1
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Yousefzadeh M, Khosrobeigi A, Salehi A. Studying the efficacy of low-dose colchicine on clinical outcomes of patients with STEMI: a randomized controlled trial. Egypt Heart J 2024; 76:85. [PMID: 38969838 PMCID: PMC11229522 DOI: 10.1186/s43044-024-00515-0] [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: 02/21/2024] [Accepted: 06/29/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Numerous studies have underscored the essential role of inflammation across all stages of atherosclerosis. While various anti-inflammatory interventions have been implemented to mitigate inflammation-induced injuries, outcomes have been conflicting. Given the essential role of inflammation in these patients and limited data regarding the efficacy of low-dose Colchicine as an anti-inflammatory drug, we aimed to study the efficacy of low-dose Colchicine on clinical outcomes of patients with STEMI in Iran. RESULTS Participants presented with STEMI and qualified revascularization at Shahid Beheshti Hospital in Qom during 2022 and 2023 were included into the study. This study included 172 STEMI patients (114 males and 58 females) within the mean age of 58.93 ± 7.79. Results indicate that colchicine (2 mg for loading dose and 0.5 mg daily for 30 days) and placebo group were not significant differences in identical profiles regarding age and gender. Analyses revealed no significant differences in clinical outcome after the 40-day follow-up period. CONCLUSIONS This study revealed that the addition of colchicine did not yield a significant benefit in enhancing the outcomes of patients with STEMI. CLINICAL TRIAL REGISTRATION This study was prospectively registered on Iranian registry of clinical trials, with registration number (IRCT20231001059578N1).
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Affiliation(s)
- Mojtaba Yousefzadeh
- Cardiology Research Department, Qom University of Medical Sciences, Qom, Iran
| | - Ali Khosrobeigi
- Cardiology Research Department, Qom University of Medical Sciences, Qom, Iran.
| | - Ayoub Salehi
- Cardiology Research Department, Qom University of Medical Sciences, Qom, Iran
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2
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Ravangard R, Ghanbari M, Attar A, Jafari A. Polypill versus medication monotherapy in the prevention of cardiovascular diseases in Iran: An economic evaluation study. Health Sci Rep 2024; 7:e2240. [PMID: 38974330 PMCID: PMC11225077 DOI: 10.1002/hsr2.2240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 05/29/2024] [Accepted: 05/31/2024] [Indexed: 07/09/2024] Open
Abstract
Background and Aims Cardiovascular diseases (CVDs) are one of the major diseases in developing and developed countries and have high prevalence and mortality rates. Pharmacological interventions, especially the use of combination medications, can have preventive effects in patients with CVDs. Recently, in the PolyIran trial, a combination of atorvastatin, hydrochlorothiazide, aspirin, and valsartan or enalapril (Polypill) was shown to be effective in providing survival benefits as a primary prevention strategy. In the present study, we examine the cost-effectiveness of the use of polypill compared to its individual components (named as medication monotherapy) in the prevention of CVDs in Iran. Methods This was an economic evaluation study conducted to compare the cost-utility of polypill with that of medication monotherapy for 10,000 hypothetical cohorts of people over 35 years of age using the Markov model and with a lifetime horizon. The study perspective was patient perspective and direct medical costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio were estimated. To deal with uncertaintysensitivity analyses were used. Results The results showed that polypill, with the lowest costs (871 USD) and highest QALYs (14.55), had the most cost-utility than medication monotherapy. Also, the results showed that the highest sensitivities were related to the utilities of angina and stroke states. At the 21,768 USD threshold, polypill had a 92% probability of being cost-effective versus other medications. Conclusion Considering that polypill had the most cost-utility, it is suggested that health system policymakers pay special attention to polypill in designing clinical guidelines. Also, through covering this medication by health insurance organizations, it is possible to complete the country's medicine pharmacopeia in preventing CVDs.
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Affiliation(s)
- Ramin Ravangard
- Health Human Resources Research Center, School of Management and Medical Information SciencesShiraz University of Medical SciencesShirazIran
| | - Mohadese Ghanbari
- School of Management and Medical Information Sciences, Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Armin Attar
- Department of Cardiovascular Medicine, TAHA clinical trial groupShiraz University of Medical SciencesShirazIran
| | - Abdosaleh Jafari
- Health Human Resources Research Center, School of Management and Medical Information SciencesShiraz University of Medical SciencesShirazIran
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3
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Altamura S, Del Pinto R, Pietropaoli D, Ferri C. Oral health as a modifiable risk factor for cardiovascular diseases. Trends Cardiovasc Med 2024; 34:267-275. [PMID: 36963476 PMCID: PMC10517086 DOI: 10.1016/j.tcm.2023.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/16/2023] [Accepted: 03/16/2023] [Indexed: 03/26/2023]
Abstract
Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality worldwide with a high socioeconomic burden. Increasing evidence supports a convincing connection with increased cardiovascular risk of periodontal diseases (PD), a group of widespread, debilitating, and costly dysbiotic relapsing-remitting inflammatory diseases of the tissues supporting the teeth. Herein, we ensembled the best available evidence on the connection between CVDs and PD to review the recently emerging concept of the latter as a non-traditional risk factor for CVDs. We focused on oral dysbiosis, inflammation-associated molecular and cellular mechanisms, and epigenetic changes as potential causative links between PD and CVDs. The available evidence on the effects of periodontal treatment on cardiovascular risk factors and diseases was also described.
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Affiliation(s)
- Serena Altamura
- Department of Life, Health & Environmental Sciences, University of L'Aquila, Italy; Center of Oral Diseases, Prevention and Translational Research - Dental Clinic, L'Aquila, Italy; Oral Diseases and Systemic Interactions Study Group (ODISSY Group), L'Aquila, Italy; PhD School in Medicine and Public Health
| | - Rita Del Pinto
- Department of Life, Health & Environmental Sciences, University of L'Aquila, Italy; Oral Diseases and Systemic Interactions Study Group (ODISSY Group), L'Aquila, Italy; Unit of Internal Medicine and Nephrology, Center for Hypertension and Cardiovascular Prevention, San Salvatore Hospital, L'Aquila, Italy
| | - Davide Pietropaoli
- Department of Life, Health & Environmental Sciences, University of L'Aquila, Italy; Center of Oral Diseases, Prevention and Translational Research - Dental Clinic, L'Aquila, Italy; Oral Diseases and Systemic Interactions Study Group (ODISSY Group), L'Aquila, Italy.
| | - Claudio Ferri
- Department of Life, Health & Environmental Sciences, University of L'Aquila, Italy; Oral Diseases and Systemic Interactions Study Group (ODISSY Group), L'Aquila, Italy; Unit of Internal Medicine and Nephrology, Center for Hypertension and Cardiovascular Prevention, San Salvatore Hospital, L'Aquila, Italy
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4
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Banco D, Mustehsan M, Shah B. Update on the Role of Colchicine in Cardiovascular Disease. Curr Cardiol Rep 2024; 26:191-198. [PMID: 38340273 DOI: 10.1007/s11886-024-02026-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE OF REVIEW This review focuses on the use of colchicine to target inflammation to prevent cardiovascular events among those at-risk for or with established coronary artery disease. RECENT FINDINGS Colchicine is an anti-inflammatory drug that reduces cardiovascular events through its effect on the IL-1β/IL-6/CRP pathway, which promotes the progression and rupture of atherosclerotic plaques. Clinical trials have demonstrated that colchicine reduces cardiovascular events by 31% among those with chronic coronary disease, and by 23% among those with recent myocardial infarction. Its ability to dampen inflammation during an acute injury may broaden its scope of use in patients at risk for cardiovascular events after major non-cardiac surgery. Colchicine is an effective anti-inflammatory therapy in the prevention of acute coronary syndrome. Ongoing studies aim to assess when, and in whom, colchicine is most effective to prevent cardiovascular events in patients at-risk for or with established coronary artery disease.
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Affiliation(s)
- Darcy Banco
- Leon H Charney Division of Cardiology, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Mohammad Mustehsan
- Leon H Charney Division of Cardiology, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Binita Shah
- Leon H Charney Division of Cardiology, NYU Grossman School of Medicine, New York, NY, 10016, USA.
- VA New York Harbor Healthcare System, 423 E 23rd Street, Office 12023-W, New York, NY, 10010, USA.
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5
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Kidder E, Gangopadhyay S, Francis S, Alfaidi M. "How to Release or Not Release, That Is the Question." A Review of Interleukin-1 Cellular Release Mechanisms in Vascular Inflammation. J Am Heart Assoc 2024; 13:e032987. [PMID: 38390810 PMCID: PMC10944040 DOI: 10.1161/jaha.123.032987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/26/2024] [Indexed: 02/24/2024]
Abstract
Cardiovascular disease remains the leading cause of death worldwide, characterized by atherosclerotic activity within large and medium-sized arteries. Inflammation has been shown to be a primary driver of atherosclerotic plaque formation, with interleukin-1 (IL-1) having a principal role. This review focuses on the current state of knowledge of molecular mechanisms of IL-1 release from cells in atherosclerotic plaques. A more in-depth understanding of the process of IL-1's release into the vascular environment is necessary for the treatment of inflammatory disease processes, as the current selection of medicines being used primarily target IL-1 after it has been released. IL-1 is secreted by several heterogenous mechanisms, some of which are cell type-specific and could provide further specialized targets for therapeutic intervention. A major unmet challenge is to understand the mechanism before and leading to IL-1 release, especially by cells in atherosclerotic plaques, including endothelial cells, vascular smooth muscle cells, and macrophages. Data so far indicate a heterogeneity of IL-1 release mechanisms that vary according to cell type and are stimulus-dependent. Unraveling this complexity may reveal new targets to block excess vascular inflammation.
