Antiangiogenic effect of sulindac sulfide could be secondary to induction of apoptosis and cell cycle arrest.

BACKGROUND: The development of colon cancer is probably angiogenesis-dependent. Recently, sulindac sulfide was shown to possess anti-angiogenic activity. In the present work, the question of whether this activity reflects a specific interaction with angiogenesis or is secondary to the effect of sulindac sulfide on the survival of endothelial cells was addressed. MATERIALS AND METHODS: Endothelial and normal mouse fibroblast cell lines were incubated with non-steroidal anti-inflammatory drugs (NSAIDs), arachidonic acid (AA) and prostaglandin E2 (PGE2). Cell viability (survival), PGE2 synthesis, cell cycle and apoptosis were measured. Western blotting and semi-quantitative RT-PCR multiplex methods verified the changes in the levels of pro-apoptotic proteins and their expressions, respectively. RESULTS: Sulindac sulfide and celecoxib inhibited the survival of endothelial cells, whereas other NSAIDs were ineffective. In contrast to celecoxib, sulindac sulfide did not affect the survival of normal fibroblast cells. Both agents inhibited the production of PGE2 from AA and arrested the cell cycle in the S-phase. Moreover, sulindac sulfide activated caspases 3 and 8, decreased the levels of Bax and Bid proteins, caused cleavage of PARP and increased the expressions of the bax and caspase 3 genes. CONCLUSION: The results suggest that the anti-angiogenic activity of sulindac sulfide is secondary to the inhibition of endothelial cell survival resulting from cell cycle arrest and apoptosis.

Evaluation of drug toxicity in clinical trials.

An increasing number of drugs removed from the market because of unacceptable toxicity raises concerns regarding pre-approval testing of drug safety. In the present paper it is postulated that the non-inferiority type of trial should be abandoned in favor of the superiority trial with active controls and less stringent (p<0.1, both for efficacy and toxicity) statistics. This approach will increase sensitivity of detection of drug-induced adverse effects at the expense of increasing false positive results regarding the difference in efficacy between the tested and reference drug. Such a move will increase the protection of future patients. In addition, the proposed design is far more acceptable from the clinical (e.g. no need to specify the statistically expected "unimportant" number of deaths) and ethical points of view, as well as being favored by the strong incentive of involved parties. In the second part of this paper arguments are presented in favor of the hypothesis that placebo (still used in some superiority trials) does not induce adverse effects. The assertion that placebo may induce adverse effects is probably biased by the nature of the clinical experiment. Such a conclusion is supported by studies indicating that placebo-induced adverse effects are disease -- and treatment -- specific. The modification of clinical trials according to the proposed changes may increase the trials' sensitivity at detecting adverse effects of drugs.

Bioequivalence of two preparations of ticlopidine evaluated using a pharmacodynamic end point.

OBJECTIVE: To evaluate the bio-equivalence of 2 ticlopidine preparations, 250 mg Iclopid tablets (Pabianickie Zaklady Farmaceutyczne, Polfa, Poland; test formulation) and 250 mg Ticlid tablets (Sanofi, France; reference formulation) using a pharmacodynamic end point, i.e the platelet aggregation test ex vivo. SUBJECTS, MATERIALS AND METHODS: The study was open, randomized, multiple-dose, two-period, crossover with a four-week washout interval. Volunteers were screened for sensitivity towards the platelet aggregation (ex vivo) effect of ADP (30 micromol/l) and sensitivity to the antiplatelet activity of ticlopidine (250 mg daily, for 3 consecutive days). Only those responding to 30 micromol/l of ADP with aggregation in the range of 40 - 75% of control (0.9% NaCI), and those responding to ticlopidine within 40 - 75% of inhibition of platelet aggregation to ADP ex vivo were randomized to the study. The dose of ticlopidine in each phase was 250 mg daily for four days. Blood samples were taken on Day 0 and Days 2, 4 (last day of ticlopidine administration), 5, 6, 9, 11 and 16 in order to follow platelet recovery. The pharmacodynamic parameter measured was expressed as the percentage inhibition of ex vivo platelet aggregation calculated from the number of platelets in the sample of whole blood remaining after ADP (30 micromol/l) compared to the control sample. The following values were calculated: area under the inhibition curve of platelet aggregation (AUC(inh 1-16)), maximal inhibition of platelet aggregation (Max(inh)) and time at which maximal inhibition of aggregation occurred (T(max inh)). RESULTS: The ratios (90% confidence intervals) of Iclopid/Ticlid for AUC(inh 1-16), Max(inh), and T(max inh) were: 1.008 (0.973 - 1.044), 1.009 (0.991 - 1.028) and 1.015 (0.988 - 1.043), respectively, satisfying the bioequivalence criteria. CONCLUSIONS: The test and the reference products are bioequivalent on the basis of the ex vivo platelet aggregation test. Our study has shown that the bioequivalence of two different preparations can be assessed by measuring a pharmacodynamic end point in a suitably selected group of subjects.

