Selektive und duale COX-1-, COX-2-Inhibitoren aus der Reihe der Methanone

Zusammenfassung: Prostaglandine (PG) sind wichtige biologische Entzündungsmediatoren, die aus der Arachidonsäure (AA) durch das Enzym Cyclooxygenase (COX) entstehen. Trotz einiger unerwünschter Wirkungen, sind Cyclooxygenase-Hemmer Mittel der Wahl zur Unterdrückung entzündlicher Prozesse. Von der Cyclooxygenase existieren zwei Isoenzyme: COX-1 und COX-2. Eine selektive Hemmung der COX-2 bzw. eine duale Hemmung der COX-1 und COX-2 wird als erfolgversprechendes Prinzip zur Behandlung von entzündlichen Erkrankungen diskutiert.Ziel der Arbeit war die Synthese und in vitro Testung sowie die Erstellung von Struktur-Wirkungs-Beziehungen selektiver bzw. dualer Hemmstoffe der COX-1/-2. Zusätzlich wurden die Substanzen auf inhibitorische Aktivität gegenüber der 5- und 12-Lipoxygenase untersucht.Ausgehend von der Struktur selektiver Hemmstoffe der COX-2 bzw. von dualen COX-1/ COX-2-Inhibitoren sowie von marktüblichen nichtsteroidalen Antirheumatika (NSAR), wurde das Diarylmethanon-Element als Basis gewählt. An diesem Strukturelement wurden Modifikationen vorgenommen, um selektive Hemmstoffe der COX-2 bzw. duale COX-1/ COX-2-Hemmstoffe zu erhalten.Die synthetisierten Verbindungen lassen sich in [4-(Methylsulfanyl)phenyl]- und [4-(Methylsulfonyl)phenyl](aryl)methanone, N-(Aroylphenyl)sulfonamide und -amide sowie (Hydroxyphenyl)(2-thienyl)methanone unterteilen.In der Reihe der [4-(Methylsulfanyl)phenyl](aryl)methanone sind potente Hemmstoffe sowohl der COX-1 als auch der COX-2 erhalten worden. Im Gegensatz dazu zeigen die [4-(Methylsulfonyl)phenyl](aryl)methanone gegenüber COX-1 und COX-2 keine inhibitorische Aktivität. Mit dem 2-Thienylderivat wurde ein potenter, dualer Hemmstoff beider Cyclooxygenase-Isoenzyme identifiziert, dessen Wirkstärke (bezüglich der COX-2) auf den Austausch von Phenyl gegen 2-Thienyl zurückzuführen ist.Die N-(Aroylphenyl)sulfonamide und -amide bilden die umfangreichste Gruppe bei den durchgeführten Untersuchungen, wobei besonders die regioisomeren N-(2-Aroylphenyl)sulfonamide und -amide eingehender studiert wurden. Auf der Basis der (2-Aroylphenyl)sulfonamide läßt sich für die Hemmung der COX-1 eine Struktur-Wirkungs-Beziehungen formulieren, die anhand Hilfe geeigneter Verbindungen überprüft wurde. Die Untersuchungen wurden zum Teil auch auf die 3- und 4-Regioisomeren ausgedehnt, wobei sich die erhaltenen Struktur-Wirkungs-Beziehungen bestätigten. Die Arylsulfonamide inhibieren bevorzugt die COX-1. Auch (4-Aroylphenyl)sulfonamide wurden auf mögliche inhibitorische Aktivität untersucht. Die Einbindung des Amidstickstoffs in ein Indolin- bzw. Tetrahydrochinolin-Ringsystem oder des Sulfonamids in ein 1,3-Propansultam führte in jedem Falle zu wenig aktiven Verbindungen gegenüber der COX-1. N-(2-Aroylphenyl)amide zeigten in Übereinstimmung mit der Hypothese an der COX-1 eine gute inhibitorische Aktivität.Aus der Reihe der (Hydroxyphenyl)(2-thienyl)methanone wurden die freien Alkohole, die Methylether und verschiedene Ester dargestellt und auf COX-1-Aktivität untersucht. Acetate, aber auch Phenole sind die potentesten Inhibitoren der COX-1. Als günstigte Positionen für die 2-Thienylcarbonyl-Einheit am Hydroxyphenylrest erweist sich die ortho- bzw. para-Position.

