Effects of Tranilast on Inflammasome and Macrophage Phenotype in a Mouse Model of Myocardial Infarction

Acute myocardial infarction (AMI) has been a devastating actuality and accounts for half of cardiovascular emergency department visits. Nucleotide oligomerization domain, leucine-rich repeat, and pyrin domain-containing protein 3 (NLRP3) inflammasome participates in the mediation of myocardial inflammation during AMI. Therefore, this study aimed to reveal the therapeutic function of tranilast, an agent targeting NLRP3, for AMI. AMI mouse model was first established by transient myocardial ischemia. Western blot and quantitative reverse transcription polymerase chain reaction assay were performed to estimate the expression levels of related genes. Flow cytometry was used to analyze the macrophage types, and the therapeutic effects of tranilast were estimated by echocardiographic analysis and Masson's trichrome stain. We demonstrated that AMI induced the activation of NLRP3 inflammasome in the heart tissues of mice with AMI. Tranilast decreased the expression of interleukin-1β and cleaved caspase-1 in bone marrow-derived macrophages and thus re-educated M1-macrophages toward the M2-phenotype both in vitro and in vivo. Tranilast inhibited the activation in the heart tissues of AMI mice and thus improved cardiac functional recovery in the AMI mouse model. In conclusion, we revealed that tranilast ameliorated myocardial infarction by inhibiting NLRP3 inflammasome and re-educating macrophage phenotype in this study.

Clinical safety and efficacy of neoadjuvant combination chemotherapy of tranilast in advanced esophageal squamous cell carcinoma: Phase I/II study (TNAC)

BACKGROUND

Transient receptor potential vanilloid 2 (TRPV2) was previously shown to play an important role in the maintenance of cancer stem cells, and its specific inhibitor, tranilast, also has potential as a targeted therapeutic agent for esophageal squamous cell carcinoma (ESCC). The present study is being conducted to confirm the safety and efficacy of the additional use of tranilast with conventional preoperative adjuvant chemotherapy for patients with advanced ESCC.

PATIENTS AND METHODS

Between 56 and 59 patients aged between 20 and 74 years with clinically diagnosed Stage II or Stage III ESCC will be enrolled. Eligible patients will receive preoperative adjuvant chemotherapy, 2 cycles of combination therapy with cisplatin, 5-fluorouracil, and tranilast. Recruitment started in November 2019, with the final follow-up being planned for March 2029. One subject has been enrolled since October 21, 2020. The pathological therapeutic effect is the primary endpoint. The objective response rate, safety of preoperative adjuvant chemotherapy, recurrence-free survival (RFS), and overall survival (OS) are the secondary endpoints. RFS and OS will be calculated as the time from surgery to first recurrence and all-cause death, respectively.

ETHICS AND DISSEMINATION

This protocol has been approved by the Institutional Review Boards of Kyoto Prefectural University of Medicine and all participating hospitals in August 30, 2019 (Number: CRB5180001). Written informed consent will be obtained from all patients before their registration, which is in accordance with the Declaration of Helsinki. The results of the present study will be disseminated via publication in peer-reviewed journals.

TRIAL REGISTRATION

Trial registration number jRCTs051190076.

TGF-β inhibition combined with cytotoxic nanomedicine normalizes triple negative breast cancer microenvironment towards anti-tumor immunity

Tumor normalization strategies aim to improve tumor blood vessel functionality (i.e., perfusion) by reducing the hyper-permeability of tumor vessels or restoring compressed vessels. Despite progress in strategies to normalize the tumor microenvironment (TME), their combinatorial antitumor effects with nanomedicine and immunotherapy remain unexplored. Methods: Here, we re-purposed the TGF-β inhibitor tranilast, an approved anti-fibrotic and antihistamine drug, and combined it with Doxil nanomedicine to normalize the TME, increase perfusion and oxygenation, and enhance anti-tumor immunity. Specifically, we employed two triple-negative breast cancer (TNBC) mouse models to primarily evaluate the therapeutic and normalization effects of tranilast combined with doxorubicin and Doxil. We demonstrated the optimized normalization effects of tranilast combined with Doxil and extended our analysis to investigate the effect of TME normalization to the efficacy of immune checkpoint inhibitors. Results: Combination of tranilast with Doxil caused a pronounced reduction in extracellular matrix components and an increase in the intratumoral vessel diameter and pericyte coverage, indicators of TME normalization. These modifications resulted in a significant increase in tumor perfusion and oxygenation and enhanced treatment efficacy as indicated by the notable reduction in tumor size. Tranilast further normalized the immune TME by restoring the infiltration of T cells and increasing the fraction of T cells that migrate away from immunosuppressive cancer-associated fibroblasts. Furthermore, we found that combining tranilast with Doxil nanomedicine, significantly improved immunostimulatory M1 macrophage content in the tumorigenic tissue and improved the efficacy of the immune checkpoint blocking antibodies anti-PD-1/anti-CTLA-4. Conclusion: Combinatorial treatment of tranilast with Doxil optimizes TME normalization, improves immunostimulation and enhances the efficacy of immunotherapy.

Avenanthramide A Induces Cellular Senescence via miR-129-3p/Pirh2/p53 Signaling Pathway To Suppress Colon Cancer Growth

Cellular senescence is the state of irreversible cell cycle arrest that provides a blockade during oncogenic transformation and tumor development. Avenanthramide A (AVN A) is an active ingredient exclusively extracted from oats, which possesses antioxidant, anti-inflammatory, and anticancer activities. However, the underlying mechanism(s) of AVN A in the prevention of cancer progression remains unclear. In the current study, we revealed that AVN A notably attenuated tumor formation in an azoxymethane/dextran sulfate sodium (AOM/DSS) mouse model. AVN A treatment triggered cellular senescence in human colon cancer cells, evidenced by enlarging cellular size, upregulating β-galactosidase activity, γ-H2AX positive staining, and G1 phase arrest. Moreover, AVN A treatment significantly increased the expression of miR-129-3p, which markedly repressed the E3 ubiquitin ligase Pirh2 and two other targets, IGF2BP3 and CDK6. The Pirh2 silencing by miR-129-3p led to a significant increase in protein levels of p53 and its downstream target p21, which subsequently induced cell senescence. Taken together, our data indicate that miR-129-3p/Pirh2/p53 is a critical signaling pathway in AVN A induced cellular senescence and AVN A could be a potential chemopreventive strategy for cancer treatment.

Distribution of methyl and isopropyl N-methylanthranilates and their metabolites in organs of rats treated with these two essential-oil constituents

Two volatile alkaloids, methyl (MMA) and isopropyl N-methylanthranilates (IMA), identified in the essential oil of Choisya ternata Kunth (Rutaceae), have been proven to possess polypharmacological properties (antinociceptive, anti-inflammatory, gastro-, hepato-, nephroprotective activities, anxiolytic and antidepressant properties, and likewise an effect on diazepam-induced sleep). In the continuation of our investigation of their urinary-metabolite profiles, we performed GC-MS analyses of the diethyl-ether extracts of selected tissues (liver, kidneys, heart, brain, lungs, quadriceps femoris muscle, and spleen) of rats intraperitoneally treated with MMA or IMA (2 g kg^-1). Organ-metabolite profiles of MMA and IMA were qualitatively mutually analogous (varying only in the alcohol moiety of the metabolites), and generally analogous to their urinary-metabolite profiles. The greatest diversity and the highest overall amount of anthranilate metabolites was found in the hepatic tissue. The principal anthranilate-related compounds in the organs of rats treated with MMA, among 12 detected, were the products of ester hydrolysis, N-methylanthranilic and anthranilic acids. In the tissues of IMA-treated rats, among 16 compounds, the most abundant ones were the unmetabolized IMA and N-methylanthranilic acid. A collection of the compositional data regarding the anthranilate-related metabolites was statistically treated by multivariate statistical analysis that provided a better insight into the possible biotransformation pathways.

