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Prostaglandin synthetase inhibitors in the treatment of primary dysmenorrhea. Outcome trials reviewed.

Clinical trials of prostaglandin synthetase inhibitors (PGSIs) prescribed for the treatment of primary dysmenorrhea were reviewed as to pain relief effectiveness, frequency and nature of side effects, and methodological adequacy. The review investigated 51 PGSI trials for a total of 1,649 women and 682 menstrual cycles and found that, over all, 72% of dysmenorrheic women reported significant pain relief to PGSI, 18% reported minimal or no pain relief, and 15% showed placebo response. Comparisons among the fenamatic compounds, ibuprofen, indomethacin, and naproxen showed the fenamates to be more effective in providing pain relief. PGSI-associated side effects were minimal for all PGSIs with the exception of indomethacin. Results were evaluated with respect to several methodological problems. Conclusions were drawn that despite these shortcomings, PGSIs are undoubtedly effective and safe for the majority of women with primary dysmenorrhea.

Clinical Trials as Topic↗

Ca(2+)- and voltage-dependent gating of Ca(2+)- and ATP-sensitive cationic channels in brain capillary endothelium.

Biophysical properties of the Ca(2+)-activated nonselective cation channel expressed in brain capillaries were studied in inside-out patches from primary cultures of rat brain microvascular endothelial cells. At -40 mV membrane potential, open probability (P(o)) was activated by cytosolic [Ca(2+)] > 1 micro M and was half-maximal at approximately 20 micro M. Increasing [Ca(2+)] stimulated opening rate with little effect on closing rate. At constant [Ca(2+)], P(o) was voltage-dependent, and effective gating charge corresponded to 0.6 +/- 0.1 unitary charges. Depolarization accelerated opening and slowed closing, thereby increasing apparent affinity for Ca(2+). Within approximately 1 min of excision, P(o) declined to a lower steady state with decreased sensitivity toward activating Ca(2+) when studied at a fixed voltage, and toward activating voltage when studied at a fixed [Ca(2+)]. Deactivated channels opened approximately 5-fold slower and closed approximately 10-fold faster. The sulfhydryl-reducing agent dithiotreitol (1 mM) completely reversed acceleration of closing rate but failed to recover opening rate. Single-channel gating was complex; distributions of open and closed dwell times contained at least four and five exponential components, respectively. The longest component of the closed-time distribution was markedly sensitive to both [Ca(2+)] and voltage. We conclude that the biophysical properties of gating of this channel are remarkably similar to those of large-conductance Ca(2+)-activated K(+) channels.

Adenosine Triphosphate↗

Block of hippocampal CAN channels by flufenamate.

Ca(2+)-activated non-selective cation (CAN) channels are activated by cytoplasmic Ca(2+) and I(CAN) underlies many slow depolarizing processes in neurons including a putative role in excitotoxicity. CAN channels in many non-neuronal cells are blocked by non-steroidal antiinflammatory drugs that are derivatives of diphenylamine-2-carboxylate (DPC). The DPC derivative flufenamate (FFA) has a complex effect on certain neurons, whereby it blocks CAN channels and increases [Ca(2+)](i). We report here that FFA, but not the parent compound, DPC, blocks CAN channels in hippocampal CA1 neurons. As was the case in other neurons, the effects of FFA are complex and include a maintained rise in [Ca(2+)](i). Furthermore, the CAN channel blocking ability of FFA persists even when the channels have been potentiated by a Ca(2+)-dependent process. The use of a CAN channel-blocking drug is important for delineating CAN channel-dependent processes and may provide a basis for therapy for CAN channel-dependent events in ischemia.

Action Potentials↗

The effect of chemical anti-inhibitors on fibrinolytic enzymes and inhibitors.

Fibrinolytic enzyme inhibitors hamper the determination of the specific fibrinolytic serine protease activity. Reportedly, chemical anti-inhibitors eliminate the influence of fibrinolytic inhibitors, but it remains unclear to what extent they change the specific activity of fibrinolytic serine proteases. We studied the influence of chemical anti-inhibitors (chloramine T, flufenamate, sodium lauryl sulfate, and methylamine) on fibrinolytic serine proteases and fibrinolytic enzyme inhibitors using the physiological substrate fibrin as plasmin substrate. Low concentrations of chloramine T (0.01 mmol/l) prevent the inhibition of plasminogen activators. Higher concentrations (1 mmol/l) reduce the inhibition of plasmin, but simultaneously quench the plasminogen activator activity. Flufenamate eliminates most fibrinolytic enzyme inhibitors, but increases the activity of plasmin (apparent recovery 140%) and plasminogen activators (apparent recovery > 200%). Sodium lauryl sulfate eliminates the major fibrinolytic enzyme inhibitors, but increases the activity of plasmin (apparent recovery > 200%) and plasminogen activator, urokinase type (apparent recovery 130%). Methylamine affects only plasmin inhibition. We conclude that chemical anti-inhibitors may invalidate the analytical specificity of methods for the determination of fibrinolytic serine protease activity.

