1
|
Nakatsuka A, Yamaguchi S, Wada J. GRP78 Contributes to the Beneficial Effects of SGLT2 Inhibitor on Proximal Tubular Cells in DKD. Diabetes 2024; 73:763-779. [PMID: 38394641 DOI: 10.2337/db23-0581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 02/13/2024] [Indexed: 02/25/2024]
Abstract
The beneficial effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors on kidney function are well-known; however, their molecular mechanisms are not fully understood. We focused on 78-kDa glucose-regulated protein (GRP78) and its interaction with SGLT2 and integrin-β1 beyond the chaperone property of GRP78. In streptozotocin (STZ)-induced diabetic mouse kidneys, GRP78, SGLT2, and integrin-β1 increased in the plasma membrane fraction, while they were suppressed by canagliflozin. The altered subcellular localization of GRP78/integrin-β1 in STZ mice promoted epithelial mesenchymal transition (EMT) and fibrosis, which were mitigated by canagliflozin. High-glucose conditions reduced intracellular GRP78, increased its secretion, and caused EMT-like changes in cultured HK2 cells, which were again inhibited by canagliflozin. Urinary GRP78 increased in STZ mice, and in vitro experiments with recombinant GRP78 suggested that inflammation spread to surrounding tubular cells and that canagliflozin reversed this effect. Under normal glucose culture, canagliflozin maintained sarco/endoplasmic reticulum (ER) Ca2+-ATPase (SERCA) activity, promoted ER robustness, reduced ER stress response impairment, and protected proximal tubular cells. In conclusion, canagliflozin restored subcellular localization of GRP78, SGLT2, and integrin-β1 and inhibited EMT and fibrosis in DKD. In nondiabetic chronic kidney disease, canagliflozin promoted ER robustness by maintaining SERCA activity and preventing ER stress response failure, and it contributed to tubular protection. ARTICLE HIGHLIGHTS
Collapse
Affiliation(s)
- Atsuko Nakatsuka
- Division of Kidney, Diabetes and Endocrine Diseases, Okayama University Hospital, Okayama, Japan
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Satoshi Yamaguchi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| |
Collapse
|
2
|
Liu M, Liu J, Wang Q, Song P, Li H, Sun Z, Shi C, Dong W. Quantitative analysis of low-content impurity crystal forms in canagliflozin tablets by NIR solid-state analysis technique. Spectrochim Acta A Mol Biomol Spectrosc 2024; 311:124000. [PMID: 38350412 DOI: 10.1016/j.saa.2024.124000] [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] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/05/2024] [Accepted: 02/04/2024] [Indexed: 02/15/2024]
Abstract
Canagliflozin (CFZ) tablets was a commercially new class of anti-diabetic drug, CFZ had various anhydrate crystal forms and two hydrate crystal forms (Canagliflozin hemihydrate (Hemi-CFZ) and Canagliflozin monohydrate (Mono-CFZ) crystal form). The active pharmaceutical ingredients (APIs) of commercially available CFZ tablets were Hemi-CFZ, was easily convert to CFZ or Mono-CFZ under the influence of temperature, pressure, humidity and other factors in tablets processing, storage, and transportation, thus affected bioavailability and efficacy of tablets. Therefore, quantitative analysis of low-content CFZ and Mono-CFZ in tablets was essential to control tablets' quality. The main objective of this study was to explore the feasibility and in-depth explain its quantitative analysis mechanism of NIR for quantitative analysis of low-content CFZ/Mono-CFZ in CFZ tablets. PLSR models for low-content CFZ/Mono-CFZ were established by NIR solid-state analysis technique in different resolutions with different wavenumber regions combined with various pretreatments methods (such as Multiplicative Scatter Correction (MSC), Standard Normal Variate (SNV), Savitzky-Golay First Derivative (SG1st), Savitzky-Golay Second Derivative (SG2nd) and Wavelet Transform (WT)), and the PLSR models were verified. The feasibility of NIR spectroscopy for quantitative analysis of low-content CFZ and Mono-CFZ in CFZ tablets was discussed and analyzed from multiple perspectives, which included the distribution of effective information on the spectrum, the influence of resolution on PLSR models performance, the variance contribution/cumulative variance contribution of PLSR model principal components (PCs), the relation of PCI loadings, scores of the spectra and CFZ/Mono-CFZ content, and the mechanism of quantitative analysis was in-depth explained simultaneously. Eventually the most suitable PLSR models in 0.0000-10.0000 % w/w % obtained. That can provide theoretical support for quantitative analysis of low-content impurity crystal during the production, storage and transportation of CFZ tablets, thus provide reference methods for quality control of CFZ tablets and a reliable reference method for quantitative analysis of impurity crystal forms and quality control of similar drugs.
Collapse
Affiliation(s)
- Mingdi Liu
- College of Chemistry and Chemical Engineering, Qinghai Minzu University, Xining 810007, PR China; State Key Laboratory of Chemical Engineering, School of Chemical Engineering and Technology, Tianjin University, Tianjin 300072, PR China; Key Laboratory of Resource Chemistry and Eco-environmental Protection in Tibetan Plateau, State Ethnic Affairs Commission, Xining 810007, PR China.
| | - Jichao Liu
- College of Chemistry and Chemical Engineering, Qinghai Minzu University, Xining 810007, PR China; Key Laboratory of Resource Chemistry and Eco-environmental Protection in Tibetan Plateau, State Ethnic Affairs Commission, Xining 810007, PR China
| | - Qiuhong Wang
- College of Chemistry and Chemical Engineering, Qinghai Minzu University, Xining 810007, PR China; Key Laboratory of Resource Chemistry and Eco-environmental Protection in Tibetan Plateau, State Ethnic Affairs Commission, Xining 810007, PR China
| | - Ping Song
- College of Chemistry and Chemical Engineering, Qinghai Minzu University, Xining 810007, PR China; Key Laboratory of Resource Chemistry and Eco-environmental Protection in Tibetan Plateau, State Ethnic Affairs Commission, Xining 810007, PR China
| | - Haichao Li
- College of Chemistry and Chemical Engineering, Qinghai Minzu University, Xining 810007, PR China; Key Laboratory of Resource Chemistry and Eco-environmental Protection in Tibetan Plateau, State Ethnic Affairs Commission, Xining 810007, PR China
| | - Zan Sun
- College of Chemistry and Chemical Engineering, Qinghai Minzu University, Xining 810007, PR China; Key Laboratory of Resource Chemistry and Eco-environmental Protection in Tibetan Plateau, State Ethnic Affairs Commission, Xining 810007, PR China
| | - Chenglong Shi
- College of Chemistry and Chemical Engineering, Qinghai Minzu University, Xining 810007, PR China; Key Laboratory of Resource Chemistry and Eco-environmental Protection in Tibetan Plateau, State Ethnic Affairs Commission, Xining 810007, PR China
| | - Weibing Dong
- College of Chemistry and Chemical Engineering, Qinghai Minzu University, Xining 810007, PR China; Key Laboratory of Resource Chemistry and Eco-environmental Protection in Tibetan Plateau, State Ethnic Affairs Commission, Xining 810007, PR China
| |
Collapse
|
3
|
Holdt‐Caspersen NS, Dethlefsen C, Vestergaard P, Hejlesen O, Hangaard S, Jensen MH. Adherence to newer second-line oral antidiabetic drugs among people with type 2 diabetes-A systematic review. Pharmacol Res Perspect 2024; 12:e1185. [PMID: 38450950 PMCID: PMC10918987 DOI: 10.1002/prp2.1185] [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: 01/22/2024] [Accepted: 02/22/2024] [Indexed: 03/08/2024] Open
Abstract
The adherence to oral antidiabetic drugs (OADs) among people with type 2 diabetes (T2D) is suboptimal. However, new OADs have been marketed within the last 10 years. As these new drugs differ in mechanism of action, treatment complexity, and side effects, they may influence adherence. Thus, the aim of this study was to assess the adherence to newer second-line OADs, defined as drugs marketed in 2012-2022, among people with T2D. A systematic review was performed in CINAHL, Cochrane Trials, Embase, PubMed, PsycINFO, and Scopus. Articles were included if they were original research of adherence to newer second-line OADs and reported objective adherence quantification. The quality of the articles was assessed using JBI's critical appraisal tools. The overall findings were reported according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines and summarized in a narrative synthesis. All seven included articles were European retrospective cohort studies investigating alogliptin, canagliflozin, dapagliflozin, empagliflozin, and unspecified types of SGLT2i. Treatment discontinuation and medication possession ratio (MPR) were the most frequently reported adherence quantification measures. Within the first 12 months of treatment, 29%-44% of subjects on SGLT2i discontinued the treatment. In terms of MPR, 61.7%-94.9% of subjects on either alogliptin, canagliflozin, dapagliflozin, empagliflozin or an unspecified SGLT2i were adherent. The two investigated adherence quantification measures, treatment discontinuation and MPR, suggest that adherence to the newer second-line OADs may be better than that of older OADs. However, a study directly comparing older and newer OADs should be done to verify this.
Collapse
Affiliation(s)
- Nynne Sophie Holdt‐Caspersen
- Department of BiostatisticsNovo NordiskAalborgDenmark
- Department of Health Science and TechnologyAalborg UniversityAalborgDenmark
| | - Claus Dethlefsen
- Department of BiostatisticsNovo NordiskAalborgDenmark
- Department of Mathematical SciencesAalborg UniversityAalborgDenmark
| | - Peter Vestergaard
- Steno Diabetes Center North DenmarkAalborg University HospitalAalborgDenmark
- Department of EndocrinologyAalborg University HospitalAalborgDenmark
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
| | - Ole Hejlesen
- Department of Health Science and TechnologyAalborg UniversityAalborgDenmark
| | - Stine Hangaard
- Department of Health Science and TechnologyAalborg UniversityAalborgDenmark
- Steno Diabetes Center North DenmarkAalborg University HospitalAalborgDenmark
| | - Morten Hasselstrøm Jensen
- Department of Health Science and TechnologyAalborg UniversityAalborgDenmark
- Department of Data OrchestrationNovo NordiskSøborgDenmark
| |
Collapse
|
4
|
Khedr LH, Rahmo RM, Eldemerdash OM, Helmy EM, Ramzy FA, Lotfy GH, Zakaria HA, Gad MM, Youhanna MM, Samaan MH, Thabet NW, Ghazal RH, Rabie MA. Implication of M2 macrophage on NLRP3 inflammasome signaling in mediating the neuroprotective effect of Canagliflozin against methotrexate-induced cognitive impairment. Int Immunopharmacol 2024; 130:111709. [PMID: 38377857 DOI: 10.1016/j.intimp.2024.111709] [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: 01/07/2024] [Revised: 02/02/2024] [Accepted: 02/13/2024] [Indexed: 02/22/2024]
Abstract
Methotrexate (MTX), a chemotherapeutic antimetabolite, has been linked to cognitive impairment in cancer patients. MTX-induced metabolic pathway disruption may result in decreased antioxidant activity and increased oxidative stress, influencing hippocampal neurogenesis and microglial activation. Nuclear factor-kappa B (NF-κB), an oxidative stress byproduct, has been linked to MTX toxicity via the activation of NLRP3 inflammasome signaling. Macrophage activation and polarization plays an important role in tissue injury. This differentiation may be mediated via either the Toll-like receptor 4 (TLR4) or NLRP3 inflammasome. Interestingly, Canagliflozin (CANA), a sodium-glucose cotransporter 2 (SGLT2) inhibitor has been recently reported to exert anti-inflammatory effects by modulating macrophage polarization balance. This study aimed to investigate CANA's protective effect against MTX-induced cognitive impairment, highlighting the possible involvement of TLR4/ NF-κB crosstalk with NLRP3 inflammasome activation and macrophage polarization. Forty-eight Male Wistar rats were divided into 4 groups; (1) received saline orally for 30 days and intravenously on days 8 and 15. (2) received Canagliflozin (CANA; 20 mg/kg/day; p.o.) for 30 days. (3) received MTX (75 mg/kg, i.v.) on day 8 and 15, then they were injected with four i.p. injections of leucovorin (LCV): the first dose was 6 mg/ kg after 18 h, and the remaining doses were 3 mg/kg after 26, 42, and 50 h of MTX administration. (4) received MTX and LCV as in group 3 in addition to CANA as in group 2. MTX-treated rats showed cognitive deficits in spatial and learning memory as evidenced in the novel object recognition and Morris water maze tests. MTX exerted an oxidative effect which was evident by the increase in MDA and decline in SOD, GSH and GPx. Moreover, it exerted an inflammatory effect via elevated caspase-1, IL-1β and IL-8. CANA treatment restored cognitive ability, reduced MTX-induced oxidative stress and neuroinflammation via attenuation of TLR4/NF-κB/NLRP3 signaling, and rebalanced macrophage polarization by promoting the M2 phenotype. Hence, targeting molecular mechanisms manipulating macrophage polarization may offer novel neuroprotective strategies for preventing or treating MTX-induced immune modulation and its detrimental sequel.
