Treatment with selective serotonin reuptake inhibitors for enhancing wound healing

Effect of duloxetine on pain relief after total knee arthroplasty: A meta-analysis of randomized controlled trials

BACKGROUND

Postoperative pain is one of the most feared complications of total knee arthroplasty. Recently, randomized controlled trials have compared the efficacy of duloxetine in patients undergoing total knee arthroplasty. However, there is no definite answer as to the efficacy and safety of duloxetine.

METHODS

Randomized controlled trials about relevant studies were searched from PubMed (1996 to July 2022), Embase (1996 to July 2022), and Cochrane Library (CENTRAL, July 2022).

RESULTS

Six high-quality studies containing 532 patients met the inclusion criteria. Results show patients in the duloxetine group had better performance in terms of visual analog scale (P < .05), equivalent morphine consumption (P < .05), and length of stay (P < .05).

CONCLUSION

Duloxetine can be used to reduce pain after knee arthroplasty in selected patients.

The potential action of SSRIs in the treatment of skin diseases including atopic dermatitis and slow-healing wounds

Selective serotonin reuptake inhibitors (SSRIs) are used to treat affective and anxiety disorders. Antidepressants have also been shown to have antimicrobial and immunomodulatory effects, which may affect the microbiota-intestinal-brain axis. Studies show that SSRIs have antimicrobial activity both in vivo and in vitro and influence bacteria by inhibiting biofilm, affecting efflux pumps, among others. A huge challenge today is the prevention and treatment of skin diseases, including atopic dermatitis (AD) and slow-healing wounds. Skin diseases including AD and non-healing wounds are serious medical problem. People suffering from these conditions feel constant discomfort, which also affects their psychological state. Research on new treatments for AD and slow-healing wounds is essential because current medications are not fully effective and have many side effects. Exploring new drug groups for AD and slow-healing wounds will allow for the creation of an alternative treatment for these diseases. SSRIs represent a hope for the treatment of skin diseases due to their immunomodulatory and antimicrobial properties.

Fluoxetine Ecofriendly Nanoemulsion Enhances Wound Healing in Diabetic Rats: In Vivo Efficacy Assessment

Impaired diabetic wound healing is a major concern for health care professionals worldwide, imposing an intense financial burden and reducing the quality of life of patients. A dysregulation of this process can be responsible for the development of intractable ulcers and the formation of excessive scars. Therefore, the identification of novel pharmacological strategies able to promote wound healing and restore the mechanical integrity of injured tissue becomes essential. In the present study, fluoxetine ecofriendly nanoemulsion (FLX-EFNE) was prepared and its potential efficacy in enhancing wound healing was tested in diabetic rats. The Box-Behnken response surface design was used to select the optimized formulation that was prepared by the high-shear homogenization-based technique. A Zetasizer was used for the characterization of the optimized formulation, providing a FLX-EFNE with a globule size of 199 nm. For the in vivo study, a wound was induced by surgical methods, and diabetic rats (streptozotocin-induced) were divided into five groups: untreated control, vehicle-treated, FLX, FLX-EFNE, and positive control receiving a commercially available formula. The treatment continued from the day of wound induction to day 21. Then, the animals were sacrificed and skin tissues were collected at the site of wounding and used for biochemical, histopathological, immunohistochemical, and mRNA expression assessments. In the FLX-EFNE treated group, the rate of wound contraction and signs of healing were significantly higher compared to all other groups. In addition, angiogenesis, proliferation, and collagen deposition were enhanced, while oxidative stress and inflammation decreased. The present data highlight the enhanced wound healing activity of the optimized FLX-EFNE formulation.

Preemptive Duloxetine Relieves Postoperative Pain and Lowers Wound Temperature in Centrally Sensitized Patients Undergoing Total Knee Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial

(1) Background: The purpose of this study was to determine whether preemptive duloxetine in patients with central sensitization (CS) is effective for acute postoperative pain control and wound healing following total knee arthroplasty (TKA). (2) Methods: CS was defined as a score of 40 points or higher on the Central Sensitization Inventory (CSI) survey. Thirty-nine patients with CS were randomly assigned to either the duloxetine group (n = 19) or the placebo group (n = 20). The duloxetine group took duloxetine 30 mg once a day, while the placebo group took the placebo medication once a day. A pain visual analog scale (VAS) and the Brief Pain Inventory (BPI), wound complications, the temperature of the surgical site, and adverse events were investigated. Skin temperature was measured at the center of the patella using a portable digital thermometer. (3) Results: The duloxetine group reported significantly lower pain VAS scores during follow-up periods up to 6 weeks after surgery (all p < 0.05). BPI interference also showed significantly superior results in the duloxetine group after surgery (all p < 0.05). Although there was no difference in the rate of wound complications between the two groups (p > 0.05), the duloxetine group showed significantly lower wound temperature than the placebo group during the follow-up period (all p < 0.05). (4) Conclusion: In this study, preemptive duloxetine effectively reduced pain and lowered wound temperature following TKA in CS patients.

