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Safarova M, Bimal T, Soffer DE, Hirsh B, Shapiro MD, Mintz G, Cha A, Gianos E. Advances in targeting LDL cholesterol: PCSK9 inhibitors and beyond. Am J Prev Cardiol 2024; 19:100701. [PMID: 39070027 PMCID: PMC11278114 DOI: 10.1016/j.ajpc.2024.100701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 06/07/2024] [Accepted: 06/22/2024] [Indexed: 07/30/2024] Open
Abstract
There is a direct relationship between the duration and level of exposure to low density lipoprotein cholesterol (LDL-C) levels over one's lifespan and cardiovascular events. Early treatment to lower elevated LDL-C is crucial for better outcomes with multiple therapies currently available to reduce atherogenic lipoproteins. Statins remain the foundation of LDL-C lowering therapy as one of the most cost-effective drugs to reduce atherosclerotic events (ASCVD) and mortality. Nonetheless, LDL-driven goal attainment remains suboptimal globally, highlighting a considerable need for non-statin therapies to address residual risk related to statin intolerance, non-adherence, and inherited lipoprotein disorders. LDL-C lowering interventions beyond statins include ezetimibe, PCSK9 monoclonal antibodies, inclisiran and bempedoic acid with specific guideline recommendations as to when to consider each. For patients with homozygous familial hypercholesterolemia requiring more advanced therapy, lomitapide and evinacumab are available, providing mechanisms that are not LDL receptor dependent. Lipoprotein apheresis remains an effective option for clinical familial hypercholesterolemia as well as elevated lipoprotein (a). There are investigational therapies being explored to add to our current armamentarium including CETP inhibitors, a third-generation PCSK9 inhibitor (small recombinant fusion protein oral PCSK9 inhibitor) and gene editing which aims to directly restore or disrupt genes of interest at the DNA level. This article is a brief review of the pharmacotherapy options beyond statins for lowering LDL-C and their impact on ASCVD risk reduction. Our primary aim is to guide physicians on the role these therapies play in achieving appropriate LDL-C goals, with an algorithm of when to consider each based on efficacy, safety and outcomes.
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Affiliation(s)
- Maya Safarova
- Division of Cardiovascular Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI USA
| | - Tia Bimal
- Northwell, New Hyde Park, NY, Cardiovascular Institute, Lenox Hill Hospital, USA
| | - Daniel E. Soffer
- Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Benjamin Hirsh
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell, Hempstead, NY, USA
- Northwell, New Hyde Park, NY, Cardiovascular Institute, Sandra Atlas Bass Heart Hospital, USA
| | - Michael D. Shapiro
- Center for the Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Guy Mintz
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell, Hempstead, NY, USA
- Northwell, New Hyde Park, NY, Cardiovascular Institute, Sandra Atlas Bass Heart Hospital, USA
| | - Agnes Cha
- Northwell/Vivo Health Pharmacy, Ambulatory Pharmacy Services, Lake Success, NY, USA
| | - Eugenia Gianos
- Northwell, New Hyde Park, NY, Cardiovascular Institute, Lenox Hill Hospital, USA
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell, Hempstead, NY, USA
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Revankar S, Park JK, Satish P, Agarwala A. Is there a role for earlier use of combination therapy? Am J Prev Cardiol 2024; 17:100639. [PMID: 38419948 PMCID: PMC10900258 DOI: 10.1016/j.ajpc.2024.100639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/02/2024] [Accepted: 02/12/2024] [Indexed: 03/02/2024] Open
Abstract
As the global population ages and cardiovascular risk factors rise, we can expect a continued increase in atherosclerotic disease. Low-density lipoprotein cholesterol (LDL-C) reduction is a cornerstone of cardiovascular risk reduction with strong, causal evidence indicating that the greatest benefit is derived from early and large decreases in LDL-C. Despite the adoption of statins as the backbone of lipid-therapy regimens, numerous studies and registry analyses reveal our collective inability to achieve LDL-C goals in high-risk patients. Combination therapy with ezetimibe has been shown to result in statistically significant decreases in LDL-C level, atheroma volume, and cardiovascular adverse event rates. A major barrier to implementing an upfront combination therapy approach is the perceived side effects from therapeutic agents although multiple studies show that a therapeutic patient-physician relationship could overcome this issue. Novel agents such as PCSK-9 inhibitors, bempedoic acid, and inclisiran have the potential to achieve similar outcomes although additional research is needed regarding the cost effectiveness of these approaches. Despite these hurdles, there is a role for the newer agents early in the disease course of high-risk patients such as those with markedly elevated LDL-C >190 mg/dL and FH. The implementation of upfront combination therapy, especially in high-risk patients, will decrease clinical inertia while allowing for earlier consideration of newer, effective agents to decrease cardiovascular burden.
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Affiliation(s)
- Shruti Revankar
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jong Kun Park
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Priyanka Satish
- The University of Texas at Austin Dell School of Medicine, Ascension Texas Cardiovascular, Austin, TX, USA
| | - Anandita Agarwala
- Center for Cardiovascular Disease Prevention, Baylor Scott and White Health Heart Hospital Baylor Plano, Plano, TX, USA
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3
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Lee J, Lee SH. Expanding the therapeutic landscape: ezetimibe as non-statin therapy for dyslipidemia. Korean J Intern Med 2023; 38:797-809. [PMID: 37866817 PMCID: PMC10636547 DOI: 10.3904/kjim.2023.243] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/21/2022] [Accepted: 09/13/2023] [Indexed: 10/24/2023] Open
Abstract
Dyslipidemia is a significant risk factor for atherosclerotic cardiovascular disease (ASCVD), and statins are the primary therapeutic options for reducing low-density lipoprotein cholesterol (LDL-C) levels. However, it can be challenging to achieve optimal LDL-C goals with statin monotherapy. Ezetimibe, a cholesterol absorption inhibitor, offers a potential non-statin therapy to optimize LDL-C management. Key clinical trials, such as IMPROVE-IT and RACING, have demonstrated that the addition of ezetimibe to statin therapy leads to further decreases in LDL-C or significant decreases in major adverse cardiovascular events (MACEs), particularly in patients with high ASCVD risk. Subsequent meta-analyses and clinical trials have further supported the beneficial effect of ezetimibe, suggesting additive decreases in LDL-C and MACEs, as well as pleiotropic effects. This review provides a comprehensive analysis of the clinical implications of ezetimibe for managing dyslipidemia; it also evaluates the available evidence that supports the role of ezetimibe as an adjunct non-statin therapy for long-term use. However, the long-term pleiotropic effects of ezetimibe remain controversial because of limited clinical data. Therefore, additional research is needed to clarify its potential benefits beyond LDL-C reduction. Nonetheless, an understanding of the role of ezetimibe in dyslipidemia management will help clinicians to develop effective treatment strategies.
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Affiliation(s)
- Jeongmin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Seung-Hwan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul,
Korea
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4
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Al Mousa E, Al-Azzam S, Araydah M, Karasneh R, Ghnaimat M, Al-Makhamreh H, Al Khawaldeh A, Ali Abu Al-Samen M, Haddad J, Al Najjar S, Alsalaheen Abbadi H, Hammoudeh AJ. A Jordanian Multidisciplinary Consensus Statement on the Management of Dyslipidemia. J Clin Med 2023; 12:4312. [PMID: 37445345 DOI: 10.3390/jcm12134312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/12/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
Atherosclerotic cardiovascular disease (ASCVD) is the primary contributor to global mortality rates, which significantly escalates healthcare expenditures. Risk factors for ASCVD (including dyslipidemia) frequently present in clusters rather than separately. Addressing these risk factors is crucial in the early initiation of a comprehensive management plan that involves both lifestyle modifications and pharmacotherapy to reduce the impact of ASCVD. A team of Jordanian professionals from various medical organizations and institutes took the initiative to create a set of guidelines for dyslipidemia screening and therapy. A detailed, comprehensive literature review was undertaken utilizing several databases and keywords. This consensus statement provides recommendations for dyslipidemia management in Jordanians on several issues including cardiovascular risk estimation, screening eligibility, risk categories, treatment goals, lifestyle changes, and statin and non-statin therapies. It is recommended that all Jordanian individuals aged 20 years old or older undergo lipid profile testing. This should be followed by determining the level of cardiovascular risk depending on the presence or absence of ASCVD and cardiovascular risk factors, eligibility for lipid-lowering therapy, and the target low-density cholesterol serum level to be achieved. In conclusion, prioritizing the management of dyslipidemia is of the utmost importance in improving public health and reducing the burden of cardiovascular diseases.
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Affiliation(s)
- Eyas Al Mousa
- Jordanian Atherosclerosis and Hypertension Society, Amman 11942, Jordan
| | - Sayer Al-Azzam
- Clinical Pharmacy Department, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
| | | | - Reema Karasneh
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan
| | - Mohammad Ghnaimat
- Jordan Society of Internal Medicine, Amman 11942, Jordan
- Jordan Society of Nephrology, Amman 11942, Jordan
| | - Hanna Al-Makhamreh
- Cardiology Division, School of Medicine, University of Jordan, Amman 11942, Jordan
| | | | | | - Jihad Haddad
- Scientific Committee, Jordanian Atherosclerosis and Hypertension Society, Amman 11942, Jordan
| | - Said Al Najjar
- Cardiology Department at Albasheer Hospital (MOH), Amman 11942, Jordan
| | | | - Ayman J Hammoudeh
- Scientific Committee, Cardiovascular Academy Group of the Jordan Cardiac Society, Amman 11942, Jordan
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Abstract
Dyslipidemia is an important risk factor for coronary artery disease and stroke. All persons with dyslipidemia should be advised to focus on lifestyle interventions, including regular aerobic exercise, a healthy diet, maintenance of a healthy weight, and abstinence from smoking. In addition to lifestyle interventions, lipid-lowering therapy should be considered for persons at moderate to high risk for atherosclerotic cardiovascular disease based on validated risk equations. Statin therapy is the first-line medical treatment for dyslipidemia due to its effectiveness and favorable adverse effect profile, but newer treatments provide additional tools for clinicians to effectively treat dyslipidemia.
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Affiliation(s)
- Marios Arvanitis
- Johns Hopkins University School of Medicine, Baltimore, Maryland (M.A., C.J.L.)
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Chang Y, Eom S, Kim M, Song TJ. Medical Management of Dyslipidemia for Secondary Stroke Prevention: Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:776. [PMID: 37109734 PMCID: PMC10141044 DOI: 10.3390/medicina59040776] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023]
Abstract
Dyslipidemia is a major risk factor for stroke, following hypertension, diabetes, and smoking, and is an important risk factor for the prevention and treatment of coronary artery disease and peripheral vascular disease, including stroke. Recent guidelines recommend considering low-density lipoprotein cholesterol (LDL-C)-lowering therapies, such as statins (preferably), ezetimibe, or proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors to prevent the occurrence or recurrence of stroke, adhering to the "lower is better" approach. In this review, we examined the evidence supporting lipid-lowering medications like statins, ezetimibe, and PCSK9 inhibitors for secondary stroke prevention and dyslipidemia management in different stroke subtypes. Stroke guidelines advocate for administering the maximum tolerable dose of statins as the primary treatment and as soon as possible despite the potential for new-onset diabetes mellitus and possible muscle and liver toxicity due to their demonstrated benefits in secondary prevention of cardiovascular diseases and mortality reduction. When statin use is insufficient for LDL lowering, ezetimibe and PCSK9 inhibitors are recommended as complementary therapies. It is essential to establish lipid-lowering therapy goals based on the stroke subtype and the presence of comorbidities.
