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Archambault JL, Hernandez TL, Nozik ES, Palmer C, Dillon M, Singh RJ, Galambos C, Delaney CA. Relationship Between Urine Serotonin and Persistent Pulmonary Hypertension of the Newborn. J Pediatr 2024:114290. [PMID: 39242076 DOI: 10.1016/j.jpeds.2024.114290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 07/22/2024] [Accepted: 08/30/2024] [Indexed: 09/09/2024]
Abstract
Urine serotonin (5-HT)/creatinine was lower at day of life 3 in newborns with pulmonary hypertension compared with controls, while the percent change in the 5-HT metabolite, 5-hydroxyindoleacetic acid (5-HIAA)/creatinine increased. We speculate that the changes in 5-HT and 5-HIAA reflect enhanced pulmonary 5-HT uptake and/or metabolism.
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Affiliation(s)
- Jamie L Archambault
- Section of Neonatology, Department of Pediatrics, University of Colorado, Aurora, Colorado, United States of America
| | - Teri L Hernandez
- College of Nursing, University of Colorado, Aurora, Colorado, United States of America; Section of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado, Aurora, Colorado, United States of America
| | - Eva S Nozik
- Section of Pediatric Critical Care, Department of Pediatrics, University of Colorado, Aurora, Colorado, United States of America
| | - Claire Palmer
- Section of Neonatology, Department of Pediatrics, University of Colorado, Aurora, Colorado, United States of America
| | - Mairead Dillon
- Section of Neonatology, Department of Pediatrics, University of Colorado, Aurora, Colorado, United States of America
| | - Ravinder J Singh
- Section of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, United States of America
| | - Csaba Galambos
- Section of Pathology, Department of Pediatrics, University of Colorado, Aurora, Colorado, United States of America
| | - Cassidy A Delaney
- Section of Neonatology, Department of Pediatrics, University of Colorado, Aurora, Colorado, United States of America.
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Archambault JL, Delaney CA. A Review of Serotonin in the Developing Lung and Neonatal Pulmonary Hypertension. Biomedicines 2023; 11:3049. [PMID: 38002049 PMCID: PMC10668978 DOI: 10.3390/biomedicines11113049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
Serotonin (5-HT) is a bioamine that has been implicated in the pathogenesis of pulmonary hypertension (PH). The lung serves as an important site of 5-HT synthesis, uptake, and metabolism with signaling primarily regulated by tryptophan hydroxylase (TPH), the 5-HT transporter (SERT), and numerous unique 5-HT receptors. The 5-HT hypothesis of PH was first proposed in the 1960s and, since that time, preclinical and clinical studies have worked to elucidate the role of 5-HT in adult PH. Over the past several decades, accumulating evidence from both clinical and preclinical studies has suggested that the 5-HT signaling pathway may play an important role in neonatal cardiopulmonary transition and the development of PH in newborns. The expression of TPH, SERT, and the 5-HT receptors is developmentally regulated, with alterations resulting in pulmonary vasoconstriction and pulmonary vascular remodeling. However, much remains unknown about the role of 5-HT in the developing and newborn lung. The purpose of this review is to discuss the implications of 5-HT on fetal and neonatal pulmonary circulation and summarize the existing preclinical and clinical literature on 5-HT in neonatal PH.
