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Peng X, Li X, Xie B, Lai Y, Sosnik A, Boucetta H, Chen Z, He W. Gout therapeutics and drug delivery. J Control Release 2023; 362:728-754. [PMID: 37690697 DOI: 10.1016/j.jconrel.2023.09.011] [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: 05/28/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 09/12/2023]
Abstract
Gout is a common inflammatory arthritis caused by persistently elevated uric acid levels. With the improvement of people's living standards, the consumption of processed food and the widespread use of drugs that induce elevated uric acid, gout rates are increasing, seriously affecting the human quality of life, and becoming a burden to health systems worldwide. Since the pathological mechanism of gout has been elucidated, there are relatively effective drug treatments in clinical practice. However, due to (bio)pharmaceutical shortcomings of these drugs, such as poor chemical stability and limited ability to target the pathophysiological pathways, traditional drug treatment strategies show low efficacy and safety. In this scenario, drug delivery systems (DDS) design that overcome these drawbacks is urgently called for. In this review, we initially describe the pathological features, the therapeutic targets, and the drugs currently in clinical use and under investigation to treat gout. We also comprehensively summarize recent research efforts utilizing lipid, polymeric and inorganic carriers to develop advanced DDS for improved gout management and therapy.
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Affiliation(s)
- Xiuju Peng
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, Nanjing 2111198, PR China
| | - Xiaotong Li
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, Nanjing 2111198, PR China
| | - Bing Xie
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, Nanjing 2111198, PR China
| | - Yaoyao Lai
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, Nanjing 2111198, PR China
| | - Alejandro Sosnik
- Department of Materials Science and Engineering, Technion - Israel Institute of Technology, Technion City, Haifa 3200003, Israel
| | - Hamza Boucetta
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, Nanjing 2111198, PR China
| | - Zhongjian Chen
- Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai 200443, China.
| | - Wei He
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, Nanjing 2111198, PR China; Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai 200443, China.
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Birzle C, Schrader H, Blutke A, Ferling H, Scholz-Göppel K, Wanke R, Schwaiger J. Detection of Diclofenac-Induced Alterations in Rainbow Trout (Oncorhynchus mykiss) Using Quantitative Stereological Methods. ENVIRONMENTAL TOXICOLOGY AND CHEMISTRY 2023; 42:859-872. [PMID: 36705425 DOI: 10.1002/etc.5573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/26/2022] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
In 2013, the nonsteroidal anti-inflammatory drug diclofenac (DCF) was included in the watch list for emerging pollutants under the European Union Water Framework Directive. Frequently, monitoring data revealed DCF concentrations in surface waters exceeding the proposed environmental quality standards of 0.04 µg L-1 and 0.126 µg L-1 . In recent literature, the possible effects of DCF on fish are discussed controversially. To contribute to a realistic risk assessment of DCF, a 28-day exposure experiment was carried on rainbow trout (Oncorhynchus mykiss). To warrant reliability of data, experiments were conducted considering the Criteria for Reporting and Evaluating Ecotoxicity Data. The test concentrations of DCF used (0.1, 0.5, 1, 5, 25, and 100 µg L-1 ) also included environmentally relevant concentrations. The lowest-observed-effect concentration (LOEC) for a significant decrease in the plasma concentrations of the DCF biomarker prostaglandin E2 was 0.5 µg L-1 (male fish). For objective evaluation of relevant histomorphological parameters of gills and trunk kidneys, unbiased quantitative stereological methods were applied. In the gills, significant increases in the thickness of the secondary lamella and in the true harmonic mean of barrier thickness in secondary lamellae were present at DCF concentrations of 25 µg L-1 and 100 µg L-1 . In the trunk kidneys, the absolute and relative volumes of nephrons were significantly decreased, paralleled by a significant increase of the volume of the interstitial renal tissue. With regard to quantitative histomorphological alterations in the trunk kidney, the observed LOEC was 0.5 µg L-1 . The quantitative histomorphological analyses that were conducted allow identification and objective quantification of even subtle but significant morphological effects and thus provide an important contribution for the comparability of study results for the determination of no-observed-effect concentrations (NOEC). Environ Toxicol Chem 2023;42:859-872. © 2023 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.
