Therapeutic potential of colchicine in cardiovascular medicine: a pharmacological review

Fan-Shun Zhang, Qing-Ze He, Chengxue Helena Qin, Peter J Little, Jian-Ping Weng, Suo-Wen Xu, Fan-Shun Zhang, Qing-Ze He, Chengxue Helena Qin, Peter J Little, Jian-Ping Weng, Suo-Wen Xu

Abstract

Colchicine is an ancient herbal drug derived from Colchicum autumnale. It was first used to treat familial Mediterranean fever and gout. Based on its unique efficacy as an anti-inflammatory agent, colchicine has been used in the therapy of cardiovascular diseases including coronary artery disease, atherosclerosis, recurrent pericarditis, vascular restenosis, heart failure, and myocardial infarction. More recently, colchicine has also shown therapeutic efficacy in alleviating cardiovascular complications of COVID-19. COLCOT and LoDoCo2 are two milestone clinical trials that confirm the curative effect of long-term administration of colchicine in reducing the incidence of cardiovascular events in patients with coronary artery disease. There is growing interest in studying the anti-inflammatory mechanisms of colchicine. The anti-inflammatory action of colchicine is mediated mainly through inhibiting the assembly of microtubules. At the cellular level, colchicine inhibits the following: (1) endothelial cell dysfunction and inflammation; (2) smooth muscle cell proliferation and migration; (3) macrophage chemotaxis, migration, and adhesion; (4) platelet activation. At the molecular level, colchicine reduces proinflammatory cytokine release and inhibits NF-κB signaling and NLRP3 inflammasome activation. In this review, we summarize the current clinical trials with proven curative effect of colchicine in treating cardiovascular diseases. We also systematically discuss the mechanisms of colchicine action in cardiovascular therapeutics. Altogether, colchicine, a bioactive constituent from an ancient medicinal herb, exerts unique anti-inflammatory effects and prominent cardiovascular actions, and will charter a new page in cardiovascular medicine.

Keywords: NF-κB; NLRP3 inflammasome; anti-inflammatory drug; atherosclerosis; cardiovascular complications of COVID-19; cardiovascular diseases; colchicine; coronary artery disease; heart failure; microtubules; myocardial infarction; recurrent pericarditis; restenosis.

Conflict of interest statement

The authors declare no competing interests.

© 2021. The Author(s), under exclusive licence to CPS and SIMM.

Figures

Fig. 1. Timeline and milestone of colchicine…
Fig. 1. Timeline and milestone of colchicine in medicinal history.
The use of colchicine dates back to Ebers papyrus. Until 1833, the legendary drug was named as “Colchicine”. From 1971 to 1979, many preclinical studies demonstrated the efficacy of colchicine in the treatment of inflammatory diseases. At the end of the 20th century, mounting evidences proved that colchicine is beneficial to cardiovascular diseases, such as atherosclerosis, pericarditis, atrial fibrillation. Until 2005, the structure of colchicine was first reported, and then clinical trials involving colchicine for cardiovascular disease were actively pursued.
Fig. 2. Usage of colchicine in various…
Fig. 2. Usage of colchicine in various diseases.
As an ancient anti-inflammatory drug, colchicine was effective for some liver diseases, lung diseases, and infectious diseases (such as COVID-19), cancer, and cardiovascular diseases (including atherosclerosis, recurrent pericarditis, restenosis, heart failure, or myocardial infarction). Colchicine has some side effects such as injury to the liver and kidney function and toxicity.
Fig. 3. The mechanisms of action of…
Fig. 3. The mechanisms of action of colchicine in cardiovascular disease protection.
This figure shows the pathogenesis of atherosclerosis and multiple cells interaction in this progress. Colchicine inhibits: (1) endothelial dysfunction; (2) the release of proinflammatory cytokines; (3) macrophage migration, chemotaxis, and adhesion; (4) platelets and immune cells activation.
Fig. 4. Molecular targets of colchicine in…
Fig. 4. Molecular targets of colchicine in cardiovascular protection.
a Mechanism of colchicine blocking β-tubulin and then disrupting the assembly of microtubules; b mechanism of colchicine targeting NF-κB and then inhibiting many important processes in atherosclerosis; c mechanism of colchicine inhibiting NLRP3 inflammasome activation.

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