Anti-angiogenic and apoptotic effects of metabolites of sulindac on chick embryo chorioallantoic membrane.

Sulindac and other nonsteroidal anti-inflammatory drugs (NSAIDs), in addition to anti-inflammatory properties, express preventive activity against colon cancer. This antineoplastic effect may result from the suppression of polyp development in patients with familial adenomatous polyposis. However, despite intense investigations the exact mechanism for sulindac protective effect is not fully elucidated. Angiogenesis, the process of new blood vessel formation, is required to support tumor growth and may be partially involved in the transformation of polyps into tumor. Therefore, we tested the hypothesis whether sulindac might inhibit angiogenesis. The effects of sulindac metabolites, sulindac sulfide and sulindac sulfone, on vascular development were evaluated using the chick embryo chorioallantoic membrane (CAM) assay in vivo. The angiogenic response was quantitated by several methods including direct stereomicroscopic observation, measurements of hemoglobin content and DNA synthesis whereas quantitation of apoptosis was based on determinations of caspase-3 activity, caspase-3 and bax protein expression, and nuclear DNA fragmentation. Our results indicated that both sulindac metabolites were equally effective in inhibition of new blood vessel formation in CAM during chick embryo development. Moreover, both metabolites of sulindac induced the process of apoptosis parallelly to the inhibition of angiogenesis.

The efficacy and potency of antiplatelet activity of ticlopidine is increased by aspirin.

Concomitant therapy with ticlopidine (T) and aspirin (ASA) profoundly increases spectrum of antiplatelet activities of both drugs. It was hypothesized that in addition to increased spectrum of activity (efficacy) each drug may potentiate the specific antiplatelet activity (potency) of the other. In 32 volunteers whole blood platelet aggregation (PA) in response to ADP, collagen, and arachidonic acid was evaluated ex vivo following 10-day treatments with normal or subthreshold doses of T or ASA with addition of second drug on the 5th day of administration of the first. PA was measured before, on day 5 and 10 of treatment. The results indicate that ASA increased spectrum of activity of T, i.e. T and ASA in combination, were significantly more effective against collagen-induced PA than either drug alone. This increased efficacy was retained when subthreshold dose of T (100 mg, qd) was used. T was without effect on AA-induced and ASA on ADP-induced PA. However, ASA potentiated effect of T on ADP-induced PA; the subthreshold dose of T (100 mg, qd) in presence of ASA (100 mg, qd) exerted powerful inhibition. Thus, combination therapy increases both efficacy and potency of T allowing for reduction of the dose.

Pharmacodynamics of ticlopidine: relation between dose and time of administration to platelet inhibition.

