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Mollace R, Gliozzi M, Macrì R, Tavernese A, Musolino V, Carresi C, Maiuolo J, Muscoli C, Tomino C, Rosano GM, Fini M, Volterrani M, Silvestrini B, Mollace V. Efficacy and Safety of Novel Aspirin Formulations: A Randomized, Double-Blind, Placebo-Controlled Study. Pharmaceutics 2022; 14:pharmaceutics14010187. [PMID: 35057084 PMCID: PMC8779026 DOI: 10.3390/pharmaceutics14010187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 01/17/2023] Open
Abstract
Low-dose aspirin represents the best option in the secondary prevention of coronary artery disease, but its extensive use in primary prevention is limited by the occurrence of gastric mucosal lesions and increased risk of bleeding. We investigated the safety profile of a novel sublingual aspirin formulation in 200 healthy volunteers, randomly assigned to ten (n = 20 each) different 7-day once-daily treatment regimens. Gastric mucosal injury based on the modified Lanza score (MLS), the histopathology of gastric mucosa and the serum determination of thromboxane B2 (TXB2) and urinary 11-dehydro-TXB2 levels were evaluated at basal as well as after 7 days of each placebo or aspirin treatment regimen. In Groups A and B (placebo—oral and sublingual, respectively), no changes in MLS and in gastric mucosal micro-vessel diameter were found at day 7. In contrast, in Groups C and D (oral standard aspirin—100 and 50 mg daily, respectively), the median MLS was significantly increased. Very few changes were found in Groups E and F (standard sublingual aspirin—100 and 50 mg, respectively). Groups G and H (oral administration of micronized collagen-cogrinded aspirin) showed gastric protection compared to Groups C and D. Moreover, Groups I and L (sublingual collagen-cogrinded aspirin—100 and 50 mg, respectively) showed a significant reduction (Group I) or total abolition (Group L) of gastric mucosal lesions and no difference compared to the standard one in serum TXB2 and urinary 11-dehydro-TXB2 levels. In conclusion, our data show that the new formulation leads to a better safety profile compared to standard aspirin, representing a better therapeutic option for extended use in primary and secondary prevention of cardiovascular diseases.
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Affiliation(s)
- Rocco Mollace
- Department of Health Science, Institute of Research for Food Safety & Health IRC-FSH, University Magna Graecia, 88100 Catanzaro, Italy; (R.M.); (M.G.); (R.M.); (A.T.); (V.M.); (C.C.); (J.M.); (C.M.); (B.S.)
- IRCCS San Raffaele Pisana, Via di Valcannuta, 00163 Rome, Italy; (C.T.); (G.M.R.); (M.F.); (M.V.)
| | - Micaela Gliozzi
- Department of Health Science, Institute of Research for Food Safety & Health IRC-FSH, University Magna Graecia, 88100 Catanzaro, Italy; (R.M.); (M.G.); (R.M.); (A.T.); (V.M.); (C.C.); (J.M.); (C.M.); (B.S.)
| | - Roberta Macrì
- Department of Health Science, Institute of Research for Food Safety & Health IRC-FSH, University Magna Graecia, 88100 Catanzaro, Italy; (R.M.); (M.G.); (R.M.); (A.T.); (V.M.); (C.C.); (J.M.); (C.M.); (B.S.)
| | - Annamaria Tavernese
- Department of Health Science, Institute of Research for Food Safety & Health IRC-FSH, University Magna Graecia, 88100 Catanzaro, Italy; (R.M.); (M.G.); (R.M.); (A.T.); (V.M.); (C.C.); (J.M.); (C.M.); (B.S.)
| | - Vincenzo Musolino
- Department of Health Science, Institute of Research for Food Safety & Health IRC-FSH, University Magna Graecia, 88100 Catanzaro, Italy; (R.M.); (M.G.); (R.M.); (A.T.); (V.M.); (C.C.); (J.M.); (C.M.); (B.S.)
