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Comparan HDM, Khaliq A, Frota LM, Pomar-Forero D, Ahmad B, Marnet E, Teixeira FJP, Thomas A, Patel P, Brunkal H, Singireddy S, Lucke-Wold B, Maciel CB, Busl KM. Cyclooxygenase 2 Inhibitors for Headache After Elective Cranial Neurosurgery: Results from a Systematic Review of Efficacy of Cyclooxygenase 2 Inhibitors for Headache After Acute Brain Injury. Neurocrit Care 2024:10.1007/s12028-024-02114-y. [PMID: 39266865 DOI: 10.1007/s12028-024-02114-y] [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: 04/07/2024] [Accepted: 08/22/2024] [Indexed: 09/14/2024]
Abstract
Headache management after acute brain injury (ABI) is challenging. Although opioids are commonly used, selective cyclooxygenase 2 inhibitors (COXIBs) may be promising alternatives. However, concerns about cardiovascular effects and bleeding risk have limited their use. We aimed at summarizing available data on efficacy of COXIBs for headache management following ABI. A systematic review was conducted through MEDLINE and Embase for articles published through September 2023 (PROSPERO identifier: CRD42022320453). No language filters were applied to the initial searches. Interventional or observational studies and systematic reviews assessing efficacy of COXIBs for headache in adults with ABI were eligible. Article selection was performed by two independent reviewers using DistillerSR. Descriptive statistics were used for data analysis, and meta-analysis was unfeasible because of study heterogeneity. Of 3190 articles identified, 6 studies met inclusion criteria: 4 randomized controlled trials and 2 retrospective cohort studies, all conducted in elective cranial neurosurgical patients (total N = 738) between 2006 and 2022. Five studies used COXIBs in the intervention group only. Of the six studies, four found a reduction in overall pain scores in the intervention group, whereas one showed improvement only at 6 h postoperatively, and one did not find significant differences. Pain scores decreased between 4 and 15%, the largest shift being from moderate to mild severity. Three studies found an overall opioid use reduction throughout hospitalization in the intervention group, whereas one reported a reduction at 12 h postoperatively only. Opioid consumption decreased between 9 and 90%. Two studies found a decrease in hospital length of stay by ~ 1 day in the intervention group. The one study reporting postoperative hemorrhage found a statistically nonsignificant 3% reduction in the intervention group. COXIBs may serve as opioid-sparing adjunctive analgesics for headache control after elective cranial surgery. Limited or no literature exists for other forms of ABI, and additional safety data remain to be elucidated.
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Affiliation(s)
- Hector David Meza Comparan
- Division of Neurocritical Care, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, 32611, USA
| | - Anum Khaliq
- Division of Neurocritical Care, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, 32611, USA
| | - Luciola Martins Frota
- Division of Neurocritical Care, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, 32611, USA
| | - Daniela Pomar-Forero
- Division of Neurocritical Care, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, 32611, USA
| | - Bakhtawar Ahmad
- Division of Neurocritical Care, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, 32611, USA
| | - Erica Marnet
- Department of Medicine, Bridgeport Hospital, Bridgeport, CT, 06610, USA
| | - Fernanda J P Teixeira
- Department of Neurology, University of Miami and Jackson Memorial Hospital, Miami, FL, 33130, USA
| | - Anita Thomas
- Division of Neurocritical Care, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, 32611, USA
| | - Priyank Patel
- Division of Neurocritical Care, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, 32611, USA
| | - Haley Brunkal
- Division of Neurocritical Care, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, 32611, USA
| | - Saanvi Singireddy
- Division of Neurocritical Care, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, 32611, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, College of Medicine, University of Florida, Gainesville, FL, 32611, USA
| | - Carolina B Maciel
- Division of Neurocritical Care, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, 32611, USA
- Department of Neurosurgery, College of Medicine, University of Florida, Gainesville, FL, 32611, USA
- Department of Neurology, Yale University School of Medicine, New Haven, CT, 06520, USA
- Department of Neurology, University of Utah, Salt Lake City, UT, 84132, USA
| | - Katharina M Busl
- Division of Neurocritical Care, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, 32611, USA.
- Department of Neurosurgery, College of Medicine, University of Florida, Gainesville, FL, 32611, USA.
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Liang S, Wang X, Zhu X. Insights from pharmacovigilance and pharmacodynamics on cardiovascular safety signals of NSAIDs. Front Pharmacol 2024; 15:1455212. [PMID: 39295938 PMCID: PMC11408209 DOI: 10.3389/fphar.2024.1455212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 08/22/2024] [Indexed: 09/21/2024] Open
Abstract
Background and Aim Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat fever, pain, and inflammation. Concerns regarding their cardiovascular safety have been raised. However, the underlying mechanism behind these events remains unknown. We aim to investigate the cardiovascular safety signals and receptor mechanisms of NSAIDs, employing a comprehensive approach that integrates pharmacovigilance and pharmacodynamics. Methods This study utilized a pharmacovigilance-pharmacodynamic approach to evaluate the cardiovascular safety of NSAIDs and explore potential receptor mechanisms involved. Data were analyzed using the OpenVigil 2.1 web application, which grants access to the FDA Adverse Event Reporting System (FAERS) database, in conjunction with the BindingDB database, which provides target information on the pharmacodynamic properties of NSAIDs. Disproportionality analysis employing the Empirical Bayes Geometric Mean (EBGM) and Reporting Odds Ratio (ROR) methods was conducted to identify signals for reporting cardiovascular-related adverse drug events (ADEs) associated with 13 NSAIDs. This analysis encompassed three System Organ Classes (SOCs) associated with the cardiovascular system: blood and lymphatic system disorders, cardiac disorders, and vascular disorders. The primary targets were identified through the receptor-NSAID interaction network. Ordinary least squares (OLS) regression models explored the relationship between pharmacovigilance signals and receptor occupancy rate. Results A total of 201,231 reports of cardiovascular-related ADEs were identified among the 13 NSAIDs. Dizziness, anemia, and hypertension were the most frequently reported Preferred Terms (PTs). Overall, nimesulide and parecoxib exhibited the strongest signal strengths of ADEs at SOC levels related to the cardiovascular system. On the other hand, our data presented naproxen and diclofenac as drugs of comparatively low signal strength. Cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) were identified as central targets. OLS regression analysis revealed that the normalized occupancy rate for either COX-1 or COX-2 was significantly inversely correlated with the log-transformed signal measures for blood and lymphatic system disorders and vascular disorders, and positively correlated with cardiac disorders and vascular disorders, respectively. This suggests that higher COX-2 receptor occupancy is associated with an increased cardiovascular risk from NSAIDs. Conclusion Cardiovascular safety of NSAIDs may depend on pharmacodynamic properties, specifically, the percentage of the occupied cyclooxygenase isoenzymes. More studies are needed to explore these relations and improve the prescription process.
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Affiliation(s)
- Shuang Liang
- Department of Pharmacy, Hebei Medical University Third Hospital, Shijiazhuang, China
| | - Xianying Wang
- Department of Pharmacy, Hebei Medical University Third Hospital, Shijiazhuang, China
| | - Xiuqing Zhu
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
- Department of Pharmacy, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou, China
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Al-Wahaibi L, Abdel-Rahman MH, El-Adl K, Youssif BGM, Bräse S, Abdel-Aziz SA. New Diaryl-1,2,4-triazolo[3,4- a]pyrimidine Hybrids as Selective COX-2/sEH Dual Inhibitors with Potent Analgesic/Anti-inflammatory and Cardioprotective Properties. ACS OMEGA 2024; 9:33494-33509. [PMID: 39130606 PMCID: PMC11307993 DOI: 10.1021/acsomega.4c00870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/24/2024] [Accepted: 05/13/2024] [Indexed: 08/13/2024]
Abstract
COX-2-selective drugs were withdrawn from the market just a few years after their development due to cardiovascular side effects. As a result, developing a selective COX-2 inhibitor as an anti-inflammatory agent with cardioprotective characteristics has become a prominent objective in medicinal chemistry. New 15 diaryl-1,2,4-triazolo[3,4-a]pyrimidine hybrids 8a-o were synthesized and investigated in vitro as dual COX-2/sEH inhibitors. Compounds 8b, 8m, and 8o have the highest potency and selectivity as COX-2 inhibitors (IC50 = 15.20, 11.60, and 10.50 μM, respectively; selectivity index (COX-1/COX-2) = 13, 20, and 25, respectively), compared to celecoxib (COX-2; IC50 = 42 μM; SI = 8). The 5-LOX inhibitory activity of compounds 8b, 8m, and 8o was further examined in vitro. Compounds 8m and 8o, the most effective COX-2 selective inhibitors, demonstrated stronger 5-LOX inhibitory action than the reference quercetin, with IC50 values of 2.90 and 3.05 μM, respectively. Additionally, compounds 8b, 8m, and 8o were the most potent dual COX-2/sEH inhibitors, with IC50 values against sEH of 3.20, 2.95, and 2.20 nM, respectively, and were equivalent to AUDA (IC50 = 1.2 nM). In vivo investigations also demonstrated that these compounds were the most efficacious as analgesic/anti-inflammatory derivatives with a high cardioprotective profile against cardiac biomarkers and inflammatory cytokines. The docking data analysis inquiry helped better understand the binding mechanisms of the most active hybrids within the COX-2 active site and supported their COX-2 selectivity. Compounds 8b, 8m, and 8o exhibited a similar orientation to rofecoxib and celecoxib, with a larger proclivity to enter the selectivity side pocket than the reference compounds.
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Affiliation(s)
- Lamya
H. Al-Wahaibi
- Department
of Chemistry, College of Sciences, Princess
Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia
| | - Mostafa H. Abdel-Rahman
- Department
of Pharmaceutical Organic Chemistry, Faculty of Pharmacy(Boys), Al-Azhar University, Assiut 71524, Egypt
| | - Khaled El-Adl
- Department
of Chemistry, Faculty of Pharmacy, Heliopolis
University for Sustainable Development, 11785 El Salam City, Cairo, Egypt
- Department
of Pharmaceutical Medicinal Chemistry and Drug Design, Faculty of Pharmacy (Boys) Al-Azhar University, 11751 Nasr City, Cairo, Egypt
| | - Bahaa G. M. Youssif
- Department
of Pharmaceutical Organic Chemistry, Faculty of Pharmacy, Assiut University, Assiut 71526, Egypt
| | - Stefan Bräse
- Institute
of Biological and Chemical Systems, IBCS-FMS, Karlsruhe Institute
of Technology, 76131 Karlsruhe, Germany
| | - Salah A. Abdel-Aziz
- Department
of Pharmaceutical Medicinal Chemistry and Drug Design, Faculty of Pharmacy (Boys) Al-Azhar University, Assiut 71524, Egypt
- Department
of Pharmaceutical Chemistry, Faculty of Pharmacy, Deraya University, Minia 61519, Egypt
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Michalaki E, Chin R, Jeong K, Qi Z, Liebman LN, González-Vargas Y, Echeverri ES, Paunovska K, Muramatsu H, Pardi N, Tamburini BJ, Jakus Z, Dahlman JE, Dixon JB. Lymphatic endothelial cell-targeting lipid nanoparticles delivering VEGFC mRNA improve lymphatic function after injury. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.07.31.605343. [PMID: 39131391 PMCID: PMC11312618 DOI: 10.1101/2024.07.31.605343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Dysfunction of the lymphatic system following injury, disease, or cancer treatment can lead to lymphedema, a debilitating condition with no cure. Advances in targeted therapy have shown promise for treating diseases where conventional therapies have been ineffective and lymphatic vessels have recently emerged as a new therapeutic target. Lipid nanoparticles (LNPs) have emerged as a promising strategy for tissue specific delivery of nucleic acids. Currently, there are no approaches to target LNPs to lymphatic endothelial cells, although it is well established that intradermal (ID) injection of nanoparticles will drain to lymphatics with remarkable efficiency. To design an LNP that would effectively deliver mRNA to LEC after ID delivery, we screened a library of 150 LNPs loaded with a reporter mRNA, for both self-assembly and delivery in vivo to lymphatic endothelial cells (LECs). We identified and validated several LNP formulations optimized for high LEC uptake when administered ID and compared their efficacy for delivery of functional mRNA with that of free mRNA and mRNA delivered with a commercially available MC3-based LNP (Onpattro™). The lead LEC-specific LNP was then loaded with VEGFC mRNA to test the therapeutic advantage of the LEC-specific LNP (namely, LNP7) for treating a mouse tail lymphatic injury model. A single dose of VEGFC mRNA delivered via LNP7 resulted in enhanced LEC proliferation at the site of injury, and an increase in lymphatic function up to 14-days post-surgery. Our results suggest a therapeutic potential of VEGFC mRNA lymphatic-specific targeted delivery in alleviating lymphatic dysfunction observed during lymphatic injury and could provide a promising approach for targeted, transient lymphangiogenic therapy.
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Affiliation(s)
- Eleftheria Michalaki
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology; Atlanta, GA, USA
| | - Rachel Chin
- Department of Biology, Georgia Institute of Technology; Atlanta, GA, USA
| | - Kiyoung Jeong
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University; Atlanta, GA, USA
| | - Zhiming Qi
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University; Atlanta, GA, USA
| | - Lauren N. Liebman
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University; Atlanta, GA, USA
| | - Yarelis González-Vargas
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University; Atlanta, GA, USA
| | - Elisa Schrader Echeverri
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University; Atlanta, GA, USA
| | - Kalina Paunovska
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University; Atlanta, GA, USA
| | - Hiromi Muramatsu
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania; Philadelphia, PA, USA
| | - Norbert Pardi
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania; Philadelphia, PA, USA
| | - Beth Jiron Tamburini
- University of Colorado School of Medicine, Department of Medicine, Aurora, CO, USA
| | - Zoltan Jakus
- Semmelweis University School of Medicine, Department of Physiology, Budapest, Hungary
| | - James E. Dahlman
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University; Atlanta, GA, USA
| | - J. Brandon Dixon
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology; Atlanta, GA, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University; Atlanta, GA, USA
- Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology; Atlanta, GA, USA
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Faber S, Brown A, Cottreau J. Safety of Oral and Topical Nonsteroidal Anti-Inflammatory Drugs. Orthop Nurs 2024; 43:234-237. [PMID: 39047276 DOI: 10.1097/nor.0000000000001044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used to manage mild to moderate pain. While limited use is appropriate for many patients, there are safety concerns with use in certain patient populations or with long-term use of these agents. Topical NSAIDs may provide analgesic benefits while decreasing the overall risks of adverse effects. This article will review safety information for both oral and topical NSAIDs.
