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Lv H, Huang L, Yang X, Zhang C, Yu H, Shang X. The clinical effectiveness of sivelestat in treating sepsis patients with both acute respiratory distress syndrome and septic cardiomyopathy. J Cardiothorac Surg 2024; 19:399. [PMID: 38937755 PMCID: PMC11210008 DOI: 10.1186/s13019-024-02835-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 06/14/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND We aimed to assess the efficacy of the neutrophil elastase inhibitor, sivelestat, in the treatment of sepsis-induced acute respiratory distress syndrome (ARDS) and septic cardiomyopathy (SCM). METHODS Between January 2019 and December 2021, we conducted a randomized trial on patients who had been diagnosed with sepsis-induced acute respiratory distress syndrome (ARDS) and septic cardiomyopathy (SCM) at Wuhan Union Hospital. The patients were divided into two groups by random envelop method, the Sivelestat group and the Control group. We measured the serum concentrations of Interleukin (IL)-6, IL-8, Tumor necrosis factor-α (TNF-α), and High-mobility group box 1 (HMGB1) at five time points, which were the baseline, 12 h, 24 h, 48 h, and 72 h after admission to the ICU. We evaluated the cardiac function by sonography and the heart rate variability (HRV) with 24-hour Holter recording between the time of admission to the intensive care unit (ICU) and 72 h after Sivelestat treatment. RESULTS From January 2019 to December 2021, a total of 70 patients were included in this study. The levels of IL-6, IL-8, and TNF-α were significantly lower in the Sivelestat group at different time points (12 h, 24 h, 48 h, and 72 h). HMGB1 levels were significantly lower at 72 h after Sivelestat treatment (19.46 ± 2.63pg/mL vs. 21.20 ± 2.03pg/mL, P = 0.003). The stroke volume (SV), tricuspid annular plane systolic excursion (TAPSE), early to late diastolic transmitral flow velocity (E/A), early (e') and late (a') diastoles were significantly low in the Control group compared with the Sivelestat group. Tei index was high in the Control group compared with the Sivelestat group (0.60 ± 0.08 vs. 0.56 ± 0.07, P = 0.029). The result of HRV showed significant differences in standard deviation of normal-to-normal intervals (SDNN), low frequency (LF), and LF/HF (high frequency) between the two groups. CONCLUSIONS Sivelestat can significantly reduce the levels of serum inflammatory factors, improve cardiac function, and reduce heart rate variability in patients with Sepsis-induced ARDS and SCM.
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Affiliation(s)
- Hui Lv
- Department of ICU, Wuhan No.1 Hospital, No.215 Zhongshan Avenue, Wuhan, China
| | - Langjing Huang
- Department of Cardiovascular Medicine, Changsha Economic Development Zone Hospital, Changsha, China
| | - Xiuhong Yang
- Department of ICU, Wuhan No.1 Hospital, No.215 Zhongshan Avenue, Wuhan, China
| | - Changdong Zhang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1277 Jiefang Avenue, Jianghan District, Wuhan, 430022, Hubei Province, China
| | - Hao Yu
- Department of Cardiology, Wuhan No.1 Hospital, No.215 Zhongshan Avenue, Wuhan, China
| | - Xiaoke Shang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1277 Jiefang Avenue, Jianghan District, Wuhan, 430022, Hubei Province, China.
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Zhou Y, Wang H, Liu A, Pu Z, Ji Q, Xu J, Xu Y, Wang Y. Sivelestat improves acute lung injury by inhibiting PI3K/AKT/mTOR signaling pathway. PLoS One 2024; 19:e0302721. [PMID: 38935660 PMCID: PMC11210789 DOI: 10.1371/journal.pone.0302721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 04/10/2024] [Indexed: 06/29/2024] Open
Abstract
OBJECTIVE To investigate the therapeutic effect and mechanism of sivelestat sodium on acute lung injury (AIL). METHODS A rat model for ALI/acute respiratory distress syndrome (ALI/ARDS) was established. Pathological examination of lung tissue was conducted to assess lung injury. Blood gas in the arteries was measured using a blood analyzer. Changes in PaO2, PaO2/FiO2, and lung wet/dry (W/D) weight ratio were carefully compared. ELISA assay was conducted to estimate cell adhesion and inflammation response. Finally, real-time reverse transcription polymerase chain reaction and western blotting assay was used to determine the activation of PI3K/AKT/mTOR pathway. RESULTS ARDS in vivo model was successfully constructed by LPS injection. Compared with the sham group, PaO2 and PaO2/FiO2 were significantly lower in the vehicle group, while the lung W/D ratio, the lung injury score, NE, VCAM-1, IL-8 andTNF-αwere significantly increased. After treatment with different doses of sivelestat sodium, we found PaO2, PaO2/FiO2 were prominently increased, while the lung W/D ratio, the lung injury score, NE, VCAM-1, IL-8, TNF-α levels were decreased in the dose-dependent manner. Meanwhile, compared with the vehicle group, the expression levels of Bax, PI3K, Akt and mTOR were significantly lower, and the expression of Bcl-2 was significantly higher after injection with sivelestat sodium. CONCLUSION Sivelestat sodium has an interventional effect on ALI in sepsis by inhibiting the PI3K/AKT/mTOR signalling pathway.
