Enhanced effect of losartan and rosuvastatin on neointima hyperplasia

Sustainability assessment of the micellar optimized HPLC method for concomitant quantification of a common triple regimen for cardiovascular disorders: application to marketed formulations and in vitro dissolution testing

Hypertension and dyslipidemia are two of the most frequently co-occurring cardiovascular risk factors. The combined regimen of hydrochlorothiazide (HCTZ), rosuvastatin (ROS), and losartan (LOS) helped in the successful management of both conditions. This work's objective is to develop an eco-friendly, sensitive, simple, and reliable chromatographic method for the simultaneous estimation of HCTZ, ROS, and the LOS ternary mixture in their pure form, and pharmaceutical formulations. Utilizing sodium dodecyl sulphate (SDS) in combination with polyoxyethylene-23-lauryl ether (Brij-35) could be a greener option with minimal environmental impact in liquid chromatographic separation techniques. Therefore, a micellar HPLC protocol was optimized and validated employing a mobile phase comprising a mixture of micelles of SDS (0.15 mol L-1) and Brij-35 (0.03 mol L-1) with 0.01 M monobasic potassium phosphate buffer, pH 3.5. The cited drugs were detected at 230 nm within five minutes, using a symmetry RP-C18 column, an isocratic elution mode, and a flow speed of 1 mL min-1. Method validation was successfully performed as stated by ICH. The suggested HPLC approach was effectively applied to determine the mentioned drugs in three pharmaceutical preparations. It was also employed for monitoring their in vitro release pattern using two innovator tablet formulations, applying the USFDA guidelines. The applied procedure was evaluated and compared with previously published HPLC approaches using various metrics, including the Eco-Scale Scoring method (AES), the Green Analytical Procedure Index (GAPI), and the Analytical Greenness Calculator (AGREE) for greenness, the most current Blue Applicability Grade Index (BAGI) for blueness, and the more inclusive RGB 12 algorism for whiteness assessment.

Continuous Wavelet Transform as a Signal Processing Technique for Spectrofluorimetric Analysis of Rosuvastatin and Losartan: Greenness and Blueness Assessment

In this study, the application of continuous wavelet transform as a signal processing technique for the spectrofluorimetric determination of rosuvastatin and losartan is investigated. Both rosuvastatin and losartan exhibited native spectrofluorometric signals with severe overlapping peaks, making their simultaneous determination challenging. To address this issue, rbio 2.4 wavelet transformation was employed to obtain zero-crossing points in the synchronous fluorescence spectra of losartan and rosuvastatin at 346 and 408 nm, respectively, making their quantification possible. The developed method was validated according to the ICH guidelines and displayed high accuracy, precision, and specificity. The method exhibited excellent linearity over concentration ranges 0.2-2.0 and 0.25-2.0 μg/mL for losartan and rosuvastatin, respectively. In addition, LOD and LOQ were 0.046 and 0.140 μg/mL for losartan and 0.036 and 0.110 μg/mL for rosuvastatin, respectively, indicating the high sensitivity of the developed method. Moreover, greenness and blueness assessments were carried, revealing a high AGREE score of 0.71 and BAGI score of 77.5 for the developed method, making it a promising greener alternative for the reported chromatographic methods. Finally, the developed method was applied to the determination of rosuvastatin and losartan in pharmaceutical formulations, posing it as a powerful greener alternative in quality control laboratories.

Drug Release and Stability Study of Innovated Losartan Potassium and Rosuvastatin Calcium Fixed-dose Combination Tablet

BACKGROUND

Patient adherence to therapy and compliance is always a challenge for care providers in the management of chronic disorders with multiple medications.

OBJECTIVE

Our study focused on formulating concurrently prescribed ARB (Angiotensin Receptor Blocker), i.e., losartan potassium, and a cholesterol-lowering statin derivative, i.e., rosuvastatin calcium, in a fixed-dose combination tablet.

METHODS

The drugs were selected based on the presence of synergism and variation in solubility characteristics. Trial batches with fixed concentrations of both active pharmaceutical ingredients (APIs) and varying quantities of different excipients were prepared by dry granulation technique and subjected to different quality control tests for tablets. Batch F5 was selected on the basis of in-process quality control data for the development of a drug release protocol. Experimental conditions were optimized. Based on the sink condition, phosphate buffer (pH 6.8) was selected as the dissolution medium. Simultaneous determination of both APIs in samples collected at predetermined time intervals was carried out using the RP-HPLC technique with acetonitrile, methanol, and water (20:25:55 v/v/v) as mobile phase.

RESULTS

Complete dissolution of both APIs in the FDC tablet was achieved in 45 min in 900 mL of the selected medium. The in vitro drug release protocol was validated for accuracy and precision without interference with sample analysis.