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Affiliation(s)
- Sara Faber
- Sara Faber, PharmD, St. Cloud VA Health Care System, St. Cloud, MN
- Alexandria Brown, PharmD, Advocate Trinity Hospital, Chicago, IL
- Jessica Cottreau, PharmD, Rosalind Franklin University College of Pharmacy, North Chicago, IL
| | - Alexandria Brown
- Sara Faber, PharmD, St. Cloud VA Health Care System, St. Cloud, MN
- Alexandria Brown, PharmD, Advocate Trinity Hospital, Chicago, IL
- Jessica Cottreau, PharmD, Rosalind Franklin University College of Pharmacy, North Chicago, IL
| | - Jessica Cottreau
- Sara Faber, PharmD, St. Cloud VA Health Care System, St. Cloud, MN
- Alexandria Brown, PharmD, Advocate Trinity Hospital, Chicago, IL
- Jessica Cottreau, PharmD, Rosalind Franklin University College of Pharmacy, North Chicago, IL
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Fullerton T, Pixton G. Long-Term Use of Rimegepant 75 mg for the Acute Treatment of Migraine is Associated with a Reduction in the Utilization of Select Analgesics and Antiemetics. J Pain Res 2024; 17:1751-1760. [PMID: 38764606 PMCID: PMC11102748 DOI: 10.2147/jpr.s456006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/02/2024] [Indexed: 05/21/2024] Open
Abstract
Purpose To examine use of concomitant analgesics and antiemetics during treatment with rimegepant in adults with migraine. Patients and Methods This was a post hoc analysis of a long-term, open-label, safety study in adults with a history of 2-14 moderate or severe migraine attacks per month. Participants self-administered rimegepant 75 mg (1) up to once daily as needed (PRN) for 52 weeks or (2) every other day plus PRN (EOD+PRN) for 12 weeks. The PRN cohort was further divided based on baseline attack frequency, with PRN (2-8) and PRN (9-14) cohorts having a history of 2-8 or 9-14 attacks per month, respectively. Use of select analgesics and antiemetics was analyzed during a 30-day pre-treatment observation period (OP) and during rimegepant treatment. Results Overall, 1800 rimegepant-treated participants (PRN n = 1514, EOD+PRN n = 286) were included in the analysis. Select analgesics or antiemetics were used by 80.1% of participants during the OP. Among 1441 participants using analgesics or antiemetics during the OP, the proportion who did not use any analgesics or antiemetics following initiation of rimegepant treatment increased during weeks 1-4 (36.9%), 5-8 (52.6%), and 9-12 (56.5%). The mean number of days per month using analgesics or antiemetics was also significantly reduced over time in all cohorts beginning at weeks 1-4 (P < 0.001 vs OP). This pattern of reduced analgesic or antiemetic use was consistent for all rimegepant cohorts, but was most pronounced in the EOD+PRN cohort in which 74.8% of participants reported ≥50% reduction in analgesic/antiemetic days at weeks 9-12. Reduction in use was maintained over time, with 61.3% of participants not using any analgesics or antiemetics during weeks 49-52 of PRN treatment. Conclusion Long-term treatment with oral rimegepant was associated with reduced analgesic and antiemetic use. Clinicaltrials.gov: NCT03266588.
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Affiliation(s)
- Terence Fullerton
- Internal Medicine and Infectious Disease, Pfizer Research and Development, Pfizer Inc., Groton, CT, USA
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Perni S, Prokopovich P. Risk equations for prosthetic joint infections (PJIs) in UK: a retrospective study using the Clinical Practice Research Datalink (CPRD) AURUM and GOLD databases. BMJ Open 2024; 14:e082501. [PMID: 38719289 PMCID: PMC11086542 DOI: 10.1136/bmjopen-2023-082501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/26/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Prosthetic joint infections (PJIs) are a serious negative outcome of arthroplasty with incidence of about 1%. Risk of PJI could depend on local treatment policies and guidelines; no UK-specific risk scoring is currently available. OBJECTIVE To determine a risk quantification model for the development of PJI using electronic health records. DESIGN Records in Clinical Practice Research Datalink (CPRD) GOLD and AURUM of patients undergoing hip or knee arthroplasty between January 2007 and December 2014, with linkage to Hospital Episode Statistics and Office of National Statistics, were obtained. Cohorts' characteristics and risk equations through parametric models were developed and compared between the two databases. Pooled cohort risk equations were determined for the UK population and simplified through stepwise selection. RESULTS After applying the inclusion/exclusion criteria, 174 905 joints (1021 developed PJI) were identified in CPRD AURUM and 48 419 joints (228 developed PJI) in CPRD GOLD. Patients undergoing hip or knee arthroplasty in both databases exhibited different sociodemographic characteristics and medical/drug history. However, the quantification of the impact of such covariates (coefficients of parametric models fitted to the survival curves) on the risk of PJI between the two cohorts was not statistically significant. The log-normal model fitted to the pooled cohorts after stepwise selection had a C-statistic >0.7. CONCLUSIONS The risk prediction tool developed here could help prevent PJI through identifying modifiable risk factors pre-surgery and identifying the patients most likely to benefit from close monitoring/preventive actions. As derived from the UK population, such tool will help the National Health Service reduce the impact of PJI on its resources and patient lives.
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Yu S, Guo A, Wang Z, Liu J, Tan G, Yang Q, Zhang M, Yibulaiyin H, Chen H, Zhang Y, Croop R, Sun Y, Liu Y, Zhao Q, Lu Z. Rimegepant orally disintegrating tablet 75 mg for acute treatment of migraine in adults from China: a subgroup analysis of a double-blind, randomized, placebo-controlled, phase 3 clinical trial. J Headache Pain 2024; 25:57. [PMID: 38627638 PMCID: PMC11020209 DOI: 10.1186/s10194-024-01731-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/11/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Rimegepant orally disintegrating tablet (ODT), an oral small-molecule calcitonin gene-related peptide receptor antagonist, is indicated for acute and preventive treatment of migraine in the United States and other countries. Previously, a large clinical trial assessed the efficacy and safety of rimegepant ODT 75 mg for the acute treatment of migraine in adults living in China or South Korea. A post hoc subgroup analysis of this trial was performed to evaluate the efficacy and safety of rimegepant for acute treatment of migraine in adults living in China. METHODS Eligible participants were ≥ 18 years of age and had a ≥ 1-year history of migraine, with 2 to 8 attacks of moderate or severe pain intensity per month and < 15 headache days per month during the 3 months before screening. Participants self-administered rimegepant ODT 75 mg or matching placebo to treat a single migraine attack of moderate or severe pain intensity. The co-primary endpoints were pain freedom and freedom from the most bothersome symptom (MBS) at 2 h post-dose. Key secondary endpoints included pain relief at 2 h post-dose, ability to function normally at 2 h post-dose, use of rescue medication within 24 h post-dose, and sustained pain freedom from 2 to 24 h and 2 to 48 h post-dose. All p values were nominal. Safety was assessed via treatment-emergent adverse events (TEAEs), electrocardiograms, vital signs, and routine laboratory tests. RESULTS Overall, 1075 participants (rimegepant, n = 538; placebo, n = 537) were included in the subgroup analysis. Rimegepant was more effective than placebo for the co-primary endpoints of pain freedom (18.2% vs. 10.6%, p = 0.0004) and freedom from the MBS (48.0% vs. 31.8%, p < 0.0001), as well as all key secondary endpoints. The incidence of TEAEs was comparable between the rimegepant (15.2%) and placebo (16.4%) groups. No signal of drug-induced liver injury was observed, and no study drug-related serious TEAEs were reported in the rimegepant group. CONCLUSIONS A single dose of rimegepant 75 mg rimegepant was effective for the acute treatment of migraine in adults living in China, with safety and tolerability similar to placebo. TRIAL REGISTRATION Clinicaltrials.gov NCT04574362 Date registered: 2020-10-05.
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Affiliation(s)
| | - Aihong Guo
- Xianyang Hospital, Yan'an University, Xianyang, China
| | - Zhen Wang
- Changsha Central Hospital, Changsha, China
| | | | - Ge Tan
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qian Yang
- Shaanxi Provincial Hospital, Xi'an, China
| | | | - Hasiyeti Yibulaiyin
- The Second Affiliated Hospital of Xinjiang Medical University, Wulumuqi, Xinjiang Province, China
| | - Huisheng Chen
- General Hospital of Northern Theater Command, District, Shenyang, Liaoning Province, China
| | - Yongbo Zhang
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | | | - Yanhui Sun
- Pfizer (China) Research and Development Co., Ltd, Shanghai, China
| | - Yu Liu
- Pfizer Inc, Beijing, China
| | | | - Zhihong Lu
- Pfizer (China) Research and Development Co., Ltd, Shanghai, China.
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Comparan HDM, Khaliq A, Frota LM, Pomar-Forero D, Ahmad B, Marnet E, Teixeira FJP, Thomas A, Patel P, Brunkal H, Singireddy S, Lucke-Wold B, Maciel CB, Busl KM. Efficacy of Cyclooxygenase-2 Inhibitors for Headache in Acute Brain Injury: A Systematic Review. RESEARCH SQUARE 2024:rs.3.rs-4232407. [PMID: 38659820 PMCID: PMC11042422 DOI: 10.21203/rs.3.rs-4232407/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Background Headache management after acute brain injury (ABI) is challenging. While opioids are commonly used, selective cyclooxygenase-2 inhibitors (COXIBs) may be promising alternatives. However, concerns about cardiovascular effects and bleeding risk have limited their use. We aimed at summarizing available data on efficacy of COXIBs for headache management following ABI. Methods A systematic review was conducted through MEDLINE and Embase for articles published through 09/2023 (PROSPERO CRD42022320453). No language filters were applied to the initial searches. Interventional or observational studies and systematic reviews assessing efficacy of COXIBs for headache in adults with ABI were eligible. Article selection was performed by two independent reviewers using Distiller SR®. Descriptive statistics were used for data analysis, while meta-analysis was unfeasible due to study heterogeneity. Results Of 3190 articles identified, six studies met inclusion criteria: four randomized controlled trials and two retrospective cohort studies, all conducted in neurosurgical patients (total n=738) between 2006-2022. Five studies used COXIBs in the intervention group only. Of the six studies, four found a reduction in overall pain scores in the intervention group, while one showed improvement only at 6 hours postoperative, and one did not find significant differences. Pain scores decreased between 4-15%, the largest shift being from moderate to mild severity. Three studies found an overall opioid use reduction throughout hospitalization in the intervention group, while one reported a reduction at 12 hours postoperative only. Opioid consumption decreased between 9-90%. Two studies found a decrease in hospital-length-of-stay by ~1 day in the intervention group. The one study reporting postoperative hemorrhage found a statistically non-significant 3% reduction in the intervention group. Conclusions In adults with ABI, COXIBs may serve as opioid-sparing adjunctive analgesics for headache control, with limited but pointed data to indicate efficacy in the post-neurosurgical setting. However, further safety data remains to be elucidated.
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Affiliation(s)
- Hector David Meza Comparan
- Department of Neurology, Division of Neurocritical Care, University of Florida, College of Medicine, Gainesville, FL 32611, USA
| | - Anum Khaliq
- Department of Neurology, Division of Neurocritical Care, University of Florida, College of Medicine, Gainesville, FL 32611, USA
| | - Luciola Martins Frota
- Department of Neurology, Division of Neurocritical Care, University of Florida, College of Medicine, Gainesville, FL 32611, USA
| | - Daniela Pomar-Forero
- Department of Neurology, Division of Neurocritical Care, University of Florida, College of Medicine, Gainesville, FL 32611, USA
| | - Bakhtawar Ahmad
- Department of Neurology, Division of Neurocritical Care, University of Florida, College of Medicine, Gainesville, FL 32611, USA
| | - Erica Marnet
- Department of Medicine, Bridgeport Hospital, Bridgeport, CT, USA 06610
| | - Fernanda J P Teixeira
- Department of Neurology, University of Miami/Jackson Memorial Hospital, FL, USA, 33130
| | - Anita Thomas
- Department of Neurology, Division of Neurocritical Care, University of Florida, College of Medicine, Gainesville, FL 32611, USA
| | - Priyank Patel
- Department of Neurology, Division of Neurocritical Care, University of Florida, College of Medicine, Gainesville, FL 32611, USA
| | - Haley Brunkal
- Department of Neurology, Division of Neurocritical Care, University of Florida, College of Medicine, Gainesville, FL 32611, USA
| | - Saanvi Singireddy
- Department of Neurology, Division of Neurocritical Care, University of Florida, College of Medicine, Gainesville, FL 32611, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, College of Medicine, Gainesville, FL 32611, USA
| | - Carolina B Maciel
- Department of Neurology, Division of Neurocritical Care, University of Florida, College of Medicine, Gainesville, FL 32611, USA; Department of Neurosurgery, University of Florida, College of Medicine, Gainesville, FL 32611, USA; Department of Neurology, Yale University School of Medicine, New Haven, CT 06520, USA; Department of Neurology, University of Utah, Salt Lake City, UT 84132, USA
| | - Katharina M Busl
- Department of Neurology, Division of Neurocritical Care, University of Florida, College of Medicine, Gainesville, FL 32611, USA; Department of Neurosurgery, University of Florida, College of Medicine, Gainesville, FL 32611, USA
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10
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Shukla R, Singh S, Kamath S, Shah U, Patel S, Kherajani K, Gupta A, Shaw P, Unnithan V, Kaithathara S, Gharde P. Interplay Between Diabetes Mellitus and the Occurrence of Osteoarthritis and Associated Conditions in Women of Menopausal Age. Cureus 2024; 16:e58502. [PMID: 38765429 PMCID: PMC11101597 DOI: 10.7759/cureus.58502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 04/17/2024] [Indexed: 05/22/2024] Open
Abstract
Osteoarthritis (OA) and diabetes mellitus (DM) have long-term deleterious chronic effects and are among the most prevalent chronic disorders. DM and its associated factors, such as hyperglycemia, have a significant contribution to the pathophysiology of OA, particularly in post-menopausal women. Women who have uncontrolled diabetes (DM) are more prone to develop osteoarthritis (OA), which may be exacerbated by poor glycemic control. Furthermore, this category of female patients with DM has an increased risk of developing fractures, even in those with initially normal bone density scores, further illustrating the correlation between DM and bone health. Additionally, multiple risk factors, including obesity, metabolic syndrome, hypertension, estrogen-based hormone therapy, and hyperuricemia, in menopausal women can lead to the development and exacerbation of OA. It is discovered that these variables have a direct or indirect impact, frequently causing inflammation and hormonal changes, which contribute to the intricate interaction between DM and OA. The management of OA and DM in women thus calls for a multi-faceted management plan including glycemic control, weight control, exercise, and specialized pain management methods catering to the specific requirements of the patients. Regularly screening for OA should be implemented for menopausal women with DM and utmost care should be provided by healthcare professionals. Regular monitoring of joint health and early management, encouraging interdisciplinary cooperation, putting preventative measures into place, and creating individualized treatment programs are essential. A thorough understanding of the link between DM and OA will ultimately lead to improved health outcomes and a better future for these individuals.
