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Limoncella S, Lazzaretti C, Paradiso E, D'Alessandro S, Barbagallo F, Pacifico S, Guerrini R, Tagliavini S, Trenti T, Santi D, Simoni M, Sola M, Di Rocco G, Casarini L. Phosphodiesterase (PDE) 5 inhibitors sildenafil, tadalafil and vardenafil impact cAMP-specific PDE8 isoforms-linked second messengers and steroid production in a mouse Leydig tumor cell line. Mol Cell Endocrinol 2022; 542:111527. [PMID: 34875337 DOI: 10.1016/j.mce.2021.111527] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/26/2021] [Accepted: 12/01/2021] [Indexed: 11/20/2022]
Abstract
Type 5 phosphodiesterase (PDE5) blockade by inhibitors (PDE5i) results in intracellular cyclic guanosine monophosphate (cGMP) increase and smooth muscle relaxation and are used for the treatment of men erectile dysfunction. Although they have high specificity for PDE5, these inhibitors are suspected to cross-interact also with cyclic adenosine monophosphate (cAMP)-specific PDEs, inducing the intracellular accumulation of this cyclic nucleotide and related testosterone increase, positively impacting male reproductive parameters. However, the link between the use of PDE5i and the activation of cAMP-mediated steroidogenesis is still unclear. We have investigated whether three PDE5i, sildenafil, tadalafil and vardenafil, cross-interacts with the high affinity cAMP-specific enzymes type 8A and 8B PDEs (PDE8A and PDE8B), in live, transfected mouse Leydig tumor (mLTC1) and human embryonic kidney (HEK293) cell lines in vitro. The PDE5i-induced production of cAMP-dependent testosterone and its precursor progesterone was evaluated as well. We have developed PDE8A/B biosensors and modified cyclic nucleotides confirming enzyme binding to cAMP, but not to cGMP, in our cell models. cAMP binding to PDE8A/B was displaced upon cell treatment with PDE5i, revealing that sildenafil, tadalafil and vardenafil have similar effectiveness in live cells, in vitro. The cross-interaction between PDE5i and PDE8A/B supports the gonadotropin-enhanced intracellular cAMP increase, occurring together with cGMP increase, as well as steroid synthesis. Indeed, we found that Leydig cell treatment by PDE5i increases progesterone and testosterone production triggered by gonadotropins. We demonstrated that PDE5i may interact with the cAMP-specific PDE8A and PDE8B, possibly inducing intracellular cAMP and sex steroid hormone increase. These findings support clinical data suggesting that PDE5i might increase testosterone levels in men.
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Affiliation(s)
- Silvia Limoncella
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Clara Lazzaretti
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; International PhD School in Clinical and Experimental Medicine (CEM), University of Modena and Reggio Emilia, Modena, Italy
| | - Elia Paradiso
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; International PhD School in Clinical and Experimental Medicine (CEM), University of Modena and Reggio Emilia, Modena, Italy
| | - Sara D'Alessandro
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; International PhD School in Clinical and Experimental Medicine (CEM), University of Modena and Reggio Emilia, Modena, Italy
| | | | - Salvatore Pacifico
- Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara, Ferrara, Italy
| | - Remo Guerrini
- Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara, Ferrara, Italy
| | - Simonetta Tagliavini
- Department of Laboratory Medicine and Pathological Anatomy, Azienda USL of Modena, Modena, Italy
| | - Tommaso Trenti
- Department of Laboratory Medicine and Pathological Anatomy, Azienda USL of Modena, Modena, Italy
| | - Daniele Santi
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Manuela Simoni
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy; Center for Genomic Research, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Sola
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulia Di Rocco
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy.
| | - Livio Casarini
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Center for Genomic Research, University of Modena and Reggio Emilia, Modena, Italy
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Sansone A, Mollaioli D, Limoncin E, Ciocca G, Bắc NH, Cao TN, Hou G, Yuan J, Zitzmann M, Giraldi A, Jannini EA. The Sexual Long COVID (SLC): Erectile Dysfunction as a Biomarker of Systemic Complications for COVID-19 Long Haulers. Sex Med Rev 2021; 10:271-285. [PMID: 34933829 PMCID: PMC8604714 DOI: 10.1016/j.sxmr.2021.11.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/30/2021] [Accepted: 11/09/2021] [Indexed: 02/08/2023]
Abstract
Introduction Long term complications of COVID-19, the disease caused by the SARS-CoV-2, involve many organ systems, dramatically worsening the quality of life, and finally contributing to impaired physical functioning. Despite the presence of well-identified pathogenetic mechanisms, the effect of “Long COVID” on sexual health has been only marginally addressed. Objectives To provide coverage of the current literature on long COVID, its epidemiology, pathophysiology, and relevance for erectile function. Methods. Comprehensive review of literature pertaining to the epidemiology and pathophysiology of long COVID, and its relevance for erectile function. Results Symptoms of long COVID are highly prevalent and involve almost all systems of the human body, with a plethora of clinical manifestations which range from minor nuisances to life-threatening conditions. “Brain fog” and fatigue are the most common complaints, although other neuropsychiatric complications, including sensory dysfunctions, anxiety, depression, and cerebrovascular events have also been reported. The respiratory and cardiovascular systems are also affected, with dyspnea, pulmonary fibrosis, endothelial dysfunction, and myocarditis occurring in some COVID long haulers. A subset of patients might develop endocrine manifestations, including onset of diabetes, thyroid dysfunction, and hypogonadism. Overall, long COVID features many complications which can impair erectile function by multiple pathogenetic mechanisms, and which could require tailored treatment: (i) careful investigation and management from the sexual medicine expert are therefore much needed, (ii) and future research on this topic is warranted. Conclusion in COVID-19 long haulers, several complications can adversely affect erectile function which, upon future tailored studies, could be used as biomarker for the severity of the long COVID disease and for its follow-up. Sansone A, Mollaioli D, Limoncin E et al. The Sexual Long COVID (SLC): Erectile Dysfunction as a Biomarker of Systemic Complications for COVID-19 Long Haulers. Sex Med Rev 2022;10:271–285.
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Affiliation(s)
- Andrea Sansone
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Daniele Mollaioli
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Erika Limoncin
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giacomo Ciocca
- Department of Dynamic and Clinical Psychology, and Health Studies, "Sapienza" University of Rome, Rome, Italy
| | - Nguyễn Hoài Bắc
- Department of Andrology and Sexual Medicine, Hanoi Medical University's Hospital, Hanoi, Vietnam
| | - Thắng Nguyễn Cao
- Department of Andrology and Sexual Medicine, Hanoi Medical University's Hospital, Hanoi, Vietnam
| | - Guangdong Hou
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jianlin Yuan
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Michael Zitzmann
- Center of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, Münster, Germany
| | - Annamaria Giraldi
- Sexological Clinic, Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark; Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Emmanuele A Jannini
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
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Prostacyclin Analogues Inhibit Platelet Reactivity, Extracellular Vesicle Release and Thrombus Formation in Patients with Pulmonary Arterial Hypertension. J Clin Med 2021; 10:jcm10051024. [PMID: 33801460 PMCID: PMC7958838 DOI: 10.3390/jcm10051024] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/12/2021] [Accepted: 02/19/2021] [Indexed: 12/13/2022] Open
Abstract
(1) Background: Prostacyclin analogues (epoprostenol, treprostinil, and iloprost) induce vasodilation in pulmonary arterial hypertension (PAH) but also inhibit platelet function. (2) Objectives: We assessed platelet function in PAH patients treated with prostacyclin analogues and not receiving prostacyclin analogues. (3) Methods: Venous blood was collected from 42 patients treated with prostacyclin analogues (49.5 ± 15.9 years, 81% female) and 38 patients not receiving prostacyclin analogues (55.5 ± 15.6 years, 74% female). Platelet reactivity was analyzed by impedance aggregometry using arachidonic acid (AA; 0.5 mM), adenosine diphosphate (ADP; 6.5 µM), and thrombin receptor-activating peptide (TRAP; 32 µM) as agonists. In a subset of patients, concentrations of extracellular vesicles (EVs) from all platelets (CD61+), activated platelets (CD61+/CD62P+), leukocytes (CD45+), and endothelial cells (CD146+) were analyzed by flow cytometry. Platelet-rich thrombus formation was measured using a whole blood perfusion system. (4) Results: Compared to controls, PAH patients treated with prostacyclin analogues had lower platelet reactivity in response to AA and ADP (p = 0.01 for both), lower concentrations of platelet and leukocyte EVs (p ≤ 0.04), delayed thrombus formation (p ≤ 0.003), and decreased thrombus size (p = 0.008). Epoprostenol did not affect platelet reactivity but decreased the concentrations of platelet and leukocyte EVs (p ≤ 0.04). Treprostinil decreased platelet reactivity in response to AA and ADP (p ≤ 0.02) but had no effect on the concentrations of EVs. All prostacyclin analogues delayed thrombus formation and decreased thrombus size (p ≤ 0.04). (5) Conclusions: PAH patients treated with prostacyclin analogues had impaired platelet reactivity, EV release, and thrombus formation, compared to patients not receiving prostacyclin analogues.
