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Monzo L, Reichenbach A, Al-Hiti H, Jurcova I, Huskova Z, Kautzner J, Melenovsky V. Pulmonary Vasculature Responsiveness to Phosphodiesterase-5A Inhibition in Heart Failure With Reduced Ejection Fraction: Possible Role of Plasma Potassium. Front Cardiovasc Med 2022; 9:883911. [PMID: 35722098 PMCID: PMC9204350 DOI: 10.3389/fcvm.2022.883911] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/19/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Phosphodiesterase-5a inhibition (PDE5i) leads to favorable changes in pulmonary hemodynamic and cardiac output (CO) in patients with advanced heart failure (HF) and reduced ejection fraction (HFrEF). The hemodynamic response to PDE5i could be heterogeneous and the clinical variables associated with these changes are scarcely investigated. Materials and Methods Of 260 patients with advanced HFrEF referred for advanced therapies [cardiac transplant/left ventricular assist device (LVAD)], 55 had pulmonary hypertension (PH) and fulfilled the criteria for the PDE5i vasoreactivity test. Right heart catheterization (RHC) was performed as a part of clinical evaluation before and after 20-mg intravenous sildenafil. Absolute and relative changes in pulmonary vascular resistance (PVR) were evaluated to assess hemodynamic response to PDE5i. Clinical, biochemical, and hemodynamic factors associated with PVR changes were identified. Results Sildenafil administration reduced PVR (− 45.3%) and transpulmonary gradient (TPG; − 34.8%) and increased CO (+ 13.6%). Relative change analysis showed a negative moderate association between baseline plasma potassium and changes in PVR (r = − 0.48; p = 0.001) and TPG (r = − 0.43; p = 0.005) after PDE5i. Aldosterone concentration shows a direct moderate association with PVR changes after PDE5i. A significant moderate association was also demonstrated between CO improvement and the severity of mitral (r = 0.42; p = 0.002) and tricuspid (r = 0.39; p = 0.004) regurgitation. Conclusion We identified plasma potassium, plasma aldosterone level, and atrioventricular valve regurgitations as potential cofounders of hemodynamic response to acute administration of PDE5i. Whether modulation of potassium levels could enhance pulmonary vasoreactivity in advanced HFrEF deserves further research.
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Affiliation(s)
- Luca Monzo
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Adrian Reichenbach
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - Hikmet Al-Hiti
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - Ivana Jurcova
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - Zuzana Huskova
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - Vojtech Melenovsky
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
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2
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Blanco-Rivero J, Xavier FE. Therapeutic Potential of Phosphodiesterase Inhibitors for Endothelial Dysfunction- Related Diseases. Curr Pharm Des 2021; 26:3633-3651. [PMID: 32242780 DOI: 10.2174/1381612826666200403172736] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 02/08/2020] [Indexed: 02/08/2023]
Abstract
Cardiovascular diseases (CVD) are considered a major health problem worldwide, being the main cause of mortality in developing and developed countries. Endothelial dysfunction, characterized by a decline in nitric oxide production and/or bioavailability, increased oxidative stress, decreased prostacyclin levels, and a reduction of endothelium-derived hyperpolarizing factor is considered an important prognostic indicator of various CVD. Changes in cyclic nucleotides production and/ or signalling, such as guanosine 3', 5'-monophosphate (cGMP) and adenosine 3', 5'-monophosphate (cAMP), also accompany many vascular disorders that course with altered endothelial function. Phosphodiesterases (PDE) are metallophosphohydrolases that catalyse cAMP and cGMP hydrolysis, thereby terminating the cyclic nucleotide-dependent signalling. The development of drugs that selectively block the activity of specific PDE families remains of great interest to the research, clinical and pharmaceutical industries. In the present review, we will discuss the effects of PDE inhibitors on CVD related to altered endothelial function, such as atherosclerosis, diabetes mellitus, arterial hypertension, stroke, aging and cirrhosis. Multiple evidences suggest that PDEs inhibition represents an attractive medical approach for the treatment of endothelial dysfunction-related diseases. Selective PDE inhibitors, especially PDE3 and PDE5 inhibitors are proposed to increase vascular NO levels by increasing antioxidant status or endothelial nitric oxide synthase expression and activation and to improve the morphological architecture of the endothelial surface. Thereby, selective PDE inhibitors can improve the endothelial function in various CVD, increasing the evidence that these drugs are potential treatment strategies for vascular dysfunction and reinforcing their potential role as an adjuvant in the pharmacotherapy of CVD.
