Tolerance of neurite outgrowth to Rho kinase inhibitors decreased by cyclooxygenase-2 inhibitor

In this study, PC12 Adh cells and Neuro-2a cells were treated with Rho-associated kinase inhibitors （Y27632 and Fasudil）, a cyclooxygenase-1 selective inhibitor （SC560）, and a cyclooxygenase-2 inhibitor （NS398）. We found that these cells became tolerant to Rho-associated kinase inhibitors, as neurite outgrowth induced by these inhibitors diminished following more than 3 days of exposure in either cell line. The proteins cyclooxygenase-2 and cytosolic prostaglandin E synthetase were upregulated at day 3. NS398 decreased the tolerance to neurite outgrowth induction in both cell lines, whereas SC560 had almost no effect. These findings indicate that cells become tolerant to neurite outgrowth induced by Rho-associated kinase inhibitors, this is at least partly associated with upregulation of proteins involved in the cyclooxygenase-2 pathway, and cyclooxygenases-2 inhibition prevents this tolerance.

Opioid-sparing effect of selective cyclooxygenase-2 inhibitors on surgical outcomes after open colorectal surgery within an enhanced recovery after surgery protocol

AIM: To evaluate the opioid-sparing effect of selective cyclooxygenase-2(COX-2) inhibitors on short-term surgical outcomes after open colorectal surgery.METHODS: Patients undergoing open colorectal resection within an enhanced recovery after surgery protocol from 2011 to 2015 were reviewed. Patients with combined general anesthesia and epidural anesthesia, and those with acute colonic obstruction or perforation were excluded. Patients receiving selective COX-2 inhibitor were compared with well-matched individuals without such a drug. Outcome measures included numeric pain score and morphine milligram equivalent(MME) consumption on postoperative day(POD) 1-3, gastrointestinal recovery(time to tolerate solid diet and time to defecate), complications and length of postoperative stay.RESULTS: There were 75 patients in each group. Pain score on POD 1-3 was not significantly different between two groups. However, MME consumption and MME consumption per kilogram body weight on POD 1-3 was significantly less in patients receiving a selective COX-2 inhibitor(P < 0.001). Median MME consumption per kilogram body weight on POD 1-3 was 0.09, 0.06 and nil, respectively in patients receiving a selective COX-2 inhibitor and 0.22, 0.25 and 0.07, respectively in the comparative group(P < 0.001), representing at least 59% opioidreduction. Patients prescribing a selective COX-2 inhibitor had a shorter median time to resumption of solid diet [1(IQR 1-2) d vs 2(IQR 2-3) d; P < 0.001] and time to first defecation [2(IQR 2-3) d vs 3(IQR 3-4) d; P < 0.001]. There was no significant difference in overall postoperative complications between two groups. However, median postoperative stay was significantly 1-d shorter in patients prescribing a selective COX-2 inhibitor [4(IQR 3-5) d vs 5(IQR 4-6) d; P < 0.001]. CONCLUSION: Perioperative administration of oral selective COX-2 inhibitors significantly decreased intravenous opioid consumption, shortened time to gastrointestinal recovery and reduced hospital stay after open colorectal surgery.

Design, Synthesis and in vitro Evaluation of Thiazole Derivatives of Ibuprofen as Cyclooxygenase-2 Inhibitors

A series of thiazole derivatives of ibuprofen, as cyclooxygenase-2 Inhibitors, were designed, synthesized and in vitro evaluated.

Selective Cyclooxygenase-2 Inhibitors: Design and Synthesis

The discovery of COX-2 provides a novel target developing more effective NSAIDs with fewer side effects. On the basis of results from the structure-activity relationships (SAR) of selective COX-2 inhibitors, we have designed and synthesized some promising compounds.

Neuroaxonal and cellular damage/protection by prostanoid receptor ligands,fatty acid derivatives and associated enzyme inhibitors

