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Alhazmi HA, Kadi AA, Attwa MW, Ahsan W, Taha MME, Khalid A. Exploring the effect of khat (Catha edulis) chewing on the pharmacokinetics of the antiplatelet drug clopidogrel in rats using the newly developed LC-MS/MS technique. OPEN CHEM 2020. [DOI: 10.1515/chem-2020-0046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
AbstractClopidogrel (CLOP) is widely used worldwide for cardiovascular complications. CLOP is highly metabolized in the liver to its active metabolite by cytochrome P450 enzymes. Studies have shown that khat, an addictive substance, is a powerful inhibitor of cytochrome P450 enzymes and can influence the metabolism of drugs that are concomitantly used. Therefore, this study was designed to evaluate the effects of khat on the pharmacokinetics of CLOP in rats. In this study, rats were administered either CLOP alone or CLOP combined with khat and their plasma were obtained at different time intervals and analyzed using the newly developed and validated liquid chromatography with tandem mass spectrometry (LC-MS/MS) method using foretinib (FTB) as the internal standard. The corresponding peak area of the analyte versus FTB was used for calculating the peak ratio. The validated LC-MS/MS method resulted in the separation of the well-defined quantifiable peaks of CLOP, FTB, and CLOP metabolite within 7 min. Results showed a significant influence of khat on the peak ratio of CLOP metabolite, which was found to be significantly decreased (P < 0.05) in comparison to CLOP alone, suggesting significant decrease in the conversion of CLOP to its active metabolite due to the inhibition of CYP450 enzymes by khat. Therefore, there might be a need for dose adjustment for regular khat chewers using CLOP.
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Affiliation(s)
- Hassan A. Alhazmi
- Substance Abuse and Toxicology Research Centre, Jazan University, P. O. Box 114, 45142, Jazan, Saudi Arabia
- Department of Pharmaceutical Chemistry, College of Pharmacy, Jazan University, P. O. Box 114, 45142, Jazan, Saudi Arabia
| | - Adnan A. Kadi
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, P. O. Box 2457Riyadh, 11451, Saudi Arabia
| | - Mohamed W. Attwa
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, P. O. Box 2457Riyadh, 11451, Saudi Arabia
| | - Waquar Ahsan
- Department of Pharmaceutical Chemistry, College of Pharmacy, Jazan University, P. O. Box 114, 45142, Jazan, Saudi Arabia
| | | | - Asaad Khalid
- Substance Abuse and Toxicology Research Centre, Jazan University, P. O. Box 114, 45142, Jazan, Saudi Arabia
- Medicinal and Aromatic Plants Research Institute, National Center for Research, P. O. Box: 2424, Khartoum-11111, Sudan
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Chin CT, Neely B, Magnus Ohman E, Armstrong PW, Corbalán R, White HD, Prabhakaran D, Winters KJ, Fox KAA, Roe MT. Time-Varying Effects of Prasugrel Versus Clopidogrel on the Long-Term Risks of Stroke After Acute Coronary Syndromes: Results From the TRILOGY ACS Trial. Stroke 2016; 47:1135-9. [PMID: 26883498 DOI: 10.1161/strokeaha.115.012454] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 01/12/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The role of more intense, sustained platelet inhibition in preventing stroke after acute coronary syndrome (ACS) is unclear. We observed a signal for reduced stroke risk in the Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes (TRILOGY ACS) trial after 12 months of treatment with prasugrel versus clopidogrel in medically managed patients with ACS. METHODS We examined 7243 patients with ACS, aged <75 years and without prior stroke, analyzing differences in baseline characteristics between patients with and without a stroke event through 30 months with a Cox proportional hazards model. We also assessed the effect of prasugrel versus clopidogrel (plus aspirin) on risk of all stroke events and ischemic stroke over time with an extended Cox proportional hazards model. RESULTS Stroke events were infrequent through 30 months (ischemic stroke=62; hemorrhagic stroke=15). Patients with stroke were older, had more comorbidities, and had a higher Global Registry of Acute Coronary Events (GRACE) risk score. There was a trend for a lower unadjusted frequency of all stroke events through 30 months for prasugrel versus clopidogrel: 31 (1.5%) versus 46 (2.2%); P=0.08. There was a significant treatment-by-time interaction for those with ischemic stroke (P=0.03), consistent with the 12-month landmarked Kaplan-Meier log-rank test showing a reduced hazard of ischemic stroke after 12 months with prasugrel (P=0.04). No significant interactions between treatment effect of prasugrel versus clopidogrel and time were observed for all stroke events. CONCLUSIONS We observed a potential late treatment effect for prasugrel versus clopidogrel for a reduced risk of ischemic stroke in medically managed patients with ACS aged <75 years. These hypothesis-generating findings suggest that longer duration and more potent platelet inhibition with prasugrel may be associated with lower risk of ischemic stroke after 12 months. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00699998.
