201
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Jiang Y, Zhou Y, Peng G, Liu N, Tian H, Pan D, Liu L, Yang X, Li C, Li W, Chen L, Ran P, Dai A. Topotecan prevents hypoxia-induced pulmonary arterial hypertension and inhibits hypoxia-inducible factor-1α and TRPC channels. Int J Biochem Cell Biol 2018; 104:161-170. [PMID: 30266526 DOI: 10.1016/j.biocel.2018.09.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 08/15/2018] [Accepted: 09/19/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND This study aimed to investigate the effects of topotecan (TPT) on the hypoxia-induced pulmonary arterial hypertension (PAH) in a rat model, and to explore the underlying mechanism. METHODS The experiments were carried out in vitro using rat PASMCs and in vivo using a rat model of hypoxia-induced PAH. RESULTS TPT significantly suppressed the hypoxia-induced upregulation of HIF-1α and TRPC1/4/6 expression both in pulmonary arterial smooth muscle cells (PASMCs) from normal rats and in pulmonary arteries from PAH model rats. Furthermore, TPT effectively inhibited intracellular Ca2+ concentration ([Ca2+]i) change (Ca2+ influx) in PASMCs from both normal rats and PAH model rats. Importantly, TPT treatment significantly inhibited the hypoxia-induced proliferation, migration and a contractile-to-synthetic phenotypic switching of normal rat PASMCs in vitro, where the effect was abrogated by overexpression of TRPC1/4/6. Furthermore, TPT administration potently attenuated the hypoxia-induced PAH-associated pulmonary arteriolar remodeling in PAH model rats, as evidenced by amelioration of elevated hemodynamic parameters, and enhanced right ventricle hypertrophy and wall thickening. CONCLUSION TPT ameliorates the hypoxia-induced pulmonary vascular remodeling in PAH, and the mechanism is associated with TPT-mediated inhibition of hypoxia-induced upregulation of HIF-1α and TRPC1/4/6 expression, Ca2+ influx, and PASMCs proliferation.
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Affiliation(s)
- Yongliang Jiang
- Respiratory Medicine, Hunan Provincial People's Hospital, Changsha, PR China
| | - Yumin Zhou
- State Key Lab of Respiratory Diseases, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, PR China
| | - Gongyong Peng
- State Key Lab of Respiratory Diseases, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, PR China
| | - Nian Liu
- Respiratory Medicine, Hunan Provincial People's Hospital, Changsha, PR China
| | - Heshen Tian
- Respiratory Medicine, Hunan Provincial People's Hospital, Changsha, PR China
| | - Dan Pan
- Respiratory Medicine, Hunan Provincial People's Hospital, Changsha, PR China
| | - Lei Liu
- Respiratory Medicine, Hunan Provincial People's Hospital, Changsha, PR China
| | - Xing Yang
- Respiratory Medicine, Hunan Provincial People's Hospital, Changsha, PR China
| | - Chao Li
- Respiratory Medicine, Hunan Provincial People's Hospital, Changsha, PR China
| | - Wen Li
- Respiratory Medicine, Hunan Provincial People's Hospital, Changsha, PR China
| | - Ling Chen
- Respiratory Medicine, Hunan Provincial People's Hospital, Changsha, PR China
| | - Pixin Ran
- State Key Lab of Respiratory Diseases, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, PR China.
| | - Aiguo Dai
- Respiratory Medicine, Hunan Provincial People's Hospital, Changsha, PR China; Institute of Respiratory Medicine, Changsha Medical College, Changsha, PR China.
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202
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Miura Y, Kataoka M, Chiba T, Inami T, Yoshino H, Satoh T. Giant Fold Gastritis Induced by Epoprostenol Infusion in Patients With Pulmonary Arterial Hypertension. Circ J 2018; 82:2676-2677. [PMID: 30135321 DOI: 10.1253/circj.cj-18-0349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Epoprostenol infusion is the strongest and most convincing therapeutic strategy for severe pulmonary arterial hypertension (PAH). This study investigated the gastrointestinal side effects of epoprostenol. Methods and Results: The study group of 12 patients treated with epoprostenol (epoprostenol group) and 4 patients without epoprostenol (control group) underwent stomach barium examination, which revealed that the prevalence of giant fold gastritis was significantly higher in the patients treated with epoprostenol (75% in epoprostenol group vs. 0% in control group; P=0.019). CONCLUSIONS Giant fold gastritis may be an important side effect of epoprostenol infusion.
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Affiliation(s)
- Yohei Miura
- Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine
| | | | - Tomohiro Chiba
- Department of Pathology, Kyorin University School of Medicine
| | - Takumi Inami
- Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine
| | - Hideaki Yoshino
- Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine
| | - Toru Satoh
- Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine
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203
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Badagliacca R, Papa S, Poscia R, Pezzuto B, Manzi G, Torre R, Fedele F, Vizza CD. The importance of right ventricular function in patients with pulmonary arterial hypertension. Expert Rev Respir Med 2018; 12:809-815. [PMID: 30142003 DOI: 10.1080/17476348.2018.1515629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Pulmonary arterial hypertension (PAH) is a progressive, life-threatening, and incurable disease. Its prognosis is based on right ventricular (RV) function. Therefore, adequate assessment of RV function is mandatory. Areas covered: This article presents the case of a patient with PAH in which the traditional diagnostic approach did not provide a complete assessment of RV function. The authors show how the analysis of other parameters yielded additional information that improved the management of this patient. Expert commentary: Despite current treatments, PAH often worsens due to progressive RV dysfunction. Appropriate assessment of RV function may facilitate the early identification of patients at risk of RV function impairment. More aggressive treatment of PAH might delay progression of the disease. Traditional risk stratification, which is based on New York Heart Association/World Health Organization (NYHA/WHO) functional class evaluation, the 6-minute walk test, and right heart catheterization, proves insufficient in many PAH patients, as it does not provide complete information about RV function. Thus, further parameters are required. Analysis of RV function, in addition to echocardiography and cardiopulmonary exercise testing, may add relevant prognostic information and improve therapy.
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Affiliation(s)
- Roberto Badagliacca
- a Department of Cardiovascular and Respiratory Science , Sapienza University of Rome , Rome , Italy
| | - Silvia Papa
- a Department of Cardiovascular and Respiratory Science , Sapienza University of Rome , Rome , Italy
| | - Roberto Poscia
- a Department of Cardiovascular and Respiratory Science , Sapienza University of Rome , Rome , Italy
| | - Beatrice Pezzuto
- a Department of Cardiovascular and Respiratory Science , Sapienza University of Rome , Rome , Italy
| | - Giovanna Manzi
- a Department of Cardiovascular and Respiratory Science , Sapienza University of Rome , Rome , Italy
| | - Roberto Torre
- a Department of Cardiovascular and Respiratory Science , Sapienza University of Rome , Rome , Italy
| | - Francesco Fedele
- a Department of Cardiovascular and Respiratory Science , Sapienza University of Rome , Rome , Italy
| | - Carmine Dario Vizza
- a Department of Cardiovascular and Respiratory Science , Sapienza University of Rome , Rome , Italy
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204
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Willis GR, Fernandez-Gonzalez A, Reis M, Mitsialis SA, Kourembanas S. Macrophage Immunomodulation: The Gatekeeper for Mesenchymal Stem Cell Derived-Exosomes in Pulmonary Arterial Hypertension? Int J Mol Sci 2018; 19:ijms19092534. [PMID: 30150544 PMCID: PMC6164282 DOI: 10.3390/ijms19092534] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 12/13/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a progressive disease characterized by remodeling of the pulmonary arteries, increased pulmonary infiltrates, loss of vascular cross-sectional area, and elevated pulmonary vascular resistance. Despite recent advances in the management of PAH, there is a pressing need for the development of new tools to effectively treat and reduce the risk of further complications. Dysregulated immunity underlies the development of PAH, and macrophages orchestrate both the initiation and resolution of pulmonary inflammation, thus, manipulation of lung macrophage function represents an attractive target for emerging immunomodulatory therapies, including cell-based approaches. Indeed, mesenchymal stem cell (MSC)-based therapies have shown promise, effectively modulating the macrophage fulcrum to favor an anti-inflammatory, pro-resolving phenotype, which is associated with both histological and functional benefits in preclinical models of pulmonary hypertension (PH). The complex interplay between immune system homeostasis and MSCs remains incompletely understood. Here, we highlight the importance of macrophage function in models of PH and summarize the development of MSC-based therapies, focusing on the significance of MSC exosomes (MEx) and the immunomodulatory and homeostatic mechanisms by which such therapies may afford their beneficial effects.
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Affiliation(s)
- Gareth R Willis
- Division of Newborn Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA.
| | - Angeles Fernandez-Gonzalez
- Division of Newborn Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA.
| | - Monica Reis
- Division of Newborn Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA.
| | - S Alex Mitsialis
- Division of Newborn Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA.
| | - Stella Kourembanas
- Division of Newborn Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA.
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205
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Korokin M, Zhernakova NI, Korokina L, Pokopejko O. Principles of pharmacological correction of pulmonary arterial hypertension. RESEARCH RESULTS IN PHARMACOLOGY 2018. [DOI: 10.3897/rrpharmacology.4.27732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Definition and classification: Pulmonary hypertension (PH) is a group of life-threatening progressive diseases of various genesis, characterized by a progressive increase in arterial pressure (AP) in the pulmonary artery (PA), the remodeling of pulmonary vessels, which leads to an increase in pulmonary vascular resistance and pulmonary arterial pressure and more often leads to right ventricular heart failure and premature death. Pulmonary hypertension is clinically divided into five groups: patients in the first group have idiopathic pulmonary arterial hypertension (IPAH), whereas in patients of other groups secondary PH associated with cardiopulmonary or other systemic diseases is observed. The development of secondary LH is caused by congenital heart defects, collagenoses, presence of thrombus in the pulmonary artery, prolonged high pressure in the left atrium, hypoxemia, chronic obstructive pulmonary diseases (COPDs). In case of secondary PH, thrombosis and other changes in the pulmonary veins occur.
Ways of pharmacological correction of pulmonary hypertension: Over the last decade pharmacotherapy of PH has been developing rapidly, and the introduction of modern methods of treatment, especially for primary PAH, has led to positive results. However, despite the progress in treatment, the functional limitations and survival of patients remain unsatisfactory. Currently, there are two levels of treatment for pulmonary hypertension: primary and specific pathogenetic therapies. Primary therapy is aimed at the main cause of PH. It also includes supportive therapy. Pathogenetic therapy includes prostanoids, endothelin receptor antagonists, and phosphodiesterase-5 inhibitors. Tactics of therapy can be established on the basis of either clinical classification, or functional class. Prostanoids are a promising group of drugs for the treatment of pulmonary arterial hypertension (PAH), since they possess not only vasodilating, but also antiplatelet and antiproliferative actions. Therefore, it seems logical to use prostacyclin and its analogs to treat patients with various forms of PAH.
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206
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Jung HO. Benefits from the Early Initiation of Macitentan for Pulmonary Arterial Hypertension. Korean Circ J 2018; 48:854-856. [PMID: 30088355 PMCID: PMC6110702 DOI: 10.4070/kcj.2018.0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 05/31/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Hae Ok Jung
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
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207
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Dai J, Zhou Q, Tang H, Chen T, Li J, Raychaudhuri P, Yuan JXJ, Zhou G. Smooth muscle cell-specific FoxM1 controls hypoxia-induced pulmonary hypertension. Cell Signal 2018; 51:119-129. [PMID: 30092353 DOI: 10.1016/j.cellsig.2018.08.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/02/2018] [Accepted: 08/02/2018] [Indexed: 12/17/2022]
Abstract
RATIONALE Forkhead box M1 (FoxM1) is a transcription factor that promotes cell proliferation by regulating a broad spectrum of genes that participate in cell cycle regulation, such as Cyclin B, CDC25B, and Aurora B Kinase. We have shown that hypoxia, a well-known stimulus for pulmonary hypertension (PH), induces FoxM1 in pulmonary artery smooth muscle cells (PASMC) in a HIF-dependent pathway, resulting in PASMC proliferation, while the suppression of FoxM1 prevents hypoxia-induced PASMC proliferation. However, the implications of FoxM1 in the development of PH remain less known. METHODS We determined FoxM1 levels in the lung samples of idiopathic PAH (pulmonary arterial hypertension) (IPAH) patients and hypoxia-induced PH mice. We generated constitutive and inducible smooth muscle cell (SMC)-specific FoxM1 knockdown or knockout mice as well as FoxM1 transgenic mice which overexpress FoxM1, and exposed them to hypoxia (10% O2, 90% N2) or normoxia (Room air, 21% oxygen) for four weeks, and measured PH indices. We also isolated mouse PASMC (mPASMC) and mouse embryonic fibroblasts (MEF) from these mice to examine the cell proliferation and expression levels of SMC contractile proteins. RESULTS We showed that in hypertensive human lungs or mouse lungs, FoxM1 levels were elevated. Constitutive knockout of FoxM1 in mouse SMC caused early lethality, whereas constitutive knockdown of FoxM1 in mouse SMC prevented hypoxia-induced PH and PASMC proliferation. Inducible knockout of FoxM1 in SMC reversed hypoxia-induced pulmonary artery wall remodeling in existing PH. Overexpression of FoxM1 enhanced hypoxia-induced pulmonary artery wall remodeling and right ventricular hypertrophy in mice. Alteration of FoxM1 status did not affect hypoxia-induced hypoxia-inducible factor (HIF) activity in mice. Knockout of FoxM1 decreased PASMC proliferation and induced expression of SMC contractile proteins and TGF-β/Smad3 signaling. CONCLUSIONS Our studies provide clear evidence that altered FoxM1 expression in PASMC contributes to PH and uncover a correlation between Smad3-dependent signaling in FoxM1-mediated proliferation and de-differentiation of PASMC.
