Effects of topical ketorolac tromethamine on tear parameters, meibography, goblet cell density, and conjunctival oxidative stress in healthy dogs

OBJECTIVES

The objective of the study was to evaluate whether a twice-daily instillation of 0.45% preservative-free ketorolac tromethamine (FKT) or 0.4% benzalkonium chloride-preserved ketorolac tromethamine (BACKT), every 12 h for 30 days may affect tear film parameters and the meibography in healthy dogs. Additionally, we assessed whether the same treatments irritated the ocular surface, affected goblet cell density (GCD), and the levels of oxidative stress biomarkers (OSB) in the conjunctiva of the same dogs.

PROCEDURES

Experimental and masked comparison study. In 11 healthy dogs baseline values of the lipid layer thickness, tear meniscus height, non-invasive tear breakup time (NI-TFBT), and the meibomian gland (MG) loss were assessed by OSAvet®. For each dog, one eye received 40 μL of BACKT, while the other received 40 μL FKT, every 12 h for 30 consecutive days. Tear parameters and meibography were repeated 15, 30, and 60 days post-treatments. Conjunctival hyperemia and blepharospasm were monitored at the same time points. At baseline and Day 30, a conjunctival biopsy was collected for GCD and OSB determination.

RESULTS

Conjunctival hyperemia and blepharospasm were not observed. At Day 15, the MG loss increased only in FKT-treated eyes (p < .001). On Day 30, both treatment groups showed increased MG loss, shortened NI-TFBT, and reduced GCD and catalase (p < .05). At Day 30, BACKT-treated eyes showed lower levels of superoxide dismutase (SOD) (p = .006) and higher levels of malondialdehyde (MDA) (p = .02). Differences between treatments were not observed for any parameter at any time point (p > .05). 60 days after treatment, OSAvet® parameters tended to return to values assessed at baseline; however, significant differences remained for MG loss (p < .05).

CONCLUSIONS

Twice-daily instillation of KT, containing or not BAC, for 30 consecutive days shortened NI-TFBT, decreased GCD, and increased the MG loss in healthy dogs. KT should be used with caution when prescribed for long periods, particularly in patients with tear film abnormalities. However, future controlled studies using KT, BAC, and other topical NSAIDs are indicated to further support this finding.

DDX3 modulates cisplatin resistance in OSCC through ALKBH5-mediated m6A-demethylation of FOXM1 and NANOG

Platinum based drugs alone or in combination with 5FU and docetaxel are common regimen chemotherapeutics for the treatment of advanced OSCC. Chemoresistance is one of the major factors of treatment failure in OSCC. Human RNA helicase DDX3 plays an important role in cell proliferation, invasion, and metastasis in several neoplasms. The potential role of DDX3 in chemoresistance is yet to be explored. Enhanced cancer stem cells (CSCs) population significantly contributes to chemoresistance and recurrence. A recent study showed that m⁶A RNA regulates self-renewal and tumorigenesis property in cancer. In this study we found genetic (shRNA) or pharmacological (ketorolac salt) inhibition of DDX3 reduced CSC population by suppressing the expression of FOXM1 and NANOG. We also found that m⁶A demethylase ALKBH5 is directly regulated by DDX3 which leads to decreased m⁶A methylation in FOXM1 and NANOG nascent transcript that contribute to chemoresistance. Here, we found DDX3 expression was upregulated in both cisplatin-resistant OSCC lines and chemoresistant tumors when compared with their respective sensitive counterparts. In a patient-derived cell xenograft model of chemoresistant OSCC, ketorolac salt restores cisplatin-mediated cell death and facilitates a significant reduction of tumor burdens. Our work uncovers a critical function of DDX3 and provides a new role in m⁶ demethylation of RNA. A combination regimen of ketorolac salt with cisplatin deserves further clinical investigation in advanced OSCC.