Chloramines↗

Evidence for a Na+-Ca2+ exchanger in rat pancreatic ducts.

Only recently has it been recognized that intracellular Ca2+ is an important cellular mediator in pancreatic ducts. The aim of the present study was to characterize the Ca2+ efflux pathway in ducts freshly prepared from rat pancreas. Lowering of extracellular Na+ concentration resulted in a significant increase in intracellular Ca2+. This effect was fast, reversible, dependent on the extracellular Na+ concentration and did not correlate with intracellular pH changes. It was abolished in Ca2+-free solutions, indicating that the outwardly directed Na+ gradient was directly coupled to a flufenamate insensitive Ca2+ influx. Removal and reintroduction of extracellular Na+ induced transient hyperpolarization and depolarization of Vm, respectively. Taken together, our data indicate that pancreatic ducts possess an electrogenic Na+-Ca2+ exchanger, which under control conditions is responsible for transporting Ca2+ out of resting duct cells.

Acetates↗

Mechanism of action of the non-steroidal anti-inflammatory drug flufenamate on [Ca2+]i and Ca(2+)-activated currents in neurons.

We have shown previously that the non-steroidal anti-inflammatory drug flufenamate (FFA) causes a maintained increase in [Ca2+]i and transient increases in a Ca(2+)-activated nonselective cation current (ICAN) and a Ca(2+)-activated slow, outward Cl- current (lo-slow) in molluscan neurons [Shaw T., Lee R.J., Partridge L.D. Action of diphenylamine carboxylate derivatives, a family of non-steroidal anti-inflammatory drugs, on [Ca2+]i and Ca(2+)-activated channels in neurons. Neurosci Lett 1995; 190:121-124]. Here we demonstrate that pretreatment of neurons with 10 microM thapsigargin eliminates the FFA-induced increase in [Ca2+]i and substantially reduces both ICAN and Io-slow supporting the hypothesis that the FFA-induced increase in [Ca2+]i results primarily from Ca2+ release from a thapsigargin-sensitive intracellular store. The [Ca2+]i response appears to be sustained, not by influx of extracellular Ca2+, but by inhibitory effects of FFA on Ca2+ removal from the cytosol. Inhibition of Ca2+ efflux may be an important component of the FFA-induced activation of both ICAN and Io-slow, as Ca2+ release by thapsigargin alone is not sufficient to activate either current. Our data also demonstrate that the effects of FFA on [Ca2+]i, ICAN and Io-slow are reversible and suggest that protein phosphorylation as well as an increase in [Ca2+]i are involved in the FFA-induced activation of Io-slow. Effects on neuronal Ca2+ handling as well as activation of ICAN or Io-slow may partially explain the analgesic effects of FFA.

Animals↗

Mechanisms through which PDGF alters intracellular calcium levels in U-1242 MG human glioma cells.

PDGF-BB induces a rapid, sustained increase in intracellular calcium levels in U-1242 MG cells. We used several calcium channel blockers to identify the types of channels involved. L channel blockers (verapamil, nimodipine, nicardipine, nitrendipine and taicatoxin) had no effect on PDGF-BB induced alterations in intracellular calcium. Blockers of P, Q and N channels (omega-agatoxin-IVA, omega-conotoxin MVIIC and omega-conotoxin GVIA) also had no effect. This indicates that these channels play an insignificant role in supplying the Ca2+ necessary for PDGF stimulated events in U-1242 MG cells. However, a T channel blocker (NDGA) and the non-specific (NS) calcium channel blockers (FFA and SK&F 9365) abolished PDGF-induced increases in intracellular calcium. This indicates that PDGF causes calcium influx through both non-specific cationic channels and T channels. To study the participation of intracellular calcium stores in this process, we used thapsigargin, caffeine and ryanodine, all of which cause depletion of intracellular calcium stores. The PDGF effect was abolished using both thapsigargin and caffeine but not ryanodine. Collectively, these data indicate that in these human glioma cells PDGF-BB induces release of intracellular calcium from caffeine- and thapsigargin-sensitive calcium stores which in turn lead to further calcium influx through both NS and T channels.

