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Hainsworth AH, Arancio O, Elahi FM, Isaacs JD, Cheng F. PDE5 inhibitor drugs for use in dementia. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2023; 9:e12412. [PMID: 37766832 PMCID: PMC10520293 DOI: 10.1002/trc2.12412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/07/2023] [Accepted: 07/08/2023] [Indexed: 09/29/2023]
Abstract
Alzheimer's disease and related dementias (ADRD) remain a major health-care challenge with few licensed medications. Repurposing existing drugs may afford prevention and treatment. Phosphodiesterase-5 (PDE5) is widely expressed in vascular myocytes, neurons, and glia. Potent, selective, Food and Drug Administration-approved PDE5 inhibitors are already in clinical use (sildenafil, vardenafil, tadalafil) as vasodilators in erectile dysfunction and pulmonary arterial hypertension. Animal data indicate cognitive benefits of PDE5 inhibitors. In humans, real-world patient data suggest that sildenafil and vardenafil are associated with reduced dementia risk. While a recent clinical trial of acute tadalafil on cerebral blood flow was neutral, there may be chronic actions of PDE5 inhibition on cerebrovascular or synaptic function. We provide a perspective on the potential utility of PDE5 inhibitors for ADRD. We conclude that further prospective clinical trials with PDE5 inhibitors are warranted. The choice of drug will depend on brain penetration, tolerability in older people, half-life, and off-target effects. HIGHLIGHTS Potent phosphodiesterase-5 (PDE5) inhibitors are in clinical use as vasodilators.In animals PDE5 inhibitors enhance synaptic function and cognitive ability.In humans the PDE5 inhibitor sildenafil is associated with reduced risk of Alzheimer's disease.Licensed PDE5 inhibitors have potential for repurposing in dementia.Prospective clinical trials of PDE5 inhibitors are warranted.
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Affiliation(s)
- Atticus H. Hainsworth
- Molecular & Clinical Sciences Research InstituteSt George's University of LondonLondonUK
- Department of NeurologySt George's University Hospitals NHS Foundation TrustLondonUK
| | - Ottavio Arancio
- Department of Pathology and Cell BiologyTaub Institute for Research on Alzheimer's Disease and the Aging BrainDepartment of MedicineColumbia UniversityNew YorkNew YorkUSA
| | - Fanny M. Elahi
- Departments of Neurology and NeuroscienceRonald M. Loeb Center for Alzheimer's DiseaseFriedman Brain InstituteIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Jeremy D. Isaacs
- Molecular & Clinical Sciences Research InstituteSt George's University of LondonLondonUK
- Department of NeurologySt George's University Hospitals NHS Foundation TrustLondonUK
| | - Feixiong Cheng
- Genomic Medicine InstituteLerner Research InstituteCleveland ClinicClevelandOhioUSA
- Department of Molecular MedicineCleveland Clinic Lerner College of MedicineCase Western Reserve UniversityClevelandOhioUSA
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2
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Kim S, Choi S, Nah S, Han S. Multiple Cerebral Infarctions and Rhabdomyolysis After Sildenafil Citrate (Viagra®) Intoxication: A Case Report. J Emerg Med 2023; 64:624-627. [PMID: 37032204 DOI: 10.1016/j.jemermed.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/14/2023] [Accepted: 02/17/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Sildenafil citrate (Viagra®) is used to treat male erectile dysfunction; however, little is known about the effects of sildenafil overdose and intoxication. We report a patient who presented with cerebral infarction and rhabdomyolysis after intentional sildenafil intoxication. CASE REPORT A 61-year-old man visited the Emergency Department complaining of dysarthria about 1 h after taking more than 30 sildenafil tablets with the intention to commit suicide. Dysarthria and dizziness were observed, but there were no other neurological symptoms. The creatine kinase level was elevated to 3118 U/L, and the patient was diagnosed with rhabdomyolysis. Brain magnetic resonance imaging revealed multiple scattered acute cerebral infarctions in both midbrain artery branches. At 4 h post-intoxication, the dysarthria had improved and we initiated dual antiplatelet therapy for cerebral infarction. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be able to anticipate and treat complications like cerebral infarction and rhabdomyolysis after sildenafil intoxication.
