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Wang R, Piggott AM, Chooi YH, Li H. Discovery, bioactivity and biosynthesis of fungal piperazines. Nat Prod Rep 2023; 40:387-411. [PMID: 36374102 DOI: 10.1039/d2np00070a] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Covering: up to the end of July, 2022Fungi are prolific producers of piperazine alkaloids, which have been shown to exhibit an array of remarkable biological activities. Since the first fungal piperazine, herquline A, was reported from Penicillium herquei Fg-372 in 1979, a plethora of structurally diverse piperazines have been isolated and characterised from various fungal strains. Significant advancements have been made in recent years towards unravelling the biosynthesis of fungal piperazines and numerous synthetic routes have been proposed. This review provides a comprehensive summary of the current knowledge of the discovery, classification, bioactivity and biosynthesis of piperazine alkaloids reported from fungi, and discusses the perspectives for exploring the structural diversity of fungal piperazines via genome mining of the untapped piperazine biosynthetic pathways.
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Affiliation(s)
- Rui Wang
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, Guangdong 510006, People's Republic of China.
| | - Andrew M Piggott
- School of Natural Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Yit-Heng Chooi
- School of Molecular Sciences, The University of Western Australia, Perth, WA 6009, Australia
| | - Hang Li
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, Guangdong 510006, People's Republic of China.
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2
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Ali A, Ali A, Salahuddin, Bakht MA, Ahsan MJ. Synthesis and Biological Evaluations of N-(4-Substituted Phenyl)-7-Hydroxy-4-Methyl-2-Oxoquinoline-1(2 H)-Carbothioamides. Polycycl Aromat Compd 2022. [DOI: 10.1080/10406638.2021.1924210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Amena Ali
- Department of Pharmaceutical Chemistry, College of Pharmacy, Taif University, Taif, Saudi Arabia
| | - Abuzer Ali
- Department of Pharmacognosy, College of Pharmacy, Taif University, Taif, Saudi Arabia
| | - Salahuddin
- Department of Pharmaceutical Chemistry, Noida Institute of Technology (Pharmacy Institute), Greater Noida, Uttar Pradesh, India
| | - Mohammad Afroz Bakht
- Department of Chemistry, College of Science and Humanity Studies, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Mohamed Jawed Ahsan
- Department of Pharmaceutical Chemistry, Maharishi Arvind College of Pharmacy, Jaipur, Rajasthan, India
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3
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Rojas JJ, Croft RA, Sterling AJ, Briggs EL, Antermite D, Schmitt DC, Blagojevic L, Haycock P, White AJP, Duarte F, Choi C, Mousseau JJ, Bull JA. Amino-oxetanes as amide isosteres by an alternative defluorosulfonylative coupling of sulfonyl fluorides. Nat Chem 2022; 14:160-169. [PMID: 35087220 DOI: 10.1038/s41557-021-00856-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 11/11/2021] [Indexed: 01/10/2023]
Abstract
Bioisosteres provide valuable design elements that medicinal chemists can use to adjust the structural and pharmacokinetic characteristics of bioactive compounds towards viable drug candidates. Aryl oxetane amines offer exciting potential as bioisosteres for benzamides-extremely common pharmacophores-but are rarely examined due to the lack of available synthetic methods. Here we describe a class of reactions for sulfonyl fluorides to form amino-oxetanes by an alternative pathway to the established SuFEx (sulfonyl-fluoride exchange) click reactivity. A defluorosulfonylation forms planar oxetane carbocations simply on warming. This disconnection, comparable to a typical amidation, will allow the application of vast existing amine libraries. The reaction is tolerant to a wide range of polar functionalities and is suitable for array formats. Ten oxetane analogues of bioactive benzamides and marketed drugs are prepared. Kinetic and computational studies support the formation of an oxetane carbocation as the rate-determining step, followed by a chemoselective nucleophile coupling step.
