Protective effect of Irsogladine on monochloramine induced gastric mucosal lesions in rats: a comparative study with rebamipide

Irsogladine improves small-intestinal injuries in regular users of nonsteroidal anti-inflammatory drugs

BACKGROUND

Nonsteroidal anti-inflammatory drugs (NSAIDs) cause a high frequency of mucosal injuries in the small intestine. However, no reliable intervention, other than cessation of NSAIDs, has been established.

OBJECTIVE

To evaluate whether irsogladine maleate reduces these injuries while continuing NSAID therapy.

DESIGN

Prospective, interventional, endoscopist-blinded, randomized, controlled trial (RCT).

SETTING

University hospital.

PATIENTS

Patients regularly taking conventional NSAIDs for more than 4 weeks.

INTERVENTIONS

We initially examined small-intestinal mucosal injuries by capsule endoscopy (CE) and screened participants for the RCT. In the RCT, patients with any mucosal injury were randomly assigned to the irsogladine group (4 mg/day) or the control group.

MAIN OUTCOME MEASUREMENTS

The primary endpoint was the rate of mucosal injury improvement after 4 weeks of treatment monitored with a second CE.

RESULTS

Sixty-one patients were evaluated with the first CE. Small intestine mucosal injuries were found in 41 patients (67.2%) and erosive or ulcerative lesions in 21 patients (34.4%). The injury prevalence was not different with gastroprotective drug treatment. Of 41 patients enrolled, 39 (19 patients in the irsogladine group and 20 in the control group) completed the study. The improvement rate was significantly higher in the irsogladine group (16/19 patients; 84.2%) than in the control group (9/20 patients; 45.0%; P = .02).

LIMITATIONS

Asymptomatic lesions, single-institution data, and single-blind setting.

CONCLUSION

Irsogladine maleate was effective for reducing NSAID-induced small-intestinal mucosal injury. (University Hospital Medical Information Network Clinical Trials Registry number UMIN000001507.).

Irsogladine maleate potentiates the effects of nitric oxide on activation of cAMP signalling pathways and suppression of mesangial cell mitogenesis

BACKGROUND AND PURPOSE

Deficiency in nitric oxide (NO) is a major factor leading to deterioration and progression of certain glomerular diseases. Agents enhancing NO availability and potentiality are renoprotective. Irsogladine maleate (IM), an anti-ulcer drug, is reported to improve gastric blood flow via NO-dependent mechanisms. We, therefore, asked whether and how IM interacted with NO on glomerular mesangial cells.

EXPERIMENTAL APPROACH

Mesangial cells were exposed to IM and NO donors. Activation of cAMP signalling pathways was assessed by intracellular cAMP, phosphorylation of VASP, activation of the cAMP response element (CRE) and expression of CRE-regulated proteins.

KEY RESULTS

IM alone did not affect cell proliferation. However, it greatly enhanced the growth-inhibitory effect of NO donor S-nitroso-N-acetylpenicillamine (SNAP). IM acted synergistically with NO on suppression of mitogen-activated protein kinase activation, induction of gap junction protein connexin43, increase of intracellular cAMP, and phosphorylation of VASP. With the use of the CRE-SEAP-based reporting system, IM and SNAP cooperatively activated cAMP response elements (CRE). A similar activation of cAMP was induced by IM with two different NO donors, the sGC activator Bay 41-2272 and the cGMP analogue 8-bromo-cGMP. The effects of SNAP and IM on cAMP activation were mimicked by phosphodiesterase 3 (PDE3) and PDE4 inhibitors. In addition, IM markedly augmented cytokine-induced expression of iNOS, production of NO and activation of CRE.

CONCLUSION AND IMPLICATIONS

The effects of NO were greatly potentiated by IM through synergistic activation of cAMP pathway. Combined therapy with IM and NO may be developed for certain renal diseases.

Rebamipide reduces indomethacin-induced gastric injury in mice via down-regulation of ICAM-1 expression

Non-steroidal anti-inflammatory drugs (NSAIDs) induced gastric mucosal injury occurs through subsequent events following free radical production derived from activated neutrophils. In this study, we hypothesized that rebamipide, a novel anti-ulcer agent, exerts a protective effect on NSAID-induced gastric injury through its antioxidant properties. The protective effect of rebamipide in a mouse model of indomethacin-induced gastric injury and mechanisms for this effect were investigated. Pre-treatment with rebamipide significantly inhibited indomethacin-induced gastric mucosal injury in mice. Gastric thiobarbituric acid reactive substances (TBARS) levels and myeloperoxidase (MPO) activity substantially increased 3 hr after indomethacin administration. These increases were significantly inhibited by pre-treatment with rebamipide. Furthermore, rebamipide pre-treatment notably decreased intercellular adhesion molecule-1 (ICAM-1) expression that was up-regulated in gastric tissue treated with indomethacin. Therefore, rebamipide may reduce indomethacin-induced gastric mucosal injuries through its antioxidant effect, which inhibits the neutrophil activation step following up-regulation of ICAM-1 expression on endothelial cells.

