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Muthusami P, Yoo SJ, Chaturvedi R, Gill N, Windram J, Schantz D, Prsa M, Caro-Dominguez P, Seed M, Grosse-Wortmann L, Ling SC, Chavhan GB. Splanchnic, Thoracoabdominal, and Cerebral Blood Flow Volumes in Healthy Children and Young Adults in Fasting and Postprandial States: Determining Reference Ranges by Using Phase-Contrast MR Imaging. Radiology 2017; 285:231-241. [DOI: 10.1148/radiol.2017162114] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Prakash Muthusami
- From the Department of Diagnostic Imaging (P.M., S.J.Y., N.T., J.W., D.S., M.P., P.C.D., M.S., L.G.W., G.B.C.), Division of Cardiology, Department of Pediatrics (S.J.Y., R.C., J.W., D.S., M.P., M.S., L.G.W.), and Division of Gastroenterology, Hepatology, and Nutrition (S.C.L.), the Hospital For Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Departments of Medical Imaging (P.M., S.J.Y., P.C.D., M.S., L.G.W., G.B.C.), and Pediatrics (R.C., S.C.L.), University of Toronto, Toronto, Canada
| | - Shi-Joon Yoo
- From the Department of Diagnostic Imaging (P.M., S.J.Y., N.T., J.W., D.S., M.P., P.C.D., M.S., L.G.W., G.B.C.), Division of Cardiology, Department of Pediatrics (S.J.Y., R.C., J.W., D.S., M.P., M.S., L.G.W.), and Division of Gastroenterology, Hepatology, and Nutrition (S.C.L.), the Hospital For Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Departments of Medical Imaging (P.M., S.J.Y., P.C.D., M.S., L.G.W., G.B.C.), and Pediatrics (R.C., S.C.L.), University of Toronto, Toronto, Canada
| | - Rajiv Chaturvedi
- From the Department of Diagnostic Imaging (P.M., S.J.Y., N.T., J.W., D.S., M.P., P.C.D., M.S., L.G.W., G.B.C.), Division of Cardiology, Department of Pediatrics (S.J.Y., R.C., J.W., D.S., M.P., M.S., L.G.W.), and Division of Gastroenterology, Hepatology, and Nutrition (S.C.L.), the Hospital For Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Departments of Medical Imaging (P.M., S.J.Y., P.C.D., M.S., L.G.W., G.B.C.), and Pediatrics (R.C., S.C.L.), University of Toronto, Toronto, Canada
| | - Navjot Gill
- From the Department of Diagnostic Imaging (P.M., S.J.Y., N.T., J.W., D.S., M.P., P.C.D., M.S., L.G.W., G.B.C.), Division of Cardiology, Department of Pediatrics (S.J.Y., R.C., J.W., D.S., M.P., M.S., L.G.W.), and Division of Gastroenterology, Hepatology, and Nutrition (S.C.L.), the Hospital For Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Departments of Medical Imaging (P.M., S.J.Y., P.C.D., M.S., L.G.W., G.B.C.), and Pediatrics (R.C., S.C.L.), University of Toronto, Toronto, Canada
| | - Jonathan Windram
- From the Department of Diagnostic Imaging (P.M., S.J.Y., N.T., J.W., D.S., M.P., P.C.D., M.S., L.G.W., G.B.C.), Division of Cardiology, Department of Pediatrics (S.J.Y., R.C., J.W., D.S., M.P., M.S., L.G.W.), and Division of Gastroenterology, Hepatology, and Nutrition (S.C.L.), the Hospital For Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Departments of Medical Imaging (P.M., S.J.Y., P.C.D., M.S., L.G.W., G.B.C.), and Pediatrics (R.C., S.C.L.), University of Toronto, Toronto, Canada
| | - Daryl Schantz
- From the Department of Diagnostic Imaging (P.M., S.J.Y., N.T., J.W., D.S., M.P., P.C.D., M.S., L.G.W., G.B.C.), Division of Cardiology, Department of Pediatrics (S.J.Y., R.C., J.W., D.S., M.P., M.S., L.G.W.), and Division of Gastroenterology, Hepatology, and Nutrition (S.C.L.), the Hospital For Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Departments of Medical Imaging (P.M., S.J.Y., P.C.D., M.S., L.G.W., G.B.C.), and Pediatrics (R.C., S.C.L.), University of Toronto, Toronto, Canada
| | - Milan Prsa
- From the Department of Diagnostic Imaging (P.M., S.J.Y., N.T., J.W., D.S., M.P., P.C.D., M.S., L.G.W., G.B.C.), Division of Cardiology, Department of Pediatrics (S.J.Y., R.C., J.W., D.S., M.P., M.S., L.G.W.), and Division of Gastroenterology, Hepatology, and Nutrition (S.C.L.), the Hospital For Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Departments of Medical Imaging (P.M., S.J.Y., P.C.D., M.S., L.G.W., G.B.C.), and Pediatrics (R.C., S.C.L.), University of Toronto, Toronto, Canada
