Amlodipine and celecoxib for treatment of hypertension and osteoarthritis pain

The role of obesity and adipose tissue dysfunction in osteoarthritis pain

Obesity has a pivotal and multifaceted role in pain associated with osteoarthritis (OA), extending beyond the mechanistic influence of BMI. It exerts its effects both directly and indirectly through various modifiable risk factors associated with OA-related pain. Adipose tissue dysfunction is highly involved in OA-related pain through local and systemic inflammation, immune dysfunction, and the production of pro-inflammatory cytokines and adipokines. Adipose tissue dysfunction is intricately connected with metabolic syndrome, which independently exerts specific effects on OA-related pain, distinct from its association with BMI. The interplay among obesity, adipose tissue dysfunction and metabolic syndrome influences OA-related pain through diverse pain mechanisms, including nociceptive pain, peripheral sensitization and central sensitization. These complex interactions contribute to the heightened pain experience observed in individuals with OA and obesity. In addition, pain management strategies are less efficient in individuals with obesity. Importantly, therapeutic interventions targeting obesity and metabolic syndrome hold promise in managing OA-related pain. A deeper understanding of the intricate relationship between obesity, metabolic syndrome and OA-related pain is crucial and could have important implications for improving pain management and developing innovative therapeutic options in OA.

Intervention effects of telenursing based on M-O-A model in empty-nest older adult individuals with chronic diseases: a randomized controlled trial

Aim

This study aims to verify the effectiveness of M-O-A telenursing intervention model in improving the health status and quality of life of the empty-nest older adult individuals with chronic diseases by a randomized comparative trial.

Methods

M-O-A telenursing intervention model was constructed based on the needs of the participants. The control group (N = 39) received routine nursing, the experimental group (N = 39) received M-O-A telenursing intervention in addition to routine nursing. After 12 weeks of intervention, the intervention effects of being a participant in the two groups were evaluated. SPSS 26.0 was used for data analysis.

Results

After 12 weeks of intervention, for the experimental group, each dimension of quality of life based on EQ-5D-3L became better, especially for "pain/discomfort," "anxiety/depression," "HRQoL" and "EQ-VAS" (all p < 0.05) and each dimension of quality of life based on SF-36 became better too, especially for "GH," "BP," "RE," "MH," "VT," "SF," "PCS," "MCS," "SF-36" (all p < 0.05). In addition, there was a statistical downward trend in blood pressure, blood glucose, weight, BMI, fat rate, nap duration, number of nocturnal awakenings, light sleep rate and a statistical upward trend in water rate, basal metabolic rate, nighttime sleep duration, deep sleep rate, rapid eye movement sleep rate, especially at the end of intervention (all p < 0.05). While for the control group, there was no statistical improvement in all these aspects.

Conclusion

The M-O-A telenursing model could effectively regulate quality of life and health condition of the empty-nest older adult individuals with chronic diseases, making it worthy of further promotion and application.

α-Solanine attenuates chondrocyte pyroptosis to improve osteoarthritis via suppressing NF-κB pathway

α-Solanine has been shown to exhibit anti-inflammatory and anti-tumour properties; however, its efficacy in treating osteoarthritis (OA) remains ambiguous. The study aimed to evaluate the therapeutic effects of α-solanine on OA development in a mouse OA model. The OA mice were subjected to varying concentrations of α-solanine, and various assessments were implemented to assess OA progression. We found that α-solanine significantly reduced osteophyte formation, subchondral sclerosis and OARSI score. And it decreased proteoglycan loss and calcification in articular cartilage. Specifically, α-solanine inhibited extracellular matrix degradation by downregulating collagen 10, matrix metalloproteinase 3 and 13, and upregulating collagen 2. Importantly, α-solanine reversed chondrocyte pyroptosis phenotype in articular cartilage of OA mice by inhibiting the elevated expressions of Caspase-1, Gsdmd and IL-1β, while also mitigating aberrant angiogenesis and sensory innervation in subchondral bone. Mechanistically, α-solanine notably hindered the early stages of OA progression by reducing I-κB phosphorylation and nuclear translocation of p65, thereby inactivating NF-κB signalling. Our findings demonstrate the capability of α-solanine to disrupt chondrocyte pyroptosis and sensory innervation, thereby improving osteoarthritic pathological progress by inhibiting NF-κB signalling. These results suggest that α-solanine could serve as a promising therapeutic agent for OA treatment.