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Affiliation(s)
- Yoonkyung Chang
- Department of Neurology, Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul 07985, Republic of Korea
| | - Soojeong Eom
- Department of Medicine, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
| | - Minjeong Kim
- Department of Medicine, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
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Lipoprotein(a) and Atherosclerotic Cardiovascular Disease, the Impact of Available Lipid-Lowering Medications on Lipoprotein(a): An Update on New Therapies. Endocr Pract 2022:S1530-891X(22)00901-6. [PMID: 36563785 DOI: 10.1016/j.eprac.2022.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/20/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To review evidence of existing and new pharmacological therapies for lowering lipoprotein(a) (Lp[a]) concentrations and their impact on clinically relevant outcomes. METHODS We searched for literature pertaining to Lp(a) and pharmacological treatments in PubMed. We reviewed articles published between 1963 and 2020. RESULTS We found that statins significantly increased Lp(a) concentrations. Therapies that demonstrated varying degrees of Lp(a) reduction included ezetimibe, niacin, proprotein convertase subtilisin/kexin type 9 inhibitors, lipoprotein apheresis, fibrates, aspirin, hormone replacement therapy, antisense oligonucleotide therapy, and small interfering RNA therapy. There was limited data from large observational studies and post hoc analyses showing the potential benefits of these therapies in improving cardiovascular outcomes. CONCLUSION There are multiple lipid-lowering agents currently being used to treat hyperlipidemia that also have a Lp(a)-lowering effect. Two RNA therapies specifically targeted to lower Lp(a) are being investigated in phase 3 clinical trials and, thus far, have shown promising results. However, evidence is lacking to determine the clinical relevance of reducing Lp(a). At present, there is a need for large-scale, randomized, controlled trials to evaluate cardiovascular outcomes associated with lowering Lp(a).
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Bruckert E, Caprio S, Wiegman A, Charng MJ, Zárate-Morales CA, Baccara-Dinet MT, Manvelian G, Ourliac A, Scemama M, Daniels SR. Efficacy and Safety of Alirocumab in Children and Adolescents With Homozygous Familial Hypercholesterolemia: Phase 3, Multinational Open-Label Study. Arterioscler Thromb Vasc Biol 2022; 42:1447-1457. [PMID: 36325897 PMCID: PMC9750107 DOI: 10.1161/atvbaha.122.317793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Despite progress in treating homozygous familial hypercholesterolemia, most patients do not achieve low-density lipoprotein cholesterol (LDL-C) targets. This study examined efficacy and safety of the PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitor, alirocumab, in pediatric patients (aged 8-17 years) with inadequately controlled homozygous familial hypercholesterolemia. METHODS In this open-label, single-arm, multinational, Phase 3 study, patients (n=18) received alirocumab 75 mg or 150 mg (bodyweight <50 kg/≥50 kg) every 2 weeks as an adjunct to background treatment. The primary endpoint was percent change in LDL-C from baseline to Week 12. Secondary endpoints included changes in LDL-C and other lipid parameters up to 48 weeks, safety/tolerability, and alirocumab pharmacokinetics. RESULTS The mean age of patients was 12.4 years; 16/18 (89%) had mutations in the low-density lipoprotein receptor gene (LDLR) and 2/18 (11%) had mutations in the LDLR adapter protein 1 gene (LDLRAP1). At baseline, mean LDL-C (standard deviation) was 373.0 (193.5) mg/dL, which decreased by 4.1% at Week 12 (primary endpoint) and 11.4%, 13.2%, and 0.4% at Weeks 4, 24, and 48, respectively. At Week 12, 9/18 (50%) patients achieved LDL-C reductions ≥15%. Mean absolute LDL-C decreases ranged from 25 to 52 mg/dL over follow-up. A post hoc analysis demonstrated heterogeneity of responses according to genotype. There were no unexpected safety/tolerability findings. Free PCSK9 was reduced to near zero for all patients at Weeks 12 and 24. CONCLUSIONS The study supports the efficacy and safety of alirocumab as a potential adjunct to treatment for some pediatric patients with homozygous familial hypercholesterolemia. REGISTRATION URL: https://www. CLINICALTRIALS gov; NCT03510715.
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Affiliation(s)
- Eric Bruckert
- Hôpital Pitié Salpêtrière, Sorbonne University Paris, France (E.B.)
| | - Sonia Caprio
- Yale Pediatric Endocrinology, New Haven, CT (S.C.)
| | - Albert Wiegman
- Department of Metabolic Disorders, Amsterdam UMC, Location AMC, Emma Children’s Hospital, the Netherlands (A.W.)
| | - Min-Ji Charng
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan, R.O.C. (M.-J.C.)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C. (M.-J.C.)
| | - Cézar A. Zárate-Morales
- Hospital “Presidente Juárez” del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Oaxaca, Oax, México (C.A.Z.-M.)
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Zhang R, Zeng J, Liu W, Meng J, Wang C, Shi L, Yang S, Chang J, Xing D. The role of NPC1L1 in cancer. Front Pharmacol 2022; 13:956619. [PMID: 36034854 PMCID: PMC9399402 DOI: 10.3389/fphar.2022.956619] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Lipid metabolism appears to play significant roles in the development of cancer. Numerous studies have shown that the evolution of malignancies, including breast, prostate, and colorectal cancers, involves cholesterol in a profound manner. A crucial part in the intestinal absorption of cholesterol is played by Niemann–Pick C1-like 1 (NPC1L1), a cholesterol transporter protein that is widely expressed in the small intestine and liver. The importance of NPC1L1 in tumor prognosis has been demonstrated in investigations in the interim. NPC1L1 also has the potential to develop into a new therapeutic target and a cancer marker. There is, however, no comprehensive review that summarizes NPC1L1’s function in cancer. To this end, we outlined NPC1L1’s functions in carcinogenesis and treatment, along with resources that can be used to further comprehend the connection between NPC1L1 and tumors.
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Affiliation(s)
- Renshuai Zhang
- Qingdao Cancer Institute, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Jun Zeng
- Qingdao Cancer Institute, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
- School of Basic Medicine, Qingdao University, Qingdao, China
| | - Wenjing Liu
- Qingdao Cancer Institute, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
- School of Basic Medicine, Qingdao University, Qingdao, China
| | - Jingsen Meng
- Qingdao Cancer Institute, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
- School of Basic Medicine, Qingdao University, Qingdao, China
| | - Chao Wang
- Qingdao Cancer Institute, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Lingyu Shi
- Qingdao Cancer Institute, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
- School of Basic Medicine, Qingdao University, Qingdao, China
| | - Shanbo Yang
- Qingdao Cancer Institute, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
- School of Basic Medicine, Qingdao University, Qingdao, China
| | - Jing Chang
- Qingdao Cancer Institute, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
- School of Basic Medicine, Qingdao University, Qingdao, China
| | - Dongming Xing
- Qingdao Cancer Institute, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
- School of Life Sciences, Tsinghua University, Beijing, China
- *Correspondence: Dongming Xing,
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Hong JH, Jeon U, Shin WY, Kim W, Seong K, Park SH, Kim HD, Chung JW, Choi J. A Paradigm Shift in Dyslipidemia Management in Primary Care: A 12-Month Cohort Study. Clin Ther 2022; 44:698-709. [DOI: 10.1016/j.clinthera.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/15/2022] [Accepted: 03/03/2022] [Indexed: 11/12/2022]
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Efficacy and safety of hybutimibe on primary hypercholesterolemia: a randomized, double-blinded, placebo and positive–controlled, parallel phase II study. CARDIOLOGY PLUS 2022. [DOI: 10.1097/cp9.0000000000000012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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12
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Liao J, Yang L, Zhou L, Zhao H, Qi X, Cui Y, Ouyang D. The NPC1L1 Gene Exerts a Notable Impact on the Reduction of Low-Density Lipoprotein Cholesterol in Response to Hyzetimibe: A Factorial-Designed Clinical Trial. Front Pharmacol 2022; 13:755469. [PMID: 35359877 PMCID: PMC8963242 DOI: 10.3389/fphar.2022.755469] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 02/09/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Hyzetimibe is a novel inhibitor of cholesterol that specifically targets the NPC1L1 gene. Significant inter-individual variability suggests the existence of an abundance of poor responders and non-responders. In addition, the current literature is inconsistent and controversial regarding the potential impact of the Niemann-Pick C1-Like 1 (NPC1L1) gene on low-density lipoprotein cholesterol (LDL-C) reduction. In light of these concerns, we performed a high-quality clinical trial to investigate the specific characteristics of NPC1L1 gene variation on LDL-C reduction. Methods: This was a multicenter, randomized, double-blind, placebo-controlled, clinical trial with a factorial design. Qualified patients were randomly assigned to one of six treatments: placebo, hyzetimibe (10 or 20 mg), atorvastatin, and atorvastatin plus hyzetimibe (10 or 20 mg). Fasting blood samples were collected and genotyped, and the concentrations of LDL-C and the targeted drug trough were determined to investigate the association between the NPC1L1 gene expression and the reduction of LDL-C. Results: In total, 727 individuals were initially recruited; of these, 444 were eligible to begin the trial. We identified one SNP (g1679C > G) that exerted significantly different impacts on LDL-C levels. As monotherapy, CC carriers experienced significantly higher reductions in the mean LDL-C (−23.99%) than either the GG (−16.45%, p < 0.01) or GC (−13.02%, p < 0.01) carriers in the hyzetimibe (20 mg) group. In contrast, when co-administered with atorvastatin, GC carriers experienced greater LDL-C reduction than non-GC carriers (-52.23% vs. −45.03%) in the hyzetimibe (20 mg) plus atorvastatin group. Furthermore, the proportions of individuals experiencing a reduction in LDL-C by >50% increased as the dose of hyzetimibe increased from 16.1% to 65.4%. Conclusion: The g1679C > G SNP in the NPC1L1 gene is critical and exerts a differential impact on the response to hyzetimibe treatment. Heterozygotic patients respond with poor efficacy when treated by monotherapy but show good responses in terms of LDL-C reduction when hyzetimibe was co-administered with atorvastatin. To treat hypercholesterolemia in a precise manner with hyzetimibe, it is necessary to identify genotype patients for the g1679C > G SNP. We also highlight the potential necessity for identifying the appropriate subjects to be treated with ezetimibe. Clinical Trial Registration: [https://clinicaltrials.gov/], identifier [CTR20150351]
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Affiliation(s)
- Jianwei Liao
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China
- Institute of Clinical Pharmacology, Central South University, Changsha, China
| | - Liyun Yang
- Zhejiang Hisun Pharmaceutical Co. Ltd, Taizhou, China
| | - Luping Zhou
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China
- Institute of Clinical Pharmacology, Central South University, Changsha, China
| | - Hongbin Zhao
- Hunan Key Laboratory for Bioanalysis of Complex Matrix Samples, Changsha, China
| | - Xiao Qi
- Hunan Key Laboratory for Bioanalysis of Complex Matrix Samples, Changsha, China
| | - Yimin Cui
- Peking University First Hospital, Beijing, China
- *Correspondence: Yimin Cui, ; Dongsheng Ouyang,
| | - Dongsheng Ouyang
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China
- Institute of Clinical Pharmacology, Central South University, Changsha, China
- Hunan Key Laboratory for Bioanalysis of Complex Matrix Samples, Changsha, China
- *Correspondence: Yimin Cui, ; Dongsheng Ouyang,
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Wang Y, Zhan S, Du H, Li J, Khan SU, Aertgeerts B, Guyatt G, Hao Q, Bekkering G, Li L, Delvaux N, Su N, Riaz I, Vandvik PO, Tian H, Li S. Safety of ezetimibe in lipid-lowering treatment: systematic review and meta-analysis of randomised controlled trials and cohort studies. BMJ MEDICINE 2022; 1:e000134. [PMID: 36936552 PMCID: PMC10012858 DOI: 10.1136/bmjmed-2022-000134] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/21/2022] [Indexed: 12/11/2022]
Abstract
Objective To determine the harms of ezetimibe in people who need lipid-lowering treatment. Design Systematic review and meta-analysis. Data sources Randomised controlled trials and cohort studies. Eligibility criteria for selecting studies Studies comparing ezetimibe with placebo, standard care, or other lipid-lowering agents in people who need lipid-lowering treatment with a follow-up duration of at least six months (or 24 weeks). The relative effects for potential harms of ezetimibe were pooled by use of random effect pairwise meta-analyses for randomised controlled trials and the evidence from observational studies was narratively summarised. The certainty of evidence was assessed using the Grading of Recommendation Assessment, Development, and Evaluation. Results 48 randomised controlled trials with 28 444 participants (median follow-up 34 weeks, range 24-312 weeks) and four observational studies with 1667 participants (median follow-up 282 weeks, range 72-400 weeks) were included. The meta-analyses of randomised trials showed moderate to high certainty that ezetimibe was not associated with cancer (relative risk 1.01; 95% confidence interval 0.92 to 1.11), fractures (0.90; 0.74 to 1.10), discontinuation due to any adverse event (0.87; 0.74 to 1.03), gastrointestinal adverse events leading to discontinuation (1.34; 0.58 to 3.08), myalgia or muscular pain leading to discontinuation (0.82; 0.51 to 1.33), neurocognitive events (1.48; 0.58 to 3.81), or new-onset diabetes (0.88; 0.61 to 1.28). The narrative analysis of observational studies provided consistent findings. No credible subgroup effects were identified for the harm outcomes, including shorter versus longer follow-up duration of trials. Conclusions Ezetimibe results in little to no difference in adverse events or other undesirable effects compared with placebo, usual care or other lipid-lowering agents. Review registration PROSPERO CRD42020187437.
