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Pannucci P, Van Daele M, Cooper SL, Wragg ES, March J, Groenen M, Hill SJ, Woolard J. Role of endothelin ET A receptors in the hypertension induced by the VEGFR-2 kinase inhibitors axitinib and lenvatinib in conscious freely-moving rats. Biochem Pharmacol 2024; 228:116007. [PMID: 38145828 DOI: 10.1016/j.bcp.2023.116007] [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] [Received: 11/26/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 12/27/2023]
Abstract
Receptor tyrosine kinase inhibitors (RTKIs) suppress tumour growth by targeting vascular endothelial growth factor receptor 2 (VEGFR-2) which is an important mediator of angiogenesis. Here, we demonstrate that two potent RTKIs, axitinib and lenvatinib, are associated with hypertensive side effects. Doppler flowmetry was used to evaluate regional haemodynamic profiles of axitinib and lenvatinib. Male Sprague Dawley rats (350-500 g) were instrumented with Doppler flow probes (renal and mesenteric arteries and descending abdominal aorta) and catheters (jugular vein and distal abdominal aorta, via the caudal artery). Rats were dosed daily with axitinib (3 or 6 mg.kg-1) or lenvatinib (1 or 3 mg.kg-1) and regional haemodynamics were recorded over a maximum of 4 days. Both RTKIs caused significant (p < 0.05) increases in mean arterial pressure (MAP), which was accompanied by significant (p < 0.05) vasoconstriction in both the mesenteric and hindquarters vascular beds. To gain insight into the involvement of endothelin-1 (ET-1) in RTKI-mediated hypertension, we also monitored heart rate (HR) and MAP in response to axitinib or lenvatinib in animals treated with the ETA receptor selective antagonist sitaxentan (5 mg.kg-1) or the mixed ETA/ETB receptor antagonist bosentan (15 mg.kg-1) over two days. Co-treatment with bosentan or sitaxentan markedly reduced the MAP effects mediated by both RTKIs (p < 0.05). Bosentan, but not sitaxentan, also attenuated ET-1 mediated increases in HR. These data suggest that selective antagonists of ETA receptors may be appropriate to alleviate the hypertensive effects of axitinib and lenvatinib.
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Affiliation(s)
- Patrizia Pannucci
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, University of Nottingham, Nottingham NG7 2UH, UK; Centre of Membrane Proteins and Receptors, University of Birmingham and Nottingham, The Midlands, UK
| | - Marieke Van Daele
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, University of Nottingham, Nottingham NG7 2UH, UK; Centre of Membrane Proteins and Receptors, University of Birmingham and Nottingham, The Midlands, UK
| | - Samantha L Cooper
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, University of Nottingham, Nottingham NG7 2UH, UK; Centre of Membrane Proteins and Receptors, University of Birmingham and Nottingham, The Midlands, UK
| | - Edward S Wragg
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, University of Nottingham, Nottingham NG7 2UH, UK; Centre of Membrane Proteins and Receptors, University of Birmingham and Nottingham, The Midlands, UK
| | - Julie March
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, University of Nottingham, Nottingham NG7 2UH, UK
| | - Marleen Groenen
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, University of Nottingham, Nottingham NG7 2UH, UK
| | - Stephen J Hill
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, University of Nottingham, Nottingham NG7 2UH, UK; Centre of Membrane Proteins and Receptors, University of Birmingham and Nottingham, The Midlands, UK.
| | - Jeanette Woolard
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, University of Nottingham, Nottingham NG7 2UH, UK; Centre of Membrane Proteins and Receptors, University of Birmingham and Nottingham, The Midlands, UK.
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Differential effects of cyclo-oxygenase 1 and 2 inhibition on angiogenesis inhibitor-induced hypertension and kidney damage. Clin Sci (Lond) 2022; 136:675-694. [PMID: 35441670 PMCID: PMC9093150 DOI: 10.1042/cs20220182] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/15/2022] [Accepted: 04/20/2022] [Indexed: 11/17/2022]
Abstract
Vascular endothelial growth factor antagonism with angiogenesis inhibitors in cancer patients induces a ‘preeclampsia-like’ syndrome including hypertension, proteinuria and elevated endothelin (ET)-1. Cyclo-oxygenase (COX) inhibition with aspirin is known to prevent the onset of preeclampsia in high-risk patients. In the present study, we hypothesised that treatment with aspirin would prevent the development of angiogenesis inhibitor-induced hypertension and kidney damage. Our aims were to compare the effects of low-dose (COX-1 inhibition) and high-dose (dual COX-1 and COX-2 inhibition) aspirin on blood pressure, vascular function, oxidative stress, ET-1 and prostanoid levels and kidney damage during angiogenesis-inhibitor therapy in rodents. To this end, Wistar Kyoto rats were treated with vehicle, angiogenesis inhibitor (sunitinib) alone or in combination with low- or high-dose aspirin for 8 days (n=5–7/group). Our results demonstrated that prostacyclin (PGI2) and ET-1 were increased during angiogenesis-inhibitor therapy, while thromboxane (TXA2) was unchanged. Both low- and high-dose aspirin blunted angiogenesis inhibitor-induced hypertension and vascular superoxide production to a similar extent, whereas only high-dose aspirin prevented albuminuria. While circulating TXA2 and prostaglandin F2α levels were reduced by both low- and high-dose aspirin, circulating and urinary levels PGI2 were only reduced by high-dose aspirin. Lastly, treatment with aspirin did not significantly affect ET-1 or vascular function. Collectively our findings suggest that prostanoids contribute to the development of angiogenesis inhibitor-induced hypertension and renal damage and that targeting the prostanoid pathway could be an effective strategy to mitigate the unwanted cardiovascular and renal toxicities associated with angiogenesis inhibitors.
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Habib YH, Gowayed MA, Abdelhady SA, El-Deeb NM, Darwish IE, El-Mas MM. Modulation by antenatal therapies of cardiovascular and renal programming in male and female offspring of preeclamptic rats. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2021; 394:2273-2287. [PMID: 34468816 DOI: 10.1007/s00210-021-02146-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/26/2021] [Indexed: 11/28/2022]
Abstract
Morbidity and mortality risks are enhanced in preeclamptic (PE) mothers and their offspring. Here, we asked if sexual dimorphism exists in (i) cardiovascular and renal damage evolved in offspring of PE mothers, and (ii) offspring responsiveness to antenatal therapies. PE was induced by administering NG-nitro-L-arginine methyl ester (L-NAME, 50 mg/kg/day, oral gavage) to pregnant rats for 7 days starting from gestational day 14. Three therapies were co-administered orally with L-NAME, atrasentan (endothelin ETA receptor antagonist), terutroban (thromboxane A2 receptor antagonist, TXA2), or α-methyldopa (α-MD, central sympatholytic drug). Cardiovascular and renal profiles were assessed in 3-month-old offspring. Compared with offspring of non-PE rats, PE offspring exhibited elevated systolic blood pressure and proteinuria and reduced heart rate and creatinine clearance (CrCl). Apart from a greater bradycardia in male offspring, similar PE effects were noted in male and female offspring. While terutroban, atrasentan, or α-MD partially and similarly blunted the PE-evoked changes in CrCl and proteinuria, terutroban was the only drug that virtually abolished PE hypertension. Rises in cardiorenal inflammatory (tumor necrosis factor alpha, TNFα) and oxidative (isoprostane) markers were mostly and equally eliminated by all therapies in the two sexes, except for a greater dampening action of atrasentan, compared with α-MD, on tissue TNFα in female offspring only. Histopathologically, antenatal terutroban or atrasentan was more effective than α-MD in rectifying cardiac structural damage, myofiber separation, and cytoplasmic alterations, in PE offspring. The repair by antenatal terutroban or atrasentan of cardiovascular and renal anomalies in PE offspring is mostly sex-independent and surpasses the protection offered by α-MD, the conventional PE therapy.
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Affiliation(s)
- Yasser H Habib
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Pharos University in Alexandria, Alexandria, Egypt
| | - Mennatallah A Gowayed
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Pharos University in Alexandria, Alexandria, Egypt
| | - Sherien A Abdelhady
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Pharos University in Alexandria, Alexandria, Egypt
| | - Nevine M El-Deeb
- Department of Clinical Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Inas E Darwish
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Pharos University in Alexandria, Alexandria, Egypt
- Department of Clinical Pharmacology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mahmoud M El-Mas
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt.
- Department of Pharmacology and Toxicology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.
