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Song Q, Wang S, Lei X, Liu Y, Wen X, Wang Z. One-Pot Route from Halogenated Amides to Piperidines and Pyrrolidines. Molecules 2022; 27:molecules27154698. [PMID: 35897866 PMCID: PMC9331508 DOI: 10.3390/molecules27154698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/17/2022] [Accepted: 07/19/2022] [Indexed: 02/01/2023] Open
Abstract
Piperidine and pyrrolidine derivatives are important nitrogen heterocyclic structures with a wide range of biological activities. However, reported methods for their construction often face problems of requiring the use of expensive metal catalysts, highly toxic reaction reagents or hazardous reaction conditions. Herein, an efficient route from halogenated amides to piperidines and pyrrolidines was disclosed. In this method, amide activation, reduction of nitrile ions, and intramolecular nucleophilic substitution were integrated in a one-pot reaction. The reaction conditions were mild and no metal catalysts were used. The synthesis of a variety of N-substituted and some C-substituted piperidines and pyrrolidines became convenient, and good yields were obtained.
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Affiliation(s)
- Qiao Song
- Department of Chemistry, Xihua University, Chengdu 610039, China; (S.W.); (X.L.); (Y.L.); (X.W.)
- Asymmetric Synthesis and Chiral Technology Key Laboratory of Sichuan Province, Yibin 644000, China
- Correspondence: (Q.S.); (Z.W.)
| | - Sheng Wang
- Department of Chemistry, Xihua University, Chengdu 610039, China; (S.W.); (X.L.); (Y.L.); (X.W.)
| | - Xiangui Lei
- Department of Chemistry, Xihua University, Chengdu 610039, China; (S.W.); (X.L.); (Y.L.); (X.W.)
- Asymmetric Synthesis and Chiral Technology Key Laboratory of Sichuan Province, Yibin 644000, China
| | - Yan Liu
- Department of Chemistry, Xihua University, Chengdu 610039, China; (S.W.); (X.L.); (Y.L.); (X.W.)
| | - Xin Wen
- Department of Chemistry, Xihua University, Chengdu 610039, China; (S.W.); (X.L.); (Y.L.); (X.W.)
| | - Zhouyu Wang
- Department of Chemistry, Xihua University, Chengdu 610039, China; (S.W.); (X.L.); (Y.L.); (X.W.)
- Asymmetric Synthesis and Chiral Technology Key Laboratory of Sichuan Province, Yibin 644000, China
- Correspondence: (Q.S.); (Z.W.)
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2
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Wang Y, Fu Z, Ma Z, Li N, Shang H. Bepridil, a class IV antiarrhythmic agent, can block the TREK-1 potassium channel. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1123. [PMID: 34430564 PMCID: PMC8350656 DOI: 10.21037/atm-20-7971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 05/17/2021] [Indexed: 11/24/2022]
Abstract
Background The TWIK-related potassium channel (TREK-1) can be regulated by different stimuli. However, it is not clear whether some antiarrhythmics affect the activity of TREK-1. In the present study, the effect of bepridil on the TREK-1 currents is investigated. Methods In a TREK-1 stably-expressed HEK-293 cell line (HEK-TREK-1), U251MG cells, and isolated mouse ventricular myocytes, the TREK-1 current and action potentials were recorded by the patch-clamp technique. The standard voltage protocol was a 200 ms constant potential at 20 mV, followed bya 500 ms ramp from –90 to +20 mV (HEK-TREK-1) or +80 mV (U251MG cells and myocytes) every 10 s. The currents at +20 mV or +80 mV were used for analysis. The docking study of bepridil’s binding model in the TREK-1 channel was performed using the Swissdock web service. Results In HEK-TREK-1 cells, BL1249 induced a significantly large outwardly rectifying current with similar baseline TREK-1 current characteristic, with a reversal potential (−70 mV). The concentration of half-maximal activation (EC50) of BL1249 was 3.45 µM. However, bepridil decreased the baseline TREK-1 currents, with a concentration of half-maximal inhibition (IC50) 0.59 µM and a Hill coefficient of 1.1. Also, bepridil inhibited BL1249-activated TREK-1 currents, with an IC50 4.08 µM and a Hill coefficient of 3.22. The outside-out patch-clamp confirmed bepridil inhibited BL1249-activated TREK-1 currents. In U251MG cells and myocytes, BL1249 activated outwardly rectifying endogenous TREK-1 currents, which could be inhibited by bepridil. BL1249 (10 µM) could decrease the peak value and reduce the duration of the action potential. Bepridil (10 µM) prolonged the duration of action potential of myocytes. The docking study revealed that bepridil might affect the K+ pore domain and the M4 modulator pocket. Conclusions Bepridil may be a blocker for the TREK-1K+channel at a clinically therapeutic concentration, providing a new mechanism of TREK-1 regulation and bepridil's antiarrhythmic effect.