CONCLUSION

In this study, a validated, accurate, and robust dissolution testing method was developed for the newly formulated FDC tablet.

Effect of resveratrol combined with atorvastatin on re-endothelialization after drug-eluting stents implantation and the underlying mechanism

AIMS

To explore whether the combination of atorvastatins and resveratrol is superior to each individual drug alone regarding re-endothelialization after drug-eluting stents (DESs) implantation.

MATERIALS AND METHODS

Ninety-four rabbits were randomized into control, atorvastatin, resveratrol, and combined medication groups. Abdominal aorta injury was induced via ballooning, followed by DES implantation. Neointimal formation and re-endothelialization after stent implantation were assessed via optical coherence tomography and scanning electron microscopy. The effects of resveratrol and atorvastatin on bone marrow-derived mesenchymal derived stem cells (BMSCs) were assessed.

KEY FINDINGS

Compared with the findings in the resveratrol and atorvastatin groups, the neointimal area and mean neointimal thickness were greater in the combined medication group, which also exhibited improved re-endothelialization. Compared with the effects of monotherapy, combined treatment further protected BMSCs against rapamycin-induced apoptosis and improved cell migration. Combined medication significantly upregulated Akt, p-Akt, eNOS, p-eNOS, and CXCR4 expression in BMSCs compared with the effects of monotherapy, and these effects were abolished by the phosphatidylinositol 3-kinase (PI3K) inhibitor LY294002.

SIGNIFICANCE

The combination of atorvastatin and resveratrol has the potential of accelerating re-endothelialization after stent implantation, reducing the risk of thrombosis and improving the safety of DESs.

Relationship of the rs1799752 polymorphism of the angiotensin-converting enzyme gene and the rs699 polymorphism of the angiotensinogen gene to the process of in-stent restenosis in a population of Polish patients with stable coronary artery disease

PURPOSE

The renin-angiotensin-aldosterone system may influence in-stent restenosis (ISR) via angiotensin II, which stimulates the production of growth factors for smooth muscle cells. The aim of this work is to assess the influence of the rs1799752 polymorphism of the angiotensin-converting enzyme (ACE) gene and the rs699 polymorphism of the angiotensinogen (AGT) gene on the ISR in Polish patients with stable coronary artery disease (SCAD) who underwent stent implantation.

MATERIAL/METHODS

Two hundred and sixty-five patients with SCAD were included in the study. All patients underwent stent implantation upon admission to the hospital and had subsequent coronary angiography performed. The patients were divided into two groups - those with significant ISR (n=53) and those without ISR (n=212). The ACE polymorphism was assessed using the classical PCR method and the AGT polymorphism was determined using the TaqMan method for SNP genotyping.

RESULTS

No difference in the frequency of angiographically significant ISR occurrence associated with the different ACE and AGT gene polymorphisms was observed. In a multivariable analysis, after correction for clinical variables, the relationship between the ACE and AGT genotypes within the scope of the analyzed polymorphisms and the process of restenosis was not found using a dominant, recessive and log-additive model. Late lumen loss was also independent of the genotypes of the polymorphisms before and after correction with angiographic variables.

CONCLUSIONS

The rs1799752 polymorphism and the rs699 polymorphism had no relationship with the occurrence of angiographically significant ISR and late lumen loss in a group of Polish patients who underwent metal stent implantation.

Valsartan decreases neointimal hyperplasia in balloon-injured rat aortic arteries by upregulating HO-1 and inhibiting angiotensin II type 1 receptor

AIMS

Upregulation of heme oxygenase (HO)-1 plays an important role in vascular protection. Valsartan attenuates neointimal hyperplasia in animal studies. The objective of this study was to examine the role of HO-1 and angiotensin II type 1 (AT1) receptor in the action of valsartan on neointimal hyperplasia in balloon-injured rat aortic arteries.

MAIN METHODS

Thirty-six male Wistar rats were randomly divided into the following three groups with twelve rats in each group: control group, surgery (model) group, and valsartan group. Aortic balloon injury was performed to elicit endothelial denudation with a 2F balloon catheter. On days 14 and 28 after injury, blood was harvested to measure bilirubin levels. Aortic arteries were harvested for morphometry analysis, to determine angiotensin II (Ang II) level, and to analyze mRNA or protein expression.

KEY FINDINGS

Compared with the control group, proliferation and intimal thickening of vascular smooth muscle cells (VSMCs) were obvious in the surgery group rats on days 14 and 28 after injury. Valsartan significantly reduced the proliferation and intimal thickening. Additionally, pretreatment with valsartan significantly reduced Ang II levels, AT1 receptor, and p38 mitogen-activated protein kinase (MAPK) expression. Valsartan increased HO-1 protein and mRNA expression, as well as increased serum bilirubin levels compared with the surgery group.