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Affiliation(s)
- Evan Kidder
- Division of Cardiology, Department of Internal MedicineLouisiana State University Health Sciences CentreShreveportLAUSA
| | - Siddhartha Gangopadhyay
- Division of Cardiology, Department of Internal MedicineLouisiana State University Health Sciences CentreShreveportLAUSA
| | - Sheila Francis
- School of Medicine and Population HealthUniversity of SheffieldSheffieldUK
| | - Mabruka Alfaidi
- Division of Cardiology, Department of Internal MedicineLouisiana State University Health Sciences CentreShreveportLAUSA
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6
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Maidana D, Arroyo-Álvarez A, Arenas-Loriente A, Barreres-Martín G, Muñoz-Alfonso C, Bompart Berroteran D, Esteve Claramunt F, Blanco del Burgo R, Cepas-Guillén P, Garcia-Blas S, Bonanad C. Inflammation as a New Therapeutic Target among Older Patients with Ischemic Heart Disease. J Clin Med 2024; 13:363. [PMID: 38256497 PMCID: PMC10816645 DOI: 10.3390/jcm13020363] [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: 12/17/2023] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
Cardiovascular (CV) diseases remain a global health challenge, with ischemic heart disease (IHD) being the primary cause of both morbidity and mortality. Despite optimal pharmacological therapy, older patients with IHD exhibit an increased susceptibility to recurrent ischemic events, significantly impacting their prognosis. Inflammation is intricately linked with the aging process and plays a pivotal role in the evolution of atherosclerosis. Emerging anti-inflammatory therapies have shown promise in reducing ischemic events among high-risk populations. This review aims to explore the potential of targeted anti-inflammatory interventions in improving clinical outcomes and the quality of life for older patients with IHD.
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Affiliation(s)
- Daniela Maidana
- INCLIVA—Instituto de Investigación Sanitaria, Biomedical Research Institute, 46010 Valencia, Spain (F.E.C.)
| | - Andrea Arroyo-Álvarez
- INCLIVA—Instituto de Investigación Sanitaria, Biomedical Research Institute, 46010 Valencia, Spain (F.E.C.)
| | | | - Guillermo Barreres-Martín
- INCLIVA—Instituto de Investigación Sanitaria, Biomedical Research Institute, 46010 Valencia, Spain (F.E.C.)
| | - Carles Muñoz-Alfonso
- INCLIVA—Instituto de Investigación Sanitaria, Biomedical Research Institute, 46010 Valencia, Spain (F.E.C.)
| | - Daznia Bompart Berroteran
- INCLIVA—Instituto de Investigación Sanitaria, Biomedical Research Institute, 46010 Valencia, Spain (F.E.C.)
| | - Francisca Esteve Claramunt
- INCLIVA—Instituto de Investigación Sanitaria, Biomedical Research Institute, 46010 Valencia, Spain (F.E.C.)
| | - Regina Blanco del Burgo
- INCLIVA—Instituto de Investigación Sanitaria, Biomedical Research Institute, 46010 Valencia, Spain (F.E.C.)
| | | | - Sergio Garcia-Blas
- INCLIVA—Instituto de Investigación Sanitaria, Biomedical Research Institute, 46010 Valencia, Spain (F.E.C.)
- Cardiology Department, Clinic University Hospital of Valencia, 46026 Valencia, Spain
| | - Clara Bonanad
- INCLIVA—Instituto de Investigación Sanitaria, Biomedical Research Institute, 46010 Valencia, Spain (F.E.C.)
- Cardiology Department, Clinic University Hospital of Valencia, 46026 Valencia, Spain
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7
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Gera P, Wasserstein DH, Frishman WH, Aronow WS. Low-Dose Colchicine for the Prevention of Cardiovascular Events After Acute Coronary Syndrome. Cardiol Rev 2024:00045415-990000000-00190. [PMID: 38189365 DOI: 10.1097/crd.0000000000000650] [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: 01/09/2024]
Abstract
Colchicine, an established anti-inflammatory drug, is examined for its potential in mitigating adverse cardiovascular events following acute coronary syndrome (ACS). ACS, primarily triggered by plaque rupture and subsequent thrombosis, is a critical cardiovascular condition. Colchicine's mechanism of action involves inhibiting microtubule activity, leading to immobilization of white blood cells and reducing inflammation. Clinical data from studies, including low-dose colchicine for secondary prevention of cardiovascular disease two and colchicine cardiovascular outcomes trial, support its efficacy in reducing major cardiovascular events post-ACS, though some studies report varying results. Colchicine can cause transient gastrointestinal side effects and is prescribed with caution in patients with certain medical conditions. The recent FDA approval of a low dose of colchicine reiterates its benefit in reducing cardiovascular risk. The cost-effectiveness of colchicine products (0.5 and 0.6 mg doses) are compared, suggesting the generic 0.6 mg dose of colchicine to be an alternative to branded forms of the drug.
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Affiliation(s)
- Priyanka Gera
- From the Westchester Medical Center, New York Medical College, Valhalla, NY
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8
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van der Pol KH, Aljofan M, Blin O, Cornel JH, Rongen GA, Woestelandt AG, Spedding M. Drug Repurposing of Generic Drugs: Challenges and the Potential Role for Government. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:831-840. [PMID: 37398987 PMCID: PMC10627937 DOI: 10.1007/s40258-023-00816-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 07/04/2023]
Abstract
Drug repurposing is the process of identifying a new use for an existing drug or active substance in an indication outside the scope of the original indication. Drug repurposing has important advantages including reduced development time and costs, and potentially large societal healthcare cost savings. However, current generic drug repurposing research faces a number of challenges in obtaining research funds. Furthermore, regardless of the success of a repurposing trial, commercial parties often lack interest in pursuing marketing authorisation for financial reasons, and academic researchers lack the knowledge, time and funding. Therefore, the new indication of a repurposed drug often does not make it 'on label'. We propose a large increase in public funding for generic drug repurposing research, including funds for the marketing authorisation process when a trial is successful, and a reduction in the regulatory burden of the marketing authorisation process for repurposed generic drugs.
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Affiliation(s)
- Karel H van der Pol
- Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mohamad Aljofan
- Department of Biomedical Science, Nazarbayev University School of Medicine, Nur-Sultan, Kazakhstan
- National Laboratory Astana, Nazarbayev University, Astana, 010000, Kazakhstan
| | - Olivier Blin
- Institut de Neurosciences des Systèmes, Aix Marseille Université, Inserm UMR 1106, Marseille, France
| | - Jan H Cornel
- Department of Cardiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands
| | - Gerard A Rongen
- Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
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9
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Zhan Y, Yue H, Zhao X, Tang J, Wu Z. Colchicine in atrial fibrillation: are old trees in bloom? Front Physiol 2023; 14:1260774. [PMID: 37916222 PMCID: PMC10616799 DOI: 10.3389/fphys.2023.1260774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/26/2023] [Indexed: 11/03/2023] Open
Abstract
Colchicine is a widely used drug that was originally used to treat gout and rheumatic diseases. In recent years, colchicine has shown high potential in the cardiovascular field. Atrial fibrillation (AF) is a cardiovascular disease with a high incidence. One of the most frequent complications following cardiovascular surgery is postoperative atrial fibrillation (POAF), which affects patient health and disease burden. This article reviews the research status of colchicine in AF and summarizes the relevant progress.
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Affiliation(s)
- Yujia Zhan
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Honghua Yue
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xueshan Zhao
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Juan Tang
- Acupuncture and Moxibustion School of Teaching, Hospital of Chengdu, University of Traditional Chinese Medicine, Tianjin, China
- Key Laboratory of Emergency and Trauma, Ministry of Education, Hainan Medical University, Haikou, China
| | - Zhong Wu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
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10
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Nelson K, Fuster V, Ridker PM. Low-Dose Colchicine for Secondary Prevention of Coronary Artery Disease: JACC Review Topic of the Week. J Am Coll Cardiol 2023; 82:648-660. [PMID: 37558377 DOI: 10.1016/j.jacc.2023.05.055] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/09/2023] [Indexed: 08/11/2023]
Abstract
Among statin-treated patients, inflammation assessed by means of high-sensitivity C-reactive protein (hsCRP) is a more powerful determinant of cardiovascular death and all-cause mortality than low-density-lipoprotein cholesterol (LDL-C). Several therapies that target residual inflammatory risk significantly reduce vascular event rates. For coronary artery disease patients already taking guideline-directed medical care, including statins, low-dose colchicine (0.5 mg/d orally) has been shown to safely lower major adverse cardiovascular events by 31% among those with stable atherosclerosis and by 23% after recent myocardial infarction. These magnitudes of benefit are larger than those seen in contemporary secondary prevention trials of adjunctive lipid-lowering agents. Low-dose colchicine is contraindicated in patients with significant renal or liver dysfunction and should be temporarily discontinued when taking concomitant agents such as clarithromycin, ketoconazole, and cyclosporine that share metabolism pathways. Lipid lowering and inflammation inhibition are not in conflict but are synergistic. In the future, combined use of aggressive LDL-C-lowering and inflammation-inhibiting therapies may become standard of care for most atherosclerosis patients. In June 2023, the U.S. Food and Drug Administration approved the use of low-dose colchicine to reduce the risk of myocardial infarction, stroke, coronary revascularization, and cardiovascular death in adult patients with established atherosclerotic disease or with multiple risk factors for cardiovascular disease.
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Affiliation(s)
- Kyle Nelson
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, New York, USA
| | - Valentin Fuster
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, New York, USA; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Paul M Ridker
- Center for Cardiovascular Disease Prevention, Divisions of Preventive Medicine and Cardiovascular Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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11
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Klement M, Drexel H, Saely CH. Impact of ezetimibe on markers of inflammation in patients treated with statins: a systematic review. Inflammopharmacology 2023:10.1007/s10787-023-01209-w. [PMID: 37261626 DOI: 10.1007/s10787-023-01209-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/22/2023] [Indexed: 06/02/2023]
Abstract
Statins are the primary pharmacological intervention to reduce LDL cholesterol; they significantly reduce inflammatory markers. Ezetimibe also reduces LDL cholesterol and reduces cardiovascular events when given on top of statin therapy. Whether ezetimibe, like statins, reduces markers of inflammation is less clear. We, therefore, conducted a systematic literature research addressing the impact of ezetimibe on CRP, TNFα and IL-6 when given on top of statin therapy. Our work indicates that overall ezetimibe reduces inflammation on top of statin treatment. However, available data are limited for CRP and even more so for TNFα and IL-6.
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Affiliation(s)
- Margaretha Klement
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Heinz Drexel
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, 6800, Feldkirch, Austria
- Department of Medicine, Academic Teaching Hospital Bregenz, Bregenz, Austria
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Christoph H Saely
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein.
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, 6800, Feldkirch, Austria.
- Department of Medicine, Academic Teaching Hospital Bregenz, Bregenz, Austria.