Cellular and mitochondrial membrane phospholipids provide the substrate for synthesis and release of prostaglandins in response to certain chemical,mechanical,noxious and other stimuli.Prostaglandin D_(2),prostaglandin E_(2),prostaglandin F_(2)α,prostaglandin I_(2)and thromboxane-A_(2)interact with five major receptors(and their sub-types)to elicit specific downstream cellular and tissue actions.In general,prostaglandins have been associated with pain,inflammation,and edema when they are present at high local concentrations and involved on a chronic basis.However,in acute settings,certain endogenous and exogenous prostaglandins have beneficial effects ranging from mediating muscle contraction/relaxation,providing cellular protection,regulating sleep,and enhancing blood flow,to lowering intraocular pressure to prevent the development of glaucoma,a blinding disease.Several classes of prostaglandins are implicated(or are considered beneficial)in certain central nervous system dysfunctions(e.g.,Alzheimer’s,Parkinson’s,and Huntington’s diseases;amyotrophic lateral sclerosis and multiple sclerosis;stroke,traumatic brain injuries and pain)and in ocular disorders(e.g.,ocular hypertension and glaucoma;allergy and inflammation;edematous retinal disorders).This review endeavors to address the physiological/pathological roles of prostaglandins in the central nervous system and ocular function in health and disease,and provides insights towards the therapeutic utility of some prostaglandin agonists and antagonists,polyunsaturated fatty acids,and cyclooxygenase inhibitors.

Effects of cyclooxygenase 2 inhibitor on growth-associated protein 43 and nerve growth factor expression in dorsal root ganglion during neuropathic pain development

BACKGROUND： Inflammatory responses in injured nerves have been recognized as important factors for initially sensitizing nociceptive neurons. Cyclooxygenase （COX） is the rate-limiting enzyme in prostaglandin synthesis, and COX-2 inhibitor is involved in mechanisms of analgesia and anti-inflammation. OBJECTIVE： To investigate the effects of COX-2 inhibitor on thermal and mechanical hyperalgesia, as well as expression of growth associated protein 43 （GAP-43） and nerve growth factor （NGF） in dorsal root ganglion, in a rat model of neuropathic pain due to chronic constriction injury. DESIGN, TIME AND SETTING： A randomized, controlled, comparison study that was performed at the Surgical Department and Pathological Laboratory, Second Affiliated Hospital of Shantou University Medical College from September 2006 to September 2007. MATERIALS： COX-2 inhibitor, Iornoxicam, was purchased from Nycomed Pharmaceutical （Austria）; rabbit anti-GAP-43, and rabbit anti-NGF polyclonal antibodies were purchased from Boster, Wuhan, China. METHODS： A total of 50 adult, Wistar rats were randomly assigned to four groups： normal control （n = 5）, model （n = 15）, normal saline control （n = 15）, and Iornoxicam treatment （n =15）. With exception of the control group, the sciatic nerve of all rats was loosely ligated to establish a model of chronic constriction injury. The model rats were divided into three subgroups according to varying post-operative survival periods： 3, 7 and 14 days （n = 5）, respectively. Rats in the Iornoxicam treatment group were intraperitoneally injected with 1.3 mg/kg lornoxicam every 12 hours throughout the entire experimental procedure. Rats in the normal saline control group were intraperitoneally injected with 1.3 mL/kg saline. MAIN OUTCOME MEASURES： Immunohistochemistry revealed expression of GAP-43 and NGF in the L5 dorsal root ganglions. Mechanical withdrawal threshold and thermal withdrawal latency were used to observe neurological behavioral changes in rats. RESULTS： The relative gray values of GAP-43- and NGF-positive neurons in the model group were remarkably increased compared with the normal control rats （P 〈 0.01）, while the relative gray values in the Iomoxicam treatment group were significantly less than the model and normal saline control groups （P 〈 0.01）. Mechanical withdrawal threshold and thermal withdrawal latency gradually decreased with increasing injury time in the model, normal saline control, and Iornoxicam treatment groups, and were significantly less than the normal control group （P 〈 0.05）. In addition, mechanical withdrawal threshold and thermal withdrawal latency were significantly greater in the Iornoxicam treatment group compared with the model and normal saline control groups （P 〈 0.05）. CONCLUSION： Intraperitoneal injection of the COX-2 inhibitor Iornoxicam attenuated mechanical and thermal hyperalgesia induced by sciatic nerve chronic constriction injury and inhibited the increased expression of GAP-43 and NGF.