Pain alleviation during castration of piglets: a comparative study of different farm options

Pain alleviation associated with castration of piglets is an important welfare issue. The present study compares the effect of different approaches and products suitable for farmer use, with the aim to alleviate pain due to castration in piglets. A randomized within-litter design, with 28 replicate litters, compared 7 treatments: handling () restraint of the piglet and manipulation of the scrotum, castration without pain relief (), 2 treatments (, ) with different concentrations of tetracaine (2 and 6%) applied topically 10 min before and immediately post-surgery, and 3 treatments with i.m. injection of different nonsteroidal anti-inflammatory drugs () 10 min prior to surgery (-meloxicam, -ketoprofen, -tolfenamic acid). Efficacy of pain relief was assessed during a 300 min period after castration by serum cortisol, behavior (walking, lying, suckling, in the nest, isolated and pain related: tremors, rubbing the rear, hunching, wagging of the tail), facial expression and scrotal skin pressure sensitivity. C pigs had greater serum cortisol concentration than all other groups at 60 min post-surgery ( < 0.001), while H pigs had lower concentrations than pigs given topical anesthesia ( < 0.001) though not injected analgesia. No treatment differences were significant at 180 min, but at 300 min cortisol concentration was greater in T2 and T6 piglets than those given NSAIDs ( = 0.03). These treatment differences were mirrored by the pressure sensitivity of the scrotum; in comparison with C piglets, those given NSAIDs showed a reduced sensitivity ( 0.003) but those given local anesthesia did not ( = 0.15). C pigs showed increased frequency of pain-related behavior in the first 30 min in comparison with all other treatments, more time isolated than H or NSAID treatments, and more time standing inactive than H or K treatments. No behavioral differences were apparent after 60 min. No differences in facial expressions were observed among treatments. In conclusion, on-farm methods for pain relief can provide some, though not complete, pain alleviation in the hours after castration. The use of topical anesthesia gave only minor benefit in comparison to NSAID agents injected prior to castration. Since the main differences in indicators of pain between positive and negative controls were observed within the first h after castration, it is important to select drugs that act quickly after administration to facilitate practical processing schedules on farm.

Sublethal effects of chlorantraniliprole on development, reproduction and vitellogenin gene (CsVg) expression in the rice stem borer, Chilo suppressalis

BACKGROUND

The rice stem borer, Chilo suppressalis (Walker), is one of the most damaging rice pests in the world. The sublethal effects of chlorantraniliprole on development,reproduction and mRNA expression levels of vitellogenin gene (CsVg) in C. suppressalis were investigated.

RESULTS

Exposure of third-instar larvae to sublethal concentrations of chlorantraniliprole (LC₁₀ and LC₃₀ ) significantly extended larval duration, lowered the mean weight of male pupae and shortened male adult longevity. Pupal duration was significantly prolonged and the mean weight of female pupae was significantly lowered in the LC₃₀ treatment group. While there were no significant sublethal effects on either the adult emergence rate or the egg hatch, the pupation rates in the LC₁₀ treatment group (41.30%) and in the LC₃₀ treatment group (23.98%) were significantly lower than the pupation rate of the control (71.86%), and LC₁₀ and LC₃₀ chlorantraniliprole significantly reduced fecundity, by 32.18 and 52.94% respectively. Furthermore, the expression levels of CsVg mRNA after exposure to LC₁₀ and LC₃₀ chlorantraniliprole significantly decreased, by 42.52 and 47.84% respectively, in 12-h-old female adults.

CONCLUSION

Sublethal concentrations of chlorantraniliprole adversely affect the development and reproduction of C. suppressalis. The downregulation of CsVg by chlorantraniliprole might have negative impacts on the fecundity of C. suppressalis. © 2016 Society of Chemical Industry.

Immune Modulation as an Effective Adjunct Post-exposure Therapeutic for B. pseudomallei

Melioidosis is caused by the facultative intracellular bacterium Burkholderia pseudomallei and is potentially fatal. Despite a growing global burden and high fatality rate, little is known about the disease. Recent studies demonstrate that cyclooxygenase-2 (COX-2) inhibition is an effective post-exposure therapeutic for pulmonary melioidosis, which works by inhibiting the production of prostaglandin E2 (PGE2). This treatment, while effective, was conducted using an experimental COX-2 inhibitor that is not approved for human or animal use. Therefore, an alternative COX-2 inhibitor needs to be identified for further studies. Tolfenamic acid (TA) is a non-steroidal anti-inflammatory drug (NSAID) COX-2 inhibitor marketed outside of the United States for the treatment of migraines. While this drug was developed for COX-2 inhibition, it has been found to modulate other aspects of inflammation as well. In this study, we used RAW 264.7 cells infected with B pseudomallei to analyze the effect of TA on cell survival, PGE2 production and regulation of COX-2 and nuclear factor- kappaB (NF-ĸB) protein expression. To evaluate the effectiveness of post-exposure treatment with TA, results were compared to Ceftazidime (CZ) treatments alone and the co-treatment of TA with a sub-therapeutic treatment of CZ determined in a study of BALB/c mice. Results revealed an increase in cell viability in vitro with TA and were able to reduce both COX-2 expression and PGE2 production while also decreasing NF-ĸB activation during infection. Co-treatment of orally administered TA and a sub-therapeutic treatment of CZ significantly increased survival outcome and cleared the bacterial load within organ tissue. Additionally, we demonstrated that post-exposure TA treatment with sub-therapeutic CZ is effective to treat melioidosis in BALB/c mice.

Burkholderia pseudomallei is the causative agent of melioidosis, a fatal tropical disease endemic in parts of Southwest Asia and Northern Australia. While it was once believed to be isolated to these areas, recent research indicates the global burden on melioidosis is growing. Furthermore, treatment of melioidosis is difficult because of the high occurrence of disease relapse and increasing antibacterial resistance. Recent research suggests that immunomodulation via COX-2 inhibition to subsequently reduce with PGE2 production is an effective therapeutic strategy for melioidosis. The current study was built on this immunomodulatory principle by using an orally administered COX-2 inhibitor and evaluating its effects on the COX-2 and NF-ĸB pathways. We also investigated whether the conjunctive therapies of immunomodulation and antibiotics increased efficacy of the treatment. We confirmed immunomodulation is effective as a post-exposure therapeutic in BALB/c mice. More importantly, we found that conjunctive post-exposure treatment via immunomodulation increased antibacterial treatment efficacy. Conjunctive therapy may prove efficacious for other infectious diseases resembling melioidosis. Hence, further research is needed to identify the long-term effects of the described treatment(s) across multiple animal models.

Small molecule tolfenamic acid and dietary spice curcumin treatment enhances antiproliferative effect in pancreatic cancer cells via suppressing Sp1, disrupting NF-kB translocation to nucleus and cell cycle phase distribution

Combination of dietary/herbal spice curcumin (Cur) and COX inhibitors has been tested for improving therapeutic efficacy in pancreatic cancer (PC). The objective of this study was to identify agent with low toxicity and COX-independent mechanism to induce PC cell growth inhibition when used along with Cur. Anticancer NSAID, tolfenamic acid (TA) and Cur combination were evaluated using PC cell lines. L3.6pl and MIA PaCa-2 cells were treated with Cur (5-25μM) or TA (25-100μM) or combination of Cur (7.5μM) and TA (50μM). Cell viability was measured at 24-72h posttreatment using CellTiter-Glo kit. While both agents showed a steady/consistent effect, Cur+TA caused higher growth inhibition. Antiproliferative effect was compared with COX inhibitors, Ibuprofen and Celebrex. Cardiotoxicity was assessed using cordiomyocytes (H9C2). The expression of Sp proteins, survivin and apoptotic markers (western blot), caspase 3/7 (caspase-Glo kit), Annexin-V staining (flow cytometry), reactive oxygen species (ROS) and cell cycle phase distribution (flow cytometry) was measured. Cells were treated with TNF-α, and NF-kB translocation from cytoplasm to nucleus was evaluated (immunofluorescence). When compared to individual agents, combination of Cur+TA caused significant increase in apoptotic markers, ROS levels and inhibited NF-kB translocation to nucleus. TA caused cell cycle arrest in G0/G1, and the combination treatment showed mostly DNA synthesis phase arrest. These results suggest that combination of Cur+TA is less toxic and effectively enhance the therapeutic efficacy in PC cells via COX-independent mechanisms.

Exploration of efficacy and bleeding with combined phosphoinositide 3-kinase β inhibition and aspirin in man

BACKGROUND

Based on animal and human data, phosphoinositide 3-kinase (PI3K)β is a promising antithrombotic target. However, the relation between efficacy and bleeding when combined with current antiplatelet therapies is unclear.

OBJECTIVE

To strengthen the PI3Kβ target validation using the short-acting inhibitor AZD6482 alone and in different combinations with P2Y12 and cyclooxygenase (COX)-1 inhibition in vitro (human platelets), in vivo (dog), and in healthy subjects.

METHODS AND RESULTS

Evaluation of complete target inhibition of PI3Kβ (by AZD6482), P2Y12 (by ticagrelor), and COX-1 (by aspirin) alone and in the different combinations vs. concentration responses for a panel of platelet agonists in vitro (adenosine diphosphate, collagen, thrombin receptor activating peptide) indicates that the rank order of antiplatelet efficacy is P2Y12  > PI3Kβ > COX-1 as monotherapy and P2Y12 plus PI3Kβ > P2Y12 plus COX-1 > PI3Kβ plus COX-1 as dual therapy, with little additional effect with triple therapy. Use of a conscious dog model to assess ex vivo antiplatelet effect in parallel with bleeding time prolongation (standard incision in the ear) confirms the wide separation of efficacy vs. bleeding for PI3Kβ inhibition and that this separation is reduced when combined with aspirin and more reduced when combined with clopidogrel. In healthy subjects, AZD6482, in combination with aspirin, shows a potential for greater antiplatelet potency but less bleeding potential compared with clopidogrel plus aspirin.

