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Platelet Redox Imbalance in Hypercholesterolemia: A Big Problem for a Small Cell. Int J Mol Sci 2022; 23:ijms231911446. [PMID: 36232746 PMCID: PMC9570056 DOI: 10.3390/ijms231911446] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 11/17/2022] Open
Abstract
The imbalance between reactive oxygen species (ROS) synthesis and their scavenging by anti-oxidant defences is the common soil of many disorders, including hypercholesterolemia. Platelets, the smallest blood cells, are deeply involved in the pathophysiology of occlusive arterial thrombi associated with myocardial infarction and stroke. A great deal of evidence shows that both increased intraplatelet ROS synthesis and impaired ROS neutralization are implicated in the thrombotic process. Hypercholesterolemia is recognized as cause of atherosclerosis, cerebro- and cardiovascular disease, and, closely related to this, is the widespread acceptance that it strongly contributes to platelet hyperreactivity via direct oxidized LDL (oxLDL)-platelet membrane interaction via scavenger receptors such as CD36 and signaling pathways including Src family kinases (SFK), mitogen-activated protein kinases (MAPK), and nicotinamide adenine dinucleotide phosphate (NADPH) oxidase. In turn, activated platelets contribute to oxLDL generation, which ends up propagating platelet activation and thrombus formation through a mechanism mediated by oxidative stress. When evaluating the effect of lipid-lowering therapies on thrombogenesis, a large body of evidence shows that the effects of statins and proprotein convertase subtilisin/kexin type 9 inhibitors are not limited to the reduction of LDL-C but also to the down-regulation of platelet reactivity mainly by mechanisms sensitive to intracellular redox balance. In this review, we will focus on the role of oxidative stress-related mechanisms as a cause of platelet hyperreactivity and the pathophysiological link of the pleiotropism of lipid-lowering agents to the beneficial effects on platelet function.
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Abstract
Rosuvastatin/ezetimibe combines two lipid-lowering agents: rosuvastatin, an HMG-CoA reductase inhibitor (i.e. statin) with particularly strong inhibitory effects on hepatic cholesterol synthesis, and ezetimibe, which inhibits the intestinal absorption of cholesterol. A fixed-dose combination (FDC) of rosuvastatin/ezetimibe is indicated as an adjunctive therapy to diet for the management of primary hypercholesterolemia in adults in numerous countries worldwide. In well-designed clinical trials evaluating the therapeutic efficacy of rosuvastatin/ezetimibe administered as either separate agents or as an FDC, rosuvastatin/ezetimibe was significantly more effective than rosuvastatin monotherapy (including at double the dose of rosuvastatin) or simvastatin/ezetimibe in reducing low-density lipoprotein cholesterol (LDL-C) and total cholesterol in adults with hypercholesterolemia. Furthermore, rosuvastatin/ezetimibe enabled significantly higher proportions of patients to achieve recommended LDL-C levels than rosuvastatin monotherapy or simvastatin/ezetimibe. Rosuvastatin/ezetimibe did not significantly differ from rosuvastatin monotherapy with respect to incidences of treatment-related or serious adverse events in these short-term trials and displayed a similar safety profile to simvastatin/ezetimibe. While additional cardiovascular outcomes data and head-to-head comparisons with atorvastatin/ezetimibe would be of interest, rosuvastatin/ezetimibe is a potent and generally well-tolerated drug combination that extends the range of options available for the pharmacological management of primary hypercholesterolemia in adults.
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Dreyer C, Placha W, Zagajewski J, Dygut J, Stangel-Wójcikiewicz K, Piwowar M. The similarity of selected statins – a comparative analysis. BIO-ALGORITHMS AND MED-SYSTEMS 2018. [DOI: 10.1515/bams-2018-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
The paper presents the physicochemical and structural characteristics as well as the comparison of selected statins. Statins are relatively popular compounds used in modern medicine. They are increasingly often combined with other medications to improve the effectiveness of therapy. We analyzed the characteristics of pravastatin, simvastatin, atorvastatin, pitavastatin, lovastatin, mevastatin, fluvastatin, and rosuvastatin obtained from the PubChem Substance database. On the basis of data related to chemical structure and physicochemical properties, the statins were grouped into more and less similar ones. Statins are not homogeneous in terms of physicochemical properties and structure. Three groups of statins were identified. Mevastatin, lovastatin, and simvastatin are the most similar to each other, while pravastatin shows a slightly lower similarity to them. Pitavastatin and fluvastatin are also highly similar, while atorvastatin and rosuvastatin, because of their properties, are the most different from other statin groups.