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Affiliation(s)
- Sechan Kim
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sungwoo Choi
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea; Department of Emergency Medicine, Armed Forces Yangju Hospital, Yangju, Republic of Korea
| | - Sangun Nah
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sangsoo Han
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
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Pauls MMH, Binnie LR, Benjamin P, Betteridge S, Clarke B, Dhillon MPK, Ghatala R, Hainsworth FAH, Howe FA, Khan U, Kruuse C, Madigan JB, Moynihan B, Patel B, Pereira AC, Rostrup E, Shtaya ABY, Spilling CA, Trippier S, Williams R, Young R, Barrick TR, Isaacs JD, Hainsworth AH. The PASTIS trial: Testing tadalafil for possible use in vascular cognitive impairment. Alzheimers Dement 2022; 18:2393-2402. [PMID: 35135037 PMCID: PMC10078742 DOI: 10.1002/alz.12559] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 10/13/2021] [Accepted: 12/07/2021] [Indexed: 01/31/2023]
Abstract
INTRODUCTION There are few randomized clinical trials in vascular cognitive impairment (VCI). This trial tested the hypothesis that the PDE5 inhibitor tadalafil, a widely used vasodilator, increases cerebral blood flow (CBF) in older people with symptomatic small vessel disease, the main cause of VCI. METHODS In a double-blind, placebo-controlled, cross-over trial, participants received tadalafil (20 mg) and placebo on two visits ≥7 days apart (randomized to order of treatment). The primary endpoint, change in subcortical CBF, was measured by arterial spin labelling. RESULTS Tadalafil increased CBF non-significantly in all subcortical areas (N = 55, age: 66.8 (8.6) years) with greatest treatment effect within white matter hyperintensities (+9.8%, P = .0960). There were incidental treatment effects on systolic and diastolic blood pressure (-7.8, -4.9 mmHg; P < .001). No serious adverse events were observed. DISCUSSION This trial did not identify a significant treatment effect of single-administration tadalafil on subcortical CBF. To detect treatment effects may require different dosing regimens.
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Affiliation(s)
- Mathilde M H Pauls
- Molecular & Clinical Sciences Research Institute, St George's University of London, London, UK.,Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Lauren R Binnie
- Molecular & Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Philip Benjamin
- Molecular & Clinical Sciences Research Institute, St George's University of London, London, UK.,Department of Neuroradiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Shai Betteridge
- Department of Neuropsychology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Brian Clarke
- Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Mohani-Preet K Dhillon
- Molecular & Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Rita Ghatala
- South London Stroke Research Network, London, UK
| | - Fearghal A H Hainsworth
- Molecular & Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Franklyn A Howe
- Molecular & Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Usman Khan
- Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Christina Kruuse
- Department of Neurology and Neurovascular Research Unit, Herlev Gentofte Hospital, Hellerup, Denmark
| | - Jeremy B Madigan
- Department of Neuroradiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Barry Moynihan
- Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK.,Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Bhavini Patel
- Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Anthony C Pereira
- Molecular & Clinical Sciences Research Institute, St George's University of London, London, UK.,Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Egill Rostrup
- Mental Health Centre, University of Copenhagen, Glostrup, Denmark
| | - Anan B Y Shtaya
- Molecular & Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Catherine A Spilling
- Molecular & Clinical Sciences Research Institute, St George's University of London, London, UK
| | | | | | - Robin Young
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Thomas R Barrick
- Molecular & Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Jeremy D Isaacs
- Molecular & Clinical Sciences Research Institute, St George's University of London, London, UK.,Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Atticus H Hainsworth
- Molecular & Clinical Sciences Research Institute, St George's University of London, London, UK.,Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
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Zhao S, Wu W, Wu P, Ding C, Xiao B, Xu Z, Hu Y, Shen M, Feng L. Significant Increase of Erectile Dysfunction in Men With Post-stroke: A Comprehensive Review. Front Neurol 2021; 12:671738. [PMID: 34393971 PMCID: PMC8355431 DOI: 10.3389/fneur.2021.671738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/25/2021] [Indexed: 11/13/2022] Open
Abstract
Men with erectile dysfunction (ED) are considered to be at risk from stroke events. Conversely, post-stroke patients are also at high risk of ED, whereas a quantitative result from all the relevant studies has not been previously addressed. Therefore, we have performed a comprehensive review and meta-analysis on this issue. This study was registered on PROSPERO (ID No. CRD42021226618). Twenty studies with a total of 3,382 stroke events were included, of which six studies were included for quantitative analysis, and the remaining 14 studies were calculated for the ratio of ED. Synthetic results from four eligible studies providing the ED cases showed that stroke patients were associated with a significantly higher risk of ED than the general population [pooled relative risk (RR) = 3.32, 95% confidence interval (CI): 1.25–8.82, P = 0.016]. Men with stroke were also found to be associated with a significant decline in International Index of Erectile Function −5 (IIEF-5) score as compared with the healthy controls [three studies, standard mean differences (SMD) = −1.8, 95% CI: −2.94 to −0.67, P = 0.002]. The prevalence of ED in post-stroke patients among 14 studies ranged from 32.1 to 77.8%, which was dramatically higher than that of the general population. The result of the GRADE-pro revealed that the quality of the evidence in this study was moderate. The present study has confirmed the high prevalence of ED in men with stroke. ED in stroke patients is a result of both neurological and psychological factors. Rehabilitative interventions rather than phosphodiesterase-5 (PDE-5) inhibitors are recommended to improve the erectile function for those survivors with ED.