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Mirabito Colafella KM, Neves KB, Montezano AC, Garrelds IM, van Veghel R, de Vries R, Uijl E, Baelde HJ, van den Meiracker AH, Touyz RM, Danser AHJ, Versmissen J. Selective ETA vs. dual ETA/B receptor blockade for the prevention of sunitinib-induced hypertension and albuminuria in WKY rats. Cardiovasc Res 2021; 116:1779-1790. [PMID: 31593221 DOI: 10.1093/cvr/cvz260] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/23/2019] [Accepted: 10/01/2019] [Indexed: 12/13/2022] Open
Abstract
AIMS Although effective in preventing tumour growth, angiogenesis inhibitors cause off-target effects including cardiovascular toxicity and renal injury, most likely via endothelin (ET)-1 up-regulation. ET-1 via stimulation of the ETA receptor has pro-hypertensive actions whereas stimulation of the ETB receptor can elicit both pro- or anti-hypertensive effects. In this study, our aim was to determine the efficacy of selective ETA vs. dual ETA/B receptor blockade for the prevention of angiogenesis inhibitor-induced hypertension and albuminuria. METHODS AND RESULTS Male Wistar Kyoto (WKY) rats were treated with vehicle, sunitinib (angiogenesis inhibitor; 14 mg/kg/day) alone or in combination with macitentan (ETA/B receptor antagonist; 30 mg/kg/day) or sitaxentan (selective ETA receptor antagonist; 30 or 100 mg/kg/day) for 8 days. Compared with vehicle, sunitinib treatment caused a rapid and sustained increase in mean arterial pressure of ∼25 mmHg. Co-treatment with macitentan or sitaxentan abolished the pressor response to sunitinib. Sunitinib did not induce endothelial dysfunction. However, it was associated with increased aortic, mesenteric, and renal oxidative stress, an effect that was absent in mesenteric arteries of the macitentan and sitaxentan co-treated groups. Albuminuria was greater in the sunitinib- than vehicle-treated group. Co-treatment with sitaxentan, but not macitentan, prevented this increase in albuminuria. Sunitinib treatment increased circulating and urinary prostacyclin levels and had no effect on thromboxane levels. These increases in prostacyclin were blunted by co-treatment with sitaxentan. CONCLUSIONS Our results demonstrate that both selective ETA and dual ETA/B receptor antagonism prevents sunitinib-induced hypertension, whereas sunitinib-induced albuminuria was only prevented by selective ETA receptor antagonism. In addition, our results uncover a role for prostacyclin in the development of these effects. In conclusion, selective ETA receptor antagonism is sufficient for the prevention of sunitinib-induced hypertension and renal injury.
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Affiliation(s)
- Katrina M Mirabito Colafella
- Cardiovascular Disease Program, Department of Physiology, Biomedicine Discovery Institute, Monash University, 26 Innovation Walk, Melbourne, VIC 3800, Australia
- Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Karla B Neves
- Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Augusto C Montezano
- Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Ingrid M Garrelds
- Cardiovascular Disease Program, Department of Physiology, Biomedicine Discovery Institute, Monash University, 26 Innovation Walk, Melbourne, VIC 3800, Australia
| | - Richard van Veghel
- Cardiovascular Disease Program, Department of Physiology, Biomedicine Discovery Institute, Monash University, 26 Innovation Walk, Melbourne, VIC 3800, Australia
| | - René de Vries
- Cardiovascular Disease Program, Department of Physiology, Biomedicine Discovery Institute, Monash University, 26 Innovation Walk, Melbourne, VIC 3800, Australia
| | - Estrellita Uijl
- Cardiovascular Disease Program, Department of Physiology, Biomedicine Discovery Institute, Monash University, 26 Innovation Walk, Melbourne, VIC 3800, Australia
| | - Hans J Baelde
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Anton H van den Meiracker
- Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Rhian M Touyz
- Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - A H Jan Danser
- Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Jorie Versmissen
- Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
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Sunitinib-induced oxidative imbalance and retinotoxic effects in rats. Life Sci 2020; 257:118072. [PMID: 32659367 DOI: 10.1016/j.lfs.2020.118072] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/05/2020] [Accepted: 07/06/2020] [Indexed: 12/29/2022]
Abstract
AIMS Sunitinib (Su), a tyrosine kinase inhibitor, is one of the most commonly used anti-angiogenic drugs. Some studies have described retinal detachment and photoreceptor damage following systemic exposure to Su, despite beneficial effects achieved with local treatment of ocular pathologies. The aim of this study was to explore the role of NADPH oxidase system and oxidative stress in eyes from Su-treated animals. MAIN METHODS Male Wistar rats were administered 25 mg Su/kg body weight/day incorporated in the chow for 3 weeks. Upon treatment completion, NADPH oxidase activity and ROS levels were measured in ocular tissue by chemiluminescence and dihydroethidium (DHE) staining, respectively. The expression of NADPH oxidase isoforms (NOX1, NOX2 and NOX4), antioxidant enzymes and endothelial/inducible nitric oxidase isoforms (eNOS/iNOS) in the eyecup and/or retina were measured via immunofluorescence, immunoblotting and RT-qPCR. KEY FINDINGS NADPH oxidase activity/expression increased in eyecup and retinas from Su-treated rats. Immunohistofluorescence studies in retinal layer confirmed a higher signal of NADPH oxidase isoforms after Su treatment. Treated animals also presented with reductions in NO levels and eNOS expression, whereas iNOS was upregulated. Finally, a significant depletion of antioxidant enzyme glutathione peroxidase was measured in eyecups of rats following Su exposure, and the opposite pattern was seen for glutathione reductase and superoxide dismutase. SIGNIFICANCE This study demonstrates that Su treatment is associated with NADPH oxidase-derived oxidative stress in the eye. Long-term treatment of Su should be properly monitored to avoid retinotoxic effects that might result in ocular pathologies and sight-threatening conditions.
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6
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Versmissen J, Mirabito Colafella KM, Koolen SLW, Danser AHJ. Vascular Cardio-Oncology: Vascular Endothelial Growth Factor inhibitors and hypertension. Cardiovasc Res 2020; 115:904-914. [PMID: 30726882 DOI: 10.1093/cvr/cvz022] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/16/2018] [Accepted: 01/24/2019] [Indexed: 12/27/2022] Open
Abstract
Since the formation of new blood vessels is essential for tumour growth and metastatic spread, inhibition of angiogenesis by targeting the vascular endothelial growth factor (VEGF) pathway is an effective strategy for various types of cancer, most importantly renal cell carcinoma, thyroid cancer, and hepatocellular carcinoma. However, VEGF inhibitors have serious side effects, most importantly hypertension and nephropathy. In case of fulminant hypertension, this may only be handled by lowering the dosage since the blood pressure rise is proportional to the amount of VEGF inhibition. These effects pathophysiologically and clinically resemble the most severe complication of pregnancy, preeclampsia, in which case an insufficient placenta leads to a rise in sFlt-1 levels causing a decrease in VEGF availability. Due to this overlap, studies in preeclampsia may provide important information for VEGF inhibitor-induced toxicity and vice versa. In both VEGF inhibitor-induced toxicity and preeclampsia, endothelin (ET)-1 appears to be a pivotal player. In this review, after briefly summarizing the anticancer effects, we discuss the mechanisms that potentially underlie the unwanted effects of VEGF inhibitors, focusing on ET-1, nitric oxide and oxidative stress, the renin-angiotensin-aldosterone system, and rarefaction. Given the salt sensitivity of this phenomenon, as well as the beneficial effects of aspirin in preeclampsia and cancer, we next provide novel treatment options for VEGF inhibitor-induced toxicity, including salt restriction, ET receptor blockade, and cyclo-oxygenase inhibition, in addition to classical antihypertensive and renoprotective drugs. We conclude with the recommendation of therapeutic drug monitoring to improve patient outcome.
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Affiliation(s)
- Jorie Versmissen
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC University Medical Center, CA Rotterdam, The Netherlands
| | - Katrina M Mirabito Colafella
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC University Medical Center, CA Rotterdam, The Netherlands.,Cardiovascular Program, Monash Biomedicine Discovery Institute, Monash University, Melbourne, Australia.,Department of Physiology, Monash University, Melbourne, Australia
| | - Stijn L W Koolen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.,Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A H Jan Danser
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC University Medical Center, CA Rotterdam, The Netherlands
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Acute vascular effects of vascular endothelial growth factor inhibition in the forearm arterial circulation. J Hypertens 2019; 38:257-265. [PMID: 31449168 PMCID: PMC7197298 DOI: 10.1097/hjh.0000000000002230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Although vascular endothelial growth factor inhibition (VEGFi) represents a major therapeutic advance in oncology, it is associated with hypertension and adverse vascular thrombotic events. Our objective was to determine whether VEGFi caused direct vascular dysfunction through increased endothelin-1 (ET-1) activity or impaired endothelial vasomotor or fibrinolytic function.
