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Ramanan SP, Singh B, Gandhamaneni SH, Sange I. Eosinophilic Esophagitis: The Role of Steroids and the Dose, Duration, and Delivery of Steroid Therapy. Cureus 2024; 16:e58343. [PMID: 38756322 PMCID: PMC11097238 DOI: 10.7759/cureus.58343] [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: 05/26/2021] [Accepted: 04/08/2024] [Indexed: 05/18/2024] Open
Abstract
Eosinophilic esophagitis (EoE) is a chronic immune-mediated condition characterized by the eosinophil infiltration of the esophagus (>15 per high power field). Recently, there has been an increase in both the incidence and prevalence of the disease. The common modalities of treatment are dietary modification, proton pump inhibitors, and steroids. However, the United States Food and Drug Administration has not approved any drugs for the treatment of EoE. This review has discussed the role of steroids in the treatment of EoE, focusing on the various formulations of the drug, its dosage, drug delivery, and duration of therapy. The study also covers the common outcomes of steroid therapy and its side effects.
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Affiliation(s)
- Sruthi Priyavadhana Ramanan
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Medicine/Surgery, Saveetha Medical College, Chennai, IND
- Internal Medicine, Henry Ford Health System, Jackson, USA
| | - Bipneet Singh
- Internal Medicine, Henry Ford Health System, Jackson, USA
| | | | - Ibrahim Sange
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Karamshibhai Jethabhai Somaiya Medical College, Hospital & Research Center, Mumbai, IND
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2
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Shanthi Chede L, Donovan MD. Evaluation of bioadhesive gels for local action in the esophagus. Int J Pharm 2023; 642:123115. [PMID: 37302670 DOI: 10.1016/j.ijpharm.2023.123115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 05/24/2023] [Accepted: 06/06/2023] [Indexed: 06/13/2023]
Abstract
Direct drug administration to the esophagus faces several obstacles, including continuous salivary dilution and removal of the dosage form from the tissue surface due to esophageal peristalsis. These actions often result in short exposure times and reduced concentrations of drug at the esophageal surface, providing limited opportunities for drug absorption into or across the esophageal mucosa. A variety of bioadhesive polymers were investigated for their ability to resist removal by salivary washings using an ex vivo porcine esophageal tissue model. Hydroxypropylmethylcellulose and carboxymethylcellulose both have reported bioadhesive properties, but neither was able to withstand repeated exposure to saliva, and the gels formulated with these polymers were quickly removed from the esophageal surface. Two polyacrylic polymers, carbomer and polycarbophil, also showed limited esophageal surface retention when exposed to salivary washing, likely due to the ionic composition of saliva affecting the inter-polymer interactions necessary for these polymers to maintain their increased viscosities. In situ gel forming polysaccharide gels (ion-triggered), including xanthan gum, gellan gum, and sodium alginate, showed superior tissue surface retention, and formulations containing these bioadhesive polymers along with ciclesonide, an anti-inflammatory soft prodrug, were investigated as potential, locally-acting esophageal delivery systems. Exposure of a segment of esophagus to the ciclesonide-containing gels resulted in therapeutic concentrations of des-ciclesonide, the active drug metabolite, in the tissues within 30 min. Increasing des-CIC concentrations were also observed over a 3-hour exposure interval suggesting continued release and absorption of ciclesonide into the esophageal tissues. These results demonstrate the ability to achieve therapeutic drug concentrations in the esophageal tissues using in situ gel-forming bioadhesive polymer delivery systems, and these systems provide promising opportunities for the local treatment of esophageal disease.
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Affiliation(s)
- Laxmi Shanthi Chede
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, The University of Iowa, 115 S Grand Avenue, Iowa City, Iowa, 52242-1112, USA
| | - Maureen D Donovan
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, The University of Iowa, 115 S Grand Avenue, Iowa City, Iowa, 52242-1112, USA.
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Blaiss M, Berger W, Chipps B, Hernandez-Trujillo V, Phipatanakul W, Steward K. Review of efficacy of ciclesonide for the treatment of asthma in children. Allergy Asthma Proc 2021; 42:461-470. [PMID: 34871153 DOI: 10.2500/aap.2021.42.210062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Ciclesonide (CIC) is an inhaled corticosteroid (ICS) approved for the maintenance treatment of asthma in patients ages ≥ 12 years. The prodrug aspect of CIC is associated with a safety profile that may make it ideal for children. Objective: The objective was to summarize efficacy results from the eight phase III, randomized, double-blind, controlled trials in children with asthma conducted during CIC clinical development. Methods: Four trials compared CIC 40, 80, or 160 µg/day with placebo. Two trials compared CIC 160 µg/day with fluticasone propionate 200 µg/day, one trial compared CIC 80 or 160 µg/day with fluticasone 200 µg/day, and one trial compared CIC 160 µg/day with budesonide 400 µg/day. Results: The primary end point was met by at least two CIC doses versus placebo in the trials in which the primary end point was the change from baseline in lung function outcome (forced expiratory volume in 1 second [FEV1] % predicted or morning peak expiratory flow [PEF]). A trial that compared CIC with placebo did not meet the primary end point of superiority in time-to-first severe wheeze exacerbation or lack of improvement. The primary end point of noninferiority to the active control (fluticasone or budesonide) in the change from baseline in a lung function outcome (FEV1, morning PEF, evening PEF) was met with the CIC 160-µg dose in all active control trials. CIC generally demonstrated statistically significant improvements in forced expiratory flow at 25%-75% of forced vital capacity, asthma symptoms, rescue medication use, and asthma control when compared with placebo and noninferiority for these outcomes compared with fluticasone or budesonide. Conclusion: In children with asthma, once-daily CIC significantly improved large and small airway function, asthma symptoms, and asthma control, and reduced rescue medication use compared with placebo. CIC was comparable with other ICS used to treat asthma in children, which demonstrated its worth for the pediatric population.
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Affiliation(s)
- Michael Blaiss
- From the Department of Pediatrics, Medical College of Georgia at Augusta University, Augusta Georgia
| | - William Berger
- Allergy and Asthma Associates of Southern California, Mission Viejo, California
| | - Bradley Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, California
| | - Vivian Hernandez-Trujillo
- Department of Pediatrics, Herbert Wertheim School of Medicine, Florida International University, Miami, Florida
| | - Wanda Phipatanakul
- Division of Immunology and Allergy, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; and
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Trevisiol S, Moulard Y, Kaabia Z, Delcourt V, Loup B, Garcia P, Boyer S, Dauriac K, Groseille G, Rouger S, Narbe R, Popot MA, Bailly-Chouriberry L. LC-HRMS/MS study of the prodrug ciclesonide and its active metabolite desisobutyryl-ciclesonide in plasma after an inhalative administration to horses for doping control purposes. Drug Test Anal 2021; 14:252-261. [PMID: 34634175 DOI: 10.1002/dta.3174] [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: 05/28/2021] [Revised: 09/14/2021] [Accepted: 09/28/2021] [Indexed: 11/11/2022]
Abstract
Ciclesonide (CIC) is the first inhaled highly potent corticosteroid that does not cause any cortisol suppression. It has been developed for the treatment of asthma in human and more recently in equine. CIC is the active compound of Aservo® EquiHaler® (Boehringer Ingelheim Vetmedica GmbH), the pre-filled inhaler generating a medicated mist based on Soft Mist™ technology. This prodrug is rapidly converted to desisobutyryl-ciclesonide (des-CIC), the main pharmacologically active compound. Due to its anti-inflammatory properties, CIC is prohibited for use in horse competitions. To set up an appropriate control, the determination of detection times and screening limits are required. Therefore, a highly sensitive analytical method based on supported liquid extraction (SLE) combined with liquid chromatography-high resolution tandem mass spectrometry (LC-HRMS/MS) was developed to detect CIC and its active metabolite des-CIC in plasma. The lower limit of detection of CIC and des-CIC was approximately 1 pg/ml in plasma. After a pilot study conducted on a single horse at the recommended dose (eight actuations twice daily corresponding to 5.5 mg/day for the first 5 days, followed by 12 actuations once daily corresponding to 4.1 mg/day in the last 5 days), the same protocol was applied in the main study using six horses. In all horses, CIC and des-CIC levels were less than 5 and 10 pg/ml, respectively, at 36 h after the end of the administration. The outcome of this risk assessment study should be useful to draw any recommendations for horse competitions.
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Affiliation(s)
- Stéphane Trevisiol
- GIE-LCH, Laboratoire des Courses Hippiques, Verrières-le-Buisson, France
| | - Yves Moulard
- GIE-LCH, Laboratoire des Courses Hippiques, Verrières-le-Buisson, France
| | - Zied Kaabia
- GIE-LCH, Laboratoire des Courses Hippiques, Verrières-le-Buisson, France
| | - Vivian Delcourt
- GIE-LCH, Laboratoire des Courses Hippiques, Verrières-le-Buisson, France
| | - Benoit Loup
- GIE-LCH, Laboratoire des Courses Hippiques, Verrières-le-Buisson, France
| | - Patrice Garcia
- GIE-LCH, Laboratoire des Courses Hippiques, Verrières-le-Buisson, France
| | - Sophie Boyer
- GIE-LCH, Laboratoire des Courses Hippiques, Verrières-le-Buisson, France
| | - Karine Dauriac
- GIE-LCH, Laboratoire des Courses Hippiques, Verrières-le-Buisson, France
| | | | - Sébastien Rouger
- GIE-LCH, Laboratoire des Courses Hippiques, Verrières-le-Buisson, France
| | - Ruediger Narbe
- Boehringer Ingelheim Vetmedica GmbH, Ingelheim am Rhein, Germany
| | - Marie-Agnès Popot
- GIE-LCH, Laboratoire des Courses Hippiques, Verrières-le-Buisson, France
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Kim SL, Choi HS, Kim JH, Lee DS. The Antiasthma Medication Ciclesonide Suppresses Breast Cancer Stem Cells through Inhibition of the Glucocorticoid Receptor Signaling-Dependent YAP Pathway. Molecules 2020; 25:molecules25246028. [PMID: 33352739 PMCID: PMC7766992 DOI: 10.3390/molecules25246028] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/11/2020] [Accepted: 12/17/2020] [Indexed: 12/23/2022] Open
Abstract
Ciclesonide is an FDA-approved glucocorticoid used to treat asthma and allergic rhinitis. However, whether it has anticancer and anti-cancer stem cell (CSC) effects is unknown. This study focused on investigating the effect of ciclesonide on breast cancer and CSCs and determining its underlying mechanism. Here, we showed that ciclesonide inhibits breast cancer and CSC formation. Similar glucocorticoids-dexamethasone and prednisone-did not inhibit CSC formation. Ciclesonide-induced glucocorticoid receptor (GR) degradation was dependent on ubiquitination. We showed via GR small interfering RNA (siRNA) that GR plays an important role in CSC formation. We showed via western blot and immunofluorescence assays that ciclesonide reduces the nuclear level of GR. The GR antagonist RU-486 also inhibited CSC formation. Ciclesonide reduced the protein level of the Hippo transducer Yes-associated protein (YAP). GR siRNA induced a decrease in YAP protein expression and inhibited mammosphere formation. The YAP inhibitor verteporfin inhibited CSC formation and transcription of the connective tissue growth factor and cysteine-rich protein 61 genes. The GR/YAP1 pathway regulated breast CSC formation. We showed that the GR/YAP signaling pathway regulates breast CSC formation and revealed a new approach for targeting GR and YAP to inhibit CSC formation.