EFFECTS OF p53 GENE THERAPY COMBINED WITH CYCLOOXYGENASE-2 INHIBITOR ON CYCLOOXYGENASE-2 GENE EXPRESSION AND GROWTH INHIBITION OF HUMAN LUNG CANCER CELLS

Background Gene therapy by adenovirus-mediated wild-type p53 gene transfer has been shown to inhibit lung cancer growth in vitro,in animal models,and in human clinical trials.The antitumor effect of selective cyclooxygenase(COX)-2 inhibitors has been demonstrated in preclinical studies.However,no information is available on the effects of p53 gene therapy combined with selective COX-2 inhibitor on COX-2 gene expression and growth inhibition of human lung cancer cells.Methods We evaluated the effects of recombinant adenovirus-p53(Ad-p53) gene therapy combined with selective COX-2 inhibitor on the proliferation,apoptosis,cell cycle arrest of human lung adenocarcinoma A549 cell line,and the effects of tumor suppressor exogenous wild type p53 on COX-2 gene expression.ResultsAd-p53 gene therapy combined with selective COX-2 inhibitor celecoxib shows significant synergistic inhibition effects on the growth of human lung adenocarcinoma A549 cell line. Exogenous p53 gene can suppress COX-2 gene expression.ConclusionsSignificant synergistic inhibition effects of A549 cell line by the combined Ad-p53 and selective COX-2 inhibitor celecoxib may be achieved by enhancement of growth inhibition,apoptosis induction and suppression of COX-2 gene expression.This study provides first evidence that the administration of p53 gene therapy in combination with COX-2 inhibitors might be a new clinical strategy for the treatment or prevention of NSCLC.

Cyclooxygenase Inhibition in Cancer Immunotherapy: Combination of Indomethacin with Cancer Vaccines Is Not Always Beneficial

Cyclooxygenase (COX)-1, but preferable COX-2 catalyzes the synthesis of PGE2 in several tumors, promoting angiogenesis and a suppressive inflammation in their microenvironments. Different types of cancer vaccines have been combined with COX-2 inhibitors, assuming that its particular mechanism of action will not influence the overall results of the combination. In this research, a possible relationship between the type of cancer vaccine and the outcome of the combination with a COX inhibitor was experimentally addressed. We investigated whether nonsteroidal anti-inflammatory drugs (NSAIDs) affect the immune response to vaccination. Three adjuvants were evaluated for humoral and cellular response using ovalbumin (OVA) as antigen. We evaluated also the impact of indomethacin in five tumor models and the correlation of this effect with the secretion of prostaglandin E2 (PGE2) of these cells. We finally studied the combination of indomethacin with two cancer vaccines in three different experimental settings. COX inhibitor did not interfere with dendritic cells maturation in vitro and did not affect the frequency of splenic immune cell populations in mice. However, the induction of OVA-specific antibodies is affected by the COX inhibitor but its impact on cytotoxic CD8+ T cell response is adjuvant-dependent. In contrast, the antitumor effect of the COX inhibitor in the 3LL-D122 tumor model is not mediated by CD4+ or CD8+ T cells. Interestingly, the in vivo effect observed in this model and others didn’t correlate with levels of PGE2 secretion by the tumor cell lines in vitro. Finally, the combination of a COX inhibitor with cancer vaccines may depend on the type of the cancer vaccine.

Treatment with neurohormonal inhibitors and prognostic outcome in pulmonary arterial hypertension with risk factors for left heart disease

BACKGROUND Despite major advances in pharmacologic treatment,patients with pulmonary arterial hypertension(PAH)still have a considerably reduced life expectancy.In this context,chronic hyperactivity of the neurohormonal axis has been shown to be detrimental in PAH,thus providing novel insights on the role of neurohormonal blockade as a potential therapeutic target.AIM To evaluate the application and prognostic effect of neurohormonal inhibitors(NEUi)in a single-center sample of patients with idiopathic PAH and risk factors for left heart disease.METHODS We analyzed data retrospectively collected from our register of right heart catheterizations performed consecutively from January 1,2005 to October 31,2018.Patients on beta-blocker,angiotensin-converting enzyme inhibitor,angiotensin receptor blocker or mineralocorticoid receptor antagonist at the time of right heart catheterization were classified as NEUi users and compared to NEUi nonrecipients.RESULTS Complete data were available for 57 PAH subjects:27 of those(47.4%)were taking at least one NEUi at the time of right heart catheterization and were compared with the remaining 36 NEUi non-recipients.NEUi users were older and had a higher cardiovascular risk profile compared to non-recipients.Additionally,NEUi non-users had a higher probability of dying during the course of follow-up than NEUi recipients(56.7%vs 25.9%,log-rank P=0.020).CONCLUSION The above data highlighted a subgroup of patients with PAH and comorbidities for left heart disease in which NEUi use has shown to be associated with improved survival.Future prospective studies are needed to identify the most appropriate therapeutic strategies in this subset population.