Collapse
Affiliation(s)
- Lobna H Khedr
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Misr International University (MIU), Cairo 44971, Egypt
| | - Rania M Rahmo
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Misr International University (MIU), Cairo 44971, Egypt
| | - Omar M Eldemerdash
- Department of Biochemistry, Faculty of Pharmacy, Misr International University (MIU), Cairo 44971, Egypt
| | - Engy M Helmy
- Pharmacy Senior Students, Faculty of Pharmacy, Misr International University (MIU), Cairo 44971, Egypt
| | - Felopateer A Ramzy
- Pharmacy Senior Students, Faculty of Pharmacy, Misr International University (MIU), Cairo 44971, Egypt
| | - George H Lotfy
- Pharmacy Senior Students, Faculty of Pharmacy, Misr International University (MIU), Cairo 44971, Egypt
| | - Habiba A Zakaria
- Pharmacy Senior Students, Faculty of Pharmacy, Misr International University (MIU), Cairo 44971, Egypt
| | - Marine M Gad
- Pharmacy Senior Students, Faculty of Pharmacy, Misr International University (MIU), Cairo 44971, Egypt
| | - Marina M Youhanna
- Pharmacy Senior Students, Faculty of Pharmacy, Misr International University (MIU), Cairo 44971, Egypt
| | - Manar H Samaan
- Pharmacy Senior Students, Faculty of Pharmacy, Misr International University (MIU), Cairo 44971, Egypt
| | - Nevert W Thabet
- Pharmacy Senior Students, Faculty of Pharmacy, Misr International University (MIU), Cairo 44971, Egypt
| | - Reem H Ghazal
- Pharmacy Senior Students, Faculty of Pharmacy, Misr International University (MIU), Cairo 44971, Egypt
| | - Mostafa A Rabie
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, 11562 Cairo, Egypt.
| |
Collapse
|
5
|
Wijnker PJM, Dinani R, van der Laan NC, Algül S, Knollmann BC, Verkerk AO, Remme CA, Zuurbier CJ, Kuster DWD, van der Velden J. Hypertrophic cardiomyopathy dysfunction mimicked in human engineered heart tissue and improved by sodium-glucose cotransporter 2 inhibitors. Cardiovasc Res 2024; 120:301-317. [PMID: 38240646 PMCID: PMC10939456 DOI: 10.1093/cvr/cvae004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 11/15/2023] [Accepted: 11/29/2023] [Indexed: 03/16/2024] Open
Abstract
AIMS Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiomyopathy, often caused by pathogenic sarcomere mutations. Early characteristics of HCM are diastolic dysfunction and hypercontractility. Treatment to prevent mutation-induced cardiac dysfunction is lacking. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are a group of antidiabetic drugs that recently showed beneficial cardiovascular outcomes in patients with acquired forms of heart failure. We here studied if SGLT2i represent a potential therapy to correct cardiomyocyte dysfunction induced by an HCM sarcomere mutation. METHODS AND RESULTS Contractility was measured of human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) harbouring an HCM mutation cultured in 2D and in 3D engineered heart tissue (EHT). Mutations in the gene encoding β-myosin heavy chain (MYH7-R403Q) or cardiac troponin T (TNNT2-R92Q) were investigated. In 2D, intracellular [Ca2+], action potential and ion currents were determined. HCM mutations in hiPSC-CMs impaired relaxation or increased force, mimicking early features observed in human HCM. SGLT2i enhance the relaxation of hiPSC-CMs, to a larger extent in HCM compared to control hiPSC-CMs. Moreover, SGLT2i-effects on relaxation in R403Q EHT increased with culture duration, i.e. hiPSC-CMs maturation. Canagliflozin's effects on relaxation were more pronounced than empagliflozin and dapagliflozin. SGLT2i acutely altered Ca2+ handling in HCM hiPSC-CMs. Analyses of SGLT2i-mediated mechanisms that may underlie enhanced relaxation in mutant hiPSC-CMs excluded SGLT2, Na+/H+ exchanger, peak and late Nav1.5 currents, and L-type Ca2+ current, but indicate an important role for the Na+/Ca2+ exchanger. Indeed, electrophysiological measurements in mutant hiPSC-CM indicate that SGLT2i altered Na+/Ca2+ exchange current. CONCLUSION SGLT2i (canagliflozin > dapagliflozin > empagliflozin) acutely enhance relaxation in human EHT, especially in HCM and upon prolonged culture. SGLT2i may represent a potential therapy to correct early cardiac dysfunction in HCM.
Collapse
Affiliation(s)
- Paul J M Wijnker
- Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, De Boelelaan 1108, 1081 HZ Amsterdam, The Netherlands
| | - Rafeeh Dinani
- Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, De Boelelaan 1108, 1081 HZ Amsterdam, The Netherlands
| | - Nico C van der Laan
- Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, De Boelelaan 1108, 1081 HZ Amsterdam, The Netherlands
| | - Sila Algül
- Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, De Boelelaan 1108, 1081 HZ Amsterdam, The Netherlands
| | - Bjorn C Knollmann
- Vanderbilt Center for Arrhythmia Research and Therapeutics, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Arie O Verkerk
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, De Boelelaan 1108, 1081 HZ Amsterdam, The Netherlands
- Experimental Cardiology, Amsterdam UMC, Academic Medical Centre, Amsterdam, The Netherlands
| | - Carol Ann Remme
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, De Boelelaan 1108, 1081 HZ Amsterdam, The Netherlands
- Experimental Cardiology, Amsterdam UMC, Academic Medical Centre, Amsterdam, The Netherlands
| | - Coert J Zuurbier
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, De Boelelaan 1108, 1081 HZ Amsterdam, The Netherlands
- Laboratory for Experimental Intensive Care and Anesthesiology (L.E.I.C.A.), Department of Anesthesiology, Amsterdam UMC, Academic Medical Centre, Amsterdam, The Netherlands
| | - Diederik W D Kuster
- Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, De Boelelaan 1108, 1081 HZ Amsterdam, The Netherlands
| | - Jolanda van der Velden
- Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, De Boelelaan 1108, 1081 HZ Amsterdam, The Netherlands
| |
Collapse
|
6
|
Negri AL. Sodium-glucose cotransporter 2 inhibitors in the treatment of refractory hypomagnesemia. Kidney Int 2024; 105:638. [PMID: 38388149 DOI: 10.1016/j.kint.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/28/2023] [Indexed: 02/24/2024]
Affiliation(s)
- Armando Luis Negri
- Instituto de Investigaciones Metabólicas, Universidad del Salvador, Buenos Aires, Argentina.
| |
Collapse
|
7
|
Daya NR, Fang M, Mathew M, Shin JI, Pankow J, Lutsey PL, Valint A, Echouffo-Tcheugui JB, Selvin E. 1,5-Anhydroglucitol: A Novel Biomarker of Adherence to Sodium-Glucose Cotransporter 2 Inhibitors. Diabetes Care 2024; 47:e9-e10. [PMID: 38091486 PMCID: PMC10834388 DOI: 10.2337/dc23-2035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 11/10/2023] [Indexed: 01/05/2024]
Affiliation(s)
- Natalie R. Daya
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Michael Fang
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mahesh Mathew
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - Jung-Im Shin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - James Pankow
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - Arielle Valint
- University of North Carolina Gillings School of Public Health, Chapel Hill, NC
| | - Justin B. Echouffo-Tcheugui
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| |
Collapse
|
8
|
de Boer RA, Díez J. Advancing the fight against fibrosis in patients with heart failure: The contribution of sodium-glucose cotransporter 2 inhibition. Eur J Heart Fail 2024; 26:285-287. [PMID: 38196302 DOI: 10.1002/ejhf.3125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/20/2023] [Indexed: 01/11/2024] Open
Affiliation(s)
- Rudolf A de Boer
- Thorax Center, Department of Cardiology, Erasmus Medical Center, Erasmus MC, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Javier Díez
- Center for Applied Medical Research (CIMA), and School of Medicine, University of Navarra, Pamplona, Spain
- Center for Network Biomedical Research of Cardiovascular Diseases (CIBERCV), Carlos III Institute of Health, Madrid, Spain
| |
Collapse
|
9
|
Fathy Elhabal S, El-Nabarawi MA, Abdelaal N, Elrefai MFM, Ghaffar SA, Khalifa MM, Mohie PM, Waggas DS, Hamdan AME, Alshawwa SZ, Saied EM, Elzohairy NA, Elnawawy T, Gad RA, Elfar N, Mohammed H, Khasawneh MA. Development of canagliflozin nanocrystals sublingual tablets in the presence of sodium caprate permeability enhancer: formulation optimization, characterization, in-vitro, in silico, and in-vivo study. Drug Deliv 2023; 30:2241665. [PMID: 37537858 PMCID: PMC10946264 DOI: 10.1080/10717544.2023.2241665] [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: 03/31/2023] [Accepted: 06/12/2023] [Indexed: 08/05/2023] Open
Abstract
Canagliflozin (CFZ) is a sodium-glucose cotransporter-2 inhibitor (SGLT2) that lowers albuminuria in type-2 diabetic patients, cardiovascular, kidney, and liver disease. CFZ is classified as class IV in the Biopharmaceutical Classification System (BCS) and is characterized by low permeability, solubility, and bioavailability, most likely attributed to hepatic first-pass metabolism. Nanocrystal-based sublingual formulations were developed in the presence of sodium caprate, as a wetting agent, and as a permeability enhancer. This formulation is suitable for children and adults and could enhance solubility, permeability, and avoid enterohepatic circulation due to absorption through the sublingual mucosa. In the present study, formulations containing various surfactants (P237, P338, PVA, and PVP K30) were prepared by the Sono-homo-assisted precipitation ion technique. The optimized formula prepared with PVP-K30 showed the smallest particle size (157 ± 0.32 nm), Zeta-potential (-18 ± 0.01), and morphology by TEM analysis. The optimized formula was subsequently formulated into a sublingual tablet containing Pharma burst-V® with a shorter disintegration time (51s) for the in-vivo study. The selected sublingual tablet improved histological and biochemical markers (blood glucose, liver, and kidney function), AMP-activated protein kinase (AMPK), and protein kinase B (AKT) pathway compared to the market formula, increased CFZ's antidiabetic potency in diabetic rabbits, boosted bioavailability by five-fold, and produced faster onset of action. These findings suggest successful treatment of diabetes with CFZ nanocrystal-sublingual tablets.
