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Sun P, Zhao L, Zhang N, Zhou J, Zhang L, Wu W, Ji B, Zhou F. Bioactivity of Dietary Polyphenols: The Role in LDL-C Lowering. Foods 2021; 10:foods10112666. [PMID: 34828946 PMCID: PMC8617782 DOI: 10.3390/foods10112666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/27/2021] [Accepted: 10/31/2021] [Indexed: 12/18/2022] Open
Abstract
Cardiovascular diseases are the leading causes of the death around the world. An elevation of the low-density lipoprotein cholesterol (LDL-C) level is one of the most important risk factors for cardiovascular diseases. To achieve optimal plasma LDL-C levels, clinal therapies were investigated which targeted different metabolism pathways. However, some therapies also caused various adverse effects. Thus, there is a need for new treatment options and/or combination therapies to inhibit the LDL-C level. Dietary polyphenols have received much attention in the prevention of cardiovascular diseases due to their potential LDL-C lowering effects. However, the effectiveness and potential mechanisms of polyphenols in lowering LDL-C is not comprehensively summarized. This review focused on dietary polyphenols that could reduce LDL-C and their mechanisms of action. This review also discussed the limitations and suggestions regarding previous studies.
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Affiliation(s)
- Peng Sun
- Beijing Key Laboratory of Functional Food from Plant Resources, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (P.S.); (N.Z.); (J.Z.); (L.Z.); (B.J.)
| | - Liang Zhao
- Beijing Advance Innovation Center for Food Nutrition and Human Health, Beijing Engineering and Technology Research Center of Food Additives, Beijing Technology and Business University, Beijing 100048, China;
| | - Nanhai Zhang
- Beijing Key Laboratory of Functional Food from Plant Resources, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (P.S.); (N.Z.); (J.Z.); (L.Z.); (B.J.)
| | - Jingxuan Zhou
- Beijing Key Laboratory of Functional Food from Plant Resources, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (P.S.); (N.Z.); (J.Z.); (L.Z.); (B.J.)
| | - Liebing Zhang
- Beijing Key Laboratory of Functional Food from Plant Resources, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (P.S.); (N.Z.); (J.Z.); (L.Z.); (B.J.)
| | - Wei Wu
- College of Engineering, China Agricultural University, Beijing 100083, China;
| | - Baoping Ji
- Beijing Key Laboratory of Functional Food from Plant Resources, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (P.S.); (N.Z.); (J.Z.); (L.Z.); (B.J.)
| | - Feng Zhou
- Beijing Key Laboratory of Functional Food from Plant Resources, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (P.S.); (N.Z.); (J.Z.); (L.Z.); (B.J.)
- Correspondence: ; Tel.: +86-10-6273-7129
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Giammanco A, Noto D, Barbagallo CM, Nardi E, Caldarella R, Ciaccio M, Averna MR, Cefalù AB. Hyperalphalipoproteinemia and Beyond: The Role of HDL in Cardiovascular Diseases. Life (Basel) 2021; 11:life11060581. [PMID: 34207236 PMCID: PMC8235218 DOI: 10.3390/life11060581] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/11/2021] [Accepted: 06/16/2021] [Indexed: 12/16/2022] Open
Abstract
Hyperalphalipoproteinemia (HALP) is a lipid disorder characterized by elevated plasma high-density lipoprotein cholesterol (HDL-C) levels above the 90th percentile of the distribution of HDL-C values in the general population. Secondary non-genetic factors such as drugs, pregnancy, alcohol intake, and liver diseases might induce HDL increases. Primary forms of HALP are caused by mutations in the genes coding for cholesteryl ester transfer protein (CETP), hepatic lipase (HL), apolipoprotein C-III (apo C-III), scavenger receptor class B type I (SR-BI) and endothelial lipase (EL). However, in the last decades, genome-wide association studies (GWAS) have also suggested a polygenic inheritance of hyperalphalipoproteinemia. Epidemiological studies have suggested that HDL-C is inversely correlated with cardiovascular (CV) risk, but recent Mendelian randomization data have shown a lack of atheroprotective causal effects of HDL-C. This review will focus on primary forms of HALP, the role of polygenic inheritance on HDL-C, associated risk for cardiovascular diseases and possible treatment options.
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Affiliation(s)
- Antonina Giammanco
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties–University of Palermo, Via del Vespro, 129, 90127 Palermo, Italy; (A.G.); (D.N.); (C.M.B.); (E.N.); (M.R.A.)
| | - Davide Noto
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties–University of Palermo, Via del Vespro, 129, 90127 Palermo, Italy; (A.G.); (D.N.); (C.M.B.); (E.N.); (M.R.A.)
| | - Carlo Maria Barbagallo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties–University of Palermo, Via del Vespro, 129, 90127 Palermo, Italy; (A.G.); (D.N.); (C.M.B.); (E.N.); (M.R.A.)
| | - Emilio Nardi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties–University of Palermo, Via del Vespro, 129, 90127 Palermo, Italy; (A.G.); (D.N.); (C.M.B.); (E.N.); (M.R.A.)
| | - Rosalia Caldarella
- Department of Laboratory Medicine, Unit of Laboratory Medicine CoreLab, University Hospital “P. Giaccone”, 90127 Palermo, Italy; (R.C.); (M.C.)
| | - Marcello Ciaccio
- Department of Laboratory Medicine, Unit of Laboratory Medicine CoreLab, University Hospital “P. Giaccone”, 90127 Palermo, Italy; (R.C.); (M.C.)
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, 90127 Palermo, Italy
| | - Maurizio Rocco Averna
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties–University of Palermo, Via del Vespro, 129, 90127 Palermo, Italy; (A.G.); (D.N.); (C.M.B.); (E.N.); (M.R.A.)
| | - Angelo Baldassare Cefalù
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties–University of Palermo, Via del Vespro, 129, 90127 Palermo, Italy; (A.G.); (D.N.); (C.M.B.); (E.N.); (M.R.A.)
- Correspondence:
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Abstract
Cholesterol metabolism and transport has been a major focus in cardiovascular disease risk modification over the past several decades. Hydroxymethylglutaryl-CoA reductase inhibitors (statins) have been the most commonly used agents, with the greatest benefit in reducing both the primary and secondary risks of cardiovascular disease. However, heart disease remains the leading cause of death in both men and women in the United States. Further investigation and intervention are required to further reduce the risk for cardiovascular disease and cardiovascular-related deaths. This review will focus on high-density lipoprotein metabolism and transport, looking particularly at cholesteryl ester transfer protein (CETP) inhibitors. While studies of the other CETP inhibitors in its class have not shown a significant improvement in the prevention of primary or secondary cardiovascular risk, anacetrapib, the fourth and latest of the CETP inhibitors to be investigated, may be more promising.
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Akram M, Patt M, Kaserer T, Temml V, Waratchareeyakul W, Kratschmar DV, Haupenthal J, Hartmann RW, Odermatt A, Schuster D. Identification of the fungicide epoxiconazole by virtual screening and biological assessment as inhibitor of human 11β-hydroxylase and aldosterone synthase. J Steroid Biochem Mol Biol 2019; 192:105358. [PMID: 30965118 DOI: 10.1016/j.jsbmb.2019.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 04/05/2019] [Accepted: 04/06/2019] [Indexed: 12/22/2022]
Abstract
Humans are constantly exposed to a multitude of environmental chemicals that may disturb endocrine functions. It is crucial to identify such chemicals and uncover their mode-of-action to avoid adverse health effects. 11β-hydroxylase (CYP11B1) and aldosterone synthase (CYP11B2) catalyze the formation of cortisol and aldosterone, respectively, in the adrenal cortex. Disruption of their synthesis by exogenous chemicals can contribute to cardio-metabolic diseases, chronic kidney disease, osteoporosis, and immune-related disorders. This study applied in silico screening and in vitro evaluation for the discovery of xenobiotics inhibiting CYP11B1 and CYP11B2. Several databases comprising environmentally relevant pollutants, chemicals in body care products, food additives and drugs were virtually screened using CYP11B1 and CYP11B2 pharmacophore models. A first round of biological testing used hamster cells overexpressing human CYP11B1 or CYP11B2 to analyze 25 selected virtual hits. Three compounds inhibited CYP11B1 and CYP11B2 with IC50 values below 3 μM. The most potent inhibitor was epoxiconazole (IC50 value of 623 nM for CYP11B1 and 113 nM for CYP11B2, respectively); flurprimidol and ancymidol were moderate inhibitors. In a second round, these three compounds were tested in human adrenal H295R cells endogenously expressing CYP11B1 and CYP11B2, confirming the potent inhibition by epoxiconazole and the more moderate effects by flurprimidol and ancymidol. Thus, the in silico screening, prioritization of chemicals for initial biological tests and use of H295R cells to provide initial mechanistic information is a promising strategy to identify potential endocrine disruptors inhibiting corticosteroid synthesis. A critical assessment of human exposure levels and in vivo evaluation of potential corticosteroid disrupting effects by epoxiconazole is required.