SIGNIFICANCE

Valsartan treatment decreased neointimal hyperplasia in balloon-injured rats. The mechanism of action might be linked to the upregulation of HO-1, downregulation of AT1 receptor and inhibition of p38MAPK signal pathway.

Oral aripiprazole-induced severe hypoglycemia

This case report highlights a very rare adverse drug reaction caused by oral aripiprazole resulting in severe hypoglycemia. A 72-year-old-male patient suffering from Parkinson disease on prolonged carbidopa plus levodopa combination therapy (carbidopa 25 mg plus levodopa 100 mg, thrice daily) for 1.3 years was recently diagnosed with psychosis and was initiated 10 mg/day oral aripiprazole. After 10 days of aripiprazole therapy, the patient experienced symptoms of hypoglycemia and on the 21st day, he was hospitalized for severe hypoglycemia. Other long-term concomitant medications taken by this patient were oral losartan (25 mg/day) and rosuvastatin (40 mg/day). Dechallenge and rechallenge with aripiprazole revealed that there is a "definite" (according to Naranjo adverse drug reaction probability scale) relationship between administration of aripiprazole and onset of hypoglycemic events.

A low-dose atorvastatin and losartan combination directly improves aortic ring relaxation and diminishes ischaemic-reperfusion injury in isolated rat hearts

Background

The cardiovascular pleiotropic effects of statins and angiotensin receptor blockers (ARBs) could be of interest for innovative preventive approaches. We aimed to investigate whether low-dose atorvastatin and losartan, separately not possessing protective cardiovascular pleiotropic effects, express them when combined.

Material/Methods

Forty-five adult male Wistar rats were anaesthetized and their thoracic aortas and hearts were isolated. Relaxation of aortic rings, coronary flow rate and the extent of myocardial ischaemic-reperfusion injury were measured. Different concentrations (0.01, 0.1, 1.0 μM) of atorvastatin and losartan added to a perfusion medium were first tested. The separate drugs, which were ineffective, were then combined at the same concentrations and the concentration was tested in the same model.

Results

Low concentrations of atorvastatin or losartan (0.1 and 1 μM, respectively) produced no effects in isolated aorta. However, surprisingly, when these drug concentrations were combined, a significantly improved endothelium-dependent relaxation of the thoracic aorta was observed. Similarly, when combining individually ineffective concentrations of atorvastatin or losartan (0.01 and 0.1 μM, respectively), significantly increased coronary flow and a decreased extent of myocardial injury were observed. By using a nitric oxide-synthase inhibitor, we demonstrated that the vasodilatory effects obtained were nitric oxide-dependent. The degree of effectiveness by the combination was comparable to that obtained by 10-fold (atorvastatin) or 100-fold (losartan) higher concentrations of the separate drugs.

Conclusions

Our results revealed that remarkable additive/synergistic effects exist between low-doses of a statin (atorvastatin) and an ARB (losartan), resulting in important cardiovascular protection. This new concept could be valuable in cardiovascular prevention.

Heterozygous inactivation of the Nf1 gene in myeloid cells enhances neointima formation via a rosuvastatin-sensitive cellular pathway

Mutations in the NF1 tumor suppressor gene cause Neurofibromatosis type 1 (NF1). Neurofibromin, the protein product of NF1, functions as a negative regulator of Ras activity. Some NF1 patients develop cardiovascular disease, which represents an underrecognized disease complication and contributes to excess morbidity and mortality. Specifically, NF1 patients develop arterial occlusion resulting in tissue ischemia and sudden death. Murine studies demonstrate that heterozygous inactivation of Nf1 (Nf1(+/-)) in bone marrow cells enhances neointima formation following arterial injury. Macrophages infiltrate Nf1(+/-) neointimas, and NF1 patients have increased circulating inflammatory monocytes in their peripheral blood. Therefore, we tested the hypothesis that heterozygous inactivation of Nf1 in myeloid cells is sufficient for neointima formation. Specific ablation of a single copy of the Nf1 gene in myeloid cells alone mobilizes a discrete pro-inflammatory murine monocyte population via a cell autonomous and gene-dosage dependent mechanism. Furthermore, lineage-restricted heterozygous inactivation of Nf1 in myeloid cells is sufficient to reproduce the enhanced neointima formation observed in Nf1(+/-) mice when compared with wild-type controls, and homozygous inactivation of Nf1 in myeloid cells amplified the degree of arterial stenosis after arterial injury. Treatment of Nf1(+/-) mice with rosuvastatin, a stain with anti-inflammatory properties, significantly reduced neointima formation when compared with control. These studies identify neurofibromin-deficient myeloid cells as critical cellular effectors of Nf1(+/-) neointima formation and propose a potential therapeutic for NF1 cardiovascular disease.