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Dang ZC, Yang Z, Liu S, Du GM, Jin L, Zhao ZZ. Efficacy of Sildenafil on healthy humans in high‑altitude hypoxia at rest and during exercise: A meta‑analysis. Exp Ther Med 2024; 27:88. [PMID: 38274336 PMCID: PMC10809317 DOI: 10.3892/etm.2024.12376] [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: 05/30/2023] [Accepted: 10/23/2023] [Indexed: 01/27/2024] Open
Abstract
The current meta-analysis aimed to fully evaluate the efficacy of Sildenafil in healthy humans at different altitudes, focusing on echocardiographic and hemodynamic parameters. Relevant studies were retrieved from the Cochrane, Embase and PubMed databases. Odds ratios (OR) were determined for dichotomous data and weighted mean differences with 95% confidence intervals (CIs) for continuous data. A total of 16 RCTs were included in the current meta-analysis. Short-term treatment with Sildenafil significantly elevated resting heart rate (P<0.01) at altitudes <4,000 meters. No significant differences in heart rate were observed between the Sildenafil and placebo groups at rest and during exercise at an altitude of >4,000 meters (P>0.05). Sildenafil improved resting cardiac output at an altitude of >5,000 meters (P<0.01) and exercising arterial oxygen saturation at <4,000 meters (P<0.01). Sildenafil reduced resting pulmonary artery systolic pressure (PASP) at altitudes >4,000 meters (P<0.01) and exercising PASP at altitudes >5,000 meters (P<0.01). Therefore, Sildenafil efficacy in healthy humans with high-altitude hypoxia is related to altitude and rest or exercise.
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Affiliation(s)
- Zhan-Cui Dang
- Department of Public Health, Medical College, Qinghai University, Xining, Qinghai 810000, P.R. China
| | - Zhiquan Yang
- Department of Rehabilitation, Women and Children's Hospital of Qinghai Province, Xining, Qinghai 810000, P.R. China
| | - Shou Liu
- Department of Public Health, Medical College, Qinghai University, Xining, Qinghai 810000, P.R. China
| | - Guo-Mei Du
- Department of Physical Examination, Qinghai Red Cross Hospital, Xining, Qinghai 810000, P.R. China
| | - Linde Jin
- Department of Cardiology, Qinghai Provincial People's Hospital, Xining, Qinghai 810000, P.R. China
| | - Zhong-Zhi Zhao
- Department of Endemic Disease Control, Qinghai Provincial Institute for Endemic Disease Prevention and Control, Xining, Qinghai 811602, P.R. China
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Belbis MD, Yap Z, Hobart SE, Ferguson SK, Hirai DM. Effects of acute phosphodiesterase type 5 inhibition on skeletal muscle interstitial PO 2 during contractions and recovery. Nitric Oxide 2024; 142:16-25. [PMID: 37979932 DOI: 10.1016/j.niox.2023.11.004] [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: 07/10/2023] [Revised: 10/26/2023] [Accepted: 11/14/2023] [Indexed: 11/20/2023]
Abstract
The oxygen partial pressure within the interstitial space (PO2is; mmHg) provides the driving force for oxygen diffusion into the myocyte thereby supporting oxidative phosphorylation. We tested the hypothesis that potentiation of the nitric oxide pathway with sildenafil (phosphodiesterase type 5 inhibitor) would enhance PO2is during muscle metabolic transitions, thereby slowing PO2is on- and accelerating PO2is off-kinetics. The rat spinotrapezius muscle (n = 17) was exposed for PO2is measurements via phosphorescence quenching under control (CON), low-dose sildenafil (1 mg/kg i.a., SIL1) and high-dose sildenafil (7 mg/kg i.a., SIL7). Data were collected at rest and during submaximal twitch contractions (1 Hz, 4-6 V, 3 min) and recovery (3 min). Mean arterial blood pressure (MAP; mmHg) was reduced with both SIL1 (pre:132 ± 5; post:99 ± 5) and SIL7 (pre:111 ± 6; post:99 ± 4) (p < 0.05). SIL7 elevated resting PO2is (18.4 ± 1.1) relative to both CON (15.7 ± 0.7) and SIL1 (15.2 ± 0.7) (p < 0.05). In addition, SIL7 increased end-recovery PO2is (17.7 ± 1.6) compared to CON (12.8 ± 0.9) and SIL1 (13.4 ± 0.8) (p < 0.05). The overall PO2is response during recovery (i.e., area under the PO2is curve) was greater in SIL7 (4107 ± 444) compared to CON (3493 ± 222) and SIL1 (3114 ± 205 mmHg s) (p < 0.05). Contrary to our hypothesis, there was no impact of acute SIL (1 or 7 mg/kg) on the speed of the PO2is response during contractions or recovery (p > 0.05). However, sildenafil lowered MAP and improved skeletal muscle interstitial oxygenation in healthy rats. Specifically, SIL7 enhanced PO2is at rest and during recovery from submaximal muscle contractions. Potentiation of the nitric oxide pathway with sildenafil enhances microvascular blood-myocyte O2 transport and is expected to improve repeated bouts of contractile activity.
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Affiliation(s)
- Michael D Belbis
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA; Department of Exercise Science, Aurora University, Aurora, IL, USA
| | - Zhen Yap
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA
| | - Sara E Hobart
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA
| | - Scott K Ferguson
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Daniel M Hirai
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA.