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Affiliation(s)
- Yang Wang
- Department of Endocrinology and Metabolism, Chinese Evidence-based Medicine Centre, Cochrane China Centre, and MAGIC China Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Shipeng Zhan
- Department of Pharmacy, Southwest Hospital, Army Medical University, Chongqing, China
| | - Heyue Du
- Department of Endocrinology and Metabolism, Chinese Evidence-based Medicine Centre, Cochrane China Centre, and MAGIC China Centre, West China Hospital, Sichuan University, Chengdu, China
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Li
- Department of Endocrinology and Metabolism, Chinese Evidence-based Medicine Centre, Cochrane China Centre, and MAGIC China Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Safi U Khan
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Bert Aertgeerts
- Department of Public Health and Primary Care, Leuven, Leuven, Belgium
| | - Gordon Guyatt
- Department of Clinical Epidemiology and Biostatistics, and Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Qiukui Hao
- Department of Clinical Epidemiology and Biostatistics, and Department of Medicine, McMaster University, Hamilton, ON, Canada
- Centre of Gerontology and Geriatrics/National Clinical Research Centre for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | | | - Ling Li
- Department of Endocrinology and Metabolism, Chinese Evidence-based Medicine Centre, Cochrane China Centre, and MAGIC China Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Nicolas Delvaux
- Department of Public Health and Primary Care, Leuven, Leuven, Belgium
| | - Na Su
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | | | - Per Olav Vandvik
- Department of Medicine, Norwegian Institute of Public Health, Oslo, Norway
- Department of Medicine, Innlandet Hospital Trust, Gjøvik, Norway
| | - Haoming Tian
- Department of Endocrinology and Metabolism, Chinese Evidence-based Medicine Centre, Cochrane China Centre, and MAGIC China Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Sheyu Li
- Department of Endocrinology and Metabolism, Chinese Evidence-based Medicine Centre, Cochrane China Centre, and MAGIC China Centre, West China Hospital, Sichuan University, Chengdu, China
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14
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Banach M, Burchardt P, Chlebus K, Dobrowolski P, Dudek D, Dyrbuś K, Gąsior M, Jankowski P, Jóźwiak J, Kłosiewicz-Latoszek L, Kowalska I, Małecki M, Prejbisz A, Rakowski M, Rysz J, Solnica B, Sitkiewicz D, Sygitowicz G, Sypniewska G, Tomasik T, Windak A, Zozulińska-Ziółkiewicz D, Cybulska B. PoLA/CFPiP/PCS/PSLD/PSD/PSH guidelines on diagnosis and therapy of lipid disorders in Poland 2021. Arch Med Sci 2021; 17:1447-1547. [PMID: 34900032 PMCID: PMC8641518 DOI: 10.5114/aoms/141941] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/03/2021] [Indexed: 12/18/2022] Open
Abstract
In Poland there are still nearly 20 million individuals with hypercholesterolaemia, most of them are unaware of their condition; that is also why only ca. 5% of patients with familial hypercholesterolaemia have been diagnosed; that is why other rare cholesterol metabolism disorders are so rarely diagnosed in Poland. Let us hope that these guidelines, being an effect of work of experts representing 6 main scientific societies, as well as the network of PoLA lipid centers being a part of the EAS lipid centers, certification of lipidologists by PoLA, or the growing number of centers for rare diseases, with a network planned by the Ministry of Health, improvements in coordinated care for patients after myocardial infarction (KOS-Zawał), reimbursement of innovative agents, as well as introduction in Poland of an effective primary prevention program, will make improvement in relation to these unmet needs in diagnostics and treatment of lipid disorders possible.
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Affiliation(s)
- Maciej Banach
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz, Lodz, Poland
- Cardiovascular Research Center, University of Zielona Gora, Zielona Gora, Poland
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother’s Memorial Hospital Research Institute (PMMHRI) in Lodz, Lodz, Poland
| | - Paweł Burchardt
- Department of Hypertensiology, Angiology, and Internal Medicine, K. Marcinkowski Poznan University of Medical Science, Poznan, Poland
- Department of Cardiology, Cardiovascular Unit, J. Strus Hospital, Poznan, Poland
| | - Krzysztof Chlebus
- First Department and Chair of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Piotr Dobrowolski
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof Dyrbuś
- 3 Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland; Silesian Center for Heart Diseases in Zabrze, Poland
| | - Mariusz Gąsior
- 3 Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland; Silesian Center for Heart Diseases in Zabrze, Poland
| | - Piotr Jankowski
- Department of Internal Medicine and Geriatric Cardiology, Centre of Postgraduate Medical Education, Warsaw, Poland
- Department of Cardiology and Arterial Hypertension, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Jacek Jóźwiak
- Department of Family Medicine and Public Health, Institute of Medical Sciences, Faculty of Medicine, University of Opole, Opole, Poland
| | | | - Irina Kowalska
- Department of Internal Medicine and Metabolic Diseases, Medical University of Bialystok, Bialystok, Poland
| | - Maciej Małecki
- Department and Chair of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Aleksander Prejbisz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Michał Rakowski
- Department of Molecular Biophysics, Institute of Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, Lodz, Poland
| | - Jacek Rysz
- Chair of Nephrology, Arterial Hypertension, and Family Medicine, Medical University of Lodz, Lodz, Poland
| | - Bogdan Solnica
- Chair of Clinical Biochemistry, Jagiellonian University Medical College, Krakow, Poland
| | - Dariusz Sitkiewicz
- Department of Clinical Chemistry and Laboratory Diagnostics, Medical University of Warsaw, Warsaw, Poland
| | - Grażyna Sygitowicz
- Department of Clinical Chemistry and Laboratory Diagnostics, Medical University of Warsaw, Warsaw, Poland
| | - Grażyna Sypniewska
- Department of Laboratory Medicine, L. Rydygier Medical College in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Tomasz Tomasik
- Chair of Family Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Adam Windak
- Chair of Family Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Dorota Zozulińska-Ziółkiewicz
- Department and Chair of Internal Medicine and Diabetology, K. Marcinkowski Poznan University of Medical Sciences, Poznan, Poland
| | - Barbara Cybulska
- National Institute of Public Health NIH – National Research Institute, Warsaw, Poland
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15
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Brandts J, Ray KK. Bempedoic acid, an inhibitor of ATP citrate lyase for the treatment of hypercholesterolemia: early indications and potential. Expert Opin Investig Drugs 2020; 29:763-770. [DOI: 10.1080/13543784.2020.1778668] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Julia Brandts
- Department of Medicine I, University Hospital RWTH Aachen , Aachen, Germany
- Imperial Centre for Cardiovascular Disease Prevention, School of Public Health, Imperial College London , London, UK
| | - Kausik K. Ray
- Imperial Centre for Cardiovascular Disease Prevention, School of Public Health, Imperial College London , London, UK
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16
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Huang CS, Yu X, Fordstrom P, Choi K, Chung BC, Roh SH, Chiu W, Zhou M, Min X, Wang Z. Cryo-EM structures of NPC1L1 reveal mechanisms of cholesterol transport and ezetimibe inhibition. SCIENCE ADVANCES 2020; 6:eabb1989. [PMID: 32596471 PMCID: PMC7304964 DOI: 10.1126/sciadv.abb1989] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/11/2020] [Indexed: 05/21/2023]
Abstract
The intestinal absorption of cholesterol is mediated by a multipass membrane protein, Niemann-Pick C1-Like 1 (NPC1L1), the molecular target of a cholesterol lowering therapy ezetimibe. While ezetimibe gained Food and Drug Administration approval in 2002, its mechanism of action has remained unclear. Here, we present two cryo-electron microscopy structures of NPC1L1, one in its apo form and the other complexed with ezetimibe. The apo form represents an open state in which the N-terminal domain (NTD) interacts loosely with the rest of NPC1L1, leaving the NTD central cavity accessible for cholesterol loading. The ezetimibe-bound form signifies a closed state in which the NTD rotates ~60°, creating a continuous tunnel enabling cholesterol movement into the plasma membrane. Ezetimibe blocks cholesterol transport by occluding the tunnel instead of competing with cholesterol binding. These findings provide insight into the molecular mechanisms of NPC1L1-mediated cholesterol transport and ezetimibe inhibition, paving the way for more effective therapeutic development.