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Affiliation(s)
- Ying Wang
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital, Shandong University, Jinan, China
| | - Zhijie Fu
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital, Shandong University, Jinan, China.,Department of Otorhinolaryngology, the First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Zhiyong Ma
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital, Shandong University, Jinan, China
| | - Na Li
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital, Shandong University, Jinan, China
| | - Hong Shang
- Key Laboratory of Cardiovascular Proteomics of Shandong Province, Department of Geriatrics, Qilu Hospital, Shandong University, Jinan, China
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3
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Loen V, Vos MA, van der Heyden MAG. The canine chronic atrioventricular block model in cardiovascular preclinical drug research. Br J Pharmacol 2021; 179:859-881. [PMID: 33684961 PMCID: PMC9291585 DOI: 10.1111/bph.15436] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/23/2021] [Accepted: 02/28/2021] [Indexed: 12/29/2022] Open
Abstract
Ventricular cardiac arrhythmia is a life threating condition arising from abnormal functioning of many factors in concert. Animal models mirroring human electrophysiology are essential to predict and understand the rare pro- and anti-arrhythmic effects of drugs. This is very well accomplished by the canine chronic atrioventricular block (CAVB) model. Here we summarize canine models for cardiovascular research, and describe the development of the CAVB model from its beginning. Understanding of the structural, contractile and electrical remodelling processes following atrioventricular (AV) block provides insight in the many factors contributing to drug-induced arrhythmia. We also review all safety pharmacology studies, efficacy and mechanistic studies on anti-arrhythmic drugs in CAVB dogs. Finally, we compare pros and cons with other in vivo preclinical animal models. In view of the tremendous amount of data obtained over the last 100 years from the CAVB dog model, it can be considered as man's best friend in preclinical drug research.
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Affiliation(s)
- Vera Loen
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marc A Vos
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
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4
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Cao X, Nagasawa Y, Zhang C, Zhang H, Aimoto M, Takahara A. Electropharmacological profile of an atrial-selective sodium channel blocker acehytisine assessed in the isoflurane-anesthetized guinea-pig model. J Pharmacol Sci 2019; 141:153-159. [PMID: 31757741 DOI: 10.1016/j.jphs.2019.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/16/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022] Open
Abstract
Experimental evidence regarding the risk of proarrhythmic potential of acehytisine is limited. We assessed its electropharmacological effect together with proarrhythmic potential at intravenous doses of 4 and 10 mg/kg (n = 6) using isoflurane-anesthetized guinea pigs in comparison with that of bepridil at 1 and 3 mg/kg, intravenously (n = 6). Acehytisine at therapeutic dose (4 mg/kg) decreased the heart rate, prolonged P wave duration, QRS width, QT interval, QTc, MAP90(sinus), MAP90(CL300) and MAP90(CL250). At supratherapeutic dose (10 mg/kg), it prolonged the PR interval besides enhancing the changes induced by the therapeutic dose. Quantitative assessment showed that peak changes in P wave duration by acehytisine at 10 mg/kg were 1.7 times longer than bepridil, and in MAP90(sinus), MAP90(CL300) and MAP90(CL250) by acehytisine were 1.9, 1.5 and 1.5 times shorter than bepridil, respectively. Importantly, qualitative assessment indicated that bepridil increased beat-to-beat variability and J-Tpeakc in a dose-related manner, confirming a higher proarrhythmic risk, whereas such dose-related responses were not observed in acehytisine, suggesting a lower proarrhythmic risk. These results suggest that acehytisine exhibits favorable pharmacological characters, i.e. potent atrial inhibition and lower proarrhythmic toxicity compared with bepridil, being a promising candidate for the treatment of paroxysmal supraventricular tachycardia.
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Affiliation(s)
- Xin Cao
- Acupuncture and Tuina School/Third Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37 Shierqiao Road, Jinniu District, Chengdu, 610075, Sichuan Province, China; Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Toho University 2-2-1 Miyama, Funabashi, Chiba, 274-8510, Japan.
| | - Yoshinobu Nagasawa
- Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Toho University 2-2-1 Miyama, Funabashi, Chiba, 274-8510, Japan
| | - Chengshun Zhang
- Acupuncture and Tuina School/Third Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37 Shierqiao Road, Jinniu District, Chengdu, 610075, Sichuan Province, China
| | - Hanxiao Zhang
- Acupuncture and Tuina School/Third Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37 Shierqiao Road, Jinniu District, Chengdu, 610075, Sichuan Province, China
| | - Megumi Aimoto
- Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Toho University 2-2-1 Miyama, Funabashi, Chiba, 274-8510, Japan
| | - Akira Takahara
- Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Toho University 2-2-1 Miyama, Funabashi, Chiba, 274-8510, Japan.
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5
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Ishizaka T, Yoshimatsu Y, Maeda Y, Chiba K, Mori K. Negative lusitropic property of nifekalant identified using ventricular pressure-volume loop analyses in anesthetized monkeys. Exp Anim 2019; 68:91-102. [PMID: 30333366 PMCID: PMC6389513 DOI: 10.1538/expanim.18-0098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The present study was conducted to clarify multiple cardiohemodynamic and
electrophysiological properties including inotropic/lusitropic effects of nifekalant, a
class III antiarrhythmic drug, in an isoflurane-anesthetized monkey. Nifekalant was
administered intravenously at the therapeutic dose of 0.3 mg/kg over 10 min to male
cynomolgus monkeys (n=4), followed by higher dose of 1 (n=3) or 3 mg/kg (n=1) that was
limited due to arrythmogenicity. Left ventricular (LV) pressure-volume (PV) analysis
revealed that the 0.3 mg/kg dose of nifekalant induced a negative lusitropic effect,
recognized as a decrease in maximal rate of reduction in LV pressure and a prolonged
isovolumic relaxation time. Nifekalant also decreased heart rate and increased LV
end-diastolic pressure, but had no effects on the other cardiohemodynamic parameters
examined. Electrophysiological analysis showed nifekalant at 0.3 mg/kg prolonged QT/QTc
intervals with no evidence of arrhythmia. Higher doses of nifekalant induced ventricular
arrhythmia in 3 out of 4 animals, in which both the short-term and long-term variability
of the QT interval increased just before the occurrence of arrhythmia. In conclusion, a
therapeutic dose of nifekalant had no effect on inotropic activity or cardiac compliance,
whereas it showed negative lusitropic properties and QT/QTc prolongation in
isoflurane-anesthetized monkeys. In addition, higher doses of nifekalant showed remarkable
QT/QTc prolongation leading to arrhythmogenicity, which showed good accordance with
clinical findings. Caution should be paid to negative lusitropic properties as well as
arrhythmogenisity for the safe use of nifekalant.