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Affiliation(s)
| | - Cassidy A. Delaney
- Section of Neonatology, Department of Pediatrics, University of Colorado, Aurora, CO 80045, USA;
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Petrić M, Perković D, Božić I, Marasović Krstulović D, Martinović Kaliterna D. The Levels of Serum Serotonin Can Be Related to Skin and Pulmonary Manifestations of Systemic Sclerosis. Medicina (B Aires) 2022; 58:medicina58020161. [PMID: 35208486 PMCID: PMC8878473 DOI: 10.3390/medicina58020161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 12/01/2022] Open
Abstract
Background and Objective: The most prominent feature of systemic sclerosis (SSc), besides vasculopathy and autoimmune disorders, is excessive fibrosis. Serotonin affects hemostasis and can induce vasoconstriction, which is presumed to be one of the pathophysiological patterns in SSc that leads to fibrosis. Our aim was to explore the possible association of serotonin with some of the clinical features of SSc in our cohort of patients. Materials and Methods: We measured serotonin levels in sera of 29 female SSc patients. Patients were 41–79 years old, their average disease duration was 9 years. Serotonin values were analyzed in correlation with clinical and laboratory parameters, such as modified Rodnan skin score (mRSS), digital ulcers (DU), and spirometry parameters-forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and lung diffusion capacity of carbon monoxide (DLCO). Statistical analyses were performed using statistical software Statistica. Results: We found correlation of serotonin level with mRSS (r = 0.388, p = 0.038). The highest values of serotonin were documented in patients with refractory DU, but this was not statistically significant. We also found a negative correlation between serotonin and FVC (r = −0.397), although it did not reach the level of significance (p = 0.114). Conclusions: Our study suggests that levels of serum serotonin could affect the course of skin fibrosis and partially restrictive pulmonary dysfunction in patients with SSc. We assume that serotonin might have influence on several features of SSc, but more studies are needed to reveal those relations.
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Teos LY, Alevizos I. Genetics of Sjögren's syndrome. Clin Immunol 2017; 182:41-47. [PMID: 28476436 PMCID: PMC5660941 DOI: 10.1016/j.clim.2017.04.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 04/30/2017] [Accepted: 04/30/2017] [Indexed: 12/14/2022]
Abstract
The pathogenesis of Sjögren's syndrome has not been elucidated. There has been evidence that genetics play an important role in the development of this disease from earlier studies. However, till now only a number of genes have been identified to be associated with SS, and these have only a weak or moderate effect. In this review we summarize the findings of the genetics studies and emphasize the need of large multicenter projects that will increase the sample sizes to provide more meaningful associations, as is the case in other common autoimmune diseases.
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Affiliation(s)
- Leyla Y Teos
- Sjögren's Syndrome and Salivary Gland Dysfunction Unit, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - Ilias Alevizos
- Sjögren's Syndrome and Salivary Gland Dysfunction Unit, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA.
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Ntelis K, Gkizas V, Filippopoulou A, Davlouros P, Alexopoulos D, Andonopoulos AP, Daoussis D. Clopidogrel treatment may associate with worsening of endothelial function and development of new digital ulcers in patients with systemic sclerosis: results from an open label, proof of concept study. BMC Musculoskelet Disord 2016; 17:213. [PMID: 27188755 PMCID: PMC4869184 DOI: 10.1186/s12891-016-1072-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/11/2016] [Indexed: 01/21/2023] Open
Abstract
Background Activated platelets release serotonin that binds 5-HT2B receptor on fibroblasts leading to fibroblast activation. Clopidogrel, an inhibitor of ADP-dependent platelet activation prevents fibrosis in animal models of systemic sclerosis (SSc). We aimed at assessing whether i) ADP-dependent platelet activation is increased in patients with SSc compared to healthy subjects and patients with rheumatoid arthritis (RA) and ii) whether clopidogrel can effectively suppress ADP-dependent activation, reduce circulating serotonin levels and hence, favorably affect fibrosis or vasculopathy in patients with systemic sclerosis. Methods Thirteen patients with SSc were recruited. Platelet activation was assessed by aggregometry prior to and following 14 days of clopidogrel treatment. At the same time points serotonin and soluble vascular cell adhesion molecule 1 (s-VCAM1), a marker of endothelial dysfunction, were measured. Results ADP-dependent platelet activation was similar between patients with SSc (n = 13), patients with RA (n = 28) and healthy subjects (n = 22) (mean ± SEM AU*min: 392.1 ± 58.4, 535.5 ± 61.33 and 570.9 ± 42.9 in patients with SSc, patients with RA and healthy subjects respectively, p = 0.14). Clopidogrel treatment significantly reduced platelet activation in patients with SSc (mean ± SEM AU*min: 392.1 ± 58.4 vs 163.8 ± 51.7, p = 0.014). Clopidogrel treatment did not affect serotonin levels but led to a significant increase in s-VCAM1 (p = 0.03). Three patients developed new digital ulcers during the study. The potential association of the study drug with the development of new digital ulcers led to early termination of the study. Conclusion Clopidogrel may worsen markers of endothelial function and associate with development of new digital ulcers in patients with SSc. Clinical trial registration ISRCTN63206606. Registered 02/Dec/2014.