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Affiliation(s)
- Shankun Zhao
- Department of Urology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Weizhou Wu
- Department of Urology, Maoming People's Hospital, Maoming, China
| | - Panxing Wu
- Department of Neurosurgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Chao Ding
- Department of Neurosurgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Bingxiang Xiao
- Department of Neurosurgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Zhengbao Xu
- Department of Neurosurgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Yan Hu
- Department of Obstetrics and Gynecology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Maolei Shen
- Department of Urology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Lu Feng
- Department of Neurosurgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
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Walker DT, Mills JN. Erectile Dysfunction and Neurological Comorbidities: a Contemporary Review. CURRENT SEXUAL HEALTH REPORTS 2020. [DOI: 10.1007/s11930-020-00265-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ölmestig J, Marlet IR, Hansen RH, Rehman S, Krawcyk RS, Rostrup E, Lambertsen KL, Kruuse C. Tadalafil may improve cerebral perfusion in small-vessel occlusion stroke-a pilot study. Brain Commun 2020; 2:fcaa020. [PMID: 33033800 PMCID: PMC7530832 DOI: 10.1093/braincomms/fcaa020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/22/2019] [Accepted: 12/28/2019] [Indexed: 01/29/2023] Open
Abstract
New treatments for cerebral small-vessel disease are needed to reduce the risk of small-vessel occlusion stroke and vascular cognitive impairment. We investigated an approach targeted to the signalling molecule cyclic guanosine monophosphate, using the phosphodiesterase 5 inhibitor tadalafil, to explore if it improves cerebral blood flow and endothelial function in patients with cerebral small-vessel disease and stroke. In a randomized, double-blinded, placebo-controlled, cross-over pilot trial (NCT02801032), we included patients who had a previous (>6 months) small-vessel occlusion stroke. They received a single dose of either 20 mg tadalafil or placebo on 2 separate days at least 1 week apart. We measured the following: baseline MRI for lesion load, repeated measurements of blood flow velocity in the middle cerebral artery by transcranial Doppler, blood oxygen saturation in the cortical microvasculature by near-infrared spectroscopy, peripheral endothelial response by EndoPAT and endothelial-specific blood biomarkers. Twenty patients with cerebral small-vessel disease stroke (3 women, 17 men), mean age 67.1 ± 9.6, were included. The baseline mean values ± standard deviations were as follows: blood flow velocity in the middle cerebral artery, 57.4 ± 10.8 cm/s; blood oxygen saturation in the cortical microvasculature, 67.0 ± 8.2%; systolic blood pressure, 145.8 ± 19.5 mmHg; and diastolic blood pressure, 81.3 ± 9.1 mmHg. We found that tadalafil significantly increased blood oxygen saturation in the cortical microvasculature at 180 min post-administration with a mean difference of 1.57 ± 3.02%. However, we saw no significant differences in transcranial Doppler measurements over time. Tadalafil had no effects on peripheral endothelial function assessed by EndoPAT and endothelial biomarker results conflicted. Our findings suggest that tadalafil may improve vascular parameters in patients with cerebral small-vessel disease stroke, although the effect size was small. Increased oxygenation of cerebral microvasculature during tadalafil treatment indicated improved perfusion in the cerebral microvasculature, theoretically presenting an attractive new therapeutic target in cerebral small-vessel disease. Future studies of the effect of long-term tadalafil treatment on cerebrovascular reactivity and endothelial function are needed to evaluate general microvascular changes and effects in cerebral small-vessel disease and stroke.