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Effects of phosphodiesterase type 5 inhibitors on choroid and ocular vasculature: a literature review. Int J Retina Vitreous 2020; 6:38. [PMID: 32782824 PMCID: PMC7412824 DOI: 10.1186/s40942-020-00241-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/29/2020] [Indexed: 11/10/2022] Open
Abstract
To provide information on the effects of phosphodiesterase type 5 (PDE5) inhibitors on choroidal vessels and central serous chorioretinopathy (CSC) and possible implications for development of exudative age-related macular degeneration (AMD). Two independent investigators conducted a qualitative review of PubMed to identify studies on the choroidal effect of PDE5 inhibitors in June 2019. The search used key words that included PDE5 inhibitors, sildenafil, tadalafil, vardenafil, choroid, choroidal flow, choroidal vessels, choroidal thickness, CSC, AMD or a combination. Only studies which assessed choroidal findings were included. Many ocular diseases are related to changes in choroidal thickness and perfusion. Patients with AMD, who have decreased choroidal perfusion, may manifest more severely diminished choroidal ability to deliver oxygen and other metabolites to the retina, leading to growth of neovascular tissue. As a result of this engorgement of the choroidal vasculature, some patients may have leakage across the retinal pigment epithelium (RPE) and accumulation of subretinal fluid, resulting in CSC. Transient visual symptoms, i.e., changes in color perception and increased light sensitivity, are well-known adverse effects, but there have been rare reports of vision-threatening ocular complications in users of PDE5 inhibitors, such as nonarteritic anterior ischemic optic neuropathy and cilioretinal artery occlusion. The choroid is a vascular tissue analogous in many respects to the corpus cavernosum, and PDE5 inhibitors may increase the choroidal thickness and perfusion. While it is intuitively obvious that thickness of the choroid alone does not guarantee better choriocapillaris oxygenation, it is a reasonable step towards ameliorating ischemia. These drugs have numerous physiologic effects on the choroid related to blood flow, such as clinical consequences in CSC and AMD.
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Palla AH, Sibhat GG, Karim A, Rehman NU, Hiben MG. Multiple Pathway-Mediated Gut-Modulatory Effects of Maerua subcordata (Gilg) DeWolf. J Exp Pharmacol 2020; 12:203-211. [PMID: 32765124 PMCID: PMC7368589 DOI: 10.2147/jep.s254818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/01/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Gastrointestinal disorders are often poorly managed, especially in developing countries, where there are limited resources and therapeutic options. Despite the rich diversity of medicinal plants that offer effective treatment options with fewer side effects, studies that provide scientific verification are lacking. Maerua subcordata (Gilg) DeWolf is among the plants claimed to have wide traditional medicine, use, including as a remedy against gastrointestinal problems. Therefore, this work aimed to evaluate the gut-modulatory effects of a crude leaf extract of M. subcordata (MSL.Cr), as well as its possible mechanism of action. METHODS A castor oil (10 mL/kg)-induced diarrheal mouse model was used to evaluate the antidiarrheal effect of MSL.Cr, and the spasmodic/antispasmodic effect of the extract was assessed using isolated rabbit jejunum with and without addition of standard cholinergic agonists/antagonists to predict the possible mechanism of action. RESULTS MSL.Cr exhibited 40% and 80% protection against castor oil-induced diarrhea in mice at doses of 500 and 1,000 mg/kg, respectively. In isolated rabbit jejunum, the extract increased spontaneous contractions at low doses (0.01-0.1 mg/mL), and was sensitive to atropine, whereas it showed complete inhibition at higher doses (0.3-1 mg/mL). It was shown that the relaxant effect was possibly mediated by the involvement of phosphodiesterase-enzyme inhibition and K+-channel activation. The extract potentiated the control concentration-response curve of carbachol, shifting it to the left, similarly to the control drug papaverine. The potassium-channel opening-like activity of MSL.Cr was possibly mediated by the involvement of aspecific K+-channels inhibition, since tetraethylammonium, anunselective antagonist of K+ channels, significantly reversed its inhibitory effect. CONCLUSION This study showed that the M. subcordata leaf extract demonstrated gut-modulatory effects, possibly mediated by a combination of muscarinic-receptor stimulation, phosphodiesterase inhibition, and aspecific K+-channel activation.
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Affiliation(s)
- Amber Hanif Palla
- Department of Basic Medical Sciences, Faculty of Pharmacy, Barrett Hodgson University, Karachi, Pakistan
| | | | - Aman Karim
- Department of Pharmacognosy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Najeeb Ur Rehman
- Department of Pharmacology and Toxicology, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj11942, Saudi Arabia
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Nelson KJ, Antiquera P, Nelson JS, Kelly KM, Abi-Jaoudeh N. Effect of long-term phosphodiesterase-5 inhibitor use on refractory lymphatic malformations in adult and teen patients. J Vasc Surg Venous Lymphat Disord 2020; 9:258-261. [PMID: 32305583 DOI: 10.1016/j.jvsv.2020.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 04/02/2020] [Indexed: 12/01/2022]
Abstract
Lymphatic malformations (LMs) are rare congenital anomalies. LMs are often refractory to standard treatments, including surgical resection, debulking, and sclerotherapy. Use of sildenafil, a phosphodiesterase-5 inhibitor, for treatment of pediatric LMs has been reported with demonstrated benefit to some patients. This case series reports treatment of three patients (aged 14-37 years) suffering from complicated or refractory LMs with a low-dose oral phosphodiesterase-5 inhibitor, resulting in significant clinical improvement.
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Affiliation(s)
- Kari J Nelson
- Department of Radiological Sciences, University of California Irvine, Orange, Calif.
| | - Pamela Antiquera
- Department of Radiological Sciences, University of California Irvine, Orange, Calif
| | - J Stuart Nelson
- Department of Surgery and Biomedical Engineering, University of California Irvine, Orange, Calif
| | - Kristen M Kelly
- Department of Dermatology, University of California Irvine, Orange, Calif
| | - Nadine Abi-Jaoudeh
- Department of Radiological Sciences, University of California Irvine, Orange, Calif
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Achiron A, Hecht I, Juza C, Barak A, Burgansky-Eliash Z. The effect of sildenafil on retinal blood velocity in healthy subjects. EYE AND VISION 2018; 5:30. [PMID: 30534576 PMCID: PMC6280412 DOI: 10.1186/s40662-018-0125-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 11/20/2018] [Indexed: 01/18/2023]
Abstract
Purpose It has been suggested that Sildenafil may have beneficial therapeutic effects in the treatment of neurodegenerative disorders. The retinal circulation is of significant interest as a marker of cerebral vascular disease since the retinal and cerebral vasculatures share many morphological and physiological properties, yet only the retinal circulation can be directly visualized. Therefore, our aim was to assess the change induced by Sildenafil on retinal blood velocity. Methods Retinal flow velocity was measured 0.5, 3 and 6 h following administration of 100 mg of Sildenafil using the Retinal Function Imager. Results No clinical change in either systemic blood pressure or retinal flow velocities were observed. However, when controlling for heart rate and blood pressure, a significant drop in venous flow velocity 6 h following treatment (mean drop 0.3 ± 0.07; 95% CI: 0.44–0.56, P = 0.023) was revealed. Conclusions In healthy volunteers, retinal venous flow velocity was significantly reduced at the 6-h time point following Sildenafil treatment. No effect was observed on arterial retinal flow velocity.