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Affiliation(s)
- Jingbo Dai
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Wood Street, Chicago, IL 60612, USA
| | - Qiyuan Zhou
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Wood Street, Chicago, IL 60612, USA
| | - Haiyang Tang
- Department of Medicine, University of Arizona, Tucson, AZ, USA; State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Tianji Chen
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Wood Street, Chicago, IL 60612, USA
| | - Jing Li
- Department of Biochemistry and Molecular Genetics, University of Illinois at Chicago, Chicago, IL, USA
| | - Pradip Raychaudhuri
- Department of Biochemistry and Molecular Genetics, University of Illinois at Chicago, Chicago, IL, USA
| | - Jason X-J Yuan
- Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Guofei Zhou
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Wood Street, Chicago, IL 60612, USA; State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
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208
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Chen T, Huang JB, Dai J, Zhou Q, Raj JU, Zhou G. PAI-1 is a novel component of the miR-17~92 signaling that regulates pulmonary artery smooth muscle cell phenotypes. Am J Physiol Lung Cell Mol Physiol 2018; 315:L149-L161. [PMID: 29644896 PMCID: PMC6139661 DOI: 10.1152/ajplung.00137.2017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 03/30/2018] [Accepted: 04/04/2018] [Indexed: 01/13/2023] Open
Abstract
We have previously reported that miR-17~92 is critically involved in the pathogenesis of pulmonary hypertension (PH). We also identified two novel mR-17/20a direct targets, PDZ and LIM domain protein 5 (PDLIM5) and prolyl hydroxylase 2 (PHD2), and elucidated the signaling pathways by which PDLIM5 and PHD2 regulate functions of pulmonary artery smooth muscle cells (PASMCs). In addition, we have shown that plasminogen activator inhibitor-1 (PAI-1) is also downregulated in PASMCs that overexpress miR-17~92. However, it is unclear whether PAI-1 is a direct target of miR-17~92 and whether it plays a role in regulating the PASMC phenotype. In this study, we have identified PAI-1 as a novel target of miR-19a/b, two members of the miR-17~92 cluster. We found that the 3'-untranslated region (UTR) of PAI-1 contains a miR-19a/b binding site and that miR-19a/b can target this site to suppress PAI-1 protein expression. MiR-17/20a, two other members of miR-17~92, may also indirectly suppress PAI-1 expression through PDLIM5. PAI-1 is a negative regulator of miR-17~92-mediated PASMC proliferation. Silencing of PAI-1 induces Smad2/calponin signaling in PASMCs, suggesting that PAI-1 is a negative regulator of the PASMC contractile phenotype. We also found that PAI-1 is essential for the metabolic gene expression in PASMCs. Furthermore, although there is no significant change in PAI-1 levels in PASMCs isolated from idiopathic pulmonary arterial hypertension and associated pulmonary arterial hypertension patients, PAI-1 is downregulated in hypoxia/Sugen-induced hypertensive rat lungs. These results suggest that miR-17~92 regulates the PASMC contractile phenotype and proliferation coordinately and synergistically by direct and indirect targeting of PAI-1.
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MESH Headings
- 3' Untranslated Regions
- Animals
- Cell Proliferation
- Gene Expression Regulation
- Humans
- Hypertension, Pulmonary/genetics
- Hypertension, Pulmonary/metabolism
- Hypertension, Pulmonary/pathology
- Male
- MicroRNAs/genetics
- MicroRNAs/metabolism
- Muscle Contraction/genetics
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/pathology
- Myocytes, Smooth Muscle/metabolism
- Myocytes, Smooth Muscle/pathology
- Plasminogen Activator Inhibitor 1/biosynthesis
- Plasminogen Activator Inhibitor 1/genetics
- Pulmonary Artery/metabolism
- Pulmonary Artery/pathology
- Rats
- Rats, Sprague-Dawley
- Signal Transduction
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Affiliation(s)
- Tianji Chen
- Department of Pediatrics, University of Illinois at Chicago , Chicago, Illinois
| | - Jason B Huang
- Department of Pediatrics, University of Illinois at Chicago , Chicago, Illinois
| | - Jingbo Dai
- Department of Pediatrics, University of Illinois at Chicago , Chicago, Illinois
| | - Qiyuan Zhou
- Department of Pediatrics, University of Illinois at Chicago , Chicago, Illinois
| | - J Usha Raj
- Department of Pediatrics, University of Illinois at Chicago , Chicago, Illinois
| | - Guofei Zhou
- Department of Pediatrics, University of Illinois at Chicago , Chicago, Illinois
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209
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Morozowich ST, Murray AW, Ramakrishna H. Pulmonary Hypertension in Patients for Transcatheter and Surgical Aortic Valve Replacement: A Focus on Outcomes and Perioperative Management. J Cardiothorac Vasc Anesth 2018; 32:2005-2018. [DOI: 10.1053/j.jvca.2017.09.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Indexed: 01/03/2023]
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210
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Sysol JR, Machado RF. Classification and pathophysiology of pulmonary hypertension. ACTA ACUST UNITED AC 2018. [DOI: 10.1002/cce2.71] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- J. R. Sysol
- Department of Medicine; Division of Pulmonary, Critical Care, Sleep and Allergy; University of Illinois at Chicago; Chicago, 60612 Illinois
- Department of Pharmacology; University of Illinois at Chicago; Chicago, 60612 Illinois
| | - R. F. Machado
- Department of Medicine; Division of Pulmonary, Critical Care, Sleep and Allergy; University of Illinois at Chicago; Chicago, 60612 Illinois
- Department of Pharmacology; University of Illinois at Chicago; Chicago, 60612 Illinois
- Division of Pulmonary; Critical Care; Sleep, and Occupational Medicine; Indiana University Department of Medicine; Indianapolis, 46202 Indiana
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211
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D'Alto M, Romeo E, Argiento P, Paciocco G, Prediletto R, Ghio S, Correale M, Lo Giudice F, Badagliacca R, Greco A, Vizza CD. Initial tadalafil and ambrisentan combination therapy in pulmonary arterial hypertension: cLinical and haemodYnamic long-term efficacy (ITALY study). J Cardiovasc Med (Hagerstown) 2018; 19:12-17. [PMID: 29215546 DOI: 10.2459/jcm.0000000000000590] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Initial combination therapy with ambrisentan and tadalafil (upfront therapy) offers clinical benefits in pulmonary arterial hypertension (PAH) and reduces the risk of clinical failure compared with monotherapy in naïve patients. The aim of study is to assess the efficacy of a 12-month upfront therapy with ambrisentan and tadalafil in improving haemodynamics in incident PAH patients. METHODS This is a multicentre retrospective analysis of real-world Italian clinical data in 56 patients with newly diagnosed PAH. Clinical evaluations, including demographics, medical history, WHO functional class, 6-min walk distance, and right heart catheterization, were collected from the patients' medical records at baseline and at 12-month follow-up. RESULTS At baseline, there were 16, 34, and 6 patients in WHO functional class II, III, and IV, respectively. Over a median follow-up of 12 months, 54 (96%) patients were still alive, 6 (11%) of whom received parenteral prostanoids. Ambrisentan-tadalafil combination was associated with significant improvements in WHO functional class (2.2 ± 0.8 vs. 2.8 ± 0.6, P < 0.001, improved in 29 patients), exercise capacity (395 ± 123 vs. 353 ± 101 m, P = 0.039), N-terminal probrain natriuretic peptide (528 ± 493 vs. 829 ± 620 pg/ml; P = 0.009), and haemodynamics (right atrial pressure 7 ± 4 vs. 9 ± 5 mmHg, P = 0.02; mean pulmonary artery pressure 45 ± 15 vs. 50 ± 13 mmHg, P = 0.03; cardiac index 3.0 ± 1.0 vs. 2.5 ± 0.9 l/min/m, P = 0.001; pulmonary vascular resistance 8 ± 4 vs. 11 ± 6 Wood units, P = 0.001) compared with baseline. CONCLUSIONS Initial combination therapy with ambrisentan and tadalafil offers clinical benefits and significant haemodynamic improvement in newly diagnosed PAH patients.
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Affiliation(s)
- Michele D'Alto
- Department of Cardiology, Second University of Naples, Monaldi Hospital, Naples
| | - Emanuele Romeo
- Department of Cardiology, Second University of Naples, Monaldi Hospital, Naples
| | - Paola Argiento
- Department of Cardiology, Second University of Naples, Monaldi Hospital, Naples
| | | | - Renato Prediletto
- Fondazione Monasterio CNR-Regione Toscana, Istituto di Fisiologia Clinica del CNR, Pisa
| | | | - Michele Correale
- Department of Cardiology, Ospedali Riuniti University Hospital, Foggia
| | | | - Roberto Badagliacca
- Department of Cardiovascular and Respiratory Disease, University of Rome La Sapienza, Rome, Italy
| | | | - Carmine Dario Vizza
- Department of Cardiovascular and Respiratory Disease, University of Rome La Sapienza, Rome, Italy
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212
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Joshi AA, Davey R, Rao Y, Shen K, Benza RL, Raina A. Association between cytokines and functional, hemodynamic parameters, and clinical outcomes in pulmonary arterial hypertension. Pulm Circ 2018; 8:2045894018794051. [PMID: 30036135 PMCID: PMC6153541 DOI: 10.1177/2045894018794051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
To assess the relationship of cytokines with functional and clinical outcomes in
pulmonary arterial hypertension (PAH). Endothelial dysfunction and vascular
inflammation are characteristic of PAH. We investigated whether markers of
angiogenesis and inflammation associated with functional, hemodynamic
parameters, and clinical outcomes in PAH. PAH patients (n = 206) were pooled
from two clinical trials: TRUST-1 and FREEDOM-C2. Baseline and post-treatment
cytokine levels were correlated to baseline clinical and hemodynamic parameters,
were assessed in clinical subgroups, and were associated with clinical outcomes.
In 206 patients (mean age = 48 years; 74% women) with WHO group-1 PAH, most
cytokine levels were higher in those with 6-min walking distance
(6MWD) < median (335 m) vs. those above median, including Ang-1 (11.9 ± 10.1
vs. 5.9 ± 6.0 ng/mL), Ang-2 (14.3 ± 11.8 vs. 12.2 ± 11.2 ng/mL), and MMP-9
(221 ± 262.3 vs. 119 ± 171 ng/mL). Baseline 6MWD inversely correlated with Ang-1
(r = −0.27, P < 0.0001), Ang-2 (r = −0.20,
P = 0.004), and MMP-9 (r = −0.27,
P < 0.0001). MMP-9 levels differed significantly by NYHA
functional class (P = 0.001) suggesting an association between
MMP-9 and subjective PAH severity. Mean Ang-2 levels were higher in those with
baseline right atrial pressure (RAP) > 15 mmHg compared to those with
RAP < 15 mmHg (23,841 vs. 11,020 pg/mL). Baseline RAP was associated with
change in MMP-9 levels (r = −0.53, P = 0.03). Finally, baseline
Ang-1, VEGF and MMP-9 levels were associated with risk of death and
hospitalization at 16-week follow-up. Inflammatory cytokines and vascular
angiogenesis markers are associated with baseline functional, hemodynamic
parameters in PAH, and predict death and hospitalization. Larger prospective
studies are needed to confirm the utility of cytokines in PAH.
