1
|
Dhakal B, Li CMY, Li R, Yeo K, Wright JA, Gieniec KA, Vrbanac L, Sammour T, Lawrence M, Thomas M, Lewis M, Perry J, Worthley DL, Woods SL, Drew P, Sallustio BC, Smith E, Horowitz JD, Maddern GJ, Licari G, Fenix K. The Antianginal Drug Perhexiline Displays Cytotoxicity against Colorectal Cancer Cells In Vitro: A Potential for Drug Repurposing. Cancers (Basel) 2022; 14:cancers14041043. [PMID: 35205791 PMCID: PMC8869789 DOI: 10.3390/cancers14041043] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/02/2022] [Accepted: 02/05/2022] [Indexed: 01/05/2023] Open
Abstract
Colorectal cancer (CRC) is the second leading cause of cancer-related death worldwide. Perhexiline, a prophylactic anti-anginal drug, has been reported to have anti-tumour effects both in vitro and in vivo. Perhexiline as used clinically is a 50:50 racemic mixture ((R)-P) of (-) and (+) enantiomers. It is not known if the enantiomers differ in terms of their effects on cancer. In this study, we examined the cytotoxic capacity of perhexiline and its enantiomers ((-)-P and (+)-P) on CRC cell lines, grown as monolayers or spheroids, and patient-derived organoids. Treatment of CRC cell lines with (R)-P, (-)-P or (+)-P reduced cell viability, with IC50 values of ~4 µM. Treatment was associated with an increase in annexin V staining and caspase 3/7 activation, indicating apoptosis induction. Caspase 3/7 activation and loss of structural integrity were also observed in CRC cell lines grown as spheroids. Drug treatment at clinically relevant concentrations significantly reduced the viability of patient-derived CRC organoids. Given these in vitro findings, perhexiline, as a racemic mixture or its enantiomers, warrants further investigation as a repurposed drug for use in the management of CRC.
Collapse
Affiliation(s)
- Bimala Dhakal
- Department of Surgery, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia; (B.D.); (C.M.Y.L.); (R.L.); (K.Y.); (P.D.); (E.S.); (G.J.M.)
- The Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, The University of Adelaide, Woodville, SA 5011, Australia; (B.C.S.); (J.D.H.)
| | - Celine Man Ying Li
- Department of Surgery, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia; (B.D.); (C.M.Y.L.); (R.L.); (K.Y.); (P.D.); (E.S.); (G.J.M.)
- The Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, The University of Adelaide, Woodville, SA 5011, Australia; (B.C.S.); (J.D.H.)
| | - Runhao Li
- Department of Surgery, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia; (B.D.); (C.M.Y.L.); (R.L.); (K.Y.); (P.D.); (E.S.); (G.J.M.)
- The Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, The University of Adelaide, Woodville, SA 5011, Australia; (B.C.S.); (J.D.H.)
- Medical Oncology, The Queen Elizabeth Hospital, Woodville, SA 5011, Australia
| | - Kenny Yeo
- Department of Surgery, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia; (B.D.); (C.M.Y.L.); (R.L.); (K.Y.); (P.D.); (E.S.); (G.J.M.)
- The Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, The University of Adelaide, Woodville, SA 5011, Australia; (B.C.S.); (J.D.H.)
| | - Josephine A. Wright
- Precision Medicine, South Australian Health and Medical Research Institute, Adelaide, SA 5005, Australia; (J.A.W.); (K.A.G.); (L.V.); (T.S.); (D.L.W.); (S.L.W.)
| | - Krystyna A. Gieniec
- Precision Medicine, South Australian Health and Medical Research Institute, Adelaide, SA 5005, Australia; (J.A.W.); (K.A.G.); (L.V.); (T.S.); (D.L.W.); (S.L.W.)
- Department of Medical Specialties, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Laura Vrbanac
- Precision Medicine, South Australian Health and Medical Research Institute, Adelaide, SA 5005, Australia; (J.A.W.); (K.A.G.); (L.V.); (T.S.); (D.L.W.); (S.L.W.)
- Department of Medical Specialties, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Tarik Sammour
- Precision Medicine, South Australian Health and Medical Research Institute, Adelaide, SA 5005, Australia; (J.A.W.); (K.A.G.); (L.V.); (T.S.); (D.L.W.); (S.L.W.)