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Affiliation(s)
- Asaf Achiron
- 1Department of Ophthalmology, Edith Wolfson Medical Center, 62 Halochamim St, 58100 Holon, Israel.,2Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idan Hecht
- 1Department of Ophthalmology, Edith Wolfson Medical Center, 62 Halochamim St, 58100 Holon, Israel.,2Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chen Juza
- 2Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,3Department of Urology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Adiel Barak
- 2Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,4Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Zvia Burgansky-Eliash
- 1Department of Ophthalmology, Edith Wolfson Medical Center, 62 Halochamim St, 58100 Holon, Israel.,2Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Khouri C, Lepelley M, Roustit M, Montastruc F, Humbert M, Cracowski JL. Comparative Safety of Drugs Targeting the Nitric Oxide Pathway in Pulmonary Hypertension: A Mixed Approach Combining a Meta-Analysis of Clinical Trials and a Disproportionality Analysis From the World Health Organization Pharmacovigilance Database. Chest 2017; 154:136-147. [PMID: 29275134 DOI: 10.1016/j.chest.2017.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 11/16/2017] [Accepted: 12/06/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Recent guidelines recommend riociguat, a soluble guanylate cyclase (sGC) stimulator, and the type 5 phosphodiesterase inhibitor (PDE5i) tadalafil or sildenafil as treatments for pulmonary arterial hypertension. We compared the safety profiles of sildenafil, tadalafil, and riociguat in pulmonary hypertension. METHODS We combined two approaches. First, we performed a meta-analysis of safety data extracted from randomized controlled trials. Second, we conducted a disproportionality analysis of data from VigiBase, the World Health Organization's global database of individual case safety reports, to compare the safety profiles with real-life data. RESULTS In the meta-analysis, a significant difference between the three drugs was only detected for gastrointestinal disorders, in disfavor of riociguat (P < .01 for interaction). In the disproportionality analysis, the use of riociguat was associated with fewer reports of visual disorders but increased reporting of gastrointestinal, hemorrhagic, and musculoskeletal disorders compared with sildenafil and tadalafil. Pharmacovigilance signals of hearing/vestibular disorders were heterogeneous: vestibular disorders (dizziness) were reported more frequently for riociguat, whereas hearing disorders (deafness) were reported less frequently compared with PDE5is. CONCLUSIONS The safety profiles of PDE5is and sGC stimulators significantly differ in pulmonary hypertension. Accordingly, there is a safety rationale in switching between PDE5is and sGC stimulators because of their different side effects. TRIAL REGISTRY PROSPERO; No.: CRD42016051986; URL: https://www.crd.york.ac.uk/prospero/.
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Affiliation(s)
- Charles Khouri
- Pharmacovigilance Unit, Grenoble Alpes University Hospital, Grenoble, France; Clinical Pharmacology Department, Grenoble Alpes University Hospital, INSERM CIC1406, Grenoble, France; Univ. Grenoble Alpes, UMR 1042-HP2, INSERM, Grenoble, France.
| | - Marion Lepelley
- Pharmacovigilance Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Matthieu Roustit
- Clinical Pharmacology Department, Grenoble Alpes University Hospital, INSERM CIC1406, Grenoble, France; Univ. Grenoble Alpes, UMR 1042-HP2, INSERM, Grenoble, France
| | - François Montastruc
- Department of Medical and Clinical Pharmacology, Faculty of Medicine, Toulouse University Hospital, Toulouse, France
| | - Marc Humbert
- Assistance Publique-Hôpitaux de Paris, Service de Pneumologie, DHU Thorax Innovation, Hôpital Bicêtre and Université Paris-Sud, Laboratoire d'Excellence en Recherche sur le Médicament et Innovation Thérapeutique and INSERM Unité 999, Le Kremlin-Bicêtre, France
| | - Jean-Luc Cracowski
- Clinical Pharmacology Department, Grenoble Alpes University Hospital, INSERM CIC1406, Grenoble, France; Univ. Grenoble Alpes, UMR 1042-HP2, INSERM, Grenoble, France
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Myeku N, Duff KE. Targeting the 26S Proteasome To Protect Against Proteotoxic Diseases. Trends Mol Med 2017; 24:18-29. [PMID: 29233753 DOI: 10.1016/j.molmed.2017.11.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 11/21/2017] [Accepted: 11/21/2017] [Indexed: 12/16/2022]
Abstract
Aggregates of misfolded proteins can compromise the function of the 26S proteasome complex, leaving neurons susceptible to accelerated and impaired protein homeostasis, thereby contributing to the pathogenesis of neurodegeneration. Strategies aimed at enhancing the function of the 26S proteasome via phosphorylation of key subunit epitopes have been effective in reducing protein aggregates in mouse models of disease. We discuss how phosphodiesterase (PDE) inhibitors and G protein-coupled receptor (GPCR)-targeted drugs might be considered as candidate therapeutics, acting on second messenger signal transduction. The range of candidates might address the need for region-, cell-, or even cellular compartment-specific modulation. Given the array of clinical and experimental drugs targeting cAMP/cGMP signaling, we propose that proteasome activators targeting secondary messengers might be exploited as novel agents for the treatment or prevention of some neurodegenerative diseases.
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Affiliation(s)
- Natura Myeku
- Department of Pathology and Cell Biology, The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA.
| | - Karen E Duff
- Department of Pathology and Cell Biology, The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA; Division of Integrative Neuroscience, New York State Psychiatric Institute, New York, NY, USA.
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Elkoundi A, Tahri A, Meziane M, Bensghir M, Lalaoui SJ. Sildenafil related cerebral venous thrombosis following spinal anesthesia. J Clin Anesth 2017; 42:47-48. [PMID: 28803125 DOI: 10.1016/j.jclinane.2017.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 08/04/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Abdelghafour Elkoundi
- Department of Anesthesiology and Intensive Care, Military Hospital Mohammed V of Rabat, Morocco; Faculty of Medicine and Pharmacy of Rabat, University Mohammed V, Rabat, Morocco.