- Department of Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Austria.
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12
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Hann SY, Cui H, Esworthy T, Zhang LG. 4D Thermo-Responsive Smart hiPSC-CM Cardiac Construct for Myocardial Cell Therapy. Int J Nanomedicine 2023; 18:1809-1821. [PMID: 37051312 PMCID: PMC10083182 DOI: 10.2147/ijn.s402855] [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: 12/27/2022] [Accepted: 04/01/2023] [Indexed: 04/08/2023] Open
Abstract
Purpose 4D fabrication techniques have been utilized for advanced biomedical therapeutics due to their ability to create dynamic constructs that can transform into desired shapes on demand. The internal structure of the human cardiovascular system is complex, where the contracting heart has a highly curved surface that changes shape with the heart's dynamic beating motion. Hence, 4D architectures that adjust their shapes as required are a good candidate to readily deliver cardiac cells into the damaged heart and/or to serve as self-morphing tissue scaffolds/patches for healing cardiac diseases. In this proof-of-concept in vitro study, a two-in-one 4D smart cardiac construct that integrates the functions of minimally invasive cell vehicles and in situ tissue patches was developed for repairing damaged myocardial tissue. Methods For this purpose, a series of thermo-responsive 4D structures with different shapes and sizes were fabricated via the combination of fused deposition modeling (FDM)-printing and stamping molding. The thermo-responsive 4D constructs were firstly optimized to exhibit their shape transformation behavior at the designated temperature for convenient control. After which, the mechanical properties, shape recovery rate, and shape recovery speed of the 4D constructs at different temperatures were thoroughly evaluated. Also, the proliferation and functional prototype of human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) on the 4D constructs were quantified and evaluated using F-actin staining and immunostaining. Results Our results showed that the 4D constructs possessed the desirable capability of shape-changing from spherical carriers to unfolded patches at human body temperature and exhibited excellent biocompatibility. Moreover, myocardial maturation in vitro with a uniform and printing pattern-specific cell distribution was observed on the surface of the unfolded 4D constructs. Conclusion We successfully developed a 4D smart cardiac construct that integrates the functions of minimally invasive cell vehicles and in situ tissue patches for repairing damaged myocardial tissue.
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Affiliation(s)
- Sung Yun Hann
- Department of Mechanical and Aerospace Engineering, The George Washington University, Washington, DC, 20052, USA
| | - Haitao Cui
- Department of Mechanical and Aerospace Engineering, The George Washington University, Washington, DC, 20052, USA
| | - Timothy Esworthy
- Department of Mechanical and Aerospace Engineering, The George Washington University, Washington, DC, 20052, USA
| | - Lijie Grace Zhang
- Department of Mechanical and Aerospace Engineering, The George Washington University, Washington, DC, 20052, USA
- Department of Electrical and Computer Engineering, The George Washington University, Washington, DC, 20052, USA
- Department of Biomedical Engineering, The George Washington University, Washington, DC, 20052, USA
- Department of Medicine, The George Washington University, Washington, DC, 20052, USA
- Correspondence: Lijie Grace Zhang, Department of Mechanical and Aerospace Engineering, The George Washington University, Science and Engineering Hall 3590, 800 22nd Street NW, Washington, DC, 20052, USA, Tel +1 202 994 2479, Fax +1 202 994 0238, Email
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13
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Khiali S, Agabalazadeh A, Sahrai H, Bannazadeh Baghi H, Rahbari Banaeian G, Entezari-Maleki T. Effect of Caffeine Consumption on Cardiovascular Disease: An Updated Review. Pharmaceut Med 2023; 37:139-151. [PMID: 36995515 DOI: 10.1007/s40290-023-00466-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 03/31/2023]
Abstract
The incidence of cardiovascular diseases has significantly increased with the expansion of the industrialization of societies, which is notably linked to lifestyle changes and an unhealthy diet. Hence, determining the healthiest diet habits and supplements seems to be an appropriate way to decrease the global burden of cardiovascular diseases. Currently, caffeine, one of the most widely consumed compounds in the world, has emerged with some promising results in the treatment of numerous pathophysiological conditions of cardiovascular diseases. A literature search was conducted in PubMed, Scopus, Science Direct, Google Scholar, and Web of Science databases for the relevant articles regarding the pharmacology, preclinical, and clinical studies on the potential effects of caffeine on cardiovascular diseases. While caffeine could improve cardiovascular outcomes through several mechanisms of action, the literature review revealed controversial clinical effects of caffeine on blood pressure, cardiac arrhythmias, acute coronary syndrome, stable angina, and heart failure. In the case of dyslipidemia, coffee consumption increased total cholesterol, triglyceride, and low-density lipoprotein. Taken together, the existence of multiple confounding factors in the caffeine studies has resulted in inconclusive data interpretation. Further well-designed studies with adequate control of the confounding factors are warranted to draw a clear conclusion on the cardiovascular efficacy and safety of caffeine.
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Affiliation(s)
- Sajad Khiali
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Daneshgah St, Tabriz, Iran
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amin Agabalazadeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Daneshgah St, Tabriz, Iran
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Sahrai
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Bannazadeh Baghi
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Gholamreza Rahbari Banaeian
- Department of Pediatrics, Faculty of Medicine, Tabriz Medical Sciences, Islamic Azad University, Tabriz, Iran
| | - Taher Entezari-Maleki
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Daneshgah St, Tabriz, Iran.
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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14
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Tardif JC, Samuel M. Inflammation contributes to cardiovascular risk in patients receiving statin therapy. Lancet 2023; 401:1245-1247. [PMID: 36893776 DOI: 10.1016/s0140-6736(23)00454-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/23/2023] [Indexed: 03/08/2023]
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15
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Torp MK, Vaage J, Stensløkken KO. Mitochondria-derived damage-associated molecular patterns and inflammation in the ischemic-reperfused heart. Acta Physiol (Oxf) 2023; 237:e13920. [PMID: 36617670 DOI: 10.1111/apha.13920] [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: 07/08/2022] [Revised: 10/01/2022] [Accepted: 01/02/2023] [Indexed: 01/10/2023]
Abstract
Cardiac cell death after myocardial infarction release endogenous structures termed damage-associated molecular patterns (DAMPs) that trigger the innate immune system and initiate a sterile inflammation in the myocardium. Cardiomyocytes are energy demanding cells and 30% of their volume are mitochondria. Mitochondria are evolutionary endosymbionts originating from bacteria containing molecular patterns similar to bacteria, termed mitochondrial DAMPs (mDAMPs). Consequently, mitochondrial debris may be particularly immunogenic and damaging. However, the role of mDAMPs in myocardial infarction is not clarified. Identifying the most harmful mDAMPs and inhibiting their early inflammatory signaling may reduce infarct size and the risk of developing post-infarct heart failure. The focus of this review is the role of mDAMPs in the immediate pro-inflammatory phase after myocardial infarction before arrival of immune cells in the myocardium. We discuss different mDAMPs, their role in physiology and present knowledge regarding their role in the inflammatory response of acute myocardial infarction.
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Affiliation(s)
- May-Kristin Torp
- Division of Physiology, Department of Molecular Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Jarle Vaage
- Division of Physiology, Department of Molecular Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Kåre-Olav Stensløkken
- Division of Physiology, Department of Molecular Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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16
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Untargeted Metabolomics Based Prediction of Therapeutic Potential for Apigenin and Chrysin. Int J Mol Sci 2023; 24:ijms24044066. [PMID: 36835484 PMCID: PMC9967419 DOI: 10.3390/ijms24044066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/05/2023] [Accepted: 02/10/2023] [Indexed: 02/22/2023] Open
Abstract
The prominent flavonoids apigenin and chrysin have been demonstrated to have systemic benefits. Our previous work was first to establish the impact of apigenin and chrysin on cellular transcriptome. In the current study, we have revealed the ability of apigenin and chrysin to alter the cellular metabolome based on our untargeted metabolomics. Based on our metabolomics data, both these structurally related flavonoids demonstrate diverging and converging properties. Apigenin demonstrated the potential to possess anti-inflammatory and vasorelaxant properties through the upregulation of intermediate metabolites of alpha-linolenic acid and linoleic acid pathways. Chrysin, on the other hand, exhibited abilities to inhibit protein and pyrimidine synthesis along with downregulation of gluconeogenesis pathways based on the altered metabolites detected. Chrysin-mediated metabolite changes are mostly due to its ability to modulate L-alanine metabolism and the urea cycle. On the other hand, both the flavonoids also demonstrated converging properties. Apigenin and chrysin were able to downregulate metabolites involved in cholesterol biosynthesis and uric acid synthesis, namely 7-dehydrocholesterol and xanthosine, respectively. This work will provide understanding regarding the diverse therapeutic potential of these naturally occurring flavonoids and help us in curbing an array of metabolic complications.
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17
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Wang Y, Gao H, Wang F, Ye Z, Mokry M, Turner AW, Ye J, Koplev S, Luo L, Alsaigh T, Adkar SS, Elishaev M, Gao X, Maegdefessel L, Björkegren JLM, Pasterkamp G, Miller CL, Ross EG, Leeper NJ. Dynamic changes in chromatin accessibility are associated with the atherogenic transitioning of vascular smooth muscle cells. Cardiovasc Res 2022; 118:2792-2804. [PMID: 34849613 PMCID: PMC9586565 DOI: 10.1093/cvr/cvab347] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 11/18/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS De-differentiation and activation of pro-inflammatory pathways are key transitions vascular smooth muscle cells (SMCs) make during atherogenesis. Here, we explored the upstream regulators of this 'atherogenic transition'. METHODS AND RESULTS Genome-wide sequencing studies, including Assay for Transposase-Accessible Chromatin using sequencing and RNA-seq, were performed on cells isolated from both murine SMC-lineage-tracing models of atherosclerosis and human atherosclerotic lesions. At the bulk level, alterations in chromatin accessibility were associated with the atherogenic transitioning of lesional SMCs, especially in relation to genes that govern differentiation status and complement-dependent inflammation. Using computational biology, we observed that a transcription factor previously related to coronary artery disease, Activating transcription factor 3 (ATF3), was predicted to be an upstream regulator of genes altered during the transition. At the single-cell level, our results indicated that ATF3 is a key repressor of SMC transitioning towards the subset of cells that promote vascular inflammation by activating the complement cascade. The expression of ATF3 and complement component C3 was negatively correlated in SMCs from human atherosclerotic lesions, suggesting translational relevance. Phenome-wide association studies indicated that genetic variation that results in reduced expression of ATF3 is correlated with an increased risk for atherosclerosis, and the expression of ATF3 was significantly down-regulated in humans with advanced vascular disease. CONCLUSION Our study indicates that the plasticity of atherosclerotic SMCs may in part be explained by dynamic changes in their chromatin architecture, which in turn may contribute to their maladaptive response to inflammation-induced stress.
