(3S-5S-6E)-7-[3-(4-fluorophenyl)-1-(propan-2-yl)-1H-indol-2-yl]-3-5-dihydroxyhept-6-enoic-acid and Arthritis--Rheumatoid

Osteoprotegerin (OPG), a member of the tumor necrosis factor receptor family, has been identified as a critical regulator of bone resorption. Considering the possible role of OPG in rheumatoid arthritis (RA) and in the osteoclastogenesis suppression effects of statins, the present study aims to investigate the effects of fluvastatin on serum levels OPG and disease activity score (DAS) in patients with RA. Forty patients with RA were randomized in a placebo-controlled trial to receive 40 mg fluvastatin or placebo as an adjunct to existing disease-modifying antirheumatic drug (DMARD) therapy (methotrexate, leflunomide, hydroxychloroquine). Patients were followed up over 12 weeks. OPG and disease activity variables were measured at baseline and after 12 weeks of treatment. After 12 weeks, the OPG level was significantly increased in the fluvastatin group compared to the placebo group. DAS-28 was significantly decreased in the fluvastatin group compared to the placebo group. C-reactive protein (CRP), morning stiffness, swollen joint count (SJC), and tender joint count (TJC) were significantly decreased in the fluvastatin group compared to the placebo group; however, erythrocyte sedimentation rate (ESR), modified health assessment questionnaire (MHAQ), and visual analogue screen (VAS) were not changed significantly. In conclusion, fluvastatin administration could increase the OPG levels and improve disease activity variables in patients with RA. Therefore, fluvastatin may serve a potential benefit in the treatment of RA patients.

Topics: Adult; Antirheumatic Agents; Arthritis, Rheumatoid; C-Reactive Protein; Double-Blind Method; Drug Therapy, Combination; Fatty Acids, Monounsaturated; Female; Fluvastatin; Health Status; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Indoles; Male; Middle Aged; Osteoprotegerin; Pain Measurement; Treatment Outcome

Cardiovascular disease (CVD) is a major problem during rheumatoid arthritis which leads to morbidity and mortality in arthritic patients. So the present study emphasizes combinatorial effect of Betulinic acid, a triterpenoid and fluvastatin, an HMG CoA reductase inhibitor on atherogenesis during arthritis. Arthritis was induced by bovine type II collagen dissolved in 0.01M acetic acid at a concentration of 4mg/mL and emulsified in equal volume of incomplete Freund's adjuvant. Betulinic acid (2mg/kg) and fluvastatin (5mg/kg) alone and in combination was administered orally from day 14 to 60. At the end of 60days, tissues and blood were isolated for evaluation of biochemical parameters. Treatment with betulinic acid and fluvastatin showed significant (p<0.05) reduction in Arthritic index, Rheumatoid factor, C-reactive protein (CRP), total lipids and anti-CCP (cyclic citrullinated peptide) antibody. Anti-inflammatory enzyme activities and oxidative stress were significantly decreased in the peripheral blood mononuclear cells by the administration of both betulinic acid and fluvastatin than alone treatments. Combination therapy was found to be a potential enhancer of the expression of anti-inflammatory cytokine interleukin-10 whereas it significantly blocked the expression of Toll-like receptors-2 and 4, inflammatory markers such as interleukin-1β, tumor necrosis factor-α, Interferon-γ, cell adhesion molecules and nuclear translocation of NF-kappa B in aorta than drug alone treated groups. So the present study summarizes a combination therapy of betulinic acid and fluvastatin that reduces the risk of both rheumatoid arthritis and CVD by modulating the expression of various inflammatory mediators through Toll-like receptors-4-NF-κB downstream signaling pathway, atherogenic index and oxidative stress in collagen induced arthritis.

