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Brown AP, Friedrichs GS, Tang HM, Traebert M, Weber V, Yao N, Yan GX. Electrophysiological Changes in the Rabbit Ventricular Wedge and Human-Induced Pluripotent Stem-Cell Derived (IPSC) Cardiomyocytes Translate to Severe Arrhythmia Observed in a Canine Toxicology Study, Not Predicted by Standard In Vitro Ion Channel Assays. Int J Toxicol 2024; 43:231-242. [PMID: 38327194 DOI: 10.1177/10915818241230900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
During drug discovery, small molecules are typically assayed in vitro for secondary pharmacology effects, which include ion channels relevant to cardiac electrophysiology. Compound A was an irreversible inhibitor of myeloperoxidase investigated for the treatment of peripheral artery disease. Oral doses in dogs at ≥5 mg/kg resulted in cardiac arrhythmias in a dose-dependent manner (at Cmax, free ≥1.53 μM) that progressed in severity with time. Nevertheless, a panel of 13 different cardiac ion channel (K, Na, and Ca) assays, including hERG, failed to identify pharmacologic risks of the molecule. Compound A and a related Compound B were evaluated for electrophysiological effects in the isolated rabbit ventricular wedge assay. Compounds A and B prolonged QT and Tp-e intervals at ≥1 and ≥.3 μM, respectively, and both prolonged QRS at ≥5 μM. Compound A produced early after depolarizations and premature ventricular complexes at ≥5 μM. These data indicate both compounds may be modulating hERG (Ikr) and Nav1.5 ion channels. In human IPSC cardiomyocytes, Compounds A and B prolonged field potential duration at ≥3 μM and induced cellular dysrhythmia at ≥10 and ≥3 μM, respectively. In a rat toxicology study, heart tissue: plasma concentration ratios for Compound A were ≥19X at 24 hours post-dose, indicating significant tissue distribution. In conclusion, in vitro ion channel assays may not always identify cardiovascular electrophysiological risks observed in vivo, which can be affected by tissue drug distribution. Risk for arrhythmia may increase with a "trappable" ion channel inhibitor, particularly if cardiac tissue drug levels achieve a critical threshold for pharmacologic effects.
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Affiliation(s)
- Alan P Brown
- Novartis Biomedical Research, Cambridge, MA, USA
| | | | | | | | | | - Nancy Yao
- Novartis Biomedical Research, East Hanover, NJ, USA
| | - Gan-Xin Yan
- Lankenau Institute for Medical Research, Wynnewood, PA, USA
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2
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Lei M, Salvage SC, Jackson AP, Huang CLH. Cardiac arrhythmogenesis: roles of ion channels and their functional modification. Front Physiol 2024; 15:1342761. [PMID: 38505707 PMCID: PMC10949183 DOI: 10.3389/fphys.2024.1342761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/22/2024] [Indexed: 03/21/2024] Open
Abstract
Cardiac arrhythmias cause significant morbidity and mortality and pose a major public health problem. They arise from disruptions in the normally orderly propagation of cardiac electrophysiological activation and recovery through successive cardiomyocytes in the heart. They reflect abnormalities in automaticity, initiation, conduction, or recovery in cardiomyocyte excitation. The latter properties are dependent on surface membrane electrophysiological mechanisms underlying the cardiac action potential. Their disruption results from spatial or temporal instabilities and heterogeneities in the generation and propagation of cellular excitation. These arise from abnormal function in their underlying surface membrane, ion channels, and transporters, as well as the interactions between them. The latter, in turn, form common regulatory targets for the hierarchical network of diverse signaling mechanisms reviewed here. In addition to direct molecular-level pharmacological or physiological actions on these surface membrane biomolecules, accessory, adhesion, signal transduction, and cytoskeletal anchoring proteins modify both their properties and localization. At the cellular level of excitation-contraction coupling processes, Ca2+ homeostatic and phosphorylation processes affect channel activity and membrane excitability directly or through intermediate signaling. Systems-level autonomic cellular signaling exerts both acute channel and longer-term actions on channel expression. Further upstream intermediaries from metabolic changes modulate the channels both themselves and through modifying Ca2+ homeostasis. Finally, longer-term organ-level inflammatory and structural changes, such as fibrotic and hypertrophic remodeling, similarly can influence all these physiological processes with potential pro-arrhythmic consequences. These normal physiological processes may target either individual or groups of ionic channel species and alter with particular pathological conditions. They are also potentially alterable by direct pharmacological action, or effects on longer-term targets modifying protein or cofactor structure, expression, or localization. Their participating specific biomolecules, often clarified in experimental genetically modified models, thus constitute potential therapeutic targets. The insights clarified by the physiological and pharmacological framework outlined here provide a basis for a recent modernized drug classification. Together, they offer a translational framework for current drug understanding. This would facilitate future mechanistically directed therapeutic advances, for which a number of examples are considered here. The latter are potentially useful for treating cardiac, in particular arrhythmic, disease.
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Affiliation(s)
- Ming Lei
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom
| | - Samantha C. Salvage
- Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
| | - Antony P. Jackson
- Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
| | - Christopher L.-H. Huang
- Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
- Physiological Laboratory, University of Cambridge, Cambridge, United Kingdom
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3
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Wren LM, DeKeyser JM, Barefield DY, Hawkins NA, McNally EM, Kearney JA, Wasserstrom JA, George AL. Sex and Gene Influence Arrhythmia Susceptibility in Murine Models of Calmodulinopathy. Circ Arrhythm Electrophysiol 2023; 16:e010891. [PMID: 37589122 PMCID: PMC10530303 DOI: 10.1161/circep.122.010891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 07/16/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Pathogenic variants in genes encoding CaM (calmodulin) are associated with a life-threatening ventricular arrhythmia syndrome (calmodulinopathy). The in vivo consequences of CaM variants have not been studied extensively and there is incomplete understanding of the genotype-phenotype relationship for recurrent variants. We investigated effects of different factors on calmodulinopathy phenotypes using 2 mouse models with a recurrent pathogenic variant (N98S) in Calm1 or Calm2. METHODS Genetically engineered mice with heterozygous N98S pathogenic variants in Calm1 or Calm2 were generated. Differences between the sexes and affected genes were assessed using multiple physiological assays at the cellular and whole animal levels. Statistical significance among groups was evaluated using 1-way ANOVA or the Kruskal-Wallis test when data were not normally distributed. RESULTS Calm1N98S/+ (Calm1S/+) or Calm2N98S/+ (Calm2S/+) mice exhibited sinus bradycardia and were more susceptible to arrhythmias after exposure to epinephrine and caffeine. Male Calm1S/+ mice had the most severe arrhythmia phenotype with evidence of early embryonic lethality, greater susceptibility for arrhythmic events, frequent premature beats, corrected QT prolongation, and more heart rate variability after epinephrine and caffeine than females with the same genotype. Calm2 S/+ mice exhibited a less severe phenotype, with female Calm2 S/+ mice having the least severe arrhythmia susceptibility. Flecainide was not effective in preventing arrhythmias in heterozygous CaM-N98S mice. Intracellular Ca2+ transients observed in isolated ventricular cardiomyocytes from male heterozygous CaM-N98S mice had lower peak amplitudes and slower sarcoplasmic reticulum Ca2+ release following in vitro exposure to epinephrine and caffeine, which were not observed in cardiomyocytes from heterozygous female CaM-N98S mice. CONCLUSIONS We report heterogeneity in arrhythmia susceptibility and cardiomyocyte Ca2+ dynamics among male and female mice heterozygous for a recurrent pathogenic variant in Calm1 or Calm2, illustrating a complex calmodulinopathy phenotype in vivo. Further investigation of sex and genetic differences may help identify the molecular basis for this heterogeneity.