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Affiliation(s)
- Juan J Rojas
- Department of Chemistry, Imperial College London, Molecular Sciences Research Hub, London, UK
| | - Rosemary A Croft
- Department of Chemistry, Imperial College London, Molecular Sciences Research Hub, London, UK
| | - Alistair J Sterling
- Department of Chemistry, Chemistry Research Laboratory, University of Oxford, Oxford, UK
| | - Edward L Briggs
- Department of Chemistry, Imperial College London, Molecular Sciences Research Hub, London, UK
| | - Daniele Antermite
- Department of Chemistry, Imperial College London, Molecular Sciences Research Hub, London, UK
| | - Daniel C Schmitt
- Pfizer Worldwide Research, Development and Medical, Groton, CT, USA
| | - Luka Blagojevic
- Department of Chemistry, Imperial College London, Molecular Sciences Research Hub, London, UK
| | - Peter Haycock
- Department of Chemistry, Imperial College London, Molecular Sciences Research Hub, London, UK
| | - Andrew J P White
- Department of Chemistry, Imperial College London, Molecular Sciences Research Hub, London, UK
| | - Fernanda Duarte
- Department of Chemistry, Chemistry Research Laboratory, University of Oxford, Oxford, UK
| | - Chulho Choi
- Pfizer Worldwide Research, Development and Medical, Groton, CT, USA
| | - James J Mousseau
- Pfizer Worldwide Research, Development and Medical, Groton, CT, USA
| | - James A Bull
- Department of Chemistry, Imperial College London, Molecular Sciences Research Hub, London, UK.
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4
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Yadav P, Shah K. Quinolines, a perpetual, multipurpose scaffold in medicinal chemistry. Bioorg Chem 2021; 109:104639. [PMID: 33618829 DOI: 10.1016/j.bioorg.2021.104639] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 01/04/2021] [Accepted: 01/04/2021] [Indexed: 02/06/2023]
Abstract
Quinoline is a versatile pharmacophore, a privileged scaffold and an outstanding fused heterocyclic compound with a wide range of pharmacological prospective such as anticancer, anti-inflammatory, antibacterial, antiviral drug and superlative moiety in drug discovery. The quinoline hybrids have already been shown excellent results with new targets with a different mode of actions as an inhibitor of cell proliferation by cell cycle arrest, apoptosis, angiogenesis, disruption of cell migration and modulation. This review emphasized the mode of action, structure activity relationship and molecular docking to reveal the various active pharmacophores of quinoline hybrids accountable for novel anticancer, anti-inflammatory, antibacterial and miscellaneous activities. Therefore, several quinoline candidates are under clinical trials for the treatment of certain diseases, for example ferroquine (antimalarial), dactolisib (antitumor) and pelitinib (EGFR TK inhibitors) etc. Plenty of research has been summarized the recent advances of quinoline derivatives and explore the various therapeutic prospects of this moiety. This review would help the researchers to strategically design diverse novel quinoline derivatives for the development of clinically viable drug candidates for the treatment of incurable diseases.
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Affiliation(s)
- Pratibha Yadav
- Institute of Pharmaceutical Research, GLA University, Mathura, UP 281406, India
| | - Kamal Shah
- Institute of Pharmaceutical Research, GLA University, Mathura, UP 281406, India.
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5
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Ahmad T, Miller PE, McCullough M, Desai NR, Riello R, Psotka M, Böhm M, Allen LA, Teerlink JR, Rosano GMC, Lindenfeld J. Why has positive inotropy failed in chronic heart failure? Lessons from prior inotrope trials. Eur J Heart Fail 2019; 21:1064-1078. [PMID: 31407860 PMCID: PMC6774302 DOI: 10.1002/ejhf.1557] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 12/11/2022] Open
Abstract
Current pharmacological therapies for heart failure with reduced ejection fraction are largely either repurposed anti‐hypertensives that blunt overactivation of the neurohormonal system or diuretics that decrease congestion. However, they do not address the symptoms of heart failure that result from reductions in cardiac output and reserve. Over the last few decades, numerous attempts have been made to develop and test positive cardiac inotropes that improve cardiac haemodynamics. However, definitive clinical trials have failed to show a survival benefit. As a result, no positive inotrope is currently approved for long‐term use in heart failure. The focus of this state‐of‐the‐art review is to revisit prior clinical trials and to understand the causes for their findings. Using the learnings from those experiences, we propose a framework for future trials of such agents that maximizes their potential for success. This includes enriching the trials with patients who are most likely to derive benefit, using biomarkers and imaging in trial design and execution, evaluating efficacy based on a wider range of intermediate phenotypes, and collecting detailed data on functional status and quality of life. With a rapidly growing population of patients with advanced heart failure, the epidemiologic insignificance of heart transplantation as a therapeutic intervention, and both the cost and morbidity associated with ventricular assist devices, there is an enormous potential for positive inotropic therapies to impact the outcomes that matter most to patients.
