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Meng XX, Nan GJ, Hu H, He JY, Li YZ, Yang GD. Effects of vitamin C on the pharmacokinetics and pharmacodynamics of nimodipine in rats. Biomed Chromatogr 2024; 38:e5827. [PMID: 38287211 DOI: 10.1002/bmc.5827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/27/2023] [Accepted: 12/27/2023] [Indexed: 01/31/2024]
Abstract
In recent years, researchers have shown a growing interest in the interactions between different pharmaceutical agents. An intriguing instance lies in the possible interaction between nimodipine and vitamin C. To investigate the pharmacokinetic and pharmacodynamic effects of vitamin C on nimodipine in rats, rats were randomly divided into a nimodipine only group and a combination group (nimodipine + vitamin C). The two groups were given intragastric administration and nimodipine blood concentrations were determined using high-performance liquid chromatography-tandem mass spectrum at different time points. Blood pressure and heart rate were measured via carotid artery cannulation. Pharmacokinetic differences were observed between the nimodipine only group and the combination group at the same dose. Compared with the nimodipine only group, the combination group's main pharmacokinetic parameters of peak concentration and area under the curve increased significantly, and the difference was statistically significant (p < 0.05); furthermore, the combination group exhibited a significant reduction in average blood pressure, while no significant effects on heart rate were observed. Vitamin C did not affect the activity of CYP450 in rat liver. The pharmacokinetic characteristics and pharmacodynamics of nimodipine were changed by vitamin C administration in rats.
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Affiliation(s)
- Xian-Xin Meng
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Guan-Jun Nan
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Hao Hu
- School of Basic Medical Sciences, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jian-Yu He
- School of Basic Medical Sciences, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yun-Zhe Li
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Guang-de Yang
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Mahmoud SH, Hefny F, Isse FA, Farooq S, Ling S, O'Kelly C, Kutsogiannis DJ. Nimodipine systemic exposure and outcomes following aneurysmal subarachnoid hemorrhage: a pilot prospective observational study (ASH-1 study). Front Neurol 2024; 14:1233267. [PMID: 38249736 PMCID: PMC10796587 DOI: 10.3389/fneur.2023.1233267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/07/2023] [Indexed: 01/23/2024] Open
Abstract
Background Nimodipine improves outcomes following aneurysmal subarachnoid hemorrhage (aSAH). Guidelines recommend that all patients should receive a fixed-dose nimodipine for 21 days. However, studies reported variability of nimodipine concentrations in aSAH. It is not clear if reduced systemic exposure contributes to worsening outcomes. The aim of this study was to compare nimodipine systemic exposure in those who experienced poor outcomes to those who experienced favorable outcomes. Methods This was a pilot prospective observational study in 30 adult patients admitted to the University of Alberta Hospital with aSAH. Data were collected from the electronic health records following enrollment. Blood samples were collected around one nimodipine 60 mg dose at a steady state, and nimodipine [total, (+)-R and (-)-S enantiomers] plasma concentrations were determined. The poor outcome was defined as a modified Rankin Scale (mRS) score at 90 days of 3-6, while the favorable outcome was an mRS score of 0-2. The correlation between nimodipine concentrations and percent changes in mean arterial pressure (MAP) before and after nimodipine administration was also determined. Furthermore, covariates potentially associated with nimodipine exposure were explored. Results In total, 20 (69%) participants had favorable outcomes and 9 (31%) had poor outcomes. Following the exclusion of those with delayed presentation (>96 h from aSAH onset), among those presented with the World Federation of Neurological Surgeons (WFNS) grade 3-5, nimodipine median (interquartile range) area under the concentration time curve (AUC0-3h) in those with favorable outcomes were 4-fold higher than in those with poor outcomes [136 (52-192) vs. 33 (23-39) ng.h/mL, respectively, value of p = 0.2]. On the other hand, among those presented with WFNS grade 1-2, nimodipine AUC0-3h in those with favorable outcomes were significantly lower than in those with poor outcomes [30 (28-36) vs. 172 (117-308) ng.h/mL, respectively, value of p = 0.03)]. (+)-R-nimodipine AUC0-3h in those who did not develop vasospasm were 4-fold significantly higher than those who had vasospasm (value of p = 0.047). (-)-S-nimodipine was significantly correlated with percentage MAP reduction. Similar results were obtained when the whole cohort was analyzed. Conclusion The study was the first to investigate the potential association between nimodipine exposure following oral dosing and outcomes. In addition, it suggests differential effects of nimodipine enantiomers, shedding light on the potential utility of nimodipine enantiomers. Larger studies are needed.
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Affiliation(s)
- Sherif Hanafy Mahmoud
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Fatma Hefny
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Fadumo Ahmed Isse
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Shahmeer Farooq
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Spencer Ling
- Pharmacy Services, University of Alberta Hospital, Alberta Health Services, Edmonton, AB, Canada
| | - Cian O'Kelly
- Vascular, Endovascular and General Neurosurgery, Division of Neurosurgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Demetrios James Kutsogiannis
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Bernava G, Tesoro R, Boto J, Challita M, Rosi A, Hofmeister J, Yilmaz H, Carrera E, Brina O, Reymond P, Muster M, Kulcsar Z, Lovblad KO, Machi P. Effectiveness of the preventive administration of vasoactive amines in counterbalancing significant patient blood pressure drops following nimodipine administration during mechanical thrombectomy procedures. Interv Neuroradiol 2023:15910199231221510. [PMID: 38105436 DOI: 10.1177/15910199231221510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Focal vasospasm (FV) of the occluded vessel can occur during the endovascular treatment of acute ischemic stroke (AIS). Nimodipine is commonly used to treat vasospasm and can play a role in distinguishing it from artery narrowing due to iatrogenic dissection or residual clot. However, nimodipine administration can result in arterial hypotension and subsequent enlargement of the ischemic core. OBJECTIVE To assess the efficacy of preventive and continuous vasoactive amine infusion to counterbalance nimodipine-induced hypotension. METHODS We reviewed data from a prospective registry of patients treated for AIS between January 2019 and January 2022 who were administered nimodipine. All patients were equipped with an arterial cannula for invasive blood pressure measurement and given vasoactive amines preemptively before general anesthesia and throughout the procedure. Data obtained from invasive monitoring of mean arterial blood pressure (MABP) in a time-lapse of 25 min before and after nimodipine administration were analyzed. RESULTS MABP significantly decreased after nimodipine administration but remained within the recommended range (81.79 ± 0.49 mmHg). Nimodipine was effective in reducing FV caused by stent retriever passage in 76.3% of cases. Furthermore, it proved valuable in diagnosing iatrogenic dissection (9.2%), residual clot (10.5%), or intracranial stenosis (4%). CONCLUSIONS Infusion of vasoactive amines effectively counteracted the intraarterial nimodipine effect, thus avoiding frank arterial hypotension during endovascular treatment. Nimodipine has been useful in differentiating the diagnosis of FV resulting from mechanical thrombectomy and other potential causes, such as iatrogenic dissection or residual clot.
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Affiliation(s)
- Gianmarco Bernava
- Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Rosa Tesoro
- Division of Anesthesia, Geneva University Hospitals, Geneva, Switzerland
| | - José Boto
- Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Myriam Challita
- Division of Anesthesia, Geneva University Hospitals, Geneva, Switzerland
| | - Andrea Rosi
- Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Jeremy Hofmeister
- Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Hasan Yilmaz
- Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Emmanuel Carrera
- Division of Neurology, Geneva University Hospitals, Geneva, Switzerland
| | - Olivier Brina
- Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Philippe Reymond
- Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Michel Muster
- Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Zsolt Kulcsar
- Division of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland
| | - Karl-Olof Lovblad
- Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Paolo Machi
- Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
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Mavridis I, Pyrgelis ES, Agapiou E, Assi J. Vasospasm in Pediatric Subarachnoid Hemorrhage. CNS Neurol Disord Drug Targets 2023; 23:CNSNDDT-EPUB-136305. [PMID: 38013445 DOI: 10.2174/0118715273274147231104160152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/06/2023] [Accepted: 10/06/2023] [Indexed: 11/29/2023]
Abstract
Cerebral vasospasm (CV) is a common severe complication of subarachnoid hemorrhage (SAH), a severe type of intracranial bleeding that is uncommon in children. The purpose of this article is to review the current literature regarding this potentially devastating complication. CV may be asymptomatic and is less common in children compared to adults. Several molecular phenomena, including inflammatory ones, contribute to its pathophysiology. Better collateral circulation and higher cerebral blood flow are protective factors in children. When clinically apparent, CV may manifest as a change in the child's neurologic status or vital signs. CV can be diagnosed using brain vessel imaging, such as computed tomography angiography, magnetic resonance angiography, digital subtraction angiography, transcranial Doppler ultrasonography, and computed tomography perfusion. A reduction of < 50% in the artery's caliber confirms the diagnosis. Besides general supportive measures and causative treatment of SAH, CV management options include the administration of calcium channel blockers and neurointerventional approaches, such as intra-arterial vasodilators and balloon angioplasty. Long-term outcomes in children are usually favorable.
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Affiliation(s)
- Ioannis Mavridis
- Pediatric Neurosurgery Unit, Department of Neurosurgery, School of Medicine, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Efstratios-Stylianos Pyrgelis
- 1st Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, 'Eginiteion' Hospital, Athens, Greece
| | - Eleni Agapiou
- Department of Physical and Rehabilitation Medicine, 'Skylitseio' General Hospital of Chios, Chios Island, Greece
| | - Jeries Assi
- School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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Ma L, Mao H, Xu J, Piao J, Piao M. Study on the Nasal Drug Delivery System of NMD Liposomes In Situ Thermosensitive Gel. AAPS PharmSciTech 2023; 24:234. [PMID: 37973673 DOI: 10.1208/s12249-023-02679-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/12/2023] [Indexed: 11/19/2023] Open
Abstract
Nimodipine (NMD) is a 1,4-dihydropyridine calcium antagonist that is effective in the prevention and treatment of cerebral arterial vasospasm and cerebral ischemic injury caused by subarachnoid hemorrhage. Since the drug itself is highly insoluble in water and has low oral bioavailability, while injectable formulations may cause pain and inflammation, the blood-brain barrier (BBB) prevents the effective delivery of therapeutic agents to the brain tissue. Therefore, in the present study, NMD liposomes were prepared by ethanol injection and innovatively lyophilised and loaded into temperature-sensitive in situ gels for intranasal administration as sprays to deliver drugs to brain tissues bypassing the blood-brain barrier. The optimal gel formulation was obtained by screening in which liposomes were divided into lecithin, cholesterol, and NMD in the ratio of 40:10: 1; Pluronic P407, Pluronic P188, Tween 80, polyvinyl ketone and ethyl nipagin in the ratio of (180:20:3:1:1); Pluronic P407, Pluronic P188, Tween 80, polyvinyl ketone, and ethyl nipagin in the ratio of (180:20:3:1:1). The prepared flow gel can form a solidified gel after a temperature of 31.07-32.07°C and a time of 58.51-59.89 s. Meanwhile, the NMD liposome gel formulation achieved sustained release over 56 h. The pharmacokinetic results of the developed NMD liposomal temperature-sensitive in situ gel and NMD temperature-sensitive in situ gel showed that liposomal nasal mucosal in situ gel is a more effective brain-targeted drug delivery system for NMD.
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Affiliation(s)
- Lin Ma
- School of Pharmacy, Yanbian University, Yanji, 133002, China
| | - HeYing Mao
- School of Pharmacy, Yanbian University, Yanji, 133002, China
| | - Jing Xu
- School of Pharmacy, Yanbian University, Yanji, 133002, China
| | - Jingshu Piao
- School of Pharmacy, Yanbian University, Yanji, 133002, China.
| | - Mingguan Piao
- School of Pharmacy, Yanbian University, Yanji, 133002, China.
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, Yanbian University, Yanji, 133002, China.
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Esfahani G, Trutschel ML, Reichert D, Mäder K. Characterization of Controlled Release Starch- Nimodipine Implant for Antispasmodic and Neuroprotective Therapies in the Brain. Mol Pharm 2023; 20:5753-5762. [PMID: 37750866 DOI: 10.1021/acs.molpharmaceut.3c00618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Parenteral depot systems can provide a constant release of drugs over a few days to months. Most of the parenteral depot products on the market are based on poly(lactic acid) and poly(lactide-co-glycolide) (PLGA). Studies have shown that acidic monomers of these polymers can lead to nonlinear release profiles or even drug inactivation before release. Therefore, finding alternatives for these polymers is of great importance. Our previous study showed the potential of starch as a natural and biodegradable polymer to form a controlled release system. Subarachnoid hemorrhage (SAH) is a life-threatening type of stroke and a major cause of death and disability in patients. Nimotop® (nimodipine (NMD)) is an FDA-approved drug for treating SAH-induced vasospasms. In addition, NMD has, in contrast to other Ca antagonists, unique neuroprotective effects. The oral administration of NMD is linked to variable absorption and systemic side effects. Therefore, the development of a local parenteral depot formulation is desirable. To avoid the formation of an acidic microenvironment and autocatalytic polymer degradation, we avoided PLGA as a matrix and investigated starch as an alternative. Implants with drug loads of 20 and 40% NMD were prepared by hot melt extrusion (HME) and sterilized with an electron beam. The effects of HME and electron beam on NMD and starch were evaluated with NMR, IR, and Raman spectroscopy. The release profile of NMD from the systems was assessed by high-performance liquid chromatography. Different spectroscopy methods confirmed the stability of NMD during the sterilization process. The homogeneity of the produced system was proven by Raman spectroscopy and scanning electron microscopy images. In vitro release studies demonstrated the sustained release of NMD over more than 3 months from both NMD systems. In summary, homogeneous nimodipine-starch implants were produced and characterized, which can be used for therapeutic purposes in the brain.
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Affiliation(s)
- Golbarg Esfahani
- Institute of Pharmacy, Martin Luther University Halle-Wittenberg, Wolfgang-Langenbeck-Straße 4, Halle 06120, Saale, Germany
| | - Marie-Luise Trutschel
- Institute of Pharmacy, Martin Luther University Halle-Wittenberg, Wolfgang-Langenbeck-Straße 4, Halle 06120, Saale, Germany
| | - Detlef Reichert
- Institute of Physics, Martin Luther University Halle-Wittenberg, Betty-Heimann-Str. 7, Halle D-06120, Saale, Germany
| | - Karsten Mäder
- Institute of Pharmacy, Martin Luther University Halle-Wittenberg, Wolfgang-Langenbeck-Straße 4, Halle 06120, Saale, Germany
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Knoll A, Durner G, Braun M, Schmitz B, Wirtz CR, König R, Pala A. Combined stent retriever angioplasty and continuous intra-arterial nimodipine infusion as salvage therapy for cerebral vasospasm and delayed cerebral ischemia after subarachnoid hemorrhage: illustrative case. J Neurosurg Case Lessons 2023; 6:CASE23339. [PMID: 37782962 PMCID: PMC10555600 DOI: 10.3171/case23339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/01/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Delayed cerebral ischemia (DCI) and cerebral vasospasm (CV) are severe complications of spontaneous subarachnoid hemorrhage (SAH) contributing to an inferior outcome. Rescue therapies include intra-arterial balloon angioplasty and repetitive and finally continuous intra-arterial nimodipine infusion. OBSERVATIONS In the presented case, a young female patient with fulminant refractory DCI and CV, despite induced hypertension and nimodipine application, was treated with three-vessel continuous intra-arterial infusion and additional repetitive angioplasty of the basilar and middle cerebral arteries using a stent retriever, leading to a good clinical outcome. Additional stent retriever dilatation to continuous intra-arterial nimodipine application in three vessel territories may represent a further escalation step in the rescue therapy for severe CV and DCI after SAH. Montreal Cognitive Assessment and SF-36 testing showed satisfactory results 3 months after initial treatment with intra-arterial nimodipine catheters in three vessel territory circulations and additional stent retriever vasodilation of severe CV. LESSONS We report a unique rescue strategy involving implantation of an additional intra-arterial catheter into the vertebral artery and repetitive stent retriever dilatations of the middle cerebral and basilar arteries as an extra therapy for continuous intra-arterial nimodipine vaspospasmolytic therapy in three vessel territories, resulting in a very good clinical outcome.
