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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; 276:114290. [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, CO
| | - Teri L Hernandez
- College of Nursing, University of Colorado, Aurora, CO; Section of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado, Aurora, CO
| | - Eva S Nozik
- Section of Pediatric Critical Care, Department of Pediatrics, University of Colorado, Aurora, CO
| | - Claire Palmer
- Section of Neonatology, Department of Pediatrics, University of Colorado, Aurora, CO
| | - Mairead Dillon
- Section of Neonatology, Department of Pediatrics, University of Colorado, Aurora, CO
| | - Ravinder J Singh
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN
| | - Csaba Galambos
- Section of Pathology, Department of Pediatrics, University of Colorado, Aurora, CO
| | - Cassidy A Delaney
- Section of Neonatology, Department of Pediatrics, University of Colorado, Aurora, CO.
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2
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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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3
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Myeloid-Derived Suppressor Cells and Pulmonary Hypertension. Int J Mol Sci 2018; 19:ijms19082277. [PMID: 30081463 PMCID: PMC6121540 DOI: 10.3390/ijms19082277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 01/04/2023] Open
Abstract
Myeloid–derived suppressor cells (MDSCs) comprised a heterogeneous subset of bone marrow–derived myeloid cells, best studied in cancer research, that are increasingly implicated in the pathogenesis of pulmonary vascular remodeling and the development of pulmonary hypertension. Stem cell transplantation represents one extreme interventional strategy for ablating the myeloid compartment but poses a number of translational challenges. There remains an outstanding need for additional therapeutic targets to impact MDSC function, including the potential to alter interactions with innate and adaptive immune subsets, or alternatively, alter trafficking receptors, metabolic pathways, and transcription factor signaling with readily available and safe drugs. In this review, we summarize the current literature on the role of myeloid cells in the development of pulmonary hypertension, first in pulmonary circulation changes associated with myelodysplastic syndromes, and then by examining intrinsic myeloid cell changes that contribute to disease progression in pulmonary hypertension. We then outline several tractable targets and pathways relevant to pulmonary hypertension via MDSC regulation. Identifying these MDSC-regulated effectors is part of an ongoing effort to impact the field of pulmonary hypertension research through identification of myeloid compartment-specific therapeutic applications in the treatment of pulmonary vasculopathies.
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Orcholski ME, Yuan K, Rajasingh C, Tsai H, Shamskhou EA, Dhillon NK, Voelkel NF, Zamanian RT, de Jesus Perez VA. Drug-induced pulmonary arterial hypertension: a primer for clinicians and scientists. Am J Physiol Lung Cell Mol Physiol 2018; 314:L967-L983. [PMID: 29417823 DOI: 10.1152/ajplung.00553.2017] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Drug-induced pulmonary arterial hypertension (D-PAH) is a form of World Health Organization Group 1 pulmonary hypertension (PH) defined by severe small vessel loss and obstructive vasculopathy, which leads to progressive right heart failure and death. To date, 16 different compounds have been associated with D-PAH, including anorexigens, recreational stimulants, and more recently, several Food and Drug Administration-approved medications. Although the clinical manifestation, pathology, and hemodynamic profile of D-PAH are indistinguishable from other forms of pulmonary arterial hypertension, its clinical course can be unpredictable and to some degree dependent on removal of the offending agent. Because only a subset of individuals develop D-PAH, it is probable that genetic susceptibilities play a role in the pathogenesis, but the characterization of the genetic factors responsible for these susceptibilities remains rudimentary. Besides aggressive treatment with PH-specific therapies, the major challenge in the management of D-PAH remains the early identification of compounds capable of injuring the pulmonary circulation in susceptible individuals. The implementation of pharmacovigilance, precision medicine strategies, and global warning systems will help facilitate the identification of high-risk drugs and incentivize regulatory strategies to prevent further outbreaks of D-PAH. The goal for this review is to inform clinicians and scientists of the prevalence of D-PAH and to highlight the growing number of common drugs that have been associated with the disease.