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Affiliation(s)
- Tariq Ahmad
- Section of Cardiovascular Medicine, New Haven, CT, USA.,Center for Outcome Research & Evaluation (CORE), Yale University School of Medicine, New Haven, CT, USA
| | | | | | - Nihar R Desai
- Section of Cardiovascular Medicine, New Haven, CT, USA.,Center for Outcome Research & Evaluation (CORE), Yale University School of Medicine, New Haven, CT, USA
| | - Ralph Riello
- Section of Cardiovascular Medicine, New Haven, CT, USA
| | | | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Larry A Allen
- Division of Cardiology, School of Medicine, University of Colorado, Aurora, CO, USA
| | - John R Teerlink
- San Francisco Veterans Affairs Medical Center, University of California San Francisco, San Francisco, CA, USA
| | - Giuseppe M C Rosano
- Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK
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6
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Heravi MM, Kheilkordi Z, Zadsirjan V, Heydari M, Malmir M. Buchwald-Hartwig reaction: An overview. J Organomet Chem 2018. [DOI: 10.1016/j.jorganchem.2018.02.023] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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7
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See YY, Dang TT, Chen A, Seayad AM. Concise Synthesis of Vesnarinone and Its Analogues by Using Pd-Catalyzed C-N Bond-Forming Reactions. European J Org Chem 2014. [DOI: 10.1002/ejoc.201403054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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8
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Ma LX, Cui BR, Wu Y, Liu JC, Cui X, Liu LP, Piao HR. Synthesis and positive inotropic evaluation of [1,2,4]triazolo[3,4-a]phthalazine and tetrazolo[5,1-a]phthalazine derivatives bearing substituted piperazine moieties. Bioorg Med Chem Lett 2014; 24:1737-41. [DOI: 10.1016/j.bmcl.2014.02.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/02/2014] [Accepted: 02/14/2014] [Indexed: 10/25/2022]
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9
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Hotta K, Nashimoto A, Yasumura E, Suzuki M, Azuma M, Iizumi Y, Shima D, Nabeshima R, Hiramoto M, Okada A, Sakata-Sogawa K, Tokunaga M, Ito T, Ando H, Sakamoto S, Kabe Y, Aizawa S, Imai T, Yamaguchi Y, Watanabe H, Handa H. Vesnarinone Suppresses TNFα mRNA Expression by Inhibiting Valosin-Containing Protein. Mol Pharmacol 2013; 83:930-8. [DOI: 10.1124/mol.112.081935] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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10
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Eickhoff JC. Placebo effect-adjusted assessment of quality of life in placebo-controlled clinical trials. Stat Med 2008; 27:1387-402. [PMID: 18219702 DOI: 10.1002/sim.3180] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Quality of life (QoL) has become an accepted and widely used endpoint in clinical trials. The analytical tools used for QoL evaluations in clinical trials differ from those used for the more traditional endpoints, such as response to disease, overall survival or progression-free survival. Since QoL assessments are generally performed on self-administered questionnaires, QoL endpoints are more prone to a placebo effect than traditional clinical endpoints. The placebo effect is a well-documented phenomenon in clinical trials, which has led to dramatic consequences on the clinical development of new therapeutic agents. In order to account for the placebo effect, a multivariate latent variable model is proposed, which allows for misclassification in the QoL item responses. The approach is flexible in the sense that it can be used for the analysis of a wide variety of multi-dimensional QoL instruments. For statistical inference, maximum likelihood estimates and their standard errors are obtained using a Monte Carlo EM algorithm. The approach is illustrated with analysis of data from a cardiovascular phase III clinical trial.