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Affiliation(s)
| | | | - Michael Braun
- Neuroradiology, University of Ulm, Günzburg, Germany
| | - Bernd Schmitz
- Neuroradiology, University of Ulm, Günzburg, Germany
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Schwarting J, Harapan BN, Lin X, Plesnila N, Terpolilli NA. Nimodipine Reduces Microvasospasms After Experimental Subarachnoid Hemorrhage. Stroke 2023; 54:2666-2670. [PMID: 37675614 DOI: 10.1161/strokeaha.123.043976] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/12/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND The only established pharmacological treatment option improving outcomes for patients suffering from subarachnoid hemorrhage (SAH) is the L-type-calcium channel inhibitor nimodipine. However, the exact mechanisms of action of nimodipine conferring neuroprotection after SAH have yet to be determined. More recently, spasms of the cerebral microcirculation were suggested to play an important role in reduced cerebral perfusion after SAH and, ultimately, outcome. It is unclear whether nimodipine may influence microvasospasms and, thus, microcirculatory dysfunction. The aim of the current study was, therefore, to assess the effect of nimodipine on microvasospasms after experimental SAH. METHODS Male C57Bl/6 N mice (n=3-5/group) were subjected to SAH using the middle cerebral artery perforation model. Six hours after SAH induction, a cranial window was prepared, and the diameter of cortical microvessels was assessed in vivo by 2-photon-microscopy before, during, and after nimodipine application. RESULTS Nimodipine significantly reduced the number of posthemorrhagic microvasospasms. The diameters of nonspastic vessels were not affected. CONCLUSIONS Our results show that nimodipine reduces the formation of microvasospasms, thus, shedding new light on the mode of action of a drug routinely used for the treatment of SAH for >3 decades. Furthermore, L-type Ca2+ channels may be involved in the pathophysiology of microvasospasm formation.
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Affiliation(s)
- Julian Schwarting
- Institute for Stroke and Dementia Research (ISD) (J.S., B.N.H., X.L., N.P., N.A.T.)
- Now with Department of Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany (J.S.)
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Germany (J.S., B.N.H., N.A.T.)
- Munich Cluster for Systems Neurology (SyNergy), Germany (J.S., B.N.H., X.L., N.P., N.A.T.)
| | - Biyan Nathanael Harapan
- Institute for Stroke and Dementia Research (ISD) (J.S., B.N.H., X.L., N.P., N.A.T.)
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Germany (J.S., B.N.H., N.A.T.)
- Munich Cluster for Systems Neurology (SyNergy), Germany (J.S., B.N.H., X.L., N.P., N.A.T.)
| | - Xiangjiang Lin
- Institute for Stroke and Dementia Research (ISD) (J.S., B.N.H., X.L., N.P., N.A.T.)
- Munich Cluster for Systems Neurology (SyNergy), Germany (J.S., B.N.H., X.L., N.P., N.A.T.)
| | - Nikolaus Plesnila
- Institute for Stroke and Dementia Research (ISD) (J.S., B.N.H., X.L., N.P., N.A.T.)
- Munich Cluster for Systems Neurology (SyNergy), Germany (J.S., B.N.H., X.L., N.P., N.A.T.)
| | - Nicole A Terpolilli
- Institute for Stroke and Dementia Research (ISD) (J.S., B.N.H., X.L., N.P., N.A.T.)
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Germany (J.S., B.N.H., N.A.T.)
- Munich Cluster for Systems Neurology (SyNergy), Germany (J.S., B.N.H., X.L., N.P., N.A.T.)
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Kim KH, Lee BJ, Koo HW. Effect of Cilostazol on Delayed Cerebral Infarction in Aneurysmal Subarachnoid Hemorrhage Using Explainable Predictive Modeling. Bioengineering (Basel) 2023; 10:797. [PMID: 37508824 PMCID: PMC10376257 DOI: 10.3390/bioengineering10070797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 06/26/2023] [Accepted: 07/02/2023] [Indexed: 07/30/2023] Open
Abstract
The studies interpreting DCI, a complication of SAH, and identifying correlations are very limited. This study aimed to investigate the effect of cilostazol on ACV and DCI after coil embolization for ruptured aneurysms (n = 432). A multivariate analysis was performed and explainable artificial intelligence approaches were used to analyze the contribution of cilostazol as a risk factor on the development of ACV and DCI with respect to global and local interpretation. The cilonimo group was significantly lower than the nimo group in ACV (13.5% vs. 29.3; p = 0.003) and DCI (7.9% vs. 20.7%; p = 0.006), respectively. In a multivariate logistic regression, the odds ratio for DCI for the cilonimo group, female sex, and aneurysm size was 0.556 (95% confidence interval (CI), 0.351-0.879; p = 0.012), 3.713 (95% CI, 1.683-8.191; p = 0.001), and 1.106 (95% CI, 1.008-1.214; p = 0.034). The risk of a DCI occurrence was significantly increased with an aneurysm size greater than 10 mm (max 80%). The mean AUC of the XGBoost and logistic regression models was 0.94 ± 0.03 and 0.95 ± 0.04, respectively. Cilostazol treatment combined with nimodipine could decrease the prevalence of ACV (13.5%) and DCI (7.9%) in patients with aSAH.
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Affiliation(s)
- Kwang Hyeon Kim
- Department of Neurosurgery, College of Medicine, Inje University Ilsan Paik Hospital, Goyang 10380, Republic of Korea
| | - Byung-Jou Lee
- Department of Neurosurgery, College of Medicine, Inje University Ilsan Paik Hospital, Goyang 10380, Republic of Korea
| | - Hae-Won Koo
- Department of Neurosurgery, College of Medicine, Inje University Ilsan Paik Hospital, Goyang 10380, Republic of Korea
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Kardash EV, Ertuzun IA, Alekseeva IV, Tarasov SA. Efficacy of the Technologically Processed Antibodies to the Brain-Specific S100 Protein in a Rat Model of Hemorrhagic Stroke. Bull Exp Biol Med 2023; 174:741-744. [PMID: 37157047 DOI: 10.1007/s10517-023-05783-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Indexed: 05/10/2023]
Abstract
We studied the ability of technologically processed antibodies to the brain-specific S100 protein (drug Prospekta) to reduce the brain lesion area, neurological disorders, and mortality in a rat model of hemorrhagic stroke. Technologically processed antibodies to S100 exerted a positive effect on all these parameters (brain lesion area, survival rate, neurological status according to the Menzies scale, and proportion of contralateral turns). This allows us to recommend further research into the spectrum of pharmacological activity and the mechanism of action of technologically processed antibodies to S100 in order to expand the indications for their use after the necessary clinical trials.
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Affiliation(s)
- E V Kardash
- Research Institute of General Pathology and Pathophysiology, Laboratory of Physiologically Active Substances, Department of Molecular and Cellular Pathophysiology, Moscow, Russia.
- LLC "MATERIA MEDICA HOLDING", Moscow, Russia.
| | - I A Ertuzun
- LLC "MATERIA MEDICA HOLDING", Moscow, Russia
| | - I V Alekseeva
- Laboratory of Systemic Mechanisms of Emotional Stress, P. K. Anokhin Research Institute of Normal Physiology, Moscow, Russia
| | - S A Tarasov
- Research Institute of General Pathology and Pathophysiology, Laboratory of Physiologically Active Substances, Department of Molecular and Cellular Pathophysiology, Moscow, Russia
- LLC "MATERIA MEDICA HOLDING", Moscow, Russia
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Mahmoud SH, Hefny FR, Panos NG, Delucilla L, Ngan Z, Perreault MM, Hamilton LA, Rowe AS, Buschur PL, Owusu-Guha J, Almohaish S, Sandler M, Armahizer MJ, Barra ME, Cook AM, Barthol CA, Hintze TD, Cantin A, Traeger J, Blunck JR, Shewmaker J, Burgess SV, Kaupp K, Brown CS, Clark SL, Wieruszewski ED, Tesoro EP, Ammar AA, Ammar MA, Binning MJ, Naydin S, Fox N, Peters DM, Mahmoud LN, Keegan SP, Brophy GM. Comparison of nimodipine formulations and administration techniques via enteral feeding tubes in patients with aneurysmal subarachnoid hemorrhage: A multicenter retrospective cohort study. Pharmacotherapy 2023; 43:279-290. [PMID: 36880540 DOI: 10.1002/phar.2791] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/07/2023] [Accepted: 02/12/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Nimodipine improves outcomes following aneurysmal subarachnoid hemorrhage (aSAH) and current guidelines suggest that patients with aSAH receive nimodipine for 21 days. Patients with no difficulty swallowing will swallow the whole capsules or tablets; otherwise, nimodipine liquid must be drawn from capsules, tablets need to be crushed, or the commercially available liquid product be used to facilitate administration through an enteral feeding tube (FT). It is not clear whether these techniques are equivalent. The goal of the study was to determine if different nimodipine formulations and administration techniques were associated with the safety and effectiveness of nimodipine in aSAH. METHODS This was a retrospective multicenter observational cohort study conducted in 21 hospitals across North America. Patients admitted with aSAH and received nimodipine by FT for ≥3 days were included. Patient demographics, disease severity, nimodipine administration, and study outcomes were collected. Safety end points included the prevalence of diarrhea and nimodipine dose reduction or discontinuation secondary to blood pressure reduction. Predictors of the study outcomes were analyzed using regression modeling. RESULTS A total of 727 patients were included. Administration of nimodipine liquid product was independently associated with higher prevalence of diarrhea compared to other administration techniques/formulations (Odds ratio [OR] 2.28, 95% confidence interval [CI] 1.41-3.67, p-value = 0.001, OR 2.76, 95% CI 1.37-5.55, p-value = 0.005, for old and new commercially available formulations, respectively). Bedside withdrawal of liquid from nimodipine capsules prior to administration was significantly associated with higher prevalence of nimodipine dose reduction or discontinuation secondary to hypotension (OR 2.82, 95% CI 1.57-5.06, p-value = 0.001). Tablet crushing and bedside withdrawal of liquid from capsules prior to administration were associated with increased odds of delayed cerebral ischemia (OR 6.66, 95% CI 3.48-12.74, p-value <0.0001 and OR 3.92, 95% CI 2.05-7.52, p-value <0.0001, respectively). CONCLUSIONS Our findings suggest that enteral nimodipine formulations and administration techniques might not be equivalent. This could be attributed to excipient differences, inconsistency and inaccuracy in medication administration, and altered nimodipine bioavailability. Further studies are needed.
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Affiliation(s)
- Sherif Hanafy Mahmoud
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Fatma R Hefny
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Nicholas G Panos
- Department of Pharmacy, Rush University Medical Center, Chicago, Illinois, USA
| | - Laura Delucilla
- Department of Pharmacy, McGill University Health Centre, Montreal, Quebec, Canada
| | - Zinquon Ngan
- Department of Pharmacy, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marc M Perreault
- Department of Pharmacy, McGill University Health Centre, Montreal, Quebec, Canada.,Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - Leslie A Hamilton
- University of Tennessee Health Science Center, College of Pharmacy, Knoxville, Tennessee, USA
| | - A Shaun Rowe
- University of Tennessee Health Science Center, College of Pharmacy, Knoxville, Tennessee, USA
| | | | | | - Sulaiman Almohaish
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, School of Pharmacy, Richmond, Virginia, USA.,College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Melissa Sandler
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, School of Pharmacy, Richmond, Virginia, USA.,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA
| | - Michael J Armahizer
- Pharmacy Services, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Megan E Barra
- Department of Pharmacy, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aaron M Cook
- UKHealthCare, University of Kentucky College of Pharmacy, Lexington, Kentucky, USA
| | - Colleen A Barthol
- Department of Pharmacotherapy & Pharmacy Services, University Health, San Antonio, Texas, USA
| | - Trager D Hintze
- Department of Pharmacy Practice, Texas A&M College of Pharmacy, College Station, Texas, USA
| | - Anna Cantin
- Hartford Hospital, Hartford, Connecticut, USA
| | - Jessica Traeger
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Joseph R Blunck
- Department of Pharmacy, Saint Luke's Hospital, Kansas City, Missouri, USA
| | - Justin Shewmaker
- Department of Pharmacy, Saint Luke's Hospital, Kansas City, Missouri, USA
| | - Sarah V Burgess
- Queen Elizabeth II Health Sciences Centre, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Kristin Kaupp
- Queen Elizabeth II Health Sciences Centre, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | | | | | | | - Eljim P Tesoro
- College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Abdalla A Ammar
- Department of Pharmacy, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Mahmoud A Ammar
- Department of Pharmacy, Yale New Haven Hospital, New Haven, Connecticut, USA
| | | | | | - Neal Fox
- Premier Health Miami Valley Hospital, Dayton, Ohio, USA
| | - David M Peters
- Cedarville University School of Pharmacy, Cedarville, Ohio, USA
| | - Leana N Mahmoud
- Department of Pharmacy, Rhode Island Hospital/Lifespan, Providence, Rhode Island, USA
| | - Shaun P Keegan
- Department of Pharmacy, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Gretchen M Brophy
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, School of Pharmacy, Richmond, Virginia, USA
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12
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Menyhárt Á, Bálint AR, Kozák P, Bari F, Farkas E. Nimodipine accelerates the restoration of functional hyperemia during spreading oligemia. J Neurochem 2023. [PMID: 36810711 DOI: 10.1111/jnc.15792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/14/2023] [Accepted: 02/18/2023] [Indexed: 02/24/2023]
Abstract
Spreading depolarization (SD) is assumed to be the pathophysiological correlate of migraine aura, leading to spreading depression of activity and a long-lasting vasoconstriction known as spreading oligemia. Furthermore, cerebrovascular reactivity is reversibly impaired after SD. Here, we explored the progressive restoration of impaired neurovascular coupling to somatosensory activation during spreading oligemia. Also, we evaluated whether nimodipine treatment accelerated the recovery of impaired neurovascular coupling after SD. Male, 4-9-month-old C57BL/6 mice (n = 11) were anesthetized with isoflurane (1%-1.5%), and SD was triggered with KCl through a burr hole made at the caudal parietal bone. EEG and cerebral blood flow (CBF) were recorded minimally invasively with a silver ball electrode and transcranial laser-Doppler flowmetry, rostral to SD elicitation. The L-type voltage-gated Ca2+ channel blocker nimodipine was administered i.p. (10 mg/kg). Whisker stimulation-related evoked potentials (EVPs) and functional hyperemia were assessed under isoflurane (0.1%)-medetomidine (0.1 mg/kg i.p.) anesthesia before, and repeatedly after SD, at 15-min intervals for 75 minutes. Nimodipine accelerated the recovery of CBF from spreading oligemia (time to full recovery, 52 ± 13 vs. 70 ± 8 min, nimodipine vs. control) and exhibited a tendency to shorten the duration of the SD-related EGG depression duration. The amplitudes of EVP and functional hyperemia were markedly reduced after SD, and progressively recovered over an hour post-SD. Nimodipine exerted no impact on EVP amplitude but consistently increased the absolute level of functional hyperemia from 20 min post-CSD (93 ± 11% vs. 66 ± 13%, nimodipine vs. control). A linear, positive correlation between EVP and functional hyperemia amplitude was skewed by nimodipine. In conclusion, nimodipine facilitated CBF restoration from spreading oligemia and the recovery of functional hyperemia post-SD, which were linked to a tendency of an accelerated return of spontaneous neural activity after SD. The use of nimodipine in migraine prophylaxis is suggested to be re-visited.