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Affiliation(s)
- Rushikesh Shukla
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shailja Singh
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shruthi Kamath
- Medicine, Kasturba Medical College, Mangalore, Mangalore, IND
| | - Urmil Shah
- Medicine, Rajiv Gandhi Medical College, Thane, IND
| | - Siddhi Patel
- Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | | | - Ananya Gupta
- Medicine, Kasturba Medical College, Mangalore, Mangalore, IND
| | - Priya Shaw
- Medicine, Burdwan Medical College and Hospital, Bardhaman, IND
| | - Vishnu Unnithan
- Nuclear Medicine, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, IND
| | | | - Pankaj Gharde
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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11
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Destere A, Merino D, Lavrut T, Rocher F, Viard D, Drici MD, Gérard AO. Drug-induced cardiac toxicity and adverse drug reactions, a narrative review. Therapie 2024; 79:161-172. [PMID: 37957054 DOI: 10.1016/j.therap.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/05/2023] [Indexed: 11/15/2023]
Abstract
Drug-induced cardiotoxicity is a primary concern in both drug development and clinical practice. Although the heart is not a common target for adverse drug reactions, some drugs still cause various adverse cardiac events, with sometimes severe consequences. Direct cardiac toxicity encompasses functional and structural changes of the cardiovascular system due to possible exposure to medicines. This phenomenon extends beyond cardiovascular drugs to include non-cardiovascular drugs including anticancer drugs such as tyrosine kinase inhibitors, anthracyclines and immune checkpoint inhibitors (ICIs), as well as various antipsychotics, venlafaxine, and even some antibiotics (such as macrolides). Cardiac ADRs comprise an array of effects, ranging from heart failure and myocardial ischemia to valvular disease, thrombosis, myocarditis, pericarditis, arrhythmias, and conduction abnormalities. The underlying mechanisms may include disturbances of ionic processes, induction of cellular damage via impaired mitochondrial function, and even hypercoagulability. To mitigate the impact of drug-induced cardiotoxicity, multi-stage evaluation guidelines have been established, following the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines for in vitro and in vivo testing. Despite preclinical safeguards, post-marketing surveillance remains critical, as certain cardiotoxic drugs may escape initial scrutiny. Indeed, historical data show that cardiovascular ADRs contribute to almost 10% of market withdrawals. The impact of drug-induced cardiotoxicity on cardiac issues, particularly heart failure, is often underestimated, with incidence rates ranging from 11.0% to over 20.0%. We here comprehensively examine different patterns of drug-induced cardiotoxicity, highlighting current concerns and emerging pharmacovigilance signals. Understanding the underlying mechanisms and the associated risk factors is critical in order to promptly identify, effectively manage, and proactively prevent drug-induced cardiac adverse events. Collaborative efforts between physicians and cardiologists, coupled with thorough assessment and close monitoring, are essential to ensuring patient safety in the face of potential drug-induced cardiotoxicity.
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Affiliation(s)
- Alexandre Destere
- Université Côte d'Azur Medical Center, Department of Clinical Pharmacology, 06000 Nice, France; Université Côte d'Azur, Inria, CNRS, Laboratoire J.A.-Dieudonné, Maasai team, 06000 Nice, France
| | - Diane Merino
- Université Côte d'Azur Medical Center, Department of Clinical Pharmacology, 06000 Nice, France; Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice CHU-Lenval, 06000 Nice, France; Université Côte d'Azur Medical Center, Department of Psychiatry, 06000 Nice, France
| | - Thibaud Lavrut
- Université Côte d'Azur Medical Center, Department of Clinical Pharmacology, 06000 Nice, France
| | - Fanny Rocher
- Université Côte d'Azur Medical Center, Department of Clinical Pharmacology, 06000 Nice, France
| | - Delphine Viard
- Université Côte d'Azur Medical Center, Department of Clinical Pharmacology, 06000 Nice, France
| | - Milou-Daniel Drici
- Université Côte d'Azur Medical Center, Department of Clinical Pharmacology, 06000 Nice, France.
| | - Alexandre O Gérard
- Université Côte d'Azur Medical Center, Department of Clinical Pharmacology, 06000 Nice, France; Université Côte d'Azur Medical Center, Department of Nephrology, 06000 Nice, France; Université Côte d'Azur, CNRS, Laboratory of Molecular Physio Medicine (LP2M), UMR 7370, 06000 Nice, France
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12
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Yoon C, Ham YS, Gil WJ, Yang CS. Exploring the potential of Toxoplasma gondii in drug development and as a delivery system. Exp Mol Med 2024; 56:289-300. [PMID: 38297164 PMCID: PMC10907749 DOI: 10.1038/s12276-024-01165-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 02/02/2024] Open
Abstract
Immune-mediated inflammatory diseases are various groups of conditions that result in immune system disorders and increased cancer risk. Despite the identification of causative cytokines and pathways, current clinical treatment for immune-mediated inflammatory diseases is limited. In addition, immune-mediated inflammatory disease treatment can increase the risk of cancer. Several previous studies have demonstrated that Toxoplasma gondii manipulates the immune response by inhibiting or stimulating cytokines, suggesting the potential for controlling and maintaining a balanced immune system. Additionally, T. gondii also has the unique characteristic of being a so-called "Trojan horse" bacterium that can be used as a drug delivery system to treat regions that have been resistant to previous drug delivery therapies. In this study, we reviewed the potential of T. gondii in drug development and as a delivery system through current research on inflammation-regulating mechanisms in immune-mediated inflammatory diseases.
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Affiliation(s)
- Chanjin Yoon
- Department of Molecular and Life Science, Hanyang University, Ansan, 15588, South Korea
- Institute of Natural Science & Technology, Hanyang University, Ansan, 15588, South Korea
| | - Yu Seong Ham
- Department of Molecular and Life Science, Hanyang University, Ansan, 15588, South Korea
- Center for Bionano Intelligence Education and Research, Ansan, 15588, South Korea
| | - Woo Jin Gil
- Department of Molecular and Life Science, Hanyang University, Ansan, 15588, South Korea
- Center for Bionano Intelligence Education and Research, Ansan, 15588, South Korea
| | - Chul-Su Yang
- Department of Molecular and Life Science, Hanyang University, Ansan, 15588, South Korea.
- Center for Bionano Intelligence Education and Research, Ansan, 15588, South Korea.
- Department of Medicinal and Life Science, Hanyang University, Ansan, 15588, South Korea.
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13
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Magaña Serrano JA, Cigarroa López JA, Chávez Mendoza A, Ivey-Miranda JB, Mendoza Zavala GH, Olmos Domínguez L, Chávez Leal SA, Pombo Bartelt JE, Herrera-Garza EH, Mercado Leal G, Parra Michel R, Aguilera Mora LF, Nuriulu Escobar PL. Vulnerable period in heart failure: a window of opportunity for the optimization of treatment - a statement by Mexican experts. Drugs Context 2024; 13:2023-8-1. [PMID: 38264402 PMCID: PMC10803129 DOI: 10.7573/dic.2023-8-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/14/2023] [Indexed: 01/25/2024] Open
Abstract
Acute heart failure (HF) is associated with poor prognosis. After the acute event, there is a vulnerable period during which the patient has a marked risk of readmission or death. Therefore, early optimization of treatment is mandatory during the vulnerable period. The objective of this article is to provide recommendations to address the management of patients with HF during the vulnerable period from a practical point of view. A group of Mexican experts met to prepare a consensus document. The vulnerable period, with a duration of up to 6 months after the acute event - either hospitalization, visit to the emergency department or the outpatient clinic/day hospital - represents a real window of opportunity to improve outcomes for these patients. To best individualize the recommendations, the management strategies were divided into three periods (early, intermediate and late vulnerable period), including not only therapeutic options but also evaluation and education. Importantly, the recommendations are addressed to the entire cardiology team, including physicians and nurses, but also other specialists implicated in the management of these patients. In conclusion, this document represents an opportunity to improve the management of this population at high risk, with the aim of reducing the burden of HF.
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Affiliation(s)
- José Antonio Magaña Serrano
- División de Insuficiencia Cardiaca y Trasplante, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - José Angel Cigarroa López
- Clínica de Insuficiencia Cardiaca Avanzada y Trasplantes de la UMAE Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMSS (Instituto Mexicano del Seguro Social), Ciudad de México, México
| | - Adolfo Chávez Mendoza
- Clínica de Insuficiencia Cardiaca y Hospital de Día, Hospital de Cardiología, Centro Médico Nacional SXXI, IMSS (Instituto Mexicano del Seguro Social), Instituto Nacional de Salud Pública, Ciudad de México, México
| | - Juan Betuel Ivey-Miranda
- Clínica de Insuficiencia Cardiaca Avanzada y Trasplantes de la UMAE Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMSS (Instituto Mexicano del Seguro Social), Ciudad de México, México
| | - Genaro Hiram Mendoza Zavala
- Clínica de Insuficiencia Cardiaca y Hospital de Día, Hospital de Cardiología, Centro Médico Nacional SXXI, IMSS (Instituto Mexicano del Seguro Social), Instituto Nacional de Salud Pública, Ciudad de México, México
| | - Luis Olmos Domínguez
- Clínica de Insuficiencia Cardiaca y Hospital de Día, Hospital de Cardiología, Centro Médico Nacional SXXI, IMSS (Instituto Mexicano del Seguro Social), Instituto Nacional de Salud Pública, Ciudad de México, México
| | | | | | - Eduardo Heberto Herrera-Garza
- Programa de Trasplante Cardiaco y Clínica de Insuficiencia Cardíaca, Hospital Christus Muguerza Alta Especialidad, Monterrey, México
| | - Gerardo Mercado Leal
- División de Cardiocirugía, Clínica de Insuficiencia Cardiaca, Trasplante Cardiaco y Hospital de Día, CMN 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | - Rodolfo Parra Michel
- Unidad de Coronaria y Clínica de Insuficiencia Cardíaca Avanzada e Hipertensión Arterial Pulmonar. Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Luisa Fernanda Aguilera Mora
- Clínica de Insuficiencia Cardiaca, Instituto Cardiovascular de Mínima Invasión, Centro Médico Puerta de Hierro, Zapopan, México
| | - Patricia Lenny Nuriulu Escobar
- Unidad de Insuficiencia Cardiaca y Cardio-Oncología del Instituto Cardiovascular de Hidalgo, Pachuca de Soto Hidalgo, Fellow SIAC, Pachuca de Soto, México
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14
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Parmar SS, Mohamed MO, Mamas MA, Wilkie R. The clinical characteristics, managements, and outcomes of acute myocardial infarction in osteoarthritis patients; a cross-sectional analysis of 6.5 million patients. Expert Rev Cardiovasc Ther 2024; 22:121-129. [PMID: 38284347 DOI: 10.1080/14779072.2024.2311696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 01/25/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVES The prevalence of osteoarthritis (OA) and cardiovascular disease are increasing and both conditions share similar risk factors. We investigated the association between OA and receipt of invasive managements and clinical outcomes in patients with acute myocardial infarction (AMI). METHODS Using the National Inpatient Sample, adjusted binary logistic regression determined the association between OA and each outcome variable. RESULTS Of 6,561,940 AMI hospitalizations, 6.3% had OA. OA patients were older and more likely to be female. OA was associated with a decreased odds of coronary angiography (adjusted odds ratio 0.91; 95% confidence interval 0.90, 0.92), PCI (0.87; 0.87, 0.88), and coronary artery bypass grafting (0.98; 0.97, 1.00). OA was associated with a decreased odds of adverse outcomes (in-hospital mortality: 0.68; 0.67, 0.69; major acute cardiovascular and cerebrovascular events: 0.71; 0.70, 0.72; all-cause bleeding: 0.76; 0.74, 0.77; and stroke/TIA: 0.84; 0.82, 0.87). CONCLUSIONS This study of a representative sample of the US population highlights that OA patients are less likely to be offered invasive interventions following AMI. OA was also associated with better outcomes post-AMI, possibly attributed to a misclassification bias where unwell patients with OA were less likely to receive an OA code because codes for serious illness took precedence.
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Affiliation(s)
- Simran Singh Parmar
- Renal and Transplantation Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Mohamed O Mohamed
- Keele Cardiovascular Research Group, Keele University, Staffordshire, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Staffordshire, UK
| | - Ross Wilkie
- School of Medicine, Keele University, Staffordshire, UK
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15
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Magierowska K, Wójcik-Grzybek D, Korbut E, Bakalarz D, Ginter G, Danielak A, Kwiecień S, Chmura A, Torregrossa R, Whiteman M, Magierowski M. The mitochondria-targeted sulfide delivery molecule attenuates drugs-induced gastropathy. Involvement of heme oxygenase pathway. Redox Biol 2023; 66:102847. [PMID: 37597422 PMCID: PMC10458696 DOI: 10.1016/j.redox.2023.102847] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/07/2023] [Accepted: 08/11/2023] [Indexed: 08/21/2023] Open
Abstract
Hydrogen sulfide (H2S) signaling and H2S-prodrugs maintain redox balance in gastrointestinal (GI) tract. Predominant effect of any H2S-donor is mitochondrial. Non-targeted H2S-moieties were shown to decrease the non-steroidal anti-inflammatory drugs (NSAIDs)-induced gastrotoxicity but in high doses. However, direct, controlled delivery of H2S to gastric mucosal mitochondria as a molecular target improving NSAIDs-pharmacology remains overlooked. Thus, we treated Wistar rats, i.g. with vehicle, mitochondria-targeted H2S-releasing AP39 (0.004-0.5 mg/kg), AP219 (0.02 mg/kg) as structural control without H2S-releasing ability, or AP39 + SnPP (10 mg/kg) as a heme oxygenase (HMOX) inhibitor. Next, animals were administered i.g. with acetylsalicylic acid (ASA, 125 mg/kg) as NSAIDs representative or comparatively with 75% ethanol to induce translational hemorrhagic or necrotic gastric lesions, that were assessed micro-/macroscopically. Activity of mitochondrial complex IV/V, and DNA oxidation were assessed biochemically. Gastric mucosal/serum content of IL-1β, IL-10, TNF-α, TGF-β1/2, ARG1, GST-α, or phosphorylation of mTOR, NF-κB, ERK, Akt, JNK, STAT3/5 were evaluated by microbeads-fluorescent xMAP®-assay; gastric mucosal mRNA level of HMOX-1/2, COX-1/2, SOD-1/2 by real-time PCR. AP39 (but not AP219) dose-dependently (0.02 and 0.1 mg/kg) diminished NSAID- (and ethanol)-induced gastric lesions and DNA oxidation, restoring mitochondrial complexes activity, ARG1, GST-α protein levels and increasing HMOX-1 and SOD-2 expression. AP39 decreased proteins levels or phosphorylation of gastric mucosal inflammation/oxidation-sensitive markers and restored mTOR phosphorylation. Pharmacological inhibition of HMOX-1 attenuated AP39-gastroprotection. We showed that mitochondria-targeted H2S released from very low i.g. doses of AP39 improved gastric mucosal capacity to cope with NSAIDs-induced mitochondrial dysfunction and redox imbalance, mechanistically requiring the activity of HMOX-1.