Topics: Animals; Anti-Inflammatory Agents; Arthritis, Experimental; Arthritis, Rheumatoid; Atherosclerosis; Betulinic Acid; C-Reactive Protein; Collagen Type II; Fatty Acids, Monounsaturated; Female; Fluvastatin; Indoles; Inflammation; Interferon-gamma; Interleukin-10; Interleukin-1beta; Leukocytes, Mononuclear; NF-kappa B; Pentacyclic Triterpenes; Rats; Rats, Sprague-Dawley; Toll-Like Receptor 4; Triterpenes; Tumor Necrosis Factor-alpha

To study effects of drugs against rheumatoid arthritis (RA) synoviocytes or fibroblast like synoviocytes (FLS) are used. To overcome the drawbacks of using FLS, this study was conducted to show the validity of SW982 synovial cell line in RA study.. 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, Annexin V propidium iodide (PI) staining, mitochondrial membrane potential assay, Triton X-114 Phase partitioning, and immunolot for apoptosis signaling in SW982 human synovial cell line were performed.. Fluvastatin induced apoptosis in a dose- and time-dependent manner in TNFα -stimulated SW982 human synovial cells. A geranylgeranylpyrophosphate (GGPP) inhibitor, but not a farnesylpyrophosphate (FPP) inhibitor, induced apoptosis, and fluvastatin-induced apoptosis was associated with the translocation of isoprenylated RhoA and Rac1 proteins from the cell membrane to the cytosol. Fluvastatin-induced downstream apoptotic signals were associated with inhibition of the phosphoinositide 3-kinase (PI3K)/Akt pathway. Accordingly, 89 kDa apoptotic cleavage fragment of poly (ADP-ribose) polymerase (PARP) was detected.. Collectively, our data indicate that fluvastatin induces apoptotic cell death in TNFα-stimulated SW982 human synovial cells through the inactivation of the geranylgerenylated membrane fraction of RhoA and Rac1 proteins and the subsequent inhibition of the PI3K/Akt signaling pathway. This finding shows the validity of SW982 cell line for RA study.

Topics: Apoptosis; Arthritis, Rheumatoid; Cell Line; Cell Survival; Fatty Acids, Monounsaturated; Fluvastatin; Humans; Indoles; Membrane Potential, Mitochondrial; Polyisoprenyl Phosphates; Signal Transduction; Synovial Fluid; Tetrazolium Salts; Thiazoles

Fluvastatin (Fluv) is reported to induce apoptosis in rheumatoid arthritis (RA) synoviocytes through the blocking of protein geranylgeranylation. We report here our investigation of whether geranylgeranylacetone (GGA) induces cell death in RA synoviocytes. Synovial tissues were obtained from patients with RA at the time of total knee arthroplasty. Fibroblast-like synoviocytes (FLS) cultured in three passages were used for the experiments. The FLS were then cultured for 48 h in 48-well flat-bottomed plates containing various concentrations of GGA (0.1-4.0 microg/ml) and either 0.1 or 0.5 microM Fluv. We also examined the effect of GGA and Fluv in human fibroblasts from normal skin (CCD-25SK) and FLS from patients with osteoarthritis (OA). Cells demonstrating cell death were counted following trypan blue staining. In the absence of GGA, there was no apparent cell death, as evidence by trypan blue staining. Concentrations of GGA between 0.1 and 4.0 microg/ml induced cell death in RA FLS, but not in skin fibroblasts (CCD-25SK) nor OA FLS. The number of synoviocytes demonstrating cell death induced by 0.1 or 0.5 microM Fluv was significantly higher than that by the medium alone. In summary, we found that GGA induced cell death in RA FLS, suggesting that GGA may be a potential new therapeutic agent for RA as well as osteoporosis.

Topics: Anti-Ulcer Agents; Arthritis, Rheumatoid; Cell Death; Cells, Cultured; Diterpenes; Drug Therapy, Combination; Fatty Acids, Monounsaturated; Fibroblasts; Fluvastatin; Humans; Indoles; Synovial Membrane; Trypan Blue

