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Gupta K, Pandey S, Bagang N, Mehra K, Singh G. Trimetazidine an emerging paradigm in renal therapeutics: Preclinical and clinical insights. Eur J Pharmacol 2021; 913:174624. [PMID: 34774496 DOI: 10.1016/j.ejphar.2021.174624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/30/2021] [Accepted: 11/03/2021] [Indexed: 10/19/2022]
Abstract
Trimetazidine (TMZ) is a well-known anti-ischemic agent used for the treatment of angina pectoris. In the past decades, the efficacy of this drug has been tested in a wide range of kidney injuries, including drug-induced nephrotoxicity (DIN), radio-contrast agent-induced nephropathy, and surgically induced renal ischemic injury. TMZhas renoprotective effects by attenuating oxidative stress, inflammatory cytokine release, maintaining oxygen and energy balance. Moreover, TMZ administration prevented kidney graft rejection in the porcine model by suppressing the infiltration of mononuclear cells, preserving mitochondrial functions, and maintaining Ca+ homeostasis. In DIN and diabetic kidney diseases,TMZ treatment prevents renal injury by inactivating immune cells, attenuating renal fibrosis, inflammation, apoptosis, and histological abnormalities. Interestingly, the clinical therapeutic efficacy of TMZ has also been documented in pre-existing kidney disease patients undergoing contrast exposure for diagnostic intervention. However, the mechanistic insights into the TMZ mediated renoprotective effects in other forms of renal injuries, including type-2 diabetes, drug-induced nephrotoxicity, and hypertension-induced chronic kidney diseases, remain uninvestigated and incomplete. Moreover, the clinical utility of TMZ as a renoprotective agent in radio-contrast-induced nephrotoxicity needs to be tested in a large patient population. Nevertheless, the available pieces of evidence suggest that TMZ is a promising and emerging renal therapy for the treatment and management of kidney diseases of variable etiologies. This review discusses the various pre-clinical and clinical findings and provides mechanistic insights into the TMZ mediated beneficial effects in various kidney diseases.
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Affiliation(s)
- Kirti Gupta
- Department of Pharmacy, Maharishi Markandeshwar Deemed to be University, Mullana, Ambala (Haryana), India
| | - Sneha Pandey
- Department of Pharmacology, Indo-Soviet Friendship College of Pharmacy, Moga, Punjab, India
| | - Newly Bagang
- Department of Pharmacology, Indo-Soviet Friendship College of Pharmacy, Moga, Punjab, India
| | - Kamalpreet Mehra
- Department of Pharmacy, Maharishi Markandeshwar Deemed to be University, Mullana, Ambala (Haryana), India
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Zhang YF, Liu DD, Zhou Y, Lou JZ. Acute kidney injury in patients with acute coronary syndrome after percutaneous coronary intervention: pathophysiologies, risk factors and preventive measures. Cardiology 2021; 146:678-689. [PMID: 34348269 DOI: 10.1159/000517991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 06/20/2021] [Indexed: 11/19/2022]
Abstract
Background: Percutaneous coronary intervention (PCI) has been an effective treatment for acute coronary syndrome (ACS) patients. Acute kidney injury (AKI) is one of the common complications after PCI, which seriously affects the living quality and survival time of patients. The approach followed for the patient with AKI after PCI depends on the clinical context and may vary by resource availability. Summary: This review focuses on the pathophysiologies, influencing factors, and preventive measures of AKI in patients with ACS after PCI. The knowledge may better serve the patients and improve their outcomes. Key Messages: Many studies have been carried out for the definition and standard of AKI in the past few years. Etiologies of AKI after PCI included renal damage of contrast medium and atherosclerotic embolism, cardiac insufficiency and surgical factors on renal function. Basic conditions, treatment modalities, and perioperative changes are major risk factors of AKI. Studies have reported that the prevention of contrast-induced nephropathy, modulating the volume overload, some pharmaceuticals and blood purification treatment are helpful to prevent the occurrence of AKI.