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Affiliation(s)
- Joakim Ölmestig
- Department of Neurology, Neurovascular Research Unit, Herlev Gentofte Hospital, University of Copenhagen, Herlev 2730, Denmark
| | - Ida R Marlet
- Department of Neurology, Neurovascular Research Unit, Herlev Gentofte Hospital, University of Copenhagen, Herlev 2730, Denmark
| | - Rasmus H Hansen
- Department of Radiology, Herlev Gentofte Hospital, Herlev 2730, Denmark
| | - Shazia Rehman
- Department of Radiology, Herlev Gentofte Hospital, Herlev 2730, Denmark
| | - Rikke Steen Krawcyk
- Department of Neurology, Neurovascular Research Unit, Herlev Gentofte Hospital, University of Copenhagen, Herlev 2730, Denmark.,Department of Physiotherapy and Occupational Therapy, Herlev Gentofte Hospital, Herlev 2730, Denmark
| | - Egill Rostrup
- Center for Neuropsychiatric Schizophrenia Research, Mental Health Center Glostrup, Capital Region Psychiatry, Glostrup 2600, Denmark
| | - Kate L Lambertsen
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, Odense 5000, Denmark.,Department of Neurology, Odense University Hospital, Odense 5000, Denmark.,BRIDGE-Brain Research Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense 5000, Denmark
| | - Christina Kruuse
- Department of Neurology, Neurovascular Research Unit, Herlev Gentofte Hospital, University of Copenhagen, Herlev 2730, Denmark.,Institute for Clinical Medicine, University of Copenhagen, 2200 Copenhagen N, Denmark
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El-Bakly W, Wagdy O, Sobhy A, abo elenain O, Riad MS, El Sayed M, Tarkhan S, Yassen M, Mahmoud A, Bassiony M, Nabil N. The efficacy and underlying mechanism of phosphodiesterase- 5 inhibitors in preventing cognitive impairment and Alzheimer pathology: A systematic review of animal studies. Behav Brain Res 2019; 372:112004. [DOI: 10.1016/j.bbr.2019.112004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 05/30/2019] [Accepted: 05/31/2019] [Indexed: 12/13/2022]
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8
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Zahavi A, Weiss S, Vieyra M, Nicholson JD, Muhsinoglu O, Barinfeld O, Zadok D, Goldenberg-Cohen N. Ocular Effects of Sildenafil in Naïve Mice and a Mouse Model of Optic Nerve Crush. ACTA ACUST UNITED AC 2019; 60:1987-1995. [DOI: 10.1167/iovs.18-26333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Alon Zahavi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Shirel Weiss
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Krieger Eye Research Laboratory, Felsenstein Medical Research Center, Petach Tikva, Israel
| | - Mark Vieyra
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - James D. Nicholson
- The Krieger Eye Research Laboratory, Felsenstein Medical Research Center, Petach Tikva, Israel
| | - Orkun Muhsinoglu
- Department of Ophthalmology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Orit Barinfeld
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Krieger Eye Research Laboratory, Felsenstein Medical Research Center, Petach Tikva, Israel
| | - David Zadok
- Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University Medical Center, Jerusalem, Israel
| | - Nitza Goldenberg-Cohen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Krieger Eye Research Laboratory, Felsenstein Medical Research Center, Petach Tikva, Israel
- Department of Ophthalmology, Bnai Zion Medical Center, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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Achiron A, Hecht I, Juza C, Barak A, Burgansky-Eliash Z. The effect of sildenafil on retinal blood velocity in healthy subjects. EYE AND VISION 2018; 5:30. [PMID: 30534576 PMCID: PMC6280412 DOI: 10.1186/s40662-018-0125-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 11/20/2018] [Indexed: 01/18/2023]
Abstract
Purpose It has been suggested that Sildenafil may have beneficial therapeutic effects in the treatment of neurodegenerative disorders. The retinal circulation is of significant interest as a marker of cerebral vascular disease since the retinal and cerebral vasculatures share many morphological and physiological properties, yet only the retinal circulation can be directly visualized. Therefore, our aim was to assess the change induced by Sildenafil on retinal blood velocity. Methods Retinal flow velocity was measured 0.5, 3 and 6 h following administration of 100 mg of Sildenafil using the Retinal Function Imager. Results No clinical change in either systemic blood pressure or retinal flow velocities were observed. However, when controlling for heart rate and blood pressure, a significant drop in venous flow velocity 6 h following treatment (mean drop 0.3 ± 0.07; 95% CI: 0.44–0.56, P = 0.023) was revealed. Conclusions In healthy volunteers, retinal venous flow velocity was significantly reduced at the 6-h time point following Sildenafil treatment. No effect was observed on arterial retinal flow velocity.
