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de Raaf MA, Kroeze Y, Middelman A, de Man FS, de Jong H, Vonk-Noordegraaf A, de Korte C, Voelkel NF, Homberg J, Bogaard HJ. Serotonin transporter is not required for the development of severe pulmonary hypertension in the Sugen hypoxia rat model. Am J Physiol Lung Cell Mol Physiol 2015; 309:L1164-73. [PMID: 26386116 DOI: 10.1152/ajplung.00127.2015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 09/03/2015] [Indexed: 01/08/2023] Open
Abstract
Increased serotonin serum levels have been proposed to play a key role in pulmonary arterial hypertension (PAH) by regulating vessel tone and vascular smooth muscle cell proliferation. An intact serotonin system, which critically depends on a normal function of the serotonin transporter (SERT), is required for the development of experimental pulmonary hypertension in rodents exposed to hypoxia or monocrotaline. While these animal models resemble human PAH only with respect to vascular media remodeling, we hypothesized that SERT is likewise required for the presence of lumen-obliterating intima remodeling, a hallmark of human PAH reproduced in the Sugen hypoxia (SuHx) rat model of severe angioproliferative pulmonary hypertension. Therefore, SERT wild-type (WT) and knockout (KO) rats were exposed to the SuHx protocol. SERT KO rats, while completely lacking SERT, were hemodynamically indistinguishable from WT rats. After exposure to SuHx, similar degrees of severe angioproliferative pulmonary hypertension and right ventricular hypertrophy developed in WT and KO rats (right ventricular systolic pressure 60 vs. 55 mmHg, intima thickness 38 vs. 30%, respectively). In conclusion, despite its implicated importance in PAH, SERT does not play an essential role in the pathogenesis of severe angioobliterative pulmonary hypertension in rats exposed to SuHx.
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Affiliation(s)
| | - Yvet Kroeze
- Department of Cognitive Neuroscience, Donders Institute for Brain, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Anthonieke Middelman
- Department of Cognitive Neuroscience, Donders Institute for Brain, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Frances S de Man
- Departments of Pulmonology and Physiology, VU University Medical Center/Institute for Cardiovascular Research, Amsterdam, The Netherlands
| | - Helma de Jong
- Department of Laboratory of Chemistry and metabolic diseases, University Medical Centre, Groningen, The Netherlands
| | | | - Chris de Korte
- Department of Radiology, Medical UltraSound Imaging Center; Radboud University Medical Centre, Nijmegen, The Netherlands; and
| | - Norbert F Voelkel
- Pulmonary and Critical Care Medicine Division, Virginia Commonwealth University, Richmond, Virginia
| | - Judith Homberg
- Department of Cognitive Neuroscience, Donders Institute for Brain, Radboud University Medical Centre, Nijmegen, The Netherlands
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Maron BA, Leopold JA. Emerging Concepts in the Molecular Basis of Pulmonary Arterial Hypertension: Part II: Neurohormonal Signaling Contributes to the Pulmonary Vascular and Right Ventricular Pathophenotype of Pulmonary Arterial Hypertension. Circulation 2015; 131:2079-91. [PMID: 26056345 DOI: 10.1161/circulationaha.114.006980] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Bradley A Maron
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., J.A.L.); and Department of Cardiology, Veterans Affairs Boston Healthcare System, Boston, MA (B.A.M.)
| | - Jane A Leopold
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., J.A.L.); and Department of Cardiology, Veterans Affairs Boston Healthcare System, Boston, MA (B.A.M.).
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103
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Bristow MR, Quaife RA. The adrenergic system in pulmonary arterial hypertension: bench to bedside (2013 Grover Conference series). Pulm Circ 2015; 5:415-23. [PMID: 26401244 PMCID: PMC4556494 DOI: 10.1086/682223] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 01/21/2015] [Indexed: 12/20/2022] Open
Abstract
In heart failure with reduced left ventricular ejection fraction (HFrEF), adrenergic activation is a key compensatory mechanism that is a major contributor to progressive ventricular remodeling and worsening of heart failure. Targeting the increased adrenergic activation with β-adrenergic receptor blocking agents has led to the development of arguably the single most effective drug therapy for HFrEF. The pressure-overloaded and ultimately remodeled/failing right ventricle (RV) in pulmonary arterial hypertension (PAH) is also adrenergically activated, which raises the issue of whether an antiadrenergic strategy could be effectively employed in this setting. Anecdotal experience suggests that it will be challenging to administer an antiadrenergic treatment such as a β-blocking agent to patients with established moderate-severe PAH. However, the same types of data and commentary were prevalent early in the development of β-blockade for HFrEF treatment. In addition, in HFrEF approaches have been developed for delivering β-blocker therapy to patients who have extremely advanced heart failure, and these general principles could be applied to RV failure in PAH. This review examines the role played by adrenergic activation in the RV faced with PAH, contrasts PAH-RV remodeling with left ventricle remodeling in settings of sustained increases in afterload, and suggests a possible approach for safely delivering an antiadrenergic treatment to patients with RV dysfunction due to moderate-severe PAH.
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Affiliation(s)
- Michael R. Bristow
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Robert A. Quaife
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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104
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Abstract
Pulmonary arterial hypertension (PAH) is a right heart failure syndrome. In early-stage PAH, the right ventricle tends to remain adapted to afterload with increased contractility and little or no increase in right heart chamber dimensions. However, less than optimal right ventricular (RV)-arterial coupling may already cause a decreased aerobic exercise capacity by limiting maximum cardiac output. In more advanced stages, RV systolic function cannot remain matched to afterload and dilatation of the right heart chamber progressively develops. In addition, diastolic dysfunction occurs due to myocardial fibrosis and sarcomeric stiffening. All these changes lead to limitation of RV flow output, increased right-sided filling pressures and under-filling of the left ventricle, with eventual decrease in systemic blood pressure and altered systolic ventricular interaction. These pathophysiological changes account for exertional dyspnoea and systemic venous congestion typical of PAH. Complete evaluation of RV failure requires echocardiographic or magnetic resonance imaging, and right heart catheterisation measurements. Treatment of RV failure in PAH relies on: decreasing afterload with drugs targeting pulmonary circulation; fluid management to optimise ventricular diastolic interactions; and inotropic interventions to reverse cardiogenic shock. To date, there has been no report of the efficacy of drug treatments that specifically target the right ventricle.
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Affiliation(s)
- Robert Naeije
- Dept of Cardiology, Erasme University Hospital, Brussels, Belgium. Dept of Experimental, Diagnostic and Specialty Medicine (DIMES), Bologna University Hospital, Bologna, Italy.
| | - Alessandra Manes
- Dept of Cardiology, Erasme University Hospital, Brussels, Belgium. Dept of Experimental, Diagnostic and Specialty Medicine (DIMES), Bologna University Hospital, Bologna, Italy
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105
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Fowler ED, Benoist D, Drinkhill MJ, Stones R, Helmes M, Wüst RCI, Stienen GJM, Steele DS, White E. Decreased creatine kinase is linked to diastolic dysfunction in rats with right heart failure induced by pulmonary artery hypertension. J Mol Cell Cardiol 2015; 86:1-8. [PMID: 26116865 PMCID: PMC4564291 DOI: 10.1016/j.yjmcc.2015.06.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 06/19/2015] [Accepted: 06/22/2015] [Indexed: 02/01/2023]
Abstract
Our objective was to investigate the role of creatine kinase in the contractile dysfunction of right ventricular failure caused by pulmonary artery hypertension. Pulmonary artery hypertension and right ventricular failure were induced in rats by monocrotaline and compared to saline-injected control animals. In vivo right ventricular diastolic pressure-volume relationships were measured in anesthetized animals; diastolic force-length relationships in single enzymatically dissociated myocytes and myocardial creatine kinase levels by Western blot. We observed diastolic dysfunction in right ventricular failure indicated by significantly steeper diastolic pressure-volume relationships in vivo and diastolic force-length relationships in single myocytes. There was a significant reduction in creatine kinase protein expression in failing right ventricle. Dysfunction also manifested as a shorter diastolic sarcomere length in failing myocytes. This was associated with a Ca(2+)-independent mechanism that was sensitive to cross-bridge cycling inhibition. In saponin-skinned failing myocytes, addition of exogenous creatine kinase significantly lengthened sarcomeres, while in intact healthy myocytes, inhibition of creatine kinase significantly shortened sarcomeres. Creatine kinase inhibition also changed the relatively flat contraction amplitude-stimulation frequency relationship of healthy myocytes into a steeply negative, failing phenotype. Decreased creatine kinase expression leads to diastolic dysfunction. We propose that this is via local reduction in ATP:ADP ratio and thus to Ca(2+)-independent force production and diastolic sarcomere shortening. Creatine kinase inhibition also mimics a definitive characteristic of heart failure, the inability to respond to increased demand. Novel therapies for pulmonary artery hypertension are needed. Our data suggest that cardiac energetics would be a potential ventricular therapeutic target.
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Affiliation(s)
- Ewan D Fowler
- Multidisciplinary Cardiovascular Research Centre, University of Leeds, UK
| | - David Benoist
- Multidisciplinary Cardiovascular Research Centre, University of Leeds, UK; L'Institut de Rythmologie et Modélisation Cardiaque, Inserm U-1045, Université de Bordeaux, France
| | - Mark J Drinkhill
- Multidisciplinary Cardiovascular Research Centre, University of Leeds, UK
| | - Rachel Stones
- Multidisciplinary Cardiovascular Research Centre, University of Leeds, UK
| | - Michiel Helmes
- Department of Physiology, Institute for Cardiovascular Research, VU University Medical Centre, Amsterdam, The Netherlands; IonOptix LLC, Milton, MA, USA
| | - Rob C I Wüst
- Department of Physiology, Institute for Cardiovascular Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Ger J M Stienen
- Department of Physiology, Institute for Cardiovascular Research, VU University Medical Centre, Amsterdam, The Netherlands; Department of Physics and Astronomy, Faculty of Science, VU University, Amsterdam, The Netherlands
| | - Derek S Steele
- Multidisciplinary Cardiovascular Research Centre, University of Leeds, UK
| | - Ed White
- Multidisciplinary Cardiovascular Research Centre, University of Leeds, UK.
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106
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Abstract
Pulmonary arterial hypertension (PAH) includes a heterogeneous group of diseases characterized by pulmonary vasoconstriction and remodeling of the lung circulation. Although PAH is a disease of the lungs, patients with PAH frequently die of right heart failure. Indeed, survival of patients with PAH depends on the adaptive response of the right ventricle (RV) to the changes in the lung circulation. PAH-specific drugs affect the function of the RV through afterload reduction and perhaps also through direct effects on the myocardium. Prostacyclins, type 5 phosphodiesterase inhibitors, and guanylyl cyclase stimulators may directly enhance myocardial contractility through increased cyclic adenosine and guanosine monophosphate availability. Although this may initially improve cardiac performance, the long-term effects on myocardial oxygen consumption and function are unclear. Cardiac effects of endothelin receptor antagonists may be opposite, as endothelin-1 is known to suppress cardiac contractility. Because PAH is increasingly considered as a disease with quasimalignant growth of cells in the pulmonary vascular wall, therapies are being developed that inhibit hypertrophy and angiogenesis, and promote apoptosis. The inherent danger of these therapies is a further compromise to the already ischemic, fibrotic, and dysfunctional RV. More recently, the right heart has been identified as a direct treatment target in PAH. The effects of well established therapies for left heart failure, such as β-adrenergic receptor blockers, inhibitors of the renin-angiotensin system, exercise training, and assist devices, are currently being investigated in PAH. Future treatment of patients with PAH will likely consist of a multifaceted approaches aiming to reduce the pressure in the lung circulation and improving right heart adaptation simultaneously.