PGE_(2)在环氧合酶-2抑制剂保护脓毒症肠屏障功能中的作用

目的探讨PGE_(2)在环氧合酶-2抑制剂保护脓毒症肠屏障功能中的作用及机制。方法按随机数字表法将大鼠分为六组,假手术组、帕瑞昔布钠对照组、脓毒症组、帕瑞昔布钠治疗组、COX-2抑制剂组和帕瑞昔布钠-COX-2抑制剂组,每组8只。采用盲肠结扎穿孔术(CLP)制备脓毒症模型,ELISA检测大鼠血清和肠组织中TNF-α、IL-6水平和抗炎细胞因子IL-10水平,蛋白质免疫印迹试验(Western Blot)检测前列腺素E_(2)(PGE_(2))、前列腺素合酶-1(mPGES-1)和前列腺素受体EP4的蛋白表达,于假手术或CLP术后24 h取四组大鼠肠组织,RT-PCR法检测PGE_(2)、mPGES-1、EP4的mRNA表达水平。结果与假手术组比较,脓毒症大鼠血清和肠组织中TNF-α、IL-6和IL-10增加(P<0.05),帕瑞昔布钠治疗后能够降低TNF-α、IL-6水平(P<0.05),IL-10水平增加(P<0.05);术后24 h时脓毒症组大鼠肠组织PGE_(2)、mPGES-1、EP4和EP2 mRNA表达水平比假手术组明显升高,差异有统计学意义(P<0.05);与脓毒症组比较,帕瑞昔布钠治疗脓毒症大鼠后,肠组织PGE_(2)、mPGES-1、EP4的mRNA水平明显降低,差异有统计学意义(P<0.05);大鼠肠组织前列腺素E_(2)(PGE_(2))、前列腺素合酶-1(mPGES-1)和前列腺素受体EP4的蛋白表达水平比假手术组明显升高,差异有统计学意义(P<0.05),帕瑞昔布钠治疗后,肠组织前列腺素E_(2)(PGE_(2))、前列腺素合酶-1(mPGES-1)和前列腺素受体EP4的蛋白表达水平明显降低,差异有统计学意义(P<0.05);术后24h时,与假手术组比较,脓毒症组、帕瑞昔布钠治疗组、COX-2抑制剂组及帕瑞昔布钠-COX-2抑制剂组肠组织TNF-α、IL-10和IL-6的水平明显升高,差异有统计学意义(P<0.05);与脓毒症组比较,帕瑞昔布钠治疗组、COX-2抑制剂组及帕瑞昔布钠-COX-2抑制剂组肠组织TNF-α、IL-6的水平明显降低,IL-10的水平明显升高,差异有统计学意义(P<0.05);与帕瑞昔布钠治疗组比较,COX-2抑制剂组及帕瑞昔布钠-COX-2抑制剂组肠组织TNF-α、IL-6的水平降低,IL-10的水平明显升高,差异有统计学意义(P<0.05)。结论帕瑞昔布钠可通过抑制炎症反应来减轻脓毒症时肠屏障功能的损伤,其机制可能通过COX-2-mPGES-1-PGE_(2)-EP4通路发挥抗炎的作用。

选择性COX-2抑制剂引起心血管风险的研究进展

非甾体抗炎药(non-steroid anti-inflammatory drugs,NSAIDs)是一种有效的、广泛使用的抗炎镇痛药物,其对环氧合酶(cyclo-oxygenase,COX)亚型(COX-1、COX-2)的抑制作用将引起不同的反应,选择性COX-2抑制剂将显著增加不良心血管事件的风险,随着此类药物使用的增加和临床循证证据的积累,其带来的心血管风险引起了越来越多学者的关注。笔者通过归纳分析最新发表文献对选择性COX-2抑制剂引起心血管风险的研究进行综述,以期辅助临床合理用药,减少不良反应,提高用药安全性。

