1
|
Herlo A, Marinescu AR, Cut TG, Laza R, Oancea CI, Manolescu D, Hogea E, Porosnicu TM, Sincaru SV, Dumache R, Ispas S, Nelson Twakor A, Nicolae M, Lazureanu VE. Risk Factors for Pulmonary Embolism in Individuals Infected with SARS-CoV2-A Single-Centre Retrospective Study. Biomedicines 2024; 12:774. [PMID: 38672130 PMCID: PMC11048050 DOI: 10.3390/biomedicines12040774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
The emergence of SARS-CoV2 has presented itself as a significant global health crisis. The prevalence of thrombotic events is known to be high in these patients, affecting various organ systems, sometimes leading to cutaneous thrombosis, pulmonary embolism (PE), stroke, or coronary thrombosis. The available evidence suggests that thromboembolism, hypercoagulability, and the excessive production of proinflammatory cytokines play a significant role in the development of multiorgan failure. Methodology: This retrospective single-centre study was conducted at "Victor Babes" University of Medicine and Pharmacy from Timisoara, Romania, involving a total of 420 patients diagnosed with COVID-19. We separated them into a CONTROL group that included 319 patients, and an intervention group (PE) with 101 patients that, subsequent to infection with the virus, developed pulmonary embolism. The study included the reporting of demographic data, laboratory findings, and comorbidities. Results: Out of a total of 420 patients, 24% experienced pulmonary embolism, while 21.42% died. Arterial thrombotic events were found to be associated with factors such as age, cardiovascular disease, levels of white blood cells, D-dimers, and albumin in the blood. The findings of the study indicate that there is an independent association between pulmonary thrombosis and hypertension (odds ratio (OR): 1.1; 95% confidence interval (CI): 0.7 to 1.7; p = 0.6463), cancer (OR: 1.1; 95% CI: 0.6 to 2.3; p = 0.6014), and COPD (OR: 1.2; 95% CI: 0.6 to 2.3; p = 0.4927). On the other hand, there is a stronger correlation between PE and obesity (OR: 2.8; 95% CI: 1.7 to 4.6; p < 0.0001), diabetes (OR: 3.3; 95% CI: 2 to 5.3; p < 0.0001), and dyslipidemia (OR: 3.6; 95% CI: 2.3 to 5.8; p < 0.0001) in a multivariable regression logistic model. Conclusions: Patients diagnosed with severe forms of COVID-19 display a comparable incidence of arterial thrombotic events, which have been linked to poor survival rates.
Collapse
Affiliation(s)
- Alexandra Herlo
- Department XIII, Discipline of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu Square, 300041 Timisoara, Romania; (A.H.); (A.R.M.); (T.G.C.); (R.L.); (V.E.L.)
| | - Adelina Raluca Marinescu
- Department XIII, Discipline of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu Square, 300041 Timisoara, Romania; (A.H.); (A.R.M.); (T.G.C.); (R.L.); (V.E.L.)
| | - Talida Georgiana Cut
- Department XIII, Discipline of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu Square, 300041 Timisoara, Romania; (A.H.); (A.R.M.); (T.G.C.); (R.L.); (V.E.L.)
| | - Ruxandra Laza
- Department XIII, Discipline of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu Square, 300041 Timisoara, Romania; (A.H.); (A.R.M.); (T.G.C.); (R.L.); (V.E.L.)
| | - Cristian Iulian Oancea
- Department XIII, Discipline of Pneumology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania;
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Diana Manolescu
- Department XV, Discipline of Radiology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania;
| | - Elena Hogea
- Department XIV, Discipline of Microbiology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania;
| | - Tamara Mirela Porosnicu
- Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
- Intensive Care Unit, Victor Babes Clinical Hospital for Infectious Diseases and Pneumology, 300041 Timisoara, Romania
| | - Suzana Vasilica Sincaru
- Emergency Institute for Cardiovascular Diseases and Transplant, Strada Gheorghe Maricescu, 540327 Targu Mures, Romania
| | - Raluca Dumache
- Department of Forensic Medicine, Bioethics, Medical Ethics and Medical Law, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Sorina Ispas
- Department of Anatomy, Faculty of General Medicine, “Ovidius” University, 900470 Constanta, Romania;
| | - Andreea Nelson Twakor
- Department of Internal Medicine, County Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania;
| | - Maria Nicolae
- Department of Pediatrics, County Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania;
| | - Voichita Elena Lazureanu
- Department XIII, Discipline of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu Square, 300041 Timisoara, Romania; (A.H.); (A.R.M.); (T.G.C.); (R.L.); (V.E.L.)
| |
Collapse
|
2
|
Chang KY, Giorgio K, Schmitz K, Walker RF, Prins KW, Pritzker MR, Archer SL, Lutsey PL, Thenappan T. Effect of Chronic Digoxin Use on Mortality and Heart Failure Hospitalization in Pulmonary Arterial Hypertension. J Am Heart Assoc 2023; 12:e027559. [PMID: 36892094 PMCID: PMC10111549 DOI: 10.1161/jaha.122.027559] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 02/01/2023] [Indexed: 03/10/2023]
Abstract
Background Digoxin acutely increases cardiac output in patients with pulmonary arterial hypertension (PAH) and right ventricular failure; however, the effects of chronic digoxin use in PAH are unclear. Methods and Results Data from the Minnesota Pulmonary Hypertension Repository were used. The primary analysis used likelihood of digoxin prescription. The primary end point was a composite of all-cause mortality or heart failure (HF) hospitalization. Secondary end points included all-cause mortality, HF hospitalization, and transplant-free survival. Multivariable Cox proportional hazards analyses determined the hazard ratios (HR) and 95% CIs for the primary and secondary end points. Among 205 patients with PAH in the repository, 32.7% (n=67) were on digoxin. Digoxin was more often prescribed to patients with severe PAH and right ventricular failure. After propensity score-matching, 49 patients were digoxin users, and 70 patients were nonusers; of these 31 (63.3%) in the digoxin group and 41 (58.6%) in nondigoxin group met the primary end point during a median follow-up time of 2.1 (0.6-5.0) years. Digoxin users had a higher combined all-cause mortality or HF hospitalization (HR, 1.82 [95% CI, 1.11-2.99]), all-cause mortality (HR, 1.92 [95% CI, 1.06-3.49]), HF hospitalization (HR, 1.89 [95% CI, 1.07-3.35]), and worse transplant-free survival (HR, 2.00 [95% CI, 1.12-3.58]) even after adjusting for patient characteristics and severity of PAH and right ventricular failure. Conclusions In this retrospective, nonrandomized cohort, digoxin treatment was associated with greater all-cause mortality and HF hospitalization, even after multivariate correction. Future randomized controlled trials should assess the safety and efficacy of chronic digoxin use in PAH.
Collapse
Affiliation(s)
- Kevin Y. Chang
- Cardiovascular Division, Department of MedicineUniversity of MinnesotaMinneapolisMNUSA
| | - Katherine Giorgio
- Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisMNUSA
| | - Katlin Schmitz
- Cardiovascular Division, Department of MedicineUniversity of MinnesotaMinneapolisMNUSA
| | - Rob F. Walker
- Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisMNUSA
| | - Kurt W. Prins
- Cardiovascular Division, Department of MedicineUniversity of MinnesotaMinneapolisMNUSA
| | - Marc R. Pritzker
- Cardiovascular Division, Department of MedicineUniversity of MinnesotaMinneapolisMNUSA
| | | | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisMNUSA
| | - Thenappan Thenappan
- Cardiovascular Division, Department of MedicineUniversity of MinnesotaMinneapolisMNUSA
| |
Collapse
|
3
|
Hong AW, Toppen W, Lee J, Wilhalme H, Saggar R, Barjaktarevic IZ. Outcomes and Prognostic Factors of Pulmonary Hypertension Patients Undergoing Emergent Endotracheal Intubation. J Intensive Care Med 2023; 38:280-289. [PMID: 35934945 PMCID: PMC9806479 DOI: 10.1177/08850666221118839] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background: Emergent endotracheal intubations (ETI) in pulmonary hypertension (PH) patients are associated with increased mortality. Post-intubation interventions that could increase survivability in this population have not been explored. We evaluate early clinical characteristics and complications following emergent endotracheal intubation and seek predictors of adverse outcomes during this post-intubation period. Methods: Retrospective cohort analysis of adult patients with groups 1 and 3 PH who underwent emergent intubation between 2005-2021 in medical and liver transplant ICUs at a tertiary medical center. PH patients were compared to non-PH patients, matched by Charlson Comorbidity Index. Primary outcomes were 24-h post-intubation and inpatient mortalities. Various 24-h post-intubation secondary outcomes were compared between PH and control cohorts. Results: We identified 48 PH and 110 non-PH patients. Pulmonary hypertension was not associated with increased 24-h mortality (OR 1.32, 95%CI 0.35-4.94, P = .18), but was associated with inpatient mortality (OR 4.03, 95%CI 1.29-12.5, P = .016) after intubation. Within 24 h post-intubation, PH patients experienced more frequent acute kidney injury (43.5% vs. 19.8%, P = .006) and required higher norepinephrine dosing equivalents (6.90 [0.13-10.6] mcg/kg/min, vs. 0.20 [0.10-2.03] mcg/kg/min, P = .037). Additionally, the median P/F ratio (PaO2/FiO2) was lower in PH patients (96.3 [58.9-201] vs. 233 [146-346] in non-PH, P = .001). Finally, a post-intubation increase in PaCO2 was associated with mortality in the PH cohort (post-intubation change in PaCO2 +5.14 ± 16.1 in non-survivors vs. -18.7 ± 28.0 in survivors, P = .007). Conclusions: Pulmonary hypertension was associated with worse outcomes after emergent endotracheal intubation than similar patients without PH. More importantly, our data suggest that the first 24 hours following intubation in the PH group represent a particularly vulnerable period that may determine long-term outcomes. Early post-intubation interventions may be key to improving survival in this population.
Collapse
Affiliation(s)
- Andrew W. Hong
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA,Igor Barjaktarevic, Department of Pulmonary
and Critical Care, UCLA Medical Center, 10833 Le Conte Ave, Los Angeles, CA,
USA.
| | - William Toppen
- Department of Medicine, University of California, Los
Angeles, CA, USA
| | - Joyce Lee
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Holly Wilhalme
- Division of General Internal Medicine and Health Services Research, David Geffen School of
Medicine, Los Angeles, CA, USA
| | - Rajan Saggar
- Department of Pulmonary and Critical Care, UCLA Medical Center, Los
Angeles, CA, USA
| | - Igor Z. Barjaktarevic
- Department of Pulmonary and Critical Care, UCLA Medical Center, Los
Angeles, CA, USA
| |
Collapse
|
4
|
|
5
|
Andrographolide Attenuates Established Pulmonary Hypertension via Rescue of Vascular Remodeling. Biomolecules 2021; 11:biom11121801. [PMID: 34944445 PMCID: PMC8699233 DOI: 10.3390/biom11121801] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/13/2021] [Accepted: 11/23/2021] [Indexed: 12/01/2022] Open
Abstract
Pulmonary hypertension (PH) is characterized by vascular remodeling caused by marked proliferation of pulmonary artery smooth muscle cells (PASMCs). Andrographolide (ANDRO) is a potent anti-inflammatory agent which possesses antioxidant, and has anticarcinogenic activity. The present study examined potential therapeutic effects of ANDRO on PH in both chronic hypoxia and Sugen5416/hypoxia mouse PH models. Effects of ANDRO were also studied in cultured human PASMCs isolated from either healthy donors or PH patients. In vivo, ANDRO decreased distal pulmonary arteries (PAs) remodeling, mean PA pressure and right ventricular hypertrophy in chronic hypoxia- and Sugen/hypoxia-induced PH in mice. ANDRO reduced cell viability, proliferation and migration, but increased cell apoptosis in the PASMCs isolated from PH patients. ANDRO also reversed the dysfunctional bone morphogenetic protein receptor type-2 (BMPR2) signaling, suppressed [Ca2+]i elevation, reactive oxygen species (ROS) generation, and the upregulated expression of IL-6 and IL-8, ET-1 and VEGF in PASMCs from PH patients. Moreover, ANDRO significantly attenuated the activation of TLR4/NF-κB, ERK- and JNK-MAPK signaling pathways and reversed the inhibition of p38-MAPK in PASMCs of PH patients. Further, ANDRO blocked hypoxia-triggered ROS generation by suppressing NADPH oxidase (NOX) activation and augmenting nuclear factor erythroid 2-related factor 2 (Nrf2) expression both in vitro and in vivo. Conventional pulmonary vasodilators have limited efficacy for the treatment of severe PH. We demonstrated that ANDRO may reverse pulmonary vascular remodeling through modulation of NOX/Nrf2-mediated oxidative stress and NF-κB-mediated inflammation. Our findings suggest that ANDRO may have therapeutic value in the treatment of PH.
