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Ma Q, Wu S, Yang L, Wei Y, He C, Wang W, Zhao Y, Wang Z, Yang S, Shi D, Liu Y, Zhou Z, Sun J, Zhou Y. Hyaluronic Acid-Guided Cerasome Nano-Agents for Simultaneous Imaging and Treatment of Advanced Atherosclerosis. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2202416. [PMID: 36529695 PMCID: PMC9929131 DOI: 10.1002/advs.202202416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 11/23/2022] [Indexed: 05/25/2023]
Abstract
Early noninvasive screening and regression therapy for vulnerable atherosclerotic plaques remain challenging. In this study, it is aimed to develop a new approach for the active targeting of atherosclerotic plaques with nano-agents to aid imaging and treatment. Biocompatible hyaluronic acid (HA)-guided cerasomes are generated to selectively target CD44-positive cells within the plaque in in vitro studies and in vivo testing in Apoe-/- mice. Rosuvastatin (RST) is encapsulated in the HA-guided cerasome nano-formulation to produce HA-CC-RST, which results in significant plaque regression as compared to treatment with the free drug. Moreover, gadodiamide-loaded HA-CC enhances magnetic resonance images of vulnerable plaques, thereby attaining the goal of improved simultaneous treatment and imaging. Transcriptomic analysis confirms plaque regression with HA-CC-RST treatment, which potentially benefits from the anti-inflammatory effect of RST. In summary, a safe and efficient nano-formulation for the targeted delivery of active agents to atherosclerotic plaques is developed and may be applicable to other diagnostic and therapeutic agents for atherosclerosis treatment.
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Affiliation(s)
- Qian Ma
- Department of CardiologyBeijing Anzhen HospitalCapital Medical University100029BeijingP. R. China
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic DiseaseClinical Center for Coronary Heart DiseaseCapital Medical UniversityBeijing100029P. R. China
- Beijing Inno Medicine Co. Ltd.Beijing100195P. R. China
| | - Sijing Wu
- Department of CardiologyBeijing Anzhen HospitalCapital Medical University100029BeijingP. R. China
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic DiseaseClinical Center for Coronary Heart DiseaseCapital Medical UniversityBeijing100029P. R. China
| | - Ling Yang
- Beijing Inno Medicine Co. Ltd.Beijing100195P. R. China
| | - Yaohua Wei
- Beijing Inno Medicine Co. Ltd.Beijing100195P. R. China
| | - Chaoyong He
- Beijing Inno Medicine Co. Ltd.Beijing100195P. R. China
| | - Wenshan Wang
- Beijing Inno Medicine Co. Ltd.Beijing100195P. R. China
| | - Yingxin Zhao
- Department of CardiologyBeijing Anzhen HospitalCapital Medical University100029BeijingP. R. China
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic DiseaseClinical Center for Coronary Heart DiseaseCapital Medical UniversityBeijing100029P. R. China
- Beijing Anzhen HospitalBeijing Institute of Heart Lung and Blood Vessel DiseaseBeijing100029P. R. China
| | - Zhijian Wang
- Department of CardiologyBeijing Anzhen HospitalCapital Medical University100029BeijingP. R. China
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic DiseaseClinical Center for Coronary Heart DiseaseCapital Medical UniversityBeijing100029P. R. China
- Beijing Anzhen HospitalBeijing Institute of Heart Lung and Blood Vessel DiseaseBeijing100029P. R. China
| | - Shiwei Yang
- Department of CardiologyBeijing Anzhen HospitalCapital Medical University100029BeijingP. R. China
