Risperidone-induced metabolic dysfunction is attenuated by Curcuma longa extract administration in mice.

Antipsychotics, such as risperidone, increase food intake and induce alteration in glucose and lipid metabolism concomitantly with overweight and body fat increase, these biological abnormalities belong to the metabolic syndrome definition (high visceral adiposity, hypertriglyceridemia, hyperglycemia, low HDL-cholesterol and high blood pressure). Curcumin is a major component of traditional turmeric (Curcuma longa) which has been reported to improve lipid and glucose metabolism and to decrease weight in obese mice. We questioned the potential capacity of curcumin, contained in Curcuma longa extract (Biocurcuma™), to attenuate the risperidone-induced metabolic dysfunction. Two groups of mice were treated once a week, for 22 weeks, with intraperitoneal injection of risperidone (Risperdal) at a dose 12.5 mpk. Two other groups received intraperitoneal injection of the vehicle of Risperdal following the same schedule. Mice of one risperidone-treated groups and of one of vehicle-treated groups were fed a diet with 0.05% Biocurcuma™ (curcumin), while mice of the two other groups received the standard diet. Curcumin limited the capacity of risperidone to reduce spontaneous motricity, but failed to impede risperidone-induced increase in food intake. Curcumin did not reduce the capacity of risperidone to induce weight gain, but decreased visceral adiposity and decreased the risperidone-induced hepatomegaly, but not steatosis. Furthermore, curcumin repressed the capacity of risperidone to induce the hepatic over expression of enzymes involved in lipid metabolism (LXRα, FAS, ACC1, LPL, PPARγ, ACO, SREBP2) and decreased risperidone-induced glucose intolerance and hypertriglyceridemia. Curcumin decreased risperidone-induced increases in serum markers of hepatotoxicity (ALAT, ASAT), as well as of one major hepatic pro-inflammatory transcription factor (NFκB: p105 mRNA and p65 protein). These findings support that nutritional doses of curcumin contained in Curcuma longa extract are able to partially counteract the risperidone-induced metabolic dysfunction in mice, suggesting that curcumin ought to be tested to reduce the capacity of risperidone to induce the metabolic syndrome in human.

Intra-articular hylastan versus steroid for knee osteoarthritis.

PURPOSE: To assess the efficacy and safety of one and two intra-articular (IA) injections of the new viscosupplement, hylastan, compared with a single IA corticosteroid injection for pain due to knee osteoarthritis (OA). Hylastan is a high-molecular-weight hyaluronan derivative prepared from bacterial fermented sodium hyaluronate that was developed to remain in the joint for longer than most other viscosupplements. METHODS: This 6-month, double-blind, randomized, parallel group, multicenter trial enrolled patients aged ≥40 years who met American College of Rheumatology criteria for knee OA and had continued pain despite conservative treatment. Patients were randomized 1:1:1 to one of three arms: 2 × 4 mL hylastan (n = 129; arthrocentesis then IA hylastan Day 0, same treatment Week 2); 1 × 4 mL hylastan (n = 130; arthrocentesis then IA hylastan Day 0, arthrocentesis only Week 2); steroid (n = 132; arthrocentesis then IA methylprednisolone acetate 40 mg Day 0, arthrocentesis only Week 2). Participants and evaluators were blinded to treatment. The primary clinical outcome measure was change from baseline in WOMAC A pain score over all postbaseline visits to Week 26. RESULTS: Statistically significant pain reduction was observed in all three arms, with similar mean (95 % CI) changes in WOMAC A: 2 × 4 mL hylastan -0.9 (-1.0, -0.7); 1 × 4 mL hylastan -0.8 (-0.9, -0.7); steroid -0.9 (-1.0, -0.8); all P < 0.0001 versus baseline. Changes in secondary outcomes (OMERACT-OARSI and WOMAC A responder rates, patient/clinical observer global assessments, and WOMAC A1 walking pain) were similar in all three arms. Target knee adverse events were comparable for all treatments. CONCLUSIONS: Both IA hylastan injection regimens were effective in relieving pain with an acceptable safety profile. IA hylastan did not show a difference versus IA corticosteroid; therefore, the hypothesis of superior pain relief was not met. Further research is needed to compare the efficacy and safety of hylastan with other viscosupplements.

