Modulation of arachidonic acid metabolism by orally administered morniflumate in man

Modeling population pharmacokinetics of morniflumate in healthy Korean men: extending pharmacometrics analysis to niflumic acid, its major active metabolite

This study aimed to quantify and explain inter-subject variability in morniflumate pharmacokinetics and identify effective covariates through population pharmacokinetics modeling. Models were constructed using bioequivalence pharmacokinetics results from healthy Korean males and individual physiological and biochemical parameters. Additionally, we incorporated previously reported pharmacokinetics results of niflumic acid, a major active metabolite of morniflumate, to extend the established population pharmacokinetics model and predict niflumic acid pharmacokinetics. Moreover, we used quantitative reports of leukotriene B4 (LTB4) synthesis inhibition in response to niflumic acid exposure to predict drug efficacy using Sigmoid Emax model. Population pharmacokinetics profiles of morniflumate were described using a multi-absorption (5-sequential) two-compartment model, and analysis of inter-individual variability suggested that volume of distribution in peripheral compartment was correlated with body mass index (BMI). Model simulation results showed that individuals with lower BMI had higher plasma concentrations of morniflumate and niflumic acid, resulting in increased and sustained inhibition of LTB4 synthesis. Under steady-state conditions, average plasma concentrations of morniflumate and niflumic acid were 2.66-2.68 times higher in group with a BMI of 17.36 kg/m2 compared to the group with a BMI of 28.41 kg/m2. Additionally, inhibition of LTB4 synthesis was 1.02 times higher in group with a BMI of 17.36 kg/m2 compared to group with a BMI of 28.41 kg/m2, and the fluctuation was significantly reduced from 6.06 to 0.01%. These findings suggest that the concentration of active metabolite in plasma following morniflumate exposure was lower in the obese group compared to the normal group, thus potentially reducing the drug's efficacy.

Morniflumate in the treatment of upper airways affections in adults: a review and meta-analysis

INTRODUCTION

We compared, by a meta-analytic process, the antipyretic and symptomatic activity, and the safety profile of morniflumate (ATC code: M01AX22) with those of other commonly used non-steroidal anti-inflammatory drugs (NSAIDs) in acute ear, nose and throat (ENT) diseases.

EVIDENCE ACQUISITION

Our search strategy was performed in various database, included Google Scholar, PubMed and Embase, the key word was "morniflumate". Interventional studies in adults with ENT or lower airway inflammatory diseases were compared in a meta-analysis for the number of symptom-free and fever-free patients at day 3 of therapy, and of drug interruptions due to adverse events (AEs). For symptoms, we included only studies on ENT inflammatory diseases; for fever and AEs, we also considered studies on lower airway inflammatory diseases. Of 33 studies retrieved, 8 (24.2%) met the inclusion criteria and compared morniflumate to placebo, nimesulide, paracetamol and other NSAIDs.

EVIDENCE SYNTHESIS

On day 3, the number of symptom-free patients was significantly higher with morniflumate vs placebo and nimesulide (+20% and +30%, respectively) and similar to the other comparators. The number of fever-free patients significantly increased (up to 70%) with morniflumate vs all comparators except paracetamol (similar). No difference was found in the number of AE-related interruptions.

CONCLUSIONS

morniflumate showed good antipyretic and symptomatic activity and a short-term safety profile at least comparable to that of other NSAIDs.

Efficacy and safety of morniflumate for the treatment of symptoms associated with soft tissue inflammation

The effectiveness of nonsteroidal antiinflammatory drugs (NSAIDs) for the management of pain in osteoarthritis and other musculoskeletal diseases is well documented. The role of NSAIDs is less clear in the treatment of conditions involving soft tissue inflammation, including the airways, ear-nose-throat (ENT) system and urogenital tract. These conditions are often treated inappropriately with antibiotics. Morniflumate, the ß-morpholinoethyl ester of niflumic acid, is a member of the fenamate family of NSAIDs indicated for the treatment of inflammatory conditions (with or without pain) affecting airways, the ENT system, urogenital tract and the osteoarticular system. Morniflumate has a 30-year history of clinical use, particularly for the treatment of pain associated with paediatric ENT infection. This article reviews evidence supporting the efficacy and safety of morniflumate. Based on available evidence and the favourable tolerability profile emerging from extensive clinical use, morniflumate appears to be a valid and well-tolerated alternative to other NSAIDs, or to antibiotics, for the treatment of pain and other symptoms of soft tissue inflammation.