Infiammazione e cancro: l'interazione COX-2/CA-IX promuove il potenziale invasivo e la sopravvivenza in ipossia delle cellule del cancro colon-rettale

Cyclooxygenase-2/Carbonic anhydrase-IX up-regulation promotes invasive potential and hypoxia survival in colorectal cancer cells Purpose: Cyclooxygenase-2 (COX-2) is a major mediator of inflammation, playing a pivotal role in colorectal carcinogenesis. Hypoxia is an universal hallmark of solid tumour in vivo. This investigation was prompted by the observation that in colorectal cancer cells the expression of COX-2 protein is positively correlated with that of the hypoxia survival gene Carbonic Anhydrase-IX (CA-IX). Experimental Design: Since COX-2 gene expression and activity is increased in hypoxia, and that CA-IX is expressed also in normoxia in colorectal cancer cells, we tested the hypothesis that COX-2 activity in normoxia, as well as in hypoxia may be functionally linked to that of CA-IX gene. We investigated the role of COX-2 and CA-IX in colorectal cancer cell lines. In this regard, we performed RNA interference to knockdown COX-2 gene in vitro and immunohistochemistry to evaluate the protein expression of COX-2 and CA-IX in human colon cancer tissue specimens ex vivo. Results: We found that COX-2, by PGE2 production, controls CA-IX gene expression in an ERK dependent manner. In line with this finding, we also showed that the COX-2 inhibition by a specific short harpin COX-2 RNA (shCOX-2) or by a specific drug (SC-236), down-regulated CA-IX expression in colon cancer cells. We then exposed colon cancer cells to hypoxia stimuli and found that COX-2/CA-IX interplay promoted hypoxia survival. Moreover, we also report that COX-2/CA-IX interplay triggers Matrix Metalloproteinase 2/9 (MMP-2/9) activation and enhances the invasiveness of colorectal cancer cells. Thus given our above observations, we found that CA-IX and COX-2 protein expressions correlate with more aggressive stage colorectal cancer tissues ex vivo. Conclusions: Taken together these data indicate that COX-2/CA-IX interplay promotes an aggressive phenotype (hypoxia survival and invasiveness) which can be modulated in vitro by COX-2 selective inhibition and which may play a role in determining the biological aggressiveness of colorectal tumours. Moreover, in vitro and ex vivo data also suggest that the signatures of inflammation (COX-2) and hypoxia (CA-IX) may be difficult to be disentangled in colon cancer, being both responsible for the up-regulation of the same pathways.