A plant-derived flavonoid inhibits entry of all HCV genotypes into human hepatocytes.

BACKGROUND & AIMS: Interferon-based therapies for hepatitis C virus (HCV) infection are limited by side effects and incomplete response rates, particularly among transplant recipients. We screened a library of plant-derived small molecules to identify HCV inhibitors with novel mechanisms. METHODS: We isolated phenolic compounds from Marrubium peregrinum L (Lamiaceae). Replication of HCV RNA, virus production, and cell entry were monitored using replicons and infectious HCV. Inhibition of HCV was measured in hepatoma cells and primary human hepatocytes using luciferase reporter gene assays, core enzyme-linked immunosorbent assays, or infectivity titration. We tested the bioavailability of the compound in mice. RESULTS: We identified a flavonoid, ladanein (BJ486K), with unreported antiviral activity and established its oral bioavailability in mice. Natural and synthetic BJ486K inhibited a post-attachment entry step, but not RNA replication or assembly; its inhibitory concentration 50% was 2.5 µm. BJ486K was effective against all major HCV genotypes, including a variant that is resistant to an entry inhibitor; it prevented infection of primary human hepatocytes. Combined administration of BJ486K and cyclosporine A had a synergistic effect in inhibition of HCV infection. CONCLUSIONS: BJ486K has oral bioavailability and interferes with entry of HCV into cultured human hepatocytes. It synergizes with cyclosporine A to inhibit HCV infection. Its inhibitory effects are independent of HCV genotype, including a variant that is resistant to an entry inhibitor against scavenger receptor class B type I. Flavonoid derivatives therefore might be developed as components of combination therapies because they are potent, broadly active inhibitors of HCV entry that could prevent graft reinfection after liver transplantation.

Antifungal activity of 10 Guadeloupean plants.

Screening of the antifungal activities of ten Guadeloupean plants was undertaken to find new extracts and formulations against superficial mycoses such as onychomycosis, athlete's foot, Pityriasis versicolor, as well as the deep fungal infection Pneumocystis pneumonia. For the first time, the CMI of these plant extracts [cyclohexane, ethanol and ethanol/water (1:1, v/v)] was determined against five dermatophytes, five Candida species, Scytalidium dimidiatum, a Malassezia sp. strain and Pneumocystis carinii. Cytotoxicity tests of the most active extracts were also performed on an HaCat keratinocyte cell line. Results suggest that the extracts of Bursera simaruba, Cedrela odorata, Enterolobium cyclocarpum and Pluchea carolinensis have interesting activities and could be good candidates for developing antifungal formulations.

Antifungal and cytotoxic activity of withanolides from Acnistus arborescens.

Three compounds were isolated from Acnistus arborescens, a tree commonly used in South and Central America in traditional medicine against several infectious diseases, some of which are caused by fungi. Bioassay-guided fractionation of a MeOH extract of leaves, based on its anti-Pneumocystis carinii activity, led to the isolation of compounds 1-3. Mono- and bidimensional NMR analyses enabled identification of two new withanolides, (20R,22R)-5beta,6beta-epoxy-4beta,12beta,20-trihydroxy-1-oxowith-2-en-24-enolide (1) and (20R,22R)-16beta-acetoxy-3beta,4beta;5beta,6beta-diepoxy-12beta,20-dihydroxy-1-oxowith-24-enolide (2), and withanolide D (3). Antifungal activity on 13 fungi responsible for human infections (five dermatophytes, one nondermatophyte mold, six yeasts, and Pneumocystis carinii) was examined. Cytotoxicity of these compounds was also evaluated in vitro.

Humulane and germacrane sesquiterpenes from Ferula lycia.

