Key result
Cilastatin demonstrates potential efficacy as a nephroprotective agent against drug-induced nephrotoxicity in preclinical and limited human studies, though large-scale human data are lacking.
Why the study?
Cilastatin may prevent imipenem-induced renal damage, prompting a review of its potential role as a nephroprotective agent alongside other well-known nephrotoxic medications.
Does cilastatin prevent drug-induced nephrotoxicity?
Does cilastatin prevent drug-induced nephrotoxicity?
Cilastatin shows potential as a nephroprotective agent against various nephrotoxic medications in preclinical and early human studies, though large clinical trials are needed.
Should not yet change practice for drug-induced nephrotoxicity; leaves open confirmation in large randomized trials.
INTRODUCTION: Cilastatin, a dehydropeptidase I inhibitor, has been used alongside imipenem, a broad spectrum antibiotic, in order to reduce its renal metabolism, consequently increasing its urinary recovery and effectiveness for many years. However, this measure could be useful in preventing imipenem-induced renal damage and decreasing the number of nephrotoxicity reports with imipenem. In this review, the authors gathered all available studies focusing on cilastatin use as a nephroprotective agent, beside well-known nephrotoxic medications like vancomycin, cisplatin, cyclosporine, or tacrolimus. AREAS COVERED: PubMed, Scopus, Google Scholar, and Medline databases were searched using key words like 'cilastatin,' 'nephroprotective,' 'nephroprotection,' 'vancomycin,' 'nephrotoxicity,' 'cisplatin,' 'cyclosporine,' 'tacrolimus,' and 'prevention' with varying combinations. All relevant animal and human studies up to the date of publication were included. EXPERT OPINION: It seems that cilastatin could potentially be effective against drug-induced nephrotoxicity via mechanisms such as reducing reactive oxygen species (ROS) production, apoptosis, P-glycoprotein suppression, and morphological changes of renal cells. Nearly all the in vitro, in vivo and human studies have supported this hypothesis. Though since cilastatin protective effect has not extensively been researched in humans, its efficacy and widespread use with other nephrotoxic agents is yet to be defined in large well-designed human studies.
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Shayan et al. (2020) conducted a review in Drug-induced nephrotoxicity. Cilastatin was evaluated on Nephroprotection against drug-induced nephrotoxicity. Cilastatin demonstrates potential efficacy as a nephroprotective agent against drug-induced nephrotoxicity in preclinical and limited human studies, though large-scale human data are lacking.
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