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Affiliation(s)
- Ying Wang
- Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, 300 Pasteur drive, Stanford, CA 94305, USA
- Stanford Cardiovascular Institute, Stanford University, 265 Campus Drive, Stanford, CA 94305, USA
| | - Hua Gao
- Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, 300 Pasteur drive, Stanford, CA 94305, USA
- Stanford Cardiovascular Institute, Stanford University, 265 Campus Drive, Stanford, CA 94305, USA
| | - Fudi Wang
- Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, 300 Pasteur drive, Stanford, CA 94305, USA
- Stanford Cardiovascular Institute, Stanford University, 265 Campus Drive, Stanford, CA 94305, USA
| | - Zhongde Ye
- Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, 300 Pasteur drive, Stanford, CA 94305, USA
- Stanford Cardiovascular Institute, Stanford University, 265 Campus Drive, Stanford, CA 94305, USA
| | - Michal Mokry
- Department of Cardiology and Laboratory of Clinical Chemistry, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, the Netherlands
| | - Adam W Turner
- Center for Public Health Genomics, Department of Public Health Sciences, University of Virginia, 1335 Lee St, Charlottesville, VA 22908, USA
| | - Jianqin Ye
- Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, 300 Pasteur drive, Stanford, CA 94305, USA
| | - Simon Koplev
- Cancer Research UK Cambridge Institute, University of Cambridge, Robinson Way, Cambridge CB2 0RE, UK
| | - Lingfeng Luo
- Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, 300 Pasteur drive, Stanford, CA 94305, USA
- Stanford Cardiovascular Institute, Stanford University, 265 Campus Drive, Stanford, CA 94305, USA
| | - Tom Alsaigh
- Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, 300 Pasteur drive, Stanford, CA 94305, USA
- Department of Cardiovascular Medicine, Stanford University School of Medicine, 870 Quarry Road Extension, Stanford, CA 94305, USA
| | - Shaunak S Adkar
- Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, 300 Pasteur drive, Stanford, CA 94305, USA
| | - Maria Elishaev
- Department of Pathology and Laboratory Medicine, Centre for Heart Lung Innvoation, University of British Columbia, 166-1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada
| | - Xiangyu Gao
- Department of Pathology and Laboratory Medicine, Centre for Heart Lung Innvoation, University of British Columbia, 166-1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada
| | - Lars Maegdefessel
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, and the German Center for Cardiovascular Research (DZHK partner site), Biedersteiner Str. 29, Munich 80802, Germany
- Department of Internal Medicine, Center for Molecular Medicine, Karolinska Institute, Visionsgatan 18, Stockholm 171 76, Sweden
| | - Johan L M Björkegren
- Department of Genetics and Genomic Sciences, Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, New York, NY 10029, USA
| | - Gerard Pasterkamp
- Department of Cardiology and Laboratory of Clinical Chemistry, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, the Netherlands
| | - Clint L Miller
- Center for Public Health Genomics, Department of Public Health Sciences, University of Virginia, 1335 Lee St, Charlottesville, VA 22908, USA
| | - Elsie G Ross
- Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, 300 Pasteur drive, Stanford, CA 94305, USA
- Stanford Cardiovascular Institute, Stanford University, 265 Campus Drive, Stanford, CA 94305, USA
| | - Nicholas J Leeper
- Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, 300 Pasteur drive, Stanford, CA 94305, USA
- Stanford Cardiovascular Institute, Stanford University, 265 Campus Drive, Stanford, CA 94305, USA
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18
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Liu Y, Zhang J, Zhang D, Yu P, Zhang J, Yu S. Research Progress on the Role of Pyroptosis in Myocardial Ischemia-Reperfusion Injury. Cells 2022; 11:cells11203271. [PMID: 36291138 PMCID: PMC9601171 DOI: 10.3390/cells11203271] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/21/2022] [Accepted: 09/29/2022] [Indexed: 11/16/2022] Open
Abstract
Myocardial ischemia-reperfusion injury (MIRI) results in the aggravation of myocardial injury caused by rapid recanalization of the ischemic myocardium. In the past few years, there is a growing interest in investigating the complex pathophysiological mechanism of MIRI for the identification of effective targets and drugs to alleviate MIRI. Currently, pyroptosis, a type of inflammatory programmed death, has received greater attention. It is involved in the MIRI development in combination with other mechanisms of MIRI, such as oxidative stress, calcium overload, necroptosis, and apoptosis, thereby forming an intertwined association between different pathways that affect MIRI by regulating common pathway molecules. This review describes the pyroptosis mechanism in MIRI and its relationship with other mechanisms, and also highlights non-coding RNAs and non-cardiomyocytes as regulators of cardiomyocyte pyroptosis by mediating associated pathways or proteins to participate in the initiation and development of MIRI. The research progress on novel small molecule drugs, clinical drugs, traditional Chinese medicine, etc. for regulating pyroptosis can play a crucial role in effective MIRI alleviation. When compared to research on other mature mechanisms, the research studies on pyroptosis in MIRI are inadequate. Although many related protective drugs have been identified, these drugs generally lack clinical applications. It is necessary to further explore and verify these drugs to expand their applications in clinical setting. Early inhibition of MIRI by targeted regulation of pyroptosis is a key concern that needs to be addressed in future studies.
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Affiliation(s)
- Yang Liu
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang 330000, China
- Key Laboratory of Anesthesiology of Jiangxi Province, Nanchang 330000, China
| | - Jing Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang 330000, China
- Key Laboratory of Anesthesiology of Jiangxi Province, Nanchang 330000, China
| | - Deju Zhang
- Food and Nutritional Sciences, School of Biological Sciences, The University of Hong Kong, Pokfulam Road, Hong Kong 999077, China
| | - Peng Yu
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang 330000, China
| | - Jun Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang 330000, China
- Key Laboratory of Anesthesiology of Jiangxi Province, Nanchang 330000, China
| | - Shuchun Yu
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang 330000, China
- Key Laboratory of Anesthesiology of Jiangxi Province, Nanchang 330000, China
- Correspondence:
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19
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Efficacy of Colchicine in the Treatment of Patients With Coronary Artery Disease: A Mini-Review. Clin Ther 2022; 44:1150-1159. [PMID: 35907660 DOI: 10.1016/j.clinthera.2022.06.009] [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: 01/26/2022] [Revised: 06/07/2022] [Accepted: 06/18/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE This review of colchicine, an effective anti-inflammatory agent, examines whether the reduction in ischemic events produced by colchicine translates to a reduction in mortality, the optimal duration of treatment, and the patient populations that benefits the most from colchicine treatment. METHODS We performed a comprehensive PubMed database search using the key words colchicine and coronary heart disease on August 23, 2021. We also screened the included reference list of manuscripts. FINDINGS Colchicine's role in the secondary prevention of coronary artery disease has been the focus of recent large-scale randomized controlled trials in chronic coronary syndrome (ie, the Low-Dose Colchicine and Low-Dose Colchicine 2 trials), acute myocardial infarction (the Colchicine Cardiovascular Outcomes Trial and Colchicine in Patients With Acute Coronary Syndrome trial), and after percutaneous coronary intervention (the Colchicine-Percutaneous Coronary Intervention trial). IMPLICATIONS Current evidence suggests that low-dose colchicine (0.5 mg once a day) reduces the risk of cardiovascular events among patients with acute myocardial infarction or chronic coronary syndrome. Colchicine has the potential to become a new standard therapy for the prevention of coronary artery disease-related atherothrombotic events because it is effective and cost-efficient and has a well-tolerated safety profile. (Clin Ther. 2022;XX:XXX-XXX) © 2022 Elsevier HS Journals, Inc.
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20
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Bicciato G, Arnold M, Gebhardt A, Katan M. Precision medicine in secondary prevention of ischemic stroke: how may blood-based biomarkers help in clinical routine? An expert opinion. Curr Opin Neurol 2022; 35:45-54. [PMID: 34839341 DOI: 10.1097/wco.0000000000001011] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW One in eight patients unfortunately suffers a new stroke within 5 years of their first stroke, even today. Research in precision medicine could lead to a more individualized treatment allocation, possibly achieving lower recurrence rates of ischemic stroke. In this narrative review, we aim to discuss potential clinical implementation of several promising candidate blood biomarkers. RECENT FINDINGS We discuss specifically some promising blood-based biomarkers, which may improve the identification of underlying causes as well as risk stratification of patients according to their specific cerebrovascular risk factor pattern. SUMMARY Multimodal profiling of ischemic stroke patients by means of blood biomarkers, in addition to established clinical and neuroradiological data, may allow in the future a refinement of decision algorithms for treatment allocation in secondary ischemic stroke prevention.
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Affiliation(s)
- Giulio Bicciato
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
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21
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Barbu E, Popescu MR, Popescu AC, Balanescu SM. Inflammation as A Precursor of Atherothrombosis, Diabetes and Early Vascular Aging. Int J Mol Sci 2022; 23:963. [PMID: 35055149 PMCID: PMC8778078 DOI: 10.3390/ijms23020963] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 02/07/2023] Open
Abstract
Vascular disease was for a long time considered a disease of the old age, but it is becoming increasingly clear that a cumulus of factors can cause early vascular aging (EVA). Inflammation plays a key role in vascular stiffening and also in other pathologies that induce vascular damage. There is a known and confirmed connection between inflammation and atherosclerosis. However, it has taken a long time to prove the beneficial effects of anti-inflammatory drugs on cardiovascular events. Diabetes can be both a product of inflammation and a cofactor implicated in the progression of vascular disease. When diabetes and inflammation are accompanied by obesity, this ominous trifecta leads to an increased incidence of atherothrombotic events. Research into earlier stages of vascular disease, and documentation of vulnerability to premature vascular disease, might be the key to success in preventing clinical events. Modulation of inflammation, combined with strict control of classical cardiovascular risk factors, seems to be the winning recipe. Identification of population subsets with a successful vascular aging (supernormal vascular aging-SUPERNOVA) pattern could also bring forth novel therapeutic interventions.