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Affiliation(s)
- Ákos Menyhárt
- Hungarian Centre of Excellence for Molecular Medicine-University of Szeged, Cerebral Blood Flow and Metabolism Research Group, Szeged, Hungary
- Department of Cell Biology and Molecular Medicine, Albert Szent-Györgyi Medical School and Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Armand Rafael Bálint
- Department of Cell Biology and Molecular Medicine, Albert Szent-Györgyi Medical School and Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
- Department of Medical Physics and Informatics, Albert Szent-Györgyi Medical School and Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Péter Kozák
- Department of Cell Biology and Molecular Medicine, Albert Szent-Györgyi Medical School and Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Ferenc Bari
- Department of Medical Physics and Informatics, Albert Szent-Györgyi Medical School and Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Eszter Farkas
- Hungarian Centre of Excellence for Molecular Medicine-University of Szeged, Cerebral Blood Flow and Metabolism Research Group, Szeged, Hungary
- Department of Cell Biology and Molecular Medicine, Albert Szent-Györgyi Medical School and Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
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13
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Enders M, Weier A, Chunder R, An Y, Bremm F, Feigenspan A, Buettner C, Ekici AB, Mingardo E, Odermatt B, Kuerten S. Impact of the Voltage-Gated Calcium Channel Antagonist Nimodipine on the Development of Oligodendrocyte Precursor Cells. Int J Mol Sci 2023; 24. [PMID: 36835129 DOI: 10.3390/ijms24043716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 02/17/2023] Open
Abstract
Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system (CNS). While most of the current treatment strategies focus on immune cell regulation, except for the drug siponimod, there is no therapeutic intervention that primarily aims at neuroprotection and remyelination. Recently, nimodipine showed a beneficial and remyelinating effect in experimental autoimmune encephalomyelitis (EAE), a mouse model of MS. Nimodipine also positively affected astrocytes, neurons, and mature oligodendrocytes. Here we investigated the effects of nimodipine, an L-type voltage-gated calcium channel antagonist, on the expression profile of myelin genes and proteins in the oligodendrocyte precursor cell (OPC) line Oli-Neu and in primary OPCs. Our data indicate that nimodipine does not have any effect on myelin-related gene and protein expression. Furthermore, nimodipine treatment did not result in any morphological changes in these cells. However, RNA sequencing and bioinformatic analyses identified potential micro (mi)RNA that could support myelination after nimodipine treatment compared to a dimethyl sulfoxide (DMSO) control. Additionally, we treated zebrafish with nimodipine and observed a significant increase in the number of mature oligodendrocytes (* p≤ 0.05). Taken together, nimodipine seems to have different positive effects on OPCs and mature oligodendrocytes.
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14
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Al-Saedi HF, Panahi Y, Ghanimi HA, Abdolmaleki A, Asadi A. Enhancement of nerve regeneration with nimodipine treatment after sciatic nerve injury. Fundam Clin Pharmacol 2023; 37:107-115. [PMID: 35989463 DOI: 10.1111/fcp.12827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/02/2022] [Accepted: 08/18/2022] [Indexed: 01/25/2023]
Abstract
Peripheral nerve injuries (PNI/s) are common orthopedic conditions, characterized by motor and sensory deficits in the damaged region. There is growing evidence that the L-type calcium channel antagonist nimodipine has neuroprotective and neuroregenerative effects in animal models of neurological disorders. The efficacy of nimodipine on improving motor function and sensation following a sciatic nerve crush model was investigated in male Wistar rats as a model of PNI. At different time periods following damage, we evaluated motor function, sensory recovery, electrophysiology, histomorphometry, and gene expression. Moreover, we used histological and mass ratio analysis of the gastrocnemius muscle to assess atrophy. Our findings suggest that the nimodipine improves motor and sensory function more quickly in the damaged region 2, 4, and 6 weeks after 1 week of treatment. Nimodipine treatment also increased the number of myelinated fibers while decreasing their thickness, as shown by histomorphometry. Additionally, nimodipine treatment increases the mRNA levels of neurotrophic factors (BDNF and NGF), which are known to contribute to the regeneration of injured neurons. The impact of nimodipine in PNI recovery may be due to its stimulation of the CREB signaling pathway and suppression of pro-inflammatory factor production.
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Affiliation(s)
| | - Yasin Panahi
- Department of Pharmacology and Toxicology, School of Pharmacy, Ardabil University of Medical Sciences (ArUMS), Ardabil, Iran
| | | | - Arash Abdolmaleki
- Department of Biophysics, Faculty of Advanced Technologies, University of Mohaghegh Ardabili, Namin, Iran
| | - Asadollah Asadi
- Department of Biology, Faculty of Science, University of Mohaghegh Ardabili, Ardabil, Iran
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15
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Kong Q, Gao N, Wang Y, Hu G, Qian J, Chen B. Functional evaluation of cyclosporine metabolism by CYP3A4 variants and potential drug interactions. Front Pharmacol 2023; 13:1044817. [PMID: 36686709 PMCID: PMC9852833 DOI: 10.3389/fphar.2022.1044817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/12/2022] [Indexed: 01/09/2023] Open
Abstract
The aim of this study is to investigate the effects of CYP3A4 genetic polymorphisms on the metabolism of cyclosporine (CsA) in vitro and identify drugs that interact with CsA. An enzymatic incubation system was developed to evaluate the kinetic parameters of CYP3A4 on CsA catalysis. A total of 132 drugs were screened to identify potential drug-drug interactions. Sprague-Dawley rats were used to determine the interaction between CsA and nimodipine and nisoldipine. The metabolite AM1 was measured by ultra-performance liquid chromatography-tandem mass spectrometry. The results demonstrate that 16 CYP3A4 variants (CYP3A4.7, 8, 9, 12, 13, 14, 16, 18, 19, 23, 24, 28, 31, 32, 33, and 34) have a lower metabolic capacity for CsA, ranging from 7.19% to 72.10%, than CYP3A4.1. In contrast, the relative clearance rate of CYP3A4.5 is significantly higher than that of CYP3A4.1. Moreover, CYP3A4.20 loses its catalytic ability, and five other variants have no significant difference. A total of 12 drugs, especially calcium channel blockers, were found to remarkably inhibit the metabolism of CsA with an inhibitory rate of over 80%. Nimodipine inhibits the activity of CsA in rat liver microsomes with an IC50 of 20.54 ± 0.93 μM, while nisoldipine has an IC50 of 16.16 ± 0.78 μM. In in vivo, three groups of Sprague-Dawley rats were administered CsA with or without nimodipine or nisoldipine; the AUC(0-t) and AUC(0-∞) of CsA were significantly increased in the nimodipine group but not obviously in the nisoldipine group. Mechanistically, the inhibition mode of nimodipine on cyclosporine metabolism is a mixed inhibition. Our data show that gene polymorphisms of CYP3A4 and nimodipine remarkably affect the metabolism of CsA, thus providing a reference for the precise administration of CsA.
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Affiliation(s)
| | | | | | - Guoxin Hu
- *Correspondence: Guoxin Hu, ; Jianchang Qian, ; Bingbing Chen,
| | - Jianchang Qian
- *Correspondence: Guoxin Hu, ; Jianchang Qian, ; Bingbing Chen,
| | - Bingbing Chen
- *Correspondence: Guoxin Hu, ; Jianchang Qian, ; Bingbing Chen,
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16
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Yang X, Han M, Wang X, Wang J, Sun X, Zhang C, Yan S, Huang L, Chen Y. Evaluation of the synergistic effects of epigallocatechin-3-gallate-loaded PEGylated-PLGA nanoparticles with nimodipine against neuronal injury after subarachnoid hemorrhage. Front Nutr 2023; 9:953326. [PMID: 36687668 PMCID: PMC9845867 DOI: 10.3389/fnut.2022.953326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/25/2022] [Indexed: 01/05/2023] Open
Abstract
Subarachnoid hemorrhage (SAH) is a devastating subtype of stroke with high mortality and morbidity. Although serious side effects might occur, nimodipine, a second-generation 1,4-dihydropyridine calcium channel blocker, is clinically used to improve neurological outcomes after SAH. Recently, (-)-epigallocatechin-3-gallate (EGCG) has been reported to inhibit Ca2+ overloading-induced mitochondrial dysfunction, oxidative stress, and neuronal cell death after SAH; however, low bioavailability, instability, and cytotoxicity at a high dose limited the clinical application of EGCG. To overcome these limitations, PEGylated-PLGA EGCG nanoparticles (EGCG-NPs) were constructed to enhance the bioavailability by using the double-emulsion method. Antioxidative activity, cytotoxicity, behavioral, and immunohistochemistry studies were carried out to determine the neuroprotective effectiveness after cotreatment with EGCG-NPs (75 mg/kg/d preconditioning for 7 days before SAH) and nimodipine (10 mg/kg/d after 30 min of SAH) by using in vivo SAH models. The optimized EGCG-NPs with a Box-Behnken design showed a small particle size of 167 nm, a zeta potential value of -22.6 mV, an encapsulation efficiency of 86%, and a sustained-release profile up to 8 days in vitro. Furthermore, EGCG-NPs (75 mg/kg/d) had superior antioxidative activity to free EGCG (100 mg/kg/d). EGCG-NPs combined with nimodipine exhibited significant synergistic effects against neuronal cell death by suppressing oxidative stress, Ca2+ overloading, mitochondrial dysfunction, and autophagy after SAH. These results suggest that cotreatment with EGCG-NPs and nimodipine may serve as a promising novel strategy for the treatment of SAH.
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Affiliation(s)
- Xianguang Yang
- College of Life Sciences, Henan Normal University, Xinxiang, Henan, China
| | - Mengguo Han
- College of Life Sciences, Henan Normal University, Xinxiang, Henan, China
| | - Xue Wang
- College of Life Sciences, Henan Normal University, Xinxiang, Henan, China
| | - Jian Wang
- College of Life Sciences, Henan Normal University, Xinxiang, Henan, China
| | - Xiaoxue Sun
- College of Life Sciences, Henan Normal University, Xinxiang, Henan, China
| | - Chunyan Zhang
- College of Life Sciences, Henan Normal University, Xinxiang, Henan, China
| | - Shuaiguo Yan
- College of Life Sciences, Henan Normal University, Xinxiang, Henan, China
| | - Liyong Huang
- Department of Neurosurgery, The First Affiliated Hospital of Xinxiang Medical University, Henan, China,Henan Key Laboratory of Neurorestoratology, The First Affiliated Hospital of Xinxiang Medical University, Henan, China,Liyong Huang ✉
| | - Ying Chen
- College of Life Sciences, Henan Normal University, Xinxiang, Henan, China,*Correspondence: Ying Chen ✉
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17
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Topcu A, Saral S, Ozturk A, Saral O, Kaya AK. The effect of the calcium channel blocker nimodipine on hippocampal BDNF/Ach levels in rats with experimental cognitive impairment. Neurol Res 2023; 45:544-553. [PMID: 36598971 DOI: 10.1080/01616412.2022.2164452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Alzheimer's disease (AD) occurs in approximately 10% to 30% of individuals aged 65 or older worldwide. Novel therapeutic agents therefore need to be discovered in addition to traditional medications. Nimodipine appears to possess the potential to reverse cognitive impairment-induced dysfunction in learning and memory through its regulatory effect on the brain-derived neurotrophic factor (BDNF), acetylcholine (Ach), and acetylcholinesterase (AChE) pathway in the hippocampus and prefrontal cortex. METHODS Twenty-four male Sprague Dawley rats weighing 380 ± 10 g were used for behavioral and biochemical analyses. These were randomly and equally assigned into one of three groups. Group 1 received saline solution alone via the intraperitoneal (i.p) route, and Group 2 received 1 mg/kg/day i.p. scopolamine once a day for three weeks for induction of learning and memory impairments. In Group 3, 10 mg/kg/day nimodipine was prepared in tap water and administered orally every day for three weeks, followed after 30 min by 1 mg/kg/day scopolamine i.p. Behavior was evaluated using the Morris Water Maze test. BDNF, ACh, and AChE levels were determined using the ELISA test in line with the manufacturer's instructions. RESULTS Nimodipine treatment significantly increased the time spent in the target quadrant and the number of entries into the target quadrant compared to the scopolamine group alone. Additionally, BDNF and ACh levels in the hippocampus and prefrontal cortex decreased following 20-day scopolamine administration, while AChE activation increased. CONCLUSION Nimodipine exhibited potentially beneficial effects by ameliorating cognitive decline following scopolamine administration in the hippocampus and prefrontal cortex.
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Affiliation(s)
- Atilla Topcu
- Department of Pharmacology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Türkiye
| | - Sinan Saral
- Department of Physiology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Türkiye
| | - Aykut Ozturk
- Department of Pharmacology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Türkiye
| | - Ozlem Saral
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Recep Tayyip Erdogan University, Rize, Türkiye
| | - Ali Koray Kaya
- Department of Physiology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Türkiye
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18
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Romanov DV, Sheyanov AM, Samsonova MD, Iuzbashian PG. [ Nimodipine in treatment of bipolar disorder]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:20-26. [PMID: 38147378 DOI: 10.17116/jnevro202312312120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
The purpose of this review is to correlate current data on the molecular mechanisms of action of the drug Nimodipine with its clinical effects and applicability in mental disorders belonging to the spectrum of affective pathology. The article discusses the prospects for using the calcium channel blocker nimodipine as a method of both mono and combination therapy for bipolar disorders with various types of course. Nimodipine is a selective blocker of voltage-dependent calcium channels, a dihydropyridine derivative. By blocking L type calcium channels, it prevents the entry of calcium ions into the cell. Due to its pronounced ability to penetrate the blood-brain barrier, it has a selective effect on brain neurons and has a vasodilating, antihypertensive and normotimic effect. Nimodipine blocks LTCC channels in brain neurons, thereby influencing synaptic plasticity, transmitter release and excitation-transcription coupling, which makes it possible to influence various clinical conditions with pathology in the area of affect, including bipolar disorders with ultra-rapid cycling, and also, in cases with high resistance and intolerance to other mood stabilizers.