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Affiliation(s)
- Christoph Birzle
- Bavarian Environment Agency, Unit Aquatic Ecotoxicology and Microbial Ecology, Wielenbach, Germany
| | - Hannah Schrader
- Bavarian Environment Agency, Unit Aquatic Ecotoxicology and Microbial Ecology, Wielenbach, Germany
| | - Andreas Blutke
- Institute of Veterinary Pathology, Center of Clinical Veterinary Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Hermann Ferling
- Bavarian Environment Agency, Unit Aquatic Ecotoxicology and Microbial Ecology, Wielenbach, Germany
| | - Karin Scholz-Göppel
- Bavarian Environment Agency, Unit Aquatic Ecotoxicology and Microbial Ecology, Wielenbach, Germany
| | - Rüdiger Wanke
- Institute of Veterinary Pathology, Center of Clinical Veterinary Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Julia Schwaiger
- Bavarian Environment Agency, Unit Aquatic Ecotoxicology and Microbial Ecology, Wielenbach, Germany
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Wojcieszyńska D, Guzik H, Guzik U. Non-steroidal anti-inflammatory drugs in the era of the Covid-19 pandemic in the context of the human and the environment. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 834:155317. [PMID: 35452725 PMCID: PMC9015952 DOI: 10.1016/j.scitotenv.2022.155317] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 05/23/2023]
Abstract
From 2019, life in the world has mainly been determined by successive waves of the COVID-19 epidemic. During this time, the virus structure, action, short- and long-term effects of the infection were discovered, and treatments were developed. This epidemic undoubtedly affected people's lives, but increasing attention is also being paid to the effects of the epidemic on the environment. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, a global scoping review of peer-reviewed information has been conducted on the use of over-the-counter non-steroidal anti-inflammatory drugs in the treatment of symptoms of SARS-CoV-2 infections and their positive and negative effects on the human body, the effects of non-steroidal anti-inflammatory drugs (NSAIDs) on aquatic organisms, and their adverse effects on non-target organisms. The literature from 1998 to 2021 was analysed using the Scopus®, Web of Science™ (WoS) and Google Scholar databases. As non-steroidal anti-inflammatory drugs place a heavy burden on the environment, all reports of the presence of these drugs in the environment during the pandemic period have been thoroughly analysed. Of the 70 peer-reviewed records within the scope, only 14% (n = 10) focussed on the analysis of non-steroidal anti-inflammatory drugs concentrations in wastewater and surface waters during the pandemic period. The percentage of these works indicates that it is still an open topic, and this issue should be supplemented with further reports in which the results obtained during the pandemic, which has been going on for several years, will be published. The authors hope this review will inspire scientists to investigate the problem of non-steroidal anti-inflammatory drugs in the environment to protect them for the next generation.
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Affiliation(s)
- Danuta Wojcieszyńska
- Institute of Biology, Biotechnology and Environmental Protection, Faculty of Natural Science, University of Silesia in Katowice, Jagiellońska 28, 40-032 Katowice, Poland
| | - Henryk Guzik
- Department of Orthopaedics and Traumatology, Medical University of Silesia, Ziołowa 45/47, 40-635 Katowice, Poland
| | - Urszula Guzik
- Institute of Biology, Biotechnology and Environmental Protection, Faculty of Natural Science, University of Silesia in Katowice, Jagiellońska 28, 40-032 Katowice, Poland.