Collapse
|
6
|
Ma Z, Viswanathan G, Sellig M, Jassal C, Choi I, Garikipati A, Xiong X, Nazo N, Rajagopal S. β-Arrestin–Mediated Angiotensin II Type 1 Receptor Activation Promotes Pulmonary Vascular Remodeling in Pulmonary Hypertension. JACC Basic Transl Sci 2021; 6:854-869. [PMID: 34869949 PMCID: PMC8617598 DOI: 10.1016/j.jacbts.2021.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 09/24/2021] [Accepted: 09/24/2021] [Indexed: 11/05/2022]
Abstract
We tested the effects of a β-arrestin–biased agonist (TRV023) of the angiotensin II (AngII) type 1 receptor (AT1R), which acts as a vasodilator while not blocking cellular proliferation, compared to a balanced agonist, AngII, and an antagonist, losartan, in PAH. In acute infusion, AngII increased right ventricular pressures while TRV023 and losartan did not. However, in chronic infusion in monocrotaline PAH rats, both TRV023 and AngII had significantly worse survival than losartan. Both TRV023 and AngII enhanced proliferation and migration of pulmonary artery smooth muscle cells from patients with PAH. β-arrestin-mediated AT1R signaling promotes vascular remodeling and worsens PAH, and suggests that the benefit of current PAH therapies is primarily through pulmonary vascular reverse remodeling.
Pulmonary arterial hypertension (PAH) is a disease of abnormal pulmonary vascular remodeling whose medical therapies are thought to primarily act as vasodilators but also may have effects on pulmonary vascular remodeling. The angiotensin II type 1 receptor (AT1R) is a G protein–coupled receptor that promotes vasoconstriction through heterotrimeric G proteins but also signals via β-arrestins, which promote cardioprotective effects and vasodilation through promoting cell survival. We found that an AT1R β-arrestin-biased agonist promoted vascular remodeling and worsened PAH, suggesting that the primary benefit of current PAH therapies is through pulmonary vascular reverse remodeling in addition to their vasodilation.
Collapse
|
7
|
Satoh K. Drug discovery focused on novel pathogenic proteins for pulmonary arterial hypertension. J Cardiol 2021; 78:1-11. [PMID: 33563508 DOI: 10.1016/j.jjcc.2021.01.009] [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: 12/24/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a fatal disease in which the wall thickening and narrowing of pulmonary microvessels progress due to complicated interactions among processes such as endothelial dysfunction, the proliferation of pulmonary artery smooth muscle cells (PASMCs) and adventitial fibrocytes, and inflammatory cell infiltration. Early diagnosis of patients with PAH is difficult and lung transplantation is the only last choice to save severely ill patients. However, the number of donors is limited. Many patients with PAH show rapid progression and a high degree of pulmonary arterial remodeling characterized by the abnormal proliferation of PASMCs, which makes treatment difficult even with multidrug therapy comprising pulmonary vasodilators. Thus, it is important to develop novel therapy targeting factors other than vasodilation, such as PASMC proliferation. In the development of PAH, inflammation and oxidative stress are deeply involved in its pathogenesis. Excessive proliferation and apoptosis resistance in PASMCs are key mechanisms underlying PAH. Based on those characteristics, we recently screened novel pathogenic proteins and have performed drug discovery targeting those proteins. To confirm the clinical significance of this, we used patient-derived blood samples to evaluate biomarker potential for diagnosis and prognosis. Moreover, we conducted high throughput screening and found several inhibitors of the pathogenic proteins. In this review, we introduce the recent progress on basic and clinical PAH research, focusing on the screening of pathogenic proteins and drug discovery.
Collapse
Affiliation(s)
- Kimio Satoh
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan.
| |
Collapse
|
8
|
Abstract
PURPOSE OF REVIEW Lung involvement is a distinctive feature of antisynthetase syndrome (ASS) and it is considered a basic disease-classifying criterion. In this review, we go over clinical features, radiological patterns, prognostic factors, pathogenesis and treatment of lung involvement in ASS patients, focusing on the clinical differences linked to the different antibody specificities known so far. RECENT FINDINGS The lung is the most common extramuscular organ involved in ASS and has the greatest impact on patient prognosis. The pulmonary disease-defining manifestation in ASS is interstitial lung disease (ILD), yet a proportion of patients also develop pulmonary arterial hypertension and, less frequently, obstructive bronchiolitis or acute respiratory failure according to drivers not yet fully understood but likely associated with the underlying autoantibody pattern. Clinical presentation of pulmonary involvement can range from milder forms to a rapidly progressive disease which may lead to chronic lung damage if misdiagnosed and not properly treated. SUMMARY The knowledge of risk factors associated with progressive or refractory lung damage is important to identify and properly treat patients with the poorest prognosis. For those with a disease not responsive to conventional therapy the efficacy of other therapeutic option is under evaluation.
Collapse
|
9
|
Ma Z, Yu YR, Badea CT, Kovacs JJ, Xiong X, Comhair S, Piantadosi CA, Rajagopal S. Vascular Endothelial Growth Factor Receptor 3 Regulates Endothelial Function Through β-Arrestin 1. Circulation 2019; 139:1629-1642. [PMID: 30586762 DOI: 10.1161/circulationaha.118.034961] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Receptor signaling is central to vascular endothelial function and is dysregulated in vascular diseases such as atherosclerosis and pulmonary arterial hypertension (PAH). Signaling pathways involved in endothelial function include vascular endothelial growth factor receptors (VEGFRs) and G protein-coupled receptors, which classically activate distinct intracellular signaling pathways and responses. The mechanisms that regulate these signaling pathways have not been fully elucidated and it is unclear what nodes for cross talk exist between these diverse signaling pathways. For example, multifunctional β-arrestin (ARRB) adapter proteins are best known as regulators of G protein-coupled receptor signaling, but their role at other receptors and their physiological importance in the setting of vascular disease are unclear. METHODS We used a combination of human samples from PAH, human microvascular endothelial cells from lung, and Arrb knockout mice to determine the role of ARRB1 in endothelial VEGFR3 signaling. In addition, a number of biochemical analyses were performed to determine the interaction between ARRB1 and VEGFR3, signaling mediators downstream of VEGFR3, and the internalization of VEGFR3. RESULTS Expression of ARRB1 and VEGFR3 was reduced in human PAH, and the deletion of Arrb1 in mice exposed to hypoxia led to worse PAH with a loss of VEGFR3 signaling. Knockdown of ARRB1 inhibited VEGF-C-induced endothelial cell proliferation, migration, and tube formation, along with reduced VEGFR3, Akt, and endothelial nitric oxide synthase phosphorylation. This regulation was mediated by direct ARRB1 binding to the VEGFR3 kinase domain and resulted in decreased VEGFR3 internalization. CONCLUSIONS Our results demonstrate a novel role for ARRB1 in VEGFR regulation and suggest a mechanism for cross talk between G protein-coupled receptors and VEGFRs in PAH. These findings also suggest that strategies to promote ARRB1-mediated VEGFR3 signaling could be useful in the treatment of pulmonary hypertension and other vascular disease.
Collapse
Affiliation(s)
- Zhiyuan Ma
- Division of Cardiology (Z.M., X.X., S.R.), Duke University Medical Center, Durham, NC
| | - Yen-Rei Yu
- Division of Pulmonary and Critical Care (Y.-R.Y., C.A.P.), Duke University Medical Center, Durham, NC
| | - Cristian T Badea
- Department of Radiology (C.T.B.), Duke University Medical Center, Durham, NC
| | - Jeffrey J Kovacs
- Department of Medicine (J.J.K.), Duke University Medical Center, Durham, NC
| | - Xinyu Xiong
- Division of Cardiology (Z.M., X.X., S.R.), Duke University Medical Center, Durham, NC
| | - Suzy Comhair
- Lerner Research Institute, Cleveland Clinic, OH (S.C.). The current address for Dr Kovacs is MD Anderson Cancer Center Institute for Applied Cancer Science and Center for Co-Clinical Trials, Houston, TX
| | - Claude A Piantadosi
- Division of Pulmonary and Critical Care (Y.-R.Y., C.A.P.), Duke University Medical Center, Durham, NC
| | - Sudarshan Rajagopal
- Division of Cardiology (Z.M., X.X., S.R.), Duke University Medical Center, Durham, NC.,Department of Biochemistry (S.R.), Duke University Medical Center, Durham, NC
| |
Collapse
|
10
|
The Role of Noninvasive Endpoints in Predicting Long-Term Outcomes in Pulmonary Arterial Hypertension. Lung 2019; 198:65-86. [PMID: 31722043 PMCID: PMC7012965 DOI: 10.1007/s00408-019-00289-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/29/2019] [Indexed: 12/26/2022]
Abstract
Background Until recently, many clinical trials in patients with pulmonary arterial hypertension (PAH) evaluated exercise capacity with 6-minute walk distance (6MWD) as the primary endpoint. Common secondary endpoints include PAH functional class (FC), which assesses symptoms, and either brain natriuretic peptide (BNP) or the inactive N-terminal cleavage product of its prohormone (NT-proBNP), which assesses cardiac function. Objective Examine the relationships among 6MWD, FC, and BNP/NT-proBNP measured at baseline or follow-up with long-term outcomes in PAH studies. Methods Relevant literature from January 1990 to April 2018 were obtained by searching PubMed, Embase, and Cochrane. Articles in English reporting on associations between 6MWD, FC, or BNP/NT-proBNP and outcomes in PAH were identified. Each endpoint was evaluated individually. Prespecified inclusion and exclusion criteria were applied at level 1 (titles/abstracts) and level 2 (full-text review). Results The database search yielded 836 unique records; 65 full-text articles were reviewed. Twenty-five studies were eligible for inclusion. Findings supported the importance of measuring PAH noninvasive endpoints in predicting long-term outcomes. Patients with shorter or decreased 6MWD, poor (III/IV) or declining FC (e.g., from II to III), or elevated or increasing BNP/NT-proBNP had a higher risk of death and costly events (e.g., hospitalization, lung transplant). FC also predicted health care resource utilization and costs. Collectively, these endpoints establish risk groups that predict likelihood of complications from PAH or death. Conclusion Assessment of 6MWD, FC, and BNP/NT-proBNP provides low-cost, efficient, and noninvasive means of predicting long-term health and economic outcomes in patients with PAH.