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Affiliation(s)
- D V Romanov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Mental Health Research Center, Moscow, Russia
| | - A M Sheyanov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - M D Samsonova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - P G Iuzbashian
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Faropoulos K, Tsolaki V, Georgakopoulou VE, Trakas I, Tarantinos K, Papalexis P, Spandidos DA, Aravantinou-Fatorou A, Mathioudakis N, Trakas N, Fotakopoulos G. Efficacy of combined intravenous plus intrathecal nimodipine administration in patients with severe cerebral vasospasm post‑aneurysmal subarachnoid hemorrhage: A retrospective cohort study. Med Int (Lond) 2022; 3:3. [PMID: 36699659 PMCID: PMC9829231 DOI: 10.3892/mi.2022.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
Aneurysmal subarachnoid hemorrhage (aSAH) and the ensuing cerebral vasospasm (CV) and delayed cerebral ischemia (DCI) comprise the main reasons for morbidity and mortality in affected patients. The present study aimed to evaluate the efficacy of the use of combined intravenous (IV) and intrathecal (IT) nimodipine therapy for preventing permanent neurological deterioration and DCI in patients suffering from CV post-hemorrhage. The evaluation was performed using computed tomography perfusion and transcranial doppler ultrasound. The present retrospective cohort study analyzed 14 out of 146 patients diagnosed with vasospasm due to spontaneous or aSAH. These patients were divided into two groups as follows: i) The IV group, which included patients treated with only IV nimodipine; and ii) the IV + IT group, which included patients who received IV nimodipine in combination with IT nimodipine. Of the 14 patients, 7 patients were males (50%), and the mean age was 50.9 years (SD ±19 years). In total, 6 patients [42.8%; 5 (35.7%) from group A and 1 (7.1%) from group B], who experienced clinical symptoms with severe CV, were administered intra-arterial calcium channel therapy or/and IT nimodipine following the early identification of symptomatic vasospasm. The rate of adverse ischemic events was lower with IT nimodipine management during the 1 month of follow-up (6 vs. 2 events; odds ratio, 15.00; 95% confidence interval, 1.03-218.31; P=0.031). On the whole, the findings of the present study suggest that the combined use of IT nimodipine with IV admission for patients post-aSAH who developed severe CV is a safe procedure that may prevent permanent neurological deterioration and delay unfavorable ischemic incidents.
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Affiliation(s)
| | - Vasiliki Tsolaki
- Department of Pulmonary and Critical Care Medicine, General University Hospital of Larisa, 41221 Larisa, Greece
| | - Vasiliki Epameinondas Georgakopoulou
- Department of Infectious Diseases-COVID-19 Unit, Laiko General Hospital, 11527 Athens, Greece,Correspondence to: Dr Vasiliki Epameinondas Georgakopoulou, Department of Infectious Diseases-COVID-19 Unit, Laiko General Hospital, 17 Agiou Thoma Street, 11527 Athens, Greece NULL
| | - Ilias Trakas
- Department of Infectious Diseases-COVID-19 Unit, Laiko General Hospital, 11527 Athens, Greece
| | - Kyriakos Tarantinos
- First Department of Pulmonology, Sismanogleio Hospital, 15126 Athens, Greece
| | - Petros Papalexis
- Unit of Endocrinology, First Department of Internal Medicine, Laiko General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece,Department of Biomedical Sciences, University of West Attica, 12243 Athens, Greece
| | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Aikaterini Aravantinou-Fatorou
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | | | - Nikolaos Trakas
- Department of Biochemistry, Sismanogleio Hospital, 15126 Athens, Greece
| | - George Fotakopoulos
- Department of Neurosurgery, General University Hospital of Larisa, 41221 Larisa, Greece
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Koopman I, van Wijngaarden PB, Rinkel GJE, Vergouwen MDI. Devastating delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. Front Neurol 2022; 13:1016111. [PMID: 36313513 PMCID: PMC9606612 DOI: 10.3389/fneur.2022.1016111] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/13/2022] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND We investigated the proportion of patients in an initial good clinical condition who developed devastating DCI, and aimed to characterize these patients by aneurysm location, blood pressure instability prior to DCI, and the extent of cerebral ischemia. METHODS We included aSAH patients admitted between 2010 and 2021 with a Glasgow Coma Scale of 11 or higher 24 h after aneurysm treatment, who developed devastating DCI, defined as DCI leading to coma for at least 48 h with cerebral infarction on the subsequent scan. Blood pressure instability was defined as nimodipine-induced blood pressure drops, dosage adjustments, or the use of blood pressure drugs before onset of DCI. Descriptive statistics were used to summarize the data. RESULTS Out of 1,211 consecutive aSAH patients, 617 patients had a good clinical condition after aneurysm treatment of whom 16 (3%) patients [14 (88%) women] were included in this study. Thirteen (81%) patients had an aneurysm in the anterior circulation. Thirteen patients (81%) had blood pressure instability: twelve (75%) had nimodipine-induced blood pressure drops, eleven (69%) received antihypertensive drugs, and 7 (44%) received hypertension induction before onset of DCI. Thirteen (81%) patients had bilateral ischemia, mainly in the anterior circulation (56%). CONCLUSIONS The proportion of aSAH patients with a good clinical condition after aneurysm treatment who develop devastating DCI is small. The vast majority of these patients had blood pressure instability. Future studies are needed to investigate if a reduction in the number and extent of blood pressure fluctuations decreases the incidence of devastating DCI.
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Affiliation(s)
| | | | | | - Mervyn D. I. Vergouwen
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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21
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Abd Elhaleem SM, Shalan S, Belal F, Elsebaei F. Insights for applying N,S-doped carbon dots as a fluorescent nanoprobe for estimation of some nitro-calcium channel blockers. R Soc Open Sci 2022; 9:220609. [PMID: 36303941 PMCID: PMC9597176 DOI: 10.1098/rsos.220609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
A facile and simple one-step hydrothermal approach was adopted for fabrication of N and S co-doped carbon quantum dots probe (NSCDs) by using thiosemicarbazide as a dopant and citric acid as a precursor. The prepared NSCDs with a high quantum yield of 0.58 were characterized using UV-visible spectroscopy, IR spectroscopy and high-resolution transmission electron microscopy. The as-obtained NSCDs could be deemed as an effective fluorescent nanosensor for the determination of some anti-hypertensive nitro-calcium channel blockers (Nitro-CCBs) including nicardipine (NIC), nifedipine (NIF) and nimodipine (NIM) whether in pure form or in their pharmaceutical formulations. Measurements of NSCD emission intensity were performed at 416 nm after being excited at 345 nm. Nitro-CCBs could induce quenching in the native fluorescence of NSCDs due to the inner filter effect and static quenching mechanism. The studied compounds were investigated within linear detection range of (10.0-100.0 µM) for NIC, (5.0-60.0 µM) for NIF and (5.0-60.0 µM) for NIM. Correlation coefficients are greater than or equal to 0.9998 and detection limits are ranged between 0.55 and 1.86 µM. The proposed method was extended to estimate the studied compounds in different pharmaceutical samples with high % recoveries ranging from (97.95 to 101.28%) and low % relative standard deviation values (less than 2%). Validation of the developed spectrofluorimetric method was done along with the International Council of Harmonization requirements.
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Affiliation(s)
- Shymaa M. Abd Elhaleem
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt
| | - Sh. Shalan
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt
| | - F. Belal
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt
| | - F. Elsebaei
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt
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22
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Yang Q, Liu J, Huang KL, Wang GY, Wang MY, Tan AH, Ran SM. A systematic review of the efficacy of donepezil hydrochloride combined with nimodipine on treating vascular dementia. Medicine (Baltimore) 2022; 101:e29307. [PMID: 35945739 PMCID: PMC9351939 DOI: 10.1097/md.0000000000029307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Vascular dementia (VaD) is a comprehensive syndrome related to the damage of cognitive function and various cerebral vascular illnesses. VaD is also generally recognized as the second most common type of dementia after Alzheimer disease, contributing to 30% of the dementia population in Asia and developing countries. The ability of donepezil hydrochloride and nimodipine had been respectively proven in improving cognitive function in vascular dementia. However, whether the combined application of both drugs contribute to better efficacy remains as a research hotspot. Studies had shown definite satisfactory result with such combination, however evidence-based evaluation of the efficacy is still lacking. Therefore, meta-analysis is employed in this study to evaluate the efficacy and safety of using donepezil hydrochloride combined with nimodipine in treating VaD to provide references for clinical treatments. The efficacy of donepezil hydrochloride combined with nimodipine on treating vascular dementia is systematically reviewed to provide evidence-based references for clinical applications. METHODS Both Chinese and English databases were searched from the start till August, 2020 for any RCT regarding the combined use of the 2 drugs in treating vascular dementia. Two investigators would later evaluate and screened out research and data based on an improved Jaded scale. Software Rev Man 5.3.0 was employed to carry out meta-analysis on clinical effificacy, mini-mental state examination (MMSE) ratings, activity of daily living (ADL) ratings, and clinical dementia scale (CDR) ratings. RESULTS Donepezil hydrochloride combined with nimodipine had demonstrated satisfactory efficacy on the treatment of vascular dementia. Improvements were namely spotted on MMSE scale, ADL scale, and CDR scale, with the utmost efficacy by 12 weeks after intervention. CONCLUSIONS Donepezil hydrochloride combined with nimodipine had good efficacy in the treatment of patients with vascular dementia, mainly in terms of improving the Simple MMSE scores, the ability to use daily living scale (ADL) scores and the CDR, and the best results were obtained after 12 weeks of intervention. Such conclusion should be cautiously evaluated.
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Affiliation(s)
- Qiang Yang
- Minda Hospital of Hubei Minzu University, Enshi, Hubei, China
| | - Jia Liu
- Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Kai-lin Huang
- Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Guang-yao Wang
- The First Affiliated Hospital of Guangxi University of Chinese Medicine, Guangxi, China
| | - Mi-yuan Wang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ai-hua Tan
- Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
- HuangGang Hospital of TCM Affifiliated to Hubei University of Chinese Medicine, Huang Gang, Hubei, China
- Institute of Geriatrics, Hubei University of Chinese Medicine, Hubei, China
| | - Si-miao Ran
- HuangGang Hospital of TCM Affifiliated to Hubei University of Chinese Medicine, Huang Gang, Hubei, China
- Institute of Geriatrics, Hubei University of Chinese Medicine, Hubei, China
- *Correspondence: Si-miao Ran, HuangGang Hospital of TCM Affiliated to Hubei University of Chinese Medicine, Huang Gang, 438000, Hubei, China (e-mail: )
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Han Z, Han Y, Huang X, Ma H, Zhang X, Song J, Dong J, Li S, Yu R, Liu H. A Novel Targeted Nanoparticle for Traumatic Brain Injury Treatment: Combined Effect of ROS Depletion and Calcium Overload Inhibition. Adv Healthc Mater 2022; 11:e2102256. [PMID: 35118827 DOI: 10.1002/adhm.202102256] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/25/2021] [Indexed: 12/11/2022]
Abstract
Survival after severe traumatic brain injury (TBI) depends on minimizing or avoiding secondary insults to the brain. Overproduction of reactive oxygen species (ROS) and Ca2+ influx at the damaged site are the key factors that cause secondary injury upon TBI. Herein, a TBI-targeted lipid covered radical scavenger nanoparticle is developed to deliver nimodipine (Np) (CL-PPS/Np), in order to inhibit Ca2+ influx in neurons by Np and to scavenge ROS in the brain trauma microenvironment by poly(propylene sulfide)60 (PPS60 ) and thus prevent TBI-associated secondary injury. In post-TBI models, CL-PPS/Np effectively accumulates into the wound cavity and prolongs the time of systemic circulation of Np. CL-PPS/Np can markedly protect the integrity of blood-brain barrier, prevent brain edema, reduce cell death and inflammatory responses, and promote functional recovery after TBI. These findings may provide a new therapy for TBI to prevent the spread of the secondary injury.
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Affiliation(s)
- Zhengzhong Han
- Institute of Nervous System Diseases Xuzhou Medical University Xuzhou 221002 P. R. China
- Department of Biomedical Engineering Southern University of Science and Technology Shenzhen Guangdong 518055 P. R. China
| | - Yuhan Han
- Institute of Nervous System Diseases Xuzhou Medical University Xuzhou 221002 P. R. China
| | - Xuyang Huang
- Institute of Nervous System Diseases Xuzhou Medical University Xuzhou 221002 P. R. China
- Department of Neurosurgery Affiliated Hospital of Xuzhou Medical University Xuzhou 221002 P. R. China
| | - Hongwei Ma
- Institute of Nervous System Diseases Xuzhou Medical University Xuzhou 221002 P. R. China
| | - Xuefeng Zhang
- Institute of Nervous System Diseases Xuzhou Medical University Xuzhou 221002 P. R. China
| | - Jingyuan Song
- School of Nursing Xuzhou Medical University Xuzhou 221002 P. R. China
| | - Jun Dong
- Department of Neurosurgery the Second Affiliated Hospital of Suzhou University Suzhou 215000 China
| | - Shanshan Li
- Jiangsu Medical Engineering Research Center of Gene Detection and Department of Forensic Medicine Xuzhou Medical University Xuzhou 221002 P. R. China
| | - Rutong Yu
- Institute of Nervous System Diseases Xuzhou Medical University Xuzhou 221002 P. R. China
- Department of Neurosurgery Affiliated Hospital of Xuzhou Medical University Xuzhou 221002 P. R. China
| | - Hongmei Liu
- Institute of Nervous System Diseases Xuzhou Medical University Xuzhou 221002 P. R. China
- Department of Biomedical Engineering Southern University of Science and Technology Shenzhen Guangdong 518055 P. R. China
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24
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Song W, Martin JH. Trans-Spinal Direct Current Stimulation Targets Ca 2+ Channels to Induce Persistent Motor Unit Responses. Front Neurosci 2022; 16:856948. [PMID: 35546896 PMCID: PMC9081846 DOI: 10.3389/fnins.2022.856948] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/04/2022] [Indexed: 01/13/2023] Open
Abstract
Trans-spinal direct current stimulation (tsDCS) is a neuromodulatory approach to augment spinal cord activity to improve function after neurological disease and injury. Little is known about the mechanisms underlying tsDCS actions on the motor system. The purpose of this study is to determine the role for a persistent inward current (PIC)-like response in motoneurons in mediating tsDCS actions. We recorded single motor units from the extensor and flexor carpi radialis muscles in healthy sedated rats and measured unit activity changes produced by cervical enlargement cathodal and anodal tsDCS (c-tsDCS; a-tsDCS). Both c-tsDCS and a-tsDCS immediately increased spontaneous motor unit firing during stimulation. After c-tsDCS was stopped, spontaneous firing persisted for a substantial period (165 ± 5s), yet after a-tsDCS activity shortly returned to baseline (27 ± 7s). Administration of the L-type calcium channel blocker Nimodipine reduced spontaneous motor unit firing during c-tsDCS and blocked the persistent response. By contrast, Nimodipine did not change unit firing during a-tsDCS but the short persistent response was blocked. Computer simulation using a two-compartment neuronal model replicated the main experimental observations: larger and more persistent responses during and after c-tsDCS than a-tsDCS. Using reduced Ca2+ conductance to model Nimodipine action, a reduced response during c-tsDCS and elimination of the persistent response was observed. Our experimental findings, supported by computer simulation, show that c-tsDCS can target Ca2+ conductances to augment motoneuron activity. As tsDCS is well-tolerated in humans, this knowledge informs therapeutic treatment strategies to achieve rehabilitation goals after injury; in particular, to increase muscle force.