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Affiliation(s)
| | - Mihaela-Roxana Popescu
- Department of Cardiology, Elias Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, 011461 Bucharest, Romania; (E.B.); (S.-M.B.)
| | - Andreea-Catarina Popescu
- Department of Cardiology, Elias Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, 011461 Bucharest, Romania; (E.B.); (S.-M.B.)
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22
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Deftereos SG, Beerkens FJ, Shah B, Giannopoulos G, Vrachatis DA, Giotaki SG, Siasos G, Nicolas J, Arnott C, Patel S, Parsons M, Tardif JC, Kovacic JC, Dangas GD. Colchicine in Cardiovascular Disease: In-Depth Review. Circulation 2022; 145:61-78. [PMID: 34965168 PMCID: PMC8726640 DOI: 10.1161/circulationaha.121.056171] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Inflammation plays a prominent role in the development of atherosclerosis and other cardiovascular diseases, and anti-inflammatory agents may improve cardiovascular outcomes. For years, colchicine has been used as a safe and well-tolerated agent in diseases such as gout and familial Mediterranean fever. The widely available therapeutic has several anti-inflammatory effects, however, that have proven effective in a broad spectrum of cardiovascular diseases as well. It is considered standard-of-care therapy for pericarditis, and several clinical trials have evaluated its role in postoperative and postablation atrial fibrillation, postpericardiotomy syndrome, coronary artery disease, percutaneous coronary interventions, and cerebrovascular disease. We aim to summarize colchicine's pharmacodynamics and the mechanism behind its anti-inflammatory effect, outline thus far accumulated evidence on treatment with colchicine in cardiovascular disease, and present ongoing randomized clinical trials. We also emphasize real-world clinical implications that should be considered on the basis of the merits and limitations of completed trials. Altogether, colchicine's simplicity, low cost, and effectiveness may provide an important addition to other standard cardiovascular therapies. Ongoing studies will address complementary questions pertaining to the use of low-dose colchicine for the treatment of cardiovascular disease.
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Affiliation(s)
| | - Frans J. Beerkens
- Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Binita Shah
- VA New York Harbor Healthcare System, New York University School of Medicine, New York, NY, USA
| | | | | | - Sotiria G. Giotaki
- Medical School, National Kapodistrian University of Athens, Athens, Greece
| | - Gerasimos Siasos
- Medical School, National Kapodistrian University of Athens, Athens, Greece
| | - Johny Nicolas
- Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Clare Arnott
- The George Institute for Global Health, & Faculty of Medicine, University of New South Wales, Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, & Sydney Medical School, University of Sydney, Sydney, Australia
| | - Sanjay Patel
- Department of Cardiology, Royal Prince Alfred Hospital, & Sydney Medical School, University of Sydney, Sydney, Australia
| | - Mark Parsons
- Department of Neurology, Liverpool Hospital & Ingham Institute for Applied Medical Research at South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia
| | - Jean-Claude Tardif
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Jason C. Kovacic
- Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Victor Chang Cardiac Research Institute, Darlinghurst, Australia; and St Vincent’s Clinical School, University of New South Wales, Darlinghurst, Australia
| | - George D. Dangas
- Medical School, National Kapodistrian University of Athens, Athens, Greece.,Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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23
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Chaffey L, Roberti A, Greaves DR. Drug repurposing in cardiovascular inflammation: Successes, failures, and future opportunities. Front Pharmacol 2022; 13:1046406. [PMID: 36339576 PMCID: PMC9634418 DOI: 10.3389/fphar.2022.1046406] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/10/2022] [Indexed: 12/15/2022] Open
Abstract
Drug repurposing is an attractive, pragmatic approach to drug discovery that has yielded success across medical fields over the years. The use of existing medicines for novel indications enables dramatically reduced development costs and timescales compared with de novo drug discovery and is therefore a promising strategy in cardiovascular disease, where new drug approvals lag significantly behind that of other fields. Extensive evidence from pre-clinical and clinical studies show that chronic inflammation is a driver of pathology in cardiovascular disease, and many efforts have been made to target cardiovascular inflammation therapeutically. This approach has been met with significant challenges however, namely off-target effects associated with broad-spectrum immunosuppression, particularly in long-term conditions such as cardiovascular disease. Nevertheless, multiple anti-inflammatory medicines have been assessed for efficacy in cardiovascular clinical trials, with most of these being repurposed from their original indications in autoimmune conditions like rheumatoid arthritis. In this review, we discuss the mixed successes of clinical trials investigating anti-inflammatory drugs in cardiovascular disease, with examples such as anti-cytokine monoclonal antibodies, colchicine, and methotrexate. Looking to the future, we highlight potential new directions for drug repurposing in cardiovascular inflammation, including the emerging concepts of drug re-engineering and chrono-pharmacology.
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24
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D'Amario D, Cappetta D, Cappannoli L, Princi G, Migliaro S, Diana G, Chouchane K, Borovac JA, Restivo A, Arcudi A, De Angelis A, Vergallo R, Montone RA, Galli M, Liuzzo G, Crea F. Colchicine in ischemic heart disease: the good, the bad and the ugly. Clin Res Cardiol 2021; 110:1531-1542. [PMID: 33713178 PMCID: PMC8484100 DOI: 10.1007/s00392-021-01828-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 02/22/2021] [Indexed: 11/25/2022]
Abstract
Inflammation is the main pathophysiological process involved in atherosclerotic plaque formation, progression, instability, and healing during the evolution of coronary artery disease (CAD). The use of colchicine, a drug used for decades in non-ischemic cardiovascular (CV) diseases and/or systemic inflammatory conditions, stimulated new perspectives on its potential application in patients with CAD. Previous mechanistic and preclinical studies revealed anti-inflammatory and immunomodulatory effects of colchicine exerted through its principal mechanism of microtubule polymerization inhibition, however, other pleiotropic effects beneficial to the CV system were observed such as inhibition of platelet aggregation and suppression of endothelial proliferation. In randomized double-blinded clinical trials informing our clinical practice, low doses of colchicine were associated with the significant reduction of cardiovascular events in patients with stable CAD and chronic coronary syndrome (CCS) while in patients with a recent acute coronary syndrome (ACS), early initiation of colchicine treatment significantly reduced major adverse CV events (MACE). On the other hand, the safety profile of colchicine and its potential causal relationship to the observed increase in non-CV deaths warrants further investigation. For these reasons, postulates of precision medicine and patient-tailored approach with regards to benefits and harms of colchicine treatment should be employed at all times due to potential toxicity of colchicine as well as the currently unresolved signal of harm concerning non-CV mortality. The main goal of this review is to provide a balanced, critical, and comprehensive evaluation of currently available evidence with respect to colchicine use in the setting of CAD.
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Affiliation(s)
- Domenico D'Amario
- Dipartimento Di Scienze Cardiovascolari E Toraciche, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A.Gemelli 8, Rome, 00168, Italy
- Università Cattolica del Sacro Cuore, Rome, 00168, Italy
| | - Donato Cappetta
- Department of Experimental Medicine, University of Campania L. Vanvitelli, Naples, 80138, Italy
| | | | | | | | - Giovanni Diana
- Università Cattolica del Sacro Cuore, Rome, 00168, Italy
| | | | - Josip A Borovac
- Department of Pathophysiology, School of Medicine, University of Split, Split, 21000, Croatia
| | | | | | - Antonella De Angelis
- Department of Experimental Medicine, University of Campania L. Vanvitelli, Naples, 80138, Italy
| | - Rocco Vergallo
- Dipartimento Di Scienze Cardiovascolari E Toraciche, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A.Gemelli 8, Rome, 00168, Italy
- Università Cattolica del Sacro Cuore, Rome, 00168, Italy
| | - Rocco A Montone
- Dipartimento Di Scienze Cardiovascolari E Toraciche, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A.Gemelli 8, Rome, 00168, Italy
| | - Mattia Galli
- Università Cattolica del Sacro Cuore, Rome, 00168, Italy
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Giovanna Liuzzo
- Dipartimento Di Scienze Cardiovascolari E Toraciche, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A.Gemelli 8, Rome, 00168, Italy.
- Università Cattolica del Sacro Cuore, Rome, 00168, Italy.
| | - Filippo Crea
- Dipartimento Di Scienze Cardiovascolari E Toraciche, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A.Gemelli 8, Rome, 00168, Italy.
- Università Cattolica del Sacro Cuore, Rome, 00168, Italy.