Collapse
|
11
|
Isoliquiritigenin Attenuates Monocrotaline-Induced Pulmonary Hypertension via Inhibition of the Inflammatory Response and PASMCs Proliferation. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:4568198. [PMID: 31239860 PMCID: PMC6556334 DOI: 10.1155/2019/4568198] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/16/2019] [Indexed: 01/13/2023]
Abstract
Pulmonary hypertension (PH) is a progressive and serious disease, where exacerbated inflammatory response plays a critical role. Isoliquiritigenin (ISL), an important flavonoid isolated from Glycyrrhizae radix, exhibits a wide range of pharmacological actions including anti-inflammation. Previously we found ISL alleviated hypoxia-induced PH; in the present study, to extend this, we evaluated the effects of ISL on monocrotaline (MCT)-induced PH and the relevant mechanisms. Rats received a single intraperitoneal injection of MCT, followed by intragastric treatments with ISL (10 mg/kg/d or 30 mg/kg/d) once a day for 28 days. The MCT administration increased the right ventricular systolic pressure (RVSP) (p < 0.001), the median width of pulmonary arteries (p < 0.01), and the weight ratio of the right ventricular wall/left ventricular wall plus septum (Fulton index) (p < 0.01) in rats; however, these changes were inhibited by both doses of ISL (p < 0.05). In addition, treatment with ISL suppressed the upregulated production of serum interleukin-6 (p < 0.01) and tumor necrosis factor-α (p < 0.05) by MCT and reversed the increases in the numbers of proliferating cell nuclear antigen (PCNA)-positive cells (p < 0.01) in the medial wall of pulmonary arteries. In in vitro experiments, ISL (10 μM, 30 μM, and 100 μM) inhibited excessive proliferation of cultured primary pulmonary artery smooth muscle cells (PASMCs) (p < 0.05, p < 0.01, and p < 0.001) in a dose-dependent manner and prevented an increase in the expressions of PCNA (p < 0.01) and phospho-Akt (p < 0.05) in PASMCs induced by hypoxia. These results suggest that ISL can attenuate MCT-induced PH via its anti-inflammatory and antiproliferative actions.
Collapse
|
12
|
Nowroozpoor A, Malekmohammad M, Seyyedi SR, Hashemian SM. Pulmonary Hypertension in Intensive Care Units: An Updated Review. TANAFFOS 2019; 18:180-207. [PMID: 32411259 PMCID: PMC7210574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pulmonary hypertension (PH) is a condition associated with high morbidity and mortality. Patients with PH who require critical care usually have severe right ventricular (RV) dysfunction. Although different groups of PH have different etiologies, pulmonary vascular dysfunction is common in these groups. PH can lead to increased pulmonary artery pressure, which can ultimately cause RV failure. Clinicians should be familiar with the presentations of this disease and diagnostic tools. The contributing factors, if present (e.g., sepsis), and coexisting conditions (e.g., arrhythmias) should be identified and addressed accordingly. The preload should be optimized by fluid administration, diuretics, and dialysis, if necessary. On the other hand, the RV afterload should be reduced to improve the RV function with pulmonary vasodilators, such as prostacyclins, inhaled nitric oxide, and phosphodiesterase type 5 inhibitors, especially in group 1 PH. Inotropes are also used to improve RV contractility, and if inadequate, use of ventricular assist devices and extracorporeal life support should be considered in suitable candidates. Moreover, vasopressors should be used to maintain systemic blood pressure, albeit cautiously, as they increase the RV afterload. Measures should be also taken to ensure adequate oxygenation. However, mechanical ventilation is avoided in RV failure. In this study, we reviewed the pathophysiology, manifestations, diagnosis, monitoring, and management strategies of PH, especially in intensive care units.
Collapse
Affiliation(s)
- Armin Nowroozpoor
- Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Malekmohammad
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyyed Reza Seyyedi
- Lung Transplantation Research Center, Department of Cardiology, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammadreza Hashemian
- Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran,,Correspondence to: Hashemian SMR, Address: Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran Email address:
| |
Collapse
|
13
|
Wright L, Dwyer N, Wahi S, Marwick TH. Relative Importance of Baseline and Longitudinal Evaluation in the Follow-Up of Vasodilator Therapy in Pulmonary Arterial Hypertension. JACC Cardiovasc Imaging 2018; 12:2103-2111. [PMID: 30343091 DOI: 10.1016/j.jcmg.2018.08.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/06/2018] [Accepted: 08/09/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the relative value of baseline and follow-up echocardiographic assessment of pulmonary artery systolic pressure (PASP) and right ventricular (RV) function in assessing response to vasodilator therapy in pulmonary arterial hypertension (PAH). BACKGROUND Routine follow-up of PASP and RV function is widely obtained in patients undergoing treatment for PAH, but the value of this reassessment is uncertain. METHODS Of 162 prospectively recruited patients with PAH, 96 were included in this analysis of patients with ≥3 sequential echocardiographic studies. PASP and RV function (including right ventricular free wall strain [RVFWS]) were measured at baseline and on follow-up 2-dimensional echocardiography. Univariate and multivariate Cox regression with nested models was used to determine incremental and independent predictors of all-cause mortality. RESULTS Changes between visits were minimal for all parameters (RVFWS, p = 0.46; RV end diastolic area, p = 0.48; tricuspid annular plane systolic excursion, p = 0.32; PASP, p = 0.66; right atrial area, p = 0.39; and inferior vena cava, p = 0.25). Over 3 years of follow-up, 29 patients died. Baseline RVFWS was an independent predictor of outcome (hazard ratio [HR]: 0.90; 95% confidence interval [CI]: 0.83 to 0.97; p = 0.007), incremental to PASP and other clinical covariates (C statistic = 0.74, p = 0.001). Those who died showed no differences in RVFWS (p = 0.50), PASP (p = 0.90), and tricuspid annular plane systolic excursion (p = 0.83) between visits. When baseline measures and follow-up time were accounted for, mean changes in RVFWS (HR: 0.78; 95% CI: 0.63 to 0.96; p = 0.002), right atrial area (HR: 1.20; 95% CI: 1.07 to 1.40; p = 0.003), and inferior vena cava (HR: 66.5; 95% CI: 8.5 to 520.5; p < 0.001) over follow-up were significant in predicting outcome. CONCLUSIONS In PAH, baseline RV function (RVFWS) is a strong predictor of outcome, independent of PASP. Changes throughout therapy appear minimal, and only changes in RVFWS, inferior vena cava, size, and right atrial area were associated with outcome.
Collapse
Affiliation(s)
- Leah Wright
- Menzies Institute for Medical Research, Hobart, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia
| | | | - Sudhir Wahi
- Princess Alexandra Hospital, Brisbane, Australia
| | | |
Collapse
|
14
|
Wang T, Zheng X, Li R, Liu X, Wu J, Zhong X, Zhang W, Liu Y, He X, Liu W, Wang H, Zeng H. Integrated bioinformatic analysis reveals YWHAB as a novel diagnostic biomarker for idiopathic pulmonary arterial hypertension. J Cell Physiol 2018; 234:6449-6462. [PMID: 30317584 DOI: 10.1002/jcp.27381] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 08/17/2018] [Indexed: 11/05/2022]
Abstract
Idiopathic pulmonary arterial hypertension (IPAH) is a severe cardiovascular disease that is a serious threat to human life. However, the specific diagnostic biomarkers have not been fully clarified and candidate regulatory targets for IPAH have not been identified. The aim of this study was to explore the potential diagnostic biomarkers and possible regulatory targets of IPAH. We performed a weighted gene coexpression network analysis and calculated module-trait correlations based on a public microarray data set (GSE703) and six modules were found to be related to IPAH. Two modules which have the strongest correlation with IPAH were further analyzed and the top 10 hub genes in the two modules were identified. Furthermore, we validated the data by quantitative real-time polymerase chain reaction (qRT-PCR) in an independent sample set originated from our study center. Overall, the qRT-PCR results were consistent with most of the results of the microarray analysis. Intriguingly, the highest change was found for YWHAB, a gene encodes a protein belonging to the 14-3-3 family of proteins, members of which mediate signal transduction by binding to phosphoserine-containing proteins. Thus, YWHAB was subsequently selected for validation. In congruent with the gene expression analysis, plasma 14-3-3β concentrations were significantly increased in patients with IPAH compared with healthy controls, and 14-3-3β expression was also positively correlated with mean pulmonary artery pressure ( R 2 = 0.8783; p < 0.001). Taken together, using weighted gene coexpression analysis, YWHAB was identified and validated in association with IPAH progression, which might serve as a biomarker and/or therapeutic target for IPAH.
Collapse
Affiliation(s)
- Tao Wang
- Department of Internal Medicine, Division of Cardiology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, China
| | - Xuan Zheng
- Laboratory of Molecular Cardiology, Wuhan Asia Heart Hospital, Wuhan University, Wuhan, China
| | - Ruidong Li
- Graduate Program in Genetics, Genomics, and Bioinformatics, University of California, Riverside, California
| | - Xintian Liu
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan University, Wuhan, China
| | - Jinhua Wu
- Department of Internal Medicine, Division of Cardiology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, China
| | - Xiaodan Zhong
- Department of Internal Medicine, Division of Cardiology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, China
| | - Wenjun Zhang
- Department of Internal Medicine, Division of Cardiology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, China
| | - Yujian Liu
- Department of Internal Medicine, Division of Cardiology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, China
| | - Xingwei He
- Department of Internal Medicine, Division of Cardiology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, China
| | - Wanjun Liu
- Department of Internal Medicine, Division of Cardiology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, China
| | - Hongjie Wang
- Department of Internal Medicine, Division of Cardiology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, China
| | - Hesong Zeng
- Department of Internal Medicine, Division of Cardiology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, China
| |
Collapse
|
15
|
Cheng XW, Narisawa M, Jin X, Murohara T, Kuzuya M. Sirtuin 1 as a potential therapeutic target in pulmonary artery hypertension. J Hypertens 2018; 36:1032-1035. [PMID: 29578961 DOI: 10.1097/hjh.0000000000001694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Xian Wu Cheng
- Department of Cardiology and Heart Center, Yanbian University Hospital, Yanji, Jilin Province, China.,Institute of Innovation for the Future Society.,Department of Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Department of Internal Medicine, Kyung Hee University, Seoul, South Korea
| | - Megumi Narisawa
- Department of Cardiology, Tajimikenlitsu General Hospital, Tajimi, Gifu Prefecture
| | - Xiongjie Jin
- Department of Cardiology and Heart Center, Yanbian University Hospital, Yanji, Jilin Province, China
| | | | - Masafumi Kuzuya
- Institute of Innovation for the Future Society.,Department of Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
16
|
Jia D, He Y, Zhu Q, Liu H, Zuo C, Chen G, Yu Y, Lu A. RAGE-mediated extracellular matrix proteins accumulation exacerbates HySu-induced pulmonary hypertension. Cardiovasc Res 2018; 113:586-597. [PMID: 28407046 DOI: 10.1093/cvr/cvx051] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 03/16/2017] [Indexed: 01/05/2023] Open
Abstract
Aims Extracellular matrix (ECM) proteins accumulation contributes to the progression of pulmonary arterial hypertension (PAH), a rare and fatal cardiovascular condition defined by high pulmonary arterial pressure, whether primary, idiopathic, or secondary to other causes. The receptor for advanced glycation end products (RAGE) is constitutively expressed in the lungs and plays an important role in ECM deposition. Nonetheless, the mechanisms by which RAGE mediates ECM deposition/formation in pulmonary arteries and its roles in PAH progression remain unclear. Methods and results Expression of RAGE and its activating ligands, S100/calgranulins and high mobility group box 1 (HMGB1), were increased in both human and mouse pulmonary arterial smooth muscle cells (PASMCs) under hypoxic conditions and were also strikingly upregulated in pulmonary arteries in hypoxia plus SU5416 (HySu)-induced PAH in mice. RAGE deletion alleviated pulmonary arterial pressure and restrained extracellular matrix accumulation in pulmonary arteries in HySu-induced PAH murine model. Moreover, blocking RAGE activity with a neutralizing antibody in human PASMCs, or RAGE deficiency in mouse PASMCs exposed to hypoxia, suppressed the expression of fibrotic proteins by reducing TGF-β1 expression. RAGE reconstitution in deficient mouse PASMCs restored hypoxia-stimulated TGF-β1 production via ERK1/2 and p38 MAPK pathway activation and subsequently increased ECM protein expression. Interestingly, HMGB1 acting on RAGE, not toll-like receptor 4 (TLR4), induced ECM deposition in PASMCs. Finally, in both idiopathic PAH patients and HySu-induced PAH mice, soluble RAGE (sRAGE) levels in serum were significantly elevated compared to those in controls. Conclusions Activation of RAGE facilitates the development of hypoxia-induced pulmonary hypertension by increase of ECM deposition in pulmonary arteries. Our results indicate that sRAGE may be a potential biomarker for PAH diagnosis and disease severity, and that RAGE may be a promising target for PAH treatment.