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Affiliation(s)
- Aditya A Joshi
- 1 Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Ryan Davey
- 2 Division of Cardiology, Western University, London, ON, Canada
| | - Youlan Rao
- 3 United Therapeutics Corporation, Research Triangle, NC, USA
| | - Kai Shen
- 3 United Therapeutics Corporation, Research Triangle, NC, USA
| | - Raymond L Benza
- 4 Section of Heart Failure/Transplant/MCS & Pulmonary Hypertension, Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Amresh Raina
- 4 Section of Heart Failure/Transplant/MCS & Pulmonary Hypertension, Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, USA
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214
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Jing X, Jiang T, Dai L, Wang X, Jia L, Wang H, An L, Liu M, Zhang R, Cheng Z. Hypoxia-induced autophagy activation through NF-κB pathway regulates cell proliferation and migration to induce pulmonary vascular remodeling. Exp Cell Res 2018; 368:174-183. [DOI: 10.1016/j.yexcr.2018.04.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/25/2018] [Accepted: 04/25/2018] [Indexed: 01/17/2023]
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Liu Y, Zhang H, Yan L, Du W, Zhang M, Chen H, Zhang L, Li G, Li J, Dong Y, Zhu D. MMP-2 and MMP-9 contribute to the angiogenic effect produced by hypoxia/15-HETE in pulmonary endothelial cells. J Mol Cell Cardiol 2018; 121:36-50. [PMID: 29913136 DOI: 10.1016/j.yjmcc.2018.06.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 06/06/2018] [Accepted: 06/13/2018] [Indexed: 11/15/2022]
Abstract
Matrix metalloproteinase-2 (MMP-2) and matrix metalloproteinase-9 (MMP-9) are the predominant gelatinases in the developing lung. Studies have shown that the expression of MMP-2 and MMP-9 is upregulated in hypoxic fibroblasts, 15-hydroxyeicosatetraenoic acid (15-HETE) regulated fibroblasts migration via modulating MMP-2 or MMP-9, and that hypoxia/15-HETE is a predominant contributor to the development of pulmonary arterial hypertension (PAH) through increased angiogenesis. However, the roles of MMP-2 and MMP-9 in pulmonary arterial endothelial cells (PAECs) angiogenesis as well as the molecular mechanism of hypoxia-regulated MMP-2 and MMP-9 expression have not been identified. The aim of this study was to investigate the role of MMP-2 and MMP-9 in PAEC proliferation and vascular angiogenesis and to determine the effects of hypoxia-induced 15-HETE on the expression of MMP-2 and MMP-9. Western blot, immunofluorescence, and real-time PCR were used to measure the expression of MMP-2 and MMP-9 in hypoxic PAECs. Immunohistochemical staining, flow cytometry, and tube formation as well as cell proliferation, viability, scratch-wound, and Boyden chamber migration assays were used to identify the roles and relationships between MMP-2, MMP-9, and 15-HETE in hypoxic PAECs. We found that hypoxia increased MMP-2 and MMP-9 expression in pulmonary artery endothelium both in vivo and in vitro in a time-dependent pattern. Moreover, administration of the MMP-2 and MMP-9 inhibitor MMI-166 significantly reversed hypoxia-induced increases in right ventricular systemic pressure (RVSP), right ventricular function, and thickening of the tunica media. Furthermore, up-regulation of MMP-2 and MMP-9 expression was induced by 15-HETE, which regulates PAEC proliferation, migration, and cell cycle transition that eventually leads to angiogenesis. Our study demonstrated that hypoxia increases the expression of MMP-2 and MMP-9 through the 15-lipoxygenase/15-HETE pathway, and that MMP-2 and MMP-9 promote PAEC angiogenesis. These findings suggest that MMP-2 and MMP-9 may serve as new potential therapeutic targets for the treatment of PAH.
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Affiliation(s)
- Ying Liu
- Department of Biopharmaceutical Key Laboratory of Heilongjiang Province, Harbin Medical University, Harbin 150001, Heilongjiang Province, China; Department of Biopharmaceutical Sciences, Harbin Medical University, Daqing, Heilongjiang Province, China
| | - Hongyue Zhang
- Department of Biopharmaceutical Key Laboratory of Heilongjiang Province, Harbin Medical University, Harbin 150001, Heilongjiang Province, China; Department of Biopharmaceutical Sciences, Harbin Medical University, Daqing, Heilongjiang Province, China
| | - Lixin Yan
- Department of Biopharmaceutical Key Laboratory of Heilongjiang Province, Harbin Medical University, Harbin 150001, Heilongjiang Province, China; Department of Biopharmaceutical Sciences, Harbin Medical University, Daqing, Heilongjiang Province, China
| | - Wei Du
- School of Pharmacy, Harbin University of Commerce, Harbin, Heilongjiang Province, China
| | - Min Zhang
- Department of Biopharmaceutical Key Laboratory of Heilongjiang Province, Harbin Medical University, Harbin 150001, Heilongjiang Province, China; Department of Biopharmaceutical Sciences, Harbin Medical University, Daqing, Heilongjiang Province, China
| | - He Chen
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Lixin Zhang
- Department of Immunology, College of Medical Laboratory Science and Technology, Harbin Medical University (Daqing), Daqing 163319, Heilongjiang Province, China
| | - Guangqun Li
- Medical Laboratory Technology, Harbin Medical University, Daqing, Heilongjiang Province, China
| | - Jijin Li
- Medical Laboratory Technology, Harbin Medical University, Daqing, Heilongjiang Province, China
| | - Yinchu Dong
- Medical Laboratory Technology, Harbin Medical University, Daqing, Heilongjiang Province, China
| | - Daling Zhu
- Department of Biopharmaceutical Key Laboratory of Heilongjiang Province, Harbin Medical University, Harbin 150001, Heilongjiang Province, China; Department of Biopharmaceutical Sciences, Harbin Medical University, Daqing, Heilongjiang Province, China.
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216
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Ramakrishnan L, Pedersen SL, Toe QK, Quinlan GJ, Wort SJ. Pulmonary Arterial Hypertension: Iron Matters. Front Physiol 2018; 9:641. [PMID: 29904352 PMCID: PMC5990599 DOI: 10.3389/fphys.2018.00641] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 05/11/2018] [Indexed: 12/16/2022] Open
Abstract
The interplay between iron and oxygen is longstanding and central to all aerobic life. Tight regulation of these interactions including homeostatic regulation of iron utilization ensures safe usage of this limited resource. However, when control is lost adverse events can ensue, which are known to contribute to an array of disease processes. Recently, associations between disrupted iron homeostasis and pulmonary artery hypertension (PAH) have been described with the suggestion that there is a contributory link with disease. This review provides a background for iron regulation in humans, describes PAH classifications, and discusses emerging literature, which suggests a role for disrupted iron homeostatic control in various sub-types of PAH, including a role for decompartmentalization of hemoglobin. Finally, the potential for therapeutic options to restore iron homeostatic balance in PAH are discussed.
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217
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de Bourcy CFA, Dekker CL, Davis MM, Nicolls MR, Quake SR. Dynamics of the human antibody repertoire after B cell depletion in systemic sclerosis. Sci Immunol 2018; 2:2/15/eaan8289. [PMID: 28963118 PMCID: PMC5800854 DOI: 10.1126/sciimmunol.aan8289] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/15/2017] [Indexed: 01/10/2023]
Abstract
Systemic sclerosis with pulmonary arterial hypertension (SSc-PAH) is a debilitating and frequently lethal disease of unknown cause lacking effective treatment options. Lymphocyte anomalies and autoantibodies observed in systemic sclerosis have suggested an autoimmune character. We study the clonal structure of the B cell repertoire in SSc-PAH using immunoglobulin heavy chain (IGH) sequencing before and after B cell depletion. We found SSc-PAH to be associated with anomalies in B cell development, namely, altered VDJ rearrangement frequencies (reduced IGHV2-5 segment usage) and an increased somatic mutation-fixation probability in expanded B cell lineages. SSc-PAH was also characterized by anomalies in B cell homeostasis, namely, an expanded immunoglobulin D-positive (IgD+) proportion with reduced mutation loads and an expanded proportion of highly antibody-secreting cells. Disease signatures pertaining to IGHV2-5 segment usage, IgD proportions, and mutation loads were temporarily reversed after B cell depletion. Analyzing the time course of B cell depletion, we find that the kinetics of naïve replenishment are predictable from baseline measurements alone, that release of plasma cells into the periphery can precede naïve replenishment, and that modes of B cell receptor diversity are highly elastic. Our findings reveal humoral immune signatures of SSc-PAH and uncover determinism in the effects of B cell depletion on the antibody repertoire.
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Affiliation(s)
| | - Cornelia L Dekker
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Mark M Davis
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA 94305, USA.,Institute for Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA 94305, USA.,Howard Hughes Medical Institute, Chevy Chase, MD 20815, USA
| | - Mark R Nicolls
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.,Veterans Affairs Palo Alto Health Care System, Medical Service, Palo Alto, CA 94303, USA
| | - Stephen R Quake
- Department of Applied Physics, Stanford University, Stanford, CA 94305, USA. .,Department of Bioengineering, Stanford University, Stanford, CA 94305, USA.,Chan Zuckerberg Biohub, San Francisco, CA 94158, USA
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218
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Clinical phenotypes and survival of pre-capillary pulmonary hypertension in systemic sclerosis. PLoS One 2018; 13:e0197112. [PMID: 29763468 PMCID: PMC5953495 DOI: 10.1371/journal.pone.0197112] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/26/2018] [Indexed: 11/25/2022] Open
Abstract
Pre-capillary pulmonary hypertension (PH) in systemic sclerosis (SSc) is a heterogeneous condition with an overall bad prognosis. The objective of this study was to identify and characterize homogeneous phenotypes by a cluster analysis in SSc patients with PH. Patients were identified from two prospective cohorts from the US and France. Clinical, pulmonary function, high-resolution chest tomography, hemodynamic and survival data were extracted. We performed cluster analysis using the k-means method and compared survival between clusters using Cox regression analysis. Cluster analysis of 200 patients identified four homogenous phenotypes. Cluster C1 included patients with mild to moderate risk pulmonary arterial hypertension (PAH) with limited or no interstitial lung disease (ILD) and low DLCO with a 3-year survival of 81.5% (95% CI: 71.4–88.2). C2 had pre-capillary PH due to extensive ILD and worse 3-year survival compared to C1 (adjusted hazard ratio [HR] 3.14; 95% CI 1.66–5.94; p = 0.0004). C3 had severe PAH and a trend towards worse survival (HR 2.53; 95% CI 0.99–6.49; p = 0.052). Cluster C4 and C1 were similar with no difference in survival (HR 0.65; 95% CI 0.19–2.27, p = 0.507) but with a higher DLCO in C4. PH in SSc can be characterized into distinct clusters that differ in prognosis.
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219
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Zheng HK, Zhao JH, Yan Y, Lian TY, Ye J, Wang XJ, Wang Z, Jing ZC, He YY, Yang P. Metabolic reprogramming of the urea cycle pathway in experimental pulmonary arterial hypertension rats induced by monocrotaline. Respir Res 2018; 19:94. [PMID: 29751839 PMCID: PMC5948901 DOI: 10.1186/s12931-018-0800-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/01/2018] [Indexed: 12/27/2022] Open
Abstract
Background Pulmonary arterial hypertension (PAH) is a rare systemic disorder associated with considerable metabolic dysfunction. Although enormous metabolomic studies on PAH have been emerging, research remains lacking on metabolic reprogramming in experimental PAH models. We aim to evaluate the metabolic changes in PAH and provide new insight into endogenous metabolic disorders of PAH. Method A single subcutaneous injection of monocrotaline (MCT) (60 mg kg− 1) was used for rats to establish PAH model. Hemodynamics and right ventricular hypertrophy were adopted to evaluate the successful establishment of PAH model. Plasma samples were assessed through targeted metabolomic profiling platform to quantify 126 endogenous metabolites. Orthogonal partial least squares discriminant analysis (OPLS-DA) was used to discriminate between MCT-treated model and control groups. Metabolite Set Enrichment Analysis was adapted to exploit the most disturbed metabolic pathways. Results Endogenous metabolites of MCT treated PAH model and control group were well profiled using this platform. A total of 13 plasma metabolites were significantly altered between the two groups. Metabolite Set Enrichment Analysis highlighted that a disruption in the urea cycle pathway may contribute to PAH onset. Moreover, five novel potential biomarkers in the urea cycle, adenosine monophosphate, urea, 4-hydroxy-proline, ornithine, N-acetylornithine, and two candidate biomarkers, namely, O-acetylcarnitine and betaine, were found to be highly correlated with PAH. Conclusion The present study suggests a new role of urea cycle disruption in the pathogenesis of PAH. We also found five urea cycle related biomarkers and another two candidate biomarkers to facilitate early diagnosis of PAH in metabolomic profile.
