Colchicine: Its mechanism of action and efficacy in crystal-induced inflammation

doi:10.1007/S11926-008-0036-3

Paper

Colchicine: Its mechanism of action and efficacy in crystal-induced inflammation

Published Oct 24, 2008 · G. Nuki

Current Rheumatology Reports

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182

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8

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Abstract

New light has been shed on the mechanisms of action of colchicine in crystal-associated arthropathies. Colchicine, long used to treat gout, arrests microtubule assembly and inhibits many cellular functions. At micromolar concentrations, it suppresses monosodium urate crystal-induced NACHT-LRR-PYD-containing protein-3 (NALP3) inflammasome-driven caspase-1 activation, IL-1β processing and release, and L-selectin expression on neutrophils. At nanomolar concentrations, colchicine blocks the release of a crystal-derived chemotactic factor from neutrophil lysosomes, blocks neutrophil adhesion to endothelium by modulating the distribution of adhesion molecules on the endothelial cells, and inhibits monosodium urate crystal-induced production of superoxide anions from neutrophils. Cytochrome P450 3A4, the multidrug transporter P-glycoprotein, and the drugs that bind these proteins influence its pharmacokinetics and pharmacodynamics. Trial evidence supports its efficacy in acute gout and in preventing gout flares, but it has narrow therapeutic index, and overdosage is associated with gastrointestinal, hepatic, renal, neuromuscular, and cerebral toxicity; bone marrow damage; and high mortality.

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Study Snapshot

Colchicine effectively reduces crystal-induced inflammation in gout by arresting microtubule assembly and inhibiting cellular functions, but has a narrow therapeutic index and potential side effects.

PopulationOlder adults (50-71 years)

Sample size24

MethodsObservational

OutcomesBody Mass Index projections

ResultsSocial networks mitigate obesity in older groups.

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Colchicine: Its mechanism of action and efficacy in crystal-induced inflammation

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References

Colchicine suppresses neutrophil superoxide production in a murine model of gouty arthritis: a rationale for use of low‐dose colchicine

Low-dose colchicine reduces neutrophil superoxide production and infiltration in a murine model of acute gouty inflammation, potentially benefiting patients with gout.

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The inflammasome complex plays a crucial role in autoinflammatory diseases and gout attacks, offering new potential treatment options for these conditions.

Is there still a place for colchicine in the treatment of acute gout?

Colchicine's continued use in acute gout treatment is controversial due to its narrow therapeutic index and potential side effects, requiring improved evidence-based guidance on the safest regimen.

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Intravenous colchicine has the smallest benefit-to-toxicity ratio for acute gout treatment, and its use may be unsafe due to potential toxicity and off-label use for back pain.

Deaths from intravenous colchicine resulting from a compounding pharmacy error--Oregon and Washington, 2007.

Intravenous colchicine for back pain can be fatal due to measuring errors in compounding pharmacies, highlighting the potential risk of using this treatment and the potential consequences of measuring errors in compounding pharmacies.

Activation of the NALP3 inflammasome is triggered by low intracellular potassium concentration

Low intracellular potassium concentration is the least common trigger of NALP3 inflammasome activation, which can be blocked by inhibiting potassium efflux from cells.

British Society for Rheumatology and British Health Professionals in Rheumatology guideline for the management of gout.

This guideline aims to improve gout management and prevention by promoting evidence-based treatment recommendations and addressing variability in practice.

Colchicine overdose: the devil is in the detail.

Colchicine overdoses are often accidental and fatal, highlighting the need for increased awareness and reassessment of its toxicity among prescribers, patients, and families.

Citations

Colchicine for the primary prevention of cardiovascular events.

The evidence on colchicine's potential cardiovascular benefits and harms for primary prevention is inconclusive due to limitations in current studies.

Biomacromolecules as Immunomodulators: Utilizing Nature’s Tools for Immune Regulation

Plant-based immunomodulatory drugs show potential for enhanced chemotherapies due to their safety and effectiveness in combating various diseases and preventing prevention.

The effect of colchicine on cholesterol crystal formation, expansion and morphology: a potential mechanism in atherosclerosis

Colchicine can reduce cholesterol crystal formation, expansion, and alter morphology, potentially contributing to its clinical benefit in patients with cardiovascular disease independent of its anti-inflammatory effects.

Delivery Strategies for Colchicine as a Critical Dose Drug: Reducing Toxicity and Enhancing Efficacy

Transdermal drug delivery for colchicine shows potential in reducing toxicity and enhancing efficacy, avoiding the first-pass effect and traumatic pain associated with oral and injection routes.

FIRST RECORD OF COLCHICUM TRIPHYLLUM (COLCHICACEAE) FROM HIGH ALTITUDE IN NORTHEASTERN ALGERIA

Colchicum triphyllum Kunze has been found at a new high-altitude location in Northeastern Algeria, highlighting the need for conservation efforts to protect this rare species.

The impact of colchicine on patients with acute and chronic coronary artery disease.

Low-dose colchicine may reduce the risk of ischemic events in patients with coronary artery disease, particularly repeated revascularizations, new myocardial infarctions, and strokes.