Rhoa Gtpase Inactivation by Statins Induces Osteosarcoma Cell Apoptosis by Inhibiting P42/P44- Mapks-Bcl-2 Signaling Independently of BMP-2 and Cell Differentiation

Total Page:16

File Type:pdf, Size:1020Kb

Rhoa Gtpase Inactivation by Statins Induces Osteosarcoma Cell Apoptosis by Inhibiting P42/P44- Mapks-Bcl-2 Signaling Independently of BMP-2 and Cell Differentiation Cell Death and Differentiation (2006) 13, 1845–1856 & 2006 Nature Publishing Group All rights reserved 1350-9047/06 $30.00 www.nature.com/cdd RhoA GTPase inactivation by statins induces osteosarcoma cell apoptosis by inhibiting p42/p44- MAPKs-Bcl-2 signaling independently of BMP-2 and cell differentiation O Fromigue´ 1, E Hay¨ 1, D Modrowski1, S Bouvet1, A Jacquel2, geranylgeranylpyrophosphate; HMG-CoA, 3-hydroxy 3-methyl- P Auberger2 and PJ Marie*,1 glutaryl coenzyme A; MAPKs, mitogen-activated protein kinases; PI3K, phosphoinositide 30 kinase; NO, nitric oxide; RT-PCR, 1 INSERM U606, University Paris 7, IFR 139, Lariboisie`re Hospital, 2 rue reverse transcription-polymerase chain reaction; TBST, tris Ambroise Pare´, 75475 Paris Cedex 10, France hydroxymethylaminomethane buffered saline Tween-20; WT, 2 INSERM U526, Faculty of Medicine Pasteur, Equipe labellise´e LNC, IFR 50, wild-type form; zVAD-fmk, z-Val-Ala-Asp-fluoromethylketone Nice, France * Corresponding author: PJ Marie, INSERM Unit 606, Hoˆpital Lariboisie`re, 2 rue Ambroise Pare´, 75475 Paris cedex 10, France. Tel: þ 33-1-49-95-63-89; Fax: þ 33-1-49-95-84-52; E-mail: [email protected] Introduction Osteosarcoma is the most common primary malignant bone Received 29.8.05; revised 20.12.05; accepted 20.12.05; published online 10.2.06 tumour occuring in children and young adults. Although Edited by SH Kaufmann aggressive chemotherapy has improved the prognosis of osteosarcoma patients, resistance to chemotherapy remains Abstract a major mechanism responsible for the failure of osteo- sarcoma treatment.1 Several studies have established that Osteosarcoma is the most common primary bone tumour apoptotic pathways contribute to the cytotoxic action of in young adults. Despite improved prognosis, resistance to chemotherapeutic drugs.2,3 Thus, combinational therapy with chemotherapy remains responsible for failure of osteo- agents that promote the apoptotic machinary may be of sarcoma treatment. The identification of signals that promote potential interest to enhance apoptosis sensitivity and apoptosis may provide clues to develop new therapeutic improve tumour burden.3,4 strategies for chemoresistant osteosarcoma. Here, we show The cholesterol-lowering agents statins were recently found 5,6 that lipophilic statins (atorvastatin, simvastatin, cerivastatin) to trigger cell death in a variety of soft tumour cells. Statins markedly induce caspases-dependent apoptosis in various inhibit the 3-hydroxy-3-methylglutaryl-coenzyme A (HMG CoA) reductase which catalyses the conversion of HMG- human osteosarcoma cells, independently of bone morpho- CoA into mevalonate during the biosynthesis of cholesterol. genetic protein (BMP)-2 signaling and cell differentiation. Mevalonate can be converted into farnesylpyrophosphate Although statins increased BMP-2 expression, the proapop- (FPP) and geranylgeranylpyrophosphate (GGPP), two iso- totic effect of statins was not prevented by the BMP prenoid residues that can be anchored onto several intracel- antagonist noggin, and was abolished by mevalonate and lular proteins through farnesylation or geranylgeranylation, a geranylgeranylpyrophosphate, suggesting the involvement of process called prenylation.5,6 Protein prenylation is necessary defective protein geranylgeranylation. Consistently, lipophilic for relocalization of target proteins to cell membranes, and statins induced membrane RhoA relocalization to the cytosol is thereby involved in the control of cell adhesion, growth and and inhibited RhoA