Five new juniferol esters (1-5), along with six known humulane derivatives (6-11), were isolated from the roots of Ferula lycia, an endemic Turkish species. The fruits of the same species were also investigated and led to the isolation of these same compounds, as well as two known germacrane esters (12 and 13). All isolated sesquiterpenes were assayed for cytotoxicity against two tyrosine kinase inhibitor-resistant cell lines, K562R and DA1-3b/M2(BCR-ABL). The two most active compounds, juniferinin (7) and 6-beta-p-hydroxybenzoyloxygermacra-1(10),4-diene (12), were moderately active against Raji lymphoma cells but also displayed some toxicity against healthy bone marrow cells.

Activity of ladanein on leukemia cell lines and its occurrence in Marrubium vulgare.

Three methoxylated flavones isolated from Marrubium peregrinum - ladanein, scutellarein-5,7,4'-trimethyl ether, and scutellarein-5,6,7,4'-tetramethyl ether - were assayed for their cytotoxicity towards a recently developed dasatinib-resistant murine leukemia cell line (DA1-3b/M2 (BCR-ABL)), together with the structurally related non-methylated flavone scutellarein. The most active compound, ladanein, was looked for in 20 common Lamiaceae species by a quick HPLC screening. Among the possible positive results, the most interesting source was found to be Marrubium vulgare, which led to the isolation and identification of ladanein for the first time in this species. Ladanein also displayed moderate (20-40 microM) activities against K562, K562R (imatinib-resistant), and 697 human leukemia cell lines but was toxic neither to MOLM13 nor to human peripheral blood mononuclear cells. This work provides a common natural source for the hemi-synthesis of future ladanein-derived flavones and the study of their antileukemic activity.

Effects of Alchornea cordifolia on elastase and superoxide anion produced by human neutrophils.

The ability of Alchornea cordifolia (Schum. and Thonn.) Müll. Arg. (Euphorbiaceae) leaves to inhibit human neutrophil elastase (HNE) and superoxide anion (O(2)(*-)) activities was evaluated on aqueous and ethyl acetate extracts as they allow for a targeted extraction of polyphenols. The direct effect of A. cordifolia extracts on HNE and O(2)(*-) was assessed in an acellular system. Results showed that extracts scavenge HNE and O(2)(*-) in a dose-dependent manner. Better activity was exhibited by the ethyl acetate extract with lower IC(50) (2.2 and 4. 1 mg/L for HNE and O(2)(*-), respectively) than for the aqueous extract. Cellular systems including isolated human polymorphonuclear neutrophils (PMN) were investigated to assess the effect of extracts on PMN metabolism. PMN were stimulated with 4beta-phorbol-12-myristate-13-acetate (PMA), calcium ionophore (CaI), or N-formyl-methionyl-leucine-phenylalanine (fMLP), each stimulant having its own stimulation pathway. From the IC(50) obtained, it can be concluded that A. cordifolia reduces HNE and O(2)(*-) liberation. Furthermore it was demonstrated that A. cordifolia extracts have no cytotoxic activity on PMN by measuring release of the cytosolic enzyme lactate dehydrogenase. As the ethyl acetate extract offers a higher rate of total phenols than the aqueous extract as well as better scavenging activity, it can be supposed that polyphenols, which are well known for their potent antioxidant and antielastase activity, are implicated in the activity of the plant. Phenolic substances such as quercetin, myricetin-3-glucopyranoside, myricetin-3-rhamnopyranoside, and proanthocyanidin A2 were identified in the ethyl acetate extract. In conclusion, the study provides proof of ethnomedical claims and partly explains the mechanisms of the anti-inflammatory action of A. cordifolia leaves.

Effects of Microdesmis keayana alkaloids on vascular parameters of erectile dysfunction.