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Affiliation(s)
- Hai-Kuo Zheng
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jun-Han Zhao
- State Key Laboratory of Cardiovascular Disease, FuWai Hospital, and Key Laboratory of Pulmonary Vascular Medicine, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yi Yan
- State Key Laboratory of Cardiovascular Disease, FuWai Hospital, and Key Laboratory of Pulmonary Vascular Medicine, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Tian-Yu Lian
- State Key Laboratory of Cardiovascular Disease, FuWai Hospital, and Key Laboratory of Pulmonary Vascular Medicine, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jue Ye
- State Key Laboratory of Cardiovascular Disease, FuWai Hospital, and Key Laboratory of Pulmonary Vascular Medicine, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiao-Jian Wang
- State Key Laboratory of Cardiovascular Disease, FuWai Hospital, and Key Laboratory of Pulmonary Vascular Medicine, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zhe Wang
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zhi-Cheng Jing
- State Key Laboratory of Cardiovascular Disease, FuWai Hospital, and Key Laboratory of Pulmonary Vascular Medicine, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yang-Yang He
- State Key Laboratory of Cardiovascular Disease, FuWai Hospital, and Key Laboratory of Pulmonary Vascular Medicine, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
| | - Ping Yang
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, China.
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220
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Andersson KE. PDE5 inhibitors - pharmacology and clinical applications 20 years after sildenafil discovery. Br J Pharmacol 2018; 175:2554-2565. [PMID: 29667180 DOI: 10.1111/bph.14205] [Citation(s) in RCA: 159] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/01/2018] [Accepted: 03/05/2018] [Indexed: 11/28/2022] Open
Abstract
The discovery of the nitric oxide/cGMP pathway was the basis for our understanding of many normal physiological functions and the pathophysiology of several diseases. Since the discovery and introduction of sildenafil, inhibitors of PDE5 have been the first-line therapy for erectile dysfunction (ED). The success of sildenafil in the treatment of ED stimulated research in the field of PDE5 inhibition and led to many new applications, such as treatment of lower urinary symptoms, and pulmonary arterial hypertension, which are now approved indications. However, PDE5 inhibitors have also been used in several other disorders not discussed in this review, and the fields of clinical use are increasing. In the present review, the pharmacological basis of the NO/cGMP pathway and the rationale and clinical use of PDE5 inhibitors in different diseases are discussed.
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Affiliation(s)
- K-E Andersson
- Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA.,Institute of Laboratory Medicine, Lund University, 223 62, Lund, Sweden
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221
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Cirulis MM, Ryan JJ. Who’s Who of Pulmonary Hypertension. Circ Genom Precis Med 2018; 11:e002116. [DOI: 10.1161/circgen.118.002116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 03/05/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Meghan M. Cirulis
- Division of Pulmonary Medicine (M.M.C.) and Division of Cardiovascular Medicine (J.J.R.), Department of Medicine, University of Utah, Salt Lake City
| | - John J. Ryan
- Division of Pulmonary Medicine (M.M.C.) and Division of Cardiovascular Medicine (J.J.R.), Department of Medicine, University of Utah, Salt Lake City
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222
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Effect of 6-min Walk Test on pro-BNP Levels in Patients with Pulmonary Arterial Hypertension. Lung 2018; 196:315-319. [PMID: 29564533 DOI: 10.1007/s00408-018-0111-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 03/16/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Plasma pro-BNP (brain natriuretic peptide) levels are often elevated in response to right ventricular (RV) volume and pressure overload, parameters potentially affected by exercise. Plasma pro-BNP levels change in association with long-term changes in pulmonary hemodynamics, thereby serving as a potential biomarker in pulmonary arterial hypertension (PAH). The 6-min Walk Test (6MWT) and pro-BNP level are often checked in a single office visit. There is no universal standard for measuring Pro-BNP levels relative to the timing of the 6MWT. Based on the studies in normal subjects indicating that pro-BNP levels changes after exercise, we hypothesized that the pro-BNP might rise after the 6MWT in PAH patients, potentially impacting clinical decisions. METHODS Patients at our center with WHO Group 1 PAH on active therapy at a stable dose for 30 days or more were enrolled. After resting the patient for 30 min, blood was drawn for baseline pro-BNP and a 6MWT was performed. Pro-BNP levels were drawn immediately after the 6MWT and 1 and 2 h later. Pro-BNP was measured using a commercially available ELISA kit. The levels before exercise and after exercise were compared using student's paired t tests. RESULTS There were 17 females and 3 male subjects. The mean age was 53 ± 11 years. Seven patients had systemic lupus erythematosus-related PAH, six had idiopathic PAH, three had scleroderma, three had portopulmonary hypertension, and one had HIV-related PAH. The mean PA pressure was 50 ± 15 mmHg with a mean pulmonary vascular resistance of 10 ± 4 Wood units. The majority of the patients were on multimodality PAH therapy, including parenteral prostacyclins. Mean 6MWT distance was 377 ± 140 m. In 14/20 patients, the pro-BNP level increased immediately after the 6MWT; in 12/20 patients, the pro-BNP level was elevated at 1 h post exercise. In the majority of the patients, the pro-BNP fell to baseline 2 h post 6MWT. CONCLUSION There appears to be a trend of pro-BNP level increasing immediately after exercise and continuing to be elevated at 1 h. Pro-BNP levels then return to baseline at 2 h post 6MWT.
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223
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Interventional Therapies in Pulmonary Hypertension. ACTA ACUST UNITED AC 2018; 71:565-574. [PMID: 29545075 DOI: 10.1016/j.rec.2018.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 01/13/2018] [Indexed: 01/20/2023]
Abstract
Despite advances in drug therapy, pulmonary hypertension-particularly arterial hypertension (PAH)-remains a fatal disease. Untreatable right heart failure (RHF) from PAH eventually ensues and remains a significant cause of death in these patients. Lowering pulmonary input impedance with different PAH-specific drugs is the obvious therapeutic target in RHF due to chronically increased afterload. However, potential clinical gain can also be expected from attempts to unload the right heart and increase systemic output. Atrial septostomy, Potts anastomosis, and pulmonary artery denervation are interventional procedures serving this purpose. Percutaneous balloon pulmonary angioplasty, another interventional therapy, has re-emerged in the last few years as a clear alternative for the management of patients with distal, inoperable, chronic thromboembolic pulmonary hypertension. The current review discusses the physiological background, experimental evidence, and potential clinical and hemodynamic benefits of all these interventional therapies regarding their use in the setting of RHF due to severe pulmonary hypertension.
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224
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Burbank MG, Sharanek A, Burban A, Mialanne H, Aerts H, Guguen-Guillouzo C, Weaver RJ, Guillouzo A. From the Cover: MechanisticInsights in Cytotoxic and Cholestatic Potential of the Endothelial Receptor Antagonists Using HepaRG Cells. Toxicol Sci 2018; 157:451-464. [PMID: 28369585 DOI: 10.1093/toxsci/kfx062] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Several endothelin receptor antagonists (ERAs) have been developed for the treatment of pulmonary arterial hypertension (PAH). Some of them have been related to clinical cases of hepatocellular injury (sitaxentan [SIT]) and/or cholestasis (bosentan [BOS]). We aimed to determine if ambrisentan (AMB) and macitentan (MAC), in addition to BOS and SIT, could potentially cause liver damage in man by use of human HepaRG cells. Our results showed that like BOS, MAC-induced cytotoxicity and cholestatic disorders characterized by bile canaliculi dilatation and impairment of myosin light chain kinase signaling. Macitentan also strongly inhibited taurocholic acid and carboxy-2',7'-dichlorofluorescein efflux while it had a much lower inhibitory effect on influx activity compared to BOS and SIT. Moreover, these three drugs caused decreased intracellular accumulation and parallel increased levels of total bile acids (BAs) in serum-free culture media. In addition, all drugs except AMB variably deregulated gene expression of BA transporters. In contrast, SIT was hepatotoxic without causing cholestatic damage, likely via the formation of reactive metabolites and AMB was not hepatotoxic. Together, our results show that some ERAs can be hepatotoxic and that the recently marketed MAC, structurally similar to BOS, can also cause cholestatic alterations in HepaRG cells. The absence of currently known or suspected cases of cholestasis in patients suffering from PAH treated with MAC is rationalized by the lower therapeutic doses and Cmax, and longer receptor residence time compared to BOS.
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Affiliation(s)
- Matthew Gibson Burbank
- Inserm UMR 991, Foie, Métabolismes et Cancer, Rennes, France.,Université Rennes 1, Rennes, France.,Biologie Servier, Gidy, France
| | - Ahmad Sharanek
- Inserm UMR 991, Foie, Métabolismes et Cancer, Rennes, France.,Université Rennes 1, Rennes, France
| | - Audrey Burban
- Inserm UMR 991, Foie, Métabolismes et Cancer, Rennes, France.,Université Rennes 1, Rennes, France
| | | | | | | | | | - André Guillouzo
- Inserm UMR 991, Foie, Métabolismes et Cancer, Rennes, France.,Université Rennes 1, Rennes, France
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225
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EP4 Agonist L-902,688 Suppresses EndMT and Attenuates Right Ventricular Cardiac Fibrosis in Experimental Pulmonary Arterial Hypertension. Int J Mol Sci 2018; 19:ijms19030727. [PMID: 29510514 PMCID: PMC5877588 DOI: 10.3390/ijms19030727] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/16/2018] [Accepted: 03/01/2018] [Indexed: 01/06/2023] Open
Abstract
Right ventricular (RV) hypertrophy is characterized by cardiac fibrosis due to endothelial–mesenchymal transition (EndMT) and increased collagen production in pulmonary arterial hypertension (PAH) patients, but the mechanisms for restoring RV function are unclear. Prostanoid agonists are effective vasodilators for PAH treatment that bind selective prostanoid receptors to modulate vascular dilation. The importance of prostanoid signaling in the RV is not clear. We investigated the effects of the EP4-specific agonist L-902,688 on cardiac fibrosis and TGF-β-induced EndMT. EP4-specific agonist treatment reduced right ventricle fibrosis in the monocrotaline (MCT)-induced PAH rat model. L-902,688 (1 µM) attenuated TGF-β-induced Twist and α-smooth muscle actin (α-SMA) expression, but these effects were reversed by AH23848 (an EP4 antagonist), highlighting the crucial role of EP4 in suppressing TGF-β-induced EndMT. These data indicate that the selective EP4 agonist L-902,688 attenuates RV fibrosis and suggest a potential approach to reducing RV fibrosis in patients with PAH.
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226
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Mu YP, Huang QH, Zhu JL, Zheng SY, Yan FR, Zhuang XL, Sham JSK, Lin MJ. Magnesium attenuates endothelin-1-induced vasoreactivity and enhances vasodilatation in mouse pulmonary arteries: Modulation by chronic hypoxic pulmonary hypertension. Exp Physiol 2018; 103:604-616. [PMID: 29363240 DOI: 10.1113/ep086655] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 01/17/2018] [Indexed: 12/28/2022]
Abstract
NEW FINDINGS What is the central question of this study? The central goal of this study was to elucidate the role of magnesium in the regulation of pulmonary vascular reactivity in relationship to hypoxic pulmonary hypertension. What is the main finding and its importance? We found that magnesium is essential for normal vasoreactivity of the pulmonary artery. Increasing the magnesium concentration attenuates vasoconstriction and improves vasodilatation via release of nitric oxide. Pulmonary hypertension is associated with endothelial dysfunction resulting in the suppression of magnesium modulation of vasodilatation. These results provide evidence that magnesium is important for the modulation of pulmonary vascular function. ABSTRACT Pulmonary hypertension (PH) is characterized by enhanced vasoreactivity and sustained pulmonary vasoconstriction, arising from aberrant Ca2+ homeostasis in pulmonary arterial (PA) smooth muscle cells. In addition to Ca2+ , magnesium, the most abundant intracellular divalent cation, also plays crucial roles in many cellular processes that regulate cardiovascular function. Recent findings suggest that magnesium regulates vascular functions by altering the vascular responses to vasodilator and vasoactive agonists and affects endothelial function by modulating endothelium-dependent vasodilatation in hypertension. Administration of magnesium also decreased pulmonary arterial pressure and improved cardiac output in animal models of PH. However, the role of magnesium in the regulation of pulmonary vascular function related to PH has not been studied. In this study, we examined the effects of magnesium on endothelin-1 (ET-1)-induced vasoconstriction, ACh-induced vasodilatation and the generation of NO in PAs of normoxic mice and chronic hypoxia (CH)-treated mice. Our data showed that removal of extracellular magnesium suppressed vasoreactivity of PAs to both ET-1 and ACh. A high concentration of magnesium (4.8 mm) inhibited ET-1-induced vasoconstriction in endothelium-intact or endothelium-disrupted PAs of normoxic and CH-treated mice, and enhanced the ACh-induced production of NO in PAs of normoxic mice. Moreover, magnesium enhanced ACh-induced vasodilatation in PAs of normoxic mice, and the enhancement was completely abolished after exposure to CH. Hence, in this study we demonstrated that increasing the magnesium concentration can attenuate the ET-1-induced contractile response and improve vasodilatation via release of NO from the endothelium. We also demonstrated that chronic exposure to hypoxia can cause endothelial dysfunction resulting in suppression of the magnesium-dependent modulation of vasodilatation.