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Justice CN, Derbala MH, Baich TM, Kempton AN, Guo AS, Ho TH, Smith SA. The Impact of Pazopanib on the Cardiovascular System. J Cardiovasc Pharmacol Ther 2018; 23:387-398. [PMID: 29706106 PMCID: PMC6257996 DOI: 10.1177/1074248418769612] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Pazopanib is an approved treatment for renal cell carcinoma and a second-line treatment for nonadipocytic soft-tissue sarcoma. However, its clinical efficacy is limited by its cardiovascular side effects. Pazopanib and other vascular endothelial growth factor receptor tyrosine kinase inhibitors have been associated with the development of hypertension, QT interval prolongation, and other cardiovascular events; however, these mechanisms are largely unknown. Gaining a deeper understanding of these mechanisms is essential for the development of appropriate surveillance strategies and possible diagnostic biomarkers to allow us to monitor patients and modulate therapy prior to significant cardiac insult. This approach will be vital in keeping patients on these life-saving therapies and may be applicable to other tyrosine kinase inhibitors as well. In this review, we provide a comprehensive overview of the preclinical and clinical side effects of pazopanib with a focus on the mechanisms responsible for its toxicity to the cardiovascular system.
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Affiliation(s)
- Cody N. Justice
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA
| | - Mohamed H. Derbala
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA
| | - Tesla M. Baich
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA
| | - Amber N. Kempton
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA
| | - Aaron S. Guo
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA
| | - Thai H. Ho
- Mayo Clinic Scottsdale, Arizona, Phoenix, AZ, USA
| | - Sakima A. Smith
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA
- Division of Cardiology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
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Tinning AR, Bengtsen C, Jensen NV, Bastholt L, Jensen BL, Madsen K. Pazopanib-Induced Hypertension in Patients With Renal Cell Carcinoma Is Associated With Low Urine Excretion of NO Metabolites. Hypertension 2018; 71:473-480. [DOI: 10.1161/hypertensionaha.117.10225] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 09/07/2017] [Accepted: 12/11/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Anne Robdrup Tinning
- From the Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense (A.R.T., C.B., B.L.J., K.M.); and Department of Oncology (N.V.J., L.B.) and Department of Pathology (K.M.), Odense University Hospital, Denmark
| | - Camilla Bengtsen
- From the Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense (A.R.T., C.B., B.L.J., K.M.); and Department of Oncology (N.V.J., L.B.) and Department of Pathology (K.M.), Odense University Hospital, Denmark
| | - Niels Viggo Jensen
- From the Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense (A.R.T., C.B., B.L.J., K.M.); and Department of Oncology (N.V.J., L.B.) and Department of Pathology (K.M.), Odense University Hospital, Denmark
| | - Lars Bastholt
- From the Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense (A.R.T., C.B., B.L.J., K.M.); and Department of Oncology (N.V.J., L.B.) and Department of Pathology (K.M.), Odense University Hospital, Denmark
| | - Boye Lagerbon Jensen
- From the Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense (A.R.T., C.B., B.L.J., K.M.); and Department of Oncology (N.V.J., L.B.) and Department of Pathology (K.M.), Odense University Hospital, Denmark
| | - Kirsten Madsen
- From the Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense (A.R.T., C.B., B.L.J., K.M.); and Department of Oncology (N.V.J., L.B.) and Department of Pathology (K.M.), Odense University Hospital, Denmark
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Collins T, Gray K, Bista M, Skinner M, Hardy C, Wang H, Mettetal JT, Harmer AR. Quantifying the relationship between inhibition of VEGF receptor 2, drug-induced blood pressure elevation and hypertension. Br J Pharmacol 2018; 175:618-630. [PMID: 29161763 DOI: 10.1111/bph.14103] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 10/20/2017] [Accepted: 11/11/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Several anti-angiogenic cancer drugs that inhibit VEGF receptor (VEGFR) signalling for efficacy are associated with a 15-60% incidence of hypertension. Tyrosine kinase inhibitors (TKIs) that have off-target activity at VEGFR-2 may also cause blood pressure elevation as an undesirable side effect. Therefore, the ability to translate VEGFR-2 off-target potency into blood pressure elevation would be useful in development of novel TKIs. Here, we have sought to quantify the relationship between VEGFR-2 inhibition and blood pressure elevation for a range of kinase inhibitors. EXPERIMENTAL APPROACH Porcine aortic endothelial cells overexpressing VEGFR-2 (PAE) were used to determine IC50 for VEGFR-2 phosphorylation. These IC50 values were compared with published reports of exposure attained during clinical use and the corresponding incidence of all-grade hypertension. Unbound average plasma concentration (Cav,u ) was selected to be the most appropriate pharmacokinetic parameter. The pharmacokinetic-pharmacodynamic (PKPD) relationship for blood pressure elevation was investigated for selected kinase inhibitors, using data derived either from clinical papers or from rat telemetry experiments. KEY RESULTS All-grade hypertension was predominantly observed when the Cav,u was >0.1-fold of the VEGFR-2 (PAE) IC50 . Furthermore, based on the PKPD analysis, an exposure-dependent blood pressure elevation >1 mmHg was observed only when the Cav,u was >0.1-fold of the VEGFR-2 (PAE) IC50 . CONCLUSIONS AND IMPLICATIONS Taken together, these data show that the risk of blood pressure elevation is proportional to the amount of VEGFR-2 inhibition, and a margin of >10-fold between VEGFR-2 IC50 and Cav,u appears to confer a minimal risk of hypertension.
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Affiliation(s)
- Teresa Collins
- AstraZeneca, Darwin Building, Cambridge Science Park, Milton Road, Cambridge, CB4, 0WG, UK
| | - Kelly Gray
- AstraZeneca, Darwin Building, Cambridge Science Park, Milton Road, Cambridge, CB4, 0WG, UK
| | - Michal Bista
- AstraZeneca, Darwin Building, Cambridge Science Park, Milton Road, Cambridge, CB4, 0WG, UK
| | - Matt Skinner
- AstraZeneca, Darwin Building, Cambridge Science Park, Milton Road, Cambridge, CB4, 0WG, UK
| | - Christopher Hardy
- AstraZeneca, Darwin Building, Cambridge Science Park, Milton Road, Cambridge, CB4, 0WG, UK
| | - Haiyun Wang
- AstraZeneca, Gatehouse Park, Waltham, MA, 02451, USA
| | | | - Alexander R Harmer
- AstraZeneca, Darwin Building, Cambridge Science Park, Milton Road, Cambridge, CB4, 0WG, UK
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11
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Lankhorst S, Jan Danser AH, van den Meiracker AH. Endothelin-1 and antiangiogenesis. Am J Physiol Regul Integr Comp Physiol 2016; 310:R230-4. [DOI: 10.1152/ajpregu.00373.2015] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 10/22/2015] [Indexed: 11/22/2022]
Abstract
Antiangiogenesis, targeting vascular endothelial growth factor (VEGF), has become a well-established treatment for patients with cancer. This treatment is associated with nitric oxide (NO) suppression and a dose-dependent activation of the endothelin system, resulting in preeclampsia-like features, particularly hypertension and renal injury. Studies in endothelium NO synthase (eNOS)-deficient mice and pharmacological treatment with endothelin receptor blockers and sildenafil indicate that an activated endothelin system, rather than NO suppression, mediates the side effects of angiogenesis inhibitors. Activation of the endothelin system is also observed in preeclamptic women, where it is related to the increased placental production of sFlt-1, the soluble form of the VEGF receptor-1. This receptor binds VEGF, thereby having the same consequences as antiangiogenic treatment with VEGF inhibitors. The side effects of antiangiogenic treatment in patients with cancer may be dose limiting, thereby impairing its therapeutic potential. In addition, because endothelin exerts proangiogenic effects, investigation of the effects of endothelin receptor blockade in patients with cancer treated with angiogenesis inhibitors is warranted.