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Affiliation(s)
- Lisa M Wren
- Department of Pharmacology (L.M.W., J.-M.D., N.A.H., J.A.K., A.L.G.), The Feinberg Cardiovascular and Renal Research Institute, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jean-Marc DeKeyser
- Department of Pharmacology (L.M.W., J.-M.D., N.A.H., J.A.K., A.L.G.), The Feinberg Cardiovascular and Renal Research Institute, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David Y Barefield
- Department of Cell and Molecular Physiology, Loyola University Chicago, Maywood, IL (D.Y.B.)
| | - Nicole A Hawkins
- Department of Pharmacology (L.M.W., J.-M.D., N.A.H., J.A.K., A.L.G.), The Feinberg Cardiovascular and Renal Research Institute, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Elizabeth M McNally
- Center for Genetic Medicine (E.M.M.), The Feinberg Cardiovascular and Renal Research Institute, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jennifer A Kearney
- Department of Pharmacology (L.M.W., J.-M.D., N.A.H., J.A.K., A.L.G.), The Feinberg Cardiovascular and Renal Research Institute, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - J Andrew Wasserstrom
- Department of Medicine (J.A.W.), The Feinberg Cardiovascular and Renal Research Institute, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alfred L George
- Department of Pharmacology (L.M.W., J.-M.D., N.A.H., J.A.K., A.L.G.), The Feinberg Cardiovascular and Renal Research Institute, Northwestern University Feinberg School of Medicine, Chicago, IL
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4
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Zheng Y, Deschênes I. Protein 14-3-3 Influences the Response of the Cardiac Sodium Channel Na v1.5 to Antiarrhythmic Drugs. J Pharmacol Exp Ther 2023; 384:417-428. [PMID: 36460339 PMCID: PMC9976794 DOI: 10.1124/jpet.122.001407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022] Open
Abstract
The cardiac sodium channel Nav1.5 is a key contributor to the cardiac action potential, and dysregulations in Nav1.5 can lead to cardiac arrhythmias. Nav1.5 is a target of numerous antiarrhythmic drugs (AADs). Previous studies identified the protein 14-3-3 as a regulator of Nav1.5 biophysical coupling. Inhibition of 14-3-3 can remove the Nav1.5 functional coupling and has been shown to inhibit the dominant-negative effect of Brugada syndrome mutations. However, it is unknown whether the coupling regulation is involved with AADs' modulation of Nav1.5. Indeed, AADs could reveal important structural and functional information about Nav1.5 coupling. Here, we investigated the modulation of Nav1.5 by four classic AADs, quinidine, lidocaine, mexiletine, and flecainide, in the presence of 14-3-3 inhibition. The experiments were carried out by high-throughput patch-clamp experiments in an HEK293 Nav1.5 stable cell line. We found that 14-3-3 inhibition can enhance acute block by quinidine, whereas the block by other drugs was not affected. We also saw changes in the use- and dose-dependency of quinidine, lidocaine, and mexiletine when inhibiting 14-3-3. Inhibiting 14-3-3 also shifted the channel activation toward hyperpolarized voltages in the presence of the four drugs studied and slowed the recovery of inactivation in the presence of quinidine. Our results demonstrated that the protein 14-3-3 and Nav1.5 coupling could impact the effects of AADs. Therefore, 14-3-3 and Nav1.5 coupling are new mechanisms to consider in the development of drugs targeting Nav1.5. SIGNIFICANCE STATEMENT: The cardiac sodium channel Nav1.5 is a target of commonly used antiarrhythmic drugs, and Nav1.5 function is regulated by the protein 14-3-3. The present study demonstrated that the regulation of Nav1.5 by 14-3-3 influences Nav1.5's response to antiarrhythmic drugs. This study provides detailed information about how 14-3-3 differentially regulated Nav1.5 functions under the influence of different drug subtypes. These findings will guide future molecular studies investigating Nav1.5 and antiarrhythmic drugs outcomes.
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Affiliation(s)
- Yang Zheng
- Department of Physiology and Cell Biology, Frick Center for Heart Failure and Arrhythmias, Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio (Y.Z., I.D.) and Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio (Y.Z.)
| | - Isabelle Deschênes
- Department of Physiology and Cell Biology, Frick Center for Heart Failure and Arrhythmias, Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio (Y.Z., I.D.) and Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio (Y.Z.)
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5
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Patel MV, Peltier HM, Matulenko MA, Koenig JR, C Scanio MJ, Gum RJ, El-Kouhen OF, Fricano MM, Lundgaard GL, Neelands T, Zhang XF, Zhan C, Pai M, Ghoreishi-Haack N, Hudzik T, Gintant G, Martin R, McGaraughty S, Xu J, Bow D, Kalvass JC, Kym PR, DeGoey DA, Kort ME. Discovery of (R)-(3-fluoropyrrolidin-1-yl)(6-((5-(trifluoromethyl)pyridin-2-yl)oxy)quinolin-2-yl)methanone (ABBV-318) and analogs as small molecule Na v1.7/ Nav1.8 blockers for the treatment of pain. Bioorg Med Chem 2022; 63:116743. [PMID: 35436748 DOI: 10.1016/j.bmc.2022.116743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/01/2022] [Accepted: 04/02/2022] [Indexed: 11/24/2022]
Abstract
The voltage-gated sodium channel Nav1.7 is an attractive target for the treatment of pain based on the high level of target validation with genetic evidence linking Nav1.7 to pain in humans. Our effort to identify selective, CNS-penetrant Nav1.7 blockers with oral activity, improved selectivity, good drug-like properties, and safety led to the discovery of 2-substituted quinolines and quinolones as potent small molecule Nav1.7 blockers. The design of these molecules focused on maintaining potency at Nav1.7, improving selectivity over the hERG channel, and overcoming phospholipidosis observed with the initial leads. The structure-activity relationship (SAR) studies leading to the discovery of (R)-(3-fluoropyrrolidin-1-yl)(6-((5-(trifluoromethyl)pyridin-2-yl)oxy)quinolin-2-yl)methanone (ABBV-318) are described herein. ABBV-318 displayed robust in vivo efficacy in both inflammatory and neuropathic rodent models of pain. ABBV-318 also inhibited Nav1.8, another sodium channel isoform that is an active target for the development of new pain treatments.
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Affiliation(s)
- Meena V Patel
- AbbVie, Research and Development, 1 North Waukegan Road, North Chicago, IL 60064, USA.
| | - Hillary M Peltier
- AbbVie, Research and Development, 1 North Waukegan Road, North Chicago, IL 60064, USA
| | - Mark A Matulenko
- AbbVie, Research and Development, 1 North Waukegan Road, North Chicago, IL 60064, USA
| | - John R Koenig
- AbbVie, Research and Development, 1 North Waukegan Road, North Chicago, IL 60064, USA
| | - Marc J C Scanio
- AbbVie, Research and Development, 1 North Waukegan Road, North Chicago, IL 60064, USA
| | - Rebecca J Gum
- AbbVie, Research and Development, 1 North Waukegan Road, North Chicago, IL 60064, USA
| | - Odile F El-Kouhen
- AbbVie, Research and Development, 1 North Waukegan Road, North Chicago, IL 60064, USA
| | - Meagan M Fricano
- AbbVie, Research and Development, 1 North Waukegan Road, North Chicago, IL 60064, USA
| | - Greta L Lundgaard
- AbbVie, Research and Development, 1 North Waukegan Road, North Chicago, IL 60064, USA
| | - Torben Neelands
- AbbVie, Research and Development, 1 North Waukegan Road, North Chicago, IL 60064, USA
| | - Xu-Feng Zhang
- AbbVie, Research and Development, 1 North Waukegan Road, North Chicago, IL 60064, USA
| | - Cenchen Zhan
- AbbVie, Research and Development, 1 North Waukegan Road, North Chicago, IL 60064, USA
| | - Madhavi Pai
- AbbVie, Research and Development, 1 North Waukegan Road, North Chicago, IL 60064, USA
| | | | - Thomas Hudzik
- AbbVie, Research and Development, 1 North Waukegan Road, North Chicago, IL 60064, USA
| | - Gary Gintant
- AbbVie, Research and Development, 1 North Waukegan Road, North Chicago, IL 60064, USA
| | - Ruth Martin
- AbbVie, Research and Development, 1 North Waukegan Road, North Chicago, IL 60064, USA
| | - Steve McGaraughty
- AbbVie, Research and Development, 1 North Waukegan Road, North Chicago, IL 60064, USA
| | - Jun Xu
- AbbVie, Research and Development, 1 North Waukegan Road, North Chicago, IL 60064, USA
| | - Daniel Bow
- AbbVie, Research and Development, 1 North Waukegan Road, North Chicago, IL 60064, USA
| | - John C Kalvass
- AbbVie, Research and Development, 1 North Waukegan Road, North Chicago, IL 60064, USA
| | - Philip R Kym
- AbbVie, Research and Development, 1 North Waukegan Road, North Chicago, IL 60064, USA
| | - David A DeGoey
- AbbVie, Research and Development, 1 North Waukegan Road, North Chicago, IL 60064, USA
| | - Michael E Kort
- AbbVie, Research and Development, 1 North Waukegan Road, North Chicago, IL 60064, USA
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6
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Ca2+-dependent modulation of voltage-gated myocyte sodium channels. Biochem Soc Trans 2021; 49:1941-1961. [PMID: 34643236 PMCID: PMC8589445 DOI: 10.1042/bst20200604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/01/2021] [Accepted: 08/31/2021] [Indexed: 12/19/2022]
Abstract
Voltage-dependent Na+ channel activation underlies action potential generation fundamental to cellular excitability. In skeletal and cardiac muscle this triggers contraction via ryanodine-receptor (RyR)-mediated sarcoplasmic reticular (SR) Ca2+ release. We here review potential feedback actions of intracellular [Ca2+] ([Ca2+]i) on Na+ channel activity, surveying their structural, genetic and cellular and functional implications, translating these to their possible clinical importance. In addition to phosphorylation sites, both Nav1.4 and Nav1.5 possess potentially regulatory binding sites for Ca2+ and/or the Ca2+-sensor calmodulin in their inactivating III–IV linker and C-terminal domains (CTD), where mutations are associated with a range of skeletal and cardiac muscle diseases. We summarize in vitro cell-attached patch clamp studies reporting correspondingly diverse, direct and indirect, Ca2+ effects upon maximal Nav1.4 and Nav1.5 currents (Imax) and their half-maximal voltages (V1/2) characterizing channel gating, in cellular expression systems and isolated myocytes. Interventions increasing cytoplasmic [Ca2+]i down-regulated Imax leaving V1/2 constant in native loose patch clamped, wild-type murine skeletal and cardiac myocytes. They correspondingly reduced action potential upstroke rates and conduction velocities, causing pro-arrhythmic effects in intact perfused hearts. Genetically modified murine RyR2-P2328S hearts modelling catecholaminergic polymorphic ventricular tachycardia (CPVT), recapitulated clinical ventricular and atrial pro-arrhythmic phenotypes following catecholaminergic challenge. These accompanied reductions in action potential conduction velocities. The latter were reversed by flecainide at RyR-blocking concentrations specifically in RyR2-P2328S as opposed to wild-type hearts, suggesting a basis for its recent therapeutic application in CPVT. We finally explore the relevance of these mechanisms in further genetic paradigms for commoner metabolic and structural cardiac disease.