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Affiliation(s)
- Yun-Ping Mu
- The Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, Fujian Medical University, Fuzhou, Fujian, PR China.,Department of Physiology & Pathophysiology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian, PR China
| | - Qiu-Hong Huang
- The Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, Fujian Medical University, Fuzhou, Fujian, PR China.,Department of Physiology & Pathophysiology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian, PR China
| | - Jie-Ling Zhu
- The Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, Fujian Medical University, Fuzhou, Fujian, PR China.,Department of Physiology & Pathophysiology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian, PR China
| | - Si-Yi Zheng
- The Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, Fujian Medical University, Fuzhou, Fujian, PR China.,Department of Physiology & Pathophysiology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian, PR China
| | - Fu-Rong Yan
- The Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, Fujian Medical University, Fuzhou, Fujian, PR China.,Department of Physiology & Pathophysiology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian, PR China
| | - Xiao-Ling Zhuang
- The Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, Fujian Medical University, Fuzhou, Fujian, PR China.,Department of Physiology & Pathophysiology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian, PR China
| | - James S K Sham
- The Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, Fujian Medical University, Fuzhou, Fujian, PR China.,Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mo-Jun Lin
- The Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, Fujian Medical University, Fuzhou, Fujian, PR China.,Department of Physiology & Pathophysiology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian, PR China
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Bhat L, Hawkinson J, Cantillon M, Reddy DG, Bhat SR, Laurent CE, Bouchard A, Biernat M, Salvail D. Evaluation of the effects of RP5063, a novel, multimodal, serotonin receptor modulator, as single-agent therapy and co-administrated with sildenafil, bosentan, and treprostinil in a monocrotaline-induced pulmonary arterial hypertension rat model. Eur J Pharmacol 2018; 827:159-166. [PMID: 29453947 DOI: 10.1016/j.ejphar.2018.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/08/2018] [Accepted: 02/09/2018] [Indexed: 12/18/2022]
Abstract
Pulmonary arterial hypertension (PAH), a condition that is defined by pulmonary vasculature constriction and remodeling, involves dysfunctional signaling of the serotonin (5-HT) receptors, 5-HT2A/2B/7. In a rat model of monocrotaline (MCT)-induced PAH, the effectiveness of RP5063 (RP), a dopamine and 5-HT receptor modulator, was evaluated as monotherapy and as an adjunct to standard PAH treatments. After a single 60 mg/kg dose of MCT, rats received vehicle (MCT+Veh; gavage twice-daily [b.i.d.]), RP (10 mg/kg; gavage b.i.d.), bosentan (B; 100 mg/kg; gavage BID), sildenafil (S; 50 mg/kg; gavage, BID), treprostinil (T; 100 ng/kg/min over 24 h intravenous), RP+B, RP+S, and RP+T for 28 days. Single-agent RP limited the functional and structural effects of PAH seen in the MCT+Veh group, with significant improvements in pulmonary hemodynamics, right ventricular (RV) hypertrophy, SO2, and pulmonary blood vessel structural changes. These effects appeared comparable with those associated with B, S, and T. Adjunctive RP treatment resulted in significantly lower mean pulmonary arterial pressures, RV systolic pressure. It also improved SO2 measurements, as compared with MCT+Veh (P < 0.05), and diastolic pulmonary artery pressure (P < 0.05), as compared with single-agent B and S therapy (Bonferroni method adjusting for multiplicity). RP+S appeared to show the most consistent and extensive effects on pulmonary hemodynamics, respiratory parameters, and histopathologic changes. These results corroborate earlier preclinical findings supporting the efficacy of single-agent RP in PAH. RP, as mono and adjunctive therapy compared with induced-control, mitigated the functional and structural effects of MCT-induced PAH.
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Affiliation(s)
| | - Jon Hawkinson
- Institute for Therapeutics Discovery & Development and Department of Medicinal Chemistry, University of Minnesota, Minnesota, MN, USA
| | | | | | - Seema R Bhat
- Reviva Pharmaceuticals, Inc., Sunnyvale, CA, USA
| | | | | | | | - Dany Salvail
- IPS Therapeutique Inc., Sherbrooke, Quebec, Canada
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228
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RV Fractional Area Change and TAPSE as Predictors of Severe Right Ventricular Dysfunction in Pulmonary Hypertension: A CMR Study. Lung 2018; 196:157-164. [DOI: 10.1007/s00408-018-0089-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 01/15/2018] [Indexed: 10/18/2022]
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229
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Pulido T, Zayas N, de Mendieta MA, Plascencia K, Escobar J. Medical therapies for pulmonary arterial hypertension. Heart Fail Rev 2018; 21:273-83. [PMID: 26791159 DOI: 10.1007/s10741-016-9527-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Pulmonary Arterial hypertension (PAH) is a chronic and progressive disease characterized by an increase in pulmonary vascular resistance due to severe remodeling of the small pulmonary arteries. In PAH, the endothelial cells fail to maintain their homeostatic balance, with the consequent impaired production of vasodilators and over-expression of vasoconstrictors and proliferators. Current treatment of PAH is based on the discovery of three main pathways of endothelial dysfunction (prostacyclin, nitric oxide and endothelin-1), and includes drugs such as prostacyclin analogs, phosphodiesterase-5 inhibitors and endothelin receptor antagonists (ERAs). Recently approved drugs that act through these classic pathways include riociguat (cyclic GMP stimulator) and macitentan (a tissue specific dual ERA). However, several new drugs and new pathways are under study. New targeted therapies include tyrosine kinase inhibitors, Rho kinase inhibitors and serotonin receptor blockers. There are now ten drugs approved for the treatment of PAH that, alone or in combination, have changed the natural history of this disease. The new drugs will allow us to further modified the patients' life expectancy and move towards a cure.
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Affiliation(s)
- Tomas Pulido
- Cardiopulmonary Department, Ignacio Chavez National Heart Institute, 1 Juan Badiano, 4th Floor, 14080, Mexico City, Mexico.
| | - Nayeli Zayas
- Cardiopulmonary Department, Ignacio Chavez National Heart Institute, 1 Juan Badiano, 4th Floor, 14080, Mexico City, Mexico
| | - Maitane Alonso de Mendieta
- Cardiopulmonary Department, Ignacio Chavez National Heart Institute, 1 Juan Badiano, 4th Floor, 14080, Mexico City, Mexico
| | - Karen Plascencia
- Cardiopulmonary Department, Ignacio Chavez National Heart Institute, 1 Juan Badiano, 4th Floor, 14080, Mexico City, Mexico
| | - Jennifer Escobar
- Cardiopulmonary Department, Ignacio Chavez National Heart Institute, 1 Juan Badiano, 4th Floor, 14080, Mexico City, Mexico
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230
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La maladie veino-occlusive pulmonaire. Rev Mal Respir 2018; 35:160-170. [DOI: 10.1016/j.rmr.2017.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 01/29/2017] [Indexed: 11/18/2022]
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231
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Chen TX, Pudasaini B, Guo J, Gong SG, Jiang R, Wang L, Zhao QH, Wu WH, Yuan P, Liu JM. Sex-specific cardiopulmonary exercise testing indices to estimate the severity of inoperable chronic thromboembolic pulmonary hypertension. Int J Chron Obstruct Pulmon Dis 2018; 13:385-397. [PMID: 29416329 PMCID: PMC5790096 DOI: 10.2147/copd.s152971] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background Sex differences in chronic thromboembolic pulmonary hypertension (CTEPH) have been revealed in few studies. Although right heart catheterization (RHC) is the gold standard for clinical diagnosis and assessment of prognosis in pulmonary hypertension (PH), cardiopulmonary exercise testing (CPET) has been a more widely used assessment of functional capacity, disease severity, prognosis, and treatment response in PH. We hypothesized that the “sex-specific” CPET indices could estimate the severity of inoperable CTEPH. Methods Data were retrieved for 33 male (age, mean ± standard deviation [SD] =62.5±13.4 years) and 40 female (age, mean ± SD =56.3±11.8 years) patients with stable CTEPH who underwent both RHC and CPET at Shanghai Pulmonary Hospital from February 2010 to February 2016. Univariate and forward/backward multiple stepwise regression analysis was performed to assess the predictive value of CPET indices to hemodynamic parameters. Event-free survival was estimated using the Kaplan–Meier method and analyzed with the log-rank test. Cox proportional hazards models were performed to determine the independent event-free survival predictors. Results Numerous CPET parameters were different between male and female patients with CTEPH and the control group. There were no significant differences in both clinical variables and RHC parameters between male and female patients with CTEPH. O2 pulse, workload, minute ventilation (VE), and end-tidal partial pressure of O2 (PETO2) at anaerobic threshold, as well as peak O2 pulse, workload, VE, and nadir VE/CO2 were significantly higher in male patients than in female patients (P<0.05). Only oxygen uptake efficiency plateau (OUEP) showed a significantly higher difference in female than male patients (P<0.05). In addition, several CPET indices correlated with hemodynamic parameters, especially pulmonary vascular resistance (PVR), which was distinctly different between the sexes. Nadir VE/CO2 was an independent predictor of PVR in male patients with CTEPH, whereas OUEP was an independent predictor of PVR in female patients with CTEPH. Conclusion Even after confounding for age and body mass index, different CPET measurements of gas exchange efficiency correlated with PVR differently between male and female patients. This potentially could be used to estimate the severity of CTEPH.
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Affiliation(s)
- Tian-Xiang Chen
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University, Shanghai, People's Republic of China
| | - Bigyan Pudasaini
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University, Shanghai, People's Republic of China
| | - Jian Guo
- Department of Pulmonary Function Test, Shanghai Pulmonary Hospital, Tongji University, Shanghai, People's Republic of China
| | - Su-Gang Gong
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University, Shanghai, People's Republic of China
| | - Rong Jiang
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University, Shanghai, People's Republic of China
| | - Lan Wang
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University, Shanghai, People's Republic of China
| | - Qin-Hua Zhao
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University, Shanghai, People's Republic of China
| | - Wen-Hui Wu
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University, Shanghai, People's Republic of China
| | - Ping Yuan
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University, Shanghai, People's Republic of China
| | - Jin-Ming Liu
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University, Shanghai, People's Republic of China
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232
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Marshall JD, Bazan I, Zhang Y, Fares WH, Lee PJ. Mitochondrial dysfunction and pulmonary hypertension: cause, effect, or both. Am J Physiol Lung Cell Mol Physiol 2018; 314:L782-L796. [PMID: 29345195 DOI: 10.1152/ajplung.00331.2017] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Pulmonary hypertension describes a heterogeneous disease defined by increased pulmonary artery pressures, and progressive increase in pulmonary vascular resistance due to pathologic remodeling of the pulmonary vasculature involving pulmonary endothelial cells, pericytes, and smooth muscle cells. This process occurs under various conditions, and although these populations vary, the clinical manifestations are the same: progressive dyspnea, increases in right ventricular (RV) afterload and dysfunction, RV-pulmonary artery uncoupling, and right-sided heart failure with systemic circulatory collapse. The overall estimated 5-yr survival rate is 72% in highly functioning patients, and as low as 28% for those presenting with advanced symptoms. Metabolic theories have been suggested as underlying the pathogenesis of pulmonary hypertension with growing evidence of the role of mitochondrial dysfunction involving the major proteins of the electron transport chain, redox-related enzymes, regulators of the proton gradient and calcium homeostasis, regulators of apoptosis, and mitophagy. There remain more studies needed to characterize mitochondrial dysfunction leading to impaired vascular relaxation, increase proliferation, and failure of regulatory mechanisms. The effects on endothelial cells and resulting interactions with their microenvironment remain uncharted territory for future discovery. Additionally, on the basis of observations that the "plexigenic lesions" of pulmonary hypertension resemble the unregulated proliferation of tumor cells, similarities between cancer pathobiology and pulmonary hypertension have been drawn, suggesting interactions between mitochondria and angiogenesis. Recently, mitochondria targeting has become feasible, which may yield new therapeutic strategies. We present a state-of-the-art review of the role of mitochondria in both the pathobiology of pulmonary hypertension and potential therapeutic targets in pulmonary vascular processes.