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Affiliation(s)
- Stephanie Lankhorst
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A. H. Jan Danser
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Anton H. van den Meiracker
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
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Inflammatory and fibrotic processes are involved in the cardiotoxic effect of sunitinib: Protective role of L-carnitine. Toxicol Lett 2015; 241:9-18. [PMID: 26581635 DOI: 10.1016/j.toxlet.2015.11.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 10/23/2015] [Accepted: 11/07/2015] [Indexed: 01/12/2023]
Abstract
Sunitinib (Su) is currently approved for treatment of several malignances. However, along with the benefits of disease stabilization, cardiovascular toxicities have also been increasingly recognized. The aim of this study was to analyze which mechanisms are involved in the cardiotoxicity caused by Su, as well as to explore the potential cardioprotective effects of l-carnitine (LC). To this end, four groups of Wistar rats were used: (1) control; (2) rats treated with 400mg LC/kg/day; (3) rats treated with 25mg Su/kg/day; and (4) rats treated with LC+Su simultaneously. In addition, cultured rat cardiomyocytes were treated with an inhibitor of nuclear factor kappa B (NF-κB), in order to examine the role of this transcription factor in this process. An elevation in the myocardial expression of pro-inflammatory cytokines, together with an increase in the mRNA expression of NF-κB, was observed in Su-treated rats. These results were accompanied by an increase in the expression of pro-fibrotic factors, nitrotyrosine and NOX 2 subunit of NADPH oxidase; and by a decrease in that of collagen degradation factor. Higher blood pressure and heart rate levels were also found in Su-treated rats. All these alterations were inhibited by co-administration of LC. Furthermore, cardiotoxic effects of Su were blocked by NF-κB inhibition. Our results suggest that: (i) inflammatory and fibrotic processes are involved in the cardiac toxicity observed following treatment with Su; (ii) these processes might be mediated by the transcription factor NF-κB; (iii) LC exerts a protective effect against arterial hypertension, cardiac inflammation and fibrosis, which are all observed after Su treatment.
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Wang J, Wang Z, Zhao Y. Incidence and risk of hypertension with ramucirumab in cancer patients: a meta-analysis of published studies. Clin Drug Investig 2015; 35:221-8. [PMID: 25697774 DOI: 10.1007/s40261-015-0272-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Ramucirumab is a novel antiangiogenic agent approved as second-line therapy for patients with advanced stomach cancer and gastroesophageal junction adenocarcinoma. Although existing evidence from clinical trials has demonstrated hypertension is one of the major adverse events of this agent, overall risks have yet to be reported. METHODS We carried out a meta-analysis of published studies to determine the overall incidence and relative risk (RR) of hypertension associated with ramucirumab. Statistical analyses were conducted to calculate the summary incidence, RRs, and 95 % confidence intervals (CIs) by using a random effects model. RESULTS Eleven studies with a total of 3,851 patients with multiple cancers were included. The overall incidence of all-grade hypertension was 20.0 % (95 % CI 15.0-26.0) with 8.6 % (95 % CI 6.3-11.7) being high-grade hypertension. The risk of developing hypertension was greater in ramucirumab-treated patients (RR for all grades 2.77, 95 % CI 1.94-3.94, p < 0.001, RR for high-grade 3.58, 95 % CI 2.45-5.23, p < 0.001). CONCLUSIONS Administration of ramucirumab to patients with cancer is associated with increased risk of hypertension.
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Affiliation(s)
- Jianhua Wang
- Department of General Surgery, Jiansu Province of Traditional Chinese Medicine, 100 Shizi Street, Hongshan Road, Nanjing, 210028, Jiangsu, People's Republic of China
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Lankhorst S, Saleh L, Danser AJ, van den Meiracker AH. Etiology of angiogenesis inhibition-related hypertension. Curr Opin Pharmacol 2014; 21:7-13. [PMID: 25500206 DOI: 10.1016/j.coph.2014.11.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 11/18/2014] [Accepted: 11/26/2014] [Indexed: 11/24/2022]
Abstract
Angiogenesis inhibition, targeting vascular endothelial growth factor (VEGF) or its receptors, is an established treatment for solid tumors. A common side effect of this treatment is the development of sometimes severe hypertension. This hypertension is associated with a decrease in nitric oxide production, activation of the endothelin-signaling pathway and renin suppression. The mechanism underlying activation of the endothelin-signaling pathway is not fully understood. Both activation of endothelial cells and disinhibition of the VEGF-induced suppression of endothelin production by endothelial cells may be involved. The development of hypertension can be a reason to discontinue the angiogenesis inhibitor, thereby compromising anticancer treatment, but possibly is also a biomarker for a favorable antitumor response.
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Affiliation(s)
- Stephanie Lankhorst
- Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Langeza Saleh
- Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Ah Jan Danser
- Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Anton H van den Meiracker
- Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands.
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Lankhorst S, Kappers MHW, van Esch JHM, Smedts FMM, Sleijfer S, Mathijssen RHJ, Baelde HJ, Danser AHJ, van den Meiracker AH. Treatment of hypertension and renal injury induced by the angiogenesis inhibitor sunitinib: preclinical study. Hypertension 2014; 64:1282-9. [PMID: 25185126 DOI: 10.1161/hypertensionaha.114.04187] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Common adverse effects of angiogenesis inhibition are hypertension and renal injury. To determine the most optimal way to prevent these adverse effects and to explore their interdependency, the following drugs were investigated in unrestrained Wistar Kyoto rats exposed to the angiogenesis inhibitor sunitinib: the dual endothelin receptor antagonist macitentan; the calcium channel blocker amlodipine; the angiotensin-converting enzyme inhibitor captopril; and the phosphodiesterase type 5 inhibitor sildenafil. Mean arterial pressure was monitored telemetrically. After 8 days, rats were euthanized and blood samples and kidneys were collected. In addition, 24-hour urine samples were collected. After sunitinib start, mean arterial pressure increased rapidly by ≈30 mm Hg. Coadministration of macitentan or amlodipine largely prevented this rise, whereas captopril or sildenafil did not. Macitentan, captopril, and sildenafil diminished the sunitinib-induced proteinuria and endothelinuria and glomerular intraepithelial protein deposition, whereas amlodipine did not. Changes in proteinuria and endothelinuria were unrelated. We conclude that in our experimental model, dual endothelin receptor antagonism and calcium channel blockade are suitable to prevent angiogenesis inhibition-induced hypertension, whereas dual endothelin receptor antagonism, angiotensin-converting enzyme inhibitor, and phosphodiesterase type 5 inhibition can prevent angiogenesis inhibition-induced proteinuria. Moreover, the variable response of hypertension and renal injury to different antihypertensive agents suggests that these side effects are, at least in part, unrelated.
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Affiliation(s)
- Stephanie Lankhorst
- From the Division of Pharmacology and Vascular Medicine, Department of Internal Medicine (S.L., M.H.W.K., J.H.M.v.E., A.H.J.D., A.H.v.d.M.) and Department of Medical Oncology, Erasmus MC Cancer Institute (S.S., R.H.J.M.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of Pathology, Reinier de Graaf Groep, Delft, The Netherlands (F.M.M.S.); Department of Internal Medicine, Amphia Hospital, Breda, The Netherlands (M.H.W.K.); and Department of Pathology, Leiden University Medical Center, Leiden (H.J.B.)
| | - Mariëtte H W Kappers
- From the Division of Pharmacology and Vascular Medicine, Department of Internal Medicine (S.L., M.H.W.K., J.H.M.v.E., A.H.J.D., A.H.v.d.M.) and Department of Medical Oncology, Erasmus MC Cancer Institute (S.S., R.H.J.M.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of Pathology, Reinier de Graaf Groep, Delft, The Netherlands (F.M.M.S.); Department of Internal Medicine, Amphia Hospital, Breda, The Netherlands (M.H.W.K.); and Department of Pathology, Leiden University Medical Center, Leiden (H.J.B.)
| | - Joep H M van Esch
- From the Division of Pharmacology and Vascular Medicine, Department of Internal Medicine (S.L., M.H.W.K., J.H.M.v.E., A.H.J.D., A.H.v.d.M.) and Department of Medical Oncology, Erasmus MC Cancer Institute (S.S., R.H.J.M.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of Pathology, Reinier de Graaf Groep, Delft, The Netherlands (F.M.M.S.); Department of Internal Medicine, Amphia Hospital, Breda, The Netherlands (M.H.W.K.); and Department of Pathology, Leiden University Medical Center, Leiden (H.J.B.)
| | - Frank M M Smedts
- From the Division of Pharmacology and Vascular Medicine, Department of Internal Medicine (S.L., M.H.W.K., J.H.M.v.E., A.H.J.D., A.H.v.d.M.) and Department of Medical Oncology, Erasmus MC Cancer Institute (S.S., R.H.J.M.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of Pathology, Reinier de Graaf Groep, Delft, The Netherlands (F.M.M.S.); Department of Internal Medicine, Amphia Hospital, Breda, The Netherlands (M.H.W.K.); and Department of Pathology, Leiden University Medical Center, Leiden (H.J.B.)
| | - Stefan Sleijfer
- From the Division of Pharmacology and Vascular Medicine, Department of Internal Medicine (S.L., M.H.W.K., J.H.M.v.E., A.H.J.D., A.H.v.d.M.) and Department of Medical Oncology, Erasmus MC Cancer Institute (S.S., R.H.J.M.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of Pathology, Reinier de Graaf Groep, Delft, The Netherlands (F.M.M.S.); Department of Internal Medicine, Amphia Hospital, Breda, The Netherlands (M.H.W.K.); and Department of Pathology, Leiden University Medical Center, Leiden (H.J.B.)