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Affiliation(s)
| | | | - Edyta Korbut
- Department of Physiology, Jagiellonian University Medical College, Cracow, Poland
| | - Dominik Bakalarz
- Department of Physiology, Jagiellonian University Medical College, Cracow, Poland; Department of Forensic Toxicology, Institute of Forensic Research, Cracow, Poland
| | - Grzegorz Ginter
- Department of Physiology, Jagiellonian University Medical College, Cracow, Poland
| | - Aleksandra Danielak
- Department of Physiology, Jagiellonian University Medical College, Cracow, Poland
| | - Sławomir Kwiecień
- Department of Physiology, Jagiellonian University Medical College, Cracow, Poland
| | - Anna Chmura
- Department of Physiology, Jagiellonian University Medical College, Cracow, Poland
| | - Roberta Torregrossa
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Matthew Whiteman
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Marcin Magierowski
- Department of Physiology, Jagiellonian University Medical College, Cracow, Poland.
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16
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Liu L, Alate R, Harrison J. Development and validation of PolyScan, an information technology triage tool for older adults with polypharmacy: a healthcare informatics study. J Prim Health Care 2023; 15:215-223. [PMID: 37756239 DOI: 10.1071/hc23034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/08/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction Polypharmacy is associated with potentially inappropriate medicine prescribing and avoidable medicine-related harm. Polypharmacy should not be perceived as inherently harmful. Instead, priority should be placed on reducing inappropriate prescribing. Aim The study aimed to develop and validate PolyScan, a primary care information technology tool, to triage older adults with polypharmacy who are prescribed potentially inappropriate medicines. Methods Twenty-one indicators from a New Zealand criteria of potentially inappropriate medicines to correct for older adults with polypharmacy were developed into a set of implementable definitions. The definitions were applied as algorithmic logic statements used to interrogate hospital and emergency department records and pharmaceutical collection data to classify whether each indicator was present at an individual patient level, and then triage individuals based on the number of indicators met. Validity was evaluated by comparing PolyScan's accuracy against a manual review of healthcare records for 300 older adults. Results PolyScan was successfully implemented as a tool that can be used to identify potentially inappropriate prescribing in older adults with polypharmacy at different levels of aggregation. The tool has utility for individual practitioners delivering patient care, primary care organisations undertaking quality improvement programmes, and policymakers considering system-level interventions for medicines-related safety. During the validity assessment, PolyScan identified nine individuals (3%) with polypharmacy and indicators of potentially inappropriate medicine. Five unique indicators were detected. PolyScan achieved 100% sensitivity, specificity, and positive and negative predictive values. Discussion PolyScan can support clinicians, clinics, and policymakers with allocation of resources, rational medicine campaigns, and identifying individuals prescribed potentially inappropriate medicines for review.
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Affiliation(s)
- Lisheng Liu
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; and Primary, Public and Community Health, MidCentral District, Te Whatu Ora, PO Box 2056, Palmerston North 4440, New Zealand
| | - Rashmi Alate
- Data Quality and Health Information Team, MidCentral District, Te Whatu Ora, PO Box 2056, Palmerston North 4440, New Zealand
| | - Jeff Harrison
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
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17
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Li R, Chen L, Ren Y, Huang J, Xu Y, Lin X, Zhen R. Efficacy and safety of acupuncture for pregnancy-related low back pain: A systematic review and meta-analysis. Heliyon 2023; 9:e18439. [PMID: 37593601 PMCID: PMC10427988 DOI: 10.1016/j.heliyon.2023.e18439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 08/19/2023] Open
Abstract
Background Pregnancy-related low back pain (PLBP) is a common musculoskeletal disorder, affecting people's physical and psychological health. Acupuncture is widely used in clinical practice as a treatment for PLBP. This study aimed to evaluate the efficacy and safety of acupuncture or acupuncture combined with other treatments for PLBP patients. Methods The Cochrane Library, PubMed, EMBASE, Web of Science, the Chinese Biological Medicine Database, China National Knowledge Infrastructure, WanFang Database, and VIP information database were searched from inception to January 31, 2022. Randomized controlled trials (RCTs) were eligible, without blinding and language restriction. Cochrane's risk of bias tool was used to assess the methodological quality. Meta-analysis was performed using RevMan 5.3. Results Twelve randomized controlled trials involving 1302 patients were included. The results showed that compared to the control group, the VAS score was significantly decreased after acupuncture treatment. In addition, no significant difference was found in the preterm delivery rate (RR = 0.38, 95%CI: 0.24 to 0.61, P = 0.97) after acupuncture treatment. Compared with other therapies, acupuncture or acupuncture plus other therapies revealed a significant increase in the effective rate (OR: 6.92, 95%CI: 2.44 to 19.67, I2 = 0%). No serious adverse events owing to acupuncture were reported. Conclusion Acupuncture or acupuncture combined with other interventions was a safe and effective therapy for treating PLBP. However, the methodological quality of the RCTs was low. More rigorous and well-designed trials should be conducted.
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Affiliation(s)
- Rong Li
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Liping Chen
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yulan Ren
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- School of Chinese Classics, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jinzhu Huang
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuqi Xu
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaoding Lin
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Runchen Zhen
- School of Chinese Classics, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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18
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Geczy QE, Thirumaran AJ, Carroll PR, McLachlan AJ, Hunter DJ. What is the most effective and safest Non-steroidal anti-inflammatory drug for treating osteoarthritis in patients with comorbidities? Expert Opin Drug Metab Toxicol 2023; 19:681-695. [PMID: 37817419 DOI: 10.1080/17425255.2023.2267424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/03/2023] [Indexed: 10/12/2023]
Abstract
INTRODUCTION Understanding what the most effective and safe non-steroidal anti-inflammatory drug (NSAID) is for managing osteoarthritis (OA) is complicated. OA is prevalent worldwide and people living with OA commonly have multiple comorbidities. The efficacy and safety of NSAIDs in a patient are influenced by their intrinsic and extrinsic factors. Current guidelines recommend the lowest dose for the shortest duration, monitoring patients for risk factors and comorbidities but generally do not specify, which NSAID is most suitable for a patient with specific comorbidities. AREAS COVERED This paper looks at the mechanism of action of all NSAIDs and reviews the current literature concerning their safety in patients with and without comorbidities. Relevant publications were identified by searching PubMed and Cochrane Library using key terms. The search was conducted from inception to 18 July 2023 and included results published before 18 July 2023. The search results and their references were then manually reviewed. EXPERT OPINION In the paper, we determine whether the current practice of 'lowest dose for shortest duration' is in fact the best approach for prescribing NSAIDs and identify which NSAIDs are most suitable given a patient's risk factors and comorbidities. Our aim is to help guide health professionals in recommending the most suitable NSAID for each patient.
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Affiliation(s)
- Quentin E Geczy
- Sydney Medical Program, The University of Sydney, Sydney, NSW, Australia
| | | | - Peter R Carroll
- School of Medicine Sydney, University of Notre Dame, Darlinghurst, NSW, Australia
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Andrew J McLachlan
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - David J Hunter
- Sydney Musculoskeletal Health, Arabanoo Precinct, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Rheumatology Department, Royal North Shore Hospital, St Leonards, NSW, Australia
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Nwobodo I, Louis H, Unimuke TO, Ikenyirimba OJ, Iloanya AC, Mathias GE, Osabor VN, Ahuekwe EF, Adeyinka AS. Molecular Simulation of the Interaction of Diclofenac with Halogen (F, Cl, Br)-Encapsulated Ga 12As 12 Nanoclusters. ACS OMEGA 2023; 8:17538-17551. [PMID: 37251115 PMCID: PMC10210178 DOI: 10.1021/acsomega.2c06097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/05/2022] [Indexed: 05/31/2023]
Abstract
Diclofenac is one of the most frequently consumed over-the-counter anti-inflammatory agents globally, and several reports have confirmed its global ubiquity in several environmental compartments. Therefore, the need to develop more efficient monitoring/sensing devices with high detection limits is still needed. Herein, quantum mechanical simulations using density functional theory (DFT) computations have been utilized to evaluate the nanosensing efficacy and probe the applicability of Ga12As12 nanostructure and its engineered derivatives (halogen encapsulation F, Br, Cl) as efficient adsorbent/sensor materials for diclofenac. Based on the DFT computations, it was observed that diclofenac preferred to interact with the adsorbent material by assuming a flat orientation on the surface while interacting via its hydrogen atoms with the As atoms at the corner of the GaAs cage forming a polar covalent As-H bond. The adsorption energies were observed to be in the range of -17.26 to -24.79 kcal/mol and therefore suggested favorable adsorption with the surface. Nonetheless, considerable deformation was observed for the Br-encapsulated derivative, and therefore, its adsorption energy was observed to be positive. Additionally, encapsulation of the GaAs nanoclusters with halogens (F and Cl) enhanced the sensing attributes by causing a decrease in the energy gap of the nanocluster. And therefore, this suggests the feasibility of the studied materials as potentiometric sensor materials. These findings could offer some implications for the potential application of GaAs and their halogen-encapsulated derivatives for electronic technological applications.
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Affiliation(s)
- Ikechukwu
C. Nwobodo
- Computational
and Bio-Simulation Research Group, University
of Calabar, P.M.B. 1115, Calabar540221, Nigeria
- Department
of Pure and Applied Chemistry, University
of Calabar, P.M.B. 1115, Calabar540221, Nigeria
| | - Hitler Louis
- Computational
and Bio-Simulation Research Group, University
of Calabar, P.M.B. 1115, Calabar540221, Nigeria
- Department
of Pure and Applied Chemistry, University
of Calabar, P.M.B. 1115, Calabar540221, Nigeria
| | - Tomsmith O. Unimuke
- Computational
and Bio-Simulation Research Group, University
of Calabar, P.M.B. 1115, Calabar540221, Nigeria
- Department
of Pure and Applied Chemistry, University
of Calabar, P.M.B. 1115, Calabar540221, Nigeria
| | - Onyinye J. Ikenyirimba
- Department
of Chemistry Education, Alex Ekwueme Federal
University, P.M.B. 1010, Abakaliki, Ebonyi State010, Nigeria
| | - Anthony C. Iloanya
- Department
of Physics, Lehigh University, Bethlehem, Pennsylvania18015, United States
| | - Gideon E. Mathias
- Computational
and Bio-Simulation Research Group, University
of Calabar, P.M.B. 1115, Calabar540221, Nigeria
- Department
of Pure and Applied Chemistry, University
of Calabar, P.M.B. 1115, Calabar540221, Nigeria
| | - Vincent N. Osabor
- Department
of Pure and Applied Chemistry, University
of Calabar, P.M.B. 1115, Calabar540221, Nigeria
| | - Eze F. Ahuekwe
- Computational
and Bio-Simulation Research Group, University
of Calabar, P.M.B. 1115, Calabar540221, Nigeria
- Department
of Biological Sciences, Covenant University, Ota112104, Ogun State, Nigeria
| | - Adedapo S. Adeyinka
- Research
Centre for Synthesis and Catalysis, Department of Chemical Sciences, University of Johannesburg, Johannesburg2006, South Africa
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20
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Curcumin-Loaded Chitosan Nanoparticle Preparation and Its Protective Effect on Celecoxib-induced Toxicity in Rat isolated Cardiomyocytes and Mitochondria. Drug Res (Stuttg) 2023; 73:125-136. [PMID: 36423624 DOI: 10.1055/a-1960-3092] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Curcumin has a wide range of pharmacological activities, including antioxidant, anti-inflammatory and tissue protective. In here we hypothesized that curcumin-loaded chitosan-coated solid lipid nanoparticles (CuCsSLN) are able to increase its overall bioavailability and hence its antioxidant and mitochondria;/lysosomal protective properties of curcumin. CuCsSLN were prepared using solvent diffusion technique for formation of solid lipid nanoparticles (SLNs) and electrostatic coating of positive-charged chitosan to negative surface of SLNs. CuCsSLN showed the encapsulation efficiency of 91.4±2.7%, the mean particle size of 208±9 nm, the polydispersity index of 0.34±0.07, and the zeta potential of+53.5±3.7 mV. The scanning electron microscope (SEM) images of nanoparticles verified their nanometric size and also spherical shape. Curcumin was released from CuCsSLN in a sustain release pattern up to 24 hours. Then isolated cardiomyocytes and mitochondria were simultaneously treated with (1) control (0.05% ethanol), (2) celecoxib (20 µg/ml) treatment, (3) celecoxib (20 µg/ml)+++CuCsSLN (1 µg/ml) treatment, (4) CuCsSLN (1 µg/ml) treatment, (5) celecoxib (20 µg/ml)+++curcumin (10 µM) treatment and (6) curcumin (10 µM) treatment for 4 h at 37°C. The results showed that celecoxib (20 µg/ml) induced a significant increase in cytotoxicity, reactive oxygen species (ROS) formation, mitochondria membrane potential (ΔΨm) collapse, lipid peroxidation, oxidative stress and mitochondrial swelling while CuCsSLN and curcumin reverted the above toxic effect of celecoxib. Our data indicated that the effect of CuCsSLN in a number of experiments, is significantly better than that of curcumin which shows the role of chitosan nanoparticles in increasing effect of curcumin.
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21
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Thai PN, Ren L, Xu W, Overton J, Timofeyev V, Nader CE, Haddad M, Yang J, Gomes AV, Hammock BD, Chiamvimonvat N, Sirish P. Chronic Diclofenac Exposure Increases Mitochondrial Oxidative Stress, Inflammatory Mediators, and Cardiac Dysfunction. Cardiovasc Drugs Ther 2023; 37:25-37. [PMID: 34499283 PMCID: PMC8904649 DOI: 10.1007/s10557-021-07253-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 01/16/2023]
Abstract
PURPOSE Nonsteroidal anti-inflammatory drugs (NSAIDs) are among one of the most commonly prescribed medications for pain and inflammation. Diclofenac (DIC) is a commonly prescribed NSAID that is known to increase the risk of cardiovascular diseases. However, the mechanisms underlying its cardiotoxic effects remain largely unknown. In this study, we tested the hypothesis that chronic exposure to DIC increases oxidative stress, which ultimately impairs cardiovascular function. METHODS AND RESULTS Mice were treated with DIC for 4 weeks and subsequently subjected to in vivo and in vitro functional assessments. Chronic DIC exposure resulted in not only systolic but also diastolic dysfunction. DIC treatment, however, did not alter blood pressure or electrocardiographic recordings. Importantly, treatment with DIC significantly increased inflammatory cytokines and chemokines as well as cardiac fibroblast activation and proliferation. There was increased reactive oxygen species (ROS) production in cardiomyocytes from DIC-treated mice, which may contribute to the more depolarized mitochondrial membrane potential and reduced energy production, leading to a significant decrease in sarcoplasmic reticulum (SR) Ca2+ load, Ca2+ transients, and sarcomere shortening. Using unbiased metabolomic analyses, we demonstrated significant alterations in oxylipin profiles towards inflammatory features in chronic DIC treatment. CONCLUSIONS Together, chronic treatment with DIC resulted in severe cardiotoxicity, which was mediated, in part, by an increase in mitochondrial oxidative stress.