Collapse
Affiliation(s)
- Sammar Fathy Elhabal
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Modern University for Technology and Information (MTI), Mokattam, Cairo, Egypt
| | - Mohamed A El-Nabarawi
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Nashwa Abdelaal
- Department of Integrative Physiology, Baylor College of Medicine, Houston, Texas, USA
| | - Mohamed Fathi Mohamed Elrefai
- Department of Anatomy, Histology, Physiology and Biochemistry, Faculty of Medicine, The Hashemite University, Zarqa, Jordan
- Department of Anatomy and Embryology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Shrouk A. Ghaffar
- Medical Affairs Department, Caduceus Lane Healthcare, Alexandria, Egypt
| | - Mohamed Mansour Khalifa
- Department of Human Physiology, Faculty of Medicine, Cairo University, Cairo, Egypt
- Department of Human Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Dania S. Waggas
- Department of Pathological Science, Fakeeh College for Medical Science, Jeddah, Saudi Arabia
| | | | - Samar Zuhair Alshawwa
- Department of Pharmaceutical Sciences, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Essa M. Saied
- Chemistry Department, Faculty of Science, Suez Canal University, Ismailia, Egypt
- Institute for Chemistry, Humboldt Universität zu Berlin, Berlin, Germany
| | - Nahla A. Elzohairy
- Air Force Specialized Hospital, Cairo, Egypt
- Department of Microbiology and Immunology, Faculty of Pharmacy, Modern University for Technology and Information (MTI), Mokattam, Cairo, Egypt
| | - Tayseer Elnawawy
- Department of pharmaceutics, Egyptian Drug Authority, Cairo, Egypt
| | - Rania A. Gad
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Nahda University, Beni-Suef (NUB), Beni-Suef, Egypt
| | - Nehal Elfar
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Horus University, New Damietta, Egypt
| | - Hanaa Mohammed
- Human Anatomy and Embryology Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | | |
Collapse
|
10
|
Taylor SI, Cherng HR, Yazdi ZS, Montasser ME, Whitlatch HB, Mitchell BD, Shuldiner AR, Streeten EA, Beitelshees AL. Pharmacogenetics of sodium-glucose co-transporter-2 inhibitors: Validation of a sex-agnostic pharmacodynamic biomarker. Diabetes Obes Metab 2023; 25:3512-3520. [PMID: 37608471 PMCID: PMC10829524 DOI: 10.1111/dom.15246] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/21/2023] [Accepted: 07/28/2023] [Indexed: 08/24/2023]
Abstract
AIM To validate pharmacodynamic responses to sodium-glucose co-transporter-2 (SGLT2) inhibitors and test for association with genetic variants in SLC5A4, SLC5A9, and SLC2A9. METHODS Canagliflozin (300 mg), a SGLT2 inhibitor, was administered to 30 healthy volunteers. Several endpoints were measured to assess clinically relevant responses, including drug-induced increases in urinary excretion of glucose, sodium and uric acid. RESULTS This pilot study confirmed that canagliflozin (300 mg) triggered acute changes in mean levels of several biomarkers: fasting plasma glucose (-4.1 mg/dL; P = 6 × 10-5 ), serum creatinine (+0.05 mg/dL; P = 8 × 10-4 ) and serum uric acid (-0.90 mg/dL; P = 5 × 10-10 ). The effects of sex on glucosuria depended upon how data were normalized. Whereas males' responses were ~60% greater when data were normalized to body surface area, males and females exhibited similar responses when glucosuria was expressed as grams of urinary glucose per gram-creatinine. The magnitude of glucosuria was not significantly correlated with fasting plasma glucose, estimated glomerular filtration rate or age in those healthy individuals without diabetes with an estimated glomerular filtration rate of more than 60 mL/min/1.73m2 . CONCLUSIONS Normalizing data relative to creatinine excretion will facilitate including data from males and females in a single analysis. Furthermore, because our ongoing pharmacogenomic study (NCT02891954) is conducted in healthy individuals, this will facilitate detection of genetic associations with limited confounding by other factors such as HbA1c and renal function.
Collapse
Affiliation(s)
- Simeon I. Taylor
- Department of Medicine, Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Baltimore, MD 20201, USA
| | - Hua-Ren Cherng
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD 20201, USA
| | - Zhinous Shahidzadeh Yazdi
- Department of Medicine, Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Baltimore, MD 20201, USA
| | - May E. Montasser
- Department of Medicine, Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Baltimore, MD 20201, USA
| | - Hilary B. Whitlatch
- Department of Medicine, Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Baltimore, MD 20201, USA
| | - Braxton D. Mitchell
- Department of Medicine, Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Baltimore, MD 20201, USA
| | - Alan R. Shuldiner
- Department of Medicine, Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Baltimore, MD 20201, USA
| | - Elizabeth A. Streeten
- Department of Medicine, Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Baltimore, MD 20201, USA
| | - Amber L. Beitelshees
- Department of Medicine, Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Baltimore, MD 20201, USA
| |
Collapse
|
11
|
In brief: Empagliflozin (Jardiance) for chronic kidney disease. Med Lett Drugs Ther 2023; 65:183-4. [PMID: 37935020 DOI: 10.58347/tml.2023.1689c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
|
12
|
Golbus JR, Gosch K, Birmingham MC, Butler J, Lingvay I, Lanfear DE, Abbate A, Kosiborod ML, Damaraju CV, Januzzi JL, Spertus J, Nallamothu BK. Association Between Wearable Device Measured Activity and Patient-Reported Outcomes for Heart Failure. JACC Heart Fail 2023; 11:1521-1530. [PMID: 37498273 DOI: 10.1016/j.jchf.2023.05.033] [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] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/10/2023] [Accepted: 05/26/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Wearable devices are increasingly used in research and clinical care though the relevance of their data in the context of validated outcomes remains unknown. OBJECTIVES The purpose of this study was to characterize the relationship between smartwatch activity and patient-centered outcomes in patients with heart failure. METHODS CHIEF-HF (Canagliflozin: Impact on Health Status, Quality of Life and Functional Status in Heart Failure) was a randomized-controlled clinical trial that enrolled participants with heart failure and a compatible smartphone. Participants were provided a Fitbit Versa 2 and completed serial Kansas City Cardiomyopathy Questionnaires (KCCQs) through a smartphone application. We evaluated the relationship between daily step count and floors climbed and KCCQ total symptom (TS) and physical limitation (PL) scores at baseline and their respective changes between 2 and 12 weeks using linear regression models, with restricted cubic splines for nonlinear associations. RESULTS In total, 425 patients were included: 44.5% women, 40.9% with reduced ejection fraction. Baseline daily step count increased across categories of KCCQ-TS scores (2,437.6 ± 1,419.5 steps/d for scores 0 to 24 vs 4,870.9 ± 3,171.3 steps/d for scores 75 to 100; P < 0.001) with similar results for KCCQ-PL scores. This relationship remained significant for KCCQ-TS and KCCQ-PL scores after multivariable adjustment. Importantly, changes in daily step count were significantly associated with nonlinear changes in KCCQ-TS (P = 0.004) and KCCQ-PL (P = 0.003) scores. Floors climbed was associated with baseline KCCQ scores alone. CONCLUSIONS Daily step count was nonlinearly associated with health status at baseline and over time in patients with heart failure. These results may inform interpretation of wearable device data in clinical and research contexts. (A Study on Impact of Canagliflozin on Health Status, Quality of Life, and Functional Status in Heart Failure [CHIEF-HF]; NCT04252287).
Collapse
Affiliation(s)
- Jessica R Golbus
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA; Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor, Michigan, USA. https://twitter.com/JRGolbus
| | - Kensey Gosch
- University of Missouri-Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | | | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, Texas, USA
| | - Ildiko Lingvay
- Department of Internal Medicine, Division of Endocrinology and Peter O'Donnel Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - David E Lanfear
- Division of Cardiovascular Medicine and Center for Individualized and Genomic Medicine Research, Department of Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Antonio Abbate
- Berne Cardiovascular Research Center, Department of Internal Medicine, Division of Cardiology, University of Virginia Health, Charlottesville, Virginia, USA
| | - Mikhail L Kosiborod
- University of Missouri-Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - C V Damaraju
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA
| | - James L Januzzi
- Massachusetts General Hospital, Harvard Medical School and Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | - John Spertus
- University of Missouri-Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Brahmajee K Nallamothu
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA; Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor, Michigan, USA; The Center for Clinical Management and Research, Ann Arbor VA Medical Center, Ann Arbor, Michigan, USA
| |
Collapse
|
13
|
Tanaka A, Kinugawa K, Kuwahara K, Ito H, Murohara T, Hirata KI, Node K. Recommendation for Appropriate Use of Sodium Glucose Cotransporter 2 Inhibitors in Treatment of Heart Failure. Circ J 2023; 87:1707-1709. [PMID: 37743518 DOI: 10.1253/circj.cj-23-0605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Affiliation(s)
| | | | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Hiroshi Ito
- Department of General Internal Medicine 3, Kawasaki Medical School
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| |
Collapse
|
14
|
Elbaz EM, Darwish A, Gad AM, Abdel Rahman AAS, Safwat MH. Canagliflozin alleviates experimentally induced benign prostate hyperplasia in a rat model: exploring potential mechanisms involving mir-128b/EGFR/EGF and JAK2/STAT3 signaling pathways through in silico and in vivo investigations. Eur J Pharmacol 2023; 957:175993. [PMID: 37598927 DOI: 10.1016/j.ejphar.2023.175993] [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: 04/22/2023] [Revised: 08/02/2023] [Accepted: 08/10/2023] [Indexed: 08/22/2023]
Abstract
Benign prostatic hyperplasia (BPH) poses a significant health concern amongst elderly males. Canagliflozin (Cana), a selective sodium-glucose co-transporter 2 (SGLT2) inhibitor, has a powerful anti-inflammatory influence. Nevertheless, its role in treating BPH has not been clarified. Therefore, the study aimed to investigate the potential ameliorative effect of Cana on experimentally induced BPH in rats and explore the underlying mechanisms compared to the standard finasteride (Fin). The study employed histological analysis, biochemical assays using ELISA, and western blotting. Animals were categorized into four groups: Control (2.5 ml/kg CMC, orally + 3 ml/kg olive oil, subcutaneous), BPH (3 mg/kg testosterone, subcutaneous + CMC orally), Fin-treated BPH (5 mg/kg, orally), and Cana-treated BPH (5 mg/kg, orally), for 28 days. The BPH group showed obvious BPH manifestations including an increase in prostate weight (PW), prostate index (PI), dihydrotestosterone (DHT) level, and histological aberrations compared to control. Fin and Cana therapy had a comparable impact. Cana treatment significantly reduced PW and PI, besides it improved prostatic biochemical, and histopathological features compared to BPH, consistent with in silico study findings. Cana was associated with downregulation of the androgen axis, increased miR-128b expression, with a lowered expression of epidermal growth factor (EGF) and its receptor. Phosphorylation of STAT3 and its downstream proliferative markers were significantly reduced suggesting apoptotic activity. Cana markedly rescued the BPH-induced upregulation of IL-1β, and iNOS levels. Altogether, the current study demonstrates that Cana could impede BPH progression, possibly by modulating miR-128b/EGFR/EGF and JAK2/STAT3 pathways and downregulating AR, cyclin D1, and PCNA immunoreactivity.
