GUT MICROBIOTA COMPOSITION AND ITS METABOLITES CHANGES IN PATIENTS WITH ATHEROSCLEROSIS AND ATRIAL FIBRILLATION

OBJECTIVE

The aim: To check changes of gut microbiota composition and its metabolites in atherosclerosis (AS) patients with or without atrial fibrillation (AF) and special connections between them and important clinic and laboratory features of investigated groups.

PATIENTS AND METHODS

Materials and methods: 300 patients were investigated. All investigated were divided into 3 groups: control group (CG) - 27 patients without AS and arrhythmias; mean group - 149 patients with AS but without arrhythmias; comparable group - 124 patients with AS and AF paroxysm. By 16-S rRNA sequencing was checked gut microbiota composition. The level of trimethylamine-N-oxide (TMAO), trimethylamine (TMA) plasma was determined by gas chromatography with mass electron detection.

RESULTS

Results: The mean and comparable groups have the significant abundance of total bacterial mass, Bacteroides Spp., Faecalibacterium Prausnitzii, Actinobacter Spp. and decreas¬ing Ruminococcus Spp. In the comparable group to the mean significant increasing of Actinobacter Spp. and decreasing Eubacterium Rectale, Ruminococcus Spp. were checked. Bacteroides Fragilis Group/ Faecalibacterium Prausnitzii ratio was significantly higher than in patients' comparable group. In the mean group patients compared with CG significant abundance of Streptococcus Spp. was checked. In the comparable group compared with CG significant leak of Eubacterium Rectale was checked. The highest amount of correlations was between Lactobacillus Spp., Streptococcus Spp. and clinic-laboratory changes. The mean and comparable groups the significant increasing of TMA ta TMAO plasma levels were checked. In patients of comparable group compared with patients mean group the significant increasing of TMAO plasma level was revealed.

CONCLUSION

Conclusions: We checked special bacterial changes of gut microbiota that are common for patients with AS and AF comparable with AS patients. TMAO plasma levels are increased significantly for patients with AS and AF comparable with AS patients. Connections between AS and AF with TMAO plasma levels are confirmed by reliable correlations between TMAO and age, BMI, GFR, HDL levels. Special bacterial species are closely connected with age, BMI, GFR, HDL, LDL, plasma TMA and TMAO levels.

Platelets amino acids spectrum and coagulation in patients with atherosclerosis

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): O.O.Bogomolets National Medical University

Relevance: Amino acids are one of the important group of myocardial metabolites. Today metabolomic analysis has become an essential tool for understanding the pathophysiology of cardiovascular disorders [1, 3]. Coagulation factors interact with platelets by binding to platelet receptors directly or indirectly or by cleaving of the platelet receptors. Arterial thrombosis as a most life threating atherosclerosis (AS) complication is characterized by significant interplay between platelets and coagulation [2]. Therefore, it is important to find pathogenic links between changes in platelet structure and coagulation data.

Materials and methods

78 patients were investigated. All patients were divided into two groups – 20 patients without AS (control group) and 58 patients with AS (mean group). Diagnosis was verified by carotid and peripheral arteries ultrasound. Statistically all groups were compatible by the main clinical features (age, gender, concominant disorders, etc.). For amino acid platelet determination, platelet-rich plasma was obtained after blood centrifugation at 3000 g 15 min of 10 ml of the remaining plasma. One milliliter of platelet-rich plasma was centrifuged at 2,500 g for 15 min to obtain a platelet pellet that was frozen at –20°C until assayed. All the samples were stored for a maximum of 3 mounth.  Platelets amino acid spectrum was checked by ion exchange liquid column gas chromatography.