activity, which resulted in decreased survival. Blocking the mevalonate pathway by HMG-CoA phospho-p42/p44- mitogen-activated protein kinases reductase inhibitors inhibits geranylgeranylation and farnesy- (MAPKs) and Bcl-2 levels. Constitutively active RhoA rescued lation, resulting in decreased prenylation of proteins and alteration of cell growth and survival functions.5 Small G- phospho-p42/p44-MAPKs and Bcl-2 and abolished statin- proteins, including the Ras, Rho and Rac families are induced apoptosis. Thus, lipophilic statins induce caspase- signaling proteins that are dependent on prenylation for their dependent osteosarcoma cell apoptosis by a RhoA-p42/p44 localization to cell membranes and for their activity.7 Notably, MAPKs-Bcl-2-mediated mechanism, independently of BMP-2 RhoA has been implicated in the control of cell growth and signaling and cell differentiation. apoptosis.7,8 Moreover, RhoA is overexpressed in several Cell Death and Differentiation (2006) 13, 1845–1856. tumours,9 suggesting its possible implication in tumorigen- doi:10.1038/sj.cdd.4401873; published online 10 February 2006 esis. However, the contribution of RhoA in osteosarcoma cell survival and its downstream signaling proteins has not been Keywords: apoptosis; osteosarcoma; statins; RhoA; MAPKs determined. The terminal differentiation of cells of the osteoblast lineage Abbreviations: Ac-DEVD-pNA, acetyl-Asp-Glu-Val-Asp-para- is directed by the integrated function of regulatory factors such nitroaniline; BMP, bone morphogenetic protein; BMPR-IB, BMP as bone morphogenetic proteins (BMPs) and downstream receptor IB; BSA, bovin serum albumin; CA, constitutively active transcription factors. BMP-2, a member of the TGF beta form; FCS, fetal calf serum; FPP, farnesylpyrophosphate; superfamily, and Runx2, a master transcription factor acting GAPDH, glyceraldehyde 3-phosphate deshydrogenase; GGPP, as BMP effector, are important regulatory signals required for RhoA mediates osteosarcoma cell apoptosis O Fromigue´ et al 1846 osteoblast differentiation.10,11 Runx2 promotes the expres- cell viability by induction of programmed cell death, we sion of phenotypic markers in postproliferative osteo- evaluated caspase activity in osteosarcoma cells treated blasts11,12 and induces suppression of preosteoblastic cell with statins. As shown in Figure 1c, lipophilic statins (10 mM) proliferation,13,14 which contributes to promote osteoblast induced a eight- to 12-fold increase in caspase-3 like activity maturation. Osteosarcoma cells are often characterized by at 24 h in SaOS2 cells. Again, pravastatin had no significant loss of differentiated phenotype with decreased expression of effect. Similarly, lipophilic statins induced a four- to 35-fold 15 osteoblast markers. Consistently, osteoblast differentiation increase in caspase-3 like activity in OHS4 cells (Figure 1c). mediated by Runx2 and the cyclin-dependent kinase (Cdk) This effect was not restricted to these two cell lines because inhibitor p27 (Kip1) is disrupted in osteosarcoma cells.16 statins increased caspase-3 like activity by up to 25-fold in Additionally, the upregulation of Runx2 with cessation of cell three other osteosarcoma cell lines which exhibit different growth observed in normal osteoblasts13 is not observed in characteristics (Table 2). Notably, statins increased caspase- osteosarcoma cells,14,17 indicating a role for Runx2 dysregu- 3 like activity in CAL-72 cells that are resistant to various lation in osteosarcoma cell proliferation and differentiation. chemotherapies.22 We also found that lipophilic statins We previously showed that, besides promoting Runx2 and increased caspase-9 activity at an early time point (15 h), cell differentiation, BMP-2 induces caspase-dependent apop- whereas caspase-8 activity or Fas/FasL expression were not tosis in human osteosarcoma cells through activation of BMP significantly