阿托伐他汀和匹格列酮对心血管高危人群的影响

目的探讨单独应用阿托伐他汀与联合应用阿托伐他汀和匹格列酮对高危心血管人群颈动脉内膜中层厚度（CIMT）、高敏C反应蛋白（hs-CRP）、基质金属蛋白酶-9（MMP-9）、脂联素及脂质状况的影响。方法90名有心血管危险因素的患者被随机分为两组：单独应用阿托伐他汀治疗组、联合应用阿托伐他汀和匹格列酮治疗组,分别检测两组患者治疗前及治疗六个月后的CIMT、hs-CRP、脂联素、MMP-9的血浆水平及检测血脂水平。结果单独应用阿托伐他汀及联合应用阿托伐他汀和匹格列酮均显示CIMT的显著降低（P〈0.001）,无组间差异（P〉0.05）。两组的MMP-9在治疗后均较治疗前降低,有统计学意义（P〈0.05）,但组间无统计学差异（P〉0.05）。两组对h-CRP、脂联素及血脂水平均有有意义的影响,组间有统计学差异,联合用药组提示影响更显著（P〈0.05）。联合用药组血浆脂联素水平明显升高而单独应用阿托伐他汀组未被观察到。结论阿托伐他汀明显改善CIMT,联合应用阿托伐他汀和匹格列酮对脂质状况和炎症因子有额外的影响。     

Comparison of glycaemic control over 1 year with pioglitazone or gliclazide in patients with Type 2 diabetes.

AIMS: To compare long-term (1 year) efficacy and safety of pioglitazone and gliclazide in patients with Type 2 diabetes. METHODS: This was a double-blind, multicentre, comparative, parallel group trial in 283 patients with Type 2 diabetes, who were randomized to receive 1-year treatment with pioglitazone 30-45 mg/day or gliclazide 80-320 mg/day. Drug dose was titrated on the basis of self-monitored blood glucose (SMBG) measurements and HbA1c values. The 1-year changes in HbA1c, fasting blood glucose (FBG), insulin, HOMA-S (HOmeostatic Model Assessment) and SMBG were compared. In a subgroup of patients (n = 10), systemic glucose production and utilization were determined by a combination of isotopic (deuterated glucose) and clamp techniques. RESULTS: In both groups, there were similar decreases in HbA1c (pioglitazone: -0.79%; gliclazide: -0.79%) and FBG (pioglitazone: -1.0 mmol/l; gliclazide: -0.7 mmol/l), whereas the slope of the reduction of fasting blood glucose was different between groups (P = 0.004). Insulin levels as well as insulin resistance assessed using HOMA-S decreased significantly only after pioglitazone treatment (-11.94 pmol/l and -1.03, respectively, both P = 0.002 vs. baseline). A significantly greater reduction in systemic glucose production was observed in the pioglitazone group (-2.48 micromol/kg/min, P = 0.042) than in the gliclazide group (-1.02 micromol/kg/min). A few, mild adverse events occurred in both groups. CONCLUSIONS: A comparable decrease in HbA1c and FBG was observed with pioglitazone and gliclazide. However, with pioglitazone there was a continuous decrease in FBG over 1 year, whereas gliclazide failed to maintain a similar trend. This favourable effect of pioglitazone was due to its insulin-sensitizing effect and ability to decrease systemic glucose production.     

吡格列酮治疗2型糖尿病疗效观察

目的　观察吡格列酮治疗 2型糖尿病的临床疗效。 方法　 采取随机双盲对照临床研究 ,在应用吡格列酮治疗前及用药后第 12周分别进行空腹血糖、糖化血红蛋白的监测 ,同时检测血常规、肝功能、肾功能、血脂、血压。 结果　吡格列酮组空腹血糖 ,糖化血红蛋白在用药后显著下降 (P <0 .0 1) ,对肝功能、肾功能、凝血功能无影响 ,也未发生过敏反应 ,疗效吡格列酮组显著优于安慰剂组。 结论　吡格列酮能提高胰岛素敏感性 ,显著降低 2型糖尿病空腹血糖及糖化血红蛋白 ,是治疗 2型糖尿病的一种新型降血糖药。     

