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Pacheco G, Lopes ALF, Oliveira APD, Corrêa WDRM, Lima LDB, Souza MHLPD, Teles AS, Nicolau LAD, Medeiros JVR. Comprehensive analysis of gastrointestinal side effects in COVID-19 patients undergoing combined pharmacological treatment with azithromycin and hydroxychloroquine: a systematic review and network meta-analysis. Crit Rev Toxicol 2024:1-14. [PMID: 38860720 DOI: 10.1080/10408444.2024.2348169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/22/2024] [Indexed: 06/12/2024]
Abstract
During the COVID-19 pandemic, several drugs were repositioned and combined to quickly find a way to mitigate the effects of the infection. However, the adverse effects of these combinations on the gastrointestinal tract are unknown. We aimed investigate whether Hydroxychloroquine (HD), Azithromycin (AZ), and Ivermectin (IV) used in combination for the treatment of COVID-19, can lead to the development of gastrointestinal disorders. This is a systematic review and network meta-analysis conducted using Stata and Revman software, respectively. The protocol was registered with PROSPERO (CRD42023372802). A search of clinical trials in Cochrane Library databases, Embase, Web of Science, Lilacs, PubMed, Scopus and Clinicaltrials.gov conducted on November 26, 2023. The eligibility of the studies was assessed based on PICO criteria, including trials that compared different treatments and control group. The analysis of the quality of the evidence was carried out according to the GRADE. Six trials involving 1,686 COVID-19 patients were included. No trials on the association of HD or AZ with IV met the inclusion criteria, only studies on the association between HD and AZ were included. Nausea, vomiting, diarrhea, abdominal pain and increased transaminases were related. The symptoms of vomiting and nausea were evaluated through a network meta-analysis, while the symptom of abdominal pain was evaluated through a meta-analysis. No significant associations with these symptoms were observed for HD, AZ, or their combination, compared to control. Low heterogeneity and absence of inconsistency in indirect and direct comparisons were noted. Limitations included small sample sizes, varied drug dosages, and potential publication bias during the pandemic peak. This review unveils that there are no associations between gastrointestinal adverse effects and the combined treatment of HD with AZ in the management of COVID-19, as compared to either the use of a control group or the administration of the drugs individually, on the other hand, highlighting the very low or low certainty of evidence for the evaluated outcomes. To accurately conclude the absence of side effects, further high-quality randomized studies are needed.
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Affiliation(s)
- Gabriella Pacheco
- Medicinal Plants Research Center (NPPM), Post-graduation Program in Pharmacology, Federal University of Piauí, Teresina, PI, Brazil
| | - André Luis Fernandes Lopes
- Biotechnology and Biodiversity Research Center (BIOTEC), Post-graduation Program in Biotechnology, Parnaíba Delta Federal University (UFDPar), Parnaíba, PI, Brazil
| | | | | | - Lucas Daniel Batista Lima
- Biotechnology and Biodiversity Research Center (BIOTEC), Post-graduation Program in Biotechnology, Parnaíba Delta Federal University (UFDPar), Parnaíba, PI, Brazil
| | | | - Ariel Soares Teles
- Biotechnology and Biodiversity Research Center (BIOTEC), Post-graduation Program in Biotechnology, Parnaíba Delta Federal University (UFDPar), Parnaíba, PI, Brazil
- Federal Institute of Maranhão (IFMA), Araioses, MA, Brazil
| | - Lucas Antonio Duarte Nicolau
- Biotechnology and Biodiversity Research Center (BIOTEC), Post-graduation Program in Biotechnology, Parnaíba Delta Federal University (UFDPar), Parnaíba, PI, Brazil
| | - Jand Venes Rolim Medeiros
- Medicinal Plants Research Center (NPPM), Post-graduation Program in Pharmacology, Federal University of Piauí, Teresina, PI, Brazil
- Biotechnology and Biodiversity Research Center (BIOTEC), Post-graduation Program in Biotechnology, Parnaíba Delta Federal University (UFDPar), Parnaíba, PI, Brazil
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An observational, retrospective, comprehensive pharmacovigilance analysis of hydroxychloroquine-associated cardiovascular adverse events in patients with and without COVID-19. Int J Clin Pharm 2022; 44:1179-1187. [PMID: 35857159 PMCID: PMC9297057 DOI: 10.1007/s11096-022-01457-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/27/2022] [Indexed: 02/05/2023]