舒芬太尼联合帕瑞昔布钠用于二次剖宫产的镇痛效果及安全性分析

【目的】探讨舒芬太尼及帕瑞昔布钠用于二次剖宫产的镇痛效果及安全性。【方法】94例将行二次剖宫产的产妇,随机分为观察组与对照组,每组47例。对照组给予舒芬太尼镇痛,观察组给予舒芬太尼联合帕瑞昔布钠镇痛。比较两组围术期指标,包括手术时间、失血量、补液量、缩宫素使用类别,采用视觉模拟评分法(VAS)对两组产妇给药后3 min(T_(1))、5 min(T_(2))、10 min(T_(3))、20 min(T_(4))、30 min(T_(5))、手术结束时(T_(6))时的疼痛程度进行评估,通过多参数监护仪检测并比较两组术后1 h、6 h、24 h、48 h时血流动力学指标[血氧饱和度(SPO_(2))、心率(HR)、呼吸频率(RR)]水平,记录两组用药期间不良反应发生率。【结果】观察组与对照组手术时间、失血量、补液量、缩宫素类别比较,差异均无统计学意义(P>0.05)。T_(1)、T_(2)、T_(3)、T_(4)、T_(5)、T_(6)时,观察组VAS评分均明显低于对照组(P<0.05)。术后1 h、6 h、24 h、48 h,观察组与对照组SPO_(2)、HR、RR比较,差异均无统计学意义(P>0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。【结论】舒芬太尼联合帕瑞昔布钠用于二次剖宫产的镇痛效果优于单一使用舒芬太尼,能够维持产妇血流动力学稳定,同时具有较高安全性,临床应用价值较高。

菟丝子治疗骨关节炎:网络药理学分析及实验验证

背景:菟丝子具有补肝肾、益精髓的功效,而骨关节炎的主要病机为肝肾亏虚,推测菟丝子与骨关节炎之间有一定的联系。目的:基于网络药理学和分子对接的分析手段挖掘骨关节炎和菟丝子之间的潜在联系,对中药本草菟丝子的作用机制进行合理的推测与验证。方法:先在中草药数据库TCMSP中筛选菟丝子的有效活性成分和作用靶点,另在疾病数据库GeneCards、OMIM、TTD中收集骨关节炎的相关基因;取交集后进行一系列分析,并筛选出核心基因;通过对核心基因的富集分析选择菟丝子作用于骨关节炎的通路,通过分子对接验证核心基因的作用,并依此选择合适的有效活性成分进行实验验证。结果与结论:①筛选出11种菟丝子的有效活性成分,菟丝子和骨关节炎有66个交集靶点基因,后续筛选出12个核心基因,包括肿瘤坏死因子、白细胞介素1B、TP53、RACα丝氨酸/苏氨酸蛋白激酶(AKT1)、血管内皮生长因子A、基质金属蛋白酶9、前列腺素过氧合酶2、胱天蛋白酶3、表皮生长因子、过氧化物酶体增生激活受体γ、白细胞介素10、血管细胞黏附因子1;②对核心基因进行富集分析后,选择经典炎症通路核因子κB信号通路进行后续菟丝子缓解骨关节炎炎症的分析验证;根据各活性成分和通路核心基因前列腺素过氧合酶2进行分子对接后得到的结果,选择亲和力最高的芝麻素进行后续细胞实验验证,结果证实了菟丝子的有效成分芝麻素可以通过抑制白细胞介素1β诱导的核因子κB信号通路降低环氧合酶2的表达;③结果表明,菟丝子的活性有效成分芝麻素通过抑制白细胞介素1β诱导的核因子κB信号通路降低环氧合酶2的表达,达到改善骨关节炎炎症的作用,证实了菟丝子在骨关节炎方面的治疗效果。

基于网络药理学与体外实验探讨淫羊藿素抗非小细胞肺癌EGFR-TKIs耐药的分子机制

目的基于网络药理学与体外实验探讨淫羊藿素抗非小细胞肺癌(NSCLC)表皮生长因子受体-酪氨酸酶抑制剂(EGFR-TKIs)耐药的分子机制。方法利用PubChem和化合物靶点预测(Swiss Target Prediction)数据库下载淫羊藿素的简化分子线性输入规范(SMILES)号及作用靶点,通过人类基因(GeneCards)和在线人类孟德尔遗传(OMIM)数据库收集NSCLC耐药疾病靶点,将药物与疾病交集靶点导入STRING数据库分析蛋白质-蛋白质相互作用(PPI)情况,运用Cytoscape 3.9.1软件内置插件计算节点拓扑参数值并筛选核心靶点,采用生物信息学分析平台(DAVID)数据库进行京都基因与基因组百科全书(KEGG)和基因本体(GO)富集分析,构建“淫羊藿素-关键靶点-疾病-通路”图。使用Pymol和Autodock Tools 1.5.7软件进行分子对接。体外实验选用NSCLC耐药株PC9OR研究淫羊藿素对细胞增殖、集落形成、迁移、侵袭和凋亡能力的影响,并对富集得到的核心靶点及关键通路进行验证。结果共筛选到淫羊藿素治疗NSCLC耐药的潜在作用靶点1952个。通过PPI网络节点拓扑参数值筛选得到13个核心靶点,涉及蛋白激酶B(AKT1)、雌激素受体α(ESR1)、B淋巴细胞瘤2(BCL2)、表皮生长因子受体(EGFR)等基因。KEGG通路富集分析显示,癌症相关通路、磷脂酰肌醇-3-激酶-蛋白激酶B(PI3K-AKT)信号通路、EGFR-TKIs耐药通路等可能在淫羊藿素治疗NSCLC EGFR-TKIs耐药的过程中起关键作用。GO富集分析显示,细胞功能涉及信号传导、凋亡过程的负调控、DNA转录的正调控等。分子对接显示淫羊藿素与各核心靶点均具有较强的结合能力。细胞实验表明,淫羊藿素抑制耐药细胞的增殖、集落形成、迁移、侵袭及促进细胞凋亡,并下调ESR1、AKT1、EGFR等mRNA表达水平以及PI3K-AKT通路磷酸化磷脂酰肌醇-3-激酶(p-PI3K)、磷酸化蛋白激酶B(p-AKT)的关键蛋白水平。结论淫羊藿素可能通过多靶点调控PI3K-AKT通路抑制EGFR-TKIs耐药细胞的增殖、集落形成、迁移、侵袭及促进细胞凋亡,从而发挥抗NSCLC EGFR-TKIs耐药的作用。