Generierung und Charakterisierung tolerogener muriner dendritischer Zellen

Mechanismen der zentralen und der peripheren Toleranz schützen den Körper vor Immunreaktionen gegen körpereigenes Gewebe oder gegen harmlose Umweltantigene. An der Aufrechterhaltung der peripheren Toleranz sind tolerogene Dendritische Zellen (DC) beteiligt. Tolerogene DC können in vitro u.a. mit Hilfe von immunsuppressiven und antiinflammatorischen Substanzen, aber auch durch virale Transduktionen, die zur Denovo- oder Überexpression toleranzassoziierter Moleküle führen, generiert werden. rnDa die Wirkung einiger immunmodulatorischer Substanzen über den intrazellulären sekundären Botenstoff cAMP vermittelt wird, sollte getestet werden, welchen Einfluss eine direkte Erhöhung des intrazellulären cAMP-Niveaus mittels Dibutyryl-cyclo-Adenosin-3´,5´-Mono-Phoshat (db-cAMP) auf die phänotypischen und funktionellen Eigenschaften von BM-DC („bone marrow derived dendritic cells“) hat.rnIm Vergleich zu unbehandelten BM-DC wiesen db-cAMP-DC ein vermindertes T-Zell-Stimulierungs-potenzial auf. Dieses verminderte T-Zell-Stimulierungspotenzial wird teilweise über die Proteinkinase A, nicht aber über Cyclooxygenase-2 (Cox-2) vermittelt. rnAnhand der FACS-Analyse mit DC- und MDSC- („myeloid derived suppressor cells“) spezifischen Markern konnte gezeigt werden, dass es sich bei den db-cAMP-DC um CD11c-positive DC mit einer vergleichsweise niedrigen Expression von MHCII und kostimulatorischen Oberflächenmolekülen handelt. Des Weiteren zeigte sich, dass sie verglichen mit BM-DC eine vermehrte mRNA-Expression der koinhibitorischen Moleküle B7-H1 und LIGHT und der toleranzassoziierten Moleküle FcγRIIB, HO-1 und Cox-2 aufweisen. Mittels ELISA konnte eine gesteigerte Expression der HO-1- und eine moderat gesteigerte PGE2-Synthese beobachtet werden. PGE2 wird mit Hilfe der Cox-2 aus Arachidonsäure gebildet.rnIm Gegensatz zu BM-DC wiesen db-cAMP-DC in beiden Reifungsstadien ein verändertes Zytokinprofil auf: Auf mRNA-Ebene zeigte sich, dass db-cAMP-DC verglichen mit BM-DC vermehrt IL-1RA und IL-10 exprimieren. Dieser Unterschied konnte für IL-10 auch mittels ELISA bestätigt werden. In den Kulturüberständen der stimulierten db-cAMP-DC konnte, im Gegensatz zu denen stimulierter BM-DC, kaum bioaktives IL-12 nachgewiesen werden. rnDb-cAMP-DC induzierten des Weiteren in kokultivierten allogenen T-Zellen ein differenzielles Zytokinprofil: Sie förderten die INFγ- und IL-17-Sezernierung durch T-Zellen, während die IL-5-Sezernierung geringer war, wenn T-Zellen mit stimulierten db-cAMP-DC kokultiviert wurden. Db-cAMP-DC hatten hingegen keinen Einfluss auf die IL-10-Produktion. Außerdem führte eine Kokultur der db-cAMP-DC mit allogenen T-Zellen nicht zu einer gesteigerten Induktion von FoxP3+ Treg. rnIn einem zweiten Ansatz sollte getestet werden ob es möglich ist die murine DC-Linie SP37A3 lentiviral mit dem toleranzassoziierten Oberflächenprotein B7-H3 zu transduzieren. Dies ist von Interesse, da die SP37A3-Zellen einige Vorteile gegenüber BM-DC aufweisen, wie z.B. ihren homogeneren Phänotyp und die Möglichkeit sie in einer Expansionskultur zu halten.rnEs konnte gezeigt werden, dass SP37A3-Zellen als Modell für myeloide DC für die Transduktion mit lentiviralen Partikeln geeignet sind. Hierbei zeigte es sich aber, dass darauf geachtet werden muss, mit konzentriertem Virus zu arbeiten und dass die Reportergen-Expression der Zielzellen über mehr als 3 Tage (mindestens 7 Tage) untersucht werden muss. Nur so kann eine eventuell auftretende Pseudotransduktion erkannt und verhindert werden. Ab einer MOI („multiplicity of infection“) von 50 konnte in SP37A3-Zellen eine Transgen-Expression nachgewiesen werden.rn

Diagnosi e terapia dei tumori delle cavita' nasali del cane

Lo studio è stato condotto su pazienti affetti da carcinoma nasale trattati con radioterapia presso il Centro Oncologico Veterinario (Sasso Marconi, BO). Lo studio, prospettico, randomizzato e in doppio cieco, ha valutato l’efficacia del trattamento radioterapico in combinazione o meno con firocoxib, un inibitore selettivo dell’enzima ciclossigenasi 2 (COX-2). Sono stati inclusi pazienti con diagnosi istologica di carcinoma nasale sottoposti a stadiazione completa. I pazienti sono stati successivamente suddivisi in due gruppi in base alla tipologia di trattamento: radioterapia associata a firocoxib (Gruppo 1) o solo radioterapia (Gruppo 2). Dopo il trattamento, i pazienti sono stati monitorati a intervalli di 3 mesi sia clinicamente che mediante esami collaterali, al fine di valutare condizioni generali del paziente, un’eventuale tossicità dovuta alla somministrazione di firocoxib e la risposta oggettiva al trattamento. Per valutare la qualità di vita dei pazienti durante la terapia, è stato richiesto ai proprietari la compilazione mensile di un questionario. La mediana del tempo libero da progressione (PFI) è stata di 228 giorni (range 73-525) nel gruppo dei pazienti trattati con radioterapia e firocoxib e di 234 giorni (range 50-475) nei pazienti trattati solo con radioterapia. La sopravvivenza mediana (OS) nel Gruppo 1 è stata di 335 giorni (range 74-620) e di 244 giorni (range 85-505) nel Gruppo 2. Non si sono riscontrate differenze significative di PFI e OS tra i due gruppi. La presenza di metastasi ai linfonodi regionali condizionava negativamente PFI e sopravvivenza (P = 0.004). I pazienti trattati con firocoxib hanno mostrato un significativo beneficio in termini di qualità di vita rispetto ai pazienti trattati con sola radioterapia (P=0.008). La radioterapia può essere considerata un’efficace opzione terapeutica per i cani affetti da neoplasie nasali. Firocoxib non sembra migliorare significativamente i tempi di sopravvivenza, ma risulta utile al fine di garantire una migliore qualità di vita.