Collapse
Affiliation(s)
- Eman M Elbaz
- Department of Biochemistry, Faculty of Pharmacy, Cairo University, Cairo, Egypt.
| | - Alshaymaa Darwish
- Department of Biochemistry, Faculty of Pharmacy, Sohag University, Sohag, Egypt.
| | - Amany M Gad
- Department of Pharmacology and Toxicology, Egyptian Drug Authority (EDA) -Formerly NODCAR, Giza 12654, Egypt; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Sinai University, Kantara Branch, Ismailia, 41636, Egypt.
| | - Amina A S Abdel Rahman
- Department of Zoology, Faculty of Women for Arts, Science and Education, Ain Shams University, Cairo, Egypt
| | - Maheera H Safwat
- Department of Biochemistry, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| |
Collapse
|
15
|
Kalra R. Sodium-glucose cotransporter 2 inhibitors in hospitalized heart failure patients: No time like now. Eur J Heart Fail 2023; 25:1806-1807. [PMID: 37661932 DOI: 10.1002/ejhf.3022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 08/28/2023] [Indexed: 09/05/2023] Open
Affiliation(s)
- Rajat Kalra
- Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
- Center for Resuscitation Medicine, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
16
|
Macedo E, Wettersten N. The Mounting Evidence for Permissive Hypercreatinemia in Acute Heart Failure: Adding Sodium Glucose Cotransporter Inhibitors to the List. Kidney360 2023; 4:1347-1349. [PMID: 37883999 PMCID: PMC10617792 DOI: 10.34067/kid.0000000000000266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Affiliation(s)
- Etienne Macedo
- Division of Nephrology, University of California, San Diego, La Jolla, California
| | - Nicholas Wettersten
- Division of Cardiovascular Medicine, San Diego Veterans Affairs Medical Center, San Diego, California
- Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, California
| |
Collapse
|
17
|
Fawzy MG, Said MA. Valuation of environmental influence of recently invented high-performance liquid chromatographic method for hypoglycemic mixtures of gliflozins and metformin in the presence of melamine impurities: Application of molecular modeling simulation approach. J Sep Sci 2023; 46:e2300267. [PMID: 37485588 DOI: 10.1002/jssc.202300267] [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: 04/18/2023] [Revised: 06/29/2023] [Accepted: 07/10/2023] [Indexed: 07/25/2023]
Abstract
Molecular modeling is the science of representing molecular structures numerically and simulating their behavior with the equations of quantum and classical physics. Coupling molecular modeling and simulation with chromatographic resolution for pharmaceutical products constitutes a new technique in pharmaceutical analysis. An innovative high-performance liquid chromatographic (HPLC) methodology was developed for the quantification of metformin hydrochloride (MET), empagliflozin (EMP), and canagliflozin (CAN) in bulk, laboratory-developed combinations, pharmaceutical tablets, and in the presence of melamine. Chromatographic separation was accomplished using a Symmetry column with 0.03 M potassium dihydrogen phosphate buffer and 0.02 M heptane sulphonic acid: acetonitrile as the mobile phase. Molecular modeling using molecular operating environment software was applied to properly select the stationary phase suitable for the developed HPLC method. Additionally, molecular modeling estimates and validates binding between the studied analytes and the stationary phase to clarify and explain the chromatographic separation and elution order. In accordance with the International Conference of Harmonization recommendations, the method was validated in terms of linearity, accuracy, precision, and selectivity. The linearity ranges (μg/ml) were 200-1500 (MET), 2-15 (EMP), and 20-150 (CAN) and the limit of detection values were in the ranges of 0.17-54.58 μg/ml. Analysis of pharmaceutical tablets using the suggested approach yielded satisfactory outcomes. As a result, it might be used in quality control laboratories to analyze the aforementioned medications.
Collapse
Affiliation(s)
- Michael Gamal Fawzy
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Egyptian Russian University, Badr City, Egypt
| | - Mohamed A Said
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Egyptian Russian University, Badr City, Egypt
| |
Collapse
|
18
|
Haneef J, Khan MD. Liquid chromatographic methods for the analysis of canagliflozin: concise overview and greener assessment. Anal Methods 2023; 15:4627-4639. [PMID: 37694570 DOI: 10.1039/d3ay00896g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
There is a pressing need for the development of greener liquid chromatographic bioanalytical methods for antidiabetic drugs for plasma monitoring and revisiting patients' dosage regimens. Besides, analytical methods are also needed for the quality assurance of finished drug products and regulatory approval. Therefore, the present review focuses on the reported liquid chromatographic methods (LC and LC-MS/MS) that are applied for quality control, forced degradation, and pharmacokinetic studies of a newer antidiabetic agent, canagliflozin (CNG). These reported studies are summarized based on liquid chromatographic separation parameters, such as column dimensions, mobile-phase compositions, flow rate, and use of different detection systems (UV, PDA, and mass spectrometry). The sample pretreatment of biological fluids, which is important for minimizing the matrix effect, is dealt with separately. Liquid-liquid extraction was found to be the most preferred methodology adopted for sample pretreatment followed by the solid-phase extraction technique. However, miniaturized novel pretreatment methods are untraceable in the literature for the extraction of CNG. Special emphasis is paid to the assessment of the greenness profiles of the reported analytical methods for the consideration of sustainable development and green analytical chemistry. Based on the National Environmental Method Index (NEMI) assessment tool, most of the reported studies fulfilled around half of the parameters and were found to be about 50% greener. It is proposed that toxic or hazardous solvents, such as acetonitrile or methanol, should be replaced with greener and environmentally friendly solvents. Thus, there is a need to develop more robust, efficient, and greener liquid chromatographic methods for the determination of CNG in biological fluids and drug products.
Collapse
Affiliation(s)
- Jamshed Haneef
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110 062, India.
| | - Mohd Danish Khan
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110 062, India.
| |
Collapse
|
19
|
Zhang T, Wang X, Wang Z, Zhai J, He L, Wang Y, Zuo Q, Ma S, Zhang G, Guo Y. Canagliflozin Ameliorates Ventricular Remodeling through Apelin/Angiotensin-Converting Enzyme 2 Signaling in Heart Failure with Preserved Ejection Fraction Rats. Pharmacology 2023; 108:478-491. [PMID: 37611563 DOI: 10.1159/000533277] [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: 03/04/2023] [Accepted: 07/24/2023] [Indexed: 08/25/2023]
Abstract
INTRODUCTION The aim of this study was to investigate the effect of canagliflozin (CANA) on ventricular remodeling in patients with preserved ejection fraction (HFpEF) heart failure and to further investigate its possible molecular mechanisms. METHODS A high-salt diet was used to induce the formation of HFpEF model in salt-sensitive rats. The rats were fed with CANA and irbesartan, respectively. The mice were divided into control group, model group, CANA group, irbesartan group, and combined drug group. After 12 weeks of feeding, the rats were evaluated by measuring the relevant indexes and echocardiography for cardiac function. Histological analysis was performed using Masson trichrome staining and immunohistochemical staining. RT-qPCR and Western blot were used to quantify the relevant genes and proteins. RESULTS In this study, CANA exhibited diuresis, decreased blood pressure, weight loss, and increased food and water intake. Following a high-salt diet, Dahl salt-sensitive rats developed hypertension followed by left ventricular diastolic dysfunction, myocardial fibrosis, and left ventricular remodeling. Myocardial hypertrophy and fibrosis were reduced, and left ventricular diastolic function and ventricular remodeling improved after CANA treatment. The combination of CANA and irbesartan was superior to monotherapy in reducing blood pressure and improving cardiac insufficiency and left ventricular diastolic dysfunction in rats. CANA improves myocardial fibrosis, left ventricular diastolic dysfunction, and ventricular remodeling by upregulating apelin, activating angiotensin-converting enzyme 2 (ACE2), and increasing ACE2/Ang (1-7)/MASR axis levels. CONCLUSION CANA improves myocardial fibrosis, left ventricular diastolic dysfunction, and ventricular remodeling in HFpEF rats through upregulation of apelin/ACE2 signaling.
Collapse
Affiliation(s)
- Tingting Zhang
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, China,
- Department of Geriatric Cardiology, Hebei General Hospital, Shijiazhuang, China,
| | - Xinyu Wang
- College of Postgraduate, Hebei North University, Zhangjiakou, China
| | - Zhongli Wang
- Department of Physical Examination Center, Hebei General Hospital, Shijiazhuang, China
| | - Jianlong Zhai
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, China
| | - Lili He
- Department of Geriatric Cardiology, Hebei General Hospital, Shijiazhuang, China
| | - Yan Wang
- Department of Geriatric Cardiology, Hebei General Hospital, Shijiazhuang, China
| | - Qingjuan Zuo
- Department of Geriatric Cardiology, Hebei General Hospital, Shijiazhuang, China
| | - Sai Ma
- Department of Internal Medicine, Hebei General Hospital, Shijiazhuang, China
| | - Guorui Zhang
- Department of Cardiology, The Third Hospital of Shijiazhuang City Affiliated to Hebei Medical University, Shijiazhuang, China
| | - Yifang Guo
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, China
- Department of Geriatric Cardiology, Hebei General Hospital, Shijiazhuang, China
| |
Collapse
|
20
|
Li X, Li Q, Zhang Z, Wang C, Huo X, Lai H, Lu H, Lu W, Qian Y, Dong W, Tan C, Liu M. Canagliflozin Inhibited the Activity of Hemolysin and Reduced the Inflammatory Response Caused by Streptococcus suis. Int J Mol Sci 2023; 24:13074. [PMID: 37685881 PMCID: PMC10487456 DOI: 10.3390/ijms241713074] [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: 07/24/2023] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
Highly virulent Streptococcus suis (S. suis) infections can cause Streptococcal toxic shock-like syndrome (STSLS) in pigs and humans, in which an excessive inflammatory response causes severe damage. Hemolysin (SLY) is a major virulence factor of S. suis serotype 2 that produces pores in the target cell membrane, leading to cytoplasmic K+ efflux and activation of the NLRP3 inflammasome, ultimately causing STSLS. The critical aspect of hemolysin in the pathogenesis of S. suis type 2 makes it an attractive target for the development of innovative anti-virulence drugs. Here, we use the S. suis toxin protein (SLY) as a target for virtual screening. A compound called canagliflozin, a hypoglycemic agent, was identified through screening. Canagliflozin significantly inhibits the hemolytic activity of hemolysin. The results combined with molecular dynamics simulation, surface plasmon resonance, and nano differential scanning fluorimetry show that canagliflozin inhibits the hemolytic activity of SLY by binding to SLY. In addition, canagliflozin markedly reduced the release of SC19-induced inflammatory factors at the cellular level and in mice. Importantly, the combination of canagliflozin and ampicillin had a 90% success rate in mice, significantly greater than the therapeutic effect of ampicillin. The findings suggest that canagliflozin may be a promising new drug candidate for S. suis infections.