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Affiliation(s)
- Constantin Dreyer
- Jagiellonian University – Medical College , Św. Anny 12 , 31-008 Krakow , Poland
| | - Wojciech Placha
- Jagiellonian University – Medical College , Chair of Medical Biochemistry , Kopernika 7 , 31-034 Krakow , Poland
| | - Jacek Zagajewski
- Jagiellonian University – Medical College , Chair of Medical Biochemistry , Kopernika 7 , 31-034 Krakow , Poland
| | - Jacek Dygut
- Jagiellonian University – Medical College , Department of Bioinformatics and Telemedicine , Łazarza 16 , 31-530 Krakow , Poland
| | | | - Monika Piwowar
- Jagiellonian University – Medical College , Department of Bioinformatics and Telemedicine , Łazarza 16 , 31-530 Krakow , Poland
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Jiao Y, Hu F, Zhang Z, Gong K, Sun X, Li A, Liu N. Efficacy and Safety of Loading-Dose Rosuvastatin Therapy in Elderly Patients with Acute Coronary Syndromes Undergoing Elective Percutaneous Coronary Intervention. Clin Drug Investig 2016; 35:777-84. [PMID: 26387028 DOI: 10.1007/s40261-015-0335-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of this work was to investigate the efficacy and safety of loading-dose rosuvastatin therapy in elderly patients with non-ST-segment elevation acute coronary syndromes (NSTEACS) undergoing elective percutaneous coronary intervention (PCI). METHODS A total of 126 patients (≥70 years old) with NSTEACS were randomly divided into two groups: (1) loading-dose rosuvastatin-treated group, treated with rosuvastatin 20 mg 12 h prior to PCI, with a second dose administered just before PCI (n = 62), and (2) control-treated group, treated with the standard method according to ACC/AHA guidelines in UAP/NSTEMI 2007 (n = 64). All patients were required to take rosuvastatin 10 mg once a day starting 24 h after the surgery irrespective of the initial randomization assignment. The serum soluble lectin-like oxidized low-density lipoprotein receptor-1 (sLox-1), high-sensitivity C-reactive protein (hs-CRP), creatinine kinase (CK)-MB, cardiac troponin I (cTnI), and brain natriuretic peptide (BNP) levels were measured prior to PCI and at 24 h and 30 days after PCI in both groups. The left ventricular ejection fraction (LVEF) levels were recorded prior to PCI and 30 days after PCI in both groups. RESULTS Compared to pre-PCI, the serum sLox-1, hs-CRP, CK-MB, and cTnI levels were increased at 24 h after PCI (all p < 0.05) in both groups. However, the increased sLox-1, hs-CRP, CK-MB, and cTnI values were significantly lower in the loading-dose rosuvastatin-treated group than in the control-treated group (p < 0.05). In addition the serum sLox-1 and hs-CRP levels were lower in the loading-dose rosuvastatin-treated group than in the control-treated group at 30 days after PCI. However, the decreased values of sLox-1and hs-CRP from 24 h after PCI to 30 days after PCI did not show any significant difference between the two groups. No significant difference was found in the serum ALT and Scr levels between the two groups before and after PCI. Compared to the control-treated group, the serum BNP level decreased (p < 0.05) and LVEF (p < 0.05) increased in the loading-dose rosuvastatin-treated group at 30 days after PCI. CONCLUSION The loading-dose rosuvastatin therapy in elderly patients with non-ST-segment elevation acute coronary syndromes undergoing elective PCI can attenuate the increase in serum hs-CRP, sLox-1, CK-MB, and cTnI levels, reduce myocardial injury and inflammatory reaction caused by PCI, and improve the LVEF level at 30 days after PCI, ensuring an effective and safe therapy.