环氧化酶2抑制剂parecoxib对C2C12骨骼肌细胞分化的影响及机制研究

目的:探讨环氧化酶2抑制剂帕瑞昔布(parecoxib)对C2C12小鼠骨骼肌细胞分化的影响及其分子机制。方法:CCK-8法检测不同浓度的parecoxib处理后C2C12细胞的活力;分化培养基诱导C2C12小鼠骨骼肌细胞48 h后,将细胞分为对照组(control组)和parecoxib组继续分化48 h。免疫荧光检测肌管细胞分化成熟的标志蛋白肌球蛋白重链(MyHC),qPCR和Western印迹分别检测My HC、肌原纤维Ⅰ型(Myh7)、Ⅱa型(Myh2)、Ⅱb型(Myh4)、Ⅱx型(Myh1)、肌生成决定因子(MyoD)、肌生成因子5(Myf5)、肌生成素(myogenin)的基因和蛋白表达。结果:0、100、150、200、250、300μmol/L的parecoxib均不影响细胞活力。与对照组相比,parecoxib组MyHC阳性肌纤维数量减少,肌管融合受损,分化程度降低,MyHC、MyHCⅡa、MyHCⅡb、MyHCⅡx、MyoG、MyoD和Myf5的mRNA水平降低(t=19.04、53.93、72.38、33.72、15.32、3.061、18,均P<0.05),MyHCⅠ的mRNA水平升高(t=17.12,P<0.01)。Western印迹结果显示,与对照组相比,parecoxib组MyHC、MyHCⅡa、MyHCⅡb、MyHCⅡx、MyoG和MyoD蛋白水平降低(t=7.297、7.852、11.43、227、80.14、11.76,均P<0.01),MyHCⅠ蛋白水平升高(t=5.891,P<0.01)。结论:Parecoxib可能通过下调MyoG、MyoD和Myf5的表达,抑制C2C12骨骼肌细胞的分化。

Current and future pharmacological therapies for managing cirrhosis and its complications

Due to the restrictions of liver transplantation,complication-guided pharmacological therapy has become the mainstay of long-term management of cirrhosis.This article aims to provide a complete overview of pharmacotherapy options that may be commenced in the outpatient setting which are available for managing cirrhosis and its complications,together with discussion of current controversies and potential future directions.PubMed/Medline/Cochrane Library were electronically searched up to December 2018 to identify studies evaluating safety,efficacy and therapeutic mechanisms of pharmacological agents in cirrhotic adults and animal models of cirrhosis.Non-selective betablockers effectively reduce variceal re-bleeding risk in cirrhotic patients with moderate/large varices,but appear ineffective for primary prevention of variceal development and may compromise renal function and haemodynamic stability in advanced decompensation.Recent observational studies suggest protective,haemodynamically-independent effects of beta-blockers relating to reduced bacterial translocation.The gut-selective antibiotic rifaximin is effective for secondary prophylaxis of hepatic encephalopathy;recent small trials also indicate its potential superiority to norfloxacin for secondary prevention of spontaneous bacterial peritonitis.Diuretics remain the mainstay of uncomplicated ascites treatment,and early trials suggest alpha-adrenergic receptor agonists may improve diuretic response in refractory ascites.Vaptans have not demonstrated clinical effectiveness in treating refractory ascites and may cause detrimental complications.Despite initial hepatotoxicity concerns,safety of statin administration has been demonstrated in compensated cirrhosis.Furthermore,statins are suggested to have protective effects upon fibrosis progression,decompensation and mortality.Evidence as to whether proton pump inhibitors cause gut-liver-brain axis dysfunction is conflicting.Emerging evidence indicates that anticoagulation therapy reduces incidence and increases recanalisation rates of non-malignant portal vein thrombosis,and may impede hepatic fibrogenesis and decompensation.Pharmacotherapy for cirrhosis should be implemented in accordance with up-to-date guidelines and in conjunction with aetiology management,nutritional optimisation and patient education.