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Affiliation(s)
- Asaf Achiron
- 1Department of Ophthalmology, Edith Wolfson Medical Center, 62 Halochamim St, 58100 Holon, Israel.,2Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idan Hecht
- 1Department of Ophthalmology, Edith Wolfson Medical Center, 62 Halochamim St, 58100 Holon, Israel.,2Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chen Juza
- 2Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,3Department of Urology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Adiel Barak
- 2Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,4Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Zvia Burgansky-Eliash
- 1Department of Ophthalmology, Edith Wolfson Medical Center, 62 Halochamim St, 58100 Holon, Israel.,2Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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10
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Pauls MMH, Moynihan B, Barrick TR, Kruuse C, Madigan JB, Hainsworth AH, Isaacs JD. The effect of phosphodiesterase-5 inhibitors on cerebral blood flow in humans: A systematic review. J Cereb Blood Flow Metab 2018; 38:189-203. [PMID: 29256324 PMCID: PMC5951021 DOI: 10.1177/0271678x17747177] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 10/17/2017] [Accepted: 10/20/2017] [Indexed: 11/29/2022]
Abstract
Agents that augment cerebral blood flow (CBF) could be potential treatments for vascular cognitive impairment. Phosphodiesterase-5 inhibitors are vasodilating drugs established in the treatment of erectile dysfunction (ED) and pulmonary hypertension. We reviewed published data on the effects of phosphodiesterase-5 inhibitors on CBF in adult humans. A systematic review according to PRISMA guidelines was performed. Embase, Medline and Cochrane Library Trials databases were searched. Sixteen studies with 353 participants in total were retrieved. Studies included healthy volunteers and patients with migraine, ED, type 2 diabetes, stroke, pulmonary hypertension, Becker muscular dystrophy and subarachnoid haemorrhage. Most studies used middle cerebral artery flow velocity to estimate CBF. Few studies employed direct measurements of tissue perfusion. Resting CBF velocity was unaffected by phosphodiesterase-5 inhibitors, but cerebrovascular regulation was improved in ED, pulmonary hypertension, diabetes, Becker's and a group of healthy volunteers. This evidence suggests that phosphodiesterase-5 inhibitors improve responsiveness of the cerebral vasculature, particularly in disease states associated with an impaired endothelial dilatory response. This supports the potential therapeutic use of phosphodiesterase-5 inhibitors in vascular cognitive impairment where CBF is reduced. Further studies with better resolution of deep CBF are warranted. The review is registered on the PROSPERO database (registration number CRD42016029668).
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Affiliation(s)
- Mathilde MH Pauls
- Molecular and Clinical Sciences Research
Institute, St George's University of London, London, UK
- Department of Neurology, St George's
University Hospitals NHS Foundation Trust, London, UK
| | - Barry Moynihan
- Department of Neurology, St George's
University Hospitals NHS Foundation Trust, London, UK
- Department of Geriatric and Stroke
Medicine, Beaumont Hospital, Dublin, Ireland
| | - Thomas R Barrick
- Molecular and Clinical Sciences Research
Institute, St George's University of London, London, UK
| | - Christina Kruuse
- Department of Neurology, Neurovascular
Research Unit, Herlev Gentofte Hospital and University of Copenhagen, Denmark
| | - Jeremy B Madigan
- Department of Neuroradiology, St
George's University Hospitals NHS Foundation Trust, London, UK
| | - Atticus H Hainsworth
- Molecular and Clinical Sciences Research
Institute, St George's University of London, London, UK
- Department of Neurology, St George's
University Hospitals NHS Foundation Trust, London, UK
| | - Jeremy D Isaacs
- Molecular and Clinical Sciences Research
Institute, St George's University of London, London, UK
- Department of Neurology, St George's
University Hospitals NHS Foundation Trust, London, UK
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11
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Ölmestig JN, Marlet IR, Hainsworth AH, Kruuse C. Phosphodiesterase 5 inhibition as a therapeutic target for ischemic stroke: A systematic review of preclinical studies. Cell Signal 2017. [DOI: 10.1016/j.cellsig.2017.06.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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13