Collapse
Affiliation(s)
- Daile Jia
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijiner Road, Shanghai 200025, China.,Key Laboratory of Food Safety Research, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, 320 yueyang Road, Shanghai 200031, China
| | - Yuhu He
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijiner Road, Shanghai 200025, China
| | - Qian Zhu
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijiner Road, Shanghai 200025, China.,Key Laboratory of Food Safety Research, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, 320 yueyang Road, Shanghai 200031, China
| | - Huan Liu
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijiner Road, Shanghai 200025, China
| | - Caojian Zuo
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijiner Road, Shanghai 200025, China
| | - Guilin Chen
- Key Laboratory of Food Safety Research, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, 320 yueyang Road, Shanghai 200031, China
| | - Ying Yu
- Key Laboratory of Food Safety Research, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, 320 yueyang Road, Shanghai 200031, China
| | - Ankang Lu
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijiner Road, Shanghai 200025, China
| |
Collapse
|
17
|
Ruiz G, Yeaw J, Lickert CA, De AP, Wade RL, Pruett J, Drake W. Using Real World Evidence to Describe Pulmonary Arterial Hypertension Treatment Patterns, Healthcare Resource Utilization, and Costs Associated with PDE-5 Inhibitor Monotherapy. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2018; 5:206-219. [PMID: 35620777 PMCID: PMC9090461 DOI: 10.36469/9812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background: Pulmonary arterial hypertension (PAH) is described by proliferation of small pulmonary arteries leading to increased pulmonary vascular resistance, right ventricular failure, and death. Research confirms long-term improvement in composite morbidity and mortality endpoints on some endothelin receptor antagonists alone and in combination with phosphodiesterase type 5 inhibitors (PDE-5is) but not with PDE-5i monotherapy. While current treatment guidelines incorporate these findings, a substantial number of patients are started or maintained on PDE-5i monotherapy. Objectives: This study describes real-world clinical practice and treatment patterns with PDE-5i monotherapy including events indicative of clinical worsening, treatment modifications, adherence, allcause healthcare resource utilization, and costs. Methods: This retrospective study analyzed PharMetrics Plus claims data including 150 million lives; study period was January 1, 2009 through December 31, 2013. Eligible patients were ≥18 years with ≥1 inpatient or ≥2 outpatient claims ≥30 days apart, a diagnosis of pulmonary hypertension or other chronic pulmonary heart disease, and an initial PDE-5i prescription. To include only World Health Organization group 1 PAH patients, ≥1 encounter for right-heart catheterization or Doppler echocardiogram was required during the pre-index period. Results: PDE-5i monotherapy for PAH treatment was associated with high treatment modification rates, low adherence, increased healthcare resource utilization, and high costs. At 12 months post index, 41.5% of patients experienced treatment modification. For the index therapy, 47% of patients had ≥80% adherence to therapy. Almost 50% of patients had ≥1 hospitalization, with costs increased three fold to $197 111 compared to $59 164 for non-hospitalized patients. Conclusions: Initial treatment with PDE-5i monotherapy was associated with substantial direct medical costs, including hospitalizations and emergency department visits, low therapy adherence and a high rate of treatment modifications.
Collapse
Affiliation(s)
- George Ruiz
- Pulmonary Hypertension Program, Medstar Heart Institute, Washington, DC, USA
| | | | | | | | | | - Janis Pruett
- Actelion Pharmaceuticals US, Inc., South San Francisco, CA, USA
| | - William Drake
- Actelion Pharmaceuticals US, Inc., South San Francisco, CA, USA
| |
Collapse
|
18
|
Jensen CW, Goldstone AB, Woo YJ. Treatment and Prognosis of Pulmonary Hypertension in the Left Ventricular Assist Device Patient. Curr Heart Fail Rep 2017; 13:140-50. [PMID: 27241336 DOI: 10.1007/s11897-016-0288-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This review will discuss the medical management of pulmonary hypertension in patients with left ventricular assist devices. Although much has been written on the management of primary pulmonary hypertension, also called pulmonary arterial hypertension, this review will instead focus on the treatment of pulmonary hypertension secondary to left heart disease. The relevant pharmacotherapy can be divided into medications for treating heart failure, such as diuretics and β-blockers, and medications for treating pulmonary hypertension. We also discuss important preoperative considerations in patients with pulmonary hypertension; the relationships between left ventricular assist devices, pulmonary hemodynamics, and right heart failure; as well as optimal perioperative and long-term postoperative medical management of pulmonary hypertension.
Collapse
Affiliation(s)
- Christopher W Jensen
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Andrew B Goldstone
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA. .,Department of Bioengineering, Stanford University, Falk Building CV-235, 300 Pasteur Drive, Stanford, CA, 94305-5407, USA.
| |
Collapse
|
19
|
Barbieri M, Ghio S, D’Alto M, Albera C, Carignola R, Mulè M, Vitulo P, Vighini M, Silvestri R, Zamboni W, Vizza CD. Initial combination therapy for patients with pulmonary arterial hypertension (PAH): a budget impact analysis from the perspective of the Italian national healthcare system. Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2018.1411259] [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]
Affiliation(s)
- Marco Barbieri
- Centre for Health Economics, University of York, York, UK
| | - Stefano Ghio
- Department of Cardiology, S. Matteo Hospital, Pavia, Italy
| | - Michele D’Alto
- Department of Cardiology, Second University of Naples, S. Matteo Hospital, Monaldi Hospital, Naples, Italy
| | - Carlo Albera
- Department of Clinical and Biological Sciences, Interstitial and Rare Lung Disease Unit, University of Turin, Orbassano, Turin, Italy
| | - Renato Carignola
- Department of Clinical and Biological Science, University of Turin, Hospital Internal Medicine I, Orbassano, Turin, Italy
| | - Massimiliano Mulè
- Cardiothoracic-Vascular and Transplant Department, A.O.U. Policlinico, Vittorio Emanuele, Catania, Italy
| | - Patrizio Vitulo
- Pulmonology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS – ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | | | | | | | - Carmine Dario Vizza
- Pulmonary Hypertension Unit, Department of Cardiovascular and Respiratory Disease, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
20
|
|
21
|
Chen Y, Yuan T, Zhang H, Yan Y, Wang D, Fang L, Lu Y, Du G. Activation of Nrf2 Attenuates Pulmonary Vascular Remodeling via Inhibiting Endothelial-to-Mesenchymal Transition: an Insight from a Plant Polyphenol. Int J Biol Sci 2017; 13:1067-1081. [PMID: 28924387 PMCID: PMC5599911 DOI: 10.7150/ijbs.20316] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/26/2017] [Indexed: 12/20/2022] Open
Abstract
The endothelial-to-mesenchymal transition (EndMT) has been demonstrated to be involved in pulmonary vascular remodeling. It is partly attributed to oxidative and inflammatory stresses in endothelial cells. In current study, we conducted a series of experiments to clarify the effect of salvianolic acid A (SAA), a kind of polyphenol compound, in the process of EndMT in human pulmonary arterial endothelial cells and in vivo therapeutic efficacy on vascular remodeling in monocrotaline (MCT)-induced EndMT. EndMT was induced by TGFβ1 in human pulmonary arterial endothelial cells (HPAECs). SAA significantly attenuated EndMT, simultaneously inhibited cell migration and reactive oxygen species (ROS) formation. In MCT-induced pulmonary arterial hypertension (PAH) model, SAA improved vascular function, decreased TGFβ1 level and inhibited inflammation. Mechanistically, SAA stimulated Nrf2 translocation and subsequent heme oxygenase-1 (HO-1) up-regulation. The effect of SAA on EndMT in vitro was abolished by ZnPP, a HO-1 inhibitor. In conclusion, this study indicates a deleterious impact of oxidative stress on EndMT. Polyphenol antioxidant treatment may provide an adjunctive action to alleviate pulmonary vascular remodeling via inhibiting EndMT.
Collapse
Affiliation(s)
- Yucai Chen
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines
| | - Tianyi Yuan
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines
- Beijing Key Laboratory of Drug Targets Identification and Drug Screening
| | - Huifang Zhang
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines
| | - Yu Yan
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines
| | - Danshu Wang
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines
| | - Lianhua Fang
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines
| | - Yang Lu
- Beijing Key Laboratory of Polymorphic Drugs, Institute of Materia Medica Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China
| | - Guanhua Du
- Beijing Key Laboratory of Drug Targets Identification and Drug Screening
| |
Collapse
|
22
|
Gómez Mesa JE. Nuevas intervenciones en hipertensión arterial pulmonar. REVISTA COLOMBIANA DE CARDIOLOGÍA 2017. [DOI: 10.1016/j.rccar.2017.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
23
|
Xiao T, Xie L, Huang M, Shen J. Differential expression of microRNA in the lungs of rats with pulmonary arterial hypertension. Mol Med Rep 2016; 15:591-596. [PMID: 28000863 PMCID: PMC5364860 DOI: 10.3892/mmr.2016.6043] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 11/03/2016] [Indexed: 01/08/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is a chronic disorder of the small pulmonary arteries, and the efficacy of the therapies and the prognosis remain poor. The pathobiology of PAH is complex, and needs to be elucidated by multiple approaches. The present study used a monocrotaline-induced PAH rat model to perform a comprehensive microRNA (miRNA) microarray screening in the lungs and identified 16 downregulated miRNAs in the lungs from PAH rats. High-enrichment gene ontology (GO) analysis identified several sets of genes, and established the miRNA-mRNA network by outlining the interactions of miRNA and GO-associated genes. Three downregulated miRNAs [miRNA 125-3p (miR-125-3p), miR-148-3p and miR-193] displayed the most marked regulatory function, and miR-148-3p and miR-193 were observed to have the highest number of target mRNAs. Signaling pathway analysis demonstrated 26 signal transduction pathways, with MAPK, TGF-β and cell cycle signaling as the most prominent. In addition, 342 genes were identified as the potential targets of these 16 miRNAs. Thus, a set of miRNAs in the lungs from rats with PAH and novel associations between biological events and PAH pathogenesis were identified, providing potential therapeutic targets for this disorder.
Collapse
Affiliation(s)
- Tingting Xiao
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, P.R. China
| | - Lijian Xie
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, P.R. China
| | - Min Huang
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, P.R. China
| | - Jie Shen
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, P.R. China
| |
Collapse
|
24
|
Yaoita N, Satoh K, Shimokawa H. Novel Therapeutic Targets of Pulmonary Hypertension. Arterioscler Thromb Vasc Biol 2016; 36:e97-e102. [DOI: 10.1161/atvbaha.116.308263] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nobuhiro Yaoita
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kimio Satoh
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| |
Collapse
|
25
|
Update on pulmonary arterial hypertension. Rev Clin Esp 2016. [DOI: 10.1016/j.rceng.2016.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
26
|
Zamanian RT, Levine DJ, Bourge RC, De Souza SA, Rosenzweig EB, Alnuaimat H, Burger C, Mathai SC, Leedom N, DeAngelis K, Lim A, De Marco T. An observational study of inhaled-treprostinil respiratory-related safety in patients with pulmonary arterial hypertension. Pulm Circ 2016; 6:329-37. [PMID: 27683610 DOI: 10.1086/688059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Inhaled treprostinil (Tyvaso) has been shown to be a safe and effective addition to pulmonary arterial hypertension (PAH) oral therapies; however, the respiratory-related safety profile of inhaled treprostinil required further elucidation in the setting of routine clinical care. The objectives of this study were to characterize respiratory-related adverse events (AEs) associated with current or recent treatment with inhaled treprostinil and to compare the incidence of respiratory-related AEs in PAH patients treated with inhaled treprostinil with that in patients treated with other Food and Drug Administration (FDA)-approved PAH therapies. This was a long-term, prospective, observational study. All respiratory-related AEs were recorded during the study. The number of PAH patients enrolled was 1,333, 666 treated with inhaled treprostinil and 667 controls (treated with an FDA-approved PAH therapy other than inhaled treprostinil), for a total of 958 and 1,094 patient-years of exposure, respectively. In the inhaled-treprostinil group, 1,281 respiratory-related AEs were reported in 403 patients (61%), and in the control group, 1,295 respiratory-related AEs were reported in 388 patients (58%). Cough, throat irritation, nasal discomfort, and hemoptysis were the most common respiratory-related AEs (occurring in ≥2% of patients in either treatment group) that demonstrated a higher number of events per patient-year of exposure in the inhaled-treprostinil group than in the control group (risk ratio [95% confidence interval]: 1.487 [1.172-1.887], 3.777 [2.050-6.956], 2.039 [1.072-3.879], and 1.957 [1.024-3.741], respectively). Overall, inhaled treprostinil was well tolerated by PAH patients in routine clinical care, with respiratory-related AEs consistent with the known safety profile (trial registration: clinicaltrials.gov identifier: NCT01266265).