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107
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Abstract
Pulmonary arterial hypertension is a progressive and debilitating disorder with an associated high morbidity and mortality rate. Significant advances in our understanding of the epidemiology, pathogenesis, and pathophysiology of pulmonary hypertension have occurred over the past several decades. This has allowed the development of new therapeutic options in this disease. Today, our selection of therapeutic modalities is broader, including calcium channel blockers, prostanoids, endothelin receptor antagonists, phosphodiesterase inhibitors, and soluble guanylate cyclase stimulators, but the disease remains fatal. This underscores the need for a continued search for novel therapies. Several potential pharmacologic agents for the treatment of pulmonary arterial hypertension are under clinical development and some promising results with these treatments have been reported. These agents include rho-kinase inhibitors, long-acting nonprostanoid prostacyclin receptor agonists, tyrosine protein kinase inhibitors, endothelial nitric oxide synthase couplers, synthetically produced vasoactive intestinal peptide, antagonists of the 5-HT2 receptors, and others. This article will review several of these promising new therapies and will discuss the current evidence regarding their potential benefit in pulmonary arterial hypertension.
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108
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Bandyopadhyay D, Bajaj NS, Zein J, Minai OA, Dweik RA. Outcomes of β-blocker use in pulmonary arterial hypertension: a propensity-matched analysis. Eur Respir J 2015; 46:750-60. [PMID: 26022959 DOI: 10.1183/09031936.00215514] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 03/01/2015] [Indexed: 01/16/2023]
Abstract
The utility and safety of β-blockers in pulmonary hypertension is controversial. Anecdotal reports suggest that β-blockers may be harmful in these patients. The aim of our study was to evaluate outcomes of β-blocker use in pulmonary hypertension.We reviewed patients from our pulmonary hypertension registry between 2000 and 2011. Patients who continued to use β-blockers were compared to those who never used β-blockers for all-cause mortality, time to clinical worsening events, defined as death, lung transplantation and hospitalisation due to pulmonary hypertension. We also evaluated the effect of β-blockers on 6-min walking distance and New York Heart Association (NYHA) functional class.133 patients used β-blockers and 375 patients never used β-blockers. Mean±sd age was 57±16 years and the median follow-up period was 78 months. Propensity-matched analysis showed that the adjusted odds ratio (95% CI) for mortality with β-blocker use was 1.13 (0.69-1.82) and for clinical worsening events was 0.96 (0.55-1.68). No significant difference was noted in probability of survival and time to clinical worsening events. Patients on β-blockers walked a shorter distance on follow-up 6 min walk test; follow-up NYHA class was similar between groups.Pulmonary hypertension patients receiving β-blockers had a similar survival and time to clinical worsening events compared to patients not receiving them. Functional outcomes were similar, although β-blocker use was associated with a tendency towards shorter walking distance.
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Affiliation(s)
- Debabrata Bandyopadhyay
- Dept of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Joe Zein
- Dept of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Omar A Minai
- Dept of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Raed A Dweik
- Dept of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
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109
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Voelkel NF, Bogaard HJ, Gomez-Arroyo J. The need to recognize the pulmonary circulation and the right ventricle as an integrated functional unit: facts and hypotheses (2013 Grover Conference series). Pulm Circ 2015; 5:81-9. [PMID: 25992273 DOI: 10.1086/679702] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 08/07/2014] [Indexed: 12/31/2022] Open
Abstract
For many patients with severe pulmonary arterial hypertension, heart failure-and, in particular, right heart failure-is the final chapter of their chronic illness. Targeted therapy for pulmonary hypertension is effective only if the right ventricular ejection fraction is maintained or improved. Because improvement of right heart function and reversal of right heart failure are treatment goals, it is important to investigate the cellular and molecular mechanisms that cause right heart failure. Here, we propose that right ventricular capillary rarefaction is an important hallmark of right heart failure and consider that the "sick lung circulation" and the pressure-overloaded right ventricle constitute a functional unit.
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Affiliation(s)
- Norbert F Voelkel
- Department of Biochemistry and Molecular Biology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Harm Jan Bogaard
- Department of Pulmonary Medicine, Vrije Universiteit (VU) Medical Center, Amsterdam, Netherlands
| | - Jose Gomez-Arroyo
- Department of Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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110
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Trip P, Rain S, Handoko ML, van der Bruggen C, Bogaard HJ, Marcus JT, Boonstra A, Westerhof N, Vonk-Noordegraaf A, de Man FS. Clinical relevance of right ventricular diastolic stiffness in pulmonary hypertension. Eur Respir J 2015; 45:1603-12. [DOI: 10.1183/09031936.00156714] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 02/17/2015] [Indexed: 11/05/2022]
Abstract
Right ventricular (RV) diastolic stiffness is increased in pulmonary arterial hypertension (PAH) patients. We investigated whether RV diastolic stiffness is associated with clinical progression and assessed the contribution of RV wall thickness to RV systolic and diastolic stiffness.Using single-beat pressure–volume analyses, we determined RV end-systolic elastance (Ees), arterial elastance (Ea), RV–arterial coupling (Ees/Ea), and RV end-diastolic elastance (stiffness, Eed) in controls (n=15), baseline PAH patients (n=63) and treated PAH patients (survival >5 years n=22 and survival <5 years n=23).We observed an association between Eed and clinical progression, with baseline Eed >0.53 mmHg·mL-1 associated with worse prognosis (age-corrected hazard ratio 0.27, p=0.02). In treated patients, Eed was higher in patients with survival <5 years than in patients with survival >5 years (0.91±0.50 versus 0.53±0.33 mmHg·mL-1, p<0.01). Wall-thickness-corrected Eed values in PAH patients with survival >5 years were not different from control values (0.76±0.47 versus 0.60±0.41 mmHg·mL-1, respectively, not significant), whereas in patients with survival <5 years, values were significantly higher (1.52±0.91 mmHg·mL-1, p<0.05 versus controls).RV diastolic stiffness is related to clinical progression in both baseline and treated PAH patients. RV diastolic stiffness is explained by the increased wall thickness in patients with >5 years survival, but not in those surviving <5 years. This suggests that intrinsic myocardial changes play a distinctive role in explaining RV diastolic stiffness at different stages of PAH.
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111
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Poels EM, da Costa Martins PA, van Empel VPM. Adaptive capacity of the right ventricle: why does it fail? Am J Physiol Heart Circ Physiol 2015; 308:H803-13. [DOI: 10.1152/ajpheart.00573.2014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 01/21/2015] [Indexed: 11/22/2022]
Abstract
Only in recent years has the right ventricle (RV) function become appreciated to be equally important to the left ventricle (LV) function to maintain cardiac output. Right ventricular failure is, irrespectively of the etiology, associated with impaired exercise tolerance and poor survival. Since the anatomy and physiology of the RV is distinctly different than that of the LV, its adaptive mechanisms and the pathways involved are different as well. RV hypertrophy is an important mechanism of the RV to preserve cardiac output. This review summarizes the current knowledge on the right ventricle and its response to pathologic situations. We will focus on the adaptive capacity of the right ventricle and the molecular pathways involved, and we will discuss potential therapeutic interventions.
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Affiliation(s)
- Ella M. Poels
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; and
- Department of Cardiology, Heart Vessel Center, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Paula A. da Costa Martins
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; and
| | - Vanessa P. M. van Empel
- Department of Cardiology, Heart Vessel Center, Maastricht University Medical Centre, Maastricht, The Netherlands
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112
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Perros F, Ranchoux B, Izikki M, Bentebbal S, Happé C, Antigny F, Jourdon P, Dorfmüller P, Lecerf F, Fadel E, Simonneau G, Humbert M, Bogaard HJ, Eddahibi S. Nebivolol for improving endothelial dysfunction, pulmonary vascular remodeling, and right heart function in pulmonary hypertension. J Am Coll Cardiol 2015; 65:668-80. [PMID: 25677428 DOI: 10.1016/j.jacc.2014.11.050] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 10/15/2014] [Accepted: 11/19/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND Endothelial cell (EC) dysfunction plays a central role in the pathogenesis of pulmonary arterial hypertension (PAH), promoting vasoconstriction, smooth muscle proliferation, and inflammation. OBJECTIVES This study sought to test the hypothesis that nebivolol, a β1-antagonist and β2,3-agonist, may improve PAH and reverse the PAH-related phenotype of pulmonary ECs (P-EC). METHODS We compared the effects of nebivolol with metoprolol, a first-generation β1-selective β-blocker, on human cultured PAH and control P-EC proliferation, vasoactive and proinflammatory factor production, and crosstalk with PA smooth muscle cells. We assessed the effects of both β-blockers in precontracted PA rings. We also compared the effects of both β-blockers in experimental PAH. RESULTS PAH P-ECs overexpressed the proinflammatory mediators interleukin-6 and monocyte chemoattractant protein-1, fibroblast growth factor-2, and the potent vasoconstrictive agent endothelin-1 as compared with control cells. This pathological phenotype was corrected by nebivolol but not metoprolol in a dose-dependent fashion. We confirmed that PAH P-EC proliferate more than control cells and stimulate more PA smooth muscle cell mitosis, a growth abnormality that was normalized by nebivolol but not by metoprolol. Nebivolol but not metoprolol induced endothelium-dependent and nitric oxide-dependent relaxation of PA. Nebivolol was more potent than metoprolol in improving cardiac function, pulmonary vascular remodeling, and inflammation of rats with monocrotaline-induced pulmonary hypertension. CONCLUSIONS Nebivolol could be a promising option for the management of PAH, improving endothelial dysfunction, pulmonary vascular remodeling, and right heart function. Until clinical studies are undertaken, however, routine use of β-blockers in PAH cannot be recommended.
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Affiliation(s)
- Frédéric Perros
- University Paris-Sud, Faculté de médecine, Kremlin-Bicêtre, France; AP-HP, DHU TORINO, Centre de Référence de l'Hypertension Pulmonaire Sévère, Service de Pneumologie et Réanimation Respiratoire, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; INSERM UMR-S 999, Labex LERMIT, Hypertension Artérielle Pulmonaire: Physiopathologie et Innovation Thérapeutique, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France.
| | - Benoît Ranchoux
- University Paris-Sud, Faculté de médecine, Kremlin-Bicêtre, France; AP-HP, DHU TORINO, Centre de Référence de l'Hypertension Pulmonaire Sévère, Service de Pneumologie et Réanimation Respiratoire, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; INSERM UMR-S 999, Labex LERMIT, Hypertension Artérielle Pulmonaire: Physiopathologie et Innovation Thérapeutique, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France
| | - Mohamed Izikki
- Inserm U1046, Université Montpellier, Montpellier, France
| | - Sana Bentebbal
- Inserm U1046, Université Montpellier, Montpellier, France
| | - Chris Happé
- Department of Pulmonary Medicine, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Fabrice Antigny
- University Paris-Sud, Faculté de médecine, Kremlin-Bicêtre, France; AP-HP, DHU TORINO, Centre de Référence de l'Hypertension Pulmonaire Sévère, Service de Pneumologie et Réanimation Respiratoire, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; INSERM UMR-S 999, Labex LERMIT, Hypertension Artérielle Pulmonaire: Physiopathologie et Innovation Thérapeutique, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France
| | - Philippe Jourdon
- University Paris-Sud, Faculté de médecine, Kremlin-Bicêtre, France; AP-HP, DHU TORINO, Centre de Référence de l'Hypertension Pulmonaire Sévère, Service de Pneumologie et Réanimation Respiratoire, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; INSERM UMR-S 999, Labex LERMIT, Hypertension Artérielle Pulmonaire: Physiopathologie et Innovation Thérapeutique, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France
| | - Peter Dorfmüller
- University Paris-Sud, Faculté de médecine, Kremlin-Bicêtre, France; AP-HP, DHU TORINO, Centre de Référence de l'Hypertension Pulmonaire Sévère, Service de Pneumologie et Réanimation Respiratoire, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; INSERM UMR-S 999, Labex LERMIT, Hypertension Artérielle Pulmonaire: Physiopathologie et Innovation Thérapeutique, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France; Service d'Anatomie Pathologique, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | - Florence Lecerf
- University Paris-Sud, Faculté de médecine, Kremlin-Bicêtre, France; AP-HP, DHU TORINO, Centre de Référence de l'Hypertension Pulmonaire Sévère, Service de Pneumologie et Réanimation Respiratoire, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; INSERM UMR-S 999, Labex LERMIT, Hypertension Artérielle Pulmonaire: Physiopathologie et Innovation Thérapeutique, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France
| | - Elie Fadel
- Service de Chirurgie Thoracique, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France
| | - Gerald Simonneau
- University Paris-Sud, Faculté de médecine, Kremlin-Bicêtre, France; AP-HP, DHU TORINO, Centre de Référence de l'Hypertension Pulmonaire Sévère, Service de Pneumologie et Réanimation Respiratoire, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; INSERM UMR-S 999, Labex LERMIT, Hypertension Artérielle Pulmonaire: Physiopathologie et Innovation Thérapeutique, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France
| | - Marc Humbert
- University Paris-Sud, Faculté de médecine, Kremlin-Bicêtre, France; AP-HP, DHU TORINO, Centre de Référence de l'Hypertension Pulmonaire Sévère, Service de Pneumologie et Réanimation Respiratoire, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; INSERM UMR-S 999, Labex LERMIT, Hypertension Artérielle Pulmonaire: Physiopathologie et Innovation Thérapeutique, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France
| | - Harm Jan Bogaard
- Department of Pulmonary Medicine, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands
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113
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114
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Humbert M, Lau EMT, Montani D, Jaïs X, Sitbon O, Simonneau G. Advances in therapeutic interventions for patients with pulmonary arterial hypertension. Circulation 2015; 130:2189-208. [PMID: 25602947 DOI: 10.1161/circulationaha.114.006974] [Citation(s) in RCA: 246] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Marc Humbert
- From the Université Paris-Sud, Le Kremlin-Bicêtre, France (M.H., D.M., X.J., O.S., G.S.); AP-HP, Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France (M.H., E.M.T.L., D.M., X.J., O.S., G.S.); INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France (M.H., E.M.T.L., D.M., X.J., O.S., G.S.); and Sydney Medical School, University of Sydney, Camperdown, Australia (E.M.T.L.).
