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Journal of Clinical Pharmacy and Therapeutics provides a forum for clinicians, pharmacists and pharmacologists to explore and report on issues of common interest. Its scope embraces all aspects of clinical drug development and therapeutics.
Yimin Cui, MD & PhD, is a Professor at Peking University First Hospital as well as the Deputy Director of National Pharmacy Education Steering Committee. His main research areas include cardiovascular and cerebrovascular drugs, especially antithrombotic drugs.
Abstracting and Indexing
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Hydrogel-Loaded Exosomes: A Promising Therapeutic Strategy for Musculoskeletal Disorders
Clinical treatment strategies for musculoskeletal disorders have been a hot research topic. Accumulating evidence suggests that hydrogels loaded with MSC-derived EVs show great potential in improving musculoskeletal injuries. The ideal hydrogels should be capable of promoting the development of new tissues and simulating the characteristics of target tissues, with the properties matching the cell-matrix constituents of autologous tissues. Although there have been numerous reports of hydrogels loaded with MSC-derived EVs for the repair of musculoskeletal injuries, such as intervertebral disc injury, tendinopathy, bone fractures, and cartilage injuries, there are still many hurdles to overcome before the clinical application of modified hydrogels. In this review, we focus on the advantages of the isolation technique of EVs in combination with different types of hydrogels. In this context, the efficacy of hydrogels loaded with MSC-derived EVs in different musculoskeletal injuries is discussed in detail to provide a reference for the future application of hydrogels loaded with MSC-derived EVs in the clinical treatment of musculoskeletal injuries.
Preparation and Evaluation of Onjisaponin B-Loaded Liposomes for Drug Delivery to Enhance Mitochondrial Function and Rescue Parkinson’s Disease by Activating Mitophagy
Onjisaponin B (OB) is the main active ingredient of Radix Polygalae with various bioactivities. However, the protective effect of OB in Parkinson’s disease (PD) has not been fully studied. Liposomes are ideal nanocarriers for drugs targeting the brain. In this study, we investigated the therapeutic effect of OB-loaded liposomes (lip OB) on a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine- (MPTP-) induced mouse model of PD and 1-methyl-4-phenylpyridinium- (MPP+-) induced cell model of PD. Our results showed that lip OB significantly ameliorated MPTP-induced motor deficits and dopaminergic neuron loss in vivo and prevented MPP+-triggered cell viability reduction and apoptosis in vitro. Lip OB also improved mitochondrial dysfunction in PD models by driving PINK1/Parkin-mediated mitophagy. Furthermore, silencing PINK1 compromised the beneficial effects of lip OB on MPP+-treated PC12 cells. These findings suggested lip OB mitigates Parkinsonism in vivo and in vitro by enhancing mitochondrial dysfunction through the PINK1/Parkin pathway of mitophagy, which provides a new possibility for treating PD.
A Real-World Safety Analysis of Upadacitinib Based on FDA Adverse Event Reporting System (FAERS)
Objectives. To investigate adverse events (AEs) associated with upadacitinib in the real world using data mining from the FDA Adverse Event Reporting System (FAERS). Methods. Disproportionality analysis, including the reporting odds ratio (ROR), the proportional reporting ratio (PRR), the Bayesian confidence propagation neural network (BCPNN), and the multiitem gamma Poisson shrinker (MGPS) algorithms, was used to quantify the signals of upadacitinib-associated AEs. Results. The study found 23683 reports of AEs associated with upadacitinib. A total of 149 substantial disproportionality preferred terms (PTs) that complied with all algorithms were identified. The infections discovered matched those mentioned in the specification and clinical trials, including pneumonia, upper respiratory tract infection, herpes zoster, and acne. Malignant and thrombotic AEs were also noted. Diverticulitis, myocardial infarction, transient ischaemic attack, and dysstasia were among the new AEs found. Upadacitinib-related AEs had a median onset time of 237 days and an interquartile range (IQR) of 78–509 days. Conclusions. The findings of our study were in line with clinical observations, and we also identified potential novel and unexpected AEs signals for upadacitinib, indicating the necessity for prospective clinical trials to corroborate these findings and demonstrate their link. Our results offered significant support for additional upadacitinib safety research.