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Affiliation(s)
- Konstantinos Ntelis
- Division of Rheumatology, Department of Internal Medicine, Patras University Hospital, University of Patras Medical School, 26504, Rion, Patras, Greece.
| | - Vasileios Gkizas
- Department of Cardiology, Patras University Hospital, University of Patras Medical School, 26504, Rion, Patras, Greece
| | - Alexandra Filippopoulou
- Division of Rheumatology, Department of Internal Medicine, Patras University Hospital, University of Patras Medical School, 26504, Rion, Patras, Greece
| | - Periclis Davlouros
- Department of Cardiology, Patras University Hospital, University of Patras Medical School, 26504, Rion, Patras, Greece
| | - Dimitrios Alexopoulos
- Department of Cardiology, Patras University Hospital, University of Patras Medical School, 26504, Rion, Patras, Greece
| | - Andrew P Andonopoulos
- Division of Rheumatology, Department of Internal Medicine, Patras University Hospital, University of Patras Medical School, 26504, Rion, Patras, Greece
| | - Dimitrios Daoussis
- Division of Rheumatology, Department of Internal Medicine, Patras University Hospital, University of Patras Medical School, 26504, Rion, Patras, Greece
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Markeljevic J, Sarac H, Bozina N, Henigsberg N, Simic M, Cicin Sain L. Serotonin transporter gene polymorphisms: Relation with platelet serotonin level in patients with primary Sjogren's syndrome. J Neuroimmunol 2015; 282:104-9. [PMID: 25903736 DOI: 10.1016/j.jneuroim.2015.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 03/26/2015] [Accepted: 04/01/2015] [Indexed: 12/16/2022]
Abstract
Significantly lower platelet serotonin level (PSL) in patients with primary Sjogren's syndrome (pSS) than in healthy controls has been reported in our prior studies. In the present report, we demonstrated effect of functional polymorphisms in the serotonin transporter gene (5-HTT) on PSL. We describe a group of 61 pSS patients and 100 healthy individuals subjects, who received PSL measurement in our prior study. All subjects were genotyped for the promoter 5-HTTLPR (L/S), rs25531 (A/G) and intronic 5-HTTVNTRin2 (l/s) polymorphisms. Overall, the presence of 5-HTTVNTRin2 ss genotype was associated with significantly lower PSL in pSS patients, not in healthy controls. Reduced PSL in pSS patients is in line with hypothesis of association between chronic immunoinflammation and 5-HT system dysregulation, identifying additional mechanisms such as altered 5-HT transport as potential genetic factor contributing to PSL depletion.
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Affiliation(s)
- J Markeljevic
- Medical School University of Zagreb, Department of Internal Medicine, University Hospital Sestre milosrdnice, HR-Vinogradska cesta 29, 10000 Zagreb, Croatia
| | - H Sarac
- Department of Neurology, University Clinical Hospital Centre Zagreb, HR-Kispaticeva 12, 10000 Zagreb, Croatia; Croatian Institute for Brain Research, Medical School University of Zagreb, HR-Salata 12, 10000 Zagreb, Croatia.
