西洛他唑在急性脑梗死患者rt-PA溶栓治疗后的作用及对血清CD62p、CD63、PAF的作用分析

摘要 目的：探讨西洛他唑在急性脑梗死患者重组人组织型纤溶酶原激活物（rt-PA）溶栓治疗后的作用及对血清血小板溶酶体膜蛋白（CD63）、α颗粒膜糖蛋白（CD62p）、血小板活化因子（PAF）的作用分析。方法：选择2020年2月至2022年2月我院接诊的90例急性脑梗死患者,按照随机数表法分为观察组及对照组,各45例。两组均接受rt-PA溶栓治疗,对照组溶栓后使用阿司匹林治疗,观察组在对照组基础上,联合西洛他唑治疗,均连续治疗14 d。比较两组临床疗效、血清CD62p、CD63、PAF、全血粘度、血浆粘度和红细胞比容（HCT）及美国国立卫生院卒中量表（NIHSS）评分、巴氏量表（Barthel指数）评分的变化及出血事件发生率。结果：观察组患者的临床疗效总有效率为91.11%,高于对照组的73.33%,有统计学意义（P＜0.05）;观察组血清CD62p、CD63、PAF均比对照组低,有统计学意义（P＜0.05）;观察组全血粘度、血浆粘度、HCT均比对照组低,有统计学意义（P＜0.05）;观察组的NIHSS评分均低于对照组,Barthel指数高于对照组,有统计学意义（P＜0.05）;两组出血事件总发生率比较,无统计学意义（P＞0.05）。结论：西洛他唑在急性脑梗死患者rt-PA溶栓治疗后的作用明显,可有效降低血清CD62p、CD63、PAF的表达,改善血小板功能,安全性较好,值得临床推广。     

Protective effect of cilostazol against doxorubicin-induced cardiomyopathy in mice

Doxorubicin (Dox) is an effective anti-cancer drug, but its use is limited because of its adverse effect of inducing irreversible dilated cardiomyopathy. Cilostazol (Cilo), a potent phosphodiesterase III inhibitor, has been reported to have an anti-inflammatory effect. Here, we investigated whether Cilo has a protective effect against Dox-induced cardiomyopathy (DIC). Mice were randomly divided into four groups: saline control, Dox (15 mg/kg), Dox (15 mg/kg) plus Cilo (50 mg/kg), and Cilo (50 mg/kg). The results showed that the coadministration of Dox and Cilo significantly enhanced left-ventricular systolic function compared with Dox alone. In addition, Cilo treatment significantly reduced Dox-induced perivascular fibrosis, collagen concentration, and connective growth factor expression in the heart. Also, Cilo administration markedly reduced Dox-induced levels of serum B-type natriuretic peptide, dysferlin, high-mobility group protein B1, Toll-like receptor 4, nuclear factor-κB p65, and cyclooxygenase-2. Furthermore, Cilo treatment significantly reduced Dox-induced oxidative stress by lowering the translocation of Nrf2 into the nucleus and the expression of NQO1, heme oxygenase 1, and superoxide dismutase-1. Our results suggest that Cilo may be a potential antifibrotic, antioxidative, and anti-inflammatory drug for DIC.     

不同剂量西洛他唑强化抗血小板对冠脉支架术后血小板高反应性的影响

目的：观察临床应用不同方案强化抗血小板治疗改善冠脉支架术后血小板高反应性的可行性、安全性及有效性。方法：选择2009年3月至2011年2月在沈阳军区总医院、中国医科大学第一附属医院、解放军第463医共入选560例冠脉支架术后血小板高反应性（HPR Highon-treatment Platelet Reactivity）患者,在给予阿司匹林300mg／天,氯吡格雷150mg／天,3天后HPR仍未缓解者,随机分为两组,一组在强化抗血小板治疗即阿司匹林300mg,氯吡格雷150mg的基础上加用小剂量西洛他唑（50mg,2／日）,另一组在标准两联方案即阿司匹林300mg,氯吡格雷75mg的基础上加用西洛他唑100mg,2／日,3天后测定HPR的缓解情况。结果：大剂量氯吡格雷治疗3天后HRP的缓解卒为54-3％（304／560）,接受不同西洛他唑剂量治疗3天后又有58．6％的患者HPR缓解,但是西洛他唑50mg组和100mg组HRP缓解率无差别（59．4％VS57．8％,P=0．80）。两组患者30天随访均无死亡及卒中事件,无主要及次要出血事件。结论：强化抗血小板治疗可改善冠脉支架术后的血小板高反应性且未增加出血风险,但其临床获益还需更长时间的随访结果进一步明确,两种强化抗血小板治疗方案对改善冠脉支架术后HPR的作用相似。     