Results

Patients of the mean group has significantly differences compared with control group: decreasing of taurine (6.54±9.49 vs 5.94±4.36 mkmol/107), threonine (0.48±1.69 vs 0.22±1.24 mkmol/107), glycine (2.10±3.79 vs 1.02±2.11 mkmol/107) and glutamine (2.54±5.70 vs 1.88±2.76 mkmol/107) levels; increasing alanine (1.99±4.03 vs 2.81±3.06 mkmol/107), valine (0.96±1.98 vs 1.63±1.26 mkmol/107) and isoleucine (0.53±1.84 vs 2.91±1.61 mkmol/107) levels. Also in mean group acquired leucine (2.51±0.93 mkmol/107) that was not present in control group. Total amount of branch-chained amino acids (BCAA) in platelets is also increased significantly. Therefore, in mean group patients were significant higher-level activated partial thromboplastin time (APTT) (34.3±2.87 vs 28.8±3.29 s) and lower fibrinogen (205±17 vs 213±2 mg/dl). Direct significant correlation was checked between glycine (r=0,634; p<0,05), alanine (r=0,587; p<0,05) and fibrinogen, also between APTT and platelets BCAA (r=0,724; p<0,01).

Conclusion

We obtained reliable changes in platelets amino acid spectrum and coagulation tests in patients with atherosclerosis. In addition, significant correlations between themes can be related with pathogenic platelets changes. In any case more deeper studies are desirable.

Treatment with EPs 7630, a Pelargonium Sidoides Root Extract, Is Effective and Safe in Patients with the Common Cold: Results From a Randomized, Double Blind, Placebo-Controlled Clinical Trial

BACKGROUND

EPs 7630 was shown to be effective and safe in the treatment of acute respiratory tract infections such as acute bronchitis, acute rhinosinusitis, and acute tonsillopharyngitis. A clinical trial was conducted to investigate its efficacy and safety in the common cold.

METHODS

In this multicenter, randomized, double-blind phase 3 clinical trial, 105 adults suffering from common cold symptoms were randomized to a thrice-daily administration of either 1 film-coated tablet containing 40 mg EPs 7630 or matched placebo for a treatment period of 10 days. The primary outcome measure was the sum of differences in the cold intensity score (CIS) from day 1 to day 5, defined as the Sum of the Symptom Intensity Differences (SSID), indicating the degree of symptom improvement in the course of 5 days of treatment. Among the secondary outcomes were clinical cure defined as (a) complete resolution of all cold symptoms (CIS = 0 points) or (b) complete resolution of all or all but one cold symptom, treatment outcome, satisfaction with treatment, and safety parameters.

RESULTS

On day 5, the mean (±SD) SSID was significantly higher in the EPs 7630 group compared with the placebo group (12.5 ± 4.4 points versus 8.8 ± 6.8 points). Moreover, 55% of patients in the EPs 7630 group rated the treatment outcome as at least "major improvement" compared with 15% of patients in the placebo group. On day 10, 45% of patients of the EPs 7630 group and 12% of patients of the placebo group had reached 0 points on the CIS (=clinical cure, definition a), whereas all or all but one symptom (clinical cure, definition b) had completely resolved in 74% (EPs 7630) and 25% of patients (placebo), respectively. Satisfaction with treatment was higher in the EPs 7630 than in the placebo group (75% vs 37%) (P values ≤ .0002). During the clinical trial, adverse events occurred in 5 patients (9.4%) in the EPs 7630 and in 7 (13.5%) in the placebo group. All adverse events were of mild intensity, with the exception of 3 events in the placebo group, which were classified as moderate.

CONCLUSIONS

Treatment with EPs 7630 was shown to be superior to placebo in patients with the common cold indicating faster reduction of symptom intensity and distinctly more pronounced effects achieved by administration of the investigational drug in patients suffering from the common cold. Results extend previous findings on efficacy, safety, and tolerability of this active substance.

Efficacy and Tolerability of High-dose Pelargonium Extract in Patients With the Common Cold