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Affiliation(s)
- Tomomichi Ishizaka
- Medicinal Safety Research Laboratories, Daiichi Sankyo Co., Ltd., 1-16-13 Kita-Kasai, Edogawa-ku, Tokyo 134-8630, Japan
| | - Yu Yoshimatsu
- Medicinal Safety Research Laboratories, Daiichi Sankyo Co., Ltd., 1-16-13 Kita-Kasai, Edogawa-ku, Tokyo 134-8630, Japan
| | - Yu Maeda
- Medicinal Safety Research Laboratories, Daiichi Sankyo Co., Ltd., 1-16-13 Kita-Kasai, Edogawa-ku, Tokyo 134-8630, Japan
| | - Katsuyoshi Chiba
- Medicinal Safety Research Laboratories, Daiichi Sankyo Co., Ltd., 1-16-13 Kita-Kasai, Edogawa-ku, Tokyo 134-8630, Japan
| | - Kazuhiko Mori
- Medicinal Safety Research Laboratories, Daiichi Sankyo Co., Ltd., 1-16-13 Kita-Kasai, Edogawa-ku, Tokyo 134-8630, Japan
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Wada T, Hagiwara-Nagasawa M, Yoshihara K, Nakazato Y, Lurie KG, Sugiyama A. Knocking the Chest as a "Bridge to Pacemaker": Treatment of Bradyasystole by Percussion Pacing - Reply. Circ J 2018; 82:2446-2447. [PMID: 30068824 DOI: 10.1253/circj.cj-18-0765] [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: 11/09/2022]
Affiliation(s)
- Takeshi Wada
- Department of Pharmacology, Faculty of Medicine, Toho University.,Department of Cardiology, Juntendo University Urayasu Hospital
| | | | - Katsunori Yoshihara
- Department of General Medicine and Emergency Care, Faculty of Medicine, Toho University
| | - Yuji Nakazato
- Department of Cardiology, Juntendo University Urayasu Hospital
| | - Keith G Lurie
- Department of Emergency Medicine, University of Minnesota Medical School
| | - Atsushi Sugiyama
- Department of Pharmacology, Faculty of Medicine, Toho University
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7
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Qiu B, Wang Y, Li C, Guo H, Xu Y. Utility of the JT Peak Interval and the JT Area in Determining the Proarrhythmic Potential of QT-Shortening Agents. J Cardiovasc Pharmacol Ther 2018; 24:160-171. [PMID: 30092655 DOI: 10.1177/1074248418791999] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Drug-induced long QT increases the risk of ventricular tachyarrhythmia known as torsades de pointes (TdP). Many biomarkers have been used to predict TdP. At present, however, there are few biomarkers for arrhythmias induced by QT-shortening drugs. The objective of the present study was to identify the best biomarkers for predicting arrhythmias caused by the 4 potassium channel openers ICA-105574, NS-1643, R-L3, and pinacidil. Our results showed that, at higher concentrations, all 4 potassium channel openers induced ventricular tachycardia (VT) and ventricular fibrillation (VF) in Langendorff-perfused guinea pig hearts, but not in rabbit hearts. The electrocardiography parameters were measured including QT/QTc, JT peak, Tp-e interval, JT area, short-term beat-to-beat QT interval variability (STV), and index of cardiac electrophysiological balance (iCEB). We found that the potassium channel openers at test concentrations shortened the QT/QTc and the JT peak interval and increased the JT area. Nevertheless, even at proarrhythmic concentrations, they did not always change STV, Tp-e, or iCEB. Receiver operating characteristic curve analysis showed that the JT peak interval representing the early repolarization phase and the JT area reflecting the dispersion of ventricular repolarization were the best predictors of VT/VF. Action potential recordings in guinea pig papillary muscle revealed that except for pinacidil, the potassium channel openers shortened APD30 in a concentration-dependent manner. They also evoked early or delayed afterdepolarizations at fast pacing rates. Patch-clamp recordings in guinea pig ventricular cardiomyocytes showed that the potassium channel openers enhanced the total outward currents during the early phase of action potential repolarization, especially at proarrhythmic concentrations. We concluded that the JT peak interval and the JT area are surrogate biomarkers identifying the risk of proarrhythmia associated with the administration of QT-shortening agents. The acceleration of early-phase repolarization and the increased dispersion of ventricular repolarization may contribute to the occurrence of arrhythmias.