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Affiliation(s)
- Jeffrey D Marshall
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine , New Haven, Connecticut
| | - Isabel Bazan
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine , New Haven, Connecticut
| | - Yi Zhang
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine , New Haven, Connecticut
| | - Wassim H Fares
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine , New Haven, Connecticut
| | - Patty J Lee
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine , New Haven, Connecticut
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233
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The Minimal Important Difference in Borg Dyspnea Score in Pulmonary Arterial Hypertension. Ann Am Thorac Soc 2018; 13:842-9. [PMID: 26974862 DOI: 10.1513/annalsats.201512-824oc] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Despite therapeutic advances, pulmonary arterial hypertension remains a disease without a cure. Focusing on symptoms, such as dyspnea, is an important part of assessing response to therapy. OBJECTIVES To determine the minimal important differences for the Borg dyspnea score and the Borg fatigue score in adult patients undergoing initial therapy for pulmonary arterial hypertension. METHODS We studied 129 patients enrolled between 2003 and 2013 in the Pulmonary Arterial Hypertension Program registry at Johns Hopkins University Hospital in Baltimore, Maryland. We analyzed baseline demographics, clinical characteristics, 6-minute-walk test distance, and Borg dyspnea and fatigue scores at baseline and at follow up 3 months after initiation of pulmonary arterial hypertension therapy. The minimal important differences for the Borg dyspnea and fatigue scores were determined using distributional and anchor-based methods, using 6-minute-walk test distance as the anchor. MEASUREMENTS AND MAIN RESULTS Most subjects were in New York Heart Association functional class II or III and had moderate to severe pulmonary arterial hypertension. The baseline Borg dyspnea score was 3.4 ± 1.9 units; the baseline Borg fatigue score was 2.8 ± 2.2 units. After therapy, the average change in the dyspnea score was -0.16 ± 1.9 units and the average change in the fatigue score was -0.21 ± 2.4 units. Using distributional methods, the minimum important difference for Borg dyspnea score ranged from 0.7 to 1.24 units and for Borg fatigue score ranged from 0.73 to 1.39 units. Using anchor-based methods, the minimum important difference for the Borg dyspnea scales was 0.36; this could not be calculated for the Borg fatigue score. CONCLUSIONS Using distributional and anchor-based methods, we estimate the minimum important difference for Borg dyspnea scale in pulmonary arterial hypertension is approximately 0.9 units. Using distributional methods only, we estimate the minimum important difference for the Borg fatigue scale is around 1 unit. Further studies are needed to determine the clinical utility of these scores in patients with pulmonary arterial hypertension.
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234
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Abstract
Pulmonary hypertension is a rapidly progressive, life-threatening, and often fatal disease. Despite many new developments in pulmonary arterial hypertension (PAH) therapy, there is currently no cure for PAH, and new therapies are desperately needed. PAH pathobiology involves a remodeling process in pulmonary arteries that plays a critical role in elevating pulmonary arterial and right ventricle pressures. The discovery and development of new therapies requires animal models of PAH that mimic the human disease, including vascular remodeling.Here we review and describe a detailed protocol for creating an in vivo model of Sugen/Hypoxia-induced PAH in mice that is commonly used to assess the efficiency of new therapies in PAH. Severe pulmonary hypertension can be established in 1 month using this protocol. Additional protocols to evaluate the model by invasive pressure measurements and histology are provided.
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235
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Ried M, Neu R, Lehle K, Großer C, Szöke T, Lang G, Hofmann HS, Hoenicka M. Superior vasodilation of human pulmonary vessels by vardenafil compared with tadalafil and sildenafil: additive effects of bosentan. Interact Cardiovasc Thorac Surg 2017; 25:254-259. [PMID: 28486684 DOI: 10.1093/icvts/ivx108] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/06/2017] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES Pulmonary arterial hypertension is characterized by pulmonary vascular proliferation and remodelling, leading to a progressive increase in pulmonary arterial resistance. Vasodilator properties of 3 different phosphodiesterase (PDE)-5 inhibitors alone and in combination with an endothelin (ET) receptor antagonist were compared in an ex vivo model. METHODS Segments of human pulmonary arteries (PAs) and pulmonary veins (PVs) were harvested from lobectomy specimens. Contractile forces were determined in an organ bath. Vessels were constricted with norepinephrine (NE) to determine the effects of sildenafil, tadalafil and vardenafil and with ET-1 to assess the effects of bosentan. RESULTS All 3 PDE-5 inhibitors had no relevant effect on the basal tone of the vessels. Both sildenafil and vardenafil significantly (P < 0.0001) reduced the responses of the vessels to NE, whereas tadalafil was effective only in PA (P = 0.0009) but not in PV (P = 0.097). Sildenafil relaxed NE-preconstricted PV (P < 0.0001) but not PA (P = 0.143). Both tadalafil and vardenafil relaxed PA and PV significantly. Vardenafil appears to be the most potent of the PDE-5 inhibitors tested. Furthermore, we analysed the combination of bosentan and vardenafil in PA. Bosentan and vardenafil reduced ET-1 and NE induced vasoconstriction stronger than vardenafil alone (P ≤ 0.049). CONCLUSIONS Vardenafil caused the most consistent antihypertensive response in this ex vivo model. However, ET receptor antagonism appears to be an even more potent mechanism. A combination therapy using vardenafil and bosentan turned out to be an effective combination to lower vessel tension in PA.
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Affiliation(s)
- Michael Ried
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Reiner Neu
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Karla Lehle
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Christian Großer
- Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Tamas Szöke
- Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Gunter Lang
- Department of Cardiothoracic and Vascular Surgery, University of Ulm Medical Center, Ulm, Germany
| | - Hans-Stefan Hofmann
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany.,Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Markus Hoenicka
- Department of Cardiothoracic and Vascular Surgery, University of Ulm Medical Center, Ulm, Germany
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Kumei S, Yuhki KI, Kojima F, Kashiwagi H, Imamichi Y, Okumura T, Narumiya S, Ushikubi F. Prostaglandin I 2 suppresses the development of diet-induced nonalcoholic steatohepatitis in mice. FASEB J 2017; 32:2354-2365. [PMID: 29247122 DOI: 10.1096/fj.201700590r] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Nonalcoholic steatohepatitis (NASH) is a hepatic manifestation of metabolic syndrome. Although the prostaglandin (PG)I2 receptor IP is expressed broadly in the liver, the role of PGI2-IP signaling in the development of NASH remains to be determined. Here, we investigated the role of the PGI2-IP system in the development of steatohepatitis using mice lacking the PGI2 receptor IP [IP-knockout (IP-KO) mice] and beraprost (BPS), a specific IP agonist. IP-KO and wild-type (WT) mice were fed a methionine- and choline-deficient diet (MCDD) for 2, 5, or 10 wk. BPS was administered orally to mice every day during the experimental periods. The effect of BPS on the expression of chemokine and inflammatory cytokines was examined also in cultured Kupffer cells. WT mice fed MCDD developed steatohepatitis at 10 wk. IP-KO mice developed steatohepatitis at 5 wk with augmented histologic derangements accompanied by increased hepatic monocyte chemoattractant protein-1 (MCP-1) and TNF-α concentrations. After 10 wk of MCDD, IP-KO mice had greater hepatic iron deposition with prominent oxidative stress, resulting in hepatocyte damage. In WT mice, BPS improved histologic and biochemical parameters of steatohepatitis, accompanied by reduced hepatic concentration of MCP-1 and TNF-α. Accordingly, BPS suppressed the LPS-stimulated Mcp-1 and Tnf-α mRNA expression in cultured Kupffer cells prepared from WT mice. PGI2-IP signaling plays a crucial role in the development and progression of steatohepatitis by modulating the inflammatory response, leading to augmented oxidative stress. We suggest that the PGI2-IP system is an attractive therapeutic target for treating patients with NASH.-Kumei, S., Yuhki, K.-I., Kojima, F., Kashiwagi, H., Imamichi, Y., Okumura, T., Narumiya, S., Ushikubi, F. Prostaglandin I2 suppresses the development of diet-induced nonalcoholic steatohepatitis in mice.
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Affiliation(s)
- Shima Kumei
- Department of Pharmacology, Asahikawa Medical University, Asahikawa, Japan.,Department of General Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Koh-Ichi Yuhki
- Department of Pharmacology, Asahikawa Medical University, Asahikawa, Japan
| | - Fumiaki Kojima
- Department of Pharmacology, Asahikawa Medical University, Asahikawa, Japan
| | - Hitoshi Kashiwagi
- Department of Pharmacology, Asahikawa Medical University, Asahikawa, Japan
| | - Yoshitaka Imamichi
- Department of Pharmacology, Asahikawa Medical University, Asahikawa, Japan
| | - Toshikatsu Okumura
- Department of General Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Shuh Narumiya
- Department of Pharmacology, Kyoto University Faculty of Medicine, Kyoto, Japan
| | - Fumitaka Ushikubi
- Department of Pharmacology, Asahikawa Medical University, Asahikawa, Japan
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237
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Bonnet S, Provencher S, Guignabert C, Perros F, Boucherat O, Schermuly RT, Hassoun PM, Rabinovitch M, Nicolls MR, Humbert M. Translating Research into Improved Patient Care in Pulmonary Arterial Hypertension. Am J Respir Crit Care Med 2017; 195:583-595. [PMID: 27649290 PMCID: PMC5440916 DOI: 10.1164/rccm.201607-1515pp] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Sébastien Bonnet
- 1 Pulmonary Hypertension Research Group, Centre de Recherche de l'Institut de Cardiologie et de Pneumologie de Québec, Quebec City, Quebec, Canada.,2 Department of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Steeve Provencher
- 1 Pulmonary Hypertension Research Group, Centre de Recherche de l'Institut de Cardiologie et de Pneumologie de Québec, Quebec City, Quebec, Canada.,2 Department of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Christophe Guignabert
- 3 INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, Paris, France.,4 Université Paris-Sud and Université Paris-Saclay, Kremlin-Bicêtre, Paris, France
| | - Frédéric Perros
- 3 INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, Paris, France.,4 Université Paris-Sud and Université Paris-Saclay, Kremlin-Bicêtre, Paris, France
| | - Olivier Boucherat
- 1 Pulmonary Hypertension Research Group, Centre de Recherche de l'Institut de Cardiologie et de Pneumologie de Québec, Quebec City, Quebec, Canada
| | - Ralph Theo Schermuly
- 5 Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Justus Liebig University Giessen, Giessen, Germany
| | - Paul M Hassoun
- 6 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Mark R Nicolls
- 8 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California.,9 VA Palo Alto Health Care System, Palo Alto, California; and
| | - Marc Humbert
- 3 INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, Paris, France.,4 Université Paris-Sud and Université Paris-Saclay, Kremlin-Bicêtre, Paris, France.,10 Assistance Publique-Hôpitaux de Paris, Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, Département Hospitalo-Universitaire Thorax Innovation, Hôpital de Bicêtre, Paris, France
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238
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Xie X, Li S, Zhu Y, Liu L, Ke R, Wang J, Yan X, Yang L, Gao L, Zang W, Li M. Egr-1 mediates leptin-induced PPARγ reduction and proliferation of pulmonary artery smooth muscle cells. Mol Biol Cell 2017; 29:356-362. [PMID: 29212876 PMCID: PMC5996952 DOI: 10.1091/mbc.e17-03-0141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 11/08/2017] [Accepted: 11/27/2017] [Indexed: 01/14/2023] Open
Abstract
Loss of peroxisome proliferator-activated receptor γ (PPARγ) has been found to contribute to pulmonary artery smooth muscle cell (PASMC) proliferation and pulmonary arterial remodeling therefore the development of pulmonary hypertension (PH). Yet, the molecular mechanisms underlying PPARγ reduction in PASMC remain poorly understood. Here, we demonstrated that leptin dose- and time-dependently inducued PPARγ down-regulation and proliferation of primary cultured rat PASMC, this was accompanied with the activation of extracellular regulated kinase1/2 (ERK1/2) signaling pathway and subsequent induction of early growth response-1 (Egr-1) expression. The presence of MEK inhibitors U0126 or PD98059, or prior silencing Egr-1 with small interfering RNA suppressed leptin-induced PPARγ reduction. In addition, activation of PPARγ by pioglitazone or targeting ERK1/2/Egr-1 suppressed leptin-induced PASMC proliferation. Taken together, our study indicates that ERK1/2 signaling pathway-mediated leptin-induced PPARγ reduction and PASMC proliferation through up-regulation of Egr-1 and suggests that targeting leptin/ERK1/2/Egr-1 pathway might have potential value in ameliorating vascular remodeling and benefit PH.