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Affiliation(s)
- Phung N Thai
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of California, Davis, 451 Health Science Drive, CA, 95616, Davis, USA
| | - Lu Ren
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of California, Davis, 451 Health Science Drive, CA, 95616, Davis, USA
| | - Wilson Xu
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of California, Davis, 451 Health Science Drive, CA, 95616, Davis, USA
| | - James Overton
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of California, Davis, 451 Health Science Drive, CA, 95616, Davis, USA
| | - Valeriy Timofeyev
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of California, Davis, 451 Health Science Drive, CA, 95616, Davis, USA
| | - Carol E Nader
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of California, Davis, 451 Health Science Drive, CA, 95616, Davis, USA
| | - Michael Haddad
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of California, Davis, 451 Health Science Drive, CA, 95616, Davis, USA
| | - Jun Yang
- Department of Entomology and Nematology and Comprehensive Cancer Center, University of California, Davis, CA, USA
| | - Aldrin V Gomes
- Department of Physiology and Membrane Biology, University of California, Davis, CA, USA
| | - Bruce D Hammock
- Department of Entomology and Nematology and Comprehensive Cancer Center, University of California, Davis, CA, USA
| | - Nipavan Chiamvimonvat
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of California, Davis, 451 Health Science Drive, CA, 95616, Davis, USA.
- Department of Pharmacology, University of California, Davis, CA, USA.
- Department of Veterans Affairs, Northern California Health Care System, 10535 Hospital Way, Mather, CA, 95655, USA.
| | - Padmini Sirish
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of California, Davis, 451 Health Science Drive, CA, 95616, Davis, USA.
- Department of Veterans Affairs, Northern California Health Care System, 10535 Hospital Way, Mather, CA, 95655, USA.
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Rout D, Sharma S, Agarwala P, Upadhyaya AK, Sharma A, Sasmal DK. Interaction of Ibuprofen with Partially Unfolded Bovine Serum Albumin in the Presence of Ionic Micelles and Oligosaccharides at Different λ ex and pH: A Spectroscopic Analysis. ACS OMEGA 2023; 8:3114-3128. [PMID: 36713709 PMCID: PMC9878652 DOI: 10.1021/acsomega.2c06447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/08/2022] [Indexed: 06/18/2023]
Abstract
The interaction between the plasma protein bovine serum albumin (BSA) and the drug ibuprofen (IBU) has been investigated at three different pH values (7.4, 6.5, and 8.0) in the presence of oligosaccharides and surfactants. The interaction analysis of BSA with oligosaccharides and surfactants has also been studied in the absence of the drug ibuprofen. The results obtained give convenient and efficient access to understand the mechanism of binding of ibuprofen to BSA, and the major forces involved are found to be hydrophobic forces, hydrogen bonding and ionic interactions. In addition to that, the formation of inclusion complexes of ibuprofen with oligosaccharides (β-CD and 2-HP-β-CD) has been observed, which has depicted that due to the hydrophobic nature of ibuprofen, it becomes more soluble in the presence of oligosaccharides, but due to the larger size of the inclusion complexes, these could not be able to access the hydrophobic pocket of BSA where tryptophan-212 (Trp-212) resides. The binding interaction between BSA and ibuprofen is observed in the presence of surfactants (SDS and CTAB), which partially unfold the protein. Non-radiative fluorescence resonance energy transfer (FRET) from Trp and Tyr residues of BSA in the presence of an anionic surfactant SDS to ibuprofen has depicted that there is a possibility of drug binding even in the partially unfolded state of BSA protein. Furthermore, the distance between the protein and the drug has been calculated from the FRET efficiency, which gives a comprehensive overview of ibuprofen binding to BSA even in its partially denatured state. The hydrophobic drug binding to the partially unfolded serum albumin protein (BSA) supports the "necklace and bead structures" model and opens up a new direction of drug loading and delivery system, which will have critical therapeutic applications in the efficient delivery of pharmacologically prominent drugs.
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23
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Mi XJ, Le HM, Lee S, Park HR, Kim YJ. Silymarin-Functionalized Selenium Nanoparticles Prevent LPS-Induced Inflammatory Response in RAW264.7 Cells through Downregulation of the PI3K/Akt/NF-κB Pathway. ACS OMEGA 2022; 7:42723-42732. [PMID: 36467957 PMCID: PMC9713780 DOI: 10.1021/acsomega.2c04140] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/17/2022] [Indexed: 06/17/2023]
Abstract
Silymarin exhibits an anti-inflammatory property in various cancers and inflammatory diseases. In our previous work, silymarin-mediated selenium nanoparticles (SeNPs) (Si-SeNPs) were developed using a green synthesis technique, and its potential as an anticancer agent was confirmed. In order to further examine the extended comprehensive potential of Si-SeNPs, this investigation focuses on studying the enhanced anti-inflammatory effect of Si-SeNPs in lipopolysaccharide (LPS)-stimulated RAW264.7 macrophages. Enzyme-linked immunosorbent assay and quantitative reverse transcription-polymerase chain reaction were used to evaluate the expression of pro-inflammatory mediators and cytokines. Western blotting and immunofluorescence assays were conducted to assess the protein expression of p-PI3K, p-Akt, p-NF-κB, and p-IκBα. Compared to silymarin, Si-SeNPs exhibited a significantly increased inhibitory effect on LPS-induced release of nitric oxide and the expression of pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNF-α) and interleukin 1β (IL-1β) in RAW264.7 cells. A western blot assay indicated that Si-SeNPs downregulated the PI3K/Akt and NF-κB signaling pathways. The immunofluorescence assay suggested that Si-SeNPs inhibited the nuclear translocation and the activation of NF-κB. In addition, 740 Y-P (PI3K agonist) was used to demonstrate that activating the PI3K/Akt signal could partially reverse the inflammatory response, suggesting a causal role of the PI3K/Akt signaling pathway in the anti-inflammatory effect of Si-SeNPs. Consequently, these findings indicate that Si-SeNPs could be a functional agent of the attenuation of LPS-induced inflammatory responses in RAW264.7 macrophages through inhibiting the PI3K/Akt/NF-κB signaling pathway. In addition, biosynthesized Si-SeNPs could be more effective at reducing inflammation than only silymarin extracts. Thus, this study lays an experimental foundation for the clinical application of using biosynthesized SeNPs as a novel candidate in the field of inflammation-associated diseases.
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Affiliation(s)
- Xiao-jie Mi
- Graduate
School of Biotechnology, and College of Life Science, Kyung Hee University, Yongin-si 17104, Gyeonggi-do, Republic of Korea
| | - Ha-Minh Le
- Graduate
School of Biotechnology, and College of Life Science, Kyung Hee University, Yongin-si 17104, Gyeonggi-do, Republic of Korea
| | - Sanghyun Lee
- Department
of Plant Science and Technology, Chung Ang
University, Anseong 17546, Republic of Korea
| | - Hye-Ryung Park
- Graduate
School of Biotechnology, and College of Life Science, Kyung Hee University, Yongin-si 17104, Gyeonggi-do, Republic of Korea
| | - Yeon-Ju Kim
- Graduate
School of Biotechnology, and College of Life Science, Kyung Hee University, Yongin-si 17104, Gyeonggi-do, Republic of Korea
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24
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Cui G, Wang Z, Liu H, Pang Z. Cytokine-mediated crosstalk between cancer stem cells and their inflammatory niche from the colorectal precancerous adenoma stage to the cancerous stage: Mechanisms and clinical implications. Front Immunol 2022; 13:1057181. [PMID: 36466926 PMCID: PMC9714270 DOI: 10.3389/fimmu.2022.1057181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/03/2022] [Indexed: 10/15/2023] Open
Abstract
The majority of colorectal cancers (CRCs) are thought to arise from precancerous adenomas. Upon exposure to diverse microenvironmental factors, precancerous stem cells (pCSCs) undergo complex genetic/molecular changes and gradually progress to form cancer stem cells (CSCs). Accumulative evidence suggests that the pCSC/CSC niche is an inflammatory dominated milieu that contains different cytokines that function as the key communicators between pCSCs/CSCs and their niche and have a decisive role in promoting CRC development, progression, and metastasis. In view of the importance and increasing data about cytokines in modulating pCSCs/CSC stemness properties and their significance in CRC, this review summarizes current new insights of cytokines, such as interleukin (IL)-4, IL-6, IL-8, IL-17A, IL-22, IL-23, IL-33 and interferon (IFN)-γ, involving in the modulation of pCSC/CSC properties and features in precancerous and cancerous lesions and discusses the possible mechanisms of adenoma progression to CRCs and their therapeutic potential.
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Affiliation(s)
- Guanglin Cui
- Research Group of Gastrointestinal Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Faculty of Health Science, Nord University, Levanger, Norway
| | - Ziqi Wang
- College of Medical Imaging, Mudanjiang Medical University, Mudanjiang, China
| | - Hanzhe Liu
- School of Stomatology, Wuhan University, Wuhan, China
| | - Zhigang Pang
- Research Group of Gastrointestinal Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Dreischulte T, Shahid F, Muth C, Schmiedl S, Haefeli WE. Prescribing Cascades: How to Detect Them, Prevent Them, and Use Them Appropriately. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:745-752. [PMID: 36045504 PMCID: PMC9853235 DOI: 10.3238/arztebl.m2022.0306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/02/2022] [Accepted: 08/11/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND A prescribing cascade is the treatment of an adverse drug reaction (ADR) with another drug. In this review, we discuss (a) the different types of prescribing cascade and (b) the measures that can be taken so that they will be recognized and dealt with appropriately, both in the hospital and in the outpatient setting. METHODS This review is based on pertinent publications retrieved by a selective literature search. RESULTS The literature distinguishes intentional from unintentional prescribing cascades, and appropriate from inappropriate ones. We further distinguish prophylactic from therapeutic prescribing cascades and draw a line between those that are necessary and those that are merely appropriate. The following main questions are essential for dealing with prescribing cascades appropriately: (1) Did the precipitating drug cause a clinically relevant ADR or risk of an ADR? (2) Is the precipitating drug still indicated? (3) Can an ADR be avoided by altering the treatment with the precipitating drug, or by (4) switching to another drug instead? (5) Can the drug used to treat the ADR actually affect it beneficially? (6) Do the benefits of the prescribing cascade outweigh its risks? CONCLUSION Prescribing cascades are not problematic in themselves; on the contrary, they are sometimes a necessary part of good prescribing practice. There is still a lack of practically implementable instruments to help physicians detect prescribing cascades reliably, assess them properly, and put them to appropriate use.
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Affiliation(s)
- Tobias Dreischulte
- Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians-University Munich; Department of General Practice and Family Medicine, Medical Faculty OWL, University of Bielefeld; Philipp Klee-of Clinical Pharmacology, Helios Clinic Wuppertal; Clinical Pharmacology, Witten/Herdecke University, Witten/Herdecke; Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelbergg
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26
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Penner LS, Gavan SP, Ashcroft DM, Peek N, Elliott RA. Does coprescribing nonsteroidal anti-inflammatory drugs and oral anticoagulants increase the risk of major bleeding, stroke and systemic embolism? Br J Clin Pharmacol 2022; 88:4789-4811. [PMID: 35484847 PMCID: PMC9796910 DOI: 10.1111/bcp.15371] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/21/2022] [Accepted: 04/11/2022] [Indexed: 01/07/2023] Open
Abstract
AIMS To examine the risk of gastrointestinal (GI) bleeding, major bleeding, stroke and systemic embolism associated with prescribing nonsteroidal anti-inflammatory drugs (NSAIDs) to adults receiving oral anticoagulant (OAC) therapy. METHODS We conducted a population-based cohort study in adults receiving OAC therapy using linked primary care (Clinical Practice Research Datalink GOLD) and hospital (Hospital Episodes Statistics) electronic health records. We used cause-specific Cox regression models with time-dependent NSAID treatment in a propensity score matched population to estimate the increased risk of GI bleeding, stroke, major bleeding and systemic embolism associated with NSAID use. RESULTS The matched cohort contained 3177 patients with OAC therapy alone and 3177 with at least 1 concomitant NSAID prescription. Compared with OAC therapy alone, concomitant prescription of NSAIDs with OACs was associated with increased risk of GI bleeding (hazard ratio [HR] 3.01, 95% confidence interval [CI] 1.63 to 5.55), stroke (HR 2.71, 95% CI 1.48 to 4.96) and major bleeding (HR 2.77, 95% CI 1.84 to 4.19). The association with systemic embolism did not reach statistical significance (HR 3.02, 95% CI 0.82 to 11.07). Sensitivity analyses indicated that the results were robust to changes in exclusion criteria and the choice of potential confounding variables. CONCLUSION When OACs are coprescribed with NSAIDs, the risk of adverse bleeding events increases and, simultaneously, the protective effect of OACs to prevent strokes reduces. There is a need for interventions that reduce hazardous prescribing of NSAIDs in people receiving OAC therapy.
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Affiliation(s)
- Leonie S. Penner
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK,NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - Sean P. Gavan
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - Darren M. Ashcroft
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK,Division of Pharmacy & Optometry, School of Health Sciences, Faculty of BiologyMedicine and Health, University of ManchesterManchesterUK
| | - Niels Peek
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK,Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - Rachel A. Elliott
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
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27
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DiCarlo AL, Carnell LS, Rios CI, Prasanna PG. Inter-agency perspective: Translating advances in biomarker discovery and medical countermeasures development between terrestrial and space radiation environments. LIFE SCIENCES IN SPACE RESEARCH 2022; 35:9-19. [PMID: 36336375 PMCID: PMC9832585 DOI: 10.1016/j.lssr.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/18/2022] [Accepted: 06/12/2022] [Indexed: 05/22/2023]
Abstract
Over the past 20+ years, the U.S. Government has made significant strides in establishing research funding and initiating a portfolio consisting of subject matter experts on radiation-induced biological effects in normal tissues. Research supported by the National Cancer Institute (NCI) provided much of the early findings on identifying cellular pathways involved in radiation injuries, due to the need to push the boundaries to kill tumor cells while minimizing damage to intervening normal tissues. By protecting normal tissue surrounding the tumors, physicians can deliver a higher radiation dose to tumors and reduce adverse effects related to the treatment. Initially relying on this critical NCI research, the National Institute of Allergy and Infectious Diseases (NIAID), first tasked with developing radiation medical countermeasures in 2004, has provided bridge funding to move basic research toward advanced development and translation. The goal of the NIAID program is to fund approaches that can one day be employed to protect civilian populations during a radiological or nuclear incident. In addition, with the reality of long-term space flights and the possibility of radiation exposures to both acute, high-intensity, and chronic lower-dose levels, the National Aeronautics and Space Administration (NASA) has identified requirements to discover and develop radioprotectors and mitigators to protect their astronauts during space missions. In sustained partnership with sister agencies, these three organizations must continue to leverage funding and findings in their overlapping research areas to accelerate biomarker identification and product development to help safeguard these different and yet undeniably similar human populations - cancer patients, public citizens, and astronauts.
