Suppression of Angioplasty-Related Inflammation by Pre-Procedural Treatment with Trimetazidine

Abstract

Percutaneous transluminal coronary angioplasty (PTCA) has been recognized as a reliable treatment procedure for acute reversible ischemia and reperfusion. Ischemic reperfusion cycle in PTCA leads to the systemic inflammation and extensive tissue injury by the production of reactive oxygen species including nitric oxide (NO) radicals. In patients with coronary artery disease, undergoing PTCA, the effects of trimetazidine (TMZ), a piperazine-derivative anti-anginal drug, were studied on several indirect markers of systemic inflammatory response: tumor necrosis factor-α (TNF-α ), C-reactive protein (CRP) and NO products (nitrite and nitrate). Patients (n = 11 each group) were untreated or pre-treated with TMZ (20 mg per orally three times a day), begun three days prior to PTCA, and marker levels were measured before the start of TMZ therapy (baseline), just before PTCA (0 hr), and 4, 24, and 48 hrs after PTCA. The baseline levels of markers were not significantly different between the untreated and pre-treated patients. In contrast, all parameters were lower in the TMZtreated group than those in the matched control group in the pre-and post-angioplasty periods. Interestingly, in the TMZ group, CRP and nitrite levels were significantly lower than in the control group at each time point of the pre-and post-angioplasty periods, but the TNF-α levels were significantly decreased only in the post-angioplasty period. Preprocedural treatment with oral TMZ for three days significantly suppressed the elevation of inflammatory markers before and shortly after PTCA. We suggest the usefulness of TMZ in preventing inflammatory cardiovascular events after PTCA.trimetazidine; percutaneous transluminal coronary angioplasty; C-reactive protein; nitric oxide; tumor necrosis factor-α .

Persistent Oxidative Stress after Myocardial Infarction Treated by Percutaneous Coronary Intervention

“…Medicaments that suppress inflammatory response to the damage, as recently described for trimetazidine (Kuralay et al 2006), could be of additional interest, while the use of aspirin known as an ti-in fl ammato r y d r u g th at h as anticoagulating and antioxidant features should be considered with care (Hobikoglu et al 2005). Therefore, novel bioengineered compounds should be tested as well as cocktails of classical antioxidants in order to reduce the reperfusion injury within the myocardium (Hung et al 2001), which may become efficient supportive treatments for myocardial recovery after AMI and successful convalescence of patients.…”

Effect of trimetazidine on acute and sub-acute models of inflammation in male wistar rats

“…The anti-inflammatory effect of trimetazidine can be attributed to decrease the levels of TNF α , NO products and CRP. [7][8][9][10] Though the results of the present study do not point at actual mechanism of trimetazidine on inflammation, this effect can be attributed to the effect of trimetazidine to decrease TNF α as reported in previous studies. [7][8][9][10] This study shows that in addition to anti anginal activity, trimetazidine may also possess anti-inflammatory properties that could be of additional benefit in the treatment of atherosclerosis and their complications like reinfarction and infarct extension, and also in preventing cardiovascular events like restenosis after PCI.…”

“…Interestingly certain studies have reported that metabolic modulator trimetazidine, which is an antianginal drug, inhibits the inflammatory markers like C reactive protein(CRP), nitric oxide products (nitrite and nitrates), interleukins (IL-1, IL-6) and TNF alpha. [7][8][9] But another study suggested that trimetazidine showed no significant reduction in the levels of IL-8, TNF-α, complement 3 and 5 and CRP. 10 Review of literature revealed paucity of studies regarding anti-inflammatory activity of the above mentioned drug in animals.…”

Effects of Trimetazidine Treatment on the Lipoprotein-Associated Phospholipase A2 Level and Exercise Parameters in Patients with Stable Angina Pectoris

“…Zhou et al reported that TMZ protected against smokinginduced left ventricular remodeling via attenuating oxidative stress, apoptosis, and infl ammation (10) . Kuralay et al found that TMZ signifi cantly reduced CRP and TNF-α levels after coronary angioplasty (11) . Lipoprotein-associated phospholipase A 2 is a novel and unique biomarker, highly specifi c for vascular infl ammation and Hematocrit (%) 40.6 ± 3.5…”