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Affiliation(s)
- Yaqing Zhou
- Department of Critical Care Medicine, Hai’an People’s Hospital, Hai’an County, Nantong City, Jiangsu Province, China
| | - Haiyan Wang
- Department of Critical Care Medicine, Hai’an Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nantong, Jiangsu Province, China
| | - Aiming Liu
- Department of Critical Care Medicine, Hai’an People’s Hospital, Hai’an County, Nantong City, Jiangsu Province, China
| | - Zunguo Pu
- Department of Critical Care Medicine, Hai’an People’s Hospital, Hai’an County, Nantong City, Jiangsu Province, China
| | - Qiuxia Ji
- Department of Clinical Pharmacy, Hai’an People’s Hospital, Hai’an County, Nantong City, Jiangsu Province, China
| | - Jianhua Xu
- Department of Clinical Pharmacy, Hai’an People’s Hospital, Hai’an County, Nantong City, Jiangsu Province, China
| | - Yuehua Xu
- Department of Clinical Pharmacy, Hai’an People’s Hospital, Hai’an County, Nantong City, Jiangsu Province, China
| | - Ying Wang
- Department of Critical Care Medicine, Nantong First People’s Hospital, Nantong City, Jiangsu Province, China
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Li K, Dong L, Gao S, Zhang J, Feng Y, Gu L, Yang J, Liu X, Wang Y, Mao Z, Jiang D, Xia Z, Zhang G, Tang J, Ma P, Zhang W. Safety, tolerability, pharmacokinetics and neutrophil elastase inhibitory effects of Sivelestat: A randomized, double-blind, placebo-controlled single- and multiple-dose escalation study in Chinese healthy subjects. Eur J Pharm Sci 2024; 195:106723. [PMID: 38336251 DOI: 10.1016/j.ejps.2024.106723] [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: 07/11/2023] [Revised: 11/29/2023] [Accepted: 02/06/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND AND OBJECTIVE Neutrophil elastase has been identified as a potential therapeutic target for acute lung injury or acute respiratory distress syndrome, and Sivelestat is a selective, reversible and competitive neutrophil elastase inhibitor. This study was designed to investigate the safety, tolerability, pharmacokinetics and neutrophil elastase inhibitory effects of Sivelestat in healthy Chinese subjects. METHODS A randomized, double-blind, placebo-controlled single- and multiple-dose escalation clinical trial was carried out. Briefly, healthy volunteers in twelve cohorts with 8 per cohort received 1.0-20.2 mg/kg/h Sivelestat or placebo in an intravenous infusion manner for two hours, and healthy volunteers in four cohorts received two hours intravenous infusion of 2.0-5.0 mg/kg/h Sivelestat or placebo with an interval of twelve hours for seven times. The safety and tolerability were evaluated and serial blood samples were collected for pharmacokinetics and neutrophil elastase inhibitory effects analysis at the specified time-point. RESULTS A total of 128 subjects were enrolled and all participants completed the study except one. Sivelestat exhibited satisfactory safety and tolerability up to 20.2 mg/kg/h in single-dose cohorts and 5.0 mg/kg/h in multiple-dose cohorts. Even so, more attention should be paid to the safety risks when using high doses. The Cmax and AUC of Sivelestat increased in a dose dependent manner, and Tmax was similar for different dose cohorts. In multiple-dose cohorts, the plasma concentrations reached steady state 48 h after first administration and the accumulation of Cmax and AUC was not obvious. Furthermore, the Cmin_ss of 5.0 mg/kg/h dose cohort could meet the needs of clinical treatment. For some reason, the pharmacodynamics data revealed that the inhibitory effect of Sivelestat on neutrophil elastase content in healthy subjects was inconclusive. CONCLUSION Sivelestat was safe and well tolerated with appropriate pharmacokinetic parameters, which provided support for more diverse dosing regimen in clinical application. CLINICAL TRIAL REGISTRATION www.chinadrugtrials.org.cn identifier is CTR20210072.
