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The Alkaloids. Chemistry and Biology 2017Cephalotaxus alkaloids represent a family of plant secondary metabolites known for 60 years. Significant activity against leukemia in mice was demonstrated for extracts... (Review)
Review
Cephalotaxus alkaloids represent a family of plant secondary metabolites known for 60 years. Significant activity against leukemia in mice was demonstrated for extracts of Cephalotaxus. Cephalotaxine (CET) (1), the major alkaloid of this series was isolated from Cephalotaxus drupacea species by Paudler in 1963. The subsequent discovery of promising antitumor activity among new Cephalotaxus derivatives reported by Chinese, Japanese, and American teams triggered extensive structure elucidation and biological studies in this family. The structural feature of this cephalotaxane family relies mainly on its tetracyclic alkaloid backbone, which comprises an azaspiranic 1-azaspiro[4.4]nonane unit (rings C and D) and a benzazepine ring system (rings A and B), which is linked by its C3 alcohol function to a chiral oxygenated side chain by a carboxylic function alpha to a tetrasubstituted carbon center. The botanical distribution of these alkaloids is limited to the Cephalotaxus genus (Cephalotaxaceae). The scope of biological activities of the Cephalotaxus alkaloids is mainly centered on the antileukemic activity of homoharringtonine (HHT) (2), which in particular demonstrated marked benefits in the treatment of orphan myeloid leukemia and was approved as soon as 2009 by European Medicine Agency and by US Food and Drug Administration in 2012. Its exact mechanism of action was partly elucidated and it was early recognized that HHT (2) inhibited protein synthesis at the level of the ribosome machinery. Interestingly, after a latency period of two decades, the topic of Cephalotaxus alkaloids reemerged as a prolific source of new natural structures. To date, more than 70 compounds have been identified and characterized. Synthetic studies also regained attention during the past two decades, and numerous methodologies were developed to access the first semisynthetic HHT (2) of high purity suitable for clinical studies, and then high grade enantiomerically pure CET (1), HHT (2), and analogs.
Topics: Animals; Antineoplastic Agents, Phytogenic; Harringtonines; Humans
PubMed: 28838429
DOI: 10.1016/bs.alkal.2017.07.001 -
Journal of the American College of... Oct 2017The clinical use of ivabradine has and continues to evolve along channels that are predicated on its mechanism of action. It selectively inhibits the funny current (I)... (Review)
Review
The clinical use of ivabradine has and continues to evolve along channels that are predicated on its mechanism of action. It selectively inhibits the funny current (I) in sinoatrial nodal tissue, resulting in a decrease in the rate of diastolic depolarization and, consequently, the heart rate, a mechanism that is distinct from those of other negative chronotropic agents. Thus, it has been evaluated and is used in select patients with systolic heart failure and chronic stable angina without clinically significant adverse effects. Although not approved for other indications, ivabradine has also shown promise in the management of inappropriate sinus tachycardia. Here, the authors review the mechanism of action of ivabradine and salient studies that have led to its current clinical indications and use.