Challenges and Opportunities for Celecoxib Repurposing

Drug repositioning, also known as drug repurposing, reprofiling, or rediscovery, is considered to be one of the most promising strategies to accelerate the development of new original drug products. Multiple examples of successful rediscovery or therapeutic switching of old molecules that did not show clinical benefits or safety in initial trials encourage the following of the discovery of new therapeutic pathways for them. This review summarizes the efforts that have been made, mostly over the last decade, to identify new therapeutic targets for celecoxib. To achieve this goal, records gathered in MEDLINE PubMed and Scopus databases along with the registry of clinical trials by the US National Library of Medicine at the U.S. National Institutes of Health were explored. Since celecoxib is a non-steroidal anti-inflammatory drug that represents the class of selective COX-2 inhibitors (coxibs), its clinical potential in metronomic cancer therapy, the treatment of mental disorders, or infectious diseases has been discussed. In the end, the perspective of a formulator, facing various challenges related to unfavorable physicochemical properties of celecoxib upon the development of new oral dosage forms, long-acting injectables, and topical formulations, including the latest trends in the pharmaceutical technology, such as the application of mesoporous carriers, biodegradable microparticles, lipid-based nanosystems, or spanlastics, was presented.

PGE2 activates EP4 in subchondral bone osteoclasts to regulate osteoarthritis

Prostaglandin E2 (PGE2), a major cyclooxygenase-2 (COX-2) product, is highly secreted by the osteoblast lineage in the subchondral bone tissue of osteoarthritis (OA) patients. However, NSAIDs, including COX-2 inhibitors, have severe side effects during OA treatment. Therefore, the identification of novel drug targets of PGE2 signaling in OA progression is urgently needed. Osteoclasts play a critical role in subchondral bone homeostasis and OA-related pain. However, the mechanisms by which PGE2 regulates osteoclast function and subsequently subchondral bone homeostasis are largely unknown. Here, we show that PGE2 acts via EP4 receptors on osteoclasts during the progression of OA and OA-related pain. Our data show that while PGE2 mediates migration and osteoclastogenesis via its EP2 and EP4 receptors, tissue-specific knockout of only the EP4 receptor in osteoclasts (EP4^LysM) reduced disease progression and osteophyte formation in a murine model of OA. Furthermore, OA-related pain was alleviated in the EP4^LysM mice, with reduced Netrin-1 secretion and CGRP-positive sensory innervation of the subchondral bone. The expression of platelet-derived growth factor-BB (PDGF-BB) was also lower in the EP4^LysM mice, which resulted in reduced type H blood vessel formation in subchondral bone. Importantly, we identified a novel potent EP4 antagonist, HL-43, which showed in vitro and in vivo effects consistent with those observed in the EP4^LysM mice. Finally, we showed that the Gαs/PI3K/AKT/MAPK signaling pathway is downstream of EP4 activation via PGE2 in osteoclasts. Together, our data demonstrate that PGE2/EP4 signaling in osteoclasts mediates angiogenesis and sensory neuron innervation in subchondral bone, promoting OA progression and pain, and that inhibition of EP4 with HL-43 has therapeutic potential in OA.

Addition of Celebrex and Pregabalin to Ropivacaine for Posterior Spinal Surgery: A Randomized, Double-Blinded, Placebo-Controlled Trial

Background

Serious pain commonly occurs after posterior spinal surgery. This study aims to evaluate the effect of preemptive and multimodal analgesia using celebrex, pregabalin and ropivacaine on pain control after this surgery.

Methods

Ninety-three patients undergoing posterior spinal surgery were enrolled in this prospective, randomized, double-blind, placebo-controlled clinical trial. All patients were treated with patient- controlled analgesia (PCA, intravenous tramadol hydrochloride and flurbiprofen) as required. They were randomized to combination analgesia intervention (oral celebrex, pregabalin and subcutaneous infiltration of ropivacaine), ropivacaine intervention (only subcutaneous infiltration of ropivacaine), and control intervention (placebo). We compared postoperative visual analog scale (VAS) scores and PCA dose among the three groups.

Results

The VAS scores were significantly lower in the combination analgesia group than in the control group at 0 h, 2 h, 12 h, 24 h, 3 d, 5 d, 7 d and 14 d after posterior spinal surgery, while combination analgesia was also superior to ropivacaine in terms of VAS scores at 24 h and 14 d postoperatively. The combination analgesia group was also associated with significantly reduced PCA consumption compared with the control group, but there was no statistical difference in PCA consumption between the ropivacaine group and control group.