| | - Cristina Carresi
- Department of Health Science, Institute of Research for Food Safety & Health IRC-FSH, University Magna Graecia, 88100 Catanzaro, Italy; (R.M.); (M.G.); (R.M.); (A.T.); (V.M.); (C.C.); (J.M.); (C.M.); (B.S.)
| | - Jessica Maiuolo
- Department of Health Science, Institute of Research for Food Safety & Health IRC-FSH, University Magna Graecia, 88100 Catanzaro, Italy; (R.M.); (M.G.); (R.M.); (A.T.); (V.M.); (C.C.); (J.M.); (C.M.); (B.S.)
| | - Carolina Muscoli
- Department of Health Science, Institute of Research for Food Safety & Health IRC-FSH, University Magna Graecia, 88100 Catanzaro, Italy; (R.M.); (M.G.); (R.M.); (A.T.); (V.M.); (C.C.); (J.M.); (C.M.); (B.S.)
- IRCCS San Raffaele Pisana, Via di Valcannuta, 00163 Rome, Italy; (C.T.); (G.M.R.); (M.F.); (M.V.)
| | - Carlo Tomino
- IRCCS San Raffaele Pisana, Via di Valcannuta, 00163 Rome, Italy; (C.T.); (G.M.R.); (M.F.); (M.V.)
| | - Giuseppe Maria Rosano
- IRCCS San Raffaele Pisana, Via di Valcannuta, 00163 Rome, Italy; (C.T.); (G.M.R.); (M.F.); (M.V.)
| | - Massimo Fini
- IRCCS San Raffaele Pisana, Via di Valcannuta, 00163 Rome, Italy; (C.T.); (G.M.R.); (M.F.); (M.V.)
| | - Maurizio Volterrani
- IRCCS San Raffaele Pisana, Via di Valcannuta, 00163 Rome, Italy; (C.T.); (G.M.R.); (M.F.); (M.V.)
| | - Bruno Silvestrini
- Department of Health Science, Institute of Research for Food Safety & Health IRC-FSH, University Magna Graecia, 88100 Catanzaro, Italy; (R.M.); (M.G.); (R.M.); (A.T.); (V.M.); (C.C.); (J.M.); (C.M.); (B.S.)
| | - Vincenzo Mollace
- Department of Health Science, Institute of Research for Food Safety & Health IRC-FSH, University Magna Graecia, 88100 Catanzaro, Italy; (R.M.); (M.G.); (R.M.); (A.T.); (V.M.); (C.C.); (J.M.); (C.M.); (B.S.)
- IRCCS San Raffaele Pisana, Via di Valcannuta, 00163 Rome, Italy; (C.T.); (G.M.R.); (M.F.); (M.V.)
- Correspondence:
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Musolino V, Gliozzi M, Bombardelli E, Nucera S, Carresi C, Maiuolo J, Mollace R, Paone S, Bosco F, Scarano F, Scicchitano M, Macrì R, Ruga S, Zito MC, Palma E, Gratteri S, Ragusa M, Volterrani M, Fini M, Mollace V. The synergistic effect of Citrus bergamia and Cynara cardunculus extracts on vascular inflammation and oxidative stress in non-alcoholic fatty liver disease. J Tradit Complement Med 2020; 10:268-274. [PMID: 32670822 PMCID: PMC7340872 DOI: 10.1016/j.jtcme.2020.02.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND AIM Non-Alcoholic Fatty Liver Disease (NAFLD) represents a risk factor for cardiovascular diseases. NAFLD is worsened by the simultaneous occurrence of type 2 diabetes mellitus (T2DM) causing an enhancement of inflammatory and fibrotic processes. Although insulin resistance appears the link between NAFLD and T2DM, current pharmacological treatments of T2DM failed to produce relevant benefits in preventing T2DM-related liver dysfunction. In this randomized, double blind, placebo-controlled clinical study, we evaluated the effect of Bergacyn, an innovative formulation originating from the combination of Bergamot Polyphenolic Fraction (BPF) and Cynara cardunculus (CyC). EXPERIMENTAL PROCEDURE 80 adult patients with a history of at least 12 months of T2DM and NAFLD received orally BPF (300 mg/daily) Cyc (300 mg/daily), separately or formulated in combination 50/50% (Bergacyn; 300 mg/daily), or placebo all containing 300 mg of bergamot albedo fibers micronized and co-grinded as excipients. RESULTS AND CONCLUSION Serum measurements and liver ultrasound analyses showed that concomitant administration of BPF and CyC produced significant improvement of NAFLD biomarkers in patients with T2DM. This effect was associated with a substantial reduction of oxidative stress/inflammatory biomarkers, thus contributing to a significant improvement of NO-mediated reactive vasodilation. Furthermore, the effect of Bergacyn showed a synergistic effect of both extracts, thus suggesting that this peculiar formulation represents a novel therapeutic strategy to counteract vascular inflammation and endothelial dysfunction in patients suffering from T2DM and NAFLD. Further studies in larger cohort of diabetic patients are required to better identify the potential of Bergacyn on metabolic disorders accompanying T2DM and NAFLD.