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Affiliation(s)
- Chee Tang Chin
- From the Cardiology Department, National Heart Centre Singapore, and Duke-NUS Graduate Medical School, Singapore (C.T.C.); Duke Clinical Research Institute, Durham, NC (B.N., E.M.O., M.T.R.); Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC (E.M.O., M.T.R.); Department of Medicine, Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada (P.W.A.); Department of Cardiovascular Diseases, Pontificia Universidad Católica de Chile, Santiago, Chile (R.C.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); Centre for Chronic Disease Control and Public Health Foundation of India, New Delhi, India (D.P.); Eli Lilly and Company, Indianapolis, IN (K.J.W.); Centre for Cardiovascular Science, University of Edinburgh, and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Benjamin Neely
- From the Cardiology Department, National Heart Centre Singapore, and Duke-NUS Graduate Medical School, Singapore (C.T.C.); Duke Clinical Research Institute, Durham, NC (B.N., E.M.O., M.T.R.); Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC (E.M.O., M.T.R.); Department of Medicine, Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada (P.W.A.); Department of Cardiovascular Diseases, Pontificia Universidad Católica de Chile, Santiago, Chile (R.C.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); Centre for Chronic Disease Control and Public Health Foundation of India, New Delhi, India (D.P.); Eli Lilly and Company, Indianapolis, IN (K.J.W.); Centre for Cardiovascular Science, University of Edinburgh, and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - E Magnus Ohman
- From the Cardiology Department, National Heart Centre Singapore, and Duke-NUS Graduate Medical School, Singapore (C.T.C.); Duke Clinical Research Institute, Durham, NC (B.N., E.M.O., M.T.R.); Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC (E.M.O., M.T.R.); Department of Medicine, Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada (P.W.A.); Department of Cardiovascular Diseases, Pontificia Universidad Católica de Chile, Santiago, Chile (R.C.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); Centre for Chronic Disease Control and Public Health Foundation of India, New Delhi, India (D.P.); Eli Lilly and Company, Indianapolis, IN (K.J.W.); Centre for Cardiovascular Science, University of Edinburgh, and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Paul W Armstrong
- From the Cardiology Department, National Heart Centre Singapore, and Duke-NUS Graduate Medical School, Singapore (C.T.C.); Duke Clinical Research Institute, Durham, NC (B.N., E.M.O., M.T.R.); Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC (E.M.O., M.T.R.); Department of Medicine, Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada (P.W.A.); Department of Cardiovascular Diseases, Pontificia Universidad Católica de Chile, Santiago, Chile (R.C.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); Centre for Chronic Disease Control and Public Health Foundation of India, New Delhi, India (D.P.); Eli Lilly and Company, Indianapolis, IN (K.J.W.); Centre for Cardiovascular Science, University of Edinburgh, and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Ramón Corbalán
- From the Cardiology Department, National Heart Centre Singapore, and Duke-NUS Graduate Medical School, Singapore (C.T.C.); Duke Clinical Research Institute, Durham, NC (B.N., E.M.O., M.T.R.); Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC (E.M.O., M.T.R.); Department of Medicine, Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada (P.W.A.); Department of Cardiovascular Diseases, Pontificia Universidad Católica de Chile, Santiago, Chile (R.C.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); Centre for Chronic Disease Control and Public Health Foundation of India, New Delhi, India (D.P.); Eli Lilly and Company, Indianapolis, IN (K.J.W.); Centre for Cardiovascular Science, University of Edinburgh, and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Harvey D White
- From the Cardiology Department, National Heart Centre Singapore, and Duke-NUS Graduate Medical School, Singapore (C.T.C.); Duke Clinical Research Institute, Durham, NC (B.N., E.M.O., M.T.R.); Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC (E.M.O., M.T.R.); Department of Medicine, Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada (P.W.A.); Department of Cardiovascular Diseases, Pontificia Universidad Católica de Chile, Santiago, Chile (R.C.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); Centre for Chronic Disease Control and Public Health Foundation of India, New Delhi, India (D.P.); Eli Lilly and Company, Indianapolis, IN (K.J.W.); Centre for Cardiovascular Science, University of Edinburgh, and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Dorairaj Prabhakaran
- From the Cardiology Department, National Heart Centre Singapore, and Duke-NUS Graduate Medical School, Singapore (C.T.C.); Duke Clinical Research Institute, Durham, NC (B.N., E.M.O., M.T.R.); Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC (E.M.O., M.T.R.); Department of Medicine, Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada (P.W.A.); Department of Cardiovascular Diseases, Pontificia Universidad Católica de Chile, Santiago, Chile (R.C.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); Centre for Chronic Disease Control and Public Health Foundation of India, New Delhi, India (D.P.); Eli Lilly and Company, Indianapolis, IN (K.J.W.); Centre for Cardiovascular Science, University of Edinburgh, and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Kenneth J Winters