| | - N Bozina
- Medical School University of Zagreb, University Hospital Zagreb, Department of Laboratory Diagnostic, HR-Kispaticeva 12, 10000 Zagreb, Croatia
| | - N Henigsberg
- Croatian Institute for Brain Research, Medical School University of Zagreb, HR-Salata 12, 10000 Zagreb, Croatia
| | - M Simic
- Institute of Immunology, HR-Rockefellerova 2, HR-10000 Zagreb, Croatia
| | - L Cicin Sain
- Rudjer Boskovic Institute, Laboratory for Neurochemistry and Molecular Neurobiology, Department of Molecular Biology, HR-Bijenicka 54, 10000 Zagreb, Croatia
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Serotonin paracrine signaling in tissue fibrosis. Biochim Biophys Acta Mol Basis Dis 2012; 1832:905-10. [PMID: 23032152 PMCID: PMC3793867 DOI: 10.1016/j.bbadis.2012.09.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 09/15/2012] [Accepted: 09/22/2012] [Indexed: 12/22/2022]
Abstract
The molecule serotonin (5-hydroxytryptamine or 5-HT) is involved in numerous biological processes both inside and outside of the central nervous system. 5-HT signals through 5-HT receptors and it is the diversity of these receptors and their subtypes that give rise to the varied physiological responses. It is clear that platelet derived serotonin is critical for normal wound healing in multiple organs including, liver, lung heart and skin. 5-HT stimulates both vasoconstriction and vasodilation, influences inflammatory responses and promotes formation of a temporary scar which acts as a scaffold for normal tissue to be restored. However, in situations of chronic injury or damage 5-HT signaling can have deleterious effects and promote aberrant wound healing resulting in tissue fibrosis and impaired organ regeneration. This review highlights the diverse actions of serotonin signaling in the pathogenesis of fibrotic disease and explores how modulating the activity of specific 5-HT receptors, in particular the 5-HT2 subclass could have the potential to limit fibrosis and restore tissue regeneration. This article is part of a Special Issue entitled: Fibrosis: Translation of basic research to human disease.
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Pauling JD, O’Donnell VB, Mchugh NJ. The contribution of platelets to the pathogenesis of Raynaud's phenomenon and systemic sclerosis. Platelets 2012; 24:503-15. [DOI: 10.3109/09537104.2012.719090] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Platelet serotonin in primary Sjögren's syndrome: level and relation with disease activity. J Neuroimmunol 2012; 251:87-9. [PMID: 22819441 DOI: 10.1016/j.jneuroim.2012.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 06/26/2012] [Accepted: 06/29/2012] [Indexed: 11/21/2022]
Abstract
Primary Sjögren's syndrome (pSS) is chronic autoimmune disorder of unknown ethiopathogenesis. In line with the concept of neuroimmunohormonal dysregulation in inflammatory rheumatic diseases, the aim of this study was to investigate platelet serotonin level (PSL) in patients with pSS and its relation with the activity and duration of the disease. Significantly lower PSL in pSS patients (N=61) was shown as compared to healthy controls (N=103). No correlation was found between PSL and the actual disease activity assessed by the recently developed EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI). Results suggest involvement of the serotonin system in the pathogenesis of pSS.
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Ramirez GA, Franchini S, Rovere-Querini P, Sabbadini MG, Manfredi AA, Maugeri N. The role of platelets in the pathogenesis of systemic sclerosis. Front Immunol 2012; 3:160. [PMID: 22719739 PMCID: PMC3376452 DOI: 10.3389/fimmu.2012.00160] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 05/29/2012] [Indexed: 12/15/2022] Open
Abstract
Systemic sclerosis (SSc) is an inflammatory disease of unknown etiology characterized by widespread organ dysfunction due to fibrosis and ischemia. Its nebulous pathogenic background and the consequent absence of an etiological therapy prevent the adoption of satisfying treatment strategies, able to improve patients’ quality of life and survival and stimulate researchers to identify a unifying pathogenic target. Platelets show a unique biological behavior, lying at the crossroads between vascular function, innate and adaptive immunity, and regulation of cell proliferation. Consequently they are also emerging players in the pathogenesis of many inflammatory diseases, including SSc. In the setting of SSc platelets are detectable in a persistent activated state, which is intimately linked to the concomitant presence of an injured endothelium and to the widespread activation of the innate and adaptive immune system. As a consistent circulating source of bioactive compounds platelets contribute to the development of many characteristic phenomena of SSc, such as fibrosis and impaired vascular tone.
