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Sun Y, Li H, Liu L, Bai X, Wu L, Shan J, Sun X, Wang Q, Guo Y. A Novel Mast Cell Stabilizer JM25-1 Rehabilitates Impaired Gut Barrier by Targeting the Corticotropin-Releasing Hormone Receptors. Pharmaceuticals (Basel) 2022; 16:ph16010047. [PMID: 36678544 PMCID: PMC9866683 DOI: 10.3390/ph16010047] [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] [Received: 11/02/2022] [Revised: 12/18/2022] [Accepted: 12/23/2022] [Indexed: 12/30/2022] Open
Abstract
Mast cell (MC) plays a central role in intestinal permeability; however, few MC-targeting drugs are currently available for protection of the intestinal barrier in clinical practice. A nonfluorinated Lidocaine analog 2-diethylamino-N-2,5-dimethylphenyl acetamide (JM25-1) displays anti-allergic effect, but its impact on MC remains elusive. In this study, we explored whether JM25-1 has therapeutic potential on intestinal barrier defect through stabilizing MC. JM25-1 alleviated release of β-hexosaminidase and cytokine production of MC. The paracellular permeability was redressed by JM25-1 in intestinal epithelial cell monolayers co-cultured with activated MC. In vivo, JM25-1 diminished intestinal mucosal MC amount and cytokine production, especially downregulating the expression of CRHR1, accompanied by an increase of CRHR2. Protective effects appeared in JM25-1-treated stress rats with a recovery of weight and intestinal barrier integrity. Through network pharmacology analysis, JM25-1 showed a therapeutic possibility for irritable bowel syndrome (IBS) with predictive targeting on PI3K/AKT/mTOR signaling. As expected, JM25-1 reinforced p-PI3K, p-AKT, p-mTOR signaling in MC, while the mTOR inhibitor Rapamycin reversed the action of JM25-1 on the expression of CRHR1 and CRHR2. Moreover, JM25-1 successfully remedied intestinal defect and declined MC and CRHR1 expression in rat colon caused by colonic mucus of IBS patients. Our data implied that JM25-1 possessed therapeutic capacity against intestinal barrier defects by targeting the CRH receptors of MC through PI3K/AKT/mTOR signaling.
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Affiliation(s)
- Yueshan Sun
- Medical Research Center, The Affiliated Hospital of Southwest Jiaotong University, The Third People’s Hospital of Chengdu, Chengdu 610031, China
| | - Hong Li
- Laboratory of Ethnopharmacology, Tissue-Orientated Property of Chinese Medicine Key Laboratory of Sichuan Province, West China School of Medicine, West China Hospital, Sichuan University, Chengdu 610065, China
| | - Lei Liu
- Medical Research Center, The Affiliated Hospital of Southwest Jiaotong University, The Third People’s Hospital of Chengdu, Chengdu 610031, China
| | - Xiaoqin Bai
- Medical Research Center, The Affiliated Hospital of Southwest Jiaotong University, The Third People’s Hospital of Chengdu, Chengdu 610031, China
| | - Liping Wu
- Digestive Department, The Affiliated Hospital of Southwest Jiaotong University, The Third People’s Hospital of Chengdu, Chengdu 610031, China
| | - Jing Shan
- Digestive Department, The Affiliated Hospital of Southwest Jiaotong University, The Third People’s Hospital of Chengdu, Chengdu 610031, China
| | - Xiaobin Sun
- Digestive Department, The Affiliated Hospital of Southwest Jiaotong University, The Third People’s Hospital of Chengdu, Chengdu 610031, China
| | - Qiong Wang
- Digestive Department, The Affiliated Hospital of Southwest Jiaotong University, The Third People’s Hospital of Chengdu, Chengdu 610031, China
- Correspondence: (Q.W.); (Y.G.)
| | - Yuanbiao Guo
- Medical Research Center, The Affiliated Hospital of Southwest Jiaotong University, The Third People’s Hospital of Chengdu, Chengdu 610031, China
- Correspondence: (Q.W.); (Y.G.)
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Indacaterol, glycopyrronium, and mometasone: pharmacological interaction and anti-inflammatory profile in hyperresponsive airways. Pharmacol Res 2021; 172:105801. [PMID: 34363950 DOI: 10.1016/j.phrs.2021.105801] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 12/11/2022]
Abstract
LABA/ICS and LABA/LAMA/ICS combinations elicit beneficial effects in asthma. Specific evidence concerning the impact of combining indacaterol acetate (IND), glycopyrronium bromide (GLY), and mometasone furoate (MF) on human airway hyperresponsiveness (AHR) and airway inflammation is still missing. The aim of this study was to characterize the synergy of IND/MF and IND/GLY/MF combinations, both once-daily treatments for asthma, in hyperresponsive airways. Passively sensitized human medium and small airways were stimulated by histamine and treated with IND/MF (molar ratio: 100/45, 100/90) and IND/GLY/MF (molar ratio: 100/37/45, 100/37/90). The effect on contractility and airway inflammation was tested. Drug interaction was assessed by Bliss Independence equation and Unified Theory. IND/MF 100/90 elicited middle-to-very strong synergistic relaxation in medium and small airways (+≈20-30% vs. additive effect, P<0.05), for IND/MF 100/45 the synergy was middle-to-very strong in small airways (+≈20% vs. additive effect, P<0.05), and additive in medium bronchi (P>0.05 vs. additive effect). IND/GLY/MF 100/37/45 and 100/37/90 induced very strong synergistic relaxation in medium and small airways (+≈30-50% vs. additive effect, P<0.05). Synergy was related with significant (P<0.05) reduction in IL-4, IL-5, IL-6, IL-9, IL-13, TNF-α, TSLP, NKA, SP, and non-neuronal ACh, and enhancement in cAMP. IND/MF and IND/GLY/MF combinations synergistically interact in hyperresponsive medium and small airways and modulate the levels of cytokines, neurokinins, ACh, and intracellular cAMP. The concentrations of MF in the combinations modulate the effects in the target tissue.
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Rogliani P, Ritondo BL, Cavalli F, Giorgino F, Girolami A, Pane G, Pezzuto G, Zerillo B, Puxeddu E, Ora J. Synergy across the drugs approved for the treatment of asthma. Minerva Med 2021; 113:17-30. [PMID: 33496162 DOI: 10.23736/s0026-4806.21.07266-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Inhaled corticosteroids are the cornerstone for the treatment of stable asthma, however, when disease severity increases, escalating therapy to combinations of drugs acting on distinct signalling pathways is required. It is advantageous to providing evidence of a synergistic interaction across drug combinations, as it allows optimizing bronchodilation while lowering the dose of single agents. In the respiratory pharmacology field, two statistical models are accepted as gold standard to characterize drug interactions, namely the Bliss Independence criterion and the Unified Theory. In this review, pharmacological interactions across drugs approved for the treatment of asthma have been systematically assessed. EVIDENCE ACQUISITION A comprehensive literature search was performed in MEDLINE for studies that used a validated pharmacological method for assessing drug interaction. The results were extracted and reported via qualitative synthesis. EVIDENCE SYNTHESIS Overall, 45 studies were identified from literature search and 5 met the inclusion criteria. Current evidence coming from ex vivo models of asthma indicates that drug combinations modulating bronchial contractility induce a synergistic bronchorelaxant effect. In murine models of lung inflammation, the combination between inhaled corticosteroids and β2- adrenoceptor agonists synergistically improve lung function and the inflammatory profile. CONCLUSIONS There is still limited knowledge regarding the mechanistic basis underlying pharmacological interactions across drugs approved for asthma. The synergism elicited by combined agents is an effect of class. Specifically designed clinical trials are needed to confirm the results coming from preclinical evidence, but also to establish the minimal dose for combined agents to induce a synergistic interaction and maximize bronchodilation.