- Department of Medical Specialties, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, SA 5005, Australia; (M.L.); (M.T.); (M.L.); (J.P.)
| | - Matthew Lawrence
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, SA 5005, Australia; (M.L.); (M.T.); (M.L.); (J.P.)
| | - Michelle Thomas
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, SA 5005, Australia; (M.L.); (M.T.); (M.L.); (J.P.)
| | - Mark Lewis
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, SA 5005, Australia; (M.L.); (M.T.); (M.L.); (J.P.)
| | - Joanne Perry
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, SA 5005, Australia; (M.L.); (M.T.); (M.L.); (J.P.)
| | - Daniel L. Worthley
- Precision Medicine, South Australian Health and Medical Research Institute, Adelaide, SA 5005, Australia; (J.A.W.); (K.A.G.); (L.V.); (T.S.); (D.L.W.); (S.L.W.)
| | - Susan L. Woods
- Precision Medicine, South Australian Health and Medical Research Institute, Adelaide, SA 5005, Australia; (J.A.W.); (K.A.G.); (L.V.); (T.S.); (D.L.W.); (S.L.W.)
- Department of Medical Specialties, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Paul Drew
- Department of Surgery, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia; (B.D.); (C.M.Y.L.); (R.L.); (K.Y.); (P.D.); (E.S.); (G.J.M.)
- The Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, The University of Adelaide, Woodville, SA 5011, Australia; (B.C.S.); (J.D.H.)
| | - Benedetta C. Sallustio
- The Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, The University of Adelaide, Woodville, SA 5011, Australia; (B.C.S.); (J.D.H.)
- Discipline of Pharmacology, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Eric Smith
- Department of Surgery, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia; (B.D.); (C.M.Y.L.); (R.L.); (K.Y.); (P.D.); (E.S.); (G.J.M.)
- The Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, The University of Adelaide, Woodville, SA 5011, Australia; (B.C.S.); (J.D.H.)
- Medical Oncology, The Queen Elizabeth Hospital, Woodville, SA 5011, Australia
| | - John D. Horowitz
- The Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, The University of Adelaide, Woodville, SA 5011, Australia; (B.C.S.); (J.D.H.)
| | - Guy J. Maddern
- Department of Surgery, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia; (B.D.); (C.M.Y.L.); (R.L.); (K.Y.); (P.D.); (E.S.); (G.J.M.)
- The Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, The University of Adelaide, Woodville, SA 5011, Australia; (B.C.S.); (J.D.H.)
| | - Giovanni Licari
- The Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, The University of Adelaide, Woodville, SA 5011, Australia; (B.C.S.); (J.D.H.)
- Discipline of Pharmacology, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia
- Correspondence: (G.L.); (K.F.)
| | - Kevin Fenix
- Department of Surgery, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia; (B.D.); (C.M.Y.L.); (R.L.); (K.Y.); (P.D.); (E.S.); (G.J.M.)
- The Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, The University of Adelaide, Woodville, SA 5011, Australia; (B.C.S.); (J.D.H.)
- Correspondence: (G.L.); (K.F.)
| |
Collapse
|
2
|
Cheng Z, Fang T, Huang J, Guo Y, Alam M, Qian H. Hypertrophic Cardiomyopathy: From Phenotype and Pathogenesis to Treatment. Front Cardiovasc Med 2021; 8:722340. [PMID: 34760939 PMCID: PMC8572854 DOI: 10.3389/fcvm.2021.722340] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/17/2021] [Indexed: 02/05/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a very common inherited cardiovascular disease (CAD) and the incidence is about 1/500 of the common population. It is caused by more than 1,400 mutations in 11 or more genes encoding the proteins of the cardiac sarcomere. HCM presents a heterogeneous clinical profile and complex pathophysiology and HCM is the most important cause of sudden cardiac death (SCD) in young people. HCM also contributes to functional disability from heart failure and stroke (caused by atrial fibrillation). Current treatments for HCM (medication, myectomy, and alcohol septal ablation) are geared toward slowing down the disease progression and symptom relief and implanted cardiac defibrillator (ICD) to prevent SCD. HCM is, however, entering a period of tight translational research that holds promise for the major advances in disease-specific therapy. Main insights into the genetic landscape of HCM have improved our understanding of molecular pathogenesis and pointed the potential targets for the development of therapeutic agents. We reviewed the critical discoveries about the treatments, mechanism of HCM, and their implications for future research.