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7
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Kubacka M, Rapacz A, Sałat K, Filipek B, Cios A, Pociecha K, Wyska E, Hubicka U, Żuromska-Witek B, Kwiecień A, Marona H, Waszkielewicz AM. KM-416, a novel phenoxyalkylaminoalkanol derivative with anticonvulsant properties exerts analgesic, local anesthetic, and antidepressant-like activities. Pharmacodynamic, pharmacokinetic, and forced degradation studies. Eur J Pharmacol 2020; 886:173540. [PMID: 32896552 DOI: 10.1016/j.ejphar.2020.173540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 10/23/2022]
Abstract
Anticonvulsant drugs are used to treat a wide range of non-epileptic conditions, including chronic, neuropathic pain. We obtained a phenoxyalkylaminoalkanol derivative, KM-416 which had previously demonstrated a significant anticonvulsant activity and had also been shown to bind to 5-HT1A, α2-receptors and SERT and not to exhibit mutagenic properties. As KM-416 is a promising compound in our search for drug candidates, in the present study we further assessed its pharmacological profile (analgesic, local anesthetic, and antidepressant-like activities) accompanied with patch-clamp studies. Considering the importance of drug safety, its influence on the cardiovascular system was also evaluated. Moreover, KM-416 was subjected to forced degradation and pharmacokinetic studies to examine its stability and pharmacokinetic parameters. KM-416 revealed a significant antinociceptive activity in the tonic - the formalin test, neurogenic - the capsaicin test, and neuropathic pain model - streptozotocin-induced peripheral neuropathy. Moreover, it exerted a local anesthetic effect. In addition, KM-416 exhibited anti-depressant like activity. The results from the patch-clamp studies indicated that KM-416 can inhibit currents elicited by activation of NMDA receptors, while it also exhibited a voltage-dependent inhibition of Na+ currents. KM-416 did not influence ventricular depolarization and repolarization. Following oral administration, pharmacokinetics of KM-416 was characterized by a rapid absorption in the rat. The brain-to-plasma AUC ratio was 6.7, indicating that KM-416 was well distributed to brain. The forced degradation studies showed that KM-416 was very stable under stress conditions. All these features made KM-416 a promising drug candidate for further development against neuropathic pain and epilepsy.
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Affiliation(s)
- Monika Kubacka
- Department of Pharmacodynamics, Jagiellonian University Medical College, Faculty of Pharmacy, 9 Medyczna Street, 30-688, Kraków, Poland.
| | - Anna Rapacz
- Department of Pharmacodynamics, Jagiellonian University Medical College, Faculty of Pharmacy, 9 Medyczna Street, 30-688, Kraków, Poland
| | - Kinga Sałat
- Department of Pharmacodynamics, Jagiellonian University Medical College, Faculty of Pharmacy, 9 Medyczna Street, 30-688, Kraków, Poland
| | - Barbara Filipek
- Department of Pharmacodynamics, Jagiellonian University Medical College, Faculty of Pharmacy, 9 Medyczna Street, 30-688, Kraków, Poland
| | - Agnieszka Cios
- Department of Pharmacokinetics and Physical Pharmacy, Jagiellonian University Medical College, Faculty of Pharmacy, 9 Medyczna Street, 30-688, Kraków, Poland
| | - Krzysztof Pociecha
- Department of Pharmacokinetics and Physical Pharmacy, Jagiellonian University Medical College, Faculty of Pharmacy, 9 Medyczna Street, 30-688, Kraków, Poland
| | - Elżbieta Wyska
- Department of Pharmacokinetics and Physical Pharmacy, Jagiellonian University Medical College, Faculty of Pharmacy, 9 Medyczna Street, 30-688, Kraków, Poland
| | - Urszula Hubicka
- Department of Inorganic and Analytical Chemistry, Jagiellonian University Medical College, Faculty of Pharmacy, 9 Medyczna Street, 30-688, Kraków, Poland
| | - Barbara Żuromska-Witek
- Department of Inorganic and Analytical Chemistry, Jagiellonian University Medical College, Faculty of Pharmacy, 9 Medyczna Street, 30-688, Kraków, Poland
| | - Anna Kwiecień
- Department of Inorganic and Analytical Chemistry, Jagiellonian University Medical College, Faculty of Pharmacy, 9 Medyczna Street, 30-688, Kraków, Poland
| | - Henryk Marona
- Department of Bioorganic Chemistry, Jagiellonian University Medical College, Faculty of Pharmacy, 9 Medyczna Street, 30-688, Kraków, Poland
| | - Anna M Waszkielewicz
- Department of Bioorganic Chemistry, Jagiellonian University Medical College, Faculty of Pharmacy, 9 Medyczna Street, 30-688, Kraków, Poland
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8
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Le Marois M, Ballet V, Sanson C, Maizières MA, Carriot T, Chantoiseau C, Partiseti M, Bohme GA. Cannabidiol inhibits multiple cardiac ion channels and shortens ventricular action potential duration in vitro. Eur J Pharmacol 2020; 886:173542. [PMID: 32910945 DOI: 10.1016/j.ejphar.2020.173542] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 12/25/2022]
Abstract
Cannabidiol (CBD) is a non-psychoactive component of Cannabis which has recently received regulatory consideration for the treatment of intractable forms of epilepsy such as the Dravet and the Lennox-Gastaut syndromes. The mechanisms of the antiepileptic effects of CBD are unclear, but several pre-clinical studies suggest the involvement of ion channels. Therefore, we have evaluated the effects of CBD on seven major cardiac currents shaping the human ventricular action potential and on Purkinje fibers isolated from rabbit hearts to assess the in vitro cardiac safety profile of CBD. We found that CBD inhibits with comparable micromolar potencies the peak and late components of the NaV1.5 sodium current, the CaV1.2 mediated L-type calcium current, as well as all the repolarizing potassium currents examined except Kir2.1. The most sensitive channels were KV7.1 and the least sensitive were KV11.1 (hERG), which underly the slow (IKs) and rapid (IKr) components, respectively, of the cardiac delayed-rectifier current. In the Purkinje fibers, CBD decreased the action potential (AP) duration more potently at half-maximal than at near complete repolarization, and slightly decreased the AP amplitude and its maximal upstroke velocity. CBD had no significant effects on the membrane resting potential except at the highest concentration tested under fast pacing rate. These data show that CBD impacts cardiac electrophysiology and suggest that caution should be exercised when prescribing CBD to carriers of cardiac channelopathies or in conjunction with other drugs known to affect heart rhythm or contractility.