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Affiliation(s)
- Giuseppe A Ramirez
- Department of Immunology, San Raffaele Scientific Institute, Università Vita-Salute San Raffaele, Milano, Italy
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Beretta L, Cossu M, Marchini M, Cappiello F, Artoni A, Motta G, Scorza R. A polymorphism in the human serotonin 5-HT2A receptor gene may protect against systemic sclerosis by reducing platelet aggregation. Arthritis Res Ther 2008; 10:R103. [PMID: 18761744 PMCID: PMC2592780 DOI: 10.1186/ar2495] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Revised: 08/01/2008] [Accepted: 09/01/2008] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Platelet aggregation may contribute to the pathogenesis of systemic sclerosis: following activation, platelets release significant amounts of serotonin - which promotes vasoconstriction and fibrosis, and further enhances aggregation. The C+1354T polymorphism in the exonic region of the serotonin 2A receptor gene determining the His452Tyr substitution was associated with blunted intracellular responses after serotonin stimulation, and may have a role in susceptibility to scleroderma. METHODS One hundred and fifteen consecutive systemic sclerosis patients and 140 well-matched healthy control individuals were genotyped by sequence-specific primer-PCR for the His452Tyr substitution of the serotonin 2A receptor gene, and associations were sought with scleroderma and its main clinical features. The functional relevance of the His452Tyr substitution was also assessed by evaluating the aggregation of platelet-rich plasma from His452/His452 and His452/Tyr452 healthy individuals after stimulation with adenosine diphosphate +/- serotonin. RESULTS The T allele of the C+1354T polymorphism was underrepresented in scleroderma patients compared with control individuals (5.2% versus 12.4%, P < 0.001, chi-square test and 1,000-fold permutation test) and its carriage reduced the risk for systemic sclerosis (odds ratio = 0.39, 95% confidence interval = 0.19 to 0.85, P < 0.01). Platelets from His452/Tyr452 healthy subjects more weakly responded to serotonin stimulation compared with platelets from His452/His452 individuals (3.2 +/- 2.6-fold versus 9.6 +/- 8.6-fold increase in aggregation, P = 0.017 by Kolmogorov-Smirnov test and P = 0.003 after correction for baseline adenosine diphosphate-induced aggregation values). CONCLUSION The His452Tyr substitution may influence susceptibility to systemic sclerosis by altering platelet aggregation in response to serotonin.
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Affiliation(s)
- Lorenzo Beretta
- Referral Center for Systemic Autoimmune Diseases, University of Milan & Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Via Pace 9, 20122 Milan, Italy.
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Montani D, Yaïci A, Jaïs X, Sztrymf B, Cabrol S, Hamid A, Parent F, Sitbon O, Dartevelle P, Simonneau G, Humbert M. Hypertension artérielle pulmonaire. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/s1155-195x(06)43390-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
The pathogenesis of Raynaud's phenomenon is not fully understood. However, the last 20 yr have witnessed enormous increases in our understanding of different mechanisms which, singly or in combination, may contribute. A key point is that Raynaud's phenomenon can be either primary (idiopathic) or secondary to a number of underlying conditions, and that the pathogenesis and pathophysiology vary between these conditions. This review concentrates upon those subtypes of Raynaud's phenomenon of most interest to rheumatologists: systemic sclerosis-related Raynaud's phenomenon, primary Raynaud's phenomenon and Raynaud's phenomenon secondary to hand-arm vibration syndrome. In this review, I shall discuss the main mechanisms thought to be important in pathophysiology under the three broad headings of 'vascular', 'neural' and 'intravascular'. While these are false distinctions because all interrelate, they facilitate discussion of the key elements: the blood vessel wall (particularly the endothelium), the neural control of vascular tone, and the many circulating factors which can impair blood flow and/or cause endothelial injury. Vascular abnormalities include those of both structure and function. Neural abnormalities include deficiency of the vasodilator calcitonin gene-related peptide (released from sensory afferents), alpha(2)-adrenoreceptor activation (possibly with up-regulation of the normally 'silent' alpha(2C)-adrenoreceptor) and a central nervous system component. Intravascular abnormalities include platelet activation, impaired fibrinolysis, increased viscosity and probably oxidant stress. As our understanding of the pathophysiology of Raynaud's phenomenon increases, so do our possibilities for identifying effective treatments.