| | - Edmund M T Lau
- From the Université Paris-Sud, Le Kremlin-Bicêtre, France (M.H., D.M., X.J., O.S., G.S.); AP-HP, Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France (M.H., E.M.T.L., D.M., X.J., O.S., G.S.); INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France (M.H., E.M.T.L., D.M., X.J., O.S., G.S.); and Sydney Medical School, University of Sydney, Camperdown, Australia (E.M.T.L.)
| | - David Montani
- From the Université Paris-Sud, Le Kremlin-Bicêtre, France (M.H., D.M., X.J., O.S., G.S.); AP-HP, Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France (M.H., E.M.T.L., D.M., X.J., O.S., G.S.); INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France (M.H., E.M.T.L., D.M., X.J., O.S., G.S.); and Sydney Medical School, University of Sydney, Camperdown, Australia (E.M.T.L.)
| | - Xavier Jaïs
- From the Université Paris-Sud, Le Kremlin-Bicêtre, France (M.H., D.M., X.J., O.S., G.S.); AP-HP, Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France (M.H., E.M.T.L., D.M., X.J., O.S., G.S.); INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France (M.H., E.M.T.L., D.M., X.J., O.S., G.S.); and Sydney Medical School, University of Sydney, Camperdown, Australia (E.M.T.L.)
| | - Oliver Sitbon
- From the Université Paris-Sud, Le Kremlin-Bicêtre, France (M.H., D.M., X.J., O.S., G.S.); AP-HP, Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France (M.H., E.M.T.L., D.M., X.J., O.S., G.S.); INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France (M.H., E.M.T.L., D.M., X.J., O.S., G.S.); and Sydney Medical School, University of Sydney, Camperdown, Australia (E.M.T.L.)
| | - Gérald Simonneau
- From the Université Paris-Sud, Le Kremlin-Bicêtre, France (M.H., D.M., X.J., O.S., G.S.); AP-HP, Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France (M.H., E.M.T.L., D.M., X.J., O.S., G.S.); INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France (M.H., E.M.T.L., D.M., X.J., O.S., G.S.); and Sydney Medical School, University of Sydney, Camperdown, Australia (E.M.T.L.)
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Moretti C, Grosso Marra W, D'Ascenzo F, Omedè P, Cannillo M, Libertucci D, Fusaro E, Meynet I, Giordana F, Salera D, Annone U, Chen SL, Marra S, Gaita F. Beta blocker for patients with pulmonary arterial hypertension: A single center experience. Int J Cardiol 2015; 184:528-532. [PMID: 25767009 DOI: 10.1016/j.ijcard.2015.02.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 02/21/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Claudio Moretti
- Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy
| | - Walter Grosso Marra
- Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy.
| | - Pierluigi Omedè
- Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy
| | - Margherita Cannillo
- Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy
| | - Daniela Libertucci
- Division of Pneumology, Department of Internal Medicine, Città Della Salute e Della Scienza, Turin, Italy
| | - Enrico Fusaro
- Division of Rheumatology, Department of Internal Medicine, Città Della Salute e Della Scienza, Turin, Italy
| | - Ilaria Meynet
- Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy
| | - Francesca Giordana
- Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy
| | - Davide Salera
- Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy
| | - Umberto Annone
- Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy
| | - S L Chen
- Department of Cardiology, Njang, China
| | - Sebastiano Marra
- Division of Cardiology, Città Della Salute e Della Scienza, Turin, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy
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116
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Andersen S, Andersen A, de Man FS, Nielsen-Kudsk JE. Sympathetic nervous system activation and β-adrenoceptor blockade in right heart failure. Eur J Heart Fail 2015; 17:358-66. [PMID: 25704592 DOI: 10.1002/ejhf.253] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 01/22/2015] [Accepted: 01/23/2015] [Indexed: 11/07/2022] Open
Abstract
Right heart failure may develop from pulmonary arterial hypertension or various forms of congenital heart disease. Right ventricular adaptation to the increased afterload is the most important prognostic factor in pulmonary hypertension and congenital heart disease, which share important pathophysiological mechanisms, despite having different aetiologies. There is substantial evidence of increased sympathetic nervous system activation in right heart failure related to both pulmonary hypertension and congenital heart disease. It is unknown to which degree this activation is an adaptive response, a maladaptive response, or if it mainly reflects disease progression. Several experimental studies and clinical trials have been conducted to answer these questions. Here, we review the existing knowledge on sympathetic nervous system activation and the effects of β-adrenoceptor blockade in experimental and clinical right heart failure. This review identifies important gaps in our understanding of the right ventricle and discusses the potential of β-blockers in the treatment of right heart failure.
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Affiliation(s)
- Stine Andersen
- Department of Cardiology - Research, Institute of Clinical Medicine, Aarhus University Hospital, Brendstrupgaardsvej 100, 8200, Aarhus N, Denmark
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117
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Naeije R, Brimioulle S, Dewachter L. Biomechanics of the right ventricle in health and disease (2013 Grover Conference series). Pulm Circ 2015; 4:395-406. [PMID: 25621153 DOI: 10.1086/677354] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 01/22/2014] [Indexed: 02/02/2023] Open
Abstract
Right ventricular (RV) function is a major determinant of the symptomatology and outcome in pulmonary hypertension. The normal RV is a thin-walled flow generator able to accommodate large changes in venous return but unable to maintain flow output in the presence of a brisk increase in pulmonary artery pressure. The RV chronically exposed to pulmonary hypertension undergoes hypertrophic changes and an increase in contractility, allowing for preserved flow output in response to peripheral demand. Failure of systolic function adaptation (homeometric adaptation, described by Anrep's law of the heart) results in increased dimensions (heterometric adaptation; Starling's law of the heart), with a negative effect on diastolic ventricular interactions, limitation of exercise capacity, and vascular congestion. Ventricular function is described by pressure-volume relationships. The gold standard of systolic function is maximum elastance (E max), or the maximal value of the ratio of pressure to volume. This value is not immediately sensitive to changes in loading conditions. The gold standard of afterload is arterial elastance (E a), defined by the ratio of pressure at E max to stroke volume. The optimal coupling of ventricular function to the arterial circulation occurs at an E max/E a ratio between 1.5 and 2. Patients with severe pulmonary hypertension present with an increased E max, a trend toward decreased E max/E a, and increased RV dimensions, along with progression of the pulmonary vascular disease, systemic factors, and left ventricular function. The molecular mechanisms of RV systolic failure are currently being investigated. It is important to refer biological findings to sound measurements of function. Surrogates for E max and E a are being developed through bedside imaging techniques.
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Affiliation(s)
- Robert Naeije
- Department of Physiology, Faculty of Medicine, Free University of Brussels, Brussels, Belgium
| | - Serge Brimioulle
- Department of Physiology, Faculty of Medicine, Free University of Brussels, Brussels, Belgium
| | - Laurence Dewachter
- Department of Physiology, Faculty of Medicine, Free University of Brussels, Brussels, Belgium
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118
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Tan W, Madhavan K, Hunter KS, Park D, Stenmark KR. Vascular stiffening in pulmonary hypertension: cause or consequence? (2013 Grover Conference series). Pulm Circ 2014; 4:560-80. [PMID: 25610594 PMCID: PMC4278618 DOI: 10.1086/677370] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 05/27/2014] [Indexed: 12/24/2022] Open
Abstract
Recent studies have indicated that systemic arterial stiffening is a precursor to hypertension and that hypertension, in turn, can perpetuate arterial stiffening. Pulmonary artery (PA) stiffening is also well documented to occur in pulmonary hypertension (PH), and there is evidence that pulmonary vascular stiffness (PVS) may be a better predictor of outcome than pulmonary vascular resistance (PVR). We have hypothesized that the decreased flow-damping function of elastic PAs in PH likely initiates and/or perpetuates dysfunction of pulmonary microvasculature. Recent studies have shown that large-vessel stiffening increases flow pulsatility in the distal pulmonary vasculature, leading to endothelial dysfunction within a proinflammatory, vasoconstricting, and profibrogenic environment. The intricate role of stiffening-stimulated high pulsatile flow in endothelial cell dysfunction includes stepwise molecular events underlying PA hypertrophy, inflammation, endothelial-mesenchymal transition, and fibrosis. In addition to contributing to microenvironmental alterations of the distal vasculature, disordered proximal-distal PA coupling likely also plays a role in increasing ventricular afterload, ultimately causing right ventricle (RV) dysfunction and death. Current therapeutic treatments do not provide a realistic approach to destiffening arteries and, thus, to potentially abrogating the effects of high pulsatile flow on the distal pulmonary vasculature or the increased work imposed by stiffening on the RV. Scrutinizing the effect of PA stiffening on high pulsatile flow-induced cellular and molecular changes, and vice versa, might lead to important new therapeutic options that abrogate PA remodeling and PH development. With a clear understanding that PA stiffening may contribute to the progression of PH to an irreversible state by contributing to chronic microvascular damage in lungs, future studies should be aimed first at defining the underlying mechanisms leading to PA stiffening and then at improved treatment approaches based on these findings.
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Affiliation(s)
- Wei Tan
- Department of Pediatrics, University of Colorado Denver, Aurora, Colorado, USA
- Cardiovascular Pulmonary Research Laboratories, University of Colorado Denver, Aurora, Colorado, USA
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, Colorado, USA
| | - Krishna Madhavan
- Department of Pediatrics, University of Colorado Denver, Aurora, Colorado, USA
- Department of Bioengineering, University of Colorado Denver, Aurora, Colorado, USA
| | - Kendall S. Hunter
- Department of Pediatrics, University of Colorado Denver, Aurora, Colorado, USA
- Department of Bioengineering, University of Colorado Denver, Aurora, Colorado, USA
| | - Daewon Park
- Department of Bioengineering, University of Colorado Denver, Aurora, Colorado, USA
| | - Kurt R. Stenmark
- Department of Pediatrics, University of Colorado Denver, Aurora, Colorado, USA
- Cardiovascular Pulmonary Research Laboratories, University of Colorado Denver, Aurora, Colorado, USA
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119
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Andersen S, Schultz JG, Andersen A, Ringgaard S, Nielsen JM, Holmboe S, Vildbrad MD, de Man FS, Bogaard HJ, Vonk-Noordegraaf A, Nielsen-Kudsk JE. Effects of Bisoprolol and Losartan Treatment in the Hypertrophic and Failing Right Heart. J Card Fail 2014; 20:864-73. [DOI: 10.1016/j.cardfail.2014.08.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 08/07/2014] [Accepted: 08/08/2014] [Indexed: 11/16/2022]
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120
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Abstract
Background—
The safety of β-blockers in patients with isolated right ventricular failure because of pulmonary arterial hypertension (PAH) is unclear.