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Eltony SA, Abdelhameed SY. Effect of chronic administration of sildenafil citrate (Viagra) on the histology of the retina and optic nerve of adult male rat. Tissue Cell 2017; 49:323-335. [PMID: 28237322 DOI: 10.1016/j.tice.2017.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 01/23/2017] [Accepted: 01/24/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Abnormal vision has been reported by 3% of patients treated with sildenafil citrate (Viagra). Although many men use Viagra for an extended period for treatment of erectile dysfunction, the implications of the long term-daily use of it on the retina and optic nerve are unclear. AIM OF THE WORK To investigate the effect of chronic daily use of sildenafil citrate in a dose equivalent to men preferred therapeutic dose on the histology of the retina and optic nerve of adult male rat. MATERIAL & METHODS Eighteen adult male Wistar rats were equally divided into three groups. Group I: control. Group II: treated with sildenafil citrate orally (10mg/kg/day) for 8 weeks. Group III (withdrawal): treated as group II and then left for 4 weeks without treatment. Specimens from the retina and optic nerve were processed for light and electron microscopy. RESULTS In sildenafil citrate treated group, the retina and optic nerve revealed vacuolations and congested blood capillaries with apoptotic endothelial and pericytic cells, and thickened basal lamina. Caspase-3 (apoptotic marker) and CD31 (endothelial marker) expression increased. Glial cells revealed morphological changes: Müller cells lost their processes, activated microglia, astrocytic clasmatodendrosis, degenerated oligodendrocytes surrounded by disintegrated myelin sheathes of the optic nerve fibers. The retina and optic nerve of the withdrawal group revealed less vacuolations and congestion, and partial recovery of the glial cells. CONCLUSION Chronic treatment with sildenafil citrate (Viagra) caused toxic effect on the structure of the retina and optic nerve of the rat. Partial recovery was observed after drug withdrawal.
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Affiliation(s)
- Sohair A Eltony
- Histology and Cell Biology Department, Faculty of Medicine, Assiut University, Egypt.
| | - Sally Y Abdelhameed
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Assiut University, Egypt
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14
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Comparison of Neuroprotective Effect of Bevacizumab and Sildenafil following Induction of Stroke in a Mouse Model. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3938523. [PMID: 27314018 PMCID: PMC4903133 DOI: 10.1155/2016/3938523] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 04/11/2016] [Accepted: 04/21/2016] [Indexed: 11/17/2022]
Abstract
To evaluate the effect of bevacizumab and sildenafil on stroke parameters in a mouse model, middle cerebral artery occlusion was induced in male C57Bl/6 mice using an intra-arterial filament method. The filament was removed after 60 minutes, and the mice were immediately given a single intraperitoneal injection of saline, bevacizumab, or sildenafil. An additional group of mice (n = 7) received bevacizumab 6 h after MCAO induction. The mice were euthanized 24 hours later and evaluated for infarct area and brain edema using triphenyltetrazolium chloride staining and ImageJ. In the saline-treated mice (n = 16), total stroke volume was 19.20 ± 6.38 mm3, mean penumbra area was 4.5 ± 2.03 mm3, and hemispheric asymmetry was 106.5%. Corresponding values in the bevacizumab group (n = 19) were 17.79 ± 5.80 mm3, 7.3 ± 3.5 mm3, and 108.6%; in the delayed (6 h) bevacizumab injected mice (n = 7) they were 9.80 ± 8.00 mm3, 2.4 ± 2.0 mm3, and 98.2%; and in the sildenafil group (n = 16) they were 18.42 ± 5.41 mm3, 5.7 ± 2.02 mm3, and 109.9%. The bevacizumab group had a significantly larger mean penumbra area when given immediately and smaller total stroke area in both groups than the saline- (p = 0.03) and sildenafil-treated (p = 0.003) groups. Only delayed bevacizumab group had reduced edema. Bevacizumab, injected immediately or delayed after injury, exerts a neuroprotective/salvage effect, whereas immediate treatment with sildenafil does not. Inflammation may play a role in the neuroprotective effect.