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Affiliation(s)
- Weiguo Song
- Department of Molecular, Cellular, and Biomedical Sciences, Center for Discovery and Innovation, City University of New York School of Medicine, New York, NY, United States.,Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - John H Martin
- Department of Molecular, Cellular, and Biomedical Sciences, Center for Discovery and Innovation, City University of New York School of Medicine, New York, NY, United States.,Neuroscience Program, Graduate Center of the City University of New York, New York, NY, United States
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Novac M, Musuc AM, Ozon EA, Sarbu I, Mitu MA, Rusu A, Gheorghe D, Petrescu S, Atkinson I, Lupuliasa D. Manufacturing and Assessing the New Orally Disintegrating Tablets, Containing Nimodipine-hydroxypropyl-β-cyclodextrin and Nimodipine-methyl-β-cyclodextrin Inclusion Complexes. Molecules 2022; 27:molecules27062012. [PMID: 35335371 PMCID: PMC8955142 DOI: 10.3390/molecules27062012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/15/2022] [Accepted: 03/19/2022] [Indexed: 01/10/2023] Open
Abstract
The aim of the present study was to manufacture new orally disintegrating tablets containing nimodipine-hydroxypropyl-β-cyclodextrin and nimodipine-methyl-β-cyclodextrin inclusion complexes. For obtaining a better quality of the manufactured tablets, three methods of the preparation of inclusion complexes, in a 1:1 molar ratio, were used comparatively; namely, a solid-state kneading method and two liquid state coprecipitation and lyophilization techniques. The physical and chemical properties of the obtained inclusion complexes, as well as their physical mixtures, were investigated using Fourier transformed infrared spectroscopy, scanning electron microscopy, X-ray diffraction analyses, and differential scanning calorimetry. The results showed that the lyophilization method can be successfully used for a better complexation. Finally, the formulation and precompression studies for tablets for oral dispersion, containing Nim-HP-β-CD and Nim-Me-β-CD inclusion complexes, were successfully assessed.
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Affiliation(s)
- Marian Novac
- Department of Pharmaceutical Technology and Biopharmacy, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 6 Traian Vuia Street, 020945 Bucharest, Romania; (M.N.); (D.L.)
| | - Adina Magdalena Musuc
- “Ilie Murgulescu” Institute of Physical Chemistry, 202 Spl. Independentei, 060021 Bucharest, Romania; (A.R.); (D.G.); (S.P.); (I.A.)
- Correspondence: (A.M.M.); (E.A.O.); (I.S.); (M.A.M.)
| | - Emma Adriana Ozon
- Department of Pharmaceutical Technology and Biopharmacy, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 6 Traian Vuia Street, 020945 Bucharest, Romania; (M.N.); (D.L.)
- Correspondence: (A.M.M.); (E.A.O.); (I.S.); (M.A.M.)
| | - Iulian Sarbu
- Department of Pharmaceutical Physics and Biophysics, Drug Industry and Pharmaceutical Biotechnologies, Faculty of Pharmacy, “Titu Maiorescu” University, 004051 Bucharest, Romania
- Correspondence: (A.M.M.); (E.A.O.); (I.S.); (M.A.M.)
| | - Mirela Adriana Mitu
- Department of Pharmaceutical Technology and Biopharmacy, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 6 Traian Vuia Street, 020945 Bucharest, Romania; (M.N.); (D.L.)
- Correspondence: (A.M.M.); (E.A.O.); (I.S.); (M.A.M.)
| | - Adriana Rusu
- “Ilie Murgulescu” Institute of Physical Chemistry, 202 Spl. Independentei, 060021 Bucharest, Romania; (A.R.); (D.G.); (S.P.); (I.A.)
| | - Daniela Gheorghe
- “Ilie Murgulescu” Institute of Physical Chemistry, 202 Spl. Independentei, 060021 Bucharest, Romania; (A.R.); (D.G.); (S.P.); (I.A.)
| | - Simona Petrescu
- “Ilie Murgulescu” Institute of Physical Chemistry, 202 Spl. Independentei, 060021 Bucharest, Romania; (A.R.); (D.G.); (S.P.); (I.A.)
| | - Irina Atkinson
- “Ilie Murgulescu” Institute of Physical Chemistry, 202 Spl. Independentei, 060021 Bucharest, Romania; (A.R.); (D.G.); (S.P.); (I.A.)
| | - Dumitru Lupuliasa
- Department of Pharmaceutical Technology and Biopharmacy, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 6 Traian Vuia Street, 020945 Bucharest, Romania; (M.N.); (D.L.)
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26
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Zhang T, Xiao Y, Li S. Safety and efficacy of nimodipine combined with flunarizine in patients with angioneurotic headache. Am J Transl Res 2022; 14:511-517. [PMID: 35173871 PMCID: PMC8829639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/23/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To observe the role of nimodipine combined with flunarizine on angioneurotic headache. METHODS Altogether 101 patients with angioneurotic headache were divided into the control group (CG, n=51) and the therapy group (TG, n=50). Patients in the CG were given nimodipine, while patients in the TG were given flunarizine on the basis of nimodipine. The clinical efficacy and adverse reactions of patients were observed. RESULTS After treatment, the Visual analog scale (VAS) scores of the TG were markedly lower than those in the CG, and the number of attacks and headache duration of patients in the TG were also markedly reduced. Observation of the clinical efficacy showed that the effective rate of the TG was markedly higher than that of the CG, but no additional adverse reactions were found. In addition, after treatment, the cerebral hemodynamics and quality of life of patients were improved. CONCLUSION Nimodipine combined with flunarizine can better promote the recovery of patients with angioneurotic headache and improve their quality of life.
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Affiliation(s)
- Tao Zhang
- Department of Neurology, Qijiang District People’s HospitalQijiang 401420, Chongqing, China
| | - Yao Xiao
- Medical Equipment Department of Chongqing Qijiang District People’s HospitalQijiang 401420, Chongqing, China
| | - Shengquan Li
- Department of Neurology, Qijiang District People’s HospitalQijiang 401420, Chongqing, China
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27
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He H, Chen X. Luteolin Attenuates Cognitive Dysfunction Induced By Chronic Cerebral Hypoperfusion Through the Modulation of The PI3K/Akt Pathway in Rats. J Vet Res 2021; 65:341-9. [PMID: 34917848 DOI: 10.2478/jvetres-2021-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 06/16/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction In our study, we evaluated the beneficial effect of luteolin in the treatment of cognitive dysfunction in rat models induced by cerebral hypoperfusion by two-vessel occlusion (2-VO). Material and Methods Seventy-five male Sprague Dawley rats were subjected to 2-VO surgery, in all but 15 (the sham group, group I) the ligation being permanent to impair cognitive abilities. The sham group rats received saline instead of a drug; 15 2-VO rats were not injected at all (the model group, group II); 15 2-VO rats were administered luteolin at 50 mg/kg b.w. (the lut 50 group, group III); to a further 15 luteolin was given at 100 mg/kg b.w. (the lut 100 group, group IV); and the final 15 received nimodipine at 16 mg/kg b.w. as positive controls (the nimodipine group, group V). Object recognition and Morris water maze tests were performed to investigate memory ability. A Western blot test was also conducted to assess expression of phosphatidylinositol 3-kinase (PI3K), its downstream target protein kinase B (Akt), and the phosphorylated form (P-Akt) in cerebral cortex and hippocampus tissue samples. Results Significant variations in the discrimination index in the object recognition test, the escape latencies in the Morris water maze test, and expression levels of PI3K-p110α and PI3K-p85 were observed three months after 2-VO surgery in both lut groups, with a significant change in the nimodipine group compared to the model group. P-Akt and Akt were expressed significantly higher in both lut groups and the nimodipine group than in the model group. Conclusion Luteolin treatment of rats cognitively dysfunctional after experimental cerebral hypo perfusion was neuroprotective by activating the PI3K/Akt signals which inhibit neuronal death in the cerebral cortex and hippocampal region.
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Göttsche J, Schweingruber N, Groth JC, Gerloff C, Westphal M, Czorlich P. Safety and Clinical Effects of Switching From Intravenous to Oral Nimodipine Administration in Aneurysmal Subarachnoid Hemorrhage. Front Neurol 2021; 12:748413. [PMID: 34867733 PMCID: PMC8636241 DOI: 10.3389/fneur.2021.748413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Several guidelines recommend oral administration of nimodipine as vasospasm prophylaxis after aneurysmal subarachnoid hemorrhage (SAH). However, in clinical practice, the drug is administered orally and intravenously (i.v.), depending on clinical conditions and local treatment regimens. We have therefore investigated the safety and clinical effects of switching from i.v. to oral nimodipine therapy. Methods: Patients with aneurysmal SAH between January 2014 and April 2018 and initial i.v. nimodipine therapy, which was subsequently switched to oral administration, were included in this retrospective study. Transcranial Doppler sonography (TCD) of the vessels of the anterior circulation was performed daily. The occurrence of vasospasm and infarction during the overall course of the treatment was recorded. Statistical level of significance was set to p < 0.05. Results: A total of 133 patients (mean age 55.8 years, 65% female) initially received nimodipine i.v. after aneurysmal SAH, which was subsequently switched to oral administration after a mean of 12 days. There were no significant increases in mean flow velocities on TCD after the switch from i.v. to oral nimodipine administration regarding the anterior cerebral artery. For the middle cerebral artery, an increase from 62.36 to 71.78 cm/sec could only be detected in the subgroup of patients with infarction. There was no clustering of complicating events such as new-onset vasospasm or infarction during or after the switch. Conclusions: Our results do not point to any safety concerns when switching nimodipine from initial i.v. to oral administration. Switching was neither associated with clinically relevant increases in TCD velocities nor other relevant adverse events.
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Affiliation(s)
- Jennifer Göttsche
- Department of Neurosurgery, Hamburg University Medical Center, Hamburg, Germany
| | - Nils Schweingruber
- Department of Neurology, Hamburg University Medical Center, Hamburg, Germany
| | | | - Christian Gerloff
- Department of Neurology, Hamburg University Medical Center, Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, Hamburg University Medical Center, Hamburg, Germany
| | - Patrick Czorlich
- Department of Neurosurgery, Hamburg University Medical Center, Hamburg, Germany
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Jain C, Choudhary N, Bhatia V, Kumar A. Mechanical clot dissolution technique for surgical clip-related occlusions: An emergent triple-step approach. Brain Circ 2021; 7:207-210. [PMID: 34667905 PMCID: PMC8459686 DOI: 10.4103/bc.bc_58_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 04/15/2021] [Accepted: 05/18/2021] [Indexed: 11/04/2022] Open
Abstract
Cerebral ischemia following clipping of cerebral aneurysms constitutes major cause of morbidity and mortality. Clip-related injury to vessel, postoperative clip rotation, prolonged temporary occlusion, intraoperative rupture, and vasospasm are some etiological factors compromising forward flow in parent or branch vessel. On suspicion of compromised forward flow, immediate intraoperative evaluation is done to detect the cause of vascular compromise and further management is done by microsurgical or endovascular means. We describe a case of ruptured distal anterior cerebral artery (ACA) aneurysm complicated by occlusion of ACA after surgical clipping. The patient was managed by endovascular means by combined technique of intra-arterial nimodipine, antiplatelet infusion, and mechanical clot disruption using J-tip microwire.
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Affiliation(s)
- Chirag Jain
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Neha Choudhary
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Bhatia
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Kumar
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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30
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Guo F, Zheng X, He Z, Zhang R, Zhang S, Wang M, Chen H, Wang W. Nimodipine Promotes Functional Recovery After Spinal Cord Injury in Rats. Front Pharmacol 2021; 12:733420. [PMID: 34594224 PMCID: PMC8477750 DOI: 10.3389/fphar.2021.733420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/02/2021] [Indexed: 12/15/2022] Open
Abstract
Spinal cord injury (SCI) is a devastating condition that results in severe motor, sensory, and autonomic dysfunction. The L-/T-type calcium channel blocker nimodipine (NMD) exerts a protective effect on neuronal injury; however, the protective effects of long-term administration of NMD in subjects with SCI remain unknown. Thus, the aim of this study was to evaluate the role of long-term treatment with NMD on a clinically relevant SCI model. Female rats with SCI induced by 25 mm contusion were subcutaneously injected with vehicle or 10 mg/kg NMD daily for six consecutive weeks. We monitored the motor score, hind limb grip strength, pain-related behaviors, and bladder function in this study to assess the efficacy of NMD in rats with SCI. Rats treated with NMD showed improvements in locomotion, pain-related behaviors, and spasticity-like symptoms, but not in open-field spontaneous activity, hind limb grip strength or bladder function. SCI lesion areas and perilesional neuronal numbers, gliosis and calcitonin gene-related peptide (CGRP+) fiber sprouting in the lumbar spinal cord and the expression of K+–Cl− cotransporter 2 (KCC2) on lumbar motor neurons were also observed to further explore the possible protective mechanisms of NMD. NMD-treated rats showed greater tissue preservation with reduced lesion areas and increased perilesional neuronal sparing. NMD-treated rats also showed improvements in gliosis, CGRP+ fiber sprouting in the lumbar spinal cord, and KCC2 expression in lumbar motor neurons. Together, these results indicate that long-term treatment with NMD improves functional recovery after SCI, which may provide a potential therapeutic strategy for the treatment of SCI.
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Affiliation(s)
- Fangliang Guo
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaolong Zheng
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ziyu He
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ruoying Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Song Zhang
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Minghuan Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong Chen
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Qureshi I, Riaz A, Khan R, Baig M, Rajput MA. Effects of Pregabalin, Nimodipine, and Their Combination in the Inhibition of Status Epilepticus and the Prevention of Death in Mice. Turk J Pharm Sci 2021; 18:398-404. [PMID: 34496479 DOI: 10.4274/tjps.galenos.2020.95776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Objectives The current study aims to evaluate the combined antiepileptic effects of pregabalin (PGB) and nimodipine (NMD) in an acute seizure model of epilepsy in mice. Materials and Methods This study assessed the combined antiepileptic effects of PGB with NMD on death protection in mice. Pentylenetetrazole was used to induce seizures. Both drugs were used singly and in combination to judge anticonvulsant effects on an acute seizure model of epilepsy in mice. Diazepam (DZ) and valproate (VPT) were used as standard antiepileptic drugs. Results The death protection in mice by both these drugs was observed in percentage and deliberated as marked change when the outcome of the tested drug was equal to ED50 of PGB and measured highly marked when the result was more than ED50 for PGB. Treatment with pregabalin and nimodipine combination revealed substantial mortality protection at 30+2.5 mg/kg dose and highly marked at doses from 35+5 mg/kg to 55+15 mg/kg, these effects were superior to individual effects of PGB, showing synergism, however lesser then classic drugs valproate and diazepam. Conclusion NMD showed synergistic anticonvulsant effect with PGB. However, clinical studies are required to establish the effectiveness of this combination in humans.