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Affiliation(s)
- Javier Blanco-Rivero
- Departamento de Fisiologia, Facultad de Medicina, Universidad Autonoma de Madrid, Madrid, Spain
| | - Fabiano E Xavier
- Departamento de Fisiologia e Farmacologia, Centro de Biociencias, Universidade Federal de Pernambuco, Recife, Brazil
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3
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Cardoso FB, Antunes-Correa LM, Silva TQAC, Silva LM, Toledo C, Ribeiro VC, Paim LR, Neilan TG, Velloso L, Nadruz W, Ramos CD, Dertkigil SS, Schreiber R, Sposito A, Matos-Souza JR, Berwanger O, Jerosch-Herold M, Coelho-Filho OR. Noninvasive imaging assessment of rehabilitation therapy in heart failure with preserved and reduced left ventricular ejection fraction (IMAGING-REHAB-HF): design and rationale. Ther Adv Chronic Dis 2019; 10:2040622319868376. [PMID: 31489153 PMCID: PMC6709440 DOI: 10.1177/2040622319868376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/12/2019] [Indexed: 12/28/2022] Open
Abstract
Background: Studies have shown significant benefits of exercise therapy in heart failure
(HF) with a reduced ejection fraction (HFrEF) and HF with a preserved
ejection fraction (HFpEF). The mechanisms responsible for the beneficial
effect of exercise in HFrEF and HFpEF are still unclear. We hypothesized
that the effect of exercise on myocardial remodeling may explain its
beneficial effect. Methods: IMAGING-REHAB-HF is a single-center, randomized, controlled clinical trial
using cardiac magnetic resonance imaging, vasomotor endothelial function,
cardiac sympathetic activity imaging and serum biomarkers to compare the
effect of exercise therapy in HFpEF (LVEF ≥ 45%) and HFrEF (LVEF < 45%).
Subjects will be assessed at baseline and after 4 months. The exercise
program will consist of three 60-min exercise sessions/week. The primary
endpoints are the effect of exercise on myocardial extracellular volume
(ECV), left ventricular (LV) systolic function, LV mass, LV mass-to-volume
and LV cardiomyocyte volume. Secondary endpoints include the effect of
exercise on vasomotor endothelial function, cardiac sympathetic activity and
plasmatic biomarkers. Patients will be allocated in a 2:1 fashion to
supervised exercise program or usual care. A total sample size of 90
patients, divided into two groups according to LVEF:HFpEF group (45
patients:30 in the intervention arm and 15 in the control arm) and HFrEF
group (45 patients:30 in the intervention arm and 15 in the control arm) –
will be necessary to achieve adequate power. Conclusion: This will be the first study to evaluate the benefits of a rehabilitation
program on cardiac remodeling in HF patients. The unique design of our study
may provide unique data to further elucidate the mechanisms involved in
reverse cardiac remodeling after exercise in HFpEF and HFrEF patients.
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Affiliation(s)
| | | | | | - Luis Miguel Silva
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Camilla Toledo
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | | | - Layde R Paim
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Tomas G Neilan
- Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lício Velloso
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Wilson Nadruz
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Celso Darío Ramos
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Sergio S Dertkigil
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Roberto Schreiber
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Andrei Sposito
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | | | - Otávio Berwanger
- Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Michael Jerosch-Herold
- Noninvasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Otávio Rizzi Coelho-Filho
- Discipline of Cardiology, Department of Internal Medicine, Hospital de Clínicas, State University of Campinas, UNICAMP, Rua Vital Brasil,251- Cidade Universitária 'Zeferino Vaz', Campinas, SP, CEP:13083-888, Brazil
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4
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Shah R, Yeri A, Das A, Courtright-Lim A, Ziegler O, Gervino E, Ocel J, Quintero-Pinzon P, Wooster L, Bailey CS, Tanriverdi K, Beaulieu LM, Freedman JE, Ghiran I, Lewis GD, Van Keuren-Jensen K, Das S. Small RNA-seq during acute maximal exercise reveal RNAs involved in vascular inflammation and cardiometabolic health: brief report. Am J Physiol Heart Circ Physiol 2017; 313:H1162-H1167. [PMID: 28916639 DOI: 10.1152/ajpheart.00500.2017] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 08/31/2017] [Accepted: 09/01/2017] [Indexed: 11/22/2022]
Abstract
Exercise improves cardiometabolic and vascular function, although the mechanisms remain unclear. Our objective was to demonstrate the diversity of circulating extracellular RNA (ex-RNA) release during acute exercise in humans and its relevance to exercise-mediated benefits on vascular inflammation. We performed plasma small RNA sequencing in 26 individuals undergoing symptom-limited maximal treadmill exercise, with replication of our top candidate miRNA in a separate cohort of 59 individuals undergoing bicycle ergometry. We found changes in miRNAs and other ex-RNAs with exercise (e.g., Y RNAs and tRNAs) implicated in cardiovascular disease. In two independent cohorts of acute maximal exercise, we identified miR-181b-5p as a key ex-RNA increased in plasma after exercise, with validation in a separate cohort. In a mouse model of acute exercise, we found significant increases in miR-181b-5p expression in skeletal muscle after acute exercise in young (but not older) mice. Previous work revealed a strong role for miR-181b-5p in vascular inflammation in obesity, insulin resistance, sepsis, and cardiovascular disease. We conclude that circulating ex-RNAs were altered in plasma after acute exercise target pathways involved in inflammation, including miR-181b-5p. Further investigation into the role of known (e.g., miRNA) and novel (e.g., Y RNAs) RNAs is warranted to uncover new mechanisms of vascular inflammation on exercise-mediated benefits on health.NEW & NOTEWORTHY How exercise provides benefits to cardiometabolic health remains unclear. We performed RNA sequencing in plasma during exercise to identify the landscape of small noncoding circulating transcriptional changes. Our results suggest a link between inflammation and exercise, providing rich data on circulating noncoding RNAs for future studies by the scientific community.