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Affiliation(s)
- Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy - .,Division of Respiratory Medicine, University Hospital Policlinico Tor Vergata, Rome, Italy -
| | - Beatrice L Ritondo
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Cavalli
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Federica Giorgino
- Division of Respiratory Medicine, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Andrea Girolami
- Division of Respiratory Medicine, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Gloria Pane
- Division of Respiratory Medicine, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Gabriella Pezzuto
- Division of Respiratory Medicine, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Bartolomeo Zerillo
- Division of Respiratory Medicine, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Ermanno Puxeddu
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy.,Division of Respiratory Medicine, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Josuel Ora
- Division of Respiratory Medicine, University Hospital Policlinico Tor Vergata, Rome, Italy
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Li X, Lv X, Jiang Z, Nie X, Wang X, Li T, Zhang L, Liu S. Application of Intravenous Lidocaine in Obese Patients Undergoing Painless Colonoscopy: A Prospective, Randomized, Double-Blind, Controlled Study. Drug Des Devel Ther 2020; 14:3509-3518. [PMID: 32943843 PMCID: PMC7468415 DOI: 10.2147/dddt.s266062] [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: 06/04/2020] [Accepted: 08/05/2020] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Propofol for procedural sedation and analgesia (PSA) for colonoscopy can result in a high prevalence of severe respiratory depression. Studies have shown that intravenous (IV) infusion of lidocaine can reduce propofol requirements significantly and increase the ventilatory response to carbon dioxide in humans. We tested the hypothesis that IV lidocaine could improve propofol-induced respiratory depression in obese patients during colonoscopy. METHODS Ninety obese patients scheduled for painless colonoscopy were randomized to receive lidocaine (1.5 mg/kg, then 2 mg/kg/h, IV) or the same volume of 0.9% saline. Intraoperative sedation was provided by propofol. The primary outcome was the number of oxygen-desaturation episodes. Secondary outcomes were: the number of apnea episodes; total propofol consumption; time to the first hypoxia episode; time to consciousness loss; intraoperative hemodynamic parameters; awakening time; adverse events; duration of post-anesthesia care unit (PACU) stay; satisfaction of endoscopists and patients. RESULTS Demographic characteristics between the two groups were comparable. The number of oxygen-desaturation episodes in group L (1.49±1.12) decreased by 0.622 (P=0.018) compared with that in group N (2.11±1.32), and the number of apnea episodes in group L decreased by 0.533 (P<0.001). Kaplan-Meier curves showed that the median time to the first hypoxia episode was longer in group L (86.78 s) than that in group N (63.83 s) (Log rank P=0.0008). The total propofol consumption, awakening time, and duration of PACU stay were reduced in group L. There was no significant difference in the prevalence of adverse events (P>0.05 for all). Satisfaction scores for endoscopists and patients in group L were higher than that in group N (P<0.001). CONCLUSION Intravenous infusion of lidocaine could significantly reduce the number of oxygen-desaturation and apnea episodes in obese patients during painless colonoscopy. This method is worthy of clinical promotion. CLINICAL TRIALS REGISTRATION ChiCTR2000028937.
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Affiliation(s)
- Xiaoxiao Li
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Xueli Lv
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Zhenfei Jiang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Xinrui Nie
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Xinghe Wang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Tong Li
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Lianyi Zhang
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Su Liu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
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Erdem AO, Erel VK, Girit Ö, Erdoğan H, Özkısacık S, Yazıcı M. -Effects of Local Anesthetics on Smooth Muscle Tissue in Rat Trachea: An In Vitro Study. Turk Thorac J 2020; 21:223-227. [PMID: 32687781 DOI: 10.5152/turkthoracj.2019.19016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 07/30/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES We evaluated the muscle responses of rat trachea to LA drugs, such as lidocaine and prilocaine, in terms of airway spasms. MATERIALS AND METHODS A total of 16 male rats were used. After ketamine anesthesia, the tracheal ring of each rat was removed and placed in the organ bath in the Krebs solution. The rat tracheal veins were randomly divided into two groups based on the LA applied at the basal tonus level: group 1 (n=8), lidocaine; group 2 (n=8), prilocaine. Second, the baths were washed. Supramaximal contraction was obtained by applying acetylcholine to the tracheal rings (n=16) at a basal tonus level. The rat tracheas with supramaximal contraction were randomly divided into two groups: group 3 (n=8), lidocaine; group 4 (n=8), prilocaine. The contraction responses of each group were recorded and statistically compared. RESULTS Lidocaine constituted a significant relaxation response in the tracheal tissue in both basal tonus and supramaximal tonus levels. Moreover, it was observed that the relaxation of lidocaine was higher in the supramaximal contraction than in the basal tonus tension level. However, for prilocaine, no significant change was observed in both tonus levels. CONCLUSION This study suggests that lidocaine as a LA drug should be preferred as the first choice in patients with respiratory risk, and that its use over prilocaine should be preferred, if supported by advanced clinical studies.
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Affiliation(s)
- Ali Onur Erdem
- Department of Pediatric Surgery, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Varlık K Erel
- Department of Anaesthesiology, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Özlem Girit
- Department of Biophysics, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Hasan Erdoğan
- Department of Internal Medicine, Adnan Menderes University School of Veterinary Medicine, Aydın, Turkey
| | - Sezen Özkısacık
- Department of Pediatric Surgery, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Mesut Yazıcı
- Department of Pediatric Surgery, Adnan Menderes University School of Medicine, Aydın, Turkey
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Moyano J, Rodríguez P, Fierro CL. Use of systemic lidocaine for postoperative acute pain management in single-lung transplantation: Case report. REVISTA DE LA FACULTAD DE MEDICINA 2020. [DOI: 10.15446/revfacmed.v68n2.75649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Lung transplantation is associated with severe pain, which can delay recovery. Systemic lidocaine has useful analgesic properties for managing acute pain, however little is known on its use after lung transplantation. Due to pharmacological alterations during the postoperative period, the use of analgesics implies a demanding process to avoid toxicity, so lidocaine may play a role in this scenario. In this sense, the purpose of this case report is to present the use of systemic lidocaine as an option for the management of acute pain when other analgesics have failed to do so.Case presentation: The case of a male patient with acute pain in the postoperative period of single-lung transplantation is presented. Opioids and non-opioid analgesics showed limited efficacy, so the systematic administration of lidocaine was decided. Systemic lidocaine was effective for pain control, functional recovery and opioid decrease during the postoperative period.Conclusions: Systemic lidocaine was a useful drug for postoperative pain management in lung transplantation, since it allowed adequate analgesia and lung function recovery with decreased use of opioids. This drug may be a component of multimodal analgesia in selected patients when other options have failed; however its routine use is not recommended.
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Rogliani P, Matera MG, Facciolo F, Page C, Cazzola M, Calzetta L. Beclomethasone dipropionate, formoterol fumarate and glycopyrronium bromide: Synergy of triple combination therapy on human airway smooth muscle ex vivo. Br J Pharmacol 2020; 177:1150-1163. [PMID: 31660611 DOI: 10.1111/bph.14909] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 10/11/2019] [Accepted: 10/12/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND PURPOSE Combining inhaled corticosteroids (ICSs), long-acting β2 -adrenoceptor agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) is recommended to treat severe forms of asthma and chronic obstructive pulmonary disease (COPD). Clinical benefits have been demonstrated for ICS/LABA/LAMA combinations. This study characterized the interaction between the ICS beclomethasone dipropionate, the LABA formoterol fumarate and the LAMA glycopyrronium bromide in human airways. EXPERIMENTAL APPROACH Human passively sensitized airways and bronchi from COPD donors were stimulated with histamine or carbachol. Tissues were incubated overnight with beclomethasone and then treated with formoterol and glycopyrronium, alone or in triple combination. The interaction was assessed by using Bliss Independence and Unified Theory theorems. KEY RESULTS Beclomethasone/formoterol/glycopyrronium combination synergistically relaxed medium bronchi and small airways. Beclomethasone/formoterol/glycopyrronium combination at 100:6:12.5 combination ratio was a balanced drug mixture leading to very strong synergistic effect on relaxation of medium bronchi (Combination Index: from 0.042 to 0.96) and middle to very strong synergy in small airways (Combination Index: from 0.018 to 0.310). The synergy was related with the activation of intracellular glucocorticoid receptors and Gsα subunit G-protein of β2 -adrenoceptors, leading to the modulation of cyclic AMP-dependent PKA pathway. CONCLUSION Triple beclomethasone/formoterol/glycopyrronium combination induces synergistic bronchorelaxant effect in medium and small human airways, at least in ex vivo experiments. Further research is needed to confirm these findings in clinical studies in patients with asthma or COPD.