Abstract
Background Coronavirus disease 2019 (COVID-19) is a global pandemic. Hydroxychloroquine (HCQ)-associated cardiovascular adverse events (CVAEs) have been increasingly reported. Aim This study aimed to present an observational, retrospective, and comprehensive pharmacovigilance analysis of CVAE associated with HCQ in patients with and without COVID-19 using the US Food and Drug Administration Adverse Events Reporting System (FAERS) data from January 2020 to December 2020. Method We identified 3302 adverse event reports from the FAERS database in the year 2020 and divided them into COVID-19 and non-COVID-19 groups, respectively. Then we analyzed whether there were differences in CVAEs between the two groups. Results We found that CVAE was higher in cases with COVID-19 compared to those without COVID-19, odds ratio (OR) of 1.26 and a 95% confidence interval (95% CI) of 1.02–1.54. Cases with COVID-19 treated with HCQ exhibited relatively higher proportions of torsade de points (TdP) and QT prolongation (OR 3.10, 95% CI 2.24–4.30), shock-associated TdP (OR 2.93, 95% CI 2.13–4.04), cardiac arrhythmias (OR 2.07, 95% CI 1.60–2.69), cardiac arrhythmia terms (including bradyarrhythmias and tachyarrhythmias) (OR 2.15, 95% CI 1.65–2.80), bradyarrhythmias (including conduction defects and disorders of sinus node function) (OR 2.56, 95% CI 1.86–3.54), and conduction defects (OR 2.56, 95% CI 1.86–3.54). Conclusion Our retrospective observational analysis suggested that the proportion of CVAE associated with HCQ, especially TdP and QT prolongation, was higher in patients with COVID-19. Understanding the effects of COVID-19 on the cardiovascular system is essential to providing comprehensive medical care to patients receiving HCQ treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s11096-022-01457-w.
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Ghasemian R, Shamshirian A, Heydari K, Malekan M, Alizadeh‐Navaei R, Ebrahimzadeh MA, Ebrahimi Warkiani M, Jafarpour H, Razavi Bazaz S, Rezaei Shahmirzadi A, Khodabandeh M, Seyfari B, Motamedzadeh A, Dadgostar E, Aalinezhad M, Sedaghat M, Razzaghi N, Zarandi B, Asadi A, Yaghoubi Naei V, Beheshti R, Hessami A, Azizi S, Mohseni AR, Shamshirian D. The role of vitamin D in the age of COVID-19: A systematic review and meta-analysis. Int J Clin Pract 2021; 75:e14675. [PMID: 34322971 PMCID: PMC8420549 DOI: 10.1111/ijcp.14675] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 07/26/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Evidence recommends that vitamin D might be a crucial supportive agent for the immune system, mainly in cytokine response regulation against COVID-19. Hence, we carried out a systematic review and meta-analysis in order to maximise the use of everything that exists about the role of vitamin D in the COVID-19. METHODS A systematic search was performed in PubMed, Scopus, Embase and Web of Science up to December 18, 2020. Studies focused on the role of vitamin D in confirmed COVID-19 patients were entered into the systematic review. RESULTS Twenty-three studies containing 11 901 participants entered into the meta-analysis. The meta-analysis indicated that 41% of COVID-19 patients were suffering from vitamin D deficiency (95% CI, 29%-55%), and in 42% of patients, levels of vitamin D were insufficient (95% CI, 24%-63%). The serum 25-hydroxyvitamin D concentration was 20.3 ng/mL among all COVID-19 patients (95% CI, 12.1-19.8). The odds of getting infected with SARS-CoV-2 are 3.3 times higher among individuals with vitamin D deficiency (95% CI, 2.5-4.3). The chance of developing severe COVID-19 is about five times higher in patients with vitamin D deficiency (OR: 5.1, 95% CI, 2.6-10.3). There is no significant association between vitamin D status and higher mortality rates (OR: 1.6, 95% CI, 0.5-4.4). CONCLUSION This study found that most of the COVID-19 patients were suffering from vitamin D deficiency/insufficiency. Also, there is about three times higher chance of getting infected with SARS-CoV-2 among vitamin-D-deficient individuals and about five times higher probability of developing the severe disease in vitamin-D-deficient patients. Vitamin D deficiency showed no significant association with mortality rates in this population.