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Affiliation(s)
- Mark E Orcholski
- Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center , Stanford, California.,The Vera Moulton Wall Center for Pulmonary Vascular Medicine, Stanford University Medical Center , Stanford, California.,Stanford Cardiovascular Institute, Stanford University Medical Center , Stanford, California
| | - Ke Yuan
- Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center , Stanford, California.,The Vera Moulton Wall Center for Pulmonary Vascular Medicine, Stanford University Medical Center , Stanford, California.,Stanford Cardiovascular Institute, Stanford University Medical Center , Stanford, California
| | | | - Halley Tsai
- Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center , Stanford, California
| | - Elya A Shamskhou
- Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center , Stanford, California.,The Vera Moulton Wall Center for Pulmonary Vascular Medicine, Stanford University Medical Center , Stanford, California.,Stanford Cardiovascular Institute, Stanford University Medical Center , Stanford, California
| | | | - Norbert F Voelkel
- School of Pharmacy, Virginia Commonwealth University , Richmond, Virginia
| | - Roham T Zamanian
- Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center , Stanford, California.,The Vera Moulton Wall Center for Pulmonary Vascular Medicine, Stanford University Medical Center , Stanford, California.,Stanford Cardiovascular Institute, Stanford University Medical Center , Stanford, California
| | - Vinicio A de Jesus Perez
- Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center , Stanford, California.,The Vera Moulton Wall Center for Pulmonary Vascular Medicine, Stanford University Medical Center , Stanford, California.,Stanford Cardiovascular Institute, Stanford University Medical Center , Stanford, California
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5
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Humbert M, Nunes H, Sitbon O, Parent F, Hervé P, Simonneau G. Risk factors for pulmonary arterial hypertension. Clin Chest Med 2001; 22:459-75. [PMID: 11590841 DOI: 10.1016/s0272-5231(05)70284-7] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The present limitations in knowledge of the potential risk factors for PPH undoubtedly are attributable to the facts that PPH is a rare disease with an unknown pathogenesis and lacking large case series. Moreover, definite epidemiologic data are rare and ideally should be obtained from epidemiologic surveys such as large case-control studies. The increased incidence of the disease in young women, the familial cases, the association with autoimmune disorders, and the recent discovery that mutation of the PPH1 gene may not be restricted to familial PPH support the hypothesis that the development of pulmonary hypertension likely implies an individual susceptibility or predisposition, which is probably genetically determined. It is also now commonly believed that the development of pulmonary hypertension in some of these predisposed individuals could be hastened or precipitated by various expression factors (some of them yet unrecognized), such as ingestion of certain drugs or diets, portal hypertension, or HIV infection.
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MESH Headings
- Altitude
- Aminorex/adverse effects
- Aminorex/analogs & derivatives
- Animals
- Anti-Inflammatory Agents, Non-Steroidal/adverse effects
- Antidepressive Agents, Second-Generation/adverse effects
- Appetite Depressants/adverse effects
- Brassica
- Comorbidity
- Eisenmenger Complex/epidemiology
- Fatty Acids, Monounsaturated
- Female
- Fenfluramine/adverse effects
- Fenfluramine/analogs & derivatives
- Glycogen Storage Disease/epidemiology
- HIV Infections/epidemiology
- Hematologic Diseases/epidemiology
- Humans
- Hypertension, Portal/epidemiology
- Hypertension, Pulmonary/chemically induced
- Hypertension, Pulmonary/epidemiology
- Hypertension, Pulmonary/etiology
- Hypertension, Pulmonary/physiopathology
- Plant Oils/adverse effects
- Pregnancy
- Pregnancy Complications, Cardiovascular/physiopathology
- Rapeseed Oil
- Risk Factors
- Smoking
- Splenectomy
- Telangiectasia, Hereditary Hemorrhagic/epidemiology
- Thrombosis/epidemiology
- Thyroid Diseases/epidemiology
- Tryptophan/adverse effects
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Affiliation(s)
- M Humbert
- Service de Pneumologie et Réanimation Respiratoire, Centre des Maladies Vasculaires Pulmonaires, Hôpital Antoine Béclère, Université Paris-Sud, Clamart, France.
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6
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Affiliation(s)
- L Abenhaim
- McGill University, Montreal, Quebec, Canada
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7
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Strother J, Fedullo P, Yi ES, Masliah E. Complex vascular lesions at autopsy in a patient with phentermine-fenfluramine use and rapidly progressing pulmonary hypertension. Arch Pathol Lab Med 1999; 123:539-40. [PMID: 10383810 DOI: 10.5858/1999-123-0539-cvlaai] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Anorectic agents, such as aminorex and fenfluramine derivatives, have been associated previously with the development of primary pulmonary hypertension. The combination diet drug phentermine-fenfluramine (or "phen-fen") was recently marketed in the United States. We describe a case of a 39-year-old woman with rapidly progressing, fatal pulmonary hypertension following administration of phentermine-fenfluramine. Autopsy was remarkable for complex pulmonary vascular lesions most consistent with thrombotic arteriopathy.