Short-Term Tolerability of Morniflumate in Patients with Cutaneous Hypersensitivity Reactions to Non-Steroidal Anti-Inflammatory Drugs

Morniflumate is the morpholinoethyl ester of niflumic acid, a non-steroidal antiinflammatory drug, derived from nicotinic acid. We studied 112 patients who had experienced cutaneous reactions after using non-steroidal anti-inflammatory drugs. Only two of all the patients who underwent an oral challenge with morniflumate had a positive result to the test. By demonstrating the low incidence of reactions to morniflumate through oral challenges, we suggest that patients with non-steroidal anti-inflammatory drug hypersensitivity may tolerate this drug which would therefore be a useful alternative.

Meclofenamic acid extends donor-recipient asynchrony in equine embryo transfer

REASONS FOR PERFORMING STUDY

A level of synchrony between embryo and uterine environment is essential for the establishment of pregnancy when performing embryo transfer. The ability to extend the acceptable degree of asynchrony would allow more efficient use of recipient mares.

OBJECTIVES

To establish if administration of the prostaglandin synthetase inhibitor, meclofenamic acid, to asynchronous recipient mares could widen the acceptable window of asynchrony for embryo transfer.

HYPOTHESIS

The prostaglandin synthetase inhibitory action of meclofenamic acid may act to suppress luteolysis and thereby allow for a greater degree of asynchrony between donor and recipient mares.

METHODS

A total of 72 Grade 1 horse embryos were transferred nonsurgically into the uteri of recipient mares that had ovulated 2 (n = 20), 3 (n = 20), 4 (n = 16) or 5 (n = 16) days before the donor. Half of the mares in each group were treated orally with 1 g meclofenamic acid, beginning on Day 9 after ovulation and continuing for 7 days after embryo transfer.

RESULTS

Comparison of recipient:donor asynchrony between treated and untreated mares was: +2 days, 9/10 pregnancies vs. 8/10 (P= 1.00); by +3 days, 8/10 vs. 2/10 (P= 0.025); by +4 days, 5/8 vs. 1/8 (P = 0.121); and by +5 days 3/8 vs. 0/8 (P = 0.20). In 10/11 meclofenamic acid-treated and 23/25 untreated recipient mares that failed to become pregnant, luteolysis occurred at the normal time (14-19 days) after ovulation.

CONCLUSION

Treatment with meclofenamic acid supported the establishment of pregnancy in recipient mares that ovulated before the donors. However, meclofenamic acid appeared to provide this support in a manner other than by suppression of luteolysis.

POTENTIAL RELEVANCE

Pregnancy rates can be increased in recipient mares that ovulate 3 days before the donor by administration of meclofenamic acid.

Effect of steroids, acetyl-cysteine and calcium-activated chloride channel inhibitors on allergic mucin expression in sinus mucosa

OBJECTIVES/HYPOTHESIS

Allergic inflammation of the upper airways is commonly associated with mucus hypersecretion. At present, there is no specific mucus regulating drug available. Our goal was to investigate the effect of glucocorticosteroids, acetyl-cysteine (ACC), and calcium-activated chloride channel (CLCA) inhibitors in a model of Th2 type cytokine induced mucin expression in human airway mucosa.

STUDY DESIGN

Prospective.

METHODS

Explanted tissue from human sinus mucosa was stimulated with interleukin (IL)-4, IL-9, or IL-13. Different concentrations of dexamethasone, ACC, or CLCA inhibitors [niflumic acid (NFA) or MSI-2216] were added to stimulated tissue. Epithelial mucin expression was quantified using periodic acid-Schiff staining.

RESULTS

IL-4, IL-9, and IL-13 significantly increased epithelial mucin expression (P < .05). Dexamethasone reduced Th2 type cytokine induced mucin expression in a dose-dependent manner being statistically significant at concentrations >or=4.0 micromol/L (IL-4) and >or=40.0 micromol/L (IL-9 and IL-13) (P < .05). ACC had no significant effect on IL-4 and IL-13 induced mucin expression, whereas IL-9 induced mucin expression was significantly decreased at concentrations >or=3.0 mmol/L (P < .05). NFA and MSI-2216 decreased Th2 type cytokine induced mucin expression in a dose-dependent manner. This effect was statistically significant at concentrations >or=100 micromol/L (NFA) and >or=50 micromol/L (MSI-2216) (P < .05).

CONCLUSIONS

Th2 type cytokines can induce mucin expression in a model of explanted human airway mucosa. Th2 type cytokine induced mucin expression can be effectively reduced by either glucocorticosteroids or CLCA inhibitors ex vivo. Besides glucocorticosteroids CLCA inhibitors may offer an alternative therapeutic approach to treat allergic mucus hypersecretion.