changed (data not shown), indicating that statins receptor IB (BMPR-IB).18 Some statins are known to activate activated caspase-9 upstream of caspase-3 in these osteo- the BMP-2 promoter,19,20 resulting in increased Runx2 sarcoma cells. To confirm that statins activate caspases in expression and osteoprogenitor cell commitment to osteo- SaOS2 and OHS4 human osteosarcoma cells, the cells blasts.21 These studies raise the question of whether statins were pretreated for 1 h with z-Val-Ala-Asp-fluoromethylketone may promote apoptosis in osteosarcoma cells through (zVAD-fmk), a broad spectrum caspases inhibitor which induction of BMP-2. In this study, we provide evidence that blocks apoptotic cell death induction but not necrotic cell lipophilic statins induce caspase-dependent apoptosis in death. As shown in Figure 1d, zVAD-fmk completely human osteosarcoma cells independently of BMP-2 signaling prevented cell death induction by lipophilic statins. These and commitment to cell differentiation, by a mechanism results show that lipophilic statins decrease human osteo- specifically involving inactivation of RhoA and p42/p44 sarcoma cell viability by induction of caspase-dependent mitogen-activated protein kinases (MAPKs)-Bcl-2 survival apoptosis. pathway. Results Statin-induced osteosarcoma cell apoptosis occurs independently of BMP-2 and cell Lipophilic statins induce caspases-dependent differentiation apoptosis in human osteosarcoma cells Statins were previously found to activate the BMP-2 promoter We first investigated whether hydrophilic and lipophilic statins and thereby to promote osteoblast differentiation.19,20 As we may induce apoptosis in human osteosarcoma cells cultured previously showed that BMP-2 promotes human osteo- in growth supporting conditions (i.e. in the presence of 10% sarcoma cell apoptosis through BMPR-IB signaling,18 we serum). As shown in Figure 1a, treatment with lipophilic tested the hypothesis that statins may induce osteosarcoma statins (atorvastatin, cerivastatin, simvastatin) for 24 h de- cell apoptosis by increasing BMP-2 production. To this goal, creased cell viability in
Recommended publications
  • Nustendi, INN-Bempedoic Acid, Ezetimibe
    Summary of risk management plan for Nustendi (Bempedoic acid/Ezetimibe) This is a summary of the risk management plan (RMP) for Nustendi. The RMP details important risks of Nustendi, how these risks can be minimized, and how more information will be obtained about Nustendi's risks and uncertainties (missing information). Nustendi's summary of product characteristics (SmPC) and its package leaflet give essential information to healthcare professionals and patients on how Nustendi should be used. This summary of the RMP for Nustendi should be read in the context of all this information, including the assessment report of the evaluation and its plain-language summary, all which is part of the European Public Assessment Report (EPAR). Important new concerns or changes to the current ones will be included in updates of Nustendi's RMP. I. The Medicine and What It Is Used For Nustendi is authorized for treatment of primary hypercholesterolemia in adults, as an adjunct to diet (see SmPC for the full indication). It contains bempedoic acid as the active substance and it is given by mouth. Further information about the evaluation of Nustendi’s benefits can be found in Nustendi’s EPAR, including in its plain-language summary, available on the EMA website, under the medicine’s webpage https://www.ema.europa.eu/en/medicines/human/EPAR/nustendi II. Risks Associated With the Medicine and Activities to Minimize or Further Characterize the Risks Important risks of Nustendi, together with measures to minimize such risks and the proposed studies for learning
    [Show full text]
  • Statins: Mechanism of Action and Effects
