Aspirin: recent developments

Association between pre-ICU aspirin administration and ARDS mortality in the MIMIC-IV database: A cohort study

BACKGROUND

Acute Respiratory Distress Syndrome (ARDS) is a severe condition with high mortality and morbidity rates. Evidence on the effectiveness of pharmacological interventions for ARDS treatment is limited. Recent studies suggest that aspirin may prevent ARDS development, but its efficacy in established ARDS is uncertain.

METHODS

We enrolled patients with ARDS using data from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. Primary outcomes were 30- and 90-day mortality rates and length of ICU stay. We employed multivariable Cox regression and linear regression models for statistical analysis and used propensity score matching (PSM) to ensure robust results.

RESULTS

The study included 10,042 participants with an average age of 61.8 ± 15.3 years. Kaplan-Meier analysis showed significantly lower 30- and 90-day mortality rates in patients treated with pre-ICU admission aspirin compared with non-aspirin use (p < 0.0001). Multivariable Cox regression models revealed a significant 63% reduction in 30-day mortality for pre-ICU aspirin users (HR = 0.37, 95% CI: 0.31-0.44, p < 0.001). Aspirin use in the ICU was associated with a 59% reduction in ICU mortality and a 0.68-day reduction in length of ICU stay (p < 0.05). These findings consistently indicate that aspirin may improve survival in patients with ARDS, even after further stratification of aspirin use and PSM analysis.

CONCLUSION

Our findings suggest that aspirin treatment before ICU admission is associated with significantly reduced 30- and 90-day mortality rates and decreased length of ICU stay in patients with ARDS.

Effect of aspirin in patients with established asymptomatic carotid atherosclerosis: A systematic review and meta-analysis

Background: Aspirin is widely used as an antiplatelet agent for secondary prevention in patients with atherosclerotic cardiovascular disease. However, it remains unclear whether aspirin can prevent the progression of carotid atherosclerosis or reduce vascular events and all-cause death. Methods: We performed a meta-analysis of the effect of aspirin in asymptomatic carotid atherosclerotic patients. Electronic databases including Pubmed, EMBase, ISI Web, Medline, Cochrane, and clinicaltrial.gov were searched for relevant randomized controlled trials. A total of five studies (841 individuals, 2,145 person-years) were included in this study. Two reviewers independently performed the study assessment and data extraction. Forest plots were used to assess the efficacy of aspirin. Egger's test was used to evaluate publication bias. Results: Aspirin did not alleviate the progression of carotid intima-media thickness (cIMT) compared with control patients (WMD: -0.05 mm, 95% confidence interval 95%CI: -0.12, 0.03). In subset analysis, aspirin was only associated with regression of cIMT when compared with the empty/placebo group (WMD: -0.10 mm, 95%CI: -0.18, -0.02). In type 2 diabetes mellitus, there were no statistical significance between groups (WMD: 0.10 mm, 95%CI: -0.31, 0.50). For the main vascular events and all-cause death, there were no differences between the aspirin group (RR: 0.73, 95%CI: 0.41, 1.31) and the control group (RR: 0.88, 95%CI: 0.41, 1.90). For outcome events, similar results were observed when patients were classified by different cIMT value (p > 0.05). The risk of gastrointestinal bleeding was similar between participants receiving and not receiving aspirin therapy (RR: 1.04, 95%CI: 0.07, 16.46). Conclusion: In patients with asymptomatic carotid atherosclerosis, low-dose aspirin may slightly alleviate the progression of cIMT, but does not reduce vascular events and all-cause death. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier PROSPERO.

Association Between Prior Aspirin Use and Acute Respiratory Distress Syndrome Incidence in At-Risk Patients: A Systematic Review and Meta-Analysis

Background

Recent studies have shown that prior antiplatelet drug use could ameliorate the risk and mortality of acute respiratory distress syndrome (ARDS). However, the connection between prior acetylsalicylic acid (aspirin) use and the risk of ARDS is unknown. Our primary objective was to perform a meta-analysis on the currently available studies to assess the association between aspirin use prior to ARDS onset and ARDS incidence in at-risk patients.

Methods

Two investigators separately searched four research databases: MEDLINE, EMBASE, Cochrane Library, and Web of Science for relevant articles from the earliest available data through to July 14, 2019. In this paper, we performed a meta-analysis of the fixed effects model using the inverse variance-weighted average method to calculate the pooled odds ratios (ORs) and 95% confidence intervals (CIs). The primary outcome was risk of ARDS, and the secondary outcome was the hospital mortality of at-risk patients.