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Affiliation(s)
- Vincenzo Musolino
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | - Micaela Gliozzi
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | - Ezio Bombardelli
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | - Saverio Nucera
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | - Cristina Carresi
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | - Jessica Maiuolo
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | - Rocco Mollace
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | - Sara Paone
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | - Francesca Bosco
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | - Federica Scarano
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | - Miriam Scicchitano
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | - Roberta Macrì
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | - Stefano Ruga
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | - Maria Caterina Zito
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | - Ernesto Palma
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | - Santo Gratteri
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | - Monica Ragusa
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | | | | | - Vincenzo Mollace
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
- San Raffaele IRCCS, Rome, Italy
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Abstract
Major considerations in the provision of healthcare are availability, affordability, accessibility, and appropriateness, especially in the setting of heart failure where disease burden is growing, developments have been rapid and newer biomarkers, diagnostic and imaging techniques, monitoring systems, devices, procedures, and drugs have all been developed in a relatively short period of time. Many monitoring and diagnostic systems have been developed but the disproportionate cost of conducting trials of their effectiveness has limited their uptake. There are added complexities, in that the utilization of doctors for the supervision of the monitoring results may be optimal in one setting and not in another because of differences in the characteristics of organization of healthcare provision, making even interpretation of the trials we have had, still difficult to interpret. New technologies are continuously changing the approach to healthcare and will reshape the structure of the healthcare systems in the future. Mobile technologies can empower patients and carers by giving them more control over their health and social care needs and reducing their dependence on healthcare professionals for monitoring their health, but a significant problem is the integration of the multitude of monitored parameters with clinical data and the recognition of intervention thresholds. Digital technology can help, but we need to prove its cost/efficacy and how it will be paid for. Governments in many European countries and worldwide are trying to establish frameworks that promote the convergence of standards and regulations for telemedicine solutions and yet simultaneously health authorities are closely scrutinizing healthcare spending, with the objective of reducing and optimizing expenditure in the provision of health services. There are multiple factors to be considered for the reimbursement models associated with the implementation of physiological monitoring yet it remains a challenge in cash-strapped health systems.
