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Ospedaletto, Italy

Balsamo R.,Dompe S.p.A | Lanata L.,Dompe S.p.A | Egan C.G.,Primula Multimedia Srl
European Respiratory Review | Year: 2010

Mucus hypersecretion is a clinical feature of severe respiratory diseases such as asthma, cystic fibrosis and chronic obstructive pulmonary disease. Airway mucosal infection and/or inflammation associated with these diseases often gives rise to inflammatory products, including neutrophil-derived DNA and filamentous actin, in addition to bacteria, apoptotic cells and cellular debris, that may collectively increase mucus production and viscosity. Mucoactive agents have been the medication of choice for the treatment of respiratory diseases in which mucus hypersecretion is a clinical complication. The main purpose of mucoactive drugs is to increase the ability to expectorate sputum and/or decrease mucus hypersecretion. Many mucoactive drugs are currently available and can be classified according to their putative mechanism of action. Mucoactive medications include expectorants, mucoregulators, mucolytics and mucokinetics. By developing our understanding of the specific effects of mucoactive agents, we may result in improved therapeutic use of these drugs. The present review provides a summary of the most clinically relevant mucoactive drugs in addition to their potential mechanism of action. © ERS 2010. Source

Egan C.G.,Primula Multimedia Srl | Pontremoli R.,University of Genoa
Journal of Nephrology | Year: 2011

Even with the availability of novel and efficacious antihypertensive agents, an insufficient number of hypertensive patients achieve their desired blood pressure (BP) target. This failure is partly due to the fact that many patients do not strictly adhere to their drug therapy and/or they report the presence of adverse effects. Traditionally, monotherapy is used as first-line treatment to achieve BP targets; however, when this fails, combination therapy is then required. In light of the need to attain BP goals, combination therapy (especially fixed-dose) is currently recommended. The main advantages of combination therapy over monotherapy are not only that of reduced dose, improved efficacy and reduced adverse effects, but also of target protection and reduced cardiovascular (CV) risk. Therefore, the development of single-administration drug combinations should also improve patient adherence to therapy and therefore help in achieving BP control. Among the various combinations available, calcium channel blockers (CCBs) and angiotensinconverting enzyme (ACE) inhibitors have been proven to be extremely effective, while also displaying good tolerability. Individually, both the third-generation CCB lercanidipine and the ACE inhibitor enalapril are effective antihypertensive agents. In addition, both of these agents also show other beneficial effects when administered as monotherapy. Of particular importance is the fact that when lercanidipine plus enalapril are administered in combination, they show synergism, thus providing added efficacy with reduced side effects. The present report provides an overview of the main clinical studies examining lercanidipine and enalapril administered as monotherapy, with particular focus on the potential renoprotective effects afforded by the fixed-dose combination lercanidipine-enalapril. © 2011 Società Italiana di Nefrologia. Source

Leonetti G.,Istituto Auxologico Italiano | Egan C.G.,Primula Multimedia Srl
Vascular Health and Risk Management | Year: 2012

β-blockers are effective antihypertensive agents and, together with diuretics, have been the cornerstone of pioneering studies showing their benefits on cardiovascular morbidity and mortality as a consequence of blood pressure reduction in patients with hypertension. However, evidence from recent meta-analyses have demonstrated no benefit afforded by atenolol compared with placebo in risk of mortality, myocardial infarction, or stroke, and a higher risk of mortality and stroke with atenolol/propranolol compared with other antihypertensive drug classes. Thus, the effect of these agents on cardiovascular morbidity and mortality in hypertensive patients, especially their use in uncomplicated hypertension, has remained largely controversial. However, it is recognized that the clinical studies used in these meta-analyses were mainly based on the older second-generation β-blockers, such as atenolol and metoprolol. Actually, considerable heterogeneity in, eg, pharmacokinetic, pharmacological, and physicochemical properties exists across the different classes of β-blockers, particularly between the second-generation and newer third-generation agents. Carvedilol is a vasodilating noncardioselective third-generation β-blocker, without the negative hemodynamic and metabolic effects of traditional β-blockers, which can be used as a cardioprotective agent. Compared with conventional β-blockers, carvedilol maintains cardiac output, has a reduced prolonged effect on heart rate, and reduces blood pressure by decreasing vascular resistance. Studies have also shown that carvedilol exhibits favorable effects on metabolic parameters, eg, glycemic control, insulin sensitivity, and lipid metabolism, suggesting that it could be considered in the treatment of patients with metabolic syndrome or diabetes. The present report provides an overview of the main clinical studies concerning carvedilol administered as either monotherapy or in combination with another antihypertensive or more frequently a diuretic agent, with particular focus on the additional benefits beyond blood pressure reduction. © 2012 Leonetti and Egan, publisher and licensee Dove Medical Press Ltd. Source

Mesenchymal stem cells (MSCs) are recognized for their potential in regenerative medicine. Due to long-term negative effects associated with insulin administration and difficulty with pancreas transplantation, patients with type-1 diabetes could significantly benefit from organ-targeted cell-based therapy. Although several pharmacological agents increase the homing capacity of MSCs, the mechanisms regulating this process are still poorly understood. In this issue, Najafi et al. have demonstrated that pre-treatment of bone marrow-derived MSCs with the iron chelator and hypoxia mimetic, deferoxamine, can increase homing to the pancreas in a rat model of diabetes. This effect appears to be driven through specific chemokines in addition to hypoxia-inducing factor 1-alpha. Results from this study provide important clues in our endeavour to solve a complex process. Further studies will help determine whether these findings may offer potential therapeutic benefit to patients with diabetes. © Informa UK, Ltd. Source

Costanzo A.M.,S. Giovanni Evangelista Hospital | Gorini A.,Abbott Laboratories | Egan C.G.,Primula Multimedia Srl | di Luzio Paparatti U.,Abbott Laboratories
Journal of Nephrology | Year: 2012

Background: Chronic kidney disease (CKD) is a major worldwide problem. A lack of CKD awareness and knowledge of associated risk factors may delay diagnosis and treatment. The purpose of this epidemiolog-ical study was to assess the presence and awareness of CKD, in addition to evaluating associated clinical characteristics. Methods: This cross-sectional observational study included 573 healthy volunteers (aged 21-62 years) based in central Italy. All participants underwent a nephrological visit, providing data on medical history, anamnesis and CKD awareness. Blood and urine samples were also collected. Results: Estimated glomerular filtration rate (eGFR) calculated by the abbreviated Modification of Diet in Renal Disease (MDRD) study formula revealed that 55% of participants had an eGFR of <90 ml/min per 1.73 m 2 compared with 24.6% by the Cockcroft-Gault formula (C-G; p<0.0001). Approximately 45% of participants showed an awareness of CKD, these subjects also having a significantly lower Framingham score (p<0.046). Approximately half of participants (51%) had insufficient levels (<30 ng/mL) of serum 25-hydroxyvi-tamin D (25(OH)D), with a higher proportion observed in female (58.3%) than male participants (45.6%, p=0.0016). Levels of 25(OH)D were negatively correlated with eGFR, measured by either MDRD or C-G (r=-0.12, p=0.0039 and r=-0.09, p=0.029 respectively). Logistic regression analysis revealed that male sex and increased serum creatinine levels were predictors associated with study outcomes (clinical risk factors). Conclusions: This study suggests that screening for CKD in the general population by eGFR calculations (MDRD or C-G) is unreliable; therefore, the monitoring of serum creatinine and other risk factors may be more appropriate. The presence of vitamin D insufficiency in apparently healthy individuals warrants further investigation. © 2011 Società Italiana di Nefrologia. Source

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