Methods and Results—
We studied 564 PAH patients (total cohort) referred to our center from 1982 to 2013. Propensity score-matching was used to match pairs of PAH patients with and without β-blocker use (matched cohort). We compared all-cause mortality between the groups in the total cohort and the matched cohort using bootstrap validation, Kaplan–Meier, and Cox proportional hazard analyses. Seventy-one of the 564 patients in the total cohort were on β-blockers. They were older, had higher prevalence of comorbidities, and were more often on diuretics, digoxin, and angiotensin converting enzyme inhibitors. The severity of PAH and right ventricular failure was similar between those with and without β-blocker use. After propensity matching, 63 patients with β-blocker use were compared with 51 patients without β-blocker use. During a median follow-up time of 4.8 years, there were 339 (60%) deaths in the total cohort and 70 deaths (61%) in the matched cohort. There was no difference in absolute mortality between those with and without β-blockers (
P
=0.71). β-Blocker use was not associated with increased all-cause mortality in the total cohort after adjusting for propensity score (adjusted hazard ratio, 1.0; 95% confidence interval, 0.7–1.5) and in the matched cohort (hazard ratio, 1.2; 95% confidence interval, 0.8–2.0).
Conclusions—
There was no statistically significant difference in long-term mortality between propensity score-matched pairs of PAH patients with and without β-blocker use. These findings need further validation in prospective clinical trials.
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121
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Manders E, Bogaard HJ, Handoko ML, van de Veerdonk MC, Keogh A, Westerhof N, Stienen GJM, Dos Remedios CG, Humbert M, Dorfmüller P, Fadel E, Guignabert C, van der Velden J, Vonk-Noordegraaf A, de Man FS, Ottenheijm CAC. Contractile dysfunction of left ventricular cardiomyocytes in patients with pulmonary arterial hypertension. J Am Coll Cardiol 2014; 64:28-37. [PMID: 24998125 DOI: 10.1016/j.jacc.2014.04.031] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 04/16/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND After lung transplantation, increased left ventricular (LV) filling can lead to LV failure, increasing the risk of post-operative complications and mortality. LV dysfunction in pulmonary arterial hypertension (PAH) is characterized by a reduced LV ejection fraction and impaired diastolic function. OBJECTIVES The pathophysiology of LV dysfunction in PAH is incompletely understood. This study sought to assess the contribution of atrophy and contractility of cardiomyocytes to LV dysfunction in PAH patients. METHODS LV function was assessed by cardiac magnetic resonance imaging. In addition, LV biopsies were obtained in 9 PAH patients and 10 donors. The cross-sectional area (CSA) and force-generating capacity of isolated single cardiomyocytes was investigated. RESULTS Magnetic resonance imaging analysis revealed a significant reduction in LV ejection fraction in PAH patients, indicating a reduction in LV contractility. The CSA of LV cardiomyocytes of PAH patients was significantly reduced (~30%), indicating LV cardiomyocyte atrophy. The maximal force-generating capacity, normalized to cardiomyocyte CSA, was significantly reduced (~25%). Also, a reduction in the number of available myosin-based cross-bridges was found to cause the contractile weakness of cardiomyocytes. This finding was supported by protein analyses, which showed an ~30% reduction in the myosin/actin ratio in cardiomyocytes from PAH patients. Finally, the phosphorylation level of sarcomeric proteins was reduced in PAH patients, which was accompanied by increased calcium sensitivity of force generation. CONCLUSIONS The contractile function and the CSA of LV cardiomyocytes is substantially reduced in PAH patients. We propose that these changes contribute to the reduced in vivo contractility of the LV in PAH patients.
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Affiliation(s)
- Emmy Manders
- Department of Pulmonology, Vrije Universiteit (VU) University Medical Center, Amsterdam, the Netherlands; Department of Physiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Harm-Jan Bogaard
- Department of Pulmonology, Vrije Universiteit (VU) University Medical Center, Amsterdam, the Netherlands
| | - M Louis Handoko
- Department of Physiology, VU University Medical Center, Amsterdam, the Netherlands; Cardiology Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Marielle C van de Veerdonk
- Department of Pulmonology, Vrije Universiteit (VU) University Medical Center, Amsterdam, the Netherlands
| | - Anne Keogh
- Heart Transplant Unit, St. Vincent's Hospital, Sydney, Australia
| | - Nico Westerhof
- Department of Pulmonology, Vrije Universiteit (VU) University Medical Center, Amsterdam, the Netherlands; Department of Physiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Ger J M Stienen
- Department of Physiology, VU University Medical Center, Amsterdam, the Netherlands; Department of Physics and Astronomy, VU University, Amsterdam, the Netherlands
| | | | - Marc Humbert
- University of Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France; Assistance Publique-Hôpitaux de Paris, Service de Pneumologie, Département Hospitalo-Universitaire, Thorax Innovation (DHU TORINO), Hôpital Bicêtre, Le Kremlin-Bicêtre, France; Inserm U999, Laboratoire d'Excellence en Recherche sur le Médicament et l'Innovation Thérapeutique (LabEx LERMIT), Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France
| | - Peter Dorfmüller
- University of Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France; Inserm U999, Laboratoire d'Excellence en Recherche sur le Médicament et l'Innovation Thérapeutique (LabEx LERMIT), Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France; Service d'Anatomie Pathologique, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France
| | - Elie Fadel
- University of Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France; Inserm U999, Laboratoire d'Excellence en Recherche sur le Médicament et l'Innovation Thérapeutique (LabEx LERMIT), Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France; Service de Chirurgie Thoracique, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France
| | - Christophe Guignabert
- University of Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France; Inserm U999, Laboratoire d'Excellence en Recherche sur le Médicament et l'Innovation Thérapeutique (LabEx LERMIT), Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France
| | - Jolanda van der Velden
- Department of Physiology, VU University Medical Center, Amsterdam, the Netherlands; ICIN Netherlands Heart Institute, Utrecht, the Netherlands
| | - Anton Vonk-Noordegraaf
- Department of Pulmonology, Vrije Universiteit (VU) University Medical Center, Amsterdam, the Netherlands
| | - Frances S de Man
- Department of Pulmonology, Vrije Universiteit (VU) University Medical Center, Amsterdam, the Netherlands.
| | - Coen A C Ottenheijm
- Department of Physiology, VU University Medical Center, Amsterdam, the Netherlands.
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Abstract
The pulmonary circulation is a high-flow and low-pressure circuit. The functional state of the pulmonary circulation is defined by pulmonary vascular pressure-flow relationships conforming to distensible vessel models with a correction for hematocrit. The product of pulmonary arterial compliance and resistance is constant, but with a slight decrease as a result of increased pulsatile hydraulic load in the presence of increased venous pressure or proximal pulmonary arterial obstruction. An increase in left atrial pressure is transmitted upstream with a ratio ≥1 for mean pulmonary artery pressure and ≤1 the diastolic pulmonary pressure. Therefore, the diastolic pressure gradient is more appropriate than the transpulmonary pressure gradient to identify pulmonary vascular disease in left heart conditions. Exercise is associated with a decrease in pulmonary vascular resistance and an increase in pulmonary arterial compliance. Right ventricular function is coupled to the pulmonary circulation with an optimal ratio of end-systolic to arterial elastances of 1.5-2.
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Affiliation(s)
- Robert Naeije
- Department of Physiology, Erasme Campus of the Free University of Brussels, CP 604, 808, Lennik Road, 1070, Brussels, Belgium,
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123
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Zamanian RT, Kudelko KT, Sung YK, Perez VDJ, Liu J, Spiekerkoetter E. Current clinical management of pulmonary arterial hypertension. Circ Res 2014; 115:131-147. [PMID: 24951763 DOI: 10.1161/circresaha.115.303827] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
During the past 2 decades, there has been a tremendous evolution in the evaluation and care of patients with pulmonary arterial hypertension (PAH). The introduction of targeted PAH therapy consisting of prostacyclin and its analogs, endothelin antagonists, phosphodiesterase-5 inhibitors, and now a soluble guanylate cyclase activator have increased therapeutic options and potentially reduced morbidity and mortality; yet, none of the current therapies have been curative. Current clinical management of PAH has become more complex given the focus on early diagnosis, an increased number of available therapeutics within each mechanistic class, and the emergence of clinically challenging scenarios such as perioperative care. Efforts to standardize the clinical care of patients with PAH have led to the formation of multidisciplinary PAH tertiary care programs that strive to offer medical care based on peer-reviewed evidence-based, and expert consensus guidelines. Furthermore, these tertiary PAH centers often support clinical and basic science research programs to gain novel insights into the pathogenesis of PAH with the goal to improve the clinical management of this devastating disease. In this article, we discuss the clinical approach and management of PAH from the perspective of a single US-based academic institution. We provide an overview of currently available clinical guidelines and offer some insight into how we approach current controversies in clinical management of certain patient subsets. We conclude with an overview of our program structure and a perspective on research and the role of a tertiary PAH center in contributing new knowledge to the field.
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Affiliation(s)
- Roham T Zamanian
- Division of Pulmonary & Critical Care Medicine, Stanford University School of Medicine.,Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine
| | - Kristina T Kudelko
- Division of Pulmonary & Critical Care Medicine, Stanford University School of Medicine.,Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine
| | - Yon K Sung
- Division of Pulmonary & Critical Care Medicine, Stanford University School of Medicine.,Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine
| | - Vinicio de Jesus Perez
- Division of Pulmonary & Critical Care Medicine, Stanford University School of Medicine.,Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine
| | - Juliana Liu
- Division of Pulmonary & Critical Care Medicine, Stanford University School of Medicine.,Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine
| | - Edda Spiekerkoetter
- Division of Pulmonary & Critical Care Medicine, Stanford University School of Medicine.,Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine
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Olschewski A, Papp R, Nagaraj C, Olschewski H. Ion channels and transporters as therapeutic targets in the pulmonary circulation. Pharmacol Ther 2014; 144:349-68. [PMID: 25108211 DOI: 10.1016/j.pharmthera.2014.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 07/22/2014] [Indexed: 10/24/2022]
Abstract
Pulmonary circulation is a low pressure, low resistance, high flow system. The low resting vascular tone is maintained by the concerted action of ion channels, exchangers and pumps. Under physiological as well as pathophysiological conditions, they are targets of locally secreted or circulating vasodilators and/or vasoconstrictors, leading to changes in expression or to posttranslational modifications. Both structural changes in the pulmonary arteries and a sustained increase in pulmonary vascular tone result in pulmonary vascular remodeling contributing to morbidity and mortality in pediatric and adult patients. There is increasing evidence demonstrating the pivotal role of ion channels such as K(+) and Cl(-) or transient receptor potential channels in different cell types which are thought to play a key role in vasoconstrictive remodeling. This review focuses on ion channels, exchangers and pumps in the pulmonary circulation and summarizes their putative pathophysiological as well as therapeutic role in pulmonary vascular remodeling. A better understanding of the mechanisms of their actions may allow for the development of new options for attenuating acute and chronic pulmonary vasoconstriction and remodeling treating the devastating disease pulmonary hypertension.