In spite of long clinical experience with ticlopidine (T) knowledge of its pharmacodynamics is limited. In this study relation between dose and time of administration of T to platelet inhibition was investigated in 62 healthy volunteers ex vivo in whole blood and platelet rich plasma. Gender-related sensitivity of platelets to ticlopidine was also evaluated. Inhibition of ADP-induced platelet aggregation by T, 500 mg, daily, was almost identical in both sexes. 100 mg daily did not inhibit ADP-induced platelet aggregation even after 14 days of administration. 250 mg daily induced strong inhibition on day 5 of administration comparable to the inhibition obtained with 500 mg daily dose. The antiplatelet (ADP) effect of T (500 mg, daily) was present on day 2-3 and full inhibitory effect on day 4 of administration. T1/2 of antiplatelet (ADP) activity of T was 5.3 days and full recovery of platelets activity 11-13 days. No rebound phenomenon was present. T (regardless the dose) inhibited platelet aggregation induced by small but not high concentrations of collagen and was without effect on arachidonic acid-induced platelet aggregation. Therefore, T is not suitable for treatment of acute event, 250 mg daily dose should be used especially for combination with other drugs and 11 days washout interval seems necessary to change the treatment or to perform surgery.

Reproducibility of isoproterenol tilt-table tests in patients with syncope.

To assess the reproducibility of head-up tilt-table testing 46 patients each underwent 2 isoproterenol tilt-table tests 1 to 6 weeks apart. Of 20 patients with an initially asymptomatic negative test result, 17 (85%) had a second negative test result. Of 20 patients whose initial test ended in syncope, 18 had a second test ending in syncope (n = 12) or presyncope (n = 6). Five of 6 patients whose first test ended in presyncope had a second test that ended in presyncope, and 1 had a second test that was asymptomatic. Finally, a total of 14 patients had at least 1 test (either the first or second) ending in presyncope, and 11 of these (79%) had another test ending in presyncope or syncope. The dose-dependence of isoproterenol was irreproducible. The reproducibility of the duration of head-up tilt necessary to elicit symptoms of presyncope or syncope was determined in the 23 patients who had these symptoms on both tests. Symptoms developed monoexponentially with duration of head-up tilt with half-times of 1.4 to 2.6 minutes, but these times did not correlate significantly between tests. In a selected subgroup of 12 patients who developed syncope in the first test and either presyncope or syncope in the second test during administration of isoproterenol (5 micrograms/min), the time of onset of presyncope correlated well (r = 0.73, p = 0.007) as did that of syncope (r = 0.86, p = 0.012). Finally, hemodynamic changes during symptoms were compared between the 2 tests.(ABSTRACT TRUNCATED AT 250 WORDS)

Spontaneous platelet aggregation, tourniquet ischaemia, and aspirin in survivors of myocardial infarction.

Platelet number, plasma beta-thromboglobulin (beta-TG), spontaneous platelet aggregation (SPA), serum thromboxane B(2) (TXB(2)), and 6-keto-PGF(101) were assessed in 9 males with proven atherosclerosis (survivors of myocardial infarction, (MI) in a stable condition) and compared with values for 9 young, healthy controls. Results were obtained before and after 3-day treatment with aspirin. In addition, SPA was assessed before and after a tourniquet test. MI survivors had higher beta-TG (p < 0.01) and SPA values (p < 0.05), and a lower platelet count (p < 0.05) than controls. Aspirin significantly attentuated all these changes. These data suggest that platelet function is increased in survivors of MI. Tourniquet-induced ischaemia significantly (p < 0.05) enhanced SPA in MI survivors but not in controls. Aspirin did not inhibit SPA following ischaemia in contrast to its effect under pre-ischaemic conditions or in controls. It seems that the proaggregatory threshold is decreased in MI survivors. The results challenge the assumption that an acute coronary event with underlying atherosclerosis is due to an interaction between atherosclerosis plaque and normal platelets.

Simple and rapid isolation of platelets using Ficoll-Uropoline cushion.