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Affiliation(s)
- Muhammad Akram
- Institute of Pharmacy / Pharmaceutical Chemistry and Center for Molecular Biosciences Innsbruck, University of Innsbruck, Innrain 80-82, 6020, Innsbruck, Austria; Department of Medicinal and Pharmaceutical Chemistry, Institute of Pharmacy, Paracelsus Medical University, Strubergasse 22, 5020, Salzburg, Austria.
| | - Melanie Patt
- Swiss Centre for Applied Human Toxicology and Division of Molecular and Systems Toxicology, Department of Pharmaceutical Sciences, University of Basel, Klingelbergstrasse 50, 4056, Basel, Switzerland.
| | - Teresa Kaserer
- Institute of Pharmacy / Pharmaceutical Chemistry and Center for Molecular Biosciences Innsbruck, University of Innsbruck, Innrain 80-82, 6020, Innsbruck, Austria.
| | - Veronika Temml
- Institute of Pharmacy / Pharmaceutical Chemistry and Center for Molecular Biosciences Innsbruck, University of Innsbruck, Innrain 80-82, 6020, Innsbruck, Austria.
| | - Watcharee Waratchareeyakul
- Department of Chemistry, Faculty of Science and Technology, Rambhai Barni Rajabhat University, 22000, Chanthaburi, Thailand.
| | - Denise V Kratschmar
- Swiss Centre for Applied Human Toxicology and Division of Molecular and Systems Toxicology, Department of Pharmaceutical Sciences, University of Basel, Klingelbergstrasse 50, 4056, Basel, Switzerland.
| | - Joerg Haupenthal
- Department of Drug Design and Optimization, Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Universitätscampus E8 1, 66123, Saarbrücken, Germany.
| | - Rolf W Hartmann
- Department of Drug Design and Optimization, Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Universitätscampus E8 1, 66123, Saarbrücken, Germany; Department of Pharmaceutical and Medicinal Chemistry, Saarland University, Campus C2.3, 66123, Saarbrücken, Germany.
| | - Alex Odermatt
- Swiss Centre for Applied Human Toxicology and Division of Molecular and Systems Toxicology, Department of Pharmaceutical Sciences, University of Basel, Klingelbergstrasse 50, 4056, Basel, Switzerland.
| | - Daniela Schuster
- Institute of Pharmacy / Pharmaceutical Chemistry and Center for Molecular Biosciences Innsbruck, University of Innsbruck, Innrain 80-82, 6020, Innsbruck, Austria; Department of Medicinal and Pharmaceutical Chemistry, Institute of Pharmacy, Paracelsus Medical University, Strubergasse 22, 5020, Salzburg, Austria.
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Do Cholesteryl Ester Transfer Protein Inhibitors Have a Role in the Treatment of Cardiovascular Disease? Am J Cardiovasc Drugs 2019; 19:229-235. [PMID: 30610681 DOI: 10.1007/s40256-018-00323-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cholesteryl ester transfer protein (CETP) plays an important role in lipid metabolism and has presented an attractive target for drug development, primarily resting on the hope that CETP inhibition would reduce cardiovascular events through its ability to increase levels of high-density lipoprotein cholesterol (HDL-C). However, clinical development of CETP inhibitors has proven disappointing, with a spectrum of results spanning from evidence of harm, to futility, to only modest benefit in large-scale cardiovascular outcomes trials. A number of additional insights from genomic studies have suggested potential benefits from these agents in specific clinical settings. We review the current state of CETP inhibitors as an approach to targeting cardiovascular risk.
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Zhao JV, Schooling CM. Effect of linoleic acid on ischemic heart disease and its risk factors: a Mendelian randomization study. BMC Med 2019; 17:61. [PMID: 30866921 PMCID: PMC6417131 DOI: 10.1186/s12916-019-1293-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 02/21/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The role of n-6 polyunsaturated fatty acids (PUFAs) in ischemic heart disease (IHD) is controversial, and dietary guidelines vary. Observationally, lower saturated fat intake and higher intake of vegetable oils rich in linoleic acid (LA), the main n-6 PUFA, is associated with lower IHD and diabetes; however, randomized controlled trials have not fully corroborated these benefits. We assessed how genetically predicted LA affected IHD and its risk factors, including diabetes, lipids, and blood pressure. We also assessed the role of LA in reticulocyte count, the red blood cell precursor, which has recently been identified as a possible causal factor in IHD. METHODS Two-sample instrumental variable analysis with genetic instruments, i.e., Mendelian randomization, was used to obtain unconfounded estimates using genetic variants strongly (p value < 5 × 10-8) and solely associated with LA, applied to an IHD case (n ≤ 76,014)-control (n ≤ 264,785) study (mainly based on the meta-analysis of CARDIoGRAMplusC4D 1000 Genomes and UK Biobank CAD SOFT GWAS), the DIAbetes Genetics Replication And Meta-analysis diabetes case (n = 26,676)-control (n = 132,532) study, lipids from the Global Lipids Genetics Consortium Results (n = 196,475), and reticulocyte count and blood pressure from the UK Biobank (n ≤ 361,194). A weighted median and Mendelian randomization Egger were used for sensitivity analysis. RESULTS Genetically predicted LA was not associated with IHD or systolic blood pressure. Genetically predicted higher serum LA was associated with lower diabetes (odds ratio (OR) 0.97 per percentage in total fatty acid increase in LA, 95% confidence interval (CI) 0.96 to 0.99) and lower lipids (low-density lipoprotein, high-density lipoprotein, and total cholesterol), but may be associated with higher diastolic blood pressure. The findings were robust to different single nucleotide polymorphism (SNP) selections, analytic methods, and correction for multiple testing. CONCLUSIONS Our novel study suggests a benefit of LA for diabetes and lipids but no benefit for IHD, blood pressure, or reticulocyte count. Explicating these paradoxical findings would facilitate identification of effective new interventions for diabetes and IHD.
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Affiliation(s)
- Jie V Zhao
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 1/F, Patrick Manson Building, 7 Sassoon Road, Hong Kong, SAR, China.
| | - C Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 1/F, Patrick Manson Building, 7 Sassoon Road, Hong Kong, SAR, China
- School of Public Health and Health Policy, City University of New York, New York, NY, USA
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Barter PJ, Rye KA. Cholesteryl Ester Transfer Protein Inhibitors as Agents to Reduce Coronary Heart Disease Risk. Cardiol Clin 2018; 36:299-310. [DOI: 10.1016/j.ccl.2017.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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8
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Steroid profiling in H295R cells to identify chemicals potentially disrupting the production of adrenal steroids. Toxicology 2017; 381:51-63. [DOI: 10.1016/j.tox.2017.02.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 02/09/2017] [Accepted: 02/16/2017] [Indexed: 12/16/2022]
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9
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Teramoto T, Kiyosue A, Iimura T, Takita Y, Riesmeyer JS, Murakami M. Efficacy and Safety of Cholesteryl Ester Transfer Protein Inhibitor Evacetrapib Administered as Monotherapy in Japanese Patients With Primary Hypercholesterolemia. Circ J 2017; 81:1686-1692. [DOI: 10.1253/circj.cj-16-1325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Arihiro Kiyosue
- Tokyo-Eki Center-Building Clinic
- Department of Cardiovascular Medicine, University of Tokyo Hospital
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Filippatos TD, Klouras E, Barkas F, Elisaf M. Cholesteryl ester transfer protein inhibitors: challenges and perspectives. Expert Rev Cardiovasc Ther 2016; 14:953-62. [DOI: 10.1080/14779072.2016.1189327] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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11
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Reyes-Soffer G, Millar JS, Ngai C, Jumes P, Coromilas E, Asztalos B, Johnson-Levonas AO, Wagner JA, Donovan DS, Karmally W, Ramakrishnan R, Holleran S, Thomas T, Dunbar RL, deGoma EM, Rafeek H, Baer AL, Liu Y, Lassman ME, Gutstein DE, Rader DJ, Ginsberg HN. Cholesteryl Ester Transfer Protein Inhibition With Anacetrapib Decreases Fractional Clearance Rates of High-Density Lipoprotein Apolipoprotein A-I and Plasma Cholesteryl Ester Transfer Protein. Arterioscler Thromb Vasc Biol 2016; 36:994-1002. [PMID: 26966279 DOI: 10.1161/atvbaha.115.306680] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 02/22/2016] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Anacetrapib (ANA), an inhibitor of cholesteryl ester transfer protein (CETP) activity, increases plasma concentrations of high-density lipoprotein cholesterol (HDL-C), apolipoprotein A-I (apoA)-I, apoA-II, and CETP. The mechanisms responsible for these treatment-related increases in apolipoproteins and plasma CETP are unknown. We performed a randomized, placebo (PBO)-controlled, double-blind, fixed-sequence study to examine the effects of ANA on the metabolism of HDL apoA-I and apoA-II and plasma CETP. APPROACH AND RESULTS Twenty-nine participants received atorvastatin (ATV) 20 mg/d plus PBO for 4 weeks, followed by ATV plus ANA 100 mg/d for 8 weeks (ATV-ANA). Ten participants received double PBO for 4 weeks followed by PBO plus ANA for 8 weeks (PBO-ANA). At the end of each treatment, we examined the kinetics of HDL apoA-I, HDL apoA-II, and plasma CETP after D3-leucine administration as well as 2D gel analysis of HDL subspecies. In the combined ATV-ANA and PBO-ANA groups, ANA treatment increased plasma HDL-C (63.0%; P<0.001) and apoA-I levels (29.5%; P<0.001). These increases were associated with reductions in HDL apoA-I fractional clearance rate (18.2%; P=0.002) without changes in production rate. Although the apoA-II levels increased by 12.6% (P<0.001), we could not discern significant changes in either apoA-II fractional clearance rate or production rate. CETP levels increased 102% (P<0.001) on ANA because of a significant reduction in the fractional clearance rate of CETP (57.6%, P<0.001) with no change in CETP production rate. CONCLUSIONS ANA treatment increases HDL apoA-I and CETP levels by decreasing the fractional clearance rate of each protein.