Effect of methyl cellulose on gelation behavior and drug release from poloxamer based ophthalmic formulations

The effect of weight average molecular weight (Mw) of methyl cellulose (MC) on the gelation behavior of Poloxamer 407 (PM) and in vitro release of Ketorolac Tromethamine (KT) from different ophthalmic formulations based on PM is examined. A drop of gelation temperature of PM is observed using MC of various M(w) by test tube tilting method, UV-vis spectroscopy, viscometry and rheometry. It is also observed that the viscosity and gel strength of all the formulations are increased with the increase in Mw of MC. PM with highest Mw of MC provides best drug release property among all the formulations. It is evident from this investigation that there is a distinct effect of M(w) of MC on the gelation behavior of PM as well as on the drug release profile of KT from PM-MC based ophthalmic formulations.

[Pharmacological correction of the ulcerogenic action of NSAIDs in rats]

Experimental preclinical investigations on a group of 90 white outbred male rats showed that preliminary preventive introduction of procaine (novocaine, 1.07 mg/kg) or taurine (7.14 mg/kg) during 7 days before the administration of ketorolak trometamine significantly reduced the number of erosive-ulcerous lesions (by more than 87%, p < 0.001) and decreased the extent of pathological changes in the morphological structure of stomach mucus membrane.

Effects of antithrombogenic agents on microvenous anastomoses in a rat model

OBJECTIVE

To compare venous thrombosis rates among animals treated with aspirin, clopidogrel bisulfate, and ketorolac tromethamine using an anastomotic "tuck" model.

DESIGN

Single-blind randomized animal study.

SETTING

An animal laboratory at a tertiary care academic referral center.

SUBJECTS

Forty-two retired Lewis breeder rats divided into 3 equal groups.

INTERVENTIONS

Before surgical intervention, 1 group received aspirin (10 mg/kg) through gavage; 1 group, clopidogrel bisulfate (5 mg/kg) through gavage; and the final group, ketorolac tromethamine (3 mg/kg) through intramuscular injection. Each rat was then anesthetized, and the femoral veins were prepared bilaterally. A 180° venotomy was made, and the vessels were anastomosed with the tuck model set-up for anastomotic failure. The vessels were checked for patency every 15 minutes for 2 hours after clamp removal.

MAIN OUTCOME MEASURES

The rate of venous thrombosis and the time to thrombosis.

RESULTS

In both the aspirin and clopidogrel groups, 2 of 28 vessels (7%) were thrombosed. Thrombosis occurred in 3 of 28 vessels (11%) in the ketorolac group (P = .86). All thromboses in the aspirin and clopidogrel groups took place at 7.5 minutes after clamp removal. In the ketorolac group, the mean time to thrombosis was 7.5 minutes (range, 0-22.5 minutes). There was no difference in time to thrombosis among the 3 groups (P = .86).

CONCLUSION

Using a microvenous tuck model set-up for anastomotic failure, we found no difference in the rate of thrombosis or the time to thrombosis in rats pretreated with aspirin, clopidogrel, or ketorolac.

The effects of ketorolac tromethamine and baicalein on the levels of inflammatory factors in human synoviocytes

This study examined the effects of ketorolac tromethamine (KT) and baicalein (BE) on the levels of inflammatory factors in human synoviocytes. The fibroblast-like synoviocytes (FLS) cells were used to determine the possible regulatory effects of KT and BE (KTBE) on the levels of inflammatory factors in FLS cells. In addition, the levels of TNF-alpha, IL-6, and IL-1beta mRNA expression in FLS cells induced by a TNF-alpha and IL-1beta co-treatment were largely inhibited by a KTBE treatment. The level of FLS cells proliferation was increased by IL-1beta and TNF-alpha, and strongly inhibited by KTBE treatment. The production of oxygen species (ROS) was inhibited by KTBE in FLS cells. KTBE appears to regulate the levels of mRNA that are important for regulating RA progression.