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic DiseaseClinical Center for Coronary Heart DiseaseCapital Medical UniversityBeijing100029P. R. China
- Beijing Anzhen HospitalBeijing Institute of Heart Lung and Blood Vessel DiseaseBeijing100029P. R. China
| | - Dongmei Shi
- Department of CardiologyBeijing Anzhen HospitalCapital Medical University100029BeijingP. R. China
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic DiseaseClinical Center for Coronary Heart DiseaseCapital Medical UniversityBeijing100029P. R. China
- Beijing Anzhen HospitalBeijing Institute of Heart Lung and Blood Vessel DiseaseBeijing100029P. R. China
| | - Yuyang Liu
- Department of CardiologyBeijing Anzhen HospitalCapital Medical University100029BeijingP. R. China
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic DiseaseClinical Center for Coronary Heart DiseaseCapital Medical UniversityBeijing100029P. R. China
- Beijing Anzhen HospitalBeijing Institute of Heart Lung and Blood Vessel DiseaseBeijing100029P. R. China
| | - Zhiming Zhou
- Department of CardiologyBeijing Anzhen HospitalCapital Medical University100029BeijingP. R. China
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic DiseaseClinical Center for Coronary Heart DiseaseCapital Medical UniversityBeijing100029P. R. China
- Beijing Anzhen HospitalBeijing Institute of Heart Lung and Blood Vessel DiseaseBeijing100029P. R. China
| | - Jiefang Sun
- Beijing Inno Medicine Co. Ltd.Beijing100195P. R. China
| | - Yujie Zhou
- Department of CardiologyBeijing Anzhen HospitalCapital Medical University100029BeijingP. R. China
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic DiseaseClinical Center for Coronary Heart DiseaseCapital Medical UniversityBeijing100029P. R. China
- Beijing Anzhen HospitalBeijing Institute of Heart Lung and Blood Vessel DiseaseBeijing100029P. R. China
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The main side effects of statins in clinical practice. КЛИНИЧЕСКАЯ ПРАКТИКА 2022. [DOI: 10.17816/clinpract108076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Statins have long occupied a central place in cardiovascular medicine, being an integral component of the prevention and treatment of atherosclerotic cardiovascular diseases (coronary heart disease and its main clinical forms, angina pectoris and myocardial infarction; transient ischemic attacks, ischemic strokes, etc.). By blocking a key enzyme of cholesterol biosynthesis, 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMG-CoA-reductase), statins normalize the parameters of the lipid spectrum, primarily, the serum levels of atherogenic low-density lipoprotein cholesterol. However, in addition to the beneficial effects of statins, side effects are also characteristic, which are a significant problem in modern clinical practice due to the fact that they can cause dangerous disorders, forcing physicians to reduce dosages or completely cancel these drugs. Understanding the side effects and the mechanisms underlying their formation is important for improving the measures for the early detection, prevention and treatment of those disorders. This article discusses such side effects of statins as myotoxicity, hepatotoxicity, nephrotoxicity. The pathogenetic mechanisms underlying these toxic effects of statins are discussed. A particular attention is paid to the effect of statins on the oxidative stress, the mechanisms of oxidative damage to cellular macromolecules (lipids, proteins and DNA) and their potential role in the development of myotoxicity, hepatotoxicity and nephrotoxicity.