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Affiliation(s)
- Andrea L DiCarlo
- Radiation and Nuclear Countermeasures Program (RNCP), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), 5601 Fishers Lane, Rockville, MD, 20852 United States of America.
| | - Lisa S Carnell
- Biological and Physical Sciences Division, National Aeronautics and Space Administration (NASA), 300 E Street SW, Washington, DC, 20546 United States of America
| | - Carmen I Rios
- Radiation and Nuclear Countermeasures Program (RNCP), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), 5601 Fishers Lane, Rockville, MD, 20852 United States of America
| | - Pataje G Prasanna
- Radiation Research Program (RRP), National Cancer Institute (NCI), National Institutes of Health (NIH), 9609 Medical Center Drive, Bethesda, MD, 20892 United States of America
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28
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Stable Gastric Pentadecapeptide BPC 157 as Useful Cytoprotective Peptide Therapy in the Heart Disturbances, Myocardial Infarction, Heart Failure, Pulmonary Hypertension, Arrhythmias, and Thrombosis Presentation. Biomedicines 2022; 10:biomedicines10112696. [PMID: 36359218 PMCID: PMC9687817 DOI: 10.3390/biomedicines10112696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/08/2022] [Accepted: 10/15/2022] [Indexed: 11/30/2022] Open
Abstract
In heart disturbances, stable gastric pentadecapeptide BPC 157 especial therapy effects combine the therapy of myocardial infarction, heart failure, pulmonary hypertension arrhythmias, and thrombosis prevention and reversal. The shared therapy effect occurred as part of its even larger cytoprotection (cardioprotection) therapy effect (direct epithelial cell protection; direct endothelium cell protection) that BPC 157 exerts as a novel cytoprotection mediator, which is native and stable in human gastric juice, as well as easily applicable. Accordingly, there is interaction with many molecular pathways, combining maintained endothelium function and maintained thrombocytes function, which counteracted thrombocytopenia in rats that underwent major vessel occlusion and deep vein thrombosis and counteracted thrombosis in all vascular studies; the coagulation pathways were not affected. These appeared as having modulatory effects on NO-system (NO-release, NOS-inhibition, NO-over-stimulation all affected), controlling vasomotor tone and the activation of the Src-Caveolin-1-eNOS pathway and modulatory effects on the prostaglandins system (BPC 157 counteracted NSAIDs toxicity, counteracted bleeding, thrombocytopenia, and in particular, leaky gut syndrome). As an essential novelty noted in the vascular studies, there was the activation of the collateral pathways. This might be the upgrading of the minor vessel to take over the function of the disabled major vessel, competing with and counteracting the Virchow triad circumstances devastatingly present, making possible the recruitment of collateral blood vessels, compensating vessel occlusion and reestablishing the blood flow or bypassing the occluded or ruptured vessel. As a part of the counteraction of the severe vessel and multiorgan failure syndrome, counteracted were the brain, lung, liver, kidney, gastrointestinal lesions, and in particular, the counteraction of the heart arrhythmias and infarction.
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29
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Yaseen IF, Farhan HA. Cardiovascular drug interventions in the cardio-oncology clinic by a cardiology pharmacist: ICOP-Pharm study. Front Cardiovasc Med 2022; 9:972455. [PMID: 36247485 PMCID: PMC9556995 DOI: 10.3389/fcvm.2022.972455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 09/06/2022] [Indexed: 12/03/2022] Open
Abstract
Background Cardio-oncology is a rapidly growing field that requires a novel service design to deal with the increasing number of patients. It is reported that the volume of patients at the cardio-oncology clinic in the United Kingdom is 535 patients/5 years and in Canada is 779 patients/7 years. The pharmacist has a role in reducing the consultation time of physicians. Objective To identify the role of a qualified cardiology pharmacist at the cardio-oncology clinic using a new paradigm based on complementary interventions with the cardiologist for the management of patients with cancer and cardiovascular risk factors and/or cardiovascular diseases (CVRF/CVD). Methods A prospective observational study was conducted at the cardio-oncology clinic in the Medical City in Baghdad, Iraq between December 2020 and December 2021. Patients with CVRF/CVD were registered. The Iraqi Cardio-Oncology Program-Pharmacist (ICOP-Pharm) paradigm was designed to involve a qualified cardiology pharmacist for initial cardiovascular (CV) drug interventions. Results Among 333 patients who attended our clinic over the 1-year interval, 200 (60%) CVRF/CVD cases were enrolled in the study, and of them 79 (40%) patients had CV drug interventions. A total of 196 interventions were done, including 147 (75%) cases performed by the cardiology pharmacist, and 92 (63%) of the latter were CV drug initiations. Among the total CVRF/CVD treated initially by the cardiology pharmacist, hypertension 32 (26%) and cancer therapy-related cardiac dysfunction 29 (24%) were the main types. Conclusion The qualified cardiology pharmacist was responsible for three-quarters of the initial CV drug interventions at the cardio-oncology clinic in a complementary approach to the cardiologist. The role of the cardiology pharmacist in the ICOP-Pharm paradigm may be one of the reasons for the ability of the heart team to manage 3-fold of the patient volume when compared with those in the United Kingdom or Canada.
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Affiliation(s)
- Israa Fadhil Yaseen
- Baghdad Heart Center, Medical City, Baghdad, Iraq
- Scientific Council of Cardiology, Iraqi Board for Medical Specializations, Baghdad, Iraq
| | - Hasan Ali Farhan
- Baghdad Heart Center, Medical City, Baghdad, Iraq
- Scientific Council of Cardiology, Iraqi Board for Medical Specializations, Baghdad, Iraq
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Perrot S, Eschalier A, Desmeules J, Lanteri-Minet M, Attal N. Practice guidelines for the treatment of acute migraine and chronic knee osteoarthritis with paracetamol: an expert appraisal on evolution over time between scientific societies. Curr Med Res Opin 2022; 38:1579-1585. [PMID: 35549792 DOI: 10.1080/03007995.2022.2076475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Paracetamol is the commonest analgesic worldwide in primary care. Despite evidence-based recommendations for management of acute and chronic pain with paracetamol, practices seem to vary considerably in its modalities of use, with or without restrictions, between renowned scientific societies and over time. OBJECTIVE Qualitative assessment of similarities, differences, and changes over time in guidelines for paracetamol use in acute and chronic pain. METHODS We focused on two common pain conditions for which paracetamol is widely used: acute migraine and chronic knee osteoarthritis (OA). In 19 guidelines (10 for acute migraine, 9 for chronic knee OA) from 10 scientific societies (AAN/AHS, ACR/AF, CHS, EFNS, EHF/LTB, ESCEO, EULAR, SFEMC, SRF, OARSI) published between 1997 and 2021, methods, results and conclusions were compared, between guidelines and over time. RESULTS In acute migraine, there was a shift from no recommendation for paracetamol or recommendation only for mild attacks to recommendation for mild to moderate attacks in updated guidelines, without restriction for use for four of the five scientific societies. In knee OA, although updated guidelines generally used the GRADE system, recommendations remained heterogeneous between scientific societies: recommendation without or with restrictions, or not recommended. Consensus is lacking regarding long-course safety and efficacy in acute pain and pain at mobilization. CONCLUSIONS Most migraine guidelines now recommend paracetamol for mild to moderate pain. Knee OA guidelines vary on the use of paracetamol: a more holistic approach is needed for this condition, considering patient profile, disease stage, and pain management during physical activity to clarify its appropriate use.
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Affiliation(s)
- Serge Perrot
- Centre d'Evaluation et Traitement de la Douleur, INSERM U987, Hôpital Cochin, Université de Paris, Paris, France
| | - Alain Eschalier
- INSERM U1107, NEURO-DOL, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Jules Desmeules
- Service de pharmacologie et toxicologie cliniques, Centre multidisciplinaire de la douleur, Département d'anesthésiologie de pharmacologie de médecine intensive et de médecine d'urgence, Hôpitaux Universitaires de Genève, Genève, Suisse
| | - Michel Lanteri-Minet
- Département d'Evaluation et Traitement de la Douleur et FHU InovPain, CHU Nice - Université Côte d'Azur, Nice, France
- INSERM U1107 Douleur Trigéminale et Migraine, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Nadine Attal
- CETD et INSERM U987, Hôpital Ambroise Paré, APHP, Boulogne Billancourt, France
- Université de Versailles Saint Quentin en Yvelines (UVSQ, Paris Saclay, Versailles Cedex, France)
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Bukhari S, Leth MF, Laursen CCW, Larsen M, Tornøe AS, Jakobsen JC, Maagaard M, Mathiesen O. Risks of serious adverse events associated with non-steroidal anti-inflammatory drugs in gastrointestinal surgery. A protocol for a systematic review with meta-analysis and trial sequential analysis. Acta Anaesthesiol Scand 2022; 66:1266-1273. [PMID: 35989476 DOI: 10.1111/aas.14143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Postoperative pain is frequent following gastrointestinal surgery and may result in prolonged hospitalisation, delayed recovery, and lower quality of life. Non-steroidal anti-inflammatory drugs (NSAIDs) are effective analgesics and recommended by Enhanced Recovery After Surgery guidelines as part of opioid-sparing multimodal treatment. However, perioperative NSAID treatment may be associated with increased risk of harm. We will investigate the risks of serious adverse events associated with perioperative NSAID treatment in patients undergoing gastrointestinal surgery. METHODS This protocol uses the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. We wish to assess the effects of NSAIDs versus placebo, usual care, or no intervention on the incidence of serious adverse in patients undergoing gastrointestinal surgery. We will include all randomised trials. To identify trials, we will search the Medical Literature Analysis and Retrieval System Online (Medline), Excerpta Medica database (Embase), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science Core Collection, and BIOSIS. Two authors will screen the literature and extract data. We will use the "Risk of Bias 2 tool" to assess the risks of systematic errors. We will perform meta-analyses using R. We will use Trial Sequential Analysis to account for the risks of random errors. We will create a "Summary of Findings"-table in which we will present our primary and secondary outcome results. We will assess the certainty of the evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE). DISCUSSION This systematic review can potentially elucidate the risks of perioperative NSAID treatment in gastrointestinal surgery and inform the already established non-opioid multimodal pain treatment regimen recommended by Enhanced Recovery After Surgery guidelines.
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Affiliation(s)
- Shaheer Bukhari
- Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital Køge, Denmark
| | - Morten Fiil Leth
- Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital Køge, Denmark
| | | | - Mia Larsen
- Department of Anaesthesiology, Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark
| | | | - Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Denmark
| | - Mathias Maagaard
- Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital Køge, Denmark
| | - Ole Mathiesen
- Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital Køge, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
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Silverman SL, Schepman P, Rice JB, Beck CG, Johnson M, White A, Robinson RL, Emir B. Drug utilization, clinical and economic outcomes of patients with osteoarthritis of the hip and/or knee treated with long-term use of traditional NSAIDs, topical NSAIDs, and COX-2 inhibitors. Curr Med Res Opin 2022; 38:1153-1166. [PMID: 35575236 DOI: 10.1080/03007995.2022.2078098] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To describe and compare baseline characteristics, healthcare and drug utilization, and negative clinical outcomes of commercially-insured patients diagnosed with OA of the hip and/or knee who initiated treatment on traditional oral NSAIDs (tNSAIDs), topical NSAIDs, or cyclooxygenase-2 inhibitors (COX-2s). METHODS A commercial claims database (1/2012-3/2017) was used to identify patients ≥18 years old, with ≥2 diagnoses of hip and/or knee OA, and ≥90 days supply of NSAIDs. Patients were assigned to cohorts based on the type of NSAID initially prescribed and observed in the 6 months before (baseline) and 36 months after (follow-up) the date of their first NSAID prescription after the first OA diagnosis. Analyses estimated baseline demographic and clinical characteristics and follow-up period drug utilization. Logistic regressions assessed the risk of gastrointestinal (GI) and acute renal failure (ARF) events. RESULTS tNSAIDs were the most frequently prescribed treatment. During the follow-up period, less than 15% of patients prescribed tNSAIDs switched to either COX-2s or topical NSAIDs and 37% of patients prescribed a COX-2 and 56% of patients prescribed a topical NSAID switched to tNSAIDs. GI and ARF events during the follow-up period ranged from 7.3-8.1% and 8.0-11.0%, respectively, across cohorts. The tNSAIDs and COX-2s cohorts had increased risk of both types of events relative to patients prescribed topical NSAIDs, controlling for other characteristics. CONCLUSIONS Analyses characterize the long-term real-world utilization of NSAIDs and associated outcomes for patients with OA of the hip and/or knee. Study results highlight the likelihood of switching and the risk of negative clinical outcomes associated with long-term use.
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Affiliation(s)
- Stewart L Silverman
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
- David Geffen School of Medicine of University of California Los Angeles, Los Angeles, CA, USA
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Varela-Chinchilla CD, Sánchez-Mejía DE, Trinidad-Calderón PA. Congenital Heart Disease: The State-of-the-Art on Its Pharmacological Therapeutics. J Cardiovasc Dev Dis 2022; 9:201. [PMID: 35877563 PMCID: PMC9316572 DOI: 10.3390/jcdd9070201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 11/17/2022] Open
Abstract
Congenital heart disease is one of the most common causes of death derived from malformations. Historically, its treatment has depended on timely diagnosis and early pharmacological and surgical interventions. Survival rates for patients with this disease have increased, primarily due to advancements in therapeutic choices, but mortality remains high. Since this disease is a time-sensitive pathology, pharmacological interventions are needed to improve clinical outcomes. Therefore, we analyzed the applications, dosage, and side effects of drugs currently used for treating congenital heart disease. Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and potassium-sparing diuretics have shown a mortality benefit in most patients. Other therapies, such as endothelin receptor antagonists, phosphodiesterase-5 inhibitors, prostaglandins, and soluble guanylyl cyclase stimulators, have benefited patients with pulmonary artery hypertension. Likewise, the adjunctive symptomatic treatment of these patients has further improved the outcomes, since antiarrhythmics, digoxin, and non-steroidal anti-inflammatory drugs have shown their benefits in these cases. Conclusively, these drugs also carry the risk of troublesome adverse effects, such as electrolyte imbalances and hemodynamic compromise. However, their benefits for survival, symptom improvement, and stabilization outweigh the possible complications from their use. Thus, cases must be assessed individually to accurately identify interventions that would be most beneficial for patients.