| | - Achraf Tahri
- Department of Anesthesiology and Intensive Care, Military Hospital Mohammed V of Rabat, Morocco; Faculty of Medicine and Pharmacy of Rabat, University Mohammed V, Rabat, Morocco
| | - Mohammed Meziane
- Department of Anesthesiology and Intensive Care, Military Hospital Mohammed V of Rabat, Morocco; Faculty of Medicine and Pharmacy of Rabat, University Mohammed V, Rabat, Morocco
| | - Mustapha Bensghir
- Department of Anesthesiology and Intensive Care, Military Hospital Mohammed V of Rabat, Morocco; Faculty of Medicine and Pharmacy of Rabat, University Mohammed V, Rabat, Morocco
| | - Salim Jaafar Lalaoui
- Department of Anesthesiology and Intensive Care, Military Hospital Mohammed V of Rabat, Morocco; Faculty of Medicine and Pharmacy of Rabat, University Mohammed V, Rabat, Morocco
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Thomason J, Lunsford K, Mackin A. Anti-platelet therapy in small animal medicine. J Vet Pharmacol Ther 2016; 39:318-35. [DOI: 10.1111/jvp.12301] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 01/29/2016] [Indexed: 01/29/2023]
Affiliation(s)
- J. Thomason
- Department of Clinical Sciences; College of Veterinary Medicine; Mississippi State University; Mississippi State MS USA
| | - K. Lunsford
- Department of Clinical Sciences; College of Veterinary Medicine; Mississippi State University; Mississippi State MS USA
| | - A. Mackin
- Department of Clinical Sciences; College of Veterinary Medicine; Mississippi State University; Mississippi State MS USA
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Donato MAM, Ribeiro EL, Torres DDOC, Soares e Silva AK, dos Santos Gomes FO, Santos e Silva B, Rocha SWS, Peixoto CA. Chronic treatment with Sildenafil has no effect on folliculogenesis or fertility in C57BL/6 and C57BL/6 knockout for iNOS mice. Tissue Cell 2015; 47:515-25. [DOI: 10.1016/j.tice.2015.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 06/20/2015] [Accepted: 07/02/2015] [Indexed: 01/25/2023]
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Rehman NU, Gilani AH, Khan A, Nazneen M, El Gamal AA, Fawzy GA, Al-Ati HY, Abdel-kader MS. Antidiarrheal and Antispasmodic Activities ofBuddleja polystachyaare Mediated Through Dual Inhibition of Ca++Influx and Phosphodiesterase Enzyme. Phytother Res 2015; 29:1211-8. [DOI: 10.1002/ptr.5367] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Najeeb-ur Rehman
- Natural Products Research Division, Department of Biological and Biomedical Sciences; The Aga Khan University Medical College; Karachi 74800 Pakistan
- Department of Pharmacy, College of Health Sciences; Mekelle University; Mekelle Ethiopia
| | - Anwarul-Hassan Gilani
- Natural Products Research Division, Department of Biological and Biomedical Sciences; The Aga Khan University Medical College; Karachi 74800 Pakistan
- Department of Pharmacy, College of Health Sciences; Mekelle University; Mekelle Ethiopia
| | - Aslam Khan
- Natural Products Research Division, Department of Biological and Biomedical Sciences; The Aga Khan University Medical College; Karachi 74800 Pakistan
- Department of Pharmacology; Institute of Basic Medical Sciences, Khyber Medical University; Peshawar Pakistan
| | - Maryam Nazneen
- Natural Products Research Division, Department of Biological and Biomedical Sciences; The Aga Khan University Medical College; Karachi 74800 Pakistan
| | - Ali A. El Gamal
- Pharmacognosy Department, College of Pharmacy; King Saud University; P.O. Box 22452 Riyadh 11495 Saudi Arabia
- Pharmacognosy Department, College of Pharmacy; University of Mansoura; Mansoura 35516 Egypt
| | - Ghada A. Fawzy
- Pharmacognosy Department, College of Pharmacy; King Saud University; P.O. Box 22452 Riyadh 11495 Saudi Arabia
- Pharmacognosy Department, College of Pharmacy; Cairo University; Cairo 11562 Egypt
| | - Hanan Y. Al-Ati
- Pharmacognosy Department, College of Pharmacy; King Saud University; P.O. Box 22452 Riyadh 11495 Saudi Arabia
| | - Maged S. Abdel-kader
- Department of Pharmacognosy, College of Pharmacy; Salman Bin Abdulaziz University; Alkharj Saudi Arabia
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El-Sayed MIK, Amin HAKA. Mechanism of endothelial cyto-protective and thrombo-resistance effects of sildenafil, vardenafil and tadalafil in male rabbit. Arch Med Sci 2015; 11:190-8. [PMID: 25861307 PMCID: PMC4379354 DOI: 10.5114/aoms.2013.33616] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 01/12/2013] [Accepted: 02/02/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION PDE5 inhibitors (PDE5inhs) have proven to be of great impact in the treatment of numerous human extra-sexual diseases and their chronic use may induce endothelial rehabilitation. This study aimed to assess the effects of PDE5inhs at chronic administration to explore the possible endothelial cyto-protective and thrombo-resistance effects. MATERIAL AND METHODS One hundred New Zealand white male rabbits were divided into four groups. The first group (control, C) received 1 ml saline/kg, the second group (S) received 10 mg/kg sildenafil, the third group (V) received 2 mg/kg vardenafil, and the fourth group (T) received 2 mg/kg tadalafil in saline I.P. three times weekly for 4 weeks. Blood samples were collected and plasma was isolated for determination of 2,3-dinor-6-keto-prostaglandin F-1α (PGF1α), 11-dehydro-TXB2 (TXB2), fibrinogen, calcium levels, prothrombin (PT), and thrombin times (TT). RESULTS PDE5inhs significantly increase PGF1α, calcium levels, PT and TT (p < 0.001) when compared with baseline data or with the saline group at the end of treatment. In contrast, PDE5inhs significantly decrease TXB2 and fibrinogen levels (p < 0.001) when compared either with their baseline data or with the saline group at the end of treatment. The tadalafil group showed a lower increase in PGF1α (p < 0.001), lower decrease in TXB2 (p < 0.001), and higher increase in calcium levels (p < 0.01, p < 0.05), lower increase in PT and TT levels (p < 0.001) when compared with sildenafil or vardenafil. CONCLUSIONS The prolonged use of PDE5inhs has time-dependent mild to moderate endothelial cyto-protective, thrombo-resistance anti-inflammatory and anti-nociception effects via activation of endothelial NOS (eNOS), increase of PGI2 synthesis and decrease of fibrinogen with significant increase in PT and TT.
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Affiliation(s)
- Mohamed-I Kotb El-Sayed
- Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, Helwan University, Cairo, Egypt
| | - Hatem Al-Kordy A Amin
- Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, Helwan University, Cairo, Egypt
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Mittal A, Paliwal S, Sharma M, Singh A, Sharma S, Yadav D. Pharmacophore based virtual screening, molecular docking and biological evaluation to identify novel PDE5 inhibitors with vasodilatory activity. Bioorg Med Chem Lett 2014; 24:3137-41. [PMID: 24856068 DOI: 10.1016/j.bmcl.2014.05.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 04/30/2014] [Accepted: 05/02/2014] [Indexed: 11/18/2022]
Abstract
Prompted by the role of PDE5 and its closely associated cAMP and cGMP in hypertension, we have attempted to discover novel PDE5 inhibitors through ligand based virtual screening. Rigorously validated model comprising of one HBA, one HY and one RA was used as a query to search the NCI database leading to retrieval of many compounds which were screened on the basis of estimated activity, fit value and Lipinski's violation. Selected compounds were subjected to docking studies which resulted into visualization of potential interaction capabilities of NCI compounds in line to pharmacophoric features. Finally three compounds were subjected to in vitro evaluation using the isolated rat aortic model. The results showed that all three compounds are potent and novel PDE5 inhibitors with vasodilatory activity range from 10(-2) to 10(-5) M.
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Affiliation(s)
- Anupama Mittal
- Department of Pharmacy, Banasthali University, P.O. Banasthali, Rajasthan 304022, India.
| | - Sarvesh Paliwal
- Department of Pharmacy, Banasthali University, P.O. Banasthali, Rajasthan 304022, India.
| | - Mukta Sharma
- Department of Pharmacy, Banasthali University, P.O. Banasthali, Rajasthan 304022, India.
| | - Aarti Singh
- Department of Pharmacy, Banasthali University, P.O. Banasthali, Rajasthan 304022, India.
| | - Swapnil Sharma
- Department of Pharmacy, Banasthali University, P.O. Banasthali, Rajasthan 304022, India.
| | - Divya Yadav
- Department of Pharmacy, Banasthali University, P.O. Banasthali, Rajasthan 304022, India.
