1
|
Rosário JDS, Moreira FH, Rosa LHF, Guerra W, Silva-Caldeira PP. Biological Activities of Bismuth Compounds: An Overview of the New Findings and the Old Challenges Not Yet Overcome. Molecules 2023; 28:5921. [PMID: 37570891 PMCID: PMC10421188 DOI: 10.3390/molecules28155921] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 08/04/2023] [Accepted: 08/05/2023] [Indexed: 08/13/2023] Open
Abstract
Bismuth-based drugs have been used primarily to treat ulcers caused by Helicobacter pylori and other gastrointestinal ailments. Combined with antibiotics, these drugs also possess synergistic activity, making them ideal for multiple therapy regimens and overcoming bacterial resistance. Compounds based on bismuth have a low cost, are safe for human use, and some of them are also effective against tumoral cells, leishmaniasis, fungi, and viruses. However, these compounds have limited bioavailability in physiological environments. As a result, there is a growing interest in developing new bismuth compounds and approaches to overcome this challenge. Considering the beneficial properties of bismuth and the importance of discovering new drugs, this review focused on the last decade's updates involving bismuth compounds, especially those with potent activity and low toxicity, desirable characteristics for developing new drugs. In addition, bismuth-based compounds with dual activity were also highlighted, as well as their modes of action and structure-activity relationship, among other relevant discoveries. In this way, we hope this review provides a fertile ground for rationalizing new bismuth-based drugs.
Collapse
Affiliation(s)
- Jânia dos Santos Rosário
- Department of Chemistry, Centro Federal de Educação Tecnológica de Minas Gerais, Belo Horizonte 30421-169, MG, Brazil
| | - Fábio Henrique Moreira
- Department of Chemistry, Centro Federal de Educação Tecnológica de Minas Gerais, Belo Horizonte 30421-169, MG, Brazil
| | - Lara Hewilin Fernandes Rosa
- Institute of Chemistry, Universidade Federal de Uberlândia, Campus Santa Mônica, Uberlândia 38400-142, MG, Brazil
| | - Wendell Guerra
- Institute of Chemistry, Universidade Federal de Uberlândia, Campus Santa Mônica, Uberlândia 38400-142, MG, Brazil
| | | |
Collapse
|
2
|
Guiard E, Lelievre B, Rouyer M, Zerbib F, Diquet B, Mégraud F, Tison F, Bignon E, Lassalle R, Droz-Perroteau C, Moore N, Blin P. Bismuth Concentrations in Patients Treated in Real-Life Practice with a Bismuth Subcitrate-Metronidazole-Tetracycline Preparation: The SAPHARY Study. Drug Saf 2020; 42:993-1003. [PMID: 31069703 DOI: 10.1007/s40264-019-00821-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION A fixed-dose association of bismuth subcitrate, metronidazole and tetracycline (BMT) (Pylera®, Allergan, NJ, USA) was made available in France in 2013 for the eradication of Helicobacter pylori. Due to a historical issue of bismuth encephalopathy, the French Health Authorities requested a study of blood and plasma bismuth concentrations with BMT in daily practice. AIMS The aim of the study was to measure eventual bismuth accumulation and neurological toxicity in patients prescribed BMT. METHODS Patients initiating BMT for H. pylori between March 2014 and December 2015 were included. A blood sample was taken before first BMT intake and 24 h after the last intake, for assay of bismuth. A concentration > 50 μg/L was considered abnormal. Neurological complaints were assessed at inclusion, at the end of the 10-day treatment course, and 28 days later. RESULTS 202 patients were included, of whom 190 took at least one dose of BMT, and 167 provided both required blood samples. Mean blood bismuth concentrations after the BMT course were 16.9 μg/L (95% confidence interval 15.6-18.3). Concentrations were > 50 μg/L (56.0 μg/L and 50.9 μg/L) in two elderly patients, one of whom presented mild, transient memory impairment during treatment. Non-serious neurological symptoms occurred in 20% of all patients and treatment failure was documented in 5% of patients. CONCLUSIONS In this study measuring blood bismuth concentrations in real-life practice, in < 1% of patients the BMT course resulted in blood bismuth concentrations > 50 μg/L. No serious neurological adverse events were observed. STUDY REGISTRATION EU-PAS register EUPAS3142 at www.encepp.eu ; ENCePP study seal.