| | - Ron H J Mathijssen
- From the Division of Pharmacology and Vascular Medicine, Department of Internal Medicine (S.L., M.H.W.K., J.H.M.v.E., A.H.J.D., A.H.v.d.M.) and Department of Medical Oncology, Erasmus MC Cancer Institute (S.S., R.H.J.M.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of Pathology, Reinier de Graaf Groep, Delft, The Netherlands (F.M.M.S.); Department of Internal Medicine, Amphia Hospital, Breda, The Netherlands (M.H.W.K.); and Department of Pathology, Leiden University Medical Center, Leiden (H.J.B.)
| | - Hans J Baelde
- From the Division of Pharmacology and Vascular Medicine, Department of Internal Medicine (S.L., M.H.W.K., J.H.M.v.E., A.H.J.D., A.H.v.d.M.) and Department of Medical Oncology, Erasmus MC Cancer Institute (S.S., R.H.J.M.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of Pathology, Reinier de Graaf Groep, Delft, The Netherlands (F.M.M.S.); Department of Internal Medicine, Amphia Hospital, Breda, The Netherlands (M.H.W.K.); and Department of Pathology, Leiden University Medical Center, Leiden (H.J.B.)
| | - A H Jan Danser
- From the Division of Pharmacology and Vascular Medicine, Department of Internal Medicine (S.L., M.H.W.K., J.H.M.v.E., A.H.J.D., A.H.v.d.M.) and Department of Medical Oncology, Erasmus MC Cancer Institute (S.S., R.H.J.M.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of Pathology, Reinier de Graaf Groep, Delft, The Netherlands (F.M.M.S.); Department of Internal Medicine, Amphia Hospital, Breda, The Netherlands (M.H.W.K.); and Department of Pathology, Leiden University Medical Center, Leiden (H.J.B.)
| | - Anton H van den Meiracker
- From the Division of Pharmacology and Vascular Medicine, Department of Internal Medicine (S.L., M.H.W.K., J.H.M.v.E., A.H.J.D., A.H.v.d.M.) and Department of Medical Oncology, Erasmus MC Cancer Institute (S.S., R.H.J.M.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of Pathology, Reinier de Graaf Groep, Delft, The Netherlands (F.M.M.S.); Department of Internal Medicine, Amphia Hospital, Breda, The Netherlands (M.H.W.K.); and Department of Pathology, Leiden University Medical Center, Leiden (H.J.B.).
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De Mey JGR, Vanhoutte PM. End o' the line revisited: moving on from nitric oxide to CGRP. Life Sci 2014; 118:120-8. [PMID: 24747136 DOI: 10.1016/j.lfs.2014.04.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 04/04/2014] [Accepted: 04/05/2014] [Indexed: 12/24/2022]
Abstract
When endothelin-1(ET-1) was discovered it was hailed as the prototypical endothelium-derived contracting factor (EDCF). However, over the years little evidence emerged convincingly demonstrating that the peptide actually contributes to moment-to-moment changes in vascular tone elicited by endothelial cells. This has been attributed to the profound inhibitory effect of nitric oxide (NO) on both the production (by the endothelium) and the action (on vascular smooth muscle) of ET-1. Hence, the peptide is likely to initiate acute changes in vascular diameter only under extreme conditions of endothelial dysfunction when the NO bioavailability is considerably reduced if not absent. The present essay discusses whether or not this concept should be revised, in particular in view of the potent inhibitory effect exerted by calcitonin gene related peptide (CGRP) released from sensorimotor nerves on vasoconstrictor responses to ET-1.
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Affiliation(s)
- Jo G R De Mey
- Institute of Molecular Medicine, University of South Denmark, Odense, Denmark; Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Paul M Vanhoutte
- Institute of Molecular Medicine, University of South Denmark, Odense, Denmark; Department of Pharmacology and Pharmacy and State Key Laboratory for Pharmaceutical Biotechnology, University of Hong Kong, Hong Kong, China.
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Fryer RM, Ng KJ, Nodop Mazurek SG, Patnaude L, Skow DJ, Muthukumarana A, Gilpin KE, Dinallo RM, Kuzmich D, Lord J, Sanyal S, Yu H, Harcken C, Cerny MA, Cerny MC, Hickey ER, Modis LK. G protein-coupled bile acid receptor 1 stimulation mediates arterial vasodilation through a K(Ca)1.1 (BK(Ca))-dependent mechanism. J Pharmacol Exp Ther 2014; 348:421-31. [PMID: 24399854 DOI: 10.1124/jpet.113.210005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Bile acids (BAs) and BA receptors, including G protein-coupled bile acid receptor 1 (GPBAR1), represent novel targets for the treatment of metabolic and inflammatory disorders. However, BAs elicit myriad effects on cardiovascular function, although this has not been specifically ascribed to GPBAR1. This study was designed to test whether stimulation of GPBAR1 elicits effects on cardiovascular function that are mechanism based that can be identified in acute ex vivo and in vivo cardiovascular models, to delineate whether effects were due to pathways known to be modulated by BAs, and to establish whether a therapeutic window between in vivo cardiovascular liabilities and on-target efficacy could be defined. The results demonstrated that the infusion of three structurally diverse and selective GPBAR1 agonists produced marked reductions in vascular tone and blood pressure in dog, but not in rat, as well as reflex tachycardia and a positive inotropic response, effects that manifested in an enhanced cardiac output. Changes in cardiovascular function were unrelated to modulation of the levothyroxine/thyroxine axis and were nitric oxide independent. A direct effect on vascular tone was confirmed in dog isolated vascular rings, whereby concentration-dependent decreases in tension that were tightly correlated with reductions in vascular tone observed in vivo and were blocked by iberiotoxin. Compound concentrations in which cardiovascular effects occurred, both ex vivo and in vivo, could not be separated from those necessary for modulation of GPBAR1-mediated efficacy, resulting in project termination. These results are the first to clearly demonstrate direct and potent peripheral arterial vasodilation due to GPBAR1 stimulation in vivo through activation of large conductance Ca(2+) activated potassium channel K(Ca)1.1.
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Affiliation(s)
- Ryan M Fryer
- Departments of Cardiometabolic Diseases Research (R.M.F., K.J.N., S.G.N.M., A.M.), Immunology and Inflammation (L.P., L.K.M.), and Medicinal Chemistry (D.J.S., K.E.G., R.M.D., D.K., J.L., S.S., H.Y., C.H., M.C.C., E.R.H.), Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, Connecticut
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Lankhorst S, Kappers MHW, van Esch JHM, Danser AHJ, van den Meiracker AH. Hypertension during vascular endothelial growth factor inhibition: focus on nitric oxide, endothelin-1, and oxidative stress. Antioxid Redox Signal 2014; 20:135-45. [PMID: 23458507 DOI: 10.1089/ars.2013.5244] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
SIGNIFICANCE Angiogenesis inhibition with humanized antibodies targeting vascular endothelial growth factor (VEGF) or orally active small tyrosine kinase inhibitors targeting VEGF receptors has become an established treatment modality for various forms of cancer. A common side effect of angiogenesis inhibition is the development of sometimes severe hypertension, which simultaneously appears to be predictive for a favorable antitumor response. RECENT ADVANCES Since VEGF increases the expression and activity of endothelial nitric oxide synthase, it has been assumed that the mean blood pressure (MAP) rise during angiogenesis inhibition is caused by a decrease in nitric oxide bioavailability. Yet, the results from experimental and clinical studies exploring this possibility are conflicting. Recent studies provided evidence that the MAP rise during angiogenesis inhibition rather is mediated by activation of the endothelin-1 (ET-1) axis, which, among others, induces oxidative stress. Nevertheless, conclusive evidence for the involvement of reactive oxygen species in the MAP rise could not be obtained so far. CRITICAL ISSUES The mechanism underlying activation of the ET-1 axis during angiogenesis inhibition is unclear, and this activation was not anticipated in view of studies showing that VEGF stimulates both the expression and production of ET-1 by endothelial cells. FUTURE DIRECTIONS In fact, this activation of the ET-1 axis may support the use of ET receptor antagonists for the treatment of angiogenesis inhibition-induced hypertension, especially because ET receptor stimulation in vascular smooth muscle cells results in VEGF production and mitogenesis in a mitogen-activated protein kinase pathway-dependent manner.