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Affiliation(s)
- Itefaq Qureshi
- University of Karachi, Department of Pharmacology, Karachi, Pakistan
| | - Azra Riaz
- University of Karachi, Department of Pharmacology, Karachi, Pakistan
| | - Rafeeq Khan
- Ziauddin University, Faculty of Pharmacy, Karachi, Pakistan
| | - Moona Baig
- University of Karachi, Department of Pharmacology, Karachi, Pakistan
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Yu Y, Li Y, Jin Z, Zhao S, Xie X, Chen F. Nimodipine reduces delayed cerebral vasospasm after intracranial tumour surgery: A Retrospective Study. Clin Exp Pharmacol Physiol 2021; 48:1613-1620. [PMID: 34343357 DOI: 10.1111/1440-1681.13564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 07/18/2021] [Accepted: 07/29/2021] [Indexed: 11/28/2022]
Abstract
Cerebral vasospasm (CVS) is a frequent and serious neurosurgical complication, without sufficient therapy. This retrospective study was performed to analyze if nimodipine can improve prognosis and reduce ischaemia secondary to delayed CVS after intracranial tumour surgery. A retrospective review was performed over the years 2011 to 2012 for patients with an anterior cranial fossa tumour and underwent intracranial tumour surgery. The surgical field was soaked with nimodipine solution or normal saline. Transcranial Doppler ultrasonography was used to measure velocity in the middle cerebral artery (MCA) and the distal extracranial internal carotid artery (eICA). Follow-up was performed using the Glasgow Outcome Scale (GOS) after discharge. There were 94 patients that met the inclusion criteria. They included 50 males and 44 females, with a mean age of 49.6 years. In the nimodipine group, CVS occurred in 13 patients; 9 patients had CVS between 4 and 7 days, and 4 had CVS between 8 and 14 days. In the normal saline group, 19 patients had CVS, 3 presented with CVS within 3 days, 11 between 4-7 days and 5 between 8-14 days. A significant difference in the occurrence of CVS was observed between the two groups. Preoperative and postoperative the MCA velocities were compared, revealing a significant change in the normal saline group but not in the nimodipine group. Nimodipine markedly improves prognosis and significantly reduces ischaemia secondary to delayed CVS after intracranial tumour surgery, as well as the risks of mortality and morbidity.
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Affiliation(s)
- Ying Yu
- Department of Neurosurgery, First Hospital of Jilin University, Jilin, China
| | - Yunqian Li
- Department of Neurosurgery, First Hospital of Jilin University, Jilin, China
| | - Zheng Jin
- Department of Neurosurgery, First Hospital of Jilin University, Jilin, China
| | - Shuai Zhao
- Department of Anesthesiology, First Hospital of Jilin University, Jilin, China
| | - Xuan Xie
- Faculty of Fisheries and Protection of Waters, South Bohemian Research Centre of Aquaculture and Biodiversity of Hydrocenoses, University of South Bohemia in Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - Fan Chen
- Department of Neurosurgery, First Hospital of Jilin University, Jilin, China
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Xin W, Wang Y, Bian Y, Lin J, Weng W, Zhao X, Gou K, Guo X, Li H. Facile synthesis of PEI-based crystalline templated mesoporous silica with molecular chirality for improved oral delivery of the poorly water-soluble drug. Drug Deliv 2021; 28:894-905. [PMID: 33960251 PMCID: PMC8118497 DOI: 10.1080/10717544.2021.1912212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The aim of this study was to build up a novel chiral mesoporous silica called PEIs@TA-CMS through a facile biomimetic strategy and to explore its potential to serve as a drug carrier for improving the delivery efficiency of poorly water-soluble drug. PEIs@TA-CMS was synthesized by using a chiral crystalline complex associated of tartaric acid and polyethyleneimine (PEIs) as templates, scaffolds and catalysts. The structural features including morphology, size, pore structure and texture properties were systematacially studied. The results showed that PEIs@TA-CMS was monodispersed spherical nanoparticles in a uniformed diameter of 120–130 nm with well-developed pore structure (SBET: 1009.94 m2/g, pore size <2.21 nm). Then PEIs@TA-CMS was employed as nimodipine (NMP) carrier and compared with the drug carry ability of MCM41. After drug loading, NMP was effectively transformed from the crystalline state to an amorphous state due to the space confinement in mesopores. As expected, PEIs@TA-CMS had superiority in both drug loading and drug release compared to MCM41. It could incorporate NMP with high efficiency, and the dissolution-promoting effect of PEIs@TA-CMS was more obvious because of the unique interconnected curved pore channels. Meanwhile, PEIs@TA-CMS could significantly improve the oral adsorption of NMP to a satisfactory level, which showed approximately 3.26-fold higher in bioavailability, and could effectively prolong the survival time of mice on cerebral anoxia from 10.98 to 17.33 min.
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Affiliation(s)
- Wei Xin
- School of Pharmacy, China Medical University, Shenyang, China.,The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yumei Wang
- School of Pharmacy, China Medical University, Shenyang, China.,School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, China
| | - Yan Bian
- School of Pharmacy, China Medical University, Shenyang, China
| | - Jiahui Lin
- School of Pharmacy, China Medical University, Shenyang, China
| | - Wenhao Weng
- School of Pharmacy, China Medical University, Shenyang, China
| | - Xinyi Zhao
- School of Pharmacy, China Medical University, Shenyang, China
| | - Kaijun Gou
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, China
| | - Xianmou Guo
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, China
| | - Heran Li
- School of Pharmacy, China Medical University, Shenyang, China.,School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, China
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Yan B, Ma P, Chen S, Cheng H, Tang M, Sun Y, Yang X, Wu Y, Cheng M. Nimodipine attenuates dibutyl phthalate-induced learning and memory impairment in kun ming mice: An in vivo study based on bioinformatics analysis. Environ Toxicol 2021; 36:821-830. [PMID: 33336902 DOI: 10.1002/tox.23084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 12/06/2020] [Indexed: 06/12/2023]
Abstract
Dibutyl phthalate (DBP), a typical representative of phthalate esters (PAEs), is used as a plasticizer in various industrial applications and has been reported to be responsible for neurobehavioral changes. Despite mounting evidence showing that nimodipine (Nim) palys a neuropharmacological and psychopharmacological role in neurons, the attenuating effects of Nim on learning and memory impairment induced by DBP exposure remain unknown. Based on bioinformatics analysis we found that the biological processes affected by both DBP and Nim may involve the calcium signaling pathway, the MAPK signaling pathway and the apoptosis pathway. The results of an in vivo study confirmed that DBP affects the levels of Ca2+ -related proteins, up-regulates phosphorylated -ERK1/2 expression and results in hippocampal neuronal damage and apoptosis, whereas Nim as a Ca2+ antagonist, has a certain neuroprotective role to avoid these adverse effects. Our data suggest that Nim could be used to attenuate the learning and memory impairment in DBP-exposed mice, to down-regulate intracellular Ca2+ levels, subordinate the ERK1/2 pathway and attenuate apoptosis in hippocampal tissue.
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Affiliation(s)
- Biao Yan
- Laboratory of Environment-immunological and neurological diseases, Research Center of Basic Medical Sciences, Hubei University of Science and Technology, Xianning, China
| | - Ping Ma
- Laboratory of Environment-immunological and neurological diseases, Research Center of Basic Medical Sciences, Hubei University of Science and Technology, Xianning, China
| | - Shaohui Chen
- Laboratory of Environment-immunological and neurological diseases, Research Center of Basic Medical Sciences, Hubei University of Science and Technology, Xianning, China
| | - Hongguo Cheng
- Hubei Engineering Research Center for Fragrant Plants, Hubei University of Science and Technology, Xianning, China
| | - Min Tang
- College of Resources Environmental Science and Engineering, Hubei University of Science and Technology, Xianning, China
| | - Yanling Sun
- Laboratory of Environment-immunological and neurological diseases, Research Center of Basic Medical Sciences, Hubei University of Science and Technology, Xianning, China
| | - Xu Yang
- Laboratory of Environment-immunological and neurological diseases, Research Center of Basic Medical Sciences, Hubei University of Science and Technology, Xianning, China
| | - Yang Wu
- Laboratory of Environment-immunological and neurological diseases, Research Center of Basic Medical Sciences, Hubei University of Science and Technology, Xianning, China
| | - Menglin Cheng
- Laboratory of Environment-immunological and neurological diseases, Research Center of Basic Medical Sciences, Hubei University of Science and Technology, Xianning, China
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35
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Ort J, Kremer B, Grüßer L, Blaumeiser-Debarry R, Clusmann H, Coburn M, Höllig A, Lindauer U. Failed Neuroprotection of Combined Inhibition of L-Type and ASIC1a Calcium Channels with Nimodipine and Amiloride. Int J Mol Sci 2020; 21:E8921. [PMID: 33255506 DOI: 10.3390/ijms21238921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 01/15/2023] Open
Abstract
Effective pharmacological neuroprotection is one of the most desired aims in modern medicine. We postulated that a combination of two clinically used drugs-nimodipine (L-Type voltage-gated calcium channel blocker) and amiloride (acid-sensing ion channel inhibitor)-might act synergistically in an experimental model of ischaemia, targeting the intracellular rise in calcium as a pathway in neuronal cell death. We used organotypic hippocampal slices of mice pups and a well-established regimen of oxygen-glucose deprivation (OGD) to assess a possible neuroprotective effect. Neither nimodipine (at 10 or 20 µM) alone or in combination with amiloride (at 100 µM) showed any amelioration. Dissolved at 2.0 Vol.% dimethyl-sulfoxide (DMSO), the combination of both components even increased cell damage (p = 0.0001), an effect not observed with amiloride alone. We conclude that neither amiloride nor nimodipine do offer neuroprotection in an in vitro ischaemia model. On a technical note, the use of DMSO should be carefully evaluated in neuroprotective experiments, since it possibly alters cell damage.
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36
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Wang W, Li P, Fang M, Li X, Zhang Y, Zhang T. SFC-MS/MS method for simultaneous determination of nimodipine and 3-n-butylphthalide in beagle plasma: application to pharmacokinetic interaction study. Bioanalysis 2020; 12:1509-19. [PMID: 33078962 DOI: 10.4155/bio-2020-0229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Aim: Nimodipine and 3-n-butylphthalide are co-administered to treat vascular dementia, but the pharmacokinetic interaction between the two drugs is still unknown. Therefore, a robust, high-throughput and economical supercritical fluid chromatography-ESI-MS/MS method has been initially developed to simultaneously determine nimodipine and 3-n-butylphthalide in beagle plasma, in order to study the safety of co-administration. Materials & methods: After a simple protein precipitation procedure, isocratic elution with mobile phase of CO2 and methanol (containing 0.3% formic acid and 2 mM ammonium acetate) was applied to minimize run time and facilitate sensitive and high-throughput bioanalysis. The method was fully validated according to US FDA Guidance. The validated method was then successfully applied in a pharmacokinetic interaction study. Results: The results indicated there is no significant pharmacokinetic interaction between the two drugs.
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Clifford KM, Madhok J, Murray NM, Mohindra V. Rescue of Nimodipine-Induced Refractory Vasoplegia With Hydroxocobalamin in Subarachnoid Hemorrhage: A Case Report. Crit Care Explor 2020; 2:e0205. [PMID: 33063021 DOI: 10.1097/CCE.0000000000000205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: We report a case of refractory vasoplegia after nimodipine administration that was unresponsive to triple vasopressor therapy and was rescued by IV hydroxocobalamin. Case Summary: An 84-year-old male presented comatose from a subarachnoid hemorrhage and developed severe hypotension unresponsive to three vasopressors following a single dose of enteral nimodipine. Multisystem point-of-care ultrasonography ruled out alternate etiologies of shock, indicating that this was likely a vasoplegic state caused by nimodipine. We administered 5 grams of IV hydroxocobalamin over 15 minutes due to the possibility of impaired nitric oxide metabolism as the driver of vasoplegia. This led to immediate improvement in hemodynamics and rapid discontinuation of vasopressors. The patient experienced chromaturia but no other adverse effects due to hydroxocobalamin. Conclusions: Nimodipine administration is a standard practice for patients with aneurysmal subarachnoid hemorrhage to reduce unfavorable outcomes from cerebral vasospasm. Although mild hypotension is a common side effect of nimodipine, in rare cases, it may become profound, leading to refractory vasoplegia. There is no evidence-base for reversal agents for nimodipine-induced vasoplegia, and this case is the first to demonstrate successful use of hydroxocobalamin as a potential rescue therapy. We also propose an algorithm for treatment of vasoplegia with consideration of medications that act on nitric oxide–mediated vasodilation and their side-effect profiles.
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38
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Isse FA, Le T, Mahmoud SH. Enantioselective assay of nimodipine in human plasma using liquid chromatography-tandem mass spectrometry. Biomed Chromatogr 2020; 35:e4971. [PMID: 32840898 DOI: 10.1002/bmc.4971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 11/07/2022]
Abstract
Nimodipine is a dihydropyridine calcium channel blocker that exhibits higher selectivity toward cerebral blood vessels compared with other members of the same class. It has been shown to improve outcomes and prevent delayed cerebral ischemia in the setting of aneurysmal subarachnoid hemorrhage, a life-threatening brain bleed. Nimodipine is a chiral compound and it is marketed as a racemic mixture of (+)-R and (-)-S enantiomers. (-)-S-Nimodipine is approximately twice as potent a vasorelaxant as the racemic mixture and is more rapidly eliminated than the (+)-R counterpart following oral dosing. Few analytical procedures have been reported to determine nimodipine enantiomers in biological samples; however, the reported methods were time-consuming, involved multistep extraction procedures and required large sample volumes. Herein, we present an LC-MS/MS method for quantifying nimodipine enantiomers in human plasma using a small sample volume (0.3 ml) and a single liquid-liquid extraction step. The peak area ratios were linear over the tested concentration ranges (1.5-75 ng/ml) with r2 > 0.99. The intraday CV and percentage error were within ±14% while the interday values were within ±13%, making this analytical method feasible for research purposes and pharmacokinetic studies.
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Affiliation(s)
- Fadumo Ahmed Isse
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Tyson Le
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Sherif Hanafy Mahmoud
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
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Elikowski W, Małek-Elikowska M, Piestrzeniewicz R, Fertała N, Zawodna M, Ganowicz-Kaatz T, Baszko A, Smól S. Takotsubo syndrome after nimodipine-induced hypotension treated with norepinephrine in a female with subarachnoid hemorrhage. Pol Merkur Lekarski 2020; 49:236-240. [PMID: 32827417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
UNLABELLED The prevalence of takotsubo syndrome (TTS) in patients with subarachnoid hemorrhage (SAH) is much higher than in the general population. Clinical and experimental observations confirm secondary to brain damage catecholamine-mediated cardiac injury resulting in reversible left ventricular (LV) dysfunction. However, other triggers can also be involved in TTS development e.g. manipulations during surgical or endovascular treatment of a bleeding intracranial aneurysm, concomitant hyponatremia or infection, intubation, blood transfusion and pharmacologic treatment. Nimodipine is recommended in SAH to prevent cerebral arteries vasospasm but can cause hypotension, so vasopressors, e.g. norepinephrine (NE) are commonly used to reach target blood pressure. A CASE REPORT The authors present a case of a 72-year-old woman with SAH in whom the disease began with a headache, syncope, decreased level of consciousness and vomiting; there were no cardiac symptoms at admission. Endovascular coiling of internal carotid artery aneurysm was performed. On day 2, she developed TTS presenting in echocardiography as apical ballooning; immediately before TTS onset, NE was started to treat nimodipine-induced hypotension. Despite severe heart failure (HF), the patient's neurological status did not deteriorate. HF symptoms remitted after a few days and LV function returned to normal after a week. Negative T waves in ECG which appeared at TTS onset disappeared after 50 days. At that moment no neurological deficits were observed. CONCLUSIONS The authors underline that in SAH patients nimodipine administration should be cautious to avoid an excessive blood pressure decrease especially in view of further catecholamines use.