CONCLUSIONS

PI3Kβ inhibition, in comparison with P2Y12 and COX-1, delivers medium antiplatelet effect but with minimal bleeding. PI3Kβ inhibition, in combination with aspirin, in healthy subjects, provides a potential for greater overall antiplatelet effect compared with clopidogrel plus aspirin, but with significantly less bleeding potential.

Tamoxifen and tranilast show a synergistic effect against breast cancer in vitro

OBJECTIVE

This study was aimed at examining a separate or combined effect of tamoxifen and tranilast drugs on growth and proliferation of breast cancer cells.

BACKGROUND

Breast cancer is one of the most common cancers and the second leading cause of cancer death among women worldwide. Tamoxifen is the most widely used anti-estrogen for the treatment of breast cancer. Studies show that a combination therapy with other drugs enhances the activity of tamoxifen. Tranilast is an anti-inflammatory drug. We hypothesize that tranilast plus tamoxifen can work synergistically and help getting better result from this anticancer drug.

METHODS

Two breast cancer cell lines, MCF-7 and MDA-MB-231, were treated with graduated concentrations of tamoxifen and tranilast alone or in combination at 24, 48 or 72 hours for MCF-7, and 48 hours for MDA-MB-231 cells. We used the MTT assay and lactate dehydrogenase leakage (LDH) assay to evaluate cell viability and cytotoxicity, respectively.

RESULTS

In both ER-positive and ER-negative breast cancer cell lines, the combination of tranilast and tamoxifen was more effective in growth inhibition than single drug exposure.

CONCLUSION

We have demonstrated that by means of a synergistic/additive inhibitory effect, tranilast was capable of enhancing the in vitro activity of tamoxifen on breast cancer cell lines. Based on the results obtained in this study, tranilast could be a candidate drug for combination therapy in resistant breast cancer patients (Fig. 9, Ref. 17).

KEYWORDS

breast cancer, Tamoxifen, Tranilast, LDH release, MTT.

Sublethal effects of insecticide seed treatments on two nearctic lady beetles (Coleoptera: Coccinellidae)

Predatory insects often feed on plants or use plant products to supplement their diet, creating a potential route of exposure to systemic insecticides used as seed treatments. This study examined whether chlorantraniliprole or thiamethoxam might negatively impact Coleomegilla maculata and Hippodamia convergens when the beetles consumed the extrafloral nectar of sunflowers grown from treated seed. We reared both species on eggs of Ephestia kuehniella and then switched adult H. convergens to a diet of greenbugs, Schizaphis graminum, in order to induce oviposition in this species. Excised sunflower stems, either treated or control and refreshed every 48 h, were provided throughout larval development, or for the first week of adult life. Exposure of C. maculata larvae to chlorantraniliprole and thiamethoxam applied as seed treatments delayed adult emergence by prolonging the pupal period. When adults were exposed, thiamethoxam reduced the preoviposition period compared to chlorantraniliprole, whereas the latter treatment cause females to produce fewer clutches during the observation period. Larvae of C. maculata did not appear to obtain sufficient hydration from the sunflower stems and their subsequent fecundity and fertility were compromised in comparison to the adult exposure experiment where larvae received supplemental water during development. Exposure of H. convergens larvae to thiamethoxam skewed the sex ratio in favor of females; both materials reduced the egg viability of resulting adults and increased the period required for eclosion. Exposure of H. convergens adults to chlorantraniliprole reduced egg eclosion times compared to thiamethoxam and exposure to both insecticides reduced pupation times in progeny. The results indicate that both insecticides have negative, sublethal impacts on the biology of these predators when they feed on extrafloral nectar of sunflower plants grown from treated seed.

Timing Spring Insecticide Applications to Target both Amyelois transitella (Lepidoptera: Pyralidae) and Anarsia lineatella (Lepidoptera: Gelechiidae) in Almond Orchards

Amyelois transitella (Walker) (Lepidoptera: Pyralidae) and Anarsia lineatella Zeller (Lepidoptera: Gelechiidae) are key Lepidoptera pests of almonds in California. Spring insecticide applications (early to mid-May) targeting either insect were not usually recommended because of the potential to disrupt natural enemies when broad-spectrum organophosphates and pyrethroids were applied. The registration of reduced risk compounds such as chlorantraniliprole, methoxyfenozide, and spinetoram, which have a higher margin of safety for natural enemies, makes spring (early to mid-May) application an acceptable control approach. We examined the efficacy of methoxyfenozide, spinetoram, and chlorantraniliprole at three spring application timings including the optimum spring timing for both A. lineatella and A. transitella in California almonds. Our study also examined the possibility of reducing larval populations of A. lineatella and A. transitella simultaneously with a single spring insecticide application. There were no significant differences in the field efficacy of insecticides targeting either A. lineatella or A. transitella, depending on application timing for the three spring timings examined in this study. In most years (2009-2011), all three timings for each compound resulted in significantly less A. transitella and A. lineatella damage when compared with an untreated control, though there was some variation in efficacy between the two species. Early to mid-May applications of the reduced-risk insecticides chlorantraniliprole and spinetoram can be used to simultaneously target A. transitella and A. lineatella with similar results across the potential timings.

Effects of chlorantraniliprole and thiamethoxam rice seed treatments on egg numbers and first instar survival of Lissorhoptrus oryzophilus (Coleoptera: Curculionidae)

Effects of treatment of rice seeds with an anthranilic diamide, chlorantraniliprole, and a neonicotinoid, thiamethoxam, on egg laying and first instar survival in rice water weevil, Lissorhoptrus oryzophilus Kuschel, were examined under greenhouse conditions. Exposure of adult weevils to rice (6-7 leaf stage) grown from seeds treated with chlorantraniliprole and thiamethoxam resulted in reduction in numbers of eggs and first instars. The low egg numbers by adults exposed to chlorantraniliprole-treated plants was confirmed as a sublethal effect on adults: adult survival was not impacted after 4 d of feeding on foliage from chlorantraniliprole-treated plants but the number of eggs laid by these weevils was reduced when released on untreated plants. Furthermore, a comparison of first instar emergence from chlorantraniliprole-treated plants and from untreated plants infested with weevils previously exposed to this chemical suggested that chlorantraniliprole was also reducing egg or first instar survival. In contrast, adults that fed on foliage from thiamethoxam-treated plants showed increased mortality. Possible sublethal effects of thiamethoxam on the number of eggs laid by adults were investigated by infesting untreated plants with weevils that survived exposure to thiamethoxam via foliar feeding (7 microg active ingredient/seed). Prior exposure to thiamethoxam through adult feeding reduced egg numbers. However, potential larvicidal or ovicidal effects of thiamethoxam seed treatments could not be detected in this study because of low first instar emergence from both thiamethoxam-treated plants and from untreated plants infested with weevils previously exposed to this chemical. These experiments revealed that the two seed treatments accomplish weevil control in different ways.

Human target validation of phosphoinositide 3-kinase (PI3K)β: effects on platelets and insulin sensitivity, using AZD6482 a novel PI3Kβ inhibitor

BACKGROUND

Based on in vitro and animal data, PI3Kβ is given an important role in platelet adhesion and aggregation but its role in insulin signaling is unclear.

OBJECTIVE

To strengthen the PI3Kβ target validation using the novel, short-acting inhibitor AZD6482.

METHODS AND RESULTS

AZD6482 is a potent, selective and ATP competitive PI3Kβ inhibitor (IC(50) 0.01 μm). A maximal anti-platelet effect was achieved at 1 μm in the in vitro and ex vivo tests both in dog and in man. In dog, in vivo AZD6482 produced a complete anti-thrombotic effect without an increased bleeding time or blood loss. AZD6482 was well tolerated in healthy volunteers during a 3-h infusion. The ex vivo anti-platelet effect and minimal bleeding time prolongation in the dog model translated well to data obtained in healthy volunteers. AZD6482 inhibited insulin-induced human adipocyte glucose uptake in vitro (IC(50) of 4.4 μm). In the euglycemic hyperinsulinemic clamp model, in rats, glucose infusion rate was not affected at 2.3 μm but reduced by about 60% at a plasma exposure of 27 μm. In man, the homeostasis model analysis (HOMA) index increased by about 10-20% at the highest plasma concentration of 5.3 μm.