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Affiliation(s)
- Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Maria Gabriella Matera
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Facciolo
- Thoracic Surgery Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Clive Page
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, UK
| | - Mario Cazzola
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Luigino Calzetta
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
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Calzetta L, Rogliani P, Page C, Rinaldi B, Cazzola M, Matera MG. Pharmacological characterization of the interaction between tiotropium bromide and olodaterol on human bronchi and small airways. Pulm Pharmacol Ther 2019; 56:39-50. [DOI: 10.1016/j.pupt.2019.03.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/08/2019] [Accepted: 03/08/2019] [Indexed: 12/20/2022]
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Pressurised metered-dose inhaler for beta-2 agonist delivery during intraoperative bronchospasm: comparison of different administration methods. Br J Anaesth 2019; 122:e26-e28. [DOI: 10.1016/j.bja.2018.10.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 10/22/2018] [Accepted: 10/25/2018] [Indexed: 11/22/2022] Open
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Ahn JH, Kim D, Chung IS, Lee JJ, Lee EK, Jeong JS. Pre-administration of remifentanil in target-controlled propofol and remifentanil anesthesia prolongs anesthesia induction in neurosurgical patients: A double-blind randomized controlled trial. Medicine (Baltimore) 2019; 98:e14144. [PMID: 30653147 PMCID: PMC6370149 DOI: 10.1097/md.0000000000014144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Pre- and co-administration of remifentanil in target-controlled propofol and remifentanil anesthesia are the most common methods in clinical practice. However, anesthesia induction time by timing remifentanil administration was not identified. Therefore, we investigated the induction time of anesthesia based on type of remifentanil administration in target-controlled anesthesia. METHODS A total of 60 patients were randomly assigned to 1 of 2 groups: Pre-administered with remifentanil before propofol infusion (Group R, n = 30) and co-administered with remifentanil with propofol (Group N, n = 30). The primary outcome was total induction time based on the order of remifentanil administration. Secondary outcomes were from start of the propofol infusion time to loss of consciousness (LOC), rocuronium onset time, time to Bispectral index (BIS) 60, and hemodynamic variables. RESULTS The mean ± SD of total induction time was 180.5 ± 49.0 s in Group N and 246.3 ± 64.7 s in Group R (mean difference: 65.8 seconds; 95% CI: 35.0-96.5 s, P < .01). Time to BIS 60 and rocuronium onset time were longer in the Group R (P < .01 and P < .01, respectively). The Δheart rate and Δcardiac output values were lower in the Group R (P = .02 and P = .04, respectively). Injection pain was reported by 11 of 28 (39%) in the Group N and in 2 of 28 (7%) in the Group R (difference in proportion: 32%, 95% CI: 10-51%, P = .01). CONCLUSION Pre-administration of remifentanil in target-controlled propofol and remifentanil anesthesia prolongs total induction time about 35% compared to co-administration of remifentanil and propofol by decreased CO.
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Affiliation(s)
- Jin Hee Ahn
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
- Department of Anesthesiology and Pain Medicine, College of Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Doyeon Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Ik Soo Chung
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jeong Jin Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Eun Kyung Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Ji Seon Jeong
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
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Calzetta L, Matera MG, Facciolo F, Cazzola M, Rogliani P. Beclomethasone dipropionate and formoterol fumarate synergistically interact in hyperresponsive medium bronchi and small airways. Respir Res 2018; 19:65. [PMID: 29650006 PMCID: PMC5897944 DOI: 10.1186/s12931-018-0770-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 04/02/2018] [Indexed: 12/15/2022] Open
Abstract
Background Corticosteroids increase the expression of β2-adrenoceptors (β2-ARs) and protect them against down-regulation. Conversely, β2-AR agonists improve the anti-inflammatory action of corticosteroids. Nevertheless, it is still uncertain whether adding a long-acting β2-AR agonist (LABA) to an inhaled corticosteroid (ICS) results in an additive effect, or there is true synergy. Therefore, the aim of this study was to pharmacologically characterize the interaction between the ICS beclomethasone diproprionate (BDP) and the LABA formoterol fumarate (FF) in a validated human ex vivo model of bronchial asthma. Methods Human medium and small airways were stimulated by histamine and treated with different concentrations of BDP and FF, administered alone and in combination at concentration-ratio reproducing ex vivo that of the currently available fixed-dose combination (FDC; BDP/FF 100:6 combination-ratio). Experiments were performed in non-sensitized (NS) and passively sensitized (PS) airways. The pharmacological interaction was assessed by using Bliss Independence and Unified Theory equations. Results BDP/FF synergistically increased the overall bronchorelaxation in NS and PS airways (+ 15.15% ± 4.02%; P < 0.05 vs. additive effect). At low-to-medium concentrations the synergistic interaction was greater in PS than in NS bronchioles (+ 16.68% ± 3.02% and + 7.27% ± 3.05%, respectively). In PS small airways a very strong synergistic interaction (Combination Index: 0.08; + 20.04% ± 2.18% vs. additive effect) was detected for the total concentrations of BDP/FF combination corresponding to 10.6 ng/ml. Conclusion BDP/FF combination synergistically relaxed human bronchi; the extent of such an interaction was very strong at low-to-medium concentrations in PS small airways. Trial registration Not applicable. Electronic supplementary material The online version of this article (10.1186/s12931-018-0770-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Luigino Calzetta
- Unit of Respiratory Medicine, Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - Maria Gabriella Matera
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesco Facciolo
- Thoracic Surgery Unit, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Mario Cazzola
- Unit of Respiratory Medicine, Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy.
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Calzetta L, Rogliani P, Page C, Roncada P, Pistocchini E, Soggiu A, Piras C, Urbani A, Matera MG. Clinical effect of corticosteroids in asthma-affected horses: A quantitative synthesis. Equine Vet J 2018; 50:594-601. [PMID: 29393535 DOI: 10.1111/evj.12815] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 01/10/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND There are limited findings from low-powered studies based on few number of subjects with equine asthma. Furthermore, no studies have been performed to assess a meaningful clinically detectable impact of corticosteroids in equine asthma. OBJECTIVES To assess and compare the clinical effect of inhaled and systemic corticosteroids in equine asthma and identify a quantitative clinical score suitable to assess the Minimal Important Difference (MID), expressed as the Minimally Clinically Detectable Difference (MCDD). STUDY DESIGN Pair-wise and network meta-analysis. METHODS Literature searches for studies on corticosteroid therapy in equine asthma were performed. The risk of publication bias was assessed by Funnel plots and Egger's test. The effect on changes in clinical scores vs. control was analysed via random-effects models and Bayesian networks. RESULTS Corticosteroids significantly improved the clinical condition (Standardised Mean Difference: -1.52, 95% CrI -2.07 to -0.98; P<0.001 vs. control). No difference was detected between inhaled and systemic corticosteroids with regard to the changes in clinical scores (Relative Effect: 0.08, 95% CrI -1.45 to 1.32; P = 0.8). An Improved clinically Detectable Equine Asthma Scoring System (IDEASS) indicated that corticosteroids improved the clinical condition of asthmatic horses by 30% compared with controls (IDEASS value: -2.36, 95% CI -3.39 to -1.33; P<0.001). A one-point change in IDEASS represented the MCDD in equine asthma. MAIN LIMITATIONS Moderate quality of evidence for systemic corticosteroids. CONCLUSIONS Inhaled corticosteroids are effective in improving the clinical condition of horses with equine asthma and prevent exacerbations. Systemic corticosteroids should be used only in selected cases with symptomatic airway hyperresponsiveness during exacerbation. IDEASS requires further validation but may represent a suitable approach to rank the level of asthma severity and assess the clinical effect of pharmacotherapy in horses with equine asthma.