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Affiliation(s)
- Bo Qiu
- Department of Pharmacology, Hebei Medical University, Shijiazhuang, Hebei, China.,The Key Laboratory of New Drug Pharmacology and Toxicology, Shijiazhuang, Hebei, China.,The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Shijiazhuang, Hebei, China.,Hebei General Hospital, Shijiazhuang, China
| | - Yuhong Wang
- Institute of Materia Medica, Chinese Academy of Medical Sciences and Beijing Union Medical College, Beijing, China
| | - Congxin Li
- Department of Pharmacology, Hebei Medical University, Shijiazhuang, Hebei, China.,The Key Laboratory of New Drug Pharmacology and Toxicology, Shijiazhuang, Hebei, China.,The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Shijiazhuang, Hebei, China
| | - Huicai Guo
- Department of Toxicology, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yanfang Xu
- Department of Pharmacology, Hebei Medical University, Shijiazhuang, Hebei, China.,The Key Laboratory of New Drug Pharmacology and Toxicology, Shijiazhuang, Hebei, China.,The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Shijiazhuang, Hebei, China
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8
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Izumi-Nakaseko H, Hagiwara-Nagasawa M, Naito AT, Goto A, Chiba K, Sekino Y, Kanda Y, Sugiyama A. Application of human induced pluripotent stem cell-derived cardiomyocytes sheets with microelectrode array system to estimate antiarrhythmic properties of multi-ion channel blockers. J Pharmacol Sci 2018; 137:372-378. [PMID: 30126708 DOI: 10.1016/j.jphs.2018.07.011] [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: 06/04/2018] [Revised: 07/09/2018] [Accepted: 07/25/2018] [Indexed: 12/25/2022] Open
Abstract
We examined electrophysiological indices of human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) sheets in order to quantitatively estimate Na+, K+ and Ca2+ channel blocking actions of bepridil and amiodarone using microelectrode array system in comparison with that of E-4031. We analyzed the field potential duration, effective refractory period, current threshold and conduction property using a programmed electrical stimulation protocol to obtain the post repolarization refractoriness and coefficient a of the relationship between the pacing cycle length and field potential duration. Electropharmacological profile of each drug was successfully characterized; namely, 1) the changes in the current threshold and conduction property provided basic information of Na+ channel blocking kinetics, 2) the relationship between pacing cycle length and field potential duration reflected drug-induced inhibition of human ether-à-go-go-related gene (hERG) K+ channel, 3) the post repolarization refractoriness indicated the relative contribution of these drugs to Na+ and K+ channel blockade, and 4) L-type Ca2+ channel blocking action was more obvious in the field potential waveform of the hiPSC-CMs sheets than that expected in the electrocardiogram in humans. Thus, this information may help to better utilize the hiPSC-CMs sheets for grasping the properties and net effects of drug-induced Na+, Ca2+ and K+ channel blockade.
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Affiliation(s)
- Hiroko Izumi-Nakaseko
- Department of Pharmacology, Faculty of Medicine, Toho University, 5-21-16 Omori-nishi, Ota-ku, Tokyo, 143-8540, Japan; Department of Pharmacology, Toho University Graduate School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo, 143-8540, Japan
| | - Mihoko Hagiwara-Nagasawa
- Department of Pharmacology, Faculty of Medicine, Toho University, 5-21-16 Omori-nishi, Ota-ku, Tokyo, 143-8540, Japan
| | - Atsuhiko T Naito
- Department of Pharmacology, Faculty of Medicine, Toho University, 5-21-16 Omori-nishi, Ota-ku, Tokyo, 143-8540, Japan; Department of Pharmacology, Toho University Graduate School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo, 143-8540, Japan
| | - Ai Goto
- Department of Pharmacology, Toho University Graduate School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo, 143-8540, Japan
| | - Koki Chiba
- Department of Pharmacology, Toho University Graduate School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo, 143-8540, Japan
| | - Yuko Sekino
- Department of Pharmacology, Faculty of Medicine, Toho University, 5-21-16 Omori-nishi, Ota-ku, Tokyo, 143-8540, Japan; Endowed Laboratory of Human Cell-Based Drug Discovery, Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yasunari Kanda
- Division of Pharmacology, National Institute of Health Sciences, 3-25-26 Tonomachi, Kawasaki-ku Kawasaki, Kanagawa, 210-9501, Japan
| | - Atsushi Sugiyama
- Department of Pharmacology, Faculty of Medicine, Toho University, 5-21-16 Omori-nishi, Ota-ku, Tokyo, 143-8540, Japan; Department of Pharmacology, Toho University Graduate School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo, 143-8540, Japan.
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Cao X, Wada T, Nakamura Y, Matsukura S, Izumi-Nakaseko H, Ando K, Naito AT, Sugiyama A. Sensitivity and Reliability of Halothane-anaesthetizedMicrominipigsto Assess Risk of Drug-induced Long QT Syndrome. Basic Clin Pharmacol Toxicol 2017; 121:465-470. [DOI: 10.1111/bcpt.12838] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 06/21/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Xin Cao
- Department of Pharmacology; Toho University Graduate School of Medicine; Ota-ku, Tokyo Japan
| | - Takeshi Wada
- Department of Pharmacology; Faculty of Medicine; Toho University; Ota-ku, Tokyo Japan
| | - Yuji Nakamura
- Department of Pharmacology; Faculty of Medicine; Toho University; Ota-ku, Tokyo Japan
| | - Suchitra Matsukura
- Department of Pharmacology; Faculty of Medicine; Toho University; Ota-ku, Tokyo Japan
| | - Hiroko Izumi-Nakaseko
- Department of Pharmacology; Faculty of Medicine; Toho University; Ota-ku, Tokyo Japan
| | - Kentaro Ando
- Department of Pharmacology; Toho University Graduate School of Medicine; Ota-ku, Tokyo Japan
- Department of Pharmacology; Faculty of Medicine; Toho University; Ota-ku, Tokyo Japan
| | - Atsuhiko T. Naito
- Department of Pharmacology; Toho University Graduate School of Medicine; Ota-ku, Tokyo Japan
- Department of Pharmacology; Faculty of Medicine; Toho University; Ota-ku, Tokyo Japan
| | - Atsushi Sugiyama
- Department of Pharmacology; Toho University Graduate School of Medicine; Ota-ku, Tokyo Japan
- Department of Pharmacology; Faculty of Medicine; Toho University; Ota-ku, Tokyo Japan
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10