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Affiliation(s)
- Jens C Eickhoff
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI 53726-2397, USA.
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11
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Sasayama S. Optimising outcomes in end-stage heart failure: differences in therapeutic responses between diverse ethnic groups. Drug Saf 2004; 27 Suppl 1:19-24. [PMID: 15293850 DOI: 10.2165/00002018-200427001-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Clinical and pathophysiological differences between Japanese and Caucasian patients are observed in many aspects of heart disease. Indeed, data derived from studies in one population cannot be automatically extrapolated to the other. The therapeutic goal of heart failure has recently been aimed at improving mortality in Western societies. The long-term use of an inotropic agent in the energy-starved failing heart has been expected to increase myocardial energy use and accelerate the disease process. However, this may not be the case in the Japanese population in whom mortality is relatively low. Therefore, vesnarinone therapy could be justified, since it allows optimal care in terms of an improved quality of life. Nevertheless, re-analysis of the findings of the Vesnarinone Trial (VEST) emphasised again the reasons for the precautions relating to vesnarinone use: (i) vesnarinone was associated with increased death, usually occurring within 7 months of initiation of the drug; (ii) the mortality rate was higher in patients receiving concomitant digoxin, which necessitated close monitoring of renal function; (iii) the mortality rate also increased in patients with severe bradycardia, indicating the importance of regular ECG monitoring; and (iv) improvements in cardiac function and symptoms by the drug may result in sudden death, particularly in patients with severe heart failure. Such patients should be closely monitored by a physician.
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12
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Greenberg B, Borghi C, Perrone S. Pharmacotherapeutic approaches for decompensated heart failure: a role for the calcium sensitiser, levosimendan? Eur J Heart Fail 2003; 5:13-21. [PMID: 12559210 DOI: 10.1016/s1388-9842(02)00118-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Although no universal definition exists, decompensated heart failure may be regarded as either a worsening of chronic heart failure or new-onset heart failure precipitated by an acute incident. Haemodynamic management of patients hospitalised with decompensated heart failure may include the administration of diuretics, vasodilators and positive inotropic agents. Until recently, these latter agents constituted the only drug class to produce a direct increase in stroke volume via enhanced myocardial contractility. However, despite their short-term benefits, the clinical utility of inotropic agents is compromised by their potentially deleterious effects on calcium handling and oxygen consumption, resulting in an increased risk of serious ventricular arrhythmias and death. In contrast, calcium sensitisers enhance cardiac performance without affecting calcium movement and, therefore, are potentially associated with a reduced risk of rhythmic disturbances. These agents constitute a heterogeneous group of compounds with different affinities for calcium sensitisation. Levosimendan is a potent calcium sensitiser with vasodilating properties that has been shown to provide symptomatic and haemodynamic improvement with no increase in oxygen consumption. Calcium sensitisation is therefore emerging as a promising treatment approach in this challenging therapeutic area.
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Affiliation(s)
- Barry Greenberg
- Department of Medicine, University of California School of Medicine, San Diego, CA 92103, USA.