Loss of 15-Hydroxyprostaglandin Dehydrogenase Increases Prostaglandin E2 in Pancreatic Tumors

Prostaglandin E2 (PGE2) is a product of cyclooxygenase (COX) and PGE synthase (PGES) and deactivated by 15-hydroxyprostaglandin dehydrogenase (PGDH). Down-regulation of PGDH contributes to PGE2 accumulation in lung and colon cancers but has not been identified in pancreatic cancer.

Celecoxib enhances radiation response of secondary bone tumors of a human non-small cell lung cancer via antiangiogenesis in vivo

Cyclooxygenase-2 (COX-2) inhibitors mediate a systemic antitumor activity via antiangiogenesis and seem to enhance the response of primary tumors to radiation. Radiosensitizing effects of COX-2 inhibition have not been reported for bone metastases. Therefore, the aim of this study was the investigation of the radiosensitizing effects of the selective COX-2 inhibitor celecoxib in secondary bone tumors of a non-small cell lung carcinoma in vivo.

Analgesic and anti-inflammatory actions of robenacoxib in acute joint inflammation in dog

The objectives of this study were to establish dose-response and blood concentration-response relationships for robenacoxib, a novel nonsteroidal anti-inflammatory drug with selectivity for inhibition of the cyclooxygenase (COX)-2 isoenzyme, in a canine model of synovitis. Acute synovitis of the stifle joint was induced by intra-articular injection of sodium urate crystals. Robenacoxib (0.25, 0.5, 1.0, 2.0 and 4.0 mg/kg), placebo and meloxicam (0.2 mg/kg) were administered subcutaneously (s.c.) 3 h after the urate crystals. Pharmacodynamic endpoints included data from forceplate analyses, clinical orthopaedic examinations and time course of inhibition of COX-1 and COX-2 in ex vivo whole blood assays. Blood was collected for pharmacokinetics. Robenacoxib produced dose-related improvement in weight-bearing, pain and swelling as assessed objectively by forceplate analysis (estimated ED(50) was 1.23 mg/kg for z peak force) and subjectively by clinical orthopaedic assessments. The analgesic and anti-inflammatory effects of robenacoxib were significantly superior to placebo (0.25-4 mg/kg robenacoxib) and were non-inferior to meloxicam (0.5-4 mg/kg robenacoxib). All dosages of robenacoxib produced significant dose-related inhibition of COX-2 (estimated ED(50) was 0.52 mg/kg) but no inhibition of COX-1. At a dosage of 1-2 mg/kg administered s.c., robenacoxib should be at least as effective as 0.2 mg/kg of meloxicam in suppressing acute joint pain and inflammation in dogs.