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Eisenstein A, Hilliard BK, Pope SD, Zhang C, Taskar P, Waizman DA, Israni-Winger K, Tian H, Luan HH, Wang A. Activation of the transcription factor NRF2 mediates the anti-inflammatory properties of a subset of over-the-counter and prescription NSAIDs. Immunity 2022; 55:1082-1095.e5. [PMID: 35588739 PMCID: PMC9205175 DOI: 10.1016/j.immuni.2022.04.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/08/2022] [Accepted: 04/21/2022] [Indexed: 12/21/2022]
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit cyclooxygenase (COX) enzymes and are ubiquitously used for their anti-inflammatory properties. However, COX inhibition alone fails to explain numerous clinical outcomes of NSAID usage. Screening commonly used NSAIDs in primary human and murine myeloid cells demonstrated that NSAIDs could be differentiated by their ability to induce growth/differentiation factor 15 (GDF15), independent of COX specificity. Using genetic and pharmacologic approaches, NSAID-mediated GDF15 induction was dependent on the activation of nuclear factor erythroid 2-related factor 2 (NRF2) in myeloid cells. Sensing by Cysteine 151 of the NRF2 chaperone, Kelch-like ECH-associated protein 1 (KEAP1) was required for NSAID activation of NRF2 and subsequent anti-inflammatory effects both in vitro and in vivo. Myeloid-specific deletion of NRF2 abolished NSAID-mediated tissue protection in murine models of gout and endotoxemia. This highlights a noncanonical NRF2-dependent mechanism of action for the anti-inflammatory activity of a subset of commonly used NSAIDs.
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Affiliation(s)
- Anna Eisenstein
- Department of Dermatology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Brandon K Hilliard
- Department of Internal Medicine and Immunobiology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Scott D Pope
- Department of Immunobiology, Yale School of Medicine, New Haven, CT 06520, USA; Howard Hughes Medical Institute, New Haven, CT, USA
| | - Cuiling Zhang
- Department of Internal Medicine and Immunobiology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Pranali Taskar
- NGM Biopharmaceuticals, South San Francisco, CA 94080, USA
| | - Daniel A Waizman
- Department of Immunobiology, Yale School of Medicine, New Haven, CT 06520, USA
| | | | - Hui Tian
- NGM Biopharmaceuticals, South San Francisco, CA 94080, USA
| | - Harding H Luan
- NGM Biopharmaceuticals, South San Francisco, CA 94080, USA.
| | - Andrew Wang
- Department of Internal Medicine and Immunobiology, Yale School of Medicine, New Haven, CT 06520, USA.
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Ren L, Li Q, Li H, Zhan X, Yang R, Li Z, Fang Z, Liu T, Wei Z, Zhao J, Lin L, Mou W, Dai W, Bai Z, Xu G, Cao J. Polysaccharide extract from Isatidis Radix inhibits multiple inflammasomes activation and alleviate gouty arthritis. Phytother Res 2022; 36:3295-3312. [PMID: 35666808 DOI: 10.1002/ptr.7514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 04/09/2022] [Accepted: 04/24/2022] [Indexed: 01/06/2023]
Abstract
The polysaccharide extract from Isatidis Radix exhibits potent antiinflammatory and antiviral activities, but the mechanism of Isatidis Radix polysaccharide (IRP) remains obscure. Herein, we reported that IRP blocked the activation of nod-like receptor pyrin domain-containing 3 (NLRP3) inflammasome, leading to the inhibiting of caspase-1 cleavage and IL-1β secretion. Mechanistically, IRP did not inhibit NLRP3 inflammasome through suppressing mitochondrial reactive oxygen species (mtROS) production. However, IRP can significantly suppress the oligomerization of apoptosis-associated speck-like protein (ASC) and subsequently block the formation of inflammasome. Next, we evaluate the role of IRP in monosodium urate (MSU)-induced gout in vivo which is a NLRP3-associated disease. We also observed that oral administration of IRP can reduce the increased ankle thickness and the secretion of IL-1β, IL-18, IL-6, TNF-α and MPO of the mouse ankle joints caused by MSU crystals. Furthermore, flow cytometry analysis highlighted a significant modulation of T helper 17 cells (Th17)/regulatory T cells (Treg) following IRP treatment in MSU induced gout. Overall, our findings suggest that IRP has comprehensive and potent antiinflammatory effects and provide a reasonable therapeutic strategy in preventing inflammasome-associated diseases, such as inflammatory gouty arthritis.