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Affiliation(s)
- L Calzetta
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - P Rogliani
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - C Page
- The Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, UK
| | - P Roncada
- Istituto Sperimentale Italiano "Lazzaro Spallanzani", Milan, Italy
| | | | - A Soggiu
- Dipartimento di Medicina Veterinaria, University of Milan, Milan, Italy
| | - C Piras
- Dipartimento di Medicina Veterinaria, University of Milan, Milan, Italy
| | - A Urbani
- Istituto di Biochimica e Biochimica Clinica, Università Cattolica, Rome, Italy
| | - M G Matera
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
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Calzetta L, Rogliani P, Pistocchini E, Mattei M, Cito G, Alfonsi P, Page C, Matera MG. Effect of lipopolysaccharide on the responsiveness of equine bronchial tissue. Pulm Pharmacol Ther 2018; 49:88-94. [PMID: 29408044 DOI: 10.1016/j.pupt.2018.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 01/25/2018] [Accepted: 01/28/2018] [Indexed: 02/09/2023]
Abstract
Recurrent airway obstruction (RAO) is a main characteristic of horses with severe equine asthma syndrome. The presence of bacterial lipopolysaccharide (LPS) in the airways of horses is thought to play a crucial role in the clinical expression of this disorder. This study pharmacologically characterized the effect of LPS on the responsiveness of equine bronchial tissue. Equine isolated bronchi were incubated overnight with LPS (0.1-100 ng/ml) and then stimulated by electrical field stimulation (EFS). The role of capsaicin sensitive-sensory nerves (capsaicin desensitization treatment), neurokinin-2 (NK2) receptors (blocked by GR159897), transient receptor potential vanilloid type 1 receptors (TRPV1; blocked by SB366791), and neurokinin A (NKA) were investigated. Untreated bronchi were used as control tissues. LPS (1 ng/ml) significantly increased the EFS-evoked contractility of equine bronchi compared with control tissues (+742 ± 123 mg; P < 0.001). At higher concentrations LPS induced desensitization to airways hyperresponsiveness (AHR; EC50: 5.9 ± 2.6 ng/ml). Capsaicin desensitization and GR159897 significantly prevented AHR induced by LPS at EFS1-50Hz (-197 ± 25%; P < 0.01). SB366791 inhibited AHR at very low EFS frequency (EFS1Hz -193 ± 29%; P < 0.01 vs. LPS-treated bronchi). LPS (1 ng/ml) significantly (P < 0.01) increased 3.7 ± 0.7 fold the release of NKA compared with control bronchi. LPS induces biphasic dysfunctional bronchial contractility due to the stimulation of capsaicin sensitive-sensory nerves, increased release of NKA, and activation of NK2 receptors, whereas TRPV1 receptors appear to play a marginal role in this response. The overnight challenge with low concentrations of LPS represents a suitable model to investigate pharmacological options that may be of value in the treatment of equine RAO.
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Affiliation(s)
- Luigino Calzetta
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy.
| | - Paola Rogliani
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | | | - Maurizio Mattei
- Department of Biology, Centro Servizi Interdipartimentale-STA, University of Rome Tor Vergata, Rome, Italy
| | - Giuseppe Cito
- ASL Roma 2, UOC Tutela Igienico Sanitaria Degli Alimenti di Origine Animale, Rome, Italy
| | - Pietro Alfonsi
- ASL Roma 2, UOC Igiene Degli Allevamenti e Delle Produzioni Zootecniche, Rome, Italy
| | - Clive Page
- The Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom
| | - Maria Gabriella Matera
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
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Calzetta L, Rogliani P, Mattei M, Alfonsi P, Cito G, Pistocchini E, Cazzola M, Matera MG. Pharmacological characterization of the interaction between tiotropium and olodaterol administered at 5:5 concentration-ratio in equine bronchi. COPD 2017; 14:526-532. [PMID: 28745522 DOI: 10.1080/15412555.2017.1344627] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Equine airways represent a suitable ex vivo model to study the functional impact of pharmacological treatments on human chronic obstructive pulmonary disorders, such as asthma and chronic obstructive pulmonary disease (COPD). We aimed to characterize the pharmacological interaction between the long-acting muscarinic antagonist (LAMA) tiotropium and the long-acting β2-agonist (LABA) olodaterol in equine airways. The effect of tiotropium and olodaterol, administered alone and in combination at the ratio of concentrations reproducing ex vivo the concentration-ratio delivered by the currently available fixed-dose combination (FDC) (5:5), was investigated on the cholinergic contractile tone induced by the parasympathetic activation of equine isolated airways. The drug interaction was analysed by using the Bliss Independence and Unified Theory models. Both tiotropium and olodaterol induced a sub-maximal concentration-dependent inhibition of bronchial contractility (Emax: tiotropium 83.6 ± 14.8%, olodaterol 76.9 ± 17.9%; pEC50: tiotropium 8.2 ± 0.5; olodaterol 8.3 ± 0.6). When administered at 5:5 concentration-ratio, tiotropium plus olodaterol completely inhibited the bronchial contractility (Emax 102.7 ± 8.4%; pEC50 9.0 ± 0.7). Strong synergistic interaction was detected for tiotropium/olodaterol combination (combination index 0.011). When administered at low concentrations, the drug mixture elicited up to 94.6 ± 9.5% effect that was 36.0 ± 8.1% greater than the expected additive effect. The results of this study demonstrate that the co-administration of tiotropium plus olodaterol at 5:5 concentration-ratio leads to synergistic inhibition of equine bronchial contractility when compared with either drug administered alone. These findings suggest that the currently available LABA/LABA FDC may be effective in delivering tiotropium/olodaterol combination at equipotency concentrations of each monocomponent into the lung and, thus, inducing synergistic effect in the airways.
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Affiliation(s)
- Luigino Calzetta
- a Department of Systems Medicine , University of Rome Tor Vergata , Rome , Italy
| | - Paola Rogliani
- a Department of Systems Medicine , University of Rome Tor Vergata , Rome , Italy
| | - Maurizio Mattei
- b Department of Biology, Centro Servizi Interdipartimentale-STA , University of Rome Tor Vergata , Rome , Italy
| | - Pietro Alfonsi
- c ASL Roma 2, UOC Igiene degli Allevamenti e delle Produzioni Zootecniche , Rome , Italy
| | - Giuseppe Cito
- d ASL Roma 2, UOC Tutela igienico sanitaria degli alimenti di origine animale , Rome , Italy
| | | | - Mario Cazzola
- a Department of Systems Medicine , University of Rome Tor Vergata , Rome , Italy
| | - Maria Gabriella Matera
- f Department of Experimental Medicine , University of Campania Luigi Vanvitelli , Naples , Italy
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Calzetta L, Rogliani P, Facciolo F, Rendina E, Cazzola M, Matera MG. Pharmacological characterization of the interaction between umeclidinium and vilanterol in human bronchi. Eur J Pharmacol 2017; 812:147-154. [PMID: 28716723 DOI: 10.1016/j.ejphar.2017.07.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/07/2017] [Accepted: 07/13/2017] [Indexed: 11/18/2022]
Abstract
The long-acting β2-agonist (LABA) / long-acting muscarinic antagonist (LAMA) fixed dose combination (FDC) therapy represents the cornerstone for the treatment of chronic obstructive pulmonary disease (COPD). Nevertheless, conflicting clinical findings still exist on the real benefit of the LABA/LAMA FDCs. Therefore, we investigated whether combining the LABA vilanterol with the LAMA umeclidinium may induce synergistic bronchorelaxant effect in isolated airways. The effect of umeclidinium and vilanterol, administered alone, in combination at the ratio of concentrations reproducing the doses delivered by Anoro® Ellipta® (55:22), or at isoeffective low concentrations, was investigated on the cholinergic contractile tone induced by the parasympathetic activation of human isolated airways. The interaction was analyzed by using the Bliss Independence and Unified Theory models. Umeclidinium and vilanterol induced a concentration-dependent relaxation of isolated bronchi, with umeclidinium significantly (P < 0.05) more potent than vilanterol (Emax at 10Hz: umeclidium 102.6 ± 6.8%, vilanterol 75.1 ± 13.8%; pEC50 at 10Hz: umeclidinium 8.6 ± 0.4, vilanterol 6.9 ± 0.6). When administered at 55:22 concentration-ratio, umeclidinium plus vilanterol completely relaxed the isolated airways (Emax at 10Hz: 99.6 ± 8.0%; pEC50 at 10Hz: 8.2 ± 0.4). No synergistic interaction was detected for umeclidinium/vilanterol combined at 55:22 ratio, whereas strong synergism was elicited when the drugs were administered at low isoeffective concentrations (+ 41.4 ± 5.8% vs. monocomponents), leading to submaximal relaxant effect (81.4 ± 5.8%). Umeclidinium and vilanterol are imbalanced when combined at 55:22 ratio, with umeclidinium over-dosed, or vice versa vilanterol under-dosed. Specific studies are needed to identify the dose ratio of umeclidinium/vilanterol combination to guarantee equipotency concentrations of each component into the lung, and induce synergistic bronchodilation.
