The contribution of pharmacogenetics to pharmacovigilance

miR-208b targets Bax to protect H9c2 cells against hypoxia-induced apoptosis

BACKGROUND

miR-208 family members have been considered as promising biomarkers in myocardial infarction (MI). Among which, miR-208a and miR-499 are reported to function as ischemic injury promoting miRNAs. This study aimed to explore the in vitro function of miR-208b in MI, which has not been widely studied.

METHODS

RT-qPCR was conducted to measure the expression changes of miR-208b in MI patients, MI mouse model and H9c2 cells stimulated by hypoxia. H9c2 cells were subjected to hypoxia before which miR-208b expression was altered by transfection. CCK-8, flow cytometry and Western blot were performed to detect cell survival. Besides, the regulatory relationship between miR-208b, Bax, and PI3K/AKT was tested by luciferase reporter, RT-qPCR and Western blot.

RESULTS

Serum levels of miR-208b in MI patients were significantly higher than those in the healthy controls. Also, miR-208b was up-regulated in mouse model and cell model of MI. Overexpression of miR-208b protected H9c2 cells against hypoxia-induced apoptosis, as the viability was increased, apoptosis rate was decreased, Bax and Cytochrome c were down-regulated, and Bcl-2 was up-regulated. Bax was a target gene of miR-208b. And miR-208b could not protect H9c2 cells when Bax was overexpressed. More interestingly, miR-208b activated PI3K/AKT pathway via targeting Bax, and the activated PI3K/AKT pathway could further repress Bax expression. Finally, blocking PI3K/AKT pathway by using LY294002 eliminated the myocardioprotective effects of miR-208b.

CONCLUSION

miR-208b is highly expressed during MI, and miR-208b protects H9c2 cells against hypoxia-induced apoptosis. miR-208b exerts myocardioprotective effect via targeting Bax and activating PI3K/AKT pathway.

Adverse drug reactions during hepatitis C treatment with direct-acting antivirals: The role of medication errors, their impact on treatment discontinuation and their preventability. New insights from the Campania Region (Italy) spontaneous reporting system

WHAT IS KNOWN AND OBJECTIVE

Medication errors, such as unnecessary treatment discontinuation during treatment with direct-acting antivirals (DAAs), can lead to imbalances in the benefit-to-risk ratio. This risk is especially high when the medication error leads to adverse drug reactions (ADRs). However, to date, evidence on the frequency of this phenomenon is scarce. This study aims to provide better insight into ADRs possibly due to medication errors leading to DAA discontinuation and their preventability.

METHODS

The Italian Pharmacovigilance Network database was used to extract individual case safety reports (ICSRs) generated from July 2012 to March 2017 via the Campania Region (Italy) spontaneous reporting system. ICSRs that included ledipasvir/sofosbuvir, ombitasvir/paritaprevir/ritonavir, dasabuvir, daclatasvir, sofosbuvir, simeprevir or elbasvir/grazoprevir as suspected drugs were included in this study. A preventability assessment was then performed utilizing the "P-Method," an algorithm that evaluates known risk factors due to medication errors that can be detected in ICSRs.

RESULTS AND DISCUSSION

Of the 355 cases included in this study, 6 (1.69%) were classified as preventable and 52 (14.6%) were classified as potentially preventable. The most frequently identified critical criteria (risk factor) for preventable or potentially preventable cases were drug-drug interactions and incorrect drug dosing as part of the antiviral treatment scheme. In total, 89 of the 355 cases (25.1%) discontinued use of the DAAs due to ADRs, of which 20 of the 89 cases (22.5%) were due to an unimportant medical event as classified by the European Medicine Agency important medical event list.

WHAT IS NEW AND CONCLUSION

This study found a proportion of preventable/potentially preventable ADRs involving DAA, which could be improved in the Campania Region (Italy). Additionally, the study identified a high proportion of seemingly unnecessary DAA discontinuations among patients who experienced ADRs.