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Alvidrez RIM, Annarapu GK, Srinivasan AJ, Liu Z, Yazdani HO, Nolfi-Donegan D, Simmons RL, Shiva S, Neal MD. High Dose of Metformin Decreases Susceptibility to Occlusive Arterial Thrombosis in Diabetic Mice. JOURNAL OF PHARMACY AND PHARMACOLOGY RESEARCH 2023; 7:192-202. [PMID: 37975061 PMCID: PMC10653203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Introduction Metformin is the most prescribed medication in Diabetes Mellitus(DM). Metformin has shown to decrease mean platelet volume, with promising antiplatelet effects. High doses of Metformin have also been associated with hypercoagulation. We hypothesize that Metformin will protect DM mice from occlusive arterial thrombus formation by altering platelet activation and mitochondrial bioenergetics. Methods DM was developed by low dose of Streptozotocin, non-DM (healthy) mice are controls. Either vehicle or Metformin was administered twice daily via oral gavage for 7-days. Ferric chloride (FeCl3) arterial thrombosis and tail bleeding time were performed. Whole blood aggregometry, platelet activation/adhesion and mitochondrial bioenergetics were evaluated. Results Metformin decreased susceptibility of DM mice to arterial thrombosis. Platelet bioenergetics show DM mice have increased platelet mitochondrial respiration, but no differences were observed with Metformin treatment. In non-DM (healthy) mice, Metformin modulated ADP-dependent increase in platelet adhesion. Non-DM (healthy) mice, Metformin shortens bleeding time with faster thrombotic occlusion. Metformin also increased platelet mitochondrial maximal respiration and spare respiratory capacity uniquely in non-DM (healthy) mice. Conclusion Metformin regulates platelet bioenergetics and ADP-mediated platelet function in DM mice which attenuates susceptibility to arterial thrombosis. Future studies will evaluate clinically relevant doses of Metformin that regulates thrombotic function in diabetic platelets.
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Affiliation(s)
- Roberto I Mota Alvidrez
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA 15213
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA 15213
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA 15213
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA 15213
- Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA 15213
- Clinical and Translational Science Center, University of New Mexico, USA 87131
- Department of Pharmaceutical Sciences, University of New Mexico, USA 87131
| | - Gowtham K Annarapu
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA 15213
| | - Amudan J Srinivasan
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA 15213
| | - Zeyu Liu
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA 15213
- Department of Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA 15213
| | - Hamza O Yazdani
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA 15213
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA 15213
- Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA 15213
| | - Deidre Nolfi-Donegan
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA 15213
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA 15213
| | - Richard L Simmons
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA 15213
| | - Sruti Shiva
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA 15213
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA 15213
| | - Matthew D Neal
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA 15213
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA 15213
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Yousaf A, Malik B, Abdelazeem B, Kunadi A. Emergent Hemodialysis Followed by Continuous Renal Replacement Therapy: A Management Challenge in a Patient With Life-Threatening Metabolic Acidosis of Multifactorial Etiology. Cureus 2022; 14:e23689. [PMID: 35505729 PMCID: PMC9056015 DOI: 10.7759/cureus.23689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2022] [Indexed: 11/06/2022] Open
Abstract
Metabolic acidosis is a frequently encountered laboratory finding in daily clinical practice. Rapid pH correction is almost always preferred and necessary while performing workup to identify the causative factors. We present the case of a 73-year-old male presenting with progressive dyspnea and severe metabolic acidosis. He had a pH of 6.6, bicarbonate of 1.8 mg/dL, lactic acid of 18.1 mg/dL, and pCO2 of 14.1 mmHg. The intensivist and nephrologist made a joint decision to rapidly correct the pH using bicarbonate and emergent hemodialysis. Subsequently, continuous renal replacement therapy (CRRT) was started, leading to a favorable outcome. Our patient's most likely etiology of lactic acidosis was metformin because he had a very high lactic acid, high anion gap metabolic acidosis, and acute renal failure on presentation. From our case and literature review, we suggest using hemodialysis, CRRT, and bicarbonate replacement for a better prognosis in patients with critical acidosis in view of frank renal failure and concurrent metformin use.
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Affiliation(s)
- Amman Yousaf
- Internal Medicine, McLaren Health Care, Flint/Michigan State University, Flint, USA
| | - Bilal Malik
- Internal Medicine, McLaren Health Care, Flint/Michigan State University, Flint, USA
| | - Basel Abdelazeem
- Internal Medicine, McLaren Health Care, Flint/Michigan State University, Flint, USA
| | - Arvind Kunadi
- Internal Medicine/Nephrology, McLaren Health Care, Flint/Michigan State University, Flint, USA
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