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Affiliation(s)
- Luigino Calzetta
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
| | - Paola Rogliani
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Facciolo
- Regina Elena National Cancer Institute, Thoracic Surgery Unit, Rome, Italy
| | - Erino Rendina
- Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy
| | - Mario Cazzola
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Maria Gabriella Matera
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
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Xu Z, Lu Y, Wang J, Ding X, Chen J, Miao C. The protective effect of propofol against TNF-α-induced apoptosis was mediated via inhibiting iNOS/NO production and maintaining intracellular Ca 2+ homeostasis in mouse hippocampal HT22 cells. Biomed Pharmacother 2017; 91:664-672. [DOI: 10.1016/j.biopha.2017.04.110] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 04/01/2017] [Accepted: 04/24/2017] [Indexed: 10/24/2022] Open
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Rogliani P, Calzetta L, Capuani B, Facciolo F, Cazzola M, Lauro D, Matera MG. Glucagon-Like Peptide 1 Receptor: A Novel Pharmacological Target for Treating Human Bronchial Hyperresponsiveness. Am J Respir Cell Mol Biol 2017; 55:804-814. [PMID: 27447052 DOI: 10.1165/rcmb.2015-0311oc] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Asthma is associated with several comorbidities, such as type 2 diabetes mellitus, which may lead to bronchial hyperresponsiveness (BHR). Because glucagon-like peptide (GLP) 1 regulates glucose homeostasis, we pharmacologically investigated the influence of the GLP1 receptor (GLP1-R) agonist, exendin-4, on BHR induced in human isolated airways. The effect of exendin-4 was assessed in human isolated airways undergoing overnight passive sensitization and high-glucose stimulation, two conditions mimicking ex vivo the BHR typical of patients with asthma and diabetes, respectively. GLP1-R activation modulated the bronchial contractile tone induced by transmural stimulation (maximum effect -56.7 ± 3.6%; onset of action, 28.2 ± 4.4 min). Exendin-4 prevented BHR induced by both high-glucose stimulation and passive sensitization (-37.8 ± 7.5% and -74.9 ± 3.9%, P < 0.05 versus control, respectively) through selective activation of GLP1-R and in an epithelium-independent manner. The cAMP-dependent protein kinase A inhibitor, KT5720, reduced the protective role of exendin-4 (P > 0.05 versus passively sensitized tissues). The GLP1-R stimulation by overnight incubation with exendin-4 induced the overexpression of adenylyl cyclase isoform V (+48.4 ± 1.3%, P < 0.05 versus passively sensitized tissues) and restored the cAMP levels depleted by this procedure (+330.8 ± 63.3%, P < 0.05 versus passively sensitized tissues). In conclusion, GLP1-R may represent a novel target for treating BHR by activating the cAMP-dependent protein kinase A pathway in human airways, and GLP1-R agonists could be used as a "new" class to treat patients with asthma and patients with type 2 diabetes mellitus with BHR.
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Affiliation(s)
- Paola Rogliani
- 1 Department of Systems Medicine, Respiratory Medicine, and
| | | | - Barbara Capuani
- 2 Department of Systems Medicine, Endocrinology and Diabetes, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Facciolo
- 3 Thoracic Surgery Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Mario Cazzola
- 1 Department of Systems Medicine, Respiratory Medicine, and
| | - Davide Lauro
- 2 Department of Systems Medicine, Endocrinology and Diabetes, University of Rome Tor Vergata, Rome, Italy
| | - Maria Gabriella Matera
- 4 Department of Experimental Medicine, Unit of Pharmacology, Second University of Naples, Naples, Italy; and
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Rogliani P, Calzetta L, Cavalli F, Matera MG, Cazzola M. Pirfenidone, nintedanib and N-acetylcysteine for the treatment of idiopathic pulmonary fibrosis: A systematic review and meta-analysis. Pulm Pharmacol Ther 2016; 40:95-103. [PMID: 27481628 DOI: 10.1016/j.pupt.2016.07.009] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 07/08/2016] [Accepted: 07/27/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND The prevalence of idiopathic pulmonary fibrosis (IPF) is increasing every year. Pirfenidone and nintedanib were approved for treatment of IPF in 2014, but they received only a conditional recommendation for use and, thus, to date no drugs are strongly recommended for IPF. The aim of this study was to assess the effectiveness and safety of the currently approved drugs for IPF and N-acetylcysteine (NAC), the most debated drug in the last update of guidelines for IPF treatment. METHODS RCTs in IPF were identified searching from databases of published and unpublished studies. The influence of pirfenidone, nintedanib and NAC on clinical outcomes, safety, and mortality was assessed via pair-wise meta-analysis. RESULTS Ten papers (3847 IPF patients; 2254 treated; 1593 placebo) were included in this study. Our results showed that both pirfenidone and nintedanib, but not NAC, were significantly effective in reducing FVC decline and the risk of FVC ≥10% decline in percent predicted over 12 months. Nintenadib significantly protected against the risk of acute exacerbation and mortality. Pirfenidone and nintedanib showed a similar and good safety profile, whereas NAC provided a signal for increased adverse events. CONCLUSIONS The rank of effectiveness emerging from this meta-analysis represents an indirect indicator of potential differences between currently approved doses of pirfenidone and nintedanib. Direct comparisons are necessary to assess this matter, and well designed bench-to-bedside studies would permit to understand the potential of combined, sequential, or adjunctive treatment regimens in which perhaps NAC may have a role for specific clusters of IPF patients.
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Affiliation(s)
- Paola Rogliani
- University of Rome Tor Vergata, Department of Systems Medicine, Unit of Respiratory Clinical Pharmacology, Rome, Italy; University of Rome Tor Vergata, Department of Systems Medicine, Chair of Respiratory Medicine, Rome, Italy
| | - Luigino Calzetta
- University of Rome Tor Vergata, Department of Systems Medicine, Unit of Respiratory Clinical Pharmacology, Rome, Italy.
| | - Francesco Cavalli
- University of Rome Tor Vergata, Department of Systems Medicine, Chair of Respiratory Medicine, Rome, Italy
| | - Maria Gabriella Matera
- Second University of Naples, Department of Experimental Medicine, Unit of Pharmacology, Naples, Italy
| | - Mario Cazzola
- University of Rome Tor Vergata, Department of Systems Medicine, Unit of Respiratory Clinical Pharmacology, Rome, Italy; University of Rome Tor Vergata, Department of Systems Medicine, Chair of Respiratory Medicine, Rome, Italy
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Calzetta L, Orlandi A, Page C, Rogliani P, Rinaldi B, Rosano G, Cazzola M, Matera MG. Brain natriuretic peptide: Much more than a biomarker. Int J Cardiol 2016; 221:1031-8. [PMID: 27447810 DOI: 10.1016/j.ijcard.2016.07.109] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 07/05/2016] [Accepted: 07/07/2016] [Indexed: 01/02/2023]
Abstract
Brain natriuretic peptide (BNP) modulates several biological processes by activating the natriuretic peptide receptor A (NPR-A). Atria and ventricles secrete BNP. BNP increases natriuresis, diuresis and vasodilatation, thus resulting in a decreased cardiac workload. BNP and NT-proBNP, which is the biologically inactive N-terminal portion of its pro-hormone, are fast and sensitive biomarkers for diagnosing heart failure. The plasma concentrations of both BNP and NT-proBNP also correlate with left ventricular function in patients with acute exacerbation of COPD, even without history of heart failure. Several studies have been conducted in vitro and in vivo, both in animals and in humans, in order to assess the potential role of the NPR-A activation as a novel therapeutic approach for treating obstructive pulmonary disorders. Unfortunately, these studies have yielded conflicting results. Nevertheless, further recent specific studies, performed in ex vivo models of asthma and COPD, have confirmed the bronchorelaxant effect of BNP and its protective role against bronchial hyperresponsiveness in human airways. These studies have also clarified the intimate mechanism of action of BNP, represented by an autocrine loop elicited by the activation of NPR-A, localized on bronchial epithelium, and the relaxant response of the surrounding ASM, which does not expresses NPR-A. This review explores the teleological activities and paradoxical effects of BNP with regard to chronic obstructive respiratory disorders, and provides an excursus on the main scientific findings that explain why BNP should be considered much more than a biomarker.