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Affiliation(s)
- Ching-Shin Huang
- Department of Therapeutic Discovery, Amgen Research, Amgen Inc., 1120 Veterans Blvd., South San Francisco, CA 94080, USA
| | - Xinchao Yu
- Department of Therapeutic Discovery, Amgen Research, Amgen Inc., 1120 Veterans Blvd., South San Francisco, CA 94080, USA
| | - Preston Fordstrom
- Department of Cardiometabolic Disorders, Amgen Research, Amgen Inc., 1120 Veterans Blvd., South San Francisco, CA 94080, USA
| | - Kaylee Choi
- Department of Therapeutic Discovery, Amgen Research, Amgen Inc., 1120 Veterans Blvd., South San Francisco, CA 94080, USA
| | - Ben C. Chung
- Department of Therapeutic Discovery, Amgen Research, Amgen Inc., 1120 Veterans Blvd., South San Francisco, CA 94080, USA
| | - Soung-Hun Roh
- Department of Bioengineering and James H. Clark Center, Stanford University, Stanford, CA 94305, USA
| | - Wah Chiu
- Department of Bioengineering and James H. Clark Center, Stanford University, Stanford, CA 94305, USA
- Division of Cryo-EM and Bioimaging, SLAC National Accelerator Laboratory, Menlo Park, CA 94025, USA
| | - Mingyue Zhou
- Department of Cardiometabolic Disorders, Amgen Research, Amgen Inc., 1120 Veterans Blvd., South San Francisco, CA 94080, USA
| | - Xiaoshan Min
- Department of Therapeutic Discovery, Amgen Research, Amgen Inc., 1120 Veterans Blvd., South San Francisco, CA 94080, USA
| | - Zhulun Wang
- Department of Therapeutic Discovery, Amgen Research, Amgen Inc., 1120 Veterans Blvd., South San Francisco, CA 94080, USA
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17
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Nakov R, Velikova T. Chemical Metabolism of Xenobiotics by Gut Microbiota. Curr Drug Metab 2020; 21:260-269. [PMID: 32124693 DOI: 10.2174/1389200221666200303113830] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 01/05/2020] [Accepted: 02/12/2020] [Indexed: 02/08/2023]
Abstract
Among the gut microbiota's newly explored roles in human biology is the ability to modify the chemical structures of foreign compounds (xenobiotics). A growing body of evidence has now provided sufficient acumen on the role of the gut microbiota on xenobiotic metabolism, which could have an intense impact on the therapy for various diseases in the future. Gut microbial xenobiotic metabolites have altered bioavailability, bioactivity and toxicity and can intervene with the actions of human xenobiotic-metabolizing enzymes to affect the destiny of other ingested molecules. These modifications are diverse and could lead to physiologically important consequences. In the current manuscript we aim to review the data currently available on how the gut microbiota directly modifies drugs, dietary compounds, chemicals, pollutants, pesticides and herbal supplements.
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Affiliation(s)
- Radislav Nakov
- Clinic of Gastroenterology, Tsaritsa Yoanna University Hospital, Medical University of Sofia, Sofia, Bulgaria
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18
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Molecular Dynamics Simulation Reveals Exposed Residues in the Ligand-Binding Domain of the Low-Density Lipoprotein Receptor that Interacts with Vesicular Stomatitis Virus-G Envelope. Viruses 2019; 11:v11111063. [PMID: 31731579 PMCID: PMC6893590 DOI: 10.3390/v11111063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/26/2019] [Accepted: 10/28/2019] [Indexed: 01/20/2023] Open
Abstract
Familial hypercholesterolemia (FH) is an autosomal dominant disease most often caused by mutations in the low-density lipoprotein receptor (LDLR) gene, which consists of 18 exons spanning 45 kb and codes for a precursor protein of 860 amino acids. Mutations in the LDLR gene lead to a reduced hepatic clearance of LDL as well as a high risk of coronary artery disease (CAD) and sudden cardiac death (SCD). Recently, LDLR transgenes have generated interest as potential therapeutic agents. However, LDLR packaging using a lentiviral vector (LVV) system pseudotyped with a vesicular stomatitis virus (VSV)-G envelope is not efficient. In this study, we modified the LVV system to improve transduction efficiency and investigated the LDLR regions responsible for transduction inhibition. Transduction efficiency of 293T cells with a 5′-LDLReGFP-3′ fusion construct was only 1.55% compared to 42.32% for the eGFP construct. Moreover, co-expression of LDLR affected eGFP packaging. To determine the specific region of the LDLR protein responsible for packaging inhibition, we designed constructs with mutations or sequential deletions at the 3′ and 5′ ends of LDLR cDNA. All constructs except one without the ligand-binding domain (LBD) (pWoLBD–eGFP) resulted in low transduction efficiency, despite successful packaging of viral RNA in the VSV envelope, as confirmed through RT-PCR. When we evaluated a direct interaction between LDLR and the VSV envelope glycoprotein using MD simulation and protein–protein interactions, we uncovered Val119, Thr120, Thr67, and Thr118 as exposed residues in the LDLR receptor that interact with the VSV protein. Together, our results suggest that the LBD of LDLR interacts with the VSV-G protein during viral packaging, which significantly reduces transduction efficiency.
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19
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Drug Treatment of Hyperlipidemia in Chinese Patients: Focus on the Use of Simvastatin and Ezetimibe Alone and in Combination. Am J Cardiovasc Drugs 2019; 19:237-247. [PMID: 30714088 DOI: 10.1007/s40256-018-00317-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Elevated serum low-density lipoprotein cholesterol (LDL-C) is a major risk factor for coronary heart disease (CHD). Many guidelines recommend LDL-C as a primary treatment target, and statins represent the cornerstone of treatment for lipid management. Recently revised guidelines recommend even more intense management of LDL-C, especially in patients at moderate and high risk. However, LDL-C levels in the Chinese population differ from those in Western populations, and the benefits and safety of the maximum allowable dose of statins have yet to be determined. Furthermore, in practice, many patients do not achieve the increasingly stringent LDL-C goals. Consequently, alternative approaches to lipid management are required. Combination therapy with ezetimibe and a statin, which have complementary mechanisms of action, is more effective than statin monotherapies, even at high doses. Several clinical studies have consistently shown that combination therapy with ezetimibe and simvastatin lowers LDL-C more potently than statin monotherapies. Moreover, the safety and tolerability profile of the combination therapy appears to be similar to that of low-dose statin monotherapies. This review discusses the role of simvastatin in combination with ezetimibe in controlling dyslipidemia in Chinese patients, particularly the efficacy and safety of combination therapy in light of recently published clinical data.
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20
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Cicero AFG, Landolfo M, Ventura F, Borghi C. Current pharmacotherapeutic options for primary dyslipidemia in adults. Expert Opin Pharmacother 2019; 20:1277-1288. [PMID: 31059312 DOI: 10.1080/14656566.2019.1604687] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Atherosclerotic cardiovascular disease (ASCVD) and its clinical manifestations, remain a leading cause of death and disability worldwide. One of the major risk factors of ASCVD is dyslipidemia and all the available guidelines suggest the importance of strategies for lipid control in a remarkable proportion of the general population. AREAS COVERED This review focuses on the therapeutic options available for the management of lipid disorders in adults. EXPERT OPINION A large body of evidence supports that statins are still the first-line option for the management of hypercholesterolemia in a large percentage of patients. Statins should be given at the appropriate dose and considering the differences in lipid-lowering potency across the different medications. The main current challenge in the treatment of lipid disorders is the need of improving patient adherence and persistence to lipid-lowering treatments beyond the drug choice and the target lipid component. To achieve this goal, the best strategy would be to treat the patients by using the appropriate drugs given at adequate doses to reach the treatment target. We should also avoid drug interactions, monitor possible untoward side effects and promote adherence to treatment by tailoring treatment strategies to each patient.
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Affiliation(s)
- Arrigo F G Cicero
- a Medicine and Surgery Science Department , University of Bologna , Bologna , Italy
| | - Matteo Landolfo
- a Medicine and Surgery Science Department , University of Bologna , Bologna , Italy
| | - Fulvio Ventura
- a Medicine and Surgery Science Department , University of Bologna , Bologna , Italy
| | - Claudio Borghi
- a Medicine and Surgery Science Department , University of Bologna , Bologna , Italy
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21
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Awad K, Mikhailidis DP, Katsiki N, Muntner P, Banach M. Effect of Ezetimibe Monotherapy on Plasma Lipoprotein(a) Concentrations in Patients with Primary Hypercholesterolemia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Drugs 2019; 78:453-462. [PMID: 29396832 DOI: 10.1007/s40265-018-0870-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Ezetimibe reduces plasma low-density lipoprotein cholesterol (LDL-C) levels by up to 20%. However, its effect on plasma lipoprotein(a) [Lp(a)] concentrations in patients with primary hypercholesterolemia has not been defined. OBJECTIVE Therefore, we performed a systematic review and meta-analysis to assess this effect based on the available randomized controlled trials (RCTs). METHODS We searched the PubMed and SCOPUS databases from inception until 28 February 2017 to identify RCTs that investigated the effect of ezetimibe monotherapy on plasma Lp(a) concentrations in patients with primary hypercholesterolemia. We pooled mean percentage changes in plasma Lp(a) concentrations as a mean difference (MD) with a 95% confidence interval (CI). RESULTS Seven RCTs with 2337 patients met the selection criteria and were included in the analysis. Overall pooled analysis suggested that ezetimibe 10 mg significantly reduced plasma Lp(a) concentrations in patients with primary hypercholesterolemia by - 7.06% (95% CI - 11.95 to - 2.18; p = 0.005) compared with placebo. No significant heterogeneity was observed (χ2 = 5.34; p = 0.5). Excluding one study from the analysis resulted in insignificant differences between the two groups (p = 0.2). Meta-regression did not find a significant association between the mean percentage changes in Lp(a) and other potential moderator variables, which included the mean percentage changes of LDL-C concentrations (p = 0.06) and baseline Lp(a) mean values (p = 0.46). CONCLUSIONS Ezetimibe monotherapy (10 mg/day) showed a small (7.06%) but statistically significant reduction in the plasma levels of Lp(a) in patients with primary hypercholesterolemia. According to current literature, this magnitude of reduction seems to have no clinical relevance. However, further studies are warranted to clarify the mechanism mediating this effect of ezetimibe and to investigate its efficacy in combination with other drugs that have shown promise in lowering Lp(a) levels.
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Affiliation(s)
- Kamal Awad
- Faculty of Medicine, Zagazig University, Zagazig, 44519, El-Sharkia, Egypt.