Selective COX-2 inhibitor,NS-398,suppresses cellular proliferation in human hepatocellular carcinoma cell lines via cell cycle arrest

AIM: To investigate the growth inhibitory mechanism of NS-398, a selective cyclooxygenase-2 (COX-2) inhibitor, in two hepatocellular carcinoma (HCC) cell lines (HepG2 and Huh7). METHODS: HepG2 and Huh7 cells were treated with NS-398. Its effects on cell viability, cell proliferation, cell cycles, and gene expression were respectively evaluated by water-soluble tetrazolium salt (WST-1) assay, 4’-6-diamidino-2-phenylindole (DAPI) staining, flow cytometer analysis, and Western blotting, with dimethyl sulfoxide (DMSO) as positive control. RESULTS: NS-398 showed dose- and time-dependent growth-inhibitory effects on the two cell lines. Proliferating cell nuclear antigen (PCNA) expressions in HepG2 and Huh7 cells, particularly in Huh7 cells were inhibited in a time- and dose-independent manner. NS-398 caused cell cycle arrest in the G1 phase with cell accumulation in the sub-G1 phase in HepG2 and Huh7 cell lines. No evidence of apoptosis was observed in two cell lines. CONCLUSION: NS-398 reduces cell proliferation by inducing cell cycle arrest in HepG2 and Huh7 cell lines, and COX-2 inhibitors may have potent chemoprevention effects on human hepatocellular carcinoma.

塞来昔布联合莫西沙星对肺炎克雷伯杆菌肺炎大鼠肺部炎症标志物及组织病理学的影响

目的研究特异性环氧化酶-2(COX-2)抑制剂塞来昔布联合莫西沙星对肺炎克雷伯杆菌肺炎大鼠肺部炎症标志物及肺组织病理学的影响。方法健康SPF级SD雄性大鼠60只,分2、4、6 d 3种给药疗程,各疗程20只大鼠随机分为5组:空白对照组(control组)、模型组(model组)、塞来昔布组(Cox组)、莫西沙星组(Mox组)、塞来昔布+莫西沙星组(Cox+Mox组),每组4只。采用直视下气管插管接种肺炎克雷伯杆菌混悬液制作肺炎模型,control组予等量无菌生理盐水接种。药物治疗组在注射细菌混悬液后次日分别腹腔注射塞来昔布及莫西沙星,分别连续2、4、6 d。给药后第3、5、7天分批处死动物,使用ELISA法测定肺组织匀浆细胞因子、环氧化酶代谢产物及热休克蛋白90(HSP90)的水平;取肺组织进行病理学检查。结果2、4、6 d 3种给药疗程的各model组肺湿重/体重均较control组升高(P<0.05),3种给药疗程的各Cox+Mox组与control组比较差异无统计学意义(P>0.05),但均较model组降低(P<0.05)。给药4 d和6 d,model组的C反应蛋白(CRP)、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、IL-1β、转化生长因子(TGF)-β、HSP90、前列腺素I_(2)(PGI_(2))、前列腺素E_(2)(PGE_(2))、血栓素A_(2)(TXA_(2))均较control组升高(P<0.05),但IL-10较control组降低(P<0.05);塞来昔布、莫西沙星及两药联合均可降低CRP、TNF-α、IL-6、IL-1β、PGI_(2)、PGE_(2)、TXA_(2)(P<0.05),塞来昔布联合莫西沙星未显示出优于单独使用塞来昔布或莫西沙星。但塞来昔布联合莫西沙星可提高IL-10(P<0.05)。肺组织病理学显示各model组的肺组织均出现明显炎症细胞浸润、肺泡间质出血、局部机化物形成等改变,塞来昔布、莫西沙星及两药联合的上述病理改变均较模型组减轻。结论塞来昔布、莫西沙星及两药联合可降低肺炎克雷伯杆菌肺炎大鼠肺部致炎细胞因子和前列腺素代谢产物水平,塞来昔布联合莫西沙星可提高抗炎因子IL-10水平。与单用塞来昔布或莫西沙星相比,两药联合在降低致炎细胞因子水平及改善肺组织病变作用方面并无显著优势。

