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Nguyen LD, Sengupta S, Cho K, Floru A, George RE, Krichevsky AM. Novel miRNA-inducing drugs enable differentiation of retinoic acid-resistant neuroblastoma cells. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.05.597584. [PMID: 38895399 PMCID: PMC11185630 DOI: 10.1101/2024.06.05.597584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Tumor cell heterogeneity in neuroblastoma, a pediatric cancer arising from neural crest-derived progenitor cells, poses a significant clinical challenge. In particular, unlike adrenergic (ADRN) neuroblastoma cells, mesenchymal (MES) cells are resistant to chemotherapy and retinoid therapy and thereby significantly contribute to relapses and treatment failures. Previous research suggested that overexpression or activation of miR-124, a neurogenic microRNA with tumor suppressor activity, can induce the differentiation of retinoic acid-resistant neuroblastoma cells. Leveraging our established screen for miRNA-modulatory small molecules, we validated PP121, a dual inhibitor of tyrosine and phosphoinositide kinases, as a robust inducer of miR-124. A combination of PP121 and BDNF-activating bufalin synergistically arrests proliferation, induces differentiation, and maintains the differentiated state of MES SK-N-AS cells for 8 weeks. RNA-seq and deconvolution analyses revealed a collapse of the ADRN core regulatory circuitry (CRC) and the emergence of novel CRCs associated with chromaffin cells and Schwann cell precursors. Using a similar protocol, we differentiated and maintained MES neuroblastoma GI-ME-N and SH-EP cell lines, as well as glioblastoma LN-229 and U-251 cell lines, for over 16 weeks. In conclusion, our novel protocol suggests a promising treatment for therapy-resistant cancers of the nervous system. Moreover, these long-lived, differentiated cells provide valuable models for studying mechanisms underlying differentiation, maturation, and senescence.
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El Gameel D, Sharif AF, Shoeib O, Elgebally EI, Fayed MM. Development and validation of a risk prediction nomogram for serious arrhythmias in acute digoxin toxicity among pediatrics: A multicenter study. Toxicon 2023; 233:107241. [PMID: 37558139 DOI: 10.1016/j.toxicon.2023.107241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/24/2023] [Accepted: 08/02/2023] [Indexed: 08/11/2023]
Abstract
Digoxin is a cardiac glycoside obtained from the leaves of the foxglove plant, Digitalis lanata. Several studies have described the safety of digoxin including various life-threatening events, notably cardiac arrhythmias. Early identification of high-risk patients and subsequent initiation of the utmost medical care are associated with a better prognosis. The assessment of serum digoxin levels, which is not always convenient, is the only tool used to evaluate the severity of digoxin exposure. However, the feasibility of this tool, particularly in resource-restricted countries, remains unclear. Therefore, the current study aimed to establish and validate a feasible alternative tool, a bedside nomogram, to identify pediatric patients diagnosed with acute digoxin intoxication who are at risk of developing serious arrhythmias. This was a two-phase, multicenter, retrospective study. The prevalence of serious arrhythmias was approximately 17%. Patients diagnosed with serious arrhythmias showed significantly higher serum digoxin, random blood glucose, and potassium levels but lower sodium, magnesium, and hemoglobin levels. Serious arrhythmias were associated with significantly lower P-R intervals, shorter QTc intervals, and more frequent digoxin effects (p < 0.05). The proposed nomogram showed that combining age and initial random blood glucose, sodium, and potassium levels could predict the future incidence of serious arrhythmia with an accuracy of 96.2% (sensitivity = 94.4%, specificity = 96.5%), an area under the curve (AUC) of 0.977, and p < 0.001. Validation of the proposed nomogram yielded an AUC for the nomogram probability of approximately 81%, and the AUC for the predicted probability using the developed model was 98.3%, indicating that both the validated model and the developed nomogram were significant predictors of serious arrhythmia. The utility of using the four-factor nomogram to determine the risk of serious arrhythmia in children exposed to an overdose of digoxin is comparable, if not superior, to the serum digoxin level.
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Affiliation(s)
- Dina El Gameel
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, Egypt; Poison Control Center, Aseer, Saudi Arabia
| | - Asmaa Fady Sharif
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, Egypt; Clinical Medical Sciences Department, College of Medicine, Dar Al-Uloom University, Riyadh, Saudi Arabia.
| | - Osama Shoeib
- Cardiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Elsayed Ibrahim Elgebally
- Department of Pediatrics, Menoufia University, Shebeen Al-kom, Egypt; Paediatric Department, Saudi German Hospital, Aseer, Saudi Arabia
| | - Manar Maher Fayed
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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Clifford LM, Meere W. Chronic Digoxin Toxicity: An Evaluation of Digoxin-Specific Antibodies and Other Management Options. Cureus 2023; 15:e38692. [PMID: 37292530 PMCID: PMC10245077 DOI: 10.7759/cureus.38692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 06/10/2023] Open
Abstract
Chronic digoxin toxicity comprises the bulk of digoxin poisonings and can be more difficult to manage than acute intoxications. A 60-year-old lady presented with severe chronic digoxin toxicity after ingesting digoxin 250mcg twice a day (BD) for two weeks. Due to hemodynamic instability on presentation, she was treated with digoxin-specific antibodies and admitted to the coronary care unit. This case of chronic digoxin toxicity did not respond to digoxin-specific antibodies and required intensive cardiac therapy with isoprenaline and intravenous electrolyte replacement, highlighting the complexities in the management of toxicity. Our patient has since recovered and remains stable. There are newer, novel therapies being trialed for the treatment of digoxin toxicity, including dextrose-insulin infusions, therapeutic plasma exchange, and rifampicin, but these require more research and investigation in this cohort of patients.
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Kalhor S, Fattahi A. Design of ionic liquids containing glucose and choline as drug carriers, finding the link between QM and MD studies. Sci Rep 2022; 12:21941. [PMID: 36535965 PMCID: PMC9763358 DOI: 10.1038/s41598-022-25963-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
Designing drug delivery systems for therapeutic compounds whose receptors are located in the cytosol of cells is challenging as a bilayer cell membrane is negatively charged. The newly designed drug delivery systems should assist the mentioned drugs in passing the membrane barriers and achieving their targets. This study concentrated on developing novel ionic liquids (ILs) that interact effectively with cell membranes. These ILs are based on glucose-containing choline and are expected to be non-toxic. The binding energies of the known pharmaceutically active ionic liquids were calculated at the B3LYP/6-311++G(d,p) level in the gas phase and compared with those of our newly designed carbohydrate-based ionic liquids. Subsequently, we employed MD simulations to obtain information about the interactions of these known and designed ILs with the cell membrane. In our approach, we adopted QM and MD studies and illustrated that there could be a link between the QM and MD results.
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Affiliation(s)
- Sepideh Kalhor
- Department of Chemistry, Sharif University of Technology, Tehran, Iran
| | - Alireza Fattahi
- Department of Chemistry, Sharif University of Technology, Tehran, Iran.
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Yadav RN, Hossain MF, Das A, Srivastava AK, Banik BK. Organocatalysis: A recent development on stereoselective synthesis of o-glycosides. CATALYSIS REVIEWS 2022. [DOI: 10.1080/01614940.2022.2041303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Ram Naresh Yadav
- Department of Chemistry, Faculty of Engineering & Technology, Veer Bahadur Singh Purvanchal University, Jaunpur, India
| | - Md. Firoj Hossain
- Department of Chemistry, University of North Bengal, Darjeeling, India
| | - Aparna Das
- Department of Mathematics and Natural Sciences, College of Sciences and Human Studies, Prince Mohammad Bin Fahd University, Khobar, Saudi Arabia
| | - Ashok Kumar Srivastava
- Department of Chemistry, Faculty of Engineering & Technology, Veer Bahadur Singh Purvanchal University, Jaunpur, India
| | - Bimal Krishna Banik
- Department of Mathematics and Natural Sciences, College of Sciences and Human Studies, Prince Mohammad Bin Fahd University, Khobar, Saudi Arabia
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Digiovanni-Kinsley S, Duke B, Giovane R, Paisley C. A Case of Digoxin Toxicity Due to Acute Renal Failure. Cureus 2021; 13:e17599. [PMID: 34646651 PMCID: PMC8482950 DOI: 10.7759/cureus.17599] [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] [Accepted: 08/31/2021] [Indexed: 11/05/2022] Open
Abstract
Since the publication of the Digitalis Investigation Group trial in 1997, digoxin use has declined significantly. Medications such as angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs) and beta-blockers that have been demonstrated to have a decrease in morbidity and mortality are prescribed in favor of digoxin. Despite the reduction in digoxin use and improved therapeutic monitoring, digoxin toxicity remains a significant cause of morbidity and mortality. When digoxin toxicity is suspected, patients should be managed with supportive care, including discontinuation of the medication, and consideration for administration of digoxin-specific antibody fragment. We present a case of digoxin toxicity precipitated by acute renal failure, with a discussion on the pathophysiology and diagnosis of digoxin toxicity, along with the indications for administration of digoxin-specific antibody fragments. While digoxin toxicity is prescribed less commonly, physicians need to maintain a high index of suspicion and be comfortable with administering digoxin-specific antibody fragment in these scenarios.