Context • The common cold (CC) is usually caused by a viral infection. Antibiotics are often prescribed unnecessarily for it, although no evidence exists for any benefit in the CC. Effective alternatives are needed. Objective • The study intended to evaluate the efficacy of 7630, a proprietary extract of Pelargonium sidoides, the active ingredient in umckaloabo, compared with a placebo for the treatment of the CC. Design • This was a prospective, double-blind, parallel-group, placebo-controlled, phase 3 clinical trial (RCT), with an adaptive group-sequential design with 2 parts, both of which were 2-arm trials. The first used a standard dose (SD) of 3 × 30 drops per day of the active medication and the second used a high dose (HD) of 3 × 60 drops per day of the active medication, against 3 × 30 drops per day and 3 × 60 drops per day of a placebo, respectively. Setting • The study took place in 8 outpatient departments affiliated with hospitals. Participants • For the entire study, 207 adults with predefined cold symptoms that had been present for 24 to 48 h prior were included in the study, with 103 participating in the SD part and 104 participating in the HD part. Intervention • In the HD part, as covered in this article, the intervention group received treatment with 3 × 60 drops per day of the active medication and the control group received a placebo (control group), for a maximum period of 10 d. Outcome Measures • The primary outcome measure was the sum of differences in the cold intensity score (CIS) from day 1 to day 3 and from day 1 to day 5, defined as the sum of the symptom intensity differences (SSID). The criteria for the secondary outcome, efficacy, were (1) diverse response criteria according to the total CIS; (2) changes in individual CIS symptoms; (3) changes in further cold-relevant symptoms; (4) ability to work; (5) activity level; (6) general well-being; (7) health-related quality of life-the EuroQol questionnaire with 5 dimensions (EQ-5D), including the visual analogue scale EQ-VAS; (8) time until onset of treatment effect; (9) treatment outcome; and (10) satisfaction with treatment. Results • From baseline to day 5, the mean CIS decreased by 11.2 ± 4.8 points for the 7630 group and 6.3 ± 4.7 points for the control group. The mean SSID was 16.0 ± 7.6 points for the control group (P < .0001). After 10 d, 90.4% of the group receiving the active medication and 21.2% of the control group were clinically cured (P < .0001). In the treatment group, participants' inability to work was significantly lower, with a mean duration of 6.4 ± 1.6 d vs 8.3 ± 2.1 d for the control group (P < .0001), and treatment outcome-complete recovery or major improvement-was significantly better at day 5 for the active treatment group compared with the control group (P < .0001). Mild-to-moderate adverse events-all nonserious-occurred in 15.4% of those receiving active treatment vs in 5.8% for the control group. Conclusions • The active medication is an effective, well tolerated, and safe treatment for the CC. It significantly reduces the severity of symptoms and shortens the duration of the disease.

[ANALYSIS OF ARACHIDONIC ACID RELATIVE CONTENT CHANGES IN ERYTHROCYTES AND PLATELETS PHOSPHOLIPIDS MEMBRANES FEATURES IN CORONARY HEART DISEASE WITH ATRIAL FIBRILLATION PATIENTS]

Erythrocytes and platelets phospholipid membranes fatty acid spectrum was detected in coronary heart disease and atrial fibrillation patients and in patients with coronary heart disease without atrial fibrillation. 87 patients were investigated. Significant decrease in the arachidonic acid relative content in coronary heart disease patients compared with healthy individuals was related. As well as a significant decrease in the arachidonic acid relative content in coronary heart disease and atrial fibrillation patients compared with coronary heart disease patients without atrial fibrillation was related too. These dates may indicate that decreasing relative content arachidonic acid can be possible pathogenetic link in the development of arrhythmias.

Efficacy and tolerability of EPs 7630 tablets in patients with acute bronchitis: a randomised, double-blind, placebo-controlled dose-finding study with a herbal drug preparation from Pelargonium sidoides

OBJECTIVE

Acute bronchitis is one of the most frequent health complaints for which patients seek medical advice. Although viral infections prevail, antibiotics are commonly prescribed. In this study, the efficacy and tolerability of EPs 7630 tablets, a herbal drug preparation from the roots of Pelargonium sidoides, were investigated in adults with acute bronchitis outside the strict indication for antibiotics.

RESEARCH DESIGN AND METHODS

In this randomised, double-blind, placebo-controlled, multicentre dose-finding trial using an adaptive group-sequential design, 406 patients were randomly assigned to one of four parallel treatment groups (10 mg EPs 7630 tablets three times a day (30-mg group), 20 mg EPs 7630 tablets three times a day (60-mg group), 30 mg EPs 7630 tablets three times a day (90-mg group) or placebo three times a day) for a treatment period of 7 days. Primary endpoint was the change in the total score of bronchitis-specific symptoms (BSS) from baseline to day 7.