    J.Cell.Mol.Med. Vol 5, No 4, 2001 pp. 378-387 Review Statins: mechanism of action and effects Camelia Stancu, Anca Sima * "Nicolae Simionescu" Institute of Cellular Biology and Pathology, Bucharest, Romania Received: November 12, 2001; Accepted: December 5, 2001 • Introduction • Effects on • Classification of statins - cholesterol esterification and - How they are obtained its accumulation in macrophages - Liver metabolism - endothelial cell function - Physico-chemical properties - inflammatory process - Specific activity - proliferation, migration and • Mechanisms for the action of statins apoptosis of arterial smooth muscle cells - Mechanisms involving lipids - stability of the atherosclerotic plaque - Mechanisms involving intracellular - platelets activation signaling pathways - coagulation process • Beneficial effects of statins • Adverse effects of statins therapy • Conclusions Abstract The beneficial effects of statins are the result of their capacity to reduce cholesterol biosyntesis, mainly in the liver, where they are selectively distributed, as well as to the modulation of lipid metabolism, derived from their effect of inhibition upon HMG-CoA reductase. Statins have antiatherosclerotic effects, that positively correlate with the percent decrease in LDL cholesterol. In addition, they can exert antiatherosclerotic effects independently of their hypolipidemic action. Because the mevalonate metabolism generates a series of isoprenoids vital for different cellular functions, from cholesterol synthesis to the control of cell growth and differentiation, HMG-CoA reductase inhibition has beneficial pleiotropic effects. Consequently, statins reduce significantly the incidence of coronary events, both in primary and secondary prevention, being the most efficient hypolipidemic compounds that have reduced the rate of mortality in coronary patients. Independent of their hypolipidemic properties, statins interfere with events involved in bone formation and impede tumor cell growth.
    [Show full text]
  • Lipobay, INN-Cerivastatin
    ANNEX I LIST OF THE NAMES, PHARMACEUTICAL FORM, STRENGTHS OF THE MEDICINAL PRODUCTS, ROUTE OF ADMINISTRATION, MARKETING AUTHORISATION HOLDERS, PACKAGING AND PACKAGE SIZES IN THE MEMBER STATES EMEA 2002 Reproduction and/or distribution of this document is authorised for non commercial purposes only provided the EMEA is acknowledged ANNEX I Marketing Authorisation Route of Member State Invented name Strength Pharmaceutical Form Packaging Package-size Holder administration Austria Bayer Austria Gesellschaft Lipobay 0.1 mg Film-coated tablet Oral use Blister 14, 20, 28, 30, G.m.b.H. 50, 98, 100 and Lerchenfelder Guertel 9-11 160 tablets A-1164 Wien Austria Bayer Austria Gesellschaft Lipobay 0.2 mg Film-coated tablet Oral use Blister 14, 20, 28, 30, G.m.b.H. 50, 98, 100 and Lerchenfelder Guertel 9-11 160 tablets A-1164 Wien Austria Bayer Austria Gesellschaft Lipobay 0.3 mg Film-coated tablet Oral use Blister 30 tablets G.m.b.H. Lerchenfelder Guertel 9-11 A-1164 Wien Austria Bayer Austria Gesellschaft Lipobay 0.4 mg Film-coated tablet Oral use Blister 30 tablets G.m.b.H. Lerchenfelder Guertel 9-11 A-1164 Wien Austria Bayer Austria Gesellschaft Liposterol 0.4 mg Film-coated tablet Oral use Blister 30 tablets G.m.b.H. Lerchenfelder Guertel 9-11 A-1164 Wien CPMP/811/02 1 EMEA 2002 Belgium Bayer NV Lipobay 0.1 mg Film-coated tablet Oral use Blister 14, 20, 28, 30, Louizalaan 143 50, 98, 100 and B-1050 Brussel 160 tablets Belgium Belgium Bayer NV Lipobay 0.2 mg Film-coated tablet Oral use Blister 14, 20, 28, 30, Louizalaan 143 50, 98, 100 and B-1050 Brussel 160 tablets Belgium Belgium Bayer NV Lipobay 0.3 mg Film-coated tablet Oral use Blister 14, 20, 28, 30, Louizalaan 143 50, 98, 100 and B-1050 Brussel 160 tablets Belgium Belgium Bayer NV Lipobay 0.4 mg Film-coated tablet Oral use Blister 14, 20, 28, 30, Louizalaan 143 50, 98, 100 and B-1050 Brussel 160 tablets Belgium Belgium Fournier Pharma S.A.