Conclusion

Combination analgesia using celebrex, pregabalin and ropivacaine is effective and safe to alleviate pain after posterior spinal surgery.

Clinical Trial Registration

Chinese Clinical Trial Registry No. ChiCTR2000031236.

Smart UV spectrophotometric methods based on simple mathematical filtration for the simultaneous determination of celecoxib and ramipril in their pharmaceutical mixtures with amlodipine: A comparative statistical study

Two newly introduced pharmaceutical mixtures of amlodipine/celecoxib and amlodipine/ramipril were developed to manage hypertension and the associated osteoarthritis. The current work presents three newly developed UV spectrophotometric methods depending on minimal mathematical manipulations on the zero-order spectrum namely: absorption correction, induced dual-wavelength, and Fourier self deconvoluted method; for the simultaneous determination of celecoxib and ramipril in their pharmaceutical combined dosage forms with amlodipine. In absorption correction and induced dual-wavelength method, celecoxib and ramipril were determined at 253 and 222 nm for absorption correction and (251-270 nm) and (222-230 nm) for induced dual-wavelength method, respectively from the zero-order spectrum after calculating the absorption correction and equality factors for amlodipine. Amlodipine itself was determined at 361 nm from the zero-order spectrum in both methods. In Fourier self deconvoluted method, celecoxib and amlodipine zero-order spectra were deconvoluted, using the spectrophotometer software built-in Fourier wavelet function, and then was determined at 360 and 269 nm, respectively. The proposed methods were simple, accurate, and sensitive requiring minimal mathematical manipulations saving the time needed for analysis. The methods were linear over the range of (5-60 μg/ml), (5-30 μg/ml), and (5-110 μg/ml) for each of amlodipine, celecoxib, and ramipril, respectively. The limit of detection was in the range of (0.5781-0.7132 μg/ml) for amlodipine, (0.6497-1.0450 μg/ml) for celecoxib, and (0.0001-0.0003 μg/ml) for ramipril that indicated the sensitivity of these suggested methods. All methods were validated as per ICH recommendations regarding linearity, range, accuracy, precision, and selectivity. A statistical comparative study executed for the proposed methods with each other and with the reported methods showed no significant difference between the proposed methods and the reported methods.

Effects of curcumin on the pharmacokinetics of amlodipine in rats and its potential mechanism

Context: Hyperlipidaemia and hypertension are often treated together with curcumin and amlodipine. It is necessary to investigate the drug-drug interaction between curcumin and amlodipine.Objective: The interaction between curcumin and amlodipine was investigated in rats and with rat liver microsomes.Methods: The pharmacokinetics of amlodipine (1 mg/kg) was investigated in rats with or without curcumin pre-treatment (2 mg/kg), six rats in each group. The metabolic stability of amlodipine was investigated with rat liver microsomes.Results: Curcumin significantly increased the C_max (26.19 ± 2.21 versus 17.80 ± 1.56 μg/L), AUC_(0-t) (507.27 ± 60.23 versus 238.68 ± 45.59 μg·h/L), and t_1/2 (14.69 ± 1.64 versus 11.43 ± 1.20 h) of amlodipine (p < 0.05). The metabolic stability of amlodipine was significantly increased with the half-life time in rat liver microsomes increased from 34.23 ± 3.33 to 44.15 ± 4.12 min, and the intrinsic rate decreased from 40.49 ± 3.26 to 31.39 ± 2.78 μL/min/mg protein.Discussion and conclusions: These results indicated that drug-drug interaction might appear during the co-administration of curcumin and amlodipine. The potential mechanism may be due to the inhibition of CYP3A4 by curcumin. Thus, this interaction should be given special attention in the clinic and needs further experiments to characterize the effect in humans.

[Nonsteroidal anti-inflammatory drugs in the treatment of anterior uveitis associated with spondyloarthritis]

Anterior uveitis (AU) is one of the common extraskeletal manifestations of spondyloarthritis (SpA). The course of AU in patients with SpA is characterized by frequent relapses. The article considers the question of local and systemic use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment and prevention of SpA-associated uveitis exacerbations.