Leukocyte populations and mRNA expression of inflammatory factors in quarter milk fractions at different somatic cell score levels in dairy cows

The effect of somatic cell count (SCC) and milk fraction on milk composition, distribution of cell populations, and mRNA expression of various inflammatory parameters was studied. Therefore, quarter milk samples were defined as cisternal (C), first 400 g of alveolar (A1), and remaining alveolar milk (A2) during the course of milking. Quarters were assigned to 4 groups according to their total SCC: 1) <12 x 10(3)/mL, 2) 12 to 100 x 10(3)/mL, 3) 100 to 350 x 10(3)/mL, and 4) >350 x 10(3)/mL. Milk constituents of interest were SCC, fat, protein, lactose sodium, and chloride ions as well as electrical conductivity. Cell populations were classified into lymphocytes, macrophages, and neutrophils (PMN). The mRNA expression of the inflammatory factors tumor necrosis factor-alpha, interleukin-1beta, cyclooxygenase-2, lactoferrin, and lysozyme was measured via real-time, quantitative reverse transcription PCR. Somatic cell count decreased from highest levels in C to lowest levels in A1 and increased thereafter to A2 in all groups. Fat content increased from C to A2 and with increasing SCC level. Lactose decreased with increasing SCC level but remained unchanged during milking. Concentrations of sodium and chloride, and electrical conductivity increased with increasing SCC but were higher in C than in A1 and A2. Protein was not affected by milk fraction or SCC level. The distribution of leukocytes was dramatically influenced by milk fraction and SCC. Lymphocytes were the dominating cell population in group 1, but the proportion of lymphocytes was low in groups 2, 3, and 4. Macrophage proportion was highest in group 2 and decreased in groups 3 and 4, whereas that of PMN increased from group 2 to 4. The content of macrophages decreased during milking in all SCC groups whereas that of PMN increased. The proportion of lymphocytes was not affected by milk fraction. The mRNA expression of all inflammatory factors showed an increase with increasing SCC but minor changes occurred during milking. In conclusion, milk fraction and SCC level have a crucial influence on the distribution of leukocyte populations and several milk constituents. The surprisingly high content of lymphocytes and concomitantly low mRNA expression of inflammatory factors in quarters with SCC <12 x 10(3)/mL indicates a different and possibly reduced readiness of the immune system to respond to invading pathogens.

The selective Cox-2 inhibitor Celecoxib suppresses angiogenesis and growth of secondary bone tumors: an intravital microscopy study in mice

BACKGROUND: The inhibition of angiogenesis is a promising strategy for the treatment of malignant primary and secondary tumors in addition to established therapies such as surgery, chemotherapy, and radiation. There is strong experimental evidence in primary tumors that Cyclooxygenase-2 (Cox-2) inhibition is a potent mechanism to reduce angiogenesis. For bone metastases which occur in up to 85% of the most frequent malignant primary tumors, the effects of Cox-2 inhibition on angiogenesis and tumor growth remain still unclear. Therefore, the aim of this study was to investigate the effects of Celecoxib, a selective Cox-2 inhibitor, on angiogenesis, microcirculation and growth of secondary bone tumors. METHODS: In 10 male severe combined immunodeficient (SCID) mice, pieces of A549 lung carcinomas were implanted into a newly developed cranial window preparation where the calvaria serves as the site for orthotopic implantation of the tumors. From day 8 after tumor implantation, five animals (Celecoxib) were treated daily with Celecoxib (30 mg/kg body weight, s.c.), and five animals (Control) with the equivalent amount of the CMC-based vehicle. Angiogenesis, microcirculation, and growth of A549 tumors were analyzed by means of intravital microscopy. Apoptosis was quantified using the TUNEL assay. RESULTS: Treatment with Celecoxib reduced both microvessel density and tumor growth. TUNEL reaction showed an increase in apoptotic cell death of tumor cells after treatment with Celecoxib as compared to Controls. CONCLUSION: Celecoxib is a potent inhibitor of tumor growth of secondary bone tumors in vivo which can be explained by its anti-angiogenic and pro-apoptotic effects. The results indicate that a combination of established therapy regimes with Cox-2 inhibition represents a possible application for the treatment of bone metastases.

Modulation of signal transduction by vitamin E

The ability of vitamin E to modulate signal transduction and gene expression has been observed in numerous studies; however, the detailed molecular mechanisms involved are often not clear. The eight natural vitamin E analogues and synthetic derivatives affect signal transduction with different potency, possibly reflecting their different ability to interact with specific proteins. Vitamin E modulates the activity of several enzymes involved in signal transduction, such as protein kinase C, protein kinase B, protein tyrosine kinases, 5-, 12-, and 15-lipoxygenases, cyclooxygenase-2, phospholipase A2, protein phosphatase 2A, protein tyrosine phosphatase, and diacylglycerol kinase. Activation of some these enzymes after stimulation of cell surface receptors with growth factors or cytokines can be normalized by vitamin E. At the molecular level, the translocation of several of these enzymes to the plasma membrane is affected by vitamin E, suggesting that the modulation of protein-membrane interactions may be a common theme for vitamin E action. In this review the main effects of vitamin E on enzymes involved in signal transduction are summarized and the possible mechanisms leading to enzyme modulation evaluated. The elucidation of the molecular and cellular events affected by vitamin E could reveal novel strategies and molecular targets for developing similarly acting compounds.