Topics: Benzazepines; Cardiovascular Agents; Cardiovascular Diseases; Cyclic Nucleotide-Gated Cation Channels; Heart Rate; Humans; Ivabradine
PubMed: 28958335
DOI: 10.1016/j.jacc.2017.08.038 -
Circulation Journal : Official Journal... Jun 2022
Topics: Antidiuretic Hormone Receptor Antagonists; Benzazepines; Humans; Tolvaptan
PubMed: 35545552
DOI: 10.1253/circj.CJ-22-0194 -
CMAJ : Canadian Medical Association... Mar 2011
Comparative Study Randomized Controlled Trial
Topics: Adolescent; Age Factors; Benzazepines; Breast Neoplasms; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Female; Humans; Hypertension; Lymph Nodes; Male; Quinoxalines; Risk Assessment; Sentinel Lymph Node Biopsy; Smoking Cessation; Survival Rate; Treatment Outcome; Varenicline
PubMed: 21422142
DOI: 10.1503/cmaj.110333 -
British Journal of Clinical Pharmacology Jan 2012
Topics: Animals; Antidiuretic Hormone Receptor Antagonists; Benzazepines; Humans; Hyponatremia; Inappropriate ADH Syndrome; Tolvaptan
PubMed: 21623874
DOI: 10.1111/j.1365-2125.2011.04029.x -
Cardiovascular Drugs and Therapy Aug 2016Stable angina pectoris affects 2-4 % of the population in Western countries and entails an annual risk of death and nonfatal myocardial infarction of 1-2 % and 3 %,... (Review)
Review
Stable angina pectoris affects 2-4 % of the population in Western countries and entails an annual risk of death and nonfatal myocardial infarction of 1-2 % and 3 %, respectively. Heart rate (HR) is linearly related to myocardial oxygen consumption and coronary blood flow, both at rest and during stress. HR reduction is a key target for the prevention of ischemia/angina and is an important mechanism of action of drugs which are recommended as first line therapy for the treatment of angina in clinical guidelines. However, many patients are often unable to tolerate the doses of beta blocker or non-dihydropyridine calcium antagonists required to achieve the desired symptom control. The selective pacemaker current inhibitor ivabradine was developed as a drug for the management of patients with angina pectoris, through its ability to reduce HR specifically. The available data suggest that ivabradine is a well-tolerated and effective anti-anginal agent and it is recommended as a second-line agent for relief of angina in guidelines. However, recent clinical trials of ivabradine have failed to show prognostic benefit and have raised potential concerns about safety. This article will review the available evidence base for the current role of ivabradine in the management of patients with symptomatic angina pectoris in the context of stable coronary artery disease.
Topics: Angina Pectoris; Benzazepines; Cardiovascular Agents; Drug Interactions; Drug Therapy, Combination; Heart Rate; Humans; Ivabradine
PubMed: 27475447
DOI: 10.1007/s10557-016-6678-x -
Epilepsy Research Sep 2021Recent preclinical and clinical studies suggest that lorcaserin, a preferential serotonin 2C receptor (5-HTR) agonist that was approved for the treatment of obesity,...
Recent preclinical and clinical studies suggest that lorcaserin, a preferential serotonin 2C receptor (5-HTR) agonist that was approved for the treatment of obesity, possesses antiepileptic properties. Here, we tested whether lorcaserin (1, 3, 5.6, 10 mg/kg) is prophylactic against audiogenic seizures (AGSs) in juvenile Fmr1 knockout mice, a mouse model of fragile X syndrome (FXS). MPEP (30 mg/kg), a non-competitive mGluR5 receptor antagonist, was used as a positive control. As lorcaserin likely engages 5-HTRs at therapeutic doses, we pretreated one group of mice with the selective 5-HTR antagonist/inverse agonist, M100907 (0.03 mg/kg), alone or before administering lorcaserin (5.6 mg/kg), to discern putative contributions of 5-HTRs to AGSs. We also assessed lorcaserin's in vitro pharmacology at human (h) and mouse (m) 5-HTRs and 5-HTRs and its in vivo interactions at m5-HTRs and m5-HTRs. MPEP significantly decreased AGS prevalence (P = 0.011) and lethality (P = 0.038). Lorcaserin, 3 mg/kg, attenuated AGS prevalence and lethality by 14 % and 32 %, respectively, however, results were not statistically significant (P = 0.5 and P = 0.06); other doses and M100907 alone or with lorcaserin also did not significantly affect AGSs. Lorcaserin exhibited full efficacy agonist activity at h5-HTRs and m5-HTRs, and near full efficacy agonist activity at h5-HTRs and m5-HTRs; selectivity for activation of 5-HTRs over 5-HTRs was greater for human (38-fold) compared to mouse (13-fold) receptors. Lorcaserin displayed relatively low affinities at antagonist-labeled 5-HTRs and 5-HTRs, regardless of species. Lorcaserin (3 and 5.6 mg/kg) increased the 5-HTR-dependent head-twitch response (HTR) elicited by (±)-2,5-dimethoxy-4-iodoamphetamine (DOI) in mice (P = 0.03 and P = 0.02). At 3 mg/kg, lorcaserin alone did not elicit an HTR. If mice were treated with the selective 5-HTR antagonist SB 242084 (0.5 or 1 mg/kg) plus lorcaserin (3 mg/kg), a significantly increased HTR was observed, relative to vehicle (P = 0.01 and P = 0.03), however, the HTR was much lower than what was elicited by DOI or DOI plus lorcaserin. Lorcaserin, 3 mg/kg, significantly reduced locomotor activity on its own, an effect reversed by SB 242084, and lorcaserin also dose-dependently reduced locomotor activity when administered prior to DOI (Ps<0.002). These data suggest that lorcaserin may engage 5-HTRs as well as 5-HTRs in mice at doses as low as 3 mg/kg. The similar activity at m5-HTRs and m5-HTRs suggests careful dosing of lorcaserin is necessary to selectively engage 5-HTRs in vivo. In conclusion, lorcaserin was ineffective at preventing AGSs in Fmr1 knockout mice. Lorcaserin may not be a suitable pharmacotherapy for seizures in FXS.