Collapse
Affiliation(s)
- Zeyi Cheng
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Tingting Fang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jinglei Huang
- School of Medicine, Lanzhou University, Lanzhou, China
| | - Yingqiang Guo
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Mahboob Alam
- Division of Cardiovascular Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Hong Qian
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
3
|
Licari G, Milne RW, Somogyi AA, Sallustio BC. Enantioselectivity in the tissue distribution of perhexiline contributes to different effects on hepatic histology and peripheral neural function in rats. Pharmacol Res Perspect 2018; 6:e00406. [PMID: 29864243 PMCID: PMC5980244 DOI: 10.1002/prp2.406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/23/2018] [Indexed: 11/10/2022] Open
Abstract
Perhexiline, a chiral drug, is a potent antiischemic agent whose clinical utility is limited by hepatic and neural toxicities. It inhibits mitochondrial carnitine palmitoyltransferase-1, however, excessive inhibition predisposes toward tissue steatosis. This pilot study investigated the distribution of the two enantiomers and their toxicological potential. Dark Agouti rats (n = 4 per group) were administered vehicle or 200 mg/kg daily of racemic, (+)- or (-)-perhexiline maleate orally for 8 weeks. Plasma biochemical liver function tests and Von Frey assessments of peripheral neural function were performed. Hepatic and neuronal histology, including lipid and glycogen content, was assessed using electron microscopy. Concentrations of the perhexiline enantiomers and metabolites were quantified in plasma, liver and heart. Plasma perhexiline concentrations following administration of racemate, (+)- or (-)-enantiomer were within the mid-upper clinical therapeutic range. There was extensive uptake of both enantiomers into liver and heart, with 2.5- to 4.5-fold greater net uptake of (+)- compared to (-)-perhexiline (P < .05) when administered as pure enantiomers, but not when administered as racemate. There was no biochemical or gross histological evidence of hepatotoxicity. However, livers of animals administered (+)-perhexiline had higher lipid (P < .01) and lower glycogen (P < .05) content, compared to those administered (-)-perhexiline. Animals administered racemic perhexiline had reduced peripheral neural function (P < .05) compared to controls or animals administered (-)-perhexiline. For the same plasma concentrations, differences in tissue distribution may contribute to disparities in the effects of (+)- and (-)-perhexiline on hepatic histology and neural function.
Collapse
Affiliation(s)
- Giovanni Licari
- Discipline of PharmacologyUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Robert W. Milne
- School of Pharmacy and Medical ScienceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Andrew A. Somogyi
- Discipline of PharmacologyUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Department of Clinical PharmacologyRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Benedetta C. Sallustio
- Discipline of PharmacologyUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Department of Clinical PharmacologyThe Queen Elizabeth HospitalWoodvilleSouth AustraliaAustralia
| |
Collapse
|
4
|
George CH, Mitchell AN, Preece R, Bannister ML, Yousef Z. Pleiotropic mechanisms of action of perhexiline in heart failure. Expert Opin Ther Pat 2016; 26:1049-59. [PMID: 27455171 DOI: 10.1080/13543776.2016.1211111] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The re-purposing of the anti-anginal drug perhexiline (PHX) has resulted in symptomatic improvements in heart failure (HF) patients. The inhibition of carnitine palmitoyltransferase-1 (CPT-1) has been proposed as the primary mechanism underlying the therapeutic benefit of PHX. This hypothesis is contentious. AREAS COVERED We reviewed the primary literature and patent landscape of PHX from its initial development in the 1960s through to its emergence as a drug beneficial for HF. We focused on its physico-chemistry, molecular targets, tissue accumulation and clinical dosing. EXPERT OPINION Dogma that the beneficial effects of PHX are due primarily to potent myocardial CPT-1 inhibition is not supported by the literature and all available evidence point to it being extremely unlikely that the major effects of PHX occur via this mechanism. In vivo PHX is much more likely to be an inhibitor of surface membrane ion channels and also to have effects on other components of cellular metabolism and reactive oxygen species (ROS) generation across the cardiovascular system. However, the possibility that minor effects of PHX on CPT-1 underpin disproportionately large effects on myocardial function cannot be entirely excluded, especially given the massive accumulation of the drug in heart tissue.
