4.7 Article

Clinical use of cyclooxygenase inhibitors impairs vitamin B-6 metabolism

期刊

AMERICAN JOURNAL OF CLINICAL NUTRITION
卷 98, 期 6, 页码 1440-1449

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OXFORD UNIV PRESS
DOI: 10.3945/ajcn.113.064477

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资金

  1. National Science Council of Taiwan [NSC100-2628-B005-002MY4, NSC101-2320-B-005-006-MY3, NSC101-2911-I-005-301]
  2. ATU plan of the Ministry of Education of Taiwan
  3. Department of Health of Taiwan [DOH97-TD-D-113-97011]
  4. Taichung Veterans General Hospital-National Chung Hsing University [997608]

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Background: A low circulating vitamin B-6 concentration, which is an independent risk factor for cardiovascular disease, is commonly seen in human inflammation. Objective: We investigated whether cyclooxygenase inhibitors alter vitamin B-6 metabolism. Design: To investigate whether subjects taking a cyclooxygenase inhibitor had an altered vitamin B-6 profile, we conducted a cross-sectional study that involved 150 rheumatoid arthritis patients, with and without cyclooxygenase inhibitor treatments. C57BL/6J mice and hyperlipidemic Syrian hamsters received drug regimens that reflected clinical nonsteroidal antiinflammatory drug (NSAID) uses in treating human inflammation. The impact of long-term physiologic use of selective and nonselective cyclooxygenase inhibitors on vitamin B-6 metabolism was systematically investigated in these independent in vivo models. Results: Patients who were taking cyclooxygenase inhibitors had lower circulating pyridoxal-5'-phosphate, especially those taking NSAIDs >6 mo. Long-term celecoxib and naproxen use reduced hepatic pyridoxal-5'-phosphate in mice. Nonselective cyclooxygenase inhibitor naproxen significantly decreased vitamin B-6 vitamers in the kidney. Conclusions: To our knowledge, we show novel findings that long-term physiologic doses of cyclooxygenase inhibitor may impede the synthesis of the coenzymatically active form of vitamin B-6. Because the cause of vitamin B-6 depletion in inflammation remains unknown, this study provides a potential mechanism that could account for the poor vitamin B-6 status in human inflammation. Moreover, this study further raises concerns about the long-term clinical use of antiinflammatory NSAIDs in humans. Vitamin B-6 status should be carefully monitored in long-term NSAID users. Future randomized placebo-controlled studies are needed to determine the impacts of antiinflammatory cyclooxygenase inhibitor use on vitamin B-6 metabolism in humans.

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