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Affiliation(s)
- Ravi Shah
- Massachusetts General Hospital, Boston, Massachusetts
| | - Ashish Yeri
- Massachusetts General Hospital, Boston, Massachusetts
| | - Avash Das
- Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Ernest Gervino
- Beth Israel Deaconess Medical Center, Boston, Massachusetts; and
| | - Jeffrey Ocel
- Beth Israel Deaconess Medical Center, Boston, Massachusetts; and
| | | | - Luke Wooster
- Department of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Cole Shields Bailey
- Department of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Kahraman Tanriverdi
- Department of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Lea M Beaulieu
- Department of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jane E Freedman
- Department of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Ionita Ghiran
- Beth Israel Deaconess Medical Center, Boston, Massachusetts; and
| | | | | | - Saumya Das
- Massachusetts General Hospital, Boston, Massachusetts;
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5
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Pofi R, Gianfrilli D, Badagliacca R, Di Dato C, Venneri MA, Giannetta E. Everything you ever wanted to know about phosphodiesterase 5 inhibitors and the heart (but never dared ask): How do they work? J Endocrinol Invest 2016; 39:131-42. [PMID: 26142740 DOI: 10.1007/s40618-015-0339-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 06/11/2015] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Phosphodiesterase 5 inhibitors (PDE5i) were developed while investigating novel treatments for coronary artery disease, but their andrological side effects shifted their indication toward the management of erectile dysfunction. Although PDE5i are now also indicated for pulmonary arterial hypertension and there are mounting preclinical and clinical evidences about their potentially beneficial cardiac effects, their use remains controversial and the involved mechanisms remain unclear. MATERIALS AND METHODS This review aimed to analyze the effects of PDE5i administration in various animal and humans models of cardiovascular diseases. RESULTS Animal studies have shown that PDE5i have protective effects in several models of cardiac disease. In humans, some studies showed that PDE5i improves microvascular and endothelial dysfunction and exerts positive effects in different samples of cardiovascular (CV) impairment. In contrast, other studies found no benefit (and no harm) in heart failure with preserved ejection fraction. The discrepancies in these findings are likely related to the fact that the mechanisms targeted by PDE5i in human disease are still poorly understood and the target population not yet identified. The mechanisms of actions herein reviewed suggest that hypertrophy, microvascular impairment, and inflammation, should be variably present for PDE5i to work. All these conditions frequently coexist in diabetes. A gender responsiveness has also been recently proposed. CONCLUSIONS Continuous PDE5 inhibition may exert cardioprotective effects, improving endothelial function and counteracting cardiac remodeling in some but not all conditions. A better patient selection could help to clarify the controversies on PDE5i use for CV disorders.
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Affiliation(s)
- R Pofi
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - D Gianfrilli
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - R Badagliacca
- Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - C Di Dato
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - M A Venneri
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - E Giannetta
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
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6
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Takahiro R, Nakamura S, Kohno H, Yoshimura N, Nakamura T, Ozawa S, Hirono K, Ichida F, Taguchi M. Contribution of CYP3A Isoforms to Dealkylation of PDE5 Inhibitors: A Comparison between Sildenafil N-Demethylation and Tadalafil Demethylenation. Biol Pharm Bull 2015; 38:58-65. [DOI: 10.1248/bpb.b14-00566] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Rikako Takahiro
- Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
| | - Saki Nakamura
- Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
| | - Hiroyuki Kohno
- Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
| | - Naoki Yoshimura
- First Department of Surgery, Faculty of Medicine, University of Toyama
| | | | - Sayaka Ozawa
- Department of Pediatrics, Faculty of Medicine, University of Toyama
| | - Keiichi Hirono
- Department of Pediatrics, Faculty of Medicine, University of Toyama
| | - Fukiko Ichida
- Department of Pediatrics, Faculty of Medicine, University of Toyama
| | - Masato Taguchi
- Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
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7
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Kass DA. Cardiac role of cyclic-GMP hydrolyzing phosphodiesterase type 5: from experimental models to clinical trials. Curr Heart Fail Rep 2012; 9:192-9. [PMID: 22798047 DOI: 10.1007/s11897-012-0101-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Cyclic guanosine monophosphate (cGMP) and its primary signaling kinase, protein kinase G, play an important role in counterbalancing stress remodeling in the heart. Growing evidence supports a positive impact on a variety of cardiac disease conditions from the suppression of cGMP hydrolysis. The latter is regulated by members of the phosphodiesterase (PDE) superfamily, of which cGMP-selective PDE5 has been best studied. Inhibitors such as sildenafil and tadalafil ameliorate cardiac pressure and volume overload, ischemic injury, and cardiotoxicity. Clinical trials have begun exploring their potential to benefit dilated cardiomyopathy and heart failure with a preserved ejection fraction. This review discusses recent developments in the field, highlighting basic science and clinical studies.