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Affiliation(s)
- A L Herrick
- University of Manchester Rheumatic Diseases Centre, Hope Hospital, Salford, UK.
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Hrycaj P. Serotonin type 3 receptor antagonist tropisetron in the treatment of chronic inflammatory rheumatic conditions--preliminary clinical experience. Scand J Rheumatol 2004; 119:55-8. [PMID: 15515416 DOI: 10.1080/03009740410007069] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Several lines of research indicate that serotonin (5-hydroxytryptamine, 5-HT) and 5-HT receptors may play a part in the pathogenesis of chronic inflammatory rheumatic conditions like rheumatoid arthritis (RA) and scleroderma/progressive systemic sclerosis (PSS). In this paper, case reports on two patients with RA who were successfully treated with 5-HT3 receptor antagonist tropisetron were presented. Short-term oral tropisetron (5-10 mg/d) induced either remission of RA or improvement in RA-related symptoms, which lasted for several weeks or months after the treatment was discontinued. Interestingly, tropisetron was effective in a patient with refractory rheumatoid vasculitis, which is a severe complication that requires high-dose glucocorticoids in most cases. The beneficial effect of 5-HT3 receptor antagonists in RA and PSS suggests that this class of drugs may have potential in the treatment of chronic inflammatory rheumatic conditions. Double blind, placebo-controlled studies are urgently needed to confirm the efficacy and tolerance of 5-HT3 receptor antagonists in larger cohorts of patients.
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Affiliation(s)
- P Hrycaj
- Department of Rheumatology and Clinical Immunology, University School of Medical Sciences, Poznan, Poland.
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Abstract
Pulmonary arterial hypertension is a life threatening complication of several connective tissue diseases including scleroderma (both diffuse and limited scleroderma, or the CREST syndrome--calcinosis cutis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, and telangectasia), systemic lupus erythomatosis (SLE), mixed connective tissue disease (MCTD), and less commonly, rheumatoid arthritis (RA) and dermatomyositis/polymyositis. This report reviews the occurrence of this complication, potential etiologies, clinical presentation, and treatment options.
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Affiliation(s)
- Karen A Fagan
- Pulmonary Hypertension Center, University of Colorado Health Sciences Center, Denver, CO, USA
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Sanchez O, Humbert M, Sitbon O, Nunes H, Garcia G, Simonneau G. [Pulmonary hypertension associated with connective tissue diseases]. Rev Med Interne 2002; 23:41-54. [PMID: 11859694 DOI: 10.1016/s0248-8663(01)00514-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Pulmonary hypertension is a rare but well-known life-threatening complication of connective tissue diseases. The aim of this article is to analyse the available literature and to report the experience of a pulmonary vascular diseases centre about this complication. CURRENT KNOWLEDGE AND KEY POINTS Scleroderma and its limited variant, the CREST syndrome (calcification, Raynaud phenomenon, esophageal dysmotility, sclerodactily, telangiectasia), is the most common connective tissue disease affected by pulmonary hypertension. Dyspnea is the main symptom and is frequently severe. Echocardiography is an excellent exam to detect pulmonary hypertension. However, right heart catheterization is necessary to confirm the diagnosis of pulmonary hypertension and to test vasoreactivity with a potent vasodilator such as nitric oxide. Pulmonary hypertension is less severe in patients with connective tissue diseases perhaps because of an earlier diagnosis. A significantly lower proportion of patients presents an acute vasodilator response, suggesting an early constitution of irreversible pulmonary vascular lesions. Continuous intravenous epoprostenol therapy seems to be less effective as compared with patients with primitive pulmonary hypertension and does not improve survival. So, we observed dramatic improvement in rare cases after immunosuppressive therapy. FUTURE PROSPECTS AND PROJECTS New treatments with oral, subcutaneous or inhaled stable prostacyclin analogs or with an endothelin receptor antagonist are currently being evaluated. The role of immunosuppressive therapy has to be defined.
