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Singh D, Singh R, Akindele AJ. Therapeutic potential of nicorandil beyond anti-anginal drug: A review on current and future perspectives. Heliyon 2024; 10:e28922. [PMID: 38617945 PMCID: PMC11015415 DOI: 10.1016/j.heliyon.2024.e28922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/16/2024] Open
Abstract
Nicorandil (NIC) is a well-known anti-anginal agent, which has been recommended as one of the second-line treatments for chronic stable angina as justified by the European guidelines. It shows an efficacy equivalent to that of classic anti-anginal agents. NIC has also been used clinically in various cardiovascular diseases such as variant or unstable angina and reperfusion-induced damage following coronary angioplasty or thrombolysis. Different mechanisms have been involved in the protective effects of nicorandil in various diseases, including opening of adenosine triphosphate-sensitive potassium (KATP) channel and donation of nitric oxide (NO). In recent years, NIC has been found to show numerous pharmacological activities such as neuroprotective, nephroprotective, hepatoprotective, cardioprotective, and testicular protective effects, among other beneficial effects on the body. The present review dwells on the pharmacological potentials of NIC beyond its anti-anginal action.
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Affiliation(s)
- Dhirendra Singh
- M.M College of Pharmacy, Maharishi Markandeshwar Mullana, Ambala, Haryana, India
| | - Randhir Singh
- Departments of Pharmacology, Central University of Punjab, Bhatinda, Punjab, India
| | - Abidemi James Akindele
- Department of Pharmacology, Therapeutics & Toxicology, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Idi-Araba, P.M.B. 12003 Lagos, Nigeria
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Kubota H, Endo H, Ishii H, Tsuchiya H, Inaba Y, Terakawa K, Takahashi Y, Noma M, Takemoto K, Taniai S, Sakata K, Soejima K, Shimoyamada H, Kamma H, Kawakami H, Kaneko Y, Hirono S, Izumi D, Ozaki K, Minamino T, Yoshino H, Sudo K. Adult ALCAPA: from histological picture to clinical features. J Cardiothorac Surg 2020; 15:14. [PMID: 31931842 PMCID: PMC6958604 DOI: 10.1186/s13019-020-1048-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 01/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital coronary anomaly that results in high mortality if left untreated. Our aim was to extend our knowledge of the histological, angiographic, and clinical characteristics of ALCAPA in order to deepen our understanding of this rare entity. CASE PRESENTATION We were involved in the assessment, treatment, and pathological evaluation of two adult ALCAPA patients who were rescued from ventricular fibrillation and then surgically treated to establish a dual coronary artery system. Histological studies indicated various chronic ischemic changes in the myocardium, patchy fibrosis, and severely thickened arteriolar walls in both ventricles. The first patient is alive and well 11.5 years after surgical correction without any implantable cardioverter defibrillator (ICD) activations. The second patient required re-do surgery 9 months after the initial operation but subsequently died. Histologically, chronic ischemic alteration of the myocardium and thickened arteriolar walls persisted even after surgical correction, and coronary angiography (CAG) showed an extremely slow flow phenomenon even after surgical correction in both patients. The average postoperative opacification rate in the first case was 7.36 + 1.12 (n = 2) in the RCA, 3.81 + 0.51 (n = 3) in the left anterior descending (LAD) artery, and 4.08 + 0.27 (n = 4) in the left circumflex (LCx) artery. The slow flow phenomenon may represent persistent high arteriolar resistance in both ventricles. CONCLUSIONS Seldom reported or new findings in adult ALCAPA were identified in two cases. More frequent diagnosis of adult ALCAPA can be expected because of the widespread availability of resuscitation and more advanced diagnostic modalities. Accumulation of pathological and clinical findings and confirmation of the long-term follow-up results after treatment may contribute to expanding our knowledge of this rare entity and establishing optimal treatment.
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Affiliation(s)
- Hiroshi Kubota
- Department of Cardiovascular Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
| | - Hidehito Endo
- Department of Cardiovascular Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Hikaru Ishii
- Department of Cardiovascular Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Hiroshi Tsuchiya
- Department of Cardiovascular Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Yusuke Inaba
- Department of Cardiovascular Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | | | - Yu Takahashi
- Department of Cardiovascular Surgery, National Disaster Medical Center, Tachikawa, Japan
| | - Mio Noma
- Department of Cardiovascular Surgery, Tokyo Metropolitan Children's Medical Center, Fuchu, Japan
| | - Kazuya Takemoto
- Department of Internal Medicine, Jyukoukai Hospital, Miyoshi, Japan
| | - Seiichi Taniai
- Department of Cardiology, Kyorin University, Mitaka, Japan
| | - Konomi Sakata
- Department of Cardiology, Kyorin University, Mitaka, Japan
| | - Kyoko Soejima
- Department of Cardiology, Kyorin University, Mitaka, Japan
| | | | - Hiroshi Kamma
- Department of Pathology, Kyorin University, Mitaka, Japan
| | | | - Yukihiro Kaneko
- Department of Cardiovascular Surgery, National Center for Child Health and Development, Tokyo, Japan
| | - Satoru Hirono
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Daisuke Izumi
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kazuyuki Ozaki
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Ahmed LA. Nicorandil: A drug with ongoing benefits and different mechanisms in various diseased conditions. Indian J Pharmacol 2019; 51:296-301. [PMID: 31831918 PMCID: PMC6892004 DOI: 10.4103/ijp.ijp_298_19] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 10/11/2019] [Accepted: 10/12/2019] [Indexed: 12/01/2022] Open
Abstract
Nicorandil is a well-known antianginal agent, which has been recommended as one of the second-line treatments for chronic stable angina as justified by the European guidelines. It shows an efficacy equivalent to that of classic antianginal agents. Nicorandil has also been applied clinically in various cardiovascular diseases such as variant or unstable angina and reperfusion-induced damage following coronary angioplasty or thrombolysis. Different mechanisms have been involved in the protective effects of nicorandil in various diseases through either opening of adenosine triphosphate-sensitive potassium (KATP) channel or donation of nitric oxide (NO). The predominance or participation of any of these proposed mechanisms depends on the dose of nicorandil used, the location of diseased conditions, and if this mechanism is still functioning or not. The protection afforded by nicorandil has been shown to be mainly attributed to KATP channel opening in experimental models of myocardial and pulmonary fibrosis as well as renal injury or glomerulonephritis, whereas NO donation predominates as a mechanism of protection in hepatic fibrosis and inflammatory bowel diseases. Therefore, in different diseased conditions, it is important to know which mechanism plays the major role in nicorandil-induced curative or protective effects. This can bring new insights into the proper use of selected medication and its recommended dose for targeting certain disease.
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Affiliation(s)
- Lamiaa Ahmed Ahmed
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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