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Yokoyama H, Nakamura Y, Saito H, Nagayama Y, Hoshiai K, Wada T, Izumi-Nakaseko H, Ando K, Akie Y, Sugiyama A. Pharmacological characterization of microminipig as a model to assess the drug-induced cardiovascular responses for non-clinical toxicity and/or safety pharmacology studies. J Toxicol Sci 2017; 42:93-101. [PMID: 28070113 DOI: 10.2131/jts.42.93] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
We tried to establish the halothane-anesthetized microminipigs as an alternative animal model for non-clinical toxicity and/or safety pharmacology studies. In order to characterize the halothane-anesthetized microminipigs, we firstly clarified the effects of halothane anesthesia on their cardiovascular system (n = 5). Then, we examined the cardiovascular effects of dl-sotalol in doses of 0.1, 0.3 and 1 mg/kg, i.v. on the halothane-anesthetized microminipigs (n = 6). Induction of the halothane anesthesia by itself prolonged the QT interval as well as QTcF, suggesting that the halothane anesthesia can reduce the cardiac repolarization reserve in microminipigs like in dogs. dl-Sotalol showed more potent negative chronotropic, dromotropic and hypotensive effects together with repolarization delay in microminipigs than in dogs, although each cardiovascular response to dl-sotalol was directionally similar between them, suggesting greater basal sympathetic tone and/or smaller volume of distribution of the drug in microminipigs than in dogs. Analyses of proarrhythmic surrogate markers indicate that Tpeak-Tend and short-term variability of QT interval may be more sensitive to detect the dl-sotalol-induced direct electrophysiological changes in microminipigs than in dogs, but its reverse will be true for J-Tpeakc. Thus, these results may help better understand the drug-induced cardiovascular responses in microminipigs.
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Matsukura S, Nakamura Y, Cao X, Wada T, Izumi-Nakaseko H, Ando K, Sugiyama A. Anti-atrial Fibrillatory Versus Proarrhythmic Potentials of Amiodarone: A New Protocol for Safety Evaluation In Vivo. Cardiovasc Toxicol 2016; 17:157-162. [DOI: 10.1007/s12012-016-9369-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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12
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Chiba T, Kondo N, Takahara A. Influences of rapid pacing-induced electrical remodeling on pharmacological manipulation of the atrial refractoriness in rabbits. J Pharmacol Sci 2016; 130:170-6. [DOI: 10.1016/j.jphs.2016.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 01/28/2016] [Accepted: 02/21/2016] [Indexed: 01/10/2023] Open
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13
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Niemeijer MN, van den Berg ME, Eijgelsheim M, van Herpen G, Stricker BH, Kors JA, Rijnbeek PR. Short-term QT variability markers for the prediction of ventricular arrhythmias and sudden cardiac death: a systematic review. Heart 2014; 100:1831-6. [PMID: 25092875 DOI: 10.1136/heartjnl-2014-305671] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Sudden cardiac death (SCD) is a major health burden and is primarily caused by ventricular arrhythmias. Currently, the most well-known marker for the risk of ventricular arrhythmias is QT/QTc prolongation. Animal studies indicate that QT variability might be a better indicator. Our objective was to give an overview of the literature on QT variability in humans, therefore we performed a free-text search in PubMed and Embase from inception through February 2013. We identified nine QT variability markers in 109 studies reporting on QT variability markers, measured on the surface ECG. QT variability can be distinguished using two characteristics: heart rate normalisation and whether QT interval is measured on consecutive beats. Most study populations were small (median 48 subjects, range 1-805) and different methods, time intervals and leads for measurement were used. QT variability markers were determinants for the risk of ventricular arrhythmias, (sudden) cardiac death and total mortality. Few studies compared the predictive value of QT variability with that of QT/QTc prolongation. A study comparing all different QT variability markers is lacking. In conclusion, QT variability markers are potential determinants of ventricular arrhythmias and cardiac mortality. However, it is unclear which marker and methodology are clinically most useful as well as what reference values are reliable. More studies on larger datasets are needed to find the most accurate marker for the prediction of arrhythmias and SCD to assess its value in addition to QT/QTc duration and its role in drug-induced arrhythmia and sudden death.
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Affiliation(s)
- Maartje N Niemeijer
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marten E van den Berg
- Department of Medical Informatics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mark Eijgelsheim
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Gerard van Herpen
- Department of Medical Informatics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands Inspectorate of Health Care, The Hague, The Netherlands
| | - Jan A Kors
- Department of Medical Informatics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter R Rijnbeek
- Department of Medical Informatics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Kobayashi K, Omuro N, Takahara A. The conventional antihistamine drug cyproheptadine lacks QT-interval-prolonging action in halothane-anesthetized guinea pigs: comparison with hydroxyzine. J Pharmacol Sci 2014; 124:92-8. [PMID: 24389819 DOI: 10.1254/jphs.13159fp] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Antihistamines are known to belong to the chemical class that may induce long QT syndrome. Among them, cyproheptadine has been shown to exert multifaceted actions on the ventricular repolarization phase; namely, shortening of the action potential duration at supra-therapeutic concentrations of 2 - 8 μM and prolongation of the QT interval at ≥ 10 μM. Since information is limited regarding the in vivo electrophysiological effects of cyproheptadine, we assessed it using the halothane-anesthetized guinea-pig model, which was compared with effects of another antihistamine drug, hydroxyzine. Sub-therapeutic to therapeutic doses of hydroxyzine at 1 and 10 mg/kg, i.v. prolonged the QT interval and duration of monophasic action potential, whereas therapeutic to supra-therapeutic doses of cyproheptadine at 0.1 and 1 mg/kg, i.v. hardly affected the indices of ventricular repolarization. These results suggest that cyproheptadine may be categorized into antihistamines with little effect on the ventricular repolarization.