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Affiliation(s)
- Andrea Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria; Experimental Anesthesiology, Department of Anesthesia and Intensive Care Medicine, Medical University of Graz, Austria.
| | - Rita Papp
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Chandran Nagaraj
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Horst Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria; Department of Internal Medicine, Division of Pulmonology, Medical University of Graz, Austria
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125
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Benoist D, Stones R, Benson AP, Fowler ED, Drinkhill MJ, Hardy MEL, Saint DA, Cazorla O, Bernus O, White E. Systems approach to the study of stretch and arrhythmias in right ventricular failure induced in rats by monocrotaline. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2014; 115:162-72. [PMID: 25016242 PMCID: PMC4210667 DOI: 10.1016/j.pbiomolbio.2014.06.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 06/27/2014] [Indexed: 02/05/2023]
Abstract
We demonstrate the synergistic benefits of using multiple technologies to investigate complex multi-scale biological responses. The combination of reductionist and integrative methodologies can reveal novel insights into mechanisms of action by tracking changes of in vivo phenomena to alterations in protein activity (or vice versa). We have applied this approach to electrical and mechanical remodelling in right ventricular failure caused by monocrotaline-induced pulmonary artery hypertension in rats. We show arrhythmogenic T-wave alternans in the ECG of conscious heart failure animals. Optical mapping of isolated hearts revealed discordant action potential duration (APD) alternans. Potential causes of the arrhythmic substrate; structural remodelling and/or steep APD restitution and dispersion were observed, with specific remodelling of the Right Ventricular Outflow Tract. At the myocyte level, [Ca(2+)]i transient alternans were observed together with decreased activity, gene and protein expression of the sarcoplasmic reticulum Ca(2+)-ATPase (SERCA). Computer simulations of the electrical and structural remodelling suggest both contribute to a less stable substrate. Echocardiography was used to estimate increased wall stress in failure, in vivo. Stretch of intact and skinned single myocytes revealed no effect on the Frank-Starling mechanism in failing myocytes. In isolated hearts acute stretch-induced arrhythmias occurred in all preparations. Significant shortening of the early APD was seen in control but not failing hearts. These observations may be linked to changes in the gene expression of candidate mechanosensitive ion channels (MSCs) TREK-1 and TRPC1/6. Computer simulations incorporating MSCs and changes in ion channels with failure, based on altered gene expression, largely reproduced experimental observations.
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Affiliation(s)
- David Benoist
- Multidisciplinary Cardiovascular Research Centre, University of Leeds, UK; L'Institut de Rythmologie et Modelisation Cardiaque, INSERM U1045, Université de Bordeaux, France
| | - Rachel Stones
- Multidisciplinary Cardiovascular Research Centre, University of Leeds, UK
| | - Alan P Benson
- Multidisciplinary Cardiovascular Research Centre, University of Leeds, UK
| | - Ewan D Fowler
- Multidisciplinary Cardiovascular Research Centre, University of Leeds, UK
| | - Mark J Drinkhill
- Multidisciplinary Cardiovascular Research Centre, University of Leeds, UK
| | - Matthew E L Hardy
- Multidisciplinary Cardiovascular Research Centre, University of Leeds, UK; Faculty of Life Sciences, University of Manchester, UK
| | - David A Saint
- School of Medical Sciences, University of Adelaide, Australia
| | - Olivier Cazorla
- INSERM U1046, Université Montpellier 1, Université Montpellier 2, France
| | - Olivier Bernus
- Multidisciplinary Cardiovascular Research Centre, University of Leeds, UK; L'Institut de Rythmologie et Modelisation Cardiaque, INSERM U1045, Université de Bordeaux, France
| | - Ed White
- Multidisciplinary Cardiovascular Research Centre, University of Leeds, UK.
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Borgdorff MA, Bartelds B, Dickinson MG, van Wiechen MPH, Steendijk P, de Vroomen M, Berger RMF. Sildenafil treatment in established right ventricular dysfunction improves diastolic function and attenuates interstitial fibrosis independent from afterload. Am J Physiol Heart Circ Physiol 2014; 307:H361-9. [DOI: 10.1152/ajpheart.00843.2013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Right ventricular (RV) function is an important determinant of prognosis in congenital heart diseases, pulmonary hypertension, and heart failure. Preventive sildenafil treatment has been shown to enhance systolic RV function and improve exercise capacity in a model of fixed RV pressure load. However, it is unknown whether sildenafil has beneficial effects when treatment is started in established RV dysfunction, which is clinically more relevant. Our aim was to assess the effects of sildenafil treatment on RV function and fibrosis in a model of established RV dysfunction due to fixed afterload. Rats were subjected to pulmonary artery banding (PAB), which induced RV dysfunction after 4 wk, characterized by reduced exercise capacity, decreased tricuspid annular plane systolic excursion, and RV dilatation. From week 4 onward, 50% of rats were treated with sildenafil (100 mg·kg−1·day−1, n = 9; PAB-SIL group) or vehicle ( n = 9; PAB-VEH group). At 8 wk, exercise capacity was assessed using cage wheels, and RV function was assessed using invasive RV pressure-volume measurements under anesthesia. Sildenafil treatment, compared with vehicle, improved RV ejection fraction (44 ± 2% vs. 34 ± 2%, P < 0.05, PAB-SIL vs. PAB-VEH groups), reduced RV end-diastolic pressure (2.3 ± 0.5 vs. 5.1 ± 0.9 mmHg, P < 0.05), and RV dilatation (end-systolic volume: 468 ± 45 vs. 643 ± 71 μl, P = 0.05). Sildenafil treatment also attenuated RV fibrosis (30 ± 6 vs. 17 ± 3‰, P < 0.05) but did not affect end-systolic elastance, exercise capacity, or PKG or PKA activity. In conclusion, sildenafil improves RV diastolic function and attenuates interstitial fibrosis in rats with established RV dysfunction, independent from afterload. These results indicate that sildenafil treatment has therapeutic potential for established RV dysfunction.
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Affiliation(s)
- Marinus A. Borgdorff
- Center for Congenital Heart Diseases, Division of Pediatric Cardiology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; and
| | - Beatrijs Bartelds
- Center for Congenital Heart Diseases, Division of Pediatric Cardiology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; and
| | - Michael G. Dickinson
- Center for Congenital Heart Diseases, Division of Pediatric Cardiology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; and
| | - Maarten P. H. van Wiechen
- Center for Congenital Heart Diseases, Division of Pediatric Cardiology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; and
| | - Paul Steendijk
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maartje de Vroomen
- Center for Congenital Heart Diseases, Division of Pediatric Cardiology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; and
| | - Rolf M. F. Berger
- Center for Congenital Heart Diseases, Division of Pediatric Cardiology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; and
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Molina CE, Johnson DM, Mehel H, Spätjens RLHMG, Mika D, Algalarrondo V, Slimane ZH, Lechêne P, Abi-Gerges N, van der Linde HJ, Leroy J, Volders PGA, Fischmeister R, Vandecasteele G. Interventricular differences in β-adrenergic responses in the canine heart: role of phosphodiesterases. J Am Heart Assoc 2014; 3:e000858. [PMID: 24904016 PMCID: PMC4309082 DOI: 10.1161/jaha.114.000858] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background RV and LV have different embryologic, structural, metabolic, and electrophysiologic characteristics, but whether interventricular differences exist in β‐adrenergic (β‐AR) responsiveness is unknown. In this study, we examine whether β‐AR response and signaling differ in right (RV) versus left (LV) ventricles. Methods and Results Sarcomere shortening, Ca2+ transients, ICa,L and IKs currents were recorded in isolated dog LV and RV midmyocytes. Intracellular [cAMP] and PKA activity were measured by live cell imaging using FRET‐based sensors. Isoproterenol increased sarcomere shortening ≈10‐fold and Ca2+‐transient amplitude ≈2‐fold in LV midmyocytes (LVMs) versus ≈25‐fold and ≈3‐fold in RVMs. FRET imaging using targeted Epac2camps sensors revealed no change in subsarcolemmal [cAMP], but a 2‐fold higher β‐AR stimulation of cytoplasmic [cAMP] in RVMs versus LVMs. Accordingly, β‐AR regulation of ICa,L and IKs were similar between LVMs and RVMs, whereas cytoplasmic PKA activity was increased in RVMs. Both PDE3 and PDE4 contributed to the β‐AR regulation of cytoplasmic [cAMP], and the difference between LVMs and RVMs was abolished by PDE3 inhibition and attenuated by PDE4 inhibition. Finally LV and RV intracavitary pressures were recorded in anesthetized beagle dogs. A bolus injection of isoproterenol increased RV dP/dtmax≈5‐fold versus 3‐fold in LV. Conclusion Canine RV and LV differ in their β‐AR response due to intrinsic differences in myocyte β‐AR downstream signaling. Enhanced β‐AR responsiveness of the RV results from higher cAMP elevation in the cytoplasm, due to a decreased degradation by PDE3 and PDE4 in the RV compared to the LV.
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Affiliation(s)
- Cristina E Molina
- INSERM UMR-S 769, LabEx LERMIT, DHU TORINO, Châtenay-Malabry, France (C.E.M., H.M., D.M., V.A., Z.H.S., P.L., L., R.F., G.V.) Université Paris-Sud, Châtenay-Malabry, France (C.E.M., H.M., D.M., V.A., Z.H.S., P.L., L., R.F., G.V.)
| | - Daniel M Johnson
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, 6202 AZ, Maastricht, The Netherlands (D.M.J., R.G.S., P.A.V.)
| | - Hind Mehel
- INSERM UMR-S 769, LabEx LERMIT, DHU TORINO, Châtenay-Malabry, France (C.E.M., H.M., D.M., V.A., Z.H.S., P.L., L., R.F., G.V.) Université Paris-Sud, Châtenay-Malabry, France (C.E.M., H.M., D.M., V.A., Z.H.S., P.L., L., R.F., G.V.)
| | - Roel L H M G Spätjens
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, 6202 AZ, Maastricht, The Netherlands (D.M.J., R.G.S., P.A.V.)
| | - Delphine Mika
- INSERM UMR-S 769, LabEx LERMIT, DHU TORINO, Châtenay-Malabry, France (C.E.M., H.M., D.M., V.A., Z.H.S., P.L., L., R.F., G.V.) Université Paris-Sud, Châtenay-Malabry, France (C.E.M., H.M., D.M., V.A., Z.H.S., P.L., L., R.F., G.V.)
| | - Vincent Algalarrondo
- INSERM UMR-S 769, LabEx LERMIT, DHU TORINO, Châtenay-Malabry, France (C.E.M., H.M., D.M., V.A., Z.H.S., P.L., L., R.F., G.V.) Université Paris-Sud, Châtenay-Malabry, France (C.E.M., H.M., D.M., V.A., Z.H.S., P.L., L., R.F., G.V.)
| | - Zeineb Haj Slimane
- INSERM UMR-S 769, LabEx LERMIT, DHU TORINO, Châtenay-Malabry, France (C.E.M., H.M., D.M., V.A., Z.H.S., P.L., L., R.F., G.V.) Université Paris-Sud, Châtenay-Malabry, France (C.E.M., H.M., D.M., V.A., Z.H.S., P.L., L., R.F., G.V.)
| | - Patrick Lechêne
- INSERM UMR-S 769, LabEx LERMIT, DHU TORINO, Châtenay-Malabry, France (C.E.M., H.M., D.M., V.A., Z.H.S., P.L., L., R.F., G.V.) Université Paris-Sud, Châtenay-Malabry, France (C.E.M., H.M., D.M., V.A., Z.H.S., P.L., L., R.F., G.V.)
| | - Najah Abi-Gerges
- Department of Translational Safety, DrugSafety and Metabolism, AstraZeneca R&D Innovative Medicines and Early Development, Alderley Park, Macclesfield, SK10 4TG, Cheshire, UK (N.A.G.)
| | - Henk J van der Linde
- Global Safety Research, Preclinical Development & Safety, Discovery Sciences, Janssen Research & Development, Beerse, Belgium (H.J.L.)
| | - Jérôme Leroy
- INSERM UMR-S 769, LabEx LERMIT, DHU TORINO, Châtenay-Malabry, France (C.E.M., H.M., D.M., V.A., Z.H.S., P.L., L., R.F., G.V.) Université Paris-Sud, Châtenay-Malabry, France (C.E.M., H.M., D.M., V.A., Z.H.S., P.L., L., R.F., G.V.)
| | - Paul G A Volders
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, 6202 AZ, Maastricht, The Netherlands (D.M.J., R.G.S., P.A.V.)
| | - Rodolphe Fischmeister
- INSERM UMR-S 769, LabEx LERMIT, DHU TORINO, Châtenay-Malabry, France (C.E.M., H.M., D.M., V.A., Z.H.S., P.L., L., R.F., G.V.) Université Paris-Sud, Châtenay-Malabry, France (C.E.M., H.M., D.M., V.A., Z.H.S., P.L., L., R.F., G.V.)
| | - Grégoire Vandecasteele
- INSERM UMR-S 769, LabEx LERMIT, DHU TORINO, Châtenay-Malabry, France (C.E.M., H.M., D.M., V.A., Z.H.S., P.L., L., R.F., G.V.) Université Paris-Sud, Châtenay-Malabry, France (C.E.M., H.M., D.M., V.A., Z.H.S., P.L., L., R.F., G.V.)