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Affiliation(s)
- Roya Ghasemian
- Antimicrobial Resistance Research CenterDepartment of Infectious DiseasesMazandaran University of Medical SciencesSariIran
| | - Amir Shamshirian
- Department of Medical Laboratory SciencesStudent Research CommitteeSchool of Allied Medical ScienceMazandaran University of Medical SciencesSariIran
- Gastrointestinal Cancer Research CenterNon‐Communicable Diseases InstituteMazandaran University of Medical SciencesSariIran
| | - Keyvan Heydari
- Gastrointestinal Cancer Research CenterNon‐Communicable Diseases InstituteMazandaran University of Medical SciencesSariIran
- Student Research CommitteeSchool of MedicineMazandaran University of Medical SciencesSariIran
| | - Mohammad Malekan
- Student Research CommitteeSchool of MedicineMazandaran University of Medical SciencesSariIran
| | - Reza Alizadeh‐Navaei
- Gastrointestinal Cancer Research CenterNon‐Communicable Diseases InstituteMazandaran University of Medical SciencesSariIran
| | - Mohammad Ali Ebrahimzadeh
- Pharmaceutical Sciences Research CenterDepartment of Medicinal ChemistrySchool of PharmacyMazandaran University of Medical ScienceSariIran
| | - Majid Ebrahimi Warkiani
- School of Biomedical EngineeringUniversity of Technology SydneySydney, UltimoNSWAustralia
- Institute of Molecular MedicineSechenov First Moscow State UniversityMoscowRussia
| | - Hamed Jafarpour
- Student Research CommitteeSchool of MedicineMazandaran University of Medical SciencesSariIran
| | - Sajad Razavi Bazaz
- School of Biomedical EngineeringUniversity of Technology SydneySydney, UltimoNSWAustralia
| | | | - Mehrdad Khodabandeh
- Neuromusculoskeletal Research CenterDepartment of Physical Medicine and RehabilitationIran University of Medical SciencesTehranIran
| | - Benyamin Seyfari
- Department of SurgeryFaculty of MedicineKashan University of Medical SciencesKashanIran
| | - Alireza Motamedzadeh
- Department of Internal MedicineFaculty of MedicineKashan University of Medical SciencesKashanIran
| | - Ehsan Dadgostar
- Department of PsychiatrySchool of MedicineIsfahan University of Medical SciencesIsfahanIran
| | - Marzieh Aalinezhad
- Department of RadiologyIsfahan University of Medical SciencesIsfahanIran
| | - Meghdad Sedaghat
- Department of Internal MedicineImam Hossein HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Nazanin Razzaghi
- Student Research CommitteeGolestan University of Medical SciencesGorganIran
| | - Bahman Zarandi
- Student Research CommitteeIran University of Medical SciencesTehranIran
| | - Anahita Asadi
- Pharmaceutical Sciences Research CenterDepartment of Medicinal ChemistrySchool of PharmacyMazandaran University of Medical ScienceSariIran
| | | | - Reza Beheshti
- Pharmaceutical Sciences Research CenterDepartment of Medicinal ChemistrySchool of PharmacyMazandaran University of Medical ScienceSariIran
| | - Amirhossein Hessami
- Department of Medical Laboratory SciencesStudent Research CommitteeSchool of Allied Medical ScienceMazandaran University of Medical SciencesSariIran
| | - Soheil Azizi
- Department of Medical Laboratory SciencesSchool of Allied Medical ScienceMazandaran University of Medical SciencesSariIran
| | - Ali Reza Mohseni
- Department of Medical Laboratory SciencesSchool of Allied Medical ScienceMazandaran University of Medical SciencesSariIran
- Thalassemia Research CenterHemoglobinopathy InstituteMazandaran University of Medical SciencesSariIran
| | - Danial Shamshirian
- Chronic Respiratory Diseases Research CenterNational Research Institute of Tuberculosis and Lung Diseases (NRITLD)Shahid Beheshti University of Medical SciencesTehranIran
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Boudesseul J, Zerhouni O, Harbert A, Rubinos C. Keeping Meta-Analyses Hygienic During the COVID-19 Pandemic. Front Public Health 2021; 9:722458. [PMID: 34660516 PMCID: PMC8511714 DOI: 10.3389/fpubh.2021.722458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/01/2021] [Indexed: 12/27/2022] Open
Abstract