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25
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Abstract
Colchicine is one of the most ancient medications still prescribed. It is extracted from the Colchicum autumnale plant and is routinely used because of its broad anti-inflammatory properties to treat gout and familial Mediterranean fever. Colchicine has shown efficacy in various clinical settings in which inflammation is a key component, and it has become first-line therapy for acute and recurrent pericarditis. Two landmark clinical trials have recently shown that colchicine significantly improves cardiovascular outcomes on background statin and antiplatelet therapy in patients with coronary artery disease, supporting its role for the prevention of atherothrombotic events. Favorable results have also emerged in atrial fibrillation. We herein briefly review the most recent data related to the multiple cardiovascular conditions for which colchicine has been successfully repurposed. Expected final online publication date for the Annual Review of Pharmacology and Toxicology, Volume 62 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Nadia Bouabdallaoui
- Montreal Heart Institute, Montreal, Quebec H1T 1C8, Canada; .,Faculty of Medicine, Université de Montréal, Montreal, Quebec H3C 3J7, Canada
| | - Jean-Claude Tardif
- Montreal Heart Institute, Montreal, Quebec H1T 1C8, Canada; .,Faculty of Medicine, Université de Montréal, Montreal, Quebec H3C 3J7, Canada
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26
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Angom RS, Zhu J, Wu ATH, Sumitra MR, Pham V, Dutta S, Wang E, Madamsetty VS, Perez-Cordero GD, Huang HS, Mukhopadhyay D, Wang Y. LCC-09, a Novel Salicylanilide Derivative, Exerts Anti-Inflammatory Effect in Vascular Endothelial Cells. J Inflamm Res 2021; 14:4551-4565. [PMID: 34526801 PMCID: PMC8436973 DOI: 10.2147/jir.s305168] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 08/07/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Endothelial cell (EC) activation facilitates leukocyte adhesion to vascular walls, which is implicated in a variety of cardiovascular diseases and is a target for prevention and treatment. Despite the development of anti-inflammatory medications, cost-effective therapies with significant anti-inflammatory effects and lower organ toxicity remain elusive. The goal of this study is to identify novel synthetic compounds that inhibit EC inflammatory response with minimal organ toxicity. METHODS AND RESULTS In this study, we discovered LCC-09, a salicylanilide derivative consisting of the functional fragment of magnolol, 2,4-difluorophenyl, and paeonol moiety of salicylate, as a novel anti-inflammatory compound in cultured ECs and zebrafish model. LCC-09 was shown to inhibit pro-inflammatory cytokine tumor necrosis factor-α (TNFα)-induced expression of adhesion molecules and inflammatory cytokines, leading to reduced leukocyte adhesion to ECs. Mechanistically, LCC-09 inhibits the phosphorylation of signal transducer and activator of transcription 1 (STAT1), TNFα-induced degradation of NF-κ-B Inhibitor-α (IκBα) and phosphorylation of NFκB p65, resulting in reduced NFκB transactivation activity and binding to E-selectin promoter. Additionally, LCC-09 attenuated TNFα-induced generation of reactive oxygen species in ECs. Molecular docking models suggest the binding of LCC-09 to NFκB essential modulator (NEMO) and Janus tyrosine kinase (JAK) may lead to dual inhibition of NFκB and STAT1. Furthermore, the anti-inflammatory effect of LCC-09 was validated in the lipopolysaccharides (LPS)-induced inflammation model in zebrafish. Our results demonstrated that LCC-09 significantly reduced the LPS-induced leukocyte recruitment and mortality of zebrafish embryos. Finally, LCC-09 was administered to cultured ECs and zebrafish embryos and showed minimal toxicities. CONCLUSION Our results support that LCC-09 inhibits EC inflammatory response but does not elicit significant toxicity.
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Affiliation(s)
- Ramcharan Singh Angom
- Department of Biochemistry and Molecular Biology, College of Medicine and Science, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Jian Zhu
- Department of Biochemistry and Molecular Biology, College of Medicine and Science, Mayo Clinic, Jacksonville, FL, 32224, USA
- Department of Cardiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, 233004, People’s Republic of China
| | - Alexander T H Wu
- The Ph.D. Program for Translational Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Maryam Rachmawati Sumitra
- Graduate Institute for Cancer Biology & Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei, 110, Taiwan
| | - Victoria Pham
- Department of Biochemistry and Molecular Biology, College of Medicine and Science, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Shamit Dutta
- Department of Biochemistry and Molecular Biology, College of Medicine and Science, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Enfeng Wang
- Department of Biochemistry and Molecular Biology, College of Medicine and Science, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Vijay Sagar Madamsetty
- Department of Biochemistry and Molecular Biology, College of Medicine and Science, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Gabriel D Perez-Cordero
- Department of Biochemistry and Molecular Biology, College of Medicine and Science, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Hsu-Shan Huang
- Graduate Institute for Cancer Biology & Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei, 110, Taiwan
| | - Debabrata Mukhopadhyay
- Department of Biochemistry and Molecular Biology, College of Medicine and Science, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Ying Wang
- Department of Cardiovascular Medicine, College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
- Department of Biochemistry and Molecular Biology, College of Medicine and Science, Mayo Clinic, Rochester, MN, 55905, USA
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27
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Soliman AM, Das S, Mahakkanukrauh P. Inflammatory Molecular Mediators and Pathways Involved in Vascular Aging and Stroke: A Comprehensive Review. Curr Med Chem 2021; 29:5522-5542. [PMID: 34488579 DOI: 10.2174/0929867328666210901122359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/01/2021] [Accepted: 07/23/2021] [Indexed: 11/22/2022]
Abstract
There is an increase in the incidence of cardiovascular diseases with aging and it is one of the leading causes of death worldwide. The main cardiovascular pathologies include atherosclerosis, stroke, myocardial infarction, hypertension and stroke. Chronic inflammation is one of the significant contributors to the age-related vascular diseases. Therefore, it is important to understand the molecular mechanisms of the persistent inflammatory conditions occurring in the blood vessels as well as the signaling pathways involved. Herein, we performed an extant search of literature involving PubMed, ISI, WoS and Scopus databases for retrieving all relevant articles with the most recent findings illustrating the potential role of various inflammatory mediators along with their proposed activated pathways in the pathogenesis and progression of vascular aging. We also highlight the major pathways contributing to age-related vascular disorders. The outlined molecular mechanisms, pathways and mediators of vascular aging represent potential drug targets that can be utilized to inhibit and/or slow the pathogenesis and progression of vascular aging.
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Affiliation(s)
- Amro M Soliman
- Department of Biological Sciences-Physiology, Cell and Developmental Biology, University of Alberta, Edmonton, AB T6G 2R3. Canada
| | - Srijit Das
- Department of Human & Clinical Anatomy, College of Medicine & Health Sciences, Sultan Qaboos University, P.C. 123, Al Khoud, Muscat. Oman
| | - Pasuk Mahakkanukrauh
- Department of Anatomy & Excellence center of Osteology Research and Training, Cadaveric Surgical and Training Center, Chiang Mai University, Chiang Mai 50200. Thailand
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28
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Tardif JC, Marquis-Gravel G. Low-Dose Colchicine for the Management of Coronary Artery Disease. J Am Coll Cardiol 2021; 78:867-869. [PMID: 34446157 DOI: 10.1016/j.jacc.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Jean-Claude Tardif
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
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29
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Marquis-Gravel G, Goodman SG, Anderson TJ, Bell AD, Bewick D, Cox J, Grégoire JC, Gupta A, Huynh T, Kertland H, Kouz S, L'Allier PL, Madan M, Mancini GBJ, McPherson R, So DYF, Welsh RC, Wong G, Tardif JC. Colchicine for Prevention of Atherothrombotic Events in Patients With Coronary Artery Disease: Review and Practical Approach for Clinicians. Can J Cardiol 2021; 37:1837-1845. [PMID: 34418482 DOI: 10.1016/j.cjca.2021.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022] Open
Abstract
A better understanding of the central role of inflammation in the development of coronary artery disease (CAD) has been the impetus for the evaluation of therapeutic strategies targeting the interleukin-1ß/interleukin-6 cytokine signaling pathway, involved in both chronic atherogenesis and in triggering of atherosclerotic plaque rupture. As an inexpensive pharmacologic agent with relatively few adverse effects that tend to be mild and tolerable, the role of colchicine in secondary prevention of atherothrombotic events has been the focus of multiple recent large-scale randomized controlled trials involving patients with stable CAD (Low-Dose Colchicine [LoDoCo] and LoDoCo2 trials), a recent myocardial infarction (Colchicine Cardiovascular Outcome Trial [COLCOT], Colchicine in Patients With Acute Coronary Syndrome [COPS], and Colchicine and Spironolactone in Patients With Myocardial Infarction/Synergy Stent Registry [CLEAR SYNERGY] trials), and undergoing percutaneous coronary interventions (Colchicine in Percutaneous Coronary Intervention [COLCHICINE-PCI] trial). Based on this evidence, low-dose colchicine (0.5 mg once daily) should be considered in patients with recent myocardial infarctions-within 30 days and, ideally, within 3 days-or with stable CAD to improve cardiovascular outcomes. Colchicine should not be used in patients with severe renal or hepatic disease because of the risk of severe toxicity. No serious adverse effect was associated with the combined use of colchicine and high-intensity statin therapy in large trials. The impact of colchicine in high-risk populations of patients with peripheral arterial disease and in those with diabetes for the primary prevention of CAD remains to be established.
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Affiliation(s)
| | - Shaun G Goodman
- St. Michael's Hospital, University of Toronto, Ontario, Canada; Canadian Heart Research Centre, Toronto, Ontario, Canada; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Todd J Anderson
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alan D Bell
- University of Toronto, Toronto, Ontario, Canada
| | - David Bewick
- New Brunswick Heart Center, Saint John, New Brunswick, Canada
| | - Jafna Cox
- Dalhousie University, Capital Health, and Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Jean C Grégoire
- Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Anil Gupta
- Trillium Health Centre, Mississauga, Ontario, Canada
| | - Thao Huynh
- Division of Cardiology, McGill University Health Center, Montréal, Québec, Canada
| | | | - Simon Kouz
- Centre Intégré de Santé et de Services Sociaux de Lanaudière-Centre Hospitalier de Lanaudière, Joliette, Québec, Canada
| | | | - Mina Madan
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - G B John Mancini
- University of British Columbia, Department of Medicine, Division of Cardiology, Vancouver, British Columbia, Canada
| | - Ruth McPherson
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Derek Y F So
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Robert C Welsh
- Mazankowski Alberta Heart Institute and University of Alberta, Edmonton, Alberta, Canada
| | - Graham Wong
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean-Claude Tardif
- Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada
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30
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Abrantes AM, Nogueira-Garcia B, Alves M, Teixeira Passos D, Brito D, Pinto FJ, Caldeira D. Low-Dose Colchicine in Coronary Artery Disease - Systematic Review and Meta-Analysis. Circ Rep 2021; 3:457-464. [PMID: 34414335 PMCID: PMC8338916 DOI: 10.1253/circrep.cr-21-0065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/09/2022] Open
Abstract
Background: Recent studies have revealed the benefits of using colchicine, a drug with anti-inflammatory properties, in coronary artery disease (CAD). This study systematically reviewed the benefits and risks of low-dose colchicine in patients with CAD. Methods and Results: We searched for randomized controlled trials (RCTs) in MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science databases (March 2020). Efficacy and safety outcomes were evaluated. Estimates are expressed as risk ratios (RRs) and 95% confidence intervals (95% CIs). Heterogeneity was assessed with I2 test. Confidence in the pooled evidence was appraised using the GRADE framework. Colchicine reduced the rate of major adverse cardiovascular events (RR 0.65; 95% CI 0.49-0.86; 6 RCTs; I2=50%; 11,718 patients; GRADE, moderate confidence), acute coronary syndrome (RR 0.64; 95% CI 0.46-0.90; I2=47%; 7 RCTs; 11,955 patients; GRADE, very low confidence), stroke (RR 0.49; 95% CI 0.30-0.78; I2=0%; 6 RCTs; 11,896 patients; GRADE, moderate confidence), and cardiovascular interventions (RR 0.61; 95% CI 0.42-0.89; I2=40%; 4 RCTs; 11,284 patients; GRADE, high confidence). Colchicine did not increase the risk of adverse events, except for gastrointestinal events (RR 1.54; 95% CI 1.11-2.13; I2=72%; 9 RCTs; 12,374 patients; GRADE, very low confidence). Conclusions: Low-dose colchicine in patients with CAD is associated with beneficial effects on prognosis, although an increased risk of gastrointestinal events was confirmed.