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Affiliation(s)
- David A Kass
- Division of Cardiology, Department of Medicine, The Johns Hopkins Medical Institutions, Ross Building, Room 858, 720 Rutland Avenue, Baltimore, MD 21205, USA.
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8
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Regulation of injury-induced neurogenesis by nitric oxide. Stem Cells Int 2012; 2012:895659. [PMID: 22997523 PMCID: PMC3444935 DOI: 10.1155/2012/895659] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 07/19/2012] [Indexed: 12/14/2022] Open
Abstract
The finding that neural stem cells (NSCs) are able to divide, migrate, and differentiate into several cellular types in the adult brain raised a new hope for restorative neurology. Nitric oxide (NO), a pleiotropic signaling molecule in the central nervous system (CNS), has been described to be able to modulate neurogenesis, acting as a pro- or antineurogenic agent. Some authors suggest that NO is a physiological inhibitor of neurogenesis, while others described NO to favor neurogenesis, particularly under inflammatory conditions. Thus, targeting the NO system may be a powerful strategy to control the formation of new neurons. However, the exact mechanisms by which NO regulates neural proliferation and differentiation are not yet completely clarified. In this paper we will discuss the potential interest of the modulation of the NO system for the treatment of neurodegenerative diseases or other pathological conditions that may affect the CNS.
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9
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Barrier M, Meloche J, Jacob MH, Courboulin A, Provencher S, Bonnet S. Today's and tomorrow's imaging and circulating biomarkers for pulmonary arterial hypertension. Cell Mol Life Sci 2012; 69:2805-31. [PMID: 22446747 PMCID: PMC11115077 DOI: 10.1007/s00018-012-0950-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 02/18/2012] [Accepted: 02/20/2012] [Indexed: 01/04/2023]
Abstract
The pathobiology of pulmonary arterial hypertension (PAH) involves a remodeling process in distal pulmonary arteries, as well as vasoconstriction and in situ thrombosis, leading to an increase in pulmonary vascular resistance, right heart failure and death. Its etiology may be idiopathic, but PAH is also frequently associated with underlying conditions such as connective tissue diseases. During the past decade, more than welcome novel therapies have been developed and are in development, including those increasingly targeting the remodeling process. These therapeutic options modestly increase the patients' long-term survival, now approaching 60% at 5 years. However, non-invasive tools for confirming PAH diagnosis, and assessing disease severity and response to therapy, are tragically lacking and would help to select the best treatment. After exclusion of other causes of pulmonary hypertension, a final diagnosis still relies on right heart catheterization, an invasive technique which cannot be repeated as often as an optimal follow-up might require. Similarly, other techniques and biomarkers used for assessing disease severity and response to treatment generally lack specificity and have significant limitations. In this review, imaging as well as current and future circulating biomarkers for diagnosis, prognosis, and follow-up are discussed.
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Affiliation(s)
- Marjorie Barrier
- Pulmonary Hypertension Research Group, Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Ste-Foy, Québec, QC G1V 4G5 Canada
| | - Jolyane Meloche
- Pulmonary Hypertension Research Group, Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Ste-Foy, Québec, QC G1V 4G5 Canada
| | - Maria Helena Jacob
- Pulmonary Hypertension Research Group, Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Ste-Foy, Québec, QC G1V 4G5 Canada
| | - Audrey Courboulin
- Pulmonary Hypertension Research Group, Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Ste-Foy, Québec, QC G1V 4G5 Canada
| | - Steeve Provencher
- Pulmonary Hypertension Research Group, Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Ste-Foy, Québec, QC G1V 4G5 Canada
| | - Sébastien Bonnet
- Pulmonary Hypertension Research Group, Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Ste-Foy, Québec, QC G1V 4G5 Canada
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10
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Abstract
Nitric oxide (NO) is recognized as one of the most important cardiovascular signaling molecules, with multiple regulatory effects on myocardial and vascular tissue as well as on other tissues and organ systems. With the growth in understanding of the range and mechanisms of NO effects on the cardiovascular system, it is now possible to consider pharmaceutical interventions that directly target NO or key steps in NO effector pathways. This article reviews aspects of the cardiovascular effects of NO, abnormalities in NO regulation in heart failure, and clinical trials of drugs that target specific aspects of NO signaling pathways.