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Affiliation(s)
- Giuseppe M C Rosano
- Department of Medical Sciences, Centre for Clinical, Basic Research IRCCS San Raffaele Pisana, via della Pisana, 235, 00163 Rome, Italy
| | - Ilaria Spoletini
- Department of Medical Sciences, Centre for Clinical, Basic Research IRCCS San Raffaele Pisana, via della Pisana, 235, 00163 Rome, Italy
- Corresponding author. Tel: +39 06 5225 2409, Fax: +39 06 5225 2465,
| | - Cristiana Vitale
- Department of Medical Sciences, Centre for Clinical, Basic Research IRCCS San Raffaele Pisana, via della Pisana, 235, 00163 Rome, Italy
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Buccheri S, Capodanno D, James S, Angiolillo DJ. Bleeding after antiplatelet therapy for the treatment of acute coronary syndromes: a review of the evidence and evolving paradigms. Expert Opin Drug Saf 2019; 18:1171-1189. [DOI: 10.1080/14740338.2019.1680637] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Sergio Buccheri
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Davide Capodanno
- Division of Cardiology, C.A.S.T., P.O. “G. Rodolico”, Azienda Ospedaliero-Universitaria “Policlinico-Vittorio Emanuele”, University of Catania, Catania, Italy
| | - Stefan James
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Dominick J. Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
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Bartko J, Schoergenhofer C, Schwameis M, Wadowski P, Kubica J, Jilma B, Hobl EL. Morphine Interaction with Aspirin: a Double-Blind, Crossover Trial in Healthy Volunteers. J Pharmacol Exp Ther 2018. [PMID: 29540563 DOI: 10.1124/jpet.117.247213] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aspirin is a cornerstone in the antiplatelet therapy for acute coronary syndromes. Coadministration of morphine may potentially influence the intestinal absorption, pharmacokinetics, and pharmacodynamics, as seen with P2Y12 inhibitors. In this trial, healthy volunteers were randomized to receive morphine (5 mg, i.v. bolus injection) at one of seven different time points before, after, or with aspirin (162 mg, p.o.) in a double-blind, placebo-controlled fashion. After a 14-day washout, subjects received placebo instead of morphine. Pharmacokinetics were determined by liquid chromatography, and aspirin's effects were measured by platelet function tests (whole-blood platelet aggregation: multiplate, platelet plug formation: PFA-100). Morphine increased the total acetylsalicylic acid exposure by 20% compared with placebo when given simultaneously with aspirin, whereas Cmax and tmax were not altered. Morphine had no significant effect on aspirin-induced platelet inhibition. In contrast to coadministration with P2Y12 inhibitors, morphine appears to have negligible interaction with aspirin.
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Affiliation(s)
- Johann Bartko
- Department of Clinical Pharmacology, Medical University of Vienna (J.B., C.S., M.S., P.W., B.J., E.-L.H.), and Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK, AUVA Trauma Centre Meidling (J.B.), Vienna, Austria; and Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland (J.K.)
| | - Christian Schoergenhofer
- Department of Clinical Pharmacology, Medical University of Vienna (J.B., C.S., M.S., P.W., B.J., E.-L.H.), and Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK, AUVA Trauma Centre Meidling (J.B.), Vienna, Austria; and Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland (J.K.)
| | - Michael Schwameis
- Department of Clinical Pharmacology, Medical University of Vienna (J.B., C.S., M.S., P.W., B.J., E.-L.H.), and Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK, AUVA Trauma Centre Meidling (J.B.), Vienna, Austria; and Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland (J.K.)
| | - Patricia Wadowski
- Department of Clinical Pharmacology, Medical University of Vienna (J.B., C.S., M.S., P.W., B.J., E.-L.H.), and Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK, AUVA Trauma Centre Meidling (J.B.), Vienna, Austria; and Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland (J.K.)
| | - Jacek Kubica
- Department of Clinical Pharmacology, Medical University of Vienna (J.B., C.S., M.S., P.W., B.J., E.-L.H.), and Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK, AUVA Trauma Centre Meidling (J.B.), Vienna, Austria; and Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland (J.K.)
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna (J.B., C.S., M.S., P.W., B.J., E.-L.H.), and Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK, AUVA Trauma Centre Meidling (J.B.), Vienna, Austria; and Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland (J.K.)
| | - Eva-Luise Hobl
- Department of Clinical Pharmacology, Medical University of Vienna (J.B., C.S., M.S., P.W., B.J., E.-L.H.), and Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK, AUVA Trauma Centre Meidling (J.B.), Vienna, Austria; and Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland (J.K.)
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