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Affiliation(s)
- Su-Lim Kim
- Interdisciplinary Graduate Program in Advanced Convergence Technology & Science, Jeju National University, Jeju 63243, Korea; (S.-L.K.); (H.S.C.); (J.-H.K.)
- Practical Translational Research Center, Jeju National University, Jeju 63243, Korea
- Bio-Health Materials Core-Facility Center, Jeju National University, Jeju 63243, Korea
- Faculty of Biotechnology, College of Applied Life Sciences, Jeju National University, SARI, Jeju 63243, Korea
- Subtropical/Tropical Organism Gene Bank, Jeju National University, Jeju 63243, Korea
| | - Hack Sun Choi
- Interdisciplinary Graduate Program in Advanced Convergence Technology & Science, Jeju National University, Jeju 63243, Korea; (S.-L.K.); (H.S.C.); (J.-H.K.)
- Practical Translational Research Center, Jeju National University, Jeju 63243, Korea
- Bio-Health Materials Core-Facility Center, Jeju National University, Jeju 63243, Korea
- Faculty of Biotechnology, College of Applied Life Sciences, Jeju National University, SARI, Jeju 63243, Korea
- Subtropical/Tropical Organism Gene Bank, Jeju National University, Jeju 63243, Korea
| | - Ji-Hyang Kim
- Interdisciplinary Graduate Program in Advanced Convergence Technology & Science, Jeju National University, Jeju 63243, Korea; (S.-L.K.); (H.S.C.); (J.-H.K.)
- Practical Translational Research Center, Jeju National University, Jeju 63243, Korea
- Bio-Health Materials Core-Facility Center, Jeju National University, Jeju 63243, Korea
- Faculty of Biotechnology, College of Applied Life Sciences, Jeju National University, SARI, Jeju 63243, Korea
- Subtropical/Tropical Organism Gene Bank, Jeju National University, Jeju 63243, Korea
| | - Dong-Sun Lee
- Interdisciplinary Graduate Program in Advanced Convergence Technology & Science, Jeju National University, Jeju 63243, Korea; (S.-L.K.); (H.S.C.); (J.-H.K.)
- Practical Translational Research Center, Jeju National University, Jeju 63243, Korea
- Bio-Health Materials Core-Facility Center, Jeju National University, Jeju 63243, Korea
- Faculty of Biotechnology, College of Applied Life Sciences, Jeju National University, SARI, Jeju 63243, Korea
- Subtropical/Tropical Organism Gene Bank, Jeju National University, Jeju 63243, Korea
- Correspondence:
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Nakajima K, Ogawa F, Sakai K, Uchiyama M, Oyama Y, Kato H, Takeuchi I. A Case of Coronavirus Disease 2019 Treated With Ciclesonide. Mayo Clin Proc 2020; 95:1296-1297. [PMID: 32402512 PMCID: PMC7158774 DOI: 10.1016/j.mayocp.2020.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Kento Nakajima
- Department of Emergency Medicine, Yokohama City University, Kanagawa, Japan
| | - Fumihiro Ogawa
- Department of Emergency Medicine, Yokohama City University, Kanagawa, Japan
| | - Kazuya Sakai
- Department of Emergency Medicine, Yokohama City University, Kanagawa, Japan
| | - Munehito Uchiyama
- Department of Emergency Medicine, Yokohama City University, Kanagawa, Japan
| | - Yutaro Oyama
- Department of Emergency Medicine, Yokohama City University, Kanagawa, Japan
| | - Hideaki Kato
- Infection Prevention and Control Department, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Ichiro Takeuchi
- Department of Emergency Medicine, Yokohama City University, Yokohama, Kanagawa, Japan
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Choi HS, Kim SL, Kim JH, Lee DS. The FDA-Approved Anti-Asthma Medicine Ciclesonide Inhibits Lung Cancer Stem Cells through Hedgehog Signaling-Mediated SOX2 Regulation. Int J Mol Sci 2020; 21:ijms21031014. [PMID: 32033067 PMCID: PMC7038186 DOI: 10.3390/ijms21031014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/30/2020] [Accepted: 02/02/2020] [Indexed: 11/21/2022] Open
Abstract
Ciclesonide is an FDA-approved glucocorticoid (GC) used to treat asthma and allergic rhinitis. However, its effects on cancer and cancer stem cells (CSCs) are unknown. Our study focuses on investigating the inhibitory effect of ciclesonide on lung cancer and CSCs and its underlying mechanism. In this study, we showed that ciclesonide inhibits the proliferation of lung cancer cells and the growth of CSCs. Similar glucocorticoids, such as dexamethasone and prednisone, do not inhibit CSC formation. We show that ciclesonide is important for CSC formation through the Hedgehog signaling pathway. Ciclesonide reduces the protein levels of GL1, GL2, and Smoothened (SMO), and a small interfering RNA (siRNA) targeting SMO inhibits tumorsphere formation. Additionally, ciclesonide reduces the transcript and protein levels of SOX2, and an siRNA targeting SOX2 inhibits tumorsphere formation. To regulate breast CSC formation, ciclesonide regulates GL1, GL2, SMO, and SOX2. Our results unveil a novel mechanism involving Hedgehog signaling and SOX2 regulated by ciclesonide in lung CSCs, and also open up the possibility of targeting Hedgehog signaling and SOX2 to prevent lung CSC formation.
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Affiliation(s)
- Hack Sun Choi
- Subtropical/Tropical Organism Gene Bank, Jeju National University, Jeju 63243, Korea
- School of Biomaterials Science and Technology, College of Applied Life Science, Jeju National University, Jeju 63243, Korea
| | - Su-Lim Kim
- School of Biomaterials Science and Technology, College of Applied Life Science, Jeju National University, Jeju 63243, Korea
- Interdisciplinary Graduate Program in Advanced Convergence Technology & Science, Jeju National University, Jeju 63243, Korea
| | - Ji-Hyang Kim
- School of Biomaterials Science and Technology, College of Applied Life Science, Jeju National University, Jeju 63243, Korea
- Interdisciplinary Graduate Program in Advanced Convergence Technology & Science, Jeju National University, Jeju 63243, Korea
| | - Dong-Sun Lee
- Subtropical/Tropical Organism Gene Bank, Jeju National University, Jeju 63243, Korea
- School of Biomaterials Science and Technology, College of Applied Life Science, Jeju National University, Jeju 63243, Korea
- Interdisciplinary Graduate Program in Advanced Convergence Technology & Science, Jeju National University, Jeju 63243, Korea
- Faculty of Biotechnology, College of Applied Life Sciences, Jeju National University, SARI, Jeju 63243, Korea
- Practical Translational Research Center, Jeju National University, Jeju 63243, Korea
- Correspondence: ; Tel.: +82-64-754-3340
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Shao J, Talton J, Wang Y, Winner L, Hochhaus G. Quantitative Assessment of Pulmonary Targeting of Inhaled Corticosteroids Using Ex Vivo Receptor Binding Studies. AAPS JOURNAL 2020; 22:39. [PMID: 32002694 DOI: 10.1208/s12248-019-0404-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/05/2019] [Indexed: 11/30/2022]
Abstract
The goal of locally acting inhaled corticosteroids is to achieve distinct pulmonary effects with reduced systemic side effects. The present work using an ex vivo receptor binding model in rats was interested in assessing pulmonary targeting for several commercially available corticosteroids by monitoring receptor occupancies in the lung and systemic organs (liver, kidney, spleen, and brain) after intravenous (IV) injection or intratracheal (IT) instillation of a dry powder administration at a dose of 100 μg/kg. Pulmonary targeting, defined as the difference in cumulative receptor occupancies (AUCE) between the lung and kidney after pulmonary delivery, differed across the investigated corticosteroids (ΔAUCE range, 33 ± 46 to 143 ± 52% *h) with the highest degree found for corticosteroids with high systemic clearance and pronounced lipophilicity (presumably allowing a long pulmonary residence time). Additionally, this study demonstrated differences in the receptor occupancies across systemic organs. Using kidney receptor occupancies as the comparator, liver receptor occupancies were reduced (ΔAUCE range: - 157 ± 43 to 178 ± 42% *h) after IV and IT administration for corticosteroids with high intrinsic clearance, while they were increased for corticosteroid prodrugs due to hepatic activation. Spleen receptor occupancies were increased after IT (ΔAUCE range: 33 ± 35 to 135 ± 28% *h), but not after IV administration. This was especially true for slowly dissolving drugs. Reduced brain uptake was also observed for ciclesonide (CIC) and des-ciclesonide (desCIC), two compounds previously not investigated. In summary, ex vivo receptor binding studies represent a powerful tool to assess the fate of ICSs.
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Affiliation(s)
- Jie Shao
- Department of Pharmaceutics, JHMHC, P3-33, College of Pharmacy, University of Florida, P.O. Box 100494, Gainesville, FL, 32610, USA
| | | | - Yaning Wang
- Department of Pharmaceutics, JHMHC, P3-33, College of Pharmacy, University of Florida, P.O. Box 100494, Gainesville, FL, 32610, USA
| | - Lawrence Winner
- Department of Statistics, University of Florida, Gainesville, FL, USA
| | - Guenther Hochhaus
- Department of Pharmaceutics, JHMHC, P3-33, College of Pharmacy, University of Florida, P.O. Box 100494, Gainesville, FL, 32610, USA.