    [Show full text]
  • Rosuvastatin
    Rosuvastatin Rosuvastatin Systematic (IUPAC) name (3R,5S,6E)-7-[4-(4-fluorophenyl)-2-(N-methylmethanesulfonamido)-6-(propan- 2-yl)pyrimidin-5-yl]-3,5-dihydroxyhept-6-enoic acid Clinical data Trade names Crestor AHFS/Drugs.com monograph MedlinePlus a603033 Pregnancy AU: D category US: X (Contraindicated) Legal status AU: Prescription Only (S4) UK: Prescription-only (POM) US: ℞-only Routes of oral administration Pharmacokinetic data Bioavailability 20%[1] Protein binding 88%[1] Metabolism Liver (CYP2C9(major) andCYP2C19-mediated; only minimally (~10%) metabolised)[1] Biological half-life 19 hours[1] Excretion Faeces (90%)[1] Identifiers CAS Registry 287714-41-4 Number ATC code C10AA07 PubChem CID: 446157 IUPHAR/BPS 2954 DrugBank DB01098 UNII 413KH5ZJ73 KEGG D01915 ChEBI CHEBI:38545 ChEMBL CHEMBL1496 PDB ligand ID FBI (PDBe, RCSB PDB) Chemical data Formula C22H28FN3O6S Molecular mass 481.539 SMILES[show] InChI[show] (what is this?) (verify) Rosuvastatin (marketed by AstraZenecaas Crestor) 10 mg tablets Rosuvastatin, marketed as Crestor, is a member of the drug class of statins, used in combination with exercise, diet, and weight-loss to treat high cholesterol and related conditions, and to prevent cardiovascular disease. It was developed by Shionogi. Crestor is the fourth- highest selling drug in the United States, accounting for approx. $5.2 billion in sales in 2013.[2] Contents [hide] 1Medical uses 2Side effects and contraindications 3Drug interactions 4Structure 5Mechanism of action 6Pharmacokinetics 7Indications and regulation
    [Show full text]
  • Pharmaceutical Appendix to the Harmonized Tariff Schedule
    Harmonized Tariff Schedule of the United States Basic Revision 3 (2021) Annotated for Statistical Reporting Purposes PHARMACEUTICAL APPENDIX TO THE HARMONIZED TARIFF SCHEDULE Harmonized Tariff Schedule of the United States Basic Revision 3 (2021) Annotated for Statistical Reporting Purposes PHARMACEUTICAL APPENDIX TO THE TARIFF SCHEDULE 2 Table 1. This table enumerates products described by International Non-proprietary Names INN which shall be entered free of duty under general note 13 to the tariff schedule. The Chemical Abstracts Service CAS registry numbers also set forth in this table are included to assist in the identification of the products concerned. For purposes of the tariff schedule, any references to a product enumerated in this table includes such product by whatever name known.
    [Show full text]
  • NCEP Drug Treatment
    NCEP Drug Treatment The information contained in this document is taken directly from the National Cholesterol Education Program, Adult Treatment Panel III (NCEP, ATP III) that is published by the National Institutes of Health – National Heart, Lung and Blood Institute. Major Classes of Drugs Available Affecting Lipoprotein Metabolism HMG CoA reductase inhibitors—lovastatin, pravastatin, simvastatin, fluvastatin, atorvastatin Bile acid sequestrants—cholestyramine, colestipol, colesevelam Nicotinic acid—crystalline, timed-release preparations, Niaspan® Fibric acid derivatives (fibrates)—gemfibrozil, fenofibrate, clofibrate Estrogen replacement Omega-3 fatty acids Major Uses and Lipid/ Lipoprotien Effects of Each Drug Class Drug Class Major Use Lipid/ Lipoprotein Effects LDL ↓ 18-55% HMG CoA reductase To lower LDL cholesterol HDL ↑ 5-15% inhibitors (statins) TG ↓ 7-30% LDL ↓ 15-30% Bile acid sequestrants To lower LDL cholesterol HDL ↑ 3-5% TG No effect or increase LDL ↓ 5-25% Useful in most lipid and Nicotinic acid HDL ↑ 15-35% lipoprotein abnormalities TG ↓ 20-50% LDL ↓ 5-20% (in nonhypertriglyceridemic persons); Hypertriglyceridemia; may be increased in hypertriglyceridemic persons Fibric acids Atherogenic dyslipidemia HDL ↑ 10-35% (more in severe hypertriglyceridemia) TG ↓ 20-50% NCEP Drug Treatment The information contained in this document is taken directly from the National Cholesterol Education Program, Adult Treatment Panel III (NCEP, ATP III) that is published by the National Institutes of Health – National Heart, Lung and
