction Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
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31
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Cazzola M, Calzetta L, Barnes PJ, Criner GJ, Martinez FJ, Papi A, Gabriella Matera M. Efficacy and safety profile of xanthines in COPD: a network meta-analysis. Eur Respir Rev 2018; 27:27/148/180010. [PMID: 29720510 DOI: 10.1183/16000617.0010-2018] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/11/2018] [Indexed: 12/23/2022] Open
Abstract
Theophylline can still have a role in the management of stable chronic obstructive pulmonary disease (COPD), but its use remains controversial, mainly due to its narrow therapeutic window. Doxofylline, another xanthine, is an effective bronchodilator and displays a better safety profile than theophylline. Therefore, we performed a quantitative synthesis to compare the efficacy and safety profile of different xanthines in COPD.The primary end-point of this meta-analysis was the impact of xanthines on lung function. In addition, we assessed the risk of adverse events by normalising data on safety as a function of person-weeks. Data obtained from 998 COPD patients were selected from 14 studies and meta-analysed using a network approach.The combined surface under the cumulative ranking curve (SUCRA) analysis of efficacy (change from baseline in forced expiratory volume in 1 s) and safety (risk of adverse events) showed that doxofylline was superior to aminophylline (comparable efficacy and significantly better safety), bamiphylline (significantly better efficacy and comparable safety), and theophylline (comparable efficacy and significantly better safety).Considering the overall efficacy/safety profile of the investigated agents, the results of this quantitative synthesis suggest that doxofylline seems to be the best xanthine for the treatment of COPD.
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Affiliation(s)
- Mario Cazzola
- Dept of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Luigino Calzetta
- Dept of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Peter J Barnes
- Airway Disease Section, National Heart and Lung Institute, Imperial College, London, UK
| | - Gerard J Criner
- Dept of Thoracic Medicine and Surgery, Temple Lung Center, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Fernando J Martinez
- Joan and Sanford I. Weill Dept of Medicine, Weill Cornell Medical College, New York - Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Alberto Papi
- Dept of Internal and Cardiorespiratory Medicine, Research Center on Asthma and COPD, University of Ferrara, Ferrara, Italy
| | - Maria Gabriella Matera
- Dept of Experimental Medicine, Unit of Pharmacology, University of Campania Luigi Vanvitelli, Naples, Italy
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Mokry J, Urbanova A, Kertys M, Mokra D. Inhibitors of phosphodiesterases in the treatment of cough. Respir Physiol Neurobiol 2018; 257:107-114. [PMID: 29337269 DOI: 10.1016/j.resp.2018.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/28/2017] [Accepted: 01/11/2018] [Indexed: 02/08/2023]
Abstract
A group of 11 enzyme families of metalophosphohydrolases called phosphodiesterases (PDEs) is responsible for a hydrolysis of intracellular cAMP and cGMP. Xanthine derivatives (methylxanthines) inhibit PDEs without selective action on their single isoforms and lead to many pharmacological effects, e.g. bronchodilation, anti-inflammatory and immunomodulating effects, and thus they can modulate the cough reflex. Contrary, selective PDE inhibitors have been developed to inhibit PDE isoforms with different pharmacological effects based on their tissue expression. In this paper, effects of non-selective PDE inhibitors (e.g. theophylline) are discussed, with a description of other putative mechanisms in their effects on cough. Antitussive effects of selective inhibitors of several PDE isoforms are reviewed, focusing on PDE1, PDE3, PDE4, PDE5 and PDE7. The inhibition of PDEs suggests participation of bronchodilation, suppression of TRPV channels and anti-inflammatory action in cough suppression. Selective PDE3, PDE4 and PDE5 inhibitors have demonstrated the most significant cough suppressive effects, confirming their benefits in chronic inflammatory airway diseases associated with bronchoconstriction and cough.