CONCLUSIONS

This is the first human target validation for PI3Kβ inhibition as anti-platelet therapy showing a mild and generalized antiplatelet effect attenuating but not completely inhibiting multiple signaling pathways with an impressive separation towards primary hemostasis. AZD6482 at 'supratherapeutic' plasma concentrations may attenuate insulin signaling, most likely through PI3Kα inhibition.

Case in which tranilast ophthalmic solution was thought to be effective for the prevention of symblepharon and recurrence after pterygium surgery

We report our experience of a case in which a combination of conjunctival symblepharon detachment, conjunctival granuloma excision, and conjunctival free flap transplantation was performed for the treatment of symblepharon after pterygium surgery, with satisfactory outcomes. The patient was referred to our hospital with pterygium recurrence, symblepharon and granuloma formation after pterygium surgery in the right eye at another hospital. We performed conjunctival symblepharon detachment along with conjunctival autograft transplantation, and started instillation of tranilast ophthalmic solution immediately after the surgery, to inhibit proliferation and adhesion formation. During the 6 months' follow-up of the patient at our hospital, the postoperative course was satisfactory, and no recurrence of symblepharon, pterygium or granuloma was observed. There were no adverse drug reactions associated with the instillation of tranilast ophthalmic solution. Tranilast ophthalmic solution may be effective not only for prevention of pterygium recurrence, but also for inhibition of symblepharon and granuloma formation.

Avenanthramides are bioavailable and accumulate in hepatic, cardiac, and skeletal muscle tissue following oral gavage in rats

Avenanthramides (AVA), polyphenols found exclusively in oats ( Avena sativa L.), may play a role in the anti-inflammatory and antiatherogenic activity of oats. The bioavailability of AVA has been demonstrated previously, but its distribution at the organ and tissue level and the extent of conjugation following ingestion have been unexplored. Synthetic AVA was administered to 24 rats by oral gavage, whereas 6 control rats received saline. AVA concentrations were measured via HPLC in plasma, liver, heart, and gastrocnemius (GAS) obtained over a 12 h period (0, 2, 4, 12 h; n = 6 at each time point). Samples were extracted with and without glucuronidase-sulfatase to assess the level of conjugation. We conclude that AVA are bioavailable to the blood circulation following oral ingestion in the rat and reach peripheral tissues where they can be taken up by various organs differentially. With AVA remaining in the organs for up to 12 h, it seems possible to maintain an increased level of AVA in the rat via repeated feedings.

Metabolism of [(14)c]chlorantraniliprole in the lactating goat

Metabolism of [(14)C]chlorantraniliprole {3-bromo-N-[4-chloro-2-methyl-6-[(methylamino)carbonyl]phenyl]-1- (3-chloro-2-pyridinyl)-1H-pyrazole-5-carboxamide} was investigated in a lactating goat following seven consecutive daily single oral doses. Each dose was equivalent to 10.4 mg/kg of feed. There was no significant transfer of residues of either chlorantraniliprole or its metabolites into fat, meat, or milk. Chlorantraniliprole and its metabolites accounted for 93.57% of the administered dose and were eliminated primarily in the excreta. Residues in meat, milk, liver, and kidney together accounted for ca. 1.5% of the administered radioactivity. A total of 19 metabolites including 3 glucuronide conjugates and intact chlorantraniliprole were identified in the feces, urine, or tissues by comparison of their HPLC retention times, mass spectral fragments (LC-MS/MS), or multiple reaction monitoring (MRM) transitions to authentic synthesized standards. The major metabolic pathways of [(14)C]chlorantraniliprole in the goat were N-demethylation, methylphenyl hydroxylation, and further oxidation to the carboxylic acid; loss of water from the N-hydroxymethyl group to yield various cyclic metabolites; and hydrolysis of N-methyl amides to form benzoic acid derivatives. Minor metabolic reactions involved cleavage of the amide bridge between the phenyl and heterocyclic rings of chlorantraniliprole.

Chemical characterization of the avenanthramide-rich extract from oat and its effect on D-galactose-induced oxidative stress in mice

The present study was to characterize the avenanthramide-rich extract (ARE) from oat bran and assess its effect on activity and gene expression of antioxidant enzymes in D-galactose-induced oxidative-stressed mice. High-performance liquid chromatography (HPLC) analysis found that ARE had 6.07% N-(3',4'-dihydroxycinnamoyl)-5-hydroxyanthranilic acid (Bc), 4.37% N-(4'-hydroxycinnamoyl)-5-hydroxyanthranilic acid (Bp), and 5.36% N-(4'-hydroxy-3'-methoxycinnamoyl)-5-hydroxyanthranilic acid (Bf). In addition, ARE was also rich in vanillic acid (0.60%), caffeic acid (0.50%), syringic acid (0.54%), p-coumaric acid (0.16%), ferulic acid (0.08%), and sinapic acid (0.03%). Administration of D-galactose markedly lowered not only the activity of superoxide dismutase (SOD) and glutathione peroxidase (GPx) but also the gene expression of manganese superoxide dismutase (SOD), copper-zinc SOD, glutathione peroxidase (GPx), and lipoprotein lipase (LPL) mRNA in mice. Administration of ARE significantly reversed the D-galactose-induced oxidative stress by increasing the activity of the antioxidant enzymes and upregulating their gene expression. This was accompanied by a significant decrease in the malondialdehyde (MDA) level in mice given ARE compared to the control. The results demonstrated that ARE possessed the antioxidant activity and was effective against D-galactose-induced oxidative stress.

Tranilast suppresses prostate cancer growth and osteoclast differentiation in vivo and in vitro

BACKGROUND

In bone metastatic sites, prostate cancer cells proliferate on interacting with osteoclasts. Tranilast, which is used for an antiallergic drug, has been shown to inhibit growth of several cancers and stromal cells. The present study was conducted to assess suppressive effects of Tranilast on prostate cancer growth and osteoclast differentiation in vivo and in vitro.

METHODS

In vivo, rat prostate cancer tissue was transplanted onto cranial bones of F344 rats and Tranilast was given for 9 days at doses of 0, 200, or 400 mg/kg/day. In vitro, human prostate cancer cell lines, LNCaP, PC3, and DU145, the rat prostate cancer cell line, PLS-10, and rat bone marrow cells were similarly treated with the agent.

RESULTS

In vivo, tumor volumes were significantly decreased in the high dose group. While cell proliferation did not appear to be affected, apoptosis was induced and tumor necrosis was apparent. Cranial bone defects were decreased in the high dose group. In vitro, cell proliferation rates of all four cell lines were reduced by Tranilast and increased apoptosis was observed in LNCaP and PLS-10. In addition, Tranilast significantly reduced osteoclast differentiation of rat bone marrow cells. Western blot analysis of PLS-10 and LNCaP revealed that phospho-GSK3beta was up-regulated and phospho-Akt was down-regulated.

CONCLUSIONS

Tranilast here suppressed rat prostate cancer growth and osteoclast differentiation. Growth of human prostate cancer cells was also inhibited. Thus, this agent deserves consideration as a candidate for conventional therapy of bone metastatic prostate cancer.

Combined treatment of pancreatic cancer with mithramycin A and tolfenamic acid promotes Sp1 degradation and synergistic antitumor activity

Mithramycin (MIT) and tolfenamic acid (TA) inhibit the activity of the transcription factor Sp1. In the present study, we investigated whether pancreatic cancer treatment with a combination of these compounds has a synergistic effect on Sp1 activity, tumor growth, and their underlying response mechanisms. Treatment of pancreatic tumor xenografts with MIT and TA produced dose-dependent antitumor activity, and significant antitumor activity of either compound alone was directly associated with systemic side effects. Combination treatment with nontoxic doses of both compounds produced synergistic antitumor activity, whereas treatment with a nontoxic dose of either compound alone lacked a discernible antitumor effect. Synergistic therapeutic effects correlated directly with synergistic antiproliferation and antiangiogenesis in vitro. Moreover, combination treatment resulted in Sp1 protein degradation, drastically downregulating expression of Sp1 and vascular endothelial growth factor. Our findings established that Sp1 is a critical target of TA and MIT in human pancreatic cancer therapy, rationalizing clinical studies to determine the effect of existing pancreatic cancer therapy regimens on Sp1 signaling in tumors and normal pancreatic tissue, and the ability of Sp1-targeting strategies to modify cancer responses.