Collapse
Affiliation(s)
- Christopher H George
- a Wales Heart Research Institute, School of Medicine , Cardiff University , Cardiff , UK
| | - Alice N Mitchell
- a Wales Heart Research Institute, School of Medicine , Cardiff University , Cardiff , UK
| | - Ryan Preece
- a Wales Heart Research Institute, School of Medicine , Cardiff University , Cardiff , UK
| | - Mark L Bannister
- a Wales Heart Research Institute, School of Medicine , Cardiff University , Cardiff , UK
| | - Zaheer Yousef
- a Wales Heart Research Institute, School of Medicine , Cardiff University , Cardiff , UK
| |
Collapse
|
5
|
Stereoselective handling of perhexiline: implications regarding accumulation within the human myocardium. Eur J Clin Pharmacol 2015; 71:1485-91. [PMID: 26376650 DOI: 10.1007/s00228-015-1934-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 08/30/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Perhexiline is a prophylactic anti-ischaemic agent with weak calcium antagonist effect which has been increasingly utilised in the management of refractory angina. The metabolic clearance of perhexiline is modulated by CYP2D6 metaboliser status and stereoselectivity. The current study sought to (1) determine whether the acute accumulation of perhexiline in the myocardium is stereoselective and (2) investigate the relationship between duration of short-term therapy and the potential stereoselective effects of perhexiline within myocardium. METHOD Patients (n = 129) from the active arm of a randomised controlled trial of preoperative perhexiline in cardiac surgery were treated with oral perhexiline for a median of 9 days. Correlates of atrial and ventricular concentrations of enantiomers were sought via univariate followed by multivariate analyses. RESULTS Myocardial uptake of both (+) and (-) perhexiline was greater in ventricles than in atria, and there was more rapid clearance of (-) than (+) perhexiline. The main determinants of atrial uptake of both (+) and (-) perhexiline were the plasma concentrations [(+) perhexiline: β = -0.256, p = 0.015; (-) perhexiline: β = -0.347, p = 0.001] and patients' age [(+) perhexiline: β = 0.300, p = 0.004; (-) perhexiline: β = 0.288, p = 0.005]. Atrial uptake of (+) enantiomer also varied directly with duration of therapy (β = 0.228, p = 0.025), while atrial uptake of (-) perhexiline varied inversely with simultaneous heart rate (β = -0.240, p = 0.015). CONCLUSION (1) Uptake of both perhexiline enantiomers into atrium is greater with advanced age and displays evidence of both saturability and minor stereoselectivity. (2) Atrial uptake of (-) perhexiline may selectively modulate heart rate reduction.
Collapse
|
6
|
Guo Y, Fan Y, Zhang J, Lomberk GA, Zhou Z, Sun L, Mathison AJ, Garcia-Barrio MT, Zhang J, Zeng L, Li L, Pennathur S, Willer CJ, Rader DJ, Urrutia R, Chen YE. Perhexiline activates KLF14 and reduces atherosclerosis by modulating ApoA-I production. J Clin Invest 2015; 125:3819-30. [PMID: 26368306 DOI: 10.1172/jci79048] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 08/07/2015] [Indexed: 12/20/2022] Open
Abstract
Recent genome-wide association studies have revealed that variations near the gene locus encoding the transcription factor Krüppel-like factor 14 (KLF14) are strongly associated with HDL cholesterol (HDL-C) levels, metabolic syndrome, and coronary heart disease. However, the precise mechanisms by which KLF14 regulates lipid metabolism and affects atherosclerosis remain largely unexplored. Here, we report that KLF14 is dysregulated in the liver of 2 dyslipidemia mouse models. We evaluated the effects of both KLF14 overexpression and genetic inactivation and determined that KLF14 regulates plasma HDL-C levels and cholesterol efflux capacity by modulating hepatic ApoA-I production. Hepatic-specific Klf14 deletion in mice resulted in decreased circulating HDL-C levels. In an attempt to pharmacologically target KLF14 as an experimental therapeutic approach, we identified perhexiline, an approved therapeutic small molecule presently in clinical use to treat angina and heart failure, as a KLF14 activator. Indeed, in WT mice, treatment with perhexiline increased HDL-C levels and cholesterol efflux capacity via KLF14-mediated upregulation of ApoA-I expression. Moreover, perhexiline administration reduced atherosclerotic lesion development in apolipoprotein E-deficient mice. Together, these results provide comprehensive insight into the KLF14-dependent regulation of HDL-C and subsequent atherosclerosis and indicate that interventions that target the KLF14 pathway should be further explored for the treatment of atherosclerosis.