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Affiliation(s)
| | - Brandon Duke
- Family Medicine, University of Alabama, Tuscaloosa, USA
| | - Richard Giovane
- Family Medicine, Regional Medical Center Clinic, Greenville, USA
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Jiang H, Qin X, Wang Q, Xu Q, Wang J, Wu Y, Chen W, Wang C, Zhang T, Xing D, Zhang R. Application of carbohydrates in approved small molecule drugs: A review. Eur J Med Chem 2021; 223:113633. [PMID: 34171659 DOI: 10.1016/j.ejmech.2021.113633] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/04/2021] [Accepted: 06/06/2021] [Indexed: 12/24/2022]
Abstract
Carbohydrates are an important energy source and play numerous key roles in all living organisms. Carbohydrates chemistry involved in diagnosis and treatment of diseases has been attracting increasing attention. Carbohydrates could be one of the major focuses of new drug discovery. Currently, however, carbohydrate-containing drugs account for only a small percentage of all drugs in clinical use, which does not match the important roles of carbohydrates in the organism. In other words, carbohydrates are a relatively untapped source of new drugs and therefore may offer exciting novel therapeutic opportunities. Here, we presented an overview of the application of carbohydrates in approved small molecule drugs and emphasized and evaluated the roles of carbohydrates in those drugs. The potential development direction of carbohydrate-containing drugs was presented after summarizing the advantages and challenges of carbohydrates in the development of new drugs.
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Affiliation(s)
- Hongfei Jiang
- The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, 266071, China; Cancer Institute, Qingdao University, Qingdao, 266071, China
| | - Xiaofei Qin
- Department of Bioengineering, Zhuhai Campus of Zunyi Medical University, Zhuhai, 519041, China
| | - Qi Wang
- Department of Critical Medicine, Hainan Maternal and Children's Medical Center, Haikou, 570312, China
| | - Qi Xu
- Laboratory of Immunology for Environment and Health, Shandong Analysis and Test Center, Qilu University of Technology Shandong Academy of Sciences, Jinan, China
| | - Jie Wang
- Cancer Institute, Qingdao University, Qingdao, 266071, China
| | - Yudong Wu
- Cancer Institute, Qingdao University, Qingdao, 266071, China
| | - Wujun Chen
- Cancer Institute, Qingdao University, Qingdao, 266071, China
| | - Chao Wang
- Cancer Institute, Qingdao University, Qingdao, 266071, China
| | - Tingting Zhang
- Cancer Institute, Qingdao University, Qingdao, 266071, China
| | - Dongming Xing
- The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, 266071, China; Cancer Institute, Qingdao University, Qingdao, 266071, China; School of Life Sciences, Tsinghua University, Beijing, 100084, China
| | - Renshuai Zhang
- The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, 266071, China; Cancer Institute, Qingdao University, Qingdao, 266071, China.
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8
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Galizzi A, Martinelli E, Spalla I, Toschi Corneliani R, Locatelli C. ECG of the Month. J Am Vet Med Assoc 2021; 258:847-851. [PMID: 33825534 DOI: 10.2460/javma.258.8.847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Shadnia S, Rahimi M, Mahdavinejad A, Saffaei A. A 5 years assessment of patients with acute digoxin poisoning: A toxicoepidemiology study in Iran. Heart Views 2021; 22:271-274. [PMID: 35330656 PMCID: PMC8939374 DOI: 10.4103/heartviews.heartviews_43_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 12/20/2021] [Indexed: 11/14/2022] Open
Abstract
Background: Digoxin poisoning leads to the development of cardiac and noncardiac complications. Digoxin immune fab is a safe and effective antidote, but clinical trials have not been performed in this regard, and most of the evidence is based on prospective studies. Understanding the toxicoepidemiology pattern of digoxin poisoning could provide valuable context for better managing its acute poisoning. Objectives: This study aimed to assess the toxicoepidemiology pattern of acute digoxin poisoning through a 5-year assessment in Iran. Methodology: In this observational study, the records of 97 patients who were referred with acute digoxin poisoning between 2010 and 2015 were evaluated. Demographic characteristics, past medical history, drug history, chief complaints, vital signs, paraclinical findings, digoxin immune fab administration, and clinical outcomes recorded. Results: The mean age of patients was 34.02 ± 17.87 years old. About 24.7% of patients had underlying diseases, and among them, heart failure was the most prevalent disease (29.2%) 42.3% of patients needed intensive care unit (ICU) admission. The mean duration of ICU stay was 4.00 ± 2.29 days. Digoxin immune fab was administered for 4.1% of patients, and an average of 6.2 ± 2.2 vials were used for them. All patients survived, and no mortality was reported. Conclusions: Digoxin immune fab administration did not alter the mortality rate. Hence, it can be concluded digoxin immune fab is not appropriate in acute poisoning, but it may be considered in chronic poisoning. Furthermore, acute digoxin poisoning is more common in Iran, and it responds appropriately to conventional treatment.
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Galton AF, Granfone MC, Caldwell DJ. Digoxin-specific antibody fragments for the treatment of suspected Nerium oleander toxicosis in a cat. JFMS Open Rep 2020; 6:2055116920969599. [PMID: 33312680 PMCID: PMC7716070 DOI: 10.1177/2055116920969599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Case summary A 6-year-old castrated male domestic shorthair cat presented for lethargy and gastrointestinal signs after possible exposure to Nerium oleander leaves. The cat developed a ventricular arrhythmia that responded positively to the administration of digoxin-specific antibody fragments. Underlying hypertrophic cardiomyopathy was also diagnosed after the development of congestive heart failure. Humane euthanasia was elected owing to a lack of significant response to continued therapy. Relevance and novel information To our knowledge, this is the first report to describe the use of digoxin-specific antibody fragments in a cat. Nerium oleander toxicosis is associated with significant morbidity and mortality, and digoxin-specific antibody fragments have been used effectively in humans and animals. The development of cardiac necrosis may have contributed to worsening arrhythmias and highlights the importance of early intervention. The use of digoxin-specific antibody fragments for suspected N oleander toxicosis in a cat resulted in a rapid response and appeared to be well tolerated.
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Affiliation(s)
- Aaron F Galton
- Critical Care Department, Arizona Veterinary Emergency and Critical Care Center, Phoenix, AZ, USA
| | - Marcella C Granfone
- Critical Care Department, Arizona Veterinary Emergency and Critical Care Center, Phoenix, AZ, USA
| | - Dana J Caldwell
- Critical Care Department, Arizona Veterinary Emergency and Critical Care Center, Phoenix, AZ, USA
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11
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Doctor Gachet, in the kitchen, with the foxglove. Cardiol Young 2020; 30:1856-1865. [PMID: 32959746 DOI: 10.1017/s1047951120002978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Vincent van Gogh (1853-1890) is one of the most famous artists in the world. During his 10-year career as an artist, he created more than 850 paintings. These works of art are now displayed in museums around the globe. It is therefore even more surprising that van Gogh sold just one painting during his lifetime. Van Gogh is also well-known for his mental illness. In 1888, at the age of 35, he famously sliced off his left ear. This was followed by multiple mental collapses in early 1889, leading to his admission to a mental hospital. Despite living in the asylum, van Gogh continued to paint and created some of his most beautiful works of art during the year at Saint-Rémy. Tragically, he committed suicide in 1890 at the age of 37. Over the 130 years since his death, there has been much speculation about the underlying illness of Vincent van Gogh. Many of his contemporary physicians felt that he had a form of epilepsy as the cause of his sudden "attacks". By the last quarter of the 19th century, science and medicine were moving rapidly forward, and there were many medical conditions that had effective treatments. One example is the use of digoxin for the treatment of heart failure, and another is the discovery of potassium bromide for seizures. This paper provides an overview of van Gogh's mental illness, the treatments that were offered by his contemporaneous physicians, and the role that these factors may have influenced his paintings.
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Ferraro F, Patella F, Costa JR, Ketteler R, Kriston‐Vizi J, Cutler DF. Modulation of endothelial organelle size as an antithrombotic strategy. J Thromb Haemost 2020; 18:3296-3308. [PMID: 32881285 PMCID: PMC8436738 DOI: 10.1111/jth.15084] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/31/2020] [Accepted: 08/24/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND It is long established that von Willebrand factor (VWF) is central to hemostasis and thrombosis. Endothelial VWF is stored in cell-specific secretory granules, Weibel-Palade bodies (WPBs), organelles generated in a wide range of lengths (0.5-5.0 µm). WPB size responds to physiological cues and pharmacological treatment, and VWF secretion from shortened WPBs dramatically reduces platelet and plasma VWF adhesion to an endothelial surface. OBJECTIVE We hypothesized that WPB-shortening represented a novel target for antithrombotic therapy. Our objective was to determine whether compounds exhibiting this activity do exist. METHODS Using a microscopy approach coupled to automated image analysis, we measured the size of WPB bodies in primary human endothelial cells treated with licensed compounds for 24 hours. RESULTS AND CONCLUSIONS A novel approach to identification of antithrombotic compounds generated a significant number of candidates with the ability to shorten WPBs. In vitro assays of two selected compounds confirm that they inhibit the pro-hemostatic activity of secreted VWF. This set of compounds acting at a very early stage of the hemostatic process could well prove to be a useful adjunct to current antithrombotic therapeutics. Further, in the current SARS-CoV-2 pandemic, with a considerable fraction of critically ill COVID-19 patients affected by hypercoagulability, these WPB size-reducing drugs might also provide welcome therapeutic leads for frontline clinicians and researchers.