Involvement of peripheral prostaglandins in formalin-induced nociceptive behaviours in the orofacial area of rats

Prostaglandins (PGs) are known to be involved in the pathogenesis of inflammation and pain. However, their role in orofacial pain is not clearly understood. The present study was undertaken to determine the effect of systemic and locally administered nonsteroidal anti-inflammatory drugs (NSAIDs) on the role of PGs in orofacial pain induced by formalin in rats. The subcutaneous injection of formalin into the rat upper lip generated behavioural responses that lasted for several minutes. The orofacial responses due to formalin were seen in two distinct phases, the early response (0-3 min) and the continuous prolonged response (9-45 min). Systemic administration of ketorolac or diclofenac (10 and 30 mg/kg, i.p.) significantly attenuated formalin-induced nociceptive behaviour in the phase-2, but not in the phase-1 of the formalin test. Similarly, subcutaneous (local) administration of ketorolac or diclofenac in the orofacial area (100 and 300 microg/lip) markedly decreased the phase-2 nociceptive response due to formalin. However, both the drugs had no effect on the phase-1 response of the formalin test. These results suggest that PGs, particularly peripheral PGs are involved in nociceptive behaviour following formalin injection in the orofacial area.

Novel Depots of Ketorolac Esters Have Long-Acting Antinociceptive and Antiinflammatory Effects

No long-acting nonsteroidal antiinflammatory drug is clinically available for the treatment of pain. In this study, we evaluated the antinociceptive and antiinflammatory effects and duration of action of several novel depots of ketorolac esters, such as ketorolac propyl ester, pentyl ester, heptyl ester, and decyl ester, and observed whether they had a long-acting effect. Four studies in Sprague-Dawley rats were performed. In Studies 1-3, the antinociceptive and antiinflammatory effects of IM ketorolac tromethamine and its base and propyl ester were evaluated. In Study 4, the antinociceptive and antiinflammatory effects of several other ketorolac esters were evaluated. We found that ketorolac tromethamine 24, 80, and 240 micromol/kg (in saline) produced significant antinociceptive and antiinflammatory effects with duration of action of approximately 6-8 h. The four ketorolac esters at a dose of 240 micromol/kg (in oil) produced significant long-acting antinociceptive and antiinflammatory effects, with duration of action of approximately 52-76 h. We concluded that IM injection of novel depots of ketorolac esters in rats produce long-acting antinociceptive and antiinflammatory effects that are 6.5- to 9.5-fold longer than the traditional dosage form of ketorolac tromethamine.

The antinociceptive and anti-inflammatory effects of five depot formulations of ketorolac propyl ester in rats

BACKGROUND

Ketorolac is a potent nonsteroidal anti-inflammatory drug. Recently, a ketorolac prodrug, ketorolac propyl ester, was synthesized in our laboratory. The aim of the study was to evaluate the antinociceptive and anti-inflammatory effects of ketorolac propyl ester in five depot formulations. The vehicles used in these formulations were injectable vegetable oils, i.e., sesame oil, peanut oil, soybean oil, castor oil, and cottonseed oil. The traditional therapentic form of ketorolac tromethamine in saline was used as control.

METHODS

Six studies were carried out to test the antinociceptive and anti-inflammatory effects of intramuscular ketorolac tromethamine (in saline) and its propyl ester (in five depot formulations) 240 micromol/kg on Sprague-Dawley rats treated with intraplantar carrageenin.

RESULTS

Ketorolac tromethamine (in saline) produced an 8 h duration of action on both antinociception and anti-inflammation, whereas ketorolac propyl ester in five oily vehicles produced 54- to 78-h durations of actions in both antinociception and anti-inflammation. Ketorolac propyl ester in cottonseed oil produced a duration of action of 78h in both antinociception and anti-inflammation.

CONCLUSIONS

All five depot formulations of ketorolac propyl ester produced longer durations of antinociceptive and anti-inflammatory effects.

Thrombophilia associated with anti-CD154 monoclonal antibody treatment and its prophylaxis in nonhuman primates

BACKGROUND

The authors previously reported thromboembolic complications associated with anti-CD154 monoclonal antibody (mAb) treatment in nonhuman primates. The underlying mechanisms of this complication and its management have not been established.

METHODS

Eighty cynomolgus monkey renal allograft recipients treated with anti-CD154 mAb were studied for the incidence of thrombosis and its prophylaxis.