    [Show full text]
  • Lipid Lowering Drugs Prescription and the Risk of Peripheral Neuropathy
    1047 J Epidemiol Community Health: first published as 10.1136/jech.2003.013409 on 16 November 2004. Downloaded from RESEARCH REPORT Lipid lowering drugs prescription and the risk of peripheral neuropathy: an exploratory case-control study using automated databases Giovanni Corrao, Antonella Zambon, Lorenza Bertu`, Edoardo Botteri, Olivia Leoni, Paolo Contiero ............................................................................................................................... J Epidemiol Community Health 2004;58:1047–1051. doi: 10.1136/jech.2003.013409 Study objective: Although lipid lowering drugs are effective in preventing morbidity and mortality from cardiovascular events, the extent of their adverse effects is not clear. This study explored the association between prescription of lipid lowering drugs and the risk of peripheral neuropathy. Design: A population based case-control study was carried out by linkage of several automated databases. Setting: Resident population of a northern Italian Province aged 40 years or more. Participants: Cases were patients discharged for peripheral neuropathy in 1998–1999. For each case up See end of article for authors’ affiliations to 20 controls were randomly selected among those eligible. Altogether 2040 case patients and 36 041 ....................... controls were included in the study. Exposure ascertainment: Prescription drug database was used to assess exposure to lipid lowering drugs Correspondence to: Professor G Corrao, at any time in the one year period preceding the index date.
    [Show full text]
  • 2 12/ 35 74Al
    (12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property Organization International Bureau (10) International Publication Number (43) International Publication Date 22 March 2012 (22.03.2012) 2 12/ 35 74 Al (51) International Patent Classification: (81) Designated States (unless otherwise indicated, for every A61K 9/16 (2006.01) A61K 9/51 (2006.01) kind of national protection available): AE, AG, AL, AM, A61K 9/14 (2006.01) AO, AT, AU, AZ, BA, BB, BG, BH, BR, BW, BY, BZ, CA, CH, CL, CN, CO, CR, CU, CZ, DE, DK, DM, DO, (21) International Application Number: DZ, EC, EE, EG, ES, FI, GB, GD, GE, GH, GM, GT, PCT/EP201 1/065959 HN, HR, HU, ID, IL, IN, IS, JP, KE, KG, KM, KN, KP, (22) International Filing Date: KR, KZ, LA, LC, LK, LR, LS, LT, LU, LY, MA, MD, 14 September 201 1 (14.09.201 1) ME, MG, MK, MN, MW, MX, MY, MZ, NA, NG, NI, NO, NZ, OM, PE, PG, PH, PL, PT, QA, RO, RS, RU, (25) Filing Language: English RW, SC, SD, SE, SG, SK, SL, SM, ST, SV, SY, TH, TJ, (26) Publication Language: English TM, TN, TR, TT, TZ, UA, UG, US, UZ, VC, VN, ZA, ZM, ZW. (30) Priority Data: 61/382,653 14 September 2010 (14.09.2010) US (84) Designated States (unless otherwise indicated, for every kind of regional protection available): ARIPO (BW, GH, (71) Applicant (for all designated States except US): GM, KE, LR, LS, MW, MZ, NA, SD, SL, SZ, TZ, UG, NANOLOGICA AB [SE/SE]; P.O Box 8182, S-104 20 ZM, ZW), Eurasian (AM, AZ, BY, KG, KZ, MD, RU, TJ, Stockholm (SE).