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Affiliation(s)
- Marguerite Le Marois
- High Content Biology, Integrated Drug Discovery, Sanofi-Aventis R&D, Vitry-sur-Seine, France
| | - Véronique Ballet
- Investigative Toxicology, Preclinical Safety, Sanofi-Aventis R&D, Alfortville, France
| | - Camille Sanson
- High Content Biology, Integrated Drug Discovery, Sanofi-Aventis R&D, Vitry-sur-Seine, France
| | - Magali-Anne Maizières
- High Content Biology, Integrated Drug Discovery, Sanofi-Aventis R&D, Vitry-sur-Seine, France
| | - Thierry Carriot
- Investigative Toxicology, Preclinical Safety, Sanofi-Aventis R&D, Alfortville, France
| | - Céline Chantoiseau
- Investigative Toxicology, Preclinical Safety, Sanofi-Aventis R&D, Alfortville, France
| | - Michel Partiseti
- High Content Biology, Integrated Drug Discovery, Sanofi-Aventis R&D, Vitry-sur-Seine, France
| | - Georg Andrees Bohme
- High Content Biology, Integrated Drug Discovery, Sanofi-Aventis R&D, Vitry-sur-Seine, France.
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9
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Shi M, Tien NT, de Haan L, Louisse J, Rietjens IMCM, Bouwmeester H. Evaluation of in vitro models of stem cell-derived cardiomyocytes to screen for potential cardiotoxicity of chemicals. Toxicol In Vitro 2020; 67:104891. [PMID: 32446838 DOI: 10.1016/j.tiv.2020.104891] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/14/2020] [Accepted: 05/16/2020] [Indexed: 12/12/2022]
Abstract
Cardiotoxicity is an important toxicological endpoint for chemical and drug safety assessment. The present study aims to evaluate two stemcell-based in vitro models for cardiotoxicity screening of chemicals. Eleven model compounds were used to evaluate responses of mouse embryonic stem cell-derived cardiomyocytes (mESC-CMs) using beating arrest as a readout and the analysis of electrophysiological parameters measured with a multi-electrode array (MEA) platform of human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs). Results revealed that the hiPSC-CM MEA assay responded to all compounds. The mESC-CM beating arrest assay was not responsive to potassium channel blockers and showed a lower sensitivity to sodium channel blockers and Na+/K+ ATPase inhibitors compared to the hiPSC-CM MEA assay. Calcium channel blockers and a β-adrenergic receptor agonist showed comparable potencies in both models. The in vitro response concentrations from hiPSC-CMs were highly concordant with human effective serum concentrations of potassium and sodium channel blockers. It is concluded that both in vitro models enable the cardiotoxicity screening with different applicability domains. The mESC-CM beating arrest assay may be used as a first step in a tiered approach while the hiPSC-CM MEA assay may be the best starting point for quantitative in vitro to in vivo extrapolations.
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Affiliation(s)
- Miaoying Shi
- Division of Toxicology, Wageningen University, P.O. box 8000, 6700, EA, Wageningen, the Netherlands.
| | - Nguyen T Tien
- Division of Toxicology, Wageningen University, P.O. box 8000, 6700, EA, Wageningen, the Netherlands
| | - Laura de Haan
- Division of Toxicology, Wageningen University, P.O. box 8000, 6700, EA, Wageningen, the Netherlands.
| | - Jochem Louisse
- Division of Toxicology, Wageningen University, P.O. box 8000, 6700, EA, Wageningen, the Netherlands.
| | - Ivonne M C M Rietjens
- Division of Toxicology, Wageningen University, P.O. box 8000, 6700, EA, Wageningen, the Netherlands.
| | - Hans Bouwmeester
- Division of Toxicology, Wageningen University, P.O. box 8000, 6700, EA, Wageningen, the Netherlands.
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10
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Dominant rule of community effect in synchronized beating behavior of cardiomyocyte networks. Biophys Rev 2020; 12:481-501. [PMID: 32367300 DOI: 10.1007/s12551-020-00688-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022] Open
Abstract
Exploiting the combination of latest microfabrication technologies and single cell measurement technologies, we can measure the interactions of single cells, and cell networks from "algebraic" and "geometric" perspectives under the full control of their environments and interactions. However, the experimental constructive single cell-based approach still remains the limitations regarding the quality and condition control of those cells. To overcome these limitations, mathematical modeling is one of the most powerful complementary approaches. In this review, we first explain our on-chip experimental methods for constructive approach, and we introduce the results of the "community effect" of beating cardiomyocyte networks as an example of this approach. On-chip analysis revealed that (1) synchronized interbeat intervals (IBIs) of cell networks were followed to the more stable beating cells even their IBIs were slower than the other cells, which is against the conventional faster firing regulation or "overdrive suppression," and (2) fluctuation of IBIs of cardiomyocyte networks decreased according to the increase of the number of connected cells regardless of their geometry. The mathematical simulation of this synchronous behavior of cardiomyocyte networks also fitted well with the experimental results after incorporating the fluctuation-dissipation theorem into the oscillating stochastic phase model, in which the concept of spatially arranged cardiomyocyte networks was involved. The constructive experiments and mathematical modeling indicated the dominant rule of synchronization behavior of beating cardiomyocyte networks is a kind of stability-oriented synchronization phenomenon as the "community effect" or a fluctuation-dissipation phenomenon. Finally, as a practical application of this approach, the predictive cardiotoxicity is introduced.
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11
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Watanabe K, Tsubouchi T, Yamada T, Hinoi E, Miyawaki I. Telemetered common marmosets is useful for the assessment of electrocardiogram parameters changes induced by multiple cardiac ion channel inhibitors. J Toxicol Sci 2019; 44:441-457. [PMID: 31270301 DOI: 10.2131/jts.44.441] [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] [Indexed: 11/02/2022]
Abstract
The objective of this study is to assess the response of telemetered common marmosets to multiple cardiac ion channel inhibitors and to clarify the usefulness of this animal model in evaluating the effects of drug candidates on electrocardiogram (ECG). Six multiple cardiac ion channel inhibitors (sotalol, astemizole, flecainide, quinidine, verapamil and terfenadine) were orally administered to telemetered common marmosets and changes in QTc, PR interval and QRS duration were evaluated. Drugs plasma levels were determined to compare the sensitivity in common marmosets to that in humans. QTc prolongation was observed in the marmosets dosed with sotalol, astemizole, flecainide, quinidine, verapamil and terfenadine. PR prolongation was noted after flecainide and verapamil administration, and QRS widening occurred following treatment with flecainide and quinidine. Drugs plasma levels associated with ECG changes in marmosets were similar to those in humans, except for verapamil-induced QTc prolongation. Verapamil-induced change is suggested due to body temperature decrease. These results indicate that telemetered common marmoset is a useful animal for evaluation of the ECG effects of multiple cardiac ion channel inhibitors and the influence of body temperature change should be considered in the assessment.
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Affiliation(s)
- Kenta Watanabe
- Preclinical Research Unit, Sumitomo Dainippon Pharma Co., Ltd.,Laboratory of Molecular Pharmacology, Division of Pharmaceutical Sciences, Kanazawa University Graduate School
| | | | - Toru Yamada
- Preclinical Research Unit, Sumitomo Dainippon Pharma Co., Ltd
| | - Eiichi Hinoi
- Laboratory of Molecular Pharmacology, Division of Pharmaceutical Sciences, Kanazawa University Graduate School
| | - Izuru Miyawaki
- Preclinical Research Unit, Sumitomo Dainippon Pharma Co., Ltd
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12
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Asahi Y, Hamada T, Hattori A, Matsuura K, Odaka M, Nomura F, Kaneko T, Abe Y, Takasuna K, Sanbuissho A, Yasuda K. On-chip spatiotemporal electrophysiological analysis of human stem cell derived cardiomyocytes enables quantitative assessment of proarrhythmia in drug development. Sci Rep 2018; 8:14536. [PMID: 30266924 PMCID: PMC6162288 DOI: 10.1038/s41598-018-32921-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 09/17/2018] [Indexed: 12/17/2022] Open
Abstract
We examined a simultaneous combined spatiotemporal field potential duration (FPD) and cell-to-cell conduction time (CT) in lined-up shaped human embryonic stem cell-derived cardiomyocytes (hESC-CMs) using an on-chip multielectrode array (MEA) system to evaluate two origins of lethal arrhythmia, repolarization and depolarization. The repolarization index, FPD, was prolonged by E-4031 and astemizole, and shortened by verapamil, flecainide and terfenadine at 10 times higher than therapeutic plasma concentrations of each drug, but it did not change after lidocaine treatment up to 100 μM. CT was increased by astemizol, flecainide, terfenadine, and lidocaine at equivalent concentrations of Nav1.5 IC50, suggesting that CT may be an index of cardiac depolarization because the increase in CT (i.e., decrease in cell-to-cell conduction speed) was relevant to Nav1.5 inhibition. Fluctuations (short-term variability; STV) of FPD and CT, STVFPD and STVCT also discriminated between torsadogenic and non-torsadogenic compounds with significant increases in their fluctuation values, enabling precise prediction of arrhythmogenic risk as potential new indices.