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Affiliation(s)
- Gissette Reyes-Soffer
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - John S Millar
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Colleen Ngai
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Patricia Jumes
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Ellie Coromilas
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Bela Asztalos
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Amy O Johnson-Levonas
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - John A Wagner
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Daniel S Donovan
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Wahida Karmally
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Rajasekhar Ramakrishnan
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Stephen Holleran
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Tiffany Thomas
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Richard L Dunbar
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Emil M deGoma
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Hashmi Rafeek
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Amanda L Baer
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Yang Liu
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Michael E Lassman
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - David E Gutstein
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Daniel J Rader
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Henry N Ginsberg
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
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12
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Rios FJ, Lopes RA, Neves KB, Camargo LL, Montezano AC, Touyz RM. Off-Target Vascular Effects of Cholesteryl Ester Transfer Protein Inhibitors Involve Redox-Sensitive and Signal Transducer and Activator of Transcription 3-Dependent Pathways. ACTA ACUST UNITED AC 2016; 357:415-22. [DOI: 10.1124/jpet.115.230748] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 03/02/2016] [Indexed: 01/20/2023]
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13
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Barter PJ, Rye KA. Targeting High-density Lipoproteins to Reduce Cardiovascular Risk: What Is the Evidence? Clin Ther 2015; 37:2716-31. [DOI: 10.1016/j.clinthera.2015.07.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 07/27/2015] [Indexed: 11/28/2022]
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14
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Viljoen A, Wierzbicki AS. Improving the odds: ezetimibe and cardiovascular disease. Int J Clin Pract 2015; 69:390-5. [PMID: 25816908 DOI: 10.1111/ijcp.12613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 12/17/2014] [Indexed: 12/25/2022] Open
Abstract
The beauty of science is that well-conducted experiments provide answers to questions which were posed in times of greater ignorance. Cardiovascular disease (CVD) is the leading cause of death worldwide and will be for some time. Cholesterol is a critical player which drives the underlying pathophysiological process of atherosclerosis. Statins are the first line treatment for lipids in CVD given their ability to low-density lipoprotein cholesterol (LDL-C) by up to 50%, and their proven benefits in both primary and secondary intervention . Despite the unprecedented efficacy of statins, additional treatments are sought to potentially reduce the residual risk that remains despite statin treatment such as that associated with reduced high-density lipoprotein cholesterol levels (HDL-C) or triglycerides . In the last 5 years, several trials have reported on their potential additional benefit beyond statin therapy. These include omega-3 fatty acids in patients with prediabetes or diabetes , fibrates in diabetes , nicotinic acid/niacin in cardiovascular disease and cholesterol ester transfer protein inhibitors in cardiovascular disease . Despite their promise, none of these treatments were able to demonstrate benefit beyond baseline statin therapy when compared with placebo . The idea that benefit beyond statin treatment may be an unachievable goal has dogged the medical community working on CVD prevention. The phrase, 'Statins for atherosclerosis - as good as it gets?' was coined in 2005 and has rung true up until now .
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Affiliation(s)
- A Viljoen
- Department of Metabolic Medicine/Chemical Pathology, Lister Hospital, Stevenage, Hertfordshire, UK
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15
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Noto D, Cefalù AB, Averna MR. Beyond statins: new lipid lowering strategies to reduce cardiovascular risk. Curr Atheroscler Rep 2014; 16:414. [PMID: 24777633 DOI: 10.1007/s11883-014-0414-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Statins are the first-line therapy in LDL-Cholesterol (LDL-C) reduction and its clinical use has contributed to significant prevention and treatment of atherosclerotic vascular disease. Yet, a significant proportion of patients remain at high risk. Recently, a number of new therapies have been developed to further lower LDL-C. These agents may provide clinical benefit on top of statin therapy in patients with high residual risk, severe hypercholesterolemia or as an alternative for patients who are intolerant to statins. We review four novel approaches based on the inhibition of proprotein convertase subtilisin/kexin type 9 (PCSK9), apolipoprotein-B100 (apoB), Cholesteryl ester transport protein (CETP) and microsomal triglyceride transfer protein (MTP). ApoB and MTP inhibitors (Mipomersen and Lomitapide) are indicated only for homozygous familial hypercholesterolemia patients. The results of ongoing trials with CETP and PCSK9 inhibitors may warrant a wider employment in different categories of patients at high risk for cardiovascular disease.
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Affiliation(s)
- Davide Noto
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Palermo, Italy,
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16
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Niesor EJ, Chaput E, Mary JL, Staempfli A, Topp A, Stauffer A, Wang H, Durrwell A. Effect of Compounds Affecting ABCA1 Expression and CETP Activity on the HDL Pathway Involved in Intestinal Absorption of Lutein and Zeaxanthin. Lipids 2014; 49:1233-43. [DOI: 10.1007/s11745-014-3958-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 09/12/2014] [Indexed: 10/24/2022]
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17
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Abstract
The cholesteryl ester transfer protein (CETP) plays an integral role in the metabolism of plasma lipoproteins. Despite two failures, CETP inhibitors are still in clinical development. We review the genetics of CETP and coronary disease, preclinical data on CETP inhibition and atherosclerosis, and the effects of CETP inhibition on cholesterol efflux and reverse cholesterol transport. We discuss the two failed CETP inhibitors, torcetrapib and dalcetrapib, and attempt to extract lessons learned. Two CETP inhibitors, anacetrapib and evacetrapib, are in phase III development, and we attempt to differentiate them from the failed drugs. Whether pharmacologic CETP inhibition will reduce the risk of cardiovascular disease is one of the most fascinating and important questions in the field of cardiovascular medicine.
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Affiliation(s)
- Daniel J Rader
- Division of Translational Medicine and Human Genetics, Cardiovascular Institute and Institute for Translational Medicine and Therapeutics, and
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18
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19
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A reappraisal of the risks and benefits of treating to target with cholesterol lowering drugs. Drugs 2014; 73:1025-54. [PMID: 23754124 DOI: 10.1007/s40265-013-0072-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Atherosclerotic cardiovascular disease (CVD) is the number one cause of death globally, and lipid modification, particularly lowering of low density lipoprotein cholesterol (LDLc), is one of the cornerstones of prevention and treatment. However, even after lowering of LDLc to conventional goals, a sizeable number of patients continue to suffer cardiovascular events. More aggressive lowering of LDLc and optimization of other lipid parameters like triglycerides (TG) and high density lipoprotein cholesterol (HDLc) have been proposed as two potential strategies to address this residual risk. These strategies entail use of maximal doses of highly potent HMG CoA reductase inhibitors (statins) and combination therapy with other lipid modifying agents. Though statins in general are fairly well tolerated, adverse events like myopathy are dose related. There are further risks with combination therapy. In this article, we review the adverse effects of lipid modifying agents used alone and in combination and weigh these effects against the evidence demonstrating their efficacy in reducing cardiovascular events, cardiovascular mortality, and all cause mortality. For patients with established CVD, statins are the only group of drugs that have shown consistent reductions in hard outcomes. Though more aggressive lipid lowering with high dose potent statins can reduce rates of non fatal events and need for interventions, the incremental mortality benefits remain unclear, and their use is associated with a higher rate of drug related adverse effects. Myopathy and renal events have been a significant concern with the use of high potency statin drugs, in particular simvastatin and rosuvastatin. For patients who have not reached target LDL levels or have residual lipid abnormalities on maximal doses of statins, the addition of other agents has not been shown to improve clinical outcomes and carries an increased risk of adverse events. The clinical benefits of drugs to raise HDLc remain unproven. In patients without known cardiovascular disease, there is conflicting evidence as to the benefits of aggressive pursuit of numerical lipid targets, particularly with respect to all cause mortality. Certainly, in statin intolerant patients, alternative agents with a low side effect profile are desirable. Bile acid sequestrants are an effective and safe choice for decreasing LDLc, and omega-3 fatty acids are safe agents to decrease TG. There remains an obvious need to design and carry out large scale studies to help determine which agents, when combined with statins, have the greatest benefit on cardiovascular disease with the least added risk. These studies should be designed to assess the impact on clinical outcomes rather than surrogate endpoints, and require a comprehensive assessment and reporting of safety outcomes.