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Affiliation(s)
- Kazuko Kobayashi
- Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Toho University, Japan
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15
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Matsuo K, Fujiwara K, Omuro N, Kimura I, Kobayashi K, Yoshio T, Takahara A. Effects of the fluoroquinolone antibacterial drug ciprofloxacin on ventricular repolarization in the halothane-anesthetized Guinea pig. J Pharmacol Sci 2013; 122:205-12. [PMID: 23803533 DOI: 10.1254/jphs.13020fp] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The fluoroquinolone antibiotic ciprofloxacin has been reported to block delayed rectifier K(+) channels at much higher concentrations than those at which it exerts its bactericidal activity. In this study using the halothane-anesthetized guinea pig, we assessed whether ciprofloxacin has a proarrhythmic activity. Ciprofloxacin at a clinically relevant dose of 3 mg/kg, i.v. did not affect any electrocardiographic parameters. At 10 mg/kg, it prolonged the QT interval and the duration of the monophasic action potential of the ventricle under sinus rhythm and constant ventricular pacing (n = 6). The extents of its effects on the ventricular repolarization phase were comparable to those of another fluoroquinolone antibiotic moxifloxacin at a clinically relevant dose of 3 mg/kg (n = 6). Meanwhile, the PR interval and QRS width were also increased by ciprofloxacin at 10 mg/kg, suggesting that the drug inhibited cardiac K(+) channels as well as Na(+) and Ca(2+) channels in vivo. These results suggest that ciprofloxacin exerted a multi-ion channel-blocking action in the heart within the supra-therapeutic dose range. Therefore, careful observation may be necessary for patients with heart disease receiving a higher dose of ciprofloxacin in order to prevent the emergence of resistance.
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Affiliation(s)
- Kazuhiro Matsuo
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Funabashi, Chiba, Japan
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16
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Hasan MA, Abbott D, Baumert M. Relation between beat-to-beat QT interval variability and T-wave amplitude in healthy subjects. Ann Noninvasive Electrocardiol 2012; 17:195-203. [PMID: 22816538 DOI: 10.1111/j.1542-474x.2012.00508.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Elevated beat-to-beat QT interval variability (QTV) has been associated with increased cardiovascular morbidity and mortality.The aim of this study was to investigate interlead differences in beat-to-beat QTV of 12-lead ECG and its relationship with the T wave amplitude. METHODS Short-term 12-lead ECGs of 72 healthy subjects (17 f, 38 ± 14 years; 55 m, 39 ± 13 years) were studied. Beat-to-beat QT intervals were extracted separately for each lead using a template matching algorithm. We calculated the standard deviation of beat-to-beat QT intervals as a marker of QTV as well as interlead correlation coefficients. In addition, we measured the median T-wave amplitude in each lead. RESULTS There was a significant difference in the standard deviation of beat-to-beat QT intervals between leads (minimum: lead V(3) (2.58 ± 1.36 ms), maximum: lead III (7.2 ± 6.4 ms), ANOVA: P < 0.0001). Single measure intraclass correlation coefficients of beat-to-beat QT intervals were 0.27 ± 0.18. Interlead correlation coefficients varied between 0.08 ± 0.33 for lead III and lead V(1) and 0.88 ± 0.09 for lead II and lead aVR. QTV was negatively correlated with the T-wave amplitude (r =-0.62, P < 0.0001). There was no significant affect of mean heart rate, age or gender on QT variability (ANOVA: P > 0.05). CONCLUSIONS QTV varies considerably between leads in magnitude as well as temporal patterns. QTV is increased when the T wave is small.
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Affiliation(s)
- Muhammad A Hasan
- School of Electrical and Electronic Engineering Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, SA, Australia
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17
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Takahara A, Fujiwara K, Ohtsuki A, Oka T, Namekata I, Tanaka H. Effects of the antitussive drug cloperastine on ventricular repolarization in halothane-anesthetized guinea pigs. J Pharmacol Sci 2012; 120:165-75. [PMID: 23047467 DOI: 10.1254/jphs.12117fp] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Cloperastine is an antitussive drug, which can be received as an over-the-counter cold medicine. The chemical structure of cloperastine is quite similar to that of the antihistamine drug diphenhydramine, which is reported to inhibit hERG K⁺ channels and clinically induce long QT syndrome after overdose. To analyze its proarrhythmic potential, we compared effects of cloperastine and diphenhydramine on the hERG K⁺ channels expressed in HEK293 cells. We further assessed their effects on the halothane-anesthetized guinea-pig heart under the monitoring of monophasic action potential (MAP) of the ventricle. Cloperastine inhibited the hERG K⁺ currents in a concentration-dependent manner with an IC₅₀ value of 0.027 μM, whose potency was 100 times greater than that of diphenhydramine (IC₅₀; 2.7 μM). In the anesthetized guinea pigs, cloperastine at a therapeutic dose of 1 mg/kg prolonged the QT interval and MAP duration without affecting PR interval or QRS width. Diphenhydramine at a therapeutic dose of 10 mg/kg prolonged the QT interval and MAP duration together with increase in PR interval and QRS width. The present results suggest that cloperastine may be categorized as a QT-prolonging drug that possibly induces arrhythmia at overdoses like diphenhydramine does.
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Affiliation(s)
- Akira Takahara
- Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Toho University, Funabashi, Chiba, Japan.