An enhanced first derivative synchronous spectrofluorimetric method for determination of the newly co-formulated drugs, amlodipine and celecoxib in pharmaceutical preparation and human plasma

BACKGROUND

A new combination of amlodipine and celecoxib has been recently introduced in order to relieve the symptoms of osteoarthritis and help treat hypertension that commonly associated with osteoarthritis.

OBJECTIVE

The current study is the first to develop and optimize a sensitive, simple and accurate first derivative synchronous spectrofluorimetric method for the simultaneous determination of amlodipine and celecoxib in bulk powder, pharmaceutical preparation and spiked human plasma.

METHOD

The method implies the use of synchronous methodology using Δλ = 100 nm and measuring the fluorescence amplitudes of the first derivative each at the zero-crossing point of the other. For amlodipine and celecoxib, the emission wavelengths were at 455 nm and 368 nm, after excitation at 367 nm and 264 nm, respectively.

RESULTS

The method was found to be linear over a wide concentration ranges of (5-600 ng/ml), (100-2000 ng/ml) with lower limits of detection of (1.16 ng/ml) and (17.16 ng/ml) for amlodipine and celecoxib, respectively. Enhancement of the fluorescence intensity was achieved by complex formation between the studied drugs and the surfactant sodium dodecyl sulfate and optimizing other experimental conditions. The method was further extended for application for determination of the studied drugs in spiked human plasma with excellent % recoveries of (95.20 ± 6.095) and (98.67 ± 6.394) for amlodipine and celecoxib, respectively. Validation of the method was successfully implemented according to recommendations delivered by guidelines of the International Conference on Harmonization.

[Forensic chemical study of Amlodipine]

Is to develop a method for determining amlodipine in the tissues of organs and blood, applicable in the practice of forensic chemical analysis. TLC, normal pressure column chromatography, HPLC and GC-MS were considered as methods of analysis. Amlodipine was isolated from the biomaterial by insisting twice with acetone for 30 min using a 2: 1 mass-isolating and biomatrix agent. The purification of recovered analyte was done in a column (150×10 mm) of a 30 µm Silasorb S-18 sorbent, eluting with an acetone - water solvent mixture (8:2). Preliminary identification was carried out in a thin layer of sorbent on «Sorbfil» plates, which was confirmed by HPLC and GC-MS methods. Determination by GC-MS was carried out in a column with a stationary phase of 5% phenyl-95% dimethylpolysiloxane. The fragmentation of molecules was an electron impact with an energy of 70 eV. Methods for the determination of amlodipine using GC-MS in biomatrix have been developed, which meet the criteria of linearity, selectivity, correctness, precision and stability. The limits of detection and quantitative determination of amlodipine in organ tissues (liver) are 0.14 and 0.24 μg/g, in blood - 0.12 and 0.20 μg/g, respectively. The methods were applied in the examination of a case of amlodipine poisoning and made it possible to determine the analyte in some organs and blood of the corpse.

Development of UV spectrophotometry methods for concurrent quantification of amlodipine and celecoxib by manipulation of ratio spectra in pure and pharmaceutical formulation

Recently, the United States Food and Drug Administration approved a new oral dosage preparation of amlodipine besylate (AML) and celecoxib (CEL) for the management of hypertension and osteoarthritis. However, no simultaneous estimation procedures for these two analytes have been described. Hence, two simple, accurate, and precise ultraviolet spectroscopic procedures that manipulated the ratio spectra were established for concurrent quantification of AML and CEL using ethanol as a solvent. The first method involves determining the peak-to-trough amplitude difference of the ratio spectra of AML and CEL. The second method involves determining the peak amplitude of the ratio first derivative (Δλ 4 nm) spectra of AML and CEL at 334.2 nm and 254.2 nm, correspondingly. Both methods showed linearity in the range of 1–6 μg mL-1 for AML and 5–40 μg mL-1 for CEL with an excellent correlation coefficient (<0.999). The proposed procedures were validated by following the International Conference on Harmonization guidelines for accuracy, precision, selectivity, recovery, and stability studies. It is evident from the low %RSD and %RE that both analytical procedures were found to be accurate and precise, respectively. The percent recovery of AML and CEL from the formulation was found to be 99.79% and 99.34% using the ratio-difference method and 100.13% and 99.70% using the ratio first-derivative method, with a low percent relative standard deviation. Further, the proposed techniques permit concurrent quantification of AML and CEL in different concentration ratios without interference from each other; hence, these techniques can be adopted for regular quality-control studies.