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, University College London Medical School, University College London (UCL), Royal Free Campus, London, UK
| | - Niki Katsiki
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Maciej Banach
- Head Department of Hypertension, WAM University Hospital in Lodz, Medical University of Lodz (MUL), Lodz, Poland.,Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland.,Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland
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22
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Sahebkar A, Simental-Mendía LE, Pirro M, Banach M, Watts GF, Sirtori C, Al-Rasadi K, Atkin SL. Impact of ezetimibe on plasma lipoprotein(a) concentrations as monotherapy or in combination with statins: a systematic review and meta-analysis of randomized controlled trials. Sci Rep 2018; 8:17887. [PMID: 30552391 PMCID: PMC6294784 DOI: 10.1038/s41598-018-36204-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 11/06/2018] [Indexed: 02/06/2023] Open
Abstract
The aim of this meta-analysis of randomized placebo-controlled clinical trials was to assess the effect of ezetimibe on plasma lipoprotein(a) concentrations. Only randomized placebo-controlled trials investigating the impact of ezetimibe treatment on cholesterol lowering that include lipoprotein(a) measurement were searched in PubMed-Medline, SCOPUS, Web of Science and Google Scholar databases (from inception to February 26th, 2018). A random-effects model and generic inverse variance method were used for quantitative data synthesis. Sensitivity analysis was conducted using the leave-one-out method. A weighted random-effects meta-regression was performed to evaluate the impact of potential confounders on lipoprotein concentrations. This meta-analysis of data from 10 randomized placebo-controlled clinical trials (15 treatment arms) involving a total of 5188 (3020 ezetimibe and 2168 control) subjects showed that ezetimibe therapy had no effect on altering plasma Lp(a) concentrations (WMD: -2.59%, 95% CI: -8.26, 3.08, p = 0.370; I2 = 88.71%, p(Q) < 0.001). In the subgroup analysis, no significant alteration in plasma Lp(a) levels was observed either in trials assessing the impact of monotherapy with ezetimibe versus placebo (WMD: -4.64%, 95% CI: -11.53, 2.25, p = 0.187; I2 = 65.38%, p(Q) = 0.005) or in trials evaluating the impact of adding ezetimibe to a statin versus statin therapy alone (WMD: -1.04%, 95% CI: -6.34, 4.26, p = 0.700; I2 = 58.51%, p(Q) = 0.025). The results of this meta-analysis suggest that ezetimibe treatment either alone or in combination with a statin does not affect plasma lipoprotein(a) levels.
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Affiliation(s)
- Amirhossein Sahebkar
- Halal Research Center of IRI, FDA, Tehran, Iran.
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
- School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
| | | | - Matteo Pirro
- Unit of Internal Medicine, Angiology and Arteriosclerosis Diseases, Department of Medicine, University of Perugia, Perugia, Italy
| | - Maciej Banach
- Department of Hypertension, WAM University Hospital in Lodz, Medical University of Lodz, Zeromskiego 113, Lodz, Poland
- Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland
| | - Gerald F Watts
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
- Lipid Disorders Clinic, Cardiometabolic Services, Department of Cardiology, Royal Perth Hospital, GPO Box X2213, Perth, Australia
| | - Cesare Sirtori
- Centro Dislipidemie, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Khalid Al-Rasadi
- Department of Clinical Biochemistry, Sultan Qaboos University Hospital, Muscat, Oman
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23
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Gupta KK, Ali S, Sanghera RS. Pharmacological Options in Atherosclerosis: A Review of the Existing Evidence. Cardiol Ther 2018; 8:5-20. [PMID: 30543029 PMCID: PMC6525235 DOI: 10.1007/s40119-018-0123-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Indexed: 12/11/2022] Open
Abstract
Coronary heart disease (CHD) is the leading cause of mortality worldwide and high low-density lipoprotein (LDL) cholesterol levels have been shown to be key in the pathogenesis of this condition. Lipid control has therefore been the subject of decades of research and has led to many large and robust randomized controlled trials, as well as the highest grossing drug of all time—Lipitor (atorvastatin). Statin therapy has long been indicated for secondary and more recently primary prevention. However, despite the large-scale use of statins, CHD prevalence remains high, and some patients do not respond to statin therapy. There has been a large push to find and test alternative lipid-lowering agents, these include fibrates, cholesterol absorption inhibitors, and proprotein convertase subtilisin/kexin type 9 (PCSK-9) inhibitors. It is the aim of this review to assess the literature surrounding each of these groups of drugs.
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Affiliation(s)
| | - Shair Ali
- St George's Hospital NHS Trust, London, UK
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24
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Kurbanoglu S, Esim O, Ozkan CK, Savaser A, Ozkan Y, Ozkan SA. Development and Validation of RP-LC Method for the Simultaneous Determination of Simvastatin and Ezetimibe in Fixed-Dose Combination Tablets and in Rabbit Serum. Chromatographia 2018. [DOI: 10.1007/s10337-018-3642-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Leporowski A, Godman B, Kurdi A, MacBride-Stewart S, Ryan M, Hurding S, Do Nascimento RCRM, Bennie M, Morton A. Ongoing activities to optimize the quality and efficiency of lipid-lowering agents in the Scottish national health service: influence and implications. Expert Rev Pharmacoecon Outcomes Res 2018; 18:655-666. [DOI: 10.1080/14737167.2018.1501558] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Axel Leporowski
- Department of Management Science, Strathclyde Business School, University of Strathclyde, Glasgow, United Kingdom
| | - Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedicial Sciences, University of Strathclyde, Glasgow, United Kingdom
- Division of Clinical Pharmacology, Karolinska University Hospital Huddinge, Stockholm, Sweden
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
| | - Amanj Kurdi
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedicial Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Sean MacBride-Stewart
- Pharmacy Prescribing Support Unit, National Health Service Greater Glasgow and Clyde, Glasgow, UK
| | - Margaret Ryan
- Pharmacy Prescribing Support Unit, National Health Service Greater Glasgow and Clyde, Glasgow, UK
| | | | - Renata CRM Do Nascimento
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedicial Sciences, University of Strathclyde, Glasgow, United Kingdom
- Post-Graduate Program of Medicines and Pharmaceutical Assistance, School of Pharmacy, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), School of Pharmacy, Federal University of Minas Gerais, Brazil
| | - Marion Bennie
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedicial Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Alec Morton
- Department of Management Science, Strathclyde Business School, University of Strathclyde, Glasgow, United Kingdom
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26
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Parini P, Melhuish TA, Wotton D, Larsson L, Ahmed O, Eriksson M, Pramfalk C. Overexpression of transforming growth factor β induced factor homeobox 1 represses NPC1L1 and lowers markers of intestinal cholesterol absorption. Atherosclerosis 2018; 275:246-255. [PMID: 29980051 DOI: 10.1016/j.atherosclerosis.2018.06.867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/07/2018] [Accepted: 06/15/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Transforming growth factor β induced factor homeobox 1 (TGIF1) is a transcriptional repressor that limits the response to transforming growth factor ß signaling and also represses transcription independent of this pathway. Recently, we found higher serum cholesterol levels and more hepatic lipid accumulation in mice lacking Tgif1, and showed that TGIF1 can repress the expression of Soat2, the gene encoding the cholesterol esterifying enzyme acyl-Coenzyme A:cholesterol acyltransferase 2. Although there is evidence that TGIF1 plays a role in lipid metabolism, its role in this metabolic pathway is not fully characterized. Here we investigate whether overexpression of TGIF1 affects intestinal cholesterol absorption. METHODS AND RESULTS TGIF1 was found to repress human and mouse Niemann-Pick C1 like 1 (Npc1l1) promoter activity in intestinal Caco2 cells. We also found TGIF1 to be able to oppose the induction of the promoter activity by sterol regulatory element binding protein 2 and hepatocyte nuclear factor 1α and 4α. To validate these effects of TGIF1 in vivo, we generated transgenic mice specifically overexpressing TGIF1 in the intestine (Villin-Tgif1). We observed lower intestinal expression levels of Npc1l1 that was associated with lower expression of ATP-binding cassette transporter (Abc) a1, Abcg5, and Abcg8. Villin-Tgif1 mice fed regular chow or a high-fat diet had lower levels of markers of intestinal cholesterol absorption than wild types. CONCLUSIONS We suggest TGIF1 as a new player in intestinal cholesterol metabolism.
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Affiliation(s)
- Paolo Parini
- Division of Clinical Chemistry, Department of Laboratory Medicine Sweden; Metabolism Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tiffany A Melhuish
- Department of Biochemistry and Molecular Genetics and Center for Cell Signaling, University of Virginia, Charlottesville, VA, USA
| | - David Wotton
- Department of Biochemistry and Molecular Genetics and Center for Cell Signaling, University of Virginia, Charlottesville, VA, USA
| | - Lilian Larsson
- Division of Clinical Chemistry, Department of Laboratory Medicine Sweden
| | - Osman Ahmed
- Division of Clinical Chemistry, Department of Laboratory Medicine Sweden; Department of Biochemistry, Faculty of Medicine, Khartoum University, Khartoum, Sudan
| | - Mats Eriksson
- Metabolism Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Camilla Pramfalk
- Division of Clinical Chemistry, Department of Laboratory Medicine Sweden; Department of Biosciences and Nutrition, NOVUM, Karolinska Institutet, Stockholm, Sweden.
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27
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Soulele K, Karalis V. On the population pharmacokinetics and the enterohepatic recirculation of total ezetimibe. Xenobiotica 2018; 49:446-456. [PMID: 29629619 DOI: 10.1080/00498254.2018.1463117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Ezetimibe is a potent cholesterol absorption inhibitor, with an erratic pharmacokinetic (PK) profile, attributed to an extensive enterohepatic recirculation (EHC). The aim of this study was to develop a population PK model able to adequately characterize the complex distribution processes of total ezetimibe. The analysis was performed on the individual concentration-time data obtained from 28 healthy subjects who participated in a bioequivalence study comparing two oral ezetimibe formulations. The population PK analysis was performed using nonlinear mixed effect modeling, where different EHC models were developed and evaluated for their performance. Total ezetimibe pharmacokinetics was best described by a four-compartment model featuring EHC through the inclusion of an additional gallbladder compartment, which was assumed to release drug at specific time-intervals consistent with food intake. The final PK model was able to adequately estimate the population pharmacokinetic parameters and to allow for a formal characterization of the pharmacokinetic profile and the secondary peaks due to enterohepatic recirculation.
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Affiliation(s)
- Konstantina Soulele
- a Department of Pharmacy, School of Health Sciences , National and Kapodistrian University of Athens , Athens , Greece
| | - Vangelis Karalis
- a Department of Pharmacy, School of Health Sciences , National and Kapodistrian University of Athens , Athens , Greece.,b Institute of Applied and Computational Mathematics (IACM)/Foundation of Research and Technology Hellas (FORTH) , Heraklion, Crete , Greece
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28
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Boonthos K, Puttilerpong C, Pengsuparp T, Manosuthi W. Short-Term Efficacy and Safety of Adding Ezetimibe to Current Regimen of Lipid-Lowering Drugs in Human Immunodeficiency Virus-Infected Thai Patients Treated with Protease Inhibitors. Jpn J Infect Dis 2018; 71:220-224. [PMID: 29709973 DOI: 10.7883/yoken.jjid.2017.182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Long-term complications of protease inhibitor (PI) treatment includes increased cardiovascular risks due to dyslipidemia in patients infected with human immunodeficiency virus (HIV). Ezetimibe reduces low-density lipoprotein cholesterol (LDL-C) without drug interactions with PIs and statins. Furthermore, the addition of ezetimibe to statins is an optional treatment in HIV-infected patients with uncontrolled dyslipidemia. The objective of this study was to determine the short-term efficacy and safety of adding ezetimibe to the currently administered statin regimen. Thirty-two patients received ezetimibe (10 mg daily) in addition to their ongoing lipid-lowering therapy for 18 weeks. Serum LDL-C, total cholesterol (TC), triglycerides (TGs), TC/high-density lipoprotein cholesterol (HDL-C) ratio, and HDL-C were measured at baseline, and weeks 6, 12, and 18. Safety parameters were assessed by adverse event reports and laboratory assessments throughout the study. The mean percent change from baseline to endpoint in LDL-C, TC, TGs, and TC/HDL-C ratio were -23.3% (p<0.001), -15.0% (p=0.001), -22.1% (p=0.004), and -16.2% (p=0.018), respectively. No adverse event or other abnormal laboratory results occurred. Addition of ezetimibe to currently administered lipid-lowering drugs in HIV-infected patients receiving PIs with uncontrolled dyslipidemia demonstrated significantly improved efficacy in reducing their LDL-C, TC, TGs, and TC/HDL-C ratio levels. Moreover, this therapy was safe and well-tolerated.