LPS-induced mucin expression in human sinus mucosa can be attenuated by hCLCA inhibitors

BACKGROUND

hCLCA1 is a member of the calcium-activated chloride channel family and is associated with disease-inducible mucus expression. Niflumic acid (NFA) and a closely related chemical structure are reported inhibitors of calcium-activated chloride channels and endotoxin-inducible mucus expression in the mouse. Therefore, we tested the hypothesis that hCLCA1 may be involved in lipopolysaccharide (LPS) induced mucin up-regulation in human airways. We also investigated the effect of NFA and MSI-2216 on LPS-induced mucin up-regulation.

MATERIALS AND METHODS

Explanted human airways and the muco-epidermoid cell line Calu-3 were stimulated with LPS. Different concentrations of NFA or MSI-2216 were added to LPS-stimulated airway mucosa and Calu-3 cells. Expression of hCLCA1 and MUC5AC mRNA and protein was quantified in human airways using real-time PCR and PAS staining. In addition, immunohistochemistry was performed for quantification of inflammatory cells (lymphocytes, monocytes, eosinophils, and neutrophils) in the submucosa of the airways. Expression of hCLCA1 protein in Calu-3 cells was analysed by FACS.

RESULTS

LPS significantly induced hCLCA1 and MUC5AC mRNA and protein expression in human airway mucosa (P < 0.05). NFA and MSI-2216 significantly decreased LPS-induced mucus expression in explanted airway mucosa in a dose-dependent manner (P < 0.05). In Calu-3 cells, LPS significantly increased hCLCA1 surface expression whereas intracellular expression was significantly decreased (P < 0.05). In Calu-3 cells, NFA and MSI-2216 also significantly reduced MUC5AC mRNA expression (P < 0.05).

CONCLUSIONS

These data suggest that hCLCA1 may play a role in LPS-induced mucin expression in human airway mucosa. Calcium-activated chloride channel inhibitors significantly decreased LPS-induced mucus expression both ex vivo and in vitro . Therefore, blocking of hCLCA1 may offer a therapeutic approach to reduce bacterial-induced mucus hypersecretion.

Monitoring eicosanoid biosynthesis via lipoxygenase and cyclooxygenase pathways in human whole blood by single HPLC run

Eicosanoids play an important role as lipid mediators for physiological and pathological processes. Inhibitors of their biosynthesis have been developed as drugs for various diseases with major health political relevance. The search for more efficient inhibitors of eicosanoid formation requires simultaneous monitoring of various metabolic pathways. We developed an HPLC-based assay system, which quantifies lipoxygenase metabolites leukotriene B4 (LTB4), 5-hydroxyeicosatetraenoic acid (5-HETE), 12-hydroxyeicosatetraenoic acid (12-HETE), 15-hydroxyeicosatetraenoic acid (15-HETE) and cyclooxygenase metabolite 12-hydroxy-5,8,10-heptadecatrienoic acid (12-HHT) in whole human blood. Eicosanoid formation in blood is initiated with calcium ionophore A23187, arachidonic acid and calcium and magnesium ions. After solid phase extraction the different eicosanoids were separated by isocratic RP-HPLC using prostaglandin B1 as authentic standard. To verify the assay we determined the IC50 of known inhibitors of eicosanoid biosynthesis (zileuton, indomethacin, nordihydroguaiaretic acid). The test system is simple. It does not require extensive methodological experience and can be carried out in any biochemical laboratory. The analytical procedure can be robotized and thus, the assay appears suitable for medium-throughput testing of drugs.

Niflumic acid suppresses interleukin-13-induced asthma phenotypes

RATIONALE

Chloride channels have been implicated in the regulation of mucus production in epithelial cells. Expression of hCLCA1, a calcium-activated chloride channel, has been reported to be increased in the airway epithelium of patients with asthma. Interleukin (IL)-13 induces the cardinal features of bronchial asthma, and glucocorticoids are not sufficient to suppress IL-13-induced airway hyperresponsiveness or goblet cell hyperplasia.

OBJECTIVES

We studied the effects of chloride channel inhibitors in IL-13-induced asthma.

METHODS

The effects of niflumic acid (NA), a relatively specific blocker of calcium-activated chloride channel (CLCA), on goblet cell hyperplasia, eosinophil accumulation, and airway hyperresponsiveness were evaluated after IL-13 instillation into the airways. Because IL-13-dependent features rely on JAK/STAT6 signaling, the effect of NA on phosphorylation of JAK2 and STAT6 after IL-13 stimulation was examined in airway epithelial cells in vitro. The expression of the mCLCA family in mouse lung after IL-13 local administration in vivo was analyzed using reverse transcription-polymerase chain reaction.