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Bubb KJ, Trinder SL, Baliga RS, Patel J, Clapp LH, MacAllister RJ, Hobbs AJ. Inhibition of phosphodiesterase 2 augments cGMP and cAMP signaling to ameliorate pulmonary hypertension. Circulation 2014; 130:496-507. [PMID: 24899690 DOI: 10.1161/circulationaha.114.009751] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Pulmonary hypertension (PH) is a life-threatening disorder characterized by increased pulmonary artery pressure, remodeling of the pulmonary vasculature, and right ventricular failure. Loss of endothelium-derived nitric oxide (NO) and prostacyclin contributes to PH pathogenesis, and current therapies are targeted to restore these pathways. Phosphodiesterases (PDEs) are a family of enzymes that break down cGMP and cAMP, which underpin the bioactivity of NO and prostacyclin. PDE5 inhibitors (eg, sildenafil) are licensed for PH, but a role for PDE2 in lung physiology and disease has yet to be established. Herein, we investigated whether PDE2 inhibition modulates pulmonary cyclic nucleotide signaling and ameliorates experimental PH. METHODS AND RESULTS The selective PDE2 inhibitor BAY 60-7550 augmented atrial natriuretic peptide- and treprostinil-evoked pulmonary vascular relaxation in isolated arteries from chronically hypoxic rats. BAY 60-7550 prevented the onset of both hypoxia- and bleomycin-induced PH and produced a significantly greater reduction in disease severity when given in combination with a neutral endopeptidase inhibitor (enhances endogenous natriuretic peptides), trepostinil, inorganic nitrate (NO donor), or a PDE5 inhibitor. Proliferation of pulmonary artery smooth muscle cells from patients with pulmonary arterial hypertension was reduced by BAY 60-7550, an effect further enhanced in the presence of atrial natriuretic peptide, NO, and treprostinil. CONCLUSIONS PDE2 inhibition elicits pulmonary dilation, prevents pulmonary vascular remodeling, and reduces the right ventricular hypertrophy characteristic of PH. This favorable pharmacodynamic profile is dependent on natriuretic peptide bioactivity and is additive with prostacyclin analogues, PDE5 inhibitor, and NO. PDE2 inhibition represents a viable, orally active therapy for PH.
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Affiliation(s)
- Kristen J Bubb
- From the William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London (K.J.B., S.L.T., R.S.B., A.J.H.); and Centre for Clinical Pharmacology, University College London (J.P., L.H.C., R.J.M.), London, United Kingdom
| | - Sarah L Trinder
- From the William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London (K.J.B., S.L.T., R.S.B., A.J.H.); and Centre for Clinical Pharmacology, University College London (J.P., L.H.C., R.J.M.), London, United Kingdom
| | - Reshma S Baliga
- From the William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London (K.J.B., S.L.T., R.S.B., A.J.H.); and Centre for Clinical Pharmacology, University College London (J.P., L.H.C., R.J.M.), London, United Kingdom
| | - Jigisha Patel
- From the William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London (K.J.B., S.L.T., R.S.B., A.J.H.); and Centre for Clinical Pharmacology, University College London (J.P., L.H.C., R.J.M.), London, United Kingdom
| | - Lucie H Clapp
- From the William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London (K.J.B., S.L.T., R.S.B., A.J.H.); and Centre for Clinical Pharmacology, University College London (J.P., L.H.C., R.J.M.), London, United Kingdom
| | - Raymond J MacAllister
- From the William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London (K.J.B., S.L.T., R.S.B., A.J.H.); and Centre for Clinical Pharmacology, University College London (J.P., L.H.C., R.J.M.), London, United Kingdom
| | - Adrian J Hobbs
- From the William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London (K.J.B., S.L.T., R.S.B., A.J.H.); and Centre for Clinical Pharmacology, University College London (J.P., L.H.C., R.J.M.), London, United Kingdom.
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Rain S, Bos DDSG, Handoko ML, Westerhof N, Stienen G, Ottenheijm C, Goebel M, Dorfmüller P, Guignabert C, Humbert M, Bogaard HJ, Remedios CD, Saripalli C, Hidalgo CG, Granzier HL, Vonk-Noordegraaf A, van der Velden J, de Man FS. Protein changes contributing to right ventricular cardiomyocyte diastolic dysfunction in pulmonary arterial hypertension. J Am Heart Assoc 2014; 3:e000716. [PMID: 24895160 PMCID: PMC4309054 DOI: 10.1161/jaha.113.000716] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Right ventricular (RV) diastolic function is impaired in patients with pulmonary arterial hypertension (PAH). Our previous study showed that elevated cardiomyocyte stiffness and myofilament Ca2+ sensitivity underlie diastolic dysfunction in PAH. This study investigates protein modifications contributing to cellular diastolic dysfunction in PAH. Methods and Results RV samples from PAH patients undergoing heart‐lung transplantation were compared to non‐failing donors (Don). Titin stiffness contribution to RV diastolic dysfunction was determined by Western‐blot analyses using antibodies to protein‐kinase‐A (PKA), Cα (PKCα) and Ca2+/calmoduling‐dependent‐kinase (CamKIIδ) titin and phospholamban (PLN) phosphorylation sites: N2B (Ser469), PEVK (Ser170 and Ser26), and PLN (Thr17), respectively. PKA and PKCα sites were significantly less phosphorylated in PAH compared with donors (P<0.0001). To test the functional relevance of PKA‐, PKCα‐, and CamKIIδ‐mediated titin phosphorylation, we measured the stiffness of single RV cardiomyocytes before and after kinase incubation. PKA significantly decreased PAH RV cardiomyocyte diastolic stiffness, PKCα further increased stiffness while CamKIIδ had no major effect. CamKIIδ activation was determined indirectly by measuring PLN Thr17phosphorylation level. No significant changes were found between the groups. Myofilament Ca2+ sensitivity is mediated by sarcomeric troponin I (cTnI) phosphorylation. We observed increased unphosphorylated cTnI in PAH compared with donors (P<0.05) and reduced PKA‐mediated cTnI phosphorylation (Ser22/23) (P<0.001). Finally, alterations in Ca2+‐handling proteins contribute to RV diastolic dysfunction due to insufficient diastolic Ca2+ clearance. PAH SERCA2a levels and PLN phosphorylation were significantly reduced compared with donors (P<0.05). Conclusions Increased titin stiffness, reduced cTnI phosphorylation, and altered levels of phosphorylation of Ca2+ handling proteins contribute to RV diastolic dysfunction in PAH.
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Affiliation(s)
- Silvia Rain
- Department of Pulmonology, VU University Medical Center/Institute for Cardiovascular Research, Amsterdam, The Netherlands (S.R., D.S.G.B., N.W., H.J.B., A.V.N., F.S.M.) Department of Physiology, VU University Medical Center/Institute for Cardiovascular Research, Amsterdam, The Netherlands (S.R., L.H., N.W., G.S., C.O., M.G., J.V., F.S.M.)
| | - Denielli da Silva Goncalves Bos
- Department of Pulmonology, VU University Medical Center/Institute for Cardiovascular Research, Amsterdam, The Netherlands (S.R., D.S.G.B., N.W., H.J.B., A.V.N., F.S.M.)
| | - M Louis Handoko
- Department of Physiology, VU University Medical Center/Institute for Cardiovascular Research, Amsterdam, The Netherlands (S.R., L.H., N.W., G.S., C.O., M.G., J.V., F.S.M.) Department of Cardiology, VU University Medical Center/Institute for Cardiovascular Research, Amsterdam, The Netherlands (L.H.)
| | - Nico Westerhof
- Department of Pulmonology, VU University Medical Center/Institute for Cardiovascular Research, Amsterdam, The Netherlands (S.R., D.S.G.B., N.W., H.J.B., A.V.N., F.S.M.) Department of Physiology, VU University Medical Center/Institute for Cardiovascular Research, Amsterdam, The Netherlands (S.R., L.H., N.W., G.S., C.O., M.G., J.V., F.S.M.)
| | - Ger Stienen
- Department of Physiology, VU University Medical Center/Institute for Cardiovascular Research, Amsterdam, The Netherlands (S.R., L.H., N.W., G.S., C.O., M.G., J.V., F.S.M.) Department of Physics and Astronomy, VU University Medical Center/Institute for Cardiovascular Research, Amsterdam, The Netherlands (G.S.)
| | - Coen Ottenheijm
- Department of Physiology, VU University Medical Center/Institute for Cardiovascular Research, Amsterdam, The Netherlands (S.R., L.H., N.W., G.S., C.O., M.G., J.V., F.S.M.)
| | - Max Goebel
- Department of Physiology, VU University Medical Center/Institute for Cardiovascular Research, Amsterdam, The Netherlands (S.R., L.H., N.W., G.S., C.O., M.G., J.V., F.S.M.)
| | - Peter Dorfmüller
- Faculté de Médecine, Université Paris-Sud, Le Kremlin-Bicêtre, France (P.D., C.G., M.H.) Inserm U999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France (P.D., C.G., M.H.)
| | - Christophe Guignabert
- Faculté de Médecine, Université Paris-Sud, Le Kremlin-Bicêtre, France (P.D., C.G., M.H.) Inserm U999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France (P.D., C.G., M.H.)
| | - Marc Humbert
- Faculté de Médecine, Université Paris-Sud, Le Kremlin-Bicêtre, France (P.D., C.G., M.H.) Inserm U999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France (P.D., C.G., M.H.) Service d'Anatomie Pathologique, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France (M.H.) Assistance Publique-Hôspitaux de Paris, Service de Pneumologie, Département Hôspital Universitaire, Thorax innovation, (DHU-TORINO), Hôpital Bicêtre, France (M.H.)
| | - Harm-Jan Bogaard
- Department of Pulmonology, VU University Medical Center/Institute for Cardiovascular Research, Amsterdam, The Netherlands (S.R., D.S.G.B., N.W., H.J.B., A.V.N., F.S.M.)
| | - Cris Dos Remedios
- Muscle Research Unit, Discipline of Anatomy & Histology, Bosch Institute, The University of Sydney, Sydney, Australia (C.R.)
| | - Chandra Saripalli
- Sarver Molecular Cardiovascular Research Program, Department of Physiology, University of Arizona, Tucson, AZ, The Netherlands (C.S., C.G.H., H.L.G.)
| | - Carlos G Hidalgo
- Sarver Molecular Cardiovascular Research Program, Department of Physiology, University of Arizona, Tucson, AZ, The Netherlands (C.S., C.G.H., H.L.G.)
| | - Henk L Granzier
- Sarver Molecular Cardiovascular Research Program, Department of Physiology, University of Arizona, Tucson, AZ, The Netherlands (C.S., C.G.H., H.L.G.)
| | - Anton Vonk-Noordegraaf
- Department of Pulmonology, VU University Medical Center/Institute for Cardiovascular Research, Amsterdam, The Netherlands (S.R., D.S.G.B., N.W., H.J.B., A.V.N., F.S.M.)
| | - Jolanda van der Velden
- Department of Physiology, VU University Medical Center/Institute for Cardiovascular Research, Amsterdam, The Netherlands (S.R., L.H., N.W., G.S., C.O., M.G., J.V., F.S.M.) ICIN - The Netherlands Heart Institute, Amsterdam, The Netherlands (J.V.)
| | - Frances S de Man
- Department of Pulmonology, VU University Medical Center/Institute for Cardiovascular Research, Amsterdam, The Netherlands (S.R., D.S.G.B., N.W., H.J.B., A.V.N., F.S.M.) Department of Physiology, VU University Medical Center/Institute for Cardiovascular Research, Amsterdam, The Netherlands (S.R., L.H., N.W., G.S., C.O., M.G., J.V., F.S.M.)