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13
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Kondo T, Suzuki Y, Kitano T, Iwai K, Watanabe M, Umehara H, Daido N, Domae N, Tashima M, Uchiyama T, Okazaki T. Vesnarinone causes oxidative damage by inhibiting catalase function through ceramide action in myeloid cell apoptosis. Mol Pharmacol 2002; 61:620-7. [PMID: 11854443 DOI: 10.1124/mol.61.3.620] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Vesnarinone is an effective inotropic agent for treating congestive heart failure, but its clinical usage is restricted because of the severe side effect of agranulocytosis. In myeloid HL-60 cells, vesnarinone increased the intracellular content of a proapoptotic lipid mediator, ceramide, in a time- and dose-dependent manner. Vesnarinone-induced apoptosis was significantly enhanced by simultaneous treatment with a cell-permeable N-acetyl sphingosine (C2-ceramide). Treatment with neither vesnarinone, C2-ceramide, nor simultaneously with vesnarinone and C2-ceramide caused a marked increase of reactive oxygen intermediates (ROI) generation measured by the 2',7'-dichlorofluorescin method. However, oxidative damage judged by the production of lipid peroxidates and the nitroblue tetrazolium-reducing ability were enhanced more significantly by simultaneous treatment with vesnarinone and C2-ceramide than by vesnarinone alone. Moreover, vesnarinone inhibited catalase function both at the protein and activity level, and this inhibition was synergistically enhanced by C2-ceramide, and vesnarinone-induced oxidative damage and apoptosis were significantly suppressed by treatment of HL-60 cells with purified catalase. C2-ceramide enhanced vesnarinone-induced inhibition of the ROI-scavenging enzyme catalase at the levels of protein and activity in HL-60 cells; in contrast, however, vesnarinone did not induce ceramide generation, oxidative damage, or catalase depletion in HL-60/ves cells, where vesnarinone could not induce apoptosis. Taken together, the results suggest that vesnarinone induces myeloid cell apoptosis by increasing oxidative damage via ceramide-induced inhibition of catalase function.
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Affiliation(s)
- Tadakazu Kondo
- Department of Hematology and Oncology, Clinical Sciences for Pathological Organs, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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14
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Cohn JN, Goldstein SO, Greenberg BH, Lorell BH, Bourge RC, Jaski BE, Gottlieb SO, McGrew F, DeMets DL, White BG. A dose-dependent increase in mortality with vesnarinone among patients with severe heart failure. Vesnarinone Trial Investigators. N Engl J Med 1998; 339:1810-6. [PMID: 9854116 DOI: 10.1056/nejm199812173392503] [Citation(s) in RCA: 485] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Vesnarinone, an inotropic drug, was shown in a short-term placebo-controlled trial to improve survival markedly in patients with severe heart failure when given at a dose of 60 mg per day, but there was a trend toward an adverse effect on survival when the dose was 120 mg per day. In a longer-term study, we evaluated the effects of daily doses of 60 mg or 30 mg of vesnarinone, as compared with placebo, on mortality and morbidity. METHODS We enrolled 3833 patients who had symptoms of New York Heart Association class III or IV heart failure and a left ventricular ejection fraction of 30 percent or less despite optimal treatment. The mean follow-up was 286 days. RESULTS There were significantly fewer deaths in the placebo group (242 deaths, or 18.9 percent) than in the 60-mg vesnarinone group (292 deaths, or 22.9 percent) and longer survival (P=0.02). The increase in mortality with vesnarinone was attributed to an increase in sudden death, presumed to be due to arrhythmia. The quality of life had improved significantly more in the 60-mg vesnarinone group than in the placebo group at 8 weeks (P<0.001) and 16 weeks (P=0.003) after randomization. Trends in mortality and in measures of the quality of life in the 30-mg vesnarinone group were similar to those in the 60-mg group but not significantly different from those in the placebo group. Agranulocytosis occurred in 1.2 percent of the patients given 60 mg of vesnarinone per day and 0.2 percent of those given 30 mg of vesnarinone. CONCLUSIONS Vesnarinone is associated with a dose-dependent increase in mortality among patients with severe heart failure, an increase that is probably related to an increase in deaths due to arrhythmia. A short-term benefit in terms of the quality of life raises issues about the appropriate therapeutic goal in treating heart failure.