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Ogawa F, Kato H, Nakajima K, Nakagawa T, Matsumura R, Oi Y, Sakai K, Uchiyama M, Ohyama Y, Abe T, Takeuchi I. Therapeutic strategy for severe COVID-19 pneumonia from clinical experience. EUR J INFLAMM 2020. [DOI: 10.1177/2058739220961591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified in December 2019 in Wuhan, China, and has resulted in global pandemic. There is currently no effective therapeutic strategy for the management of mechanical ventilation or antiviral drugs for the treatment of this disease. As such, the development of a therapeutic strategy is urgently needed and should be established as soon as possible. In this case series, a therapeutic strategy was initially developed based on previous treatment methods used for the treatment of SARS and MERS in the absence of treatment options for COVID-19 due to a lack of information. During the search for a potential treatment, clinical findings were obtained from patients with severe COVID-19, and one therapeutic strategy was established. This therapeutic strategy was then applied to severe COVID-19 patients. In addition, we can require some interesting clinical features and characteristics of COVID-19 from blood analysis and physical findings. Here, we reported on the clinical features and characteristics of a therapeutic strategy for the treatment of severe COVID-19 pneumonia at our institution.
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Affiliation(s)
- Fumihiro Ogawa
- Department of Emergency Medicine, Yokohama City University, School of Medicine, Yokohama, Kanagawa, Japan
| | - Hideaki Kato
- Infection Prevention and Control Department, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Kento Nakajima
- Department of Emergency Medicine, Yokohama City University, School of Medicine, Yokohama, Kanagawa, Japan
| | - Tomoki Nakagawa
- Department of Emergency Medicine, Yokohama City University, School of Medicine, Yokohama, Kanagawa, Japan
| | - Reo Matsumura
- Department of Emergency Medicine, Yokohama City University, School of Medicine, Yokohama, Kanagawa, Japan
| | - Yasufumi Oi
- Department of Emergency Medicine, Yokohama City University, School of Medicine, Yokohama, Kanagawa, Japan
| | - Kazuya Sakai
- Department of Emergency Medicine, Yokohama City University, School of Medicine, Yokohama, Kanagawa, Japan
| | - Munehito Uchiyama
- Department of Emergency Medicine, Yokohama City University, School of Medicine, Yokohama, Kanagawa, Japan
| | - Yutaro Ohyama
- Department of Emergency Medicine, Yokohama City University, School of Medicine, Yokohama, Kanagawa, Japan
| | - Takeru Abe
- Department of Emergency Medicine, Yokohama City University, School of Medicine, Yokohama, Kanagawa, Japan
| | - Ichiro Takeuchi
- Department of Emergency Medicine, Yokohama City University, School of Medicine, Yokohama, Kanagawa, Japan
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Ericsson T, Fridén M, Kärrman-Mårdh C, Dainty I, Grime K. Benchmarking of Human Dose Prediction for Inhaled Medicines from Preclinical In Vivo Data. Pharm Res 2017; 34:2557-2567. [DOI: 10.1007/s11095-017-2218-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/21/2017] [Indexed: 12/31/2022]
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Dong K, Zhang H, Yan Y, Sun J, Dong Y, Wang K, Zhang L, Shi X, Xing J. Improvement of side-effects and treatment on the experimental colitis in mice of a resin microcapsule-loading hydrocortisone sodium succinate. Drug Dev Ind Pharm 2016; 43:448-457. [PMID: 27819157 DOI: 10.1080/03639045.2016.1258410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
CONTEXT Extensive or long-time use of corticosteroids often causes many toxic side-effects. The ion exchange resins and the coating material, Eudragit, can be used in combination to form a new oral delivery system to deliver corticosteroids. OBJECTIVES The resin microcapsule (DRM) composed by Amberlite 717 and Eudragit S100 was used to target hydrocortisone (HC) to the colon in order to improve its treatment effect on ulcerative colitis (UC) and reduce its toxic side-effects. METHODS Hydrocortisone sodium succinate (HSS) was sequentially encapsulated in Amberlite 717 and Eudragit S100 to prepare the HSS-loaded resin microcapsule (HSS-DRM). The scanning electron microscopy (SEM) was employed to investigate the morphology and structure of HSS-DRM. The in vitro release and in vivo studies of pharmacokinetics and intestinal drug residues in rat were used to study the colon-targeting of HSS-DRM. The mouse induced by 2,4,6-trinitrobenzenesulfonic acid was used to study the treatment of HSS-DRM on experimental colitis. RESULTS SEM study showed good morphology and structure of HSS-DRM. In the in vitro release study, > 80% of HSS was released in the colon environment (pH 7.4). The in vivo studies showed good colon-targeting of HSS-DRM (Tmax = 0.97 h, Cmax = 118.28 µg/mL of HSS; Tmax = 2.16 h, Cmax = 64.47 µg/mL of HSS-DRM). Moreover, the HSS-DRM could reduce adverse reactions induced by HSS and had good therapeutic effects on the experimental colitis. CONCLUSIONS The resin microcapsule system has good colon-targeting and can be used in the development of colon-targeting preparations.
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Affiliation(s)
- Kai Dong
- a Department of Pharmaceutics, School of Pharmacy , Xi'an Jiaotong University , Xi'an , Shaanxi , China
| | - Hefeng Zhang
- b Department of Pharmacy , The first Hospital of Yulin , Yulin , Shaanxi , China
| | - Yan Yan
- a Department of Pharmaceutics, School of Pharmacy , Xi'an Jiaotong University , Xi'an , Shaanxi , China
| | - Jinyao Sun
- c Department of Pharmacy , The first Affiliated Hospital of Xi'an Jiaotong University , Xi'an , Shaanxi , China
| | - Yalin Dong
- c Department of Pharmacy , The first Affiliated Hospital of Xi'an Jiaotong University , Xi'an , Shaanxi , China
| | - Ke Wang
- a Department of Pharmaceutics, School of Pharmacy , Xi'an Jiaotong University , Xi'an , Shaanxi , China
| | - Lu Zhang
- a Department of Pharmaceutics, School of Pharmacy , Xi'an Jiaotong University , Xi'an , Shaanxi , China
| | - Xianpeng Shi
- a Department of Pharmaceutics, School of Pharmacy , Xi'an Jiaotong University , Xi'an , Shaanxi , China
| | - Jianfeng Xing
- a Department of Pharmaceutics, School of Pharmacy , Xi'an Jiaotong University , Xi'an , Shaanxi , China
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Mukker JK, Singh RSP, Derendorf H. Ciclesonide: A Pro-Soft Drug Approach for Mitigation of Side Effects of Inhaled Corticosteroids. J Pharm Sci 2016; 105:2509-2514. [PMID: 27339407 DOI: 10.1016/j.xphs.2016.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 04/19/2016] [Accepted: 05/03/2016] [Indexed: 10/21/2022]
Abstract
Inhaled corticosteroids are used as one of the first-line drug therapy in patients with asthma. However, their long-term use is associated with various oropharyngeal and systemic side and adverse effects. Design of pro-soft drug is one of the strategies, which was adopted in the design of ciclesonide for mitigation of side effects usually observed with the use of inhaled corticosteroids. Ciclesonide, a pro-soft drug, is converted to an active metabolite desisobutyryl-ciclesonide in the lungs. The anti-inflammatory effect of desisobutyryl-ciclesonide is much higher than ciclesonide, and therefore, the local effect of the metabolite is higher with lower systemic side effects. Ciclesonide has favorable pharmacokinetic and pharmacodynamic properties as inhaled corticosteroid including low oral bioavailability, high plasma protein binding and rapid systemic clearance, high pulmonary deposition and distribution and long pulmonary residence duration. These advantageous properties make ciclesonide a very effective treatment option with low side effects. Various clinical studies support safety and efficacy of ciclesonide use in mild, moderate, and severe asthma patients.
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Affiliation(s)
- Jatinder Kaur Mukker
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, Florida 32610
| | | | - Hartmut Derendorf
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, Florida 32610.
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Colice GL. Pharmacodynamic and pharmacokinetic considerations in choosing an inhaled corticosteroid. ACTA ACUST UNITED AC 2016; 5:245-53. [PMID: 16808544 DOI: 10.2165/00151829-200605040-00003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Inhaled corticosteroids are effective in controlling airway inflammation. Their anti-inflammatory effect is primarily topical, at the site of deposition in the airways. Consequently, traditional pharmacodynamic and pharmacokinetic concepts, which rely on measuring blood concentrations of drug, have limited applicability for evaluating the efficacy of topically acting inhaled corticosteroids. Important factors affecting efficacy of inhaled corticosteroids are: (i) intrinsic properties of the drugs, particularly their affinity for the corticosteroid receptor; and (ii) the newer pharmacodynamic concept of deposition characteristics of the drug formulation. Small particle formulations, especially those developed in the metered-dose inhaler with the new hydrofluoroalkane propellant, deposit to a much greater extent in the lung and may consequently have improved clinical efficacy. Lipid conjugation of inhaled corticosteroids within the lung may allow prolonged duration of effect, enabling once-daily administration. Pharmacodynamic and pharmacokinetic principles probably do not play a role in describing upper airway adverse effects occurring with inhaled corticosteroids. These are probably also determined by intrinsic properties of the drug and deposition characteristics. However, pharmacodynamic and pharmacokinetic principles seem to be important in addressing systemic safety concerns with inhaled corticosteroids. Those inhaled corticosteroids with a longer serum half-life, especially if they have higher affinity for the corticosteroid receptor, may be associated with greater systemic effects. A new pharmacokinetic concept suggests that increased protein binding within the systemic circulation and high systemic clearance of an inhaled corticosteroid may reduce the risk for systemic effects. These new pharmacodynamic and pharmacokinetic concepts provide a useful framework for identifying the characteristics of an inhaled corticosteroid with an improved benefit-to-risk profile. Increased lung deposition and reduced deposition in the upper airway should result in an inhaled corticosteroid with favorable clinical efficacy and a decreased risk for topical upper airway adverse effects. An inhaled corticosteroid with high plasma protein binding and rapid clearance might pose much less risk for systemic adverse effects than currently available drugs in this class.