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Affiliation(s)
- Krisda Boonthos
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University
| | - Chankit Puttilerpong
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University
| | - Thitima Pengsuparp
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University
| | - Weerawat Manosuthi
- Department of Medicine, Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health
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29
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Shinozawa E, Amano Y, Yamakawa H, Haba M, Shimada M, Tozawa R. Antidyslipidemic potential of a novel farnesoid X receptor antagonist in a hamster model of dyslipidemia: Comparative studies of other nonstatin agents. Pharmacol Res Perspect 2018. [PMID: 29541476 PMCID: PMC5842406 DOI: 10.1002/prp2.390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
We attempted to clarify the therapeutic capability of antagonists of the farnesoid X receptor (FXR), a nuclear receptor that regulates lipid and bile acid metabolism. Herein, we report the antidyslipidemic effects of a novel synthesized FXR antagonist, compound‐T1, utilizing a dyslipidemic hamster model. Compound‐T1 selectively inhibited chenodeoxycholic acid‐induced FXR activation (IC50, 2.1 nmol·L−1). A hamster model of diet‐induced hyperlipidemia was prepared to investigate the antidyslipidemic effects of compound‐T1 through comparative studies of the nonstatin lipid‐modulating agents ezetimibe, cholestyramine, and torcetrapib. In the hamster model, compound‐T1 (6 mg·kg−1·day−1, p.o.) increased the level of plasma high‐density lipoprotein (HDL)‐cholesterol (+22.2%) and decreased the levels of plasma non‐HDL‐cholesterol (−43.6%) and triglycerides (−31.1%). Compound‐T1 also increased hepatic cholesterol 7α‐hydroxylase expression and fecal bile acid excretion, and decreased hepatic cholesterol content. Moreover, the hamster model could reflect clinical results of other nonstatin agents. Torcetrapib especially increased large HDL particles compared with compound‐T1. Additionally, in the human hepatoma Huh‐7 cells, compound‐T1 enhanced apolipoprotein A‐I secretion at a concentration close to its IC50 value for FXR. Our results indicated the usefulness of the hamster model in evaluating FXR antagonists and nonstatin agents. Notably, compound‐T1 exhibited beneficial effects on both blood non‐HDL‐cholesterol and HDL‐cholesterol, which are thought to involve enhancement of cholesterol catabolism and apolipoprotein A‐I production. These findings aid the understanding of the antidyslipidemic potential of FXR antagonists with a unique lipid and bile acid modulation.
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Affiliation(s)
- Emiko Shinozawa
- Research Takeda Pharmaceutical Company Limited Fujisawa Kanagawa Japan
| | - Yuichiro Amano
- Research Takeda Pharmaceutical Company Limited Fujisawa Kanagawa Japan
| | - Hiroko Yamakawa
- Research Takeda Pharmaceutical Company Limited Fujisawa Kanagawa Japan
| | - Megumi Haba
- Research Takeda Pharmaceutical Company Limited Fujisawa Kanagawa Japan
| | - Mitsuyuki Shimada
- Research Takeda Pharmaceutical Company Limited Fujisawa Kanagawa Japan
| | - Ryuichi Tozawa
- Research Takeda Pharmaceutical Company Limited Fujisawa Kanagawa Japan
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30
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Abstract
The human gut microbiota makes key contributions to the metabolism of ingested compounds (xenobiotics), transforming hundreds of dietary components, industrial chemicals, and pharmaceuticals into metabolites with altered activities, toxicities, and lifetimes within the body. The chemistry of gut microbial xenobiotic metabolism is often distinct from that of host enzymes. Despite their important consequences for human biology, the gut microbes, genes, and enzymes involved in xenobiotic metabolism are poorly understood. Linking these microbial transformations to enzymes and elucidating their biological effects is undoubtedly challenging. However, recent studies demonstrate that integrating traditional and emerging technologies can enable progress toward this goal. Ultimately, a molecular understanding of gut microbial xenobiotic metabolism will guide personalized medicine and nutrition, inform toxicology risk assessment, and improve drug discovery and development.
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Affiliation(s)
- Nitzan Koppel
- Department of Chemistry and Chemical Biology, Harvard University, 12 Oxford Street, Cambridge, MA 02138, USA
| | - Vayu Maini Rekdal
- Department of Chemistry and Chemical Biology, Harvard University, 12 Oxford Street, Cambridge, MA 02138, USA
| | - Emily P Balskus
- Department of Chemistry and Chemical Biology, Harvard University, 12 Oxford Street, Cambridge, MA 02138, USA. .,Broad Institute, Cambridge, MA 02139, USA
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31
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Tarakameh Samani S, Mosallanejad B, Razi Jalali M, Jamshidian J, Avizeh R. Comparative evaluation of the effects of ezetimibe and atorvastatin on serum lipid profile changes in experimental hypercholesterolemia in cat. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s00580-017-2561-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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32
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Abstract
Each month, subscribers to The Formulary Monograph Service receive five to six well-documented monographs on drugs that are newly released or are in late Phase III trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. The monographs are published in printed form and on diskettes that allow customization. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800–322–4349. The March 2003 monograph topics are adalimumab, eletriptan, cyclosporine ophthalmic emulsion, montelukast for allergic rhinitis, and icodextrin peritoneal dialysis solution. The DUE is on adalimumab.
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Affiliation(s)
- Dennis J. Cada
- The Formulary, 310 North Riverpoint Boulevard, PO Box 1495, Spokane, WA 99210–1495
| | - Terri Levien
- Drug Information Pharmacist, Drug Information Center, Washington State University Spokane, 310 North Riverpoint Boulevard, PO Box 1495, Spokane, WA 99210–1495
| | - Danial E. Baker
- Drug Information Center and College of Pharmacy, Washington State University Spokane, 310 North Riverpoint Boulevard, PO Box 1495, Spokane, WA 99210–1495
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33
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Banach M, Jankowski P, Jóźwiak J, Cybulska B, Windak A, Guzik T, Mamcarz A, Broncel M, Tomasik T, Rysz J, Jankowska-Zduńczyk A, Hoffman P, Mastalerz-Migas A. PoLA/CFPiP/PCS Guidelines for the Management of Dyslipidaemias for Family Physicians 2016. Arch Med Sci 2017; 13:1-45. [PMID: 28144253 PMCID: PMC5206369 DOI: 10.5114/aoms.2017.64712] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 11/05/2016] [Indexed: 02/06/2023] Open
Affiliation(s)
- Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
| | - Piotr Jankowski
- 1 Department of Cardiology, Interventional Electrocardiology and Hypertension, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Jacek Jóźwiak
- Institute of Health and Nutrition Sciences, Czestochowa University of Technology, Czestochowa, Poland
| | | | - Adam Windak
- Department of Family Medicine, Chair of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Guzik
- Department of Internal Diseases and Rural Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Artur Mamcarz
- 3 Department of Internal Diseases and Cardiology, 2 Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Marlena Broncel
- Department of Internal Diseases and Clinical Pharmacology, Medical University of Lodz, Lodz, Poland
| | - Tomasz Tomasik
- Department of Family Medicine, Chair of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
| | | | - Piotr Hoffman
- Department of Congenital Cardiac Defects, Institute of Cardiology, Warsaw, Poland
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35
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Yang L, Zhao P, Zhao J, Wang J, Shi L, Wang X. Effects of ezetimibe and anticoagulant combined therapy on progressing stroke: a randomized, placebo-controlled study. J Neurol 2016; 263:2438-2445. [PMID: 27632179 DOI: 10.1007/s00415-016-8283-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 08/28/2016] [Accepted: 09/01/2016] [Indexed: 01/22/2023]
Abstract
Despite the high prevalence of progressing stroke in patients with acute stroke, preventative treatments are still the unmet needs for those patients. The aim of this study was to evaluate, prospectively, the efficacy and safety of ezetimibe in the prevention of acute progressing stroke and thereby the improvement of patient outcome. A total of 423 patients (267 men and 156 women with a mean age of 65.2 years) were randomly assigned to receive ezetimibe (10 mg daily oral administration, n = 209) or placebo (n = 214) for 14 consecutive days. Analytical procedures performed at baseline (i.e., day 1) and 14 days after the treatments were completed. These included a real-time three-dimensional ultrasound (RT-3DU) examination for carotid plaque volume, clinical laboratory analyses of serum levels of IL-6 and MMP-9, as well as lipid parameters and liver dysfunction marker ALT and TBIL. Ezetimibe significantly reduced the average NIHSS score after 14 days of treatment and attenuated the stroke progression rate, which was associated with reduction in carotid plaque volume and attenuation of serum levels of IL-6, MMP-9, and LDL, without inducing liver dysfunction. Ezetimibe treatment may be a beneficial and effective strategy for preventing progressing stroke.
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Affiliation(s)
- Lan Yang
- The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Pingping Zhao
- The Third Hospital of Shijiazhuang, Shijiazhuang, China
| | - Jing Zhao
- The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Juan Wang
- The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lei Shi
- Quyang County People's Hospital, Quyang, China
| | - Xiaopeng Wang
- The Second Hospital of Hebei Medical University, Shijiazhuang, China.
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36
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Abstract
The launch of ezetimibe, a novel cholesterol absorption inhibitor in 2003 may well herald the dawn of combination therapy in the management of dyslipidaemia. The recent identification of NPC 1L1 as the probable specific sterol permease involved in intestinal cholesterol absorption is an important breakthrough in the understanding of the mechanisms of cholesterol absorption. Combination of statin therapy with blockade of exogenous cholesterol absorption (the so called dual inhibition of cholesterol metabolism) is discussed together with the potential for tailoring therapy to the physiological profile of patients' cholesterol metabolism.
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Affiliation(s)
- Alan Rees
- Cardiff and Vale NHS Trust, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK,
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37
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Mathematically modelling the dynamics of cholesterol metabolism and ageing. Biosystems 2016; 145:19-32. [DOI: 10.1016/j.biosystems.2016.05.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 04/29/2016] [Accepted: 05/03/2016] [Indexed: 11/21/2022]
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Abstract
Dyslipidemia is one of a number of independent risk factors for cardiovascular disease. Numerous large-scale, randomized clinical trials demonstrate the benefit of aggressive lipid-modifying therapy in reducing the mortality and morbidity associated with cardiovascular disease. Despite these data and the wide dissemination of clinical practice guidelines outlining management strategies for patients with dyslipidemia, particularly those at the greatest cardiovascular risk, studies indicate that a significant proportion of patients are not screened, initiated on appropriate therapy, or treated to target lipid levels. Pharmacists, as part of the multidisciplinary team, can play a vital role in assisting in the management of patients with dyslipidemias. This article reviews published studies that have evaluated the pharmacist's role in lipid management, reviews the process for managing a patient with dyslipidemia, and provides suggestions on how pharmacists can become more involved in lipid management.