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11
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Li L, Haider HK, Wang L, Lu G, Ashraf M. Adenoviral short hairpin RNA therapy targeting phosphodiesterase 5a relieves cardiac remodeling and dysfunction following myocardial infarction. Am J Physiol Heart Circ Physiol 2012; 302:H2112-21. [PMID: 22447941 DOI: 10.1152/ajpheart.00339.2011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We previously showed that treatment with tadalafil, a long-acting phosphodiesterase-5a (PDE5a) inhibitor, effectively prevented adverse left ventricular (LV) remodeling of the infarcted heart. We hypothesized that short-hairpin RNA (shRNA) therapy targeting PDE5a would simulate the effects of pharmacological intervention for treatment of postinfarction LV remodeling and dysfunction. Experimental model of myocardial infarction was developed in female mice by permanent ligation of left coronary artery. Immediately after that, an adenoviral vector encoding for shRNA sequence targeting PDE5a (Ad-shPDE5a) was injected intramyocardially, which specifically inhibited PDE5a in the heart. Four weeks later, Ad-shPDE5a treated mice showed significant mitigation of the left ventricle (LV) dilatation and dysfunction as indicated by smaller LV cavity and more preserved ejection fraction and fractional shortening. Infarction size and fibrosis were significantly reduced in Ad-shPDE5a-treated mice. Additionally, more salvaged cardiomyocytes, significantly reduced collagen contents, and higher blood vessel density were observed in Ad-shPDE5a-treated mice. The cytoprotective effects of Ad-shPDE5a were demonstrated in vitro in Ad-shPDE5a transfected cardiomyocytes cultured under oxygen glucose deprivation. Among downstream mediators of PDE5a signaling, cyclic GMP (cGMP) and cGMP-dependent protein kinase G (PKG) were activated with concomitant reduction in caspase-3 activity. However, no significant change in PKA and cAMP activities were observed in Ad-shPDE5a-treated hearts. Inhibition with shRNA improved cardiac remodeling and dysfunction by reducing infarction size and cardiac fibrosis and increased cGMP and PKG activity. These findings suggest that PDE5 inhibition with Ad-shPDE5a is a novel approach for treatment of myocardial infarction.
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Affiliation(s)
- Longhu Li
- Department of Pathology and Laboratory Medicine, University of Cincinnati, Cincinnati, OH 45267-0529, USA
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12
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Bardin PG. Treatment of obstructive airway diseases with roflumilast, a novel phosphodiesterase 4 inhibitor. Expert Rev Clin Immunol 2010; 3:469-76. [PMID: 20477153 DOI: 10.1586/1744666x.3.4.469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Obstructive airway diseases, chronic obstructive pulmonary disease (COPD) and asthma have a high prevalence worldwide and constitute a considerable burden of disease. Although various treatments have evolved for these illnesses, they are often only partially effective in relieving symptoms and reducing underlying airway abnormalities. Inhaled bronchodilators and glucocorticosteroids have been the mainstay of therapy and no new classes of drug with effective anti-inflammatory activities have been introduced to clinical practice for almost 20 years. Recently, a new class of compounds, phosphodiesterase 4 inhibitors, have undergone development. This article will examine one such compound, roflumilast, which has recently shown promise as therapy for the principal obstructive lung diseases - COPD and asthma.
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Affiliation(s)
- Philip G Bardin
- Department of Respiratory & Sleep Medicine, Centre for Inflammatory Diseases and Monash Institute of Medical Research, Monash University and Medical Centre, 246 Clayton Road, Clayton, Melbourne VIC 3168, Australia.
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13
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Tan T, Scholz PM, Weiss HR. Hypoxia inducible factor-1 improves the negative functional effects of natriuretic peptide and nitric oxide signaling in hypertrophic cardiac myocytes. Life Sci 2010; 87:9-16. [PMID: 20470788 DOI: 10.1016/j.lfs.2010.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Revised: 04/22/2010] [Accepted: 04/29/2010] [Indexed: 11/19/2022]
Abstract
AIMS Both natriuretic peptides and nitric oxide may be protective in cardiac hypertrophy, although their functional effects are diminished in hypertrophy. Hypoxia inducible factor-1 (HIF-1) may also protect in cardiac hypertrophy. We hypothesized that upregulation of HIF-1 would protect the functional effects of cyclic GMP (cGMP) signaling in hypertrophied ventricular myocytes. MAIN METHODS A cardiac hypertrophy model was created in mice by transverse aorta constriction. HIF-1 was increased by deferoxamine (150 mg/kg for 2 days). HIF-1alpha protein levels were examined. Functional parameters were measured (edge detector) on freshly isolated myocytes at baseline and after BNP (brain natriuretic peptide, 10(-8)-10(-7)M) or CNP (C-type natriuretic peptide, 10(-8)-10(-7)M) or SNAP (S-nitroso-N-acetyl-penicillamine, a nitric oxide donor, 10(-6)-10(-5)M) followed by KT5823 (a cyclic GMP-dependent protein kinase (PKG) inhibitor, 10(-6)M). We also determined PKG expression levels and kinase activity. KEY FINDINGS We found that under control conditions, BNP (-24%), CNP (-22%) and SNAP (-23%) reduced myocyte shortening, while KT5823 partially restored function. Deferoxamine treated control myocytes responded similarly. Baseline function was reduced in the myocytes from hypertrophied heart. BNP, CNP, SNAP and KT5823 also had no significant effects on function in these myocytes. Deferoxamine restored the negative functional effects of BNP (-22%), CNP (-18%) and SNAP (-19%) in hypertrophic cardiac myocytes and KT5823 partially reversed this effect. Additionally, deferoxamine maintained PKG expression levels and activity in hypertrophied heart. SIGNIFICANCE Our results indicated that the HIF-1 protected the functional effects of cGMP signaling in cardiac hypertrophy through preservation of PKG.