RESULTS

Between day 0 and day 7, the mean BSS score decreased by 2.7 +/- 2.3 (placebo), 4.3 +/- 1.9 (30-mg group), 6.1 +/- 2.1 (60-mg group), and 6.3 +/- 2.0 points (90-mg group), respectively. The differences between the EPs 7630 groups and placebo were statistically significant (p < 0.0001, each). The secondary endpoints showed comparable results. EPs 7630 was well-tolerated. All documented adverse events were of mild to moderate intensity; their frequency was dose-dependent. No serious adverse events were reported.

CONCLUSION

This study demonstrated statistically significant and clinically relevant superiority of all three tested dosages of EPs 7630 over placebo. All dosages of EPs 7630 were well-tolerated. Taking into account both efficacy and safety, the results of this study indicate that the 20 mg tablets of EPs 7630 taken three times daily constitute the optimal dose with respect to the benefit-risk ratio.

Particular features of systolic and diastolic functions in patients with metabolic syndrome

In many epidemiological studies, the relationship between metabolic syndrome and the development of congestive heart failure has been established. Due to the latter, an increased interest has been noticed in scientific studies about the changes in the function of the heart in patients with metabolic syndrome and possible disturbance mechanisms of the pumping function of the heart in this group of patients. In our research, 120 patients with metabolic syndrome and 20 health individuals were studied. The cardiac functions were assessed with the ultrasound imaging machine "Aloka SSD 5000" (Japan) convex sensor of frequency 3.5 MHz with generally used methods. In the course of the experiment, in patients with MS, concentric hypertrophy of the heart and disturbance of the diastolic function of the heart was noticed. Also it was set that there was a significant correlation between the indexes, which in a superlative degree demonstrate abdominal obesity (WHR) and the indexes of LV hypertrophy during diastole (r = 0.72; P < 0.001), LVM (r = 0.81; P < 0.001) and LA (r = 0.63; P < 0.001).

Efficacy of a pelargonium sidoides preparation in patients with the common cold: a randomized, double blind, placebo-controlled clinical trial

BACKGROUND

The common cold is a viral infection with symptoms such as sneezing, sore throat, and running nose. It is one of the most prevalent illnesses in the world, and although commonly caused by rhinoviruses, antibiotics are often prescribed unnecessarily. Therefore, it is of utmost importance to evaluate alternative treatments such as herbal medications, whose efficacy and safety is proven by pharmacological and clinical studies.

OBJECTIVE

The aim of the present study was to evaluate the efficacy of a liquid herbal drug preparation from the roots of Pelargonium sidoides compared with placebo in adult patients with the common cold.

DESIGN

The study was designed as a multicenter, prospective, randomized, double blind, parallel group, placebo-controlled phase III clinical trial with an adaptive group-sequential design.

SETTING

The study took place in eight outpatient departments affiliated with hospitals.

PATIENTS

One hundred three male and female adult patients with at least two major and one minor or with one major and three minor cold symptoms (maximum symptom score of 40 points), present for 24 to 48 hours, and who gave provision of informed consent were randomized to receive either 30 drops (1.5 mL) of the liquid herbal drug preparation EPs or placebo three times a day.

INTERVENTION

Patients received randomized treatment for a maximum period of 10 days.

MEASUREMENTS

The primary outcome criterion was the sum of symptom intensity differences (SSID) of the cold intensity score (CIS) from day one to day five. The CIS consists of the following 10 cold symptoms: nasal drainage, sore throat, nasal congestion, sneezing, scratchy throat, hoarseness, cough, headache, muscle aches, and fever.

RESULTS

From baseline to day five, the mean SSID improved by 14.6 +/- 5.3 points in the EPs group compared with 7.6 +/- 7.5 points in the placebo group. This difference was statistically significant (P < .0001). The mean CIS decreased by 10.4 +/- 3.0 points and 5.6 +/- 4.3 points in EPs and placebo-treated patients, respectively. After 10 days, 78.8% versus 31.4% in the EPs versus placebo group were clinically cured (CIS equals zero points or complete resolution of all but a maximum of one cold symptom; P < .0001). The mean duration of inability to work was significantly lower in the EPs treatment group (6.9 +/- 1.8 days) than in the placebo group (8.2 +/- 2.1 days; P = .0003). Treatment outcome (rates of complete recovery or major improvement from disease [integrative medicine outcomes scale]) was assessed better in the EPs treatment group than in the placebo group by both the investigator and the patient on day five (P < .0001). Adverse events occurred in three of 103 patients (2.9%), with two of 52 (3.8%) and one of 51 (2.0%) patients in the EPs and placebo group, respectively. All adverse events were assessed as nonserious. At the end of treatment, all patients (100%) in the active treatment group judged the subjective tolerability of EPs as good or very good.