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Affiliation(s)
- Kari L. Olson
- School of Pharmacy, University of Colorado at Denver and Health Sciences Center; 16601 East Centretech Parkway, Aurora, CO 80011
| | - Lisa A. Potts
- Ambulatory Care, Department of Pharmacy, Harper University Hospital, Detroit, Michigan
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39
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Patel J, Martin SS, Banach M. Expert opinion: the therapeutic challenges faced by statin intolerance. Expert Opin Pharmacother 2016; 17:1497-507. [DOI: 10.1080/14656566.2016.1197202] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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40
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Coadministration of ezetimibe with pegylated interferon plus ribavirin could improve early virological response in chronic hepatitis C obese Egyptian patients. Eur J Gastroenterol Hepatol 2016; 28:553-7. [PMID: 26872109 DOI: 10.1097/meg.0000000000000587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Ezetimibe has been reported to inhibit viral entry and to reduce BMI and has been proposed as a novel therapeutic agent for chronic hepatitis C (CHC), potentiating the effects of pegylated interferon and ribavirin (peg-IFN/RBV). OBJECTIVE The aim of the study was to assess the effects of ezetimibe coadministration with peg-IFN/RBV combination on the early virological response (EVR) rates in nonobese and obese patients with CHC genotype 4 (CHC-4). PATIENTS AND METHODS A total of 144 CHC-4 patients were divided into two groups; group 1 included nonobese patients (n=76) and group 2 included obese patients (n=68). Each group was further subclassified into equal control and treated groups. The control groups received peg-IFN/RBV combination for 24 weeks, and the treated groups received peg-IFN/RBV plus ezetimibe for 12 weeks and then only peg-IFN/RBV for the remaining 12 weeks. RESULTS The study revealed that EVR significantly improved in the obese patients (85.3 vs. 64.7% in the treated and control groups, respectively, at P<0.05) without any significant improvement in the nonobese patients. Biochemical responses (defined as normalization of alanine aminotransferase at week 12) were markedly improved in the treated groups in both the nonobese and obese groups compared with their respective controls. CONCLUSION The addition of ezetimibe to peg-IFN/RBV combination significantly improves EVR rates in obese patients compared with nonobese patients, and remarkably improves the biochemical responses in both obese and nonobese patients with CHC-4. This may shed light on a new strategy for the treatment of CHC, particularly in obese Egyptian patients.
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41
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Steep improvement in dissolution profile of ezetimibe through co-inclusion in urea. JOURNAL OF PHARMACEUTICAL INVESTIGATION 2016. [DOI: 10.1007/s40005-016-0236-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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42
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Caz V, Gil-Ramírez A, Santamaría M, Tabernero M, Soler-Rivas C, Martín-Hernández R, Marín FR, Reglero G, Largo C. Plasma Cholesterol-Lowering Activity of Lard Functionalized with Mushroom Extracts Is Independent of Niemann-Pick C1-like 1 Protein and ABC Sterol Transporter Gene Expression in Hypercholesterolemic Mice. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2016; 64:1686-1694. [PMID: 26900983 DOI: 10.1021/acs.jafc.5b05490] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Interest in food matrices supplemented with mushrooms as hypocholesterolemic functional foods is increasing. This study was to (i) investigate the hypocholesterolemic activity of lard functionalized with mushroom extracts (LF) including fungal β-glucans, water-soluble polysaccharides, or ergosterol and (ii) examine the LF influence on transcriptional mechanisms involved in cholesterol metabolism. mRNA levels of 17 cholesterol-related genes were evaluated in jejunum, cecum, and liver of high cholesterol-fed mice. The four tested LFs decreased plasma cholesterol by 22-42%, HDLc by 18-40%, and LDLc by 27-51%, and two of them increased mRNA levels of jejunal Npc1l1 and Abcg5 and hepatic Npc1l1. mRNA levels of other cholesterol-related genes were unchanged. These findings suggest that LF may have potential as a dietary supplement for counteracting diet-induced hypercholesterolemia and could be a source for the development of novel cholesterol-lowering functional foods. However, the cholesterol-lowering effect was unrelated to transcriptional changes, suggesting that post-transcriptional mechanisms could be involved.
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Affiliation(s)
- Víctor Caz
- Department of Experimental Surgery, Research Institute Hospital La Paz (IdiPAZ) , Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Alicia Gil-Ramírez
- Department of Production and Characterization of Novel Foods, CIAL - Research Institute in Food Science (UAM+CSIC), Universidad Autónoma de Madrid , C/Nicolas Cabrera 9, Campus de Cantoblanco, 28049 Madrid, Spain
| | - Mónica Santamaría
- Department of Experimental Surgery, Research Institute Hospital La Paz (IdiPAZ) , Paseo de la Castellana 261, 28046 Madrid, Spain
| | - María Tabernero
- Department of Experimental Surgery, Research Institute Hospital La Paz (IdiPAZ) , Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Cristina Soler-Rivas
- Department of Production and Characterization of Novel Foods, CIAL - Research Institute in Food Science (UAM+CSIC), Universidad Autónoma de Madrid , C/Nicolas Cabrera 9, Campus de Cantoblanco, 28049 Madrid, Spain
| | - Roberto Martín-Hernández
- IMDEA Food Institute, Pabellón Central del Antiguo Hospital de Cantoblanco (Edificio 7) , Crta. de Cantoblanco 8, 28049 Madrid, Spain
| | - Francisco R Marín
- Department of Production and Characterization of Novel Foods, CIAL - Research Institute in Food Science (UAM+CSIC), Universidad Autónoma de Madrid , C/Nicolas Cabrera 9, Campus de Cantoblanco, 28049 Madrid, Spain
| | - Guillermo Reglero
- Department of Production and Characterization of Novel Foods, CIAL - Research Institute in Food Science (UAM+CSIC), Universidad Autónoma de Madrid , C/Nicolas Cabrera 9, Campus de Cantoblanco, 28049 Madrid, Spain
- IMDEA Food Institute, Pabellón Central del Antiguo Hospital de Cantoblanco (Edificio 7) , Crta. de Cantoblanco 8, 28049 Madrid, Spain
| | - Carlota Largo
- Department of Experimental Surgery, Research Institute Hospital La Paz (IdiPAZ) , Paseo de la Castellana 261, 28046 Madrid, Spain
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Reith C, Armitage J. Management of residual risk after statin therapy. Atherosclerosis 2016; 245:161-70. [DOI: 10.1016/j.atherosclerosis.2015.12.018] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 12/10/2015] [Accepted: 12/12/2015] [Indexed: 01/19/2023]
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Abstract
Cardiovascular disease (CVD) is still the most prominent cause of death and morbidity in the world, and one of the major risk factors for developing CVD is hypercholesterolemia. Familial hypercholesterolemia (FH) is a dominantly inherited disorder characterized by markedly elevated plasma low-density lipoprotein cholesterol and premature coronary heart disease. Currently, several treatment options are available for children with FH. Lifestyle adjustments are the first step in treatment. If this is not sufficient, statins are the preferred initial pharmacological therapy and they have been proven effective and safe. However, treatment goals are often not achieved and, hence, there is a need for novel treatment options. Currently, several options are being studied in adults and first results are promising. However, studies in children are still to be awaited.
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Affiliation(s)
- Ilse K Luirink
- Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands,
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Saeedi R, Johns K, Frohlich J, Bennett MT, Bondy G. Lipid lowering efficacy and safety of Ezetimibe combined with rosuvastatin compared with titrating rosuvastatin monotherapy in HIV-positive patients. Lipids Health Dis 2015; 14:57. [PMID: 26087958 PMCID: PMC4488121 DOI: 10.1186/s12944-015-0054-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 06/02/2015] [Indexed: 01/14/2023] Open
Abstract
Background HIV-infected patients on antiretroviral therapy frequently develop dyslipidemias and, despite therapy with potent lipid-lowering agents, a high percentage does not achieve guideline recommended lipid targets. In this study, we examined the efficacy of combination treatment with a statin and the cholesterol transport blocker, ezetimibe, vs. monotherapy with a statin in HIV-infected patients not achieving lipid goals. Methods This was a 12-week, prospective, randomized, open-label clinical trial. Patients were eligible if they had an apolipoprotein B (apoB) >0.80 g/L despite therapy with rosuvastatin 10 mg daily for a minimum of 12 weeks. Patients were randomized to take ezetimibe 10 mg/rosuvastatin 10 mg or rosuvastatin 20 mg for 12 weeks. Percentage and absolute change in apoB (primary outcome), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), non-HDL-C, apoliporpotein A1 (apoA1), apoB/apoA1, TC/HDL-C, atherogenic index of plasma (API), and high-sensitivity C-reactive protein (hsCRP) were compared. Changes in safety parameters (such as AST, ALT, CK) and clinical symptoms were also assessed. Results Forty-three patients (23 on ezetimibe 10 mg/rosuvastatin 10 mg and 20 on rosuvastatin 20 mg) completed the trial. Baseline characteristics did not differ between the groups. Significant improvements in apoB were seen with both ezetimibe plus rosuvastatin (mean of -0.17 g/L, p < 0.001) and rosuvastatin 20 mg (mean of -0.13 g/L, p = 0.03) treatment groups, but did not differ between groups (p = 0.53). Significant between-group differences were observed for mean TC (-1.01 mmol/L vs. -0.50 mmol/L, p = 0.03), TG (-0.62 mmol/L vs -0.17 mmol/L, p = 0.03), and non-HDL-C (-0.97 mmol/L vs. -0.53 mmol/L, p = 0.03) all in favour of the ezetimibe plus rosuvastatin group. Two patients, both in the rosuvastatin 20 mg group, experienced mild myalgias; neither discontinued the study. Conclusions The addition of ezetimibe to rosuvastatin appears to be safe in patients with HIV. Furthermore, the combination of ezetimibe and rosuvastatin improved TG, AIP and non-HDL cholesterol levels more than a dose increase in rosuvastatin in patients with HIV-associated dyslipidemia.