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Affiliation(s)
- Ana Mafalda Abrantes
- Internal Medicine Department 2, Santa Maria Hospital - Northern Lisbon University Hospital Center (CHULN) Lisbon Portugal
| | - Beatriz Nogueira-Garcia
- Cardiology Department, Santa Maria Hospital - Northern Lisbon University Hospital Center (CHULN) Lisbon Portugal
| | - Mariana Alves
- Internal Medicine Department 3, Pulido Valente Hospital - Northern Lisbon University Hospital Center (CHULN) Lisbon Portugal.,Clinical and Therapeutic Pharmacology Laboratory, Faculty of Medicine, University of Lisbon Lisbon Portugal.,Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon Lisbon Portugal
| | - Dúlio Teixeira Passos
- Internal Medicine Department 2, Santa Maria Hospital - Northern Lisbon University Hospital Center (CHULN) Lisbon Portugal
| | - Dulce Brito
- Cardiology Department, Santa Maria Hospital - Northern Lisbon University Hospital Center (CHULN) Lisbon Portugal.,Cardiovascular Center, University of Lisbon Lisbon Portugal.,Academic Medical Center of Lisbon, Faculty of Medicine, University of Lisbon Lisbon Portugal
| | - Fausto J Pinto
- Cardiology Department, Santa Maria Hospital - Northern Lisbon University Hospital Center (CHULN) Lisbon Portugal.,Cardiovascular Center, University of Lisbon Lisbon Portugal.,Academic Medical Center of Lisbon, Faculty of Medicine, University of Lisbon Lisbon Portugal
| | - Daniel Caldeira
- Cardiology Department, Santa Maria Hospital - Northern Lisbon University Hospital Center (CHULN) Lisbon Portugal.,Clinical and Therapeutic Pharmacology Laboratory, Faculty of Medicine, University of Lisbon Lisbon Portugal.,Cardiovascular Center, University of Lisbon Lisbon Portugal.,Academic Medical Center of Lisbon, Faculty of Medicine, University of Lisbon Lisbon Portugal
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31
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Arnold N, Lechner K, Waldeyer C, Shapiro MD, Koenig W. Inflammation and Cardiovascular Disease: The Future. Eur Cardiol 2021; 16:e20. [PMID: 34093741 PMCID: PMC8157394 DOI: 10.15420/ecr.2020.50] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/24/2021] [Indexed: 02/06/2023] Open
Abstract
Despite considerable advances in reducing the global burden of atherosclerotic cardiovascular disease by targeting conventional risk factors, significant residual risk remains, with low-grade inflammation being one of the strongest risk modifiers. Inflammatory processes within the arterial wall or systemic circulation, which are driven in a large part by modified lipoproteins but subsequently trigger a hypercoagulable state, are a hallmark of atherosclerotic cardiovascular disease and, in particular, its clinical complications. Extending conventional guideline-based clinical risk stratification algorithms by adding biomarkers of inflammation may refine phenotypic screening, improve risk stratification and guide treatment eligibility in cardiovascular disease prevention. The integration of interventions aimed at lowering the inflammatory burden, alone or in combination with aggressive lipid-modifying or even antithrombotic agents, for those at high cardiovascular risk may hold the potential to reduce the still substantial burden of cardiometabolic disease. This review provides perspectives on future clinical research in atherosclerosis addressing the tight interplay between inflammation, lipid metabolism and thrombosis, and its translation into clinical practice.
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Affiliation(s)
- Natalie Arnold
- Department of Cardiology, University Heart and Vascular Center Hamburg Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck Hamburg, Germany
| | - Katharina Lechner
- Deutsches Herzzentrum München, Technische Universität München Munich, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance Munich, Germany
| | - Christoph Waldeyer
- Department of Cardiology, University Heart and Vascular Center Hamburg Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck Hamburg, Germany
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine Winston-Salem, North Carolina, US
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München Munich, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance Munich, Germany.,Institute of Epidemiology and Medical Biometry, University of Ulm Ulm, Germany
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32
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Samuel M, Tardif JC, Bouabdallaoui N, Khairy P, Dubé MP, Blondeau L, Guertin MC. Colchicine for Secondary Prevention of Cardiovascular Disease: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Can J Cardiol 2021; 37:776-785. [DOI: 10.1016/j.cjca.2020.10.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/14/2020] [Accepted: 10/14/2020] [Indexed: 12/24/2022] Open
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33
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Katira A, Katira R. Colchicine in coronary artery disease. Postgrad Med J 2021; 98:718-721. [PMID: 33782205 DOI: 10.1136/postgradmedj-2020-139611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/10/2021] [Accepted: 02/20/2021] [Indexed: 12/16/2022]
Abstract
Coronary artery disease (CAD) is a major cause of morbidity and mortality worldwide. Inflammation has been seen to be a key feature of atherosclerosis and CAD, with a raised C-reactive protein being a marker of poor prognosis. Thus, the role of anti-inflammatory agents has been investigated in CAD. Colchicine is a well-known, inexpensive drug with marked anti-inflammatory effects. Here, we discuss the role of colchicine in stable CAD and post-acute coronary syndrome. We suggest that colchicine may play a key role in prevention of cardiovascular events in patients with stable and unstable CAD as colchicine is associated with a reduction in the rate of myocardial infarction and other major cardiovascular outcomes.
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Affiliation(s)
- Arnav Katira
- Department of Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - Ravish Katira
- Cardiology Department, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, UK
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34
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Samuel M, Tardif JC. Lessons learned from large Cardiovascular Outcome Trials targeting inflammation in cardiovascular disease (CANTOS, CIRT, COLCOT and LoDoCo2). Future Cardiol 2021; 17:411-414. [PMID: 33687270 DOI: 10.2217/fca-2021-0027] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Michelle Samuel
- Montreal Heart Institute, University of Montreal, Montreal H1T 1C8, Canada
| | - Jean-Claude Tardif
- Montreal Heart Institute, University of Montreal, Montreal H1T 1C8, Canada
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35
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Bresson D, Roubille F, Prieur C, Biere L, Ivanes F, Bouleti C, Dubreuil O, Rioufol G, Boutitie F, Sideris G, Elbaz M, Bochaton T, De Bourguignon C, El Jonhy N, Dufay N, Dhelens C, Croisille P, Prunier F, Angoulvant D, Ovize M, Maucort-Boulch D, Mewton N. Colchicine for Left Ventricular Infarct Size Reduction in Acute Myocardial Infarction: A Phase II, Multicenter, Randomized, Double-Blinded, Placebo-Controlled Study Protocol - The COVERT-MI Study. Cardiology 2021; 146:151-160. [PMID: 33582664 DOI: 10.1159/000512772] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/30/2020] [Indexed: 11/19/2022]
Abstract
Inflammatory processes have been identified as key mediators of ischemia-reperfusion injury in ST-segment elevation myocardial infarction (STEMI). They add damage to the myocardium and are associated with clinical adverse events (heart failure and cardiovascular death) and poor myocardial recovery. Colchicine is a well-known alkaloid with potent anti-inflammatory properties. In a proof-of-concept phase II trial, colchicine has been associated with a significant 50% reduction of infarct size (assessed by creatine kinase levels) in comparison to placebo in acute STEMI patients referred for primary percutaneous coronary intervention (PPCI). The Colchicine in STEMI Patients Study (COVERT-MI) is an ongoing confirmative prospective, multicenter, randomized, double-blind trial testing whether a short course oral treatment with colchicine versus placebo decreases myocardial injury in patients presenting with STEMI referred for PPCI. Adult patients, with a first STEMI episode and an initial TIMI flow ≤1, referred for PPCI, will be randomized (n = 194) in a 1:1 ratio to receive an oral bolus of colchicine of 2 mg followed by 0.5 mg b.i.d. treatment during 5 days or matching placebo. The primary endpoint will be the reduction in infarct size as assessed by cardiac magnetic resonance at 5 ± 2 days between both groups. The main secondary endpoints will be tested between groups in hierarchical order with left ventricular ejection fraction at 5 days, microvascular obstruction presence at 5 days, and absolute adverse left ventricular remodeling between 5 days and 3 months. This academic study is being financed by a grant from the French Ministry of Health (PHRCN-16-0357). Results from this study will contribute to a better understanding of the complex pathophysiology underlying myocardial injury after STEMI. The present study describes the rationale, design, and methods of the trial.