Characterization and Physical Stability of Tolfenamic Acid-PVP K30 Solid Dispersions

Obtaining a stable formulation with high bioavailability of a poorly water-soluble drug often presents a challenge to the formulation scientist. Transformation of the drug into its more soluble high-energy amorphous form is one method used for improving the dissolution rate of such compounds. The present study uses the spray-drying technique for preparation of solid dispersions (SDs) of tolfenamic acid (TA) and polyvinylpyrrolidone K-30 (PVP). The SDs and TA in the form of a spray-dried powder were initially characterized and compared with a physical mixture and starting materials. Stability of the SDs was monitored over 12 weeks at 25 degrees C and 60% RH. XRPD studies revealed changes in solid state during the formation of the SDs and indicated the presence of TA in the amorphous state. FTIR, together with TGA, suggested molecular interactions (hydrogen-bonding) in the SDs. Dissolution studies proved an increase in the dissolution rate of TA from all SDs. The SDs with higher content of PVP retained TA in the amorphous state throughout the stability study. However, SDs with lower content showed recrystallization of TA after 1 week. Thus, this study reveals the possibility of preparing stable SDs of amorphous TA in PVP with improved dissolution rate.

Tranilast attenuates diastolic dysfunction and structural injury in experimental diabetic cardiomyopathy

Diastolic dysfunction is an increasingly recognized complication of diabetes that develops in relatively young patients as a result of diabetic cardiomyopathy (DCM). With recent advances in echocardiographic technology now permitting the reliable assessment of diastolic function in the rat, we examined cardiac function and structure in diabetic rodents and assessed the effects of intervening with tranilast, an antifibrotic compound that has been shown to attenuate the actions of transforming growth factor-beta (TGF-beta) in cardiac fibroblasts. We also sought to examine the mechanism whereby tranilast inhibits the actions of TGF-beta. Six-week-old heterozygous (mRen-2)27 rats were randomized to receive either streptozotocin or citrate buffer and then further randomized to receive either tranilast (400 mg x kg(-1) x day(-1) by twice daily gavage) or vehicle for another 8 wk. Cell signaling was examined in neonatal cardiac fibroblasts. After 8 wk, diabetic rats showed evidence of impaired diastolic function with reduced early-to-late atrial wave ratio and prolonged deceleration time in association with fibrosis, apoptosis, and hypertrophy (all P < 0.05). Treatment with tranilast prevented the development of diastolic dysfunction and the histopathological features of DCM. While tranilast did not affect Smad phosphorylation, it significantly attenuated TGF-beta-induced p44/42 mitogen-activated protein kinase phosphorylation.

Reduction of post-surgical adhesion formation with tranilast

BACKGROUND

Preclinical studies using the rabbit sidewall and double uterine horn models were used to assess time and dose response of tranilast delivered via subcutaneous pump, p.o., or as an intraperitoneal bolus in viscoelastic gels as well as an intraperitoneal biodegradable poly(p-dioxanone) fiber in reducing adhesions compared to vehicle controls.

MATERIALS AND METHODS

New Zealand white rabbits underwent laparotomy followed by: 1) uterine horn abrasion and peripheral devascularization or 2) cecal abrasion and sidewall deperitonealization. Tranilast treatment using various vehicles and dosages was compared to vehicle alone versus no treatment. Animals were euthanized after 7 to 21 days. Adhesion formation was assessed by two independent observers.

RESULTS

There were reductions in adhesion formation when drug was delivered topically, but oral drug alone was not effective. When tranilast was given preoperatively, oral drug added to the adhesion reduction of intraperitoneal administered drug. Tranilast in a viscoelastic carrier as well as in a biodegradable fiber was effective at reducing adhesions in the double uterine horn model. The slow release of tranilast from a biodegradable rod produced overall the best results. There were no safety issues.

CONCLUSION

Tranilast was effective in reducing adhesions when given in a variety of vehicles in different rabbit models of adhesion formation. Overall, the sustained intraperitoneal delivery of tranilast from biodegradable fibers was the most suitable for clinical testing.

Topical Bromfenac Sodium for Long-Term Management of Vernal Keratoconjunctivitis

BACKGROUND/AIMS

We evaluated the efficacy and safety of long-term management of patients with vernal keratoconjunctivitis (VKC) with bromfenac sodium eye drops in combination with corticosteroids and anti-allergic eye drops.

METHODS

Twenty-two patients with VKC were randomly assigned to receive two test eye drops, either bromfenac sodium 0.1% (group A) or placebo eye drops (normal saline; group B) for a mean observation period of 20.9 months. Topical corticosteroids and mast cell stabilizers were continued during the observation period.

RESULTS

The mean 2-year recurrence rate was 90.9% in group A and 11.3% in group B, with a significant difference. No serious side effect was observed in group A.

CONCLUSION

These results suggest that bromfenac sodium eye drops can be used as baseline local treatment in patients with VKC.

Slow-Releasing Tranilast in Polytetrafluoroethylene/Polylactide-co-glycolide Laminate Delays Adjustment after Strabismus Surgery in Rabbit Model

PURPOSE

To determine the usefulness of slow-releasing tranilast in polytetrafluoroethylene/polylactide-co-glycolide (PTFE/PLGA) laminate for delayed adjustable strabismus surgery.

METHODS

A prospective, masked-observer, controlled study was performed in 25 rabbits. Fifty rabbit eyes were divided randomly into three groups. After a recession of the superior rectus muscle (SRM), a PTFE/PLGA laminate containing tranilast, PTFE alone, or balanced salt solution was applied beneath and over the SRM in the PTFE/PLGA-tranilast group (group P-T), the PTFE group (group P), and the control group, respectively. Delayed adjustment was performed by a masked observer once on each SRM 3 or 5 weeks after surgery. Adjustability, adjustment lengths, forces required, and adhesion degrees were evaluated.

RESULTS

In the control group, adjustment was impossible in any eye 3 or 5 weeks after surgery. In group P, adjustment was possible in 5 of 8 eyes 3 weeks after surgery and in 5 of 10 eyes 5 weeks after surgery. In group P-T, adjustment was possible in 8 of 10 eyes 3 and 5 weeks after surgery. On comparing adjustability, a significant difference was observed between group P-T and the control group 3 and 5 weeks after surgery (P = 0.006, P = 0.006, respectively). A significant difference was observed between group P-T and the control group (P = 0.016) in terms of adhesion between SRMs and conjunctivae 5 weeks after surgery.

CONCLUSIONS

Slow-releasing tranilast in PTFE/PLGA was found to reduce adhesion and allowed delayed adjustment in most eyes for up to 5 weeks after surgery.

Tranilast Suppresses the Disease Development of the Adjuvant- and Streptococcal Cell Wall-Induced Arthritis in Rats

This study explores the effects of the anti-allergic and anti-fibrotic agent tranilast on adjuvant- and streptococcal cell wall-induced arthritis in rats, animal models of rheumatoid arthritis in humans. Tranilast (150 or 300 mg/kg, twice daily) or vehicle only was administered orally to the two arthritis models, from 17 days before sensitization. As a comparative control, methotrexate (0.1 mg/kg, once daily) was given to another group. Tranilast suppressed the increase in foot volumes, paw thicknesses, clinical scores, and histopathological scores of the ankle joints in both models dose-dependently. In addition, the fibrosis indices of the ankles were dramatically decreased by tranilast in both of the models. Compared to the effects of methotrexate, tranilast seemed to work more effectively in the streptococcal cell wall-induced arthritis model than in the adjuvant-induced arthritis model. From these observations, it can be concluded that tranilast suppresses the development of arthritis in multiple models and is potentially a novel therapeutic agent for human rheumatoid arthritis.

Mast cell, a promising therapeutic target in tubulointerstitial fibrosis

Tubulointerstitial fibrosis is a final common pathway to the eventual structural desolation of kidneys. However, the mechanism involved in this phenomenon is still poorly understood, and current therapies are ineffective or only marginally effective. Mast cell has a variety of physiological and pathological functions through the production of heparin, histamine, neutrophil chemoattractants, immunoregulatory cytokines, and mast cell-specific serine proteases tryptase and chymase. The survival and proliferation of mast cell are dependent upon stem cell factor. Presently, mast cells are known to participate in the pathogenesis of tubulointerstitial fibrosis in many kidney diseases. Several therapeutic approaches to inhibit mast cell activation have already demonstrated some clinical utility in tissue fibrosis or inflammatory diseases such as the use of mast cell stabilizers, inhibitors of tryptase or chymase, blockade of stem cell factor and anti-IgE therapy. We hypothesize that mast cell has a significant role in the progression of tubulointerstitial fibrosis, thus the treatment strategies based on mast cell appear to be promising in these conditions. Development of these novel therapeutic approaches will enable us to target any types of renal disease.