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Katusic ZS, Austin SA. Neurovascular Protective Function of Endothelial Nitric Oxide - Recent Advances. Circ J 2016; 80:1499-503. [PMID: 27238834 DOI: 10.1253/circj.cj-16-0423] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In the central nervous system endothelial nitric oxide (NO) is an essential molecule responsible for the preservation of the functional integrity of the neurovascular unit. NO causes vasodilatation and is an important inhibitor of platelet aggregation, smooth muscle cell proliferation, and white blood cell adhesion. In addition, endothelium-derived NO exerts anti-inflammatory and pro-angiogenic effects. More recently, it has been recognized that endothelial NO modulates the expression and processing of amyloid precursor protein in cerebrovascular endothelium and neuronal tissue. Studies in endothelial NO synthase (eNOS) knockout mice indicate that endothelial NO functions as a neurovascular protective molecule during aging. Indeed, genetic inactivation of eNOS exacerbates the detrimental effects of aging on cerebrovascular, microglial, and neuronal functions as well as on cognition. These findings suggest that the preservation of healthy endothelium and normal function of eNOS might be important therapeutic targets. Because the beneficial effects of NO are mostly mediated by the activation of guanylate cyclase/cyclic GMP signaling, inhibitors of phosphodiesterase isoforms, or activation of this signaling with exercise, may offer therapeutic opportunities in the prevention and treatment of aging-induced cognitive decline and Alzheimer's disease. Most recent advances in understanding the molecular mechanisms linking loss of endothelial NO with cognitive decline will be discussed in this review. (Circ J 2016; 80: 1499-1503).
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Affiliation(s)
- Zvonimir S Katusic
- Department of Anesthesiology and Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic
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Effects of daily low-dose treatment with phosphodiesterase type 5 inhibitor on cognition, depression, somatization and erectile function in patients with erectile dysfunction: a double-blind, placebo-controlled study. Int J Impot Res 2013; 26:76-80. [PMID: 24285284 DOI: 10.1038/ijir.2013.38] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 08/29/2013] [Accepted: 10/21/2013] [Indexed: 01/09/2023]
Abstract
Phosphodiesterase type 5 (PDE5) inhibitors have recently been shown to have cognitive-enhancing effects in animal models and in our previous pilot study. To investigate the efficacy of daily low-dose treatment with a PDE5 inhibitor on cognitive function, depression and somatization in patients with erectile dysfunction (ED), 8-week, double-blind, placebo-controlled study enrolled 60 male patients with ED for ≥ 3 months without cognitive impairment. Forty-nine patients completed the study. Patients were randomized to receive either daily low-dose udenafil 50 mg or placebo for 2 months. The International Index of Erectile Function-5 (IIEF-5), the Korean version of the Mini-Mental State Examination (K-MMSE) for general cognitive function and the Seoul Neuropsychological Screening Battery for comprehensive neuropsychological examination, the Physical Health Questionnaire-9 (PHQ-9) for depression and the Physical Health Questionnaire-15 (PHQ-15) for somatization were administered at baseline and at 2 months. The change in the mean IIEF-5 was significantly higher in the udenafil group than the placebo group (6.08 ± 4.72 vs 2.20 ± 3.50, P=0.008). The changes in the PHQ-9 and PHQ-15 were -2.04 ± 3.14 and -2.17 ± 2.87 in the udenafil group, and 1.20 ± 1.63 and 0.56 ± 2.48 in the placebo group (both, P<0.001). The changes in the K-MMSE and Digit Span Forward were 1.25 ± 1.26 and 0.92 ± 1.02 in the udenafil group, and -0.52 ± 1.19 and -0.24 ± 1.13 in the placebo group (both, P<0.001). However, there were no differences in the other neuropsychological tests. Daily dosing with a PDE5 inhibitor seems to improve cognitive function, depression and somatization, as well as erectile function, in patients with ED.
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García-Osta A, Cuadrado-Tejedor M, García-Barroso C, Oyarzábal J, Franco R. Phosphodiesterases as therapeutic targets for Alzheimer's disease. ACS Chem Neurosci 2012; 3:832-44. [PMID: 23173065 DOI: 10.1021/cn3000907] [Citation(s) in RCA: 175] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 10/01/2012] [Indexed: 01/10/2023] Open
Abstract
Alzheimer's disease (AD) is the most common form of dementia among the elderly. In AD patients, memory loss is accompanied by the formation of beta-amyloid plaques and the appearance of tau in a pathological form. Given the lack of effective treatments for AD, the development of new management strategies for these patients is critical. The continued failure to find effective therapies using molecules aimed at addressing the anti-beta amyloid pathology has led researchers to focus on other non-amyloid-based approaches to restore memory function. Promising non-amyloid related candidate targets include phosphosdiesterases (PDEs), and indeed, Rolipram, a specific PDE4 inhibitor, was the first compound found to effectively restore cognitive deficits in animal models of AD. More recently, PDE5 inhibitors have also been shown to effectively restore memory function. Accordingly, inhibitors of other members of the PDE family may also improve memory performance in AD and non-AD animal models. Hence, in this review, we will summarize the data supporting the use of PDE inhibitors as cognitive enhancers and we will discuss the possible mechanisms of action underlying these effects. We shall also adopt a medicinal chemistry perspective that leads us to propose the most promising PDE candidates on the basis of inhibitor selectivity, brain distribution, and mechanism of action.