Collapse
|
7
|
Tylutki Z, Polak S. Plasma vs heart tissue concentration in humans - literature data analysis of drugs distribution. Biopharm Drug Dispos 2015; 36:337-351. [PMID: 25765563 DOI: 10.1002/bdd.1944] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 01/05/2015] [Accepted: 03/04/2015] [Indexed: 12/12/2022]
Abstract
Little is known about the uptake of drugs into the human heart, although it is of great importance nowadays, when science desires to predict tissue level behavior rather than to measure it. Although the drug concentration in cardiac tissue seems a better predictor for physiological and electrophysiological changes than its level in plasma, knowledge of this value is very limited. Tissue to plasma partition coefficients (Kp) come to rescue since they characterize the distribution of a drug among tissues as being one of the input parameters in physiologically based pharmacokinetic (PBPK) models. The article reviews cardiac surgery and forensic medical studies to provide a reference for drug concentrations in human cardiac tissue. Firstly, the focus is on whether a drug penetrates into heart tissue at a therapeutic level; the provided values refer to antibiotics, antifungals and anticancer drugs. Drugs that directly affect cardiomyocyte electrophysiology are another group of interest. Measured levels of amiodarone, digoxin, perhexiline and verapamil in different sites in human cardiac tissue where the compounds might meet ion channels, gives an insight into how these more lipophilic drugs penetrate the heart. Much data are derived from postmortem studies and they provide insight to the cardiac distribution of more than 200 drugs. The analysis depicts potential problems in defining the active concentration location, what may indirectly suggest multiple mechanisms involved in the drug distribution within the heart. Copyright © 2015 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Zofia Tylutki
- Unit of Pharmacoepidemiology and Pharmacoeconomics, Department of Social Pharmacy, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9 Str, , 30-688, Cracow, Poland
| | - Sebastian Polak
- Unit of Pharmacoepidemiology and Pharmacoeconomics, Department of Social Pharmacy, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9 Str, , 30-688, Cracow, Poland
| |
Collapse
|
8
|
Senanayake EL, Howell NJ, Ranasinghe AM, Drury NE, Freemantle N, Frenneaux M, Oelofse T, Green D, Wilson IC, Rooney SJ, Mascaro J, Graham TR, Bhudia S, Lewis M, Pagano D. Multicentre double-blind randomized controlled trial of perhexiline as a metabolic modulator to augment myocardial protection in patients with left ventricular hypertrophy undergoing cardiac surgery. Eur J Cardiothorac Surg 2014; 48:354-62. [PMID: 25538197 DOI: 10.1093/ejcts/ezu452] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 10/06/2014] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES Patients undergoing cardiac surgery require adequate myocardial protection. Manipulating myocardial metabolism may improve the extent of myocardial protection. Perhexiline has been shown to be an effective anti-anginal agent due to its metabolic modulation properties by inhibiting the uptake of free fatty acids into the mitochondrion, and thereby promoting a more efficient carbohydrate-driven myocardial metabolism. Metabolic modulation may augment myocardial protection, particularly in patients with left ventricular hypertrophy (LVH) known to have a deranged metabolic state and are at risk of poor postoperative outcomes. This study aimed to evaluate the role of perhexiline as an adjunct in myocardial protection in patients with LVH secondary to aortic stenosis (AS), undergoing an aortic valve replacement (AVR). METHODS In a multicentre double-blind randomized controlled trial of patients with AS undergoing AVR ± coronary artery bypass graft surgery, patients were randomized to preoperative oral therapy with either perhexiline or placebo. The primary end point was incidence of inotrope use to improve haemodynamic performance due to a low cardiac output state during the first 6 h of reperfusion, judged by a blinded end points committee. Secondary outcome measures included haemodynamic measurements, electrocardiographic and biochemical markers of new myocardial injury and clinical safety outcome measures. RESULTS The trial was halted early on the advice of the Data Safety and Monitoring Board. Sixty-two patients were randomized to perhexiline and 65 to placebo. Of these, 112 (54 perhexiline and 48 placebo) patients received the intervention, remained in the trial at the time of the operation and were analysed. Of 110 patients who achieved the primary end point, 30 patients (16 perhexiline and 14 placebo) had inotropes started appropriately; there was no difference in the incidence of inotrope usage OR of 1.65 [confidence interval (CI): 0.67-4.06] P = 0.28. There was no difference in myocardial injury as evidenced by electrocardiogram odds ratio (OR) of 0.36 (CI: 0.07-1.97) P = 0.24 or postoperative troponin release. Gross secondary outcome measures were comparable between the groups. CONCLUSIONS Perhexiline as a metabolic modulator to enhance standard myocardial protection does not provide an additional benefit in haemodynamic performance or attenuate myocardial injury in the hypertrophied heart secondary to AS. The role of perhexiline in cardiac surgery is limited.