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Kalgutkar AS, Frederick KS, Hatch HL, Ambler CM, Perry DA, Garigipati RS, Chang GC, Lefker BA, Clark RW, Morehouse LA, Francone O, Hu X. Identification of a novel, non-tetrahydroquinoline variant of the cholesteryl ester transfer protein (CETP) inhibitor torcetrapib, with improved aqueous solubility. Xenobiotica 2013; 44:591-605. [DOI: 10.3109/00498254.2013.874611] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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21
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Kohli P, Giugliano RP. Low-density lipoprotein lowering in 2013 by nonstatin agents: the discovery and development of promising novel targeted therapies. J Cardiovasc Pharmacol Ther 2013; 18:199-210. [PMID: 23580658 DOI: 10.1177/1074248413480270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Dyslipidemia is a major risk factor for the development of coronary artery disease, a leading cause of morbidity and mortality worldwide. Lowering low-density lipoprotein (LDL) has significantly reduced the risk of death and other major cardiovascular events, and statins remain the therapy of choice. However, as some patients are limited by the side effects of statins, cannot achieve their target LDL on statin therapy, or have other abnormalities in their lipid profile, alternative agents are being developed. In this review, we highlight the major classes of novel nonstatin LDL-lowering agents that are currently in various stages of development. Although many hold great promise, the results of large Phase III trials will be needed to definitely establish the efficacy, safety, and clinical utility of these agents in the general population.
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Affiliation(s)
- Payal Kohli
- TIMI Study Group/Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Nishi H, Arai H, Momiyama T. NCI-H295R, a human adrenal cortex-derived cell line, expresses purinergic receptors linked to Ca²⁺-mobilization/influx and cortisol secretion. PLoS One 2013; 8:e71022. [PMID: 23951072 PMCID: PMC3738630 DOI: 10.1371/journal.pone.0071022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 06/30/2013] [Indexed: 01/06/2023] Open
Abstract
Purinergic receptor expression and involvement in steroidogenesis were examined in NCI-H295R (H295R), a human adrenal cortex cell line which expresses all the key enzymes necessary for steroidogenesis. mRNA/protein for multiple P1 (A2A and A2B), P2X (P2X5 and P2X7), and P2Y (P2Y1, P2Y2, P2Y6, P2Y12, P2Y13, and P2Y14) purinergic receptors were detected in H295R. 2MeS-ATP (10–1000 µM), a P2Y1 agonist, induced glucocorticoid (GC) secretion in a dose-dependent manner, while other extracellular purine/pyrimidine agonists (1–1000 µM) had no distinct effect on GC secretion. Extracellular purines, even non-steroidogenic ones, induced Ca2+-mobilization in the cells, independently of the extracellular Ca2+ concentration. Increases in intracellular Ca2+ concentration induced by extracellular purine agonists were transient, except when induced by ATP or 2MeS-ATP. Angiotensin II (AngII: 100 nM) and dibutyryl-cyclic AMP (db-cAMP: 500 µM) induced both GC secretion and Ca2+-mobilization in the presence of extracellular Ca2+ (1.2 mM). GC secretion by AngII was reduced by nifedipine (10–100 µM); whereas the Ca2+ channel blocker did not inhibit GC secretion by 2MeS-ATP. Thapsigargin followed by extracellular Ca2+ exposure induced Ca2+-influx in H295R, and the cells expressed mRNA/protein of the component molecules for store-operated calcium entry (SOCE): transient receptor C (TRPC) channels, calcium release-activated calcium channel protein 1 (Orai-1), and the stromal interaction molecule 1 (STIM1). In P2Y1-knockdown, 2MeS-ATP-induced GC secretion was significantly inhibited. These results suggest that H295R expresses a functional P2Y1 purinergic receptor for intracellular Ca2+-mobilization, and that P2Y1 is linked to SOCE-activation, leading to Ca2+-influx which might be necessary for glucocorticoid secretion.
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Affiliation(s)
- Haruhisa Nishi
- Pharmacology, The Jikei University School of Medicine, Tokyo, Japan.
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23
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Karalis I, Rensen PCN, Jukema JW. Journey through cholesteryl ester transfer protein inhibition: from bench to bedside. Circ Cardiovasc Qual Outcomes 2013; 6:360-6. [PMID: 23674310 DOI: 10.1161/circoutcomes.111.000014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Ioannis Karalis
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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24
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Bordalo ADB, Nobre AL, Dantas M, Cravino J. [Elevated HDL is the main negative risk factor for coronary artery disease in the elderly patient with calcific aortic valve disease]. Rev Port Cardiol 2012; 31:415-24. [PMID: 22609029 DOI: 10.1016/j.repc.2011.12.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 12/15/2011] [Indexed: 11/17/2022] Open
Abstract
UNLABELLED In spite of high prevalences of hypertension and hypercholesterolemia, the majority of elderly patients admitted for aortic valve surgery due to calcific aortic valve disease (CAVD) do not have significant coronary artery disease (CAD). OBJECTIVE To evaluate the lipid profile (LP) of patients undergoing surgery for CAVD and to correlate this with coronary angiographic data and prior cardiovascular risk factor profile. METHODS This was a prospective observational cohort study of 264 consecutive patients aged >59 years (mean 72), 126 men (48%) and 138 women (52%). According to the angiographic presence (irregularities, moderate or significant lesions) or absence (normal angiogram) of significant CAD respectively, patients were divided into two groups: A (n=127, 48%) and B (n=137, 52%). A mean of 3.5 classical risk factors were identified in men and 2.6 in women. LP (obtained on admission, in the fasting state) included total cholesterol (TC), HDL, triglycerides (TG), LDL, and lipoprotein(a). RESULTS With the exception of male gender, diabetes and HDL, the other factors studied - smoking, hypertension, TC, TG, LDL (in both statin-treated and non-statin-treated patients) and lipoprotein(a) - did not show significant differences between groups A and B; LDL was 116 +/- 40mg/dl in group A vs. 123 +/- 38mg/dl in group B, in non-statin-treated patients; significant CAD was identified in 64% of men vs. 26% of women (p < 0.001); 43% of group A had diabetes vs. 27% of group B (p<0.01); HDL was 49 +/- 14mg/dl in group A vs. 59 +/- 16mg/dl in group B (p < 0.001); HDL in group A was 49 +/- 14 mg/dl in men vs. 49 +/- 13 mg/dl in women (NS) and 45 +/- 13 mg/dl in diabetic patients vs. 52 +/- 14 mg/dl in non-diabetics (p <0.02); HDL in group B diabetic patients was 54 +/- 17 mg/dl in men vs. 56 +/- 18 mg/dl in women (NS), and HDL in group B non-diabetic patients was 55 +/- 13mg/dl in men vs. 63 +/- 17 mg/dl in women (p < 0.02). Multivariate analysis showed that only low HDL and diabetes (in women) were independent risk factors for significant CAD. The effect of male gender as a risk factor appears to be exerted mainly through lower HDL levels. CONCLUSIONS Elevated HDL is the main negative risk factor for significant CAD in elderly high-risk but mildly dyslipidemic CAVD patients. HDL does not appear to have any protective effect in the pathophysiology of CAVD. In terms of long-term intervention, primary prevention of significant CAD should in the future be hybrid, focusing mainly on improving HDL function, but also on lowering LDL.
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Affiliation(s)
- Alvaro Donas-Botto Bordalo
- Serviço de Cirurgia Cardiotorácica, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal.