Effect of tranilast in early-stage diabetic nephropathy

BACKGROUND

Tranilast is an antifibrotic drug known to suppress collagen synthesis by fibroblasts by interfering with the effects of TGF-beta. We recently reported that it slowed the progression rate of advanced diabetic nephropathy (DN) by reducing the accumulation of collagens in renal tissue. The present study was undertaken to examine the effect of tranilast on early-stage DN.

METHODS

Among out-patients with diabetes mellitus, we selected patients with (i) urinary albumin excretion of 30-1000 mg/g creatinine (/gCr) in the first morning urine, (ii) serum creatinine (SCr) < or =1.2 mg/dl and no haematuria and (iii) currently taking an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Twenty patients fulfilled the criteria, of whom 10 were selected at random and commenced on tranilast [100 mg, 3 times daily; T(+) group]. The remaining 10 patients comprised the T(-) group. Excretion of both urinary type IV collagen (U-IV) and albumin (U-A) in the first morning urine was measured every 3 months. The follow-up period was 1 year.

RESULTS

At baseline, no significant differences were observed in SCr, HbA(1c), blood pressure and U-A excretion between the T(+) and T(-) groups, but U-IV excretion in the T(+) group was higher than in the T(-) group (6.4 +/- 0.66 vs 3.7 +/- 0.36 microg/gCr, mean +/- SEM, P < 0.01). At 1 year, SCr was not different from the baseline in either group. In the T(+) group, however, excretion rates of both U-IV and U-A tended to decrease with time, and after 1 year, were significantly decreased compared with excretion at baseline (U-A: 279 +/- 78 to 191 +/- 62 mg/gCr; P = 0.049, U-IV: 6.4 +/- 0.66 to 4.4 +/- 0.99 microg/gCr; P = 0.02). In contrast, in the T(-) group, excretion of both U-A and U-IV tended to increase with time. The changes of both U-A and U-IV excretions in the two groups took statistically different trends through tranilast treatment (P = 0.01 and P = 0.04, respectively).

CONCLUSIONS

Our results suggest that tranilast could be therapeutically beneficial in early-stage DN.

Study of the Critical Points in Lobenzarit Disodium Hydrophilic Matrices for Controlled Drug Delivery

Percolation theory is a multidisciplinary theory that studies chaotic systems. It has been applied in the pharmaceutical field since 1987. The application of this theory to study the release and hydration rate of hydrophilic matrices allowed for first time to explain the changes in release and hydration kinetic of swellable matrices type controlled delivery systems. The objective of the present paper is to estimate the percolation threshold of HPMC K4M in matrices of lobenzarit disodium and to apply the obtained result to the design of hydrophilic matrices for the controlled delivery of this drug. The materials used to prepare the tablets were Lobenzarit disodium (LBD) and HPMC of viscosity grade K4M. The drug mean particle size was 42+/-0.61 mum and the polymer was sieved and 150-200 microm granulometric fraction was selected. The formulations studied were prepared with different excipient contents in the range of 10-80% w/w. Dissolution studies were carried out using the paddle method and the water uptake measurements were performed using a modified Enslin apparatus. In order to estimate the percolation threshold, the behaviour of the kinetic parameters with respect to the volumetric fraction of each component at time zero, was studied. According to percolation theory, the critical points observed in dissolution and water uptake studies are attributed to the existence of an excipient percolation threshold. This threshold was situated between (18.58 to 24.33% v/v of HPMC). Therefore, the LBD-HPMC K4M matrices with a relative HPMC particle size of should be formulated with an excipient content above 24.33% v/v of HPMC, to obtain a control of the drug release from these systems.

The block of CFTR by scorpion venom is state-dependent

Cystic fibrosis transmembrane conductance regulator (CFTR) adenosine triphosphate-dependent chloride channels are expressed in epithelial cells and are associated with a number of genetic disorders, including cystic fibrosis. Venom of the scorpion Leirus quinquestriatus hebraeus reversibly inhibits CFTR when applied to its cytoplasmic surface. To examine the state-dependence of inhibition we recorded wild-type and mutant CFTR channel currents using inside-out membrane patches from Xenopus oocytes. Application of either venom or diphenylamine-2-carboxylate to channels that were either activated (open) or resting (closed) indicate primarily closed state-dependent inhibition of CFTR by venom, whereas diphenylamine-2-carboxylate showed no state-dependence of block. Efficacy of venom-mediated macroscopic current inhibition was inversely related to channel activity. Analysis of single-channel and macropatch data indicated that venom could either inhibit channel opening, if it binds during an interburst closed state or in the absence of cytosolic adenosine triphosphate, or introduce new intraburst closed states, if it binds during an open event. The on-rate of venom binding for intraburst block could be modulated by changing CFTR activity with vanadate or adenylyl-imidodiphosphate, or by introducing the Walker A mutation K1250A. These findings represent the first description of state-dependent inhibition of CFTR and suggest that the active toxin could be used as a tool to study the conformational changes that occur during CFTR gating.

Treatment of Autoimmune Neuroinflammation with a Synthetic Tryptophan Metabolite

Local catabolism of the amino acid tryptophan (Trp) by indoleamine 2,3-dioxygenase (IDO) is considered an important mechanism of regulating T cell immunity. We show that IDO transcription was increased when myelin-specific T cells were stimulated with tolerogenic altered self-peptides. Catabolites of Trp suppressed proliferation of myelin-specific T cells and inhibited production of proinflammatory T helper–1 (TH1) cytokines. N-(3,4,-Dimethoxycinnamoyl) anthranilic acid (3,4-DAA), an orally active synthetic derivative of the Trp metabolite anthranilic acid, reversed paralysis in mice with experimental autoimmune encephalomyelitis, a model of multiple sclerosis (MS). Trp catabolites and their derivatives offer a new strategy for treating TH1-mediated autoimmune diseases such as MS.

Annular elastolytic giant cell granuloma in an infant: Improvement after treatment with oral tranilast and topical pimecrolimus

Annular elastolytic giant cell granuloma (AEGCG) is a rare granulomatous skin disease of unknown origin that is characterized clinically by annular patches with erythematous borders and hypopigmented centers and histologically by loss of elastic fibers and elastophagocytosis. We report a case of AEGCG in an 8-month-old boy that was successfully treated with oral tranilast and topical pimecrolimus (Elidel 1.0% cream).

The effects of drug delivery via hydrophilic acrylic (hydrogel) intraocular lens systems on the epithelial cells in culture

BACKGROUND AND OBJECTIVE

Secondary posterior subcapsular opacification is still among the most important complications after phacoemulsification.

MATERIALS AND METHODS

This study was designed to assess the inhibitory effects of drugs delivered via hydrophilic acrylic (hydrogel) intraocular lens (IOL) systems in vitro. Lens epithelial cells were collected from albino rabbits. The following seven groups of hydrogel IOLs were prepared: untreated IOLs and IOLs infiltrated with diclofenac sodium, tranilast, mitomycin C, colchicines, 5-fluorouracil, and ethylenediaminetetraacetic acid. The IOLs were fixed to a Cell Culture Insert; they were then bathed and incubated in minimum essential medium containing cultured lens epithelial cells. Subsequently, a comparative analysis of the cells adhering to the collagen membrane and the lens surfaces was conducted.

RESULTS

Adhesion of lens epithelial cells to the lens surfaces and the collagen membrane was observed in the control group. However, only slight cellular adhesion was found on the surfaces of the IOLs and on the collagen membrane in the treated IOL groups.

CONCLUSION

Use of hydrogel IOLs infiltrated with drugs was associated with inhibition of posterior subcapsular opacification in vitro.

Oral aspirin challenges in patients with a history of intolerance to single non-steroidal anti-inflammatory drugs

Summary Background In the clinical practice patients with a history of acute urticaria induced by a single non-steroidal anti-inflammatory drug (NSAID) and seeking for safe alternative drugs generally undergo tolerance tests with alternative NSAIDs that have little or no cyclooxygenase-1 (COX-1) enzyme inhibitory activity. This practice does not allow for the detection of single NSAID reactors and may lead to unnecessary avoidance of many potentially useful NSAIDs.

OBJECTIVE

Evaluate aspirin challenge as a means to distinguish single from multiple NSAID intolerance in patients with a clinical history of acute urticaria induced by a single NSAID. Methods One hundred and seventeen otherwise normal subjects with a history of acute urticaria following the ingestion of a single NSAID (pyrazolones (n=58), nimesulide (n=17), propionic acid derivatives (n=13), aryl acetic acid derivatives (n=14), acetaminophen (n=9), piroxicam (n=5), and indometacin (n=1)) underwent single-blind placebo-controlled oral challenges with aspirin. Aspirin-intolerant subjects underwent further tolerance tests drugs exerting little or no inhibitory activity on COX-1 enzyme (including paracetamol, nimesulide, rofecoxib, tramadol, and floctafenine). Results Aspirin induced urticaria in 28/117 (24%) patients. Five out of 28 (18%) aspirin reactors did not tolerate alternative NSAID on subsequent oral challenges. Conclusion In subjects with a history of urticaria induced by a single NSAID (other than aspirin) the diagnostic workup should start with an aspirin challenge in order to detect single/multiple NSAID reactors.