Collapse
Affiliation(s)
- Eshan L Senanayake
- Department of Cardiothoracic Surgery, University Hospitals Birmingham NHS FT, Birmingham, UK School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
| | - Neil J Howell
- Department of Cardiothoracic Surgery, University Hospitals Birmingham NHS FT, Birmingham, UK School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
| | - Aaron M Ranasinghe
- Department of Cardiothoracic Surgery, University Hospitals Birmingham NHS FT, Birmingham, UK School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
| | - Nigel E Drury
- Department of Cardiothoracic Surgery, University Hospitals Birmingham NHS FT, Birmingham, UK
| | - Nick Freemantle
- Department of Primary Care and Population Health, University College London, London, UK
| | | | - Tessa Oelofse
- Department of Cardiothoracic Anaesthesia, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - David Green
- Department of Cardiothoracic Anaesthesia, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Ian C Wilson
- Department of Cardiothoracic Surgery, University Hospitals Birmingham NHS FT, Birmingham, UK
| | - Stephen J Rooney
- Department of Cardiothoracic Surgery, University Hospitals Birmingham NHS FT, Birmingham, UK
| | - Jorge Mascaro
- Department of Cardiothoracic Surgery, University Hospitals Birmingham NHS FT, Birmingham, UK
| | - Timothy R Graham
- Department of Cardiothoracic Surgery, University Hospitals Birmingham NHS FT, Birmingham, UK
| | - Sunil Bhudia
- Department of Cardiothoracic Surgery, University Hospital Coventry and Warwickshire, Coventry, UK
| | - Michael Lewis
- Department of Cardiothoracic Surgery, Royal Sussex County Hospital, Brighton, UK
| | - Domenico Pagano
- Department of Cardiothoracic Surgery, University Hospitals Birmingham NHS FT, Birmingham, UK
| |
Collapse
|
9
|
Wassermann AM, Lounkine E, Urban L, Whitebread S, Chen S, Hughes K, Guo H, Kutlina E, Fekete A, Klumpp M, Glick M. A screening pattern recognition method finds new and divergent targets for drugs and natural products. ACS Chem Biol 2014; 9:1622-31. [PMID: 24802392 DOI: 10.1021/cb5001839] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Computational target prediction methods using chemical descriptors have been applied exhaustively in drug discovery to elucidate the mechanisms-of-action (MOAs) of small molecules. To predict truly novel and unexpected small molecule-target interactions, compounds must be compared by means other than their chemical structure alone. Here we investigated predictions made by a method, HTS fingerprints (HTSFPs), that matches patterns of activities in experimental screens. Over 1,400 drugs and 1,300 natural products (NPs) were screened in more than 200 diverse assays, creating encodable activity patterns. The comparison of these activity patterns to an MOA-annotated reference panel led to the prediction of 5,281 and 2,798 previously unknown targets for the NP and drug sets, respectively. Intriguingly, there was limited overlap among the targets predicted; the drugs were more biased toward membrane receptors and the NPs toward soluble enzymes, consistent with the idea that they represent unexplored pharmacologies. Importantly, HTSFPs inferred targets that were beyond the prediction capabilities of standard chemical descriptors, especially for NPs but also for the more explored drug set. Of 65 drug-target predictions that we tested in vitro, 48 (73.8%) were confirmed with AC50 values ranging from 38 nM to 29 μM. Among these interactions was the inhibition of cyclooxygenases 1 and 2 by the HIV protease inhibitor Tipranavir. These newly discovered targets that are phylogenetically and phylochemically distant to the primary target provide an explanation for spontaneous bleeding events observed for patients treated with this drug, a physiological effect that was previously difficult to reconcile with the drug's known MOA.
Collapse
Affiliation(s)
- Anne Mai Wassermann
- Novartis Institutes for Biomedical Research Inc., 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Eugen Lounkine
- Novartis Institutes for Biomedical Research Inc., 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Laszlo Urban
- Novartis Institutes for Biomedical Research Inc., 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Steven Whitebread
- Novartis Institutes for Biomedical Research Inc., 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Shanni Chen
- Novartis Institutes for Biomedical Research Inc., 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Kevin Hughes
- Novartis Institutes for Biomedical Research Inc., 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Hongqiu Guo
- Novartis Institutes for Biomedical Research Inc., 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Elena Kutlina
- Novartis Institutes for Biomedical Research Inc., 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Alexander Fekete
- Novartis Institutes for Biomedical Research Inc., 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Martin Klumpp
- Novartis Institutes for Biomedical Research Inc., Novartis Campus, 4056 Basel, Switzerland
| | - Meir Glick
- Novartis Institutes for Biomedical Research Inc., 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| |
Collapse
|