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Casula M, Gazzotti M, Bonaiti F, OImastroni E, Arca M, Averna M, Zambon A, Catapano AL. Reported muscle symptoms during statin treatment amongst Italian dyslipidaemic patients in the real-life setting: the PROSISA Study. J Intern Med 2021; 290:116-128. [PMID: 33259671 PMCID: PMC8359216 DOI: 10.1111/joim.13219] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/14/2020] [Accepted: 11/05/2020] [Indexed: 12/31/2022]
Abstract
AIM Statin-associated muscle symptoms (SAMS) are a major determinant of poor treatment adherence and/or discontinuation, but a definitive diagnosis of SAMS is challenging. The PROSISA study was an observational retrospective study aimed to assess the prevalence of reported SAMS in a cohort of dyslipidaemic patients. METHODS Demographic/anamnestic data, biochemical values and occurrence of SAMS were collected by 23 Italian Lipid Clinics. Adjusted logistic regression was performed to estimate odds ratio (OR) and 95% confidence intervals for association between probability of reporting SAMS and several factors. RESULTS Analyses were carried out on 16 717 statin-treated patients (mean ± SD, age 60.5 ± 12.0 years; 52.1% men). During statin therapy, 9.6% (N = 1599) of patients reported SAMS. Women and physically active subjects were more likely to report SAMS (OR 1.23 [1.10-1.37] and OR 1.35 [1.14-1.60], respectively), whist age ≥ 65 (OR 0.79 [0.70-0.89]), presence of type 2 diabetes mellitus (OR 0.62 [0.51-0.74]), use of concomitant nonstatin lipid-lowering drugs (OR 0.87 [0.76-0.99]), use of high-intensity statins (OR 0.79 [0.69-0.90]) and use of potential interacting drugs (OR 0.63 [0.48-0.84]) were associated with lower probability of reporting SAMS. Amongst patients reporting SAMS, 82.2% underwent dechallenge (treatment interruption) and/or rechallenge (change or restart of statin therapy), with reappearance of muscular symptoms in 38.4% (3.01% of the whole cohort). CONCLUSIONS The reported prevalence of SAMS was 9.6% of the whole PROSISA cohort, but only a third of patients still reported SAMS after dechallenge/rechallenge. These results emphasize the need for a better management of SAMS to implement a more accurate diagnosis and treatment re-evaluation.
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Affiliation(s)
- M Casula
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy.,IRCCS MultiMedica, Milan, Italy
| | - M Gazzotti
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - F Bonaiti
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - E OImastroni
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - M Arca
- Department of Translational and Precision Medicine, Unit of Internal Medicine and Metabolic Diseases, Sapienza University, Rome, Italy
| | - M Averna
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities, University of Palermo, Palermo, Italy
| | - A Zambon
- IRCCS MultiMedica, Milan, Italy.,Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - A L Catapano
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy.,IRCCS MultiMedica, Milan, Italy
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Statins, toxicity, and their adverse effects via oxidative imbalance. Toxicology 2021. [DOI: 10.1016/b978-0-12-819092-0.00026-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kaur H, Singh J, Kashyap JR, Rohilla R, Singh H, Jaswal S, Kumar R. Relationship Between Statin-associated Muscle Symptoms, Serum Vitamin D and Low-density Lipoprotein Cholesterol - A Cross-sectional Study. EUROPEAN ENDOCRINOLOGY 2020; 16:137-142. [PMID: 33117445 DOI: 10.17925/ee.2020.16.2.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/23/2020] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Statin-associated muscle symptoms (SAMS) can lead to medication non-adherence among statin users. There is a complex relationship between SAMS, vitamin D and low-density lipoprotein cholesterol (LDL-C). The objective of this study was to evaluate the relationship between vitamin D, LDL-C and occurrence of SAMS. METHODS This was a cross-sectional study in patients using statins. Thorough patient histories were taken, a clinical examination was conducted and SAMS were recorded. Levels of vitamin D, creatine phosphokinase (CPK) and LDL-C were measured. These parameters were compared amongst statin users with SAMS and those without SAMS. Levels of vitamin D and LDL-C were converted into percentiles and their relationship with SAMS was evaluated in terms of odds ratio. Receiver operating characteristics (ROC) were drawn, taking vitamin D and LDL-C as predictors of SAMS. RESULTS A total of 121 statin users were enrolled in this study. Thirty-eight patients (31.4%) presented with SAMS. Significantly lower levels of serum vitamin D were observed amongst statin users with SAMS compared with those without SAMS (19.8 ± 9.67 ng/mL versus 25.0 ± 14.6 ng/mL; 95% confidence interval -10.4 to -0.07; p=0.04). With vitamin D levels less than or equal to 5th, 10th and 25th percentile, the chances of occurrence of SAMS were significantly higher, but not at the 50th percentile (corresponding vitamin D level of 20.21 ng/mL). LDL-C did not show any conclusive relationship with SAMS. ROC curves showed a significant discrimination for vitamin D levels, but not for LDL-C. CONCLUSION Statin users with low levels of vitamin D are at increased risk of developing SAMS. However, LDL-C status of statin users failed to predict any meaningful association with SAMS. Given the small sample size of this study, these results should be regarded as preliminary.