Becaplermin↗

Hydrogen peroxide increases the intracellular calcium activity in rat mesangial cells in primary culture.

Oxygen radicals are known to be mediators of renal injury under several pathophysiological conditions. We have examined the effect of hydrogen peroxide (H2O2) on intracellular calcium activity ([Ca2+]i) in mesangial cells in primary culture. Mesangial cells were loaded with 1 mumol/liter fura-2, and kept in a Ringer-like solution. Fura-2 fluorescence was measured in an inverted microscope at 37 degrees C. Angiotensin II (0.1 nmol/liter) and ATP (0.1 mumol/liter) induced a rapid transient increase of [Ca2+]i, which was followed by a sustained plateau (N = 37 and N = 24). In contrast, the addition of H2O2 (0.01 to 10 mmol/liter, N = 157) caused a time- and concentration-dependent slow increase of [Ca2+]i, which reached a stable [Ca2+]i plateau after 3 to 10 minutes (ED50: 100 mumol/liter). After the removal of H2O2 [Ca2+]i decreased partially and reached a stable value approximately 90% above the resting [Ca2+]i value. Addition of 100 mumol/liter H2O2 to an extracellular Ca(2+)-free solution resulted either in no rise of [Ca2+]i in some experiments (N = 7), or [Ca2+]i oscillations in others (N = 10). In the presence of H2O2 (> 25 mumol/liter), the angiotensin II or ATP mediated increases in [Ca2+]i were almost completely inhibited (N = 15 and N = 10). The cations Ni2+ and La3+ and the Ca(2+)-antagonist verapamil (10 mumol/liter) did not inhibit the H2O2 mediated increase of -Ca2+-i (N = 6 to 9). Flufenamate (100 mumol/liter), an inhibitor of non-selective cation channels inhibited the H2O2 induced increase of [Ca2+]i by 63 +/- 11% (N = 7). Preincubation of the cells with a disulphide reducing agent (dithiothreitol, 500 mumol/liter, N = 5) or an iron-chelator (deferoxamine, 100 mumol/liter, N = 5) attenuated the H2O2 mediated effect by 95 +/- 15% and 74 +/- 6%, respectively. The H2O2 mediated [Ca2+]i increase was completely inhibited when mesangial cells were preincubated with 1 mumol/liter U-83836E, an inhibitor of lipid peroxidation (N = 7), and inhibited by 84 +/- 6% when the cells were pretreated with 1 mmol/liter pyruvate (N = 5). The data indicate that H2O2: (i) increases [Ca2+]i in mesangial cells by a mechanism distinct from angiotensin II or ATP and (ii) that it inhibits the [Ca2+]i response to both agonists.

Adenosine Triphosphate↗

Agonist-induced activation of a non-selective ion current in glomerular endothelial cells.

The control of intracellular calcium activity ([Ca2+]i) and membrane voltage (Vm) play an important role in regulating functions of glomerular endothelial cells (GEC). We investigated the effect of extracellular ATP on the intracellular [Ca2+]i, Vm and ion conductances in GEC. ATP (100 mumol/liter) induced a rapid increase of [Ca2+]i in GEC from 20 +/- 6 to 442 +/- 84 nmol/liter, which was followed by a sustained Ca2+ plateau of 112 +/- 29 nmol/liter. In a bath solution with a low extracellular Ca2+ concentration the ATP-induced [Ca2+]i peak was still present, but the [Ca2+]i plateau was completely prevented. In 186 experiments with the patch clamp technique the addition of ATP (1 to 100 mumol/liter) to GEC induced a transient small hyperpolarization, which was followed by a depolarization. During the ATP-induced depolarization an increase of the whole cell conductance was found. The Ca2+ ionophore A23187 (10 mumol/liter) mimicked the effect of ATP on Vm. Reduction of the extracellular Ca2+ to 1 mumol/liter itself depolarized GEC reversibly from -88 +/- 2 to -60 +/- 12 mV and increased the ATP-induced depolarization to -18 +/- 3 mV. In the absence of Na+ in the bathing solution (replacement by NMDG+) ATP induced only an attenuated depolarization and no inward current was activated. Flufenamate (100 mumol/liter), a blocker of non-selective ion channels inhibited the ATP-induced depolarization of Vm significantly by 58 +/- 13%, whereas nicardipine (10 mumol/liter) or amiloride (10 mumol/liter) had no effect. Our data indicate that the resting Vm of GEC cells is almost completely dominated by K+ conductances and that ATP activates a Ca2+ dependent non-selective ion conductance in GEC.

Adenosine Triphosphate↗