A simplified procedure for separation of human platelets from plasma proteins when a small volume of blood is available has been developed. In this method two centrifugations of platelets layered on Ficoll-Uropoline cushion was applied. In the first step, platelet rich plasma layered over Ficoll-Uropoline solution was centrifuged (700 g, 30 min), bounded platelets recovered with the help of HEPES buffer, and centrifuged again (1000 g, 10 min) on Ficoll-Uropoline cushion. This rapid and simple procedure yielded platelets separated from von Willebrand factor, fibrinogen and albumin, as judged by bioassay and measurement of radiolabeled plasma proteins. The obtained preparation of platelets was stable and the platelet function preserved for 3 h as evidenced by platelet aggregation and fibrinogen binding analysis. The procedure is inexpensive and convenient for small volumes of blood.

Effects of taurine depletion on intrinsic contractility of rat ventricular papillary muscles.

Contractile parameters in Krebs-Henseleit media containing various calcium concentrations were compared in left ventricular papillary muscles of two groups of rats: control and taurine depleted. All tests were carried out with the muscles at initial length, Lmax, the length that produced maximal active tension. From measurements of after- and un-loaded contractions, the velocity-tension curves and the derived maximum velocity of shortening were not different between the groups. Time to peak shortening and extent of shortening were not altered, while relaxation times and contraction duration were significantly prolonged for taurine-depleted muscles. Peak isometric tension and its rate of development were significantly reduced in taurine-depleted muscles compared with controls. Postrest (3 min) stimuli and paired stimuli (200-ms interval) evoked similar potentiated contractile responses in both groups, such that the ratio of their peak tensions remained unchanged. For taurine-depleted muscles the force-frequency relationship (a negative staircase) was parallel to, but lower than, control. These experiments suggest that taurine deficiency leads to reductions in action potential triggered calcium release from internal stores, and deficits in calcium sequestration. This may result from disfacilitation of calcium binding to the sarcoplasmic reticulum and other storage sites during taurine deficiency.

Plasma beta-thromboglobulin in acute myocardial infarction with ventricular arrhythmias.

Patients with myocardial infarction, complicated by ventricular arrhythmias (Lown grade greater than or equal to 2), had higher (p less than 0.05) plasma beta-thromboglobulin level than that found in patients with uncomplicated infarction. This indicates higher platelet activation in the former group than in the latter. Such data provide rationale for clinical trial of antiplatelet drugs in cases of myocardial infarction complicated by severe arrhythmias.

Angiogenic activity and neovascularization in adenocarcinoma of endometrium.

Angiogenic activity of adenocarcinoma of endometrium was evaluated by qualitative and quantitative assays that measure vessel growth in chorioallantoic membrane (CAM) of chick embryo and incorporation of [3H] thymidine to DNA of CAM, respectively. In addition, histological specimens of adenocarcinoma with the vascular system filled with contrasting medium, were examined for the presence of neovascularization. Both qualitative and quantitative assays on CAM indicated that adenocarcinoma of endometrium possessed angiogenic activity. Histological analysis suggested that neovascularization took place during development of adenocarcinoma. It is therefore possible that neovascularization in this tumor is stimulated by its angiogenic activity.

Angiogenesis: quantitative assessment by the chick chorioallantoic membrane assay.

The aim of the present work was to improve quantitative assessment of angiogenesis by chick chorioallantoic membrane (CAM) assay based on measurement of DNA synthesis. Following incubation of [3H]thymidine (3H-T) with CAM in vivo, incorporation of 3H-T to DNA fraction was expressed as percent of total 3H-T present in the initial homogenate of CAM, regardless of CAM weight and full recovery of applied radioactivity. The assay required simple, partial isolation of DNA to remove traces of free or unspecifically bound 3H-T. These modifications gave a reproducible assay with adequate precision (10-20%). DNA content of CAM did not change between 10-15 days of embryo development and growth of CAM was completed on day 11. 10 to 12-day old CAMs were used for evaluation of the assay. Using a qualitative approach (visual scoring), tissues of several tumors were implanted on CAM. Extracts of tumors that produced the highest score stimulated DNA synthesis in CAM. A similar effect was induced by EGF while cytostatics inhibited DNA synthesis in CAM. Since stimulation of angiogenesis is not a cell type-specific phenomenon, the assay in the present modification should aid the studies on angiogenic factors. With the help of this assay the angiogenic activity of adenocarcinoma of human endometrium was described.