RESULTS

Without anticoagulation prophylaxis, thromboembolic complications were seen in 5 of 11 recipients. With addition of perioperative heparin, the incidence was decreased to 2 of 10. No further improvement was observed by adding intraoperative prostaglandin (PG) E1. However, addition of ketorolac tromethamine to PGE1 and heparin decreased the incidence of thrombosis (one of eight). Most recently, the authors have found that ketorolac administration alone resulted in no thrombosis in 25 consecutive recipients.

CONCLUSIONS

Ketorolac is remarkably effective in preventing thromboembolism associated with anti-CD154 mAb treatment, suggesting the mechanism underlying this complication may be related to platelet activation leading to enhanced aggregation.

Antinociceptive and neurotoxicologic screening of chronic intrathecal administration of ketorolac tromethamine in the rat

Many drugs are tested intrathecally to investigate alternatives to opioids. We aimed to explore the analgesic and possible neurotoxic effects of chronic intrathecally-administered ketorolac tromethamine in rats. Catheters were placed via atlantoaxial interval in 28 Wistar rats under anesthesia of intraperitoneally-injected thiopental 30 mg/kg. Rats were randomized into 4 groups and administered 4 repeated intrathecal doses of therapy with 5-day intervals. The control group received 10 microL of saline, and the other groups received 50, 150, and 400 microg of ketorolac tromethamine respectively. The formalin test, behavioral test, and histopathological examination of four different spinal cord levels were performed. Neither behavioral testing nor histopathological examination revealed abnormalities that would suggest neurotoxicity. Formalin tests showed that both phase I and phase II responses of ketorolac tromethamine groups were significantly less than those of the control group. Although phase I responses did not differ during comparisons among ketorolac tromethamine-administered groups, phase II responses decreased significantly in groups that received 150 and 400 microg of ketorolac tromethamine. Intrathecally administered ketorolac tromethamine reduced nociceptive responses and exhibited no untoward neurological effect even at large doses. However, its intrathecal use as a safe alternative drug for chronic pain remains to be investigated in other species.

IMPLICATIONS

The present study is unique because it has demonstrated that chronic intrathecal administration of ketorolac tromethamine in rats, even at considerably large doses, showed a potent analgesic effect during the formalin test without exhibiting any neurotoxic side effect.

Peripheral prostanoid levels and nonsteroidal anti-inflammatory drug analgesia: replicate clinical trials in a tissue injury model

BACKGROUND

Nonsteroidal anti-inflammatory drug (NSAID) analgesia is generally attributed to peripheral suppression of cyclooxygenase (COX) enzymes, leading to decreased products of the arachidonic acid cascade. This study evaluated the in vivo relationship between levels of prostanoids at the site of tissue injury and analgesia after systemic or local NSAID administration in a clinical model of tissue injury.

METHODS

Subjects in two replicate clinical trials had one or two mandibular third molars removed and a microdialysis probe implanted at the surgical site for measurement of immunoreactive prostaglandin E(2) (PGE(2)) or immunoreactive thromboxane B(2) (TxB(2)) and pain measured concurrently. In the first study, ketorolac tromethamine (INN, ketorolac) was administered at pain onset in a 30-mg intramuscular dose, a 1-mg intramuscular dose, or a 1-mg submucosal dose at the extraction site in comparison with placebo. In the second study, subjects received either ketorolac tromethamine 30 mg by the intravenous route or placebo at pain onset.

RESULTS

PGE(2) was detectable in the first postoperative sample, decreased over the next hour, and then increased significantly coincident with the onset of postoperative pain. Administration of 30 mg ketorolac tromethamine produced parallel decreases in pain, PGE(2) levels, and TxB(2) levels at the surgical site. Administration of 1 mg ketorolac tromethamine intramuscularly or directly at the surgical site was analgesic but without measurable effects on PGE(2) levels.

CONCLUSION

The temporal profile of PGE(2) and TxB(2) in the immediate postoperative period is consistent with constitutive COX-1 initially, followed by an increase in PGE(2) resulting from expression of COX-2. The temporal association between NSAID analgesia and decreased prostanoids at the site of injury is consistent with a dual COX-1/COX-2 peripheral site of action. The analgesic effects of 1 mg ketorolac tromethamine without a reduction in PGE(2) at the site of injury suggests an additional central site for NSAID analgesia.

