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Kistemaker LEM, Elzinga CRS, Tautermann CS, Pieper MP, Seeliger D, Alikhil S, Schmidt M, Meurs H, Gosens R. Second M 3 muscarinic receptor binding site contributes to bronchoprotection by tiotropium. Br J Pharmacol 2019; 176:2864-2876. [PMID: 31077341 DOI: 10.1111/bph.14707] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 04/16/2019] [Accepted: 04/29/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND PURPOSE The bronchodilator tiotropium binds not only to its main binding site on the M3 muscarinic receptor but also to an allosteric site. Here, we have investigated the functional relevance of this allosteric binding and the potential contribution of this behaviour to interactions with long-acting β-adrenoceptor agonists, as combination therapy with anticholinergic agents and β-adrenoceptor agonists improves lung function in chronic obstructive pulmonary disease. EXPERIMENTAL APPROACH ACh, tiotropium, and atropine binding to M3 receptors were modelled using molecular dynamics simulations. Contractions of bovine and human tracheal smooth muscle strips were studied. KEY RESULTS Molecular dynamics simulation revealed extracellular vestibule binding of tiotropium, and not atropine, to M3 receptors as a secondary low affinity binding site, preventing ACh entry into the orthosteric binding pocket. This resulted in a low (allosteric binding) and high (orthosteric binding) functional affinity of tiotropium in protecting against methacholine-induced contractions of airway smooth muscle, which was not observed for atropine and glycopyrrolate. Moreover, antagonism by tiotropium was insurmountable in nature. This behaviour facilitated functional interactions of tiotropium with the β-agonist olodaterol, which synergistically enhanced bronchoprotective effects of tiotropium. This was not seen for glycopyrrolate and olodaterol or indacaterol but was mimicked by the interaction of tiotropium and forskolin, indicating no direct β-adrenoceptor-M3 receptor crosstalk in this effect. CONCLUSIONS AND IMPLICATIONS We propose that tiotropium has two binding sites at the M3 receptor that prevent ACh action, which, together with slow dissociation kinetics, may contribute to insurmountable antagonism and enhanced functional interactions with β-adrenoceptor agonists.
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Affiliation(s)
- Loes E M Kistemaker
- Department of Molecular Pharmacology, University of Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Carolina R S Elzinga
- Department of Molecular Pharmacology, University of Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Christofer S Tautermann
- Department of Medicinal Chemistry, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Michael P Pieper
- Immunology and Respiratory Disease Research, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Daniel Seeliger
- Department of Medicinal Chemistry, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Suraya Alikhil
- Department of Molecular Pharmacology, University of Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Martina Schmidt
- Department of Molecular Pharmacology, University of Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Herman Meurs
- Department of Molecular Pharmacology, University of Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Reinoud Gosens
- Department of Molecular Pharmacology, University of Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Oliveira MVCD, Pizzichini E, da Costa CH, Fritscher CC, Vianna EO, Teixeira PJZ, Stirbulov R, Rabahi MF, Pinho NCD. Evaluation of the preference, satisfaction and correct use of Breezhaler ® and Respimat ® inhalers in patients with chronic obstructive pulmonary disease - INHALATOR study. Respir Med 2018; 144:61-67. [PMID: 30366585 DOI: 10.1016/j.rmed.2018.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 10/02/2018] [Accepted: 10/06/2018] [Indexed: 11/24/2022]
Abstract
The INHALATOR study was a randomized, multicentre, open label, two-period of 7 days each, crossover study, with 7 days of washout in-between, aiming to evaluate the correct use, satisfaction and preference between Breezhaler® and Respimat® devices in patients under daily use of open Spiriva® or open Onbrize®, as monotherapy for treatment of mild or moderate COPD. Patients aged ≥40 years with a smoking history of at least 10 pack-year were included in the study. Primary endpoint was the rate of correct use of each device at the first day of treatment after reading the drug leaflet information and was evaluated under the supervision of a trained evaluator. At the end of each treatment phase, the inhaler use was re-evaluated and a satisfaction questionnaire was completed. The patients' preference for the inhaler devices was assessed at the end of the study. After exclusions due to screening failures, 140 patients were randomized: 136 received at least one dose of Breezhaler® and 135 of Respimat®. At treatment start, the rate of correct inhaler use was 40.4% (95%CI: 32.2%-48.7%) for Breezhaler® and 36.3% (95%CI: 28.2%-44.4%) for Respimat® (p = 0.451). After 7 days, the rates were 68.9% (95%CI: 61.1%-76.7%) and 60.4% (95%CI: 52.2%-68.7%), respectively (p = 0.077). According to the Feeling of Satisfaction with Inhaler Questionnaire - FSI 10 patients were more satisfied using Breezhaler® than Respimat® and 57.1% preferred using Breezhaler® (p = 0.001) while 30.1% preferred Respimat® (p < 0.001).
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Affiliation(s)
- Maria Vera Cruz de Oliveira
- Hospital do Servidor Público Estadual de São Paulo, Rua Pedro de Toledo, 1800 Bl F. 3° Andar, São Paulo/SP, 04039-901, Brazil
| | - Emilio Pizzichini
- NUPAIVA, Hospital Universitário, UFSC, Campos Universitário S/N, Trindade, Florianópolis /SC, 88040-970, Brazil
| | - Claudia Henrique da Costa
- UERJ, Policlínica Piquet Carneiro, Av. Marechal Rondon 381, São Francisco Xavier, Rio de Janeiro / RJ, 20950-003, Brazil
| | - Carlos Cezar Fritscher
- Hospital São Lucas da PUCRS, Av Ipiranga 6690, 4° andar, Porto Alegre / RS, 90610-000, Brazil
| | - Elcio Oliveira Vianna
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, USP, Av. Bandeirantes 3900, CEP 14048-900, Ribeirão Preto, SP, Brazil
| | - Paulo José Zimermann Teixeira
- Irmandade da Santa Casa de Misericórdia de Porto Alegre-UFCSPA, Rua Prof. Annes Dias, 295, Pavilhão Pereira Filho, 1° andar, Porto Alegre / RS, 90020-090, Brazil
| | - Roberto Stirbulov
- Centro de Pesquisa Clínica em Pneumologia da Irmandade Santa Casa de Misericórdia de São Paulo, Rua Dr. Cesário Motta Jr. 112, Vila Buarque, São Paulo / SP, Brazil
| | - Marcelo Fouad Rabahi
- CLARE, Clínica de Pneumologia SS, Av. B 483, Setor Oeste, Goiânia / GO, 74110-030, Brazil
| | - Nadine Cordeiro de Pinho
- Novartis Biociências S.A. Brasil, Av. Prof. Vicente Rao, 90, Santo Amaro, São Paulo / SP, 04636-000, Brazil.
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