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Affiliation(s)
- O Sanchez
- Service de pneumologie et réanimation respiratoire, UPRES EA 2705 Maladies vasculaires pulmonaires, hôpital Antoine-Béclère, 157, rue de la Porte de Trivaux, 92141 Clamart, France
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Rothman RB, Redmon J, Bantle JP. Reply:. Am J Cardiol 2000. [DOI: 10.1016/s0002-9149(00)01158-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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MacLean MR. Endothelin-1 and serotonin: mediators of primary and secondary pulmonary hypertension? THE JOURNAL OF LABORATORY AND CLINICAL MEDICINE 1999; 134:105-14. [PMID: 10444023 DOI: 10.1016/s0022-2143(99)90114-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M R MacLean
- Pulmonary Research Group, Division of Neuroscience and Biomedical Systems, Institute of Biomedical and Life Sciences, Glasgow University, Scotland
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Egermayer P, Town GI, Peacock AJ. Role of serotonin in the pathogenesis of acute and chronic pulmonary hypertension. Thorax 1999; 54:161-8. [PMID: 10325923 PMCID: PMC1745408 DOI: 10.1136/thx.54.2.161] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- P Egermayer
- Canterbury Respiratory Research Group, Christchurch School of Medicine, New Zealand
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MacLean MR, Clayton RA, Templeton AG, Morecroft I. Evidence for 5-HT1-like receptor-mediated vasoconstriction in human pulmonary artery. Br J Pharmacol 1996; 119:277-82. [PMID: 8886409 PMCID: PMC1915869 DOI: 10.1111/j.1476-5381.1996.tb15982.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
1. The 5-hydroxytryptamine (5-HT) receptors mediating contraction of human isolated pulmonary artery rings were investigated. Responses to the agonists 5-carboximidotryptamine (5-CT, non-selective 5-HT1 agonist), sumatriptan (5-HT1D-like receptor agonist), 5-HT and 8-hydroxy-2-(di-n-propylamino)-tetralin (8-OH-DPAT, 5-HT1A receptor agonist) were studied. Responses to 5-HT and sumatriptan in the presence of the antagonists, methiothepin (non-selective 5-HT1+2-receptor antagonist), ketanserin (5-HT2A receptor antagonist) and the novel antagonist, GR55562 (5-HT1D receptor antagonist) were also studied. 2. All agonists contracted human pulmonary artery ring preparations in the following order of potency 5-CT > 5-HT = sumatriptan > 8-OH-DPAT. Maximum responses to 5-HT, 5-CT and sumatriptan were not significantly different. 3. Methiothepin 1 nM and 10 nM, but not 0.1 nM reduced the maximum contractile responses to 5-HT but did not alter tissue sensitivity to 5-HT. Methiothepin 0.1 nM, 1 nM and 10 nM had a similar effect on responses to sumatriptan. 4. The 5-HT2A receptor antagonist ketanserin (10 nM, 100 nM and 1 microM) also reduced the maximum contractile response to both 5-HT and sumatriptan without affecting tissue sensitivity to these agonists. 5. The novel 5-HT1D receptor antagonist, GR55562, inhibited responses to 5-HT and sumatriptan in a true competitive fashion. 6. The results suggest that the human pulmonary artery has a functional population of 5-HT1D-like receptors which are involved in the contractile response to 5-HT.