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Affiliation(s)
- Xinming Xie
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Shaojun Li
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Yanting Zhu
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Lu Liu
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Rui Ke
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Jian Wang
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Xin Yan
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Lan Yang
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Li Gao
- Division of Allergy and Clinical Immunology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21224
| | - Weijin Zang
- Department of Pharmacology, School of Basic Medical Sciences, Xian Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, China
| | - Manxiang Li
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
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239
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Sysol JR, Chen J, Singla S, Zhao S, Comhair S, Natarajan V, Machado RF. Micro-RNA-1 is decreased by hypoxia and contributes to the development of pulmonary vascular remodeling via regulation of sphingosine kinase 1. Am J Physiol Lung Cell Mol Physiol 2017; 314:L461-L472. [PMID: 29167124 DOI: 10.1152/ajplung.00057.2017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Sphingosine kinase 1 (SphK1) upregulation is associated with pathologic pulmonary vascular remodeling in pulmonary arterial hypertension (PAH), but the mechanisms controlling its expression are undefined. In this study, we sought to characterize the regulation of SphK1 expression by micro-RNAs (miRs). In silico analysis of the SphK1 3'-untranslated region identified several putative miR binding sites, with miR-1-3p (miR-1) being the most highly predicted target. Therefore we further investigated the role of miR-1 in modulating SphK1 expression and characterized its effects on the phenotype of pulmonary artery smooth muscle cells (PASMCs) and the development of experimental pulmonary hypertension in vivo. Our results demonstrate that miR-1 is downregulated by hypoxia in PASMCs and can directly inhibit SphK1 expression. Overexpression of miR-1 in human PASMCs inhibits basal and hypoxia-induced proliferation and migration. Human PASMCs isolated from PAH patients exhibit reduced miR-1 expression. We also demonstrate that miR-1 is downregulated in mouse lung tissues during experimental hypoxia-mediated pulmonary hypertension (HPH), consistent with upregulation of SphK1. Furthermore, administration of miR-1 mimics in vivo prevented the development of HPH in mice and attenuated induction of SphK1 in PASMCs. These data reveal the importance of miR-1 in regulating SphK1 expression during hypoxia in PASMCs. A pivotal role is played by miR-1 in pulmonary vascular remodeling, including PASMC proliferation and migration, and its overexpression protects from the development of HPH in vivo. These studies improve our understanding of the molecular mechanisms underlying the pathogenesis of pulmonary hypertension.
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Affiliation(s)
- Justin R Sysol
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago , Chicago, Illinois.,Department of Pharmacology, University of Illinois at Chicago , Chicago, Illinois.,Medical Scientist Training Program, University of Illinois at Chicago , Chicago, Illinois
| | - Jiwang Chen
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago , Chicago, Illinois
| | - Sunit Singla
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago , Chicago, Illinois
| | - Shuangping Zhao
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago , Chicago, Illinois
| | | | - Viswanathan Natarajan
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago , Chicago, Illinois.,Department of Pharmacology, University of Illinois at Chicago , Chicago, Illinois
| | - Roberto F Machado
- Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Indiana University , Indianapolis, Indiana
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Savale L, Weatherald J, Jaïs X, Vuillard C, Boucly A, Jevnikar M, Montani D, Mercier O, Simonneau G, Fadel E, Sitbon O, Humbert M. Acute decompensated pulmonary hypertension. Eur Respir Rev 2017; 26:26/146/170092. [PMID: 29141964 PMCID: PMC9488744 DOI: 10.1183/16000617.0092-2017] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 09/17/2017] [Indexed: 12/02/2022] Open
Abstract
Acute right heart failure in chronic precapillary pulmonary hypertension is characterised by a rapidly progressive syndrome with systemic congestion resulting from impaired right ventricular filling and/or reduced right ventricular flow output. This clinical picture results from an imbalance between the afterload imposed on the right ventricle and its adaptation capacity. Acute decompensated pulmonary hypertension is associated with a very poor prognosis in the short term. Despite its major impact on survival, its optimal management remains very challenging for specialised centres, without specific recommendations. Identification of trigger factors, optimisation of fluid volume and pharmacological support to improve right ventricular function and perfusion pressure are the main therapeutic areas to consider in order to improve clinical condition. At the same time, specific management of pulmonary hypertension according to the aetiology is mandatory to reduce right ventricular afterload. Over the past decade, the development of extracorporeal life support in refractory right heart failure combined with urgent transplantation has probably contributed to a significant improvement in survival for selected patients. However, there remains a considerable need for further research in this field. Acute decompensated PH is a life-threatening condition requiring specific management in a specialised centrehttp://ow.ly/non530fkhmA
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241
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Grady D, Weiss M, Hernandez-Sanchez J, Pepke-Zaba J. Medication and patient factors associated with adherence to pulmonary hypertension targeted therapies. Pulm Circ 2017; 8:2045893217743616. [PMID: 29099657 PMCID: PMC5731720 DOI: 10.1177/2045893217743616] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The aims of this study were to investigate the medication adherence of patients on pulmonary hypertension (PH)-targeted therapies and uncover factors that might influence adherence values. Patients taking at least one specialist medicine (sildenafil, tadalafil, bosentan, ambrisentan, iloprost, epoprostenol, treprostinil) completed a Morisky Medication Adherence Scale-8 (MMAS-8) questionnaire. Participants' MMAS-8 scores were used to estimate overall medicine adherence. Potential adherence co-factor data were collected from patient databases and hospital discharge summaries. The MMAS-8 questionnaire was completed by 263 patients (mean age = 61.6 ± 14.8 years, 70.6% women). Data from MMAS-8 showed that 47.9% reported high adherence, 40.3% moderate adherence, and 11.8% low adherence. Factors associated with adherence as measured by the MMAS-8 included: older age; taking monotherapy; and having a higher number of co-morbidities or concurrent medicines. Higher administration frequency, greater length of time on targeted therapy, and use of a compliance aid had a negative association with adherence. Overall adherence to PH specialist medicines is relatively high but a proportion of patients report sub-optimal adherence behavior. A number of factors may help to recognize susceptible patients.
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Affiliation(s)
- Duncan Grady
- 1 2144 Pharmacy Department, Papworth Hospital NHS Foundation Trust , Papworth Everard, UK
| | - Marjorie Weiss
- 2 2112 Department of Pharmacy and Pharmacology, University of Bath , Bath, UK
| | - Jules Hernandez-Sanchez
- 3 2144 Papworth Trials Unit Collaboration, Papworth Hospital NHS Foundation Trust , Papworth Everard, UK
| | - Joanna Pepke-Zaba
- 4 2144 Pulmonary Vascular Disease Unit, Papworth Hospital NHS Foundation Trust , Papworth Everard, UK
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242
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Benza RL, Raina A, Gupta H, Murali S, Burden A, Zastrow MS, Park MH, Simon MA. Bosentan-based, treat-to-target therapy in patients with pulmonary arterial hypertension: results from the COMPASS-3 study. Pulm Circ 2017; 8:2045893217741480. [PMID: 29064349 PMCID: PMC5798685 DOI: 10.1177/2045893217741480] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The phase 4 COMPASS-3 study evaluated whether a singular endpoint produces clinically meaningful outcomes in patients with pulmonary arterial hypertension (PAH). The relationship between cardiac magnetic resonance imaging (cMRI)-derived parameters and right heart catheterization (RHC) measurements was also examined. In COMPASS-3 (ClinicalTrials.gov NCT00433329), 100 patients with PAH received bosentan monotherapy for 16 weeks. Patients continued monotherapy if their 6-min walk distance (6MWD) was ≥380 m, or otherwise received add-on sildenafil for an additional 12 weeks. 6MWD, RHC, and cMRI were performed at baseline, week 16, and week 28 (6MWD and cMRI). Baseline median 6MWD was 274 m and 82% of patients had WHO Functional Class III/IV. At week 16, 17% (n = 16) of remaining patients achieved the 6MWD threshold and 78 (83%) did not. In the intention-to-treat population, median 6MWD increased significantly relative to baseline (week 16 = 308 m; week 28 = 327 m; P < 0.001). At week 28, 9/16 (monotherapy) and 15/76 (20%; add-on sildenafil) patients met the target threshold. Baseline cMRI-derived and RHC-derived parameters showed moderate-to-strong correlations (e.g. right to left ventricular end-diastolic ratio [RVEDV:LVEDV] correlated strongly with pulmonary vascular resistance [r = +0.729, P < 0.0001]). cMRI-derived parameters predicted clinical worsening/decline (e.g. week 16 RVEDV:LVDEV [P = 0.0172]). Time to clinical worsening/decline did not differ between patients based on 6MWD threshold achievement. No unexpected safety events were reported. A substantial proportion of patients failed to achieve the goal of 380 m, regardless of treatment. Several cMRI parameters predicted clinical worsening/decline and its non-invasive nature further supports its use in future clinical trials.
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Affiliation(s)
| | - Amresh Raina
- 1 6618 Allegheny General Hospital, Pittsburgh, PA, USA
| | - Himanshu Gupta
- 2 University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Annie Burden
- 3 Statistical Consultancy, Quanticate, Hitchin, Hertfordshire, UK
| | - Michael S Zastrow
- 4 17430 Former employee of Actelion Pharmaceuticals US, South San Francisco, CA, USA
| | - Myung H Park
- 5 23534 Houston Methodist Hospital, Houston, TX, USA
| | - Marc A Simon
- 6 University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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243
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Preston IR, Channick RN, Chin K, Di Scala L, Farber HW, Gaine S, Galiè N, Ghofrani HA, Hoeper MM, Lang IM, McLaughlin VV, Preiss R, Simonneau G, Sitbon O, Tapson VF, Rubin LJ. Temporary treatment interruptions with oral selexipag in pulmonary arterial hypertension: Insights from the Prostacyclin (PGI 2) Receptor Agonist in Pulmonary Arterial Hypertension (GRIPHON) study. J Heart Lung Transplant 2017; 37:401-408. [PMID: 29096938 DOI: 10.1016/j.healun.2017.09.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 09/22/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Parenteral prostacyclin analogs that target the prostacyclin pathway have been used to treat pulmonary arterial hypertension (PAH) since the 1990s. Abrupt discontinuation of parenteral prostacyclin analogs can be associated with acute deterioration of PAH. Less is known about temporary interruption of oral therapies that target the prostacyclin pathway, such as selexipag. METHODS We evaluated the frequency, duration, reasons, and consequences of temporary selexipag interruptions among PAH patients enrolled in the Prostacyclin (PGI2) Receptor Agonist in Pulmonary Arterial Hypertension (GRIPHON) study. In GRIPHON, patients were randomized to selexipag or placebo and titrated to an individualized highest tolerated dose (200 to 1,600 µg twice daily) over 12 weeks, after which patients entered the maintenance phase. Treatment interruptions were allowed; if the interruption was < 3 days, treatment was restarted at the previous highest tolerated dose; if the interruption was ≥ 3 days, retitration from 200 µg twice daily was required. Descriptive analyses were performed. RESULTS At least 1 treatment interruption occurred in 111 of 574 patients (19.3%) in the selexipag group and in 58 of 582 (10.0%) in the placebo group. Baseline characteristics were similar between patients with and without an interruption. Of the 111 patients in whom selexipag was temporarily interrupted, 94 (85%) were receiving background PAH therapy. Adverse events were the most common reason for selexipag interruption. Selexipag interruptions and reinstitution of treatment were well tolerated. There were no episodes of acute deterioration during treatment interruption. CONCLUSIONS Based on observations from GRIPHON, selexipag interruptions can be expected in clinical practice. However, temporarily interrupting selexipag was well tolerated and manageable.