Results

This article included seven studies altogether, enrolling 6,764 at-risk patients. Our meta-analysis revealed that, compared to non-aspirin use, prior aspirin use was linked with a significantly lower incidence of ARDS in at-risk patients (OR, 0.78; 95% CI, 0.64–0.96; P = 0.018) with low statistical heterogeneity (I² = 1.7%). Additionally, difference between prior aspirin use and non-aspirin use was not remarkable for hospital mortality in at-risk patients (OR, 0.88; 95% CI, 0.73–1.07; P = 0.204), and this analysis did not involve statistical heterogeneity (I² = 0%).

Conclusions

This article indicates an association between prior aspirin use and a lower incidence of ARDS in at-risk patients, suggesting that aspirin use could potentially lower the risk of ARDS, and the investigation of such an effect is an interesting area for future clinical studies.

The effect of aspirin in preventing the acute respiratory distress syndrome/acute lung injury: A meta-analysis

BACKGROUND

The effects of aspirin in preventing the occurrence of acute respiratory distress syndrome (ARDS)/acute lung injury (ALI) among adult patients are controversial. We aimed to further determine the effectiveness of aspirin in reducing the rate of ARDS/ALI.

METHODS

The Pubmed, Embase, Medline, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials (CENTRAL) as well as the Information Sciences Institute (ISI) Web of Science were searched for all controlled studies that research the role of aspirin in adult patients who have the risk of ARDS/ALI. The outcomes were the ARDS/ALI rate and the mortality. Cochrane systematic review software, Review Manager (RevMan), the R software for statistical computing version 3.2.0, and the metafor package were used to test the hypothesis by Mann-Whitney U test. The heterogeneity test and sensitivity analyses were conducted, and random-effects or fixed-effects model was applied to calculate odds ratio (OR) and mean difference (MD) for dichotomous and continuous data, respectively.

RESULTS

Six trials involving 6562 patients were pooled in our final study. No significant heterogeneity was found in outcome measures. Aspirin could reduce the rate of ARDS/ALI (OR 0.71, 95% confidence interval (CI) 0.58-0.86) but not the mortality (OR 0.87, 95% CI 0.71-1.07).

CONCLUSIONS

In patients with risk of ARDS/ALI, aspirin could provide protective effect on the rate of ARDS/ALI, but it could not reduce the mortality.

Beneficial effect of aspirin against interferon-α-2b-induced depressive behavior in Sprague Dawley rats

Accumulating data advocates that inflammatory mediators may contribute to depression in experimental models as well as in humans. Nonetheless, whether anti-inflammatory treatments can prevent depression still remains controversial. To substantiate our hypothesis, we used an interferon-α-2b model of depression using Sprague Dawley rats. Interferon-α-2b is a cytokine which activates immune response and also produces depression. The animals were treated for 21 days with aspirin (10 mg/kg, per oral (p.o.)) dexamethasone (1 mg/kg p.o.) and amitriptyline (10 mg/kg p.o.). Amitriptyline was used as reference standard, and given concurrently with aspirin and dexamethasone to examine any synergy. Interferon-α-2b (6000 IU/kg, intraperitoneal (i.p.)) was administered in all the above groups daily, except normal control. Tests performed included sucrose preference test, behavioural tests like forced swim test, elevated plus maze, light dark box and locomotor activity along with biochemical estimations like serum cortisol and brain neurotransmitters. The rats in the group treated with Interferon-α-2b produced depressive behaviour in rats. We found that animals treated with aspirin decreased immobility time in forced swim test, increased sucrose preference, decreased serum cortisol and increased brain serotonin levels signifying antidepressant action. In contrast, there was no effect in groups treated with dexamethasone. Our results suggest that aspirin can serve as a potential antidepressant both individually and as adjuvant agent in the treatment of depression. Inhibition of the cyclo-oxygenase-2 levels and prostaglandins concentration or any other potential physiological and biochemical mechanisms may be involved in antidepressant effect.

