[The influence of mildronate on peripheral neuropathy and some characteristics of glucose and lipid metabolism in rat streptozotocin-induced diabetes mellitus model]

Lipidomics Provides New Insight into Pathogenesis and Therapeutic Targets of the Ischemia-Reperfusion Injury

Lipids play an essential role in both tissue protection and damage. Tissue ischemia creates anaerobic conditions in which enzyme inactivation occurs, and reperfusion can initiate oxidative stress that leads to harmful changes in membrane lipids, the formation of aldehydes, and chain damage until cell death. The critical event in such a series of harmful events in the cell is the unwanted accumulation of fatty acids that leads to lipotoxicity. Lipid analysis provides additional insight into the pathogenesis of ischemia/reperfusion (I/R) disorders and reveals new targets for drug action. The profile of changes in the composition of fatty acids in the cell, as well as the time course of these changes, indicate both the mechanism of damage and new therapeutic possibilities. A therapeutic approach to reperfusion lipotoxicity involves attenuation of fatty acids overload, i.e., their transport to adipose tissue and/or inhibition of the adverse effects of fatty acids on cell damage and death. The latter option involves using PPAR agonists and drugs that modulate the transport of fatty acids via carnitine into the interior of the mitochondria or the redirection of long-chain fatty acids to peroxisomes.

[An Experience of Meldonium Use in Patients with Ventricular Arrhythmias of Ischemic Genesis]

Ischemic heart disease (IHD) is often accompanied by cardiac rhythm disturbances particularly ventricular arrhythmias (VA) and their appearance in both chronic and acute forms of IHD is usually regarded as dangerous signal requiring the use of antiarrhythmic drugs. An important addition to hemodynamic therapy can be considered the use of cytoprotective drugs that improve the energy potential of cardiomyocytes. The purpose of this work is to study the comparative evaluation of the Mildronate effectiveness in patients with IHD and VA.

METHODS

Under dynamic observation were 147 patients with IHD and VA (Lown II-IV functional class). The diagnosis of angina pectoris was confirmed by clinical, exercise bicycle ergometry, Holter ECG monitoring, and echocardiography data. Holter ECG monitoring was used for recording VA, heart rate, episodes of ST-segment depression. The levels of total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDLC), high-density lipoprotein cholesterol were determined. All patients were randomly divided into 2 groups. The first group (81 patients) received standard antianginal and antiarrhythmic therapy plus meldonium for 2 months. The second (control) group (66 patients) received standard antianginal and antiarrhythmic therapy only. Statistical analysis of the data was carried out using the statistical package SPSS 13.0.

RESULTS

A comparative analysis of the results showed that the use of meldonium in combination with basic therapy significantly improved clinical condition and quality of life indicators, increased exercise tolerance and improved systolic and diastolic dysfunction in patients with IHD and VA. The positive effect of meldonium on LDLC levels was observed. Moreover, the combination of basic antianginal and antiarrhythmic therapy and meldonium in patients with ischemic genesis VA promoted significant reduction of ischemic episodes and decrease of VA, in particular allorhythmia.

CONCLUSION

Results of this study suggest that the use of meldonium in patients with IHD and VA helps to optimize myocardial energy metabolism in conditions of ischemia and reperfusion.

Pharmacological effects of meldonium: Biochemical mechanisms and biomarkers of cardiometabolic activity

Meldonium (mildronate; 3-(2,2,2-trimethylhydrazinium)propionate; THP; MET-88) is a clinically used cardioprotective drug, which mechanism of action is based on the regulation of energy metabolism pathways through l-carnitine lowering effect. l-Carnitine biosynthesis enzyme γ-butyrobetaine hydroxylase and carnitine/organic cation transporter type 2 (OCTN2) are the main known drug targets of meldonium, and through inhibition of these activities meldonium induces adaptive changes in the cellular energy homeostasis. Since l-carnitine is involved in the metabolism of fatty acids, the decline in its levels stimulates glucose metabolism and decreases concentrations of l-carnitine related metabolites, such as long-chain acylcarnitines and trimethylamine-N-oxide. Here, we briefly reviewed the pharmacological effects and mechanisms of meldonium in treatment of heart failure, myocardial infarction, arrhythmia, atherosclerosis and diabetes.

"TREAT THE PATIENT, RATHER THAN THE DISEASE": MILDRONATE AS A COMPONENT OF COMPLEX CARDIOVASCULAR THERAPY

The paper focuses on cytoprotective and additional effects of mildronate. The emphasis is on the latest original research evidence on mildronate effects in the settings of cardiovascular and cerebral ischemia. The authors also describe the latest laboratory data on the new therapeutic potential of mildronate.