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Abstract
We aimed to summarize the etiology, clinical characteristics, diagnosis, and possible treatment options of sexual dysfunction in diabetic patients of both sexes. Details of dysfunction in diabetic women are less conclusive than in men due to the lack of standardized evaluation of sexual function in women. Male sexual dysfunction is a common complication of diabetes, including abnormalities of orgasmic/ejaculatory function and desire/libido in addition to penile erection. The prevalence of erectile dysfunction (ED) among diabetic men varies from 35% to 75%. Diabetes-induced ED has a multifactorial etiology including metabolic, neurologic, vascular, hormonal, and psychological components. ED should be regarded as the first sign of cardiovascular disease because it can be present before development of symptomatic coronary artery disease, as larger coronary vessels better tolerate the same amount of plaque compared to smaller penile arteries. The diagnosis of ED is based on validated questionnaires and determination of functional and organic abnormalities. First-, second- and third-line therapy may be applied. Phosphodiesterase-5 (PDE-5) inhibitor treatment from the first-line options leads to smooth muscle relaxation in the corpus cavernosum and enhancement in blood flow, resulting in erection during sexual stimulus. The use of PDE-5 inhibitors in the presence of oral nitrates is strictly contraindicated in diabetic men, as in nondiabetic subjects. All PDE-5 inhibitors have been evaluated for ED in diabetic patients with convincing efficacy data. Second-line therapy includes intracavernosal, trans- or intraurethral administration of vasoactive drugs or application of a vacuum device. Third-line therapies are the implantation of penile prosthesis and penile revascularization.
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Affiliation(s)
- Várkonyi Tamás
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary.
| | - Peter Kempler
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
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Abstract
Male sexuality in the elderly is an important issue with a growing relevance. In contrast to the assumption of an asexual state when becoming older, recent representative surveys show that the majority of men maintain sexual desires and fantasies into old age. Sexual activity primarily depends on the availability of a partner and on maintaining intimacy and sexuality in the face of changes in the sexual response cycle and increasing comorbidity. This review aims to clarify the normal aging process, the sexual behavior of aging males and the prevalence of sexual dysfunction.
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Affiliation(s)
- L Rinnab
- Schwerpunkt Medikamentöse Tumortherapie & Andrologie, Praxis für Urologie und Männermedizin Neu-Ulm, Augsburgerstraße 1a, 89231 Neu-Ulm, Deutschland.
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Udeoji DU, Schwarz ER. Tadalafil as monotherapy and in combination regimens for the treatment of pulmonary arterial hypertension. Ther Adv Respir Dis 2012; 7:39-49. [PMID: 23129569 DOI: 10.1177/1753465812463627] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The purpose of this review is to evaluate the use of tadalafil as monotherapy and in combination regimens for the treatment of pulmonary arterial hypertension (PAH). A systematic English language search of the medical literature using PubMed was conducted between January 1960 and May 2012 using the search terms 'tadalafil', 'therapy', 'pulmonary (arterial) hypertension' and 'combination therapy'. Special emphasis was given to controlled clinical trials and case studies relevant for the use of tadalafil in PAH. The search revealed 113 relevant publications, 31 of which were clinical trials, 52 were reviews and 12 were case reports. Of these, 12 were clinical studies in human patients with PAH who were treated with tadalafil alone, and seven were clinical studies in human patients with PAH who were treated with tadalafil in combination with other agents. Only clinical studies in human patients were included. Exclusion criteria were monotherapy other than using tadalafil and any combination therapy that excluded tadalafil as part of the treatment regimen. Overall, 1353 human subjects were studied; 896 were treated with tadalafil alone while 457 subjects were treated with tadalafil in coadministration. Tadalafil appears to be an effective and a safe treatment option for patients with PAH. It improves clinical status, exercise capacity, hemodynamic parameters, compliance issues and quality of life and reduces the occurrence of clinical worsening. Tadalafil in combination therapy seems to be additive and synergistic in relaxing pulmonary vascular muscle cells but more clinical trials on human subjects are warranted.
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Affiliation(s)
- Dioma U Udeoji
- Heart Institute of Southern California, Beverly Hills, Los Angeles, CA, USA.
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20
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Porst H, Hell-Momeni K, Büttner H. Chronic PDE-5 inhibition in patients with erectile dysfunction – a treatment approach using tadalafil once-daily. Expert Opin Pharmacother 2012; 13:1481-94. [DOI: 10.1517/14656566.2012.693162] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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21
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Fike CD, Kaplowitz M, Zhang Y, Dantuma M, Madden JA. Effect of a phosphodiesterase 5 inhibitor on pulmonary and cerebral arteries of newborn piglets with chronic hypoxia-induced pulmonary hypertension. Neonatology 2012; 101:28-39. [PMID: 21791937 PMCID: PMC3151003 DOI: 10.1159/000326270] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Accepted: 02/14/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND The use of phosphodiesterase 5 (PDE5) inhibitors to treat newborns with pulmonary hypertension is increasing. The effect of PDE5 inhibitors on the neonatal cerebral circulation remains unknown. The neonatal piglet model of chronic hypoxia-induced pulmonary hypertension allows the study of the effects of PDE5 inhibitors on both the pulmonary and cerebral circulations. OBJECTIVES To determine whether the PDE5 inhibitor, zaprinast, causes dilation in pulmonary and middle cerebral arteries (MCA) of normoxic newborn piglets and those with chronic hypoxia-induced pulmonary hypertension, and to evaluate whether zaprinast alters responses to increased pressure (autoregulatory ability) of the MCA. METHODS Two-day-old piglets were raised in normoxia or hypoxia for 3 or 10 days. Pulmonary arteries and MCA were isolated and pressurized, after which changes in diameter to zaprinast were measured. MCA pressure-diameter relationships were determined. RESULTS Dilation to zaprinast was similar in pulmonary arteries from normoxic and hypoxic piglets. Zaprinast dilated MCA from all groups but the response was diminished in MCA from piglets raised in hypoxia for 10 days. MCA pressure-diameter relationships (autoregulation) did not differ between the groups. CONCLUSIONS Pulmonary artery dilation to zaprinast supports the use of PDE5 inhibitors to treat pulmonary hypertension in neonates. PDE5 inhibitors function as MCA dilators but do not impair the pressure-diameter behavior of the cerebral circulation of either normoxic newborn piglets or those with chronic hypoxia-induced pulmonary hypertension. These findings suggest that cerebral autoregulation is likely to be intact with acute PDE5 inhibitor treatment in infants with pulmonary hypertension in conditions associated with chronic hypoxia.
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Affiliation(s)
- Candice D Fike
- Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN 37232-0656, USA.
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Khan M, Khan AU, Gilani AH. Pharmacological explanation for the medicinal use of Juniperus excelsa in hyperactive gastrointestinal and respiratory disorders. J Nat Med 2011; 66:292-301. [PMID: 22134420 DOI: 10.1007/s11418-011-0605-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 09/02/2011] [Indexed: 12/12/2022]
Abstract
Crude extract of Juniperus excelsa (JeExt), which tested positive for the presence of anthraquinone, flavonoids, saponins, sterols, terpenes and tannin, exhibited a protective effect against castor oil-induced diarrhoea in mice at 100-1000 mg/kg. In rabbit jejunum preparations, JeExt (0.01-1.0 mg/mL) caused relaxation of spontaneous and K(+) (80 mM)-induced contractions at similar concentrations to papaverine, whereas verapamil was relatively more potent against K(+). JeExt (0.03-0.3 mg/mL) shifted Ca(2+) concentration-response curves to the right, like papaverine or verapamil. JeExt (0.003-0.01 mg/mL) caused a leftward shift of isoprenaline-induced inhibitory concentration-response curves, similar to papaverine. JeExt (1.0-30 mg/kg) caused suppression of carbachol (CCh, 100 μg/kg)-induced increase in inspiratory pressure of anaesthetized rats. In guinea-pig trachea, JeExt (0.001-3.0 mg/mL) relaxed CCh (1 μM)- and high K(+)-induced contractions and shifted isoprenaline-induced inhibitory curves to the left. This study suggests that Juniperus excelsa possibly exhibits a combination of Ca(2+) antagonist and phosphodiesterase inhibitory effects, which provides a pharmacological basis for its traditional use in disorders of gut and airways hyperactivity, such as diarrhoea, colic and asthma.