Aspirin alleviates cardiac fibrosis in mice by inhibiting autophagy

Aspirin (ASA) is a cardioprotective drug with anti-cardiac fibrosis action in vivo. This study was aimed to clarify the anti-cardiac fibrosis action of ASA and the underlying mechanisms. Two heart injury models (injection of isoproterenol and ligation of the left anterior descending branch) were used in mice to induce cardiac fibrosis. The animals were treated with ASA (10 mg·kg^-1·d^-1, ig) for 21 and 14 d, respectively. ASA administration significantly improved cardiac function, and ameliorated heart damage and fibrosis in the mice. The mechanisms underlying ASA's anti-fibrotic effect were further analyzed in neonatal cardiac fibroblasts (CFs) exposed to hypoxia in vitro. ASA (0.5-5 mmol/L) dose-dependently inhibited the proliferation and Akt phosphorylation in the CFs. In addition, ASA significantly inhibited CF apoptosis, and decreased the levels of apoptosis markers (cleaved caspase 3 and Parp1), which might serve as a side effect of anti-fibrotic effect of ASA. Furthermore, ASA dose-dependently inhibited the autophagy in the CFs, as evidenced by the reduced levels of autophagy marker LC3-II. The autophagy inhibitor Pepstatin A (PepA) promoted the inhibitory effect of ASA on CF proliferation, whereas the autophagy inducer rapamycin rescued ASA-caused inhibition of CF proliferation, suggesting an autophagy-dependent anti-proliferative effect of ASA. Both p38 inhibitor SB203580 and ROS scavenger N-acetyl-cysteine (NAC) significantly decreased Akt phosphorylation in CFs in the basal and hypoxic situations, but they both significantly increased LC3-II levels in the CFs. Our results suggest that an autophagy- and p38/ROS-dependent pathway mediates the anti-cardiac fibrosis effect of ASA in CFs. As PepA and SB203580 did not affect ASA-caused inhibition of CF apoptosis, the drug combination will enhance ASA's therapeutic effects.

In vivo study of pro-inflammatory cytokine changes in serum and synovial fluid during treatment with celecoxib and etoricoxib and correlation with VAS pain change and synovial membrane penetration index in patients with inflammatory arthritis

Objectives

To determine the impact of celecoxib and etoricoxib therapy on serum and synovial fluid levels of IL-1β, IL-6, TNF-α, sTNFR1, sTNFR2 and IL-1Ra in patients with inflammatory arthritis. To determine the correlation between cytokine changes and synovial membrane penetration index of the study drugs, and pain VAS change.

Methods

Fifty-one patients with inflammatory synovial fluid accumulation in a knee joint (33 women), randomized on 3 groups of 17 each: 100 mg b.i.d. celecoxib treated group, 90 mg o.d. etoricoxib treated group, and the control group with no NSAID treatment. Cytokines serum and synovial fluid levels as well as membrane penetration index were assessed prior and after treatment.

Results

Celecoxib led to decrease of both synovial fluid and serum levels of IL-6 (p=0.017 and p=0.003, respectively). In the etoricoxib treated group synovial fluid IL-6 concentration was significantly decreased after treatment (p=0.019). Correlating the study drugs penetration index with the change of cytokines and their receptors levels, positive correlation was found with the reduction of synovial fluid IL-1β for the celecoxib (p=0.032) and with the increase of synovial fluid sTNFR1 for the etoricoxib group (p=0.028). Pain VAS reduction was positively correlated with decrease of synovial fluid IL-1β (p=0.041) and IL-6 levels (p<0.005) and negative with synovial fluid sTNFR1 changes (p=0.045) in celecoxib group, and negative with serum TNF-α decrease (p=0.044) in the etoricoxib group.

Conclusion

Our results suggest that celecoxib and etoricoxib inhibit the inflammatory cytokines, mostly in synovial fluid but also in serum, causing through this mechanism, decrease of inflammation, irrespective to COX-2 inhibition.

Selective killing effect of oxytetracycline, propafenone and metamizole on A549 or Hela cells

OBJECTIVE

To determine the selective killing effect of oxytetracycline, propafenone and metamizole on A549 or Hela cells.

METHODS

Proliferation assay, lactate dehydrogenase (LDH) assay, apoptosis detecting, flow cytometry and western blot were performed.

RESULTS

It was found that treatment with propafenone at the concentration of 0.014 g/L or higher for 48 h could induce apoptosis in Hela cells greatly, while it was not observed in oxytetracycline and metamizole at the concentration of 0.20 g/L for 48 h. Oxytetracycline, propafenone and metamizole all displayed evident inhibitory effects on the proliferation of A549 cells. The results of LDH assay demonstrated that the drugs at the test range of concentration did not cause necrosis in the cells. Propafenone could elevate the protein level of P53 effectively (P<0.01).