Effects of inhibition of thromboxane A2 synthesis in aspirin-induced asthma.

Since inhibition of cyclooxygenase precipitates asthmatic attacks in patients with aspirin idiosyncrasy, we have evaluated the effects of pharmacologic inhibition of thromboxane A2 (TXA2) synthetase, next to cyclooxygenase enzyme in arachidonic acid cascade. Sixteen patients with aspirin-induced asthma received increasing doses on 3 days (25 to 400 mg) of an imidazole derivative, OKY-046, which specifically blocks TXA2 synthetase. Twenty-three healthy control subjects received a single dose of 400 mg of OKY-046. In both patients and control subjects, the inhibitor at a dose of 400 mg produced (1) a pronounced fall in thromboxane B2 serum levels, (2) a rise in serum 6-keto-prostaglandin F1 alpha, and (3) a depression in platelet aggregability to arachidonic acid and adenosine diphosphate. The drug, however, neither precipitated attacks of asthma nor impaired pulmonary function tests throughout a 24-hour observation period. Five patients, but none of the control subjects, developed transient nasal congestion about 1 hour after taking the drug. Thus, inhibition of TXA2 synthetase, contrary to inhibition of cyclooxygenase, does not affect bronchopulmonary function in patients with asthma and aspirin intolerance.

Formation of prostacyclin-sensitive platelet aggregates in human whole blood in vitro. Part II. The occurrence of the phenomenon in males suffering from acute myocardial infarction.

The de-aggregatory effect of prostacyclin (PGI2) and the rate of spontaneous platelet aggregation (SPA) were studied in vitro in whole blood of 24 males with acute myocardial infarction (MI) and 18 males, patient controls (PC). The de-aggregatory effect of PGI2 and the rate of SPA (measured as a percentage of changes in free platelet number in whole blood) were higher (p less than 0.01) in MI than PC. The de-aggregatory effect of PGI2 in whole blood was higher (p less than 0.05) on the first day of MI than on day 14 following MI. The highest de-aggregatory effect of PGI2 was found in whole blood of patients with MI complicated by ventricular fibrillation. In neither of the groups did the de-aggregatory effect of PGI2 correlate with patients' age, haematocrit, erythrocyte and leucocyte counts, triglycerides, HDL, LDL or total cholesterol levels. In the MI group, de-aggregatory effect of PGI2 was correlated with free platelet concentration (r = -0.59, p less than 0.05), elevation of glutamic oxalacetic transaminase (r = 0.53, p less than 0.05) and creatinine phosphokinase (r = 0.69, p less than 0.001). The de-aggregatory effect of PGI2 in blood of patients with evolving MI did not differ from that in PC. It is concluded that the increased rate of SPA and formation of PGI2-sensitive platelet aggregates in vitro in whole blood of MI patients are secondary to myocardial necrosis.

Formation of prostacyclin-sensitive platelet aggregates in human whole blood in vitro. Part I. The occurrence of the phenomenon in healthy male volunteers.

When unstirred citrated blood of young males was left to stand at 21 degrees C, the number of free platelets decreased as measured with a whole blood platelet counter. This decrease indicated spontaneous platelet aggregation (SPA) since it was accompanied by the time-dependent increase in platelet micro-aggregates and plasma beta-thromboglobulin while lactate dehydrogenase level did not change significantly. Addition of PGI2 to whole blood increased free platelet count and decreased the number of platelet micro-aggregates. The de-aggregatory effect of PGI2 (measured as a percentage increase in free platelet number) was correlated with the initial amount of platelet micro-aggregates. Blood storage enhanced SPA and de-aggregatory effect of prostacyclin. Immediately after blood collection de-aggregatory effect of prostacyclin was absent. Our results favour an assumption that prostacyclin-sensitive platelet aggregates in blood of young volunteers are formed in vitro rather than in vivo.