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Affiliation(s)
- Francesco Ferraro
- Endothelial Cell Biology Group, MRC Laboratory for Molecular Cell BiologyUniversity College LondonLondonUK
- Present address:
Department of Biology and Evolution of Marine Organisms (BEOM)Stazione Zoologica Anton DohrnVilla ComunaleNaplesItaly
| | - Francesca Patella
- Endothelial Cell Biology Group, MRC Laboratory for Molecular Cell BiologyUniversity College LondonLondonUK
| | - Joana R. Costa
- Cell Signalling and Autophagy GroupMRC Laboratory for Molecular Cell BiologyUniversity College LondonLondonUK
- Present address:
Leukaemia Biology Research GroupDepartment of Haematology, Cancer InstituteUniversity College LondonLondonUK
| | - Robin Ketteler
- Cell Signalling and Autophagy GroupMRC Laboratory for Molecular Cell BiologyUniversity College LondonLondonUK
| | - Janos Kriston‐Vizi
- Bioinformatics Image Core (BIONIC)MRC Laboratory for Molecular Cell BiologyUniversity College LondonLondonUK
| | - Daniel F. Cutler
- Endothelial Cell Biology Group, MRC Laboratory for Molecular Cell BiologyUniversity College LondonLondonUK
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Newman RA, Sastry KJ, Arav-Boger R, Cai H, Matos R, Harrod R. Antiviral Effects of Oleandrin. J Exp Pharmacol 2020; 12:503-515. [PMID: 33262663 PMCID: PMC7686471 DOI: 10.2147/jep.s273120] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/25/2020] [Indexed: 12/13/2022] Open
Abstract
Over the past 15 years, investigators have reported on the utility and safety of cardiac glycosides for numerous health benefits including those as treatments for malignant disease, stroke-mediated ischemic injury and certain neurodegenerative diseases. In addition to those, there is a growing body of evidence for novel antiviral effects of selected cardiac glycoside molecules. One unique cardiac glycoside, oleandrin derived from Nerium oleander, has been reported to have antiviral activity specifically against 'enveloped' viruses including HIV and HTLV-1. Importantly, a recent publication has presented in vitro evidence for oleandrin's ability to inhibit production of infectious virus particles when used for treatment prior to, as well as after infection by SARS-CoV-2/COVID-19. This review will highlight the known in vitro antiviral effects of oleandrin as well as present previously unpublished effects of this novel cardiac glycoside against Ebola virus, Cytomegalovirus, and Herpes simplex viruses.
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Affiliation(s)
- Robert A Newman
- Department of Experimental Therapeutics, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77054, USA.,Phoenix Biotechnology, Inc, San Antonio, TX 78217, USA
| | - K Jagannadha Sastry
- Departments of Thoracic, Head and Neck Medical Oncology and Veterinary Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ravit Arav-Boger
- Division of Infectious Diseases, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Hongyi Cai
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | | | - Robert Harrod
- Department of Biological Sciences, the Dedman College Center for Drug Discovery, Design & Delivery, Southern Methodist University, Dallas, TX 75275, USA
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Patocka J, Nepovimova E, Wu W, Kuca K. Digoxin: Pharmacology and toxicology-A review. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2020; 79:103400. [PMID: 32464466 DOI: 10.1016/j.etap.2020.103400] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 05/25/2023]
Abstract
Digoxin is a cardiac glycoside used as drug in case of heart problems, including congestive heart failure, atrial fibrillation or flutter, and certain cardiac arrhythmias. It has a very narrow therapeutic window of the medication. Digoxin is toxic substance with well known cardiotoxic effect. In this work, pharmacology and toxicology of digoxin are summarized; Its pharmacokinetics, pharmacodynamics, available acute toxicity data (different species, different administration routes) are summarized in this article. Moreover, its treatment side effect and human poisonings are thoroughly discussed. Finally, appropriate therapy regimen is proposed.
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Affiliation(s)
- Jiri Patocka
- Faculty of Health and Social Studies, Department of Radiology and Toxicology, University of South Bohemia Ceske Budejovice, Ceske Budejovice, Czech Republic; Biomedical Research Centre, University Hospital, Hradec Kralove, Czech Republic
| | - Eugenie Nepovimova
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, Hradec Kralove, Czech Republic
| | - Wenda Wu
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, Hradec Kralove, Czech Republic; MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, China.
| | - Kamil Kuca
- Biomedical Research Centre, University Hospital, Hradec Kralove, Czech Republic; Department of Chemistry, Faculty of Science, University of Hradec Kralove, Hradec Kralove, Czech Republic.
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15
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Brillatz T, Jacmin M, Vougogiannopoulou K, Petrakis EA, Kalpoutzakis E, Houriet J, Pellissier L, Rutz A, Marcourt L, Queiroz EF, Crawford AD, Skaltsounis AL, Wolfender JL. Antiseizure potential of the ancient Greek medicinal plant Helleborus odorus subsp. cyclophyllus and identification of its main active principles. JOURNAL OF ETHNOPHARMACOLOGY 2020; 259:112954. [PMID: 32445663 DOI: 10.1016/j.jep.2020.112954] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/22/2020] [Accepted: 05/06/2020] [Indexed: 06/11/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Ethnopharmacological data and ancient texts support the use of black hellebore (Helleborus odorus subsp. cyclophyllus, Ranunculaceae) for the management and treatment of epilepsy in ancient Greece. AIM OF THE STUDY A pharmacological investigation of the root methanolic extract (RME) was conducted using the zebrafish epilepsy model to isolate and identify the compounds responsible for a potential antiseizure activity and to provide evidence of its historical use. In addition, a comprehensive metabolite profiling of this studied species was proposed. MATERIALS AND METHODS The roots were extracted by solvents of increasing polarity and root decoction (RDE) was also prepared. The extracts were evaluated for antiseizure activity using a larval zebrafish epilepsy model with pentylenetetrazole (PTZ)-induced seizures. The RME exhibited the highest antiseizure activity and was therefore selected for bioactivity-guided fractionation. Isolated compounds were fully characterized by NMR and high-resolution tandem mass spectrometry (HRMS/MS). The UHPLC-HRMS/MS analyses of the RME and RDE were used for dereplication and metabolite profiling. RESULTS The RME showed 80% inhibition of PTZ-induced locomotor activity (300 μg/ml). This extract was fractionated and resulted in the isolation of a new glucopyranosyl-deoxyribonolactone (1) and a new furostanol saponin derivative (2), as well as of 20-hydroxyecdysone (3), hellebrin (4), a spirostanol glycoside derivative (5) and deglucohellebrin (6). The antiseizure activity of RME was found to be mainly due to the new furostanol saponin (2) and hellebrin (4), which reduced 45% and 60% of PTZ-induced seizures (135 μM, respectively). Besides, the aglycone of hellebrin, hellebrigenin (S34), was also active (45% at 7 μM). To further characterize the chemical composition of both RME and RDE, 30 compounds (A7-33, A35-37) were annotated based on UHPLC-HRMS/MS metabolite profiling. This revealed the presence of additional bufadienolides, furostanols, and evidenced alkaloids. CONCLUSIONS This study is the first to identify the molecular basis of the ethnopharmacological use of black hellebore for the treatment of epilepsy. This was achieved using a microscale zebrafish epilepsy model to rapidly quantify in vivo antiseizure activity. The UHPLC-HRMS/MS profiling revealed the chemical diversity of the extracts and the presence of numerous bufadienolides, furostanols and ecdysteroids, also present in the decoction.
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Affiliation(s)
- Théo Brillatz
- School of Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, CMU - Rue Michel Servet 1, CH-1211, Geneva 4, Switzerland
| | - Maxime Jacmin
- Luxembourg Centre for Systems Biomedicine, Université du Luxembourg 6, Avenue du Swing, 4367, Belvaux, Luxembourg; Theracule S.á r.l., 9, Avenue des Hauts-Fourneaux, 4362, Belval, Luxembourg
| | - Konstantina Vougogiannopoulou
- Department of Pharmacognosy and Natural Products Chemistry, Faculty of Pharmacy, National and Kapodistrian University of Athens, Panepistimiopolis Zografou, 15771, Athens, Greece
| | - Eleftherios A Petrakis
- Department of Pharmacognosy and Natural Products Chemistry, Faculty of Pharmacy, National and Kapodistrian University of Athens, Panepistimiopolis Zografou, 15771, Athens, Greece
| | - Eleftherios Kalpoutzakis
- Department of Pharmacognosy and Natural Products Chemistry, Faculty of Pharmacy, National and Kapodistrian University of Athens, Panepistimiopolis Zografou, 15771, Athens, Greece
| | - Joëlle Houriet
- School of Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, CMU - Rue Michel Servet 1, CH-1211, Geneva 4, Switzerland
| | - Léonie Pellissier
- School of Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, CMU - Rue Michel Servet 1, CH-1211, Geneva 4, Switzerland
| | - Adriano Rutz
- School of Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, CMU - Rue Michel Servet 1, CH-1211, Geneva 4, Switzerland
| | - Laurence Marcourt
- School of Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, CMU - Rue Michel Servet 1, CH-1211, Geneva 4, Switzerland
| | - Emerson Ferreira Queiroz
- School of Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, CMU - Rue Michel Servet 1, CH-1211, Geneva 4, Switzerland
| | - Alexander D Crawford
- Luxembourg Centre for Systems Biomedicine, Université du Luxembourg 6, Avenue du Swing, 4367, Belvaux, Luxembourg; Theracule S.á r.l., 9, Avenue des Hauts-Fourneaux, 4362, Belval, Luxembourg; Department of Preclinical Sciences & Pathology, Norwegian University of Life Sciences, Ullevålsveien 72, 0454, Oslo, Norway
| | - Alexios-Leandros Skaltsounis
- Department of Pharmacognosy and Natural Products Chemistry, Faculty of Pharmacy, National and Kapodistrian University of Athens, Panepistimiopolis Zografou, 15771, Athens, Greece.
| | - Jean-Luc Wolfender
- School of Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, CMU - Rue Michel Servet 1, CH-1211, Geneva 4, Switzerland.