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25
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Waters DD. Utility of Biomarkers and Imaging in the Development of Drugs for the Treatment of Coronary Atherosclerosis. Can J Cardiol 2012; 28:687-92. [DOI: 10.1016/j.cjca.2012.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 03/08/2012] [Accepted: 03/09/2012] [Indexed: 11/26/2022] Open
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26
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Katz PM, Leiter LA. Drugs Targeting High-Density Lipoprotein Cholesterol for Coronary Artery Disease Management. Can J Cardiol 2012; 28:667-77. [DOI: 10.1016/j.cjca.2012.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Revised: 03/23/2012] [Accepted: 03/23/2012] [Indexed: 11/15/2022] Open
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Abstract
HDL is known to be inversely correlated with cardiovascular disease due to its diverse antiatherogenic functions. These functions include cholesterol efflux and reverse cholesterol transport, antioxidative and anti-inflammatory activities. However, HDL has been shown to undergo a loss of function in several pathophysiological states, as in the acute phase response, obesity and chronic inflammatory diseases. Some of these diseases were also shown to be associated with increased risk for cardiovascular disease. One such disease that is associated with HDL dysfunction and accelerated atherosclerosis is diabetes mellitus, a disease in which the HDL particle undergoes diverse structural modifications that result in significant changes in its function. This review will summarize the changes that occur in HDL in diabetes mellitus and how these changes lead to HDL dysfunction. Possible treatments for HDL dysfunction are also briefly described.
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Affiliation(s)
- Dan Farbstein
- Technion Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.
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28
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Rhainds D, Arsenault BJ, Brodeur MR, Tardif JC. An update on the clinical development of dalcetrapib (RO4607381), a cholesteryl ester transfer protein modulator that increases HDL cholesterol levels. Future Cardiol 2012; 8:513-31. [DOI: 10.2217/fca.12.25] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
CETP is the target of CETP inhibitors such as anacetrapib and the modulator dalcetrapib. Both molecules have entered Phase III clinical trials, with the ultimate goal of reducing cardiovascular events by raising HDL cholesterol. At the 600-mg dose selected for the dal-OUTCOMES study, dalcetrapib is expected to inhibit CETP activity by approximately 30% and raise HDL-C by approximately 30% with limited effects on LDL cholesterol. Importantly, dalcetrapib does not raise blood pressure or aldosterone levels, two effects previously associated with the CETP inhibitor torcetrapib. Dalcetrapib has been well tolerated at the 600-mg dose. In the dal-PLAQUE atherosclerosis imaging study, dalcetrapib reduced the enlargement of total vessel area over time. In May 2012, following the results of the second interim analysis of dal-OUTCOMES, the Data and Safety Monitoring Board recommended stopping the study owing to a lack of clinically significant benefit, which was followed by Roche’s (Basel, Switzerland) decision to terminate the study and the dalcetrapib program (dal-HEART). Contrary to anacetrapib, a potent CETP inhibitor that markedly increases HDL cholesterol and significantly reduces LDL cholesterol, dalcetrapib has allowed us to test the hypothesis that an isolated, moderate elevation in HDL cholesterol prevents cardiovascular events.
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Affiliation(s)
- David Rhainds
- Atherosclerosis Research Group, Montreal Heart Institute, 5000 Belanger St., Montreal, Quebec, H1T 1C8, Canada
| | - Benoit J Arsenault
- Atherosclerosis Research Group, Montreal Heart Institute, 5000 Belanger St., Montreal, Quebec, H1T 1C8, Canada
| | - Mathieu R Brodeur
- Atherosclerosis Research Group, Montreal Heart Institute, 5000 Belanger St., Montreal, Quebec, H1T 1C8, Canada
| | - Jean-Claude Tardif
- Atherosclerosis Research Group, Montreal Heart Institute, 5000 Belanger St., Montreal, Quebec, H1T 1C8, Canada
- Faculty of Medicine, Université de Montréal, 2900, Boulevard Édouard-Montpetit Montréal, Québec H3T 1J4, Canada
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Hooper AJ, Burnett JR. Dalcetrapib , a cholesteryl ester transfer protein modulator. Expert Opin Investig Drugs 2012; 21:1427-32. [PMID: 22725099 DOI: 10.1517/13543784.2012.699040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Cholesteryl ester transfer protein (CETP) plays an important role in reverse cholesterol transport by transferring cholesteryl esters from high-density lipoprotein (HDL) to the apolipoprotein B-containing lipoproteins. Inhibition of CETP is a target to increase HDL-cholesterol and potentially reduce atherosclerosis. Dalcetrapib is an orally administered CETP inhibitor developed for the treatment of primary hypercholesterolaemia and mixed hyperlipidaemia. AREAS COVERED AREAS COVERED are: mode of action, preclinical development and clinical trials of dalcetrapib, a CETP modulator. The article provides an understanding of the pharmacokinetic and pharmacodynamic characteristics of dalcetrapib and insight into its clinical efficacy and safety. In clinical trials, dalcetrapib produced significant elevations in HDL-cholesterol when taken alone or in combination with statin with no effect on blood pressure or expression of genes involved in the renin-angiotensin-aldosterone system. EXPERT OPINION Although dalcetrapib is the least potent CETP inhibitor, it does not impair the formation of CETP-induced pre-β HDL, which might be needed to increase reverse cholesterol transport. While dalcetrapib is well-tolerated and does not show major side effects, the recent interim results of the Phase III dal-OUTCOMES trial have shown the lack of a clinically meaningful benefit, and further testing of the drug has been halted.
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Affiliation(s)
- Amanda J Hooper
- Royal Perth Hospital, Department of Core Clinical Pathology & Biochemistry, PathWest Laboratory Medicine WA, Perth, Western Australia
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30
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Harikrishnan LS, Finlay HJ, Qiao JX, Kamau MG, Jiang J, Wang TC, Li J, Cooper CB, Poss MA, Adam LP, Taylor DS, Chen AYA, Yin X, Sleph PG, Yang RZ, Sitkoff DF, Galella MA, Nirschl DS, Van Kirk K, Miller AV, Huang CS, Chang M, Chen XQ, Salvati ME, Wexler RR, Lawrence RM. Diphenylpyridylethanamine (DPPE) Derivatives as Cholesteryl Ester Transfer Protein (CETP) Inhibitors. J Med Chem 2012; 55:6162-75. [DOI: 10.1021/jm300611v] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Lalgudi S. Harikrishnan
- Department of Chemistry, ‡Department of Biology, §Department of Computer
Aided Drug Design, ∥Department of Materials Science, ⊥Synthesis and Analysis Technology Team, #Department of Preclinical
Candidate Optimization, and ∞Department of Pharmaceutics, Bristol-Myers Squibb Company, P.O. Box 4000, Princeton,
New Jersey 08543-4000, United States
| | - Heather J. Finlay
- Department of Chemistry, ‡Department of Biology, §Department of Computer
Aided Drug Design, ∥Department of Materials Science, ⊥Synthesis and Analysis Technology Team, #Department of Preclinical
Candidate Optimization, and ∞Department of Pharmaceutics, Bristol-Myers Squibb Company, P.O. Box 4000, Princeton,
New Jersey 08543-4000, United States
| | - Jennifer X. Qiao
- Department of Chemistry, ‡Department of Biology, §Department of Computer
Aided Drug Design, ∥Department of Materials Science, ⊥Synthesis and Analysis Technology Team, #Department of Preclinical
Candidate Optimization, and ∞Department of Pharmaceutics, Bristol-Myers Squibb Company, P.O. Box 4000, Princeton,
New Jersey 08543-4000, United States
| | - Muthoni G. Kamau
- Department of Chemistry, ‡Department of Biology, §Department of Computer
Aided Drug Design, ∥Department of Materials Science, ⊥Synthesis and Analysis Technology Team, #Department of Preclinical
Candidate Optimization, and ∞Department of Pharmaceutics, Bristol-Myers Squibb Company, P.O. Box 4000, Princeton,
New Jersey 08543-4000, United States
| | - Ji Jiang
- Department of Chemistry, ‡Department of Biology, §Department of Computer
Aided Drug Design, ∥Department of Materials Science, ⊥Synthesis and Analysis Technology Team, #Department of Preclinical
Candidate Optimization, and ∞Department of Pharmaceutics, Bristol-Myers Squibb Company, P.O. Box 4000, Princeton,
New Jersey 08543-4000, United States
| | - Tammy C. Wang
- Department of Chemistry, ‡Department of Biology, §Department of Computer
Aided Drug Design, ∥Department of Materials Science, ⊥Synthesis and Analysis Technology Team, #Department of Preclinical
Candidate Optimization, and ∞Department of Pharmaceutics, Bristol-Myers Squibb Company, P.O. Box 4000, Princeton,
New Jersey 08543-4000, United States
| | - James Li
- Department of Chemistry, ‡Department of Biology, §Department of Computer