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Affiliation(s)
- Yungen Jiao
- Department of Cardiology, Institute of Cardiovascular Disease, Zhongda Hospital of Southeast University Medical School, Southeast University, Nanjing, 210000, China
- Department of Cardiology, First People's Hospital of Yangzhou, The Second Clinical Medical School of Yangzhou University, Yangzhou, 225400, China
| | - Feng Hu
- Department of Cardiology, First People's Hospital of Yangzhou, The Second Clinical Medical School of Yangzhou University, Yangzhou, 225400, China
| | - Zhengang Zhang
- Department of Cardiology, First People's Hospital of Yangzhou, The Second Clinical Medical School of Yangzhou University, Yangzhou, 225400, China
| | - Kaizheng Gong
- Department of Cardiology, First People's Hospital of Yangzhou, The Second Clinical Medical School of Yangzhou University, Yangzhou, 225400, China
| | - Xiaoning Sun
- Department of Cardiology, First People's Hospital of Yangzhou, The Second Clinical Medical School of Yangzhou University, Yangzhou, 225400, China
| | - Aihua Li
- Department of Cardiology, First People's Hospital of Yangzhou, The Second Clinical Medical School of Yangzhou University, Yangzhou, 225400, China
| | - Naifeng Liu
- Department of Cardiology, Institute of Cardiovascular Disease, Zhongda Hospital of Southeast University Medical School, Southeast University, Nanjing, 210000, China.
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Koca İ, Özgür A, Er M, Gümüş M, Açikalin Coşkun K, Tutar Y. Design and synthesis of pyrimidinyl acyl thioureas as novel Hsp90 inhibitors in invasive ductal breast cancer and its bone metastasis. Eur J Med Chem 2016; 122:280-290. [PMID: 27376491 DOI: 10.1016/j.ejmech.2016.06.032] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 06/14/2016] [Accepted: 06/18/2016] [Indexed: 01/09/2023]
Abstract
Invasive ductal carcinoma is the most common breast malignancies tumors and has tendency to bone metastases. Many oncogenic client proteins involved in formation of metastatic pathways. Stabilization, regulation, and maintenance of these oncogenic client proteins are provided with Heat Shock Protein 90 (Hsp90). Hsp90 perform these processes through its ATP binding and subsequent hydrolysis energy. Therefore, designing Hsp90 inhibitors is a novel cancer treatment method. However, many Hsp90 inhibitors have solubility problems and showed adverse effects in clinical trials. Thus, we designed and synthesized novel pyrimidinyl acyl thiourea derivatives to selectively inhibit Hsp90 alpha in human invasive ductal breast (MCF-7) and human bone osteosarcoma (Saos-2) cell lines. In vitro experiments showed that the compounds inhibited cell proliferation, ATP hydrolysis, and exhibited cytotoxic effect on these cancer cell lines. Further, gene expression was analyzed by microarray studies on MCF-7 cell lines. Several genes that play vital roles in breast cancer pathogenesis displayed altered gene expression in the presence of a selected pyrimidinyl acyl thiourea compound. Molecular docking studies were also performed to determine interaction between Hsp90 ATPase domain and pyrimidinyl acyl thiourea derivatives. The results indicated that the compounds are able to interact with Hsp90 ATP binding pocket and inhibit ATPase function. The designed compounds powerfully inhibit Hsp90 by an average of 1 μM inhibition constant. And further, the compounds perturb Hsp90 N terminal domain proper orientation and ATP may not provide required conformational change for Hsp90 function as evidenced by in silico experiments. Therefore, the designed compounds effectively inhibited both invasive ductal breast carcinoma and bone metastasis. Pyrimidinyl acyl thiourea derivatives may provide a drug template for effective treatment of invasive ductal breast carcinoma and its bone metastasis as well as new therapeutic perspective for drug design.
