Rapid response to lipids profile and leukocyte gene expression after rosuvastatin administration in Chinese healthy volunteers:

Pharmacogenomics in the development and characterization of atheroprotective drugs

Atherosclerosis is the main cause of cardiovascular disease (CVD) and can lead to stroke, myocardial infarction, and death. The clinically available atheroprotective drugs aim mainly at reducing the levels of circulating low-density lipoprotein (LDL), increasing high-density lipoprotein (HDL), and attenuating inflammation. However, the cardiovascular risk remains high, along with morbidity, mortality, and incidence of adverse drug events. Pharmacogenomics is increasingly contributing towards the characterization of existing atheroprotective drugs, the evaluation of novel ones, and the identification of promising, unexplored therapeutic targets, at the global molecular pathway level. This chapter presents highlights of pharmacogenomics investigations and discoveries that have contributed towards the elucidation of pharmacological atheroprotection, while opening the way to new therapeutic approaches.

Treating influenza with statins and other immunomodulatory agents

Statins not only reduce levels of LDL-cholesterol, they counteract the inflammatory changes associated with acute coronary syndrome and improve survival. Similarly, in patients hospitalized with laboratory-confirmed seasonal influenza, statin treatment is associated with a 41% reduction in 30-day mortality. Most patients of any age who are at increased risk of influenza mortality have chronic low-grade inflammation characteristic of metabolic syndrome. Moreover, differences in the immune responses of children and adults seem responsible for the low mortality in children and high mortality in adults seen in the 1918 influenza pandemic and in other acute infectious and non-infectious conditions. These differences probably reflect human evolutionary development. Thus the host response to influenza seems to be the major determinant of outcome. Outpatient statins are associated with reductions in hospitalizations and deaths due to sepsis and pneumonia. Inpatient statins are also associated with reductions in short-term pneumonia mortality. Other immunomodulatory agents--ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), PPARγ and PPARα agonists (glitazones and fibrates) and AMPK agonists (metformin)--also reduce mortality in patients with pneumonia (ACEIs, ARBs) or in mouse models of influenza (PPAR and AMPK agonists). In experimental studies, treatment has not increased virus replication. Thus effective management of influenza may not always require targeting the virus with vaccines or antiviral agents. Clinical investigators, not systems biologists, have been the first to suggest that immunomodulatory agents might be used to treat influenza patients, but randomized controlled trials will be needed to provide convincing evidence that they work. To guide the choice of which agent(s) to study, we need new types of laboratory research in animal models and clinical and epidemiological research in patients with critical illness. These studies will have crucial implications for global public health. During the 2009 H1N1 influenza pandemic, timely and affordable supplies of vaccines and antiviral agents were unavailable to more than 90% of the world's people. In contrast, statins and other immunomodulatory agents are currently produced as inexpensive generics, global supplies are huge, and they would be available to treat patients in any country with a basic health care system on the first pandemic day. Treatment with statins and other immunomodulatory agents represents a new approach to reducing mortality caused by seasonal and pandemic influenza.

Rabdomiólise após exercício físico não intenso

Discutiremos um raro caso clínico de rabdomiólise ocorrido após um exercício físico habitual e não intenso, em paciente masculino de 34 anos e os prováveis fatores desencadeantes envolvidos, bem como suas implicações clínicas. Destacando-se a elevação expressiva e não vista em outros trabalhos como da creatinoquinase, enzimas hepáticas, e as medidas clínicas adotadas para a prevenção de complicações renais sérias e com risco grave para o paciente em análise.

Efficacy of blackcurrant oil soft capsule, a Chinese herbal drug, in hyperlipidemia treatment

Blackcurrant oil soft capsule (BOSC) is an effective and safe herbal medicine for the treatment of hyperlipidemia and has been approved for the market in China. No studies have been performed, however, to confirm whether BOSC is effective in reducing the serum lipid level in a large-scale ordinary or special patient population. In this study, we conducted an observational study at five investigative sites that was designed to further investigate the efficacy of BOSC on serum lipid level lowering in a large-scale target patient population and include a relative factors analysis for the serum lipid decrease. Serum total cholesterol (TC), triglycerides (TGs) and high density lipoprotein-cholesterol (HDL-C) were measured before and after drug administration. TC and TGs were detected by enzymatic analysis, while HDL-C was detected by PTA-Mg(2+) precipitation. A total of 2,154 dyslipidemic patients were recruited and took BOSC 1.8 g b.i.d. every day for 6 weeks. In terms of serum lipid lowering, the overall curative rate was 37.19%, the marked effective rate was 52.28% and the effective rate was 79.06%. The corresponding effective rate of TC, TGs and HDL-C was 80.98%, 78.28% and 67.07%, respectively. Multivariate analyses with adjustment for centers, gender and age indicated that BOSC was almost ineffective in patients with a disease course <36 months (OR: 0.467, 95% CI: 0.359-0.607) and was effective in mild hyperlipidemia (OR: 3.176, 2.535-3.978) and in subjects with lower BMIs (BMI <24: 3.472, 2.171-5.552; BMI between 24 and 28: 2.310, 1.832-2.911 compared with BMI >or= 28). No serious adverse events were reported during the study period. Therefore, we conclude that BOSC is effective in decreasing TC and TG levels and in increasing the serum HDL-C level, especially in mildly hyperlipidemic patients and those with a lower BMI. Moreover, because it is a natural raw material, BOSC may be safer and more effective in the treatment of hyperlipidemia.