Central sensitization is a risk factor for wound complications after primary total knee arthroplasty

PURPOSE

Postoperative wound complication is a significant risk factor for subsequent deep periprosthetic joint infection after total knee arthroplasty (TKA). Central sensitization is an abnormal enhancement of pain mechanism involving the central nervous system. Although psychological disorder is widely considered as a risk factor, the relationship between central sensitization and wound complication is currently unclear. Therefore, the purpose of this study was to investigate whether central sensitization was associated with high wound complication rate after primary TKA.

MATERIALS AND METHODS

Between January and June 2016, 161 patients undergoing unilateral TKA were prospectively divided into two groups based on central sensitization inventory score of 40 points after excluding cases with known risk factors such as physical comorbidities, health-related behaviors, and psychological disorders. Group 1 consisted of 112 patients (112 knees) whose central sensitization inventory score was < 40 points and group 2 consisted of 49 patients (49 knees) whose central sensitization inventory score was ≥ 40 points. Wound complications were defined as wound dehiscence, suture granuloma, prolonged wound oozing after postoperative day 5, significant hematoma formation, or surgical site infection recorded during the initial 90-day postoperative period. Demographic data, visual analog scale (VAS), central sensitization inventory score, and wound complications were compared between the two groups.

RESULTS

Wound complications developed in 3 (2.7%) knees in group 1 and 14 (28.6%) knees in group 2 (p < 0.001). Multivariate logistic regression analysis showed that the odds of postoperative wound complications were increased 15.7 times in patients with central sensitization inventory score ≥ 40 (95% CI 4.1-60.0, p < 0.001).

CONCLUSION

Central sensitization is a risk factor for the development of postoperative wound complication after primary TKA.

LEVEL OF EVIDENCE

II.

Immunomodulatory Action of Substituted 1,3,4-Thiadiazines on the Course of Myocardial Infarction

This review focuses on the biological action of the compounds from the group of substituted 1,3,4-thiadiazines on stress response and myocardial infarction. The aim of this review is to propose the possible mechanisms of action of 1,3,4-thiadiazines and offer prospectives in the development of new derivatives as therapeutic agents. It is known, that compounds that have biological effects similar to those used as antidepressants can down-regulate the secretion of proinflammatory cytokines, up-regulate the release of anti-inflammatory ones and affect cell recruitment, which allows them to be considered immunomodulators as well. The results of pharmacological evaluation, in silico studies, and in vivo experiments of several compounds from the group of substituted 1,3,4-thiadiazines with antidepressant properties are presented. It is proposed that the cardioprotective effects of substituted 1,3,4-thiadiazines might be explained by the peculiarities of their multi-target action: the ability of the compounds to interact with various types of receptors and transporters of dopaminergic, serotonergic and acetylcholinergic systems and to block the kinase signal pathway PI3K-AKT. The described effects of substituted 1,3,4-thiadiazines suggest that it is necessary to search for a new agents for limiting the peripheral inflammatory/ischemic damage through the entral mechanisms of stress reaction and modifying pro-inflammatory cytokine signaling pathways in the brain.

Effects of paroxetine on cutaneous wound healing in healthy and diabetic rats

OBJECTIVE

The aim of this study was to evaluate the histologic effects of acute paroxetine administration on wound healing in healthy and streptozotocin-induced diabetic rats.

DESIGN

This study has a randomized controlled experimental design.

SETTING

Healthy (n = 32) and diabetic (n = 32) rats were further divided into 2 groups of saline or paroxetine administration.

PARTICIPANTS

Sixty-four male Sprague-Dawley rats were used in this study.

INTERVENTIONS

Paroxetine was injected intraperitoneally every day. Full-thickness excision wounds were created with a 4-mm dermal punch on the back of all rats. The healing wound area was removed with a 6-mm dermal punch at postwounding days 1, 3, 7, and 14.