CONCLUSIONS

Oxytetracycline, propafenone and metamizol (dipyrone) all displayed evident inhibitory effects on the proliferation of A549 cells. Propafenone also displayed evident inhibitory effects on the proliferation of Hela cells.

Positional isomers of aspirin are equally potent in inhibiting colon cancer cell growth: differences in mode of cyclooxygenase inhibition

We compared the differential effects of positional isomers of acetylsalicylic acid (o-ASA, m-ASA, and p-ASA) on cyclooxygenase (COX) inhibition, gastric prostaglandin E2 (PGE2), malondialdehyde, tumor necrosis factor-alpha (TNF-α) levels, superoxide dismutase (SOD) activity, human adenocarcinoma colon cancer cell growth inhibition, cell proliferation, apoptosis, and cell-cycle progression. We also evaluated the gastric toxicity exerted by ASA isomers. All ASA isomers inhibit COX enzymes, but only the o-ASA exerted an irreversible inhibitory profile. We did not observe a significant difference between ASA isomers in their ability to decrease the in vivo synthesis of PGE2 and SOD activity. Furthermore, all isomers increased the levels of gastric and TNF-α when administered orally at equimolar doses. We observed a dose-dependent cell growth inhibitory effect; the order of potency was p-ASA > m-ASA ≈ o-ASA. There was a dose-dependent decrease in cell proliferation and an increase in apoptosis, with a concomitant Go/G1 arrest. The ulcerogenic profile of the three ASA isomers showed a significant difference between o-ASA (aspirin) and its two positional isomers when administered orally at equimolar doses (1 mmol/kg); the ulcer index (UI) for o-ASA indicated extensive mucosal injury (UI = 38), whereas m-ASA and p-ASA produced a significantly decreased toxic response (UI = 12 and 8, respectively) under the same experimental conditions. These results suggest that the three positional isomers of ASA exert practically the same biologic profile in vitro and in vivo but showed different safety profiles. The mechanism of gastric ulcer formation exerted by aspirin and its two isomers warrants a more detailed and thorough investigation.

'Old drugs for new applications': can orthopedic research benefit from this strategy?

New drug exploration is difficult in a clinical setting and the development of new drugs may be costly and time consuming. With further research into the pathological mechanisms and etiology of diseases as well as the rapid development of biological techniques, many 'old drugs' that have been applied in clinics may have new therapeutic functions which may shed light on clinical management. Based on this, we have investigated the 'old drugs for new applications' strategy in pharmacology which may be less expensive and more efficient in the clinical setting. In this paper we have explored and illustrated the potential applications of 'old drugs' for the treatment of orthopedic diseases, especially in arthritis and osteoporosis therapy.

Circulating salicylic acid and metabolic and inflammatory responses after fruit ingestion

We hypothesized that fruit ingestion provides measurable amounts of salicylic acid (SA) and produces different metabolic and inflammatory responses compared to mere fruit sugars. In a randomized-crossover study, 26 healthy subjects received a peach shake meal (PSM) (SA: 0,06 ± 0,001 mg/100 g) and a mixed sugar meal (MSM), consisting in an aqueous solution with the same sugars found in the peach shake. In order to control for the SA contribution from meals in the previous day, 16 subjects (Group 1) abstained from fruits and vegetables consumption the evening before trials, and 10 subjects (Group 2) maintained their usual diet. Circulating SA, glucose, insulin, free fatty acids, and interleukin-6 were determined. Basal SA was lower in Group 1 than in Group 2 (0.09 ± 0.02 vs. 0.30 ± 0.03 μmol/l, p < 0.001), peaked at 90 min in both groups (0.18 ± 0.01 vs. 0.38 ± 0.02 μmol/l, p < 0.01) and remained above baseline (p < 0.05) up to 3 h. Glycemia increased less after PSM at 15 min (p < 0.01) with a lower average glucose excursion (p < 0.05). Insulin peaked at 45 min with both meals but decreased less rapidly with PSM. Free fatty acids decreased more (p < 0.01), and interleukin-6 increased less (p < 0.05) with PSM. Dietary fruit intake increases the concentration of SA in vivo, and provides non-nutrients capable to modulate the inflammatory and metabolic responses to carbohydrates.

