There are three stages in the management of gout: (i) treating the acute attack; (ii) lowering excess stores of uric acid to prevent flares of gouty arthritis and to prevent tissue deposition of urate; and (iii) providing prophylaxis to prevent acute flares. It is important to distinguish between therapy to reduce acute inflammation in acute gout and therapy to manage hyperuricaemia in patients with chronic gouty arthritis. During the acute gouty attack nonpharmacological treatments such as topical ice and rest of the inflamed joint are useful. NSAIDs are the preferred treatment in acute gout. The most important determinant of therapeutic success is not which NSAID is chosen, but rather how soon NSAID therapy is initiated. Other treatments include oral and intravenous colchicine, intra-articular and systemic corticosteroids, and intramuscular corticotropin. Optimal treatment of chronic gout requires long-standing reduction in serum uric acid. The urate-lowering drugs used to treat chronic gout are the uricosuric drugs, the uricostatic drugs, which are xanthine oxidase inhibitors, and the uricolytic drugs. Xanthine oxidase inhibitors such as allopurinol, oxipurinol and febuxastat should be used as first-line treatment in patients with renal calculi, renal insufficiency, concomitant diuretic therapy and ciclosporin (cyclosporine) therapy, and urate overproduction. Uricosuric drugs include probenecid, benzbromarone, micronised fenofibrate and losartan. They are the urate-lowering drugs of choice in allopurinol-allergic patients and underexcretors with normal renal function and no history of urolithiasis. The use of recombinant urate oxidase in patients with chronic gout is limited by the need for parenteral administration, the potential antigenicity and production of anti-urate oxidase antibodies, and declining efficacy. The effectiveness of colchicine prophylaxis as an isolated therapy is still to be confirmed by placebo-controlled trials. Another issue is prophylaxis with NSAIDs. There are no comparative studies with colchicine.

Management of acute and chronic gouty arthritis: present state-of-the-art.

Es wird eine von Purpurogallin, bzw. Pyrogallol ausgehende Totalsynthese des Colchicins, des Hauptalkaloids der Herbstzeitlose, beschrieben.

Synthese des Colchicins

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection, is a pandemic causing havoc globally. Currently, there are no Food and Drug Administration (FDA)-approved drugs to treat COVID-19. In the absence of effective treatment, off-label drug use, in lieu of evidence from published randomized, double-blind, placebo-controlled clinical trials, is common in COVID-19. Although it is vital to treat affected patients with antiviral drugs, there is a knowledge gap regarding the use of anti-inflammatory drugs in these patients. Colchicine trials to combat inflammation in COVID-19 patients have not received much attention. We await the results of ongoing colchicine randomized controlled trials in COVID-19, evaluating colchicine’s efficacy in treating COVID-19. This review gives a spotlight on colchicine’s anti-inflammatory and antiviral properties and why colchicine may help fight COVID-19. This review summarizes colchicine’s mechanism of action via the tubulin-colchicine complex. Furthermore, it discussed how colchicine interferes with several inflammatory pathways, including inhibition of neutrophil chemotaxis, adhesion, and mobilization; disruption of superoxide production, inflammasome inhibition, and tumor necrosis factor reduction; and its possible antiviral properties. In addition, colchicine dosing and pharmacokinetics, as well as drug interactions and how they relate to ongoing, colchicine in COVID-19 clinical trials, are examined.

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Colchicine in COVID-19: an Old Drug, New Use.

Publisher Summary This chapter discusses that practical synthesis of natural (aS, 7S)-colchicine and its 3-demethyl analog remain a challenge for organic chemists. Variation of the structure of colchicine has led to several possibly less toxic analogs, such as deacetylcolchicine and 3-demethylthiocolchicine. Whereas the former can readily be applied in the form of water-soluble salts, the latter, which is not very soluble in water or commonly used solvents, requires study about its formulation. Information on the metabolism of colchicine and its analogs in humans is still inadequate. The same conclusion holds for the biosynthesis of colchicine, which lacks details in the construction of the tropolonic unit and in the formation of the acetamido group. The chapter reviews the beneficial effects of colchicines, which reported in amyloidosis, familial Mediterranean fever, and cirrhosis, for which presently no good therapeutic agents are available, may stimulate interest in the development of one of its less toxic analogs, including phenyltropolones and biphenyls with proper substitution and proper axial chirality.

Chapter 3 Tropolonic Colchicum Alkaloids and Allo Congeners

Numerous molecules containing a biaryl unit have been found in Nature. Many of them exhibit a variety of biological actions. In this review, we will focus only on natural bridged biaryls that possess axial chirality and exhibit antimitotic activities. Thus, we will first present the occurrence and structure of three families of natural compounds that display these particular structural and biological features: the allocolchicinoids, steganes and rhazinilam-type compounds. We will then describe the semi-synthetic and synthetic approaches to biaryls belonging to these three series. Their interaction with tubulin, a heterodimeric protein that is critical for the formation of microtubules and consequently of the mitotic spindle, will be discussed.

Natural Bridged Biaryls with Axial Chirality and Antimitotic Properties

Der energische oxydative Abbau von Colchicin mit Ozon und die nachfolgende Oxydation der Ozonisationsprodukte mit Perameisensaure fuhrten zu N-Acetyl-L-glutaminsaure. Fur das Colchicin ist somit die Konfiguration I bewiesen.

E. Hardegger

Papers

Die Konfiguration des Colchicins und verwandter Verbindungen