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Affiliation(s)
- İrfan Koca
- Bozok University, Faculty of Arts and Sciences, Department of Chemistry, Yozgat, Turkey.
| | - Aykut Özgür
- Gaziosmanpaşa University, Faculty of Natural Sciences and Engineering, Department of Bioengineering, Tokat, Turkey
| | - Muhammet Er
- Bozok University, Faculty of Arts and Sciences, Department of Chemistry, Yozgat, Turkey
| | - Mehmet Gümüş
- Bozok University, Faculty of Arts and Sciences, Department of Chemistry, Yozgat, Turkey
| | - Kübra Açikalin Coşkun
- Gaziosmanpaşa University, Faculty of Natural Sciences and Engineering, Department of Bioengineering, Tokat, Turkey
| | - Yusuf Tutar
- Cumhuriyet University, Faculty of Pharmacy, Department of Basic Sciences, Division of Biochemistry, Sivas, Turkey.
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Abstract
SIGNIFICANCE Reactive oxidant species (ROS) are highly reactive molecules produced by several cell lines including platelets and serve as second messenger for intracellular signaling. In recent years it became evident that ROS are also implicated in the thrombotic process. Statins are lipid lowering molecules which reduce serum cholesterol and retard atherosclerotic complication and its clinical sequelae. However there is evidence that statins may exert an antiplatelet effects by interfering with redox signaling. RECENT ADVANCES Experimental and clinical studies provided evidence that intra-platelet ROS formation is implicated in the process of thrombosis, as impaired ROS neutralization is associated with serious thrombotic complication and eventually death. Recent studies demonstrated that statins possess antiplatelet activity via inhibition of platelet NADPH oxidase-derived ROS formation. This effect results in down-regulation of isoprostanes, which are pro-aggregating molecules, and up-regulation of nitric oxide, which is a platelet inhibitor; such changes occurred immediately after statin's administration and were independent from lipid lowering property. CRITICAL ISSUES Experimental and clinical studies documented that statins possess an antithrombotic effects which may account for thrombotic-related vascular outcomes. This has been evidenced in clinical settings such as percutaneous coronary intervention, myocardial infarction and venous thrombosis. It is still unclear, however, if the statin's antithrombotic effect is dose-related. FUTURE DIRECTIONS Future studies should be addressed to analyze if the antiplatelet effect of statins may preferentially occur at high dosage of statins. Furthermore, the antiplatelet effects of statins could turn useful in clinical settings where the clinical efficacy of aspirin and other antiplatelet drugs are still uncertain.
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Violi F, Carnevale R, Pastori D, Pignatelli P. Antioxidant and antiplatelet effects of atorvastatin by Nox2 inhibition. Trends Cardiovasc Med 2013; 24:142-8. [PMID: 24263084 DOI: 10.1016/j.tcm.2013.09.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 09/17/2013] [Accepted: 09/18/2013] [Indexed: 10/26/2022]
Abstract
In recent years, it became evident that reactive oxygen species (ROS) are implicated in the thrombotic process. Statins are lipid-lowering agents able to lower serum cholesterol levels and retard atherosclerotic complications and their clinical sequelae. There is evidence that, among statins, atorvastatin may exert antiplatelet effects by interfering with redox signaling. Recent studies demonstrated that atorvastatin possesses antiplatelet activity via inhibition of platelet formation of NADPH oxidase-derived ROS. This effect results in down-regulation of isoprostanes, which are pro-aggregating molecules, and up-regulation of nitric oxide, which is a platelet inhibitor; such changes occurred immediately after atorvastatin administration and were independent from lipid-lowering property. Experimental and clinical studies documented that statins possess antithrombotic effects, which may account for the reduction of thrombotic-related vascular outcomes. This has been evidenced in different cardiovascular clinical settings such as percutaneous coronary intervention (PCI), myocardial infarction (MI), and venous thrombosis. Future studies should be addressed to analyze if the antiplatelet effect of atorvastatin may preferentially occur at high dosage. Interestingly, the antiplatelet effects of statins could be useful in clinical settings where the clinical efficacy of aspirin and other antiplatelet drugs is still uncertain.