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Affiliation(s)
- Stephanie Lankhorst
- Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, Erasmus MC , Rotterdam, The Netherlands
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20
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Tan RJ, Zhou L, Zhou D, Lin L, Liu Y. Endothelin receptor a blockade is an ineffective treatment for adriamycin nephropathy. PLoS One 2013; 8:e79963. [PMID: 24265790 PMCID: PMC3825716 DOI: 10.1371/journal.pone.0079963] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 09/28/2013] [Indexed: 11/24/2022] Open
Abstract
Endothelin is a vasoconstricting peptide that plays a key role in vascular homeostasis, exerting its biologic effects via two receptors, the endothelin receptor A (ETA) and endothelin receptor B (ETB). Activation of ETA and ETB has opposing actions, in which hyperactive ETA is generally vasoconstrictive and pathologic. Selective ETA blockade has been shown to be beneficial in renal injuries such as diabetic nephropathy and can improve proteinuria. Atrasentan is a selective pharmacologic ETA blocker that preferentially inhibits ETA activation. In this study, we evaluated the efficacy of ETA blockade by atrasentan in ameliorating proteinuria and kidney injury in murine adriamycin nephropathy, a model of human focal segmental glomerulosclerosis. We found that ETA expression was unaltered during the course of adriamycin nephropathy. Whether initiated prior to injury in a prevention protocol (5 mg/kg/day, i.p.) or after injury onset in a therapeutic protocol (7 mg/kg or 20 mg/kg three times a week, i.p.), atrasentan did not significantly affect the initiation and progression of adriamycin-induced albuminuria (as measured by urinary albumin-to-creatinine ratios). Indices of glomerular damage were also not improved in atrasentan-treated groups, in either the prevention or therapeutic protocols. Atrasentan also failed to improve kidney function as determined by serum creatinine, histologic damage, and mRNA expression of numerous fibrosis-related genes such as collagen-I and TGF-β1. Therefore, we conclude that selective blockade of ETA by atrasentan has no effect on preventing or ameliorating proteinuria and kidney injury in adriamycin nephropathy.
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Affiliation(s)
- Roderick J. Tan
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Lili Zhou
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Dong Zhou
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Lin Lin
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Youhua Liu
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
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Wang Z, Xu J, Nie W, Huang G, Tang J, Guan X. Risk of hypertension with regorafenib in cancer patients: a systematic review and meta-analysis. Eur J Clin Pharmacol 2013; 70:225-31. [PMID: 24150533 DOI: 10.1007/s00228-013-1598-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 09/30/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Regorafenib is a novel multikinase inhibitor approved for use in metastatic colorectal cancer (mCRC) and locally advanced gastrointestinal stromal tumors (GISTs). Hypertension is one of the major adverse events of this agent, but to date the incidence and risk of hypertension with regorafenib have not been systematically investigated. We have conducted a systematic review and meta-analysis of published clinical trials to determine its overall incidence and risk. METHODS PubMed, Web of Science and abstracts presented at the American Society of Clinical Oncology annual meetings were searched to identify relevant studies published up to September 9, 2013. Eligible studies were prospective phase II or III clinical trials using regorafenib in cancer patients with data on hypertension available. The incidence and relative risk (RR) of hypertension were calculated using a random-effects model. RESULTS Data from a total of 1,069 patients (regorafenib n = 750; controls n = 319) from five clinical trials were included for analysis. The overall incidence of all-grade and high-grade hypertension were 44.4 % [95 % confidence interval (CI) 30.8-59.0 %) and 12.5 % (95 % CI 5.2-27.1 %), respectively. The use of regorafenib in cancer patients was associated with a significantly increased risk of all-grade (RR 3.76, 95 % CI 2.35-5.99) and high-grade (RR, 8.39, 95 % CI 3.10-22.71) hypertension. The risk might vary with tumor types (P = 0.000). CONCLUSIONS Patients with cancer receiving regorafenib have a significantly higher risk of developing hypertension. Close monitoring and appropriate management of this hypertension are strongly recommended.
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Affiliation(s)
- Zexing Wang
- Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu Province, 210002, People's Republic of China
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Schmidinger M. Understanding and managing toxicities of vascular endothelial growth factor (VEGF) inhibitors. EJC Suppl 2013; 11:172-91. [PMID: 26217127 PMCID: PMC4041401 DOI: 10.1016/j.ejcsup.2013.07.016] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Mechanism of hypertension and proteinuria during angiogenesis inhibition. J Hypertens 2013; 31:444-54; discussion 454. [DOI: 10.1097/hjh.0b013e32835c1d1b] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
For a few years, new targeted therapies have been used for metastatic cancers, targeting VEGF and its receptors and improving patients' survival for metastatic carcinoma (kidney, GIST, breast, colorectal). The objective of these treatments is to block either circulating VEGF (bevacizumab; VEGF-Trap), or tyrosine kinase receptors (especially the VEGF receptor) (sorafenib, sunitinib, brivanib, imatinib, etc.). Indeed, VEGF stimulates endothelial cell proliferation and then tumour growth and metastasis. However, all these antiangiogenic drugs share similar side effects, most frequently gastrointestinal disturbance, skin toxicity and hypertension. Hypertension seems to be especially frequent in case of good response. Renal side effects have probably been underestimated in the first place and their exact frequency is not known, needing some specific trials and registries. Proteinuria, thrombotic microangiopathies and acute renal failures have been reported: renal biopsies might be necessary for precise evaluation of renal damages. Physiopathology seems very close to preeclampsia. Good collaboration between oncologists, nephrologists and cardiologists is therefore crucial in order to continue these targeted therapies safely for the patients.
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Affiliation(s)
- Cécile Vigneau
- Service de Néphrologie, Centre Hospitalier Universitaire Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France.
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Fryer RM, Muthukumarana A, Harrison PC, Nodop Mazurek S, Chen RR, Harrington KE, Dinallo RM, Horan JC, Patnaude L, Modis LK, Reinhart GA. The clinically-tested S1P receptor agonists, FTY720 and BAF312, demonstrate subtype-specific bradycardia (S1P₁) and hypertension (S1P₃) in rat. PLoS One 2012; 7:e52985. [PMID: 23285242 PMCID: PMC3532212 DOI: 10.1371/journal.pone.0052985] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 11/22/2012] [Indexed: 12/21/2022] Open
Abstract
Sphingosine-1-phospate (S1P) and S1P receptor agonists elicit mechanism-based effects on cardiovascular function in vivo. Indeed, FTY720 (non-selective S1P(X) receptor agonist) produces modest hypertension in patients (2-3 mmHg in 1-yr trial) as well as acute bradycardia independent of changes in blood pressure. However, the precise receptor subtypes responsible is controversial, likely dependent upon the cardiovascular response in question (e.g. bradycardia, hypertension), and perhaps even species-dependent since functional differences in rodent, rabbit, and human have been suggested. Thus, we characterized the S1P receptor subtype specificity for each compound in vitro and, in vivo, the cardiovascular effects of FTY720 and the more selective S1P₁,₅ agonist, BAF312, were tested during acute i.v. infusion in anesthetized rats and after oral administration for 10 days in telemetry-instrumented conscious rats. Acute i.v. infusion of FTY720 (0.1, 0.3, 1.0 mg/kg/20 min) or BAF312 (0.5, 1.5, 5.0 mg/kg/20 min) elicited acute bradycardia in anesthetized rats demonstrating an S1P₁ mediated mechanism-of-action. However, while FTY720 (0.5, 1.5, 5.0 mg/kg/d) elicited dose-dependent hypertension after multiple days of oral administration in rat at clinically relevant plasma concentrations (24-hr mean blood pressure = 8.4, 12.8, 16.2 mmHg above baseline vs. 3 mmHg in vehicle controls), BAF312 (0.3, 3.0, 30.0 mg/kg/d) had no significant effect on blood pressure at any dose tested suggesting that hypertension produced by FTY720 is mediated S1P₃ receptors. In summary, in vitro selectivity results in combination with studies performed in anesthetized and conscious rats administered two clinically tested S1P agonists, FTY720 or BAF312, suggest that S1P₁ receptors mediate bradycardia while hypertension is mediated by S1P₃ receptor activation.
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Affiliation(s)
- Ryan M Fryer
- Department of Cardiometabolic Disease Research, Boehringer-Ingelheim Pharmaceuticals Inc., Ridgefield, Connecticut, United States of America.