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MESH Headings
- Animals
- Carbazoles/administration & dosage
- Cardiomegaly/physiopathology
- Cyclic GMP/metabolism
- Cyclic GMP-Dependent Protein Kinases/metabolism
- Deferoxamine/pharmacology
- Disease Models, Animal
- Dose-Response Relationship, Drug
- Female
- Hypoxia-Inducible Factor 1/genetics
- Hypoxia-Inducible Factor 1/metabolism
- Hypoxia-Inducible Factor 1, alpha Subunit/genetics
- Hypoxia-Inducible Factor 1, alpha Subunit/metabolism
- Male
- Mice
- Mice, Inbred C57BL
- Myocytes, Cardiac/metabolism
- Myocytes, Cardiac/pathology
- Natriuretic Peptide, Brain/administration & dosage
- Natriuretic Peptide, Brain/metabolism
- Natriuretic Peptide, C-Type/administration & dosage
- Natriuretic Peptide, C-Type/metabolism
- Nitric Oxide/metabolism
- S-Nitroso-N-Acetylpenicillamine/pharmacology
- Signal Transduction
- Up-Regulation
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Affiliation(s)
- Tao Tan
- Heart and Brain Circulation Laboratory, Department of Physiology and Biophysics, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, 675 Hoes Lane West, Piscataway, NJ 08854-5635, USA
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14
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Pokreisz P, Vandenwijngaert S, Bito V, Van den Bergh A, Lenaerts I, Busch C, Marsboom G, Gheysens O, Vermeersch P, Biesmans L, Liu X, Gillijns H, Pellens M, Van Lommel A, Buys E, Schoonjans L, Vanhaecke J, Verbeken E, Sipido K, Herijgers P, Bloch KD, Janssens SP. Ventricular phosphodiesterase-5 expression is increased in patients with advanced heart failure and contributes to adverse ventricular remodeling after myocardial infarction in mice. Circulation 2009; 119:408-16. [PMID: 19139381 DOI: 10.1161/circulationaha.108.822072] [Citation(s) in RCA: 145] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ventricular expression of phosphodiesterase-5 (PDE5), an enzyme responsible for cGMP catabolism, is increased in human right ventricular hypertrophy, but its role in left ventricular (LV) failure remains incompletely understood. We therefore measured LV PDE5 expression in patients with advanced systolic heart failure and characterized LV remodeling after myocardial infarction in transgenic mice with cardiomyocyte-specific overexpression of PDE5 (PDE5-TG). METHODS AND RESULTS Immunoblot and immunohistochemistry techniques revealed that PDE5 expression was greater in explanted LVs from patients with dilated and ischemic cardiomyopathy than in control hearts. To evaluate the impact of increased ventricular PDE5 levels on cardiac function, PDE5-TG mice were generated. Confocal and immunoelectron microscopy revealed increased PDE5 expression in cardiomyocytes, predominantly localized to Z-bands. At baseline, myocardial cGMP levels, cell shortening, and calcium handling in isolated cardiomyocytes and LV hemodynamic measurements were similar in PDE5-TG and wild-type littermates. Ten days after myocardial infarction, LV cGMP levels had increased to a greater extent in wild-type mice than in PDE5-TG mice (P<0.05). Ten weeks after myocardial infarction, LV end-systolic and end-diastolic volumes were larger in PDE5-TG than in wild-type mice (57+/-5 versus 39+/-4 and 65+/-6 versus 48+/-4 muL, respectively; P<0.01 for both). LV systolic dysfunction and diastolic dysfunction were more marked in PDE5-TG than in wild-type mice, associated with enhanced hypertrophy and reduced contractile function in isolated cardiomyocytes from remote myocardium. CONCLUSIONS Increased PDE5 expression predisposes mice to adverse LV remodeling after myocardial infarction. Increased myocardial PDE5 expression in patients with advanced cardiomyopathy may contribute to the development of heart failure and represents an important therapeutic target.