Collapse
Affiliation(s)
- Xiaodan Li
- Hubei Biopesticide Engineering Research Centre, Wuhan 430000, China;
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan 430000, China; (Q.L.); (Z.Z.); (C.W.); (X.H.); (H.L.); (H.L.); (W.L.); (Y.Q.); (W.D.); (C.T.)
| | - Qingyuan Li
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan 430000, China; (Q.L.); (Z.Z.); (C.W.); (X.H.); (H.L.); (H.L.); (W.L.); (Y.Q.); (W.D.); (C.T.)
| | - Zhaoran Zhang
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan 430000, China; (Q.L.); (Z.Z.); (C.W.); (X.H.); (H.L.); (H.L.); (W.L.); (Y.Q.); (W.D.); (C.T.)
| | - Chenchen Wang
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan 430000, China; (Q.L.); (Z.Z.); (C.W.); (X.H.); (H.L.); (H.L.); (W.L.); (Y.Q.); (W.D.); (C.T.)
| | - Xinyu Huo
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan 430000, China; (Q.L.); (Z.Z.); (C.W.); (X.H.); (H.L.); (H.L.); (W.L.); (Y.Q.); (W.D.); (C.T.)
| | - Hongjiang Lai
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan 430000, China; (Q.L.); (Z.Z.); (C.W.); (X.H.); (H.L.); (H.L.); (W.L.); (Y.Q.); (W.D.); (C.T.)
| | - Hao Lu
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan 430000, China; (Q.L.); (Z.Z.); (C.W.); (X.H.); (H.L.); (H.L.); (W.L.); (Y.Q.); (W.D.); (C.T.)
| | - Wenjia Lu
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan 430000, China; (Q.L.); (Z.Z.); (C.W.); (X.H.); (H.L.); (H.L.); (W.L.); (Y.Q.); (W.D.); (C.T.)
| | - Yulin Qian
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan 430000, China; (Q.L.); (Z.Z.); (C.W.); (X.H.); (H.L.); (H.L.); (W.L.); (Y.Q.); (W.D.); (C.T.)
| | - Wenqi Dong
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan 430000, China; (Q.L.); (Z.Z.); (C.W.); (X.H.); (H.L.); (H.L.); (W.L.); (Y.Q.); (W.D.); (C.T.)
| | - Chen Tan
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan 430000, China; (Q.L.); (Z.Z.); (C.W.); (X.H.); (H.L.); (H.L.); (W.L.); (Y.Q.); (W.D.); (C.T.)
| | - Manli Liu
- Hubei Biopesticide Engineering Research Centre, Wuhan 430000, China;
| |
Collapse
|
21
|
Bellastella G, Caruso P, Carbone C, di Nuzzo M, Scappaticcio L, Paglionico VA, Maiorino MI, Esposito K. Case Report: Post-gastrectomy reactive hyperinsulinemic hypoglicaemia: glucose trends before and after canagliflozin treatment. Front Endocrinol (Lausanne) 2023; 14:1193696. [PMID: 37645417 PMCID: PMC10461623 DOI: 10.3389/fendo.2023.1193696] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 06/14/2023] [Indexed: 08/31/2023] Open
Abstract
The pathogenesis of post-gastrectomy reactive hyperinsulinaemic hypoglycaemia is not yet fully clarified. Recent studies suggest an up-regulation of the intestinal glucose transporter SGLT-1 aimed to prevent carbohydrate malabsorption. The overexpression of SGLT-1 could therefore represents one of the mechanisms underlying the wide glycemic excursions found in patients after gastrectomy, but studies investigating the use of SGLT-1/SGLT-2 inhibitors in patients with post-gastrectomy reactive hyperinsulinemic hypoglycaemia are very scant in the literature. We report the case of a 37-year-old non diabetic man who frequently presented symptoms of hypoglycaemia in the postprandial period. In 2012, he underwent Roux en-Y gastric bypass (RYGB) and after two years, he started to experience typical symptoms of reactive hyperinsulinaemic hypoglycaemia. We suggested healthy modifications of dietary habits and periodic follow-up visits with a dietitian. After three months, the patient still presented symptoms of reactive hypoglycaemia; we provided him with Flash Glucose Monitoring (FGM) to assess trend of glucose levels in interstitial fluid during the day and we decided to introduce canagliflozin 300 mg/day before the main meal. Hypoglycaemic events previously referred by the patient and clearly recorded by FGM completely disappeared taking canagliflozin. We found a reduction of time spent in hypoglycaemia, an improvement of glycemic variability and an increase of time in target range. It was also noted a reduction of time spent in hyperglicemia with consequent improvement of average glucose values and of glucose main indicator. This is the first report with FGM supporting a role of canagliflozin in the management of post-gastrectomy reactive hyperinsulinaemic hypoglycaemia. Our preliminary results are very limited but in line with those of the literature and showed for the first time a reduction of hypoglycaemic events and an improvement of glycemic variability through a flash glucose monitoring system. Further studies are mandatory to confirm this therapeutic opportunity.
Collapse
Affiliation(s)
- G. Bellastella
- Unit of Endocrinology and Metabolic Diseases, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - P. Caruso
- Unit of Endocrinology and Metabolic Diseases, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - C. Carbone
- Unit of Endocrinology and Metabolic Diseases, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - M. di Nuzzo
- Unit of Endocrinology and Metabolic Diseases, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - L. Scappaticcio
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - V. Amoresano Paglionico
- Unit of Endocrinology and Metabolic Diseases, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - M. I. Maiorino
- Unit of Endocrinology and Metabolic Diseases, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - K. Esposito
- Unit of Endocrinology and Metabolic Diseases, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| |
Collapse
|
22
|
Strachinaru M, Roussoulières A, Manintveld OC. Sodium-glucose cotransporter 2 inhibitors for chronic heart failure: The ultimate solution? Eur J Heart Fail 2023; 25:1361-1363. [PMID: 37349853 DOI: 10.1002/ejhf.2942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 06/18/2023] [Indexed: 06/24/2023] Open
Affiliation(s)
- Mihai Strachinaru
- Department of Cardiology, Pulmonary Vascular Diseases and Heart failure Clinic, Brussels University Hospital-Erasme Hospital, Brussels, Belgium
- Department of Cardiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ana Roussoulières
- Department of Cardiology, Pulmonary Vascular Diseases and Heart failure Clinic, Brussels University Hospital-Erasme Hospital, Brussels, Belgium
| | - Olivier C Manintveld
- Department of Cardiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
- Erasmus MC Transplant Institute, Rotterdam, The Netherlands
| |
Collapse
|
23
|
Kuoni S, Müller D, Simões-Wüst AP, Steiner R. Simultaneous LC-MS/MS quantification of SGLT2 inhibitors and antipyrine in medium and tissue from human ex vivo placenta perfusions. J Chromatogr B Analyt Technol Biomed Life Sci 2023; 1228:123841. [PMID: 37542935 DOI: 10.1016/j.jchromb.2023.123841] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/29/2023] [Accepted: 07/22/2023] [Indexed: 08/07/2023]
Abstract
A liquid chromatography - tandem mass spectrometry (LC-MS/MS) method has been developed to simultaneously measure four sodium glucose co-transporter 2 (SGLT2) inhibitors and the transfer marker antipyrine (ANTI) in perfusion medium and placental tissue collected from ex vivo human placental perfusions. The four SGLT2 inhibitors were empagliflozin (EMPA), dapagliflozin (DAPA), ertugliflozin (ERTU) and canagliflozin (CANA). Chromatographic separation was achieved on an Uptisphere® C18 reversed phase column (50 mm × 4.6 mm × 5 µm) within 2.85 min, using a gradient elution with 10 mM ammonium formate in water (mobile phase A) and acetonitrile (mobile phase B) both with 0.1% formic acid. Analysis of ammonium adduct ions was performed on an AB SCIEX 6500+ triple quadrupole mass spectrometer using positive electrospray ionisation and scheduled multiple reaction monitoring (sMRM). The transitions were m/z 468.00 → 355.20 (EMPA), m/z 426.00 → 167.20 (DAPA), m/z 437.10 → 206.90 (ERTU), m/z 462.00 → 249.00 (CANA) and m/z 189.20 → 55.90 (ANTI). The method was validated according to the European Medicines Agency guidelines and was proven to be selective, linear within a concentration range of 1-1000 µg/L (DAPA, CANA, ANTI) and 1-500 µg/L (EMPA, ERTU), accurate, precise and free of carry-over, instabilities, recovery and matrix effect issues. This newly developed method is suitable to analyse perfusion medium and placenta tissue samples collected during ex vivo human placenta perfusions. It thereby enables quantification of transport across the placental barrier of the SGLT2 inhibitors EMPA, DAPA, ERTU and CANA as well as the transfer marker ANTI.
Collapse
Affiliation(s)
- Sabrina Kuoni
- Department of Obstetrics, University Hospital Zurich, University of Zurich, CH-8091 Zurich, Switzerland
| | - Daniel Müller
- Institute of Clinical Chemistry, University and University Hospital of Zurich, CH-8091 Zurich, Switzerland
| | - Ana Paula Simões-Wüst
- Department of Obstetrics, University Hospital Zurich, University of Zurich, CH-8091 Zurich, Switzerland.
| | - Regula Steiner
- Institute of Clinical Chemistry, University and University Hospital of Zurich, CH-8091 Zurich, Switzerland.
| |
Collapse
|
24
|
Sotagliflozin (Inpefa) for heart failure. Med Lett Drugs Ther 2023; 65:114-6. [PMID: 37460142 DOI: 10.58347/tml.2023.1681b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
|
25
|
Nassif M, Birmingham MC, Lanfear DE, Golbus JR, Gupta B, Fawcett C, Harrison MC, Spertus JA. Recruitment Strategies of a Decentralized Randomized Placebo Controlled Clinical Trial: The Canagliflozin Impact on Health Status, Quality of Life and Functional Status in Heart Failure (CHIEF-HF) Trial. J Card Fail 2023; 29:863-869. [PMID: 37040839 DOI: 10.1016/j.cardfail.2023.04.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 04/05/2023] [Accepted: 04/05/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND There has been growing Interest in patient-centered clinical trials using mobile technologies to reduce the need for in-person visits. The CHIEF-HF (Canagliflozin Impact on Health Status, Quality of Life and Functional Status in Heart Failure) trial was designed as a double-blind, randomized, fully decentralized clinical trial (DCT) that identified, consented, treated, and followed participants without any in-person visits. Patient-reported questionnaires were the primary outcome, which were collected by a mobile application. To inform future DCTs, we sought to describe the strategies used in successful trial recruitment. METHODS This article describes the operational structure and novel strategies employed in a completely DCT by summarizing the recruitment, enrollment, engagement, retention, and follow-up processes used in the execution of the trial at 18 centers. RESULTS A total of 18 sites contacted 130,832 potential participants, of which 2572 (2.0%) opened a hyperlink to the study website, completed a brief survey, and agreed to be contacted for potential inclusion. Of these, 1333 were eligible, and 658 consented; there were 182 screen failures, due primarily to baseline Kansas City Cardiomyopathy Questionnaire scores' not meeting inclusion criteria, resulting in 476 participants' being enrolled (18.5%). There was significant site-level variation in the number of patients invited (median = 2976; range 73-46,920) and in those agreeing to be contacted (median = 2.4%; range 0.05%-16.4%). At the site with the highest enrollment, patients contacted by electronic medical record portal messaging were more likely to opt into the study successfully than those contacted by e-mail alone (7.8% vs 4.4%). CONCLUSIONS CHIEF-HF used a novel design and operational structure to test the efficacy of a therapeutic treatment, but marked variability across sites and strategies for recruiting participants was observed. This approach may be advantageous for clinical research across a broader range of therapeutic areas, but further optimization of recruitment efforts is warranted. REGISTRATION NCT04252287 https://clinicaltrials.gov/ct2/show/NCT04252287.