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Jesus-Gonzalez de N, Robinson E, Penchev R, von Mehren M, Heinrich MC, Tap W, Wang Q, Demetri G, George S, Humphreys BD. Regorafenib induces rapid and reversible changes in plasma nitric oxide and endothelin-1. Am J Hypertens 2012; 25:1118-23. [PMID: 22785409 PMCID: PMC3578478 DOI: 10.1038/ajh.2012.97] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 05/18/2012] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Hypertension is a toxicity of antiangiogenic therapies and a possible biomarker that identifies patients with superior cancer outcomes. Understanding its mechanism will aid in treatment and could lead to the development of other biomarkers for predicting toxicity and anticancer efficacy. Recent evidence implicates nitric oxide (NO) suppression and endothelin-1 (ET-1) stimulation as potential mechanisms leading to antiangiogenic therapy-induced hypertension. The aim of this study was to evaluate the effects of regorafenib, a novel broad-spectrum kinase inhibitor with activity against multiple targets, including vascular endothelial growth factor receptor 2 inhibition, on NO and ET-1 levels. METHODS Regorafenib was administered to 32 subjects with gastrointestinal stromal tumor on a 3-week-on, 1-week-off basis. Plasma levels of NO and ET-1 were measured at baseline, 2, 4, and 6 weeks of therapy. Data analysis was by Wilcoxon rank-sum and paired t-tests. RESULTS Twenty subjects (63%) developed regorafenib-induced hypertension. Two weeks after starting regorafenib therapy, plasma ET-1 levels increased (25% increase, P < 0.05) and NO was suppressed (20% decrease, P < 0.05). These normalized after 1-week washout but ET-1 rose again by 30% (P < 0.05) and NO fell by 50% (P < 0.05) after restarting regorafenib. CONCLUSIONS These findings indicate that regorafenib induces a coordinated and reversible suppression of NO and stimulation of ET-1. Whether NO and ET-1 might predict therapeutic efficacy in these patients requires further study.
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Affiliation(s)
- Nilka Jesus-Gonzalez de
- Division of Nephrology, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Emily Robinson
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Radostin Penchev
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Margaret von Mehren
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Michael C. Heinrich
- Division of Hematology/Oncology, Oregon Health and Sciences University, Knight Cancer Institute, Portland, Oregon, USA
| | - William Tap
- Melanoma/Sarcoma Service, Division of Solid Tumors, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Qian Wang
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - George Demetri
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Suzanne George
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Benjamin D. Humphreys
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Lance Armstrong Foundation Adult Survivorship Clinic, Dana Farber Cancer Institute, Boston, Massachusetts, USA
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Zhang Y, Li L, Hua Y, Nunn JM, Dong F, Yanagisawa M, Ren J. Cardiac-specific knockout of ET(A) receptor mitigates low ambient temperature-induced cardiac hypertrophy and contractile dysfunction. J Mol Cell Biol 2012; 4:97-107. [PMID: 22442497 DOI: 10.1093/jmcb/mjs002] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Cold exposure is associated with oxidative stress and cardiac dysfunction. The endothelin (ET) system, which plays a key role in myocardial homeostasis, may participate in cold exposure-induced cardiovascular dysfunction. This study was designed to examine the role of ET-1 in cold stress-induced cardiac geometric and contractile responses. Wild-type (WT) and ET(A) receptor knockout (ETAKO) mice were assigned to normal or cold exposure (4°C) environment for 2 and 5 weeks prior to evaluation of cardiac geometry, contractile, and intracellular Ca(2+) properties. Levels of the temperature sensor transient receptor potential vanilloid (TRPV1), mitochondrial proteins for biogenesis and oxidative phosphorylation, including UCP2, HSP90, and PGC1α were evaluated. Cold stress triggered cardiac hypertrophy, depressed myocardial contractile capacity, including fractional shortening, peak shortening, and maximal velocity of shortening/relengthening, reduced intracellular Ca(2+) release, prolonged intracellular Ca(2+) decay and relengthening duration, generation of ROS and superoxide, as well as apoptosis, the effects of which were blunted by ETAKO. Western blotting revealed downregulated TRPV1 and PGC1α as well as upregulated UCP2 and activation of GSK3β, GATA4, and CREB in cold-stressed WT mouse hearts, which were obliterated by ETAKO. Levels of HSP90, an essential regulator for thermotolerance, were unchanged. The TRPV1 agonist SA13353 attenuated whereas TRPV1 antagonist capsazepine mimicked cold stress- or ET-1-induced cardiac anomalies. The GSK3β inhibitor SB216763 ablated cold stress-induced cardiac contractile (but not remodeling) changes and ET-1-induced TRPV1 downregulation. These data suggest that ETAKO protects against cold exposure-induced cardiac remodeling and dysfunction mediated through TRPV1 and mitochondrial function.
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Affiliation(s)
- Yingmei Zhang
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
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Kappers MH, de Beer VJ, Zhou Z, Danser AJ, Sleijfer S, Duncker DJ, van den Meiracker AH, Merkus D. Sunitinib-Induced Systemic Vasoconstriction in Swine Is Endothelin Mediated and Does Not Involve Nitric Oxide or Oxidative Stress. Hypertension 2012; 59:151-7. [DOI: 10.1161/hypertensionaha.111.182220] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Angiogenesis inhibition with agents targeting tyrosine kinases of vascular endothelial growth factor receptors is an established anticancer treatment, but is, unfortunately, frequently accompanied by systemic hypertension and cardiac toxicity. Whether vascular endothelial growth factor receptor antagonism also has adverse effects on the pulmonary and coronary circulations is presently unknown. In chronically instrumented awake swine, the effects of the vascular endothelial growth factor receptor antagonist sunitinib on the systemic, pulmonary, and coronary circulation were studied. One week after sunitinib (50 mg PO daily), mean aortic blood pressure (MABP) had increased from 83±5 mm Hg at baseline to 97±6 mm Hg (
P
<0.05) because of a 57±20% increase in systemic vascular resistance as cardiac output decreased. In contrast, sunitinib had no discernible effects on pulmonary and coronary hemodynamics or cardiac function. We subsequently investigated the mechanisms underlying the sunitinib-induced systemic hypertension. Intravenous administration of NO synthase inhibitor
N
G
-nitro-
l
-arginine increased MABP by 24±1 mm Hg under baseline conditions, whereas it increased MABP even further after sunitinib administration (32±3 mm Hg;
P
<0.05). Reactive oxygen species scavenging with a mixture of antioxidants lowered MABP by 13±2 mm Hg before but only by 5±2 mm Hg (
P
<0.05) after sunitinib administration. However, intravenous administration of the dual endothelin A/endothelin B receptor blocker tezosentan, which did not lower MABP at baseline, completely reversed MABP to presunitinib values. These findings indicate that sunitinib produces vasoconstriction selectively in the systemic vascular bed, without affecting pulmonary or coronary circulations. The sunitinib-mediated systemic hypertension is principally attributed to an increased vasoconstrictor influence of endothelin, with no apparent contributions of a loss of NO bioavailability or increased oxidative stress.