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Affiliation(s)
- Ya-Feng Zhang
- Department of Healthcare-associated Infection Management, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Da-Dong Liu
- Department of Critical Care Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Yue Zhou
- Department of Blood Purification Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Ji-Zhuang Lou
- Department of Blood Purification Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Halim ME, Omar MA, Abdallah NA, Nagy DM. The first spectrofluorimetric approach for accurate determination of trimetazidine in its dosage forms: Application to content uniformity testing. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2020; 242:118710. [PMID: 32712572 DOI: 10.1016/j.saa.2020.118710] [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: 05/25/2020] [Revised: 06/22/2020] [Accepted: 07/15/2020] [Indexed: 06/11/2023]
Abstract
A novel sensitive and simple spectrofluorimetric method has been developed then validated for the determination of trimetazidine in pure form and its tablets. This method is found on the reaction between trimetazidine's secondary amine moiety with NBD-Cl reagent, using borate buffer at pH 8.0 yielding a highly fluorescent product whose fluorescence intensity was measured at 526 nm (excitation at 466 nm). A calibration curve plotted showed that the linear range of the presented method was (50-700 ng/ml) with a correlation coefficient of 0.9998. The limits of detection (LOD) and limits of quantitation (LOQ) values were 15.01 and 45.50 ng/ml respectively. The presented approach was validated according to ICH guidelines and successfully applied for determining trimetazidine in its tablets with a mean percentage recovery of 99.65% ± 1.04, 99.23% ± 0.80 and 98.33% ± 1.03 for Metacardia® (20 mg), Vastor ® (20 mg) and Tricardia® (20 mg) tablets respectively. Finally, the proposed method was adopted to study the content uniformity test according to USP guidelines.
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Affiliation(s)
- Monica E Halim
- Analytical Chemistry Department, Faculty of Pharmacy, Minia University, Minia, Egypt
| | - Mahmoud A Omar
- Department of Pharmacognosy and Pharmaceutical Chemistry, College of Pharmacy, Taibah University, Medinah, Saudi Arabia; Pharmaceutical Analysis Department, Faculty of Pharmacy, Minia University, Minia, Egypt.
| | - Nehad A Abdallah
- Department of Pharmacognosy and Pharmaceutical Chemistry, College of Pharmacy, Taibah University, Medinah, Saudi Arabia
| | - Dalia M Nagy
- Analytical Chemistry Department, Faculty of Pharmacy, Minia University, Minia, Egypt
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Abdelhamid AM, Mahmoud SS, Abdelrahman AE, Said NM, Toam M, Samy W, Amer MAM. Protective effect of cerium oxide nanoparticles on cisplatin and oxaliplatin primary toxicities in male albino rats. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2020; 393:2411-2425. [PMID: 32710137 DOI: 10.1007/s00210-020-01946-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 07/09/2020] [Indexed: 01/09/2023]
Abstract
Cisplatin and oxaliplatin are widely used anticancer drugs. Their use is restricted by their dose-limiting side effects: nephrotoxicity and neurotoxicity, respectively. Cerium oxide nanoparticles (CONPs) are promising antioxidant and anti-inflammatory agent. To test the possible ameliorative impact of CONPs on the toxic effect of cisplatin and oxaliplatin in male albino rats. Forty eight rats were divided into 6 groups: control group, CONPs group, cisplatin group, cisplatin and CONPs group, oxaliplatin group, and oxaliplatin and CONPs group. After 4 weeks, serum urea and creatinine, renal tissue level of interleukin 10 (IL10), and total antioxidant (TAO) were measured in control, CONPs, and cisplatin groups. The other kidney was used for histopathological and immunohistochemical studies. The right sciatic nerves and the lumbar spinal cord of rats from control, CONPs, and oxaliplatin groups were used for immunohistochemical evaluations of nitrotyrosine, myelin basic protein (MBP), and glial fibrillary acidic protein (GFAP). Cisplatin significantly increased serum urea and creatinine levels, significantly decreased the kidney level of IL10 and TAO with marked tubular necrosis, hemorrhage and renal damage. Also, it decreased IL10 immunohistochemical expression. CONPs significantly decreased the serum urea and creatinine level and increased IL10 and TAO with lower renal damage and strong IL10 expression compared with cisplatin group. Oxaliplatin significantly decreased MBP immunoreactivity and increased nitrotyrosine immunoreactivity. In the lumbar spinal cord, GFAP immunoreactivity was significantly increased. CONPs significantly increased MBP and decreased nitrotyrosine immunoreactivity. GFAP immunoreactivity was significantly decreased. CONPs ameliorated cisplatin and oxaliplatin primary toxicities through anti-inflammatory and antioxidant characteristics.