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Affiliation(s)
- Gene L Colice
- Pulmonary, Critical Care and Respiratory Services, Washington Hospital Center, The George Washington University School of Medicine, Washington, DC, USA
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Kochar B, Dellon ES. Management of proton pump inhibitor responsive-esophageal eosinophilia and eosinophilic esophagitis: controversies in treatment approaches. Expert Rev Gastroenterol Hepatol 2015; 9:1359-69. [PMID: 26365201 PMCID: PMC4644096 DOI: 10.1586/17474124.2015.1088384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Eosinophilic esophagitis (EoE) is a chronic immune-mediated clinicopathologic disease. The prevalence of EoE is approximately 1/2000 persons, EoE is now the most common cause of food impactions, with healthcare expenditures approaching US$ 1 billion annually. This article will discuss challenges related to proton pump inhibitor responsive esophageal eosinophilia, including distinguishing this condition from EoE and understanding the mechanisms behind the PPI response. For EoE, we will review multiple ongoing debates about treatment and monitoring strategies, including selecting treatment outcomes, optimizing medication formulations, approaching the steroid-refractory patient, conducting dietary elimination, prescribing long-term maintenance therapy and performing esophageal dilation.
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Affiliation(s)
- Bharati Kochar
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Evan S. Dellon
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
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Abstract
Eosinophilic esophagitis (EoE) is a relatively common chronic immune-mediated disease of the esophagus characterized clinically by symptoms of esophageal dysfunction that vary by age. Histologically, EoE results in marked esophageal eosinophilia despite treatment with high-dose proton pump inhibition. The cornerstone of treatment is dietary restriction and/or pharmacologic therapy, mainly with topical steroids. This review briefly describes dietary therapy, but focuses on the various medical options in the treatment of EoE, with an emphasis on steroid-based therapy. Numerous landmark studies are reviewed describing the symptomatic and histologic endpoints as well as safety data. The literature strongly supports the use of topical steroid therapy as a means of significantly decreasing eosinophilic mucosal disease. Specifically, high-dose fluticasone propionate appears to be very effective, and has been shown to result in the resolution of mucosal eosinophilia in a large percentage of treated patients. Long-term studies over many years will need to determine whether mucosal healing will change the natural history of this stricture-causing disease. In addition to topical therapy, various other drug-based therapies are reported, including newer immune-based monoclonal antibodies.
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Affiliation(s)
- Prerna Trivedy
- The Unterberg Children's Hospital at Monmouth Medical Center, Long Branch, NJ, USA
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Sun YH, Ge LT, Jiang JX, Shen HJ, Jia YL, Dong XW, Sun Y, Xie QM. Formoterol synergy with des-ciclesonide inhibits IL-4 expression in IgE/antigen-induced mast cells by inhibiting JNK activation. Eur J Pharmacol 2015; 761:161-7. [PMID: 26003274 DOI: 10.1016/j.ejphar.2015.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 05/01/2015] [Accepted: 05/04/2015] [Indexed: 10/23/2022]
Abstract
Inhaled corticosteroid (ICS) therapy in combination with long-acting β-adrenergic agonists (LABA) is the most important treatment for allergic asthma, although the mechanism still remains unclear. However, mast cells play a central role in the pathogenesis of asthma. In this study, we explored the sole or synergetic effects of des-ciclesonide (ICS) and formoterol (LABA) on the cytokines IL-4 and IL-13 and on histamine release from mast cells (RBL-2H3 cells). We found that des-ciclesonide (0.1, 1 and 10nM) and formoterol (0.1, 1 and 10μM) alone attenuated DNP-BSA-induced IL-4 and IL-13 production, respectively, in a concentration-dependent manner in DNP-IgE-sensitized mast cells. Des-ciclesonide (0.2nM) and formoterol (1μM) alone also reduced histamine production. However, the combination of des-ciclesonide (0.2nM) and formoterol (1μM) had a synergistic inhibition effect on IL-4 mRNA expression and protein production but not IL-13 and histamine release. The JNK inhibitor SP600125 (10μM) inhibited antigen-induced mRNA expression and protein production of IL-4. Des-ciclesonide and formoterol alone inhibited the activation of JNK in a concentration-dependent manner, and the combination of des-ciclesonide (0.2nM) and formoterol (1μM) exhibited greater inhibition effect compared with des-ciclesonide (0.2nM) or formoterol (1μM) alone. Taken together, these synergistic effects on mast cells might provide the rationale for the development of the most recent ICS/LABA combination approved for asthma therapy.
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Affiliation(s)
- Yan-hong Sun
- Zhejiang Respiratory Drugs Research Laboratory of CFDA, Medical College of Zhejiang University, Hangzhou 310058, China
| | - Ling-tian Ge
- Medical College, Yangzhou University, 11 Huaihai Road, Yangzhou City, Jiangsu Province 225001, China
| | - Jun-xia Jiang
- Zhejiang Respiratory Drugs Research Laboratory of CFDA, Medical College of Zhejiang University, Hangzhou 310058, China
| | - Hui-juan Shen
- Zhejiang Respiratory Drugs Research Laboratory of CFDA, Medical College of Zhejiang University, Hangzhou 310058, China
| | - Yong-liang Jia
- Zhejiang Respiratory Drugs Research Laboratory of CFDA, Medical College of Zhejiang University, Hangzhou 310058, China
| | - Xin-wei Dong
- Zhejiang Respiratory Drugs Research Laboratory of CFDA, Medical College of Zhejiang University, Hangzhou 310058, China
| | - Yun Sun
- Medical College, Yangzhou University, 11 Huaihai Road, Yangzhou City, Jiangsu Province 225001, China
| | - Qiang-min Xie
- Zhejiang Respiratory Drugs Research Laboratory of CFDA, Medical College of Zhejiang University, Hangzhou 310058, China.
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Kim CH, Kim JK, Kim HJ, Cho JH, Kim JS, Kim YD, Lee HM, Kim SW, Cho KS, Lee SH, Rhee CS, Dhong HJ, Rha KS, Yoon JH. Comparison of intranasal ciclesonide, oral levocetirizine, and combination treatment for allergic rhinitis. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2014; 7:158-66. [PMID: 25729623 PMCID: PMC4341337 DOI: 10.4168/aair.2015.7.2.158] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 07/21/2014] [Indexed: 11/26/2022]
Abstract
Purpose To evaluate the efficacy and safety of once-daily ciclesonide in comparison to both levocetirizine alone, and a ciclesonide/levocetirizine combination in patients with seasonal allergic rhinitis (SAR) and perennial allergic rhinitis (PAR). Methods Subjects exhibiting moderate to severe allergic rhinitis for longer than 1 year were randomized in an open-label, 3-arm, parallel group, multicenter study. Subjects received 200 µg ciclesonide, 5 mg levocetirizine, or a combination of both. Changes from baseline until the end-of-study visit (2 weeks following) were evaluated by reflective total nasal symptom scores (rTNSSs), reflective total ocular symptom scores (rTOSSs), physician-assessed overall nasal signs and symptoms severity (PANS), and rhinoconjunctivitis quality-of-life questionnaires (RQLQ). Results Significant improvements in rTNSS, PANS, and RQLQ in the ciclesonide monotherapy group were observed in comparison to the levocetirizine alone group. Three individual symptoms of rTNSS, including runny nose, nasal itching, and congestion, were improved in the ciclesonide-treated group. rTOSS scores for ciclesonide monotherapy improved from baseline, but no superiority over levocetirizine was shown. The absolute score and changes in rTNSS and PANS were positively correlated. Ciclesonide spray was more effective than levocetirizine in reducing nasal symptoms in both SAR and PAR patients. Ciclesonide and levocetrizine were well tolerated alone and in combination. Conclusions Our results provide support for an AR and its Impact on Asthma (ARIA) recommendation stipulating that ciclesonide is superior to levocetirizine for the treatment of AR, with tolerable safety. Addition of levocetirizine to ciclesonide did not give further clinical benefit over monotherapy.
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Affiliation(s)
- Chang-Hoon Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Kook Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Konkuk University, Seoul, Korea
| | - Hyun Jun Kim
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Jin Hee Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, The Catholic University of Korea, Seoul, Korea
| | - Jung-Soo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Kyungpook National University, Daegu, Korea
| | - Yong-Dae Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Yeungnam University, Daegu, Korea
| | - Heung-Man Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Sung Wan Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyunghee University, Seoul, Korea
| | - Kyu-Sup Cho
- Department of Otorhinolaryngology, Pusan National University School of Medicine, Busan, Korea
| | - Sang Hag Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Chae-Seo Rhee
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul, Korea
| | - Hun-Jong Dhong
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki-Sang Rha
- Department of Otolaryngology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Joo-Heon Yoon
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
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Abstract
Topical steroid therapy has been used to treat eosinophilic esophagitis (EoE) for more than 15 years. We review the treatment trials of topical steroid therapy in adult patients with EoE. Currently, there is no commercially available preparation designed to deliver the steroid to the esophagus. Current regimens consist of swallowing steroid preparations designed for inhalation treatment for asthma. In the short term, steroids are associated with an approximately 15% to 25% incidence of asymptomatic esophageal candidiasis, but otherwise appear to be well tolerated.