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Affiliation(s)
- Mariëtte H.W. Kappers
- From the Division of Pharmacology and Vascular Medicine, Department of Internal Medicine (M.H.W.K., A.H.J.D., A.H.v.d.M.), Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter (V.J.d.B., Z.Z., D.J.D., D.M.), and Department of Medical Oncology (S.S.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Vincent J. de Beer
- From the Division of Pharmacology and Vascular Medicine, Department of Internal Medicine (M.H.W.K., A.H.J.D., A.H.v.d.M.), Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter (V.J.d.B., Z.Z., D.J.D., D.M.), and Department of Medical Oncology (S.S.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Zhichao Zhou
- From the Division of Pharmacology and Vascular Medicine, Department of Internal Medicine (M.H.W.K., A.H.J.D., A.H.v.d.M.), Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter (V.J.d.B., Z.Z., D.J.D., D.M.), and Department of Medical Oncology (S.S.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - A.H. Jan Danser
- From the Division of Pharmacology and Vascular Medicine, Department of Internal Medicine (M.H.W.K., A.H.J.D., A.H.v.d.M.), Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter (V.J.d.B., Z.Z., D.J.D., D.M.), and Department of Medical Oncology (S.S.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Stefan Sleijfer
- From the Division of Pharmacology and Vascular Medicine, Department of Internal Medicine (M.H.W.K., A.H.J.D., A.H.v.d.M.), Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter (V.J.d.B., Z.Z., D.J.D., D.M.), and Department of Medical Oncology (S.S.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Dirk J. Duncker
- From the Division of Pharmacology and Vascular Medicine, Department of Internal Medicine (M.H.W.K., A.H.J.D., A.H.v.d.M.), Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter (V.J.d.B., Z.Z., D.J.D., D.M.), and Department of Medical Oncology (S.S.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Anton H. van den Meiracker
- From the Division of Pharmacology and Vascular Medicine, Department of Internal Medicine (M.H.W.K., A.H.J.D., A.H.v.d.M.), Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter (V.J.d.B., Z.Z., D.J.D., D.M.), and Department of Medical Oncology (S.S.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Daphne Merkus
- From the Division of Pharmacology and Vascular Medicine, Department of Internal Medicine (M.H.W.K., A.H.J.D., A.H.v.d.M.), Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter (V.J.d.B., Z.Z., D.J.D., D.M.), and Department of Medical Oncology (S.S.), Erasmus Medical Center, Rotterdam, The Netherlands
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Fryer RM, Muthukumarana A, Chen RR, Smith JD, Mazurek SN, Harrington KE, Dinallo RM, Burke J, DiCapua FM, Guo X, Kirrane TM, Snow RJ, Zhang Y, Soleymanzadeh F, Madwed JB, Kashem MA, Kugler SZ, O'Neill MM, Harrison PC, Reinhart GA, Boyer SJ. Mitigation of off-target adrenergic binding and effects on cardiovascular function in the discovery of novel ribosomal S6 kinase 2 inhibitors. J Pharmacol Exp Ther 2011; 340:492-500. [PMID: 22128344 DOI: 10.1124/jpet.111.189365] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We previously reported the discovery of a novel ribosomal S6 kinase 2 (RSK2) inhibitor, (R)-5-Methyl-1-oxo-2,3,4,5-tetrahydro-1H-[1,4]diazepino[1,2-a] indole-8-carboxylic acid [1-(3-dimethylamino-propyl)-1H-benzoimidazol-2-yl]-amide (BIX 02565), with high potency (IC(50) = 1.1 nM) targeted for the treatment of heart failure. In the present study, we report that despite nanomolar potency at the target, BIX 02565 elicits off-target binding at multiple adrenergic receptor subtypes that are important in the control of vascular tone and cardiac function. To elucidate in vivo the functional consequence of receptor binding, we characterized the cardiovascular (CV) profile of the compound in an anesthetized rat CV screen and telemetry-instrumented conscious rats. Infusion of BIX 02565 (1, 3, and 10 mg/kg) in the rat CV screen resulted in a precipitous decrease in both mean arterial pressure (MAP; to -65 ± 6 mm Hg below baseline) and heart rate (-93 ± 13 beats/min). In telemetry-instrumented rats, BIX 02565 (30, 100, and 300 mg/kg p.o. QD for 4 days) elicited concentration-dependent decreases in MAP after each dose (to -39 ± 4 mm Hg on day 4 at T(max)); analysis by Demming regression demonstrated strong correlation independent of route of administration and influence of anesthesia. Because of pronounced off-target effects of BIX 02565 on cardiovascular function, a high-throughput selectivity screen at adrenergic α(1A) and α(2A) was performed for 30 additional RSK2 inhibitors in a novel chemical series; a wide range of adrenergic binding was achieved (0-92% inhibition), allowing for differentiation within the series. Eleven lead compounds with differential binding were advanced to the rat CV screen for in vivo profiling. This led to the identification of potent RSK2 inhibitors (cellular IC(50) <0.14 nM) without relevant α(1A) and α(2A) inhibition and no adverse cardiovascular effects in vivo.
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Affiliation(s)
- Ryan M Fryer
- Department of Cardiometabolic Disease Research, Boehringer-Ingelheim Pharmaceuticals, Inc., 900 Ridgebury Road, Ridgefield, CT 06877-0368, USA.
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van den Meiracker AH, Danser AHJ, Sleijfer S, Kappers MHW. Re: Hypertension as a biomarker of efficacy in patients with metastatic renal cell carcinoma treated with sunitinib. J Natl Cancer Inst 2011; 103:1557; author reply 1558. [PMID: 21862728 DOI: 10.1093/jnci/djr328] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Kappers MHW, Smedts FMM, Horn T, van Esch JHM, Sleijfer S, Leijten F, Wesseling S, Strevens H, Jan Danser AH, van den Meiracker AH. The vascular endothelial growth factor receptor inhibitor sunitinib causes a preeclampsia-like syndrome with activation of the endothelin system. Hypertension 2011; 58:295-302. [PMID: 21670421 DOI: 10.1161/hypertensionaha.111.173559] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Angiogenesis inhibition is an established treatment for several tumor types. Unfortunately, this therapy is associated with adverse effects, including hypertension and renal toxicity, referred to as "preeclampsia." Recently, we demonstrated in patients and in rats that the multitarget tyrosine kinase inhibitor sunitinib induces a rise in blood pressure (BP), renal dysfunction, and proteinuria associated with activation of the endothelin system. In the current study we investigated the effects of sunitinib on rat renal histology, including the resemblance with preeclampsia, as well as the roles of endothelin 1, decreased nitric oxide (NO) bioavailability, and increased oxidative stress in the development of sunitinib-induced hypertension and renal toxicity. In rats on sunitinib, light and electron microscopic examination revealed marked glomerular endotheliosis, a characteristic histological feature of preeclampsia, which was partly reversible after sunitinib discontinuation. The histological abnormalities were accompanied by an increase in urinary excretion of endothelin 1 and diminished NO metabolite excretion. In rats on sunitinib alone, BP increased (ΔBP: 31.6±0.9 mm Hg). This rise could largely be prevented with the endothelin receptor antagonist macitentan (ΔBP: 12.3±1.5 mm Hg) and only mildly with Tempol, a superoxide dismutase mimetic (ΔBP: 25.9±2.3 mm Hg). Both compounds could not prevent the sunitinib-induced rise in serum creatinine or renal histological abnormalities and had no effect on urine nitrates but decreased proteinuria and urinary endothelin 1 excretion. Our findings indicate that both the endothelin system and oxidative stress play important roles in the development of sunitinib-induced proteinuria and that the endothelin system rather than oxidative stress is important for the development of sunitinib-induced hypertension.
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Affiliation(s)
- Mariëtte H W Kappers
- Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, Erasmus MC, 's Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
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Kappers MH, van Esch JH, Sluiter W, Sleijfer S, Danser AHJ, van den Meiracker AH. Hypertension Induced by the Tyrosine Kinase Inhibitor Sunitinib Is Associated With Increased Circulating Endothelin-1 Levels. Hypertension 2010; 56:675-81. [DOI: 10.1161/hypertensionaha.109.149690] [Citation(s) in RCA: 207] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Mariëtte H.W. Kappers
- From the Division of Pharmacology, Vascular and Metabolic Diseases, Department of Internal Medicine (M.H.W.K., J.H.M.v.E., A.H.J.D., A.H.v.d.M.) and Departments of Neurology (W.S.) and Medical Oncology (S.S.), Erasmus MC, Rotterdam, The Netherlands
| | - Joep H.M. van Esch
- From the Division of Pharmacology, Vascular and Metabolic Diseases, Department of Internal Medicine (M.H.W.K., J.H.M.v.E., A.H.J.D., A.H.v.d.M.) and Departments of Neurology (W.S.) and Medical Oncology (S.S.), Erasmus MC, Rotterdam, The Netherlands
| | - Wim Sluiter
- From the Division of Pharmacology, Vascular and Metabolic Diseases, Department of Internal Medicine (M.H.W.K., J.H.M.v.E., A.H.J.D., A.H.v.d.M.) and Departments of Neurology (W.S.) and Medical Oncology (S.S.), Erasmus MC, Rotterdam, The Netherlands
| | - Stefan Sleijfer
- From the Division of Pharmacology, Vascular and Metabolic Diseases, Department of Internal Medicine (M.H.W.K., J.H.M.v.E., A.H.J.D., A.H.v.d.M.) and Departments of Neurology (W.S.) and Medical Oncology (S.S.), Erasmus MC, Rotterdam, The Netherlands
| | - A. H. Jan Danser
- From the Division of Pharmacology, Vascular and Metabolic Diseases, Department of Internal Medicine (M.H.W.K., J.H.M.v.E., A.H.J.D., A.H.v.d.M.) and Departments of Neurology (W.S.) and Medical Oncology (S.S.), Erasmus MC, Rotterdam, The Netherlands
| | - Anton H. van den Meiracker
- From the Division of Pharmacology, Vascular and Metabolic Diseases, Department of Internal Medicine (M.H.W.K., J.H.M.v.E., A.H.J.D., A.H.v.d.M.) and Departments of Neurology (W.S.) and Medical Oncology (S.S.), Erasmus MC, Rotterdam, The Netherlands
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Affiliation(s)
- Neeraj Dhaun
- From the Clinical Pharmacology Unit (D.J.W.), University of Edinburgh, Queen’s Medical Research Institute, Edinburgh, United Kingdom; Department of Renal Medicine (N.D.), Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - David J. Webb
- From the Clinical Pharmacology Unit (D.J.W.), University of Edinburgh, Queen’s Medical Research Institute, Edinburgh, United Kingdom; Department of Renal Medicine (N.D.), Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Kappers MHW, van Esch JHM, Sleijfer S, Danser AHJ, van den Meiracker AH. Cardiovascular and renal toxicity during angiogenesis inhibition: clinical and mechanistic aspects. J Hypertens 2009; 27:2297-309. [DOI: 10.1097/hjh.0b013e3283309b59] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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