CONCLUSIONS

EPs represents an effective treatment of the common cold. It significantly reduces the severity of symptoms and shortens the duration of the common cold compared with placebo. The herbal drug is well tolerated.

[The effect of alpha-1 adrenergic blockade on the clinical course, immune status and blood plasma lipid spectrum in patients with ischemic heart disease]

Results are submitted of investigations designed to study effects of prazosine on the clinical course, immune and lipid spectrum of blood plasma in IHD patients with functional class I-II middle-aged and elderly-onset exertional angina. Efficiency of prazosine monotherapy was recordable in all FC I-II effort angina patients 30 to 50 years old, which fact was manifested by a decline in the number of angina attacks over the 24-hour period, number and duration of both pain and symptom-free myocardial ischemia, improvement in physical load tolerance. Also recordable in all patients was a positive effect of the drug on blood plasma lipid spectrum and certain immunological indices.

[The clinical characteristics of the course of hypertension in patients with disorders of the rheological properties of the blood]

As many as 185 patients with stage I-III hypertensive disease were examined, their age ranging between 30 and 70 years. Investigation of rheologic properties of blood involved determination of hematocrit value, blood viscosity, aggregation of erythrocytes, platelets, content of fibrinogen, products of fibrin cleavage. It has been ascertained that in patients with stage I hypertensive disease, disorders of rheologic properties of blood are characterised by disturbances in the platelet link of the bloodflow, with the degree being dependent on the cerebral symptomatology; those in patients with stage II hypertensive disease were evidenced by high values for blood viscosity; as to stage III disease complicated by disordered cerebral bloodflow, the degree of rheologic abnormalities may characterize the course and outcome of the disease.

[The role of segmental analgesic mechanisms in the development of silent myocardial ischemia in patients with initial coronary atherosclerosis]

In patients with ischemic heart disease (IHD) with early coronary atherosclerosis the ratio of the myocardial ischemia pain episodes (MIPE) to myocardial ischemia pain-free episodes (MIPFE) is 1:4. In IHD patients, an important role to play in the development of MIPFE has the first segmental link in the analgetic system leading to a segmental rise of the electropain sensitivity threshold. Blockade of alpha 1-adrenoreceptors with prazosinum decreases the activity of analgesic mechanisms and favours transition from MIPFE to MIPE. In patients with the initial stages of coronary atherosclerosis, prazosinum promotes a significant alleviation of both MIPFE and MIPE.

[Cardiohemodynamics and microcirculation in patients with ischemic heart disease undergoing beta-adrenergic receptor stimulation and blockade]

A study of 76 patients with ischemic heart disease is presented who revealed during coronography stenosis of one-three coronary arteries equalling 50-75% of the vessel lumen. Analysis of the effect of anaprilin and nonachlazin on the clinical course and hemodynamics revealed that in patients with initial coronary atherosclerosis of middle age beta-adrenodependent vasodilation of the coronary arteries decreased. In these patients anaprilin may increase the frequency of attacks of spontaneous stenocardia. On the contrary, nonachlazin reduces manifestations of stenocardia but it may be used only in patients with a high tolerance to physical load.

[Clinical and diagnostic features of the initial forms of coronary atherosclerosis]

A study is presented of 123 patients with ischemic heart disease showing stenosis of one-two coronary arteries (50% of lumen) and high tolerance to physical load (100 Wt and more). Stenocardia was characterized by development of attacks during rest while average loads were well tolerated by the patients. Pain had a typical location and irradiation, attacks were frequent often provoked by psychoemotional stress and high level of physical load, were controlled by nitroglycerine. It is proposed to call this syndrome "initial stenocardia".