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Affiliation(s)
- J Strother
- Department of Pathology, University of California, San Diego, La Jolla, CA 92093-0624, USA
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8
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Affiliation(s)
- A P Fishman
- University of Pennsylvania Medical Center, Philadelphia, PA, USA.
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Abenhaim L, Moride Y, Brenot F, Rich S, Benichou J, Kurz X, Higenbottam T, Oakley C, Wouters E, Aubier M, Simonneau G, Bégaud B. Appetite-suppressant drugs and the risk of primary pulmonary hypertension. International Primary Pulmonary Hypertension Study Group. N Engl J Med 1996; 335:609-16. [PMID: 8692238 DOI: 10.1056/nejm199608293350901] [Citation(s) in RCA: 712] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Recently, a cluster of patients was observed in France in whom primary pulmonary hypertension developed in patients exposed to derivatives of fenfluramine in appetite suppressants (anorexic agents), which are used for weight control. We investigated the potential role of anorexic agents and other suspected risk factors for primary pulmonary hypertension. METHODS In a case-control study, we assessed 95 patients with primary pulmonary hypertension from 35 centers in France, Belgium, the United Kingdom, and the Netherlands and 355 controls recruited from general practices and matched to the patients' sex and age. RESULTS The use of anorexic drugs (mainly derivatives of fenfluramine) was associated with an increased risk of primary pulmonary hypertension (odds ratio with any anorexic-drug use, 6.3; 95 percent confidence interval, 3.0 to 13.2). For the use of anorexic agents in the preceding year, the odds ratio was 10.1 (95 percent confidence interval, 3.4 to 29.9). When anorexic drugs were used to a total of more than three months, the odds ratio was 23.1 (95 percent confidence interval, 6.9 to 77.7). We also confirmed an association with several previously identified risk factors: a family history of pulmonary hypertension, infection with the human immunodeficiency virus, cirrhosis, and use of cocaine or intravenous drugs. CONCLUSIONS The use of anorexic drugs was associated with the development of primary pulmonary hypertension. Active surveillance for this disease should be considered, particularly since their use is expected to increase in the near future.
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Affiliation(s)
- L Abenhaim
- Centre for Clinical Epidemiology and Community Studies, McGill University, Montreal, Canada
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10
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Thomas SH, Butt AY, Corris PA, Egan JJ, Higenbottam TW, Madden BP, Waller PC. Appetite suppressants and primary pulmonary hypertension in the United Kingdom. Heart 1995; 74:660-3. [PMID: 8541174 PMCID: PMC484125 DOI: 10.1136/hrt.74.6.660] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Amphetamine-like appetite suppressants, particularly fenfluramines, have been implicated in the aetiology of primary pulmonary hypertension. At one specialist centre in France 20% of patients with primary pulmonary hypertension had been exposed to fenfluramine. The prevalence of primary pulmonary hypertension associated with fenfluramines and other appetite suppressants in the United Kingdom is unknown. This study was performed to measure prior exposure to appetite suppressants in patients with primary pulmonary hypertension. SETTING Heart lung transplantation centres in England. PATIENTS United Kingdom residents with proven primary pulmonary hypertension referred for consideration of heart lung transplantation. METHODS Case surveillance study, obtaining data from the hospital and general practitioner's notes and directly from the patients or their relatives. RESULTS 55 patients were identified. Drug histories were available from hospital records in all patients, from the general practitioner's notes in 51, and from the patients or relatives in 44. Of these, 3 female patients had been exposed to appetite suppressants (2 fenfluramine, 1 diethylpropion): 2 have since died. In each case exposure was brief and apparently predated the development of symptoms by several years. CONCLUSIONS Exposure of patients with severe primary pulmonary hypertension to fenfluramine and other appetite suppressants is uncommon in the United Kingdom unlike in France, where most of the cases associating primary pulmonary hypertension with fenfluramine use have originated. This may reflect more conservative prescribing of these agents in the United Kingdom.