Nitric oxide release is not required to decrease the ulcerogenic profile of nonsteroidal anti-inflammatory drugs

The objective of this work was to evaluate the biological properties of a new series of nitric oxide-releasing nonsteroidal anti-inflammatory drugs (NO-NSAIDs) possessing a tyrosol linker between the NSAID and the NO-releasing moiety (PROLI/NO); however, initial screening of ester intermediates without the PROLI/NO group showed the required (desirable) efficacy/safety ratio, which questioned the need for NO in the design. In this regard, NSAID ester intermediates were potent and selective COX-2 inhibitors in vitro, showed equipotent anti-inflammatory activity compared to the corresponding parent NSAID, but showed a markedly reduced gastric toxicity when administered orally. These results provide complementary evidence to challenge the currently accepted notion that hybrid NO-NSAIDs exert their cytoprotective effects by releasing NO. Results obtained in this work constitute a good body of evidence to initiate a debate about the future replacement of NSAID prodrugs for unprotected NSAIDs (possessing a free carboxylic acid group) currently in clinical use.

Lung Injury Prevention with Aspirin (LIPS-A): a protocol for a multicentre randomised clinical trial in medical patients at high risk of acute lung injury

INTRODUCTION

Acute lung injury (ALI) is a devastating condition that places a heavy burden on public health resources. Although the need for effective ALI prevention strategies is increasingly recognised, no effective preventative strategies exist. The Lung Injury Prevention Study with Aspirin (LIPS-A) aims to test whether aspirin (ASA) could prevent and/or mitigate the development of ALI.

METHODS AND ANALYSIS

LIPS-A is a multicentre, double-blind, randomised clinical trial testing the hypothesis that the early administration of ASA will result in a reduced incidence of ALI in adult patients at high risk. This investigation will enrol 400 study participants from 14 hospitals across the USA. Conditional logistic regression will be used to test the primary hypothesis that early ASA administration will decrease the incidence of ALI.

ETHICS AND DISSEMINATION

Safety oversight will be under the direction of an independent Data and Safety Monitoring Board (DSMB). Approval of the protocol was obtained from the DSMB prior to enrolling the first study participant. Approval of both the protocol and informed consent documents were also obtained from the institutional review board of each participating institution prior to enrolling study participants at the respective site. In addition to providing important clinical and mechanistic information, this investigation will inform the scientific merit and feasibility of a phase III trial on ASA as an ALI prevention agent. The findings of this investigation, as well as associated ancillary studies, will be disseminated in the form of oral and abstract presentations at major national and international medical specialty meetings. The primary objective and other significant findings will also be presented in manuscript form. All final, published manuscripts resulting from this protocol will be submitted to Pub Med Central in accordance with the National Institute of Health Public Access Policy.

Association of prehospitalization aspirin therapy and acute lung injury: results of a multicenter international observational study of at-risk patients

OBJECTIVE

To evaluate the association between prehospitalization aspirin therapy and incident acute lung injury in a heterogeneous cohort of at-risk medical patients.

DESIGN

This is a secondary analysis of a prospective multicenter international cohort investigation.

SETTING

Multicenter observational study including 20 US hospitals and two hospitals in Turkey.

PATIENTS

Consecutive, adult, nonsurgical patients admitted to the hospital with at least one major risk factor for acute lung injury.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Baseline characteristics and acute lung injury risk factors/modifiers were identified. The presence of aspirin therapy and the propensity to receive this therapy were determined. The primary outcome was acute lung injury during hospitalization. Secondary outcomes included intensive care unit and hospital mortality and intensive care unit and hospital length of stay. Twenty-two hospitals enrolled 3855 at-risk patients over a 6-month period. Nine hundred seventy-six (25.3%) were receiving aspirin at the time of hospitalization. Two hundred forty (6.2%) patients developed acute lung injury. Univariate analysis noted a reduced incidence of acute lung injury in those receiving aspirin therapy (odds ratio [OR], 0.65; 95% confidence interval [CI], 0.46-0.90; p = .010). This association was attenuated in a stratified analysis based on deciles of aspirin propensity scores (Cochran-Mantel-Haenszel pooled OR, 0.70; 95% CI, 0.48-1.03; p = .072).

CONCLUSIONS

After adjusting for the propensity to receive aspirin therapy, no statistically significant associations between prehospitalization aspirin therapy and acute lung injury were identified; however, a prospective clinical trial to further evaluate this association appears warranted.