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Chen Z, Huang Y, Cao D, Qiu S, Chen B, Li J, Bao Y, Wei Q, Han P, Liu L. Function of sildenafil on diseases other than urogenital system: An umbrella review. Front Pharmacol 2023; 14:1033492. [PMID: 36814496 PMCID: PMC9939646 DOI: 10.3389/fphar.2023.1033492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/16/2023] [Indexed: 02/09/2023] Open
Abstract
Background: To investigate the function of sildenafil on diseases other than urogenital system, an umbrella review was conducted. Methods: Meta-analysis and systematic reviews on this topic were comprehensively evaluated in this umbrella review. Quality of evidence was evaluated through AMSTAR and the Grading of Recommendations, Assessment, Development and Evaluation system to generate a reliable and valid conclusion. Results: 77 out of 1164 meta-analysis were enrolled. 33 significant outcomes and 41 non-significant outcomes were extracted from all eligible articles. We found sildenafil did significant help in reducing arterial systolic pressure, mean pulmonary arterial pressure, pulmonary arterial pressure, systolic pulmonary arterial pressure in patients with pulmonary and cardiovascular diseases. Besides, sildenafil also improved exercise capacity or performance in patients with pulmonary and cardiovascular diseases. Other than these patients, this drug contributed great help in pregnant women with fetal growth restriction and preeclampsia by increasing the weight of newborns and lowering uterine and umbilical pulsatility indices. Additionally, it was reported that utilization of sildenafil has brought increased risk of melanoma. Conclusion: We can conclude from our study that sildenafil played an important role in many fields, especially in vascular protection. This finding provides a strong evidence for further expansion of sildenafil utilization in other diseases.
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Affiliation(s)
- Zeyu Chen
- Department of Urology and Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China,West China School of Clinical Medicine, Sichuan University, Chengdu, China
| | - Yin Huang
- Department of Urology and Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China,West China School of Clinical Medicine, Sichuan University, Chengdu, China
| | - Dehong Cao
- Department of Urology and Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Shi Qiu
- Department of Urology and Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Chen
- Department of Urology and Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China,West China School of Clinical Medicine, Sichuan University, Chengdu, China
| | - Jin Li
- Department of Urology and Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China,West China School of Clinical Medicine, Sichuan University, Chengdu, China
| | - Yige Bao
- Department of Urology and Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Wei
- Department of Urology and Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Han
- Department of Urology and Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Ping Han, ; Liangren Liu,
| | - Liangren Liu
- Department of Urology and Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Ping Han, ; Liangren Liu,
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Carter EA, Koch S, O'Donovan JP, Sheel AW, Milsom WK, Koehle MS. Perfusion of Intrapulmonary Arteriovenous Anastomoses Is Not Related to VO 2max in Hypoxia and Is Unchanged by Oral Sildenafil. High Alt Med Biol 2019; 20:399-406. [PMID: 31618060 DOI: 10.1089/ham.2019.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Perfusion of intrapulmonary arteriovenous anastomoses (IPAVA) is increased during exercise and in hypoxia and is associated with variations in oxygen saturation (SPO2), resulting in blood bypassing the pulmonary microcirculation. Sildenafil is a pulmonary vasodilator that improves SPO2 and endurance performance in hypoxia. The purpose of this study was to determine if 50 mg sildenafil would reduce IPAVA perfusion (QIPAVA) and if the decrement in maximal exercise capacity (VO2max) in hypoxia is related to QIPAVA. We hypothesized that during progressive levels of hypoxia at rest (FIO2 = 0.21, 0.14, 0.12), sildenafil would increase SPO2 and reduce bubble score (estimate of QIPAVA) compared to placebo, and that the decrement in VO2max in hypoxia would be positively correlated with bubble score at rest in hypoxia. Materials and Methods: Fourteen endurance-trained men performed a graded maximal exercise test at sea level and at a simulated altitude of 3000 m, followed by two experimental visits where, after randomly ingesting sildenafil or placebo, they underwent agitated saline contrast echocardiography during progressive levels of hypoxia at rest. Results: All participants experienced a decrement in power output in hypoxia that ranged from 9% to 19% lower than sea level values. Compared to normoxia, bubble score increased significantly in hypoxia (p < 0.001) with no effect of sildenafil (p = 0.580). There was a negative correlation between SPO2 and bubble score (p < 0.001). The decrement in peak power output at VO2max in hypoxia was unrelated to IPAVA perfusion in resting hypoxia (p = 0.32). Several participants demonstrated QIPAVA greater than zero in room air, indicating that arterial hypoxemia may not be the sole mechanism for QIPAVA. Conclusion: These results indicate that the VO2max decrement caused by hypoxia is not related to QIPAVA and that sildenafil does not improve VO2max in hypoxia through modulation of QIPAVA.
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Affiliation(s)
- Eric A Carter
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Sarah Koch
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - James P O'Donovan
- Sports Medicine Department, Sports Surgery Clinic, Santry, Ireland.,Division of Sport and Exercise Medicine, Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - A William Sheel
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - William K Milsom
- Department of Zoology, University of British Columbia, Vancouver, Canada
| | - Michael S Koehle
- School of Kinesiology, University of British Columbia, Vancouver, Canada.,Division of Sport and Exercise Medicine, Department of Family Practice, University of British Columbia, Vancouver, Canada
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