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Affiliation(s)
- Munasib Khan
- Natural Products Research Unit, Department of Biological and Biomedical Sciences, Aga Khan University Medical College, Karachi 74800, Pakistan
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Khalaf MAM, Abbas MF, El-Fakahany HM. Effects of chronic tadalafil use on the testes and sperm parameters of old albino rats. Andrologia 2011; 44 Suppl 1:370-5. [DOI: 10.1111/j.1439-0272.2011.01191.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Strano-Rossi S, Anzillotti L, de la Torre X, Botrè F. A gas chromatography/mass spectrometry method for the determination of sildenafil, vardenafil and tadalafil and their metabolites in human urine. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2010; 24:1697-1706. [PMID: 20486268 DOI: 10.1002/rcm.4568] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Sildenafil (SDF), vardenafil (VDF) and tadalafil (TDF) are phosphodiesterase type 5 enzyme inhibitors (PDE5Is), used in the treatment of erectile disorders and to improve breathing efficiency in pulmonary hypertension. The increasing incidence of their use among young athletes has drawn the attention of the anti-doping authorities to the possible abuse of PDE5Is by athletes due to their pharmacological activities. This paper describes a method for the determination in urine of PDE5Is and their metabolites by gas chromatography/mass spectrometry (GC/MS) after liquid/liquid extraction of the analytes from urine and derivatisation to obtain trimethylsilyl derivatives. The metabolic profile was studied on real samples collected from subjects taking PDE5Is (Viagra, Levitra or Cialis); the main urinary metabolites were identified and their MS fragmentation characterized. The sample pre-treatment and GC/MS conditions for the detection of the metabolites have been optimised. A method for their preliminary screening and subsequent confirmation is described that takes into account the general requirements of a routine doping analysis to be used for the screening of large numbers of samples. The main metabolites identified can be included in a general purpose screening method and all the metabolites in a more specific confirmation method. The method developed has been applied for the screening of PDE5Is in 5000 urine samples. Based on the obtained results, the proposed method appears to be of practical use in analytical and forensic toxicology, including doping analysis.
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Affiliation(s)
- Sabina Strano-Rossi
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Largo Giulio Onesti 1, 00197 Rome RM, Italy.
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Ozdegirmenci O, Kucukozkan T, Akdag E, Topal T, Haberal A, Kayir H, Oter S, Akyol M, Uzbay T. Effects of sildenafil and tadalafil on ischemia/reperfusion injury in fetal rat brain. J Matern Fetal Neonatal Med 2010; 24:317-23. [PMID: 20540678 DOI: 10.3109/14767058.2010.492061] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of the present study was to evaluate the effects of phosphodiesterase type 5 (PDE5) inhibitory drugs, sildenafil and tadalafil, in ischemia/reperfusion (I/R)-induced oxidative injury in fetal rat brain. METHODS Timed pregnant adult Wistar rats were randomly assigned to the following groups (n = 6 for each group): saline + none I/R (1), saline + I/R (2), sildenafil + none I/R (3); sildenafil + I/R (4), tadalafil + none I/R (5) and tadalafil + I/R (6). Fetal ischemia was induced by clamping the utero-ovarian artery bilaterally. Fetuses were delivered and 268 fetal rats were decapitated. Malondialdehyde (MDA) levels and, superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities were assessed in fetal brain tissue homogenates by spectrophotometric methods. RESULTS In saline + I/R group, MDA levels were increased and, SOD and GSH-Px activities were decreased significantly comparing with saline + none I/R group. Both tadalafil and sildenafil treatment decreased the MDA levels significantly in ischemia/reperfusion groups, whereas this effect was significantly more potent with tadalafil. SOD levels were significantly decreased in all groups after I/R. Tadalafil seems to be more effective than sildenafil by means of increasing GSH-Px activity significantly after I/R. CONCLUSION Our results indicate some beneficial effects of PDE5 inhibitory drugs, especially tadalafil, on oxidative I/R injury in fetal rat brains.
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Affiliation(s)
- Ozlem Ozdegirmenci
- Department of Obstetric and Gynecology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey.
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Open-label, Intermittent Dose, Prospective Study Evaluating the Effects of Tadalafil on Lower Urinary Tract Symptoms and Erectile Function in Patients with Benign Prostatic Hyperplasia: Continuation and Durability of Effects. Int Neurourol J 2010; 14:7-12. [PMID: 21120170 DOI: 10.5213/inj.2010.14.1.7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2010] [Accepted: 04/26/2010] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Benign prostatic hyperplasia is often accompanied by age-related comorbidity, such as erectile dysfunction (ED). Recent data suggest an association between ED and lower urinary tract symptoms (LUTS), and increasing evidence indicates that the clinical use of phosphodiesterase type 5 (PDE5) inhibitors provides relief from LUTS. The aim of the present study was to investigate the effects of tadalafil (20 mg once every 3 days for 12 weeks, p.o.) in men with moderate-to-severe ED and LUTS and to investigate the duration of the effects of tadalafil beyond treatment cessation. MATERIALS AND METHODS Men with an International Index of Erectile Function-5 (IIEF-5) score of less than 11 (representing "moderate-to-severe" ED status) and with an International Prostate Symptom Score (IPSS) of more than 8 (representing "moderate-to-severe" LUTS status) were enrolled. IPSS (total score, storage subscore, and voiding subscore) and IIEF-5 scores before treatment (baseline), during treatment (weeks 4 and 12 after treatment commencement), and after treatment (weeks 16 and 20after treatment commencement) were compared. RESULTS IPSS and IIEF-5 scores were significantly different between baseline and week 12 after treatment commencement. Furthermore, these scores were significantly different between baseline and week 20 after treatment commencement. However, except for IIEF-5 scores, no significant differences were observed between week 12 and week 20. CONCLUSIONS Treatment with 20 mg tadalafil (once every 3 days) had beneficial effects on LUTS and ED beyond treatment cessation in patients with moderate-to-severe ED and LUTS.
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Romanini CV, Schiavon AP, Ferreira EDF, de Oliveira RMW, Milani H. Sildenafil prevents mortality and reduces hippocampal damage after permanent, stepwise, 4-vessel occlusion in rats. Brain Res Bull 2010; 81:631-40. [DOI: 10.1016/j.brainresbull.2009.12.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 12/22/2009] [Indexed: 11/30/2022]
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Ky Ng W, Rosenblatt Y, B Brock G, B O'gorman D, Siang Gan B. Phosphodiesterase Inhibitors in Vascular Ischemia: A Case Report and Review of Their Use in Ischemic Conditions. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2010. [DOI: 10.1177/229255031001800109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The treatment of digital ischemia remains difficult. Sildenafil (Viagra, Pfizer UK), a selective phosphodiesterase inhibitor, increases blood flow and is currently marketed for the treatment of erectile dysfunction. A case of a 57-year-old man with progressive episodic ischemia and pain of the fingertips resulting in finger tip ulceration is presented. After failure of medical and surgical management, a trial of oral sildenafil resulted in marked symptomatic improvement of his bilateral digital ischemia. Review of the literature shows that, particularly in patients with an underlying disease such as scleroderma with a vasospastic component, a marked improvement in digital blood flow may be observed with sildenafil use. Overall, based on a number of case reports and preliminary animal studies in the literature, sildenafil appears to have a growing significance in the treatment of hand ischemia. Similarly, there is evidence that phosphodiesterase 5 inhibitors may be used as an adjunct to improving skin flap survival.