Aided Drug Design, ∥Department of Materials Science, ⊥Synthesis and Analysis Technology Team, #Department of Preclinical
Candidate Optimization, and ∞Department of Pharmaceutics, Bristol-Myers Squibb Company, P.O. Box 4000, Princeton,
New Jersey 08543-4000, United States
| | - Christopher B. Cooper
- Department of Chemistry, ‡Department of Biology, §Department of Computer
Aided Drug Design, ∥Department of Materials Science, ⊥Synthesis and Analysis Technology Team, #Department of Preclinical
Candidate Optimization, and ∞Department of Pharmaceutics, Bristol-Myers Squibb Company, P.O. Box 4000, Princeton,
New Jersey 08543-4000, United States
| | - Michael A. Poss
- Department of Chemistry, ‡Department of Biology, §Department of Computer
Aided Drug Design, ∥Department of Materials Science, ⊥Synthesis and Analysis Technology Team, #Department of Preclinical
Candidate Optimization, and ∞Department of Pharmaceutics, Bristol-Myers Squibb Company, P.O. Box 4000, Princeton,
New Jersey 08543-4000, United States
| | - Leonard P. Adam
- Department of Chemistry, ‡Department of Biology, §Department of Computer
Aided Drug Design, ∥Department of Materials Science, ⊥Synthesis and Analysis Technology Team, #Department of Preclinical
Candidate Optimization, and ∞Department of Pharmaceutics, Bristol-Myers Squibb Company, P.O. Box 4000, Princeton,
New Jersey 08543-4000, United States
| | - David S. Taylor
- Department of Chemistry, ‡Department of Biology, §Department of Computer
Aided Drug Design, ∥Department of Materials Science, ⊥Synthesis and Analysis Technology Team, #Department of Preclinical
Candidate Optimization, and ∞Department of Pharmaceutics, Bristol-Myers Squibb Company, P.O. Box 4000, Princeton,
New Jersey 08543-4000, United States
| | - Alice Ye A. Chen
- Department of Chemistry, ‡Department of Biology, §Department of Computer
Aided Drug Design, ∥Department of Materials Science, ⊥Synthesis and Analysis Technology Team, #Department of Preclinical
Candidate Optimization, and ∞Department of Pharmaceutics, Bristol-Myers Squibb Company, P.O. Box 4000, Princeton,
New Jersey 08543-4000, United States
| | - Xiaohong Yin
- Department of Chemistry, ‡Department of Biology, §Department of Computer
Aided Drug Design, ∥Department of Materials Science, ⊥Synthesis and Analysis Technology Team, #Department of Preclinical
Candidate Optimization, and ∞Department of Pharmaceutics, Bristol-Myers Squibb Company, P.O. Box 4000, Princeton,
New Jersey 08543-4000, United States
| | - Paul G. Sleph
- Department of Chemistry, ‡Department of Biology, §Department of Computer
Aided Drug Design, ∥Department of Materials Science, ⊥Synthesis and Analysis Technology Team, #Department of Preclinical
Candidate Optimization, and ∞Department of Pharmaceutics, Bristol-Myers Squibb Company, P.O. Box 4000, Princeton,
New Jersey 08543-4000, United States
| | - Richard Z. Yang
- Department of Chemistry, ‡Department of Biology, §Department of Computer
Aided Drug Design, ∥Department of Materials Science, ⊥Synthesis and Analysis Technology Team, #Department of Preclinical
Candidate Optimization, and ∞Department of Pharmaceutics, Bristol-Myers Squibb Company, P.O. Box 4000, Princeton,
New Jersey 08543-4000, United States
| | - Doree F. Sitkoff
- Department of Chemistry, ‡Department of Biology, §Department of Computer
Aided Drug Design, ∥Department of Materials Science, ⊥Synthesis and Analysis Technology Team, #Department of Preclinical
Candidate Optimization, and ∞Department of Pharmaceutics, Bristol-Myers Squibb Company, P.O. Box 4000, Princeton,
New Jersey 08543-4000, United States
| | - Michael A. Galella
- Department of Chemistry, ‡Department of Biology, §Department of Computer
Aided Drug Design, ∥Department of Materials Science, ⊥Synthesis and Analysis Technology Team, #Department of Preclinical
Candidate Optimization, and ∞Department of Pharmaceutics, Bristol-Myers Squibb Company, P.O. Box 4000, Princeton,
New Jersey 08543-4000, United States
| | - David S. Nirschl
- Department of Chemistry, ‡Department of Biology, §Department of Computer
Aided Drug Design, ∥Department of Materials Science, ⊥Synthesis and Analysis Technology Team, #Department of Preclinical
Candidate Optimization, and ∞Department of Pharmaceutics, Bristol-Myers Squibb Company, P.O. Box 4000, Princeton,
New Jersey 08543-4000, United States
| | - Katy Van Kirk
- Department of Chemistry, ‡Department of Biology, §Department of Computer
Aided Drug Design, ∥Department of Materials Science, ⊥Synthesis and Analysis Technology Team, #Department of Preclinical
Candidate Optimization, and ∞Department of Pharmaceutics, Bristol-Myers Squibb Company, P.O. Box 4000, Princeton,
New Jersey 08543-4000, United States
| | - Arthur V. Miller
- Department of Chemistry, ‡Department of Biology, §Department of Computer
Aided Drug Design, ∥Department of Materials Science, ⊥Synthesis and Analysis Technology Team, #Department of Preclinical
Candidate Optimization, and ∞Department of Pharmaceutics, Bristol-Myers Squibb Company, P.O. Box 4000, Princeton,
New Jersey 08543-4000, United States
| | - Christine S. Huang
- Department of Chemistry, ‡Department of Biology, §Department of Computer
Aided Drug Design, ∥Department of Materials Science, ⊥Synthesis and Analysis Technology Team, #Department of Preclinical
Candidate Optimization, and ∞Department of Pharmaceutics, Bristol-Myers Squibb Company, P.O. Box 4000, Princeton,
New Jersey 08543-4000, United States
| | - Ming Chang
- Department of Chemistry, ‡Department of Biology, §Department of Computer
Aided Drug Design, ∥Department of Materials Science, ⊥Synthesis and Analysis Technology Team, #Department of Preclinical
Candidate Optimization, and ∞Department of Pharmaceutics, Bristol-Myers Squibb Company, P.O. Box 4000, Princeton,
New Jersey 08543-4000, United States
| | - Xue-Qing Chen
- Department of Chemistry, ‡Department of Biology, §Department of Computer
Aided Drug Design, ∥Department of Materials Science, ⊥Synthesis and Analysis Technology Team, #Department of Preclinical
Candidate Optimization, and ∞Department of Pharmaceutics, Bristol-Myers Squibb Company, P.O. Box 4000, Princeton,
New Jersey 08543-4000, United States
| | - Mark E. Salvati
- Department of Chemistry, ‡Department of Biology, §Department of Computer
Aided Drug Design, ∥Department of Materials Science, ⊥Synthesis and Analysis Technology Team, #Department of Preclinical
Candidate Optimization, and ∞Department of Pharmaceutics, Bristol-Myers Squibb Company, P.O. Box 4000, Princeton,
New Jersey 08543-4000, United States
| | - Ruth R. Wexler
- Department of Chemistry, ‡Department of Biology, §Department of Computer
Aided Drug Design, ∥Department of Materials Science, ⊥Synthesis and Analysis Technology Team, #Department of Preclinical
Candidate Optimization, and ∞Department of Pharmaceutics, Bristol-Myers Squibb Company, P.O. Box 4000, Princeton,
New Jersey 08543-4000, United States
| | - R. Michael Lawrence
- Department of Chemistry, ‡Department of Biology, §Department of Computer
Aided Drug Design, ∥Department of Materials Science, ⊥Synthesis and Analysis Technology Team, #Department of Preclinical
Candidate Optimization, and ∞Department of Pharmaceutics, Bristol-Myers Squibb Company, P.O. Box 4000, Princeton,
New Jersey 08543-4000, United States
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Elevated HDL is the main negative risk factor for coronary artery disease in the elderly patient with calcific aortic valve disease. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2012. [DOI: 10.1016/j.repce.2012.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Barter PJ, Rye KA. Cholesteryl ester transfer protein inhibition as a strategy to reduce cardiovascular risk. J Lipid Res 2012; 53:1755-66. [PMID: 22550134 DOI: 10.1194/jlr.r024075] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Human and rabbit plasma contain a cholesteryl ester transfer protein (CETP) that promotes net mass transfers of cholesteryl esters from high density lipoproteins (HDL) to other plasma lipoprotein fractions. As predicted, inhibition of CETP in both humans and rabbits increases the concentration of cholesterol in the potentially protective HDL fraction, while decreasing it in potentially proatherogenic non-HDL fractions. Inhibition of CETP in rabbits also inhibits the development of diet-induced atherosclerosis. However, use of the CETP inhibitor torcetrapib in humans did not reduce atheroma in three imaging trials and caused an excess of deaths and cardiovascular events in a large clinical outcome trial. The precise explanation for the harm caused by torcetrapib is unknown but may relate to documented, potentially harmful effects unrelated to inhibition of CETP. More recently, a trial using the weak CETP inhibitor dalcetrapib, which raises HDL levels less effectively than torcetrapib and does not lower non-HDL lipoprotein levels, was terminated early for reasons of futility. There was no evidence that dalcetrapib caused harm in that trial. Despite these setbacks, the hypothesis that CETP inhibitors will be antiatherogenic in humans is still being tested in studies with anacetrapib and evacetrapib, two CETP inhibitors that are much more potent than dalcetrapib and that do not share the off-target adverse effects of torcetrapib.