To investigate the effect of statins on vascular dysfunction in rat adjuvant-induced arthritis (AIA).. Fluvastatin (5 mg/kg/day) was administered orally to rats with AIA, for 21 days after the onset of arthritis. The vasodilatory response to acetylcholine of aortic rings isolated from rats with AIA that were not treated or were treated with fluvastatin and from normal rats was determined. The amounts of 4-hydroxy-2-nonenal (HNE) and nitrotyrosine in aortas were measured by Western blotting. In vitro and in situ superoxide production in aortas was evaluated based on fluorogenic oxidation of dihydroethidium to ethidium. Expression of NAD(P)H components and endothelial nitric oxide synthase (eNOS) in aortas was examined by real-time reverse transcriptase-polymerase chain reaction and Western blotting. Serum levels of tetrahydrobiopterin, a critical eNOS cofactor, were determined by high-performance liquid chromatography.. Fluvastatin reversed endothelial dysfunction in AIA without affecting the clinical severity of arthritis or serum cholesterol concentration. Fluvastatin reduced the amounts of HNE and nitrotyrosine in the aorta, and the levels of superoxide expressed in endothelial cells and smooth muscle cells in the tissue, in rats with AIA. NADH- or L-arginine-induced superoxide production was not observed in the aortic samples from fluvastatin-treated rats with AIA. Fluvastatin decreased the levels of expression of messenger RNA for p22phox, a NAD(P)H oxidase component, in the aortas of rats with AIA, but did not affect the expression of eNOS. Serum levels of tetrahydrobiopterin were significantly reduced in rats with AIA, and were increased by administration of fluvastatin.. Our findings demonstrate that fluvastatin has potent vascular protective effects in AIA and provide additional scientific rationale for the use of statins to reduce cardiovascular mortality in patients with rheumatoid arthritis.

Topics: Acetylcholine; Animals; Anticholesteremic Agents; Aorta, Thoracic; Arthritis, Experimental; Arthritis, Rheumatoid; Biopterins; Cardiovascular Diseases; Disease Models, Animal; Endothelium, Vascular; Fatty Acids, Monounsaturated; Fluvastatin; Indoles; Male; NADPH Oxidases; Nitric Oxide Synthase Type III; Oxidative Stress; Rats; Rats, Inbred Lew; Superoxides; Vasodilation; Vasodilator Agents

To determine whether statins induce apoptosis in rheumatoid arthritis (RA) synoviocytes.. The effects of lipophilic and hydrophilic statins (fluvastatin and pravastatin, respectively) on the apoptosis of cultured RA synoviocytes were examined in vitro. Apoptosis was analyzed by flow cytometry after staining with JC-1 (to measure the mitochondrial transmembrane potential), active caspase 3, annexin V, and propidium iodide. Add-back experiments were conducted to determine which downstream products of the mevalonate pathway could suppress apoptosis. Modulation of various signaling pathways induced by statins, including protein prenylation, was also investigated.. Fluvastatin, but not pravastatin, induced apoptosis in RA synoviocytes in a concentration-dependent (1-10 microM) and time-dependent (48-96 hours) manner. Another lipophilic statin, pitavastatin, displayed almost the same effects as fluvastatin. In sharp contrast, lipophilic statins did not significantly increase apoptosis in synoviocytes from patients with osteoarthropathy. Apoptosis induced by fluvastatin was mitochondrial- and caspase 3-dependent and was abrogated by mevalonate and geranylgeranyl pyrophosphate, but not by farnesyl pyrophosphate. In addition, the geranylgeranyl transferase inhibitor GGTI-298 mimicked the effect of fluvastatin on RA synoviocytes. Treatment of RA synoviocytes with the RhoA kinase inhibitor Y-27632 caused apoptosis. Fluvastatin decreased the amount of RhoA protein in the membrane fraction, but increased the amount in the cytosolic fraction.. Fluvastatin induced apoptosis in RA synoviocytes through a mitochondrial- and caspase 3-dependent pathway and by the blockage of mevalonate pathways, particularly through the inhibition of protein geranylgeranylation and RhoA/RhoA kinase pathways. These findings suggest that lipophilic statins have potential as novel therapeutic agents for RA.

Topics: Apoptosis; Arthritis, Rheumatoid; Benzamides; Cells, Cultured; Dose-Response Relationship, Drug; Enzyme Inhibitors; Fatty Acids, Monounsaturated; Fluvastatin; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Indoles; Mevalonic Acid; Polyisoprenyl Phosphates; Protein Prenylation; Synovial Membrane

Topics: Abdominal Pain; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Rheumatoid; Celecoxib; Cyclooxygenase Inhibitors; Diarrhea; Dose-Response Relationship, Drug; Drug Interactions; Fatty Acids, Monounsaturated; Fluconazole; Fluvastatin; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Indoles; Osteoarthritis; Pyrazoles; Sulfonamides