MAIN OUTCOME MEASURES

Polymorphonuclear leukocyte, mononuclear inflammatory cell, fibroblast, and blood vessel counts and epithelialization were evaluated under light microscope.

MAIN RESULTS

There was no statistically significant difference observed in the polymorphonuclear leukocyte, mononuclear inflammatory cell, and blood vessel counts in the healthy and diabetic rats with and without paroxetine administration. The number of fibroblasts was significantly higher at postwounding day 14 of the paroxetine-administered healthy rats compared with the saline-administered healthy rats (P = .04). However, the number of fibroblasts did not show any difference by paroxetine administration in the diabetic rats. There was no statistically significant difference in epithelialization regarding all the postwounding days, but complete epithelialization was observed in all rats on postwounding day 14 in the healthy and paroxetine-administered group.

CONCLUSION

Short-term paroxetine administration may enhance cutaneous wound healing by increasing the number of fibroblasts and causing better epithelialization over time in healthy rats but not in diabetic rats.

Paroxetine differentially modulates LPS-induced TNFα and IL-6 production in mouse macrophages

Paroxetine is a selective serotonin reuptake inhibitor (SSRI) that is clinically used for the treatment of depression in human patients. Because of recent reports on the role of serotonin in modulating inflammation and the link between inflammation and depression, we sought to test the effect of paroxetine directly on macrophage response to an inflammatory stimulus. Lipopolysaccharide (LPS) treatment of mouse macrophages significantly enhanced TNFα and IL-6 production. Paroxetine treatment of macrophages, however, significantly inhibited LPS-induced IL-6 production. In contrast, paroxetine enhanced LPS-induced TNFα production in macrophages. These effects of paroxetine were mimicked by fluoxetine, another SSRI. To determine if the effects of paroxetine are mediated via modulation of the 5-HT system, we treated macrophages with 5-HT or 5-HT receptor antagonist (LY215840) in the presence of LPS and/or paroxetine. 5-HT treatment by itself did not affect LPS-induced cytokine production. LY215840, however, reversed paroxetine's effect on LPS-induced TNFα production but not IL-6. To understand the signaling mechanisms, we examined paroxetine's effect on MAPK and NFκB pathways. While paroxetine inhibited LPS-induced IκBα phosphorylation, MAPK pathways were mostly unaffected. Together these data demonstrate that paroxetine has critical but differential effects on IL-6 and TNFα production in macrophages and that it likely regulates these cytokines via distinct mechanisms.

Brain monoamines and antidepressant-like responses in MRL/MpJ versus C57BL/6J mice

The MRL/MpJ mouse demonstrates enhanced wound healing and tissue regeneration and increased neurotrophic mobilization to chronic antidepressant drug treatments. This study compared brain monoamine systems between MRL/MpJ and C57BL/6J mice as a potential basis for strain differences after chronic antidepressant treatment. MRL/MpJ mice had significantly higher tissue levels of serotonin and dopamine in multiple brain regions. Microdialysis studies demonstrated that baseline levels of extracellular serotonin did not differ between strains. However, acute administration of the selective serotonin reuptake inhibitor citalopram produced an increase in extracellular serotonin in the ventral hippocampus of MRL/MpJ mice that was twice as large as achieved in C57BL/6J mice. The greater effects in MRL/MpJ mice on 5-HT levels were not maintained after local perfusion of citalopram, suggesting that mechanisms outside of the hippocampus were responsible for the greater effect of citalopram after systemic injection. The density of serotonin and norepinephrine transporters in the hippocampus was significantly higher in MRL/MpJ mice. In addition, the expression of 5-HT(1A) mRNA was lower in the hippocampus, 5-HT(1B) mRNA was higher in the hippocampus and brainstem and SERT mRNA was higher in the brain stem of MRL/MpJ mice. The exaggerated neurotransmitter release in MRL/MpJ mice was accompanied by reduced baseline immobility in the tail suspension test and a greater reduction of immobility produced by citalopram or the tricyclic antidepressant desipramine. These data suggest that differences in the response to acute and chronic antidepressant treatments between the two strains could be attributed to differences in serotonin or catecholamine transmission.