A Spanish founder mutation in the chloride channel gene, CLCNKB, as a cause of atypical Bartter syndrome in adult age

BACKGROUND: Mutations in the chloride channel gene, CLCNKB, usually cause classic Bartter syndrome (cBS) or a mixed Bartter-Gitelman phenotype in the first years of life. METHODS: We report an adult woman with atypical BS caused by a homozygous missense mutation, A204T, in the CLCNKB gene, which has previously been described as the apparently unique cause of cBS in Spain. RESULTS: The evaluation of this patient revealed an overlap of phenotypic features ranging from severe biochemical and systemic disturbances typical of cBS to scarce symptoms and diagnosis in the adult age typical of Gitelman syndrome. The tubular disease caused a dramatic effect on mental, growth and puberal development leading to low IQ, final short stature and abnormal ovarian function. Furthermore, low serum PTH concentrations with concomitant nephrocalcinosis and normocalcaemia were observed. Both ovarian function and serum PTH levels were normalized after treatment with cyclooxygenase inhibitors. CONCLUSIONS: The present report confirms a weak genotype-phenotype correlation in patients with CLCNKB mutations and supports the founder effect of the A204T mutation in Spain. In our country, the genetic diagnosis of adult patients with hereditary hypokalaemic tubulopathies should include a screening of A204T mutation in the CLCNKB gene.

gamma-tocopherol, the major form of vitamin E in the US diet, deserves more attention

gamma-tocopherol is the major form of vitamin E in many plant seeds and in the US diet, but has drawn little attention compared with alpha-tocopherol, the predominant form of vitamin E in tissues and the primary form in supplements. However, recent studies indicate that gamma-tocopherol may be important to human health and that it possesses unique features that distinguish it from alpha-tocopherol. gamma-Tocopherol appears to be a more effective trap for lipophilic electrophiles than is alpha-tocopherol. gamma-Tocopherol is well absorbed and accumulates to a significant degree in some human tissues; it is metabolized, however, largely to 2,7,8-trimethyl-2-(beta-carboxyethyl)-6-hydroxychroman (gamma-CEHC), which is mainly excreted in the urine. gamma-CEHC, but not the corresponding metabolite derived from alpha-tocopherol, has natriuretic activity that may be of physiologic importance. Both gamma-tocopherol and gamma-CEHC, but not alpha-tocopherol, inhibit cyclooxygenase activity and, thus, possess antiinflammatory properties. Some human and animal studies indicate that plasma concentrations of gamma-tocopherol are inversely associated with the incidence of cardiovascular disease and prostate cancer. These distinguishing features of gamma-tocopherol and its metabolite suggest that gamma-tocopherol may contribute significantly to human health in ways not recognized previously. This possibility should be further evaluated, especially considering that high doses of alpha-tocopherol deplete plasma and tissue gamma-tocopherol, in contrast with supplementation with gamma-tocopherol, which increases both. We review current information on the bioavailability, metabolism, chemistry, and nonantioxidant activities of gamma-tocopherol and epidemiologic data concerning the relation between gamma-tocopherol and cardiovascular disease and cancer.