[Ketorolac tromethamine (ketanov) in dentistry]

The trial of ketanov, nonnarcotic nonsteroidal antiinflammatory drug with potent analgetic effect, allows to recommend its wider use in dentistry.

Thioglycollate peritonitis in mice lacking C5, 5-lipoxygenase, or p47(phox): complement, leukotrienes, and reactive oxidants in acute inflammation

Leukotriene B(4) (LTB(4)) is an easily diffusible proinflammatory chemotactic factor that has been posited to prime the initial inflammatory response for the action of other mediators, including C5a. 5-Lipoxygenase-deficient (5LX(-/-)) and C5-deficient mice only generated about 50% as much peritoneal leukocytosis as wild-type mice following intraperitoneal (IP) challenge with the sterile irritant, thioglycollate (P<0.005). Pretreatment of C5- mice with the specific 5-lipoxygenase inhibitor, zileuton, reduced peritoneal leukocytosis to almost unstimulated levels, suggesting that LTB(4) can act independently of C5a. Previously, LTB(4) and C5a have been shown in vitro to be inactivated by metabolites of superoxide. In the current study, we examined the fate of LTB(4) in the p47(phox-/-) mouse model of chronic granulomatous disease (CGD) in which the phagocyte NADPH oxidase is unable to produce superoxide. p47(phox-/-) mice generated more thioglycollate-elicited peritoneal leukocytosis than wild-type mice. Pretreatment with zileuton caused a 76% reduction in peritoneal leukocytosis in p47(phox-/-) mice (P<0.005) and a 54% reduction in wild-type mice (P<0.05), whereas pretreatment with dexamethasone or toradol (a cyclooxygenase inhibitor) had no effect. Following IP LTB(4) (1 microg/mouse), total recovered peritoneal LTB(4) was similar between p47(phox-/-) and wild-type mice at 10 and 30 min, but was approximately fivefold greater in p47(phox-/-) mice at 180 min. These data suggest that LTB(4) and C5a have separate but overlapping roles in thioglycollate-elicited peritonitis, and at least the leukotriene component is, in turn, regulated by reactive oxidants.

Effect of Topical Diclofenac and Ketorolac on Patient Discomfort and Corneal Sensitivity

PURPOSE

To determine if at clinical dosages, the topical nonsteroidal anti-inflammatory drugs diclofenac and ketorolac decrease corneal sensitivity, and if there is a difference in discomfort on instillation.

METHODS

In a double-masked study, 30 patients were randomized to receive two of three topical drops, Endosol, diclofenac sodium, and ketorolac tromethamine. A microaesthesiometer was used to evaluate corneal sensation. Baseline corneal sensitivity was obtained on each patient. Corneal sensory thresholds were remeasured at 7 and 15 minutes following eyedrop application. Patients also completed a questionnaire that graded the burning caused by the medications.

RESULTS

No significant decrease in corneal sensory thresholds was found with diclofenac or ketorolac compared with control at baseline (P = .50), 7 minutes (P = .41), or 15 minutes (P = .82). There was significantly more burning with diclofenac and ketorolac compared to control. There was a small but not statistically significant (P = .28) trend of more burning with ketorolac than diclofenac.

CONCLUSION

Neither diclofenac nor ketorolac were found to decrease corneal sensation compared to control. There was no significant difference in burning upon instillation reported by patients.