Collapse
Affiliation(s)
- R T Zamanian
- Vera Moulton Wall Center for Pulmonary Vascular Disease at Stanford University, Stanford, California, USA
| | - D J Levine
- University of Texas Health Science Center, San Antonio, Texas, USA
| | - R C Bourge
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - S A De Souza
- Winthrop University Hospital, Mineola, New York, USA
| | - E B Rosenzweig
- Columbia University Medical Center, New York, New York, USA
| | - H Alnuaimat
- University of Florida, Gainesville, Florida, USA
| | - C Burger
- Mayo Clinic Jacksonville, Jacksonville, Florida, USA
| | - S C Mathai
- Johns Hopkins University, Baltimore, Maryland, USA
| | - N Leedom
- United Therapeutics, Research Triangle Park, North Carolina, USA
| | - K DeAngelis
- United Therapeutics, Research Triangle Park, North Carolina, USA
| | - A Lim
- United Therapeutics, Research Triangle Park, North Carolina, USA
| | - T De Marco
- University of California, San Francisco, California, USA
| |
Collapse
|
27
|
Fuji S, Matsushita S, Hyodo K, Osaka M, Sakamoto H, Tanioka K, Miyakawa K, Kubota M, Hiramatsu Y, Tokunaga C. Association between endothelial function and micro-vascular remodeling measured by synchrotron radiation pulmonary micro-angiography in pulmonary arterial hypertension. Gen Thorac Cardiovasc Surg 2016; 64:597-603. [PMID: 27393332 DOI: 10.1007/s11748-016-0684-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/01/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Pulmonary arterial hypertension (PAH) is a progressive disease which causes increased vascular resistance. In this study, our purpose was to quantify the micro-vascular remodeling in monocrotaline-induced PAH rats using synchrotron radiation pulmonary micro-angiography (SRPA), a method we have previously established in an in vivo rat model. To determine the relationship between endothelial function and vascular remodeling, the local expression of endothelin-1 (ET-1), endothelial nitric oxide synthase (eNOS) and vascular endothelial growth factor (VEGF) was evaluated using immunohistochemical staining. METHODS Monocrotaline-induced PAH rats were created by subcutaneous injection of monocrotaline. After 2 weeks, SRPA was performed at the Photon Factory of the High Energy Accelerator Research Organization. The internal diameters of pulmonary arterioles were measured using SRPA images. Semi-quantified analyses of ET-1, eNOS and VEGF expression in pulmonary arterioles were performed by immunohistochemical staining. RESULTS Micro-vascular density and the internal diameters of pulmonary arterioles were significantly decreased in PAH. ET-1 expression was significantly increased in PAH compared with the control (1.53 ± 0.45 vs. 0.80 ± 0.14) and eNOS expression was significantly decreased in PAH compared with the control (1.12 ± 0.59 vs. 1.91 ± 0.66), although VEGF expression did not differ between the groups. CONCLUSIONS SRPA can be effectively used for visualizing the decreased pulmonary micro-vasculature associated with PAH. Increased ET-1 expression and decreased eNOS expression may contribute to the proliferation and vasospasm of pulmonary arterioles induced by endothelial dysfunction due to PAH. This SRPA technology may help to identify a correlation between endothelial function and micro-vasculature remodeling in PAH.
Collapse
Affiliation(s)
- Satoko Fuji
- School of Medicine, University of Tsukuba, Tsukuba, Japan
| | | | - Kazuyuki Hyodo
- Photon Factory, High Energy Accelerator Research Organization, Tsukuba, Japan
| | - Motoo Osaka
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8577, Japan
| | - Hiroaki Sakamoto
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8577, Japan
| | | | | | - Misao Kubota
- NHK Science and Technology Research Laboratories, Tsukuba, Japan
| | - Yuji Hiramatsu
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8577, Japan
| | - Chiho Tokunaga
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8577, Japan.
| |
Collapse
|
28
|
Protective Roles of Endothelial AMP-Activated Protein Kinase Against Hypoxia-Induced Pulmonary Hypertension in Mice. Circ Res 2016; 119:197-209. [DOI: 10.1161/circresaha.115.308178] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 05/23/2016] [Indexed: 12/31/2022]
Abstract
Rationale:
Endothelial AMP-activated protein kinase (AMPK) plays an important role for vascular homeostasis, and its role is impaired by vascular inflammation. However, the role of endothelial AMPK in the pathogenesis of pulmonary arterial hypertension (PAH) remains to be elucidated.
Objective:
To determine the role of endothelial AMPK in the development of PAH.
Methods and Results:
Immunostaining showed that endothelial AMPK is downregulated in the pulmonary arteries of patients with PAH and hypoxia mouse model of pulmonary hypertension (PH). To elucidate the role of endothelial AMPK in PH, we used endothelial-specific AMPK-knockout mice (
eAMPK
–/–
), which were exposed to hypoxia. Under normoxic condition,
eAMPK
–/–
mice showed the normal morphology of pulmonary arteries compared with littermate controls (
eAMPK
flox/flox
). In contrast, development of hypoxia-induced PH was accelerated in
eAMPK
–/–
mice compared with controls. Furthermore, the exacerbation of PH in
eAMPK
–/–
mice was accompanied by reduced endothelial function, upregulation of growth factors, and increased proliferation of pulmonary artery smooth muscle cells. Importantly, conditioned medium from endothelial cells promoted pulmonary artery smooth muscle cell proliferation, which was further enhanced by the treatment with AMPK inhibitor. Serum levels of inflammatory cytokines, including tumor necrosis factor-α and interferon-γ were significantly increased in patients with PAH compared with healthy controls. Consistently, endothelial AMPK and cell proliferation were significantly reduced by the treatment with serum from patients with PAH compared with controls. Importantly, long-term treatment with metformin, an AMPK activator, significantly attenuated hypoxia-induced PH in mice.
Conclusions:
These results indicate that endothelial AMPK is a novel therapeutic target for the treatment of PAH.
Collapse
|
29
|
Abstract
Twenty years ago, Rho-kinase was identified as an important downstream effector of the small GTP-binding protein, RhoA. Thereafter, a series of studies demonstrated the important roles of Rho-kinase in the cardiovascular system. The RhoA/Rho-kinase pathway is now widely known to play important roles in many cellular functions, including contraction, motility, proliferation, and apoptosis, and its excessive activity induces oxidative stress and promotes the development of cardiovascular diseases. Furthermore, the important role of Rho-kinase has been demonstrated in the pathogenesis of vasospasm, arteriosclerosis, ischemia/reperfusion injury, hypertension, pulmonary hypertension, and heart failure. Cyclophilin A is secreted by vascular smooth muscle cells and inflammatory cells and activated platelets in a Rho-kinase-dependent manner, playing important roles in a wide range of cardiovascular diseases. Thus, the RhoA/Rho-kinase pathway plays crucial roles under both physiological and pathological conditions and is an important therapeutic target in cardiovascular medicine. Recently, functional differences between ROCK1 and ROCK2 have been reported in vitro. ROCK1 is specifically cleaved by caspase-3, whereas granzyme B cleaves ROCK2. However, limited information is available on the functional differences and interactions between ROCK1 and ROCK2 in the cardiovascular system in vivo. Herein, we will review the recent advances about the importance of RhoA/Rho-kinase in the cardiovascular system.
Collapse
Affiliation(s)
- Hiroaki Shimokawa
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Shinichiro Sunamura
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kimio Satoh
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| |
Collapse
|
30
|
Abstract
Despite >100 clinical trials, only 2 new drugs had been approved by the US Food and Drug Administration for the treatment of chronic heart failure in more than a decade: the aldosterone antagonist eplerenone in 2003 and a fixed dose combination of hydralazine-isosorbide dinitrate in 2005. In contrast, 2015 has witnessed the Food and Drug Administration approval of 2 new drugs, both for the treatment of chronic heart failure with reduced ejection fraction: ivabradine and another combination drug, sacubitril/valsartan or LCZ696. Seemingly overnight, a range of therapeutic possibilities, evoking new physiological mechanisms, promise great hope for a disease that often carries a prognosis worse than many forms of cancer. Importantly, the newly available therapies represent a culmination of basic and translational research that actually spans many decades. This review will summarize newer drugs currently being used in the treatment of heart failure, as well as newer strategies increasingly explored for their utility during the stages of the heart failure syndrome.
Collapse
Affiliation(s)
- Anjali Tiku Owens
- From the Cardiovascular Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Susan C Brozena
- From the Cardiovascular Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Mariell Jessup
- From the Cardiovascular Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia.
| |
Collapse
|
31
|
Salvianolic acid A attenuates vascular remodeling in a pulmonary arterial hypertension rat model. Acta Pharmacol Sin 2016; 37:772-82. [PMID: 27180980 DOI: 10.1038/aps.2016.22] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 03/08/2016] [Indexed: 12/28/2022] Open
Abstract
AIM The current therapeutic approaches have a limited effect on the dysregulated pulmonary vascular remodeling, which is characteristic of pulmonary arterial hypertension (PAH). In this study we examined whether salvianolic acid A (SAA) extracted from the traditional Chinese medicine 'Dan Shen' attenuated vascular remodeling in a PAH rat model, and elucidated the underlying mechanisms. METHODS PAH was induced in rats by injecting a single dose of monocrotaline (MCT 60 mg/kg, sc). The rats were orally treated with either SAA (0.3, 1, 3 mg·kg(-1)·d(-1)) or a positive control bosentan (30 mg·kg(-1)·d(-1)) for 4 weeks. Echocardiography and hemodynamic measurements were performed on d 28. Then the hearts and lungs were harvested, the organ indices and pulmonary artery wall thickness were calculated, and biochemical and histochemical analysis were conducted. The levels of apoptotic and signaling proteins in the lungs were measured using immunoblotting. RESULTS Treatment with SAA or bosentan effectively ameliorated MCT-induced pulmonary artery remodeling, pulmonary hemodynamic abnormalities and the subsequent increases of right ventricular systolic pressure (RVSP). Furthermore, the treatments significantly attenuated MCT-induced hypertrophic damage of myocardium, parenchymal injury and collagen deposition in the lungs. Moreover, the treatments attenuated MCT-induced apoptosis and fibrosis in the lungs. The treatments partially restored MCT-induced reductions of bone morphogenetic protein type II receptor (BMPRII) and phosphorylated Smad1/5 in the lungs. CONCLUSION SAA ameliorates the pulmonary arterial remodeling in MCT-induced PAH rats most likely via activating the BMPRII-Smad pathway and inhibiting apoptosis. Thus, SAA may have therapeutic potential for the patients at high risk of PAH.