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Affiliation(s)
- Amira Mohamed Abdelhamid
- Clinical pharmacology department, faculty of medicine, Zagazig University, Zagazig, Sharqia, Egypt.
| | - Shireen Sami Mahmoud
- Clinical pharmacology department, faculty of medicine, Zagazig University, Zagazig, Sharqia, Egypt
| | - Aziza E Abdelrahman
- Pathology department, faculty of medicine, Zagazig University, Zagazig, Egypt
| | - Nelly Mohamed Said
- Pathology department, faculty of medicine, Zagazig University, Zagazig, Egypt
| | - Mostafa Toam
- Clinical Oncology department, faculty of medicine, Zagazig University, Zagazig, Egypt
| | - Walaa Samy
- Biochemistry department, faculty of medicine, Zagazig University, Zagazig, Egypt
| | - Marwa AbdEl-Moniem Amer
- Forensic Medicine and Clinical toxicology department, faculty of medicine, Zagazig University, Zagazig, Egypt
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Fu H, Zhang J, Zhang H, Zhang P, Fu X, Zeng Z, Zhang X, Li W, Yang S, Liu X, Fu N. Trimetazidine can prevent the occurrence of contrast-induced nephropathy after percutaneous coronary intervention in elderly patients with renal insufficiency. Perfusion 2020; 36:603-609. [PMID: 32909511 DOI: 10.1177/0267659120957856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Contrast-induced nephropathy (CIN) has become a common cause of hospital-acquired acute kidney injury in elderly patients. Trimetazidine (TMZ) is a type of anti-ischemic drug developed in recent years, which can reduce the incidence of CIN. This study aimed to evaluate the efficacy of TMZ in the prevention of contrast-induced nephropathy in elderly patients with renal insufficiency undergoing percutaneous coronary intervention (PCI) and to explore the mechanism of action. METHODS A total of 310 elderly patients with renal insufficiency undergoing elective PCI were enrolled and randomly assigned to a control group (n = 155, hydration only) and a TMZ group (n = 155, 20 mg thrice daily orally 24 hours before and 72 hours after PCI). The primary endpoint of the study was the incidence of CIN, which was defined as an increase of 25% or more, or an absolute increase of 0.5 mg/dL or more in serum creatinine from baseline value, at 48 to 72 hours following the exposure to contrast media (CM). RESULTS The incidence of CIN was significantly lower in the TMZ group than that in the control group (3.2% vs. 9.7%, p = 0.021). There was no difference regarding the incidence of major adverse events during hospitalization between the TMZ group and control group (1.9% vs. 2.6%, p = 1.000). Binary logistic regression results showed that TMZ was protective factors of CIN (OR = 0.274; 95% CI: 0.089-0.847; p = 0.025). CONCLUSION Therefore, we came to the conclusion that prophylactic administration of TMZ can prevent the occurrence of CIN in elderly patients with renal insufficiency undergoing PCI and has a certain protective effect on the renal function of patients. According to the experimental results and the mechanism of TMZ on cardiomyocytes, we speculate that TMZ increases kidney glucose metabolism, reduces fatty acid oxidation, and also has a protective effect on kidney free radical damage and ischemia-reperfusion injury.