| | - Pablo Caro-Dominguez
- From the Department of Diagnostic Imaging (P.M., S.J.Y., N.T., J.W., D.S., M.P., P.C.D., M.S., L.G.W., G.B.C.), Division of Cardiology, Department of Pediatrics (S.J.Y., R.C., J.W., D.S., M.P., M.S., L.G.W.), and Division of Gastroenterology, Hepatology, and Nutrition (S.C.L.), the Hospital For Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Departments of Medical Imaging (P.M., S.J.Y., P.C.D., M.S., L.G.W., G.B.C.), and Pediatrics (R.C., S.C.L.), University of Toronto, Toronto, Canada
| | - Mike Seed
- From the Department of Diagnostic Imaging (P.M., S.J.Y., N.T., J.W., D.S., M.P., P.C.D., M.S., L.G.W., G.B.C.), Division of Cardiology, Department of Pediatrics (S.J.Y., R.C., J.W., D.S., M.P., M.S., L.G.W.), and Division of Gastroenterology, Hepatology, and Nutrition (S.C.L.), the Hospital For Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Departments of Medical Imaging (P.M., S.J.Y., P.C.D., M.S., L.G.W., G.B.C.), and Pediatrics (R.C., S.C.L.), University of Toronto, Toronto, Canada
| | - Lars Grosse-Wortmann
- From the Department of Diagnostic Imaging (P.M., S.J.Y., N.T., J.W., D.S., M.P., P.C.D., M.S., L.G.W., G.B.C.), Division of Cardiology, Department of Pediatrics (S.J.Y., R.C., J.W., D.S., M.P., M.S., L.G.W.), and Division of Gastroenterology, Hepatology, and Nutrition (S.C.L.), the Hospital For Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Departments of Medical Imaging (P.M., S.J.Y., P.C.D., M.S., L.G.W., G.B.C.), and Pediatrics (R.C., S.C.L.), University of Toronto, Toronto, Canada
| | - Simon C. Ling
- From the Department of Diagnostic Imaging (P.M., S.J.Y., N.T., J.W., D.S., M.P., P.C.D., M.S., L.G.W., G.B.C.), Division of Cardiology, Department of Pediatrics (S.J.Y., R.C., J.W., D.S., M.P., M.S., L.G.W.), and Division of Gastroenterology, Hepatology, and Nutrition (S.C.L.), the Hospital For Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Departments of Medical Imaging (P.M., S.J.Y., P.C.D., M.S., L.G.W., G.B.C.), and Pediatrics (R.C., S.C.L.), University of Toronto, Toronto, Canada
| | - Govind B. Chavhan
- From the Department of Diagnostic Imaging (P.M., S.J.Y., N.T., J.W., D.S., M.P., P.C.D., M.S., L.G.W., G.B.C.), Division of Cardiology, Department of Pediatrics (S.J.Y., R.C., J.W., D.S., M.P., M.S., L.G.W.), and Division of Gastroenterology, Hepatology, and Nutrition (S.C.L.), the Hospital For Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Departments of Medical Imaging (P.M., S.J.Y., P.C.D., M.S., L.G.W., G.B.C.), and Pediatrics (R.C., S.C.L.), University of Toronto, Toronto, Canada
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Snowdon VK, Lachlan NJ, Hoy AM, Hadoke PWF, Semple SI, Patel D, Mungall W, Kendall TJ, Thomson A, Lennen RJ, Jansen MA, Moran CM, Pellicoro A, Ramachandran P, Shaw I, Aucott RL, Severin T, Saini R, Pak J, Yates D, Dongre N, Duffield JS, Webb DJ, Iredale JP, Hayes PC, Fallowfield JA. Serelaxin as a potential treatment for renal dysfunction in cirrhosis: Preclinical evaluation and results of a randomized phase 2 trial. PLoS Med 2017; 14:e1002248. [PMID: 28245243 PMCID: PMC5330452 DOI: 10.1371/journal.pmed.1002248] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 02/02/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Chronic liver scarring from any cause leads to cirrhosis, portal hypertension, and a progressive decline in renal blood flow and renal function. Extreme renal vasoconstriction characterizes hepatorenal syndrome, a functional and potentially reversible form of acute kidney injury in patients with advanced cirrhosis, but current therapy with systemic vasoconstrictors is ineffective in a substantial proportion of patients and is limited by ischemic adverse events. Serelaxin (recombinant human relaxin-2) is a peptide molecule with anti-fibrotic and vasoprotective properties that binds to relaxin family peptide receptor-1 (RXFP1) and has been shown to increase renal perfusion in healthy human volunteers. We hypothesized that serelaxin could ameliorate renal vasoconstriction and renal dysfunction in