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Affiliation(s)
- Lutong Ren
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China.,Department of Hepatology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.,China Military Institute of Chinese Materia, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Infectious Diseases, Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Qiang Li
- Department of Hepatology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.,China Military Institute of Chinese Materia, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hui Li
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China.,Department of Hepatology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.,China Military Institute of Chinese Materia, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiaoyan Zhan
- Department of Hepatology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.,China Military Institute of Chinese Materia, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ruichuang Yang
- Department of Pharmacy, Inner Mongolia People's Hospital, Hohhot, China
| | - Zhiyong Li
- Department of Hepatology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.,China Military Institute of Chinese Materia, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhie Fang
- Department of Hepatology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.,China Military Institute of Chinese Materia, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Tingting Liu
- Department of Hepatology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.,China Military Institute of Chinese Materia, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ziying Wei
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China.,Department of Hepatology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.,China Military Institute of Chinese Materia, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jia Zhao
- Department of Hepatology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.,China Military Institute of Chinese Materia, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Li Lin
- Department of Hepatology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.,China Military Institute of Chinese Materia, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Wenqing Mou
- Department of Hepatology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.,China Military Institute of Chinese Materia, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Wenzhang Dai
- Department of Hepatology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.,China Military Institute of Chinese Materia, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhaofang Bai
- Department of Hepatology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.,China Military Institute of Chinese Materia, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Guang Xu
- Department of Hepatology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.,China Military Institute of Chinese Materia, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.,Department of Pharmacy, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Junling Cao
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China.,School of Chinese Medicine, Capital Medical University, Beijing, China
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D'Souza RS, Langford B, Wilson RE, Her YF, Schappell J, Eller JS, Evans TC, Hagedorn JM. The State-of-the-art Pharmacotherapeutic Options for the Treatment of Chronic Non-Cancer Pain. Expert Opin Pharmacother 2022; 23:775-789. [PMID: 35354341 DOI: 10.1080/14656566.2022.2060741] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Pharmacotherapeutic options continue to expand for the treatment of chronic non-cancer pain. There has been an increasing emphasis on multimodal analgesia. This strategy employs use of multiple analgesic medications each with a distinct mechanism of action, which when administered concomitantly may provide profound analgesia. AREAS COVERED The authors describe evidence from randomized controlled trials and systematic reviews on a variety of established medications including anti-inflammatory agents, opioids, anti-convulsants, anti-depressants, N-methyl-D-aspartate receptor antagonists, sodium channel blockers, cannabinoids, and alpha-2-receptor blockers. Furthermore, they provide developing evidence on more novel pharmacotherapeutics including alpha lipoic acid, acetyl-L-carnitine, low dose naltrexone, calcitonin gene-related peptide antagonists, targeted toxin therapy, Nav1.7 inhibitors, neurotensin agonists, purinoceptor antagonists, and sigma-1 receptor antagonists. Furthermore, the authors review the safety and adverse effect profile for these agents. EXPERT OPINION In this era of the opioid epidemic, clinicians should first offer non-opioid analgesics and employ a multimodal analgesic strategy. Current guidelines recommend a personalized approach to the chronic pain treatment, in each case accounting for type, location, severity, and chronicity of pain. Clinicians should also carefully consider the risk-to-benefit ratio to the patient based on the drug side effect profile, patient age, and comorbidities.