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Affiliation(s)
- Luigino Calzetta
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Augusto Orlandi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Clive Page
- The Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom
| | - Paola Rogliani
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Barbara Rinaldi
- Department of Experimental Medicine, Second University of Naples, Naples, Italy
| | - Giuseppe Rosano
- Cardiovascular & Cell Science Institute, St George's Hospital NHS Trust, University of London, London, United Kingdom; Department of Medical Sciences, IRCCS San Raffaele, Rome, Italy
| | - Mario Cazzola
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
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Cazzola M, Calzetta L, Puxeddu E, Ora J, Facciolo F, Rogliani P, Matera MG. Pharmacological characterisation of the interaction between glycopyrronium bromide and indacaterol fumarate in human isolated bronchi, small airways and bronchial epithelial cells. Respir Res 2016; 17:70. [PMID: 27296533 PMCID: PMC4906998 DOI: 10.1186/s12931-016-0386-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 06/03/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nowadays, there is a considerable gap in knowledge concerning the mechanism(s) by which long-acting β2-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) interact to induce bronchodilation. This study aimed to characterise the pharmacological interaction between glycopyrronium bromide and indacaterol fumarate and to identify the mechanism(s) leading to the bronchorelaxant effect of this interaction. METHODS The effects of glycopyrronium plus indacaterol on the contractile tone of medium and small human isolated bronchi were evaluated, and acetylcholine and cAMP concentrations were quantified. The interaction was assessed by Bliss Independence approach. RESULTS Glycopyrronium plus indacaterol synergistically inhibited the bronchial tone (medium bronchi, +32.51 % ± 7.86 %; small bronchi, +28.46 % ± 5.35 %; P < 0.05 vs. additive effect). The maximal effect was reached 140 min post-administration. A significant (P < 0.05) synergistic effect was observed during 9 h post-administration on the cholinergic tone, but not on the histaminergic contractility. Co-administration of glycopyrronium and indacaterol reduced the release of acetylcholine from the epithelium but not from bronchi, and enhanced cAMP levels in bronchi and epithelial cells (P < 0.05 vs. control), an effect that was inhibited by the selective KCa(++) channel blocker iberiotoxin. The role of cAMP-dependent pathway was confirmed by the synergistic effect elicited by the adenylate cyclase activator forskolin on glycopyrronium (P < 0.05 vs. additive effect), but not on indacaterol (P > 0.05 vs. additive effect), with regard of the bronchial relaxant response and cAMP increase. CONCLUSIONS Glycopyrronium/indacaterol co-administration leads to a synergistic improvement of bronchodilation by increasing cAMP concentrations in both airway smooth muscle and bronchial epithelium, and by decreasing acetylcholine release from the epithelium.
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Affiliation(s)
- Mario Cazzola
- Department of Systems Medicine, Chair of Respiratory Medicine, University of Rome Tor Vergata, Rome, Italy.,Department of Systems Medicine, Respiratory Pharmacology Research Unit, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.,Division of Respiratory Medicine, University Hospital Tor Vergata, Rome, Italy
| | - Luigino Calzetta
- Department of Systems Medicine, Respiratory Pharmacology Research Unit, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.
| | - Ermanno Puxeddu
- Department of Systems Medicine, Chair of Respiratory Medicine, University of Rome Tor Vergata, Rome, Italy.,Division of Respiratory Medicine, University Hospital Tor Vergata, Rome, Italy
| | - Josuel Ora
- Division of Respiratory Medicine, University Hospital Tor Vergata, Rome, Italy
| | - Francesco Facciolo
- Regina Elena National Cancer Institute, Thoracic Surgery Unit, Rome, Italy
| | - Paola Rogliani
- Department of Systems Medicine, Chair of Respiratory Medicine, University of Rome Tor Vergata, Rome, Italy.,Division of Respiratory Medicine, University Hospital Tor Vergata, Rome, Italy
| | - Maria Gabriella Matera
- Department of Experimental Medicine, Unit of Pharmacology, Second University of Naples, Naples, Italy
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Interaction between corticosteroids and muscarinic antagonists in human airways. Pulm Pharmacol Ther 2015; 36:1-9. [PMID: 26656790 DOI: 10.1016/j.pupt.2015.11.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/05/2015] [Accepted: 11/25/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND To date there is emerging clinical evidence to add long-acting anti-muscarinic agents (LAMAs) with inhaled corticosteroid (ICSs) in asthma, but the pharmacological rationale that supports the use of such a combination has not yet been explained. The aim of this study was to pharmacologically investigate the interaction between the ICS beclomethasone and the LAMA glycopyrronium on the human airway smooth muscle (ASM) tone. METHODS We investigated the rapid non-genomic bronchorelaxant effect of beclomethasone and glycopyrronium, administered alone and in combination, in human isolated bronchi and bronchioles. Experiments were carried out also in passively sensitized airways and the pharmacological analysis of drug interaction was performed by Bliss Independence method. RESULTS The acute administration of beclomethasone and glycopyrronium induced a significant relaxation of passively sensitized ASM pre-contracted with histamine, by causing submaximal/maximal inhibition of the contractile tone in both medium bronchi and bronchioles. Beclomethasone was characterized by a rapid non-genomic and epithelium independent bronchorelaxant effect. In passively sensitized airways, this effect seemed to be dependent by the activation of a Gsα--cyclic adenosine monophosphate (cAMP)--protein kinase A cascade. While no synergistic interaction was detected in non-sensitized bronchi, the beclomethasone/glycopyrronium combination synergistically enhanced the relaxation of passively sensitized medium and small bronchi. The synergistic interaction between beclomethasone and glycopyrronium was associated with an increase of cAMP concentrations. CONCLUSIONS Our study provides for the first time the pharmacological rationale for combining low doses of an ICS plus a LAMA.
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Calzetta L, Soggiu A, Roncada P, Bonizzi L, Pistocchini E, Urbani A, Rinaldi B, Matera MG. Propofol protects against opioid-induced hyperresponsiveness of airway smooth muscle in a horse model of target-controlled infusion anaesthesia. Eur J Pharmacol 2015; 765:463-71. [DOI: 10.1016/j.ejphar.2015.09.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 09/03/2015] [Accepted: 09/04/2015] [Indexed: 11/29/2022]
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Cazzola M, Calzetta L, Ora J, Puxeddu E, Rogliani P, Matera MG. Searching for the synergistic effect between aclidinium and formoterol: From bench to bedside. Respir Med 2015; 109:1305-11. [DOI: 10.1016/j.rmed.2015.08.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 07/20/2015] [Accepted: 08/10/2015] [Indexed: 11/24/2022]
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Rogliani P, Calzetta L, Ora J, Lipsi R, Segreti A, Matera MG, Cazzola M. Pharmacological assessment of the onset of action of aclidinium and glycopyrronium versus tiotropium in COPD patients and human isolated bronchi. Eur J Pharmacol 2015; 761:383-90. [DOI: 10.1016/j.ejphar.2015.04.042] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 04/20/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
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25
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Calzetta L, Matera MG, Cazzola M. Pharmacological interaction between LABAs and LAMAs in the airways: optimizing synergy. Eur J Pharmacol 2015; 761:168-73. [PMID: 25981302 DOI: 10.1016/j.ejphar.2015.05.020] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/11/2015] [Accepted: 05/14/2015] [Indexed: 11/17/2022]
Abstract
Nowadays there is solid clinical information for combining β2-agonists and anti-muscarinic agents, although the nature (additive or synergistic) of the net clinical result obtained by co-administration of these two classes of bronchodilators is not completely elucidated from a pharmacological point of view. Recent preclinical studies demonstrated that combining a long-acting β2-agonist (LABA) with a long-acting anti-muscarinic agent (LAMA) provides synergistic benefit on airway smooth muscle relaxation, which may have major implications for the use of LABA/LAMA combinations in the treatment COPD. Indeed, the LABA/LAMA synergism has been proved also in patients with moderate-to-severe COPD. Nevertheless, there is still a strong medical need for dose-finding clinical trials designed to identify the most favourable doses of LABA/LAMA combinations able to induce a real synergism. We strongly believe that the Bliss Independence theory represents an effective model for investigating the cross-talk between β2-adrenoreceptor and the muscarinic pathways leading to the synergistic interaction between β2-agonists and anti-muscarinic agents. In any case, the possibility of eliciting a synergistic bronchodilator effect when combining a LABA and a LAMA suggests that the therapeutic approach proposed by GOLD recommendations to only use LABA/LAMA combination in more severe COPD patients who are not controlled by a single bronchodilator should be reconsidered. We support the possibility of an early intervention with low doses of LABA/LAMA combination to optimize bronchodilation and reduce the risk of adverse events that characterize both LABAs and LAMAs, especially when administered at the full doses currently approved for the treatment of COPD.