Poor Correlation of Rivaroxaban Concentration with the Routine Coagulation Screening Test in Chinese Patients with Atrial Fibrillation
Aims. The aim of this study is to assess the relationship between rivaroxaban plasma concentration quantified by the gold standard and anticoagulant activities measured by routine coagulation assays in Chinese atrial fibrillation (AF) patients. Whether the normal results of these tests were reliable to rule out clinically relevant rivaroxaban levels at various thresholds was also explored. The effect of clinical drug-drug interactions (DDIs) on the exposure and anticoagulant effect of rivaroxaban were further evaluated. Methods. 116 patients receiving rivaroxaban for the management of nonvalvular AF were recruited. Rivaroxaban concentrations and coagulation tests were measured by ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) and a blood coagulation analyzer, respectively. Results. The correlation of trough concentration (Ctrough) and prothrombin time (PT) or international normalized ratio (INR) was moderate with Spearman’s correlation coefficient of 0.495 and 0.506, respectively. A normal PT/INR was unable to rule out Ctrough levels of >30 ng/mL and >50 ng/mL, but the negative predictive value reached 100% to exclude Ctrough of >100 ng/mL. Ctrough showed a small correlation with activated partial thromboplastin time (aPTT) (Spearman’s correlation coefficient: 0.241) and no correlation with thrombin time (TT) (Spearman’s correlation coefficient: 0.074). Neither aPTT nor TT accurately predicted Ctrough at any concentration. Peak concentration (Cpeak) did not correlate with any coagulation parameters. The presence of digoxin and febuxostat significantly increased rivaroxaban Ctrough by 2.18 fold and prolonged PT and INR by 44.16% and 43.60%, respectively. Conclusions. Normal routine coagulation assays were insufficient to monitor therapy with rivaroxaban. Poor correlations between rivaroxaban concentration and routine coagulation assays were observed in Chinese AF patients. The use of digoxin/febuxostat alone had no effect on rivaroxaban concentrations; however, combined strong breast cancer resistance protein inhibitor (febuxostat) and P-glycoprotein probe (digoxin) in patients with renal impairment is likely to cause clinically significant DDI with rivaroxaban. More studies are needed to establish routine therapeutic drug monitoring of rivaroxaban in clinical practice.
Neuromuscular Blocking Agents and Cancer: A Narrative Review
Objective. Neuromuscular blocking agents (NMBAs) are part of the three elements of general anaesthesia (sedation, analgesia, and muscle relaxation), which can relax muscles and facilitate intubation and surgery. It has been reported that cancer cells are prone to invasion or metastasis during surgery, but various anaesthetics are currently used in cancer resection, particularly NMBA, and the effects on cancer cell behavior are poorly understood. Guidelines for the correct application of NMBA in cancer surgery have not been reported; therefore, the aim of this paper is to explore the relationship between NMBA and cancer. Methods. Two investigators independently searched PubMed, Embase, the Cochrane Library, Web of Science, and CBM for articles of NMBA and cancer. Results. The available evidence suggests that cisatracurium may be more appropriate for use in anaesthesia for cancer surgery, while rocuronium deserves further attention, particularly for breast and gastric cancer surgery, and vecuronium is suitable for breast cancer and non-small-cell lung cancer, while it is used with caution in gastric cancer. Also, the relationship between NMBA (mivacurium, succinylcholine, gantacurium, and decamethonium bromide) and cancer is unclear and deserves further study. Conclusion. The effect of different NMBAs on cancer cells varies, and the effect of some NMBAs on cancer cells is unclear, and most of the current findings are only from in vitro studies, which need to be validated by further clinical studies in the future to better guide the clinical application of NMBAs.
Exploration of the Mechanism of Valsartan Treatment in Chronic Renal Failure: Network Pharmacology and Experimental Validation
Objective. To investigate the targets and mechanisms of valsartan in the treatment of chronic renal failure based on network pharmacology and animal experiment validation. Methods. The objectives of using valsartan were predicted with the PubChem and SwissTargetPrediction databases. Relevant targets of chronic renal failure have been searched in various disease databases, with the common purposes of drugs and diseases extracted. Network analysis was carried out with the STRING database to construct a protein-protein interaction (PPI) network, as Cytoscape 3.9.1 software was used to analyze network topology of the key targets and establish the “valsartan-core target gene” network. Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed on core targets to explore their possible molecular mechanisms. The chronic renal failure mouse model was established by the plat method. Hematoxylin-eosin (H&E) and Masson staining observed morphological changes in renal problems of each group, as levels of serum Cre, BUN, T-SOD, and MDA in each group were detected by kit; real-time PCR was used to detect the relative expression of mRNA of TNF-αIL-1β, IL-6, and IL-10 in renal disease of mice in each group, with WB detect CALM, PKCα, and CaMKIV protein expression levels in renal disease from each group. Results. The network pharmacology approach identified 10 key targets for treatment of chronic renal failure with valsartan, including EGFR, PTGS2, PPARG, and ERBB2. KEGG enrichment analysis predicted that the drug exerted neuroactive ligand-receptor interaction, the calcium signaling pathway, the HIF-1 signaling pathway, the proteoglycans in cancer, PD-L1 expression, and the PD-1 checkpoint pathway in cancer. Results from animal experiments were compared to those of the model group, as renal function was significantly improved in the valsartan-dose group. The serum levels of Cre, BUN, and MDA and relative mRNA expression of TNF-α, IL-1β, and IL-6 decreased significantly, while serum T-SOD levels, relative mRNA expression of IL-10, and the protein expression level of CALM, PKCα, and CaMKIV increased significantly ( < 0.05 and < 0.001). Conclusion. Valsartan yields certain renal protection, which may improve chronic renal failure in mice through the calcium signaling pathway.