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18
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Beat-to-beat variability of repolarization as a new biomarker for proarrhythmia in vivo. Heart Rhythm 2012; 9:1718-26. [DOI: 10.1016/j.hrthm.2012.05.016] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Indexed: 11/20/2022]
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19
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Nalos L, Varkevisser R, Jonsson MKB, Houtman MJC, Beekman JD, van der Nagel R, Thomsen MB, Duker G, Sartipy P, de Boer TP, Peschar M, Rook MB, van Veen TAB, van der Heyden MAG, Vos MA. Comparison of the IKr blockers moxifloxacin, dofetilide and E-4031 in five screening models of pro-arrhythmia reveals lack of specificity of isolated cardiomyocytes. Br J Pharmacol 2012; 165:467-78. [PMID: 21718297 DOI: 10.1111/j.1476-5381.2011.01558.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND AND PURPOSE Drug development requires the testing of new chemical entities for adverse effects. For cardiac safety screening, improved assays are urgently needed. Isolated adult cardiomyocytes (CM) and human embryonic stem cell-derived cardiomyocytes (hESC-CM) could be used to identify pro-arrhythmic compounds. In the present study, five assays were employed to investigate their sensitivity and specificity for evaluating the pro-arrhythmic properties of I(Kr) blockers, using moxifloxacin (safe compound) and dofetilide or E-4031 (unsafe compounds). EXPERIMENTAL APPROACH Assays included the anaesthetized remodelled chronic complete AV block (CAVB) dog, the anaesthetized methoxamine-sensitized unremodelled rabbit, multi-cellular hESC-CM clusters, isolated CM obtained from CAVB dogs and isolated CM obtained from the normal rabbit. Arrhythmic outcome was defined as Torsade de Pointes (TdP) in the animal models and early afterdepolarizations (EADs) in the cell models. KEY RESULTS At clinically relevant concentrations (5-12 µM), moxifloxacin was free of pro-arrhythmic properties in all assays with the exception of the isolated CM, in which 10 µM induced EADs in 35% of the CAVB CM and in 23% of the rabbit CM. At supra-therapeutic concentrations (≥100 µM), moxifloxacin was pro-arrhythmic in the isolated rabbit CM (33%), in the hESC-CM clusters (18%), and in the methoxamine rabbit (17%). Dofetilide and E-4031 induced EADs or TdP in all assays (50-83%), and the induction correlated with a significant increase in beat-to-beat variability of repolarization. CONCLUSION AND IMPLICATIONS Isolated cardiomyocytes lack specificity to discriminate between TdP liability of the I(Kr) blocking drugs moxifloxacin and dofetilide or E4031.
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Affiliation(s)
- L Nalos
- Department of Medical Physiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
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20
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Baumert M, Schlaich MP, Nalivaiko E, Lambert E, Sari CI, Kaye DM, Elser MD, Sanders P, Lambert G. Relation between QT interval variability and cardiac sympathetic activity in hypertension. Am J Physiol Heart Circ Physiol 2011; 300:H1412-7. [PMID: 21257917 DOI: 10.1152/ajpheart.01184.2010] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Elevated QT interval variability is a predictor of malignant ventricular arrhythmia, but the underlying mechanisms are incompletely understood. A recent study in dogs with pacing-induced heart failure suggests that QT variability is linked to cardiac sympathetic nerve activity. The aim of this study was to determine whether increased cardiac sympathetic activity is associated with increased beat-to-beat QT interval variability in patients with essential hypertension. We recorded resting norepinephrine (NE) spillover into the coronary sinus and single-lead, short-term, high-resolution, body-surface ECG in 23 patients with essential hypertension and 9 normotensive control subjects. To assess beat-to-beat QT interval variability, we calculated the overall QT variability (QTVN) as well as the QT variability index (QTVi). Cardiac NE spillover (12.2 ± 6.5 vs. 20.7 ± 14.7, P = 0.03) and QTVi (-1.75 ± 0.36 vs. -1.42 ± 0.50, P = 0.05) were significantly increased in hypertensive patients compared with normotensive subjects. QTVN was significantly correlated with cardiac NE spillover (r(2) = 0.31, P = 0.001), with RR variability (r(2) = 0.20, P = 0.008), and with systolic blood pressure (r(2) = 0.16, P = 0.02). Linear regression analysis identified the former two as independent predictors of QTVN. In conclusion, elevated repolarization lability is directly associated with sympathetic cardiac activation in patients with essential hypertension.
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Affiliation(s)
- Mathias Baumert
- School of Electrical and Electronic Engineering, University of Adelaide, Australia.