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16
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Tan J, Liu H, Huang M, Li N, Tang S, Meng J, Tang S, Zhou H, Kijlstra A, Yang P, Hou S. Small molecules targeting RORγt inhibit autoimmune disease by suppressing Th17 cell differentiation. Cell Death Dis 2020; 11:697. [PMID: 32829384 PMCID: PMC7443190 DOI: 10.1038/s41419-020-02891-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 08/01/2020] [Accepted: 08/03/2020] [Indexed: 02/08/2023]
Abstract
Th17 cells, a lymphocyte subpopulation that is characterized by the expression of the transcription factor "retinoic acid receptor-related orphan receptor gamma-t" (RORγt), plays an important role in the pathogenesis of autoimmune disease. The current study was set up to discover novel and non-steroidal small-molecule inverse agonists of RORγt and to determine their effects on autoimmune disease. Structure-based virtual screening (SBVS) was used to find compounds targeting RORγt. Flow cytometry was used to detect the Th17 cell differentiation. Inverse agonists were intraperitoneally administered to mice undergoing experimental autoimmune uveitis (EAU), experimental autoimmune encephalomyelitis (EAE) or type 1 diabetes. The effects of the inverse agonists were evaluated by clinical or histopathological scoring. Among 1.3 million compounds screened, CQMU151 and CQMU152 were found to inhibit Th17 cell differentiation without affecting the differentiation of Th1 and Treg lineages (both P = 0.001). These compounds also reduced the severity of EAU (P = 0.01 and 0.013) and functional studies showed that they reduced the number of Th17 cell and the expression of IL-17(Th17), but not IFN-γ(Th1) and TGF-β(Treg) in mouse retinas. Further studies showed that these compounds may reduce the expression of p-STAT3 by reducing the positive feedback loop of IL-17/IL-6/STAT3. These compounds also reduced the impaired blood-retinal barrier function by upregulating the expression of tight junction proteins. These compounds were also found to reduce the severity of EAE and type 1 diabetes. Our results showed that RORγt inverse agonists may inhibit the development of autoimmune diseases and may provide new clues for the treatment of Th17-mediated immune diseases.
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MESH Headings
- Animals
- Autoimmune Diseases/metabolism
- Autoimmune Diseases/physiopathology
- Cell Differentiation/drug effects
- China
- Diabetes Mellitus, Experimental/immunology
- Encephalomyelitis, Autoimmune, Experimental/immunology
- Female
- Flow Cytometry/methods
- Interleukin-17/metabolism
- Lymphocyte Activation
- Lymphocytes/metabolism
- Mice, Inbred C57BL
- Nuclear Receptor Subfamily 1, Group F, Member 3/agonists
- Nuclear Receptor Subfamily 1, Group F, Member 3/metabolism
- Receptors, Retinoic Acid/metabolism
- STAT3 Transcription Factor/metabolism
- T-Lymphocytes, Regulatory/immunology
- Th17 Cells/immunology
- Th17 Cells/metabolism
- Transforming Growth Factor beta/metabolism
- Retinoic Acid Receptor gamma
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Affiliation(s)
- Jun Tan
- The First Affiliated Hospital, Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing, P. R. China
| | - Huan Liu
- The First Affiliated Hospital, Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing, P. R. China
| | - Minhao Huang
- Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, 510530, China
| | - Na Li
- College of Basic Medicine, Chongqing Medical University, Chongqing, 400016, P. R. China
| | - Shibing Tang
- Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, 510530, China
| | - Jiayu Meng
- The First Affiliated Hospital, Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing, P. R. China
| | - Shiyun Tang
- The First Affiliated Hospital, Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing, P. R. China
| | - Hongxiu Zhou
- The First Affiliated Hospital, Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing, P. R. China
| | - Aize Kijlstra
- Eye Research Institute Maastricht, Department of Ophthalmology, University Hospital Maastricht, Maastricht, The Netherlands
| | - Peizeng Yang
- The First Affiliated Hospital, Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing, P. R. China
| | - Shengping Hou
- The First Affiliated Hospital, Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing, P. R. China.
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Malysheva SV, Mulder PPJ, Masquelier J. Development and Validation of a UHPLC-ESI-MS/MS Method for Quantification of Oleandrin and Other Cardiac Glycosides and Evaluation of Their Levels in Herbs and Spices from the Belgian Market. Toxins (Basel) 2020; 12:E243. [PMID: 32283845 PMCID: PMC7232191 DOI: 10.3390/toxins12040243] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/04/2020] [Accepted: 04/08/2020] [Indexed: 01/02/2023] Open
Abstract
Cardiac glycosides (CGs) are naturally occurring plant secondary metabolites that can be toxic to humans and animals. The aim of this work was to develop a targeted analytical method utilizing liquid chromatography-tandem mass spectrometry (LC-MS/MS) for quantification of these plant toxins in a herbal-based food and human urine. The method included oleandrin, digoxin, digitoxin, convallatoxin, and ouabain. Samples of culinary herbs were extracted with acetonitrile and cleaned using Oasis® MAX solid-phase extraction (SPE), while samples of urine were diluted with acidified water and purified on Oasis® HLB SPE cartridges. Limits of quantification were in the range of 1.5-15 ng/g for herbs and 0.025-1 ng/mL for urine. The mean recovery of the method complied with the acceptable range of 70-120% for most CGs, and relative standard deviations were at maximum 14% and 19% for repeatability and reproducibility, respectively. Method linearity was good with calculated R² values above 0.997. The expanded measurement uncertainty was estimated to be in the range of 7-37%. The LC-MS/MS method was used to examine 65 samples of culinary herbs and herb and spice mixtures collected in Belgium, from supermarkets and local stores. The samples were found to be free from the analyzed CGs.
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Affiliation(s)
| | - Patrick P. J. Mulder
- Wageningen Food Safety Research, Wageningen University and Research, 6708 WB Wageningen, The Netherlands;
| | - Julien Masquelier
- Unit Toxins, Organic Contaminants and Additives, Sciensano, 1050 Brussels, Belgium;
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18
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Yunos NM, Osman A, Jauri MH, Sallehudin NJ, Mutalip SSM. The In Vitro Anti-Cancer Activities of 17βH-Neriifolin Isolated from Cerbera odollam and its Binding Activity on Na+, K+-ATPase. Curr Pharm Biotechnol 2020; 21:37-44. [DOI: 10.2174/1389201020666190917154850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 07/22/2019] [Accepted: 08/02/2019] [Indexed: 11/22/2022]
Abstract
Background:17βH-neriifolin, a cardiac glycoside compound had been successfully isolated from Cerbera odollam leaves based on the bioassay guided-isolation procedure. The aim of these studies were to determine the in vitro anti-cancer and binding effects of 17βH-neriifolin on Na+, K+-ATPase.Methods:The in vitro anti-cancer effects were evaluated using Sulphorhodamine B and Hoescht 33342 assays. The Na+, K+-ATPase assay was carried out using Malachite Green assay. In silico molecular docking studies and in vitro malachite green assay were used to predict the binding activities of 17βH-neriifolin on Na+, K+-ATPase and ouabain was also included as for comparison studies.Results:The compound was tested against breast (MCF-7, T47D), colorectal (HT-29), ovarian (A2780, SKOV-3) and skin (A375) cancer cell lines that gave IC50 values ranged from 0.022 ± 0.0015 to 0.030 ± 0.0018 μM. The mechanism of cell death of 17βH-neriifolin was further evaluated using Hoescht 33342 assay and it was found that the compound killed the cancer cells via apoptosis. 17βHneriifolin and ouabain both bound at α-subunit in Na+, K+-ATPase and their binding energy were - 8.16 ± 0.74 kcal/mol and -8.18 ± 0.48 kcal/mol respectively.Conclusion:The results had confirmed the anti-proliferative effects exerted by 17βH-neriifolin in the breast, colorectal, ovarian and skin cancer cell lines. 17βH-neriifolin had shown to cause apoptotic cell death in the respective cancer cell lines.17βH-neriifolin and ouabain both bound at α-subunit in Na+, K+-ATPase and their binding energy were -8.16 ± 0.74 kcal/mol and -8.18 ± 0.48 kcal/mol respectively. This is the first report to reveal that 17βH-neriifolin managed to bind to the pocket of α-subunit of Na+.K+-ATPase.