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Affiliation(s)
- S H Thomas
- Wolfson Unit of Clinical Pharmacology, University of Newcastle upon Tyne, Newcastle
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11
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Affiliation(s)
- J M Kay
- Department of Laboratory Medicine, St Joseph's Hospital, Hamilton, Ontario, Canada
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12
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Schaiberger PH, Kennedy TC, Miller FC, Gal J, Petty TL. Pulmonary hypertension associated with long-term inhalation of "crank" methamphetamine. Chest 1993; 104:614-6. [PMID: 8101799 DOI: 10.1378/chest.104.2.614] [Citation(s) in RCA: 80] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
We present the case of a 33-year-old white male truck driver with a ten-year history of 3.5-g/wk "crank" and "peanut butter methamphetamine" inhalation (methamphetamine and propylhexedrine, respectively). This patient developed marked pulmonary hypertension as a probable consequence of abuse of these drugs. Proposed mechanisms of disease invoke toxic endothelial injury, hypoxic insult, direct spasm, vasculitis, and dysregulation of mediators of vascular tone. The possible role of genetics is discussed in reference to variability of human response to sympathomimetic challenge.
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13
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Abstract
Primary pulmonary hypertension is a rare disease of unknown etiology, which mainly affects people in the third and fourth decades. Although the clinical cause is highly variable and spontaneous regression has been described, survival rates are usually poor, averaging only three years after diagnosis. Treatment with vasodilator agents, especially calcium channel blockers and prostaglandins, usually improves symptoms, but have not been shown to improve chances for survival. In a few selected patients who continue to deteriorate despite medical treatment, lung transplantation may be the only option for improving function and survival.
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Affiliation(s)
- M T Olivari
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas 75235-9047
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14
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Gómez-Sánchez MA, Mestre de Juan MJ, Gómez-Pajuelo C, López JI, Díaz de Atauri MJ, Martínez-Tello FJ. Pulmonary hypertension due to toxic oil syndrome. A clinicopathologic study. Chest 1989; 95:325-31. [PMID: 2914483 DOI: 10.1378/chest.95.2.325] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Clinical and pathologic findings in seven patients who died of severe pulmonary artery hypertension due to toxic oil syndrome are assessed. These cases correspond to a late stage of evolution of the disease characterized by progressive deterioration in clinical features--increasing dyspnea, chest pain, syncope, and death (in low-output heart failure). The main pathologic pulmonary vascular findings consisted of plexiform lesions, thromboses, and venous lesions. Endothelial damage induced by the toxic agents is suggested as an initial causative mechanism, perpetuated by intimal proliferation and in situ thrombosis. Plexiform lesions appear late and active histologically. This new cause of pulmonary artery hypertension, with pathologic findings similar to those found in primary pulmonary hypertension, may help in understanding the pathophysiology of this unknown disease.
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15
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Saner H, Gurtner HP, Preisig R, Küpfer A. Polymorphic debrisoquine and mephenytoin hydroxylation in patients with pulmonary hypertension of vascular origin after aminorex fumarate. Eur J Clin Pharmacol 1986; 31:437-42. [PMID: 3816924 DOI: 10.1007/bf00613521] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
During the period 1967 to 1971 an increase in the incidence of pulmonary hypertension of vascular origin (PHVO) was observed in Austria, Federal Republic of Germany, and Switzerland. Most patients had been given aminorex fumarate and a possible link was suspected. We therefore investigated the possibility of genetically-determined drug hydroxylation deficiencies (debrisoquine or mephenytoin type) in these patients as an explanation for the development of PHVO. Seventeen patients took 10 mg debrisoquine and 100 mg mephenytoin orally. Sixteen PHVO patients were classified as extensive metabolizers of debrisoquine with logarithmic metabolic ratios of -0.35 +/- 0.11 (mean +/- SEM), whereas one patient was a poor metabolizer with a logarithmic metabolic ratio of 1.82. For the mephenytoin hydroxylation sixteen patients with PHVO were extensive metabolizers, with logarithmic hydroxylation indices of 0.27 +/- 0.05. One poor metabolizer of mephenytoin had a logarithmic hydroxylation index of 1.59. Deficient hydroxylation of debrisoquine and mephenytoin was found in two different patients. The prevalence of poor metabolizers among patients with PHVO after aminorex fumarate was therefore approximately 9% for both debrisoquine and mephenytoin. This corresponds closely to the data of our reference population study where genetic debrisoquine and mephenytoin hydroxylation deficiencies occurred independently, with a prevalence of 10% and 5% respectively. Thus, the normal prevalence of extensive drug hydroxylation phenotypes in patients with PHVO is not consistent with the hypothesis that the development of PHVO after aminorex fumarate might be related to a pharmacogenetically determined impairment of polymorphic drug oxidation.