Collapse
Affiliation(s)
- Michael Nassif
- University of Missouri - Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, MO
| | | | - David E Lanfear
- Heart and Vascular Institute, Henry Ford Health System, Detroit, MI
| | | | - Bhanu Gupta
- University of Kansas Medical Center, Kansas City, KS
| | | | | | - John A Spertus
- University of Missouri - Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, MO.
| |
Collapse
|
26
|
Liu M, Liu J, Wang Q, Song P, Li H, Wu S, Gong J. Quantitative analysis of low content polymorphic impurities in canagliflozin tablets by PXRD, NIR, ATR-FITR and Raman solid-state analysis techniques combined with stoichiometry. Spectrochim Acta A Mol Biomol Spectrosc 2023; 293:122458. [PMID: 36801728 DOI: 10.1016/j.saa.2023.122458] [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] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/31/2023] [Accepted: 02/04/2023] [Indexed: 06/18/2023]
Abstract
Canagliflozin (CFZ) was a commercially new class of anti-diabetic drug, which had various anhydrate crystal forms and two hydrate crystal forms (Canagliflozin hemihydrate (Hemi-CFZ) and Canagliflozin monohydrate (Mono-CFZ) crystal form). Commercially available CFZ tablets' active pharmaceutical ingredient (API) was Hemi-CFZ, which was easy conversion to CFZ or Mono-CFZ under the influence of temperature, pressure, humidity and other factors in tablets processing, storage, and transportation, thus affected bioavailability and efficacy of tablets. Therefore, quantitative analysis low content of CFZ and Mono-CFZ in tablets was essential to control tablets' quality. The main objective of this study was to examine the feasibility of Powder X-ray Diffraction (PXRD), Near Infrared Spectroscopy (NIR), Attenuated Total Reflectance Fourier Transform Infrared Spectroscopy (ATR-FTIR) and Raman for quantitative analysis the low content of CFZ or Mono-CFZ in ternary mixtures. PLSR calibration models for low content of CFZ and Mono-CFZ were established by the solid analysis techniques of PXRD, NIR, ATR-FTIR and Raman combined with various pretreatments (such as Multiplicative Scatter Correction (MSC), Standard Normal Variate (SNV), Savitzky-Golay First Derivative (SG1st), Savitzky-Golay Second Derivative (SG2nd) and Wavelet Transform (WT)), and the correction models were verified. However, compared with PXRD, ATR-FTIR and Raman, NIR due to its water sensitivity was the most suitable for the quantitative analysis low content of CFZ or Mono-CFZ in tablets. Partial Least Squares Regression (PLSR) model for quantitative analysis low content of CFZ in tablets was as follow: Y = 0.0480 + 0.9928 X, R2 = 0.9986, LOD = 0.1596 %, LOQ = 0.4838 %, SG1st + WT pretreated. And that of Mono-CFZ were Y = 0.0050 + 0.9996 X, R2 = 0.9996, LOD = 0.0164 %, LOQ = 0.0498 %, MSC + WT pretreated and Y = 0.0051 + 0.9996 X, R2 = 0.9996, LOD = 0.0167 %, LOQ = 0.0505 %, SNV + WT pretreated, respectively. That can be used for quantitative analysis of impurity crystal content in drug production to ensure drug quality.
Collapse
Affiliation(s)
- Mingdi Liu
- State Key Laboratory of Chemical Engineering, School of Chemical Engineering and Technology, Tianjin University, Tianjin 300072, PR China; College of Chemistry and Chemical Engineering, Qinghai Minzu University, Xining 810007, PR China; Key Laboratory of Resource Chemistry and Eco-environmental Protection in Tibetan Plateau, State Ethnic Affairs Commission, Xining 810007, PR China
| | - Jichao Liu
- College of Chemistry and Chemical Engineering, Qinghai Minzu University, Xining 810007, PR China; Key Laboratory of Resource Chemistry and Eco-environmental Protection in Tibetan Plateau, State Ethnic Affairs Commission, Xining 810007, PR China
| | - Qiuhong Wang
- College of Chemistry and Chemical Engineering, Qinghai Minzu University, Xining 810007, PR China; Key Laboratory of Resource Chemistry and Eco-environmental Protection in Tibetan Plateau, State Ethnic Affairs Commission, Xining 810007, PR China
| | - Ping Song
- College of Chemistry and Chemical Engineering, Qinghai Minzu University, Xining 810007, PR China; Key Laboratory of Resource Chemistry and Eco-environmental Protection in Tibetan Plateau, State Ethnic Affairs Commission, Xining 810007, PR China
| | - Haichao Li
- College of Chemistry and Chemical Engineering, Qinghai Minzu University, Xining 810007, PR China; Key Laboratory of Resource Chemistry and Eco-environmental Protection in Tibetan Plateau, State Ethnic Affairs Commission, Xining 810007, PR China
| | - Songgu Wu
- State Key Laboratory of Chemical Engineering, School of Chemical Engineering and Technology, Tianjin University, Tianjin 300072, PR China; College of Chemistry and Chemical Engineering, Qinghai Minzu University, Xining 810007, PR China.
| | - Junbo Gong
- State Key Laboratory of Chemical Engineering, School of Chemical Engineering and Technology, Tianjin University, Tianjin 300072, PR China; College of Chemistry and Chemical Engineering, Qinghai Minzu University, Xining 810007, PR China
| |
Collapse
|
27
|
Fuchs Andersen C, Glenthøj A, Jensen J. Letter regarding the article 'Little at a time: trying to understand the battery of benefits of sodium-glucose cotransporter 2 inhibitors in heart failure'. Eur J Heart Fail 2023; 25:598. [PMID: 36693808 DOI: 10.1002/ejhf.2782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/15/2023] [Indexed: 01/26/2023] Open
Affiliation(s)
| | - Andreas Glenthøj
- Department of Haematology, Centre for Cancer and Organ Diseases, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Jensen
- Department of Cardiology, Herlev and Gentofte University Hospital, Herlev, Denmark
| |
Collapse
|
28
|
López-Vilella R, Trenado VD, Cervera BG, Sánchez-Lázaro I, Bonet LA. Sodium-glucose cotransporter 2 inhibitors reduce cardiovascular events in acute heart failure. A real-world analysis. Eur J Intern Med 2022; 104:128-130. [PMID: 35773170 DOI: 10.1016/j.ejim.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/09/2022] [Indexed: 11/25/2022]
Affiliation(s)
| | | | | | - Ignacio Sánchez-Lázaro
- Hospital Universitari i Politècnic La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Almenar Bonet
- Hospital Universitari i Politècnic La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, University of Valencia, Spain
| |
Collapse
|
29
|
Proietti R, Lip GYH. Sodium-glucose cotransporter 2 inhibitors: An additional management option for patients with atrial fibrillation? Diabetes Obes Metab 2022; 24:1897-1900. [PMID: 35837983 DOI: 10.1111/dom.14818] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Riccardo Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| |
Collapse
|
30
|
Kuchay MS, Misra A. Sodium-glucose cotransporter-2 inhibitors as first-line pharmacological therapy for type 2 diabetes? Diabetes Metab Syndr 2022; 16:102580. [PMID: 35921765 DOI: 10.1016/j.dsx.2022.102580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Mohammad Shafi Kuchay
- Division of Endocrinology and Diabetes, Medanta the Medicity Hospital, Gurugram, 122001, Haryana, India.
| | - Anoop Misra
- Fortis CDOC Hospital for Diabetes and Allied Sciences, New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation (NDOC), and Diabetes Foundation, India
| |
Collapse
|
31
|
Inada A, Inada O, Yasunami Y, Arakawa K, Nabeshima YI, Fukatsu A. Amelioration of Murine Diabetic Nephropathy with a SGLT2 Inhibitor Is Associated with Suppressing Abnormal Expression of Hypoxia-Inducible Factors. Am J Pathol 2022; 192:1028-1052. [PMID: 35460614 DOI: 10.1016/j.ajpath.2022.03.015] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/27/2022] [Accepted: 03/31/2022] [Indexed: 06/14/2023]
Abstract
Diabetic nephropathy (DN), once manifested, is unlikely to completely recover. Factors that influence DN progression were explored by investigating the process of glomerulosclerosis and interstitial fibrosis and chronological changes in glucose, albuminuria, hyperfiltration, and expressions of sodium-glucose cotransporter 2 (SGLT2) and hypoxia-inducible factors (HIFs) up to 50 weeks in inducible cAMP early repressor transgenic mice, a model of severe DN. Long-term intervention with the SGLT2 inhibitor canagliflozin or islet transplantation or heminephrectomy was used. Inducible cAMP early repressor transgenic mice exhibited progressive diabetic glomerulosclerosis and mild interstitial fibrosis, and expressed extensive HIF-1α and HIF-2α in glomerulus and tubules, with sustained hyperfiltration up to 50 weeks. Canagliflozin ameliorated glomerulosclerosis/interstitial fibrosis gradually and reduced HIF overexpression. Islet-transplanted mice exhibited no amelioration. None of the heminephrectomized diabetic mice survived the hyperfiltration overload, but all of the canagliflozin-treated mice survived with re-expressions of HIF-1α and HIF-2α. These results suggest that persistent glomerular hyperfiltration might initiate glomerular injury, and persistent overexpression of HIFs could promote the development of glomerulosclerosis and interstitial fibrosis. Canagliflozin attenuated both changes. Oxidative stress or hypoxia was undetectable in this model. The abnormal expression of HIF-1α and HIF-2α may be a potential therapeutic target for preventing glomerulosclerosis and interstitial fibrosis.
Collapse
Affiliation(s)
- Akari Inada
- Laboratory of Molecular Life Science, Institute of Biomedical Research and Innovation (IBRI), Kobe, Japan; Clinical Research Department, Institute of Biomedical Research and Innovation (IBRI), Kobe, Japan.
| | - Oogi Inada
- Diabetes and Genes, Advanced Medical Initiatives, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Kenji Arakawa
- Medical Intelligence Department, Ikuyaku, Integrated Value Development Division, Tanabe Mitsubishi Pharma Corporation, Tokyo, Japan
| | - Yo-Ichi Nabeshima
- Clinical Research Department, Institute of Biomedical Research and Innovation (IBRI), Kobe, Japan
| | | |
Collapse
|
32
|
Chen G, Li X, Cui Q, Zhou Y, Zhao B, Mei D. Acute kidney injury following SGLT2 inhibitors among diabetic patients: a pharmacovigilance study. Int Urol Nephrol 2022; 54:2949-2957. [PMID: 35579781 DOI: 10.1007/s11255-022-03211-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/09/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE The sodium-glucose cotransporter-2 (SGLT2) inhibitors have changed the treatment of type 2 diabetes mellitus. Several studies evaluated SGLT2 inhibitor-related acute kidney injury (AKI), but pharmacoepidemiology studies are needed to compare the adverse events in different SGLT2 inhibitors (SGLT2i). METHODS We used disproportionality analysis and Bayesian analysis in data mining to screen the AKI cases after initiating different SGLT2i among diabetic patients, based on the FDA's Adverse Event Reporting System (FAERS) updated to December 2020. We also investigated the onset time and fatality rates of SGLT2i-associated AKI, which was based on preferred terms (PTs) coded for the renal adverse events in the structure of the FARES database. RESULTS We identified 2483 cases of AKI following SGLT2i regimens among diabetic patients. Most of them were 45-64 years old (58.46%) and > 65 years old (28.67%). Canagliflozin generated the largest number of AKI reports (n = 1650, 66.45%) in our study. Canagliflozin showed the strongest association among SGLT2i, evidenced by the highest reporting odds ratio (ROR = 3.70, two-sided 95% CI 3.51-3.91), proportional reporting ratio (PRR = 3.39, χ2 = 2635.06), and empirical Bayes geometric mean (EBGM = 3.18, one-sided 95% CI 3.04). The median onset time to AKI was 72.0 (interquartile range [IQR] 21.0-266.0) days after SGLT2i initiation. The general hospitalization rate of SGLT2i-associated AKI was 63.50%, and the fatality rate was 1.59%. The deceased patients (62.94 ± 10.69 years) were significantly older than the survived ones (57.82 ± 11.84 years) (P = 0.011). CONCLUSION We compared AKI events in the real-world practice of various SGLT2i among diabetic cases from the FAERS database. It is essential to monitor kidney function during the early administration of SGLT2i. Concern should be paid for AKI in patients older than 65 taking SGLT2i.