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Affiliation(s)
| | | | | | - Natalia Fertała
- Józef Struś Hospital, Poznań, Poland: Department of Internal Medicine
| | - Magdalena Zawodna
- Józef Struś Hospital, Poznań, Poland: Department of Internal Medicine
| | | | - Alina Baszko
- Józef Struś Hospital, Poznań, Poland: Radiology Unit
| | - Sławomir Smól
- Józef Struś Hospital, Poznań, Poland: Department of Neurosurgery
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Li F, Fei Q, Mao D, Si Q, Dai M, Ma Q, Zhang H, Bai L, He N. Comparative Pharmacokinetics of Nimodipine in Rat Plasma and Tissues Following Intraocular, Intragastric, and Intravenous Administration. AAPS PharmSciTech 2020; 21:234. [PMID: 32794077 DOI: 10.1208/s12249-020-01772-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/22/2020] [Indexed: 11/30/2022] Open
Abstract
We investigated the pharmacokinetics of nimodipine (NMD) in rats plasma and tissues following intraocular (io), intragastric (ig), and intravenous (iv) administration at doses of 5.0 mg/kg io and iv and 10.0 mg/kg ig. After a single dose of NMD, plasma, heart, liver, spleen, lung, kidney, and brain samples were collected at the scheduled time points. The concentration of NMD in rat plasma and tissues was determined by high-performance liquid chromatography, and the main pharmacokinetic parameters were calculated and compared. NMD was rapidly absorbed and reached the maximum plasma concentration in approximately 5 min after io administration. The absolute bioavailability after io administration was higher than that after ig administration (40.05% vs. 5.67%). There were significant differences in the tissue distribution of NMD with different administration routes. After io administration, NMD was distributed more in the lung, spleen, and brain tissues, and less in the kidney. The maximum drug concentration after io administration in the heart, liver, spleen, lung, kidney, and brain was 1.00, 0.47, 2.02, 1.47, 0.22, and 5.79 times higher than that after via ig administration, and the area under the curve value was 0.59, 0.78, 1.71, 1.84, 0.25, and 4.59 times greater, respectively. Nimodipine appears to achieve systemic effects via io administration. Compared with ig, io administration could significantly increase NMD distribution in the brain tissue, indicating that NMD could be delivered to the brain via io administration.
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Affiliation(s)
- Fang Li
- Department of Pharmaceutics, College of Pharmacy, Anhui University of Chinese Medicine, No. 1, Qianjiang Road, Hefei, 230012, Anhui, China.,College of Biology and Pharmaceutical Engineering, West Anhui University, Lu'an, 237012, China
| | - Qingsong Fei
- Department of Pharmaceutics, College of Pharmacy, Anhui University of Chinese Medicine, No. 1, Qianjiang Road, Hefei, 230012, Anhui, China
| | - Dan Mao
- Department of Pharmaceutics, College of Pharmacy, Anhui University of Chinese Medicine, No. 1, Qianjiang Road, Hefei, 230012, Anhui, China
| | - Qiaoyun Si
- Department of Pharmaceutics, College of Pharmacy, Anhui University of Chinese Medicine, No. 1, Qianjiang Road, Hefei, 230012, Anhui, China
| | - Manman Dai
- Department of Pharmaceutics, College of Pharmacy, Anhui University of Chinese Medicine, No. 1, Qianjiang Road, Hefei, 230012, Anhui, China
| | - Qun Ma
- Department of Pharmaceutics, College of Pharmacy, Anhui University of Chinese Medicine, No. 1, Qianjiang Road, Hefei, 230012, Anhui, China
| | - Huimin Zhang
- Department of Pharmaceutics, College of Pharmacy, Anhui University of Chinese Medicine, No. 1, Qianjiang Road, Hefei, 230012, Anhui, China
| | - Luyu Bai
- Department of Pharmaceutics, College of Pharmacy, Anhui University of Chinese Medicine, No. 1, Qianjiang Road, Hefei, 230012, Anhui, China
| | - Ning He
- Department of Pharmaceutics, College of Pharmacy, Anhui University of Chinese Medicine, No. 1, Qianjiang Road, Hefei, 230012, Anhui, China. .,Institute of Pharmaceutics, Anhui Academy of Chinese Medical Sciences, Hefei, 230012, China. .,Anhui Province Key Laboratory of Chinese Medicinal Formula, Hefei, 230012, China. .,Anhui Province Key Laboratory of Pharmaceutical Preparation Technology and Application, Hefei, 230012, China.
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Fu C, Wu Q, Zhang Z, Xia Z, Liu Z, Lu H, Wang Y, Huang G. Development of a sensitive and rapid UHPLC-MS/MS method for simultaneous quantification of nine compounds in rat plasma and application in a comparative pharmacokinetic study after oral administration of Xuefu Zhuyu Decoction and nimodipine. Biomed Chromatogr 2020; 34:e4872. [PMID: 32358897 DOI: 10.1002/bmc.4872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/16/2020] [Accepted: 04/28/2020] [Indexed: 01/30/2023]
Abstract
Xuefu Zhuyu Decoction (XFZYD) is a traditional Chinese medicine prescription used for the clinical treatment of traumatic brain injury (TBI). The purpose of this work was to develop a sensitive and rapid UHPLC-MS/MS method to simultaneously study the pharmacokinetics of nimodipine and eight components of XFZYD, namely, amygdalin, hydroxysafflor yellow A, rutin, liquiritin, narirutin, naringin, neohesperidin and saikosaponin A, in rats with and without TBI. Multiple reaction monitoring was highly selective in the detection of nine analytes and the internal standard without obvious interference. The calibration curves displayed good linearity (r > 0.99) over a wide concentration range. The mean absolute recoveries of the nine analytes were 85-106%, and all matrix effects were in the range 80-120%. The intra- and inter-day precision and accuracy were acceptable (RSD, <15%; RE%, ±20%). The validated method was successfully applied to compare the pharmacokinetics in four experimental groups, including control rats orally administered XFZYD and TBI model rats orally administered XFZYD, XFZYD and nimodipine, or nimodipine alone. The results showed that herb-drug interactions occurred between XFZYD and nimodipine in the treatment of TBI, nimodipine affected the pharmacokinetics of XFZYD, and XFZYD affected the absorption, distribution and excretion of nimodipine in vivo.
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Affiliation(s)
- Chunyan Fu
- College of Chemistry and Chemical Engineering, Central South University, Changsha, Hunan, P. R. China.,College of Pharmacy, Shaoyang University, Shaoyang, Hunan, P. R. China
| | - Qian Wu
- College of Chemistry and Chemical Engineering, Central South University, Changsha, Hunan, P. R. China
| | - Zhimin Zhang
- College of Chemistry and Chemical Engineering, Central South University, Changsha, Hunan, P. R. China
| | - Zian Xia
- Laboratory of Ethnopharmacology, Institute of Integrated Traditional Chinese and Western Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
| | - Zhaoying Liu
- Hunan Engineering Research Center of Veterinary Drug, College of Veterinary Medicine, Hunan Agricultural University, Changsha, Hunan, P. R. China
| | - Hongmei Lu
- College of Chemistry and Chemical Engineering, Central South University, Changsha, Hunan, P. R. China
| | - Yang Wang
- Laboratory of Ethnopharmacology, Institute of Integrated Traditional Chinese and Western Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
| | - Gang Huang
- Guangzhou Analytical Application Center, Shimadzu Corporation, Guangzhou, China
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Li JW, Ren SH, Ren JR, Zhen ZG, Li LR, Hao XD, Ji HM. Nimodipine Improves Cognitive Impairment After Subarachnoid Hemorrhage in Rats Through IncRNA NEAT1/miR-27a/MAPT Axis. Drug Des Devel Ther 2020; 14:2295-2306. [PMID: 32606599 PMCID: PMC7293909 DOI: 10.2147/dddt.s248115] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/27/2020] [Indexed: 12/20/2022]
Abstract
Background Subarachnoid hemorrhage (SAH) is a cerebral hemorrhage disease that severely damages the brain and causes cognitive impairment (CI). Therefore, accurate and appropriate treatment strategies are urgently needed. The application of nimodipine can not only improve blood circulation in patients with SAH but also repair ischemic neuron injury. Purpose To investigate the effects of nimodipine and lncRNA nuclear paraspeckle assembly transcript 1 (NEAT1)/miR-27a/microtubule-associated protein tau (MAPT) axis on CI after SAH. Methods One hundred and twenty healthy male rats were selected and equally divided into control group, sham operation group, model group, PBS group, nimodipine group (drug group), NC siRNA group, NC mimics group, NEAT1 siRNA, miR-27a mimics, MAPT siRNA, drug + NEAT1-ad, and drug + NC-ad groups by random number table. Rats in the model group were constructed by double-hemorrhage model, and expression vectors were injected into the tail to regulate the expression of lncRNA NEAT1, miR-27a and MAPT. In addition, Western blot was employed to detect brain tissue protein, flow cytometry was applied to measure brain tissue apoptosis, and MTT was utilized to determine cell activity, so as to evaluate brain damage and cognitive function in each group. Results Nimodipine, down-regulated lncRNA NEAT1, up-regulated miR-27a and down-regulated MAPT all improved brain damage and CI, inhibited brain tissue cell apoptosis, and enhanced brain cell activity. The common binding sites of lncRNA NEAT1 and MAPT were found on the miR-27a sequence fragment, and miR-27a could be paired with the former two. Nimodipine was found to cause the down-regulation of lncRNA NEAT1 and MAPT, as well as the up-regulation of miR-27a. Conclusion Nimodipine can improve CI after SAH in rats through the lncRNA NEAT1/miR-27a/MAPT axis.
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Affiliation(s)
- Jun-Wei Li
- Department of Neurosurgery, The People's Hospital of Shanxi Province, Taiyuan, Shanxi Province, People's Republic of China
| | - Shao-Hua Ren
- Department of Neurosurgery, The People's Hospital of Shanxi Province, Taiyuan, Shanxi Province, People's Republic of China
| | - Jin-Rui Ren
- Department of Neurosurgery, The People's Hospital of Shanxi Province, Taiyuan, Shanxi Province, People's Republic of China
| | - Zi-Gang Zhen
- Department of Neurosurgery, The People's Hospital of Shanxi Province, Taiyuan, Shanxi Province, People's Republic of China
| | - Li-Rong Li
- Department of Neurosurgery, The People's Hospital of Shanxi Province, Taiyuan, Shanxi Province, People's Republic of China
| | - Xu-Dong Hao
- Department of Neurosurgery, The People's Hospital of Shanxi Province, Taiyuan, Shanxi Province, People's Republic of China
| | - Hong-Ming Ji
- Department of Neurosurgery, The People's Hospital of Shanxi Province, Taiyuan, Shanxi Province, People's Republic of China
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Liu X, Zhao N, Zeng K, Xiao P, Sheng P, Luo X, Wang Y. Effects of nimodipine combined with betahistine on CRP and other inflammatory cytokines and vascular endothelial function in patients with hypertensive cerebral vasospasm. Clin Hemorheol Microcirc 2020; 75:279-289. [PMID: 32280080 DOI: 10.3233/ch-190589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aims to investigate the effect of nimodipine combined with betahistine on the levels of CRP and other inflammatory cytokines, as well as vascular endothelial function in patients with hypertensive cerebral vasospasm. METHODS A total of 80 patients with hypertensive cerebral vasospasm from March 2016 to September 2018 were enrolled and randomly equally divided into two groups. At 1 week before enrollment, the application of all antihypertensive drugs was stopped. Then amlodipine tablets were used in control group, based on which nimodipine tablets were applied in observation group. All the patients included were followed up for 1 month. The changes in the cerebral vasospasm index in the course of treatment as well as inflammatory cytokines and indicators related to vascular endothelial function at 1 month after treatment were measured and compared between the two groups. The correlations of the cerebral vasospasm index with the changes in inflammatory cytokines and vascular endothelial function-related factors in the body were analyzed. Finally, the effective rates of blood pressure regulation and cerebral vasospasm treatment were compared, while the adverse reactions and the overall clinical treatment effect of the two groups were evaluated. RESULTS The cerebral vasospasm indexes in observation group were significantly lower than those in control group at 3 d, 1 week and 1 month after treatment (p < 0.05). At 1 month after treatment, the levels of inflammatory cytokines such as high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) in observation group were significantly reduced compared to those in control group (p < 0.05). As for vascular endothelial function-related indicators, the endothelin-1 (ET-1) level in observation group was markedly lower than that in control group, whereas the level of nitric oxide (NO) was statistically higher than that in control group (p < 0.05). The cerebral vasospasm index was statistically positively correlated with changes in hs-CRP, IL-6, TNF-α and ET-1 (p < 0.05), but negatively correlated with changes in NO (p < 0.05). Besides, the effective rates of blood pressure regulation and cerebral vasospasm treatment in observation group were significantly higher than those in control group (p < 0.05). The overall treatment effective rate in observation group was markedly higher than that in control group (p < 0.05), and there were no significant differences of adverse reactions between the two groups (p > 0.05). CONCLUSION For the treatment of hypertensive cerebral vasospasm, combined application of betahistine on the basis of nimodipine can effectively reduce the body's aseptic inflammatory responses, improve vascular endothelial function and increase the cerebral circulation blood flow, which offers a favorable strategy for clinical therapy.
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Affiliation(s)
- Xuanwei Liu
- Department of Rehabilitation, ShenZhen DaPeng New District NanAo People's Hospital, Shenzhen, Guangdong, China
| | - Na'na Zhao
- Department of Acupuncture and Massage, Shenzhen Luohu District Hospital of Chinese Medicine, Shenzhen, Guangdong, China
| | - Kexue Zeng
- Department of Acupuncture and Massage, GuangDong Province Second Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Peng Xiao
- Department of Rehabilitation, ShenZhen DaPeng New District NanAo People's Hospital, Shenzhen, Guangdong, China
| | - Pengjie Sheng
- Department of Acupuncture and Massage, Shenzhen Luohu District Hospital of Chinese Medicine, Shenzhen, Guangdong, China
| | - Xun Luo
- Department of Rehabilitation, Shenzhen Sanming Group, Kerry Rehabilitation Medicine Research, Shenzhen, Guangdong, China
| | - Yulong Wang
- Department of Rehabilitation, The First Affiliated Hospital, Shenzhen University, Shenzhen, Guangdong, China
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Abstract
Subarachnoid hemorrhage is a devastating form of stroke with often detrimental outcomes for patients. Here we describe a patient with subarachnoid hemorrhage treated with nimodipine, which resulted in marked bradycardia with junctional atrioventricular heart block. Nimodipine is metabolized predominantly by the cytochrome P450 3A subfamily, and its use is often associated with adverse events, such as hypotension and bradycardia, which can be exacerbated by advanced age. Our patient had the CYP3A5*3/*3 genotype, possibly predisposing her to poor metabolism of this drug. Our case report demonstrates the potential for pharmacogenomics in patients with subarachnoid hemorrhage to help predict their response to nimodipine, minimize adverse drug reactions, and potentially individualize dosing to improve future clinical outcomes.