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Affiliation(s)
- Carlos Daniel Varela-Chinchilla
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Ave. Ignacio Morones Prieto 3000 Pte., Col. Los Doctores, Monterrey 64710, N.L., Mexico; (C.D.V.-C.); (D.E.S.-M.)
| | - Daniela Edith Sánchez-Mejía
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Ave. Ignacio Morones Prieto 3000 Pte., Col. Los Doctores, Monterrey 64710, N.L., Mexico; (C.D.V.-C.); (D.E.S.-M.)
| | - Plinio A. Trinidad-Calderón
- Tecnológico de Monterrey, Escuela de Ingeniería y Ciencias, Ave. Eugenio Garza Sada 2501, Monterrey 64849, N.L., Mexico
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Hiram R. Resolution-promoting autacoids demonstrate promising cardioprotective effects against heart diseases. Mol Biol Rep 2022; 49:5179-5197. [PMID: 35142983 PMCID: PMC9262808 DOI: 10.1007/s11033-022-07230-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/03/2022] [Indexed: 12/12/2022]
Abstract
Chronic heart diseases have in common an unresolved inflammatory status. In atherosclerosis, myocarditis, myocardial infarction, or atrial fibrillation, mounting evidence suggests that unresolved inflammation contributes to the chronicity, aggravation, and morbidity of the disease. Following cardiac injury or infection, acute inflammation is a normal and required process to repair damaged tissues or eliminate pathogens and promote restoration of normal functions and structures. However, if acute inflammation is not followed by resolution, a chronic and deleterious inflammatory status may occur, characterized by the persistence of inflammatory biomarkers, promoting aggravation of myocardial pathogenesis, abnormal structural remodeling, development of cardiac fibrosis, and loss of function. Although traditional antiinflammatory strategies, including the use of COX-inhibitors, to inhibit the production of inflammation promotors failed to promote homeostasis, mounting evidence suggests that activation of specific endogenous autacoids may promote resolution and perpetuate cardioprotective effects. The recent discovery of the active mechanism of resolution suggests that proresolving signals and cellular processes may help to terminate inflammation and combat the development of its chronic profile in cardiac diseases. This review discussed (I) the preclinical and clinical evidence of inflammation-resolution in cardiac disorders including atrial fibrillation; (II) how and why many traditional antiinflammatory treatments failed to prevent or cure cardiac inflammation and fibrosis; and (III) whether new therapeutic strategies may interact with the resolution machinery to have cardioprotective effects. RvD D-series resolving, RvE E-series resolving, LXA4 lipoxin A4, MaR1 maresin-1.
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Affiliation(s)
- Roddy Hiram
- Department of Medicine, Faculty of Medicine, Montreal Heart Institute (MHI), Université de Montréal, Research Center, 5000 Belanger, St. Montreal, QC, H1T 1C8, Canada.
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Cardiovascular risk and mortality in patients with hyperuricemia treated with febuxostat or allopurinol: a retrospective nation-wide cohort study in Austria 2014-2017. Rheumatol Int 2022; 42:1597-1603. [PMID: 35589988 PMCID: PMC9349126 DOI: 10.1007/s00296-022-05139-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/27/2022] [Indexed: 11/30/2022]
Abstract
Patients with hyperuricemia and gout are at an increased risk for cardiovascular (CV) disease. Inhibition of the xanthine oxidase with allopurinol or febuxostat have become the mainstay for urate lowering therapy. However, it has been suggested that febuxostat increases the risk for CV mortality as compared to allopurinol. The aim of this retrospective cohort study was to assess the CV risk among patients with febuxostat or allopurinol therapy. Patients who initiated urate lowering therapy with febuxostat or allopurinol between 2014 and 2017 were selected from the drug reimbursement database of the Austrian health insurances funds. The primary CV endpoint was a composite of angina pectoris, nonfatal myocardial infarction, nonfatal subarachnoid or cerebral hemorrhage, nonfatal ischemic stroke, or death from any cause. In total, 28.068 patients (62.1% male) with a mean age of 71 years were included. 7.767 initiated febuxostat treatment and 20.301 received allopurinol. The incidence rate per 100 patient-years of the composite primary endpoint was 448 (febuxostat) and 356 (allopurinol) with a corresponding adjusted hazard ratio (HR) of 0.58 (95% CI 0.53–0.63) for allopurinol vs. febuxostat initiators. Similar HR were found for secondary endpoints including all-cause mortality [0.61 (95% CI 0.55–0.68)] and separate analyses of cardiac events [0.48 (95% CI 0.38–0.61)] and ischemic stroke [0.47 (95% CI 0.36–0.61)]. Data from this Austrian population-based study suggests that febuxostat initiators are at an increased risk for nonfatal CV events or death from any cause as compared to those with allopurinol. This is consistent with CV concerns of other trials, which limited the broad therapeutic use of febuxostat.
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36
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Li L, Marozoff S, Lu N, Xie H, Kopec JA, Cibere J, Esdaile JM, Aviña-Zubieta JA. Association of tramadol with all-cause mortality, cardiovascular diseases, venous thromboembolism, and hip fractures among patients with osteoarthritis: a population-based study. Arthritis Res Ther 2022; 24:85. [PMID: 35410440 PMCID: PMC8996663 DOI: 10.1186/s13075-022-02764-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background The use of tramadol among osteoarthritis (OA) patients has been increasing rapidly around the world, but population-based studies on its safety profile among OA patients are scarce. We sought to determine if tramadol use in OA patients is associated with increased risks of all-cause mortality, cardiovascular diseases (CVD), venous thromboembolism (VTE), and hip fractures compared with commonly prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) or codeine. Methods Using administrative health datasets from British Columbia, Canada, we conducted a sequential propensity score-matched cohort study among all OA patients between 2005 and 2013. The tramadol cohort (i.e., tramadol initiation) was matched with four comparator cohorts (i.e., initiation of naproxen, diclofenac, cyclooxygenase-2 [Cox-2] inhibitors, or codeine). Outcomes are all-cause mortality, first-ever CVD, VTE, and hip fractures within the year after the treatment initiation. Patients were followed until they either experienced an event, left the province, or the 1-year follow-up period ended, whichever occurred first. Cox proportional hazard models were used to estimate hazard ratios after adjusting for competing risk of death. Results Overall, 100,358 OA patients were included (mean age: 68 years, 63% females). All-cause mortality was higher for tramadol compared to NSAIDs with rate differences (RDs/1000 person-years, 95% CI) ranging from 3.3 (0.0–6.7) to 8.1 (4.9–11.4) and hazard ratios (HRs, 95% CI) ranging from 1.2 (1.0–1.4) to 1.5 (1.3–1.8). For CVD, no differences were observed between tramadol and NSAIDs. Tramadol had a higher risk of VTE compared to diclofenac, with RD/1000 person-years (95% CI) of 2.2 (0.7–3.7) and HR (95% CI) of 1.7 (1.3–2.2). Tramadol also had a higher risk of hip fractures compared to diclofenac and Cox-2 inhibitors with RDs/1000 person-years (95% CI) of 1.9 (0.4–3.4) and 1.7 (0.2–3.3), respectively, and HRs (95% CI) of 1.6 (1.2–2.0) and 1.4 (1.1–1.9), respectively. No differences were observed between tramadol and NSAIDs for all events. Conclusions OA patients initiating tramadol have an increased risk of mortality, VTE, and hip fractures within 1 year compared with commonly prescribed NSAIDs, but not with codeine. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02764-3.
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Affiliation(s)
- Lingyi Li
- Arthritis Research Canada, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada.,Experimental Medicine Program, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Shelby Marozoff
- Arthritis Research Canada, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada
| | - Na Lu
- Arthritis Research Canada, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada
| | - Hui Xie
- Arthritis Research Canada, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Jacek A Kopec
- Arthritis Research Canada, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Jolanda Cibere
- Arthritis Research Canada, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada.,Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - John M Esdaile
- Arthritis Research Canada, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada.,Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - J Antonio Aviña-Zubieta
- Arthritis Research Canada, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada. .,Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada.
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Mei Y, Williams JS, Webb EK, Shea AK, MacDonald MJ, Al-Khazraji BK. Roles of Hormone Replacement Therapy and Menopause on Osteoarthritis and Cardiovascular Disease Outcomes: A Narrative Review. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:825147. [PMID: 36189062 PMCID: PMC9397736 DOI: 10.3389/fresc.2022.825147] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/07/2022] [Indexed: 11/28/2022]
Abstract
Osteoarthritis (OA) is a highly prevalent condition characterized by degradation of the joints. OA and cardiovascular disease (CVD) are leading contributors to disease burden worldwide, with a high level of overlap between the risk factors and occurrence of both conditions. Chief among the risk factors that contribute to OA and CVD are sex and age, which are both independent and interacting traits. Specifically, the prevalence of both conditions is higher in older women, which may be mediated by the occurrence of menopause. Menopause represents a significant transition in a women's life, and the rapid decline in circulating sex hormones, estrogen and progesterone, leads to complex physiological changes. Declines in hormone levels may partially explain the increase in prevalence of OA and CVD in post-menopausal women. In theory, the use of hormone therapy (HT) may buffer adverse effects of menopause; however, it is unclear whether HT offers protective effects for the onset or progression of these diseases. Studies have shown mixed results when describing the influence of HT on disease risk among post-menopausal women, which warrants further exploration. The roles that increasing age, female sex, HT, and CVD play in OA risk demonstrate that OA is a multifaceted condition. This review provides a timely consolidation of current literature and suggests aims for future research directions to bridge gaps in the understanding of how OA, CVD, and HT interact in post-menopausal women.
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Affiliation(s)
- Yixue Mei
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Jennifer S. Williams
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Erin K. Webb
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Alison K. Shea
- Department of Obstetrics and Gynaecology, Faculty of Medicine, McMaster University, Hamilton, ON, Canada
| | - Maureen J. MacDonald
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Baraa K. Al-Khazraji
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, Canada
- *Correspondence: Baraa K. Al-KhazrajiS
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Antiflammatory activity and potential dermatological applications of characterized humic acids from a lignite and a green compost. Sci Rep 2022; 12:2152. [PMID: 35140310 PMCID: PMC8828863 DOI: 10.1038/s41598-022-06251-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 01/24/2022] [Indexed: 11/09/2022] Open
Abstract
Long-term exposure to air pollution has been associated with the development of some inflammatory processes related to skin. The goal of modern medicine is the development of new products with antiflammatory action deriving from natural sources to improve environmental and economic sustainability. In this study, two different humic acids (HA) were isolated from from lignite (HA-LIG) and composted artichoke wastes (HA-CYN) and characterized by infrared spectrometry, NMR spectroscopy, thermochemolysis-GC/MS, and high-performance size-exclusion chromatography (HPSEC), while their antiflammatory activity was evaluated on HaCaT cells. Spectroscopic results showing the predominance of apolar aliphatic and aromatic components in HA-LIG, whereas HA-CYN revealed a presence of polysaccharides and polyphenolic lignin residues. The HA application on human keratinocyte pre-treated with Urban Dust revealed a general increase of viability suggesting a protective effect of humic matter due to the content of aromatic, phenolic and lignin components. Conversely, the gene expression of IL-6 and IL-1β cytokines indicated a significant decrease after application of HA-LIG, thus exhibiting a greater antiflammatory power than HA-CYN. The specific combination of HA protective hydrophobic components, viable conformational arrangements, and content of bioactive molecules, suggests an innovative applicability of humic matter in dermatology as skin protectors from environmental irritants and as antiflammatory agents.
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Kaur B, Singh P. Inflammation: Biochemistry, Cellular Targets, Anti-inflammatory Agents and Challenges with Special Emphasis on Cyclooxygenase-2. Bioorg Chem 2022; 121:105663. [DOI: 10.1016/j.bioorg.2022.105663] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/17/2022] [Accepted: 02/05/2022] [Indexed: 12/13/2022]
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Minnema L, Gupta A, Mishra SK, Lascelles BDX. Investigating the Role of Artemin and Its Cognate Receptor, GFRα3, in Osteoarthritis Pain. Front Neurosci 2022; 16:738976. [PMID: 35153665 PMCID: PMC8829392 DOI: 10.3389/fnins.2022.738976] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 01/05/2022] [Indexed: 11/13/2022] Open
Abstract
Osteoarthritis (OA) associated pain (OA-pain) is a significant global problem. OA-pain limits limb use and mobility and is associated with widespread sensitivity. Therapeutic options are limited, and the available options are often associated with adverse effects. The lack of therapeutic options is partly due to a lack of understanding of clinically relevant underlying neural mechanisms of OA-pain. In previous work in naturally occurring OA-pain in dogs, we identified potential signaling molecules (artemin/GFRα3) that were upregulated. Here, we use multiple approaches, including cellular, mouse genetic, immunological suppression in a mouse model of OA, and clinically relevant measures of sensitivity and limb use to explore the functional role of artemin/GFRα3 signaling in OA-pain. We found the monoiodoacetate (MIA)-induced OA-pain in mice is associated with decreased limb use and hypersensitivity. Exogenous artemin induces mechanical, heat, and cold hypersensitivity, and systemic intraperitoneal anti-artemin monoclonal antibody administration reverses this hypersensitivity and restores limb use in mice with MIA-induced OA-pain. An artemin receptor GFRα3 expression is increased in sensory neurons in the MIA model. Our results provide a molecular basis of arthritis pain linked with artemin/GFRα3 signaling and indicate that further work is warranted to investigate the neuronal plasticity and the pathways that drive pain in OA.
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Affiliation(s)
- Laura Minnema
- Translational Research in Pain Program, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
| | - Ankita Gupta
- Translational Research in Pain Program, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
| | - Santosh K. Mishra
- Department of Molecular and Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
- Comparative Pain Research and Education Center, North Carolina State University, Raleigh, NC, United States
- *Correspondence: Santosh K. Mishra,
| | - B. Duncan X. Lascelles
- Translational Research in Pain Program, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
- Comparative Pain Research and Education Center, North Carolina State University, Raleigh, NC, United States
- Thurston Arthritis Center, UNC School of Medicine, Chapel Hill, NC, United States
- B. Duncan X. Lascelles,
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41
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Ain QU, Sarfraz M, Prasesti GK, Dewi TI, Kurniati NF. Confounders in Identification and Analysis of Inflammatory Biomarkers in Cardiovascular Diseases. Biomolecules 2021; 11:biom11101464. [PMID: 34680097 PMCID: PMC8533132 DOI: 10.3390/biom11101464] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 02/08/2023] Open
Abstract
Proinflammatory biomarkers have been increasingly used in epidemiologic and intervention studies over the past decades to evaluate and identify an association of systemic inflammation with cardiovascular diseases. Although there is a strong correlation between the elevated level of inflammatory biomarkers and the pathology of various cardiovascular diseases, the mechanisms of the underlying cause are unclear. Identification of pro-inflammatory biomarkers such as cytokines, chemokines, acute phase proteins, and other soluble immune factors can help in the early diagnosis of disease. The presence of certain confounding factors such as variations in age, sex, socio-economic status, body mass index, medication and other substance use, and medical illness, as well as inconsistencies in methodological practices such as sample collection, assaying, and data cleaning and transformation, may contribute to variations in results. The purpose of the review is to identify and summarize the effect of demographic factors, epidemiological factors, medication use, and analytical and pre-analytical factors with a panel of inflammatory biomarkers CRP, IL-1b, IL-6, TNFa, and the soluble TNF receptors on the concentration of these inflammatory biomarkers in serum.
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Affiliation(s)
- Qurrat Ul Ain
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Bandung Institute of Technology, Bandung 40132, Indonesia; (Q.U.A.); (G.K.P.)
| | - Mehak Sarfraz
- Department of Pharmacy, Comsats University Islamabad Abbottabad Campus, Abbottabad 22060, Pakistan;
| | - Gayuk Kalih Prasesti
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Bandung Institute of Technology, Bandung 40132, Indonesia; (Q.U.A.); (G.K.P.)
| | - Triwedya Indra Dewi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung 40124, Indonesia;
| | - Neng Fisheri Kurniati
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Bandung Institute of Technology, Bandung 40132, Indonesia; (Q.U.A.); (G.K.P.)