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Das S, Mukherjee H, Ahmed SM, Haldar PK, Mandal AB, Mahapatra A, Mukherjee PK, Chakraborti S, Chattopadhyay D. Evaluation of an ethnomedicinal combination containing Semecarpus kurzii and Hernandia peltata used for the management of inflammation. PHARMACEUTICAL BIOLOGY 2013; 51:677-685. [PMID: 23527893 DOI: 10.3109/13880209.2012.762405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
CONTEXT Scientific validation of an ethnomedicinal combination consisting of Semecarpus kurzii Engler (Anacardeaceae) leaves (SKL) and Hernandia peltata Meisn (Hernandeaceae) stem-bark (HPB), traditionally used in ailments related to inflammation, pain and fever. OBJECTIVE To validate in vivo and in vitro analgesic and antiinflammatory activities of methanol extract of SKL, HPB and their combination. MATERIALS AND METHODS Analgesic activity was tested by acetic acid induced writhing reflex and tail flick in Swiss albino mice, while the anti-inflammatory activity was studied in acute, subacute and chronic model on Wistar rats. The vascular permeability, membrane stabilization and protein denaturation were examined to know the possible mode of action. RESULTS Significant (p < 0.01) analgesic (78.04% inhibition of writhing) and antiinflammatory (72.54% inhibition of paw edema) activity was observed in combination of SKL and HPB extracts at 250 mg/kg each. The SKL extract alone inhibits acetic acid-induced vascular permeability (64.4%) at 500 mg/kg, while in combination at 250 mg/kg each, the inhibition was 69.49% (p < 0.01). Furthermore, SKL in combination with HPB (0.25 mg/mL each) prevent RBC hemolysis (61.91%) and inhibition of protein denaturation (76.52%)-like indomethacin. DISCUSSION AND CONCLUSION The SKL and HPB extract, alone (500 mg/kg) and in combination, (250 mg/kg each) had significant analgesic and antiinflammatory activity, probably by inhibiting the release of certain inflammatory mediators and membrane stabilization, due to the presence of triterpenes, tannins and related phytochemicals in the extracts. Thus, our results demonstrated that this combination provide the scientific rationale of its folk use.
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Affiliation(s)
- Sonali Das
- Directorate of Seed Research, Kushmaur, Maunath Bhanjan, Uttar Pradesh, India
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Nave R, Wingertzahn MA, Brookman S, Kaida S, Matsunaga T. Safety, Tolerability, and Exposure of Ciclesonide Nasal Spray in Healthy and Asymptomatic Subjects With Seasonal Allergic Rhinitis. J Clin Pharmacol 2013; 46:461-7. [PMID: 16554455 DOI: 10.1177/0091270006286437] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ciclesonide is an intranasal corticosteroid in development for the treatment of allergic rhinitis. To assess the safety, tolerability, and pharmacokinetics of ciclesonide, adult healthy volunteers and asymptomatic subjects with seasonal allergic rhinitis were randomized to receive intranasal ciclesonide or placebo for 14 days. Serum concentrations of ciclesonide and its active metabolite, desisobutyryl-ciclesonide, were measured using high-performance liquid chromatography assay with tandem mass spectrometric detection, with lower limits of quantification of 25 and 10 pg/mL, respectively. Adrenal function was monitored by diurnal serum free and 24-hour urine cortisol concentrations. Despite the use of a sensitive assay and a high ciclesonide dose (800 microg/d), serum levels of ciclesonide and desisobutyryl-ciclesonide were below the lower limits of quantification for the majority of samples assayed. Ciclesonide was well tolerated and did not appear to affect serum or urine free cortisol levels. The low systemic exposure and favorable safety profile support the continued clinical development of ciclesonide nasal spray.
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Affiliation(s)
- Ruediger Nave
- ALTANA Pharma AG, Byk-Gulden-Str. 2, 78467 Konstanz, Germany
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22
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Teramoto T, Matsui E, Fukao T, Sakai K, Yonezawa H, Kato Z, Ohnishi H, Kaneko H, Kondo N, Azuma J, Nishima S. Repeated-dose pharmacokinetics of inhaled ciclesonide (CIC-HFA) in Japanese children with bronchial asthma: a phase I study. Allergol Int 2012; 61:619-24. [PMID: 23000724 DOI: 10.2332/allergolint.11-oa-0378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 05/31/2012] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Ciclesonide (CIC) is a highly safe, inhaled corticosteroid (ICS) that is converted into a pharmacologically active metabolite (des-isobutyryl-ciclesonide); this metabolite, in turn, exerts a local anti-inflammatory effect on lung tissue. The present study was undertaken to analyze the pharmacokinetics of des-isobutyryl-ciclesonide in the serum of Japanese children with bronchial asthma treated by repeated doses of CIC and to compare the data thus obtained with those obtained for Caucasian children with bronchial asthma. METHODS Eight Japanese children with bronchial asthma were treated for 7 days with CIC-hydrofluoroalkalane (CIC-HFA) 200 μg/day administered by a metered-dose inhaler. The study was designed to assess the pharmacokinetics after 7-day repeated administration by which the steady state can be achieved, based on the results of an earlier study involving healthy Japanese adult males who received 7-day repeated administration of CIC-HFA. Blood was sampled at multiple time points on Day 7 of treatment for measurement of the serum des-isobutyryl-ciclesonide level. RESULTS The pharmacokinetic parameters (AUC from time zero to last observed concentration [AUC(t)], AUC over the dosage interval τ at steady state [AUC(ss)], maximum concentration [C(max)], and terminal elimination half-life [T(1/2)]) and the temporal changes in the serum levels of des-isobutyryl-ciclesonide after repeated administration of CIC-HFA (200 μg/day) in Japanese children with bronchial asthma differed only slightly from those in Caucasian children with bronchial asthma. No serious adverse events were noted during the study period. Additionally, no abnormalities were detected in the serum cortisol level, other laboratory parameters, or vital signs. CONCLUSIONS Our results suggest that there is little difference in the pharmacokinetics of des-isobutyryl-ciclesonide up on repeated administration of CIC-HFA between Japanese and Caucasian children with bronchial asthma. And our study suggests that CIC-HFA (200 μg/day, once daily) can be administered safely for 7 days, without raising any safety concerns.
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Affiliation(s)
- Takahide Teramoto
- Department of Pediatric, Gifu University Graduate School of Medicine, Japan. t−tera@gifu−u.ac.jp
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Tomašković L, Komac M, Makaruha Stegić O, Munić V, Ralić J, Stanić B, Banjanac M, Marković S, Hrvačić B, Čipčić Paljetak H, Padovan J, Glojnarić I, Eraković Haber V, Mesić M, Merćep M. Macrolactonolides: a novel class of anti-inflammatory compounds. Bioorg Med Chem 2012. [PMID: 23199485 DOI: 10.1016/j.bmc.2012.10.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A new concept in design of safe glucocorticoid therapy was introduced by conjugating potent glucocorticoid steroids with macrolides (macrolactonolides). These compounds were synthesized from various steroid 17β-carboxylic acids and 9a-N-(3-aminoalkyl) derivatives of 9-deokso-9a-aza-9a-homoeritromicin A and 3-descladinosyl-9-deokso-9a-aza-9a-homoeritromicin A using stable alkyl chain. Combining property of macrolides to preferentially accumulate in immune cells, especially in phagocyte cells, with anti-inflammatory activity of classic steroids, we designed molecules which showed good anti-inflammatory activity in ovalbumin (OVA) induced asthma in rats. The synthesis, in vitro and in vivo anti-inflammatory activity of this novel class of compounds are described.
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Affiliation(s)
- Linda Tomašković
- GlaxoSmithKline Research Centre Limited, Prilaz baruna Filipovića 29, HR-10000 Zagreb, Croatia.
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Kamimura M, Izumi S, Hamamoto Y, Morita A, Toyota E, Kobayashi N, Kudo K. Superiority of nebulized corticosteroids over dry powder inhalers in certain patients with cough variant asthma or cough-predominant asthma. Allergol Int 2012; 61:411-7. [PMID: 22627846 DOI: 10.2332/allergolint.11-oa-0357] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 01/23/2012] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The particle distribution might differ between nebulizer therapy and metered-dose inhaler (MDI) or dry powder inhaler (DPI) therapy because the particles repeatedly enter/re-enter the airways with the nebulizer. Inhaled corticosteroids (ICS) were administered with a nebulizer to assess the benefit of changes in the distribution of particles in patients with cough variant asthma (CVA) and cough-predominant asthma (CPA). METHODS Patients whose symptoms were not controlled by their current therapy were enrolled. In patients receiving high-dose ICS by MDI or DPI (ICS-MDI/DPI), steroid therapy was switched to 1,320μg/day of nebulized dexamethasone (1,600μg as dexamethasone sodium phosphate) (chronic steroid-independent group). In patients receiving systemic steroids regardless of their ICS-MDI/DPI therapy, nebulized dexamethasone was added and any concurrent ICS-MDI/DPI therapy was halted to detect a steroid-sparing effect (chronic steroid-dependent group). In patients with acute exacerbation of CVA or CPA and persistent symptoms despite systemic corticosteroids, nebulized dexamethasone was added to assess its effect (acute group). RESULTS Superior symptom control was achieved in 10 out of 12 steroid-independent patients, 3 out of 6 steroid-dependent patients, and all 7 acute patients. CONCLUSIONS Delivery of ICS via a nebulizer has advantages over ICS-MDI/DPI in some patients with CVA or CPA.
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Affiliation(s)
- Mitsuhiro Kamimura
- Department of Pulmonology, National Hospital Organization Disaster Medical Center, 3256Midori-machi, Tachikawa-shi, Tokyo, Japan.
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Sahib MN, Darwis Y, Peh KK, Abdulameer SA, Fung Tan YT. Incorporation of Beclomethasone Dipropionate into Polyethylene Glycol-Diacyl Lipid Micelles as a Pulmonary Delivery System. Drug Dev Res 2012. [DOI: 10.1002/ddr.21000] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Mohanad Naji Sahib
- School of Pharmaceutical Sciences; Universiti Sains Malaysia; Penang; Malaysia
| | - Yusrida Darwis
- School of Pharmaceutical Sciences; Universiti Sains Malaysia; Penang; Malaysia
| | - Kok Khiang Peh
- School of Pharmaceutical Sciences; Universiti Sains Malaysia; Penang; Malaysia
| | | | - Yvonne Tze Fung Tan
- School of Pharmaceutical Sciences; Universiti Sains Malaysia; Penang; Malaysia
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Schroeder S, Fleischer DM, Masterson JC, Gelfand E, Furuta GT, Atkins D. Successful treatment of eosinophilic esophagitis with ciclesonide. J Allergy Clin Immunol 2012; 129:1419-21. [PMID: 22480537 DOI: 10.1016/j.jaci.2012.03.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 02/09/2012] [Accepted: 03/09/2012] [Indexed: 12/13/2022]
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Jacobs RL. Ciclesonide for the treatment of seasonal allergic rhinitis. Expert Rev Clin Immunol 2012; 7:735-41. [PMID: 22014013 DOI: 10.1586/eci.11.70] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Allergic rhinitis is considered one of the most common afflictions of humans, affecting up to 30% of the world's population, and is increasing in incidence. Primary symptoms, comorbid conditions and complications of this disorder exact a significant toll, resulting in an enormous physical, social and economic impact on society. Single-season allergic rhinitis accounts for approximately 20% of cases of allergic rhinitis with another 40% having mixed seasonal-perennial presentations. Management of this disorder encompasses several treatment options, with intranasal corticosteroids recommended as first-line treatment in moderate-to-severe seasonal allergic rhinitis in current practice parameters. Ciclesonide is the most recently approved product in this category for the management of seasonal allergic rhinitis and is the subject of this article.