Collapse
|
32
|
Mejía Chew CR, Alcolea Batres S, Ríos Blanco JJ. Update in pulmonary arterial hypertension. Rev Clin Esp 2016; 216:436-444. [PMID: 27156166 DOI: 10.1016/j.rce.2016.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 01/26/2016] [Accepted: 04/01/2016] [Indexed: 01/08/2023]
Abstract
Pulmonary arterial hypertension is a rare and progressive disease that mainly affects the pulmonary arterioles (precapillary), regardless of the triggering aetiology. The prevalence of pulmonary hypertension and pulmonary arterial hypertension in Spain is estimated at 19.2 and 16 cases per million inhabitants, respectively. The diagnosis of pulmonary arterial hypertension is based on haemodynamic criteria (mean pulmonary artery pressure ≥25mmHg, pulmonary capillary wedge pressure ≤15mmHg and pulmonary vascular resistance >3 Wood units) and therefore requires the implementation of right cardiac catheterisation. Sequential therapy with a single drug has been used in clinical practice. However, recent European guidelines recommend combined initial therapy in some situations. This review conducts a critical update of our knowledge of this disease according to the latest guidelines and recommendations.
Collapse
Affiliation(s)
- C R Mejía Chew
- Grupo Hipertensión Pulmonar La Paz (GRUHPAZ), Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, España.
| | - S Alcolea Batres
- Grupo Hipertensión Pulmonar La Paz (GRUHPAZ), Servicio de Neumología, Hospital Universitario La Paz, Madrid, España
| | - J J Ríos Blanco
- Grupo Hipertensión Pulmonar La Paz (GRUHPAZ), Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, España
| |
Collapse
|
33
|
Fukushima S, Miyagawa S, Sakai Y, Sawa Y. A sustained-release drug-delivery system of synthetic prostacyclin agonist, ONO-1301SR: a new reagent to enhance cardiac tissue salvage and/or regeneration in the damaged heart. Heart Fail Rev 2016; 20:401-13. [PMID: 25708182 PMCID: PMC4464640 DOI: 10.1007/s10741-015-9477-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cardiac failure is a major cause of mortality and morbidity worldwide, since the standard treatment for cardiac failure in the clinical practice is chiefly to focus on removal of insults against the heart or minimisation of additional factors to exacerbate cardiac failure, but not on regeneration of the damaged cardiac tissue. A synthetic prostacyclin agonist, ONO-1301, has been developed as a long-acting drug for acute and chronic pathologies related to regional ischaemia, inflammation and/or interstitial fibrosis by pre-clinical studies. In addition, poly-lactic co-glycolic acid-polymerised form of ONO-1301, ONO-1301SR, was generated to achieve a further sustained release of this drug into the targeted region. This unique reagent has been shown to act on fibroblasts, vascular smooth muscle cells and endothelial cells in the tissue via the prostaglandin IP receptor to exert paracrinal release of multiple protective factors, such as hepatocyte growth factor, vascular endothelial growth factor or stromal cell-derived factor-1, into the adjacent damaged tissue, which is salvaged and/or regenerated as a result. Our laboratory developed a new surgical approach to treat acute and chronic cardiac failure using a variety of animal models, in which ONO-1301SR is directly placed over the cardiac surface to maximise the therapeutic effects and minimise the systemic complications. This review summarises basic and pre-clinical information of ONO-1301 and ONO-1301SR as a new reagent to enhance tissue salvage and/or regeneration, with a particular focus on the therapeutic effects on acute and chronic cardiac failure and underlying mechanisms, to explore a potential in launching the clinical study.
Collapse
Affiliation(s)
- Satsuki Fukushima
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan,
| | | | | | | |
Collapse
|
34
|
Abstract
Pulmonary arterial hypertension (PAH) is a progressive disease marked by the irreversible pulmonary vascular changes of vasoconstriction, thrombosis, and proliferation of smooth muscle and endothelial cells. The untreated clinical course is characterized by progressive dyspnea and a median survival of less than 3 years. Many of these patients are of child-bearing age; however, pregnancy leads to physiologic changes that are particularly poorly tolerated in PAH, conferring a 30%-56% mortality. We present a case of PAH that spontaneously resolved after termination of pregnancy and recurred during each of two subsequent pregnancies. To our knowledge, this case is unique, because no cases of spontaneous resolution of idiopathic PAH have been reported in adults, nor have there been any reports of pulmonary hypertension that is isolated to the gestational period.
Collapse
Affiliation(s)
- Matthew Moll
- Boston Medical Center, Boston, Massachusetts, USA
| | - Julie G Payne
- Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Melissa H Tukey
- Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Harrison W Farber
- Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts, USA
| |
Collapse
|
35
|
Labrousse-Arias D, Castillo-González R, Rogers NM, Torres-Capelli M, Barreira B, Aragonés J, Cogolludo Á, Isenberg JS, Calzada MJ. HIF-2α-mediated induction of pulmonary thrombospondin-1 contributes to hypoxia-driven vascular remodelling and vasoconstriction. Cardiovasc Res 2015; 109:115-30. [PMID: 26503986 PMCID: PMC4692290 DOI: 10.1093/cvr/cvv243] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 10/11/2015] [Indexed: 11/12/2022] Open
Abstract
Aims Hypoxic conditions stimulate pulmonary vasoconstriction and vascular remodelling, both pathognomonic changes in pulmonary arterial hypertension (PAH). The secreted protein thrombospondin-1 (TSP1) is involved in the maintenance of lung homeostasis. New work identified a role for TSP1 in promoting PAH. Nonetheless, it is largely unknown how hypoxia regulates TSP1 in the lung and whether this contributes to pathological events during PAH. Methods and results In cell and animal experiments, we found that hypoxia induces TSP1 in lungs, pulmonary artery smooth muscle cells and endothelial cells, and pulmonary fibroblasts. Using a murine model of constitutive hypoxia, gene silencing, and luciferase reporter experiments, we found that hypoxia-mediated induction of pulmonary TSP1 is a hypoxia-inducible factor (HIF)-2α-dependent process. Additionally, hypoxic tsp1−/− pulmonary fibroblasts and pulmonary artery smooth muscle cell displayed decreased migration compared with wild-type (WT) cells. Furthermore, hypoxia-mediated induction of TSP1 destabilized endothelial cell–cell interactions. This provides genetic evidence that TSP1 contributes to vascular remodelling during PAH. Expanding cell data to whole tissues, we found that, under hypoxia, pulmonary arteries (PAs) from WT mice had significantly decreased sensitivity to acetylcholine (Ach)-stimulated endothelial-dependent vasodilation. In contrast, hypoxic tsp1−/− PAs retained sensitivity to Ach, mediated in part by TSP1 regulation of pulmonary Kv channels. Translating these preclinical studies, we find in the lungs from individuals with end-stage PAH, both TSP1 and HIF-2α protein expression increased in the pulmonary vasculature compared with non-PAH controls. Conclusions These findings demonstrate that HIF-2α is clearly implicated in the TSP1 pulmonary regulation and provide new insights on its contribution to PAH-driven vascular remodelling and vasoconstriction.
Collapse
Affiliation(s)
- David Labrousse-Arias
- Instituto de Investigacion Sanitaria Princesa (IIS-IP), Department of Medicine, School of Medicine, Universidad Autonoma of Madrid, Diego de Leon 62, Madrid 28006, Spain
| | - Raquel Castillo-González
- Instituto de Investigacion Sanitaria Princesa (IIS-IP), Department of Medicine, School of Medicine, Universidad Autonoma of Madrid, Diego de Leon 62, Madrid 28006, Spain
| | - Natasha M Rogers
- Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh School of Medicine Pittsburgh, PA, USA
| | - Mar Torres-Capelli
- Instituto de Investigacion Sanitaria Princesa (IIS-IP), Department of Medicine, School of Medicine, Universidad Autonoma of Madrid, Diego de Leon 62, Madrid 28006, Spain
| | - Bianca Barreira
- Department of Pharmacology, Faculty of Medicine, Universidad Complutense of Madrid, Madrid, Spain
| | - Julián Aragonés
- Instituto de Investigacion Sanitaria Princesa (IIS-IP), Department of Medicine, School of Medicine, Universidad Autonoma of Madrid, Diego de Leon 62, Madrid 28006, Spain
| | - Ángel Cogolludo
- Department of Pharmacology, Faculty of Medicine, Universidad Complutense of Madrid, Madrid, Spain Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), Spain
| | - Jeffrey S Isenberg
- Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh School of Medicine Pittsburgh, PA, USA Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, E1258, BST, 200 Lothrop Street, Pittsburgh, PA 15261, USA
| | - María J Calzada
- Instituto de Investigacion Sanitaria Princesa (IIS-IP), Department of Medicine, School of Medicine, Universidad Autonoma of Madrid, Diego de Leon 62, Madrid 28006, Spain
| |
Collapse
|
36
|
Qian J, Tian W, Jiang X, Tamosiuniene R, Sung YK, Shuffle EM, Tu AB, Valenzuela A, Jiang S, Zamanian RT, Fiorentino DF, Voelkel NF, Peters-Golden M, Stenmark KR, Chung L, Rabinovitch M, Nicolls MR. Leukotriene B4 Activates Pulmonary Artery Adventitial Fibroblasts in Pulmonary Hypertension. Hypertension 2015; 66:1227-1239. [PMID: 26558820 DOI: 10.1161/hypertensionaha.115.06370] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 09/10/2015] [Indexed: 12/14/2022]
Abstract
A recent study demonstrated a significant role for leukotriene B4 (LTB4) causing pulmonary vascular remodeling in pulmonary arterial hypertension. LTB4 was found to directly injure luminal endothelial cells and promote growth of the smooth muscle cell layer of pulmonary arterioles. The purpose of this study was to determine the effects of LTB4 on the pulmonary adventitial layer, largely composed of fibroblasts. Here, we demonstrate that LTB4 enhanced human pulmonary artery adventitial fibroblast proliferation, migration, and differentiation in a dose-dependent manner through its cognate G-protein-coupled receptor, BLT1. LTB4 activated human pulmonary artery adventitial fibroblast by upregulating p38 mitogen-activated protein kinase as well as Nox4-signaling pathways. In an autoimmune model of pulmonary hypertension, inhibition of these pathways blocked perivascular inflammation, decreased Nox4 expression, reduced reactive oxygen species production, reversed arteriolar adventitial fibroblast activation, and attenuated pulmonary hypertension development. This study uncovers a novel mechanism by which LTB4 further promotes pulmonary arterial hypertension pathogenesis, beyond its established effects on endothelial and smooth muscle cells, by activating adventitial fibroblasts.
Collapse
Affiliation(s)
- Jin Qian
- VA Palo Alto Health Care System, Palo Alto, CA 94304.,Stanford University, School of Medicine, Stanford, CA 94305
| | - Wen Tian
- VA Palo Alto Health Care System, Palo Alto, CA 94304.,Stanford University, School of Medicine, Stanford, CA 94305
| | - Xinguo Jiang
- VA Palo Alto Health Care System, Palo Alto, CA 94304.,Stanford University, School of Medicine, Stanford, CA 94305
| | - Rasa Tamosiuniene
- VA Palo Alto Health Care System, Palo Alto, CA 94304.,Stanford University, School of Medicine, Stanford, CA 94305
| | - Yon K Sung
- VA Palo Alto Health Care System, Palo Alto, CA 94304.,Stanford University, School of Medicine, Stanford, CA 94305
| | - Eric M Shuffle
- VA Palo Alto Health Care System, Palo Alto, CA 94304.,Stanford University, School of Medicine, Stanford, CA 94305
| | - Allen B Tu
- VA Palo Alto Health Care System, Palo Alto, CA 94304.,Stanford University, School of Medicine, Stanford, CA 94305
| | | | - Shirley Jiang
- Stanford University, School of Medicine, Stanford, CA 94305
| | | | | | | | | | - Kurt R Stenmark
- University of Colorado Denver, School of Medicine, Aurora, CO 80045
| | - Lorinda Chung
- Stanford University, School of Medicine, Stanford, CA 94305
| | | | - Mark R Nicolls
- VA Palo Alto Health Care System, Palo Alto, CA 94304.,Stanford University, School of Medicine, Stanford, CA 94305
| |
Collapse
|
37
|
Use of outcome measures in pulmonary hypertension clinical trials. Am Heart J 2015; 170:419-29.e3. [PMID: 26385024 DOI: 10.1016/j.ahj.2015.06.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 06/16/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To evaluate the use of surrogate measures in pulmonary hypertension (PH) clinical trials and how it relates to clinical practice. BACKGROUND Studies of pulmonary arterial hypertension (PAH) employ a variety of surrogate measures in addition to clinical events because of a small patient population, participant burden, and costs. The use of these measures in PH drug trials is poorly defined. METHODS We searched PubMed/MEDLINE/Embase for randomized or prospective cohort PAH clinical treatment trials from 1985 to 2013. Extracted data included intervention, trial duration, study design, patient characteristics, and primary and secondary outcome measures. To compare with clinical practice, we assessed the use of surrogate measures in a clinical sample of patients on PH medications at Duke University Medical Center between 2003 and 2014. RESULTS Between 1985 and 2013, 126 PAH trials were identified and analyzed. Surrogate measures served as primary endpoints in 119 trials (94.0%). Inclusion of invasive hemodynamics decreased over time (78.6%, 75.0%, 52.2%; P for trend = .02), while functional testing (7.1%, 60.0%, 81.5%; P for trend < .0001) and functional status or quality of life (0%, 47.6%, 62.8%; P for trend < .0001) increased in PAH trials over the same time periods. Echocardiography data were reported as a primary or secondary outcome in 32 trials (25.4%) with increased use from 1985-1994 to 1995-2004 (7.1% vs 35.0%, P = .04), but the trend did not continue to 2005-2013 (25.0%). In comparison, among 450 patients on PAH therapies at our institution between 2003 and 2013, clinical assessments regularly incorporated serial echocardiography and 6-minute walk distance tests (92% and 95% of patients, respectively) and repeat measurement of invasive hemodynamics (46% of patients). CONCLUSIONS The majority of PAH trials have utilized surrogate measures as primary endpoints. The use of these surrogate endpoints has evolved significantly over time with increasing use of patient-centered endpoints and decreasing or stable use of imaging and invasive measures. In contrast, imaging and invasive measures are commonly used in contemporary clinical practice. Further research is needed to validate and standardize currently used measures.