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Spruijt OA, Bogaard HJ, Vonk-Noordegraaf A. Assessment of right ventricular responses to therapy in pulmonary hypertension. Drug Discov Today 2014; 19:1246-50. [PMID: 24637045 DOI: 10.1016/j.drudis.2014.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 03/07/2014] [Indexed: 10/25/2022]
Abstract
Irrespective of its cause, pulmonary hypertension (PH) leads to an increase in pulmonary vascular resistance (PVR). Failing adaption of the right ventricle (RV) to the increased afterload is the main cause of death in PH patients and therefore monitoring RV function during treatment is essential. However, consensus on the optimal method for serial assessment of RV function is lacking and therefore the major clinical trials on PH-specific therapies have not provided clear answers with respect to the response of the RV to treatment. This short review will give an overview of the most important load-dependent and load-independent parameters for assessing RV response to therapy in PH patients.
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Affiliation(s)
- Onno A Spruijt
- Department of Pulmonary Diseases, VU University Medical Center, ZH-4A-48, 1000 SN Amsterdam, The Netherlands
| | - Harm-Jan Bogaard
- Department of Pulmonary Diseases, VU University Medical Center, ZH-4A-48, 1000 SN Amsterdam, The Netherlands.
| | - Anton Vonk-Noordegraaf
- Department of Pulmonary Diseases, VU University Medical Center, ZH-4A-48, 1000 SN Amsterdam, The Netherlands
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Vonk-Noordegraaf A, Haddad F, Chin KM, Forfia PR, Kawut SM, Lumens J, Naeije R, Newman J, Oudiz RJ, Provencher S, Torbicki A, Voelkel NF, Hassoun PM. Right heart adaptation to pulmonary arterial hypertension: physiology and pathobiology. J Am Coll Cardiol 2014; 62:D22-33. [PMID: 24355638 DOI: 10.1016/j.jacc.2013.10.027] [Citation(s) in RCA: 674] [Impact Index Per Article: 67.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 10/22/2013] [Indexed: 12/22/2022]
Abstract
Survival in patients with pulmonary arterial hypertension (PAH) is closely related to right ventricular (RV) function. Although pulmonary load is an important determinant of RV systolic function in PAH, there remains a significant variability in RV adaptation to pulmonary hypertension. In this report, the authors discuss the emerging concepts of right heart pathobiology in PAH. More specifically, the discussion focuses on the following questions. 1) How is right heart failure syndrome best defined? 2) What are the underlying molecular mechanisms of the failing right ventricle in PAH? 3) How are RV contractility and function and their prognostic implications best assessed? 4) What is the role of targeted RV therapy? Throughout the report, the authors highlight differences between right and left heart failure and outline key areas of future investigation.
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Affiliation(s)
| | - François Haddad
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California
| | - Kelly M Chin
- Department of Internal Medicine, Pulmonary Division, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Paul R Forfia
- Pulmonary Hypertension and Right Heart Failure Program, Temple University Hospital, Philadelphia, Pennsylvania
| | - Steven M Kawut
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joost Lumens
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Robert Naeije
- Department of Pathophysiology, Faculty of Medicine, Free University of Brussels, Brussels, Belgium
| | - John Newman
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Ronald J Oudiz
- The David Geffen School of Medicine at UCLA, Liu Center for Pulmonary Hypertension, Division of Cardiology, Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Steve Provencher
- Pulmonary Hypertension Research Group, Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Chemin Sainte-Foy, Québec, Canada
| | - Adam Torbicki
- Department of Pulmonary Circulation and Thromboembolic Diseases, Centre of Postgraduate Medical Education, ECZ, Otwock, Poland
| | - Norbert F Voelkel
- Division of Pulmonary and Critical Care Medicine and Victoria Johnson Lab for Lung Research, Virginia Commonwealth University, Richmond, Virginia; Johns Hopkins University, Baltimore, Maryland
| | - Paul M Hassoun
- Department of Internal Medicine, Pulmonary Division, University of Texas Southwestern Medical Center, Dallas, Texas
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133
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O'Connell C, O'Callaghan DS, Humbert M. Novel medical therapies for pulmonary arterial hypertension. Clin Chest Med 2014; 34:867-80. [PMID: 24267310 DOI: 10.1016/j.ccm.2013.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Available targeted therapies for pulmonary arterial hypertension are capable only of slowing progression of the disease and a cure remains elusive. However with the improved understanding of the pulmonary vascular remodeling that characterizes the disease, there is optimism that the disconnect between preclinical and clinical studies may be bridged with some of the newer therapies that are now at different stages of clinical evaluation. This article examines the evidence behind these new candidate treatments that may become part of the arsenal available for clinicians managing this devastating disease.
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Affiliation(s)
- Caroline O'Connell
- Department of Respiratory Medicine, Mater Misericordiae University Hospital, 56 Eccles Street, Dublin 7, Ireland.
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134
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Pressure-overload-induced right heart failure. Pflugers Arch 2014; 466:1055-63. [PMID: 24488007 DOI: 10.1007/s00424-014-1450-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 01/13/2014] [Indexed: 01/27/2023]
Abstract
Although pulmonary arterial hypertension originates in the lung and is caused by progressive remodeling of the small pulmonary arterioles, patients die from the consequences of pressure-overload-induced right heart failure. Prognosis is poor, and currently there are no selective treatments targeting the failing right ventricle. Therefore, it is of utmost importance to obtain more insights into the mechanisms of right ventricular adaptation and the transition toward right heart failure. In this review, we propose that the same adaptive mechanisms, which initially preserve right ventricular systolic function and maintain cardiac output, eventually initiate the transition toward right heart failure.
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135
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McCabe C, White PA, Hoole SP, Axell RG, Priest AN, Gopalan D, Taboada D, MacKenzie Ross R, Morrell NW, Shapiro LM, Pepke-Zaba J. Right ventricular dysfunction in chronic thromboembolic obstruction of the pulmonary artery: a pressure-volume study using the conductance catheter. J Appl Physiol (1985) 2013; 116:355-63. [PMID: 24356516 DOI: 10.1152/japplphysiol.01123.2013] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pressure-volume loops describe dynamic ventricular performance, relevant to patients with and at risk of pulmonary hypertension. We used conductance catheter-derived pressure-volume loops to measure right ventricular (RV) mechanics in patients with chronic thromboembolic pulmonary arterial obstruction at different stages of pathological adaptation. Resting conductance catheterization was performed in 24 patients: 10 with chronic thromboembolic pulmonary hypertension (CTEPH), 7 with chronic thromboembolic disease without pulmonary hypertension (CTED), and 7 controls. To assess the validity of conductance measurements, RV volumes were compared in a subset of 8 patients with contemporaneous cardiac magnetic resonance (CMR). Control, CTED, and CTEPH groups showed different pressure-volume loop morphology, most notable during systolic ejection. Prolonged diastolic relaxation was seen in patients with CTED and CTEPH [tau = 56.2 ± 6.7 (controls) vs. 69.7 ± 10.0 (CTED) vs. 67.9 ± 6.2 ms (CTEPH), P = 0.02]. Control and CTED groups had lower afterload (Ea) and contractility (Ees) compared with the CTEPH group (Ea = 0.30 ± 0.10 vs. 0.52 ± 0.24 vs. 1.92 ± 0.70 mmHg/ml, respectively, P < 0.001) (Ees = 0.44 ± 0.20 vs. 0.59 ± 0.15 vs. 1.13 ± 0.43 mmHg/ml, P < 0.01) with more efficient ventriculoarterial coupling (Ees/Ea = 1.46 ± 0.30 vs. 1.27 ± 0.36 vs. 0.60 ± 0.18, respectively, P < 0.001). Stroke volume assessed by CMR and conductance showed closest agreement (mean bias +9 ml, 95% CI -1 to +19 ml) compared with end-diastolic volume (+48 ml, -16 to 111 ml) and end-systolic volume (+37 ml, -21 to 94 ml). RV conductance catheterization detects novel alteration in pressure-volume loop morphology and delayed RV relaxation in CTED, which distinguish this group from controls. The observed agreement in stroke volume assessed by CMR and conductance suggests RV mechanics are usefully measured by conductance catheter in chronic thromboembolic obstruction.
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Affiliation(s)
- Colm McCabe
- Pulmonary Vascular Disease Unit, Papworth Hospital, Cambridge, United Kingdom
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136
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Rain S, Handoko ML, Trip P, Gan CTJ, Westerhof N, Stienen GJ, Paulus WJ, Ottenheijm CAC, Marcus JT, Dorfmüller P, Guignabert C, Humbert M, Macdonald P, Dos Remedios C, Postmus PE, Saripalli C, Hidalgo CG, Granzier HL, Vonk-Noordegraaf A, van der Velden J, de Man FS. Right ventricular diastolic impairment in patients with pulmonary arterial hypertension. Circulation 2013; 128:2016-25, 1-10. [PMID: 24056688 DOI: 10.1161/circulationaha.113.001873] [Citation(s) in RCA: 264] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The role of right ventricular (RV) diastolic stiffness in pulmonary arterial hypertension (PAH) is not well established. Therefore, we investigated the presence and possible underlying mechanisms of RV diastolic stiffness in PAH patients. METHODS AND RESULTS Single-beat RV pressure-volume analyses were performed in 21 PAH patients and 7 control subjects to study RV diastolic stiffness. Data are presented as mean ± SEM. RV diastolic stiffness (β) was significantly increased in PAH patients (PAH, 0.050 ± 0.005 versus control, 0.029 ± 0.003; P<0.05) and was closely associated with disease severity. Subsequently, we searched for possible underlying mechanisms using RV tissue of PAH patients undergoing heart/lung transplantation and nonfailing donors. Histological analyses revealed increased cardiomyocyte cross-sectional areas (PAH, 453 ± 31 μm² versus control, 218 ± 21 μm²; P<0.001), indicating RV hypertrophy. In addition, the amount of RV fibrosis was enhanced in PAH tissue (PAH, 9.6 ± 0.7% versus control, 7.2 ± 0.6%; P<0.01). To investigate the contribution of stiffening of the sarcomere (the contractile apparatus of RV cardiomyocytes) to RV diastolic stiffness, we isolated and membrane-permeabilized single RV cardiomyocytes. Passive tension at different sarcomere lengths was significantly higher in PAH patients compared with control subjects (>200%; Pinteraction <0.001), indicating stiffening of RV sarcomeres. An important regulator of sarcomeric stiffening is the sarcomeric protein titin. Therefore, we investigated titin isoform composition and phosphorylation. No alterations were observed in titin isoform composition (N2BA/N2B ratio: PAH, 0.78 ± 0.07 versus control, 0.91 ± 0.08), but titin phosphorylation in RV tissue of PAH patients was significantly reduced (PAH, 0.16 ± 0.01 arbitrary units versus control, 0.20 ± 0.01 arbitrary units; P<0.05). CONCLUSIONS RV diastolic stiffness is significantly increased in PAH patients, with important contributions from increased collagen and intrinsic stiffening of the RV cardiomyocyte sarcomeres.
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Affiliation(s)
- Silvia Rain
- Departments of Pulmonology (S.R., P.T., C.T.-J.G., N.W., P.E.P., A.V.-N., F.S.d.M.), Physiology (S.R., M.L.H., N.W., G.J.S., W.J.P., C.A.C.O., J.v.d.V., F.S.d.M.), Cardiology (M.L.H.), and Medical Physics (J.T.M.), VU University Medical Center/Institute for Cardiovascular Research, Amsterdam, the Netherlands; Université Paris-Sud, Le Kremlin-Bicêtre, France (P.D., C.G., M.H.); INSERM UMR 999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France (P.D., C.G., M.H.); AP-HP, Hôpital de Bicêtre, Service de Pneumologie, DHU Thorax Innovation, Le Kremlin-Bicêtre, France (M.H.); Heart & Lung Transplant Unit, St. Vincent's Hospital and Victor Chang Cardiac Research Institute, Sydney, Australia (P.M.); Muscle Research Unit, Institute for Biomedical Research, University of Sydney, Sydney, Australia (C.d.R.); Sarver Molecular Cardiovascular Research Program, Department of Physiology, University of Arizona, Tucson (C.S., C.G.H., H.L.G.); and ICIN-The Netherlands Heart Institute, Utrecht, the Netherlands (J.v.d.V.)