“川芎-当归”药对主要活性成分的网络药理学研究

目的应用网络药理学方法探究川芎-当归药对的主要活性成分、靶点和药理作用机制。方法研究时间为2020年9—12月。首先以“川芎”“当归”为关键词,在TCMSP 2.3数据库中检索药材的成分、靶点和对应疾病数据,构建“药物-成分靶点-疾病”网络,进行基因本体(gene ontology,GO)分类富集分析、京都基因和基因组百科全书(kyoto encyclopedia of genes and genomes,KEGG)通路富集分析,探究“川芎-当归”药对作用机制。结果“药物-成分-靶点-疾病”网络包含2个药物、10个活性成分,71个作用靶点,191种疾病。关键靶点涉及环氧化酶2(PTGS2)、过氧化物酶体增生激活受体γ(PPARG)、雌激素受体(ESR1)、β2肾上腺素能受体(ADRB2)、周期蛋白依赖激酶2(CDK2)、热休克蛋白90(HSP90)、促分裂原活化蛋白激酶14(MAPK14)、胆碱能受体2(CHRM2)、5羟色胺受体2A(HTR2A)、凝血因子Ⅱ受体(F2R)、盐皮质激素受体(NR3C2)、内皮型一氧化氮合酶(NOS3)等,关键疾病涉及疼痛、心血管疾病、乳腺癌、阿尔茨海默病、炎症、癌症、焦虑症、精神分裂症、前列腺癌、实体肿瘤、脑损伤等。GO富集分析得到237个条目,包括生物过程178个,分子功能26个,细胞组成33个。通路富集分析包含66条通路,主要涉及神经活性配体-受体相互作用、钙离子信号通道、癌症通路、5-羟色胺能突触、大肠癌、雌激素信号通路、心肌细胞的肾上腺素能信号、甲状腺激素信号通路、cAMP信号通路、血管内皮生长因子信号通路等。结论“川芎-当归”药对中多个成分作用于多个靶点和通路,对疼痛、心血管疾病、乳腺癌、阿尔茨海默病、炎症、癌症等多种疾病均一定的治疗作用。

环氧酶-2抑制剂对关节炎大鼠小肠黏膜的影响

目的探讨环氧酶-2抑制剂对关节炎大鼠小肠黏膜的影响。方法将32只雄性SD大鼠随机分为空白对照组、造模对照组、空白给药组和造模给药组,造模对照组、造模给药组给予弗氏完全佐剂右后足跖注射,空白对照组、空白给药组注射等量生理盐水。1周后造模给药组、空白给药组给予选择性环氧酶-2抑制剂塞来昔布(溶于1%甲基纤维素)灌胃28 d,空白对照组、造模对照组给予等量溶剂。处死大鼠后观察小肠黏膜大体损伤、病理评分,酶联免疫吸附试验检测末段小肠前列腺素浓度。结果造模对照组与造模给药组模型复制第7天的足周径比较,差异无统计学意义(P>0.05),但两组分别与空白对照组和空白给药组比较,差异有统计学意义(P<0.05),空白对照组与空白给药组比较,差异无统计学意义(P>0.05)。空白对照组与造模对照组小肠黏膜损伤面积比较,差异有统计学意义(P<0.05),空白给药组与空白对照组比较,差异有统计学意义(P<0.05)。造模对照组、空白给药组和造模给药组组间小肠黏膜病理评分比较,差异无统计学意义(P>0.05),且空白对照组与其他3组比较,差异有统计学意义(P<0.05)。造模对照组、造模给药组小肠前列腺素浓度较空白对照组降低(P<0.05),造模对照组较空白给药组降低(P<0.05)。结论塞来昔布可致大鼠小肠黏膜损伤;佐剂性关节炎大鼠存在小肠黏膜损伤,塞来昔布可增加其小肠黏膜损伤面积,但不增加损伤程度;塞来昔布对关节炎大鼠与正常大鼠的小肠黏膜损伤相似;小肠黏膜前列腺素浓度下降可能与全身炎症所致小肠损伤有关,但可能不是COX-2抑制剂小肠损伤的主要或起始事件。