Morpholinium thiazotati in the treatment of liver diseases and combined liver and heart diseases (narrative review)

The review analyzes preclinical and clinical studies of thiotriazoline in liver and heart diseases, and their combination, highlighting the most promising areas for further research. Thiotriazoline (morpholinium thiazotate, morpholine-4-ium 2-(5-methyl1H-1,2,4-triazol-3-ylsulfanyl)acetate) is an organic salt derived from heterocycles of morpholine (tetrahydro-1,4-oxazine) and 1,2,4-triazole. It has the ability to reduce oxidative and nitrosative stress, justifying its broad clinical use. The capacity of thiotriazoline to suppress nitrotyrosine and peroxynitrite production is relevant for both cardiovascular diseases and liver diseases. Several studies demonstrate its efficacy in treating heart conditions by improving endothelial dysfunction and enhancing myocardial hemodynamics. These properties have been confirmed in randomized clinical trials (RCTs) and meta-analyses, including patients with chronic coronary artery disease and acute coronary syndrome. Notably, thiotriazoline has shown promising results in patients with non-alcoholic fatty liver disease (NAFLD) and alcoholic fatty liver disease (AFLD), where atherosclerotic cardiovascular disease (e.g., hypertension, ischemic heart disease, heart failure) is a major comorbidity. The underlying mechanisms include insulin resistance, chronic inflammation, and dyslipidemia. Thiotriazoline improves microcirculation in the liver and heart, reduces oxidative stress, and mitigates inflammation. Clinical trials report symptom relief, improved liver function tests, and enhanced physical functioning in these patients. The review also discusses thiotriazoline’s role in managing cardioand hepatotoxicity induced by chemotherapy and anti-tuberculosis treatment. In some cases, its use allowed patients to continue and complete therapy, indirectly improving prognosis. Finally, the review outlines limitations of existing studies and identifies key areas for future research on thiotriazoline in modern clinical practice.

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