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Affiliation(s)
- Yumiko Asahi
- Medicinal Safety Research Laboratories, Kasai R&D Center, Daiichi-Sankyo Co. Ltd., Edogawa, Tokyo, 134-8630, Japan
| | - Tomoyo Hamada
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda, Tokyo, 101-0062, Japan
- Chiome Bioscience Inc. Shibuya, Tokyo, 151-0071, Japan
| | - Akihiro Hattori
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda, Tokyo, 101-0062, Japan
- Organization for University Research Initiatives, Waseda University, 3-14-9 Ookubo, Shinjuku, Tokyo, 169-0072, Japan
- Waseda Bioscience Research Institute in Singapore (WABOIS), Helios, 11 Biopolis Way, 138667, Singapore
| | - Kenji Matsuura
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda, Tokyo, 101-0062, Japan
- Organization for University Research Initiatives, Waseda University, 3-14-9 Ookubo, Shinjuku, Tokyo, 169-0072, Japan
- Waseda Bioscience Research Institute in Singapore (WABOIS), Helios, 11 Biopolis Way, 138667, Singapore
| | - Masao Odaka
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda, Tokyo, 101-0062, Japan
- Organization for University Research Initiatives, Waseda University, 3-14-9 Ookubo, Shinjuku, Tokyo, 169-0072, Japan
- Waseda Bioscience Research Institute in Singapore (WABOIS), Helios, 11 Biopolis Way, 138667, Singapore
| | - Fumimasa Nomura
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda, Tokyo, 101-0062, Japan
| | - Tomoyuki Kaneko
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda, Tokyo, 101-0062, Japan
- Department of Frontier Bioscience, Hosei Univ., Koganei, Tokyo, 184-8584, Japan
| | - Yasuyuki Abe
- Medicinal Safety Research Laboratories, Kasai R&D Center, Daiichi-Sankyo Co. Ltd., Edogawa, Tokyo, 134-8630, Japan
| | - Kiyoshi Takasuna
- Medicinal Safety Research Laboratories, Kasai R&D Center, Daiichi-Sankyo Co. Ltd., Edogawa, Tokyo, 134-8630, Japan
| | - Atsushi Sanbuissho
- Medicinal Safety Research Laboratories, Kasai R&D Center, Daiichi-Sankyo Co. Ltd., Edogawa, Tokyo, 134-8630, Japan
| | - Kenji Yasuda
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda, Tokyo, 101-0062, Japan.
- Organization for University Research Initiatives, Waseda University, 3-14-9 Ookubo, Shinjuku, Tokyo, 169-0072, Japan.
- Waseda Bioscience Research Institute in Singapore (WABOIS), Helios, 11 Biopolis Way, 138667, Singapore.
- Department of Pure and Applied Physics, Graduate School of Advanced Science and Engineering, Waseda University, 3-4-1 Okubo, Shinjuku, Tokyo, 169-8555, Japan.
- Department of Physics, School of Advanced Science and Engineering, Waseda University, 3-4-1 Okubo, Shinjuku, Tokyo, 169-8555, Japan.
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13
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Bergenholm L, Parkinson J, Mettetal J, Evans ND, Chappell MJ, Collins T. Predicting QRS and PR interval prolongations in humans using nonclinical data. Br J Pharmacol 2017; 174:3268-3283. [PMID: 28675424 DOI: 10.1111/bph.13940] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 06/04/2017] [Accepted: 06/09/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Risk of cardiac conduction slowing (QRS/PR prolongations) is assessed prior to clinical trials using in vitro and in vivo studies. Understanding the quantitative translation of these studies to the clinical situation enables improved risk assessment in the nonclinical phase. EXPERIMENTAL APPROACH Four compounds that prolong QRS and/or PR (AZD1305, flecainide, quinidine and verapamil) were characterized using in vitro (sodium/calcium channels), in vivo (guinea pigs/dogs) and clinical data. Concentration-matched translational relationships were developed based on in vitro and in vivo modelling, and the in vitro to clinical translation of AZD1305 was quantified using an in vitro model. KEY RESULTS Meaningful (10%) human QRS/PR effects correlated with low levels of in vitro Nav 1.5 block (3-7%) and Cav 1.2 binding (13-21%) for all compounds. The in vitro model developed using AZD1305 successfully predicted QRS/PR effects for the remaining drugs. Meaningful QRS/PR changes in humans correlated with small effects in guinea pigs and dogs (QRS 2.3-4.6% and PR 2.3-10%), suggesting that worst-case human effects can be predicted by assuming four times greater effects at the same concentration from dog/guinea pig data. CONCLUSION AND IMPLICATIONS Small changes in vitro and in vivo consistently translated to meaningful PR/QRS changes in humans across compounds. Assuming broad applicability of these approaches to assess cardiovascular safety risk for non-arrhythmic drugs, this study provides a means of predicting human QRS/PR effects of new drugs from effects observed in nonclinical studies.
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Affiliation(s)
- L Bergenholm
- Biomedical and Biological Systems Laboratory, School of Engineering, University of Warwick, Coventry, UK.,Drug Metabolism and Pharmacokinetics, Cardiovascular and Metabolic Diseases, Innovative Medicines and Early Development, AstraZeneca, Gothenburg, Sweden
| | - J Parkinson
- Early Clinical Development, Quantitative Clinical Pharmacology, Innovative Medicines and Early Development, AstraZeneca, Gothenburg, Sweden
| | - J Mettetal
- Safety and ADME Translational Sciences, Drug Safety and Metabolism, Innovative Medicines and Early Development, AstraZeneca, Cambridge, UK
| | - N D Evans
- Biomedical and Biological Systems Laboratory, School of Engineering, University of Warwick, Coventry, UK
| | - M J Chappell
- Biomedical and Biological Systems Laboratory, School of Engineering, University of Warwick, Coventry, UK
| | - T Collins
- Safety and ADME Translational Sciences, Drug Safety and Metabolism, Innovative Medicines and Early Development, AstraZeneca, Cambridge, UK
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14
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Abstract
Cardiac arrhythmias can follow disruption of the normal cellular electrophysiological processes underlying excitable activity and their tissue propagation as coherent wavefronts from the primary sinoatrial node pacemaker, through the atria, conducting structures and ventricular myocardium. These physiological events are driven by interacting, voltage-dependent, processes of activation, inactivation, and recovery in the ion channels present in cardiomyocyte membranes. Generation and conduction of these events are further modulated by intracellular Ca2+ homeostasis, and metabolic and structural change. This review describes experimental studies on murine models for known clinical arrhythmic conditions in which these mechanisms were modified by genetic, physiological, or pharmacological manipulation. These exemplars yielded molecular, physiological, and structural phenotypes often directly translatable to their corresponding clinical conditions, which could be investigated at the molecular, cellular, tissue, organ, and whole animal levels. Arrhythmogenesis could be explored during normal pacing activity, regular stimulation, following imposed extra-stimuli, or during progressively incremented steady pacing frequencies. Arrhythmic substrate was identified with temporal and spatial functional heterogeneities predisposing to reentrant excitation phenomena. These could arise from abnormalities in cardiac pacing function, tissue electrical connectivity, and cellular excitation and recovery. Triggering events during or following recovery from action potential excitation could thereby lead to sustained arrhythmia. These surface membrane processes were modified by alterations in cellular Ca2+ homeostasis and energetics, as well as cellular and tissue structural change. Study of murine systems thus offers major insights into both our understanding of normal cardiac activity and its propagation, and their relationship to mechanisms generating clinical arrhythmias.