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Affiliation(s)
- Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | - Brendan Langford
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | - Rachel E Wilson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | - Yeng F Her
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | - Justin Schappell
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Hospital, Rochester, MN, USA
| | - Jennifer S Eller
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | - Timothy C Evans
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
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Abstract
INTRODUCTION Gout is the most common form of inflammatory arthritis affecting millions of people around the world. Painful flares and tophaceous deposits can be debilitating, reducing quality of life among those affected and putting strain on health care systems. AREAS COVERED This review provides an overview of the treatment of gout for flare pain management and lowering serum urate. Firstline agents are discussed with emphasis on emerging evidence. Novel therapies are also covered. EXPERT OPINION Lifestyle modifications form a part of gout prevention. Regarding gout flare pharmacotherapy NSAIDs, colchicine and glucocorticoids are first line agents. The IL-1β antagonists also are highly effective for arresting flares but their cost-effectiveness render them as salvage therapies. Allopurinol is an agent of first choice for urate lowering therapy (ULT). In South East Asian and Black populations screening for HLA*B58:01 mutation is a cost-effective approach to decrease the occurrence of the rare but potentially very serious allopurinol hypersensitivity syndrome (AHS.). Febuxostat is another efficacious urate lowering therapy but it has received U.S. FDA black box warning for cardiovascular safety and careful consideration is warranted before its initiation in patients with high cardiovascular risk. Novel uricosurics are a class for continued drug development; verinurad and arhalofenate are agents with future promise. For patients with recalcitrant gout, pegloticase is another effective option in the rheumatologist's armamentarium. Its immunogenicity significantly threatens the achievement of sustained urate lowering responses. Abrogating pegloticase's immunogenicity with immunomodulatory co-therapy may lend to sustained efficacy.
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Affiliation(s)
- K E G Blake
- Clinical Fellow, Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham, 1720 2nd Ave South, FOT 839. Birmingham, AL 35294-3408
| | - Jordan L Saag
- Medical Student, University of Central Florida College of Medicine, 6850 Lake Nona Blvd. Orlando, FL 32827
| | - Kenneth G Saag
- Director, Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham, 1720 2nd Ave South, FOT 839. Birmingham, AL 35294-3408
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Abstract
The purpose of gout treatment is to alleviate symptoms of flares, prevent flares from recurring by lowering serum urate, and minimize structural joint damage and functional impairment. In recent years, several new medications to treat gout have been developed, and novel agents continue to be investigated, in addition to several long-established treatments. Although a number of effective therapies are available, optimal management and outcomes are frequently not achieved due to physician under prescribing of urate-lowering therapy (ULT) and poor adherence with therapy when it is prescribed. This article reviews recent developments in the management of gout with reference to recently published clinical guidelines, outlines some important questions regarding the safety and efficacy of particular agents, and remaining gaps in our knowledge about the most effective strategies for using currently available treatments.
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Affiliation(s)
- Lisa K Stamp
- Department of Medicine, University of Otago Christchurch, PO Box 4345, Christchurch, 8140, New Zealand.
| | - Hamish Farquhar
- Department of Medicine, University of Otago Christchurch, PO Box 4345, Christchurch, 8140, New Zealand.