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Affiliation(s)
- Ioana R Preston
- Pulmonary, Critical Care, and Sleep Division, Tufts Medical Center, Boston, Massachusetts.
| | - Richard N Channick
- Pulmonary and Critical Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Kelly Chin
- Pulmonary and Critical Care Division, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Harrison W Farber
- The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
| | - Sean Gaine
- National Pulmonary Hypertension Unit, Mater Misericordiae Hospital, Dublin, Ireland
| | - Nazzareno Galiè
- Department of Experimental, Diagnostic and Specialty Medicine, Bologna University Hospital, Bologna, Italy
| | - Hossein-Ardeschir Ghofrani
- Department of Internal Medicine, University of Giessen and Marburg Lung Center, Giessen, Germany, member of the German Center of Lung Research, Giessen, Germany; Department of Medicine, Imperial College London, London, United Kingdom
| | - Marius M Hoeper
- Department of Respiratory Medicine, Hannover Medical School, Hannover, member of the German Center of Lung Research, Giessen, Germany
| | - Irene M Lang
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Vallerie V McLaughlin
- Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - Ralph Preiss
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - Gérald Simonneau
- Faculté de Médecine, Hôpital Universitaire de Bicêtre, Université Paris-Sud, Le Kremlin Bicêtre, France
| | - Olivier Sitbon
- Faculté de Médecine, Hôpital Universitaire de Bicêtre, Université Paris-Sud, Le Kremlin Bicêtre, France
| | - Victor F Tapson
- Center for Pulmonary Vascular Diseases and Venous Thromboembolism, Cedars-Sinai Medical Center, Los Angeles, California
| | - Lewis J Rubin
- Department of Medicine, University of California, San Diego Medical School, San Diego, California
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Moonen A, Garsia R, Youssef P, Torzillo P, Corte T, Boehm C, Cordina R, Celermajer D, Lau E. Outcomes of pulmonary arterial hypertension therapy in Australia: is monotherapy adequate? Intern Med J 2017; 47:1124-1128. [DOI: 10.1111/imj.13495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/12/2017] [Accepted: 05/22/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Avalon Moonen
- Pulmonary Hypertension Clinic Royal Prince Alfred Hospital Sydney New South Wales Australia
| | - Roger Garsia
- Pulmonary Hypertension Clinic Royal Prince Alfred Hospital Sydney New South Wales Australia
- Sydney Medical School University of Sydney Sydney New South Wales Australia
| | - Peter Youssef
- Pulmonary Hypertension Clinic Royal Prince Alfred Hospital Sydney New South Wales Australia
- Sydney Medical School University of Sydney Sydney New South Wales Australia
| | - Paul Torzillo
- Pulmonary Hypertension Clinic Royal Prince Alfred Hospital Sydney New South Wales Australia
- Sydney Medical School University of Sydney Sydney New South Wales Australia
| | - Tamera Corte
- Pulmonary Hypertension Clinic Royal Prince Alfred Hospital Sydney New South Wales Australia
- Sydney Medical School University of Sydney Sydney New South Wales Australia
| | - Christiane Boehm
- Pulmonary Hypertension Clinic Royal Prince Alfred Hospital Sydney New South Wales Australia
| | - Rachael Cordina
- Pulmonary Hypertension Clinic Royal Prince Alfred Hospital Sydney New South Wales Australia
- Sydney Medical School University of Sydney Sydney New South Wales Australia
| | - David Celermajer
- Pulmonary Hypertension Clinic Royal Prince Alfred Hospital Sydney New South Wales Australia
- Sydney Medical School University of Sydney Sydney New South Wales Australia
| | - Edmund Lau
- Pulmonary Hypertension Clinic Royal Prince Alfred Hospital Sydney New South Wales Australia
- Sydney Medical School University of Sydney Sydney New South Wales Australia
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245
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Jiang R, Zhao Q, Wu W, Zhang R, Yuan P, Gong S, He J, Luo C, Qiu H, Wang L, Liu J. Efficacy and safety of a calcium sensitizer, levosimendan, in patients with right heart failure due to pulmonary hypertension. CLINICAL RESPIRATORY JOURNAL 2017; 12:1518-1525. [PMID: 28862394 DOI: 10.1111/crj.12699] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 08/18/2017] [Accepted: 08/28/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Rong Jiang
- Department of Cardio‐Pulmonary CirculationShanghai Pulmonary Hospital, Tongji University School of MedicineShanghai200433 China
| | - Qin‐Hua Zhao
- Department of Cardio‐Pulmonary CirculationShanghai Pulmonary Hospital, Tongji University School of MedicineShanghai200433 China
| | - Wen‐Hui Wu
- Department of Cardio‐Pulmonary CirculationShanghai Pulmonary Hospital, Tongji University School of MedicineShanghai200433 China
| | - Rui Zhang
- Department of Cardio‐Pulmonary CirculationShanghai Pulmonary Hospital, Tongji University School of MedicineShanghai200433 China
| | - Ping Yuan
- Department of Cardio‐Pulmonary CirculationShanghai Pulmonary Hospital, Tongji University School of MedicineShanghai200433 China
| | - Su‐Gang Gong
- Department of Cardio‐Pulmonary CirculationShanghai Pulmonary Hospital, Tongji University School of MedicineShanghai200433 China
| | - Jing He
- Department of Cardio‐Pulmonary CirculationShanghai Pulmonary Hospital, Tongji University School of MedicineShanghai200433 China
| | - Ci‐Jun Luo
- Department of Cardio‐Pulmonary CirculationShanghai Pulmonary Hospital, Tongji University School of MedicineShanghai200433 China
| | - Hong‐Ling Qiu
- Department of Cardio‐Pulmonary CirculationShanghai Pulmonary Hospital, Tongji University School of MedicineShanghai200433 China
| | - Lan Wang
- Department of Cardio‐Pulmonary CirculationShanghai Pulmonary Hospital, Tongji University School of MedicineShanghai200433 China
| | - Jin‐Ming Liu
- Department of Cardio‐Pulmonary CirculationShanghai Pulmonary Hospital, Tongji University School of MedicineShanghai200433 China
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Sildenafil dosed concomitantly with bosentan for adult pulmonary arterial hypertension in a randomized controlled trial. BMC Cardiovasc Disord 2017; 17:239. [PMID: 28874133 PMCID: PMC5586020 DOI: 10.1186/s12872-017-0674-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 08/29/2017] [Indexed: 01/24/2023] Open
Abstract
Background Few controlled clinical trials exist to support oral combination therapy in pulmonary arterial hypertension (PAH). Methods Patients with PAH (idiopathic [IPAH] or associated with connective tissue disease [APAH-CTD]) taking bosentan (62.5 or 125 mg twice daily at a stable dose for ≥3 months) were randomized (1:1) to sildenafil (20 mg, 3 times daily; n = 50) or placebo (n = 53). The primary endpoint was change from baseline in 6-min walk distance (6MWD) at week 12, assessed using analysis of covariance. Patients could continue in a 52-week extension study. An analysis of covariance main-effects model was used, which included categorical terms for treatment, baseline 6MWD (<325 m; ≥325 m), and baseline aetiology; sensitivity analyses were subsequently performed. Results In sildenafil versus placebo arms, week-12 6MWD increases were similar (least squares mean difference [sildenafil–placebo], −2.4 m [90% CI: –21.8 to 17.1 m]; P = 0.6); mean ± SD changes from baseline were 26.4 ± 45.7 versus 11.8 ± 57.4 m, respectively, in IPAH (65% of population) and −18.3 ± 82.0 versus 17.5 ± 59.1 m in APAH-CTD (35% of population). One-year survival was 96%; patients maintained modest 6MWD improvements. Changes in WHO functional class and Borg dyspnoea score and incidence of clinical worsening did not differ. Headache, diarrhoea, and flushing were more common with sildenafil. Conclusions Sildenafil, in addition to stable (≥3 months) bosentan therapy, had no benefit over placebo for 12-week change from baseline in 6MWD. The influence of PAH aetiology warrants future study. Trial registration ClinicalTrials.gov NCT00323297 (registration date: May 5, 2006). Electronic supplementary material The online version of this article (10.1186/s12872-017-0674-3) contains supplementary material, which is available to authorized users.
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Associations of Exercise Tolerance With Hemodynamic Parameters for Pulmonary Arterial Hypertension and for Chronic Thromboembolic Pulmonary Hypertension. J Cardiopulm Rehabil Prev 2017; 37:341-346. [DOI: 10.1097/hcr.0000000000000257] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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248
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RP5063, a novel, multimodal, serotonin receptor modulator, prevents Sugen 5416-hypoxia–induced pulmonary arterial hypertension in rats. Eur J Pharmacol 2017; 810:83-91. [DOI: 10.1016/j.ejphar.2017.05.052] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/24/2017] [Accepted: 05/29/2017] [Indexed: 11/20/2022]
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Benli E, Ayyildiz SN, Cirrik S, Koktürk S, Cirakoglu A, Noyan T, Ayyildiz A, Germiyanoglu C. The effect of tadalafil therapy on kidney damage caused by sepsis in a polymicrobial septic model induced in rats: a biochemical and histopathological study. Int Braz J Urol 2017; 43:345-355. [PMID: 27622284 PMCID: PMC5433375 DOI: 10.1590/s1677-5538.ibju.2016.0075] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 04/28/2016] [Indexed: 01/12/2023] Open
Abstract
Introduction Sepsis is an inflammatory reaction to bacteria involving the whole body and is a significant cause of mortality and economic costs. The purpose of this research was to determine whether tadalafil exhibits a preventive effect on sepsis in a septic model induced in rats with cecal ligation and puncture (CLP). Materials and Methods Rats were randomly separated into groups, 10 rats in each: (i) a sham (control) group, (ii) an untreated sepsis group, (iii) a sepsis group treated with 5mg/kg tadalafil and (iv) a sepsis group treated with 10mg/kg tadalafil. A polymicrobial sepsis model was induced in rats using CLP. Rats were sacrificed after 16h, and blood and kidney tissues were collected for biochemical and histopathological study. Results Levels of the inflammatory parameter IL-6 decreased significantly in the sepsis groups receiving tadalafil in comparison with the untreated sepsis group (p<0.05). In terms of histopathology, inflammation scores investigated in kidney tissues decreased significantly in the sepsis groups receiving tadalafil compared to the untreated sepsis group (p<0.05). In addition, levels of creatinine and cystatin C measured in septic rats receiving tadalafil were lower by a clear degree than in septic rats (p<0.05). Conclusion In this study, tadalafil exhibited a preventive effect for sepsis-related damage by suppressing inflammation in serum and kidney tissue of septic rats in a polymicrobial sepsis model induced with CLP.
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Affiliation(s)
- Erdal Benli
- Department of Urology, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Sema Nur Ayyildiz
- Department of Biochemistry, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Selma Cirrik
- Department of Physiology, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Sibel Koktürk
- Department of Histolology, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Abdullah Cirakoglu
- Department of Urology, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Tevfik Noyan
- Department of Biochemistry, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Ali Ayyildiz
- Department of Urology, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Cankon Germiyanoglu
- Department of Urology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
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Natural reversal of pulmonary vascular remodeling and right ventricular remodeling in SU5416/hypoxia-treated Sprague-Dawley rats. PLoS One 2017; 12:e0182551. [PMID: 28809956 PMCID: PMC5557492 DOI: 10.1371/journal.pone.0182551] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/20/2017] [Indexed: 01/18/2023] Open
Abstract
Aims Pulmonary arterial hypertension (PAH) is a lethal disease and improved therapeutic strategies are needed. Increased pulmonary arterial pressure, due to vasoconstriction and vascular remodeling, causes right ventricle (RV) failure and death in patients. The treatment of Sprague-Dawley rats with SU5416 injection and exposure to chronic hypoxia for three weeks followed by maintenance in normoxia promote progressive and severe PAH with pathologic features that resemble human PAH. At 5–17 weeks after the SU5416 injection, PAH is developed with pulmonary vascular remodeling as well as RV hypertrophy and fibrosis. The present study investigated subsequent events that occur in these PAH animals. Methods & results At 35 weeks after the SU5416 injection, rats still maintained high RV pressure, but pulmonary vascular remodeling was significantly reduced. Metabolomics analysis revealed that lungs of normal rats and rats from the 35-week time point had different metabolomics profiles. Despite the maintenance of high RV pressure, fibrosis was resolved at 35-weeks. Masson’s trichrome stain and Western blotting monitoring collagen 1 determined 12% fibrosis in the RV at 17-weeks, and this was decreased to 5% at 35-weeks. The level of myofibroblasts was elevated at 17-weeks and normalized at 35-weeks. Conclusions These results suggest that biological systems possess natural ways to resolve pulmonary and RV remodeling. The resolution of RV fibrosis appears to involve the reduction of myofibroblast-dependent collagen synthesis. Understanding these endogenous mechanisms should help improve therapeutic strategies to treat PAH and RV failure.
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