    [Show full text]
  • Anatomical Classification Guidelines V2020 EPHMRA ANATOMICAL
    EPHMRA ANATOMICAL CLASSIFICATION GUIDELINES 2020 Anatomical Classification Guidelines V2020 "The Anatomical Classification of Pharmaceutical Products has been developed and maintained by the European Pharmaceutical Marketing Research Association (EphMRA) and is therefore the intellectual property of this Association. EphMRA's Classification Committee prepares the guidelines for this classification system and takes care for new entries, changes and improvements in consultation with the product's manufacturer. The contents of the Anatomical Classification of Pharmaceutical Products remain the copyright to EphMRA. Permission for use need not be sought and no fee is required. We would appreciate, however, the acknowledgement of EphMRA Copyright in publications etc. Users of this classification system should keep in mind that Pharmaceutical markets can be segmented according to numerous criteria." © EphMRA 2020 Anatomical Classification Guidelines V2020 CONTENTS PAGE INTRODUCTION A ALIMENTARY TRACT AND METABOLISM 1 B BLOOD AND BLOOD FORMING ORGANS 28 C CARDIOVASCULAR SYSTEM 35 D DERMATOLOGICALS 50 G GENITO-URINARY SYSTEM AND SEX HORMONES 57 H SYSTEMIC HORMONAL PREPARATIONS (EXCLUDING SEX HORMONES) 65 J GENERAL ANTI-INFECTIVES SYSTEMIC 69 K HOSPITAL SOLUTIONS 84 L ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS 92 M MUSCULO-SKELETAL SYSTEM 102 N NERVOUS SYSTEM 107 P PARASITOLOGY 118 R RESPIRATORY SYSTEM 120 S SENSORY ORGANS 132 T DIAGNOSTIC AGENTS 139 V VARIOUS 141 Anatomical Classification Guidelines V2020 INTRODUCTION The Anatomical Classification was initiated in 1971 by EphMRA. It has been developed jointly by Intellus/PBIRG and EphMRA. It is a subjective method of grouping certain pharmaceutical products and does not represent any particular market, as would be the case with any other classification system.
    [Show full text]
  • Treatment Strategy for Dyslipidemia in Cardiovascular Disease Prevention: Focus on Old and New Drugs
    pharmacy Article Treatment Strategy for Dyslipidemia in Cardiovascular Disease Prevention: Focus on Old and New Drugs Donatella Zodda 1,*, Rosario Giammona 2 and Silvia Schifilliti 2 1 Drug Department of Local Health Unit (ASP), Viale Giostra, 98168 Messina, Italy 2 Clinical Pharmacy Fellowship, University of Messina, Viale Annunziata, 98168 Messina, Italy; [email protected] (R.G.); silvia.schifi[email protected] (S.S.) * Correspondence: [email protected]; Tel.: +39-090-3653902 Received: 12 November 2017; Accepted: 11 January 2018; Published: 21 January 2018 Abstract: Prevention and treatment of dyslipidemia should be considered as an integral part of individual cardiovascular prevention interventions, which should be addressed primarily to those at higher risk who benefit most. To date, statins remain the first-choice therapy, as they have been shown to reduce the risk of major vascular events by lowering low-density lipoprotein cholesterol (LDL-C). However, due to adherence to statin therapy or statin resistance, many patients do not reach LDL-C target levels. Ezetimibe, fibrates, and nicotinic acid represent the second-choice drugs to be used in combination with statins if lipid targets cannot be reached. In addition, anti-PCSK9 drugs (evolocumab and alirocumab) provide an effective solution for patients with familial hypercholesterolemia (FH) and statin intolerance at very high cardiovascular risk. Recently, studies demonstrated the effects of two novel lipid-lowering agents (lomitapide and mipomersen) for the management of homozygous FH by decreasing LDL-C values and reducing cardiovascular events. However, the costs for these new therapies made the cost–effectiveness debate more complicated. Keywords: lipid lowering therapy; dyslipidemia; statins; fibrate; PCSK9 inhibitors; lomitapide 1.