人血浆中吡格列酮的固相萃取高效液相色谱法测定

以吡格列酮的同系物 PIOGA为内标 ,采用 C2 固相萃取紫外检测的 HPL C分析法测定人血浆中吡格列酮的浓度。 C1 8分析柱 (15 0× 4.6 mm,5 μm) ,流动相 :水 -乙腈 -冰醋酸 (5 40∶ 46 0∶ 1.2 ,用氨试液调至 p H6 .0 ) ,流速 :1.0 ml/ min,检测波长 2 6 9nm。取血样 0 .5 m l,加入内标经 C2 固相萃取后进样 40μl。最低定量限 (L OQ)为10 ng/ ml,线性范围为 10～ 16 0 0 ng/ ml     

吡格列酮抑制人胶质瘤SNB19细胞生长及诱导其凋亡

目的 探讨吡格列酮(PGZ)对人神经胶质瘤细胞株SNB19增殖和凋亡的影响及其机制。方法 用MTT、流式细胞仪、Tunel和Western blot分析技术。结果 吡格列酮能够抑制SNB19细胞增殖和诱导其凋亡,同时伴有Bax表达的增高和pRb、Bcl-2表达的降低。结论 PGZ能够在体外抑制胶质瘤SNB19细胞的生长并诱导其凋亡,提示PGZ有可能成为一种新的治疗胶质瘤药物。     

高糖环境中吡格列酮对MC3T3-E1成骨细胞的作用及其机制

目的观察高糖环境下吡格列酮对MC3T3-E1成骨细胞的作用并探讨其可能机制。方法高糖(22.5 mmol·L~(-1))环境培养MC3T3-E1细胞,分为对照组,吡格列酮2.5、5、10μmol·L~(-1)组,干预24、48 h。检测细胞增殖活性、凋亡率、骨钙素和碱性磷酸酶(ALP)分泌水平,以及过氧化物酶体增殖物激活受体γ(PPARγ)、成骨因子runt相关基因2(Runx2)和骨形态蛋白2(BMP-2)mRNA的表达水平。并分析PPARγ、Runx2的表达与骨钙素、ALP、BMP-2的相关性。结果在相同干预时限,吡格列酮各组MC3T3-E1成骨细胞增殖活性、骨钙素和ALP的分泌水平、Runx2 mRNA和BMP-2 mRNA的表达均低于对照组,凋亡率和PPARγmRNA的表达高于对照组(P<0.05)。随吡格列酮浓度增加,细胞增殖活性、骨钙素和ALP的分泌、Runx2 mRNA和BMP-2 mRNA的表达均降低,而细胞凋亡率和PPARγmRNA的表达增高(P<0.05)。与干预24 h相比,干预48 h时相同浓度吡格列酮组细胞增殖活性,骨钙素和ALP的分泌水平,PPARγ、Runx2、BMP-2 mRNA的表达或无变化或略增加。结论高糖环境下吡格列酮对成骨细胞有损害作用,促进PPARγ表达、抑制Runx2的表达可能为其作用机制之一。     

盐酸吡格列酮胶囊的人体相对生物利用度

目的:评价盐酸吡格列酮胶囊的人体生物等效性.方法:18名男性健康志愿者随机交叉口服受试制剂盐酸吡格列酮胶囊和参比制剂盐酸吡格列酮片30 mg,采用反相高效液相色谱-紫外检测法测定血浆药物浓度.结果:受试制剂和参比制剂的Tmax分别为(1.9±0.5),(2.1±0.6)h;Cmax分别为(1 480.0±234.9),(1 436.5±206.4)μg·L-1;t1/2β分别为(6.0±1.4),(6.4±1.4)h;AUC0→24分别为(8 893.6±1979.9),(8893.2±1913.8)μg·L-1·h;AUC0→∞.分别为(9 706.4±2 394.5),(9928.3±2512.4)μg·L-1·h,盐酸吡格列酮胶囊的相对生物利用度为(101.4±17.5)%.结论:经统计学分析,盐酸吡格列酮胶囊与盐酸吡格列酮片具有生物等效性.     