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Affiliation(s)
- Didier Bresson
- University Hospital of Mulhouse, Hôpital Emile Muller, Mulhouse, France
| | - François Roubille
- Cardiology Department, PhyMedExp, INSERM, CNRS, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Cyril Prieur
- Coronary Care Unit, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Bron, France
| | - Loic Biere
- Institut MITOVASC, CNRS 6015 INSERM U1083, CHU Angers, Service de Cardiologie, Angers Cedex, Université d'Angers, Angers, France
| | - Fabrice Ivanes
- Cardiology Department CHRU de Tours & EA4245 T2i Tours University, Tours, France
| | - Claire Bouleti
- CIC Inserm 1402n CHU de Poitiers, Université de Poitiers, Poitiers, France
| | - Olivier Dubreuil
- Invasive Cardiology Department, Centre Hospitalier Saint-Joseph Saint-Luc, Lyon, France
| | - Gilles Rioufol
- Coronary Care Unit, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Bron, France.,Centre d'Investigation Clinique, Inserm 1407, CarMeN Unit Inserm 1060, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Bron, France
| | - Florent Boutitie
- Biostatistical Department - Bioinformatique, Pôle de Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Georges Sideris
- Cardiology Department, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Meyer Elbaz
- Interventional Cardiology Department, CHU de Rangueil, Toulouse, France
| | - Thomas Bochaton
- Centre d'Investigation Clinique, Inserm 1407, CarMeN Unit Inserm 1060, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Bron, France
| | - Charles De Bourguignon
- Centre d'Investigation Clinique, Inserm 1407, CarMeN Unit Inserm 1060, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Bron, France
| | - Naoual El Jonhy
- Centre d'Investigation Clinique, Inserm 1407, CarMeN Unit Inserm 1060, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Bron, France
| | - Nathalie Dufay
- NeuroBioTec, Centre de Ressources Biologiques des HCL, Hôpital Neurologique, Bron, France
| | - Carole Dhelens
- Pharmacy Department, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Pierre Croisille
- Department Radiology, CREATIS CNRS 5220 INSERM U1206 Research Lab, Hôpital Nord University Hospital/CHU Saint Etienne, Avenue Albert Raimond, Saint-Priest en Jarez, France
| | - Fabrice Prunier
- Institut MITOVASC, CNRS 6015 INSERM U1083, CHU Angers, Service de Cardiologie, Angers Cedex, Université d'Angers, Angers, France
| | - Denis Angoulvant
- Cardiology Department CHRU de Tours & EA4245 T2i Tours University, Tours, France
| | - Michel Ovize
- Centre d'Investigation Clinique, Inserm 1407, CarMeN Unit Inserm 1060, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Bron, France
| | - Delphine Maucort-Boulch
- Biostatistical Department - Bioinformatique, Pôle de Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Nathan Mewton
- Centre d'Investigation Clinique, Inserm 1407, CarMeN Unit Inserm 1060, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Bron, France,
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36
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Bouabdallaoui N, Tardif JC, Waters DD, Pinto FJ, Maggioni AP, Diaz R, Berry C, Koenig W, Lopez-Sendon J, Gamra H, Kiwan GS, Blondeau L, Orfanos A, Ibrahim R, Grégoire JC, Dubé MP, Samuel M, Morel O, Lim P, Bertrand OF, Kouz S, Guertin MC, L’Allier PL, Roubille F. Time-to-treatment initiation of colchicine and cardiovascular outcomes after myocardial infarction in the Colchicine Cardiovascular Outcomes Trial (COLCOT). Eur Heart J 2020; 41:4092-4099. [PMID: 32860034 PMCID: PMC7700755 DOI: 10.1093/eurheartj/ehaa659] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/15/2020] [Accepted: 07/28/2020] [Indexed: 12/18/2022] Open
Abstract
AIMS The COLchicine Cardiovascular Outcomes Trial (COLCOT) demonstrated the benefits of targeting inflammation after myocardial infarction (MI). We aimed to determine whether time-to-treatment initiation (TTI) influences the beneficial impact of colchicine. METHODS AND RESULTS In COLCOT, patients were randomly assigned to receive colchicine or placebo within 30 days post-MI. Time-to-treatment initiation was defined as the length of time between the index MI and the initiation of study medication. The primary efficacy endpoint was a composite of cardiovascular death, resuscitated cardiac arrest, MI, stroke, or urgent hospitalization for angina requiring coronary revascularization. The relationship between endpoints and various TTI (<3, 4-7 and >8 days) was examined using multivariable Cox regression models. Amongst the 4661 patients included in this analysis, there were 1193, 720, and 2748 patients, respectively, in the three TTI strata. After a median follow-up of 22.7 months, there was a significant reduction in the incidence of the primary endpoint for patients in whom colchicine was initiated < Day 3 compared with placebo [hazard ratios (HR) = 0.52, 95% confidence intervals (CI) 0.32-0.84], in contrast to patients in whom colchicine was initiated between Days 4 and 7 (HR = 0.96, 95% CI 0.53-1.75) or > Day 8 (HR = 0.82, 95% CI 0.61-1.11). The beneficial effects of early initiation of colchicine were also demonstrated for urgent hospitalization for angina requiring revascularization (HR = 0.35), all coronary revascularization (HR = 0.63), and the composite of cardiovascular death, resuscitated cardiac arrest, MI, or stroke (HR = 0.55, all P < 0.05). CONCLUSION Patients benefit from early, in-hospital initiation of colchicine after MI. TRIAL REGISTRATION COLCOT ClinicalTrials.gov number, NCT02551094.
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Affiliation(s)
- Nadia Bouabdallaoui
- Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada and Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Claude Tardif
- Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada and Université de Montréal, Montreal, Quebec, Canada
| | | | - Fausto J Pinto
- Santa Maria University Hospital (CHULN), CAML, CCUL, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | | | - Rafael Diaz
- Estudios Clinicos Latinoamerica, Rosario, Argentina
| | - Colin Berry
- University of Glasgow and NHS Glasgow Clinical Research Facility, Glasgow, UK
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
- Institute of Epidemiology and Medical Biometry, University of Ulm, Germany
| | | | - Habib Gamra
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | | | - Lucie Blondeau
- The Montreal Health Innovations Coordinating Center (MHICC), Montreal, Canada
| | - Andreas Orfanos
- The Montreal Health Innovations Coordinating Center (MHICC), Montreal, Canada
| | - Reda Ibrahim
- Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada and Université de Montréal, Montreal, Quebec, Canada
| | - Jean C Grégoire
- Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada and Université de Montréal, Montreal, Quebec, Canada
| | - Marie-Pierre Dubé
- Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada and Université de Montréal, Montreal, Quebec, Canada
| | - Michelle Samuel
- Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada and Université de Montréal, Montreal, Quebec, Canada
| | - Olivier Morel
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France
| | - Pascal Lim
- Department of Cardiology, AP-HP, Hôpital Universitaire Henri-Mondor and INSERM U955, Université Paris-Est Créteil, Créteil, France
| | | | - Simon Kouz
- Centre Hospitalier Régional de Lanaudière, Joliette, Canada
| | | | - Philippe L L’Allier
- Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada and Université de Montréal, Montreal, Quebec, Canada
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Abstract
Atherosclerosis, the pathology underlying heart attacks, strokes and peripheral artery disease, is a chronic inflammatory disease of the artery wall initiated by elevated low-density lipoprotein (LDL) cholesterol levels. LDL accumulates in the artery wall, where it can become oxidized to oxLDL. T cell responses to ApoB, a core protein found in LDL and other lipoproteins, are detectable in healthy mice and people. Most of the ApoB-specific CD4T cells are FoxP3+ regulatory T cells (Treg). In the course of atherosclerosis development, the number of ApoB-reactive T cells expands. At the same time, their phenotype changes, showing cell surface markers, transcription factors and transcriptomes resembling other T-helper lineages like Th17, Th1 and follicular helper (TFH) cells. TFH cells enter germinal centers and provide T cell help to B cells, enabling antibody isotype switch from IgM to IgG and supporting affinity maturation. In people and mice with atherosclerosis, IgG and IgM antibodies to oxLDL are detectable. Higher IgM antibody titers to oxLDL are associated with less, IgG antibodies with more atherosclerosis. Thus, both T and B cells play critical roles in atherosclerosis. Modifying the adaptive immune response to ApoB holds promise for preventing atherosclerosis and reducing disease burden.
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Affiliation(s)
- Klaus Ley
- Center for Autoimmunity and Inflammation, Inflammation Biology Laboratory, La Jolla Institute for Immunology, 9420 Athena Circle Drive, La Jolla, CA 92037, U.S.A
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Liberale L, Montecucco F, Schwarz L, Lüscher TF, Camici GG. Inflammation and cardiovascular diseases: lessons from seminal clinical trials. Cardiovasc Res 2020; 117:411-422. [PMID: 32666079 DOI: 10.1093/cvr/cvaa211] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/29/2020] [Accepted: 07/07/2020] [Indexed: 12/12/2022] Open
Abstract
Inflammation has been long regarded as a key contributor to atherosclerosis. Inflammatory cells and soluble mediators play critical roles throughout arterial plaque development and accordingly, targeting inflammatory pathways effectively reduces atherosclerotic burden in animal models of cardiovascular (CV) diseases. Yet, clinical translation often led to inconclusive or even contradictory results. The Canakinumab Anti-inflammatory Thrombosis Outcome Study (CANTOS) followed by the Colchicine Cardiovascular Outcomes Trial (COLCOT) were the first two randomized clinical trials to convincingly demonstrate the effectiveness of specific anti-inflammatory treatments in the field of CV prevention, while other phase III trials-including the Cardiovascular Inflammation Reduction Trial one using methotrexate-were futile. This manuscript reviews the main characteristics and findings of recent anti-inflammatory Phase III trials in cardiology and discusses their similarities and differences in order to get further insights into the contribution of specific inflammatory pathways on CV outcomes. CANTOS and COLCOT demonstrated efficacy of two anti-inflammatory drugs (canakinumab and colchicine, respectively) in the secondary prevention of major adverse CV events (MACE) thus providing the first confirmation of the involvement of a specific inflammatory pathway in human atherosclerotic CV disease (ASCVD). Also, they highlighted the NOD-, LRR-, and pyrin domain-containing protein 3 inflammasome-related pathway as an effective therapeutic target to blunt ASCVD. In contrast, other trials interfering with a number of inflammasome-independent pathways failed to provide benefit. Lastly, all anti-inflammatory trials underscored the importance of balancing the risk of impaired host defence with an increase in infections and the prevention of MACE in CV patients with residual inflammatory risk.
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Affiliation(s)
- Luca Liberale
- Center for Molecular Cardiology, University of Zurich, 12 Wagistrasse, 8952 Schlieren, Switzerland.,First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Fabrizio Montecucco
- IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, 10 Largo Benzi, 16132 Genoa, Italy.,First Clinic of Internal Medicine, Department of Internal Medicine, Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Lena Schwarz
- Center for Molecular Cardiology, University of Zurich, 12 Wagistrasse, 8952 Schlieren, Switzerland
| | - Thomas F Lüscher
- Center for Molecular Cardiology, University of Zurich, 12 Wagistrasse, 8952 Schlieren, Switzerland.,Royal Brompton and Harefield Hospitals and Imperial College, London, UK
| | - Giovanni G Camici
- Center for Molecular Cardiology, University of Zurich, 12 Wagistrasse, 8952 Schlieren, Switzerland.,Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8092 Zurich, Switzerland.,Department of Research and Education, University Hospital Zurich, Rämistrasse 100, 8092, Zurich, Switzerland
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