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Affiliation(s)
- Philip J Barter
- The Heart Research Institute, Sydney, New South Wales, 2042, Australia.
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Abstract
High-density lipoprotein (HDL) cholesterol levels bear an inverse relationship to cardiovascular risk. To date, however, no intervention specifically targeting HDL has been demonstrated to reduce cardiovascular risk. Cholesterol ester transfer protein (CETP) mediates transfer of cholesterol ester from HDL to apolipoprotein B-containing particles. Most, but not all observational cohort studies indicate that genetic polymorphisms of CETP associated with reduced activity and higher HDL cholesterol levels are also associated with reduced cardiovascular risk. Some, but not all studies indicate that CETP inhibition in rabbits retards atherosclerosis, whereas transgenic CETP expression in mice promotes atherosclerosis. Torcetrapib, the first CETP inhibitor to reach phase III clinical development, was abandoned due to excess mortality associated with increases in aldosterone and blood pressure. Two other CETP inhibitors have entered phase III clinical development. Anacetrapib is a potent inhibitor of CETP that produces very large increases in HDL cholesterol and large reductions in low-density lipoprotein (LDL) cholesterol, beyond those achieved with statins. Dalcetrapib is a less potent CETP inhibitor that produces smaller increases in HDL cholesterol with minimal effect on LDL cholesterol. Both agents appear to allow efflux of cholesterol from macrophages to HDL in vitro, and neither agent affects blood pressure or aldosterone in vivo. Two large cardiovascular outcomes trials, one with anacetrapib and one with dalcetrapib, should provide a conclusive test of the hypothesis that inhibition of CETP decreases cardiovascular risk.
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Johns DG, Duffy J, Fisher T, Hubbard BK, Forrest MJ. On- and Off-Target Pharmacology of Torcetrapib. Drugs 2012; 72:491-507. [DOI: 10.2165/11599310-000000000-00000] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Monitoring Cyp2b10 mRNA expression at cessation of 2-year carcinogenesis bioassay in mouse liver provides evidence for a carcinogenic mechanism devoid of human relevance: The dalcetrapib experience. Toxicol Appl Pharmacol 2012; 259:355-65. [DOI: 10.1016/j.taap.2012.01.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 01/16/2012] [Accepted: 01/19/2012] [Indexed: 11/23/2022]
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Lüscher TF, Taddei S, Kaski JC, Jukema JW, Kallend D, Münzel T, Kastelein JJP, Deanfield JE. Vascular effects and safety of dalcetrapib in patients with or at risk of coronary heart disease: the dal-VESSEL randomized clinical trial. Eur Heart J 2012; 33:857-65. [PMID: 22345126 DOI: 10.1093/eurheartj/ehs019] [Citation(s) in RCA: 173] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
AIMS High-density lipoprotein cholesterol (HDL-C) is inversely associated with cardiovascular (CV) events and thus an attractive therapeutic target. However, in spite of marked elevations in HDL-C, the first cholesterol transport protein (CETP) inhibitor torcetrapib raised blood pressure (BP), impaired endothelial function, and increased CV mortality and morbidity. Dalcetrapib is a novel molecule acting on CETP with a different chemical structure to torcetrapib. As HDL stimulates nitric oxide (NO), suppresses inflammation, and exerts protective CV effects, we investigated the effects of dalcetrapib on endothelial function, blood pressure, inflammatory markers, and lipids in patients with, or at risk of, coronary heart disease (CHD) in a double-blind randomized placebo-controlled trial (clinicaltrials.gov number NCT00655538). METHODS AND RESULTS Patients with target low-density lipoprotein cholesterol (LDL-C) levels received dalcetrapib 600 mg/day or placebo for 36 weeks on top of standard therapy (including statins). The primary outcome measures were the change from baseline of flow-mediated dilatation (%FMD) of the right brachial artery after 5 min of cuff occlusion at 12 weeks and the 24 h ambulatory blood pressure monitoring (ABPM) at week 4. Secondary outcomes included change from baseline in FMD after 36 weeks and the change in ABPM at 12 and 36 weeks, changes in HDL-C, LDL-C, triglycerides, CETP activity, as well as standard safety parameters. Four hundred seventy-six patients were randomized. Baseline FMD was 4.1 ± 2.2 and 4.0 ± 2.4% with placebo or dalcetrapib, respectively and did not change significantly from placebo after 12 and 36 weeks (P = 0.1764 and 0.9515, respectively). After 4, 24, and 36 weeks of treatment with dalcetrapib, CETP activity decreased by 51, 53, and 56% (placebo corrected, all P < 0.0001), while at weeks 4, 12, and 36 HDL-C increased by 25, 27, and 31% (placebo corrected, all P < 0.0001). Low-density lipoprotein cholesterol levels did not change. At baseline, ABPM was 125 ± 12/74 ± 8mmHg in the placebo and 128 ± 11/75 ± 7mmHg in the dalcetrapib group (P = 0.3372 and 0.1248, respectively, placebo-corrected change from baseline) and did not change for up to 36 weeks. Biomarkers of inflammation, oxidative stress, and coagulation did not change during follow-up except for Lp-PLA(2) mass levels which increased by 17% (placebo corrected). Overall 7 patients given dalcetrapib and 8 patients given placebo experienced at least one pre-specified adjudicated event (11 events with dalcetrapib and 12 events with placebo). CONCLUSION The dal-VESSEL trial has established the tolerability and safety of CETP-inhibition with dalcetrapib in patients with or at risk of CHD. Dalcetrapib reduced CETP activity and increased HDL-C levels without affecting NO-dependent endothelial function, blood pressure, or markers of inflammation and oxidative stress. The dal-OUTCOMES trial (NCT00658515) will show whether dalcetrapib improves outcomes in spite of a lack of effect on endothelial function.
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Affiliation(s)
- Thomas F Lüscher
- Department of Cardiology, Cardiovascular Centre, University of Zurich, 8091 Zurich, Switzerland.
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Niesor EJ, Chaput E, Staempfli A, Blum D, Derks M, Kallend D. Effect of dalcetrapib, a CETP modulator, on non-cholesterol sterol markers of cholesterol homeostasis in healthy subjects. Atherosclerosis 2011; 219:761-7. [DOI: 10.1016/j.atherosclerosis.2011.09.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 09/07/2011] [Accepted: 09/09/2011] [Indexed: 11/16/2022]
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Barter P, Rye KA. Cholesteryl ester transfer protein inhibition to reduce cardiovascular risk: Where are we now? Trends Pharmacol Sci 2011; 32:694-9. [PMID: 22088767 DOI: 10.1016/j.tips.2011.07.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 07/25/2011] [Accepted: 07/26/2011] [Indexed: 11/17/2022]
Abstract
Elevated low-density lipoprotein-cholesterol (LDL-C) and reduced high-density lipoprotein-cholesterol (HDL-C) are major risk factors for the development of cardiovascular disease. One approach to raising HDL-C is to inhibit the cholesteryl ester transfer protein (CETP), a plasma protein that promotes transfer of cholesteryl esters from HDL and other lipoprotein fractions. Drugs that inhibit CETP increase HDL-C and some lower LDL-C. However, the development of torcetrapib, the first CETP inhibitor to be tested in a human clinical outcomes trial, was terminated because it caused an excess of deaths and cardiovascular events. There is evidence, however, that torcetrapib had adverse off-target effects unrelated to CETP inhibition. This has opened the way for retesting of the hypothesis that CETP inhibitors will be anti-atherogenic in studies conducted with agents such as dalcetrapib and anacetrapib that do not share the off-target effects of torcetrapib. Clinical outcome trials with dalcetrapib and anacetrapib are currently under way.
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Affiliation(s)
- Philip Barter
- The Heart Research Institute, 7 Eliza Street, Newtown, Sydney 2042, Australia.