盐酸吡格列酮对鼠心脏成纤维细胞增殖的影响

目的 观察胰岛素增敏剂盐酸吡格列酮(PIO)对Wistar大鼠心脏成纤维细胞(CFs)增殖的抑制作用,探讨其与一氧化氮合酶-一氧化氮(NOS-NO)系统活性的关系.方法 采用胶原酶消化法培养Wistar大鼠的CFs、四氮唑蓝(MTT)比色法测定CFs的增殖情况、硝酸还原酶法测定CFs培养上清NO含量、分光光度计法测定CFs培养上清NOS活性.结果 CFs吸光值(A490值)随PIO干预浓度增加和作用时间延长而减低,呈浓度和时间依赖性;5×10-6 mol/L的PIO干预48 h后,CFs培养上清NO含量(221.7±35.3) μmol/L和NOS活性(15.38±1.82) U/mL高于对照组[(112.1±8.9 μmol/L)和(11.24±0.49) U/mL](P＜0.01).结论 PIO能够抑制大鼠CFs的增殖,具有浓度和时间依赖性,其效应可能是通过上调NOS-NO系统的活性来实现的.     

Thiazolidinediones under preclinical and early clinical development for the treatment of Parkinson’s disease

Introduction: Current treatment of Parkinson’s disease (PD) is limited to symptomatic dopaminergic therapy, while no interventions have been shown to slow down disease progression.

Areas covered: The following article highlights a group of PPAR-γ agonists called thiazolidinediones (TZDs), which are currently being tested for a putative disease-modifying benefit in PD, using pioglitazone as a prototypic compound. PPAR-γ is highly expressed in neurons of the substantia nigra and CNS immune cells. Preclinical data in rodent and primate support an effect of TZDs in preventing and/or arresting neurodegeneration and development of motor symptoms. Although no data on the neuroprotective effect of TZDs is currently available, a clinical trial is ongoing where the primary objective is to assess pioglitazone’s impact on the progression of PD. The trial is also evaluating the drug’s safety concerns.

Expert opinion: The efficacy data from clinical trials must be carefully weighed against the safety concerns. However, given the solid preclinical data, and since the safety data are not yet fully conclusive and limited to the diabetic population, PPAR-γ research in PD can continue with caution. Ideally, drug discovery and development efforts will lead to the identification of new compounds with reduced risk of peripheral side effects.     

Physiologically based pharmacokinetics model predicts the lack of inhibition by repaglinide on the metabolism of pioglitazone

Purpose: Repaglinide and pioglitazone are both CYP2C8 and CYP3A4 substrates. This study was to determine whether repaglinide has an inhibitory effect on the metabolism of pioglitazone in vitro, in silico and in vivo. Method: In vitro, the effect of repaglinide on the metabolism of pioglitazone was assessed in pooled human liver microsomes. In silico, an IVIVE‐PBPK linked model was built with Simcyp®. Then, a randomized, 2‐phase cross‐over clinical study was conducted in 12 healthy volunteers. Results: Repaglinide showed a strong inhibitory effect on the metabolism of pioglitazone in vitro (K_i = 0.0757 µm ), [I]/K_i > 0.1. The Simcyp® prediction ratios of AUC and C_max between the two treatment groups were both about 1.01. The pharmacokinetics of pioglitazone in clinical trials showed no significant difference between these two treatment groups (p > 0.05). Conclusion: Repaglinide has no significant inhibitory effect on the metabolism of pioglitazone in vivo, which is inconsistent with the in vitro results. The lack of an inhibitory effect was partly due to extensive plasma protein binding and to the high in vivo clearance of repaglinide, for the concentration of repaglinide in vivo was far smaller than in vitro. Copyright © 2015 John Wiley & Sons, Ltd.