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Affiliation(s)
- Juraj Mokry
- Department of Pharmacology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; Biomedical Center Martin (BioMed), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia.
| | - Anna Urbanova
- Department of Pharmacology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; Biomedical Center Martin (BioMed), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Martin Kertys
- Department of Pharmacology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; Biomedical Center Martin (BioMed), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Daniela Mokra
- Biomedical Center Martin (BioMed), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
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Patai Z, Guttman A, Mikus EG. Assessment of the Airway Smooth Muscle Relaxant Effect of Drotaverine. Pharmacology 2018; 101:163-169. [PMID: 29301136 DOI: 10.1159/000485921] [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: 11/03/2017] [Accepted: 11/29/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Drotaverine, a type 4 cyclic nucleotide phosphodiesterase (PDE4) inhibitor, blocks the degradation of 3',5'-cyclic adenosine monophosphate. However, published receptor binding data showed that drotaverin also binds to the L-type voltage-operated calcium channel (L-VOCC). Based on these molecular mechanisms of action, a direct and indirect (by blocking the constrictor response) relaxant effect on airway smooth muscle can be predicted, which has not yet been assessed. SUMMARY Accordingly, drotaverine and reference agents were tested both on the histamine-, methacholine-, or KCl-induced contraction response and on precontracted guinea pig tracheal preparations. It was found that drotaverine not only relaxed the precontracted tracheal preparations but also decreased mediator-induced contraction. These effects of drotaverine were concentration dependent, with a significantly higher potency on the KCl-induced response, than on either the histamine or methacholine induced one. A similar result was noted for nifedipine. The PDE inhibitor, theophylline, also relaxed the precontracted preparations but was ineffective on the mediator-induced contraction in a physiologically relevant concentration range. Moreover, theophylline did not show selectivity and was the least potent relaxant among the 3 tested molecules. Key Message: These results show that drotaverine is a more potent airway smooth muscle relaxant molecule than theophylline. This enhanced potency on relaxation and inhibition of the constrictor response, at least partly, may be explained by the combined L-VOCC blocking and PDE inhibitory potential of drotaverine.
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Affiliation(s)
- Zoltán Patai
- LabMagister Training and Science Ltd., Budapest, Hungary.,Horvath Csaba Laboratory of Bioseparation Sciences, MMKK, University of Debrecen, Debrecen, Hungary
| | - András Guttman
- Horvath Csaba Laboratory of Bioseparation Sciences, MMKK, University of Debrecen, Debrecen, Hungary.,MTA-PA Translational Glycomics Research Group, MUKKI, University of Pannonia, Veszprém, Hungary
| | - Endre G Mikus
- LabMagister Training and Science Ltd., Budapest, Hungary
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Kalkan S, Hocaoglu N, Buyukdelig M, Gurdal H. Binding of Amitriptyline to Adenosine A1 or A2a Receptors Using Radioligand Binding Assay. INT J PHARMACOL 2017. [DOI: 10.3923/ijp.2018.116.120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Matera MG, Page C, Cazzola M. Doxofylline is not just another theophylline! Int J Chron Obstruct Pulmon Dis 2017; 12:3487-3493. [PMID: 29255355 PMCID: PMC5723117 DOI: 10.2147/copd.s150887] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Doxofylline, which differs from theophylline in containing the dioxalane group at position 7, has comparable efficacy to theophylline in the treatment of respiratory diseases, but with an improved tolerability profile and a favorable risk-to-benefit ratio. Furthermore, it does not have significant drug-drug interactions as exhibited with theophylline, which make using theophylline more challenging, especially in elderly patients with co-morbidities receiving multiple classes of drug. It is now clear that doxofylline also possesses a distinct pharmacological profile from theophylline (no significant effect on any of the known phosphodiesterase isoforms, no significant adenosine receptor antagonism, no direct effect on histone deacetylases, interaction with β2-adrenoceptors) and therefore, should not be considered as just a modified theophylline. Randomized clinical trials of doxofylline to investigate the use of this drug to reduce exacerbations and hospitalizations due to asthma or COPD as an alternative to expensive biologics, and certainly as an alternative to theophylline are to be encouraged.