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Affiliation(s)
- Harsheen Kaur
- MBBS Student, Government Medical College and Hospital, Chandigarh, India
| | - Jagjit Singh
- Department of Pharmacology, Government Medical College and Hospital, Chandigarh, India
| | - Jeet Ram Kashyap
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Ravi Rohilla
- Department of Community Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Harmanjit Singh
- Department of Pharmacology, Government Medical College and Hospital, Chandigarh, India
| | - Shivani Jaswal
- Department of Biochemistry, Government Medical College and Hospital, Chandigarh, India
| | - Rajiv Kumar
- Department of Pharmacology, Government Medical College and Hospital, Chandigarh, India
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Mulchandani R, Lyngdoh T, Chakraborty P, Kakkar AK. Satisfaction With Statin Treatment Among Adult Coronary Artery Disease Patients: An Experience From a Resource-Constrained Setting. Heart Lung Circ 2018; 28:1788-1794. [PMID: 30704841 DOI: 10.1016/j.hlc.2018.10.024] [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: 01/22/2018] [Revised: 10/09/2018] [Accepted: 10/25/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Statins are the most widely prescribed hypolipidaemic drugs for coronary artery disease (CAD) patients, but have been found to cause muscle and nerve related adverse effects which can affect patient satisfaction with treatment. Literature on treatment satisfaction among statin users, especially from resource-limited settings is inadequate. The aim of this cross-sectional study was to assess the level of satisfaction with treatment among statin users and evaluate the relationship between adverse effects experienced by patients and their satisfaction with the medication. METHODS This study included 300 adult CAD patients visiting the cardiology department of a tertiary care hospital in the northern region of India, who were prescribed statins for their diagnoses. An interviewer administered, validated and standardised Treatment Satisfaction Questionnaire for Medication (version 1.4) was used for data collection. RESULTS Around three quarters of the population reported being overall satisfied with their medication. Mean scores were calculated for Effectiveness, Convenience, Side-Effects and Global Satisfaction. The patients reported high scores (above 60%) for all domains. Those experiencing any adverse effect were found to be more likely to report lower effectiveness. Additionally, medication effectiveness showed a positive correlation with overall treatment satisfaction. CONCLUSIONS The study shows that treatment satisfaction is critical to gauge patient experiences with the treatment which can impact medication adherence and compliance. It's a crucial measure especially among CAD and other chronic disease patients since greater satisfaction can improve clinical outcomes. More research is warranted to better understand the relationship between medication effectiveness and treatment satisfaction.
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Affiliation(s)
| | | | - Praloy Chakraborty
- Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ashish Kumar Kakkar
- Department of Pharmacology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
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Perianesthetic Implications and Considerations for Myasthenia Gravis. J Perianesth Nurs 2018; 34:4-15. [PMID: 29980408 DOI: 10.1016/j.jopan.2018.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 03/25/2018] [Accepted: 03/30/2018] [Indexed: 11/21/2022]
Abstract
Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disease in which antibodies against the post-nicotinic acetylcholine receptor at the neuromuscular junction develop. Although the exact cause of MG remains unknown, the thymus is a common factor in many cases. Patients with underlying junctional disease, such as MG, have greater anesthesia-related risks because of their known predisposition toward prolonged muscle weakness. Medications given in the perioperative period, such as anesthetic agents, antibiotics, cardiovascular drugs, and corticosteroids, affect neuromuscular transmission that contributes to muscle weakness. Judicious use of neuromuscular blocking agents for patients with MG must be considered. This patient population is at high risk for respiratory failure, and therefore must be carefully assessed throughout the perioperative period to ensure that a regular spontaneous respiratory pattern is sufficient to provide adequate oxygenation. Perianesthesia providers must consider anesthetic, ventilatory, and pharmacologic implications when proposing, providing, and recovering anesthesia for the patient with MG.
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