MEASUREMENTS AND MAIN RESULTS

Treatment with NA inhibited not only IL-13-induced goblet cell hyperplasia but also airway hyperresponsiveness and eosinophilic infiltration. NA suppressed the eotaxin levels in bronchoalveolar lavage fluids and overexpression of the MUC5AC gene, a marker of goblet cell hyperplasia, in the lung after IL-13 instillation. NA suppressed JAK2 activation, STAT6 activation, and eotaxin expression in epithelial cells. The expression of mCLCA3 (mouse homolog hCLCA1), but not that of other CLCA family members, was up-regulated by IL-13.

CONCLUSIONS

These findings suggest that a chloride channel inhibitor can control IL-13-mediated airway features at least by suppressing JAK/STAT6 activation.

Effects of chloride channel blockers on rat renal vascular responses to angiotensin II and norepinephrine

The aim of the present study was to investigate the role of Ca2+-activated Cl-channels in the renal vasoconstriction elicited by angiotensin II (ANG II) and norepinephrine (NE). Renal blood flow (RBF) was measured in vivo using electromagnetic flowmetry. Ratiometric photometry of fura 2 fluorescence was used to estimate intracellular free Ca2+concentration ([Ca2+]i) in isolated preglomerular vessels from rat kidneys. Renal arterial injection of ANG II (2-4 ng) and NE (20-40 ng) produced a transient decrease in RBF. Administration of ANG II (10-7M) and NE (5 × 10-6M) to the isolated preglomerular vessels caused a prompt increase in [Ca2+]i. Renal preinfusion of DIDS (0.6 and 1.25 μmol/min) attenuated the ANG II-induced vasoconstriction to ∼35% of the control response, whereas the effects of NE were unaltered. Niflumic acid (0.14 and 0.28 μmol/min) and 2-[(2-cyclopentenyl-6,7-dichloro-2,3-dihydro-2-methyl-1-oxo-1 H-inden-5-yl)oxy]acetic acid (IAA-94; 0.045 and 0.09 μmol/min) did not affect the vasoconstrictive responses of these compounds. Pretreatment with niflumic acid (50 μM) or IAA-94 (30 μM) for 2 min decreased baseline [Ca2+]ibut did not change the magnitude of the [Ca2+]iresponse to ANG II and NE in the isolated vessels. The present results do not support the hypothesis that Ca2+-activated Cl-channels play a crucial role in the hemodynamic effects of ANG II and NE in rat renal vasculature.

Anion channel blockers differentially affect T-type Ca(2+) currents of mouse spermatogenic cells, alpha1E currents expressed in Xenopus oocytes and the sperm acrosome reaction

The direct electrophysiological characterization of sperm Ca(2+) channels has been precluded by their small size and flat shape. An alternative to study these channels is to use spermatogenic cells, the progenitors of sperm, which are larger and easier to patch-clamp. In mouse and rat, the only voltage-dependent Ca(2+) currents displayed by these cells are of the T type. Because compounds that block these currents inhibit the zona pellucida-induced Ca(2+) uptake and the sperm acrosome reaction (AR) at similar concentrations, it is likely that they are fundamental for this process. Recent single channel recordings in mouse sperm demonstrated the presence of a Cl(-) channel. This channel and the zona pellucida (ZP)-induced AR were inhibited by niflumic acid (NA), an anion channel blocker [Espinosa et al. (1998): FEBS Lett 426:47-51]. Because NA and other anion channel blockers modulate cationic channels as well, it became important to determine whether they affect the T-type Ca(2+) currents of spermatogenic cells. These currents were blocked in a voltage-dependent manner by NA, 1, 9-dideoxyforskolin (DDF), and 5-nitro-2-(3-phenylpropylamine)benzoic acid (NPPB). The IC(50) values at -20 mV were 43 microM for NA, 28 microM for DDF, and 15 microM for NPPB. Moreover, DDF partially inhibited the ZP-induced AR (40% at 1 microM) and NPPB displayed an IC(50) value of 6 microM for this reaction. These results suggest that NA and DDF do not inhibit the ZP-induced AR by blocking T-type Ca(2+) currents, while NPPB may do so. Interestingly 200 microM NA was basically unable to inhibit alpha1E Ca(2+) channels expressed in Xenopus oocytes, questioning that this alpha subunit codes for the T-type Ca(2+) channels present in spermatogenic cells. Evidence for the presence of alpha1C, alpha1G, and alpha1H in mouse pachytene spematocytes and in round and condensing spermatids is presented.