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Affiliation(s)
- Christopher L-H Huang
- Physiological Laboratory and the Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
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15
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Duchêne A, Perier M, Zhao Y, Liu X, Thomasson J, Chauveau F, Piérard C, Lagarde D, Picoli C, Jeanson T, Mouthon F, Dauvilliers Y, Giaume C, Lin JS, Charvériat M. Impact of Astroglial Connexins on Modafinil Pharmacological Properties. Sleep 2016; 39:1283-92. [PMID: 27091533 DOI: 10.5665/sleep.5854] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/27/2016] [Indexed: 01/11/2023] Open
Abstract
STUDY OBJECTIVES Modafinil is a non-amphetaminic wake-promoting compound used as therapy against sleepiness and narcolepsy. Its mode of action is complex, but modafinil has been recently proposed to act as a cellular-coupling enhancer in glial cells, through modulation of gap junctions constituted by connexins. The present study investigated in mice the impact of connexins on the effects of modafinil using connexin inhibitors. METHODS Modafinil was administered alone or combined with inhibitors of astrocyte connexin, meclofenamic acid, or flecainide, respectively, acting on Cx30 and Cx43. Sleep-wake states were monitored in wild-type and narcoleptic orexin knockout mice. A spontaneous alternation task was used to evaluate working memory in wild-type mice. The effects of the compounds on astroglial intercellular coupling were determined using dye transfer in acute cortical slices. RESULTS Meclofenamic acid had little modulation on the effects of modafinil, but flecainide enhanced the wake-promoting and pro-cognitive effects of modafinil. Co-administration of modafinil/flecainide resulted in a marked decrease in the number and duration of direct transitions to rapid eye movement sleep, which are characteristic of narcoleptic episodes in orexin knockout mice. Furthermore, modafinil enhanced the connexin-mediated astroglial cell coupling, whereas flecainide reduced it. Finally, this modafinil-induced effect was reversed by co-administration with flecainide. CONCLUSIONS Our study indicates that flecainide impacts the pharmacological effects of modafinil, likely through the normalization of Cx30-dependent gap junctional coupling in astroglial networks. The enhancement of the wake-promoting, behavioral, and cognitive outcomes of modafinil demonstrated here with flecainide would open new perspectives in the management of sleep disorders such as narcolepsy. COMMENTARY A commentary on this article appears in this issue on page 1175.
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Affiliation(s)
| | - Magali Perier
- Laboratory Waking, CRNL, INSERM-U1028/CNRS-UMR5292, Claude Bernard University, Lyon Cedex, France
| | - Yan Zhao
- Laboratory Waking, CRNL, INSERM-U1028/CNRS-UMR5292, Claude Bernard University, Lyon Cedex, France
| | - Xinhe Liu
- Collège de France, Centre for Interdisciplinary Research in Biology (CIRB), Paris, France
| | - Julien Thomasson
- Institut de Recherche Biomédicale des Armées, Brétigny-sur-Orge, France
| | - Frédéric Chauveau
- Institut de Recherche Biomédicale des Armées, Brétigny-sur-Orge, France
| | | | - Didier Lagarde
- Institut de Recherche Biomédicale des Armées, Brétigny-sur-Orge, France
| | - Christèle Picoli
- Theranexus, Lyon, France.,CEA/IMETI/Theranexus, Fontenayaux-Roses, France
| | - Tiffany Jeanson
- Theranexus, Lyon, France.,Collège de France, Centre for Interdisciplinary Research in Biology (CIRB), Paris, France
| | | | - Yves Dauvilliers
- National Reference Centre for Narcolepsy, Sleep Unit, CHU Montpellier, INSERM U1061, France
| | - Christian Giaume
- Collège de France, Centre for Interdisciplinary Research in Biology (CIRB), Paris, France
| | - Jian-Sheng Lin
- Laboratory Waking, CRNL, INSERM-U1028/CNRS-UMR5292, Claude Bernard University, Lyon Cedex, France
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16
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Accardi MV, Troncy E, Abtout S, Ascah A, Maghezzi S, Authier S. Rat cardiovascular telemetry: Marginal distribution applied to positive control drugs. J Pharmacol Toxicol Methods 2016; 81:120-7. [PMID: 27039258 DOI: 10.1016/j.vascn.2016.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 03/25/2016] [Accepted: 03/27/2016] [Indexed: 11/26/2022]
Abstract
Cardiovascular effects are considered frequent during drug safety testing. This investigation aimed to characterize the pharmacological response of the conscious telemetered rat in vivo model to known cardiovascular active agents. These effects were analyzed using statistical analysis and cloud representation with marginal distribution curves for the contractility index and heart rate as to assess the effect relationship between cardiac variables. Arterial blood pressure, left ventricular pressure, electrocardiogram and body temperature were monitored. The application of data cloud with marginal distribution curves to heart rate and contractility index provided an interesting tactic during the interpretation of drug-induced changes particularly during selective time resolution (i.e. marginal distribution curves restricted to Tmax). Taken together, the present data suggests that marginal distribution curves can be a valuable interpretation strategy when using the rat cardiovascular telemetry model to detect drug-induced cardiovascular effects. Marginal distribution curves could also be considered during the interpretation of other inter-dependent parameters in safety pharmacology studies.
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Affiliation(s)
- M V Accardi
- CiToxLAB North America, 445 Armand Frappier, Laval, QC H7V 4B3, Canada
| | - E Troncy
- Faculty of Veterinary Medicine, University of Montreal, P.O. box 5000, St-Hyacinthe, QC J2S 7C6, Canada
| | - S Abtout
- CiToxLAB North America, 445 Armand Frappier, Laval, QC H7V 4B3, Canada
| | - A Ascah
- CiToxLAB North America, 445 Armand Frappier, Laval, QC H7V 4B3, Canada
| | - S Maghezzi
- CiToxLAB North America, 445 Armand Frappier, Laval, QC H7V 4B3, Canada
| | - S Authier
- CiToxLAB North America, 445 Armand Frappier, Laval, QC H7V 4B3, Canada; Faculty of Veterinary Medicine, University of Montreal, P.O. box 5000, St-Hyacinthe, QC J2S 7C6, Canada.
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17
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CSAHi study: Validation of multi-electrode array systems (MEA60/2100) for prediction of drug-induced proarrhythmia using human iPS cell-derived cardiomyocytes -assessment of inter-facility and cells lot-to-lot-variability. Regul Toxicol Pharmacol 2016; 77:75-86. [PMID: 26884090 DOI: 10.1016/j.yrtph.2016.02.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 02/01/2016] [Accepted: 02/12/2016] [Indexed: 01/22/2023]
Abstract
In vitro screening of hERG channels are recommended under ICH S7B guidelines to predict drug-induced QT prolongation and Torsade de Pointes (TdP), whereas proarrhythmia is known to be evoked by blockage of other ion channels involved in cardiac contraction and compensation mechanisms. A consortium for drug safety assessment using human iPS cells-derived cardiomyocytes (hiPS-CMs), CSAHi, has been organized to establish a novel in vitro test system that would enable better prediction of drug-induced proarrhythmia and QT prolongation. Here we report the inter-facility and cells lot-to-lot variability evaluated with FPDc (corrected field potential duration), FPDc10 (10% FPDc change concentration), beat rate and incidence of arrhythmia-like waveform or arrest on hiPS-CMs in a multi-electrode array system. Arrhythmia-like waveforms were evident for all test compounds, other than chromanol 293B, that evoked FPDc prolongation in this system and are reported to induce TdP in clinical practice. There was no apparent cells lot-to-lot variability, while inter-facility variabilities were limited within ranges from 3.9- to 20-folds for FPDc10 and about 10-folds for the minimum concentration inducing arrhythmia-like waveform or arrests. In conclusion, the new assay model reported here would enable accurate prediction of a drug potential for proarrhythmia.
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18
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Bergenholm L, Collins T, Evans ND, Chappell MJ, Parkinson J. PKPD modelling of PR and QRS intervals in conscious dogs using standard safety pharmacology data. J Pharmacol Toxicol Methods 2016; 79:34-44. [PMID: 26780675 DOI: 10.1016/j.vascn.2016.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 12/23/2015] [Accepted: 01/07/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Pharmacokinetic-pharmacodynamic (PKPD) modelling can improve safety assessment, but few PKPD models describing drug-induced QRS and PR prolongations have been published. This investigation aims to develop and evaluate PKPD models for describing QRS and PR effects in routine safety studies. METHODS Exposure and telemetry data from safety pharmacology studies in conscious beagle dogs were acquired. Mixed effects baseline and PK-QRS/PR models were developed for the anti-arrhythmic compounds AZD1305, flecainide, quinidine and verapamil and the anti-muscarinic compounds AZD8683 and AZD9164. RR interval correction and circadian rhythms were investigated for predicting baseline variability. Individual PK predictions were used to drive the pharmacological effects evaluating linear and non-linear direct and effect compartment models. RESULTS Conduction slowing induced by the tested anti-arrhythmics was direct and proportional at low exposures, whilst time delays and non-linear effects were evident for the tested anti-muscarinics. AZD1305, flecainide and quinidine induced QRS widening with 4.2, 10 and 5.6% μM(-1) unbound drug. AZD1305 and flecainide also prolonged PR with 13.5 and 11.5% μM(-1). PR prolongations induced by the anti-muscarinics and verapamil were best described by Emax models with maximal effects ranging from 55 to 95%. RR interval correction and circadian rhythm improved PR but not QRS modelling. However, circadian rhythm had minor impact on estimated drug effects. DISCUSSION Baseline and drug-induced effects on QRS and PR intervals can be effectively described with PKPD models using routine data, providing quantitative safety information to support drug discovery and development.