Topics: Animals; Anticonvulsants; Benzazepines; Epilepsy, Reflex; Mice; Mice, Knockout
PubMed: 34130255
DOI: 10.1016/j.eplepsyres.2021.106677 -
Medicine Apr 2016Many studies show that ivabradine is effective for stable angina.This meta-analysis was performed to determine the effect of treatment duration and control group type on... (Meta-Analysis)
Meta-Analysis Review
Many studies show that ivabradine is effective for stable angina.This meta-analysis was performed to determine the effect of treatment duration and control group type on ivabradine efficacy in stable angina pectoris.Relevant articles in the English language in the PUBMED and EMBASE databases and related websites were identified by using the search terms "ivabradine," "angina," "randomized controlled trials," and "Iva." The final search date was November 2, 2015.Articles were included if they were published randomized controlled trials that related to ivabradine treatment of stable angina pectoris.Patients with stable angina pectoris were included.The patients were classified according to treatment duration (<3 vs ≥3 months) or type of control group (placebo vs beta-receptor blocker). Angina outcomes were heart rate at rest or peak, exercise duration, and time to angina onset.Seven articles were selected. There were 3747 patients: 2100 and 1647 were in the ivabradine and control groups, respectively. The ivabradine group had significantly longer exercise duration when they had been treated for at least 3 months, but not when treatment time was less than 3 months. Ivabradine significantly improved time to angina onset regardless of treatment duration. Control group type did not influence the effect of exercise duration (significant) or time to angina onset (significant).Compared with beta-blocker and placebo, ivabradine improved exercise duration and time to onset of angina in patients with stable angina. However, its ability to improve exercise duration only became significant after at least 3 months of treatment.
Topics: Angina, Stable; Benzazepines; Cardiovascular Agents; Humans; Ivabradine; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 27057864
DOI: 10.1097/MD.0000000000003245 -
The New England Journal of Medicine Nov 2008A 57-year-old man with a 60-pack-year history visits his primary care provider because he wants to quit smoking. He has a history of stable coronary artery disease,... (Review)
Review
A 57-year-old man with a 60-pack-year history visits his primary care provider because he wants to quit smoking. He has a history of stable coronary artery disease, peripheral vascular disease, and hypertension. He also has severe obstructive lung disease (forced expiratory volume in 1 second, 39% of the predicted value) with a progressive increase in dyspnea. He has quit smoking and has had numerous relapses; the longest duration of abstinence from smoking was 7 months. Each relapse involved casual smoking to “test himself.” During previous attempts to quit, he has used a nicotine patch, a nicotine inhaler, and sustained-release bupropion. He feels motivated to quit smoking because he recently heard about a new medication to aid in quitting, and he wants to improve his health. The patient and his physician discuss the therapeutic options and agree that varenicline (Chantix) may be an option.
Topics: Benzazepines; Brain; Coronary Artery Disease; Humans; Male; Middle Aged; Motivation; Nicotine; Nicotinic Agonists; Practice Guidelines as Topic; Pulmonary Disease, Chronic Obstructive; Quinoxalines; Receptors, Nicotinic; Smoking Cessation; Tobacco Use Disorder; Varenicline
PubMed: 18987369
DOI: 10.1056/NEJMct0800146 -
Clinical Journal of the American... Dec 2020
Topics: Antidiuretic Hormone Receptor Antagonists; Benzazepines; Humans; Polycystic Kidney, Autosomal Dominant; Tolvaptan
PubMed: 33376103
DOI: 10.2215/CJN.17981120