- Correspondence: ; +62-853-1582-6154
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42
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Genetic variations and epigenetic modulations in CYP genes: Implications in NSAID-treatment of arthritis patients. THE NUCLEUS 2021. [DOI: 10.1007/s13237-021-00373-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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43
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Ruane JJ, Ross A, Zigmont V, McClure D, Gascon G. A Single-Blinded Randomized Controlled Trial of Mesenchymal Stem Cell Therapy for the Treatment of Osteoarthritis of the Knee with Active Control. J Stem Cells Regen Med 2021; 17:3-17. [PMID: 34434003 DOI: 10.46582/jsrm.1701002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 04/20/2020] [Indexed: 01/13/2023]
Abstract
Background: Osteoarthritis is most prevalent in the knee and drives the growing incidence of total knee arthroplasty. There is a need to explore non-surgical treatment options to increase the portfolio of alternatives available. The study aimed to determine the clinical response to an autologous bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) intra-articular injection compared to an active comparator. Methods: The study was a prospective, single-blinded, randomized controlled pilot study. Participants with diagnosed knee osteoarthritis were allocated to one of two treatment groups to receive a BMAC injection immediately followed by a PRP injection or a single injection of Gel-One® crosslinked hyaluronate (HA). Outcomes were assessed at 3, 6, and 12 months post-treatment. Results: Significant improvements were observed in both treatment groups for all Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales with the exception of the symptoms assessment at 12 months in the HA group. BMAC KOOS scores peaked at 12 months, while HA KOOS scores generally peaked at 6 months. The gap in mean scores at 12 months in favor of the BMAC group did not reach statistical significance. Secondary outcomes included a greater reduction in pain at 12 months in the BMAC group (-3.13 points; 95% CI: -3.96, -3.29) compared to the HA group (-1.56 points; 95% CI: -2.59, -0.53; p= 0.02) via the numeric pain rating scale. Conclusions: Results demonstrate that both treatment groups experienced clinically and statistically significant improvement across the KOOS subscales. While BMAC has shown promise in the treatment of knee OA, there is a need for multi-center investigations with larger sample sizes, an extended follow-up, and placebo-based control. ClinicalTrials.gov Identifier: NCT02958267.
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Affiliation(s)
- Joseph J Ruane
- OhioHealth McConnell Spine Sport and Joint Physicians, OhioHealth Physician Group, Columbus, Ohio - USA
| | - Andrew Ross
- OhioHealth Population Health Services, OhioHealth Corporation, Columbus, Ohio - USA
| | - Victoria Zigmont
- OhioHealth Population Health Services, OhioHealth Corporation, Columbus, Ohio - USA
| | - Deanna McClure
- OhioHealth McConnell Spine Sport and Joint Physicians, OhioHealth Physician Group, Columbus, Ohio - USA
| | - Gregg Gascon
- OhioHealth Population Health Services, OhioHealth Corporation, Columbus, Ohio - USA
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44
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Abstract
Pain management in both outpatient and inpatient settings demands a multidisciplinary approach entailing medical, physical and psychological therapies. Among these, multimodal analgesic regimens stand out as a promising treatment options. Cyclo-oxygenase (COX) inhibitor/opioid receptor agonist combinations hold great potential as effective pillars in the multimodal pain management by providing adequate analgesia with fewer safety risks due to COX inhibitors’ opioid-sparing effect. Thus, these combinations, either freely or in fixed-dose formulation, offer a feasible option for the prescribing clinicians who seek to maximise therapeutic effect while simultaneously minimise adverse effects. The selection of the appropriate non-steroidal anti-inflammatory drug (NSAID) and opioid agent at optimal doses is essential. It should be tailored to the patients’ analgesic necessities, and his/her gastrointestinal and cardiovascular risk, and potential concurrent aspirin use. Moreover, it should allow for addiction risk and the potential opioid-induced bowel dysfunction and constipation. To ensure an optimal match between the characteristics of the patient and the properties of the chosen medication, and to guide adequate and well-tolerated treatment decisions, it is of paramount importance to expand clinicians’ knowledge of the currently available COX inhibitor/opioid receptor agonist combinations. This invited narrative review deals with the literature evidence covering the components of multimodal opioid-sparing analgesic regimens. Also, it provides insights into the clinically relevant choice criteria to ensure a patient-tailored analgesia.
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45
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Accelerated DNA methylation age and medication use among African Americans. Aging (Albany NY) 2021; 13:14604-14629. [PMID: 34083497 PMCID: PMC8221348 DOI: 10.18632/aging.203115] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 05/14/2021] [Indexed: 12/16/2022]
Abstract
DNA methylation age acceleration, the discrepancy between epigenetic age and chronological age, is associated with mortality and chronic diseases, including diabetes, hypertension, and hyperlipidemia. In this study, we investigate whether medications commonly used to treat these diseases in 15 drug categories are associated with four epigenetic age acceleration measures: HorvathAge acceleration (HorvathAA), HannumAge acceleration (HannumAA), PhenoAge acceleration, and GrimAge acceleration (GrimAA) using cross-sectional (Phase 1, N=1,100) and longitudinal (Phases 1 and 2, N=266) data from African Americans in the Genetic Epidemiology Network of Arteriopathy (GENOA) study. In cross-sectional analyses, the use of calcium channel blockers was associated with 1.27 years lower HannumAA after adjusting for covariates including hypertension (p=0.001). Longitudinal analyses showed that, compared to those who never used antihypertensives, those who started to take antihypertensives after Phase 1 had a 0.97-year decrease in GrimAA (p=0.007). In addition, compared to those who never used NSAID analgesics, those who started to take them after Phase 1 had a 2.61-year increase in HorvathAA (p=0.0005). Our study demonstrates that three commonly used medications are associated with DNAm age acceleration in African Americans and sheds light on the potential epigenetic effects of pharmaceuticals on aging at the cellular level.
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Kamil M, Fatima A, Ullah S, Ali G, Khan R, Ismail N, Qayum M, Irimie M, Dinu CG, Ahmedah HT, Cocuz ME. Toxicological Evaluation of Novel Cyclohexenone Derivative in an Animal Model through Histopathological and Biochemical Techniques. TOXICS 2021; 9:119. [PMID: 34070633 PMCID: PMC8227666 DOI: 10.3390/toxics9060119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/04/2021] [Accepted: 05/19/2021] [Indexed: 12/13/2022]
Abstract
Toxicity studies were conducted to provide safety data of potential drug candidates by determining lethal and toxic doses. This study was designed for pre-clinical evaluation of novel cyclohexenone derivative with respect to the acute and sub-acute toxicity along with the diabetogenic potential. Acute and sub-acute toxicity were assessed after intraperitoneal (i.p) injection of the investigational compound through selected doses for 21 days. This was followed by assessment of isolated body organs (liver, kidney, heart and pancreas) via biochemical indicators and histopathological techniques. No signs of toxicity were revealed in the study of acute toxicity. Similarly, a sub-acute toxicity study showed no significant difference in biochemical indicators on 11th and 21st days between treated and control groups. However, in blood urea nitrogen (BUN) and random blood glucose/sugar (RBS) values, significant differences were recorded. Histopathological evaluation of liver, kidney, pancreas and heart tissues revealed mild to severe changes in the form of steatosis, inflammation, fibrosis, necrosis and myofibrillary damages on 11th and 21st days of treatment. In conclusion, the median lethal dose of the tested compound was expected to be greater than 500 mg/kg. No significant change occurred in selected biomarkers, except BUN and RBS levels, but a histopathological study showed moderate toxic effect on liver, kidney, pancreas and heart tissues by the cyclohexenone derivative.
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Affiliation(s)
- Muhammad Kamil
- Department of Pharmacy, University of Peshawar, Peshawar 25120, Pakistan; (M.K.); (A.F.); (G.A.)
| | - Arifa Fatima
- Department of Pharmacy, University of Peshawar, Peshawar 25120, Pakistan; (M.K.); (A.F.); (G.A.)
| | - Sami Ullah
- Department of Pharmacy, University of Peshawar, Peshawar 25120, Pakistan; (M.K.); (A.F.); (G.A.)
| | - Gowhar Ali
- Department of Pharmacy, University of Peshawar, Peshawar 25120, Pakistan; (M.K.); (A.F.); (G.A.)
| | - Rasool Khan
- Department of Organic Chemistry, Institute of Chemical Sciences, University of Peshawar, Peshawar 25120, Pakistan;
| | - Naila Ismail
- Department of Pathology, Kabir Medical College, Gandhara University, Peshawar 25000, Pakistan;
| | - Mughal Qayum
- Department of Pharmacy, Kohat University of Science and Technology, Kohat 26000, Pakistan;
| | - Marius Irimie
- Faculty of Medicine, Transilvania University of Brasov, 500019 Brasov, Romania;
| | | | - Hanadi Talal Ahmedah
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Rabigh 25732, Saudi Arabia
| | - Maria Elena Cocuz
- Faculty of Medicine, Transilvania University of Brasov, 500019 Brasov, Romania;
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Danielak A, Wallace JL, Brzozowski T, Magierowski M. Gaseous Mediators as a Key Molecular Targets for the Development of Gastrointestinal-Safe Anti-Inflammatory Pharmacology. Front Pharmacol 2021; 12:657457. [PMID: 33995080 PMCID: PMC8116801 DOI: 10.3389/fphar.2021.657457] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/23/2021] [Indexed: 12/14/2022] Open
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) represent one of the most widely used classes of drugs and play a pivotal role in the therapy of numerous inflammatory diseases. However, the adverse effects of these drugs, especially when applied chronically, frequently affect gastrointestinal (GI) tract, resulting in ulceration and bleeding, which constitutes a significant limitation in clinical practice. On the other hand, it has been recently discovered that gaseous mediators nitric oxide (NO), hydrogen sulfide (H2S) and carbon monoxide (CO) contribute to many physiological processes in the GI tract, including the maintenance of GI mucosal barrier integrity. Therefore, based on the possible therapeutic properties of NO, H2S and CO, a novel NSAIDs with ability to release one or more of those gaseous messengers have been synthesized. Until now, both preclinical and clinical studies have shown promising effects with respect to the anti-inflammatory potency as well as GI-safety of these novel NSAIDs. This review provides an overview of the gaseous mediators-based NSAIDs along with their mechanisms of action, with special emphasis on possible implications for GI mucosal defense mechanisms.
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Affiliation(s)
- Aleksandra Danielak
- Department of Physiology, Jagiellonian University Medical College, Cracow, Poland
| | - John L Wallace
- Department of Physiology and Pharmacology, University of Calgary, Calgary, AB, Canada
| | - Tomasz Brzozowski
- Department of Physiology, Jagiellonian University Medical College, Cracow, Poland
| | - Marcin Magierowski
- Department of Physiology, Jagiellonian University Medical College, Cracow, Poland
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48
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Ozgok A, Demir AZ. Opioid-free anesthesia works like a charm in cardiac surgery. Anesth Pain Med (Seoul) 2021; 16:213-214. [PMID: 33940770 PMCID: PMC8107243 DOI: 10.17085/apm.21017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/15/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Aysegul Ozgok
- Department of Anaesthesiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Aslı Z Demir
- Department of Anaesthesiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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49
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Tiwari S, Yang J, Morisseau C, Durbin-Johnson B, Hammock BD, Gomes AV. Ibuprofen alters epoxide hydrolase activity and epoxy-oxylipin metabolites associated with different metabolic pathways in murine livers. Sci Rep 2021; 11:7042. [PMID: 33782432 PMCID: PMC8007717 DOI: 10.1038/s41598-021-86284-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 03/11/2021] [Indexed: 11/09/2022] Open
Abstract
Over the last decade oxylipins have become more recognized for their involvement in several diseases. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are known to inhibit cyclooxygenase (COX) enzymes, but how NSAIDs affect oxylipins, in addition to COX products, in animal tissues is not well understood. Oxylipins in livers from male and female mice treated with 100 mg/kg/day of ibuprofen for 7 days were investigated. The results showed that ibuprofen treated male livers contained 7 times more altered oxylipins than ibuprofen treated female livers. In male and female livers some prostaglandins were altered, while diols, hydroxy fatty acids and epoxides were significantly altered in male livers. Some soluble epoxide hydrolase (sEH) products, such as 9,10-DiHODE were found to be decreased, while sEH substrates (such as 9(10)-EpODE and 5(6)-EpETrE) were found to be increased in male livers treated with ibuprofen, but not in ibuprofen treated female livers. The enzymatic activities of sEH and microsomal epoxide hydrolase (mEH) were elevated by ibuprofen in both males and females. Analyzing the influence of sex on the effect of ibuprofen on oxylipins and COX products showed that approximately 27% of oxylipins detected were influenced by sex. The results reveal that ibuprofen disturbs not only the COX pathway, but also the CYP450 and lipoxygenase pathways in male mice, suggesting that ibuprofen is likely to generate sex related differences in biologically active oxylipins. Increased sEH activity after ibuprofen treatment is likely to be one of the mechanisms by which the liver reduces the higher levels of EpODEs and EpETrEs.
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Affiliation(s)
- Shuchita Tiwari
- Department of Neurobiology, Physiology, and Behavior, University of California, Davis, CA, 95616, USA
| | - Jun Yang
- Department of Entomology and Nematology, and Comprehensive Cancer Center, University of California, Davis, CA, 95616, USA
| | - Christophe Morisseau
- Department of Entomology and Nematology, and Comprehensive Cancer Center, University of California, Davis, CA, 95616, USA
| | | | - Bruce D Hammock
- Department of Entomology and Nematology, and Comprehensive Cancer Center, University of California, Davis, CA, 95616, USA
| | - Aldrin V Gomes
- Department of Neurobiology, Physiology, and Behavior, University of California, Davis, CA, 95616, USA. .,Department of Physiology and Membrane Biology, University of California, Davis, CA, USA.
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50
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Hill J, Zawia NH. Fenamates as Potential Therapeutics for Neurodegenerative Disorders. Cells 2021; 10:702. [PMID: 33809987 PMCID: PMC8004804 DOI: 10.3390/cells10030702] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 11/16/2022] Open
Abstract
Neurodegenerative disorders are desperately lacking treatment options. It is imperative that drug repurposing be considered in the fight against neurodegenerative diseases. Fenamates have been studied for efficacy in treating several neurodegenerative diseases. The purpose of this review is to comprehensively present the past and current research on fenamates in the context of neurodegenerative diseases with a special emphasis on tolfenamic acid and Alzheimer's disease. Furthermore, this review discusses the major molecular pathways modulated by fenamates.
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Affiliation(s)
- Jaunetta Hill
- Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston, RI 02881, USA;
| | - Nasser H. Zawia
- Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston, RI 02881, USA;
- Interdisciplinary Neuroscience Program, University of Rhode Island, Kingston, RI 02881, USA
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, RI 02881, USA
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