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Affiliation(s)
- Francesco Violi
- I Clinica Medica, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy.
| | - Roberto Carnevale
- I Clinica Medica, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy
| | - Daniele Pastori
- I Clinica Medica, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy
| | - Pasquale Pignatelli
- I Clinica Medica, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy
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Abstract
Rosuvastatin is one of the most potent statins available for reducing circulating low-density lipoprotein cholesterol (LDL-C) levels, which enables more high-risk patients to achieve their lipid goals. Its favorable balance of effects on atherogenic and protective lipoproteins and its pleiotropic effects, including anti-inflammatory and antioxidant effects and improvement in endothelial dysfunction, are associated with slowing of progression of atherosclerosis within the artery wall and have been translated into clinical benefits for cardiovascular outcomes. This review provides an update on the safety and the efficacy of rosuvastatin in recent large clinical trials. It appears that rosuvastatin has a beneficial effect on the progression of atherosclerosis across the clinical dosage range of 2.5–40 mg. It reduced cardiovascular events in relatively low-risk subjects with elevated high-sensitivity C-reactive protein and normal low-density lipoprotein cholesterol. As with other statins, rosuvastatin did not show overall benefit in terms of survival in patients with heart failure, but certain clinical or biochemical markers reflecting underlying disease characteristics may help to identify subgroups of patients that benefit from statin therapy. In patients with end-stage renal disease undergoing chronic hemodialysis, rosuvastatin had no effect on reducing cardiovascular events. Although there is a slightly increased risk of incident diabetes with this class of agents, the absolute benefits of statin therapy on cardiovascular events overweigh the risk in patients with moderate or high cardiovascular risk or with documented cardiovascular disease. As with other statins, rosuvastatin is an appropriate therapy in addition to antihypertensive treatment to reduce cardiovascular risk in hypertensive patients.
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Affiliation(s)
- Miao Hu
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Shatin, Hong Kong
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Pignatelli P, Carnevale R, Di Santo S, Bartimoccia S, Nocella C, Vicario T, Loffredo L, Angelico F, Violi F. Rosuvastatin reduces platelet recruitment by inhibiting NADPH oxidase activation. Biochem Pharmacol 2012; 84:1635-42. [PMID: 23022230 DOI: 10.1016/j.bcp.2012.09.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 09/13/2012] [Indexed: 12/11/2022]
Abstract
Rosuvastatin increased vascular endothelial NO and attenuated platelet activation after ischemia-reperfusion in mice; nevertheless, the influence of rosuvastatin on the activation of human platelets and the underlying mechanism has never been investigated. In an in vitro study platelets from 8 healthy donors were incubated with scalar concentrations of rosuvastatin (1-10 μM) before activation. Platelet recruitment (PR), that mimics the propagation of platelet aggregation and is dependent upon isoprostane formation, was investigated. PR was inhibited by rosuvastatin in concentration-dependent manner concomitantly with down-regulation of platelet release of the pro-thrombotic molecule CD40L. This effect was associated with lower production of platelet reactive oxygen species (ROS), isoprostane and activation of the glycoprotein IIb/IIIa and was counteracted by exogenous addition of isoprostanes. Conversely, rosuvastatin concentration-dependently increased platelet NO. Platelet isoprostane formation mainly depends from NADPH oxidase. Rosuvastatin concentration-dependently inhibited platelet sNOX2-dp release, a specific marker of NADPH oxidase activation, PKC phosphorylation and p47(phox) translocation from cytosol to membranes. In an ex vivo study 10 hypercolesterolemic patients were randomly allocated to diet or rosuvastatin (20 mg). We observed that as early as 2h after rosuvastatin PR, platelet isoprostanes formation, platelet CD40L and sNOX2-dp decreased while platelet NO increased; no changes were detected in diet-assigned patients. This study shows that in vitro rosuvastatin impairs platelet activation via inhibition of NOX2-derived oxidative stress. This effect, which is associated ex vivo with acute inhibition of platelet activation, suggests that rosuvastatin behaves as an antiplatelet drug.
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Affiliation(s)
- Pasquale Pignatelli
- Prima Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy.
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