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Affiliation(s)
- Luigino Calzetta
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
| | | | - Mario Cazzola
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
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26
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Rinaldi B, Donniacuo M, Sodano L, Gritti G, Martuscelli E, Orlandi A, Rafaniello C, Rossi F, Calzetta L, Capuano A, Matera MG. Effects of chronic treatment with the new ultra-long-acting β2 -adrenoceptor agonist indacaterol alone or in combination with the β1 -adrenoceptor blocker metoprolol on cardiac remodelling. Br J Pharmacol 2015; 172:3627-37. [PMID: 25825265 DOI: 10.1111/bph.13148] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 03/21/2015] [Accepted: 03/26/2015] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND AND PURPOSE The ability of a chronic treatment with indacaterol, a new ultra-long-acting β2 -adrenoceptor agonist, to reverse cardiac remodelling and its effects in combination with metoprolol, a selective β1 -adrenoceptor antagonist, were investigated on myocardial infarction in a rat model of heart failure (HF). EXPERIMENTAL APPROACH We investigated the effects of indacaterol and metoprolol, administered alone or in combination, on myocardial histology, β-adrenoceptor-mediated pathways, markers of remodelling and haemodynamic parameters in a rat model of HF. Five groups of rats were assessed: sham-operated rats; HF rats; HF + indacaterol 0.3 mg·kg(-1) ·day(-1) ; HF + metoprolol 100 mg·kg(-1) ·day(-1) ; HF + metoprolol + indacaterol. All pharmacological treatments continued for 15 weeks. KEY RESULTS Treatment with either indacaterol or metoprolol significantly reduced the infarct size in HF rats. However, the combination of indacaterol and metoprolol reduced the infarct size even further, reduced both BP and heart rate, reversed the decrease in ejection fraction, normalized left ventricular systolic and diastolic internal diameters, normalized the decreased β1 adrenoceptor mRNA expression as well as cardiac cAMP levels and reduced cardiac GPCR kinase 2 expression, compared with the untreated HF group. CONCLUSION AND IMPLICATIONS The results of our study demonstrated an additive interaction between indacaterol and metoprolol in normalizing and reversing cardiac remodelling in our experimental model of HF. The translation of these findings to clinical practice might be of interest, as this combination of drugs could be safer and more effective in patients suffering from HF and COPD.
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Affiliation(s)
- Barbara Rinaldi
- Centre of Excellence for Cardiovascular Diseases, Second University of Naples, Naples, Italy.,Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology L. Donatelli, Second University of Naples, Naples, Italy
| | - Maria Donniacuo
- Centre of Excellence for Cardiovascular Diseases, Second University of Naples, Naples, Italy
| | - Loredana Sodano
- Centre of Excellence for Cardiovascular Diseases, Second University of Naples, Naples, Italy
| | - Giulia Gritti
- Centre of Excellence for Cardiovascular Diseases, Second University of Naples, Naples, Italy
| | - Eugenio Martuscelli
- Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Augusto Orlandi
- Anatomic Pathology, Department of Biomedicine and Prevention, University of Rome 'Tor Vergata', Rome, Italy
| | - Concetta Rafaniello
- Centre of Excellence for Cardiovascular Diseases, Second University of Naples, Naples, Italy.,Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology L. Donatelli, Second University of Naples, Naples, Italy
| | - Francesco Rossi
- Centre of Excellence for Cardiovascular Diseases, Second University of Naples, Naples, Italy.,Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology L. Donatelli, Second University of Naples, Naples, Italy
| | - Luigino Calzetta
- Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Annalisa Capuano
- Centre of Excellence for Cardiovascular Diseases, Second University of Naples, Naples, Italy.,Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology L. Donatelli, Second University of Naples, Naples, Italy
| | - Maria Gabriella Matera
- Centre of Excellence for Cardiovascular Diseases, Second University of Naples, Naples, Italy
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27
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Calzetta L, Cazzola M, Page CP, Rogliani P, Facciolo F, Matera MG. Pharmacological characterization of the interaction between the dual phosphodiesterase (PDE) 3/4 inhibitor RPL554 and glycopyrronium on human isolated bronchi and small airways. Pulm Pharmacol Ther 2015; 32:15-23. [PMID: 25899618 DOI: 10.1016/j.pupt.2015.03.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 03/02/2015] [Accepted: 03/03/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The dual PDE3/4 inhibitor RPL 554 causes bronchodilation in patients with asthma or COPD and synergistically interacts with muscarinic receptor antagonists in relaxing human isolated bronchi in acute experimental settings. In the present study we investigated the long-lasting interaction between RPL554 and glycopyrronium by testing these drugs for their ability to relax both medium and small human isolated bronchi. METHODS The relaxant effect and duration of action of RPL554 and glycopyrronium, alone, or in combination, were studied on the contractile tone induced by electrical field stimulation (EFS) or carbachol in medium and small human isolated bronchi. Relaxation was expressed as percentage of maximal response and synergy analyzed by Bliss Independence theory. RESULTS Low concentrations of RPL554 and glycopyrronium induced maximal relaxation of medium bronchi at 160 ± 20 min and 50 ± 10 min, respectively, an effect detectable for at least 4 h. Maximal synergy was observed at ≃ 2 hrs (-71.4 ± 5.1%), and the combination extended the relaxation to at least 6 hrs, when the contractile tone was -41.2 ± 8.5% of the control responses. The combination induced the greatest effectiveness for EFS at 3 Hz and low-to-middle concentrations also produced significant synergism on small airways (21.1 ± 4.0%,P < 0.05), compared with the additive response. The combination induced lumen area enhancement of 69.1 ± 2.4% (P < 0.05), compared with the additive response (51.0 ± 5.4%). CONCLUSIONS RPL554 and glycopyrronium demonstrated a synergistic interaction in relaxing both human medium and small isolated bronchi, in terms of peak relaxation and an extended duration of action, suggesting that this combination may have a beneficial role in the treatment of asthma or COPD.
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Affiliation(s)
- Luigino Calzetta
- Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy.
| | - Mario Cazzola
- Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Clive P Page
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, UK
| | - Paola Rogliani
- Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy
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Li Q, Lu J, Wang X. Propofol and remifentanil at moderate and high concentrations affect proliferation and differentiation of neural stem/progenitor cells. Neural Regen Res 2015; 9:2002-7. [PMID: 25598783 PMCID: PMC4283284 DOI: 10.4103/1673-5374.145384] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2014] [Indexed: 12/27/2022] Open
Abstract
Propofol and remifentanil alter intracellular Ca2+ concentration ([Ca2+]i) in neural stem/progenitor cells by activating γ-aminobutyric acid type A receptors and by reducing testosterone levels. However, whether this process affects neural stem/progenitor cell proliferation and differentiation remains unknown. In the present study, we applied propofol and remifentanil, alone or in combination, at low, moderate or high concentrations (1, 2–2.5 and 4–5 times the clinically effective blood drug concentration), to neural stem/progenitor cells from the hippocampi of newborn rat pups. Low concentrations of propofol, remifentanil or both had no noticeable effect on cell proliferation or differentiation; however, moderate and high concentrations of propofol and/or remifentanil markedly suppressed neural stem/progenitor cell proliferation and differentiation, and induced a decrease in [Ca2+]i during the initial stage of neural stem/progenitor cell differentiation. We therefore propose that propofol and remifentanil interfere with the proliferation and differentiation of neural stem/progenitor cells by altering [Ca2+]i. Our findings suggest that propofol and/or remifentanil should be used with caution in pediatric anesthesia.
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Affiliation(s)
- Qing Li
- Department of Anesthesiology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China ; Anesthesiology Research Institude, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China
| | - Jiang Lu
- Department of Anesthesiology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China ; Anesthesiology Research Institude, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China
| | - Xianyu Wang
- Department of Anesthesiology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China ; Anesthesiology Research Institude, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China
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29
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Cazzola M, Calzetta L, Page CP, Rogliani P, Facciolo F, Gavaldà A, Matera MG. Pharmacological characterization of the interaction between aclidinium bromide and formoterol fumarate on human isolated bronchi. Eur J Pharmacol 2014; 745:135-43. [DOI: 10.1016/j.ejphar.2014.10.025] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 10/13/2014] [Accepted: 10/15/2014] [Indexed: 02/04/2023]
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30
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Cazzola M, Calzetta L, Segreti A, Facciolo F, Rogliani P, Matera MG. Translational Study Searching for Synergy between Glycopyrronium and Indacaterol. COPD 2014; 12:175-81. [PMID: 25222881 DOI: 10.3109/15412555.2014.922172] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We aimed to explore whether the acute bronchodilation induced by indacaterol 150 μg and glycopyrronium bromide 50 μg is additive or synergistic with respect to monocomponents by testing the type of effect ex vivo on isolated human bronchi and then in vivo in COPD patients. Both indacaterol and glycopyrronium caused a concentration-dependent relaxation of human isolated bronchial tissues sub-maximally pre-contracted with acetylcholine; glycopyrronium was significantly more potent than indacaterol. The analysis of data using the Bliss Independence (BI) criterion indicated that glycopyrronium plus indacaterol produced an additive interaction at the isoeffective concentrations inducing EC20 and a significant synergistic relaxant effect at isoeffective concentrations inducing EC30. In COPD patients, the inhalation of indacaterol and glycopyrronium in combination significantly anticipated at 15 min post-administration the mean peak of bronchodilatory effect compared to the two drugs administered alone. The study of interaction between indacaterol and glycopyrronium by BI analysis evidenced an additive effect for FEV1 between 5 min and 180 min post-inhalation, with synergistic interaction at 15 min post-administration, compared to the bronchodilation induced by these drugs administered alone. This study suggests that the combination ensures a broncholytic effect that is greater than that induced by the single monocomponents.