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21
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Sugiyama A, Nakamura Y, Akie Y, Saito H, Izumi Y, Yamazaki H, Kaneko N, Itoh K. Microminipig, a Non-rodent Experimental Animal Optimized for Life Science Research: In Vivo Proarrhythmia Models of Drug-Induced Long QT Syndrome: Development of Chronic Atrioventricular Block Model of Microminipig. J Pharmacol Sci 2011; 115:122-126. [DOI: 10.1254/jphs.10r21fm] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 11/16/2010] [Indexed: 10/18/2022] Open
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22
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Nishi I, Sugiyama A, Takahara A, Kuroki K, Igawa M, Enomoto T, Iida K, Koseki S, Aonuma K. Utility of Short-Term Variability of Repolarization as a Marker for Monitoring a Safe Exercise Training Program in Patients With Cardiac Diseases. Int Heart J 2011; 52:304-7. [DOI: 10.1536/ihj.52.304] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Isao Nishi
- Division of Cardiology, Tsukuba Memorial Hospital
| | | | - Akira Takahara
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University
| | - Kenji Kuroki
- Division of Cardiology, Tsukuba Memorial Hospital
| | | | | | - Kaname Iida
- Division of Cardiology, Tsukuba Memorial Hospital
| | | | - Kazutaka Aonuma
- Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba
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23
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Clobutinol delays ventricular repolarization in the guinea pig heart: comparison with cardiac effects of HERG K+ channel inhibitor E-4031. J Cardiovasc Pharmacol 2010; 54:552-9. [PMID: 19770670 DOI: 10.1097/fjc.0b013e3181bfb17c] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Clobutinol has been clinically reported to induce long QT syndrome. To clarify its cardiac electrophysiological properties, we compared effects of clobutinol on the isolated myocardium and anesthetized guinea pig heart with those of a hERG K channel blocker, E-4031. In isolated guinea pig ventricular tissues, clobutinol (3 microM) as well as E-4031 (10-100 nM) prolonged the action potential duration without affecting maximum upstroke velocity, but no further prolongation was observed after application of 30 microM clobutinol. In anesthetized closed-chest guinea pigs, clobutinol (1 and 10 mg/kg, intravenously) and E-4031 (0.01 and 1 mg/kg, intravenously) prolonged the QT interval and duration of the monophasic action potential (MAP) in a dose-dependent manner and at the same time increased the beat-to-beat variability of the MAP duration and reversed use-dependent prolongation of the MAP duration and triangulation of the MAP configuration. These results suggest that clobutinol delayed the ventricular repolarization and increased the proarrhythmic parameters linked to the hERG K channel inhibitor-induced torsade de pointes arrhythmias.
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24
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Shah RR. Drug-induced QT interval shortening: potential harbinger of proarrhythmia and regulatory perspectives. Br J Pharmacol 2010; 159:58-69. [PMID: 19563537 PMCID: PMC2823352 DOI: 10.1111/j.1476-5381.2009.00191.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 01/07/2009] [Accepted: 01/14/2009] [Indexed: 01/08/2023] Open
Abstract
ATP-dependent potassium channel openers such as pinacidil and levcromakalim have long been known to shorten action potential duration and to be profibrillatory in non-clinical models, raising concerns on the clinical safety of drugs that shorten QT interval. Routine non-clinical evaluation of new drugs for their potential to affect cardiac repolarization has revealed that drugs may also shorten QT interval. The description of congenital short QT syndrome in 2000, together with the associated arrhythmias, suggests that drug-induced short QT interval may be proarrhythmic, and an uncanny parallel is evolving between our appreciation of the short and the long QT intervals. Epidemiological studies report an over-representation of short QT interval values in patients with idiopathic ventricular fibrillation. Therefore, as new compounds that shorten QT interval are progressed further into clinical development, questions will inevitably arise on their safety. Arising from the current risk-averse clinical and regulatory environment and concerns on proarrhythmic safety of drugs, together with our lack of a better understanding of the clinical significance of short QT interval, new drugs that substantially shorten QT interval will likely receive an unfavourable regulatory review unless these drugs fulfil an unmet clinical need. This review provides estimates of parameters of QT shortening that may be of potential clinical significance. Rufinamide, a recently approved anticonvulsant, illustrates the current regulatory approach to drugs that shorten QT interval. However, to further substantiate or confirm the safety of these drugs, their approval may well be conditional upon large-scale post-marketing studies with a focus on cardiac safety.
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Affiliation(s)
- Rashmi R Shah
- Medicines and Healthcare products Regulatory Agency, London, UK.
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25
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Takahara A, Nakamura Y, Wagatsuma H, Aritomi S, Nakayama A, Satoh Y, Akie Y, Sugiyama A. Long-term blockade of L/N-type Ca(2+) channels by cilnidipine ameliorates repolarization abnormality of the canine hypertrophied heart. Br J Pharmacol 2009; 158:1366-74. [PMID: 19785655 PMCID: PMC2782346 DOI: 10.1111/j.1476-5381.2009.00407.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Revised: 05/27/2009] [Accepted: 06/09/2009] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND PURPOSE The heart of the canine model of chronic atrioventricular block is known to have a ventricular electrical remodelling, which mimics the pathophysiology of long QT syndrome. Using this model, we explored a new pharmacological therapeutic strategy for the prevention of cardiac sudden death. EXPERIMENTAL APPROACH The L-type Ca(2+) channel blocker amlodipine (2.5 mg.day(-1)), L/N-type Ca(2+) channel blocker cilnidipine (5 mg.day(-1)), or the angiotensin II receptor blocker candesartan (12 mg.day(-1)) was administered orally to the dogs with chronic atrioventricular block for 4 weeks. Electropharmacological assessments with the monophasic action potential (MAP) recordings and blood sample analyses were performed before and 4 weeks after the start of drug administration. KEY RESULTS Amlodipine and cilnidipine decreased the blood pressure, while candesartan hardly affected it. The QT interval, MAP duration and beat-to-beat variability of the ventricular repolarization period were shortened only in the cilnidipine group, but such effects were not observed in the amlodipine or candesartan group. Plasma concentrations of adrenaline, angiotensin II and aldosterone decreased in the cilnidipine group. In contrast, plasma concentrations of angiotensin II and aldosterone were elevated in the amlodipine group, whereas in the candesartan group an increase in plasma levels of angiotensin II and a decrease in noradrenaline and adrenaline concentrations were observed. CONCLUSIONS AND IMPLICATIONS Long-term blockade of L/N-type Ca(2+) channels ameliorated the ventricular electrical remodelling in the hypertrophied heart which causes the prolongation of the QT interval. This could provide a novel therapeutic strategy for the treatment of cardiovascular diseases.
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Affiliation(s)
- A Takahara
- Department of Pharmacology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan
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