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Affiliation(s)
- Nurhanan M. Yunos
- Bioactivity Programme, Natural Products Division, Forest Research Institute Malaysia, 52109, Kepong Selangor, Malaysia
| | - Asiah Osman
- Bioactivity Programme, Natural Products Division, Forest Research Institute Malaysia, 52109, Kepong Selangor, Malaysia
| | - Muhammad H. Jauri
- Phytochemistry Programme, Natural Products Division, Forest Research Institute Malaysia, 52109, Kepong Selangor, Malaysia
| | - Nor J. Sallehudin
- Bioactivity Programme, Natural Products Division, Forest Research Institute Malaysia, 52109, Kepong Selangor, Malaysia
| | - Siti Syarifah Mohd Mutalip
- Bioactivity Programme, Natural Products Division, Forest Research Institute Malaysia, 52109, Kepong Selangor, Malaysia
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19
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A Probable Fatal Case of Oleander (Nerium oleander) Poisoning on a Cattle Farm: A New Method of Detection and Quantification of the Oleandrin Toxin in Rumen. Toxins (Basel) 2019; 11:toxins11080442. [PMID: 31349685 PMCID: PMC6723884 DOI: 10.3390/toxins11080442] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/01/2019] [Accepted: 07/21/2019] [Indexed: 11/16/2022] Open
Abstract
Oleander (Nerium oleander) is an ornamental plant common in tropical and sub-tropical regions that is becoming increasingly widespread, even in temperate regions. Oleander poisoning may occur in animals and humans. The main active components contained in the plant are cardiac glycosides belonging to the class of cardenolides that are toxic to many species, from human to insects. This work describes a case of oleander poisoning that occurred on a small cattle farm and resulted in the fatality of all six resident animals. Furthermore, the investigation of the poisonous agent is described, with particular focus on the characterization of the oleandrin toxin that was recovered from the forage and rumen contents. The innovation of this study is the first description of the detection and quantification of the oleandrin toxin by liquid chromatography-high resolution mass spectrometry (LC-HRMS) in rumen.
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20
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Malhamé I, Gandhi C, Tarabulsi G, Esposito M, Lombardi K, Chu A, Chen KK. Maternal monitoring and safety considerations during antiarrhythmic treatment for fetal supraventricular tachycardia. Obstet Med 2019; 12:66-75. [PMID: 31217810 PMCID: PMC6560838 DOI: 10.1177/1753495x18808118] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/25/2018] [Indexed: 11/16/2022] Open
Abstract
Fetal tachycardia is a rare complication during pregnancy. After exclusion of maternal and fetal conditions that can result in a secondary fetal tachycardia, supraventricular tachycardia is the most common cause of a primary sustained fetal tachyarrhythmia. In cases of sustained fetal supraventricular tachycardia, maternal administration of digoxin, flecainide, sotalol, and more rarely amiodarone, is considered. As these medications have the potential to cause significant adverse effects, we sought to examine maternal safety during transplacental treatment of fetal supraventricular tachycardia. In this narrative review we summarize the literature addressing pharmacologic properties, monitoring, and adverse reactions associated with medications most commonly prescribed for transplacental therapy of fetal supraventricular tachycardia. We also describe maternal monitoring practices and adverse events currently reported in the literature. In light of our findings, we provide clinicians with a suggested maternal monitoring protocol aimed at optimizing safety.
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Affiliation(s)
- Isabelle Malhamé
- Department of Medicine, Women and Infants Hospital, Providence, RI, USA
| | - Christy Gandhi
- Department of Medicine, Women and Infants Hospital, Providence, RI, USA
| | - Gofran Tarabulsi
- Department of Medicine, Women and Infants Hospital, Providence, RI, USA
| | - Matthew Esposito
- Department of Obstetrics and Gynecology, Women and Infants Hospital, Providence, RI, USA
| | - Kristin Lombardi
- Department of Pediatrics, Hasbro Children’s Hospital, Providence, RI, USA
| | - Antony Chu
- Department of Medicine, Rhode Island Hospital, Providence, RI, USA
| | - Kenneth K Chen
- Department of Medicine, Women and Infants Hospital, Providence, RI, USA
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21
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Maury Y, Poydenot P, Brinon B, Lesueur L, Gide J, Roquevière S, Côme J, Polvèche H, Auboeuf D, Alexandre Denis J, Pietu G, Furling D, Lechuga M, Baghdoyan S, Peschanski M, Martinat C. Pluripotent Stem Cell-Based Drug Screening Reveals Cardiac Glycosides as Modulators of Myotonic Dystrophy Type 1. iScience 2019; 11:258-271. [PMID: 30639849 PMCID: PMC6327858 DOI: 10.1016/j.isci.2018.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 12/14/2018] [Accepted: 12/20/2018] [Indexed: 02/06/2023] Open
Abstract
There is currently no treatment for myotonic dystrophy type 1 (DM1), the most frequent myopathy of genetic origin. This progressive neuromuscular disease is caused by nuclear-retained RNAs containing expanded CUG repeats. These toxic RNAs alter the activities of RNA splicing factors, resulting in alternative splicing misregulation. By combining human mutated pluripotent stem cells and phenotypic drug screening, we revealed that cardiac glycosides act as modulators for both upstream nuclear aggregations of DMPK mRNAs and several downstream alternative mRNA splicing defects. However, these occurred at different drug concentration ranges. Similar biological effects were recorded in a DM1 mouse model. At the mechanistic level, we demonstrated that this effect was calcium dependent and was synergic with inhibition of the ERK pathway. These results further underscore the value of stem-cell-based assays for drug discovery in monogenic diseases. Myotonic dystrophy type 1 hPSCs were adapted for high content screening FDA-approved cardiac glycosides normalize in vitro and in vivo DM1 biological markers Cardiac glycosides synergize with the ERK pathway to normalize DM1 biomarkers This study emphasizes the value of human pluripotent stem cells for drug discovery
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Affiliation(s)
- Yves Maury
- CECS, I-STEM, AFM, 91100 Corbeil-Essonnes, France
| | | | | | - Lea Lesueur
- INSERM, UMR 861, UEVE, ISTEM, AFM, 91100 Corbeil-Essonnes, France
| | | | | | - Julien Côme
- CECS, I-STEM, AFM, 91100 Corbeil-Essonnes, France
| | | | | | | | - Geneviève Pietu
- INSERM, UMR 861, UEVE, ISTEM, AFM, 91100 Corbeil-Essonnes, France
| | - Denis Furling
- Sorbonne Universités UPMC Univ Paris 06, INSERM, Centre de Recherche en Myologie - UMRS974, Institut de Myologie, 75013 Paris, France
| | - Marc Lechuga
- CECS, I-STEM, AFM, 91100 Corbeil-Essonnes, France
| | | | - Marc Peschanski
- CECS, I-STEM, AFM, 91100 Corbeil-Essonnes, France; INSERM, UMR 861, UEVE, ISTEM, AFM, 91100 Corbeil-Essonnes, France
| | - Cécile Martinat
- INSERM, UMR 861, UEVE, ISTEM, AFM, 91100 Corbeil-Essonnes, France.
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22
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Fu J, Wu Z, Zhang L. Clinical applications of the naturally occurring or synthetic glycosylated low molecular weight drugs. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2019; 163:487-522. [DOI: 10.1016/bs.pmbts.2019.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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23
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Botelho AFM, Pierezan F, Soto-Blanco B, Melo MM. A review of cardiac glycosides: Structure, toxicokinetics, clinical signs, diagnosis and antineoplastic potential. Toxicon 2018; 158:63-68. [PMID: 30529380 DOI: 10.1016/j.toxicon.2018.11.429] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/22/2018] [Accepted: 11/22/2018] [Indexed: 01/25/2023]
Abstract
Cardiac glycosides (CGs) are secondary compounds found in plants and amphibians and are widely distributed in nature with potential cardiovascular action. Their mechanism is based on the blockage of the heart's sodium potassium ATPase, with a positive inotropic effect. Some of the most well-known CGs are digoxin, ouabain, oleandrin, and bufalin. They have similar chemical structures: a lactone ring, steroid ring, and sugar moiety. Digoxin, ouabain, and oleandrin are classified as cardenolides, consisting of a lactone ring with five carbons, while bufalin is classified as bufodienolides, with a six-carbon ring. Small structural differences determine variations in the toxicokinetics and toxicodynamics of such substances. Most case reports of poisoning caused by CGs are associated with cardiovascular toxicity, causing a variety of arrhythmias and lesions in the heart tissue. Experimental studies also describe important similarities among different CGs, especially regarding species sensitivity. Recent studies furthermore focus on their antineoplastic potential, with controversial results. Data from research studies and case reports were reviewed to identify the main characteristics of the CGs, including toxicokinetics, toxicodynamics, clinical signs, electrocardiographic, pathological findings, antineoplastic potential and the main techniques used for diagnostic purposes.