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Affiliation(s)
- Peter Pokreisz
- Vesalius Research Center, Flanders Institute for Biotechnology, Leuven, Belgium
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15
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Puzzo D, Sapienza S, Arancio O, Palmeri A. Role of phosphodiesterase 5 in synaptic plasticity and memory. Neuropsychiatr Dis Treat 2008; 4:371-87. [PMID: 18728748 PMCID: PMC2518390 DOI: 10.2147/ndt.s2447] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Phosphodiesterases (PDEs) are enzymes that break down the phosphodiesteric bond of the cyclic nucleotides, cAMP and cGMP, second messengers that regulate many biological processes. PDEs participate in the regulation of signal transduction by means of a fine regulation of cyclic nucleotides so that the response to cell stimuli is both specific and activates the correct third messengers. Several PDE inhibitors have been developed and used as therapeutic agents because they increase cyclic nucleotide levels by blocking the PDE function. In particular, sildenafil, an inhibitor of PDE5, has been mainly used in the treatment of erectile dysfunction but is now also utilized against pulmonary hypertension. This review examines the physiological role of PDE5 in synaptic plasticity and memory and the use of PDE5 inhibitors as possible therapeutic agents against disorders of the central nervous system (CNS).
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Affiliation(s)
- Daniela Puzzo
- Dept of Physiological Sciences, University of Catania Catania, Italy.
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16
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Abstract
Phosphodiesterase type 5A (PDE5A) selectively hydrolyzes cyclic GMP. Inhibitors of PDE5A such as sildenafil are widely used to treat erectile dysfunction, but growing evidence supports important roles for the enzyme in both the vasculature and heart. In disorders such as cardiac failure, PDE5A upregulation may contribute to a decline in cGMP and protein kinase G signaling, exacerbating dysfunction. PDE5A plays an important role in the pulmonary vasculature where its inhibition benefits patients with pulmonary hypertension. In the heart, PDE5A signaling appears compartmentalized, and its inhibition is cardioprotective against ischemia-reperfusion and antracycline toxicity, blunts acute adrenergic contractile stimulation, and can suppress chronic hypertrophy and dysfunction attributable to pressure-overload. In this review, we discuss the molecular biology, pharmacology, and physiology of PDE5A, mechanisms of vascular and cardiac regulation, and recent evidence supporting the utility of selective PDE5A inhibition for the treatment of cardiovascular disorders.
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Affiliation(s)
- David A Kass
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD 21205, USA.
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17
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Boswell-Smith V, Page CP. Roflumilast: a phosphodiesterase-4 inhibitor for the treatment of respiratory disease. Expert Opin Investig Drugs 2007; 15:1105-13. [PMID: 16916276 DOI: 10.1517/13543784.15.9.1105] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Asthma and chronic obstructive pulmonary disease (COPD) are two of the most common chronic diseases worldwide, yet the classes of drug licensed to treat these conditions have not changed appreciably over the last 20 years. Inhaled bronchodilators and glucocorticosteroids (often in combination) form the mainstay of therapy for respiratory diseases, but many patients (including the elderly and children) can have problems using inhaler devices and there is a clear preference for oral therapy. The prevalence of these respiratory diseases is on the increase worldwide and continues to represent an area of medicine with unmet medical needs, particularly in the treatment of COPD. Despite this increase, very few new classes of drugs have been introduced into clinical practice. Phosphodiesterase-4 inhibitors are a novel class of drugs in development for the treatment of respiratory diseases and there are a number of lead compounds in late clinical development. This review focuses on one of the most promising drugs in development, roflumilast, which has undergone extensive clinical evaluation.
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Affiliation(s)
- Victoria Boswell-Smith
- The Sackler Institute of Pulmonary Pharmacology, Kings College London School of Biomedical, Health and Life Sciences, 5th Floor, Hodgkin Building, Guys Campus, Kings College London, London SE1 1UL, UK
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18
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Jakobsen S, Kodahl GM, Olsen AK, Cumming P. Synthesis, radiolabeling and in vivo evaluation of [11C]RAL-01, a potential phosphodiesterase 5 radioligand. Nucl Med Biol 2006; 33:593-7. [PMID: 16843833 DOI: 10.1016/j.nucmedbio.2006.04.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2005] [Revised: 04/11/2006] [Accepted: 04/30/2006] [Indexed: 11/15/2022]
Abstract
Very few tracers are available for imaging studies of second messenger systems. We developed a radiosynthesis for the phosphodiesterase (PDE) 5 inhibitor [(11)C]RAL-01. Whole body distribution studies using positron emission tomography (PET) revealed a time-dependant passage through the liver and accumulation of radioactivity in the bile of the Landrace pig. Displaceable binding was readily discerned in the myocardium, and traces of binding were seen in pulmonary tissue, consistent with the use of this class of drug in the treatment of pulmonary hypertension and heart failure. [(11)C]RAL-01 readily entered the brain and obtained an equilibrium distribution volume of 4-5 ml g(-1). Mean parametric images suggested the presence of a small displaceable binding component, but this binding was not significant in the present group of three pigs. Thus, [(11)C]RAL-01 shows considerable promise for PET studies of biliary elimination and of PDE5 binding in the cardiovascular system. However, analogues of higher affinity may be required for investigations of central nervous system binding sites.