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Affiliation(s)
- Wendy Ky Ng
- the Hand and Upper Limb Centre
- Schulich School of Medicine and Dentistry
| | - Yishai Rosenblatt
- the Hand and Upper Limb Centre
- Schulich School of Medicine and Dentistry
| | - Gerald B Brock
- Schulich School of Medicine and Dentistry
- Division of Urology
- Department of Surgery
| | - David B O'gorman
- the Hand and Upper Limb Centre
- Schulich School of Medicine and Dentistry
- Department of Surgery
- Department of Biochemistry
- Division of Plastic Surgery
| | - Bing Siang Gan
- the Hand and Upper Limb Centre
- Schulich School of Medicine and Dentistry
- Department of Surgery
- Division of Plastic Surgery
- Division of Physiology and Pharmacology
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Follicle development and luteal cell morphology altered by phosphodiesterase-5 inhibitor. Micron 2009; 40:845-50. [DOI: 10.1016/j.micron.2009.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 06/15/2009] [Accepted: 06/16/2009] [Indexed: 02/02/2023]
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Porst H, Hell-Momeni K, Büttner H. Chronische PDE-5-Hemmung bei erektiler Dysfunktion. Urologe A 2009; 48:1318, 1320-9. [DOI: 10.1007/s00120-009-2089-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Wolk R, Smith WB, Neutel JM, Rubino J, Xuan D, Mancuso J, Gilbert J, Pressler ML. Blood Pressure Lowering Effects of a New Long-Acting Inhibitor of Phosphodiesterase 5 in Patients With Mild to Moderate Hypertension. Hypertension 2009; 53:1091-7. [DOI: 10.1161/hypertensionaha.109.132225] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Inhibition of phosphodiesterase 5 is an attractive candidate mechanism for blood pressure (BP) lowering. In this study, a novel long-acting phosphodiesterase 5 inhibitor, PF-00489791, was evaluated in 133 patients with mild to moderate hypertension, randomized into 1 of 4 groups: placebo, 4 mg, 10 mg, and 20 mg titrated after 14 days of dosing to 40 mg. Study medication was administered once daily for 28 days. Ambulatory BP monitoring was used. There was a statistically significant decrease (compared with placebo) in mean daytime systolic BP on day 28 at the 10 and 20/40 mg doses (by ≈5 and ≈7 mm Hg, respectively). Changes in mean daytime diastolic BP corresponded with those in systolic BP. The magnitude of BP lowering was greater on day 1 than on days 14 and 28, but the response was sustained between days 14 and 28. PF-00489791 also exerted BP lowering effects on mean 24-hour ambulatory BP. There was a dose-related increase in plasma cGMP concentration (statistically significant at the 20/40 mg dose). There was an increased incidence of headaches at the 10 and 20/40 mg doses (22% and 21%, respectively, compared with 12% with placebo) and an increased incidence of dyspepsia/gastroesophageal reflux disease and musculoskeletal adverse events at the 20/40 mg dose. In conclusion, PF-00489791 causes a clinically meaningful and sustained BP lowering in patients with hypertension. It is generally safe and well tolerated at the clinically efficacious doses.
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Affiliation(s)
- Robert Wolk
- From Pfizer Global Research & Development (R.W., D.X., J.M., J.G., M.L.P.), Pfizer Inc, New London, Conn; Volunteer Research Group (W.B.S.), Knoxville, Tenn; Orange County Research Center (J.M.N.), Tustin, Calif; and Triangle Medical Research (J.R.), Raleigh, NC
| | - William B. Smith
- From Pfizer Global Research & Development (R.W., D.X., J.M., J.G., M.L.P.), Pfizer Inc, New London, Conn; Volunteer Research Group (W.B.S.), Knoxville, Tenn; Orange County Research Center (J.M.N.), Tustin, Calif; and Triangle Medical Research (J.R.), Raleigh, NC
| | - Joel M. Neutel
- From Pfizer Global Research & Development (R.W., D.X., J.M., J.G., M.L.P.), Pfizer Inc, New London, Conn; Volunteer Research Group (W.B.S.), Knoxville, Tenn; Orange County Research Center (J.M.N.), Tustin, Calif; and Triangle Medical Research (J.R.), Raleigh, NC
| | - John Rubino
- From Pfizer Global Research & Development (R.W., D.X., J.M., J.G., M.L.P.), Pfizer Inc, New London, Conn; Volunteer Research Group (W.B.S.), Knoxville, Tenn; Orange County Research Center (J.M.N.), Tustin, Calif; and Triangle Medical Research (J.R.), Raleigh, NC
| | - Dawei Xuan
- From Pfizer Global Research & Development (R.W., D.X., J.M., J.G., M.L.P.), Pfizer Inc, New London, Conn; Volunteer Research Group (W.B.S.), Knoxville, Tenn; Orange County Research Center (J.M.N.), Tustin, Calif; and Triangle Medical Research (J.R.), Raleigh, NC
| | - James Mancuso
- From Pfizer Global Research & Development (R.W., D.X., J.M., J.G., M.L.P.), Pfizer Inc, New London, Conn; Volunteer Research Group (W.B.S.), Knoxville, Tenn; Orange County Research Center (J.M.N.), Tustin, Calif; and Triangle Medical Research (J.R.), Raleigh, NC
| | - James Gilbert
- From Pfizer Global Research & Development (R.W., D.X., J.M., J.G., M.L.P.), Pfizer Inc, New London, Conn; Volunteer Research Group (W.B.S.), Knoxville, Tenn; Orange County Research Center (J.M.N.), Tustin, Calif; and Triangle Medical Research (J.R.), Raleigh, NC
| | - Milton L. Pressler
- From Pfizer Global Research & Development (R.W., D.X., J.M., J.G., M.L.P.), Pfizer Inc, New London, Conn; Volunteer Research Group (W.B.S.), Knoxville, Tenn; Orange County Research Center (J.M.N.), Tustin, Calif; and Triangle Medical Research (J.R.), Raleigh, NC
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Managing Erectile Dysfunction in Patients With Cardiovascular Diseases: The Efficacy and Safety of Phosphodiesterase-5 Inhibitors. Am J Lifestyle Med 2009. [DOI: 10.1177/1559827608331164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Patients with cardiovascular disease have a high prevalence of erectile dysfunction. Recent evidence demonstrated that erectile dysfunction is an early indication of coronary artery disease. Phosphodiesterase-5 (PDE-5) inhibitors are effective in managing erectile dysfunction due to cardiovascular disease. However, when used together with nitrates or other vasodilators such as alpha-antagonists, they may cause hypotension. Clinical studies demonstrated that in patients with stable coronary artery disease, heart failure, and hypertension controlled by medications who were not receiving nitrates, PDE-5 inhibitors were well tolerated. Therefore, it is important for clinicians to carefully evaluate each patient before initiating PDE-5 inhibitors. PDE-5 inhibitors are absolutely contraindicated with concurrent nitrate use. No PDE-5 inhibitors should be administered within 12 hours after the last nitrate dose. If a patient develops chest pain while taking PDE-5 inhibitors, nitrates should be administered only after the PDE-5 inhibitors have been washed out of the system, based on the half-life of individual agents (washed-out period for sildenafil ∽20 hours; vardenafil ∽ 24 hours; tadalafil ∽88 hours [or 3-4 days]). If symptomatic hypotension occurs, patients should be put in a Trendelenburg position. Fluid resuscitation therapy and alpha-agonists should be used to support blood pressure, if necessary. PDE-5 inhibitors have not been studied in patients with severe and unstable cardiac conditions.
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Effect of phosphodiesterase-5 inhibitor on hearing. The Journal of Laryngology & Otology 2009; 123:718-22. [DOI: 10.1017/s002221510900423x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:Following a report of sudden hearing loss in a patient taking phosphodiesterase type 5 inhibitor, and a Food and Drug Administration announcement concerning this class of drugs, a study was planned to investigate if ototoxicity occurs in patients using phosphodiesterase 5 inhibitor for erectile dysfunction.Methods:Eighteen patients with erectile dysfunction who had been using phosphodiesterase 5 inhibitor were included in the study. Audiometric tests were performed on all patients, between the frequencies 250 and 16 000 Hz, before and 1, 5 and 72 hours after drug ingestion.Results:Four patients showed a unilateral threshold decrease compatible with ototoxicity criteria; this change was reversible. A statistically significant difference in pre- versus post-drug hearing thresholds was observed in the right ear at 10 000 Hz (p = 0.008). There were no statistically significant hearing threshold differences at any other frequencies (p > 0.05).Conclusion:Although temporary ototoxicity was noted in four patients, we could not find any permanent, deleterious effect of phosphodiesterase type 5 inhibitor on hearing thresholds.