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Affiliation(s)
- Linnéa Bergenholm
- Biomedical & Biological Systems Laboratory, School of Engineering, University of Warwick, Coventry, UK
| | - Teresa Collins
- Translational Safety, Drug Safety and Metabolism, iMED, AstraZeneca, Cambridge, UK
| | - Neil D Evans
- Biomedical & Biological Systems Laboratory, School of Engineering, University of Warwick, Coventry, UK
| | - Michael J Chappell
- Biomedical & Biological Systems Laboratory, School of Engineering, University of Warwick, Coventry, UK
| | - Joanna Parkinson
- Early Clinical Development, Quantitative Clinical Pharmacology, iMED, AstraZeneca, Mölndal, Sweden
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19
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Kremer JJ, Bills AJ, Hanke NJ, Chen H, Meier WA, Osinski MA, Foley CM. Evaluation of cardiovascular changes in dogs administered three positive controls using jacketed external telemetry-blood pressure (JET-BP). J Pharmacol Toxicol Methods 2015; 75:27-37. [DOI: 10.1016/j.vascn.2015.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 05/14/2015] [Accepted: 05/14/2015] [Indexed: 12/17/2022]
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20
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Curran J, Louch WE. Linking ryanodine receptor Ca(2+) leak and Na(+) current in heart: a day in the life of flecainide. Acta Physiol (Oxf) 2015; 214:300-2. [PMID: 25976700 DOI: 10.1111/apha.12526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J. Curran
- Department of Physiology and Cell Biology; Dorothy M. Davis Heart and Lung Research Institute; The Ohio State University Wexner Medical Center; Columbus OH USA
| | - W. E. Louch
- Institute for Experimental Medical Research; Oslo University Hospital; University of Oslo; Oslo Norway
- K.G. Jebsen Cardiac Research Center and Center for Heart Failure Research; University of Oslo; Oslo Norway
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21
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Gintant G. In Vitro Early Safety Pharmacology Screening: Perspectives Related to Cardiovascular Safety. Handb Exp Pharmacol 2015; 229:47-64. [PMID: 26091635 DOI: 10.1007/978-3-662-46943-9_2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In vitro screening for cardiovascular safety liabilities of novel drug candidates presents a challenge for the pharmaceutical industry. Such approaches rely on detecting pharmacologic effects on key components of complex integrated system early in drug discovery to define potential safety liabilities. Key to such studies are the concepts of hazard identification vs. risk assessment, drug specificity vs. selectivity, and an appreciation of the challenges faced when attempting to translate in vitro findings to preclinical in vivo as well as clinical effects. This chapter defines some key aspects of early safety pharmacology screening for cardiovascular liabilities, citing studies of two key depolarizing cardiac currents (fast sodium current and L-type calcium current) as examples linked to effects on cardiac conduction and repolarization.
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22
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Gintant G. Cardiac Sodium Current (Na v1.5). METHODS AND PRINCIPLES IN MEDICINAL CHEMISTRY 2015. [DOI: 10.1002/9783527673643.ch12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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23
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Deletion of PDK1 causes cardiac sodium current reduction in mice. PLoS One 2015; 10:e0122436. [PMID: 25781322 PMCID: PMC4363661 DOI: 10.1371/journal.pone.0122436] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 02/14/2015] [Indexed: 01/01/2023] Open
Abstract
Background The AGC protein kinase family regulates multiple cellular functions. 3-phosphoinositide-dependent protein kinase-1 (PDK1) is involved in the pathogenesis of arrhythmia, and its downstream factor, Forkhead box O1 (Foxo1), negatively regulates the expression of the cardiac sodium channel, Nav1.5. Mice are known to die suddenly after PDK1 deletion within 11 weeks, but the underlying electrophysiological bases are unclear. Thus, the aim of this study was to investigate the potential mechanisms between PDK1 signaling pathway and cardiac sodium current. Methods and Results Using patch clamp and western blotting techniques, we investigated the role of the PDK1-Foxo1 pathway in PDK1 knockout mice and cultured cardiomyocytes. We found that PDK1 knockout mice undergo slower heart rate, prolonged QRS and QTc intervals and abnormal conduction within the first few weeks of birth. Furthermore, the peak sodium current is decreased by 33% in cells lacking PDK1. The phosphorylation of Akt (308T) and Foxo1 (24T) and the expression of Nav1.5 in the myocardium of PDK1-knockout mice are decreased, while the nuclear localization of Foxo1 is increased. The role of the PDK1-Foxo1 pathway in regulating Nav1.5 levels and sodium current density was verified using selective PDK1, Akt and Foxo1 inhibitors and isolated neonatal rat cardiomyocytes. Conclusion These results indicate that PDK1 participates in the dysregulation of electrophysiological basis by regulating the PDK1-Foxo1 pathway, which in turn regulates the expression of Nav1.5 and cardiac sodium channel function.
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Chen H, Chan JYW, Li S, Liu JJ, Wyman IW, Lee SMY, Macartney DH, Wang R. In vivo reversal of general anesthesia by cucurbit[7]uril with zebrafish models. RSC Adv 2015. [DOI: 10.1039/c5ra09406b] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We demonstrate for the first time that cucurbit[7]uril effectively reversed general anesthesia induced by tricaine in zebrafish models.
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Affiliation(s)
- Huanxian Chen
- State Key Laboratory of Quality Research in Chinese Medicine
- Institute of Chinese Medical Sciences
- University of Macau
- Taipa
- China
| | - Judy Y. W. Chan
- State Key Laboratory of Quality Research in Chinese Medicine
- Institute of Chinese Medical Sciences
- University of Macau
- Taipa
- China
| | - Shengke Li
- State Key Laboratory of Quality Research in Chinese Medicine
- Institute of Chinese Medical Sciences
- University of Macau
- Taipa
- China
| | | | - Ian W. Wyman
- Department of Chemistry
- Queen's University
- Kingston
- Canada
| | - Simon M. Y. Lee
- State Key Laboratory of Quality Research in Chinese Medicine
- Institute of Chinese Medical Sciences
- University of Macau
- Taipa
- China
| | | | - Ruibing Wang
- State Key Laboratory of Quality Research in Chinese Medicine
- Institute of Chinese Medical Sciences
- University of Macau
- Taipa
- China
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Sällström J, Al-Saffar A, Pehrson R. Pharmacokinetic–pharmacodynamic modeling of QRS-prolongation by flecainide: Heart rate-dependent effects during sinus rhythm in conscious telemetered dogs. J Pharmacol Toxicol Methods 2014; 69:24-9. [DOI: 10.1016/j.vascn.2013.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 09/12/2013] [Accepted: 10/08/2013] [Indexed: 11/27/2022]
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Abstract
Late I Na is an integral part of the sodium current, which persists long after the fast-inactivating component. The magnitude of the late I Na is relatively small in all species and in all types of cardiomyocytes as compared with the amplitude of the fast sodium current, but it contributes significantly to the shape and duration of the action potential. This late component had been shown to increase in several acquired or congenital conditions, including hypoxia, oxidative stress, and heart failure, or due to mutations in SCN5A, which encodes the α-subunit of the sodium channel, as well as in channel-interacting proteins, including multiple β subunits and anchoring proteins. Patients with enhanced late I Na exhibit the type-3 long QT syndrome (LQT3) characterized by high propensity for the life-threatening ventricular arrhythmias, such as Torsade de Pointes (TdP), as well as for atrial fibrillation. There are several distinct mechanisms of arrhythmogenesis due to abnormal late I Na, including abnormal automaticity, early and delayed after depolarization-induced triggered activity, and dramatic increase of ventricular dispersion of repolarization. Many local anesthetic and antiarrhythmic agents have a higher potency to block late I Na as compared with fast I Na. Several novel compounds, including ranolazine, GS-458967, and F15845, appear to be the most selective inhibitors of cardiac late I Na reported to date. Selective inhibition of late I Na is expected to be an effective strategy for correcting these acquired and congenital channelopathies.