西洛他唑对糖尿病视网膜病变中血小板反应素表达影响的研究

探讨西洛他唑对糖尿病视网膜病变病理生理中的影响及可能的作用机制.用链脲佐菌素(STZ)腹腔注射建立糖尿病模型,用免疫组织化学法、实时荧光定量PCR法观察西洛他唑治疗组、糖尿病对照组和正常对照组视网膜中血小板反应素(TSP-1)的变化.每隔1周测量血糖一次,4周后糖尿病治疗组、糖尿病组与正常组大鼠的体重、血糖有显著性差异(P＜0.01);糖尿病治疗组、糖尿病对照组和正常对照组间TSP-1表达有显著性差异(P＜0.01).在早期糖尿病大鼠的视网膜神经节细胞层、内核层中均有明显的TSP-1表达,糖尿病西洛他唑治疗组视网膜中TSP-1的表达要低于糖尿病对照组.实验显示西洛他唑可能通过阻止TSP-1的过度表达,在一定程度上延缓其糖尿病视网膜病变的发生.     

Cilostazol induces mitochondrial fatty acid β-oxidation in C2C12 myotubes

Cilostazol is a drug licensed for the treatment of intermittent claudication. Its main action is to elevate intracellular levels of cyclic monophosphate (cAMP) by inhibiting the activity of type III phosphodiesterase, a cAMP-degrading enzyme. The effects of cilostazol on fatty acid oxidation (FAO) are as yet unknown. In this study, we report that cilostazol can elevate complete FAO and decrease both triacylglycerol (TAG) accumulation and TAG secretion. This use of cilostazol treatment increases expression of PGC-1α and, subsequently, its target genes, such as ERRα, NOR1, CD36, CPT1, MCAD, and ACO. Expression of these factors is linked to fatty acid β-oxidation but this effect is inhibited by H-89, a specific inhibitor of the PKA/CREB pathway. Importantly, knockdown of PGC-1α using siRNA abolished the effects of cilostazol in fatty acid oxidation (FAO) and TAG metabolism. These findings suggested that the PKA/CREB/PGC-1α pathway plays a critical role in cilostazol-induced fatty acid oxidation and TAG metabolism.     

Investigation of binding proteins for anti-platelet agent K-134 by Drug-Western method

K-134 ((-)-6-[3-[3-cyclopropyl-3-[(1R, 2R)-2-hydroxycyclohexyl]ureido]-propoxy]-2(1H)-quinolinone) is a novel anti-platelet agent with anti-hyperplastic activities. We found previously that K-134 is a potent phosphodiesterase-3 (PDE3) inhibitor. In the present study, we found other K-134-binding proteins by Drug-Western method. We isolated two clones that can bind directly to K-134, cofilin-2, and CD36 in vitro. Comparison of their amino acid sequences showed similarity over a short stretch [KxxxxVxIxWxxE] in part in the collagen-binding region of CD36. K-134 inhibited binding between CD36 and collagen type-I; however, other PDE3 inhibitors, cilostazol, amrinone, and an inactive derivative of K-134, 4S-OH-K-134, showed little or no effect on binding. It was strongly suggested that the direct binding between K-134 and CD36 is a characteristic effect of K-134, and the homologous stretch may be necessary for binding to K-134. These results also suggested that these interactions are involved in the mechanisms of the anti-platelet and anti-hyperplastic effects of K-134.     

Induction of reactive oxygen species from isolated rat glomeruli by protein kinase C activation and TNF-alpha stimulation, and effects of a phosphodiesterase inhibitor

Diabetic nephropathy is a major complication of diabetes leading to end-stage renal disease, which requires hemodialysis. Although the mechanism by which it progresses is largely unknown, the role of hyperglycemia-derived oxidative stress has recently been the focus of attention as the cause of diabetic complications. Constituent cells of the renal glomeruli have the capacity to release reactive oxygen species (ROS) upon stimulation of NADPH oxidase activated by protein kinase C (PKC). Hyperglycemia and insulin resistance in the diabetic state are often associated with activation of PKC and tumor necrosis factor (TNF)-alpha, respectively. The aim of this study is to clarify the signaling pathway leading to ROS production by PKC and TNF-alpha in rat glomeruli. Isolated rat glomeruli were stimulated with phorbol 12-myristate 13-acetate (PMA) and TNF-alpha, and the amount of ROS was measured using a chemiluminescence method. Stimulation with PMA (10 ng/ml) generated ROS with a peak value of 136+/-1.2 cpm/mg protein (mean+/-SEM). The PKC inhibitor H-7, the NADPH oxidase inhibitor diphenylene iodonium and the phosphatidylinositol-3 (PI-3) kinase inhibitor wortmannin inhibited PMA-induced ROS production by 100%, 100% and 80%, respectively. In addition, TNF-alpha stimulated ROS production (283+/-5.8/mg protein/20 min). The phosphodiesterase inhibitor cilostazol activates protein kinase A and is reported to improve albuminuria in diabetic rats. Cilostazol (100 microg/ml) inhibited PMA, and TNF-alpha-induced ROS production by 78+/-1.8, and 19+/-2.7%, respectively. The effects of cilostazol were not additive with wortmannin. Cilostazol arrests oxidative stress induced by PKC activation by inhibiting the PI-3 kinase-dependent pathway, and may thus prevent the development of diabetic nephropathy.     