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Affiliation(s)
- Ana Flávia M Botelho
- Department of Veterinary Clinic and Surgery, Veterinary College, Universidade Federal de Minas Gerais, Avenida Antônio Carlos 6627, Belo Horizonte, MG, 30123-970, Brazil
| | - Felipe Pierezan
- Department of Veterinary Clinic and Surgery, Veterinary College, Universidade Federal de Minas Gerais, Avenida Antônio Carlos 6627, Belo Horizonte, MG, 30123-970, Brazil
| | - Benito Soto-Blanco
- Department of Veterinary Clinic and Surgery, Veterinary College, Universidade Federal de Minas Gerais, Avenida Antônio Carlos 6627, Belo Horizonte, MG, 30123-970, Brazil.
| | - Marília Martins Melo
- Department of Veterinary Clinic and Surgery, Veterinary College, Universidade Federal de Minas Gerais, Avenida Antônio Carlos 6627, Belo Horizonte, MG, 30123-970, Brazil
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24
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Buzaglo N, Golomb M, Rosen H, Beeri R, Ami HCB, Langane F, Pierre S, Lichtstein D. Augmentation of Ouabain-Induced Increase in Heart Muscle Contractility by Akt Inhibitor MK-2206. J Cardiovasc Pharmacol Ther 2018; 24:78-89. [DOI: 10.1177/1074248418788301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cardiac steroids (CSs), such as ouabain and digoxin, increase the force of contraction of heart muscle and are used for the treatment of congestive heart failure (CHF). However, their small therapeutic window limits their use. It is well established that Na+, K+-ATPase inhibition mediates CS-induced increase in heart contractility. Recently, the involvement of intracellular signal transduction was implicated in this effect. The aim of the present study was to test the hypothesis that combined treatment with ouabain and Akt inhibitor (MK-2206) augments ouabain-induced inotropy in mammalian models. We demonstrate that the combined treatment led to an ouabain-induced increase in contractility at concentrations at which ouabain alone was ineffective. This was shown in 3 experimental systems: neonatal primary rat cardiomyocytes, a Langendorff preparation, and an in vivo myocardial infarction induced by left anterior descending coronary artery (LAD) ligation. Furthermore, cell viability experiments revealed that this treatment protected primary cardiomyocytes from MK-2206 toxicity and in vivo reduced the size of scar tissue 10 days post-LAD ligation. We propose that Akt activity imposes a constant inhibitory force on muscle contraction, which is attenuated by low concentrations of MK-2206, resulting in potentiation of the ouabain effect. This demonstration of the increase in the CS effect advocates the development of the combined treatment in CHF.
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Affiliation(s)
- Nahum Buzaglo
- Department of Medical Neurobiology, Institute for Medical Research Israel-Canada, The Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Mordechai Golomb
- The Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Haim Rosen
- Department of Microbiology and Molecular Genetics, Institute for Medical Research Israel-Canada, The Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Ronen Beeri
- The Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Hagit Cohen-Ben Ami
- Department of Medical Neurobiology, Institute for Medical Research Israel-Canada, The Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Fattal Langane
- Marshall Institute for Interdisciplinary Research, Huntington, WV, USA
| | - Sandrine Pierre
- Marshall Institute for Interdisciplinary Research, Huntington, WV, USA
| | - David Lichtstein
- Department of Medical Neurobiology, Institute for Medical Research Israel-Canada, The Hebrew University Hadassah Medical School, Jerusalem, Israel
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25
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Shin JH, Kang KW, Kim JG, Lee SJ. Concurrent renal dysfunction with ischemic heart disease is an important determinant for cardiac and cerebrovascular mortality in patients on chronic digoxin therapy for atrial fibrillation. Kidney Res Clin Pract 2018; 37:130-137. [PMID: 29971208 PMCID: PMC6027812 DOI: 10.23876/j.krcp.2018.37.2.130] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 05/04/2018] [Accepted: 05/06/2018] [Indexed: 12/19/2022] Open
Abstract
Background Major adverse cardiac and cerebrovascular events (MACCEs) are main concerns in patients with atrial fibrillation (AF); however, factors affecting MACCEs remain inconclusive in AF patients chronically treated with digoxin. We investigated the major clinical determinants for fatal MACCEs in AF patients treated with digoxin over a 10-year follow-up period. Methods We analyzed a retrospective cohort of 1,480 AF patients at Eulji University Hospital, Daejeon, South Korea from March 2004 to August 2015. Among this population, 402 consecutive patients receiving chronic digoxin therapy were selected for the study. Data for electrocardiography, medication history, laboratory values including the serum digoxin concentration (SDC) and fatal MACCEs were collected. All data were divided and compared between groups based on the occurrence of MACCEs. Results The overall incidence of fatal MACCEs among the 402 digoxin-treated AF patients (age, 68 ± 11 years; male, 40.3%) was 12.1%. These fatalities resulted from heart failure (46.1%), fatal stroke (26.9%), fatal myocardial infarction (15.3%) and sudden cardiac death (5.7%). A higher prevalence of diabetes, pre-existing ischemic heart disease (IHD), lower estimated glomerular filtration rate (eGFR), higher SDC, and junctional bradycardia were more frequently observed in patients with MACCEs compared to those without MACCEs. Multivariable analysis showed that an eGFR of ≤ 60 mL/min/1.73 m2 and pre-existing IHD had a hazard ratio of 3.35 and a confidence interval of 1.64-6.87 (P < 0.001) for fatal MACCEs. Conclusion Chronic kidney disease stage III-V with pre-existing IHD is significantly associated with increased cardiac and cerebrovascular mortality in AF patients with chronic digoxin use.
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Affiliation(s)
- Jong Ho Shin
- Division of Nephrology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
| | - Ki-Woon Kang
- Division of Cardiology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
| | - Jae Guk Kim
- Division of Neurology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
| | - Soo Joo Lee
- Division of Neurology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
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Alshammari TM, Alhindi SA, Alrashdi AM, Benmerzouga I, Aljofan M. Pharmacy Malpractice: The rate and prevalence of dispensing high-risk prescription-only medications at community pharmacies in Saudi Arabia. Saudi Pharm J 2016; 25:709-714. [PMID: 28725143 PMCID: PMC5506661 DOI: 10.1016/j.jsps.2016.10.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 10/07/2016] [Indexed: 12/03/2022] Open
Abstract
Objective To assess the compliance of community pharmacies with the regulations that prohibit the dispensing of prescription-only medications in the absence of a physician prescription in Saudi Arabia. Method A cross-sectional study was conducted in the period between October 2014 and January 2015. A list of 10 prescription-only medications were selected to be studied. 150 community pharmacies were visited across 6 major regions in Saudi Arabia to assess the prevalence of non-compliance among community pharmacies. Pharmacies were selected in random and researchers (disguised as patients) requested to purchase prescription-only medications in the absence of a prescription. Not all medications were purchased at once. Data were recorded per pharmacy, where pharmacies that approved dispense of the selected drug were scored as non-compliant and the pharmacies that rejected dispense of the selected drug were scored as compliant. Compliance rate was calculated per region per drug. Pharmacies based in governmental hospitals were visited in parallel. A total of 20 were visited. Data and statistical analysis were performed using Statistical Analyses Software (SAS 9.3). Results A total of 150 pharmacies were visited over a period of 3 months. On average, the percent approved dispense of prescription-only drugs across 6 regions in Saudi Arabia is 63% and the percent rejected dispense is 37% representing a significant non-compliance rate regarding the selected list of medications in this study. The frequency of dispense per medication across 6 major regions in Saudi Arabia is as follows: Isosorbide dinitrate (86%), Enoxaparin (82%), nitroglycerin (74%), Propranolol (73%), Verapamil (70%), Warfarin (65%), Methyldopa (64%), Ciprofloxacin (57%) and Codeine (4%). Conclusions Non-compliance of community pharmacies with the law of pharmaceutical practice is at an alarming rate in the Kingdom of Saudi Arabia and authoritative figures must intervene to impede and combat such activities.
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Affiliation(s)
- Thamir M Alshammari
- Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Algaed Rd, P.O. Box: 2440, Hail, Saudi Arabia
| | - Salman A Alhindi
- Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Algaed Rd, P.O. Box: 2440, Hail, Saudi Arabia
| | - Ahmed M Alrashdi
- Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Algaed Rd, P.O. Box: 2440, Hail, Saudi Arabia
| | - Imaan Benmerzouga
- Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Algaed Rd, P.O. Box: 2440, Hail, Saudi Arabia
| | - Mohamad Aljofan
- Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Algaed Rd, P.O. Box: 2440, Hail, Saudi Arabia
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Johnnides S, Green T, Eubig P. Toad Intoxication in the Dog by Rhinella marina : The Clinical Syndrome and Current Treatment Recommendations. J Am Anim Hosp Assoc 2016; 52:205-11. [PMID: 27259028 DOI: 10.5326/jaaha-ms-6365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Oral exposure to the secretions of Rhinella marina (formerly Bufo marinus ) can carry a high fatality rate without early and appropriate treatment. In dogs, the clinical syndrome, which is evident almost immediately, manifests in profuse ptyalism along with gastrointestinal, respiratory, and neurologic signs. Severe cardiac arrhythmias develop less frequently. This review will cover the history, toxicology, and clinical syndrome of Rhinella marina intoxication, and will discuss the recommended therapies for stabilization.