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Affiliation(s)
- Courtney L James
- Mayo Clinic Alix School of Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Marion T Turnbull
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - William D Freeman
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA.,Department of Neurologic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA.,Department of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
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45
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Carlson AP, Hänggi D, Wong GK, Etminan N, Mayer SA, Aldrich F, Diringer MN, Schmutzhard E, Faleck HJ, Ng D, Saville BR, Bleck T, Grubb R, Miller M, Suarez JI, Proskin HM, Macdonald RL. Single-Dose Intraventricular Nimodipine Microparticles Versus Oral Nimodipine for Aneurysmal Subarachnoid Hemorrhage. Stroke 2020; 51:1142-1149. [PMID: 32138631 DOI: 10.1161/strokeaha.119.027396] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- EG-1962 is a sustained release formulation of nimodipine administered via external ventricular drain in patients with aneurysmal subarachnoid hemorrhage. A randomized, open-label, phase 1/2a, dose-escalation study provided impetus for this study to evaluate efficacy and safety of a single intraventricular 600 mg dose of EG-1962 to patients with aneurysmal subarachnoid hemorrhage, compared with standard of care oral nimodipine. Methods- Subjects were World Federation of Neurological Surgeons grades 2-4, modified Fisher grades 2-4 and had an external ventricular drain inserted as part of standard of care. The primary end point was the proportion of subjects with favorable outcome at day 90 after aneurysmal subarachnoid hemorrhage (extended Glasgow outcome scale 6-8). The proportion of subjects with favorable outcome at day 90 on the Montreal cognitive assessment, as well as the incidence of delayed cerebral ischemia and infarction, use of rescue therapy and safety were evaluated. Results- The study was halted by the independent data monitoring board after planned interim analysis of 210 subjects (289 randomized) with day 90 outcome found the study was unlikely to achieve its primary end point. After day 90 follow-up of all subjects, the proportion with favorable outcome on the extended Glasgow outcome scale was 45% (65/144) in the EG-1962 and 42% (62/145) in the placebo group (risk ratio, 1.01 [95% CI, 0.83-1.22], P=0.95). Consistent with its mechanism of action, EG-1962 significantly reduced vasospasm (50% [69/138] EG-1962 versus 63% [91/144], P=0.025) and hypotension (7% [9/138] versus 10% [14/144]). Analysis of prespecified subject strata suggested potential efficacy in World Federation of Neurological Surgeons 3-4 subjects (46% [32/69] EG-1962 versus 32% [24/75] placebo, odds ratio, 1.22 [95% CI, 0.94-1.58], P=0.13). No safety concerns were identified that halted the study or that preclude further development. Conclusions- There was no significant increase in favorable outcome for EG-1962 compared with standard of care in the overall study population. The safety profile was acceptable. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT02790632.
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Affiliation(s)
- Andrew P Carlson
- From the Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque (A.P.C.)
| | - Daniel Hänggi
- Department of Neurosurgery, Düsseldorf University Hospital, Heinrich-Heine-Universität, Germany (D.H.)
| | - George K Wong
- Department of Surgery and Neurosurgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China (G.K.W.)
| | - Nima Etminan
- Department of Neurosurgery, Ruprecht-Karls-University Heidelberg, Mannheim, Germany (N.E.)
| | - Stephan A Mayer
- Department of Neurology, Henry Ford Health System, Detroit, MI (S.A.M.)
| | | | - Michael N Diringer
- Neurological Critical Care, Washington University School of Medicine, St Louis, MO (M.N.D.)
| | - Erich Schmutzhard
- Department of Neurology, Neurointensive Care Unit, Medical University Innsbruck, Austria (E.S.)
| | | | - David Ng
- WuXi Clinical, Austin, TX (D.N.)
| | | | - Thomas Bleck
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL (T.B.)
| | - Robert Grubb
- Department of Neurological Surgery, Washington University Medical Center, St Louis, MO (R.G.)
| | - Michael Miller
- Integrated Medical Development, Princeton Junction, NJ (M.M.)
| | - Jose I Suarez
- Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD (J.I.S.)
| | - Howard M Proskin
- Howard M. Proskin & Associates, Rochester, New York, NY (H.M.P.)
| | - R Loch Macdonald
- Edge Therapeutics, Berkeley Heights, NJ (H.J.F., R.L.M.).,Division of Neurosurgery, Department of Surgery, University Neurosciences Institute, University of Toronto, Canada (R.L.M.).,Department of Neurosurgery, University of California San Francisco-Fresno (R.L.M.)
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Enders M, Heider T, Ludwig A, Kuerten S. Strategies for Neuroprotection in Multiple Sclerosis and the Role of Calcium. Int J Mol Sci 2020; 21:E1663. [PMID: 32121306 DOI: 10.3390/ijms21051663] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/16/2020] [Accepted: 02/26/2020] [Indexed: 12/12/2022] Open
Abstract
Calcium ions are vital for maintaining the physiological and biochemical processes inside cells. The central nervous system (CNS) is particularly dependent on calcium homeostasis and its dysregulation has been associated with several neurodegenerative disorders including Parkinson’s disease (PD), Alzheimer’s disease (AD) and Huntington’s disease (HD), as well as with multiple sclerosis (MS). Hence, the modulation of calcium influx into the cells and the targeting of calcium-mediated signaling pathways may present a promising therapeutic approach for these diseases. This review provides an overview on calcium channels in neurons and glial cells. Special emphasis is put on MS, a chronic autoimmune disease of the CNS. While the initial relapsing-remitting stage of MS can be treated effectively with immune modulatory and immunosuppressive drugs, the subsequent progressive stage has remained largely untreatable. Here we summarize several approaches that have been and are currently being tested for their neuroprotective capacities in MS and we discuss which role calcium could play in this regard.
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Huang S, Huang Z, Fu Z, Shi Y, Dai Q, Tang S, Gu Y, Xu Y, Chen J, Wu X, Ren F. A Novel Drug Delivery Carrier Comprised of Nimodipine Drug Solution and a Nanoemulsion: Preparation, Characterization, in vitro, and in vivo Studies. Int J Nanomedicine 2020; 15:1161-1172. [PMID: 32110014 PMCID: PMC7036601 DOI: 10.2147/ijn.s226591] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 02/03/2020] [Indexed: 12/18/2022] Open
Abstract
Purpose Nimodipine (NIMO) is used clinically to treat ischemic damage resulting from subarachnoid hemorrhage. However, clinical application of NIMO is limited by poor aqueous solubility and low safety. To overcome these limitations, a novel two-vial NIMO-loaded nanoemulsion (NIMO-TNE) was designed in this study. Methods NIMO-TNE was prepared by mixing a nimodipine-polyethylene glycol 400 (NIMO-PEG400) solution and a commercially available 20% injectable blank nanoemulsion (BNE). Drug distribution in NIMO-TNE, physical stability, and dilution stability were evaluated in vitro, and pharmacokinetics and pharmacodynamics were evaluated in vivo. Safety was assessed using the hemolysis test and the intravenous irritation test, and acute toxicity of NIMO-TNE was compared with that of commercial Nimotop injection. Results Drug loading (DL) in NIMO-TNE was enhanced 5-fold compared with that in Nimotop injection. The mean particle size of NIMO-TNE was 241.53 ± 1.48 nm. NIMO-TNE and NIMO-TNE diluted in 5% glucose injection and 0.9% sodium chloride was stable for a sufficient duration to allow for clinical use. In addition, NIMO-TNE exhibited a similar pharmacokinetic profile and similar brain ischemia reduction in a rat middle cerebral artery occlusion (MCAO) model compared to Nimotop injection. Furthermore, NIMO-TNE did not induce hemolysis at 37°C, and NIMO-TNE induced less intravenous irritation than Nimotop injection. Moreover, NIMO-TNE could be injected at a 23-fold higher dose than the LD50 of Nimotop injection with no obvious toxicity or side effects. Conclusion NIMO-TNE is a promising formulation suitable for intravenous injection, is easy to prepare, and exhibits excellent safety.
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Affiliation(s)
- Saixu Huang
- Shanghai Key Laboratory of New Drug Design, School of Pharmacy, East China University of Science and Technology, Shanghai, People's Republic of China.,Engineering Research Centre of Pharmaceutical Process Chemistry, Ministry of Education, East China University of Science and Technology, Shanghai, People's Republic of China.,Shanghai Weier Biological Medicine Science and Technology Co. Ltd., Shanghai, People's Republic of China
| | - Zhiyong Huang
- Shanghai Key Laboratory of New Drug Design, School of Pharmacy, East China University of Science and Technology, Shanghai, People's Republic of China.,Engineering Research Centre of Pharmaceutical Process Chemistry, Ministry of Education, East China University of Science and Technology, Shanghai, People's Republic of China.,Shanghai Weier Biological Medicine Science and Technology Co. Ltd., Shanghai, People's Republic of China
| | - Zhiqin Fu
- Shanghai Weier Biological Medicine Science and Technology Co. Ltd., Shanghai, People's Republic of China
| | - Yamin Shi
- Shanghai Weier Biological Medicine Science and Technology Co. Ltd., Shanghai, People's Republic of China.,Department of Pharmacy, Fujian University of Traditional Chinese Medicine, Fujian, People's Republic of China
| | - Qi Dai
- Shanghai Key Laboratory of New Drug Design, School of Pharmacy, East China University of Science and Technology, Shanghai, People's Republic of China.,Engineering Research Centre of Pharmaceutical Process Chemistry, Ministry of Education, East China University of Science and Technology, Shanghai, People's Republic of China
| | - Shuyan Tang
- Shanghai Weier Biological Medicine Science and Technology Co. Ltd., Shanghai, People's Republic of China
| | - Yongwei Gu
- Shanghai Weier Biological Medicine Science and Technology Co. Ltd., Shanghai, People's Republic of China
| | - Youfa Xu
- Shanghai Weier Biological Medicine Science and Technology Co. Ltd., Shanghai, People's Republic of China
| | - Jianming Chen
- Shanghai Weier Biological Medicine Science and Technology Co. Ltd., Shanghai, People's Republic of China.,Department of Pharmacy, Fujian University of Traditional Chinese Medicine, Fujian, People's Republic of China
| | - Xin Wu
- Shanghai Weier Biological Medicine Science and Technology Co. Ltd., Shanghai, People's Republic of China
| | - Fuzheng Ren
- Shanghai Key Laboratory of New Drug Design, School of Pharmacy, East China University of Science and Technology, Shanghai, People's Republic of China.,Engineering Research Centre of Pharmaceutical Process Chemistry, Ministry of Education, East China University of Science and Technology, Shanghai, People's Republic of China
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48
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Affiliation(s)
| | - Tom A Schweizer
- Neuroscience Research Program, Li Ka Shing Knowledge Institute, Institute of Medical Science (T.A.S.)
| | - R Loch Macdonald
- Division of Neurosurgery, Departments of Surgery and Physiology, Keenan Research Centre for Biomedical Science, St Michael's Hospital, University of Toronto, Ontario, Canada (R.L.M.)
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49
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Azadi R, Alipour-Talesh G, Yazdanpanah MJ, Alavizadeh SH, Maleki M, Banihashemi M, Jaafari MR. Study of the in vitro and in vivo antileishmanial activities of nimodipine in susceptible BALB/c mice. J Vector Borne Dis 2020; 57:78-84. [PMID: 33818460 DOI: 10.4103/0972-9062.308805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND & OBJECTIVES Pentavalent antimonials are the standard treatment for cutaneous leishmaniasis (CL), however, treatment failures are frequent. Nimodipine, a calcium channel blocker is known to show promising antiprotozoal effects. Here, we investigated the antileishmanial effect of Nimodipine in both in vitro and in vivo BALB/c mice model of CL. We also compared the in vivo effect with amphotericin B and meglumine antimoniate in the experimental CL mice model. METHODS Colorimetric alamar blue assay and J774 A.1 mouse macrophage cells were used to determine the effect of nimodipine on promastigotes and amastigotes viability, respectively. Then, the in vivo activity of nimodipine was compared to that of conventional therapies in both the early and established courses of Leishmania major infection in susceptible non-healing BALB/c mice. RESULTS Nimodipine was highly active against promastigotes and amastigotes of L. major with IC50 values of 49.40 and 15.03 μM, respectively. In the early model, the combination therapy with meglumine antimoniate and nimodipine showed no parasites in the spleen or footpad of animals. The footpad thickness was significantly lower in mice treated with either nimodipine (1 mg/kg or 2.5 mg/kg) or amphotericin B compared to the control group in the established lesions model. However, no complete remission was observed in the footpad lesion of any of the treatment groups (nimodipine, amphotericin B, meglumine antimoniate, and combination therapy). INTERPRETATION & CONCLUSION The effect of nimodipine was comparable to that of amphotericin B and meglumine antimoniate in early and established CL lesion models. Since nimodipine is more cost-effective than conventional therapies, our results merit further investigation in other animal models and voluntary human subjects.
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Affiliation(s)
- Reza Azadi
- Research Center for Skin Diseases and Cutaneous Leishmaniasis; Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Mohammad Javad Yazdanpanah
- Research Center for Skin Diseases and Cutaneous Leishmaniasis; Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyedeh Hoda Alavizadeh
- School of Pharmacy; Nanotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoud Maleki
- Research Center for Skin Diseases and Cutaneous Leishmaniasis; Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahnaz Banihashemi
- Research Center for Skin Diseases and Cutaneous Leishmaniasis, Mashhad, Iran
| | - Mahmoud Reza Jaafari
- School of Pharmacy; Nanotechnology Research Center; Department of Pharmaceutical Nanotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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50
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Carlson AP, Hänggi D, Macdonald RL, Shuttleworth CW. Nimodipine Reappraised: An Old Drug With a Future. Curr Neuropharmacol 2020; 18:65-82. [PMID: 31560289 PMCID: PMC7327937 DOI: 10.2174/1570159x17666190927113021] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/02/2019] [Accepted: 09/25/2019] [Indexed: 12/21/2022] Open
Abstract
Nimodipine is a dihydropyridine calcium channel antagonist that blocks the flux of extracellular calcium through L-type, voltage-gated calcium channels. While nimodipine is FDAapproved for the prevention and treatment of neurological deficits in patients with aneurysmal subarachnoid hemorrhage (aSAH), it affects myriad cell types throughout the body, and thus, likely has more complex mechanisms of action than simple inhibition of cerebral vasoconstriction. Newer understanding of the pathophysiology of delayed ischemic injury after a variety of acute neurologic injuries including aSAH, traumatic brain injury (TBI) and ischemic stroke, coupled with advances in the drug delivery method for nimodipine, have reignited interest in refining its potential therapeutic use. In this context, this review seeks to establish a firm understanding of current data on nimodipine's role in the mechanisms of delayed injury in aSAH, TBI, and ischemic stroke, and assess the extensive clinical data evaluating its use in these conditions. In addition, we will review pivotal trials using locally administered, sustained release nimodipine and discuss why such an approach has evaded demonstration of efficacy, while seemingly having the potential to significantly improve clinical care.
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Affiliation(s)
- Andrew P. Carlson
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Daniel Hänggi
- Department of Neurosurgery, University of Dusseldorf Hospital, Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Robert L. Macdonald
- University of California San Francisco Fresno Department of Neurosurgery and University Neurosciences Institute and Division of Neurosurgery, Department of Surgery, University of Toronto, Canada
| | - Claude W. Shuttleworth
- Department of Neuroscience University of New Mexico School of Medicine, Albuquerque, NM, USA
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