patients with cirrhosis and portal hypertension. METHODS AND FINDINGS To establish preclinical proof of concept, we developed two independent rat models of cirrhosis that were characterized by progressive reduction in renal blood flow and glomerular filtration rate and showed evidence of renal endothelial dysfunction. We then set out to further explore and validate our hypothesis in a phase 2 randomized open-label parallel-group study in male and female patients with alcohol-related cirrhosis and portal hypertension. Forty patients were randomized 1:1 to treatment with serelaxin intravenous (i.v.) infusion (for 60 min at 80 μg/kg/d and then 60 min at 30 μg/kg/d) or terlipressin (single 2-mg i.v. bolus), and the regional hemodynamic effects were quantified by phase contrast magnetic resonance angiography at baseline and after 120 min. The primary endpoint was the change from baseline in total renal artery blood flow. Therapeutic targeting of renal vasoconstriction with serelaxin in the rat models increased kidney perfusion, oxygenation, and function through reduction in renal vascular resistance, reversal of endothelial dysfunction, and increased activation of the AKT/eNOS/NO signaling pathway in the kidney. In the randomized clinical study, infusion of serelaxin for 120 min increased total renal arterial blood flow by 65% (95% CI 40%, 95%; p < 0.001) from baseline. Administration of serelaxin was safe and well tolerated, with no detrimental effect on systemic blood pressure or hepatic perfusion. The clinical study's main limitations were the relatively small sample size and stable, well-compensated population. CONCLUSIONS Our mechanistic findings in rat models and exploratory study in human cirrhosis suggest the therapeutic potential of selective renal vasodilation using serelaxin as a new treatment for renal dysfunction in cirrhosis, although further validation in patients with more advanced cirrhosis and renal dysfunction is required. TRIAL REGISTRATION ClinicalTrials.gov NCT01640964.
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Affiliation(s)
- Victoria K Snowdon
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
| | - Neil J Lachlan
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
| | - Anna M Hoy
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
| | - Patrick W F Hadoke
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Scott I Semple
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
- Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Dilip Patel
- Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Will Mungall
- Biological Services, University of Edinburgh, Edinburgh, United Kingdom
| | - Timothy J Kendall
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
| | - Adrian Thomson
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Ross J Lennen
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Maurits A Jansen
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Carmel M Moran
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Antonella Pellicoro
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
| | - Prakash Ramachandran
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
| | - Isaac Shaw
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
| | - Rebecca L Aucott
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Rajnish Saini
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, United States of America
| | - Judy Pak
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, United States of America
| | - Denise Yates
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, United States of America
| | | | - Jeremy S Duffield
- Division of Nephrology and Lung Biology, University of Washington, Seattle, Washington, United States of America
| | - David J Webb
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - John P Iredale
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
| | - Peter C Hayes
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
| | - Jonathan A Fallowfield
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
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