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Affiliation(s)
- Mario Cazzola
- 1Department of Systems Medicine, University of Rome Tor Vergata , Rome , Italy
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31
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Calzetta L, Rossi P, Bove P, Alfonsi P, Bonizzi L, Roncada P, Bernardini R, Ricciardi E, Montuori M, Pistocchini E, Mauti P, Mattei M. Novel and effective balanced intravenous-inhalant anaesthetic protocol in swine by using unrestricted drugs. Exp Anim 2014; 63:423-33. [PMID: 25030879 PMCID: PMC4244291 DOI: 10.1538/expanim.63.423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Nowadays, because of increasing employment of swine for experimental studies and medical
training, it is hopeful to investigate novel and effective anaesthetic protocols for
preserving the animal welfare in medical investigation and concurrently improving the
quality of research. Therefore, the aim of this study was to investigate a novel and
effective anaesthetic protocol in swine undergoing major surgery, by translating know-how
of combined anaesthesia from human protocols. Seven landrace swine were anaesthetized for
three hours by a combined trial anaesthetic protocol (sedation: medetomidine,
acepromazine, atropine and tramadol; induction: propofol, medetomidine and acepromazine;
anaesthesia: isofluorane, propofol, medetomidine and acepromazine) and both clinical and
haemodynamic parameters were compared with those of five swine anaesthetized with a
control protocol (sedation: diazepam, ketamine and atropina; induction: diazepam and
ketamine; anaesthesia: isofluorane). Both cardiac frequency (CF) and mean blood pressure
(MBP) were significantly (P<0.05) more stable in trial protocol (CF:
78.3 ± 4.6-81.1 ± 5, MBP: 63.9 ± 10.7-96.4 ± 13.0) compared to control protocol (CF: 93.7
± 5.5-102.5 ± 8.5, MBP: 71.0 ± 6.6-108.7 ± 7.2). The body temperature remained stable in
trial protocol (°C: 36.9 ± 0.7-37.2 ± 0.3) compared to control anaesthesia (°C: 36.4 ±
0.3-37.3 ± 0.2, P<0.05). Haematosis improved undergoing combined
anaesthesia (+2%, P<0.05) whereas did not change in control animals.
There were no differences in respiratory rate between trial and control protocols. This
study demonstrates that the proposed balanced intravenous-inhalant protocol permits to
carry out a very effective, stable and safe anaesthesia in swine undergoing deep
anaesthesia.
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Affiliation(s)
- Luigino Calzetta
- Laboratory of Systems Approaches and Non-Communicable Diseases, IRCCS San Raffaele Pisana, Via di Val Cannuta, 247-00166 Rome, Italy
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32
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Matteis M, Polverino F, Spaziano G, Roviezzo F, Santoriello C, Sullo N, Bucci MR, Rossi F, Polverino M, Owen CA, D'Agostino B. Effects of sex hormones on bronchial reactivity during the menstrual cycle. BMC Pulm Med 2014; 14:108. [PMID: 24984749 PMCID: PMC4106209 DOI: 10.1186/1471-2466-14-108] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 06/26/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Many asthmatic women complain of symptom exacerbations in particular periods, i.e. during pregnancy and menstrual cycles (perimenstrual asthma: PMA)". The goal of this study was to study the effect of the luteal and follicular phases of the menstrual cycle on bronchial reactivity (BR) in a group of asthmatic women. METHODS For this purpose, 36 pre-menopausal women were enrolled and underwent testing for resting pulmonary function, measurement of the diffusing capacity of the lung for carbon monoxide (DLCO), and airway responsiveness to methacholine in the follicular and luteal phases of their menstrual cycles. We also measured plasma hormone levels and levels of cyclic adenosine monophosphate (cAMP; a mediator of bronchial smooth muscle contraction) and testosterone in induced sputum samples. RESULTS Our study showed that about 30% of the asthmatic women had decreased PC20FEV1.0 in the follicular phase of menstrual cycle with a significant correlation between PC20FEV1.0 and serum testosterone levels. Moreover, marked increases in sputum testosterone levels (mean=2.6-fold increase) together with significant increases in sputum cAMP concentrations (mean=3.6-fold increases) were observed during the luteal phase of asthmatic patients, suggesting that testosterone contributes to the pathophysiology of PMA. We excluded the possibility that testosterone directly inhibits phosphodiesterase (PDE) activity as incubating PDE with testosterone in vitro did not reduce PDE catalytic activity. CONCLUSIONS In conclusion, our data show that PC20FEV1.0 was decreased in the follicular phase of the menstrual cycle in about 30% of women and was associated with lower cAMP levels in sputum samples, which may contribute to bronchoconstriction. Our results also suggest a link between PMA and testosterone levels. However, whether these findings are of clinical significance in terms of the management of asthma or asthma worsening during the menstrual cycle needs further investigation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Bruno D'Agostino
- Department of Experimental Medicine-Section of Pharmacology, 2nd University of Naples, 80136 Naples, Italy.
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CALZETTA L, ROSSI P, BOVE P, ALFONSI P, BONIZZI L, RONCADA P, BERNARDINI R, RICCIARDI E, MONTUORI M, PISTOCCHINI E, MAUTI P, MATTEI M. A Novel and Effective Balanced Intravenous-Inhalant Anaesthetic Protocol in Swine by Using Unrestricted Drugs. Exp Anim 2014. [DOI: 10.1538/expanim.14-0011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Luigino CALZETTA
- Laboratory of Systems Approaches and Non-Communicable Diseases, IRCCS San Raffaele Pisana, Via di Val Cannuta, 247-00166 Rome, Italy
| | - Piero ROSSI
- Department of Surgery, University of Rome “Tor Vergata”, Rome, Italy
| | - Pierluigi BOVE
- Department of Surgery, University of Rome “Tor Vergata”, Rome, Italy
| | - Pietro ALFONSI
- ASL Roma B, UOC Igiene degli Allevamenti e delle Produzioni Zootecniche, Rome, Italy
| | - Luigi BONIZZI
- Dipartimento di Scienze Veterinarie e Sanità Pubblica (DIVET), Università degli Studi di Milano, Milan, Italy
| | - Paola RONCADA
- Dipartimento di Scienze Veterinarie e Sanità Pubblica (DIVET), Università degli Studi di Milano, Milan, Italy
- Istituto Sperimentale Italiano L. Spallanzani, Milan, Italy
| | - Roberta BERNARDINI
- Centro di Servizi Interdipartimentale, Stazione per la Tecnologia Animale, University of Rome “Tor Vergata”, Rome, Italy
| | - Edoardo RICCIARDI
- Department of Surgery, University of Rome “Tor Vergata”, Rome, Italy
| | - Mauro MONTUORI
- Department of Surgery, University of Rome “Tor Vergata”, Rome, Italy
| | - Elena PISTOCCHINI
- Centro di Servizi Interdipartimentale, Stazione per la Tecnologia Animale, University of Rome “Tor Vergata”, Rome, Italy
- CDVet, Laboratorio Analisi Veterinarie, Rome, Italy
| | | | - Maurizio MATTEI
- Centro di Servizi Interdipartimentale, Stazione per la Tecnologia Animale, University of Rome “Tor Vergata”, Rome, Italy
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Calzetta L, Page CP, Spina D, Cazzola M, Rogliani P, Facciolo F, Matera MG. Effect of the Mixed Phosphodiesterase 3/4 Inhibitor RPL554 on Human Isolated Bronchial Smooth Muscle Tone. J Pharmacol Exp Ther 2013; 346:414-23. [DOI: 10.1124/jpet.113.204644] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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