Collapse
Affiliation(s)
- Estelle Guiard
- Bordeaux PharmacoEpi, University of Bordeaux, Bâtiment Le Tondu, Case 41, 146, rue Léo Saignat, 33076, Bordeaux Cedex, France.,INSERM CIC1401, CHU Bordeaux, Bordeaux, France
| | | | - Magali Rouyer
- Bordeaux PharmacoEpi, University of Bordeaux, Bâtiment Le Tondu, Case 41, 146, rue Léo Saignat, 33076, Bordeaux Cedex, France.,INSERM CIC1401, CHU Bordeaux, Bordeaux, France
| | - Frank Zerbib
- Department of Gastroenterology, Hepatology and Digestive Oncology, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Bertrand Diquet
- Laboratory of Pharmacology and Toxicology, CHU Angers, Angers, France
| | - Francis Mégraud
- Laboratory of Bacteriology, CHU Bordeaux, French National Reference Center for Helicobacters, Bordeaux, France.,INSERM U1053, University of Bordeaux, Bordeaux, France
| | - François Tison
- Department of Neurology, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Emmanuelle Bignon
- Bordeaux PharmacoEpi, University of Bordeaux, Bâtiment Le Tondu, Case 41, 146, rue Léo Saignat, 33076, Bordeaux Cedex, France.,INSERM CIC1401, CHU Bordeaux, Bordeaux, France
| | - Régis Lassalle
- Bordeaux PharmacoEpi, University of Bordeaux, Bâtiment Le Tondu, Case 41, 146, rue Léo Saignat, 33076, Bordeaux Cedex, France.,INSERM CIC1401, CHU Bordeaux, Bordeaux, France
| | - Cécile Droz-Perroteau
- Bordeaux PharmacoEpi, University of Bordeaux, Bâtiment Le Tondu, Case 41, 146, rue Léo Saignat, 33076, Bordeaux Cedex, France.,INSERM CIC1401, CHU Bordeaux, Bordeaux, France
| | - Nicholas Moore
- Bordeaux PharmacoEpi, University of Bordeaux, Bâtiment Le Tondu, Case 41, 146, rue Léo Saignat, 33076, Bordeaux Cedex, France.,INSERM CIC1401, CHU Bordeaux, Bordeaux, France.,INSERM U1219, University of Bordeaux, Bordeaux, France
| | - Patrick Blin
- Bordeaux PharmacoEpi, University of Bordeaux, Bâtiment Le Tondu, Case 41, 146, rue Léo Saignat, 33076, Bordeaux Cedex, France. .,INSERM CIC1401, CHU Bordeaux, Bordeaux, France.
| |
Collapse
|
3
|
Delchier JC, Malfertheiner P, Thieroff-Ekerdt R. Use of a combination formulation of bismuth, metronidazole and tetracycline with omeprazole as a rescue therapy for eradication of Helicobacter pylori. Aliment Pharmacol Ther 2014; 40:171-7. [PMID: 24863854 DOI: 10.1111/apt.12808] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 03/17/2014] [Accepted: 05/06/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Helicobacter pylori infection occurs in children and adults worldwide. Standard triple therapy of omeprazole, amoxicillin and clarithromycin (OAC) may not be optimal. AIM To evaluate quadruple therapy with bismuth subcitrate potassium, metronidazole and tetracycline hydrochloride, given with omeprazole in H. pylori infected subjects who failed previous OAC eradication therapy. METHODS This was a multicenter, open-label, single-arm, multinational study. Helicobacter pylori-positive subjects who had failed ≥1 previous course of OAC therapy with or without up to three supplemental treatments in the previous year. Subjects were treated for 10 days with a combination formulation containing bismuth subcitrate potassium 140 mg, tetracycline hydrochloride 125 mg, and metronidazole 125 mg, three capsules four times daily (q.d.s.), and omeprazole 20 mg twice daily (b.d.). The primary endpoint was H. pylori eradication rate defined as one negative (13) C-urea breath test ≥28 days post-treatment. RESULTS Helicobacter pylori eradication rates ranged from 93.2% to 93.8% in the intent-to-treat population (n = 49), and from 94.7% to 95.0% in the PP population (n = 40). No clinically meaningful differences were observed when analysed by country. Metronidazole resistance was observed in 16/49 (32.7%) subjects and clarithromycin resistance in 31/49 (63.3%) subjects. Thirty-three subjects (67.3%) reported 87 adverse events, and only one (2%) discontinued the study for an adverse event. CONCLUSIONS A quadruple regimen of bismuth, metronidazole and tetracycline plus omeprazole produces a high eradication rate in subjects previously failing H. pylori eradication regimens. This bismuth-based regimen offers an effective option as rescue therapy.