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Affiliation(s)
- M R MacLean
- Division of Neuroscience and Biomedical Systems, University of Glasgow
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Hervé P, Launay JM, Scrobohaci ML, Brenot F, Simonneau G, Petitpretz P, Poubeau P, Cerrina J, Duroux P, Drouet L. Increased plasma serotonin in primary pulmonary hypertension. Am J Med 1995; 99:249-54. [PMID: 7653484 DOI: 10.1016/s0002-9343(99)80156-9] [Citation(s) in RCA: 349] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE Pulmonary hypertension can occur in patients who have disorders associated with altered platelet serotonin storage, including collagen vascular disease and platelet storage pool disease. We tested the hypothesis that primary pulmonary hypertension (PPH) may be also associated with impaired handling of serotonin by platelets, resulting in increased plasma serotonin levels. PATIENTS AND METHODS We used radioenzymatic assays to measure serotonin in platelets and plasma and serotonin released during in vitro platelet aggregation in 16 patients with PPH, and in 16 normal controls matched for age and sex. Six patients were restudied after heart-lung transplantation to determine whether serotonin abnormalities persisted after pulmonary arterial pressure returned to normal. RESULTS Patients had decreased platelet serotonin concentration (1.8 +/- 0.6 x 10(-18) mol/platelet versus 3.2 +/- 0.2 x 10(-18) mol/platelet in controls; P < 0.01) and increased plasma serotonin concentration (30.1 +/- 9.2 x 10(-9) mol/L versus 0.6 +/- 0.1 x 10(-9) mol/L in controls; P < 0.001). Serotonin released during in vitro platelet aggregation was higher in patients than in controls. After heart-lung transplantation, platelet serotonin concentrations remained decreased and plasma levels remained increased. CONCLUSIONS Abnormal handling of serotonin by platelets leading to an increase in plasma serotonin occurs in PPH. The persistent decrease in platelet storage of serotonin after heart-lung transplantation suggests that this platelet abnormality is not secondary to PPH.
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Affiliation(s)
- P Hervé
- Service de Pneumologie et Réanimation Respiratoire, Hôpital Antoine Béclère, Université Paris Sud, Clamart, France
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Frishman WH, Huberfeld S, Okin S, Wang YH, Kumar A, Shareef B. Serotonin and serotonin antagonism in cardiovascular and non-cardiovascular disease. J Clin Pharmacol 1995; 35:541-72. [PMID: 7665716 DOI: 10.1002/j.1552-4604.1995.tb05013.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Serotonin, or 5-hydroxytryptamine, is a naturally-occurring vasoactive substance found primarily in the brain, enterochromaffin tissue, and blood platelets. It has diffuse cardiophysiologic effects. The multiple effects of serotonin on blood vessels can be explained by the existence of 2 serotonergic receptor subtypes (the S1 receptor mediates vasodilation, and the S2 receptor vasoconstriction). Serotonin via the S2 receptor also augments the actions of several other vasoconstricting substances. Serotonin may be responsible for causing, or at least perpetuating, some forms of systemic hypertension through peripheral and central nervous system (CNS) actions. Ketanserin is a highly selective S2-serotonergic antagonist with additional alpha-adrenergic blocking activity, which has been proposed as a therapy for various cardiovascular diseases including hypertension. It has been shown to be more effective than placebo in treating hypertension and comparable in effectiveness to other antihypertensive drugs. Its major side effects relate to the CNS, and prolongation of the electrocardiogram QT interval has been described. Caution must be used when using ketanserin in patients receiving potassium- and magnesium-losing agents, because of the risk of torsades de pointes. Ketanserin has potential utility in the treatment of eclampsia, peripheral vascular disease, carcinoid syndrome, and "shock lung." The drug is not yet approved for clinical use in the United States.
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Affiliation(s)
- W H Frishman
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
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Affiliation(s)
- J J Belch
- Department of Medicine, Ninewells Hospital, Dundee
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