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Affiliation(s)
- Ramesh Saeedi
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, Canada.
| | - Kevin Johns
- Experimental Medicine Program, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
| | - Jiri Frohlich
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, Canada.
| | - Matthew T Bennett
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada.
| | - Gregory Bondy
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, Canada. .,Departments of Medicine and Pathology, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
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Chang E, Kim L, Choi JM, Park SE, Rhee EJ, Lee WY, Oh KW, Park SW, Park DI, Park CY. Ezetimibe stimulates intestinal glucagon-like peptide 1 secretion via the MEK/ERK pathway rather than dipeptidyl peptidase 4 inhibition. Metabolism 2015; 64:633-41. [PMID: 25704082 DOI: 10.1016/j.metabol.2015.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 01/31/2015] [Accepted: 02/04/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Ezetimibe is known as a Niemann-Pick C1-Like 1 (NPC1L1) inhibitor and has been used as an agent for hypercholesterolemia. In our previous study, ezetimibe administration improved glycemic control and increased glucagon like peptide-1 (GLP-1), an incretin hormone with anti-diabetic properties. However, the mechanisms by which ezetimibe stimulates GLP-1 secretion are not fully understood. Thus, the specific aim of this study was to investigate the mechanism(s) by which ezetimibe stimulates GLP-1 secretion. MATERIALS/METHODS Male KK/H1J mice were divided into following groups: AIN-93G (NC), NC with ezetimibe (10 mg/kg/day), 45% high fat (HF) diet, and HF diet with ezetimibe. To investigate the role of ezetimibe in glucose homeostasis and GLP-1 secretion, an insulin tolerance test was performed and serum and intestinal GLP-1 levels and intestinal mRNA expression involved in GLP-1 synthesis were measured after 6 weeks of ezetimibe treatment. In vivo and in vitro dipeptidyl peptidase-4 (DPP-4) inhibition assays were employed to demonstrate the association between ezetimibe-induced GLP-1 change and DPP-4. The molecular mechanism by which ezetimibe affects GLP-1 secretion was evaluated by using human enteroendocrine NCI-H716 cells. RESULTS Ezetimibe supplementation significantly ameliorated HF-increased glucose and insulin resistance in the type 2 diabetic KK/H1J mouse model. Serum and intestinal active GLP-1 levels were significantly increased by ezetimibe in HF-fed animals. However, mRNA expression of genes involved in intestinal GLP-1 synthesis was not altered. Furthermore, ezetimibe did not inhibit the activity of either in vivo or in vitro dipeptidyl peptidase-4 (DPP-4). The direct effects of ezetimibe on GLP-1 secretion and L cell secretory mechanisms were examined in human NCI-H716 intestinal cells. Ezetimibe significantly stimulated active GLP-1 secretion, which was accompanied by the activation of mitogen-activated protein/extracellular signal-regulated kinase kinase (MEK)/extracellular signal-regulated kinase (ERK). Ezetimibe-increased GLP-1 secretion was abrogated by inhibiting the MEK/ERK pathway with PD98059. CONCLUSION These findings suggest a possible novel biological role of ezetimibe in glycemic control to stimulate intestinal GLP-1 secretion via the MEK/ERK signaling pathway.
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Affiliation(s)
- Eugene Chang
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul, Republic of Korea
| | - Lisa Kim
- Diabetes Research Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Mook Choi
- Diabetes Research Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Se Eun Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun-Jung Rhee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won-Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ki-Won Oh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung-Woo Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Il Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheol-Young Park
- Diabetes Research Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Saito I, Azuma K, Kakikawa T, Oshima N, Hanson ME, Tershakovec AM. A randomized, double-blind, placebo-controlled study of the effect of ezetimibe on glucose metabolism in subjects with type 2 diabetes mellitus and hypercholesterolemia. Lipids Health Dis 2015; 14:40. [PMID: 25929253 PMCID: PMC4450465 DOI: 10.1186/s12944-015-0036-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 04/16/2015] [Indexed: 11/10/2022] Open
Abstract
Background Recent evidence points to an increased incidence of new-onset diabetes and a negative impact on glucose parameters with statin use. This study examined the safety of ezetimibe vs placebo for change from baseline to week 24 in HbA1c (primary endpoint), glycoalbumin, and fasting plasma glucose (secondary endpoints) in Japanese subjects with type 2 diabetes and hypercholesterolemia. Methods This was a randomized, double-blind, placebo-controlled, parallel-group, multi-site trial. Adults with type 2 diabetes and hypercholesterolemia whose LDL-C measured <140 mg/dl (subjects receiving lipid-lowering drugs) or <160 mg/dl (subjects not receiving lipid-lowering drugs) at the start of the screening phase, were randomized after a 5-week wash-out period to ezetimibe 10 mg or placebo (1:1) for 24 weeks. Changes in HbA1c, glycoalbumin and fasting plasma glucose from baseline to week 24 were evaluated. The non-inferiority margin was set at 0.5% for HbA1c. Results Overall, 152 subjects were randomized (75 to ezetimibe and 77 to placebo). From baseline to 24 weeks, HbA1c significantly increased in both the ezetimibe and placebo groups (between-treatment difference 0.08 [95% CI: −0.07 to 0.23]). Ezetimibe was statistically non-inferior to placebo. At 24 weeks, the mean change from baseline in glycoalbumin levels (between-treatment differences 0.00 [95% CI: −0.47, 0.47]) and fasting plasma glucose (between-treatment differences −4.8 [95% CI: −12.1, 2.1]) were similar in both treatment groups. Conclusions These results suggest that ezetimibe 10 mg does not result in dysregulation of glucose metabolism in Japanese patients with type 2 diabetes and hypercholesterolemia over 24 weeks of treatment. Trial registration ClinicalTrials.gov identifier NCT01611883. Electronic supplementary material The online version of this article (doi:10.1186/s12944-015-0036-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Itori Saito
- MSD KK, Japan development, Clinical research, Kitanomaru Square, 1-13-12 Kudan-kita, Chiyoda-ku, 102-8667, Tokyo, Japan.
| | - Kyoichi Azuma
- MSD KK, Japan development, Clinical research, Kitanomaru Square, 1-13-12 Kudan-kita, Chiyoda-ku, 102-8667, Tokyo, Japan.
| | - Taro Kakikawa
- MSD KK, Japan development, Clinical research, Kitanomaru Square, 1-13-12 Kudan-kita, Chiyoda-ku, 102-8667, Tokyo, Japan.
| | - Nobuyuki Oshima
- MSD KK, Japan development, Clinical research, Kitanomaru Square, 1-13-12 Kudan-kita, Chiyoda-ku, 102-8667, Tokyo, Japan.
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Zambrano T, Saavedra N, Lanas F, Caamaño J, Salazar LA. Efficacy of Ezetimibe Is Not Related to NPC1L1 Gene Polymorphisms in a Pilot Study of Chilean Hypercholesterolemic Subjects. Mol Diagn Ther 2015; 19:45-52. [DOI: 10.1007/s40291-014-0128-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Alghamdi RH, O'Reilly P, Lu C, Gomes J, Lagace TA, Basak A. LDL-R promoting activity of peptides derived from human PCSK9 catalytic domain (153-421): design, synthesis and biochemical evaluation. Eur J Med Chem 2015; 92:890-907. [PMID: 25679794 DOI: 10.1016/j.ejmech.2015.01.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 01/09/2015] [Accepted: 01/10/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND High level of Low Density Lipoprotein-Cholesterol (LDL-C) in circulation in the blood is associated with an elevated risk of cardiovascular disease (CVD) and stroke. Currently the statin drugs which inhibit the enzyme HMG-CoA reductase responsible for cholesterol synthesis in the liver are very effective in lowering LDL-cholesterol. However these drugs are often associated with serious side effects particularly for ∼10-12% of cases. Therefore there is a need to develop non-statin based cholesterol reducing agents. Recently it was revealed that the secreted Proprotein Convertase Subtilisin Kexin 9 (PCSK9) binds with LDL-receptor (LDL-R) causing its degradation in the lysosome with the result of LDL-C accumulating in the blood. Thus PCSK9 has become an alternative target for development of non-statin cholesterol reducing agents. It is established that the catalytic domain of PCSK9 (aa153-421) and the EGF-A domain of LDL-R (aa314-355) are involved in the above bind leading to the reduction of LDL-R level and accumulation of LDL-C. OBJECTIVE The major goal of this study is to identify peptide/s from the catalytic domain of hPCSK9 that can block the binding of hPCSK9 and LDL-R and therefore can reduce LDL-R degradation leading to the clearance of LDL-C from the plasma. RESULTS Using 51 synthetic linear peptides (P1-P51) of 15aa long with 10 amino acids overlapping sequences spanning the entire catalytic segment of hPCSK9 (aa153-421), we identified two domains of hPCSK9 namely (aa323-358) and (aa365-384) that exhibited strong binding affinity towards synthetic EGF-A peptide. The results were based on mass spectrometry, fluorescence spectroscopy and native gel electrophoresis. Thus peptides containing the above segments in part (P35-P39 and P42-P47) exhibited LDL-R promoting activity when added exogenously to culture medium of growing human hepatic cells like HepG2 and HuH7. The effects were particularly significant with peptides P36, P37, P46 and P47. Interestingly, the first two peptides are present within the disulphide loop Cys(323)-Cys(358) and contain the key gain of function mutation D(374)/Y site while the last two peptides contain another disulphide bridge loop Cys(375)-Cys(378) and the second most potent gain of function mutation R(357)/H. Further studies revealed that S-S bridged cyclic loop peptide hPCSK9(365-384) exhibited the highest (∼3.5-fold) LDL-R promoting activity in both HepG2 and HuH7 when applied at 5 μM concentration level. This effect is completely abrogated when one of the Cys residues is substituted by Ala thereby preventing any S-S bond formation. This suggested its critical role in the bioactivity. It is proposed that LDL-R promoting activity of this and other selected PCSK9 catalytic peptides such as P36, P37, P46 and P47 are most likely mediated via intervention of PCSK9:LDL-R complex formation. Our findings may find useful application in future development of small molecule PCSK9 inhibitors for intervention of hypercholesterolemia and associated cardiovascular disease.
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Affiliation(s)
- Rasha H Alghamdi
- Interdisciplinary School of Health Sciences Unit, Faculty of Health Science, U Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada
| | - Paul O'Reilly
- Interdisciplinary School of Health Sciences Unit, Faculty of Health Science, U Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada
| | - Chunyu Lu
- Interdisciplinary School of Health Sciences Unit, Faculty of Health Science, U Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada
| | - James Gomes
- Interdisciplinary School of Health Sciences Unit, Faculty of Health Science, U Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada
| | - Thomas A Lagace
- Lipoprotein Receptor Biology Laboratory, Department of Pathology and Laboratory Medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada
| | - Ajoy Basak
- Interdisciplinary School of Health Sciences Unit, Faculty of Health Science, U Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada; Chronic Disease Program, Ottawa Hospital Research Institute, U Ottawa, 725 Parkdale Ave, Ottawa, ON K1Y4E9, Canada.
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Ragbourne SC, Crook MA. Use of lipid-lowering medications in myasthenia gravis: a case report and literature review. J Clin Lipidol 2014; 9:256-9. [PMID: 25911083 DOI: 10.1016/j.jacl.2014.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 12/03/2014] [Accepted: 12/08/2014] [Indexed: 11/18/2022]
Abstract
We present a patient with myasthenia gravis (MG) who developed worsening of his condition after starting ezetimibe. We review the literature concerning lipid-modifying medications and MG. The use of bile acid sequestrant agents may have a place in the lipid management of MG patients because they did not seem to cause muscle-related side effects or worsening of MG.
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Affiliation(s)
- Sophie C Ragbourne
- Department of Clinical Biochemistry, Lewisham Hospital NHS Trust, London, UK; Guy's Hospital, Southwark, London, UK
| | - Martin A Crook
- Department of Clinical Biochemistry, Lewisham Hospital NHS Trust, London, UK; Department of Metabolic Medicine, University Hospital Lewishsam, London, UK; Guy's Hospital, Southwark, London, UK; St Thomas' Hospital, Lambeth, UK; University of Greenwich, London, UK.
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