Microdesmis keayana (Pandaceae) is an African tropical plant whose roots are used in traditional medicine for erection impairment but the compounds responsible for its action are unknown. Two major alkaloids recently isolated from the roots of M. keayana, keayanidine B and keayanine, were tested for vasorelaxing properties using isolated rat aortic rings precontracted by phenylephrine to confirm its traditional use. Influence of the alkaloids on the endothelial production of endothelial nitric oxide synthase (eNOS) was measured by quantitative polymerase chain reaction (QPCR) analysis. Scavenging activities were assessed versus 1,1-diphenyl-2-picrylhydrazyle (DPPH) and reactive oxygen species (ROS) such as superoxide anion (O(2)(*-) and hydrogen peroxide (H(2)O(2)) in cell-free and cellular systems. The results showed that keayanidine B and keayanine had significant vasorelaxing properties. This effect could be due to their strong antioxidant activity versus O(2)(*-) and H(2)O(2) and to their stimulation of eNOS mRNA expression. Therefore these alkaloids could indirectly stimulate NO production in the vascular bed and would explain the traditional use of M. keayana in erectile dysfunction.

Activity of elaeochytrin A from Ferula elaeochytris on leukemia cell lines.

Phytochemical investigation of the roots of Ferula elaeochytris made it possible to isolate two sesquiterpene esters, 6-anthraniloyljaeschkeanadiol (elaeochytrin A) and 4beta-hydroxy-6alpha-(p-hydroxybenzoyloxy)dauc-9-ene (elaeochytrin B), as well as eight known compounds: 6-angeloyljaeschkeanadiol, teferidin, ferutinin, 6-(p-hydroxybenzoyl)epoxyjaeschkeanadiol, 6-(p-hydroxybenzoyl)lancerotriol, 5-caffeoylquinic acid, 1,5-dicaffeoylquinic acid and sandrosaponin IX. The cytotoxic activities of all compounds were investigated on K562R (imatinib-resistant) human chronic myeloid leukaemia and DA1-3b/M2(BCR-ABL) (dasatinib-resistant) mouse leukemia cell line. Elaeochytrin A was the most active compound on both cell lines (IC(50)=12.4 and 7.8microM, respectively). It was also tested on non-resistant human promyelocytic leukemia cells (HL60, IC(50)=13.1microM) and was not toxic to normal peripheral blood mononuclear cells up to 100microM.

Letter: characterisation and identification of spermine and spermidine derivatives in Microdesmis keayana and Microdesmis puberula roots by electrospray ionisation tandem mass spectrometry and high-performance liquid chromatography/electrospray ionisation tandem mass spectrometry.

Three new N(1),N(5),N(14)-tris(4- hydroxycinnamoyl)spermines were identified in hydromethanolic root extracts of Microdesmis keayana J. Léonard and Microdesmis puberula Hook f. The electrospray ionisation tandem mass spectrometry (ESI-MS/MS) technique with specific nuclear magnetic resonance analysis of hydrolysed products made it possible to identify N(1),N(5),N(14)-tris(p-coumaroyl)spermine, N(1)-feruloyl,N(5),N(14)-di(p-coumaroyl)spermine and N(1),N(5),N(14)-tris(feruloyl)spermine, named keayanines B, C and D, respectively. ESI-MS/MS analysis most effectively provided structural data although high-performance liquid chromatography/electrospray ionisation tandem mass spectrometry was also used to characterise four other compounds from Microdesmis puberula-keayanidines A, B, C and keayanine A-which had already been identified in M. keayana. This chemical data is the first to be published for M. puberula which is a commonly used plant in Central African traditional medicine.

Ethnopharmacology of Lippia alba.