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Affiliation(s)
- Kun Li
- Department of Pharmacy, Henan Provincial People's Hospital, Zhengzhou, China; Department of Pharmacy, Zhengzhou University People's Hospital, Zhengzhou, China; Department of Pharmacy, People's Hospital of Henan University, Zhengzhou, China
| | - Lingfang Dong
- Department of Pharmacy, Henan Provincial People's Hospital, Zhengzhou, China; Department of Pharmacy, Zhengzhou University People's Hospital, Zhengzhou, China; Department of Pharmacy, People's Hospital of Henan University, Zhengzhou, China
| | - Shan Gao
- Department of Pharmacy, Henan Provincial People's Hospital, Zhengzhou, China; Department of Pharmacy, Zhengzhou University People's Hospital, Zhengzhou, China; Department of Pharmacy, People's Hospital of Henan University, Zhengzhou, China
| | - Jingying Zhang
- Department of Pharmacy, Henan Provincial People's Hospital, Zhengzhou, China; Department of Pharmacy, Zhengzhou University People's Hospital, Zhengzhou, China; Department of Pharmacy, People's Hospital of Henan University, Zhengzhou, China
| | - Yinghua Feng
- Department of Pharmacy, Henan Provincial People's Hospital, Zhengzhou, China; Department of Pharmacy, Zhengzhou University People's Hospital, Zhengzhou, China; Department of Pharmacy, People's Hospital of Henan University, Zhengzhou, China
| | - Li Gu
- Department of Pharmacy, Henan Provincial People's Hospital, Zhengzhou, China; Department of Pharmacy, Zhengzhou University People's Hospital, Zhengzhou, China; Department of Pharmacy, People's Hospital of Henan University, Zhengzhou, China
| | - Jie Yang
- Department of Pharmacy, Henan Provincial People's Hospital, Zhengzhou, China; Department of Pharmacy, Zhengzhou University People's Hospital, Zhengzhou, China; Department of Pharmacy, People's Hospital of Henan University, Zhengzhou, China
| | - Xing Liu
- Department of Pharmacy, Henan Provincial People's Hospital, Zhengzhou, China; Department of Pharmacy, Zhengzhou University People's Hospital, Zhengzhou, China; Department of Pharmacy, People's Hospital of Henan University, Zhengzhou, China
| | - Yaqin Wang
- Department of Pharmacy, Henan Provincial People's Hospital, Zhengzhou, China; Department of Pharmacy, Zhengzhou University People's Hospital, Zhengzhou, China; Department of Pharmacy, People's Hospital of Henan University, Zhengzhou, China
| | - Zhenkun Mao
- Department of Pharmacy, Henan Provincial People's Hospital, Zhengzhou, China; Department of Pharmacy, Zhengzhou University People's Hospital, Zhengzhou, China; Department of Pharmacy, People's Hospital of Henan University, Zhengzhou, China
| | - Dandan Jiang
- Department of Pharmacy, Henan Provincial People's Hospital, Zhengzhou, China; Department of Pharmacy, Zhengzhou University People's Hospital, Zhengzhou, China; Department of Pharmacy, People's Hospital of Henan University, Zhengzhou, China
| | - Zhengchao Xia
- Department of Pharmacy, Henan Provincial People's Hospital, Zhengzhou, China; Department of Pharmacy, Zhengzhou University People's Hospital, Zhengzhou, China; Department of Pharmacy, People's Hospital of Henan University, Zhengzhou, China
| | - Guoliang Zhang
- Shanghai Precise Biotechnology Co., Ltd, Shanghai, China
| | - Jingwen Tang
- Shanghai Huilun Pharmaceutical Co., Ltd, Shanghai, China
| | - Peizhi Ma
- Department of Pharmacy, Henan Provincial People's Hospital, Zhengzhou, China; Department of Pharmacy, Zhengzhou University People's Hospital, Zhengzhou, China; Department of Pharmacy, People's Hospital of Henan University, Zhengzhou, China
| | - Wei Zhang
- Department of Pharmacy, Henan Provincial People's Hospital, Zhengzhou, China; Department of Pharmacy, Zhengzhou University People's Hospital, Zhengzhou, China; Department of Pharmacy, People's Hospital of Henan University, Zhengzhou, China.
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