Cilostazol reduces MCP-1-induced chemotaxis and adhesion of THP-1 monocytes by inhibiting CCR2 gene expression

The chemotaxis and adhesion of monocytes to the injured endothelium in the early atherosclerosis is important. Cilostazol, a specific phosphodiesterase type III inhibitor, is known to exhibit anti-atherosclerotic effects mediated by different mechanisms. This study aimed to investigate the modulating effect of cilostazol on the MCP-1-induced chemotaxis and adhesion of monocytes. The gene expression of CCR2, the major receptor of MCP-1 in THP-1 monocytes, was also analyzed. The chemotaxis of monocytes toward MCP-1 was investigated using the transwell filter assay. Cilostazol dose-dependently inhibited the MCP-1-induced chemotaxis of monocytes which was shown to be cAMP-dependent. Using western blot analysis and flow cytometry method, we demonstrated the decrease of CCR2 protein at the cell membrane of monocytes by cilostazol treatment. Results from RT/real-time PCR confirmed the decrease of CCR2 mRNA expression by cilostazol which was also mediated by cAMP. Similar inhibition was also noted in human peripheral monocytes. The post-CCR2 signaling pathways including p44/42 and p38 MAPK were examined by western blot analysis. Result confirmed the inhibitory effect of cilostazol on the phosphorylation of p44/42 and p38 MAPK after MCP-1 stimulation. The activation of monocytes after MCP-1 treatment exhibited enhanced adhesion to vascular endothelial cells which was dose-dependently suppressed by cilostazol. Together, cilostazol was demonstrated, for the first time, to inhibit the CCR2 gene expression and MCP-1-induced chemotaxis and adhesion of monocytes which might therefore reduce the infiltration of monocytes during the early atherosclerosis. The present study provides an additional molecular mechanism underlying the anti-atherosclerotic effects of cilostazol.     

Cilostazol suppresses adhesion of human neutrophils to HUVECs stimulated by FMLP and its mechanisms

The interaction between neutrophils and endothelial cells (ECs) is of great importance in many physiological and pathological progresses. Although cilostazol (CLZ), a novel selective phosphodiesterase (PDE) type 3 inhibitor, has been proved to be useful in vasodilatation and inhibition of platelet aggregation, its effect on adhesion is not clearly known. In this study, we examined the effects and investigated the mechanisms of cilostazol on neutrophil adhesion to human umbilical endothelial cells (HUVECs) triggered by N-formyl-methionyl-leucyl-phenylal-anine (FMLP), a chemotactic peptide. The soluble vascular cell adhesive molecule-1 (sVCAM-1) release from FMLP (10 microM)-stimulated HUVECs was determined by ELISA kits. Fluo-2, a fluorescent indicator, was used to investigate intracellular free calcium concentration ([Ca2+]i) in HUVECs. HL-60 cells were induced to be neutrophilic by DMSO and loaded with Fluo-3, another fluorescent indicator, to detect [Ca2+]i, and CLA was used as a chemiluminescent indicator to determine superoxide production in neutrophilic cells. The result showed that CLZ (1-100 microM) significantly inhibited neutrophil adhesion to FMLP-stimulated HUVECs. In HUVECs, CLZ obviously downregulated sVCAM-1 level, while it had no meaningful influence [Ca2)]i. But in neutrophils, FMLP-activated superoxide generation and [Ca2+]i increase were found being inhibited by exposure to CLZ . Furthermore, we also demonstrated that Ca2+ increase was preceded to the superoxide generation in neutrophils. The results suggest that CLZ involves in adhesion reactions between neutrophil and ECs, partly via VCAM-1 expression in ECs, and decreasing [Ca2+]i induced activation of neutrophils, which means a lot to prevent atherosclerosis and other cardiovascular diseases.