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Affiliation(s)
- J N Cohn
- Department of Medicine, University of Minnesota Medical School, Minneapolis 55455, USA
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15
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Piano MR, Bondmass M, Schwertz DW. The molecular and cellular pathophysiology of heart failure. Heart Lung 1998; 27:3-19; quiz 20-1. [PMID: 9493878 DOI: 10.1016/s0147-9563(98)90063-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In the United States, it is estimated that heart failure develops in 465,000 people each year. Heart failure occurs in both men and women and is associated with a high morbidity and mortality rate in both sexes and in all races. Our knowledge of the pathophysiology of heart failure has advanced beyond the cardiorenal-neurohumoral model and now includes changes in myocyte structure and function. Cellular changes in heart failure include myocyte hypertrophy, abnormalities in calcium homeostasis, excitation-contraction coupling, cross-bridge cycling, and changes in the cytoskeletal architecture. Data also indicate that some of these changes are found during the compensated stage of heart failure; whereas other changes are found during overt decompensation and are associated with changes in systolic and diastolic function. The transition from compensated to decompensated heart failure is more than likely related to the overexpression of neurohormones and peptides such as norepinephrine, angiotensin II, and proinflammatory cytokines. The purpose of this article is to review the epidemiology and cellular pathophysiology of heart failure.
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Affiliation(s)
- M R Piano
- Department of Medical-Surgical Nursing, University of Illinois at Chicago College of Nursing, 60612, USA
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16
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Immunomodulatory therapy and survival with cardiac disease. Heart Fail Rev 1996. [DOI: 10.1007/bf00127811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Forker AD. A cardiologist's perspective on evolving concepts in the management of congestive heart failure. J Clin Pharmacol 1996; 36:973-84. [PMID: 8973986 DOI: 10.1177/009127009603601101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The conceptual framework for treatment of congestive heart failure has changed dramatically in the past 30 years. The 1950s and 1960s were characterized by manipulation of the left ventricular function curve by digitalis and diuretics. The 1970s focused on relief of symptoms by afterload reduction with vasodilators. Then stimulation of cardiac output with inotropes was shown to relieve symptoms, but patients died sooner. Now the focus is on the neurohumeral milieu and methods to counteract excess renin-angiotensin and sympathetic nervous system stimulation. Angiotensin-converting enzyme inhibitors are the drugs of choice because they also improve survival, but beta-blockers are becoming popular. The effect of molecular cardiology on practice guidelines for congestive heart failure is yet to be seen.
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Affiliation(s)
- A D Forker
- Section of Cardiology, University of Missouri-Kansas City Medical School 64108, USA
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Abstract
Cytokines are soluble peptides that mediate cell-to-cell interactions via specific cell surface receptors. There is a growing body of evidence that cytokines may play an important role in the pathogenesis of heart failure, and the intriguing possibility has been postulated that anticytokine therapy may favorably alter the clinical outcome of heart failure. As cytokines are essentially pleiotropic and redundant in nature, elimination of a single cytokine from the biologic system often fails to have major consequences. Therefore, the prospect has been raised for developing immunomodulating therapy for heart failure, enabling the simultaneous modification of the actions of multiple cytokines. The recently observed clinical benefit of vesnarinone on mortality and morbidity in patients with heart failure has been attributed to this immunomodulation. In the murine model of myocarditis and heart failure, vesnarinone enhanced the cumulative survival rate without affecting virus replication on virus-induced cytopathic effects. Vesnarinone inhibited excessive cytotoxicity of natural killer cells presumably by suppressing activation mediated by K channel inhibition. Vesnarinone also inhibited the production of cytokines. Cytokine inhibitory effects were different from those of other phosphodiesterase inhibitors or direct elevation of intracellular cyclic adenosine monophosphate, suggesting that the effects did not appear to be derived solely from a cyclic adenosine monophosphate-elevating action. Such cytokine regulation also appeared to be different in normal patients and in patients with heart failure. In conclusion, vesnarinone exerts an immunomodulating effect by suppressing natural killer cell activity and inhibiting cytokine production. These findings may hold open the hope that immunomodulation could be a new therapeutic modality. However, further studies on the long-term safety and efficacy of vesnarinone are warranted to establish the eventual status of this agent in the treatment of heart failure.
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Affiliation(s)
- S Sasayama
- Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan
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