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Affiliation(s)
- Steen Jakobsen
- PET Centre, Aarhus University Hospitals, 8000 Aarhus, Denmark.
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19
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Bender AT, Beavo JA. Cyclic Nucleotide Phosphodiesterases: Molecular Regulation to Clinical Use. Pharmacol Rev 2006; 58:488-520. [PMID: 16968949 DOI: 10.1124/pr.58.3.5] [Citation(s) in RCA: 1317] [Impact Index Per Article: 73.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Cyclic nucleotide phosphodiesterases (PDEs) are enzymes that regulate the cellular levels of the second messengers, cAMP and cGMP, by controlling their rates of degradation. There are 11 different PDE families, with each family typically having several different isoforms and splice variants. These unique PDEs differ in their three-dimensional structure, kinetic properties, modes of regulation, intracellular localization, cellular expression, and inhibitor sensitivities. Current data suggest that individual isozymes modulate distinct regulatory pathways in the cell. These properties therefore offer the opportunity for selectively targeting specific PDEs for treatment of specific disease states. The feasibility of these enzymes as drug targets is exemplified by the commercial and clinical successes of the erectile dysfunction drugs, sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra). PDE inhibitors are also currently available or in development for treatment of a variety of other pathological conditions. In this review the basic biochemical properties, cellular regulation, expression patterns, and physiological functions of the different PDE isoforms will be discussed. How these properties relate to the current and future development of PDE inhibitors as pharmacological agents is especially considered. PDEs hold great promise as drug targets and recent research advances make this an exciting time for the field of PDE research.
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Affiliation(s)
- Andrew T Bender
- Department of Pharmacology, University of Washington Medical School, Health Sciences Building, Box 357280, Seattle, WA 98195-7280, USA
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20
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Chen HH, Huntley BK, Schirger JA, Cataliotti A, Burnett JC. Maximizing the renal cyclic 3'-5'-guanosine monophosphate system with type V phosphodiesterase inhibition and exogenous natriuretic peptide: a novel strategy to improve renal function in experimental overt heart failure. J Am Soc Nephrol 2006; 17:2742-7. [PMID: 16928803 PMCID: PMC2647144 DOI: 10.1681/asn.2006020161] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Type V phosphodiesterase (PDE V) metabolizes cyclic guanosine monophosphate (cGMP) and is abundant in the kidney and vasculature and was found recently in the heart. Sildenafil is a PDE V inhibitor that is used clinically for erectile dysfunction. Brain natriuretic peptide (BNP) is a cardiac peptide with vasodilating, lusitropic, and natriuretic properties that are mediated via cGMP. It was hypothesized that chronic inhibition of PDE V (PDE VI) will enhance the renal actions of exogenous BNP by potentiating the renal cGMP. The cardiorenal and humoral function was determined at baseline in two groups of dogs with pacing-induced overt chronic heart failure (CHF; 240 bpm for 10 d): Group 1 (n = 6) received Sildenafil 50 mg orally three times daily during the 10 d of pacing, and group 2 (n = 5) received no PDE V inhibitor. The response to acute subcutaneous BNP (5 microg/kg) administration also was compared in both groups on day 11. The GFR was assessed by inulin clearance (P < 0.05). There was no improvement of renal function in group 1 after 10 d of PDE VI as compared with group 2, despite having higher cardiac output (P < 0.05). Group 1 had significantly higher plasma (44 +/- 2 versus 21 +/- 3 pmol/ml; P < 0.05) and urinary cGMP (4219 +/- 900 versus 1954 +/- 300 pmol/min; P < 0.05) as compared with group 2. With acute subcutaneous BNP administration, group 1 had a natriuretic and diuretic response that was associated with an increase in GFR (30 +/- 6 to 45 +/- 6 ml/min; P < 0.05) and that was not observed in group 2 (25 +/- 6 to 29 +/- 4 ml/min). Plasma BNP increased to a similar extent in both groups with subcutaneous BNP. In contrast, group 1 had a much greater urinary cGMP excretion (4219 +/- 900 to 8600 +/- 1600 pmol/min; P < 0.05) as compared with group 2 (1954 +/- 300 to 3580 +/- 351 pmol/min; P < 0.05). In experimental overt CHF, chronic administration of PDE V inhibitor did not enhance renal function despite an improvement in cardiac output. However, chronic PDE VI significantly enhanced the renal hemodynamic and excretory responses to exogenous BNP. This study supports a role for PDE V as contributing to renal maladaptation in a model of experimental overt CHF and the strategy of maximizing the renal cGMP system by combined PDE VI and natriuretic peptides in CHF to improve renal function.
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Affiliation(s)
- Horng H Chen
- Cardiorenal Research Laboratory, Guggenheim 915, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA.
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21
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