Despite the massive distribution of different vaccines globally, the current pandemic has revealed the crucial need for an efficient treatment against COVID-19. Meta-analyses have historically been extremely useful to determine treatment efficacy but recent debates about the use of hydroxychloroquine for COVID-19 patients resulted in contradictory meta-analytical results. Different factors during the COVID-19 pandemic have impacted key features of conducting a good meta-analysis. Some meta-analyses did not evaluate or treat substantial heterogeneity (I2 > 75%); others did not include additional analysis for publication bias; none checked for evidence of p–hacking in the primary studies nor used recent methods (i.e., p-curve or p-uniform) to estimate the average population-size effect. These inconsistencies may contribute to contradictory results in the research evaluating COVID-19 treatments. A prominent example of this is the use of hydroxychloroquine, where some studies reported a large positive effect, whereas others indicated no significant effect or even increased mortality when hydroxychloroquine was used with the antibiotic azithromycin. In this paper, we first recall the benefits and fundamental steps of good quality meta-analysis. Then, we examine various meta-analyses on hydroxychloroquine treatments for COVID-19 patients that led to contradictory results and causes for this discrepancy. We then highlight recent tools that contribute to evaluate publication bias and p-hacking (i.e., p-curve, p-uniform) and conclude by making technical recommendations that meta-analyses should follow even during extreme global events such as a pandemic.
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Affiliation(s)
- Jordane Boudesseul
- Facultad de Psicología, Instituto de Investigación Científica, Universidad de Lima, Lima, Peru
| | | | - Allie Harbert
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Clio Rubinos
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Chivese T, Musa OAH, Hindy G, Al-Wattary N, Badran S, Soliman N, Aboughalia ATM, Matizanadzo JT, Emara MM, Thalib L, Doi SAR. Efficacy of chloroquine and hydroxychloroquine in treating COVID-19 infection: A meta-review of systematic reviews and an updated meta-analysis. Travel Med Infect Dis 2021; 43:102135. [PMID: 34265436 PMCID: PMC8273040 DOI: 10.1016/j.tmaid.2021.102135] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 12/14/2022]
Abstract
Objective To synthesize findings from systematic reviews and meta-analyses on the efficacy and safety of chloroquine (CQ) and hydroxychloroquine (HCQ) with or without Azithromycin for treating COVID-19, and to update the evidence using a meta-analysis. Methods A comprehensive search was carried out in electronic databases for systematic reviews, meta-analyses and experimental studies which investigated the efficacy and safety of CQ, HCQ with or without Azithromycin to treat COVID-19. Findings from the reviews were synthesised using tables and forest plots and the quality effect model was used for the updated meta-analysis. The main outcomes were mortality, the need for intensive care services, disease exacerbation, viral clearance and occurrence of adverse events. Results Thirteen reviews with 40 primary studies were included. Two meta-analyses reported a high risk of mortality, with ORs of 2.2 and 3.0, and the two others found no association between HCQ and mortality. Findings from two meta-analyses showed that HCQ with Azithromycin increased the risk of mortality, with similar ORs of 2.5. The updated meta-analysis of experimental studies showed that the drugs were not effective in reducing mortality (RR 1.1, 95%CI 1.0–1.3, I2 = 0.0%), need for intensive care services (OR 1.1, 95%CI 0.9–1.4, I2 = 0.0%), virological cure (OR 1.5, 95%CI 0.5–4.4, I2 = 39.6%) or disease exacerbation (OR 1.2, 95%CI 0.3–5.9, I2 = 31.9%) but increased the odds of adverse events (OR 12,3, 95%CI 2.5–59.9, I2 = 76.6%). Conclusion There is conclusive evidence that CQ and HCQ, with or without Azithromycin are not effective in treating COVID-19 or its exacerbation. Registration PROSPERO: CRD42020191353.