- From the Cardiology Department, National Heart Centre Singapore, and Duke-NUS Graduate Medical School, Singapore (C.T.C.); Duke Clinical Research Institute, Durham, NC (B.N., E.M.O., M.T.R.); Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC (E.M.O., M.T.R.); Department of Medicine, Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada (P.W.A.); Department of Cardiovascular Diseases, Pontificia Universidad Católica de Chile, Santiago, Chile (R.C.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); Centre for Chronic Disease Control and Public Health Foundation of India, New Delhi, India (D.P.); Eli Lilly and Company, Indianapolis, IN (K.J.W.); Centre for Cardiovascular Science, University of Edinburgh, and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Keith A A Fox
- From the Cardiology Department, National Heart Centre Singapore, and Duke-NUS Graduate Medical School, Singapore (C.T.C.); Duke Clinical Research Institute, Durham, NC (B.N., E.M.O., M.T.R.); Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC (E.M.O., M.T.R.); Department of Medicine, Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada (P.W.A.); Department of Cardiovascular Diseases, Pontificia Universidad Católica de Chile, Santiago, Chile (R.C.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); Centre for Chronic Disease Control and Public Health Foundation of India, New Delhi, India (D.P.); Eli Lilly and Company, Indianapolis, IN (K.J.W.); Centre for Cardiovascular Science, University of Edinburgh, and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Matthew T Roe
- From the Cardiology Department, National Heart Centre Singapore, and Duke-NUS Graduate Medical School, Singapore (C.T.C.); Duke Clinical Research Institute, Durham, NC (B.N., E.M.O., M.T.R.); Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC (E.M.O., M.T.R.); Department of Medicine, Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada (P.W.A.); Department of Cardiovascular Diseases, Pontificia Universidad Católica de Chile, Santiago, Chile (R.C.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); Centre for Chronic Disease Control and Public Health Foundation of India, New Delhi, India (D.P.); Eli Lilly and Company, Indianapolis, IN (K.J.W.); Centre for Cardiovascular Science, University of Edinburgh, and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.).
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Pedata F, Dettori I, Coppi E, Melani A, Fusco I, Corradetti R, Pugliese AM. Purinergic signalling in brain ischemia. Neuropharmacology 2015; 104:105-30. [PMID: 26581499 DOI: 10.1016/j.neuropharm.2015.11.007] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 11/04/2015] [Accepted: 11/06/2015] [Indexed: 12/18/2022]
Abstract
Ischemia is a multifactorial pathology characterized by different events evolving in the time. After ischemia a primary damage due to the early massive increase of extracellular glutamate is followed by activation of resident immune cells, i.e microglia, and production or activation of inflammation mediators. Protracted neuroinflammation is now recognized as the predominant mechanism of secondary brain injury progression. Extracellular concentrations of ATP and adenosine in the brain increase dramatically during ischemia in concentrations able to stimulate their respective specific P2 and P1 receptors. Both ATP P2 and adenosine P1 receptor subtypes exert important roles in ischemia. Although adenosine exerts a clear neuroprotective effect through A1 receptors during ischemia, the use of selective A1 agonists is hampered by undesirable peripheral effects. Evidence up to now in literature indicate that A2A receptor antagonists provide protection centrally by reducing excitotoxicity, while agonists at A2A (and possibly also A2B) and A3 receptors provide protection by controlling massive infiltration and neuroinflammation in the hours and days after brain ischemia. Among P2X receptors most evidence indicate that P2X7 receptor contribute to the damage induced by the ischemic insult due to intracellular Ca(2+) loading in central cells and facilitation of glutamate release. Antagonism of P2X7 receptors might represent a new treatment to attenuate brain damage and to promote proliferation and maturation of brain immature resident cells that can promote tissue repair following cerebral ischemia. Among P2Y receptors, antagonists of P2Y12 receptors are of value because of their antiplatelet activity and possibly because of additional anti-inflammatory effects. Moreover strategies that modify adenosine or ATP concentrations at injury sites might be of value to limit damage after ischemia. This article is part of the Special Issue entitled 'Purines in Neurodegeneration and Neuroregeneration'.
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Affiliation(s)
- Felicita Pedata
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Viale Pieraccini, 6, 50139 Florence, Italy.
| | - Ilaria Dettori
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Viale Pieraccini, 6, 50139 Florence, Italy
| | - Elisabetta Coppi
- Department of Health Sciences, University of Florence, Viale Pieraccini, 6, 50139 Florence, Italy
| | - Alessia Melani
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Viale Pieraccini, 6, 50139 Florence, Italy
| | - Irene Fusco
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Viale Pieraccini, 6, 50139 Florence, Italy
| | - Renato Corradetti
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Viale Pieraccini, 6, 50139 Florence, Italy
| | - Anna Maria Pugliese
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Viale Pieraccini, 6, 50139 Florence, Italy
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