    [Show full text]
  • Health Technology Assessment (HTA)
    Federal Department of Home Affairs Federal Office of Public Health FOPH Health and Accident Insurance Directorate Section Health Technology Assessment Health Technology Assessment (HTA) Scoping Report Title The treatment of primary hypercholesterolaemia and mixed/combined hyperlipidaemia with ezetimibe-containing medicines Author/Affiliation Jonathan Henry Jacobsen, Royal Australasian College of Surgeons Ning Ma, Royal Australasian College of Surgeons Akwasi Ampofo, Royal Australasian College of Surgeons Virginie Gaget, Royal Australasian College of Surgeons Thomas Vreugdenburg, Royal Australasian College of Surgeons David Tivey, Royal Australasian College of Surgeons Bundesamt für Gesundheit Sektion Health Technology Assessment Schwarzenburgstrasse 157 CH-3003 Bern Schweiz Tel.: +41 58 462 92 30 E-mail: [email protected] 1 Technology Ezetimibe-containing medicines Date 6 July 2020 Type of Technology Pharmaceuticals Executive Summary: Dyslipidaemia is a key risk factor in the development of atherosclerosis and cardiovascular diseases (CVDs). Ezetimibe, a cholesterol absorption inhibitor, is currently used to treat dyslipidaemias and CVDs in Switzerland; however, there is ongoing debate regarding its effectiveness. In light of this, the Swiss Federal Office of Public Health is re-evaluating the indications for the reimbursement of ezetimibe. This report aims to determine the feasibility of conducting a health technology assessment (HTA) of ezetimibe based on the clinical, economic, legal, social, ethical and organisation data identified during the scoping phase. The objective of the HTA is to evaluate the safety, efficacy, effectiveness, cost-effectiveness and budgetary impact of ezetimibe (by itself or in combination with statins or fenofibrate) compared to placebo, statins or fenofibrate monotherapies in patients who have (i) primary hypercholesterolaemia (familial and non-familial) with or without pre-existing atherosclerotic cardiovascular disease (ASCVD) or (ii) mixed/combined hyperlipidaemia with or without pre-existing ASCVD.
    [Show full text]
  • Review of Existing Classification Efforts
    Project No. TREN-05-FP6TR-S07.61320-518404-DRUID DRUID Driving under the Influence of Drugs, Alcohol and Medicines Integrated Project 1.6. Sustainable Development, Global Change and Ecosystem 1.6.2: Sustainable Surface Transport 6th Framework Programme Deliverable 4.1.1 Review of existing classification efforts Due date of deliverable: (15.01.2008) Actual submission date: (07.02.2008) Start date of project: 15.10.2006 Duration: 48 months Organisation name of lead contractor for this deliverable: UGent Revision 1.0 Project co-funded by the European Commission within the Sixth Framework Programme (2002-2006) Dissemination Level PU Public X PP Restricted to other programme participants (including the Commission Services) RE Restricted to a group specified by the consortium (including the Commission Services) CO Confidential, only for members of the consortium (including the Commission Services) Task 4.1 : Review of existing classification efforts Authors: Kristof Pil, Elke Raes, Thomas Van den Neste, An-Sofie Goessaert, Jolien Veramme, Alain Verstraete (Ghent University, Belgium) Partners: - F. Javier Alvarez (work package leader), M. Trinidad Gómez-Talegón, Inmaculada Fierro (University of Valladolid, Spain) - Monica Colas, Juan Carlos Gonzalez-Luque (DGT, Spain) - Han de Gier, Sylvia Hummel, Sholeh Mobaser (University of Groningen, the Netherlands) - Martina Albrecht, Michael Heiβing (Bundesanstalt für Straßenwesen, Germany) - Michel Mallaret, Charles Mercier-Guyon (University of Grenoble, Centre Regional de Pharmacovigilance, France) - Vassilis Papakostopoulos, Villy Portouli, Andriani Mousadakou (Centre for Research and Technology Hellas, Greece) DRUID 6th Framework Programme Deliverable D.4.1.1. Revision 1.0 Review of Existing Classification Efforts Page 2 of 127 Introduction DRUID work package 4 focusses on the classification and labeling of medicinal drugs according to their influence on driving performance.
    [Show full text]