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Affiliation(s)
- Robert L Jacobs
- Biogenics Research Institute & Biogenics Research Chamber, 8229 Fredericksburg Road, San Antonio, TX, USA.
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Szelenyi I. Nanomedicine: evolutionary and revolutionary developments in the treatment of certain inflammatory diseases. Inflamm Res 2011; 61:1-9. [PMID: 22057873 DOI: 10.1007/s00011-011-0393-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 09/22/2011] [Accepted: 10/13/2011] [Indexed: 12/15/2022] Open
Abstract
Nanomedicine, although in a nascent stage of development at present, is already a reality. Several pharmaceutical products using this modern technology are already on the market. Nanotechnology offers many potential benefits to medical research. Nanoparticle-based drug carriers can increase the efficacy and safety of drugs by enhancing capacity, improving solubility, combining multiple drugs, protecting against metabolism, and controlling release. Nanoparticles can also form the basis of multifunctional drug delivery vehicles by combining targeting, imaging, and therapeutic moieties. Multifunctional nanoparticles have tremendous potential to treat human diseases. The use of non-viral carriers (nanoparticles) can also improve the cellular/nuclear uptake of corresponding nucleotides. Preclinical characterization of nanoparticles intended for medical applications is complicated-due to the variety of materials used, their unique surface properties, and multifunctional nature. It is hard to predict what precise course nanomedicine will take in years to come. It is, however, very likely that this relatively young research area will become a driving force behind a vast revolution in medical treatment.
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Affiliation(s)
- Istvan Szelenyi
- Doerenkamp-Lehrstuhl für Innovationen im Tier- und Verbraucherschutz, Institut für Experimentelle und Klinische Pharmakologie und Toxikologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
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Ciclesonide modulates in vitro allergen-driven activation of blood mononuclear cells and allergen-specific T-cell blasts. Immunol Lett 2011; 141:190-6. [PMID: 22015638 DOI: 10.1016/j.imlet.2011.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 10/05/2011] [Accepted: 10/05/2011] [Indexed: 12/28/2022]
Abstract
BACKGROUND Ciclesonide, an inhaled corticosteroid with almost no affinity for the glucocorticoid receptor, is highly effective in downregulating in vitro pro-inflammatory activities of airway parenchymal cells when converted into the active metabolite desisobutyryl-ciclesonide. OBJECTIVE We evaluate whether ciclesonide could effectively downregulate also antigen- or allergen-induced activation of peripheral blood mononuclear cell and of allergen-specific T-cell blasts. METHODS Peripheral blood mononuclear cells were isolated from non atopic and atopic asthmatic children sensitized to Phleum pratense (PhlP5). Proliferation toward Candida albicans or PhlP5 in the presence of ciclesonide or desisobutyryl-ciclesonide (0.003-3.0 μM) was evaluated as [(3)H]thymidine incorporation. Modulation of PhlP5-specific T-cell blasts proliferation and PhlP5-induced interleukin 4 expression by ciclesonide and desisobutyryl-ciclesonide were measured. RESULTS Peripheral blood mononuclear cell proliferation to C. albicans was dose-dependently inhibited by 0.3-3.0 μM ciclesonide and desisobutyryl-ciclesonide but inhibition by desisobutyryl-ciclesonide was higher. A significant proliferation to PhlP5 was observed only in cultures from atopic subjects: an effective downregulation was already detected at 0.03 μM ciclesonide and 0.003 μM desisobutyryl-ciclesonide (complete inhibition at 3 μM ciclesonide and 0.03 μM desisobutyryl-ciclesonide). 3 μM ciclesonide and desisobutyryl-ciclesonide reduced the PhlP5-specific T-cell blast proliferation and interleukin 4-producing cell proportion. CONCLUSIONS AND CLINICAL RELEVANCE These in vitro data, obtained at concentrations similar to those reached in vivo at bronchial level, are in favor of an efficient inhibition of ciclesonide on the T-cell mediated response toward allergens. Additional studies are required to confirm these preliminary data on the reduced activity of the drug on allergen-specific T-cell blast activation that may have clinical relevance.
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30
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Singas E, Karpel JP. Profile of ciclesonide for the maintenance treatment of asthma. Ther Clin Risk Manag 2011; 7:351-8. [PMID: 21941441 PMCID: PMC3176168 DOI: 10.2147/tcrm.s5433] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Ciclesonide is a nonhalogenated synthetic inhaled corticosteroid (ICS) that has been approved by the US Food and Drug Administration for the treatment of all severities of persistent asthma. It is available as a hydrofluroalkane pressurized metered-dose inhaler in two strengths, 80 mcg/activation and 160 mcg/activation, with the recommenced dosage being two inhalations twice-daily. It is a prodrug that is converted in the lung to its active form, which possesses 100-fold greater glucocorticoid-receptor-binding affinity than the parent compound. Its relative receptor affinity is similar to budesonide. In clinical studies, ciclesonide was effective in improving pulmonary function, reducing asthma symptoms, and reducing or eliminating the need for oral corticosteroids (OCSs). Patients with severe asthma dependent on OCSs and high doses of ICSs were able to achieve greater asthma control and reduce or even eliminate the use of OCSs when switched to ciclesonide. In comparison with fluticasone propionate and budesonide, ciclesonide was demonstrated to be at least as effective in maintaining pulmonary function and asthma control. In clinical trials, ciclesonide was well tolerated, with the majority of adverse events considered mild or moderate in intensity. It had low systemic bioavailability and no clinically significant hypothalamic–pituitary–adrenal axis suppression at therapeutic doses. Its safety profile establishes ciclesonide as an important addition to the currently available ICSs.
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Affiliation(s)
- Effie Singas
- North Shore University Hospital, NS-LIJ Health System, New York, NY, USA
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31
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Barsoum FF. Synthesis and Molecular Modeling Studies of Anti-inflammatory Active 1H-Pyrrolizine-5-carboxamides. Arch Pharm (Weinheim) 2010; 344:56-65. [DOI: 10.1002/ardp.201000166] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2010] [Revised: 07/01/2010] [Accepted: 07/12/2010] [Indexed: 11/09/2022]
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32
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Pedersen S, Potter P, Dachev S, Bosheva M, Kaczmarek J, Springer E, Dunkel J, Engelstätter R. Efficacy and safety of three ciclesonide doses vs placebo in children with asthma: the RAINBOW study. Respir Med 2010; 104:1618-28. [PMID: 20619624 DOI: 10.1016/j.rmed.2010.06.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 06/14/2010] [Accepted: 06/15/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of three doses of ciclesonide (with or without spacer) in children with persistent asthma. PATIENTS AND METHODS This was a multicentre, double-blind, placebo-controlled, 12-week study of ciclesonide 40, 80 or 160 μg (once daily pm). Children (6-11 years) were randomised 1:1 to treatment via a metered dose inhaler (MDI) or MDI plus spacer. The primary variable was change from baseline in mean morning peak expiratory flow (PEF). Secondary variables included: time to first lack of efficacy (LOE), asthma control, forced expiratory volume in 1 s (FEV(1)), asthma symptom score and quality of life (QoL). Safety assessments included: adverse events (AEs), urinary cortisol excretion and body height. RESULTS In total, 1073 children received treatment. At endpoint, mean morning PEF significantly improved with all doses of ciclesonide vs. placebo. There was no difference over placebo in time to first LOE, but ciclesonide was superior to placebo on asthma control, symptom score, FEV(1) and QoL. There were no differences between the spacer or non-spacer subgroups. The incidences of AEs were comparable between treatment groups (approximately 35%) and there were no between-group differences in body height or urinary cortisol. CONCLUSIONS Ciclesonide 40-160 μg once daily is effective and well tolerated in children with persistent asthma; its efficacy and safety are unaffected by the use of a spacer. clinicaltrials.gov registration number: NCT00384189.
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Affiliation(s)
- Søren Pedersen
- University of Southern Denmark, Pediatric Research Unit, Kolding Hospital, Kolding, Denmark.
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33
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Boss H, Minic P, Nave R. Similar Results in Children with Asthma for Steady State Pharmacokinetic Parameters of Ciclesonide Inhaled with or without Spacer. CLINICAL MEDICINE INSIGHTS-PEDIATRICS 2010; 4:1-10. [PMID: 23761990 PMCID: PMC3666986 DOI: 10.4137/cmped.s4311] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: Ciclesonide is an inhaled corticosteroid administered by a metered dose inhaler (MDI) to treat bronchial asthma. After inhalation, the inactive ciclesonide is converted by esterases in the airways to active metabolite desisobutyryl-ciclesonide (des-CIC). Aim: To compare the pharmacokinetic (PK) parameters of des-CIC in children after administration of therapeutic dose of ciclesonide with and without spacer (AeroChamber Plus™). Methods: Open-label, 3 period, cross over, repeated dose, PK study in 37 children with mild to moderate stable asthma (age: 6–11 y; body weight: 20–53 kg). During each 7-day treatment period, ciclesonide was inhaled once in the morning: A) 160 μg MDI with spacer, B) 80 μg MDI with spacer, and C) 160 μg MDI without spacer. Serum PK parameters of ciclesonide and des-CIC were determined on Day 7 of each period. The primary PK parameters were the AUCτ and Cmax for des-CIC. Results: Inhaling ciclesonide with spacer led to a dose proportional systemic exposure (AUCτ) of des-CIC (0.316 μg*h/L for 80 μg and 0.663 μg*h/L for 160 μg). The dose-normalized systemic exposure for des-CIC (based on AUCτ) was 27% higher after inhalation of ciclesonide 80 μg or 160 μg with spacer than without spacer; the corresponding Cmax values for des-CIC were, respectively, 63% and 55% higher with spacer. No clinically relevant abnormalities or adverse drug reactions were observed. Conclusions: Inhalation of therapeutic ciclesonide dose with spacer led to a slight increase in the systemic exposure of des-CIC, which does not warrant dose adjustment.