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Jia E, Zhang Y, Ma W, Li B, Geng H, Zhong L, Yao X, Xie J, Xiao Y, Jiang Y, Qiu X, Xiao M, Cui X, Wei J, Zhang J. Initiation of febuxostat for acute gout flare does not prolong the current episode: a randomized clinical trial. Rheumatology (Oxford) 2021; 60:4199-4204. [PMID: 33404656 PMCID: PMC8409997 DOI: 10.1093/rheumatology/keaa908] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/24/2020] [Indexed: 12/27/2022] Open
Abstract
Objective Our objective was to determine whether initiation of febuxostat during an acute gout flare prolongs the current episode. Methods In this randomized, placebo-controlled, single-blinded, multicentre trial, patients with acute gout flares within 72 h were randomized (1:1) to the placebo and febuxostat (40 mg/day) groups. All patients were administered diclofenac (150 mg/day) for 7 days and then open-labelled on the eighth day. Febuxostat 40 mg daily and diclofenac 75 mg daily were administered from day 8 through 28 for the remission period. The dose of diclofenac was 150 mg/day before remission in both arms, and the original protocol was maintained until remission. The primary outcome was ‘days to resolution’. Results We randomized 140 patients, 70 into each arm. The mean days to resolution was 5.98 days [median 7.00, interquartile range (IQR) 2.45 days] for the placebo and 6.50 days (median 7.00, IQR 3.67 days) for the febuxostat group (P = 0.578). The rate of resolution within 7 days was 84.38% for the placebo group and 76.92% for the febuxostat group (P = 0.284). There were no statistically significant differences in joint pain, swelling, tenderness and erythema scores at days 1, 3, 5 and 7. The mean serum uric acid levels were 507.54 and 362.62 μmol/l for the placebo and febuxostat group, respectively, on day 7 (P = 0.000). The rate of recurrent gout flares was 10.00% for the placebo group and 6.56% for the febuxostat group from day 8 through 28 (P = 0.492). Conclusion Initiation of febuxostat administration during an acute gout flare did not prolong the duration of acute flares. Trial registration Chinese Clinical Trial Registry, http://www.chictr.org.cn/, ChiCTR1800015962
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Affiliation(s)
- Ertao Jia
- The Department of Rheumatology, the Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen
| | - Yanying Zhang
- The Department of Rheumatology, the Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen
| | - Wukai Ma
- The Department of Rheumatology, the Second Affiliated Hospital of Guizhou University of traditional Chinese Medicine, Guiyang
| | - Bo Li
- The Department of Rheumatology, People's Hospital of Longhua District Shenzhen, Shenzhen
| | - Hongling Geng
- The Department of Gynecology, Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou
| | - Li Zhong
- The Department of Rheumatology, the Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen
| | - Xueming Yao
- The Department of Rheumatology, the Second Affiliated Hospital of Guizhou University of traditional Chinese Medicine, Guiyang
| | - Jingjing Xie
- The Department of Rheumatology, the Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen
| | - Yuya Xiao
- The Department of Rheumatology, the Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen
| | - Yubao Jiang
- The Department of Rheumatology, the Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen
| | - Xia Qiu
- The Department of Rheumatology, the Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen
| | - Min Xiao
- The Department of Rheumatology, the Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen
| | - Xiang Cui
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Jiaxin Wei
- The Department of Rheumatology, the Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen
| | - Jianyong Zhang
- The Department of Rheumatology, the Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen
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10
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da Cruz RMD, Mendonça-Junior FJB, de Mélo NB, Scotti L, de Araújo RSA, de Almeida RN, de Moura RO. Thiophene-Based Compounds with Potential Anti-Inflammatory Activity. Pharmaceuticals (Basel) 2021; 14:ph14070692. [PMID: 34358118 PMCID: PMC8308569 DOI: 10.3390/ph14070692] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 01/18/2023] Open
Abstract
Rheumatoid arthritis, arthrosis and gout, among other chronic inflammatory diseases are public health problems and represent major therapeutic challenges. Non-steroidal anti-inflammatory drugs (NSAIDs) are the most prescribed clinical treatments, despite their severe side effects and their exclusive action in improving symptoms, without effectively promoting the cure. However, recent advances in the fields of pharmacology, medicinal chemistry, and chemoinformatics have provided valuable information and opportunities for development of new anti-inflammatory drug candidates. For drug design and discovery, thiophene derivatives are privileged structures. Thiophene-based compounds, like the commercial drugs Tinoridine and Tiaprofenic acid, are known for their anti-inflammatory properties. The present review provides an update on the role of thiophene-based derivatives in inflammation. Studies on mechanisms of action, interactions with receptors (especially against cyclooxygenase (COX) and lipoxygenase (LOX)), and structure-activity relationships are also presented and discussed. The results demonstrate the importance of thiophene-based compounds as privileged structures for the design and discovery of novel anti-inflammatory agents. The studies reveal important structural characteristics. The presence of carboxylic acids, esters, amines, and amides, as well as methyl and methoxy groups, has been frequently described, and highlights the importance of these groups for anti-inflammatory activity and biological target recognition, especially for inhibition of COX and LOX enzymes.