Collapse
|
38
|
Kim JD, Lee A, Choi J, Park Y, Kang H, Chang W, Lee MS, Kim J. Epigenetic modulation as a therapeutic approach for pulmonary arterial hypertension. Exp Mol Med 2015; 47:e175. [PMID: 26228095 PMCID: PMC4525299 DOI: 10.1038/emm.2015.45] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is a rare but progressive and currently incurable disease, which is characterized by vascular remodeling in association with muscularization of the arterioles, medial thickening and plexiform lesion formation. Despite our advanced understanding of the pathogenesis of PAH and the recent therapeutic advances, PAH still remains a fatal disease. In addition, the susceptibility to PAH has not yet been adequately explained. Much evidence points to the involvement of epigenetic changes in the pathogenesis of a number of human diseases including cancer, peripheral hypertension and asthma. The knowledge gained from the epigenetic study of various human diseases can also be applied to PAH. Thus, the pursuit of novel therapeutic targets via understanding the epigenetic alterations involved in the pathogenesis of PAH, such as DNA methylation, histone modification and microRNA, might be an attractive therapeutic avenue for the development of a novel and more effective treatment. This review provides a general overview of the current advances in epigenetics associated with PAH, and discusses the potential for improved treatment through understanding the role of epigenetics in the development of PAH.
Collapse
Affiliation(s)
- Jun-Dae Kim
- Department of Internal Medicine, Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Aram Lee
- Department of Life Systems, Sookmyung Women's University, Seoul, Korea
| | - Jihea Choi
- Department of Life Systems, Sookmyung Women's University, Seoul, Korea
| | - Youngsook Park
- Department of Life Systems, Sookmyung Women's University, Seoul, Korea
| | - Hyesoo Kang
- Department of Life Systems, Sookmyung Women's University, Seoul, Korea
| | - Woochul Chang
- Department of Biology Education, College of Education, Pusan National University, Busan, Korea
| | - Myeong-Sok Lee
- Department of Life Systems, Sookmyung Women's University, Seoul, Korea
| | - Jongmin Kim
- Department of Life Systems, Sookmyung Women's University, Seoul, Korea
| |
Collapse
|
39
|
Lung transplantation for pulmonary hypertension: management of pulmonary hypertension on the waiting list. CURRENT PULMONOLOGY REPORTS 2015. [DOI: 10.1007/s13665-015-0111-y] [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]
|
40
|
Satoh K, Kikuchi N, Kurosawa R, Shimokawa H. PDE1C negatively regulates growth factor receptor degradation and promotes VSMC proliferation. Circ Res 2015; 116:1098-100. [PMID: 25814676 DOI: 10.1161/circresaha.115.306139] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Kimio Satoh
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Nobuhiro Kikuchi
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryo Kurosawa
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| |
Collapse
|
41
|
Sidharta PN, Treiber A, Dingemanse J. Clinical pharmacokinetics and pharmacodynamics of the endothelin receptor antagonist macitentan. Clin Pharmacokinet 2015; 54:457-71. [PMID: 25860376 PMCID: PMC4412377 DOI: 10.1007/s40262-015-0255-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Pulmonary arterial hypertension (PAH) is a progressive disease of the lung vascular system, which leads to right-sided heart failure and ultimately death if untreated. Treatments to regulate the pulmonary vascular pressure target the prostacyclin, nitric oxide, and endothelin (ET) pathways. Macitentan, an oral, once-daily, dual ETA and ETB receptor antagonist with high affinity and sustained receptor binding is the first ET receptor antagonist to show significant reduction of the risk of morbidity and mortality in PAH patients in a large-scale phase III study with a long-term outcome. Here we present a review of the available clinical pharmacokinetic, pharmacodynamic, pharmacokinetic/pharmacodynamic relationship, and drug-drug interaction data of macitentan in healthy subjects, patients with PAH, and in special populations.
Collapse
Affiliation(s)
- P N Sidharta
- Department of Clinical Pharmacology, Actelion Pharmaceuticals Ltd, Gewerbestrasse 16, 4123, Allschwil, Switzerland,
| | | | | |
Collapse
|
42
|
Phosphodiesterase-1 Inhibitory Activity of Two Flavonoids Isolated from Pistacia integerrima J. L. Stewart Galls. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:506564. [PMID: 25945110 PMCID: PMC4402172 DOI: 10.1155/2015/506564] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 03/12/2015] [Accepted: 03/18/2015] [Indexed: 12/11/2022]
Abstract
Pistacia integerrima is one of twenty species among the genus Pistacia. Long horn-shaped galls that develop on this plant are harvested and used in Ayurveda and Indian traditional medicine to make "karkatshringi", a herbal medicine used for the treatment of asthma and different disorders of respiratory tract. However, until now, the molecular mechanisms of action of "karkatshringi" and its chemical characterization are partially known. This study deals with the isolation and characterization of the active constituents from the methanolic extract of P. integerrima galls and it was also oriented to evaluate in vitro and in silico their potential enzymatic inhibitory activity against phosphodiesterase-1 (PDE1), a well-known enzyme involved in airway smooth muscle activity and airway inflammation. Our results showed that the methanolic extract of P. integerrima galls and some of its active constituents [naringenin (1) and 3,5,7,4'-tetrahydroxy-flavanone (2)] are able in vitro to inhibit PDE1 activity (59.20 ± 4.95%, 75.90 ± 5.90%, and 65.25 ± 5.25%, resp.) and demonstrate in silico an interesting interaction with this enzymatic site. Taken together, our results add new knowledge of chemical constituents responsible for the biological activity of P. integerrima and contextually legitimate the use of this plant in folk medicine.
Collapse
|
43
|
Tsai MT, Hsu CH, Luo CY, Hu YN, Roan JN. Bridge-to-recovery strategy using extracorporeal membrane oxygenation for critical pulmonary hypertension complicated with cardiogenic shock. Interact Cardiovasc Thorac Surg 2015; 21:55-61. [DOI: 10.1093/icvts/ivv070] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 03/06/2015] [Indexed: 11/13/2022] Open
|
44
|
Sidharta PN, Krähenbühl S, Dingemanse J. Pharmacokinetic and pharmacodynamic evaluation of macitentan , a novel endothelin receptor antagonist for the treatment of pulmonary arterial hypertension. Expert Opin Drug Metab Toxicol 2015; 11:437-49. [PMID: 25604973 DOI: 10.1517/17425255.2015.1000859] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Pulmonary arterial hypertension (PAH) is a chronic disorder of the pulmonary vasculature characterized by elevated mean pulmonary arterial pressure eventually leading to right-sided heart failure and premature death. Macitentan is an oral, once-daily, dual endothelin (ET)A and ETB receptor antagonist with high affinity and sustained receptor binding that was approved in the USA, Europe, Canada, and Switzerland for the treatment of PAH. AREAS COVERED This review discusses the pharmacokinetics (PK) and pharmacodynamics (PD) of macitentan and its drug interaction potential based on preclinical and clinical data. EXPERT OPINION Up to date, macitentan is the only registered treatment for PAH that significantly reduced morbidity and mortality as a combined endpoint in a long-term event-driven study. The safety profile of macitentan is favorable with respect to hepatic safety and edema/fluid retention and may be better than that of other ET receptor antagonists such as bosentan and ambrisentan. The PK profile supports a once-a-day dosing regimen. Macitentan has limited interactions with other drugs. Based on these characteristics macitentan is an important new addition to the treatment of PAH.
Collapse
Affiliation(s)
- Patricia N Sidharta
- Actelion Pharmaceuticals Ltd., Department of Clinical Pharmacology , Gewerbestrasse 16, CH-4123 Allschwil , Switzerland +41 61 656686 ; +41 61 5656200 ;
| | | | | |
Collapse
|
45
|
Lederer H, Muggli B, Speich R, Treder U, Stricker H, Goede J, Ulrich S, Stämpfli SF, Breitenstein A. Haemosiderin-laden sputum macrophages for diagnosis in pulmonary veno-occlusive disease. PLoS One 2014; 9:e115219. [PMID: 25501010 PMCID: PMC4264865 DOI: 10.1371/journal.pone.0115219] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 11/20/2014] [Indexed: 11/28/2022] Open
Abstract
Aims Pulmonary veno-occlusive disease (PVOD) is a rare condition of pulmonary arterial hypertension (PAH), in which post-capillary veins are affected. Since the therapeutic approach in PVOD differs from other forms of PAH, it is crucial to establish the diagnosis. Due to the fact that affected patients are often hemodynamically unstable, minimal invasive procedures are necessary for the diagnostic work-up. Chronic alveolar haemorrhage has been observed during bronchoalveolar lavage in PVOD cases. This study therefore investigates whether signs of alveolar haemorrhage can also be found in the sputum of these patients. Methods and Results Six patients suffering from PVOD were included in this analysis. As controls, patients with idiopathic PAH (n = 11), chronic thromboembolic PH (n = 9) and with sclerodermia-associated PH (n = 10) were assessed. Sputum from every patient was obtained by a non-invasive manner. The amount of haemosiderin-laden macrophages was determined using the Golde score. There were statistically significant more haemosiderin-laden macrophages in the sputum of patients suffering from PVOD as compared to the other groups (P<0.05). Assuming a cut-off of 200 on the Golde score, all of the 6 PVOD patients surpassed this value compared with only 1 out of the 30 cases with precapillary PH. Thus, sensitivity and specificity with respect to the diagnosis of PVOD was 100% and 97%, respectively. Conclusion The content of haemosiderin-laden macrophages in the sputum of patients suffering from PVOD is significantly higher as compared to other forms of PH and may be useful in the non-invasive diagnostic work-up of these patients.
