Trimetazidine ameliorates hindlimb ischaemic damage in type 2 diabetic mice

Effects of trimetazidine on oxidant-antioxidant balance and angiogenesis; an in vivo experimental study

BACKGROUND

We evaluated the effects of trimetazidine (TMZ) on the oxidative-antioxidative balance and angiogenesis in an in vivo experimental model. This study aims to evaluate the effects of trimetazidine on angiogenesis through histological analysis and to assess its impact on oxidative-antioxidative balance through biochemical measurements.

METHODS

In this study, Ross 308 breed chicken eggs (n = 40) were used, and embryos were divided into four distinct groups. On the eighth day of incubation, the vascular density of the embryos was examined. Following the assessment of vascular development, 4-5 mL of albumin was collected via syringe to measure oxidative stress markers. Each group consisted of 10 embryos, with a total of 40 embryos used in the study. The groups were organized as follows: Control Group (CG), Bevacizumab Group (BC), Trimetazidine 10⁻⁴ Group, and Trimetazidine 10⁻⁵ Group.

RESULTS

When the total oxidative capacity (TOC) levels were compared among the groups, the bevacizumab group exhibited significantly higher values than the control group (p < 0.05). In oxidative stress index (OSI) measurements, the bevacizumab group also showed significantly higher values compared to the control group (p < 0.05). In contrast, when the total antioxidant capacity (TAC) levels were compared, both the Trimetazidine 10⁻⁴ and Trimetazidine 10⁻⁵ groups demonstrated significantly higher values than the control group (p < 0.05). Regarding angiogenesis scoring, the bevacizumab group exhibited a significant anti-angiogenic effect compared to the control group. However, no statistically significant difference was observed between the Trimetazidine 10⁻⁴ and Trimetazidine 10⁻⁵ groups and the control group (p > 0.05).

CONCLUSION

Trimetazidine demonstrated significant antioxidant activity in an in vivo Chorioallantoic Membrane (CAM) model at both 10⁻⁴ M and 10⁻⁵ M concentrations. However, no positive or negative effects on angiogenesis were detected. We believe that the real-time observation of angiogenesis in our study provided significant value to our research.

Trimetazidine in Cardiovascular Disease and Beyond: A Comprehensive Review

Trimetazidine is a metabolic modulator that acts as a competitive inhibitor of the terminal enzyme in the β-oxidation pathway to shift energy substrate from free fatty acids to the more oxygen-efficient glucose metabolism. The resulting conservation of cellular adenosine triphosphate generation in the face of ischemia/hypoxia mediates the anti-ischemic efficacy of trimetazidine. Clinically, trimetazidine has been approved as an add-on treatment in patients with symptomatic angina that is poorly controlled with first-line agents or who cannot tolerate the first-line therapy. In addition, trimetazidine has demonstrated antioxidant, cytoprotective, and anti-apoptotic activity with applications beyond angina. The aim of this review was to summarize the mechanism of action and anti-anginal efficacy of trimetazidine and to discuss the putative role of these pleiotropic effects and the evidence behind its application in cardiovascular diseases in general.

Role of Trimetazidine in Ameliorating Endothelial Dysfunction: A Review

Endothelial dysfunction is a hallmark of cardiovascular diseases, contributing to impaired vasodilation, altered hemodynamics, and atherosclerosis progression. Trimetazidine, traditionally used for angina pectoris, exhibits diverse therapeutic effects on endothelial dysfunction. This review aims to elucidate the mechanisms underlying trimetazidine's actions and its potential as a therapeutic agent for endothelial dysfunction and associated cardiovascular disorders. Trimetazidine enhances vasodilation and hemodynamic function by modulating endothelial nitric oxide synthase activity, nitric oxide production, and endothelin-1. It also ameliorates metabolic parameters, including reducing blood glucose, mitigating oxidative stress, and dampening inflammation. Additionally, trimetazidine exerts antiatherosclerotic effects by inhibiting plaque formation and promoting its stability. Moreover, it regulates apoptosis and angiogenesis, fostering endothelial cell survival and neovascularization. Understanding trimetazidine's multifaceted mechanisms underscores its potential as a therapeutic agent for endothelial dysfunction and associated cardiovascular disorders, warranting further investigation for clinical translation.

Recent developments in targets for ischemic foot disease

Diabetes is a key risk factor for ischaemic foot disease, which causes pain, tissue loss, hospital admission, and major amputation. Currently, treatment focuses on revascularisation, but many patients are unsuitable for surgery and revascularisation is frequently unsuccessful. The authors describe recent research in animal models and clinical trials investigating novel medical targets for ischaemia, including theories about impaired wound healing, animal models for limb ischaemia and recent randomised controlled trials testing novel medical therapies. Novel targets identified in animal models included stimulating mobilisation of CD34+ progenitor cells through upregulating oncostatin M or microRNA-181, downregulating tumour necrosis factor superfamily member 14, or activating the Wingless pathway. Within the ischaemic limb vasculature, upregulation of apolipoprotein L domain containing 1, microRNA-130b or long noncoding RNA that enhances endothelial nitric oxide synthase expression promoted limb blood supply recovery, angiogenesis, and arteriogenesis. Similarly, administration of soluble guanylate cyclase stimulators riociguat or praliciguat or 3-ketoacyl-CoA thiolase inhibitor trimetazidine promoted blood flow recovery. Translating pre-clinical findings to patients has been challenging, mainly due to limitations in clinically translatable animal models of human disease. Promising results have been reported for administering plasmids encoding hepatocyte growth factor or intra-arterial injection of bone marrow derived cells in small clinical trials. It remains to be seen whether these high resource therapies can be developed to be widely applicable. In conclusion, an ever-expanding list of potential targets for medical revascularisation is being identified. It is hoped that through ongoing research and further larger clinical trials, these will translate into new broadly applicable therapies to improve outcomes.

Effects of Trimetazidine on Right Ventricular Function and Ventricular Remodeling in Patients with Pulmonary Artery Hypertension: A Randomised Controlled Trial

BACKGROUND

Pulmonary artery hypertension (PAH) is a chronic and progressive disease. Although current therapy has improved the disease prognosis, PAH has a poor survival rate. The key feature leading to disease progression and death is right ventricular (RV) failure.

METHODS AND RESULTS

We assessed the role of trimetazidine, a fatty acid beta-oxidation (FAO) inhibitor, in right ventricular function, remodeling, and functional class in PAH patients, with a placebo-controlled double-blind, case-crossover trial. Twenty-seven PAH subjects were enrolled, randomized, and assigned to trimetazidine or placebo for three months and then reallocated to the other study arm. The primary endpoint was RV morphology and function change after three months of treatment. Secondary endpoints were the change in exercise capacity assessed by a 6 min walk test after three months of treatment and the change in pro-BNP and Galectin-3 plasma levels after three months. Trimetazidine use was safe and well-tolerated. After three months of treatment, patients in the trimetazidine group showed a small but significant reduction of RV diastolic area, and a substantial increase in the 6 min walk distance (418 vs. 438 mt, p = 0.023), without significant changes in biomarkers.

CONCLUSIONS

A short course of trimetazidine is safe and well-tolerated on PAH patients, and it is associated with significant increases in the 6MWT and minor but significant improvement in RV remodeling. The therapeutic potential of this drug should be evaluated in larger clinical trials.