INTRODUCTION: Chemical, ethnopharmacological and pharmacological research on Lippia alba (Mill.) N.E. Brown and the evidence that exists for its various usages have been looked for, focusing on high quality studies. ETHNOPHARMACOLOGICAL INVESTIGATION: The species is mainly used against digestive and respiratory ailments, and as a sedative and antihypertensive remedy. CHEMICAL CONSTITUENTS: Seven chemotypes exist for the essential oil, the non-volatile compounds are iridioids, phenylethanoids, flavone glycosides and biflavonoids. BIOLOGICAL ACTIVITIES AND ETHNOPHARMACOLOGICAL APPRAISAL: Some positive, although partial, results have been obtained on sedative and anxiolytic activities. Real effects in other traditional uses can mainly be explained by anti-infectious and analgesic properties, at the moment. CONCLUSION: Well conducted biological studies are still needed for several indications of this species. Its use as a sedative deserves a clinical investigation. The chemical variability of the species seems important both in the essential oil and in non-volatile compounds, so future research on the pharmacological properties of these extracts should provide more chemical data which will increase their validity.

Vasoactivity, antioxidant and aphrodisiac properties of Caesalpinia benthamiana roots.

AIMS OF THE STUDY: Caesalpinia benthamiana (=Mezoneuron benthamianum) (Fabaceae) is an African tropical plant whose roots are used in traditional medicine as an aqueous decoction for many purposes, especially for erection impairment but its action mechanism is unknown. The action of Caesalpinia benthamiana on sexual behaviour and some assays on potential modes of action were performed. MATERIALS AND METHODS: The aqueous extract of Caesalpinia benthamiana (AECB) was tested for vasorelaxing properties using isolated rat aortic rings precontracted by phenylephrine. Influence of AECB in the production of endothelial isoform of nitric oxide synthase (eNOS) was measured by quantitative polymerase chain reaction (QPCR) analysis. Scavenging activities versus reactive oxygen species (ROS), such as superoxide anion (O(2).(-)), hydrogen peroxide (H(2)O(2)), and hypochlorous acid (HOCl) were assessed. Action of AECB on the cellular generation of O(2).(-) was also tested in a physiopathology model of oxidative burst using human polymorphonuclear neutrophils stimulated by phorbol myristate acetate. The aphrodisiac properties of AECB administered orally by gavage (50 mg/kg body weight) to male rats were evaluated by observing the sexual behaviour of animals. Finally, a short-term toxicity study was undertaken to establish the therapeutic index of AECB administered orally to rats at high dose (2 g/kg body weight). RESULTS: C. benthamiana roots are rich in phenolic compounds (gallic acid, resveratrol and tannins). The results showed that AECB had significant vasorelaxing properties. The extract also had a strong radical activity against ROS in cell-free and cellular systems and stimulated eNOS mRNA expression. As for the aphrodisiac activity of AECB in male rats, results have shown that sexual parameters are stimulated. Furthermore, after oral administration at high dose, AECB causes no mortality or changes in rats' behaviour. CONCLUSION: AECB enhanced the sexual activity of male rats. This could be partly explained by its vasorelaxant properties, which may be caused by an increase in NO production in vascular bed and a decrease in its destruction.

Vasoactivity and antioxidant properties of Microdesmis keayana roots.

Endothelial isoform of nitric oxide synthase (eNOS) mRNA expression increases in the corpora cavernosum, penile arteries and arterioles during erection. But eNOS expression and nitric oxide (NO), the product of its catalytic action, are inactivated by reactive oxygen species (ROS), especially by superoxide anion. ROS are involved in the impairment of endothelium-dependent relaxation and are responsible for some of the pathologies linked to erectile dysfunction (i.e. hypertension, atherosclerosis, etc.). While investigating Microdesmis keayana J. Léonard (Pandaceae) (syn. Microdesmis puberula Hook.f. ex. Planch.), used in African traditional medicine for erectile dysfunction, the hypotensive and the vasorelaxing properties of the aqueous extract of Microdesmis keayana (AEMK) were, respectively, tested using normotensive rabbits and aorta strips of guinea pigs in an organ bath experience. Interaction of AEMK in endothelial production of eNOS was measured by the quantitative polymerase chain reaction (QPCR) analysis. The scavenging activities versus ROS, such as superoxide anion (O(2)(.-)), hydrogen peroxide (H(2)O(2)), hypochlorous acid (HOCl) and hydroxyl radical (HO.) were evaluated. Action of AEMK on cellular generation of superoxide anion was also tested in a physiopathology model of oxidative burst using human polymorphonuclear neutrophils (PMNs) stimulated by phorbol myristate acetate. The results showed that Microdesmis keayana roots had significant hypotensive and vasorelaxing properties. These properties are due to both antioxidant activities and stimulation of eNOS mRNA expression. Therefore, AEMK stimulated indirectly NO production in the vascular bed.