Effect of risk factors on complicated and uncomplicated ulcers in the TARGET lumiracoxib outcomes study

BACKGROUND ; AIMS: Selective cyclooxygenase-2 inhibitors were developed to reduce the gastrointestinal risk associated with nonsteroidal anti-inflammatory drugs (NSAIDs). The Therapeutic Arthritis Research and Gastrointestinal Event Trial was the largest study to evaluate primarily the gastrointestinal safety outcomes of selective cyclooxygenase-2 inhibitors. Data from the Therapeutic Arthritis Research and Gastrointestinal Event Trial were used to identify risk factors and investigate the safety of lumiracoxib in subgroups. METHODS: Patients with osteoarthritis (age, >or=50 y) were randomized to receive lumiracoxib 400 mg once daily, naproxen 500 mg twice daily, or ibuprofen 800 mg 3 times daily for 12 months. Events were categorized by a blinded adjudication committee. The primary end point was all definite or probable ulcer complications. RESULTS: For patients taking NSAIDs, factors associated with an increased risk of ulcer complications were age 65 years or older (hazard ratio [HR], 2.30; 95% confidence interval [CI], 1.48-3.59), previous history of gastrointestinal bleed or ulcer (HR, 3.61; 95% CI, 1.86-7.00), non-Caucasian racial origin (HR, 2.10; 95% CI, 1.35-3.27), and male sex (HR, 1.70; 95% CI, 1.08-2.68). With lumiracoxib, significant risk factors were age 65 years or older (HR, 3.18; 95% CI, 1.40-7.20), male sex (HR, 2.60; 95% CI, 1.25-5.40), non-Caucasian racial origin (HR, 2.16; 95% CI, 1.02-4.59), and concomitant aspirin use (HR, 2.89; 95% CI, 1.40-5.97). Increased risks in patients age 65 years and older were increased further if other risk factors were present. Lumiracoxib maintained an advantage over NSAIDs across all subgroups except aspirin use. CONCLUSIONS: Lumiracoxib was associated with a reduced risk of ulcer complications compared with NSAIDs in all significant subgroups except aspirin users.

[The treatment of orthostatic hypotension with metoclopramide]

The dopamine receptor antagonist metoclopramide (paspertin, primpéran, gastrosil, meclopran, gastro-timelets), used as monotherapy or in combination with an inhibitor of the cyclooxygenase enzyme, affords good results in orthostatic hypotension due to insufficiency of the sympathetic nervous system. The mechanism of action in these cases is unclear but is assumed to be elevation of vascular tone in the splanchnic vessels. A case is discussed which documents the effectiveness of metoclopramide therapy in orthostatic hypotension, even in absence of signs of autonomic dysfunction.

Pharmacological inhibition of integrin alphavbeta3 aggravates experimental liver fibrosis and suppresses hepatic angiogenesis

The vitronectin receptor integrin alphavbeta3 promotes angiogenesis by mediating migration and proliferation of endothelial cells, but also drives fibrogenic activation of hepatic stellate cells (HSCs) in vitro. Expecting antifibrotic synergism, we studied the effect of alphavbeta3 inhibition in two in vivo models of liver fibrogenesis. Liver fibrosis was induced in rats by way of bile duct ligation (BDL) for 6 weeks or thioacetamide (TAA) injections for 12 weeks. A specific alphavbeta3 (alphavbeta5) inhibitor (Cilengitide) was given intraperitoneally twice daily at 15 mg/kg during BDL or after TAA administration. Liver collagen was determined as hydroxyproline, and gene expression was quantified by way of quantitative polymerase chain reaction. Liver angiogenesis, macrophage infiltration, and hypoxia were assessed by way of CD31, CD68 and hypoxia-inducible factor-1alpha immunostaining. Cilengitide decreased overall vessel formation. This was significant in portal areas of BDL and septal areas of TAA fibrotic rats and was associated with a significant increase of liver collagen by 31% (BDL) and 27% (TAA), and up-regulation of profibrogenic genes and matrix metalloproteinase-13. Treatment increased gamma glutamyl transpeptidase in both models, while other serum markers remained unchanged. alphavbeta3 inhibition resulted in mild liver hypoxia, as evidenced by up-regulation of hypoxia-inducible genes. Liver infiltration by macrophages/Kupffer cells was not affected, although increases in tumor necrosis factor alpha, interleukin-18, and cyclooxygenase-2 messenger RNA indicated modest macrophage activation. CONCLUSION: Specific inhibition of integrin alphavbeta3 (alphavbeta5) in vivo decreased angiogenesis but worsened biliary (BDL) and septal (TAA) fibrosis, despite its antifibrogenic effect on HSCs in vitro. Angiogenesis inhibitors should be used with caution in patients with hepatic fibrosis.