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Affiliation(s)
- Maria Gabriella Matera
- Department of Experimental Medicine, Unit of Pharmacology, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Clive Page
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, UK
| | - Mario Cazzola
- Department of Experimental Medicine and Surgery, Chair of Respiratory Medicine, University of Rome 'Tor Vergata', Rome, Italy
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Cazzola M, Rogliani P, Puxeddu E, Ora J, Matera MG. An overview of the current management of chronic obstructive pulmonary disease: can we go beyond the GOLD recommendations? Expert Rev Respir Med 2017; 12:43-54. [DOI: 10.1080/17476348.2018.1398086] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Mario Cazzola
- Department of Systems Medicine, Chair of Respiratory Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Paola Rogliani
- Department of Systems Medicine, Chair of Respiratory Medicine, University of Rome “Tor Vergata”, Rome, Italy
- Division of Respiratory Medicine, Department of Internal Medicine, University Hospital “Tor Vergata”, Rome, Italy
| | - Ermanno Puxeddu
- Department of Systems Medicine, Chair of Respiratory Medicine, University of Rome “Tor Vergata”, Rome, Italy
- Division of Respiratory Medicine, Department of Internal Medicine, University Hospital “Tor Vergata”, Rome, Italy
| | - Josuel Ora
- Division of Respiratory Medicine, Department of Internal Medicine, University Hospital “Tor Vergata”, Rome, Italy
| | - Maria Gabriella Matera
- Department of Experimental Medicine, Unit of Pharmacology, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Steroid sparing effects of doxofylline. Pulm Pharmacol Ther 2017; 48:1-4. [PMID: 29031617 DOI: 10.1016/j.pupt.2017.10.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 10/11/2017] [Accepted: 10/12/2017] [Indexed: 12/18/2022]
Abstract
Glucocorticosteroids are widely used in the treatment of asthma and chronic obstructive pulmonary disease (COPD). However, there are growing concerns about the side effect profile of this class of drug, particularly an increased risk of pneumonia. Over the last two decades there have been many attempts to find drugs to allow a reduction of glucocorticosteroids, including xanthines such as theophylline. Use of xanthines has been shown to lead to a reduction in the requirement for glucocorticosteroids, although xanthines also have a narrow therapeutic window limiting their wider use. Doxofylline is another xanthine that has been shown to be of clinical benefit in patients with asthma or COPD, but to have a wider therapeutic window than theophylline. In the present study we have demonstrated that doxofylline produces a clear steroid sparing effect in both an allergic and a non-allergic model of lung inflammation. Thus, we have shown that concomitant treatment with a low dose of doxofylline and a low dose of the glucocorticosteroid dexamethasone (that alone had no effect) significantly reduced both allergen-induced eosinophil infiltration into the lungs of allergic mice, and lipopolysaccharide (LPS)-induced neutrophil infiltration into the lung, equivalent to a higher dose of each drug. Our results suggest that doxofylline demonstrates significant anti-inflammatory activity in the lung which can result in significant steroid sparing activity.
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García Morales OM, Rojas-Reyes MX, Dennis RJ. Oral xanthine derivatives (theophylline and doxofylline) for patients with stable chronic obstructive pulmonary disease (COPD). THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2017. [DOI: 10.1002/14651858.cd012748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Olga M García Morales
- Faculty of Medicine, Pontificia Universidad Javeriana; Department of Internal Medicine; Bogotá Colombia
- Hospital Universitario San Ignacio; Pulmonary Unit, Department of Internal Medicine; Bogotá Colombia
| | - Maria Ximena Rojas-Reyes
- Pontificia Universidad Javeriana; Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine; Cr. 7 #40-62, 2nd floor Bogotá DC Colombia
| | - Rodolfo J Dennis
- Pontificia Universidad Javeriana; Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine; Cr. 7 #40-62, 2nd floor Bogotá DC Colombia
- Fundacion Cardioinfantil Instituto de Cardiologia; Research Department; Bogotá Colombia
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