Collapse
Affiliation(s)
- Heidi Lederer
- Zurich Pulmonary Hypertension Program, Clinic for Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Bettina Muggli
- Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Rudolf Speich
- Zurich Pulmonary Hypertension Program, Clinic for Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Ula Treder
- Zurich Pulmonary Hypertension Program, Clinic for Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Hans Stricker
- Ospedale La Carità, Via all' Ospedale, Locarno, Switzerland
| | - Jeroen Goede
- Department of Hematolgy, University Hospital Zurich, Zurich, Switzerland
| | - Silvia Ulrich
- Zurich Pulmonary Hypertension Program, Clinic for Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Simon F. Stämpfli
- Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Alexander Breitenstein
- Zurich Pulmonary Hypertension Program, Clinic for Internal Medicine, University Hospital Zurich, Zurich, Switzerland
- Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
- Department of Cardiology, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
- * E-mail:
| |
Collapse
|
46
|
|
47
|
Satoh K, Satoh T, Kikuchi N, Omura J, Kurosawa R, Suzuki K, Sugimura K, Aoki T, Nochioka K, Tatebe S, Miyamichi-Yamamoto S, Miura M, Shimizu T, Ikeda S, Yaoita N, Fukumoto Y, Minami T, Miyata S, Nakamura K, Ito H, Kadomatsu K, Shimokawa H. Basigin mediates pulmonary hypertension by promoting inflammation and vascular smooth muscle cell proliferation. Circ Res 2014; 115:738-50. [PMID: 25149188 DOI: 10.1161/circresaha.115.304563] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
RATIONALE Cyclophilin A (CyPA) is secreted from vascular smooth muscle cells (VSMCs) by oxidative stress and promotes VSMC proliferation. However, the role of extracellular CyPA and its receptor Basigin (Bsg, encoded by Bsg) in the pathogenesis of pulmonary hypertension (PH) remains to be elucidated. OBJECTIVE To determine the role of CyPA/Bsg signaling in the development of PH. METHODS AND RESULTS In the pulmonary arteries of patients with PH, immunostaining revealed strong expression of CyPA and Bsg. The pulmonary arteries of CyPA(±) and Bsg(±) mice exposed to normoxia did not differ in morphology compared with their littermate controls. In contrast, CyPA(±) and Bsg(±) mice exposed to hypoxia for 4 weeks revealed significantly reduced right ventricular systolic pressure, pulmonary artery remodeling, and right ventricular hypertrophy compared with their littermate controls. These features were unaltered by bone marrow reconstitution. To further evaluate the role of vascular Bsg, we harvested pulmonary VSMCs from Bsg(+/+) and Bsg(±) mice. Proliferation was significantly reduced in Bsg(±) compared with Bsg(+/+) VSMCs. Mechanistic studies demonstrated that Bsg(±) VSMCs revealed reduced extracellular signal-regulated kinase 1/2 activation and less secretion of cytokines/chemokines and growth factors (eg, platelet-derived growth factor-BB). Finally, in the clinical study, plasma CyPA levels in patients with PH were increased in accordance with the severity of pulmonary vascular resistance. Furthermore, event-free curve revealed that high plasma CyPA levels predicted poor outcome in patients with PH. CONCLUSIONS These results indicate the crucial role of extracellular CyPA and vascular Bsg in the pathogenesis of PH.
Collapse
Affiliation(s)
- Kimio Satoh
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K. Satoh, T.S., N.K., J.O., R.K., K. Suzuki, K. Sugimura, T.A., K.N., S.T., S.M.-Y., M.M., T.S., S.I., N.Y., Y.F., T.M., S.M., H.S.); Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama City, Japan (K.N., H.I.); and Department of Biochemistry, Nagoya University Graduate School of Medicine, Nagoya, Japan (K.K.)
| | - Taijyu Satoh
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K. Satoh, T.S., N.K., J.O., R.K., K. Suzuki, K. Sugimura, T.A., K.N., S.T., S.M.-Y., M.M., T.S., S.I., N.Y., Y.F., T.M., S.M., H.S.); Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama City, Japan (K.N., H.I.); and Department of Biochemistry, Nagoya University Graduate School of Medicine, Nagoya, Japan (K.K.)
| | - Nobuhiro Kikuchi
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K. Satoh, T.S., N.K., J.O., R.K., K. Suzuki, K. Sugimura, T.A., K.N., S.T., S.M.-Y., M.M., T.S., S.I., N.Y., Y.F., T.M., S.M., H.S.); Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama City, Japan (K.N., H.I.); and Department of Biochemistry, Nagoya University Graduate School of Medicine, Nagoya, Japan (K.K.)
| | - Junichi Omura
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K. Satoh, T.S., N.K., J.O., R.K., K. Suzuki, K. Sugimura, T.A., K.N., S.T., S.M.-Y., M.M., T.S., S.I., N.Y., Y.F., T.M., S.M., H.S.); Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama City, Japan (K.N., H.I.); and Department of Biochemistry, Nagoya University Graduate School of Medicine, Nagoya, Japan (K.K.)
| | - Ryo Kurosawa
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K. Satoh, T.S., N.K., J.O., R.K., K. Suzuki, K. Sugimura, T.A., K.N., S.T., S.M.-Y., M.M., T.S., S.I., N.Y., Y.F., T.M., S.M., H.S.); Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama City, Japan (K.N., H.I.); and Department of Biochemistry, Nagoya University Graduate School of Medicine, Nagoya, Japan (K.K.)
| | - Kota Suzuki
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K. Satoh, T.S., N.K., J.O., R.K., K. Suzuki, K. Sugimura, T.A., K.N., S.T., S.M.-Y., M.M., T.S., S.I., N.Y., Y.F., T.M., S.M., H.S.); Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama City, Japan (K.N., H.I.); and Department of Biochemistry, Nagoya University Graduate School of Medicine, Nagoya, Japan (K.K.)
| | - Koichiro Sugimura
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K. Satoh, T.S., N.K., J.O., R.K., K. Suzuki, K. Sugimura, T.A., K.N., S.T., S.M.-Y., M.M., T.S., S.I., N.Y., Y.F., T.M., S.M., H.S.); Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama City, Japan (K.N., H.I.); and Department of Biochemistry, Nagoya University Graduate School of Medicine, Nagoya, Japan (K.K.)
| | - Tatsuo Aoki
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K. Satoh, T.S., N.K., J.O., R.K., K. Suzuki, K. Sugimura, T.A., K.N., S.T., S.M.-Y., M.M., T.S., S.I., N.Y., Y.F., T.M., S.M., H.S.); Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama City, Japan (K.N., H.I.); and Department of Biochemistry, Nagoya University Graduate School of Medicine, Nagoya, Japan (K.K.)
| | - Kotaro Nochioka
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K. Satoh, T.S., N.K., J.O., R.K., K. Suzuki, K. Sugimura, T.A., K.N., S.T., S.M.-Y., M.M., T.S., S.I., N.Y., Y.F., T.M., S.M., H.S.); Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama City, Japan (K.N., H.I.); and Department of Biochemistry, Nagoya University Graduate School of Medicine, Nagoya, Japan (K.K.)
| | - Shunsuke Tatebe
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K. Satoh, T.S., N.K., J.O., R.K., K. Suzuki, K. Sugimura, T.A., K.N., S.T., S.M.-Y., M.M., T.S., S.I., N.Y., Y.F., T.M., S.M., H.S.); Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama City, Japan (K.N., H.I.); and Department of Biochemistry, Nagoya University Graduate School of Medicine, Nagoya, Japan (K.K.)
| | - Saori Miyamichi-Yamamoto
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K. Satoh, T.S., N.K., J.O., R.K., K. Suzuki, K. Sugimura, T.A., K.N., S.T., S.M.-Y., M.M., T.S., S.I., N.Y., Y.F., T.M., S.M., H.S.); Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama City, Japan (K.N., H.I.); and Department of Biochemistry, Nagoya University Graduate School of Medicine, Nagoya, Japan (K.K.)
| | - Masanobu Miura
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K. Satoh, T.S., N.K., J.O., R.K., K. Suzuki, K. Sugimura, T.A., K.N., S.T., S.M.-Y., M.M., T.S., S.I., N.Y., Y.F., T.M., S.M., H.S.); Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama City, Japan (K.N., H.I.); and Department of Biochemistry, Nagoya University Graduate School of Medicine, Nagoya, Japan (K.K.)
| | - Toru Shimizu
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K. Satoh, T.S., N.K., J.O., R.K., K. Suzuki, K. Sugimura, T.A., K.N., S.T., S.M.-Y., M.M., T.S., S.I., N.Y., Y.F., T.M., S.M., H.S.); Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama City, Japan (K.N., H.I.); and Department of Biochemistry, Nagoya University Graduate School of Medicine, Nagoya, Japan (K.K.)
| | - Shohei Ikeda
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K. Satoh, T.S., N.K., J.O., R.K., K. Suzuki, K. Sugimura, T.A., K.N., S.T., S.M.-Y., M.M., T.S., S.I., N.Y., Y.F., T.M., S.M., H.S.); Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama City, Japan (K.N., H.I.); and Department of Biochemistry, Nagoya University Graduate School of Medicine, Nagoya, Japan (K.K.)
| | - Nobuhiro Yaoita
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K. Satoh, T.S., N.K., J.O., R.K., K. Suzuki, K. Sugimura, T.A., K.N., S.T., S.M.-Y., M.M., T.S., S.I., N.Y., Y.F., T.M., S.M., H.S.); Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama City, Japan (K.N., H.I.); and Department of Biochemistry, Nagoya University Graduate School of Medicine, Nagoya, Japan (K.K.)
| | - Yoshihiro Fukumoto
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K. Satoh, T.S., N.K., J.O., R.K., K. Suzuki, K. Sugimura, T.A., K.N., S.T., S.M.-Y., M.M., T.S., S.I., N.Y., Y.F., T.M., S.M., H.S.); Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama City, Japan (K.N., H.I.); and Department of Biochemistry, Nagoya University Graduate School of Medicine, Nagoya, Japan (K.K.)
| | - Tatsuro Minami
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K. Satoh, T.S., N.K., J.O., R.K., K. Suzuki, K. Sugimura, T.A., K.N., S.T., S.M.-Y., M.M., T.S., S.I., N.Y., Y.F., T.M., S.M., H.S.); Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama City, Japan (K.N., H.I.); and Department of Biochemistry, Nagoya University Graduate School of Medicine, Nagoya, Japan (K.K.)
| | - Satoshi Miyata
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K. Satoh, T.S., N.K., J.O., R.K., K. Suzuki, K. Sugimura, T.A., K.N., S.T., S.M.-Y., M.M., T.S., S.I., N.Y., Y.F., T.M., S.M., H.S.); Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama City, Japan (K.N., H.I.); and Department of Biochemistry, Nagoya University Graduate School of Medicine, Nagoya, Japan (K.K.)
| | - Kazufumi Nakamura
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K. Satoh, T.S., N.K., J.O., R.K., K. Suzuki, K. Sugimura, T.A., K.N., S.T., S.M.-Y., M.M., T.S., S.I., N.Y., Y.F., T.M., S.M., H.S.); Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama City, Japan (K.N., H.I.); and Department of Biochemistry, Nagoya University Graduate School of Medicine, Nagoya, Japan (K.K.)
| | - Hiroshi Ito
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K. Satoh, T.S., N.K., J.O., R.K., K. Suzuki, K. Sugimura, T.A., K.N., S.T., S.M.-Y., M.M., T.S., S.I., N.Y., Y.F., T.M., S.M., H.S.); Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama City, Japan (K.N., H.I.); and Department of Biochemistry, Nagoya University Graduate School of Medicine, Nagoya, Japan (K.K.)
| | - Kenji Kadomatsu
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K. Satoh, T.S., N.K., J.O., R.K., K. Suzuki, K. Sugimura, T.A., K.N., S.T., S.M.-Y., M.M., T.S., S.I., N.Y., Y.F., T.M., S.M., H.S.); Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama City, Japan (K.N., H.I.); and Department of Biochemistry, Nagoya University Graduate School of Medicine, Nagoya, Japan (K.K.)
| | - Hiroaki Shimokawa
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K. Satoh, T.S., N.K., J.O., R.K., K. Suzuki, K. Sugimura, T.A., K.N., S.T., S.M.-Y., M.M., T.S., S.I., N.Y., Y.F., T.M., S.M., H.S.); Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama City, Japan (K.N., H.I.); and Department of Biochemistry, Nagoya University Graduate School of Medicine, Nagoya, Japan (K.K.).
| |
Collapse
|