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Affiliation(s)
- H Boss
- Nycomed GmbH, Byk Gulden Str. 2, 78467 Konstanz, Germany
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34
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Devillier P, Naline E, Dubus JC. Pourquoi et comment mesurer et optimiser le dépôt pulmonaire des traitements inhalés ? Rev Mal Respir 2009; 26:1127-37. [DOI: 10.1016/s0761-8425(09)73539-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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35
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Nave R. Clinical pharmacokinetic and pharmacodynamic profile of inhaled ciclesonide. Clin Pharmacokinet 2009; 48:243-52. [PMID: 19492869 DOI: 10.2165/00003088-200948040-00002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Asthma is a chronic inflammatory disease of the airways, and inhaled corticosteroids (ICSs) are recommended as first-line therapy for persistent asthma of all severities. Ciclesonide is a novel ICS, which is administered as an aerosol solution in a metered-dose inhaler, using hydrofluoroalkane-134a as a propellant. Because of the high respirable particle fraction, high pulmonary deposition is obtained in patients, which constitutes the basis of effective therapeutic action. The parent compound, ciclesonide, is pharmacologically inactive and is activated in the target organ, the lung, to form its only pharmacologically active metabolite, desisobutyryl-ciclesonide (des-CIC). Low oral deposition combined with minimal formation of des-CIC in the oropharynx may minimize the typical oropharyngeal adverse events associated with ICSs. Low oral bioavailability, rapid clearance and high protein binding reduce pharmacologically relevant systemic exposure. The unique pharmacokinetic and pharmacodynamic profile of ciclesonide offers a rationale that supports the favourable risk-benefit profile observed in clinical trials in patients with persistent asthma.
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Affiliation(s)
- Rüdiger Nave
- Department of Pharmacometrics/Pharmacokinetics, Nycomed GmbH, Konstanz, Germany.
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36
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Schaffner TJ, Skoner DP. Ciclesonide: a safe and effective inhaled corticosteroid for the treatment of asthma. J Asthma Allergy 2009; 2:25-32. [PMID: 21437141 PMCID: PMC3048607 DOI: 10.2147/jaa.s4651] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Ciclesonide is a novel inhaled corticosteroid used in the continuous treatment of mild-to-severe asthma. Its formulation and mechanism of action yield a low oral and systemic bioavailability, and high pulmonary deposition. In multiple clinical trials, ciclesonide is at least as effective as either fluticasone propionate or budesonide at symptom control, while in many cases having improved safety outcomes and tolerability. The improved safety and comparable efficacy profiles of ciclesonide demonstrated in current studies could potentially yield a treatment option that may lead to improved adherence and outcome.
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Affiliation(s)
- Timothy J Schaffner
- Division of Allergy, Asthma, and Immunology, Allegheny General Hospital, Pittsburgh, PA, USA
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37
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Abstract
Ciclesonide (Alvesco) is an inhaled corticosteroid used in the preventative treatment of persistent bronchial asthma in adults, adolescents and, in some countries, children. The drug is delivered by a non-chlorofluorocarbon hydrofluoroalkane (HFA) metered-dose inhaler (MDI). In the lungs, ciclesonide is converted to an active metabolite, which is responsible for the beneficial effects of the drug in patients with asthma. Ciclesonide and its active metabolite have low systemic bioavailability and therefore have a low potential to produce systemic adverse events. Inhaled ciclesonide delivered by HFA-MDI is effective in the prophylactic treatment of persistent asthma in adults, adolescents and children, and is generally well tolerated. In general, ciclesonide improves lung function and reduces asthma symptoms and rescue medication use in adults and adolescents with asthma of varying severity. The drug is generally no less effective than other inhaled corticosteroids with regard to maintaining or improving lung function and may have a more favourable tolerability profile than some other agents in this class. Ciclesonide has also shown efficacy in paediatric patients with asthma. Data on its long-term effects on other clinical outcomes, such as asthma exacerbations, would be of interest. Further comparative and long-term studies would also be beneficial in order to definitively position ciclesonide with respect to other inhaled corticosteroids. In the meantime, ciclesonide offers an effective and well tolerated first-line preventative treatment option for persistent asthma.
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Affiliation(s)
- Emma D Deeks
- Wolters Kluwer Health
- Adis, Auckland, New Zealand.
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38
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Couroux P, Kunjibettu S, Hall N, Wingertzahn MA. Onset of action of ciclesonide once daily in the treatment of seasonal allergic rhinitis. Ann Allergy Asthma Immunol 2009; 102:62-8. [DOI: 10.1016/s1081-1206(10)60110-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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39
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Williams B, Smith WB, Kette FE. Intranasal ciclesonide for allergic rhinitis. J Asthma Allergy 2008; 1:49-54. [PMID: 21436985 PMCID: PMC3121337 DOI: 10.2147/jaa.s3082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Ciclesonide is a novel corticosteroid which is optimized for topical use. It is a pro-drug which is activated locally in the airway mucosa, lipid-conjugated for local retention, and has very high protein binding in circulation leading to low systemic bioavailability. These characteristics should lead to highly selective activity with reduced local and systemic side effects. It has been established as an inhaled medication for asthma and has also been shown in double-blind trials to be efficacious for the treatment of seasonal and perennial allergic rhinitis. However no data have yet demonstrated superiority over existing nasal topical corticosteroids, either in terms of efficacy or adverse effects, and trials have not yet clearly shown efficacy in rhinitis in children. Therefore the place of ciclesonide in the treatment of allergic rhinitis relative to other existing products remains unclear.
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Affiliation(s)
- Ben Williams
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide South Australia
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40
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Nonaka T, Katsuura Y, Sugiyama H, Miyagi F. [Pharmacological properties and clinical effects of the inhaled corticosteroid ciclesonide (Alvesco inhaler) for treatment of asthma]. Nihon Yakurigaku Zasshi 2008; 132:237-43. [PMID: 18854626 DOI: 10.1254/fpj.132.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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41
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Nettis E, Colanardi MC, Calogiuri GF, Ferrannini A, Vacca A, Tursi A. Allergic Reactions to Inhalant Glucocorticosteroids: A Hot Topic for Pneumologists and Allergologists. Immunopharmacol Immunotoxicol 2008; 28:511-34. [PMID: 16997799 DOI: 10.1080/08923970600927827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Allergic contact dermatitis to topical glucocorticosteroids (GCS) is a delayed type cell-mediated hypersensitivity reaction; it is frequently observed in dermatological and allergological practice, although its incidence is likely underestimated. By contrast, allergic contact sensitization to inhalant GCS is virtually unknown to most pneumologists. Here, we review some cases of adverse reactions to inhalant GCS in terms of pathogenetic mechanisms, risk factors, epidemiology, and allergic cross-sensitivity. In fact, this particular form of sensitization to drugs that have a wide spectrum of use in pneumological practice deserves more attention than in the past.
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Affiliation(s)
- E Nettis
- Department of Internal Medicine, Immunology and Infectious Diseases, Section of Allergy and Clinical Immunology, University of Bari, Bari, Italy.
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42
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Wang H, Aslanian R, Madison VS. Induced-fit docking of mometasone furoate and further evidence for glucocorticoid receptor 17alpha pocket flexibility. J Mol Graph Model 2008; 27:512-21. [PMID: 18986818 DOI: 10.1016/j.jmgm.2008.09.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Revised: 08/22/2008] [Accepted: 09/02/2008] [Indexed: 11/18/2022]
Abstract
An induced-fit docking method was used to characterize the interactions of the glucocorticoid receptor binding-site with mometasone furoate, a glucocorticoid with a lipophilic ester at the C17alpha position. Two validation studies demonstrated that the protocol can reproduce crystal structures of nuclear receptors, and is appropriate for modeling ligand binding to the glucocorticoid receptor. Key hydrogen bonding interactions between mometasone furoate and the glucocorticoid receptor, as well as favorable hydrophobic interactions between the furoate group and the 17alpha pocket, contribute to high affinity and specificity of this ligand for the receptor. Using the glucocorticoid des-ciclesonide, which has an even larger moiety at the 16,17alpha position, induced-fit docking demonstrates the ability of the 17alpha pocket of the receptor to expand even further to accommodate the ligand.
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Affiliation(s)
- Hongwu Wang
- Department of Structural Chemistry, Schering-Plough Research Institute, 2015 Galloping Hill Road, Kenilworth, NJ 07033, USA.
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Abstract
Ciclesonide nasal spray delivers the corticosteroid ciclesonide as a hypotonic spray via a metered-dose manual pump. Systemic exposure to ciclesonide and its active metabolite desisobutyryl-ciclesonide is low after intranasal administration. High protein binding (approximately 99%) and rapid first-pass clearance further reduce systemic exposure to the drug. In well designed trials, intranasal ciclesonide 200 microg once daily for 2-4 weeks was more effective than placebo in terms of improving nasal symptoms in adolescents and adults with moderate to severe seasonal allergic rhinitis. Quality of life measures were statistically significantly improved in ciclesonide relative to placebo recipients during the first 2 weeks of therapy. Similarly, in adolescents and adults with moderately severe perennial allergic rhinitis, ciclesonide 200 microg once daily was more effective than placebo in terms of reducing nasal symptoms in well designed trials of 6 weeks' and 1 year's duration. Improvements relative to placebo in quality of life measures were not considered clinically relevant. Ciclesonide nasal spray was generally well tolerated in these clinical trials; most adverse events were mild to moderate in intensity.
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Affiliation(s)
- Sohita Dhillon
- Wolters Kluwer Health/Adis, 41 Centorian Drive, Private Bag 65901, Mairangi Bay, North Shore 0754, Auckland, New Zealand.