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16
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 42-1985. A 61-year-old man with worsening dyspnea and evidence of pulmonary hypertension. N Engl J Med 1985; 313:1003-12. [PMID: 4047097 DOI: 10.1056/nejm198510173131607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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17
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Cotter L. Vasodilator treatment of primary pulmonary hypertension. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1984; 164:359-68. [PMID: 6695579 DOI: 10.1007/978-1-4684-8616-2_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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18
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Garcia-Dorado D, Miller DD, Garcia EJ, Delcan JL, Maroto E, Chaitman BR. An epidemic of pulmonary hypertension after toxic rapeseed oil ingestion in Spain. J Am Coll Cardiol 1983; 1:1216-22. [PMID: 6833663 DOI: 10.1016/s0735-1097(83)80133-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The cardiac profile of 38 patients readmitted to the hospital with the clinical and radiologic findings of pulmonary artery hypertension and right ventricular failure 2 months after ingestion of toxic rapeseed oil was determined with M-mode and two-dimensional echocardiography, pulsed Doppler flow studies and right and left heart catheterization and ventriculography. The echocardiogram and pulsed Doppler recordings revealed right ventricular enlargement in 84% of the patients, indirect evidence of pulmonary artery hypertension in 76% and tricuspid insufficiency in 13%. At cardiac catheterization (n = 11) the mean (+/- standard deviation) pulmonary artery pressure was 40 +/- 9 mm Hg, mean pulmonary systemic vascular resistance ratio was 0.45 +/- 0.12 and mean right ventricular end-diastolic pressure was 13 +/- 4 mm Hg. Pulmonary artery hypertension was sustained after the acute administration of 100% oxygen and persisted in six patients who were restudied within 6 months. Cardiac index and left heart pressures were normal in all but one patient. The contrast ventriculographic studies revealed right ventricular dilation in all patients, tricuspid regurgitation in three patients and a normal left ventricular contraction pattern in all but one patient. The data confirm that symptomatic pulmonary artery hypertension and associated right ventricular dysfunction can complicate toxic rapeseed oil ingestion and that these findings persist for at least 6 months.
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19
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Douglas JG, Munro JF, Kitchin AH, Muir AL, Proudfoot AT. Pulmonary hypertension and fenfluramine. BMJ : BRITISH MEDICAL JOURNAL 1981; 283:881-3. [PMID: 6793158 PMCID: PMC1507127 DOI: 10.1136/bmj.283.6296.881] [Citation(s) in RCA: 121] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Pulmonary hypertension developed in two women who had been taking fenfluramine for over eight months for weight reduction. On withdrawing the drug symptoms and electrocardiographic evidence of pulmonary hypertension disappeared in both cases. In one patient, however, the evidence recurred after rechallenge with fenfluramine.These findings are strong evidence that fenfluramine may cause pulmonary hypertension. Hence any patient taking the drug should report immediately any deterioration in exercise tolerance.
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20
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O'Neill D, Morton R, Kennedy JA. Progressive primary pulmonary hypertension in a patient born at high altitude. Heart 1981; 45:725-8. [PMID: 7259922 PMCID: PMC482588 DOI: 10.1136/hrt.45.6.725] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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Abstract
Detailed hemodynamic and metabolic studies were performed during the course of phenformin related lactic acidosis in two patients. Arterial blood lactate was increased to 11.5 and 26.1 mM/L and arterial blood pH was reduced to 7.05 and 6.80 units, respectively. A marked reduction in cardiac indices (0.94 and 1.15 L/min/m2), stroke volume, and stroke work were observed, with either normal or increased arterial resistance. Mild increases in pulmonary artery systolic pressure (50/11), 45/25 mmHg) were observed, but necropsy in both cases disclosed no evidence of pulmonary vascular obstruction. In the absence of increases in central venous and pulmonary artery wedge pressure, a cardiac failure was excluded as primary cause of the low output state. Hypovolemia was excluded on the basis of radioisotope dilution measurements of plasma volume and red cell mass and no increase in cardiac output followed volume expansion. Oxygen extraction from blood was not grossly impaired. These observations indicate that phenformin-related lactic acidosis may evolve as a circulatory defect characteristic of shock in which oxygen delivery rather than oxygen utilization is impaired. The hemodynamic defect is best explained by a defect in the intravascular distribution of blood volume.
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22
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Assan R, Heuclin C, Ganeval D, Bismuth C, George J, Girard JR. Metformin-induced lactic acidosis in the presence of acute renal failure. Diabetologia 1977; 13:211-7. [PMID: 406158 DOI: 10.1007/bf01219702] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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23
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24
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Editorial: Phenformin and hypertension. BRITISH MEDICAL JOURNAL 1975; 3:724-5. [PMID: 1174869 PMCID: PMC1674688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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25
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