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Affiliation(s)
- Stephanie Johnnides
- From the Department of Comparative Biosciences, College of Veterinary Medicine, University of Illinois, Urbana, IL (P.E.); Lakeshore Veterinary Specialists, Glendale, WI (S.J.); and VCA Metroplex Animal Hospital, Irving, TX (T.G.)
| | - Tiffany Green
- From the Department of Comparative Biosciences, College of Veterinary Medicine, University of Illinois, Urbana, IL (P.E.); Lakeshore Veterinary Specialists, Glendale, WI (S.J.); and VCA Metroplex Animal Hospital, Irving, TX (T.G.)
| | - Paul Eubig
- From the Department of Comparative Biosciences, College of Veterinary Medicine, University of Illinois, Urbana, IL (P.E.); Lakeshore Veterinary Specialists, Glendale, WI (S.J.); and VCA Metroplex Animal Hospital, Irving, TX (T.G.)
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Santamaria-Herrera MA, Ríos-Pérez EB, de la Rosa JAM, García-Castañeda M, Osornio-Garduño DS, Ramos-Mondragón R, Mancilla-Percino T, Avila G. MDIMP, a novel cardiac Ca(2+) channel blocker with atrial selectivity. Eur J Pharmacol 2016; 781:218-28. [PMID: 27089820 DOI: 10.1016/j.ejphar.2016.04.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 04/12/2016] [Accepted: 04/13/2016] [Indexed: 11/20/2022]
Abstract
In cardiac muscle cells both T-and L-type Ca(2+) channels (TTCCs and LTCCs, respectively) are expressed, and the latter are relevant to a process known as excitation-contraction coupling (ECC). Evidence obtained from docking studies suggests that isoindolines derived from α-amino acids bind to the LTCC CaV1.2. In the present study, we investigated whether methyl (S)-2-(1,3-dihydroisoindol-2-yl)-4-methylpentanoate (MDIMP), which is derived from L-leucine, modulates both Ca(2+) channels and ECC. To this end, mechanical properties, as well as Ca(2+) transients and currents, were all investigated in isolated cardiac myocytes. The effects of MDIMP on CaV1.2 (transiently expressed in 293T/17 cells) were also studied. In this system, evidence was found for an inhibitory action that develops and recovers in min, with an IC50 of 450µM. With respect to myocytes: atrial-TTCCs, atrial-LTCCs, and ventricular-LTCCs were also inhibited, in that order of potency. Accordingly, Ca(2+) transients, contractions, and window currents of LTCCs were all reduced more strongly in atrial cells. Interestingly, while the modulation of LTCCs was state-independent in these cells, it was state-dependent, and dual, on the ventricular ones. Furthermore, practically all of the ventricular LTCCs were closed at resting membrane potentials. This could explain their resistance to MDIMP, as they were affected in only open or inactivated states. All these features in turn explain the preferential down-regulation of the atrial ECC. Thus, our results support the view that isoindolines bind to Ca(2+) channels, improve our knowledge of the corresponding structure-function relationship, and may be relevant for conditions where decreased atrial activity is desired.
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Affiliation(s)
| | | | | | | | | | - Roberto Ramos-Mondragón
- Department of Biochemistry, Cinvestav-IPN, AP 14-740, México City, DF 07000, Mexico; Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, 2800 Plymouth Rd, 26-235N, Ann Arbor, MI 48109, USA
| | | | - Guillermo Avila
- Department of Biochemistry, Cinvestav-IPN, AP 14-740, México City, DF 07000, Mexico.
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Buzaglo N, Rosen H, Ben Ami HC, Inbal A, Lichtstein D. Essential Opposite Roles of ERK and Akt Signaling in Cardiac Steroid-Induced Increase in Heart Contractility. ACTA ACUST UNITED AC 2016; 357:345-56. [DOI: 10.1124/jpet.115.230763] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/16/2016] [Indexed: 02/04/2023]
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Hinshaw SJH, Ogbeifun O, Wandu WS, Lyu C, Shi G, Li Y, Qian H, Gery I. Digoxin Inhibits Induction of Experimental Autoimmune Uveitis in Mice, but Causes Severe Retinal Degeneration. Invest Ophthalmol Vis Sci 2016; 57:1441-7. [PMID: 27028065 PMCID: PMC4821074 DOI: 10.1167/iovs.15-19040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/24/2016] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Digoxin, a major medication for heart disease, was recently reported to have immunosuppressive capacity. Here, we determined the immunosuppressive capacity of digoxin on the development of experimental autoimmune uveitis (EAU) and on related immune responses. METHODS The B10.A mice were immunized with interphotoreceptor retinoid-binding protein (IRBP) and were treated daily with digoxin or vehicle control. On postimmunization day 14, the mouse eyes were examined histologically, while spleen cells were tested for cytokine production in response to IRBP and purified protein derivative. The immunosuppressive activity of digoxin was also tested in vitro, by its capacity to inhibit development of Th1 or Th17 cells. To investigate the degenerative effect of digoxin on the retina, naïve (FVB/N × B10.BR)F1 mice were similarly treated with digoxin and tested histologically and by ERG. RESULTS Treatment with digoxin inhibited the development of EAU, as well as the cellular response to IRBP. Unexpectedly, treatment with digoxin suppressed the production of interferon-γ to a larger extent than the production of interleukin 17. Importantly, digoxin treatment induced severe retinal degeneration, determined by histologic analysis with thinning across all layers of the retina. Digoxin treatment also induced dose-dependent vision loss monitored by ERG on naïve mice without induction of EAU. CONCLUSIONS Treatment of mice with digoxin inhibited the development of EAU and cellular immune response to IRBP. However, the treatment induced severe damage to the retina. Thus, the use of digoxin in humans should be avoided due to its toxicity to the retina.
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Affiliation(s)
- Samuel J. H. Hinshaw
- Laboratory of Immunology National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Osato Ogbeifun
- Laboratory of Immunology National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Wambui S. Wandu
- Laboratory of Immunology National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Cancan Lyu
- Laboratory of Immunology National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Guangpu Shi
- Laboratory of Immunology National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Yichao Li
- Visual Function Core, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Haohua Qian
- Visual Function Core, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Igal Gery
- Laboratory of Immunology National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
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Abstract
Digoxin has long been used for rate control in atrial fibrillation (AF); its safety remains controversial.We performed a literature search using MEDLINE (source PubMed, January 1, 1966, to July 31, 2015) and EMBASE (January 1, 1980, to July 31, 2015) with no restrictions. Studies that reported relative risk (RR) estimates with 95% confidence intervals (CIs) for the associations of interest were included. Pooled effect estimates were obtained by using random-effects meta-analysis.Twenty-two studies involving 586,594 patients were identified. Patients taking digoxin, as compared with those who took no digoxin, experienced an increased risk of death from any cause (RR: 1.29[95% CI 1.16-1.43]), even after reported adjustment for propensity scores (RR: 1.28[95% CI 1.18-1.39]). The risk of death was increased with patients with or without heart failure (RR: 1.12[95% CI 1.02-1.23] and RR: 1.26[95% CI 1.15-1.29], respectively), and patients taking or not taking beta blockers (RR: 1.17 [95% CI 1.06-1.30] and RR: 1.28 [95% CI 1.08-1.51], respectively). Digoxin use was also associated with increased risk of cardiovascular death (RR: 1.32 [95% CI 1.07-1.64]), arrhythmic death (RR: 1.38 [95% CI 1.07-1.79]), and stroke (RR: 1.20 [95% CI 1.004-1.44]). Digoxin treatment is associated with an absolute risk increase of 19 (95% CI 13-26) additional deaths from any cause per 1000 person-years.Digoxin use is associated with a significant increased risk for death from any cause in patients with AF. This finding suggests a need for reconsideration of present treatment recommendations on use of digoxin in AF.
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Affiliation(s)
- Wu-Tao Zeng
- From the Department of Cardiology (W-TZ, Y-JC), the Eastern Hospital of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Department of Emergency (Z-HL), the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Department of Obstetrics and Gynecology (Z-YL), the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Department of Cardiology (MZ), Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Serum digoxin concentrations and clinical signs and symptoms of digoxin toxicity in the paediatric population. Cardiol Young 2016; 26:493-8. [PMID: 25912244 DOI: 10.1017/s1047951115000505] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Serum digoxin levels have limited utility for determining digoxin toxicity in adults. Paediatric data assessing the utility of monitoring serum digoxin concentration are scarce. We sought to determine whether serum digoxin concentrations are associated with signs and symptoms of digoxin toxicity in children. METHODS We carried out a retrospective review of patients 2 ng/ml). RESULTS There were 87 patients who met study criteria (male 46%, mean age 8.4 years). CHD was present in 67.8% and electrocardiograms were performed in 72.4% of the patients. The most common indication for digoxin toxicity was heart failure symptoms (61.5%). Toxic serum digoxin concentrations were present in 6.9% of patients (mean 2.6 ng/ml). Symptoms associated with digoxin toxicity occurred in 48.4%, with nausea/vomiting as the most common symptom (36.4%), followed by tachycardia (29.5%). Compared with those without toxic serum digoxin concentrations, significantly more patients with toxic serum digoxin concentrations were female (p=0.02). The presence of electrocardiogram abnormalities and/or signs and symptoms of digoxin toxicity was not significantly different between patients with and without serum digoxin concentrations (p>0.05). CONCLUSION Serum digoxin concentrations in children are not strongly associated with signs and symptoms of digoxin toxicity.