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44
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Berger WE, Nayak A, Lanier BQ, Kaiser HB, LaForce C, Darken P, Hall N, Wingertzahn M. Efficacy and Safety of Once-Daily Ciclesonide Nasal Spray in Children With Allergic Rhinitis. ACTA ACUST UNITED AC 2008. [DOI: 10.1089/pai.2007.0022.73] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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45
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Böhmer GM, Drollmann A, Gleiter CH, Nave R. Effect of Coadministered Ketoconazole, a Strong Cytochrome P450 3A4 Enzyme Inhibitor, on the Pharmacokinetics of Ciclesonide and its Active Metabolite Desisobutyryl-Ciclesonide. Clin Pharmacokinet 2008; 47:343-9. [DOI: 10.2165/00003088-200847050-00005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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46
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Magnussen H, Hofman J, Staneta P, Lawo JP, Hellwig M, Engelstätter R. Similar efficacy of ciclesonide once daily versus fluticasone propionate twice daily in patients with persistent asthma. J Asthma 2007; 44:555-63. [PMID: 17885859 DOI: 10.1080/02770900701537081] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This 12-week, double-blind, parallel-group study compared the efficacy and safety of once daily ciclesonide and twice daily fluticasone propionate in patients aged 12-75 years with persistent asthma. Patients were randomized to once-daily ciclesonide 80 micro g (n = 278) or 160 micro g (n = 271), or twice daily fluticasone propionate 88 micro g (n = 259) (all ex-actuator). Significant improvements from baseline were seen in all three treatment groups for forced expiratory volume in 1 second, asthma symptom scores and rescue medication use (all p < 0.0001). Asthma exacerbation rates were low (each ciclesonide group, n = 2; fluticasone group, n = 1). Adverse event reporting indicated good tolerability. Once daily ciclesonide 80 micro g or 160 micro g showed comparable efficacy and tolerability to twice daily fluticasone propionate 88 micro g in persistent asthma.
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Affiliation(s)
- Helgo Magnussen
- Center for Pneumology and Thoracic Surgery, Pulmonary Research Institute, Hospital Grosshansdorf, Grosshansdorf, Germany.
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47
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Adachi M, Ishihara K, Inoue H, Kudo K, Takahashi K, Morita Y, Masuda KI, Sakai T, Kato R, Miyamoto T. Efficacy and safety of inhaled ciclesonide compared with chlorofluorocarbon beclomethasone dipropionate in adults with moderate to severe persistent asthma. Respirology 2007; 12:573-80. [PMID: 17587425 DOI: 10.1111/j.1440-1843.2007.01112.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Inhaled corticosteroids are recognized as first-line therapy in the management of asthma; however, their use may be limited by systemic and local side-effects. Ciclesonide, a novel pro-drug inhaled corticosteroid, is activated in the lungs and is expected to have less systemic and local side-effects. This study evaluated the efficacy and safety of ciclesonide in hydrofluoroalkane (HFA) compared with beclomethasone dipropionate (BDP) in a chlorofluorocarbon (CFC) formulation in adult patients with moderate to severe asthma. METHODS This was a multicentre, randomized, open-label, parallel-group comparative study. The patients were given 800 microg/day of CFC-BDP in the four-week baseline period. After the baseline period, 319 patients were randomly allocated into three groups which, respectively, received HFA-ciclesonide 400 microg/day (without a spacer), HFA-ciclesonide 800 microg/day (without spacer) and CFC-BDP 800 microg/day (with spacer) for the eight-week treatment period. The primary efficacy variable was morning PEF. RESULTS The morning PEF increased by 16.02 L/min in the 400 microg HFA-ciclesonide group, 23.98 L/min in the 800 microg HFA-ciclesonide group and 5.91 L/min in the 800 microg CFC-BDP group. Better outcomes were achieved by the use of 800 microg/day of HFA-ciclesonide compared with 800 microg/day of CFC-BDP (P = 0.001). There was no difference in adverse events between the groups. CONCLUSION In adult patients with moderate to severe asthma, 800 microg/day of HFA-ciclesonide was significantly more effective than 800 microg/day of CFC-BDP. Ciclesonide at doses of 400 microg/day and 800 microg/day was safe and well tolerated.
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Affiliation(s)
- Mitsuru Adachi
- First Department of Internal Medicine, Showa University, School of Medicine, Tokyo, Japan.
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48
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Adachi M, Ishihara K, Inoue H, Kudo K, Takahashi K, Morita Y, Masuda KI, Takada Y, Kato R, Miyamoto T. Efficacy and safety of once-daily inhaled ciclesonide in adults with mild to moderate asthma: a double-blind, placebo-controlled study. Respirology 2007; 12:566-72. [PMID: 17587424 DOI: 10.1111/j.1440-1843.2007.01111.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Inhaled corticosteroids are recommended as first-line therapy for the management of asthma, although side-effects may limit their use. Ciclesonide, a novel pro-drug inhaled corticosteroid, exerts potent and prolonged local anti-inflammatory effects in the lungs, and is considered to have an improved safety and tolerability profile. The aim of this study was to evaluate the efficacy and safety of ciclesonide in adult patients with mild to moderate asthma. METHODS A placebo-controlled, multicentre, randomized, double-blind, parallel-group study was conducted. During the 4-week baseline period, patients were given 400 microg/day of beclomethasone dipropionate in a chlorofluorocarbon formulation. After the baseline period, 311 patients were given once-daily 100, 200 or 400 microg of ciclesonide or placebo for an 8-week treatment period without the use of a spacer. The primary efficacy variable was morning PEF. RESULTS Changes in the morning PEF (least squares mean) at the end of the study were 4.23 L/min (P < 0.001) in the 100 microg group, 3.75 L/min (P < 0.001) in the 200 microg group, -0.40 L/min (P < 0.001) in the 400 microg group, as compared with -24.95 L/min in the placebo group. In the ciclesonide groups, the PEF remained at the same level as the baseline period. No large differences were observed between the placebo group and the ciclesonide groups regarding safety. CONCLUSION Once-daily administration of ciclesonide at doses of 100, 200 or 400 microg was shown to be effective in adult patients with mild to moderate asthma. Ciclesonide is considered to have favourable safety profiles and be well tolerated.
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Affiliation(s)
- Mitsuru Adachi
- First Department of Internal Medicine, Showa University, School of Medicine, Tokyo, Japan.
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Boero S, Sabatini F, Silvestri M, Petecchia L, Nachira A, Pezzolo A, Scarso L, Rossi GA. Modulation of human lung fibroblast functions by ciclesonide: evidence for its conversion into the active metabolite desisobutyryl-ciclesonide. Immunol Lett 2007; 112:39-46. [PMID: 17707916 DOI: 10.1016/j.imlet.2007.06.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2007] [Revised: 06/21/2007] [Accepted: 06/26/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Ciclesonide, an inhaled corticosteroid administered as inactive compound with almost no binding affinity for the glucocorticoid receptor, is clinically effective in asthma being converted by airway epithelial cells into its active metabolite desisobutyryl-(des)-ciclesonide. AIM To evaluate whether ciclesonide could directly modulate in vitro bronchial fibroblast functions being converted into des-ciclesonide by these pluripotent cells involved in the regulation of airway inflammation and remodelling. METHODS Ciclesonide (0.09-9.0 microM) was added to a human adult lung fibroblast cell line (CCL-202), seeded in medium in the presence of the following cytokines and growth factors: (a) basic fibroblast growth factor (bFGF) for cell proliferation, measured by tritiated thymidine ([3H]TdR) incorporation; (b) tumour necrosis factor (TNF)-alpha, to stimulate intercellular adhesion molecule (ICAM)-1 expression and monocyte chemoattractant protein-1 (MCP-1) and eotaxin release, evaluated by flow cytometry and ELISA, respectively; (c) transforming growth factor (TGF)-beta1, for induction of alpha smooth muscle actin (alpha-SMA) protein expression and modification of the organization of alpha-SMA stress fibres, evaluated by Western blot analysis and fluorescence microscopy. RESULTS The presence of ciclesonide in cell cultures induced a significant downregulation of: (a) bFGF-induced fibroblast proliferation and TNF-alpha-induced ICAM-1 expression, at the 0.3-9.0 microM concentrations (p<0.05); (b) TNF-alpha-induced MCP-1 release, at all the concentrations tested (p<0.05); (c) TNF-alpha-induced eotaxin release, at the three highest concentrations (0.9-9.0 microM) (p<0.05); (d) TGF-beta1-induced of alpha-SMA protein expression at the 0.3-3.0 microM concentrations, associated with a reduction in the organization of alpha-SMA stress fibres. CONCLUSIONS These data show at cellular level an effective anti-inflammatory activity of ciclesonide on human lung fibroblasts and support the hypothesis that also these cells, in addition to airway epithelial cells, may be involved in converting the parental compound into its active metabolite in the airways.
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Affiliation(s)
- Silvia Boero
- Pulmonary Disease Unit, G. Gaslini Institute, Largo G. Gaslini 5, 16147 Genoa, Italy
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Valotis A, Högger P. Human receptor kinetics and lung tissue retention of the enhanced-affinity glucocorticoid fluticasone furoate. Respir Res 2007; 8:54. [PMID: 17650349 PMCID: PMC1950704 DOI: 10.1186/1465-9921-8-54] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2006] [Accepted: 07/25/2007] [Indexed: 11/10/2022] Open
Abstract
Fluticasone furoate (FF)--USAN approved name, a new topically active glucocorticoid has been recently identified. The aim of this study was to characterise the binding affinity of this compound to the human lung glucocorticoid receptor in relation to other glucocorticoids. Additionally, we sought to determine the binding behaviour of fluticasone furoate to human lung tissue. The glucocorticoid receptor binding kinetics of fluticasone furoate revealed a remarkably fast association and a slow dissociation resulting in a relative receptor affinity (RRA) of 2989 +/- 135 with reference to dexamethasone (RRA: 100 +/- 5). Thus, the RRA of FF exceeds the RRAs of all currently clinically used corticosteroids such as mometasone furoate (MF; RRA 2244), fluticasone propionate (FP; RRA 1775), ciclesonide's active metabolite (RRA 1212 - rat receptor data) or budesonide (RRA 855). FP and FF displayed pronounced retention in human lung tissue in vitro. Lowest tissue binding was found for MF. There was no indication of instability or chemical modification of FF in human lung tissue. These advantageous binding attributes may contribute to a highly efficacious profile for FF as a topical treatment for inflammatory disorders of the respiratory tract.
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Affiliation(s)
- Anagnostis Valotis
- Universität Würzburg, Institut für Pharmazie und Lebensmittelchemie, Würzburg, Germany
| | - Petra Högger
- Universität Würzburg, Institut für Pharmazie und Lebensmittelchemie, Würzburg, Germany
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