Influence of marbofloxacin on the pharmacokinetics and pharmacodynamics of tolfenamic acid in calves

Pharmacokinetic and pharmacodynamic properties of tolfenamic acid (TA) in calves were determined in serum and fluids of inflamed (carrageenan administered) and non-inflamed subcutaneously implanted tissue cages after intramuscular administration both alone and in combination with marbofloxacin (MB). MB significantly altered the pharmacokinetics of TA: mean values were Cmax = 2.14 and 1.64 microg/mL, AUC = 27.38 and 16.80 microg.h/mL, Vd(area)/F = 0.87 and 1.17 L/kg, and ClB/F = 0.074 and 0.128 L/kg/h, respectively, after administration of TA alone and TA + MB. T(1/2)K10 and MRT were not significantly different for the two treatments. The pharmacodynamic properties of TA were not influenced by MB co-administration, in spite of the alterations in some TA pharmacokinetic parameters. TA inhibited prostaglandin E2 (PGE2) synthesis in vivo in inflammatory exudate by 50-88% for up to 48 h after both TA treatments. Inhibition of synthesis of serum thromboxane B2 (TxB2) ex vivo ranged from 40 to 85% up to 24 h after both TA and TA + MB. From the derived pharmacokinetic and eicosanoid inhibition data for TA, pharmacodynamic parameters for serum TxB2 and exudate PGE2 inhibition expressing efficacy (Emax = 78.1 and 97.5%), potency (IC50 = 0.256 and 0.265 microg/mL), sensitivity (N = 1.96 and 2.29) and the pharmacokinetic parameter equilibration time (t(1/2)K(e0) = 0.695 and 24.0 h), respectively, were determined. In this model TA was a nonselective inhibitor of cyclo-oxygenase (COX) (COX-1:COX-2 IC50 ratio = 1.37). TA, both alone and co-administered with MB, did not affect leucocyte numbers in exudate, transudate or blood. Partial attenuation of skin temperature rise over inflamed tissue cages and reduction of zymosan-induced skin swelling were recorded after administration of TA and TA + MB with no significant differences between the two treatments. These data provide a basis for the rational use of TA in combination with MB in calf medicine.

Anti-allergic agent tranilast decreases development of obliterative airway disease in rat model of heterotopic tracheal transplantation

BACKGROUND

Tranilast is an anti-allergic agent known to inhibit the release of histamine, interleukin-1beta, transforming growth factor beta1, and platelet-derived growth factor from various cells and currently is used to treat allergic diseases, keloids, and hypertrophic scars. We evaluated the ability of tranilast to inhibit the development of obliterative airway disease (OAD) in a rat model of heterotopic tracheal transplantation.

METHODS

We transplanted tracheal segments from donor rats (Brown Norway) into subcutaneous pouches in major histocompatibility complex-incompatible recipient rats (Lewis). At Days 21 and 28 after transplantation, we histologically assessed the harvested allografts scored the degree of OAD, on a scale from zero to 4 as previously described, caused by fibroproliferative tissue.

RESULTS

Recipient animals treated orally with 400 mg/kg/day tranilast throughout the experiment showed significantly decreased OAD compared with control animals, with a histologic score of 1.1 +/- 0.4 vs 3.0 +/- 1.3, respectively (mean +/- SD, p=0.007), at Day 21 after transplantation and 2.0 +/- 1.4 vs 3.9 +/- 0.4, respectively (mean +/- SD, p=0.017), at Day 28 after transplantation.

CONCLUSION

These results showed that treatment with tranilast significantly decreased fibroproliferative airway changes associated with allograft rejection in a rat model of tracheal transplantation, suggesting that tranilast may be useful in preventing bronchiolitis obliterans after lung transplantation.

Potent and Orally Bioavailable Non-Peptide Antagonists at the Human Bradykinin B1 Receptor Based on a 2-Alkylamino-5-sulfamoylbenzamide Core

The bradykinin B(1) receptor is rapidly induced after inflammation or tissue trauma and appears to play an important role in the maintenance of hyperalgesia in inflammatory conditions. Here, we describe the optimization process to identify novel, potent non-peptide human B(1) receptor antagonists based on a 2-alkylamino-5-sulfamoylbenzamide core. Optimized derivatives are selective, functional B(1) antagonists with low nanomolar affinity and exhibit oral bioavailability in animals.

Geranyl N-dimethylallylanthranilate, a new compound from Esenbeckia yaaxhokob

Through a bioactivity-guided fractionation from the acetone extract of the leaves from Esenbeckia yaaxhokob geranyl N-dimethylallylanthranilate ( 1), the first natural N- and O-prenylated anthranilate, was isolated in addition of the known natural products caryophyllene beta-oxide, caryolane-5beta,9beta-diol, spathulenol ( 2), friedeline, friedelanol, decaprenol, flindersiamine ( 3) and beta-sitosterol. The antimicrobial activities of the extract, fractions and pure compounds were evaluated against two Gram (+) and four Gram (-) bacteria. Compounds 1 and 2 exhibited moderated antimicrobial activity against Staphyloccocus aureus, while 3 was active against S. aureus and Streptococcus faecalis.

Preventive Effect of Tranilast on Oleic Acid-Induced Lung Injury in Guinea Pigs

Acute respiratory distress syndrome or acute lung injury (ARDS)/(ALI) involve the severe lung injury with pulmonary vascular hyper-permeability and hypoxemia induced by inflammatory reactions. Since ARDS/ALI carries high mortality, the development of new drugs against ARDS/ALI is required. We examined the effect of tranilast, an anti-allergic drug, on vascular hyper-permeability in the lungs and airways, and on hypoxemia, in oleic acid (OA)-induced acute lung injury, an animal model of ARDS/ALI. The increase in pulmonary and airway vascular permeability and the decrease in partial oxygen pressure of arterial blood induced by an intravenous injection of OA were drastically ameliorated by the oral administration of tranilast in a dose-dependent manner. This is the first report to prove that tranilast prevents pulmonary and airway vascular permeability and hypoxemia induced by OA. These results suggest that tranilast may be a candidate drug for the treatment of ARDS/ALI.

Therapeutic Potential of Oral Antiproliferative Agents in the Prevention of Coronary Restenosis

The treatment of coronary artery disease has reached many milestones - from balloon angioplasty to drug-eluting stents. The last decade witnessed the revolution of bare metal stents with new designs, alloys and strut thicknesses. Yet restenosis, the aphorismic 'Achilles heel', remains to be conquered. The restenosis rates with balloon angioplasty alone are 30-40% and are reduced to 20-30% with stents. Although intravascular brachytherapy proved to be a durable and safely used technique to treat in-stent restenosis, clinical event rates were not reduced to single digits.Drug-eluting stents are showing positive results in this direction, but it is too early to predict their efficacy in various subsets of lesions. With the increased usage of these stents, there are reports of problems such as late stent malapposition, subacute and late thromboses, and aneurysm formations due to the vessel toxicity associated with this method of treatment. Furthermore, when multivessel stenting is considered, the cost of drug-eluting stents is a significant problem given the fact that these are no longer 'zero restenosis' devices. There is a definite need for a simple, safe and durable solution to restenosis. Oral agents are an alternative delivery strategy that can target multiple coronary lesions, which are targets for catheter-based revascularisation with any approved metal stent and with potentially lower cost. Although oral agents have been an interesting option to treat restenosis and several agents have been tested in trials since the 1980s, the results were disappointing. The development of devices such as intravascular ultrasound has led to a greater understanding of restenosis mechanisms, and the focus on pathophysiological mechanisms, which centred mainly on platelets, growth factors and lipids, has changed to inflammation, endothelium and smooth muscle cell proliferation.Accordingly, the targets of pharmaceutical agents have shifted from platelets to cell cycle inhibition, smooth muscle cell proliferation and migration, synthesis of extra cellular matrix, and inflammatory mediators. Initial encouraging results with oral drugs such as cilostazol, sirolimus (rapamycin) and thiazolidinediones indicate a definite place for this strategy to reduce restenosis. A desirable oral agent would be anti-inflammatory, inhibit smooth muscle cell migration and proliferation, promote endothelial growth, and be well tolerated and free from significant adverse effects. It may be useful to start with a high loading dose before stent implantation and then follow with a short-term lower maintenance dose. Future trials should be aimed at finding an ideal agent, effective loading dose, maintenance dose and optimum duration of therapy.

