|NEWS AND VIEWS
|Year : 2018 | Volume
| Issue : 2 | Page : 111
News and views
Department of Pharmacology, JIPMER, Puducherry, India
|Date of Web Publication||11-Sep-2018|
Dr. Priyadharsini Rajendran
Department of Pharmacology, JIPMER, Puducherry
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Rajendran P. News and views. Int J Clin Exp Physiol 2018;5:111
| News|| |
| Phosphodiesterase 5 Inhibitors and Diabetic Peripheral Neuropathy|| |
Diabetes mellitus is a chronic debilitating medical condition. The global prevalence of diabetes is estimated to reach 7.7% by 2030. Despite numerous advances in the care and management, there is still substantial morbidity and mortality in diabetic patients because of complications associated with it. Peripheral neuropathy is one of the most disabling complications of diabetes. It has been found that the decrease in the peripheral nerve conduction velocity in diabetic neuropathy may be attributed to the vascular dysfunction, segmental demyelination, and axonal degeneration. Therefore, decreased blood flow to the distal nerves due to axonal degeneration of the peripheral nerves leads degeneration of the nerve fibers presenting with symptoms of numbness, loss of sensation, and pain in the hands and feet.
Although there are currently different drugs available for the treatment of painful diabetic neuropathy, they are not much effective because of their own adverse effect profile. Since vascular dysfunction produces progressive neuronal degeneration, the role of drugs affecting the neurovascular functions may be recognized as one of the targets for diabetic neuropathy. Interestingly, the potential role of phosphodiesterase-5 (PDE5) inhibitors such as sildenafil and tadalafil has been explored in the treatment of diabetic neuropathy recently. PDE5 inhibitors cause hydrolysis and accumulation of cyclic guanosine monophosphate. They play an important role in the modulation of pain perception, regulation of neurovascular function by activating the protein kinases, leading to axonal remodeling, and improvement in neurological function. Further, they also produce changes in the gene expression of pro-inflammatory and anti-inflammatory cytokines in the experimental animals. Although these drugs are currently approved for the treatment of erectile dysfunction and pulmonary arterial hypertension with a known safety profile, their ability to target multiple signaling pathways in axon remodeling may prove to have promising therapeutic application for patients with diabetic peripheral neuropathy.
Naja F, Mousa D, Alameddine M, Shoaib H, Itani L, Mourad Y, et al. Prevalence and correlates of complementary and alternative medicine use among diabetic patients in Beirut, Lebanon: A cross-sectional study. BMC Complement Altern Med 2014;14:185.
Wang L, Chopp M, Szalad A, Lu X, Jia L, Lu M, et al. Tadalafil promotes the recovery of peripheral neuropathy in type II diabetic mice. PLoS One 2016;11:e0159665.
| Views|| |
| Chelation Therapy for Cardiovascular Diseases|| |
The efficacy and safety of intravenous administration of disodium edetate or ethylenediaminetetraacetic acid (EDTA) in the treatment of cardiovascular diseases (CVDs) are controversial. Although there is a lack of sufficient evidence to prove their beneficial effect in improving the clinical outcomes in CVD patients, there is still an off-label use of EDTA as a substitute for surgery (coronary artery bypass graft [CABG]). The exact mechanism by which EDTA acts is still unknown, but the proposed mechanisms of action for the reversal of cardiovascular disease by EDTA include calcium chelation and free radical scavenging action, resulting in the dissolution of atheromatous plaques. Besides these properties, it has been claimed that they may have an effect on improving the endothelial function by increasing the release of nitric oxide. On the contrary, considering the safety point of view, there are potential adverse effects also. The cost incurred for such therapy is also much higher. The results of the first trial to assess chelation therapy conducted in postmyocardial infraction diabetic patients did not provide enough evidence to support the role of chelation therapy in CVD. Many randomized controlled clinical trials also lack evidence to support chelation therapy as routine or substitute for proven therapies. The possible role of chelation therapy in the treatment of CVD is unclear and requires well-designed clinical trials to demonstrate its proven benefit.
| References|| |
Naja F, Mousa D, Alameddine M, Shoaib H, Itani L, Mourad Y, et al.
Prevalence and correlates of complementary and alternative medicine use among diabetic patients in Beirut, Lebanon: A cross-sectional study. BMC Complement Altern Med 2014;14:185.
Wang L, Chopp M, Szalad A, Lu X, Jia L, Lu M, et al.
Tadalafil promotes the recovery of peripheral neuropathy in type II diabetic mice. PLoS One 2016;11:e0159665.