Collapse
Affiliation(s)
- Gang Chen
- Nephrology Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaolin Li
- Pharmacy Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Quexuan Cui
- Nephrology Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yangzhong Zhou
- Nephrology Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Bin Zhao
- Pharmacy Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
| | - Dan Mei
- Pharmacy Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| |
Collapse
|
33
|
In brief: Expanded heart failure indication for empagliflozin (Jardiance). Med Lett Drugs Ther 2022; 64:57. [PMID: 35436772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
|
34
|
Vymyslický F, Křížek T, Kozlík P, Kubíčková A, Heřt J, Bartosińska E. Alternative method for canagliflozin oxidation analysis using an electrochemical flow cell - Comparative study. J Pharm Biomed Anal 2022; 207:114341. [PMID: 34474952 DOI: 10.1016/j.jpba.2021.114341] [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: 05/07/2021] [Revised: 07/26/2021] [Accepted: 08/22/2021] [Indexed: 11/18/2022]
Abstract
This paper highlights the potential of electrochemical flow cells for oxidative-stress testing of active pharmaceutical ingredients using canagliflozin as a model substance. Based on design of experiments, we developed our method through a reduced combinatorial design, optimizing the following independent variables: cell size, electrolyte flow rate, electrolyte concentration, and electrolyte pH. Using ammonium phosphate buffer with methanol in a 50/50 vol ratio as a working electrolyte, we electrochemically oxidized samples and analyzed them by high-performance liquid chromatography, considering the following dependent variables: peak area of each impurity, peak area of canagliflozin, and the percentage of the corresponding peak areas. Our results showed that the most significant independent variables were electrolyte pH and flow rate. By data optimization, we determined the most suitable conditions for electrochemical oxidation of canagliflozin, namely 50 µm cell size, 300 mM electrolyte concentration, 0.1 mL/h electrolyte flow rate, and electrolyte pH = 4. The repeatability of the method, expressed as the relative standard deviation of the canagliflozin peak area, measured in ten separately oxidized samples, was 1.64%. For comparison purposes, we performed a degradation experiment using hydrogen peroxide, identifying five identical impurities in both cases, as confirmed by mass spectrometry. The degradation products formed when using the chemical method after 1, 3, and 7 days totaled 0.09%, 0.75%, and 3.75%, respectively, and the degradation products formed when using the electrochemical method after 3 h totaled 3.11%. Oxidation with hydrogen peroxide required 7 days, whereas electrochemical oxidation was completed in 3 h. Overall, the electrochemical method significantly saves time and reduces the consumption of active ingredients and solvents thanks to the miniaturized size of the electrochemical cell, thereby minimizing the costs of forced degradation studies.
Collapse
Affiliation(s)
- Filip Vymyslický
- Charles University, Faculty of Science, Department of Analytical Chemistry, Hlavova 8/2030, 128 43 Prague 2, Czech Republic
| | - Tomáš Křížek
- Charles University, Faculty of Science, Department of Analytical Chemistry, Hlavova 8/2030, 128 43 Prague 2, Czech Republic.
| | - Petr Kozlík
- Charles University, Faculty of Science, Department of Analytical Chemistry, Hlavova 8/2030, 128 43 Prague 2, Czech Republic
| | - Anna Kubíčková
- Charles University, Faculty of Science, Department of Analytical Chemistry, Hlavova 8/2030, 128 43 Prague 2, Czech Republic
| | - Jakub Heřt
- Zentiva Group, a.s., U Kabelovny 130, 102 37 Prague 10, Czech Republic
| | - Ewa Bartosińska
- Zentiva Group, a.s., U Kabelovny 130, 102 37 Prague 10, Czech Republic
| |
Collapse
|
35
|
Moussa BA, Mahrouse MA, Fawzy MG. Smart spectrophotometric methods for the simultaneous determination of newly co-formulated hypoglycemic drugs in binary mixtures. Spectrochim Acta A Mol Biomol Spectrosc 2021; 257:119763. [PMID: 33872950 DOI: 10.1016/j.saa.2021.119763] [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: 01/27/2021] [Revised: 03/14/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
Achieving good glycemic control in patients with type II diabetes mellitus is essential for preventing both microvascular and macrovascular complications. Combination therapy represents the principle strategy for successful long term control of type II diabetes mellitus with minimal complications. Two sensitive, precise and non-destructive spectroscopic methods were developed for the simultaneous estimation of two new co-formulated hypoglycemic drugs; canagliflozin/metformin (CAG/MEF) and empagliflozin/linagliptin (EMG/LIG) in tablets with no need of previous separation. The first method was amplitude modulation (a normalized spectra-based UV spectrophotometric method) for the analysis of (CAG/MEF) binary mixture. The amplitude of the constant at the plateau region at (264-310 nm) on the ratio spectrum was measured and used for the determination of CAG concentration in the mixture. On the other hand, MEF was estimated by subtracting the previously obtained amplitude from the total amplitude of CAG and MEF at the isosbestic point (λiso) at 250 nm. The second method was chemometric-assisted FTIR spectrophotometric method for the determination of (EMG/LIG) binary mixture. (EMG/LIG) mixture in chloroform was analyzed using FTIR in the region 4000-400 cm-1. The spectral region 3900-2900 cm-1 was selected for (EMG/LIG) determination using principal component regression and partial least squares chemometric methods. The methods were validated according to ICH guidelines. The studied drugs were successfully determined in tablets applying the developed methods. Validation parameters were in agreement with acceptance limits, ensuring methods accuracy and selectivity. Besides, no significant difference was obtained by statistically comparing the obtained results with the reported one.
Collapse
Affiliation(s)
- Bahia Abbas Moussa
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, Cairo University, Kasr El-Aini St., Cairo 11562, Egypt
| | - Marianne Alphonse Mahrouse
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, Cairo University, Kasr El-Aini St., Cairo 11562, Egypt.
| | - Michael Gamal Fawzy
- Pharmaceutical Medicinal Chemistry Department, Faculty of Pharmacy, Egyptian Russian University, Badr City, Cairo 11829, Egypt
| |
Collapse
|
36
|
Singh SK, Singh R, Singh SP. A Perfect Beta-Blocker for Kidney: Sglt-2 Inhibitor. J Assoc Physicians India 2021; 69:11-12. [PMID: 34431284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
| | - Rina Singh
- Pediatrician, Endocrine Center, Varanasi
| | | |
Collapse
|
37
|
Willis M, Asseburg C, Slee A, Nilsson A, Neslusan C. Macrovascular Risk Equations Based on the CANVAS Program. Pharmacoeconomics 2021; 39:447-461. [PMID: 33580867 DOI: 10.1007/s40273-021-01001-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/16/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Widely used risk equations for cardiovascular outcomes for individuals with type 2 diabetes mellitus (T2DM) have been incapable of predicting cardioprotective effects observed in recent cardiovascular outcomes trials (CVOTs) involving individuals with T2DM at high risk for or with established cardiovascular disease (CVD). OBJECTIVE We developed cardiovascular and mortality risk equations using patient-level data from the CANVAS (CANagliflozin cardioVascular Assessment Study) Program to address this shortcoming. METHODS Data from 10,142 patients with T2DM at high risk for or with established CVD, randomized to canagliflozin + standard of care (SoC) or SoC alone and followed for a mean duration of 3.6 years in the CANVAS Program were used to derive parametric risk equations for myocardial infarction (MI), stroke, hospitalization for heart failure (HHF), and death. Accumulated knowledge from the widely used UKPDS-OM2 (United Kingdom Prospective Diabetes Study Outcomes Model 2) was leveraged, and any departures in parameterization were limited to those necessary to provide adequate goodness of fit. Candidate explanatory covariates were selected using only the placebo arm to minimize confounding effects. Internal validation was performed separately by study treatment arm. RESULTS UKPDS-OM2 predicted CANVAS Program outcomes poorly. Recalibrating UKPDS-OM2 intercepts improved calibration in some cases. Refitting the coefficients but otherwise preserving the UKPDS-OM2 structure improved the fit substantially, which was sufficient for stroke and death. For MI, reselecting UKPDS-OM2 covariates and functional form proved sufficient. For HHF, selection from a broad set of candidate covariates and inclusion of a canagliflozin indicator was required. CONCLUSION These risk equations address some of the limitations of widely used risk equations, such as the UKPDS-OM2, for modeling cardioprotective treatments for individuals with T2DM and high cardiovascular risk, including derivation from overly healthy patients treated with agents that lack cardioprotection and have been described as reflecting a different therapeutic era. Future work is needed to examine external validity.
Collapse
Affiliation(s)
- Michael Willis
- Swedish Institute for Health Economics, Box 2017, 220 02, Lund, Sweden.
| | | | | | - Andreas Nilsson
- Swedish Institute for Health Economics, Box 2017, 220 02, Lund, Sweden
| | | |
Collapse
|
38
|
Zhou YL, Zhang YG, Zhang R, Zhou YL, Li N, Wang MY, Tian HM, Li SY. Population diversity of cardiovascular outcome trials and real-world patients with diabetes in a Chinese tertiary hospital. Chin Med J (Engl) 2021; 134:1317-1323. [PMID: 33734138 PMCID: PMC8183749 DOI: 10.1097/cm9.0000000000001407] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 08/04/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Recent cardiovascular outcome trials (CVOTs) changed the therapeutic strategy of guidelines for type 2 diabetes. We compared the characteristics of patients from real-world hospital settings with those of participants in recent pragmatic randomized trials. METHODS This electronic medical record (EMR)-based retrospective observational study investigated the data of patients with diabetes from inpatient and outpatient settings in West China Hospital of Sichuan University from January 1, 2011, to June 30, 2019. We identified patients meeting the inclusion criteria of a pragmatic randomized trial (EMPA-REG OUTCOME) based on EMRs and compared their baseline characteristics with those of the trial participants. The cutoff for the clinical significance of each characteristic was set as its minimal clinically important difference based on expert consultation. RESULTS We included 48,257 inpatients and 36,857 outpatients with diabetes and found that 8389 (17.4%) inpatients and 2646 (7.2%) outpatients met the inclusion criteria for the EMPA-REG OUTCOME trial. Compared with the trial population, the real-world inpatients meeting the eligibility criteria of the EMPA-REG OUTCOME had similar age, blood pressure, and lipid profiles but comprised of fewer males, metformin users, anti-hypertensive drug users, and aspirin users, and had a lower body mass index. The group of outpatients meeting the eligibility criteria had fewer males, similar age, fewer metformin users, fewer insulin users, fewer anti-hypertensive drug users, and fewer aspirin users compared with the trial population. CONCLUSIONS The trial population in EMPA-REG OUTCOME represents only a small portion of patients with diabetes from the inpatient and outpatient departments of a Chinese tertiary medical center. Evidence localization in different clinical settings and validation are essential to enabling extrapolation of the results from CVOTs in patients with diabetes to Chinese clinical practice.