Significance of changes of gastrointestinal peptides in blood and ileum of experimental spleen deficiency rats

AIM: To explore the mechanism of spleen deficiency (SD) by studying the relationship of gastro-intestinal peptides level and ileal electro-mechanical activity of SD rats and cold restrain rats.

METHODS: (1) spleen deficiency (SD) model was established by feeding Houpou:Zhishi: Dahuang in the ratio of 3:3:2, 3 ml/time, for 42 days. (2) The cold restrain stress model: Animals were restrained on grille and placed in a cool water at 18 °C for 3 h. (3) Substance P (SP) and vasoactive intestinal peptide (VIP) levels in all layers of initial part of ileum and blood in rats were measured by radioimmunoassays (RIA) while changes of electric activity and motility in ileum of rats were recorded with electrode and strain gauge.

RESULTS: SP levels in ileum and blood of experimental SD rats were significantly higher than that of the control groups (9.89 ± 5.65 vs 1.22 ± 1.18, P < 0.005, in ileum; 22.7 ± 3.95 vs 6.60 ± 1.47, P < 0.001, in blood) while the VIP levels of the SD rats were significantly lower than that of the controls (3.50 ± 2.01 vs 9.10 ± 4.91, P < 0.05, in ileum; 229.8 ± 62.4 vs 560.4 ± 151.3, P < 0.001, in blood). As compared with the controls, the average frequency of slow electric waves (21.3 ± 0.96 vs 18.2 ± 2.28, P < 0.05) and motility (21.5 ± 0.58 vs 18 ± 2.65, P < 0.005) of SD rats increased obviously and the frequency of fast waves of SD rat also increased. In spontaneous recovery cases, SP levels recovered significantly (compared with the SD groups, 2.99 ± 0.62 vs 9.89 ± 5.65, P < 0.001, in ileum; 14.4 ± 4.22 vs 22.7 ± 3.95, P < 0.001, in blood) but did not drop to normal. After the SD rats treated with Chinese herbs (Jiawei Sijun zi Tang), SP improved (compared with SD cases, 2.20 ± 1.25 vs 9.89 ± 5.65, (P < 0.001), in ileum; 10.7 ± 1.88 vs 22.7 ± 3.95, (P < 0.001), in blood) and VIP in blood also improved (compared with SD rats, 485.7 ± 229.0 vs 229.8 ± 62.4, P < 0.01) while the amplitude of motility decreased apparently (compared with the SD rats, 0.64 ± 0.096 vs 0.89 ± 0.15, P < 0.01). The ileal SP levels of cool stress didn’t change while the ileal VIP levels of cool stress became significantly lower than that of the control groups (2.87 ± 0.87 vs 9.10 ± 4.91, P < 0.01). The blood SP levels of cool stress were significantly higher (15.60 ± 1.83 vs 6.60 ± 1.47, P < 0.001) whereas the blood VIP levels of cool stress were significantly lower than that of the control group (153.4 ± 70.46 vs 560.4 ± 151.30, P < 0.001).

CONCLUSION: Changes of SP and VIP levels in initial part of ileum and blood of SD rats and cool stress rats may be closely related to the gastrointestinal motility disorders presented in SD and cool stress rats. the Chinese herbs (Jiawei Sijun zi Tang) currently used have partially therapeutic effect.

Irsogladine Prevents Monochloramine-Induced Gastric Mucosal Lesions by Improving the Decrease in Mucosal Blood Flow Due to the Disturbance of Nitric Oxide Synthesis in Rats

The inhibitory effect of an anti-ulcer drug irsogladine [2,4-diamino-6-(2,5-dichlorophenyl)-s-triazine maleate] on monochloramine (NH(2)Cl)-induced gastric mucosal lesions and its mechanisms of action were clarified in rats. Irsogladine dose-dependently prevented the formation of gastric mucosal lesions induced by 60 mM NH(2)Cl. The mucosal protective effect of irsogladine was not influenced by capsaicin-sensitive sensory defunctionalization. On the other hand, its protective effect was diminished by the inhibitor of nitric oxide synthase N(G)-nitro-L-arginine methylester (L-NAME), but not by the inducible nitric oxide synthase selective inhibitor aminoguanidine. Irsogladine restored the NH(2)Cl-induced decrease in the gastric cGMP formation as an index of nitric oxide synthesis, while it alone had no influence on the cGMP formation in intact tissues. Pretreatment with L-NAME abolished the recovery of cGMP by irsogladine. Furthermore, irsogladine ameliorated the NH(2)Cl-induced decrease in gastric mucosal blood flow, which was also reversed by pretreatment with L-NAME. These findings suggest that the improvement of the decrease in mucosal blood flow subsequent to the disturbance of gastric nitric oxide synthesis is involved in the protective effect of irsogladine on gastric mucosal lesions caused by NH(2)Cl.