Collapse
Affiliation(s)
- J C Delchier
- Gastroenterology Unit, Albert Chenevier-Henri Mondor Hospital AP-HP, UPEC Université Paris 12, Paris, France
| | | | | |
Collapse
|
4
|
de C Bergamaschi C, Berto LA, Venâncio PC, Cogo K, Franz-Montan M, Motta RHL, Santamaria MP, Groppo FC. Concentrations of metronidazole in human plasma and saliva after tablet or gel administration. ACTA ACUST UNITED AC 2013; 66:40-7. [PMID: 24341948 DOI: 10.1111/jphp.12161] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 09/16/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to determine the pharmacokinetic profile of metronidazole (Mtz) tablet and to compare Mtz gel and tablet concentrations in both blood plasma and saliva. METHODS In this randomized cross-over study with a 1-week washout period, 13 volunteers randomly received one (a single oral dose of 750 mg Mtz (Flagyl®--tablet) and 2) 3 g of 15% Mtz benzoate gel (applied by using a dental tray). The HPLC with ultraviolet detection was used to quantify plasma and saliva concentrations of Mtz. The pharmacokinetic parameters (PPs) areas under the curves from 0 to 48 h (AUC0-48) and from 0 to infinity (AUC0-∞), the maximum plasma concentration (C(max)), the time to C(max), volume of distribution and renal clearance were determined for Mtz tablet. KEY FINDINGS Considering the Mtz tablet, plasma showed higher Mtz concentration from 6 to 24 h after drug administration and the highest values concerning AUC0-48 h and AUC0-∞ than those obtained in saliva (P < 0.05). No significant differences were observed between plasma and saliva concentrations for Mtz gel. CONCLUSIONS The study showed that some PPs were higher in plasma (P < 0.05) than in saliva concerning Mtz tablet. Gel formulation had similar Mtz bioavailability in plasma and saliva resulting in systemic absorption.
Collapse
|
6
|
Saleem A, Qasim A, O'Connor HJ, O'Morain CA. Pylera for the eradication of Helicobacter pylori infection. Expert Rev Anti Infect Ther 2009; 7:793-9. [PMID: 19735221 DOI: 10.1586/eri.09.55] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
An ideal antibiotic regimen for Helicobacter pylori should achieve eradication rates of approximately 90%. Current 7-day triple therapy is successful in about two-thirds of patients. A novel treatment is required to achieve higher eradication with minimal induction of bacterial resistance. The aim of this article is to evaluate the safety and efficacy of a single triple capsule (Pylera) containing bismuth, metronidazole and tetracycline, given with omeprazole for the eradication of H. pylori infection. Extensive literature searches were conducted using PubMed data from 1982 to 2007. This search included headings of H. pylori, bismuth and eradication therapy. The triple capsule Pylera, when given with omeprazole, achieved eradication rates ranging between 84 and 97%. Eradication rates were similar for clarithromycin- and metronidazole-resistant strains. Eradication rates with an omeprazole, bismuth, metronidazole and tetracycline regimen appeared comparable for metronidazole-resistant and -sensitive strains. This effect is not seen with the use of triple therapy in cases of clarithromycin resistance. Clinical trials did not report any serious side effects from bismuth-based regimens and compliance was similar to standard triple therapy. Bismuth-based triple therapy using Pylera is a simplified, effective and well-tolerated regimen achieving cure rates of above 90%.
Collapse
Affiliation(s)
- Aamir Saleem
- Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Tallaght, Trinity College Dublin, Ireland.
| | | | | | | |
Collapse
|
7
|
Ford AC, Malfertheiner P, Giguere M, Santana J, Khan M, Moayyedi P. Adverse events with bismuth salts for Helicobacter pylori eradication: systematic review and meta-analysis. World J Gastroenterol 2009. [PMID: 19109870 DOI: 10.3748/wjg.v14.i48.7361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM To assess the safety of bismuth used in Helicobacter pylori (H pylori) eradication therapy regimens. METHODS We conducted a systematic review and meta-analysis. MEDLINE and EMBASE were searched (up to October 2007) to identify randomised controlled trials comparing bismuth with placebo or no treatment, or bismuth salts in combination with antibiotics as part of eradication therapy with the same dose and duration of antibiotics alone or, in combination, with acid suppression. Total numbers of adverse events were recorded. Data were pooled and expressed as relative risks with 95% confidence intervals (CI). RESULTS We identified 35 randomised controlled trials containing 4763 patients. There were no serious adverse events occurring with bismuth therapy. There was no statistically significant difference detected in total adverse events with bismuth [relative risk (RR) = 1.01; 95% CI: 0.87-1.16], specific individual adverse events, with the exception of dark stools (RR = 5.06; 95% CI: 1.59-16.12), or adverse events leading to withdrawal of therapy (RR = 0.86; 95% CI: 0.54-1.37). CONCLUSION Bismuth for the treatment of H pylori is safe and well-tolerated. The only adverse event occurring significantly more commonly was dark stools.