Biodegradable stents as a platform to drug loading

Despite technical and mechanical improvement in coronary stents the incidence of restenosis caused by in-stent neointimal hyperplasia remains high. Oral administration of numerous pharmacological agents has failed to reduce restenosis after coronary stenting in humans, possibly owing to insufficient local drug concentration. Therefore, drug-eluting stents were developed as a vehicle for local drug administration. The authors developed a new drug-eluting polymer stent that is made of poly-l-lactic acid polymer mixed with tranilast, an anti-allergic drug that inhibits the migration and proliferation of vascular smooth muscle cells induced by platelet-derived growth factor and transforming growth factor->1. Polymer stents might be superior to polymer-coated metallic stents as local drug delivery stents in terms of biodegradation and the amount of loaded drug. Drug-mixed polymer stents can be loaded with a larger amount of drug than can drug-coated metallic stents because the polymer stent struts can contain the drug. Clinical application is required to assess the safety and efficacy of drug-eluting polymer stents against stent restenosis.

Tranilast slows the progression of advanced diabetic nephropathy

BACKGROUND

Tranilast, N-(3,4-dimethoxycinnamoyl) anthranilic acid, suppresses collagen synthesis by various cells, including macrophages and fibroblasts, by interfering with the actions of transforming growth factor-beta 1. We investigated the effect of tranilast on progression of diabetic nephropathy (DN), since this process is associated with accumulation of collagens in the glomerulus and interstitium.

METHODS

Tranilast (100 mg, 3 times daily) was administered to 9 outpatients with advanced DN who were receiving an angiotensin-converting enzyme inhibitor or an angiotensin II receptor antagonist and who exhibited a progressive decline in renal function. The decline in renal function before and during tranilast treatment was evaluated for each patient on the basis of the slope in reciprocal serum creatinine (1/S(Cr)) over time. Urinary type IV collagen (U-IV.C) and protein (U-P) excretions were measured just before commencement of tranilast treatment and every 2 months during the treatment.

RESULTS

One male patient dropped out soon after commencement of tranilast treatment due to development of lung cancer, and hemodialysis was introduced in one female patient 6 months after the start of treatment. In the 8 patients who did not drop out, 1/S(Cr) was significantly less steep during tranilast treatment than before treatment (-0.00748 +/- 0.00700 vs. -0.01348 +/- 0.00636 dl/mg/month, respectively; p = 0.0374). U-IV.C and U-P tended to decrease with time, although the decrease was statistically insignificant.

CONCLUSIONS

Our data suggest that tranilast treatment may suppress accumulation of collagens in renal tissue and may be therapeutically useful for reducing the progression of advanced DN.

[Effectiveness of tolfenamic acid in the prevention of migraine]

The migraine prophylactic effect of tolfenamic acid 300 mg versus pizotifen 1.5 was evaluated in a prospective, randomized, double-blind, parallel group study. 192 patients were included with a frequency of 4-8 moderate to severe migraine attacks monthly, with or without aura, fulfilling the diagnostic criteria for migraine as defined by the International Headache Society. A four-week baseline period without medication was followed by 12 weeks of treatment with tolfenamic acid 300 mg or pizotifen 1.5 mg. In both periods patients were allowed to take escape medication (paracetamol and codeine) if the treatment was inefficient. All the patients had a headache diary before and during treatment. The primary criterion of efficacy was reduction in attack frequency per 4 weeks. Also reduction in intensity or duration of migraine attacks in hours at the end of 12 weeks treatment compared to the baseline period was measured. Both groups exhibited significant reduction in attack frequency (p < 0.001). Tolfenamic acid significantly reduced severity compared to the run-in period (p = 0.009). Patients treated with pizotifen needed more escape medication when compared to the run-in period (p < 0.01). Tolerance, especially weight gain, was a major drawback with pizotifen. Because of its high efficacy, excellent tolerability and low cost, tolfenamic acid is an interesting option for migraine prophylaxis.

Treatment of oligoasthenozoospermia with tranilast, a mast cell blocker, after long-term administration

The authors retrospectively examined whether long-term administration of tranilast improves semen parameters in severe oligoasthenozoospermia. Fifty-two patients presenting with sperm concentration of less than 10 x 10(6) sperm/mL were enrolled. Subjects were partitioned into 3 groups as follows: patients displaying an atrophic testis with elevated (FSH) (group 1), patients exhibiting normal testicular volume with elevated FSH (group 2), and patients with normal testicular volume and normal FSH levels (group 3). Tranilast (300mg/day) was administered until pregnancy was achieved or for a period of up to 12 months. Sperm concentration was significantly increased at 3 months in 16 subjects (44%) in groups 1 and 3. In group 2, sperm concentration was increased at 12 months (5 of 16 subjects; 31%). Total sperm count was obviously elevated at 3 months in groups 1 and 2, and at 6 months in group 3. Six pregnancies were achieved via natural intercourse. Tranilast, a mast cell blocker, demonstrates a certain clinical benefit in terms of improvement of semen parameters involving severe oligoasthenozoospermia, but it does not appear to afford clinical benefit in long-term administration.

Effect of Tranilast on Proliferation, Collagen Gel Contraction, and Transforming Growth Factor Beta Secretion of Retinal Pigment Epithelial Cells and Fibroblasts

The efficiency of tranilast for the treatment of proliferative vitreoretinopathy (PVR) was investigated in vitro. A tetrazolium-based colorimetric assay showed that the 300-microM concentration of tranilast inhibited proliferation of bovine retinal pigment epithelial (RPE) cells and rabbit dermal fibroblasts with no toxicity. The contraction of collagen gels embedded with these cells was evaluated in the cultures. Compared with the gel incubated with minimal essential medium and 0.35% bovine serum albumin and/or fetal calf serum, tranilast inhibited gel contraction. Enzyme-linked immunosorbent assay revealed that a 300-microM concentration of tranilast inhibited transforming growth factor-beta(1) (TGF-beta(1)) secretion significantly (p < 0.01). These results suggest that tranilast may inhibit the proliferation of RPE cells and fibroblasts and contraction of intraocular fibrous membranes by suppressing TGF-beta(1) secretion from these cells with a potential to treat PVR.

Results of Prevention of REStenosis with Tranilast and its Outcomes (PRESTO) trial

BACKGROUND

Restenosis after percutaneous coronary intervention (PCI) is a major problem affecting 15% to 30% of patients after stent placement. No oral agent has shown a beneficial effect on restenosis or on associated major adverse cardiovascular events. In limited trials, the oral agent tranilast has been shown to decrease the frequency of angiographic restenosis after PCI.

METHODS AND RESULTS

In this double-blind, randomized, placebo-controlled trial of tranilast (300 and 450 mg BID for 1 or 3 months), 11 484 patients were enrolled. Enrollment and drug were initiated within 4 hours after successful PCI of at least 1 vessel. The primary end point was the first occurrence of death, myocardial infarction, or ischemia-driven target vessel revascularization within 9 months and was 15.8% in the placebo group and 15.5% to 16.1% in the tranilast groups (P=0.77 to 0.81). Myocardial infarction was the only component of major adverse cardiovascular events to show some evidence of a reduction with tranilast (450 mg BID for 3 months): 1.1% versus 1.8% with placebo (P=0.061 for intent-to-treat population). The primary reason for not completing treatment was > or =1 hepatic laboratory test abnormality (11.4% versus 0.2% with placebo, P<0.01). In the angiographic substudy composed of 2018 patients, minimal lumen diameter (MLD) was measured by quantitative coronary angiography. At follow-up, MLD was 1.76+/-0.77 mm in the placebo group, which was not different from MLD in the tranilast groups (1.72 to 1.78+/-0.76 to 80 mm, P=0.49 to 0.89). In a subset of these patients (n=1107), intravascular ultrasound was performed at follow-up. Plaque volume was not different between the placebo and tranilast groups (39.3 versus 37.5 to 46.1 mm(3), respectively; P=0.16 to 0.72).

CONCLUSIONS

Tranilast does not improve the quantitative measures of restenosis (angiographic and intravascular ultrasound) or its clinical sequelae.

Tranilast as an additional treatment with conservative therapy for concave deformity following traumatic hematoma

Fibrotic scar tissue resulting from a cheek hematoma sometimes seriously contracts to form a concave deformity, despite conservative therapy. We used Tranilast as an additional treatment with conservative therapy for four patients who were resistant to massage and compression therapy. Four months after oral administration of Tranilast, all the deformities were resolved. Tranilast is used for the treatment of allergic diseases and keloids. It inhibits the release of transforming growth factor b-1, interleukin-1 b, and prostaglandin E2. It also suppresses collagen synthesis by fibroblasts.