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Abstract
During the last decades it turned out that the NO/cGMP signaling cascade is one of the most prominent regulators of a variety of physiological and pathophysiological processes in a broad range of mammalian tissues. Thus cGMP is a key second messenger and targeting this pathway by increasing intracellular cGMP levels is a very successful approach in pharmacology as shown for nitrates, PDE5 inhibitors and more recently for stimulators of the guanylate cyclase. Besides the beneficial effects of cGMP elevation in cardiac, vascular, pulmonary, renal or liver disorders the launch of PDE5 inhibitors for the treatment of erectile dysfunction 10 years ago, has directed a lot of attention to the NO/cGMP signaling in the lower urinary tract. Triggered by the use of PDE5 inhibitors in ED it turned out that cGMP is a common regulatory mechanism for lower urinary tract function also beyond ED. In recent years intense research and development efforts were undertaken to elucidate the role of the NO/cGMP and to fully exploit the therapeutic implications of cGMP elevation in urological disorders in ED and beyond. Therefore we have summarized the effects of cGMP elevation for treatment of erectile dysfunction in males and in females. We have also reviewed the recent pre-clinical and clinical lines of evidence for treatment options of benign prostatic hyperplasia and lower urinary tract symptoms in male patients and overactive bladder and urinary incontinence in female patients. In addition we also touch more speculative concepts using cGMP elevating drugs for the treatment of premature ejaculation, peyornies disease and stone disease.
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Zumbé J, Porst H, Sommer F, Grohmann W, Beneke M, Ulbrich E. Comparable Efficacy of Once-Daily Versus On-Demand Vardenafil in Men with Mild-to-Moderate Erectile Dysfunction: Findings of the RESTORE Study. Eur Urol 2008; 54:204-10. [DOI: 10.1016/j.eururo.2008.03.056] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Accepted: 03/18/2008] [Indexed: 10/22/2022]
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Grover-Páez F, Villegas Rivera G, Guillén Ortíz R. Sildenafil citrate diminishes microalbuminuria and the percentage of A1c in male patients with type 2 diabetes. Diabetes Res Clin Pract 2007; 78:136-40. [PMID: 17374416 DOI: 10.1016/j.diabres.2007.02.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2006] [Accepted: 02/10/2007] [Indexed: 11/17/2022]
Abstract
UNLABELLED Sildenafil citrate has shown to display beneficial cardiovascular effects, suggesting that it may have other systemic benefits involving the endothelium. There is little data regarding the long-term use of this drug and the effects of this on different organs. OBJECTIVE The primary aim of this study was to determine whether sildenafil citrate diminishes concentrations of microalbuminuria and percentage of A1c in patients with type 2 diabetes. DESIGN A double-blind, randomized, controlled trial in 40 male patients, age 35-50, with type 2 diabetes. Subjects received sildenafil citrate 50 mg daily (n=20) or placebo (n=20) for 30 days. Levels of hs-CRP, microalbuminuria, homocysteine, A1c and erectile function were measured at baseline and to the end of the study. RESULTS Men that received sildenafil citrate displayed a significant decrease in the microalbuminuria concentrations (p<0.01) versus baseline, (p=0.02) versus placebo and A1c (p<0.01) versus baseline, (p=0.01) versus placebo. In addition, we observed a significant increase in the total IIEF score after 30 days of treatment (p<0.01) versus baseline, (p<0.01) versus placebo. CONCLUSIONS The administration of 50mg of sildenafil citrate for 30 consecutive days diminishes microalbuminuria and the percentage of A1c in patients with type 2 diabetes.
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Affiliation(s)
- Fernando Grover-Páez
- Health Research Division, Gynecology and Obstetrics Hospital, Centro Medico Nacional de Occidente, Instituto Mexicano del Seguro Social, Avenida Eulogio Parra 3022, Colonia Prados Providencia, CP 44670 Guadalajara, Jalisco, Mexico.
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Bella AJ, Deyoung LX, Al-Numi M, Brock GB. Daily Administration of Phosphodiesterase Type 5 Inhibitors for Urological and Nonurological Indications. Eur Urol 2007; 52:990-1005. [PMID: 17646047 DOI: 10.1016/j.eururo.2007.06.048] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2007] [Accepted: 06/29/2007] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Although the discovery of phosphodiesterases (PDEs) was made soon after the identification of cyclic adenosine monophosphate nearly half a century ago, their true importance in medicine has taken many decades to be realised. The recognition of the important role PDE enzymes play and the impact of altering intracellular cyclic nucleotide levels became significant for most urologists and clinicians in the early 1990s with the discovery of sildenafil, a PDE5 inhibitor (PDE5-I). Once approved around the world, on-demand use of PDE5-Is became the gold standard. Recently, the potential beneficial effects of PDE5-Is on the pulmonary, vascular, and other systems has led to examination of alternative dosing regimens. In this review, we have synthesised the available published peer-reviewed literature to provide a critical contemporary view of evolving indications for PDE5-Is and how alternative dosing regimens may impact on sexual and other functions. METHODS MEDLINE search of all peer-reviewed English literature for the period 1990-2007. RESULTS The plethora of articles detailing potential uses of PDE5-I in multiple fields of medicine was uncovered. Use of alternative dosing regimens shows great promise across a number of clinical indications, including post-radical retropubic prostatectomy, pulmonary hypertension, endothelial dysfunction, and salvage of on-demand PDE5-I nonresponders. CONCLUSIONS Use of PDE5-I on a daily basis may evolve into a major form of drug administration both for men with erectile dysfunction and for those with a myriad of other conditions shown to benefit from this approach.
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Affiliation(s)
- Anthony J Bella
- Department of Surgery, Division of Urology, University of Ottawa, Ottawa, Canada
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Rufa A, Cerase A, Monti L, Dotti MT, Giorgio A, Sicurelli F, Federico A. Recurrent venous thrombosis including cerebral venous sinus thrombosis in a patient taking sildenafil for erectile dysfunction. J Neurol Sci 2007; 260:293-5. [PMID: 17572443 DOI: 10.1016/j.jns.2007.05.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Revised: 05/07/2007] [Accepted: 05/10/2007] [Indexed: 11/29/2022]
Abstract
Acquired or hereditary prothrombotic risk factors may lead to cerebral venous sinus thrombosis (CVST), particularly when other predisposing factors coexist. A 57-year-old man experienced right leg deep venous thrombosis, severe thrombosis of the haemorrhoid plexus and CVST over a 12-month period during which he was taking sildenafil regularly twice a week. Sildenafil is a phosphodiesterase 5 (PDE5)-inhibitor used for erectile dysfunction (ED). A slight reduction in antithrombin III and free protein S levels was demonstrated. After suspension of sildenafil and six months on oral anticoagulants, clinical improvement was obtained. Recurrent venous thrombosis, including CVST, may complicate prolonged treatment with PDE5-inhibitors in subjects at risk. Periodic monitoring of clotting factors is recommended in these subjects.
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Affiliation(s)
- A Rufa
- Dipartimento di Scienze Neurologiche e del Comportamento, Università di Siena, Italy
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Kukreja R, Salloum F, Xi L. Anti-ischemic effects of sildenafil, vardenafil and tadalafil in heart. Int J Impot Res 2007; 19:226-7. [PMID: 17136101 DOI: 10.1038/sj.ijir.3901533] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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