Collapse
Affiliation(s)
- Alexander C Ford
- Gastroenterology Division, McMaster University Medical Centre, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada.
| | | | | | | | | | | |
Collapse
|
8
|
Ford AC, Malfertheiner P, Giguère M, Santana J, Khan M, Moayyedi P. Adverse events with bismuth salts for Helicobacter pylori eradication: Systematic review and meta-analysis. World J Gastroenterol 2008; 14:7361-70. [PMID: 19109870 PMCID: PMC2778120 DOI: 10.3748/wjg.14.7361] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the safety of bismuth used in Helicobacter pylori (H pylori) eradication therapy regimens.
METHODS: We conducted a systematic review and meta-analysis. MEDLINE and EMBASE were searched (up to October 2007) to identify randomised controlled trials comparing bismuth with placebo or no treatment, or bismuth salts in combination with antibiotics as part of eradication therapy with the same dose and duration of antibiotics alone or, in combination, with acid suppression. Total numbers of adverse events were recorded. Data were pooled and expressed as relative risks with 95% confidence intervals (CI).
RESULTS: We identified 35 randomised controlled trials containing 4763 patients. There were no serious adverse events occurring with bismuth therapy. There was no statistically significant difference detected in total adverse events with bismuth [relative risk (RR) = 1.01; 95% CI: 0.87-1.16], specific individual adverse events, with the exception of dark stools (RR = 5.06; 95% CI: 1.59-16.12), or adverse events leading to withdrawal of therapy (RR = 0.86; 95% CI: 0.54-1.37).
CONCLUSION: Bismuth for the treatment of H pylori is safe and well-tolerated. The only adverse event occurring significantly more commonly was dark stools.
Collapse
|
9
|
Miquel G, Nekaa T, Kahn PH, Hémadi M, El Hage Chahine JM. Mechanism of Formation of the Complex between Transferrin and Bismuth, and Interaction with Transferrin Receptor 1. Biochemistry 2004; 43:14722-31. [PMID: 15544343 DOI: 10.1021/bi048484p] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The kinetics and thermodynamics of Bi(III) exchange between bismuth mononitrilotriacetate (BiL) and human serum transferrin as well as those of the interaction between bismuth-loaded transferrin and transferrin receptor 1 (TFR) were investigated at pH 7.4-8.9. Bismuth is rapidly exchanged between BiL and the C-site of human serum apotransferrin in interaction with bicarbonate to yield an intermediate complex with an effective equilibrium constant K(1) of 6 +/- 4, a direct second-order rate constant k(1) of (2.45 +/- 0.20) x 10(5) M(-1) s(-1), and a reverse second-order rate constant k(-1) of (1.5 +/- 0.5) x 10(6) M(-1) s(-1). The intermediate complex loses a single proton with a proton dissociation constant K(1a) of 2.4 +/- 1 nM to yield a first kinetic product. This product then undergoes a modification in its conformation followed by two proton losses with a first-order rate constant k(2) = 25 +/- 1.5 s(-1) to produce a second kinetic intermediate, which in turn undergoes a last modification in the conformation to yield the bismuth-saturated transferrin in its final state. This last process rate-controls Bi(III) uptake by the N-site of the protein and is independent of the experimental parameters with a constant reciprocal relaxation time tau(3)(-1) of (3 +/- 1) x 10(-2) s(-1). The mechanism of bismuth uptake differs from that of iron and probably does not involve the same transition in conformation from open to closed upon iron uptake. The interaction of bismuth-loaded transferrin with TFR occurs in a single very fast kinetic step with a dissociation constant K(d) of 4 +/- 0.4 microM, a second-order rate constant k(d) of (2.2 +/- 1.5) x 10(8) M(-1) s(-1), and a first-order rate constant k(-d) of 900 +/- 400 s(-1). This mechanism is different from that observed with the ferric holotransferrin and implies that the interaction between TFR and bismuth-loaded transferrin probably takes place on the helical domain of the receptor which is specific for the C-site of transferrin and HFE. The relevance of bismuth incorporation by the transferrin receptor-mediated iron acquisition pathway is discussed.
Collapse
Affiliation(s)
- Geneviève Miquel
- Interfaces, Traitements, Organisation et Dynamique des Systèmes, Université Paris 7-CNRS UMR 7086, 1 rue Guy de la Brosse, 75005 Paris, France
| | | | | | | | | |
Collapse
|