The role of aspirin in childhood tuberculous meningitis

Arterial stroke is the main cause of poor outcome in childhood tuberculous meningitis. Aspirin has an antithrombotic action at low dose and anti-ischemic and anti-inflammatory properties, which are dose-related. The aim of the study was to explore the possible benefits of aspirin in children with tuberculous meningitis. A total of 146 consecutive children with a diagnosis of probable tuberculous meningitis were studied. Patients were randomized into 3 groups: (1) placebo group, (2) low-dose aspirin group, and (3) high-dose aspirin group. Twenty-nine additional patients who received aspirin before admission were excluded from the randomized study, but continued on low-dose aspirin. Aspirin, irrespective of dose, did not show any significant benefit regarding morbidity (hemiparesis and developmental outcome) and mortality. Aspirin was well tolerated, but 1 death was probably related to aspirin. The fact that the outcome of the high-dose aspirin group compared favorably with the other treatment groups despite younger age and more severe neurological involvement at baseline needs further investigation.

Comparison between 3-Nitrooxyphenyl acetylsalicylate (NO-ASA) and O2-(acetylsalicyloxymethyl)-1-(pyrrolidin-1-yl)diazen-1-ium-1,2-diolate (NONO-ASA) as safe anti-inflammatory, analgesic, antipyretic, antioxidant prodrugs

Chronic inflammation is an underlying etiological factor in carcinogenesis; nonsteroidal anti-inflammatory drugs (NSAIDs) and their chemically modified NO-releasing prodrugs (NO-NSAIDs) are promising chemopreventive agents. The aim of this study was to conduct a head-to-head comparison between two NO-ASAs possessing different NO donor groups, an organic nitrate [3-nitrooxyphenyl acetylsalicylate (NO-ASA; NCX-4016)] and an N-diazeniumdiolate [NONO-ASA, O(2)- (acetylsalicyloxymethyl)-1-(pyrrolidin-1-yl)diazen-1-ium-1,2-diolate (NONO-ASA; CVM-01)], as antiulcerogenic, analgesic, anti-inflammatory, and antipyretic agents. All drugs were administered orally at equimolar doses. For antiulcerogenic study, 6 h after administration, the number and size of hemorrhagic lesions in stomachs from euthanized animals were counted. Tissue samples were frozen for prostaglandin E(2) (PGE(2)), superoxide dismutase (SOD), and malondialdehyde determination. For anti-inflammatory study, 1 h after drug administration, the volume of carrageenan-induced rat paw edemas was measured for 6 h. For antipyretic study, 1 h after dosing, fever was induced by intraperitoneal LPS, and body core temperatures measured for 5 h. For analgesic study, time-dependent analgesic effect of prodrugs was evaluated by carrageenan-induced hyperalgesia. Drugs were administered 30 min after carrageenan. NO-ASA and NONO-ASA were equipotent as analgesic and anti-inflammatory agents but were better than aspirin. Despite a drastic reduction of PGE(2) in stomach tissue, both prodrugs were devoid of gastric side effects. Lipid peroxidation induced by aspirin was higher than that observed by prodrugs. SOD activity induced by both prodrugs was similar, but approximately 2-fold higher than that induced by aspirin. CVM-01 is as effective as NCX-4016 in anti-inflammatory, analgesic, and antipyretic assays in vivo, and it showed an equivalent safety profile in the stomach. These results underscore the use of N-diazeniumdiolate moieties in drug design.

(Nitrooxyacyloxy)methyl esters of aspirin as novel nitric oxide releasing aspirins

A series of (nitrooxyacyloxy)methyl esters of aspirin were synthesized and evaluated as new NO-donor aspirins. Different amounts of aspirin were released in serum from these products according to the nature of nitrooxyacyloxy moiety present. In the aromatic series, there is a rather good linear correlation between the amount of aspirin released and the potencies of the products in inhibiting platelet aggregation induced by collagen. Both the native compounds and the related nitrooxy-substituted acid metabolites were able to relax rat aorta strips precontracted with phenylephrine, in keeping with a NO-induced activation of the sGC as a mechanism that underlies the vasodilator effect. The products here described are new improved examples of NO-donor aspirins containing nitrooxy groups. They could represent an alternative to the use of aspirin in a variety of clinical applications.

Physicochemical profile and in vitro permeation behavior of a new class of non-steroidal anti-inflammatory drug candidates

Recently a new series of nitrooxy-acyl derivatives of salicylic acid (SA) was described presenting similar anti-inflammatory activities but reduced or no gastrotoxicity compared to aspirin. In this work, lipophilicity and permeability profiles of SA derivatives were performed to evaluate their ADME properties related to oral or transdermic delivery. All tested compounds showed potential good passive permeation through gastrointestinal track and also through percutaneous barrier which could be a way to avoid the first hepatic pass.