Collapse
Affiliation(s)
- Yi-Ling Zhou
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Yong-Gang Zhang
- Cochrane China Center, MAGIC China Center, Chinese Evidence-based Medicine Center, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Rui Zhang
- The Informatic Center, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - You-Lian Zhou
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Nan Li
- The Informatic Center, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Mi-Ye Wang
- The Informatic Center, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Hao-Ming Tian
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - She-Yu Li
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Cochrane China Center, MAGIC China Center, Chinese Evidence-based Medicine Center, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Engineering Research Center for Medical Information Technology, Ministry of Education, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| |
Collapse
|
39
|
Ida S, Kaneko R, Imataka K, Okubo K, Shirakura Y, Azuma K, Fujiwara R, Murata K. Effects of Antidiabetic Drugs on Muscle Mass in Type 2 Diabetes Mellitus. Curr Diabetes Rev 2021; 17:293-303. [PMID: 32628589 DOI: 10.2174/1573399816666200705210006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/16/2020] [Accepted: 06/21/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND When considering the administration of glucagon-like peptide-1 receptor agonists (GLP-1RAs), sodium-glucose cotransporter-2 (SGLT2) inhibitors, or metformin, it is important to understand their weight loss effect as well as the degree of muscle loss caused by each drug in clinical practice. OBJECTIVE To comparatively examine the effects of GLP-1RAs and oral antidiabetic drugs, including SGLT2 inhibitors and metformin, on muscle mass and body weight in patients with type 2 diabetes via a network meta-analysis of randomized controlled trials. METHODS We included randomized controlled trials evaluating the effects of antidiabetic drugs on muscle mass and body weight. Mean difference (MD) and 95% confidence intervals (CIs) were calculated using a random-effects network meta-analysis. RESULTS Of the studies identified, 18 randomized controlled trials (1, 363 subjects) satisfied the eligibility criteria. In all studies, the effects of these drugs on fat-free mass (FFM) were evaluated. Therefore, FFM, which is used as an alternative index of muscle mass, was included in the study. Semaglutide (MD: -1.68, 95% CI: -2.84 to -0.52), dapagliflozin (-0.53, -0.93 to -0.13), and canagliflozin (-0.90, -1.73 to -0.07) showed a significant decrease in FFM compared with the placebo. Metformin did not show a significant decrease in FFM compared with the placebo. When compared with the placebo, semaglutide, dapagliflozin, ipragliflozin, and canagliflozin showed a significant weight loss. CONCLUSION Although semaglutide, dapaglifrozin, and canagliflozin have a large weight loss effect, it is important to pay attention to muscle loss because a decrease in FFM was observed.
Collapse
Affiliation(s)
- Satoshi Ida
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, Mie, Japan
| | - Ryutaro Kaneko
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, Mie, Japan
| | - Kanako Imataka
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, Mie, Japan
| | - Kaoru Okubo
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, Mie, Japan
| | | | - Kentaro Azuma
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, Mie, Japan
| | - Ryoko Fujiwara
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, Mie, Japan
| | - Kazuya Murata
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, Mie, Japan
| |
Collapse
|
40
|
León-Jiménez D, López-Mendoza M, Pérez-Temprano R, Górriz JL, Miramontes-González JP. In response to the paper 'High-protein diet: A barrier to the nephroprotective effects of sodium-glucose co-transporter-2 inhibitors?'. Diabetes Obes Metab 2020; 22:1701-1702. [PMID: 32424874 DOI: 10.1111/dom.14087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 11/29/2022]
Affiliation(s)
- David León-Jiménez
- Internal Medicine Diabetes, Obesity and Vascular Risk.Virgen del Rocío University Hospital, University of Seville, Seville, Spain
| | | | - Ramón Pérez-Temprano
- Internal Medicine, Risk Vascular Unit, Virgen Macarena University Hospital, Seville, Spain
| | - José Luis Górriz
- Department of Nephrology, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, Valencia, Spain
| | - José Pablo Miramontes-González
- Internal Medicine Hospital Río Hortega. Instituto de Investigaciones Biomédicas de Salamanca-IBSAL, Universidad Pontificia de Salamanca, Salamanca, Spain
| |
Collapse
|
41
|
Scheen AJ. [Cardiovascular and renal protection with SGLT2 inhibitors: from EMPA-REG OUTCOME to VERTIS CV]. Rev Med Suisse 2020; 16:1483-1488. [PMID: 32852168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The landmark study EMPA-REG OUTCOME firstly demonstrated both a cardiovascular and renal protection with empagliflozin in patients with type 2 diabetes (T2DM) and established cardiovascular disease. Since 2015, two other trials showed a reduction in the hospitalisations for heart failure and the progression of the renal disease, also in patients with multiple risk factors, CANVAS with canagliflozin and DECLARE-TIMI 58 with dapagliflozin. CREDENCE (canagliflozin in T2DM patients with kidney disease) confirmed a renal protection and DAPA-HF (dapagliflozin in patients, with or without T2DM, but reduced ejection fraction) showed a less acute deterioration of heart failure. The positive effect of SGLT2 inhibitors on heart failure predominates, an effect recently confirmed in VERTIS CV with ertugliflozin.
Collapse
Affiliation(s)
- André J Scheen
- service de diabetologie, nutrition et maladies metaboliques, departement de medecine, chu liege, sart tilman (b35), avenue de l'hopital 1, 4000 liege, belgique
| |
Collapse
|
42
|
Patoulias D, Papadopoulos C, Doumas M. Sodium-glucose co-transporter-2 inhibitor and glucagon-like peptide-1 receptor agonist combination treatment: Promising, but shall we look at other indices? Int J Cardiol 2020; 323:259. [PMID: 32810546 DOI: 10.1016/j.ijcard.2020.08.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 08/11/2020] [Indexed: 01/15/2023]
Affiliation(s)
- Dimitrios Patoulias
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital "Hippokration", Greece.
| | - Christodoulos Papadopoulos
- Third Department of Cardiology, Aristotle University of Thessaloniki, General Hospital "Hippokration", Greece
| | - Michael Doumas
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital "Hippokration", Greece; Veterans Affairs Medical Center, George Washington University, Washington, DC, United States of America
| |
Collapse
|
43
|
Tanaka A, Hisauchi I, Taguchi I, Sezai A, Toyoda S, Tomiyama H, Sata M, Ueda S, Oyama J, Kitakaze M, Murohara T, Node K. Effects of canagliflozin in patients with type 2 diabetes and chronic heart failure: a randomized trial (CANDLE). ESC Heart Fail 2020; 7:1585-1594. [PMID: 32349193 PMCID: PMC7373938 DOI: 10.1002/ehf2.12707] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [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: 02/16/2020] [Accepted: 03/31/2020] [Indexed: 12/13/2022] Open
Abstract
AIMS Little is known about the impact of sodium glucose co-transporter 2 (SGLT2) inhibitors on cardiac biomarkers, such as natriuretic peptides, in type 2 diabetes (T2D) patients with concomitant chronic heart failure (CHF). We compared the effect of canagliflozin with glimepiride, based on changes in N-terminal pro-brain natriuretic peptide (NT-proBNP), in that patient population. METHODS AND RESULTS Patients with T2D and stable CHF, randomized to receive canagliflozin 100 mg or glimepiride (starting-dose: 0.5 mg), were examined using the primary endpoint of non-inferiority of canagliflozin vs. glimepiride, defined as a margin of 1.1 in the upper limit of the two-sided 95% confidence interval (CI) for the group ratio of percentage change in NT-proBNP at 24 weeks. Data analysis of 233 patients showed mean left ventricular ejection fraction (LVEF) at randomization was 57.6 ± 14.6%, with 71% of patients having a preserved LVEF (≥50%). Ratio of NT-proBNP percentage change was 0.48 (95% CI, -0.13 to 1.59, P = 0.226) and therefore did not meet the prespecified non-inferiority margin. However, NT-proBNP levels did show a non-significant trend lower in the canagliflozin group [adjusted group difference; -74.7 pg/mL (95% CI, -159.3 to 10.9), P = 0.087] and also in the subgroup with preserved LVEF [-58.3 (95% CI, -127.6 to 11.0, P = 0.098]). CONCLUSIONS This study did not meet the predefined primary endpoint of changes in NT-proBNP levels, with 24 weeks of treatment with canagliflozin vs. glimepiride. Further research is warranted to determine whether patients with heart failure with preserved ejection fraction, regardless of diabetes status, could potentially benefit from treatment with SGLT2 inhibitors.
Collapse
Affiliation(s)
- Atsushi Tanaka
- Department of Cardiovascular MedicineSaga UniversitySagaJapan
| | - Itaru Hisauchi
- Department of CardiologyDokkyo Medical University Saitama Medical CenterKoshigayaJapan
| | - Isao Taguchi
- Department of CardiologyDokkyo Medical University Saitama Medical CenterKoshigayaJapan
| | - Akira Sezai
- The Department of Cardiovascular SurgeryNihon University School of MedicineTokyoJapan
| | - Shigeru Toyoda
- Department of Cardiovascular MedicineDokkyo Medical University School of MedicineMibuJapan
| | | | - Masataka Sata
- Department of Cardiovascular MedicineTokushima University Graduate SchoolTokushimaJapan
| | - Shinichiro Ueda
- Department of Clinical Pharmacology and TherapeuticsUniversity of the RyukyusNishiharaJapan
| | - Jun‐ichi Oyama
- Department of Cardiovascular MedicineSaga UniversitySagaJapan
| | - Masafumi Kitakaze
- Department of Clinical Medicine and DevelopmentNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Toyoaki Murohara
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Koichi Node
- Department of Cardiovascular MedicineSaga UniversitySagaJapan
| | | |
Collapse
|
44
|
Singh AK, Singh R. Reply to Sodium-glucose co-transporter-2 inhibitors, cardiovascular outcomes and the impact of gender: Class effect or statistical play of chance? Diabetes Metab Syndr 2020; 14:335. [PMID: 32302947 DOI: 10.1016/j.dsx.2020.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
45
|
Lo KB, McCullough PA, Rangaswami J. Mediators of the Effects of Canagliflozin on Heart Failure: Central Role of the Cardiorenal Axis. JACC Heart Fail 2020; 8:426. [PMID: 32354418 DOI: 10.1016/j.jchf.2020.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/07/2020] [Indexed: 06/11/2023]
|
46
|
Heerspink HJL, Li J, Neal B, de Zeeuw D. Reply: Mediators of the Effects of Canagliflozin on Heart Failure: Central Role of the Cardiorenal Axis. JACC Heart Fail 2020; 8:427. [PMID: 32354419 DOI: 10.1016/j.jchf.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 02/16/2020] [Indexed: 06/11/2023]
|
47
|
O'Sullivan JW. Prevention of cardiovascular disease and renal failure in type 2 diabetes: sodium-glucose cotransporter-2 (SGLT2) inhibitors. BMJ Evid Based Med 2020; 25:79-80. [PMID: 31366588 DOI: 10.1136/bmjebm-2019-111231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Jack W O'Sullivan
- Division of Cardiology, Department of Medicine, Stanford University, Palo Alto, California, USA
- Centre for Evidence-Based Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
48
|
|
49
|
Jha V. Reducing risk of kidney failure in people with diabetes. Natl Med J India 2020; 33:31-32. [PMID: 33565484 DOI: 10.4103/0970-258x.308239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Vivekanand Jha
- George Institute for Global Health, New Delhi, India University of Oxford, Oxford, UK University of New South Wales, Sydney, Australia
| |
Collapse
|
50
|
Affiliation(s)
- André J Scheen
- Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, Centre Hospitalier Universitaire Liège, and Division of Clinical Pharmacology, Center for Interdisciplinary Research on Medicines, Liège University, B-4000 Liège, Belgium
| |
Collapse
|