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Abstract
Digoxin toxicity can emerge during long-term therapy as well as after an overdose. It can occur even when the serum digoxin concentration is within the therapeutic range. Toxicity causes anorexia, nausea, vomiting and neurological symptoms. It can also trigger fatal arrhythmias. There is a range of indications for using digoxin-specific antibody fragments. The amount ingested and serum digoxin concentration help to determine the dose required, but are not essential. Digoxin-specific antibody fragments are safe and effective in severe toxicity. Monitoring should continue after treatment because of the small risk of rebound toxicity. Restarting therapy should take into account the indication for digoxin and any reasons why the concentration became toxic.
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Aremu AO, Moyo M, Amoo SO, Van Staden J. Ethnobotany, therapeutic value, phytochemistry and conservation status of Bowiea volubilis: A widely used bulbous plant in southern Africa. JOURNAL OF ETHNOPHARMACOLOGY 2015; 174:308-316. [PMID: 26277489 DOI: 10.1016/j.jep.2015.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 08/04/2015] [Accepted: 08/11/2015] [Indexed: 06/04/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Bowiea volubilis Harv. ex Hook.f. (Family: Asparagaceae) is a bulbous medicinal plant widely used against numerous ailments including headache, muscular pains, infertility, cystitis and venereal diseases in southern Africa. AIM OF THE REVIEW To provide a critical and updated review of Bowiea volubilis with regards to its abundance, medicinal importance, conservation status and potential means to sustain its availability for future generations. METHODS A comprehensive literature search using online databases such as Web of Science, Google Scholar, Scopus and Springerlink as well as ethnobotanical literature was done in order to obtain, collate, synthesize and critically analyze available information on Bowiea volubilis. RESULTS On the basis of its wide distribution in many Provinces in South Africa, Bowiea volubilis has a long history of applications among the different ethnic groups. These applications include its uses as purgatives and for the treatment or relief of microbial infections, skin disorders, pains and inflammation. Scientific validation of its diverse uses in traditional medicine has been demonstrated via antimicrobial, anti-inflammatory and toxicity assays. Available results indicate a general poor antimicrobial activity especially with the bulb extracts while the anti-inflammatory activity appears promising. Phytochemical screenings revealed that Bowiea volubilis contains cardiac glycosides and related compounds while reports of other classes of compounds are unavailable. In line with its usage in traditional medicine, the majority of available studies on the species have focused on the use of different solvent extracts from the bulbs. The destructive harvesting of bulbs has led to a continuous decimation of wild populations. Consequently, there are increasing conservational concerns on the sustainability of this species for continuous supply to meet escalating demands. CONCLUSIONS Bowiea volubilis remains a widely used medicinal plant and available but limited scientific evidence indicates its anti-inflammatory potential. The abundance of cardiac glycosides in its phytochemical composition provides an indication on the therapeutic potential. More research efforts including the application of different biotechnological techniques are still required in order to guarantee its sustainable use over time.
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Affiliation(s)
- Adeyemi O Aremu
- Research Centre for Plant Growth and Development, School of Life Sciences, University of KwaZulu-Natal, Pietermaritzburg, Private Bag X01, Scottsville 3209, South Africa
| | - Mack Moyo
- Research Centre for Plant Growth and Development, School of Life Sciences, University of KwaZulu-Natal, Pietermaritzburg, Private Bag X01, Scottsville 3209, South Africa
| | - Stephen O Amoo
- Research Centre for Plant Growth and Development, School of Life Sciences, University of KwaZulu-Natal, Pietermaritzburg, Private Bag X01, Scottsville 3209, South Africa; Agricultural Research Council, Roodeplaat Vegetable and Ornamental Plant Institute, Private Bag X293, Pretoria 0001, South Africa
| | - Johannes Van Staden
- Research Centre for Plant Growth and Development, School of Life Sciences, University of KwaZulu-Natal, Pietermaritzburg, Private Bag X01, Scottsville 3209, South Africa.
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Allen LA, Fonarow GC, Simon DN, Thomas LE, Marzec LN, Pokorney SD, Gersh BJ, Go AS, Hylek EM, Kowey PR, Mahaffey KW, Chang P, Peterson ED, Piccini JP. Digoxin Use and Subsequent Outcomes Among Patients in a Contemporary Atrial Fibrillation Cohort. J Am Coll Cardiol 2015; 65:2691-8. [PMID: 26112191 DOI: 10.1016/j.jacc.2015.04.045] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 03/31/2015] [Accepted: 04/14/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although digoxin has long been used to treat atrial fibrillation (AF) and heart failure (HF), its safety remains controversial. OBJECTIVES This study sought to describe digoxin use over time in patients with AF who were stratified by the presence or absence of HF, to characterize the predictors of digoxin use and initiation, and to correlate digoxin use with outcomes. METHODS Longitudinal patterns of digoxin use and its association with a variety of outcomes were assessed in a prospective outpatient registry conducted at 174 U.S. sites with enrollment from June 2010 to August 2011. RESULTS Among 9,619 patients with AF and serial follow-up every 6 months for up to 3 years, 2,267 (23.6%) received digoxin at study enrollment, 681 (7.1%) were initiated on digoxin during follow-up, and 6,671 (69.4%) were never prescribed digoxin. After adjusting for other medications, heart rate was 72.9 beats/min among digoxin users and 71.5 beats/min among nonusers (p < 0.0001). Prevalent digoxin use at registry enrollment was not associated with subsequent onset of symptoms, hospitalization, or mortality (in patients with HF, adjusted hazard ratio [HR] for death: 1.04; without HF, HR: 1.22). Incident digoxin use during follow-up was not associated with subsequent death in patients with HF (propensity adjusted HR: 1.05), but was associated with subsequent death in those without HF (propensity adjusted HR: 1.99). CONCLUSIONS After adjustment for detailed clinical factors, digoxin use in registry patients with AF had a neutral association with outcomes under most circumstances. Because of the multiple conflicting observational reports about digoxin's safety and possible concerns in specific clinical situations, a large pragmatic trial of digoxin therapy in AF is needed.
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Affiliation(s)
- Larry A Allen
- University of Colorado School of Medicine, Aurora, Colorado.
| | | | | | - Laine E Thomas
- Duke Clinical Research Institute, Durham, North Carolina
| | - Lucas N Marzec
- University of Colorado School of Medicine, Aurora, Colorado
| | | | | | - Alan S Go
- Kaiser Permanente Northern California, Oakland, California
| | - Elaine M Hylek
- Boston University School of Medicine, Boston, Massachusetts
| | - Peter R Kowey
- Lankenau Heart Institute and the Jefferson Medical College, Philadelphia, Pennsylvania
| | | | - Paul Chang
- Janssen Scientific Affairs, Raritan, New Jersey
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Dukić L, Simundić AM, Malogorski D. Comparison of digoxin concentration in plastic serum tubes with clot activator and heparinized plasma tubes. Biochem Med (Zagreb) 2014; 24:146-50. [PMID: 24627723 PMCID: PMC3936983 DOI: 10.11613/bm.2014.016] [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: 10/20/2013] [Accepted: 01/15/2014] [Indexed: 11/16/2022] Open
Abstract
Introduction: Sample type recommended by the manufacturer for the digoxin Abbott assay is either serum collected in glass tubes or plasma (sodium heparin, lithium heparin, citrate, EDTA or oxalate as anticoagulant) collected in plastic tubes. In our hospital samples are collected in plastic tubes. Our hypothesis was that the serum sample collected in plastic serum tube can be used interchangeably with plasma sample for measurement of digoxin concentration. Our aim was verification of plastic serum tubes for determination of digoxin concentration. Materials and methods: Concentration of digoxin was determined simultaneously in 26 venous blood plasma (plastic Vacuette, LH Lithium heparin) and serum (plastic Vacuette, Z Serum Clot activator; both Greiner Bio-One GmbH, Kremsmünster, Austria) samples, on Abbott AxSYM analyzer using the original Abbott Digoxin III assay (Abbott, Wiesbaden, Germany). Tube comparability was assessed using the Passing Bablok regression and Bland-Altman plot. Results: Serum and plasma digoxin concentrations are comparable. Passing Bablok intercept (0.08 [95% CI = −0.10 to 0.20]) and slope (0.99 [95% CI = 0.92 to 1.11]) showed there is no constant or proportional error. Conclusion: Blood samples drawn in plastic serum tubes and plastic plasma tubes can be interchangeably used for determination of digoxin concentration.
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Affiliation(s)
- Lora Dukić
- University Department of Chemistry, Medical School University Hospital Sestre Milosrdnice, Zagreb, Croatia
| | - Ana-Maria Simundić
- University Department of Chemistry, Medical School University Hospital Sestre Milosrdnice, Zagreb, Croatia
| | - Davorin Malogorski
- University Department of Chemistry, Medical School University Hospital Sestre Milosrdnice, Zagreb, Croatia
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Kassop D, Donovan MS, Cohee BM, Mabe DL, Wedam EF, Atwood JE. An unusual case of cardiac glycoside toxicity. Int J Cardiol 2013; 170:434-7. [PMID: 24315350 DOI: 10.1016/j.ijcard.2013.11.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 11/02/2013] [Indexed: 11/25/2022]
Affiliation(s)
- David Kassop
- Cardiovascular Disease Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD, United States.
| | - Michael S Donovan
- Cardiovascular Disease Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Brian M Cohee
- Pulmonary Disease and Critical Care Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Donovan L Mabe
- Internal Medicine Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Erich F Wedam
- Cardiovascular Disease Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - John E Atwood
- Cardiovascular Disease Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD, United States
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