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Affiliation(s)
- Han Fu
- Tianjin Medical University, Tianjin, China
| | | | | | | | | | | | - Xue Zhang
- Tianjin Medical University, Tianjin, China
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Wang Y, Zhang H, Yang Z, Miao D, Zhang D. Rho Kinase Inhibitor, Fasudil, Attenuates Contrast‐induced Acute Kidney Injury. Basic Clin Pharmacol Toxicol 2017; 122:278-287. [PMID: 28929640 DOI: 10.1111/bcpt.12895] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/21/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Yiming Wang
- Department of Cardiology First Affiliated Hospital of Nanjing Medical University Nanjing China
- Department of Cardiology Zhenjiang First People's Hospital Zhenjiang China
| | - Hao Zhang
- Department of Cardiology First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Zhijian Yang
- Department of Cardiology First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Dengshun Miao
- Research Center for Bone and Stem Cells Nanjing Medical University Nanjing China
| | - Dingguo Zhang
- Department of Cardiology First Affiliated Hospital of Nanjing Medical University Nanjing China
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Zou H, Zhu XX, Ding YH, Jin QY, Qian LY, Huang DS, Cen XJ. Trimetazidine in conditions other than coronary disease, old drug, new tricks? Int J Cardiol 2017; 234:1-6. [DOI: 10.1016/j.ijcard.2017.02.083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 01/06/2017] [Accepted: 02/20/2017] [Indexed: 12/14/2022]
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Chalikias G, Drosos I, Tziakas DN. Prevention of Contrast-Induced Acute Kidney Injury: an Update. Cardiovasc Drugs Ther 2016; 30:515-524. [DOI: 10.1007/s10557-016-6683-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Nadkarni GN, Konstantinidis I, Patel A, Yacoub R, Kumbala D, Patel RAG, Annapureddy N, Pakanati KC, Simoes PK, Javed F, Benjo AM. Trimetazidine Decreases Risk of Contrast-Induced Nephropathy in Patients With Chronic Kidney Disease. J Cardiovasc Pharmacol Ther 2015; 20:539-46. [DOI: 10.1177/1074248415573320] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 01/13/2015] [Indexed: 11/16/2022]
Abstract
Objectives: We sought to synthesize and analyze the available data from randomized controlled trials (RCTs) for trimetazidine (TMZ) in the prevention of contrast-induced nephropathy (CIN). Background: Contrast-induced nephropathy after coronary angiography is associated with poor outcomes. Trimetazidine is an anti-ischemic drug that might reduce incidence of CIN, but current data are inconclusive. Methods: We searched MEDLINE/PubMed, EMBASE, Scopus, Cochrane Library, Web of Science, and ScienceDirect electronic databases for RCTs comparing intravenous hydration with normal saline (NS) and/or N-acetyl cysteine (NAC) versus TMZ plus NS ± NAC for prevention of CIN. We used RevMan 5.2 for statistical analysis with the fixed effects model. Results: Of the 808 studies, 3 RCTs met criteria with 290 patients in the TMZ plus NS ± NAC group and 292 patients in the NS ± NAC group. The mean age of patients was 59.5 years, and baseline serum creatinine ranged from 1.3 to 2 mg/dL. Trimetazidine significantly reduced the incidence of CIN by 11% (risk difference 0.11; 95% confidence interval, 0.16-0.06; P < .01). There was no significant heterogeneity between the studies (I2 statistic = 0). The number needed to treat to prevent 1 episode of CIN was 9. Conclusions: The addition of TMZ to NS ± NAC significantly decreased the incidence of CIN in patients undergoing coronary angiography. In conclusion, TMZ could be considered as a potential tool for prevention of CIN in patients with renal dysfunction.
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Affiliation(s)
- Girish N. Nadkarni
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ioannis Konstantinidis
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Achint Patel
- Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rabi Yacoub
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Damodar Kumbala
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rajan A. G. Patel
- Division of Cardiology, Department of Medicine, Ochsner Clinic Foundation, Jefferson, LA, USA
| | - Narender Annapureddy
- Division of Rheumatology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Priya K. Simoes
- Department of Medicine, St. Luke’s Roosevelt Hospital Center at Mount Sinai, New York, NY, USA
| | - Fahad Javed
- Division of Cardiology, Department of Medicine, Ochsner Clinic Foundation, Jefferson, LA, USA
| | - Alexandre M. Benjo
- Division of Cardiology, Department of Medicine, Ochsner Clinic Foundation, Jefferson, LA, USA
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Akgüllü Ç, Hekim T, Eryılmaz U, Boyacıoğlu M, Güngör H, Meteoğlu İ, Karul A, Onbaşılı OA. The usefulness of carvedilol and nebivolol in preventing contrast nephropathy in rats. Ren Fail 2015; 37:511-7. [DOI: 10.3109/0886022x.2015.1006087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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