The essential oil of Lippia alba: analysis of samples from French overseas departments and review of previous works.

This paper contains new data on the chemical composition of the essential oil of Lippia alba (Mill.) N. E. Brown, as well as an overview of the available literature. Although the composition of the essential oil of this species is well-documented, discrepancies between the reported results suggest that many chemotypes and morphotypes exist. The analysis of essential oils obtained from the leaves of samples from three different locations in the French Overseas Departments (French Guiana, Martinique, and two different places in Guadeloupe) have shown that the composition of each one is quite different. This new data, along with a review and discussion of published studies, enabled us to establish seven distinct chemotypes. Possible connections between these chemotypes and morphotypes already described were also investigated.

N1,N5,N10-Tris(4-hydroxycinnamoyl)spermidines from Microdesmis keayana roots.

Three new N1,N5,N10-tris(4-hydroxycinnamoyl)spermidines were isolated from a methanolic root extract of Microdesmis keayana. They were identified as N5,N10-di(p-coumaroyl)-N1-feruloylspermidine,N5-(p-coumaroyl)-N1,N10-diferuloylspermidine, and N1,N5,N10-triferuloylspermidine, and were named keayanidines A, B, and C (1-3), respectively. Their structures were established by spectral techniques(electrospray mass spectrometry, one- and two-dimensional NMR). A 4',4'',4'''-trimethylated derivative was prepared by methylation of keayanidine C, and the same compound was synthesized fromspermidine and 3,4-dimethoxycinnamic acid to confirm the spectral attributions of the NMR data of the natural compounds. Radical-scavenging properties of all compounds were evaluated by 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical spectrophotometric assay.

Natural phenylpropanoids inhibit lipoprotein-induced endothelin-1 secretion by endothelial cells.

There is increasing evidence that oxidized low-density lipoproteins (Ox-LDL) might be involved in the pathogenesis of atherosclerosis and it has been reported that polyphenols inhibit LDL peroxidation and atherosclerosis. Endothelin-1 (ET-1) is a potent vasoconstrictor peptide isolated from endothelial cells and it induces smooth muscle cell proliferation. ET-1 secretion is increased in atheroma and induces deleterious effects such as vasospasm and atherosclerosis. The goal of this study was to test the effect of four natural phenolic compounds against copper-oxidized LDL (Cu-LDL)-induced ET-1 liberation by bovine aortic endothelial cells (BAEC). The tested compounds were phenylpropanoid glycosides previously isolated from the aerial parts of Marrubium vulgare L. (acteoside 1, forsythoside B 2, arenarioside 3 and ballotetroside 4). ET-1 secretion increased when cells were incubated with Cu-LDL but the compounds 1-4 inhibited this increase. These results were confirmed by quantitative-polymerase chain reaction (QPCR) analysis. Since ET-1 plays an important role in atherosclerosis development, our work suggests that the tested phenylpropanoids could have a beneficial effect in inhibiting atherosclerosis development.

Isolation and pharmacological activity of phenylpropanoid esters from Marrubium vulgare.

The isolation and identification of major phenylpropanoid esters from Marrubium vulgare: (+) (E)-caffeoyl-L-malic acid 1, acteoside 2, forsythoside B 3, arenarioside 4, ballotetroside 5, as well as their anti-inflammatory activity are reported for the first time. We evaluated the inhibitory effects of these five compounds on cyclooxygenase (Cox) catalysed prostaglandin biosynthesis activity. Only the glycosidic phenylpropanoid esters showed an inhibitory activity towards the Cox-2 enzyme and three of them: acteoside 2, forsythoside B 3, arenarioside 4, exhibited higher inhibitory potencies on Cox-2 than on Cox-1. These results are of interest, as Cox-2 is mainly associated with inflammation and the Cox-1 inhibition with adverse side effects often observed with non-steroidal anti-inflammatory drugs. The occurrence of these phenylpropanoid esters could also explain some other pharmacological properties of M. vulgare.