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Affiliation(s)
- Tawanda Chivese
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar.
| | - Omran A H Musa
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - George Hindy
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Noor Al-Wattary
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Saif Badran
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar; Hamad General Hospital, Doha, Qatar
| | - Nada Soliman
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | | | | | - Mohamed M Emara
- Basic Medical Sciences Department, College of Medicine, QU Health, Qatar University, Doha, Qatar; Biomedical and Pharmaceutical Research Unit, QU Health, Qatar University, Doha, Qatar
| | - Lukman Thalib
- Department of Biostatistics, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey
| | - Suhail A R Doi
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
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Li J, Liu HH, Yin XD, Li CC, Wang J. COVID-19 illness and autoimmune diseases: recent insights. Inflamm Res 2021; 70:407-428. [PMID: 33640999 PMCID: PMC7914392 DOI: 10.1007/s00011-021-01446-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/25/2021] [Accepted: 02/18/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The aim of this review is to explore whether patients with autoimmune diseases (AIDs) were at high risk of infection during the COVID-19 epidemic and how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic affected immune system. METHODS A systematic literature search was performed using the foreign databases (NCBI, web of science, EBSCO, ELSEVIER ScienceDirect) and Chinese databases (WanFang, CNKI (China National Knowledge Infrastructure), VIP, CBM) to locate all relevant publications (up to January 10, 2021). The search strategies used Medical Search Headings (MeSH) headings and keywords for "COVID-19" or "SARS-CoV-2" or "coronavirus" and "autoimmune disease". RESULTS This review evaluates the effect of SARS-CoV-2 on the immune system through ACE-2 receptor binding as the main pathway for cell attachment and invasion. It is speculated that SARS-COV-2 infection can activate lymphocytes and inflammatory response, which may play a role in the clinical onset of AIDs and also patients were treated with immunomodulatory drugs during COVID-19 outbreak. Preliminary studies suggested that the risk of developing severe forms of COVID-19 in patients with AIDs treated with immunomodulators or biologics might not increase. A large number of samples are needed for further verification, leading to an excessive immune response to external stimuli. CONCLUSION The relationship between autoimmune diseases and SARS-CoV-2 infection is complex. During the COVID-19 epidemic, individualized interventions for AIDs should be provided such as Internet-based service.
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Affiliation(s)
- Juan Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, People's Republic of China
- Medical Data Processing Center of School of Public Health of Anhui Medical University, Anhui Medical University, Hefei, China
| | - Hong-Hui Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, People's Republic of China
- Medical Data Processing Center of School of Public Health of Anhui Medical University, Anhui Medical University, Hefei, China
| | - Xiao-Dong Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, People's Republic of China
- Medical Data Processing Center of School of Public Health of Anhui Medical University, Anhui Medical University, Hefei, China
| | - Cheng-Cheng Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, People's Republic of China
- Medical Data Processing Center of School of Public Health of Anhui Medical University, Anhui Medical University, Hefei, China
| | - Jing Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, People's Republic of China.