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Affiliation(s)
- Ryldene Marques Duarte da Cruz
- Post-Graduation Program in Natural and Synthetic Bioactive Products, Federal University of Paraíba, João Pessoa 58051-900, PB, Brazil; (R.M.D.d.C.); (L.S.); (R.N.d.A.)
| | - Francisco Jaime Bezerra Mendonça-Junior
- Post-Graduation Program in Natural and Synthetic Bioactive Products, Federal University of Paraíba, João Pessoa 58051-900, PB, Brazil; (R.M.D.d.C.); (L.S.); (R.N.d.A.)
- Laboratory of Synthesis and Drug Delivery, State University of Paraíba, João Pessoa 58071-160, PB, Brazil; (N.B.d.M.); (R.S.A.d.A.); (R.O.d.M.)
- Correspondence: ; Tel.: +55-83-9-9924-1423
| | - Natália Barbosa de Mélo
- Laboratory of Synthesis and Drug Delivery, State University of Paraíba, João Pessoa 58071-160, PB, Brazil; (N.B.d.M.); (R.S.A.d.A.); (R.O.d.M.)
| | - Luciana Scotti
- Post-Graduation Program in Natural and Synthetic Bioactive Products, Federal University of Paraíba, João Pessoa 58051-900, PB, Brazil; (R.M.D.d.C.); (L.S.); (R.N.d.A.)
| | - Rodrigo Santos Aquino de Araújo
- Laboratory of Synthesis and Drug Delivery, State University of Paraíba, João Pessoa 58071-160, PB, Brazil; (N.B.d.M.); (R.S.A.d.A.); (R.O.d.M.)
| | - Reinaldo Nóbrega de Almeida
- Post-Graduation Program in Natural and Synthetic Bioactive Products, Federal University of Paraíba, João Pessoa 58051-900, PB, Brazil; (R.M.D.d.C.); (L.S.); (R.N.d.A.)
| | - Ricardo Olímpio de Moura
- Laboratory of Synthesis and Drug Delivery, State University of Paraíba, João Pessoa 58071-160, PB, Brazil; (N.B.d.M.); (R.S.A.d.A.); (R.O.d.M.)
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Gómez-Valenzuela F, Escobar E, Pérez-Tomás R, Montecinos VP. The Inflammatory Profile of the Tumor Microenvironment, Orchestrated by Cyclooxygenase-2, Promotes Epithelial-Mesenchymal Transition. Front Oncol 2021; 11:686792. [PMID: 34178680 PMCID: PMC8222670 DOI: 10.3389/fonc.2021.686792] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/13/2021] [Indexed: 12/11/2022] Open
Abstract
The tumor microenvironment (TME) corresponds to a complex and dynamic interconnection between the extracellular matrix and malignant cells and their surrounding stroma composed of immune and mesenchymal cells. The TME has constant cellular communication through cytokines that sustain an inflammatory profile, which favors tumor progression, angiogenesis, cell invasion, and metastasis. Although the epithelial-mesenchymal transition (EMT) represents a relevant metastasis-initiating event that promotes an invasive phenotype in malignant epithelial cells, its relationship with the inflammatory profile of the TME is poorly understood. Previous evidence strongly suggests that cyclooxygenase-2 (COX-2) overexpression, a pro-inflammatory enzyme related to chronic unresolved inflammation, is associated with common EMT-signaling pathways. This review article summarizes how COX-2 overexpression, within the context of the TME, orchestrates the EMT process and promotes initial metastatic-related events.
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Affiliation(s)
- Fernán Gómez-Valenzuela
- Department of Hematology-Oncology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Enrico Escobar
- Department of Oral Pathology and Medicine, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Ricardo Pérez-Tomás
- Department of Pathology and Experimental Therapy - Bellvitge, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Viviana P Montecinos
- Department of Hematology-Oncology, Pontificia Universidad Católica de Chile, Santiago, Chile
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