Effects of a caffeine-free Cola nitida nuts extract on elastase/alpha-1-proteinase inhibitor balance.

In an infection, polymorphonuclear neutrophils (PMN) become activated and they produce oxidizing compounds and elastase in the extracellular medium. Alpha-1-proteinase inhibitor (alpha1PI), a protease inhibitor which is inactivated by oxidants, is the main endogenous inhibitor of elastase helping to limit excessive elastase activity. This study evaluates the ability of a plant extract, Cola nitida nuts, to protect alpha1PI from inactivation by oxidizing compounds as reactive oxygen species. On the one hand, we have evaluated the direct effect of cola nut extract on neutrophil elastase, and on the H(2)O(2) and myeloperoxidase (MPO)-H(2)O(2) system via cell-free systems. Results showed that cola nut extract scavenges H(2)O(2) and therefore protects alpha1PI from HOCl which is produced from the MPO-H(2)O(2) system. Experiments also showed that cola extract has the capacity to limit elastase activity. On the other hand, we have worked on cellular systems including isolated PMN with the aim to study the effect of cola extract on PMN metabolism. PMN were stimulated with PMA, calcium ionophore or fMLP. Each stimulant possesses its own stimulation pathway. According to the inhibitory concentration obtained at 50%, the results on cellular systems led to the conclusion that cola extract can reduce elastase liberation from PMN. It can then be concluded that cola nut extract can protect alpha1PI from inactivation, and has an effect both on elastase liberation and elastase activity. The cola nut extract effect is rather biased towards a reduction in elastase release, thus limiting the injurious effects caused by this enzyme.

Long-Term (1-Year) Safety and Efficacy of a Single 6-mL Injection of Hylan G-F 20 in Indian Patients with Symptomatic Knee Osteoarthritis.

INTRODUCTION: The prevalence of symptomatic knee osteoarthritis (OA) among Asians ≥65 years is estimated to double by 2040. This study was designed to evaluate the safety and efficacy of a single, 6-mL intra-articular injection of hylan G-F 20 in Indian patients with knee OA at 26 weeks through to 52 weeks. METHODS: This study was an open-label, multicentre, phase 4 clinical trial. Enrolled patients (N=394) were ≥30 years old with Kellgren-Lawrence grade 1-3 OA; all patients received hylan G-F 20. WOMAC, SF-12, PTGA, and COGA scores, and OA medication use were evaluated at weeks 1, 4, 12, 26, 39, and 52 (initial treatment phase). At 26, 39, or 52 weeks, eligible patients could participate in a repeat treatment phase. McNemar-Bowkers, paired t-tests and ANOVA analyses were performed (alpha=0.05). RESULTS: At 26 weeks, statistically significant changes from baseline were observed in all efficacy parameters, including the primary efficacy endpoint of WOMAC A1 (p<0.0001). Improvements continued for 52 weeks. No significant changes occurred in concomitant medication use. Eleven patients (2.8%) were re-injected at week 26 or 52. After repeat injection, statistically significant decreases were observed in WOMAC A1, WOMAC C and PTGA scores (p≤0.028). Twenty-three (5.8%) patients reported 26 local target knee AEs. CONCLUSION: Among Indian patients within this study, a 6-mL hylan G-F 20 injection was well tolerated and effective in treating symptomatic knee OA with significant long-term (1 year) improvement of outcomes. When needed, repeat treatment was safe and efficacious for 4 weeks. TRIAL REGISTRATION: Clinical Trial Registry of India (CTRI/2010/091/000052) www.ctri.nic.in/Clinicaltrials/login.php.