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Simic B, Hermann M, Shaw SG, Bigler L, Stalder U, Dörries C, Besler C, Lüscher TF, Ruschitzka F. Torcetrapib impairs endothelial function in hypertension. Eur Heart J 2011; 33:1615-24. [DOI: 10.1093/eurheartj/ehr348] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Barter PJ, Rye KA, Tardif JC, Waters DD, Boekholdt SM, Breazna A, Kastelein JJ. Effect of Torcetrapib on Glucose, Insulin, and Hemoglobin A
1c
in Subjects in the Investigation of Lipid Level Management to Understand its Impact in Atherosclerotic Events (ILLUMINATE) Trial. Circulation 2011; 124:555-62. [PMID: 21804130 DOI: 10.1161/circulationaha.111.018259] [Citation(s) in RCA: 139] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background—
High-density lipoproteins have antidiabetic properties in vitro. Furthermore, elevated high-density lipoprotein levels accompanying a genetic deficiency of cholesteryl ester transfer protein are associated with decreased levels of plasma glucose. We now investigate effects on glucose homeostasis of inhibiting cholesteryl ester transfer protein with torcetrapib.
Methods and Results—
A post hoc analysis of the Investigation of Lipid Level Management to Understand its Impact in Atherosclerotic Events (ILLUMINATE) trial was conducted to investigate effects of the cholesteryl ester transfer protein inhibitor torcetrapib on glycemic control in the 6661 diabetic patients in the trial. At baseline, there were no differences between the 2 treatment arms with respect to plasma glucose, insulin, hemoglobin A
1c
, or the homeostasis model assessment of insulin resistance. After 3 months, the diabetic subjects taking the combination of torcetrapib plus atorvastatin had plasma glucose levels 0.34 mmol/L lower (
P
<0.0001) and insulin levels 11.7 μU/mL lower (
P
<0.0001) than in those receiving atorvastatin alone. Homeostasis model assessment of insulin resistance values decreased from 49.1 to 47.3 (
P
<0.0001) in the torcetrapib/atorvastatin arm compared with an increase in homeostasis model assessment of insulin resistance in the atorvastatin arm. At the 6-month time point, the mean hemoglobin A
1c
level in the atorvastatin arm was 7.29% compared with 7.06% in the torcetrapib/atorvastatin arm (
P
<0.0001). These effects of torcetrapib remained apparent for up to 12 months. Torcetrapib also lowered both glucose and insulin levels in the participants without diabetes mellitus, although the effects were not as great as in those with diabetes mellitus.
Conclusions—
Treatment with torcetrapib improves glycemic control in atorvastatin-treated patients with type 2 diabetes mellitus. It remains to be determined whether this effect is the consequence of raising high-density lipoprotein.at
Clinical Trial Registration—
http:www.clinicaltrials.gov
. Unique identifier: NCT00134264.
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Affiliation(s)
- Philip J. Barter
- From the Heart Research Institute and University of Sydney, Sydney, Australia (P.J.B., K.R.); Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada (J.T.); San Francisco General Hospital, San Francisco, CA (D.D.W.); Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands (S.M.B., J.J.P.K.); and Pfizer, Inc, New York, NY (A.B.)
| | - Kerry-Anne Rye
- From the Heart Research Institute and University of Sydney, Sydney, Australia (P.J.B., K.R.); Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada (J.T.); San Francisco General Hospital, San Francisco, CA (D.D.W.); Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands (S.M.B., J.J.P.K.); and Pfizer, Inc, New York, NY (A.B.)
| | - Jean-Claude Tardif
- From the Heart Research Institute and University of Sydney, Sydney, Australia (P.J.B., K.R.); Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada (J.T.); San Francisco General Hospital, San Francisco, CA (D.D.W.); Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands (S.M.B., J.J.P.K.); and Pfizer, Inc, New York, NY (A.B.)
| | - David D. Waters
- From the Heart Research Institute and University of Sydney, Sydney, Australia (P.J.B., K.R.); Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada (J.T.); San Francisco General Hospital, San Francisco, CA (D.D.W.); Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands (S.M.B., J.J.P.K.); and Pfizer, Inc, New York, NY (A.B.)
| | - S. Matthijs Boekholdt
- From the Heart Research Institute and University of Sydney, Sydney, Australia (P.J.B., K.R.); Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada (J.T.); San Francisco General Hospital, San Francisco, CA (D.D.W.); Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands (S.M.B., J.J.P.K.); and Pfizer, Inc, New York, NY (A.B.)
| | - Andrei Breazna
- From the Heart Research Institute and University of Sydney, Sydney, Australia (P.J.B., K.R.); Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada (J.T.); San Francisco General Hospital, San Francisco, CA (D.D.W.); Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands (S.M.B., J.J.P.K.); and Pfizer, Inc, New York, NY (A.B.)
| | - John J.P. Kastelein
- From the Heart Research Institute and University of Sydney, Sydney, Australia (P.J.B., K.R.); Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada (J.T.); San Francisco General Hospital, San Francisco, CA (D.D.W.); Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands (S.M.B., J.J.P.K.); and Pfizer, Inc, New York, NY (A.B.)
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Krishna R, Wagner JA. Applications of 'decisionable' biomarkers in cardiovascular drug development. Biomark Med 2011; 4:815-27. [PMID: 21133701 DOI: 10.2217/bmm.10.107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Biomarkers are now increasingly employed in drug development for decision-making. New targets and candidate drugs should not only have drug-like properties (i.e., be 'drugable'), but the supporting biomarker platform should be 'decisionable'. For example, biomarkers for target engagement have supported the biologic plausibility for novel mechanisms and have aided in accelerated proof of concept. In many other circumstances, biomarkers have aided in the elucidation of mechanisms of action and disease progression. In this article, decisonable biomarker principles that aid in decision-making within the realm of early discovery through to clinical proof of concept are discussed. Case studies of applications of both target engagement and disease-related biomarkers are illustrated in the field of cardiovascular drug discovery and translational development. We propose that biomarkers, if prospectively implemented in an early development program, have the potential to accelerate drug development, facilitate the design of informative trials and dose selection for accelerated development, and establish an overall increase in probability of developmental success and efficiency.
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Affiliation(s)
- Rajesh Krishna
- Department of Clinical Pharmacology, Merck Research Laboratories, Rahway, NJ 07065, USA.
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Denelavas A, Weibel F, Prummer M, Imbach A, Clerc RG, Apfel CM, Hertel C. Real-time cellular impedance measurements detect Ca(2+) channel-dependent oscillations of morphology in human H295R adrenoma cells. BIOCHIMICA ET BIOPHYSICA ACTA-MOLECULAR CELL RESEARCH 2011; 1813:754-62. [PMID: 21262275 DOI: 10.1016/j.bbamcr.2011.01.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 12/07/2010] [Accepted: 01/13/2011] [Indexed: 01/15/2023]
Abstract
Endocrine cells, such as H295R have been widely used to study secretion of steroid and other hormones. Exocytosis-dependent hormone release is accompanied by an increase in plasma membrane surface area and a decrease in vesicle content. Recovery of vesicles and decrease in plasma membrane area is achieved by endocytotic processes. These changes in the extent of the surface area lead to morphological changes which can be determined by label-free real-time impedance measurements. Exo- and endocytosis have been described to be triggered by activation of L-type Ca(2+) channels. The present study demonstrates that activation of L-type calcium channels induces prolonged oscillating changes in cellular impedance. The data support the hypothesis that a tight regulation of the intracellular Ca(2+) concentration is a prerequisite for the observed cellular impedance oscillations. Furthermore evidence is presented for a mechanism in which the oscillations depend on a Ca(2+)-triggered calmodulin-dependent cascade involving myosin light chain kinase, nonmuscle myosin II and ultimately actin polymerization, a known determinant for cell shape changes and exocytosis in secretory cells. The described assay provides a method to determine continuously prolonged changes in cellular morphology such as exo/endocytosis cycles. This article is part of a Special Issue entitled: 11th European Symposium on Calcium.
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Affiliation(s)
- Athanasios Denelavas
- Metabolic Diseases, F. Hoffmann-La Roche Ltd., Pharma Research and Early Development, Basel, Switzerland
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Barter PJ. Point: The Relationship between Cholesteryl Ester Transfer Protein and Cardiovascular Risk. Clin Chem 2010; 56:1547-9. [DOI: 10.1373/clinchem.2010.150565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Davidson MH. Update on CETP inhibition. J Clin Lipidol 2010; 4:394-8. [DOI: 10.1016/j.jacl.2010.08.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Accepted: 08/09/2010] [Indexed: 11/16/2022]
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Is a blood pressure rise the only deleterious off-target effect of cholesterol ester transfer protein inhibitors? J Hypertens 2010; 28:1614-6. [DOI: 10.1097/hjh.0b013e32833c575b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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