- Medical Data Processing Center of School of Public Health of Anhui Medical University, Anhui Medical University, Hefei, China.
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Mishra P, Parveen R, Bajpai R, Samim M, Agarwal NB. Impact of cardiovascular diseases on severity of COVID-19 patients:
A systematic review. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021. [DOI: 10.47102/annals-acadmedsg.2020367] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
ABSTRACT
Introduction: Coronavirus disease 2019 (COVID-19) cases are increasing rapidly worldwide. Similar
to Middle East respiratory syndrome where cardiovascular diseases were present in nearly 30% of cases,
the increased presence of cardiovascular comorbidities remains true for COVID-19 as well. The mechanism
of this association remains unclear at this time. Therefore, we reviewed the available literature and tried
to find the probable association between cardiovascular disease with disease severity and mortality in
COVID-19 patients.
Methods: We searched Medline (via PubMed) and Cochrane Central Register of Controlled Trials for
articles published until Sept 5, 2020. Nineteen articles were included involving 6,872 COVID-19 patients.
Results: The random-effect meta-analysis showed that cardiovascular disease was significantly associated
with severity and mortality for COVID-19: odds ratio (OR) 2.89, 95% confidence interval (CI) 1.98–4.21
for severity and OR 3.00, 95% CI 1.67–5.39 for mortality, respectively. Risk of COVID-19 severity was
higher in patients having diabetes, hypertension, chronic obstructive pulmonary disease, malignancy,
cerebrovascular disease and chronic kidney disease. Similarly, patients with diabetes, hypertension, chronic
liver disease, cerebrovascular disease and chronic kidney disease were at higher risk of mortality.
Conclusion: Our findings showed that cardiovascular disease has a negative effect on health status of
COVID-19 patients. However, large prevalence studies demonstrating the consequences of comorbid
cardiovascular disease are urgently needed to understand the extent of these concerning comorbidities.
Keywords: Cardiovascular disease, COVID-19, SARS-CoV-2
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Kopustinskiene DM, Bernatoniene J. Molecular Mechanisms of Melatonin-Mediated Cell Protection and Signaling in Health and Disease. Pharmaceutics 2021; 13:pharmaceutics13020129. [PMID: 33498316 PMCID: PMC7909293 DOI: 10.3390/pharmaceutics13020129] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/14/2021] [Accepted: 01/18/2021] [Indexed: 01/07/2023] Open
Abstract
Melatonin, an endogenously synthesized indolamine, is a powerful antioxidant exerting beneficial action in many pathological conditions. Melatonin protects from oxidative stress in ischemic/reperfusion injury, neurodegenerative diseases, and aging, decreases inflammation, modulates the immune system, inhibits proliferation, counteracts the Warburg effect, and promotes apoptosis in various cancer models. Melatonin stimulates antioxidant enzymes in the cells, protects mitochondrial membrane phospholipids, especially cardiolipin, from oxidation thus preserving integrity of the membranes, affects mitochondrial membrane potential, stimulates activity of respiratory chain enzymes, and decreases the opening of mitochondrial permeability transition pore and cytochrome c release. This review will focus on the molecular mechanisms of melatonin effects in the cells during normal and pathological conditions and possible melatonin clinical applications.
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Affiliation(s)
- Dalia M. Kopustinskiene
- Institute of Pharmaceutical Technologies, Faculty of Pharmacy, Medical Academy, Lithuanian University of Health Sciences, Sukileliu pr. 13, LT-50161 Kaunas, Lithuania;
| | - Jurga Bernatoniene
- Institute of Pharmaceutical Technologies, Faculty of Pharmacy, Medical Academy, Lithuanian University of Health Sciences, Sukileliu pr. 13, LT-50161 Kaunas, Lithuania;
- Department of Drug Technology and Social Pharmacy, Faculty of Pharmacy, Medical Academy, Lithuanian University of Health Sciences, Sukileliu pr. 13, LT-50161 Kaunas, Lithuania
- Correspondence:
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