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Affiliation(s)
- Ana García-Osta
- Molecular and Cell Neuropharmacology
Laboratory, Neurosciences Division, CIMA (Centro de investigación Médica Aplicada), Avda Pio
XII, Pamplona, Spain
| | - Mar Cuadrado-Tejedor
- Molecular and Cell Neuropharmacology
Laboratory, Neurosciences Division, CIMA (Centro de investigación Médica Aplicada), Avda Pio
XII, Pamplona, Spain
| | - Carolina García-Barroso
- Molecular and Cell Neuropharmacology
Laboratory, Neurosciences Division, CIMA (Centro de investigación Médica Aplicada), Avda Pio
XII, Pamplona, Spain
| | - Julen Oyarzábal
- Molecular and Cell Neuropharmacology
Laboratory, Neurosciences Division, CIMA (Centro de investigación Médica Aplicada), Avda Pio
XII, Pamplona, Spain
- Small
Molecule Discovery Platform, CIMA (Centro
de investigación Médica
Aplicada), Avda Pio XII, Pamplona, Spain
| | - Rafael Franco
- Molecular and Cell Neuropharmacology
Laboratory, Neurosciences Division, CIMA (Centro de investigación Médica Aplicada), Avda Pio
XII, Pamplona, Spain
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Mukherjee KK, Singh SK, Khosla VK, Mohindra S, Salunke P. Safety and efficacy of sildenafil citrate in reversal of cerebral vasospasm: A feasibility study. Surg Neurol Int 2012; 3:3. [PMID: 22347673 PMCID: PMC3280003 DOI: 10.4103/2152-7806.92164] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 12/13/2011] [Indexed: 12/28/2022] Open
Abstract
Objective: Cerebral vasospasm is the commonest cause for mortality and morbidity in patients following clipping of a ruptured aneurysm. Selective phosphodiesterase (PDE) inhibitor like sildenafil acts as a vasodilator. The objective of this study was to evaluate the safety and feasibility of oral sildenafil citrate in patients with symptomatic refractory vasospasm. Methods: A total of 832 patients with aneurysmal subarachnoid bleed were operated in 4 years. Two hundred and seventy-three patients had vasospasm. Of these, 72 patients had refractory cerebral vasospasm. Vasospasm was defined as refractory when institution of “HHH” failed to reverse the transcranial Doppler (TCD) values even after 24 hours. Computed tomography (CT) scan showed no infarct, hematoma, or hydrocephalus, and the serum electrolytes were within normal limits. They received 100–150 mg of sildenafil every 4 hours. Response was evaluated by 2-hourly TCD. Results: Eight patients had sustained (TCD values normal for >48 hours) and four had temporary relief in vasospasm, as suggested. Four patients developed complications significant enough to terminate the therapy. Conclusions: Sildenafil citrate may be effective in patients with refractory symptomatic vasospasm. It calls upon the pharmacologists and scientists to discover newer supraselective PDE inhibitors, specific to PDE receptors in brain vessels.
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Abstract
Haemodynamic stroke is a type of ischaemic stroke that is caused by hypoperfusion rather than by embolism or local vasculopathy. It can be caused by systemic diseases such as heart failure or hypotension, but also by severe obstruction of the carotid or vertebral arteries. Patients with haemodynamic stroke or transient ischaemic attack might show specific clinical features that distinguish them from patients with embolism or local small-vessel disease. Ancillary investigations of cerebral perfusion can show whether blood flow to the brain is compromised and provide important prognostic information. Management of patients who have hypoperfusion as the major cause of ischaemic stroke or as a contributing factor is hampered by the lack of clinical trials. Treatment aimed at increasing cerebral blood flow might be considered in selected patients on the basis of information from case series. Further research is needed to define criteria for the diagnosis of haemodynamic stroke and to investigate treatment options in controlled studies.
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Affiliation(s)
- Catharina J M Klijn
- Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, Netherlands.
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