Pain mediators and wound healing--establishing the connection

Pain accompanies every disruption of the skin surface in a normal sensate individual. The intensity and duration of the pain varies depending on the nature of trauma, the healing trajectory and various host factors. Pain mediator release is the mechanism for pain perception following peripheral stimulus and central interpretation. The various mediators may have promoting effects on wound healing in the short term, but it appears that protracted release of these mediators may well have detrimental effects on wound healing. The exaggerated release of pain mediators may result in nociceptor hypersensitization, hyperinflammatory cellular and extracellular matrix (ECM) changes, and in some cases, the potential for a fibrotic healing pattern. This relates to an imbalance between mediators with differing healing characteristics arising in certain pathological conditions. In this respect, it may be worth examining pain mediator agonists or antagonists, not only on compassionate grounds of pain control, but relating to the potential effects on overall wound healing.

Uso tópico de ketanserina na cicatrização de feridas cutâneas induzidas em equinos

Estudou-se a eficácia do uso tópico de ketanserina como promotor da cicatrização de feridas cutâneas induzidas em equinos. As feridas foram produzidas em ambos os metâmeros na região da garupa de oito cavalos adultos, em formato quadrangular, medindo cinco centímetros de lado. Aleatoriamente um dos metâmeros foi escolhido como tratado, permanecendo o contralateral como controle. As lesões do grupocontrole foram lavadas somente com água e detergente neutro e no grupo tratado foi realizado o mesmo procedimento seguido de aplicação tópica de ketanserina. A evolução macroscópica e microscópica do processo cicatricial foi avaliada e a área de cada ferida determinada no decorrer do período experimental. Não foram verificadas diferenças significativas entre as feridas do grupo-controle e do grupo tratado com ketanserina durante 56 dias de avaliação.

Safety and efficacy of s-citalopram in patients with co-morbid major depression and diabetes mellitus

OBJECTIVE

The presence of co-morbid depressive symptoms may have a negative impact on the management of diabetes mellitus. Moreover, some antidepressants may adversely affect glycemic control. Selective serotonin reuptake inhibitors (SSRIs) may improve glycemic control and may be beneficial for patients with co-morbid depression and diabetes. We examined the safety and efficacy of s-citalopram therapy in patients with co-morbid depression and diabetes, and its ability to improve glycemic control.

RESEARCH DESIGN AND METHODS

17 patients were enrolled into the trial and 14 patients received open-label s-citalopram therapy for up to 16 weeks. Clinical outcome measures included the 17-item Hamilton depression rating (HAM-D 17) and the clinical global impressions severity (CGI/S) and change (CGI/C) ratings. In addition, fasting glucose, fructosamine, and glycosylated hemoglobin-A(1C) measures were obtained before and during s-citalopram therapy.

RESULTS

We observed a significant reduction in mean HAM-D 17 (p<0.001), CGI/S (p=0.001) and CGI/C (p=0.001) ratings during s-citalopram therapy. We also observed a modest, non-significant reduction in fasting glucose, fructosamine, and glycosylated hemoglobin-A(1C) levels during s-citalopram therapy.

LIMITATION

Limitations of this study include a modest patient sample size and a 16-week treatment duration which may have been insufficient to demonstrate the full effect of SSRI therapy on glycemic control.

CONCLUSION

We observed a significant reduction in depressive symptoms and modest, non-significant reductions in fasting glucose, fructosamine, and glycosylated hemoglobin-A(1C) levels during SSRI therapy of co-morbid depression and diabetes.

Fluoxetine enhances cutaneous wound healing in chronically stressed Wistar rats

OBJECTIVES

To evaluate the histologic and clinical effects of fluoxetine administration on wound healing in chronically stressed and nonstressed Wistar rats.

STUDY DESIGN

Full-thickness incisional wounds were created on the lower back of 72 female Wistar rats. Animals were divided into 2 stress and nonstress groups according to application of stress regimen and 3 subdivisions based on placebo, acute, or chronic administration of fluoxetine. Wound length, width, and linear healing rate based on wound area were measured for 2 weeks postwounding. Biopsies of 3 rats from each group were taken at days 1, 4, 7, and 14 to perform histomorphometric measurements by light microscopy. Analysis of covariance and analysis of variance were used to analyze wound length and other variables, respectively.

RESULTS

Fluoxetine treatment significantly reduced mean wound length and healing period (P<.01). Although stress decreased the linear healing rate by 48%, fluoxetine treatment increased it by 68% and 31% in stressed and nonstressed rats, respectively. Stress significantly diminished infiltration of neutrophils and monocytes (P<.01), disrupted spatial organization of fibroblasts, and delayed neovascularization. Fluoxetine precluded these effects successfully.

CONCLUSION

Fluoxetine significantly improves healing of cutaneous wounds in stressed and, to a lesser extent, in nonstressed animals.