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137
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Abstract
The right ventricle (RV) is increasingly recognized for its role in heart disease. In fact, RV function is a strong predictor of outcome in patients with cardiovascular disease. Although the focus in heart failure has been on the left ventricle (LV), recently the spotlight has been shifting to include the RV. The RV and LV have different embryological origins and respond differently to stressors and to therapies. Newer therapies targeting the RV have been investigated in an attempt to improve right-ventricular adaptation to cardiovascular diseases. In this review, we summarize the differences between the RV and LV and focus on novel therapies that target the RV.
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Affiliation(s)
- Samar Farha
- Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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138
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Friehs I, Illigens B, Melnychenko I, Zhong-Hu T, Zeisberg E, Del Nido PJ. An animal model of endocardial fibroelastosis. J Surg Res 2013; 182:94-100. [PMID: 22938709 PMCID: PMC3524408 DOI: 10.1016/j.jss.2012.07.069] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 07/19/2012] [Accepted: 07/30/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Hypoplastic left heart syndrome (HLHS) is one of the most common severe congenital cardiac anomalies, characterized by a marked hypoplasia of left-sided structures of the heart, which is commonly accompanied by a thick layer of fibroelastic tissue, termed endocardial fibroelastosis (EFE). Because human EFE develops only in fetal or neonatal hearts, and often in association with reduced blood flow, we sought to mimic these conditions by subjecting neonatal and 2-wk-old rat hearts to variations of the heterotopically transplanted heart model with either no intracavitary or normal flow and compare endocardium with human EFE tissue. MATERIALS AND METHODS Hearts obtained from neonatal and 2-wk-old rats were heterotopically transplanted in young adult Lewis rats in a working (loaded) or nonworking (unloaded) mode. After 2-wk survival, hearts were explanted for histologic analysis by staining for collagen, elastin, and cellular elements. These sections were compared with human EFE tissue from HLHS. RESULTS EFE, consisting of collagen and elastin with scarce cellular and vascular components, developed only in neonatal unloaded transplanted hearts and displayed the same histopathologic findings as EFE from patients with HLHS. Loaded hearts and 2-wk-old hearts did not show these alterations. CONCLUSIONS This animal model for EFE will serve as a tool to study the mechanisms of EFE formation, such as fluid forces, in HLHS in a systematic manner. A better understanding of the underlying cause of the EFE formation in HLHS will help to develop novel treatment strategies to better preserve growth of the hypoplastic left ventricle.
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Affiliation(s)
- Ingeborg Friehs
- Department of Cardiac Surgery, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA.
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139
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Ivabradine in pulmonary arterial hypertension: can we delay the need for parenteral prostanoid therapy? Clin Res Cardiol 2013; 102:391-3. [DOI: 10.1007/s00392-013-0541-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 01/23/2013] [Indexed: 10/27/2022]
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140
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de Man FS, Handoko ML, Guignabert C, Bogaard HJ, Vonk-Noordegraaf A. Neurohormonal Axis in Patients with Pulmonary Arterial Hypertension. Am J Respir Crit Care Med 2013; 187:14-9. [DOI: 10.1164/rccm.201209-1663pp] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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141
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Shayduk OY, Taratukhin EO. Pathogenetic therapy of heart failure: beta-adrenoblockers. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2012. [DOI: 10.15829/1728-8800-2012-6-68-70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The paper discusses key aspects of the chronic heart failure (CHF) pathogenesis, which justify the use of β-adrenoblockers (β-AB) in the treatment of CHF. The authors present the clinical and experimental evidence confirming the effectiveness of these agents in CHF patients. Dose titration and the use of β-AB in various clinical groups are also discussed.
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Affiliation(s)
- O. Yu. Shayduk
- N. I. Pirogov Russian National Medical University, Moscow
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142
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Hameed AG, Arnold ND, Chamberlain J, Pickworth JA, Paiva C, Dawson S, Cross S, Long L, Zhao L, Morrell NW, Crossman DC, Newman CMH, Kiely DG, Francis SE, Lawrie A. Inhibition of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) reverses experimental pulmonary hypertension. ACTA ACUST UNITED AC 2012; 209:1919-35. [PMID: 23071256 PMCID: PMC3478928 DOI: 10.1084/jem.20112716] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Genetic deletion of TRAIL or antibody blockade prevents the development of pulmonary arterial hypertension and can reverse vascular remodeling in established disease. Pulmonary arterial hypertension (PAH) is a life-threatening disease characterized by the progressive narrowing and occlusion of small pulmonary arteries. Current therapies fail to fully reverse this vascular remodeling. Identifying key pathways in disease pathogenesis is therefore required for the development of new-targeted therapeutics. We have previously reported tumor necrosis factor–related apoptosis-inducing ligand (TRAIL) immunoreactivity within pulmonary vascular lesions from patients with idiopathic PAH and animal models. Because TRAIL can induce both endothelial cell apoptosis and smooth muscle cell proliferation in the systemic circulation, we hypothesized that TRAIL is an important mediator in the pathogenesis of PAH. We demonstrate for the first time that TRAIL is a potent stimulus for pulmonary vascular remodeling in human cells and rodent models. Furthermore, antibody blockade or genetic deletion of TRAIL prevents the development of PAH in three independent rodent models. Finally, anti-TRAIL antibody treatment of rodents with established PAH reverses pulmonary vascular remodeling by reducing proliferation and inducing apoptosis, improves hemodynamic indices, and significantly increases survival. These preclinical investigations are the first to demonstrate the importance of TRAIL in PAH pathogenesis and highlight its potential as a novel therapeutic target to direct future translational therapies.
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Affiliation(s)
- Abdul G Hameed
- Department of Cardiovascular Science, 2 Department of Neuroscience, University of Sheffield, S10 2RX Sheffield, UK
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143
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de Man FS, Tu L, Handoko ML, Rain S, Ruiter G, François C, Schalij I, Dorfmüller P, Simonneau G, Fadel E, Perros F, Boonstra A, Postmus PE, van der Velden J, Vonk-Noordegraaf A, Humbert M, Eddahibi S, Guignabert C. Dysregulated renin-angiotensin-aldosterone system contributes to pulmonary arterial hypertension. Am J Respir Crit Care Med 2012; 186:780-9. [PMID: 22859525 PMCID: PMC5104838 DOI: 10.1164/rccm.201203-0411oc] [Citation(s) in RCA: 240] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
RATIONALE Patients with idiopathic pulmonary arterial hypertension (iPAH) often have a low cardiac output. To compensate, neurohormonal systems such as the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system are up-regulated, but this may have long-term negative effects on the progression of iPAH. OBJECTIVES Assess systemic and pulmonary RAAS activity in patients with iPAH and determine the efficacy of chronic RAAS inhibition in experimental PAH. METHODS We collected 79 blood samples from 58 patients with iPAH in the VU University Medical Center Amsterdam (between 2004 and 2010) to determine systemic RAAS activity. MEASUREMENTS AND MAIN RESULTS We observed increased levels of renin, angiotensin (Ang)I, and AngII, which were associated with disease progression (P < 0.05) and mortality (P < 0.05). To determine pulmonary RAAS activity, lung specimens were obtained from patients with iPAH (during lung transplantation, n = 13) and control subjects (during lobectomy or pneumonectomy for cancer, n = 14). Local RAAS activity in pulmonary arteries of patients with iPAH was increased, demonstrated by elevated angiotensin-converting enzyme activity in pulmonary endothelial cells and increased AngII type 1 (AT(1)) receptor expression and signaling. In addition, local RAAS up-regulation was associated with increased pulmonary artery smooth muscle cell proliferation via enhanced AT(1) receptor signaling in patients with iPAH compared with control subjects. Finally, to determine the therapeutic potential of RAAS activity, we assessed the chronic effects of an AT(1) receptor antagonist (losartan) in the monocrotaline PAH rat model (60 mg/kg). Losartan delayed disease progression, decreased right ventricular afterload and pulmonary vascular remodeling, and restored right ventricular-arterial coupling in rats with PAH. CONCLUSIONS Systemic and pulmonary RAAS activities are increased in patients with iPAH and are associated with increased pulmonary vascular remodeling. Chronic inhibition of RAAS by losartan is beneficial in experimental PAH.
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Affiliation(s)
- Frances S de Man
- VU University Medical Center, Department of Pulmonology, De Boelelaan 1117, Amsterdam, The Netherlands.
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144
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Manders E, de Man FS, Handoko ML, Westerhof N, van Hees HWH, Stienen GJM, Vonk-Noordegraaf A, Ottenheijm CAC. Diaphragm weakness in pulmonary arterial hypertension: role of sarcomeric dysfunction. Am J Physiol Lung Cell Mol Physiol 2012; 303:L1070-8. [PMID: 22962018 DOI: 10.1152/ajplung.00135.2012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We previously demonstrated that diaphragm muscle weakness is present in experimental pulmonary arterial hypertension (PH). However, the nature of this diaphragm weakness is still unknown. Therefore, the aim of this study was to investigate whether changes at the sarcomeric level contribute to diaphragm weakness in PH. For this purpose, in control rats and rats with monocrotaline-induced PH, contractile performance and myosin heavy chain content of demembranated single diaphragm fibers were determined. We observed a reduced maximal tension of 20% (P < 0.05), whereas tension cost was preserved in type 2X and 2B diaphragm fibers in PH compared with control. The reduced maximal tension was associated with a reduction of force generated per half-sarcomeric myosin heavy chain content. Additionally, reduced Ca(2+) sensitivity of force generation was found in type 2X fibers compared with control, which could exacerbate diaphragm muscle weakness at submaximal activation. No changes in maximal tension and Ca(2+) sensitivity of force generation were observed in fibers from the nonrespiratory extensor digitorum longus muscle. Together, these findings indicate that diaphragm weakness in PH is at least partly caused by sarcomeric dysfunction, which appears to be specific for the diaphragm.
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Affiliation(s)
- Emmy Manders
- Department of Pulmonology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
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145
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Mak S, Witte KK, Al-Hesayen A, Granton JJ, Parker JD. Cardiac sympathetic activation in patients with pulmonary arterial hypertension. Am J Physiol Regul Integr Comp Physiol 2012; 302:R1153-7. [DOI: 10.1152/ajpregu.00652.2011] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Patients with congestive heart failure (CHF) due to left ventricular (LV) dysfunction have sympathetic activation specifically directed to the myocardium. Although pulmonary arterial hypertension (PAH) is associated with increased systemic sympathetic activity, its impact on sympathetic drive to ventricular myocardium is unknown. Fifteen patients with PAH (9 women; 54 ± 12 years) were studied: 10 with idiopathic PAH and 5 with a connective tissue disorder. We measured hemodynamics, as well as radiolabeled and endogenous concentrations of arterial and coronary sinus norepinephrine (NE). These measures were repeated after inhaled nitric oxide (NO). Measurement of transcardiac NE concentrations and the cardiac extraction of radiolabeled NE allowed calculation of the corrected transcardiac gradient of NE (CTCG of NE). Comparative data were collected from 15 patients (9 women: 55 ± 12 yr) with normal LV function and 15 patients with CHF (10 women; 53 ± 12 yr). PAH patients had elevated arterial NE concentrations compared with those with normal LV function but were similar to those with CHF. The CTCG of NE was higher in those with PAH than in the normal LV group (3.6 ± 2.2 vs. 1.5 ± 0.9 pmol/ml; P < 0.01) but similar to that seen in those with CHF (3.3 ± 1.4; P = NS). Inhaled NO, which reduced pulmonary artery pressure and increased cardiac output, had no effect on cardiac sympathetic activity. Therefore, cardiac sympathetic activation occurs in PAH. The mechanism of this activation remains uncertain but does not involve elevations in left heart filling pressure.
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Affiliation(s)
- Susanna Mak
- Division of Cardiology, Department of Medicine, Mount Sinai Hospital, University Health Network, Toronto, Canada
| | - Klaus K. Witte
- Institute of Membrane and Systems Biology, Leeds General Infirmary, Leeds, United Kingdom
| | - Abdul Al-Hesayen
- Division of Cardiology, St. Michael's Hospital, Toronto, Canada; and
| | - John J. Granton
- Division of Respirology, Department of Medicine, Mount Sinai, University Health Network, Toronto, Canada
| | - John D. Parker
- Division of Cardiology, Department of Medicine, Mount Sinai Hospital, University Health Network, Toronto, Canada
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