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Chain ASY, Sturkenboom MCJM, Danhof M, Della Pasqua OE. Establishing in vitro to clinical correlations in the evaluation of cardiovascular safety pharmacology. DRUG DISCOVERY TODAY. TECHNOLOGIES 2013; 10:e373-e383. [PMID: 24050134 DOI: 10.1016/j.ddtec.2012.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Preclinical studies are vital in establishing the efficacy and safety of a new chemical entity (NCE) in humans. To deliver meaningful information, experiments have to be well defined and provide outcome that is relevant and translatable to humans. This review briefly surveys the various preclinical experiments that are frequently conducted to assess drug effects on cardiac conductivity in early drug development. We examine the different approaches used to establish correlations between non-clinical and clinical settings and discuss their value in the evaluation of cardiovascular risk.
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Morissette P, Nishida M, Trepakova E, Imredy J, Lagrutta A, Chaves A, Hoagland K, Hoe CML, Zrada MM, Travis JJ, Zingaro GJ, Gerenser P, Friedrichs G, Salata JJ. The anesthetized guinea pig: An effective early cardiovascular derisking and lead optimization model. J Pharmacol Toxicol Methods 2013; 68:137-49. [DOI: 10.1016/j.vascn.2013.04.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 04/19/2013] [Accepted: 04/27/2013] [Indexed: 10/26/2022]
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Harris K, Aylott M, Cui Y, Louttit JB, McMahon NC, Sridhar A. Comparison of Electrophysiological Data From Human-Induced Pluripotent Stem Cell–Derived Cardiomyocytes to Functional Preclinical Safety Assays. Toxicol Sci 2013; 134:412-26. [DOI: 10.1093/toxsci/kft113] [Citation(s) in RCA: 177] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Reducing safety-related drug attrition: the use of in vitro pharmacological profiling. Nat Rev Drug Discov 2012. [DOI: 10.1038/nrd3845] [Citation(s) in RCA: 470] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Cros C, Skinner M, Moors J, Lainee P, Valentin JP. Detecting drug-induced prolongation of the QRS complex: new insights for cardiac safety assessment. Toxicol Appl Pharmacol 2012; 265:200-8. [PMID: 23073507 DOI: 10.1016/j.taap.2012.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 09/14/2012] [Accepted: 10/03/2012] [Indexed: 01/17/2023]
Abstract
BACKGROUND Drugs slowing the conduction of the cardiac action potential and prolonging QRS complex duration by blocking the sodium current (I(Na)) may carry pro-arrhythmic risks. Due to the frequency-dependent block of I(Na), this study assesses whether activity-related spontaneous increases in heart rate (HR) occurring during standard dog telemetry studies can be used to optimise the detection of class I antiarrhythmic-induced QRS prolongation. METHODS Telemetered dogs were orally dosed with quinidine (class Ia), mexiletine (class Ib) or flecainide (class Ic). QRS duration was determined standardly (5 beats averaged at rest) but also prior to and at the plateau of each acute increase in HR (3 beats averaged at steady state), and averaged over 1h period from 1h pre-dose to 5h post-dose. RESULTS Compared to time-matched vehicle, at rest, only quinidine and flecainide induced increases in QRS duration (E(max) 13% and 20% respectively, P<0.01-0.001) whereas mexiletine had no effect. Importantly, the increase in QRS duration was enhanced at peak HR with an additional effect of +0.7 ± 0.5 ms (quinidine, NS), +1.8 ± 0.8 ms (mexiletine, P<0.05) and +2.8 ± 0.8 ms (flecainide, P<0.01) (calculated as QRS at basal HR-QRS at high HR). CONCLUSION Electrocardiogram recordings during elevated HR, not considered during routine analysis optimised for detecting QT prolongation, can be used to sensitise the detection of QRS prolongation. This could prove useful when borderline QRS effects are detected. Analysing during acute increases in HR could also be useful for detecting drug-induced effects on other aspects of cardiac function.
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Affiliation(s)
- C Cros
- Safety Pharmacology, Global Safety Assessment, Safety Assessment UK, AstraZeneca R&D, Alderley Park, Macclesfield, SK10 4TG, UK.
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Marks L, Borland S, Philp K, Ewart L, Lainée P, Skinner M, Kirk S, Valentin JP. The role of the anaesthetised guinea-pig in the preclinical cardiac safety evaluation of drug candidate compounds. Toxicol Appl Pharmacol 2012; 263:171-83. [DOI: 10.1016/j.taap.2012.06.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 06/07/2012] [Accepted: 06/11/2012] [Indexed: 11/30/2022]
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Erdemli G, Kim AM, Ju H, Springer C, Penland RC, Hoffmann PK. Cardiac Safety Implications of hNav1.5 Blockade and a Framework for Pre-Clinical Evaluation. Front Pharmacol 2012; 3:6. [PMID: 22303294 PMCID: PMC3266668 DOI: 10.3389/fphar.2012.00006] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 01/12/2012] [Indexed: 12/17/2022] Open
Abstract
The human cardiac sodium channel (hNav1.5, encoded by the SCN5A gene) is critical for action potential generation and propagation in the heart. Drug-induced sodium channel inhibition decreases the rate of cardiomyocyte depolarization and consequently conduction velocity and can have serious implications for cardiac safety. Genetic mutations in hNav1.5 have also been linked to a number of cardiac diseases. Therefore, off-target hNav1.5 inhibition may be considered a risk marker for a drug candidate. Given the potential safety implications for patients and the costs of late stage drug development, detection, and mitigation of hNav1.5 liabilities early in drug discovery and development becomes important. In this review, we describe a pre-clinical strategy to identify hNav1.5 liabilities that incorporates in vitro, in vivo, and in silico techniques and the application of this information in the integrated risk assessment at different stages of drug discovery and development.
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Affiliation(s)
- Gül Erdemli
- Center for Proteomic Chemistry, Novartis Institutes for Biomedical Research Cambridge, MA, USA
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Gintant GA, Gallacher DJ, Pugsley MK. The 'overly-sensitive' heart: sodium channel block and QRS interval prolongation. Br J Pharmacol 2011; 164:254-9. [PMID: 21488862 PMCID: PMC3174406 DOI: 10.1111/j.1476-5381.2011.01433.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 04/06/2011] [Indexed: 11/30/2022] Open
Abstract
UNLABELLED Cardiac safety remains of paramount importance in the development of successful clinical drug candidates. Great progress has been made recently in understanding liabilities associated with delayed ventricular repolarization (manifest as QT prolongation) and in predicting (thus avoiding) drugs that delay repolarization based on application of strategic preclinical assays. Following the advances made in clinical electrophysiological monitoring and conduct of thorough QT studies, focus is now shifting towards monitoring of additional drug-induced effects, particularly on ventricular conduction (measured as changes in the QRS interval on the ECG) as part of evolving clinical thorough ECG studies. In this issue of the British Journal of Pharmacology, a study by Harmer et al. proposes provisional safety margins for QRS prolongation in man based on retrospective clinical data and a single in vitro approach to assess potency of block of cardiac sodium current (hNav1.5), the ionic current responsible for ventricular conduction (observed as QRS prolongation). The present commentary places their study in context with evolving preclinical cardiac electrophysiological safety assessments, along with discussions focused on ensuring the proper 'translation' of preclinical findings with potential clinical concerns. Given the extant limitations and uncertainties of presently available data, as well as our limited understanding of the pro-arrhythmic potential associated with these changes, due caution should be applied when considering the proposed in vitro-based margins for drug-induced QRS prolongation measured clinically. Additional validation with multiple preclinical models and more rigorous clinical safety studies will be necessary to substantiate these recommended margins. LINKED ARTICLE This article is a commentary on Harmer et al., pp. 260-273 of this issue. To view this paper visit http://dx.doi.org/10.1111/j.1476-5381.2011.01415.x.
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Affiliation(s)
- Gary A Gintant
- Department of Integrative Pharmacology, Abbott LaboratoriesAbbott Park, IL, USA
| | - David J Gallacher
- Center of Excellence for Cardiovascular Safety Research and Mechanistic Pharmacology, Janssen Pharmaceutical Companies of Johnson & JohnsonBeerse, Belgium
| | - Michael K Pugsley
- Department of Toxicology & Pathology, Johnson & Johnson Pharmaceutical Research & DevelopmentRaritan, NJ, USA
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