Effects of a non-steroidal (ketorolac tromethamine) and a steroidal (dexamethasone) anti-inflammatory drug on refractive state and ocular growth

Topical steroidal anti-inflammatory drugs (SAID) and non-steroidal anti-inflammatory drugs (NSAID) are known to affect fluid balance. The effects of twice daily topical applications of Maxidex (dexamethasone, a SAID), Acular (ketorolac, a NSAID), and saline were examined biometrically on the development of refractive errors and eye growth in chicks raised from days 3-12 wearing either a monocular +10 D, 0 D, or -10 D lens. Biometric analysis showed that neither SAID nor NSAID nor saline affected refractive error compensation but that the anti-inflammatory drugs affected eye growth. In chicks reared with a +10 D lens, dexamethasone induced a decrease in axial length (AL), vitreous chamber (VC) and anterior chamber (AC) depth, while ketorolac only induced a decrease in AC. In -10 D lens chicks dexamethasone again induced a decrease in AL and VC, but did not affect AC depth, whereas ketorolac only induced an increase in AC depth. Taken together, these results suggest that anti-inflammatory drugs can induce changes in ocular size without affecting refractive state and, as such, have implications for the management of progressive myopia.

Sublingual hyoscyamine sulfate in combination with ketorolac tromethamine for ureteral colic: a randomized, double-blind, controlled trial

STUDY OBJECTIVE

We evaluate the safety and efficacy of a single dose of hyoscyamine sulfate in combination with ketorolac tromethamine for the reduction of pain in emergency department patients with ureteral colic.

METHODS

We conducted a prospective, randomized, double-blind study at 2 EDs with residency programs in emergency medicine. Patients were at least 18 years old and presented to the ED with an initial history and physical examination consistent with ureteral colic. Patients received a single intravenous dose of 30 mg of ketorolac tromethamine given over a 1-minute period with either a single sublingual dose of 0.125 mg of hyoscyamine sulfate or a placebo. If inadequate analgesia was noted after 30 minutes, a standard dose of meperidine could be administered for rescue. All other treatments including intravenous fluids and antiemetics were standardized. The main study outcome was change in visual analog scale pain score from baseline to 30 minutes.

RESULTS

Seventy-two patients were evaluated for inclusion. Thirteen patients who had self-administered pain medications within 4 hours of presentation were excluded before randomization. Sixteen patients who did not have a renal calculus confirmed by either intravenous urogram or helical computed tomography were also excluded from efficacy analysis. There did not appear to be any clinically important differences in the baseline characteristics between the 2 groups. The repeated-measures analysis of the remaining 43 patients showed no clinically important difference in pain score using the visual analog scale at any time point. There were no clinically important differences between the 2 study groups for amount of rescue meperidine administered or end-of-study global satisfaction scores.

CONCLUSION

Hyoscyamine sulfate did not provide any additional pain relief from ureteral colic when administered with ketorolac tromethamine. There was no clinically important difference in change of pain scores at 30 minutes in patients with ureteral colic receiving supplemental hyoscyamine sulfate.

Effect of topical anti-inflammatory drugs on corneal and limbal wound healing

PURPOSE

To examine the effect of topical treatment with either steroidal or nonsteroidal anti-inflammatory drugs (NSAIDs) on the wound healing of corneal and limbal incisions using histologic criteria.

SETTING

Loyola University Medical Center, Maywood, Illinois, USA.

METHODS

Eighteen eyes of 9 cats were used for the study. All right eyes received a temporal limbal incision and the left eyes, a clear corneal incision. All eyes were treated with ofloxacin 0.3% postoperatively for 3 days. The animals were equally divided among 3 groups. Group 1 received topical steroid drops (prednisolone acetate 1%) for 7 days maximum; Group 2 received topical NSAID drops (ketorolac tromethamine 0.5%) for 7 days maximum; Group 3 received no additional treatment. One animal from each group was killed and the eye enucleated 3, 7, or 28 days postoperatively. The eyes were processed for staining with hematoxylin-eosin and smooth muscle actin, and corneal sections were evaluated in a blind fashion by an ophthalmic pathologist.

RESULTS

Three and 7 days after surgery (1) the limbal incision exhibited more prominent wound healing than the similarly treated clear corneal incision, and (2) the steroid-treated corneas had less wound healing than untreated or NSAID-treated corneas. At 28 days, the wounds in all eyes were almost completely healed.

CONCLUSIONS

Limbal incisions heal faster than clear corneal incisions. Steroids, but not NSAIDs, inhibit wound healing. Cataract surgery using limbal incisions and postoperative topical NSAIDs may result in faster wound healing and provide a reduced risk of related postoperative complications.